Expandable trial with telescopic stabilizers
Systems and methods for distracting an intervertebral disc space are provided. The systems use an expandable trial with telescopic stabilizers. The systems and methods of distracting an intervertebral space are provided in a manner that addresses the problem of subsidence. The method includes inserting the trial into the intervertebral space in a collapsed state and, once inserted, the trial is then used for distracting the intervertebral space using an expansion that includes a first stage and a second stage. The first stage includes expanding the trial laterally toward the peripheral zones of the top vertebral plate and the bottom vertebral plate, and the second stage includes expanding the trial vertically to distract the intervertebral space.
1. A method of distracting an intervertebral space, the method comprising:
using an expandable trial for an intervertebral space, the trial including
an expandable shell having a proximal region with an end, a mid-region, a distal region with an end, and a lumen; the proximal region having a slider-guide flexibly attached to an expandable head in the distal region, the expandable head having
a top subhead and a bottom subhead operably connected through a plurality of telescopic stabilizers, each telescopic stabilizer having
a linear member; and,
a guide;
wherein, the linear member slidably translates with it's respective guide to stabilize and/or align the relationship between the top subhead and the bottom subhead when expanding the expandable shell from a collapsed state to an expanded state and collapsing the expandable shell from the expanded state to the collapsed state;
creating a point of entry into an intervertebral disc, the intervertebral disc having a nucleus pulposus surrounded by an annulus fibrosis, and the point of entry having the maximum lateral dimension created through the annulus fibrosis;
removing the nucleus pulposus from within the intervertebral disc through the point of entry, leaving the intervertebral space for expansion of the head of the trial within the annulus fibrosis, the intervertebral space having the top vertebral plate and the bottom vertebral plate;
inserting the head in the collapsed state through the point of entry into the intervertebral space; and,
distracting the intervertebral space, the distracting including slidably translating the telescopic stabilizer in the expansion of the head to the expanded state.
2. The method of claim 1 , further comprising retaining the trial with a retractable retention plunger and retracting the plunger to expand the trial.
3. The method of claim 1 , wherein the lateral dimension of the point of entry ranges from about 5 mm to about 18 mm.
4. The method of claim 1 , wherein the distracting includes selecting an amount of vertical expansion.
5. The method of claim 1 , wherein the distracting includes selecting a vertical expansion component that includes a vertical-expansion wedge with angle ⊖ V ranging from 30° to 50°.
6. The method of claim 4 , wherein the distracting includes selecting a vertical expansion component that includes a vertical-expansion wedge with angle ⊖ V ranging from 10° to 90°.
7. The method of claim 1 , wherein for the inserting and the distracting, the head has
a transverse cross-section in the collapsed state having a maximum dimension ranging from 5 mm to 18 mm for placing the frame in an intervertebral space through an annular opening for expansion in the intervertebral space; and,
a transverse cross-section in the expanded state having a maximum dimension ranging from 6.5 to 28 mm in the intervertebral space.
8. The method of claim 1 , wherein for the inserting and the distracting, the linear member comprises a rod, and the guide is configured complementary to the rod.
9. The method of claim 1 , wherein for the inserting and the distracting, the proximal end of a shim is configured to receive an axial proximal-to-distal force through an actuation bar for an axial translation of the shim into the shell, the actuation bar having a proximal portion with a proximal end, a distal portion with a distal end, and configured to transfer the axial proximal-to-distal force to the shim through the slider-guide.
10. The method of claim 1 , wherein for the inserting and the distracting, the trial has at least 2 telescopic stabilizers.
11. The method of claim 1 , wherein the using of the expandable trial includes inducing the vertical expansion of the head in the intervertebral space with a vertical expansion component.
12. The method of claim 11 , wherein the inducing of the vertical expansion includes transferring an axial proximal-to-distal force from an actuation screw that is operably attached to the proximal end of the actuation bar to an actuation component having a proximal end and a distal end that is operably connected to the vertical expansion component.