Method of repairing sacroiliac fusion
View Patent ↗A method of repairing a prior sacroiliac fusion that was not effective at stabilizing a sacroiliac joint. The prior sacroiliac fusion used a first fastening device that extended between an ilium and a sacrum. At least one aperture is formed that at least partially extends through at least one of an ilium and a sacrum. An undercutting system is inserted at least partially into the aperture and is used to cut tissue between the ilium and the sacrum. A second fastening device is inserted into the first aperture to retain the ilium in a stationary position with respect to the sacrum.
1. A method of repairing a prior sacroiliac fusion that was not effective at stabilizing a sacroiliac joint, wherein the prior sacroiliac fusion used a first fastening device that extended between an ilium and a sacrum, wherein the method comprises:
providing an undercutting system that comprises an insertion apparatus and a cutting assembly;
forming a first aperture that at least partially extends through at least one of an ilium and a sacrum;
inserting the undercutting system at least partially into the first aperture;
extending the cutting assembly to between the sacrum and the ilium;
cutting tissue between the ilium and the sacrum with the cutting assembly;
removing the undercutting system from the first aperture; and
inserting a second fastening device into the first aperture, wherein the second fastening device engages the ilium and the sacrum to retain the ilium and the sacrum in a stationary position with respect to each other.
2. The method of claim 1 , and further comprising removing at least a portion of the first fastening device from the sacroiliac joint.
3. The method of claim 2 , wherein the first aperture was used in conjunction with the prior sacroiliac fusion and wherein the forming the first aperture comprises changing a shape and/or a size of the first aperture.
4. The method of claim 1 , and further comprising:
extending the cutting assembly from within the insertion apparatus to between the sacrum and the ilium before cutting the tissue; and
retracting the cutting assembly from between the sacrum and the ilium to within the insertion apparatus after cutting the tissue.
5. The method of claim 1 , wherein when the cutting assembly is in the retracted position, the cutting assembly is within an outer periphery of the undercutting system.
6. The method of claim 1 , wherein the undercutting system provides a mechanical advantage for extending the cutting assembly.
7. The method of claim 1 , wherein proximate a distal end of the undercutting system, the undercutting system is oriented about a central axis and wherein as the cutting assembly moves to the extended position, a distal end of the cutting assembly moves away from the central axis.
8. The method of claim 1 , wherein an area of the cut tissue is greater than an area of the first aperture.
9. The method of claim 1 , wherein cutting the tissue comprises removing at least a portion of a surface of the ilium and the sacrum with the cutting assembly to produce bleeding bone.
10. The method of claim 1 , wherein the cutting assembly has a cutting surface on at least one edge thereof.
11. The method of claim 1 , wherein the cutting assembly comprises a first cutting assembly and a second cutting assembly and wherein cutting tissue comprises:
moving the first cutting assembly between the ilium and the sacrum; and
moving the second cutting assembly between the ilium and the sacrum.
12. The method of claim 11 , wherein the second cutting assembly extends over at least a portion of the first cutting assembly.
13. The method of claim 11 , wherein the second cutting assembly is sharper than the first cutting assembly.
14. The method of claim 11 , wherein the second cutting assembly has a height that is greater than a height of the first cutting assembly.
15. The method of claim 11 , wherein:
moving the first cutting assembly between the ilium and the sacrum causes the first cutting assembly to extend into an intra-articular region between the ilium and the sacrum; and
moving the second cutting assembly between the ilium and the sacrum comprises:
cutting tissue between the ilium and the sacrum; and
removing at least a portion of a surface of the ilium and the sacrum to produce bleeding bone.
16. The method of claim 1 , wherein the second fastening device is a screw, a peg, a pin, a cage, glue or a coupled device having a ball and a socket.
17. The method of claim 1 , wherein the cutting assembly resists movement in a radial direction with respect to the insertion apparatus.
18. The method of claim 1 , wherein the cutting assembly exhibits flexibility in a distal-proximal direction with respect to the insertion apparatus.
19. The method of claim 1 , wherein a distal end of the insertion apparatus has a width and wherein the cutting assembly is substantially within the width when the cutting assembly is in the retracted configuration.
20. The method of claim 1 , and further comprising a cutting assembly locking mechanism, wherein the cutting assembly locking mechanism is movable between a locked configuration and an unlocked configuration, wherein the cutting assembly is retained in a stationary position with respect to the insertion apparatus when the cutting assembly lock mechanism is in the locked configuration and wherein the cutting assembly is rotatable with respect to the insertion apparatus when the cutting assembly lock mechanism is in the unlocked configuration.
21. The method of claim 1 , wherein the insertion apparatus further comprises a control portion operably attached thereto proximate a proximal end thereof and wherein the control portion is operably attached to the cutting assembly for moving the cutting assembly between the extended configuration and the retracted configuration.
22. The method of claim 1 , wherein the first aperture extends completely through the ilium and extends partially through the sacrum.
23. The method of claim 1 , and further comprising removing the cut tissue from between the sacrum and the ilium.
24. A method of repairing a prior sacroiliac fusion that was not effective at stabilizing a sacroiliac joint, wherein the prior sacroiliac fusion used a first fastening device that extended between an ilium and a sacrum, wherein the method comprises:
providing an undercutting system that comprises an insertion apparatus and a cutting assembly;
removing the first fastening device from engagement with a first aperture in an ilium and an aperture in a sacrum;
inserting the undercutting system at least partially into the first aperture;
extending the cutting assembly between the sacrum and the ilium;
cutting tissue between the ilium and the sacrum with the cutting assembly;
removing the undercutting system from the first aperture; and
inserting a second fastening device into the first aperture, wherein the second fastening device retains the ilium and the sacrum in a stationary position with respect to each other.
25. The method of claim 24 , and further comprising changing a shape and/or a size of the first aperture.
26. The method of claim 24 , and further comprising:
extending the cutting assembly from within the insertion apparatus to between the sacrum and the ilium; and
retracting the cutting assembly from between the sacrum and the ilium to within the insertion apparatus.
27. The method of claim 24 , wherein the undercutting system provides a mechanical advantage to extend the cutting assembly.
28. The method of claim 24 , wherein proximate a distal end of the undercutting system, the undercutting system is oriented about a central axis and wherein as the cutting assembly moves to the extended position, a distal end of the cutting assembly moves away from the central axis.
29. The method of claim 24 , wherein an area of the cut tissue is greater than an area of the first aperture.
30. The method of claim 24 , wherein the cutting assembly has a cutting surface on at least one edge thereof.
31. The method of claim 24 , wherein the cutting assembly comprises a first cutting assembly and a second cutting assembly and wherein cutting tissue comprises:
moving the first cutting assembly between the ilium and the sacrum; and
moving the second cutting assembly between the ilium and the sacrum.
32. The method of claim 31 , wherein the second cutting assembly extends over at least a portion of the first cutting assembly.
33. The method of claim 31 , wherein the second cutting assembly is sharper than the first cutting assembly.
34. The method of claim 31 , wherein the second cutting assembly has a height that is greater than a height of the first cutting assembly.
35. The method of claim 31 , wherein:
moving the first cutting assembly between the ilium and the sacrum causes the first cutting assembly to extend into an intra-articular region between the ilium and the sacrum; and
moving the second cutting assembly between the ilium and the sacrum comprises:
cutting tissue between the ilium and the sacrum; and
removing at least a portion of a surface of the ilium and the sacrum to produce bleeding bone.
36. The method of claim 24 , wherein the second fastening device is a screw, a peg, a pin, a cage, glue or a coupled device having a ball and a socket.
37. The method of claim 24 , wherein the cutting assembly resists movement in a radial direction with respect to the insertion apparatus.
38. The method of claim 24 , wherein the cutting assembly exhibits flexibility in a distal-proximal direction with respect to the insertion apparatus.
39. The method of claim 24 , wherein a distal end of the insertion apparatus has a width and wherein the cutting assembly is substantially within the width when the cutting assembly is in the retracted configuration.
40. The method of claim 24 , and further comprising a cutting assembly locking mechanism, wherein the cutting assembly locking mechanism is movable between a locked configuration and an unlocked configuration, wherein the cutting assembly is retained in a stationary position with respect to the insertion apparatus when the cutting assembly lock mechanism is in the locked configuration and wherein the cutting assembly is rotatable with respect to the insertion apparatus when the cutting assembly lock mechanism is in the unlocked configuration.
41. The method of claim 24 , wherein the insertion apparatus further comprises a control portion operably attached thereto proximate a proximal end thereof and wherein the control portion is operably attached to the cutting assembly for moving the cutting assembly between the extended configuration and the retracted configuration.
42. The method of claim 24 , wherein the first aperture extends completely through the ilium and extends partially through the sacrum.
43. The method of claim 24 , and further comprising removing the cut tissue from between the sacrum and the ilium.