Instruments and methods for non-parallel disc space preparation
View Patent ↗Flexible shavers and curved access ports that reduce access and trajectory problems associated with conventional lateral approaches to the lower spine. These devices and methods allow for preparing a disc space in the lower spine at an angle that is parallel to the disc space. Consequently, these devices and methods allow for preparing with less endplate damage.
1. A method of intervertebral disc space preparation, comprising the steps of:
a) selecting a shaver having a flexible shaft and a shaving head;
b) inserting the shaver into an intervertebral disc space bounded by opposed vertebral endplates, and
c) contacting the shaver to a vertebral endplate
d) shaving the vertebral endplate with the shaving head of the shaver by rotating the shaving head with the shaving head being substantially parallel to the vertebral endplate and the flexible shaft being not substantially parallel to the vertebral endplate.
2. The method of claim 1 wherein the flexible shaft is made of a flexible material.
3. The method of claim 1 wherein the flexible shaft has a universal joint.
4. The method of claim 1 wherein the flexible shaft is slotted to impart flexibility.
5. The method of claim 1 wherein the flexible shaft comprises a spring.
6. A method of preparing an intervertebral disc space between opposing vertebral endplates, comprising the steps of:
a) inserting a curved port into a lateral aspect of the disc space, the curved port having a bore.
7. The method of claim 6 wherein the insertion is in a substantially coronal plane of a human spine.
8. The method of claim 7 wherein the curved port has a substantially straight proximal end portion and a curved distal end portion.
9. The method of claim 8 wherein the curved distal end portion of the curved port is docked to a vertebral body and is oriented substantially parallel to the opposing vertebral endplates.
10. The method of claim 6 wherein the curved port has a distal end portion having a securement feature, and further comprising the step of:
b) docking the port to a vertebral body via the securement feature.
11. The method of claim 6 further comprising the step of:
b) inserting a substantially straight, bendable shaver into the curved port;
c) advancing the shaver through the port and into an intervertebral disc space bounded by a vertebral endplate so that the shaver bends in the port, and
d) contacting the shaver to the vertebral endplate.
12. The method of claim 11 wherein the bore of the port has a shape corresponding to a cross-section of the shaver so as to determine the orientation of the shaver within the bore.
13. The method of claim 11 wherein the bendable shaver has a shaft made of a flexible material.
14. The method of claim 11 wherein the bendable shaver has a shaft having a universal joint.
15. The method of claim 11 wherein the disc space is the L5/S1 disc space.
16. The method of claim 11 wherein the disc space is the L4/L5 disc space.
17. The method of claim 1 wherein shaving the vertebral endplate with the shaving head further comprises shaving the vertebral endplate with the entire flexed portion of the flexible shaft located outside of the intervertebral disc space.
18. The method of claim 6 wherein the curved port further comprises:
an outer cannula having a bore, and
an inner cannula having a bore, and
wherein the method further comprises:
b) inserting a substantially straight, bendable shaver into the inner cannula of the curved port.
19. The method of claim 18 wherein the inner cannula has a bore having a non-circular transverse cross-section.
20. The method of claim 18 wherein the bores of the cannulae each has an areal cross-section, wherein the areal cross-section of the bore of the inner cannula is less than 50% of the areal cross-section of the bore of the outer cannula.
21. The method of claim 20 wherein the inner cannula comprises upper and lower inserts having opposing faces and wherein the opposing faces each comprise a longitudinal groove therein.
22. The method of claim 11 further comprising:
shaving the vertebral endplate with a shaving head of the shaver; and
rotating the flexible shaft and rotating the shaving head while shaving the vertebral endplate and flexing the flexible shaft with the shaving head substantially parallel to the vertebral endplate.