Facet joint replacement instruments and methods
A facet joint replacement system includes an inferior implant with an inferior articular surface, a superior implant with a superior articular surface, and an optional crossbar. The inferior implant and the superior implant are each polyaxially adjustably connected to fixation elements which anchor the implants to adjacent vertebrae. The optional crossbar may be polyaxially adjustably connected to bilateral implants. The system components may be provided in kits which provide components of various sizes and shapes. A set of surgical instruments may facilitate implantation of the facet joint replacement system by providing tools for bone preparation, trialing, implant insertion, implant alignment, and lock-out of modular interconnections.
1. A system for replacing at least a portion of a natural facet joint between a first vertebra and a second vertebra, the system comprising:
a first fixation member implantable in a pedicle of the second vertebra; and
an inferior facet joint implant comprising:
an inferior articular body including an inferior articular surface having a shape that mimics a shape of a natural inferior facet articular surface of the second vertebra;
an inferior strut formed separately from the inferior articular surface, the inferior strut comprising a first end and a second end, wherein the first end of the inferior strut is securable to the first fixation member and the second end of the inferior strut is received in the inferior articular body; and
an attachment mechanism comprising a threaded expansion portion and a split shell having at least one lobe, wherein the attachment mechanism is received in the inferior articular body, the attachment mechanism further comprising an adjustable configuration in which the inferior articular body is connected to the second end of the inferior strut in a manner that permits relative rotation between the inferior articular body and the inferior strut in about three orthogonal axes, and a locked configuration in which the inferior articular body is rigidly secured to the inferior strut.
2. The system of claim 1 , wherein the threaded expansion portion comprises a threaded conical expander.
3. The system of claim 2 , wherein the threaded conical expander comprises a pair of opposed flanges.
4. The system of claim 1 , wherein the attachment mechanism further comprises a locking member, wherein the locking member is actuatable to exert force against the inferior strut to restrict rotation of the inferior strut relative to the inferior articular body to provide the locked configuration.
5. The system of claim 4 , wherein the locking member comprises a nut that is threaded onto a threaded post of the threaded expansion portion.
6. The system of claim 5 , wherein the attachment mechanism further comprises a split clamp.
7. The system of claim 1 , further comprising:
a second fixation member implantable in the first vertebra; and
a superior facet joint implant securable to the second fixation member, the superior facet joint implant comprising a superior articular surface shaped to replace a natural superior articular surface of the first vertebra.
8. The system of claim 1 , wherein the inferior strut further comprises a tapered portion positioned between the first end and the second end.
9. The system of claim 1 , wherein the inferior strut is radially symmetrical such that a cross-section taken orthogonal to the longitudinal axis of the inferior strut at any location along the inferior strut is circular in shape.
10. The system of claim 1 , wherein the inferior facet joint implant is one of a left inferior facet joint implant configured to be implanted on the left lateral side of the second vertebra to replace the natural left inferior facet joint, and a right inferior facet joint implant configured to be implanted on the right lateral side of the second vertebra to replace the natural right inferior facet joint.
11. The system of claim 1 , wherein the first fixation member comprises an adjustable configuration in which the first end of the inferior strut is connected to the first fixation member in a manner that permits relative rotation between the first end of the inferior strut and the first fixation member about three orthogonal axes, and a locked configuration in which the first end of the inferior strut is rigidly secured to the first fixation member.
12. A system for replacing at least a portion of a natural facet joint that controls motion between a first vertebra and a second vertebra, the system comprising:
a first fixation member implantable in a pedicle of the second vertebra; and
an inferior facet joint implant comprising:
an inferior articular body including an inferior articular surface having a shape that mimics a shape of a natural inferior articular surface of the second vertebra;
an inferior strut formed separately from the inferior articular surface, the inferior strut comprising a first end and a second end, wherein the first end is securable to the fixation member and the second end is received in the inferior articular body;
an attachment mechanism comprising a threaded expansion portion, a split shell having at least one lobe, and a nut, wherein the attachment mechanism is received in the inferior articular body;
a second fixation member implantable in a pedicle of the second vertebra; and
a second inferior facet joint implant comprising:
a second inferior articular body including a second inferior articular surface shaped to replace a second natural inferior articular surface of the second vertebra, wherein the second inferior articular surface makes up at least part of a second outer surface of the second inferior articular body;
a second inferior strut formed separately from the second inferior articular surface, the second inferior strut comprising a first end and a second end, wherein the first end is securable to the second fixation member and the second end is received in the second inferior articular body; and
a second attachment mechanism comprising a second threaded expansion portion, a second split shell and a second nut.
13. The system of claim 12 , wherein the system includes a cross link rod having a first end and a second end, the first end received by the attachment mechanism and the second end received by the second attachment mechanism.
14. The system of claim 12 , wherein the attachment mechanism comprises an adjustable configuration in which the inferior articular surface is connected to the second end of the inferior strut in a manner that permits relative rotation between the inferior articular body and the second end about three orthogonal axes, and a locked configuration in which the inferior articular body is rigidly secured to the second end of the inferior strut.
15. The system of claim 12 , wherein the second attachment mechanism comprises an adjustable configuration in which the second inferior articular body is connected to the second end of the second inferior strut in a manner that permits relative rotation between the second inferior articular body and the second end of the second inferior strut about three orthogonal axes, and a locked configuration in which the second inferior articular body is rigidly secured to the second end of the second inferior strut.
16. A system for replacing at least a portion of a natural facet joint that controls motion between a first vertebra and a second vertebra, the system comprising:
a first fixation member implantable in a pedicle of the second vertebra; and
an inferior facet joint implant comprising:
an inferior articular body including an inferior articular surface having a shape that mimics a shape of a natural inferior facet articular surface of the second vertebra;
an inferior strut formed separately from the inferior articular surface, the inferior strut comprising a first end and a second end, wherein the first end is securable to the fixation member and the second end is received in the inferior articular body; and
an attachment mechanism comprising a threaded expansion portion and a split shell having at least one lobe for receiving the threaded expansion portion therein, the attachment mechanism further comprising an adjustable configuration in which the inferior articular body is connected to the second end of the inferior strut in a manner that permits relative rotation between the inferior articular body and the second end of the inferior strut about three orthogonal axes, and a locked configuration in which the inferior articular body is rigidly secured to the second end of the inferior strut.
17. The system of claim 16 , further comprising:
a second fixation member implantable in the first vertebra; and
a superior facet joint implant securable to the second fixation member, the superior facet joint implant comprising a superior articular body including a superior articular surface shaped to replace a natural superior articular surface of the first vertebra.
18. The system of claim 16 , wherein the first fixation member comprises an adjustable configuration in which the first end of the inferior strut is connected to the first fixation member in a manner that permits relative rotation between the first end and the first fixation member about three orthogonal axes, and a locked configuration in which the first end is rigidly secured to the first fixation member.
19. The system of claim 16 , wherein the attachment mechanism further comprises a locking member, wherein the locking member is actuatable to exert force against the second end of the inferior strut to restrict rotation of the second end relative to the inferior articular body to provide the locked configuration.