Magnetically actuateable rod insertion for minimally invasive surgery
The present disclosure describes a spinal fixation system comprising a telescoping spinal rod, as well as methods of its use and a guide tower for use therewith. The telescoping rod can be extended after it has been inserted into the patient below the fascia, which permits it to be extended in the sub-fascial space.
1. A system for spinal fixation, the system comprising:
a first bone anchor including
a distal bone fastener member, and
a proximal rod housing comprising a first rod channel;
a first telescoping spinal rod dimensioned to fit within the first rod channel, the first telescoping spinal rod having an extended configuration and a collapsed configuration, wherein the first telescoping spinal rod has a first longitudinal length in the collapsed configuration and a second longitudinal length in the extended configuration, and wherein the first longitudinal length is less than the distance between a vertebral pedicle in a subject and an adjacent vertebral pedicle in the subject; and
a guide tower assembly for guiding a spinal rod into position from the first bone anchor to a second bone anchor, wherein the guide tower assembly comprises:
an elongate tower member having a proximal end, a distal end, and a longitudinal axis;
a lumen running from the proximal end to the distal end of the elongate tower member;
a longitudinal slot in the elongate tower member that connects to the lumen;
a bone anchor engagement member at the distal end of the tower member configured to reversibly fasten the elongate tower member to the proximal rod housing of the first bone anchor;
a first rod holder having a first rod engagement feature at a distal end of the first rod holder and a first translating shaft connected to the first rod engagement feature, wherein the first translating shaft is capable of translating relative to the elongate tower member parallel to the longitudinal axis of the elongate tower member, and wherein the first rod engagement feature translates with the first translating shaft; and
a second rod holder having a second rod engagement feature at a distal end of the second rod holder and a second translating shaft connected to the second rod engagement feature, wherein the second translating shaft is capable of translating relative to the elongate tower member parallel to the longitudinal axis of the elongate tower member, wherein the second rod engagement feature translates with the second translating shaft and wherein the second translating shaft is capable of translating at a different velocity than a velocity of translation of the first translating shaft.
2. The system of claim 1 , wherein the first telescoping spinal rod comprises a rod magnet configured to rotate when exposed to a spinning magnetic field and cause the first telescoping spinal rod to either extend or collapse depending on the direction of rotation of the spinning magnetic field.
3. The system of claim 2 , wherein the first telescoping spinal rod comprises:
a first elongate element containing a cavity;
a second elongate element dimensioned to at least partially fit within the cavity; and
a lead screw coupled to rotate when the rod magnet rotates, and comprising an externally threaded region, such that rotation of the lead screw causes the second elongate element to translate relative to the first elongate element.
4. The system of claim 1 , wherein the second longitudinal length is no less than the distance between the vertebral pedicle in a subject and an adjacent vertebral pedicle in the subject.
5. The system of claim 1 , configured to allow the first telescoping spinal rod to be inserted towards the first bone anchor with an axis of the first telescoping spinal rod generally parallel to the guide tower assembly and reoriented to a position with the axis of the first telescoping spinal rod generally perpendicular to the guide tower assembly prior to adjusting the first telescoping spinal rod to the extended position, the distal end of the first spinal telescoping rod passing through the longitudinal slot and underneath the fascia.
6. The system of claim 1 , configured to allow the first telescoping spinal rod to be coupled directly to the guide tower assembly for insertion without an inserter.
7. The system of claim 1 , wherein at least one of the first translating shaft and the second translating shaft is a threaded shaft operatively connected to a first shaft magnet, such that rotation of the first shaft magnet causes the threaded shaft to translate.
8. The system of claim 1 , wherein
the first translating shaft is a threaded shaft operatively connected to a first shaft magnet, such that rotation of the first shaft magnet causes the first threaded shaft to translate parallel to the longitudinal axis of the guide tower; and
the second translating shaft is a threaded shaft operatively connected to a second magnet, such that rotation of the second magnet causes the second threaded shaft to translate parallel to the longitudinal axis of the guide tower.
9. The system of claim 8 , wherein the first shaft magnet and the second magnet are rotatably mounted to rotate when exposed to a rotating magnetic field, and wherein the thread pitch of the first threaded shaft does not equal the thread pitch of the second threaded shaft.
10. The system of claim 1 , wherein the first and second rod engagement features are configured to engage the rod until the rod is seated in the first bone anchor.
11. The system of claim 1 , wherein the longitudinal slot has a circumferential width sufficient to admit a spinal rod.
12. A system for spinal fixation, the system comprising:
a first bone anchor comprising a distal bone fastener member, and a proximal rod housing comprising a first rod channel;
a first telescoping spinal rod dimensioned to fit within the first rod channel, the first telescoping spinal rod having an extended configuration and a collapsed configuration, wherein the first telescoping spinal rod has a first longitudinal length in the collapsed configuration and a second longitudinal length in the extended configuration, and wherein the first longitudinal length is less than the distance between a vertebral pedicle in a subject and an adjacent vertebral pedicle in the subject; and
a guide tower assembly for guiding a spinal rod into position from the first bone anchor to a second bone anchor, the guide tower assembly comprising:
an elongate tower member having a proximal end, a distal end, and a longitudinal axis;
a first rod holder having a first rod engagement feature at a distal end of the first rod holder and a first translating shaft connected to the first rod engagement feature, wherein the first translating shaft is capable of translating relative to the elongate tower member parallel to the longitudinal axis of the elongate tower member, and wherein the first rod engagement feature translates with the first translating shaft; and
a second rod holder having a second rod engagement feature at a distal end of the second rod holder and a second translating shaft connected to the second rod engagement feature, wherein the second translating shaft is capable of translating relative to the elongate tower member parallel to the longitudinal axis of the elongate tower member, wherein the second rod engagement feature translates with the second translating shaft and wherein the second translating shaft is capable of translating at a different velocity than a velocity of translation of the first translating shaft.
13. The system of claim 12 , wherein the guide tower member further comprises:
a lumen running from the proximal end to the distal end of the elongate tower member.
14. The system of claim 13 , wherein the guide tower member further comprises:
a longitudinal slot in the elongate tower member that connects to the lumen.
15. The system of claim 12 , wherein the guide tower member comprises:
a bone anchor engagement member at the distal end of the tower member configured to reversibly fasten the elongate tower member to the proximal rod housing of the first bone anchor.
16. The system of claim 12 , wherein at least one of the first translating shaft and the second translating shaft is a threaded shaft operatively connected to a first shaft magnet, such that rotation of the first shaft magnet causes the threaded shaft to translate.
17. The system of claim 12 , wherein
the first translating shaft is a threaded shaft operatively connected to a first shaft magnet, such that rotation of the first shaft magnet causes the first threaded shaft to translate parallel to the longitudinal axis of the guide tower; and
the second translating shaft is a threaded shaft operatively connected to a second magnet, such that rotation of the second magnet causes the second threaded shaft to translate parallel to the longitudinal axis of the guide tower.
18. The system of claim 17 , wherein the first shaft magnet and the second magnet are rotatably mounted to rotate when exposed to a rotating magnetic field.
19. The system of claim 18 , wherein the thread pitch of the first threaded shaft does not equal the thread pitch of the second threaded shaft.
20. The system of claim 12 , wherein the first telescoping spinal rod comprises a rod magnet configured to rotate when exposed to a spinning magnetic field and cause the first telescoping spinal rod to either extend or collapse depending on the direction of rotation of the spinning magnetic field.
21. The system of claim 20 , wherein the first telescoping spinal rod comprises:
a first elongate element containing a cavity;
a second elongate element dimensioned to at least partially fit within the cavity; and
a lead screw coupled to rotate when the rod magnet rotates, and comprising an externally threaded region, such that rotation of the lead screw causes the second elongate element to translate relative to the first elongate element.