Methods and apparatus for intervertebral disc prosthesis insertion
A method for inserting an intervertebral disc prosthesis into a space between two vertebrae involves inserting the prosthesis partway into the space under constraint to prevent endplates of the prosthesis from articulating, releasing the prosthesis from constraint, and inserting the unconstrained prosthesis farther into the space. In some embodiments, the method involves grasping the prosthesis with a grasping device to insert the prosthesis partway under constraint, loosing the grasping device to release the prosthesis from constraint, and pushing the prosthesis farther into the disc space using the grasping device and/or one or more separate pusher devices. A system includes a grasping device, at least one separate pushing device, and optionally a vertebral spreading device and/or a vertebral midline indicator device.
1. An instrument set for inserting an articulating intervertebral prosthesis into a space between two adjacent vertebrae, the set comprising:
a prosthesis grasping device configured to grasp two endplates of the prosthesis and hold the prosthesis endplates stationary with respect to one another while pushing the prosthesis into the space; and
at least one prosthesis pusher device configured for engaging and pushing the endplates of the prosthesis into the space, wherein the pusher device is a discrete instrument from the prosthesis grasping device configured to be used separately from the prosthesis grasping device and wherein the pusher device comprises:
an elongate shaft having a proximal end and a distal end;
a concave pusher portion disposed at the distal end of the elongate shaft, the concave pusher portion adapted to engage a curved portion of the endplates and to push the endplates into the space; and
a handle disposed at the proximal end of the elongate shaft.
2. A set as in claim 1 , wherein the grasping device is adapted to grasp the endplates such that they are prevented from articulating about a core of the prosthesis.
3. A set as in claim 2 , wherein the grasping device is adapted to grasp the endplates such that when the endplates are grasped by the grasping device the endplates are not in contact with the pusher.
4. A set as in claim 1 , wherein the grasping member comprises movable opposing jaws adapted to grasp rims of the two endplates.
5. A set as in claim 4 , wherein the grasping device is coupled with an actuator to open and close the opposing jaws.
6. A set as in claim 1 , wherein the grasping device is adapted to push the endplates simultaneously into the space.
7. A set as in claim 1 , further comprising a vertebral spacing device for increasing a height of the space between the two vertebrae, wherein the prosthesis grasping device is adapted to slide through the vertebral spacing device disposed between the two adjacent vertebrae.
8. A set as in claim 7 , wherein the pusher device is adapted to slide through the spacing device.
9. A set as in claim 1 , wherein the concave pusher portion is adapted to push one of the endplates individually into the space.
10. A set as in claim 1 , wherein the pusher device comprises multiple pusher devices of different configurations.
11. A set as in claim 1 , wherein the concave pusher portion includes a concave inner surface configured for pushing against rims of the endplates.
12. A set as in claim 1 , wherein the handle of the pusher is configured to allow a force to be applied manually or by taping the prosthesis into place.
13. A set as in claim 1 , further comprising an articulate intervertebral prosthesis including two endplates the prosthesis configured to be grasped by the prosthesis grasping device and to be pushed into the space by the prosthesis pusher device.
14. A set as in claim 1 , wherein the prosthesis grasping device includes movable opposing jaws configured to move toward and away from one another in a lateral direction of the implant to grasp the two endplates.
15. A set as in claim 1 , further comprising a second prosthesis pusher device configured for engaging and pushing the endplates of the prosthesis into the space, wherein the second pusher device has a different configuration or size from the at least one pusher device.
16. A set as in claim 1 , wherein the handle of the pusher is configured to allow a force to be applied to the handle to push the prosthesis into place.
17. An instrument set of multiple discrete instruments for inserting an articulating intervertebral prosthesis into a space between two adjacent vertebrae, the set comprising:
a prosthesis grasping device configured to grasp two endplates of the prosthesis and hold the prosthesis endplates stationary with respect to one another while pushing the prosthesis into the space; and
at least two prosthesis pusher devices, each pusher device configured for engaging and pushing the endplates of the prosthesis into the space, wherein each of the pusher devices is configured to be used separately from the prosthesis grasping device and each of the pusher devices has a different configuration or size and wherein the pusher devices each comprise:
an elongate shaft having a proximal end and a distal end;
a pusher portion disposed at the distal end of the elongate shaft and adapted to engage and to push the endplates into the space; and
a handle disposed at the proximal end of the elongate shaft.
18. A set as in claim 17 , wherein the at least two pushers having different shapes.
19. A set as in claim 17 , wherein the handle of the pusher is configured to allow a force to be applied to the handle to push the prosthesis into place.
20. A set as in claim 17 , wherein the grasping device is adapted to grasp the endplates such that when the endplates are grasped by the grasping device the endplates are prevented from articulating and the endplates are not in contact with the pusher.