Interbody fusion implant and related methods
An implant for performing interbody fusion within a human spine, inserters for such an implant, and associated methodology. The implant is preferably formed in situ from at least two separate but lockable members (a base member and a closure member). The base member may be implanted into an interbody space first, after which the end plates may be finally prepared and the base member packed with fusion promoting substances before engaging and locking the closure member. The closure member provides structural support for the adjacent vertebral bodies (along with the base member) and may be selected after implantation of the base member having a specific length, width, height, taper, etc. . . . to ensure an optimal sizing of the implant for desired restoration of disc height, coronal taper, sagittal taper, etc. . . . .
1. A method of performing lateral interbody fusion of an affected intervertebral disc within a patient's lumbar or thoracic spine, the disc including nucleus pulposus surrounded by an annulus, and the disc bounded by adjacent vertebral bodies, each having an inner cancellous bone region bounded by an outer cortical bone region, comprising the steps of:
(a) creating an operative corridor to an affected disc in the lumbar or thoracic spine by using a lateral approach to the spine;
(b) creating an implant region within the affected disc extending from an ipsilateral aspect of the cortical bone region to a contralateral aspect of the cortical bone region, and including the cancellous bone region extending there between;
(c) implanting a base member having side walls and an end wall such that at least a portion of the end wall provides structural support between contralateral aspects of the cortical bone regions of the adjacent vertebral bodies, the side walls and end wall of the base member defining an open trailing end and an interior bounded by the side walls and end wall, the side walls and end wall forming a protective barrier between the interior of the base member and surrounding neural tissues and/or vasculature;
(d) performing final endplate preparation within the interior of the base member to define a fusion area within the cancellous bone adjacent to the interior of the base member;
(e) introducing fusion promoting material into the interior of the base member and into contact with the fusion area of the exposed cancellous bone;
(f) implanting a closure member such that it encloses the interior of the base member after the fusion promoting material has been introduced and such that at least a portion of the closure member provides structural support between ipsilateral aspects of the cortical bone regions of the adjacent vertebral bodies;
(g) advancing first and second elongated ties, each elongated tie having a first embedded portion terminating at a first terminal end thereof and a second projecting portion that includes a second terminal end thereof located opposite the first terminal end, each first embedded portion being either received in and affixed to one of the side walls with its projecting portion away from a respective second end, or received in and affixed to the closure member with its projecting portion projecting from a respective overlapping portion, the projecting portion including an end portion, which includes the second terminal end, the end portion being no wider than the rest of the projecting portion;
(h) receiving the first and second elongated ties within first and second elongated bores, each bore being defined in either a respective side wall or defined in the closure member, each bore having a mouth defined at a respective second end of a side wall or at a respective overlapping portion dimensioned to receive a respective projecting portion, and each bore having an interior dimensioned to have at least a portion of an interior surface thereof frictionally engage a respective projecting portion of a respective elongated tie, wherein the bores register with the projecting portions to allow the closure member and the side walls to align with one another during assembly of the closure member onto the side walls of the base member; and
(i) closing the operative corridor.
2. The method of performing lateral interbody fusion of claim 1 , wherein step (b) involves performing an annulotomy on an ipsilateral aspect of the annulus, a partial discectomy of the nucleus pulposus, and at least a partial release of the contralateral annulus to create the implant region within the affected disc.
3. The method of performing lateral interbody fusion of claim 1 , wherein step (c) involves selecting the base member in order to achieve a desired restoration of disc height, sagittal balance and/or coronal balance.
4. The method of performing lateral interbody fusion of claim 3 , wherein selecting the base member includes at least one of the steps of sizing and distracting.
5. The method of performing lateral interbody fusion of claim 1 , wherein step (f) involves selecting the closure member in order to achieve a desired restoration of disc height, sagittal balance and/or coronal balance.
6. The method of performing lateral interbody fusion of claim 5 , wherein selecting the closure member involves determining the optimal size and shape of the closure member to ensure at least a portion of the closure member provides structural support between the ipsilateral aspects of the cortical bone regions of the adjacent vertebral bodies.
7. The method of performing lateral interbody fusion of claim 6 , wherein the closure member may be selected having different height or shape dimensions as the base member in order to customize the degree of sagittal and/or coronal balance of the patient's spine.