Robot guided oblique spinal stabilization
A robotic system for performing minimally invasive spinal stabilization, using two screws inserted in oblique trajectories from an inferior vertebra pedicle into the adjacent superior vertebra body. The procedure is less traumatic than such procedures performed using open back surgery, by virtue of the robot used to guide the surgeon along a safe trajectory, avoiding damage to nerves surrounding the vertebrae. The robot arm is advantageous since no access is provided in a minimally invasive procedure for direct viewing of the operation site, and the accuracy required for oblique entry can readily be achieved only using robotic control. This robotic system also obviates the need for a large number of fluoroscope images to check drill insertion position relative to the surrounding nerves. Disc cleaning tools with flexible wire heads are also described. The drilling trajectory is determined by comparing fluoroscope images to preoperative images showing the planned path.
1. A method for performing spinal stabilization between two adjacent vertebrae of a subject, the method comprising:
drilling two oblique posterior entry passages, one from each pedicle region in an inferior one of said two adjacent vertebrae into the body of the adjacent superior vertebra towards its anterior cortical rim;
cleaning the disc space between said two adjacent vertebrae;
inserting an inflatable distraction balloon through a first one of said oblique posterior entry passages into said disc space between said two adjacent vertebrae, and inflating said distraction balloon;
inserting a screw obliquely into said inferior and superior vertebrae along the other one of said oblique posterior entry passages, such that said vertebrae are mutually fixed in position;
deflating and withdrawing said distraction balloon; and
inserting a second screw obliquely between said inferior and superior vertebrae along the first one of said oblique posterior entry passages, such that said vertebrae are firmly fixed in position.
2. A method for performing spinal stabilization between two adjacent vertebrae of a subject according to claim 1 , further comprising the step of inserting bone grafting material into said disc space through said first oblique posterior entry passage after deflation and withdrawal of said distraction balloon.
3. A method for performing spinal stabilization between two adjacent vertebrae of a subject according to claim 1 , wherein said oblique posterior entry passages are drilled with the aid of a robot.
4. A method for performing spinal stabilization between two adjacent vertebrae of a subject according to claim 1 , wherein said oblique posterior entry passages are drilled using a mechanical positioner aligned by a surgeon.
5. A method according to claim 1 , wherein cleaning said disc space is performed using a tool, comprising:
a hollow tubular sleeve;
a central element disposed coaxially within said hollow tubular sleeve; said central element being rotatable relative to said hollow tubular sleeve; and
at least one flexible cutting element attached to a distal end of said central element, such that rotation of said central element causes said at least one flexible cutting element to morcelize nucleus material in said intervertebral space.
6. A method according to claim 5 , wherein said central element comprises a screw element, such that said morcelized nucleus material can be removed from said intervertebral space by rotation of said central element.
7. A method according to claim 5 , wherein said at least one flexible cutting element comprises at least one wire element.
8. A method according to claim 7 , wherein said at least one wire element comprises at least one loop of wire.
9. A method according to claim 5 , wherein said at least one flexible cutting element is constructed of a shape memory alloy.
10. A method according to claim 5 , wherein said at least one flexible cutting element changes its angle of attack relative to the axis of said tool as at least a portion of said tool is rotated.
11. A method according to claim 5 , wherein said at least one flexible cutting element is operative to clean the end plates of the vertebrae associated with said intervertebral space.
12. A method according to claim 1 , wherein cleaning said disc space is performed using a tool, comprising:
a hollow tubular sleeve;
a central element disposed coaxially within said hollow tubular sleeve; said central element being longitudinally moveable relative to said hollow tubular sleeve; and
at least one flexible cutting element attached to a distal end of said central element, such that longitudinal motion of said central element of said central element causes said flexible cutting element to operate at different distances from the distal end of said tool,
wherein said hollow tubular sleeve and said central element are rotatable, such that that rotation of said central element causes said flexible cutting element to morcelize nucleus material in said intervertebral space.
13. A method according to claim 12 , wherein said at least one flexible cutting element is at least one loop of wire, one of whose ends is attached to said hollow tubular sleeve, and the other of whose ends is attached to said central element, such that longitudinal motion of said central element causes said at least one loop to expand or to contract.
14. A method according to claim 12 , wherein said tool further comprises a screw element, such that said morcelized nucleus material can be removed from said intervertebral space by rotation of said central element.
15. A method according to claim 12 , wherein said flexible cutting element is constructed of a shape memory alloy.
16. A method according to claim 12 , wherein said at least one flexible cutting element changes its angle of attack relative to the axis of said tool as at least a portion of said tool is rotated.
17. A method according to claim 12 , wherein said at least one flexible cutting element is operative to clean the end plates of the vertebrae associated with said intervertebral space.