Spinal osteotomy
Disclosed are systems, devices, methods and surgical procedures for altering and/or correcting the alignment of adjacent bones, including bones of the spine.
1. A surgical method for creating a desired lordosis or kyphosis between a first upper vertebrae and a second lower vertebrae, comprising:
removing at least a portion of a natural intervertebral disc from between the upper and lower vertebrae to create a disc space;
removing at least a portion of a natural pedicle and a posterior rim portion of the lower vertebrae;
inserting an upper portion and a lower portion of a first arthroplasty device at least partially into the disc space, the lower portion of the first arthroplasty device including:
an upwardly facing lower articulation surface configured to movably engage a downwardly facing upper articulation surface of the upper portion to form an articulating joint,
a bridge portion extending through the resected posterior rim portion, the bridge portion having a first surface for engaging with a remaining portion of the natural pedicle outside of the disc space, and
a lower extension limiter positioned posteriorly of the upwardly facing lower articulation surface, the lower extension limiter including an upwardly protruding extension having a medial-lateral width that is wider than a medial-lateral width of an adjacent section of the bridge portion, the upwardly protruding extension engaging with a recessed portion of the upper portion to inhibit posterior movement of the upper portion relative to the lower portion; and
attaching the first arthroplasty device to the lower vertebrae with a bone fastener.
2. The surgical method of claim 1 , further comprising the step of removing at least a portion of a natural endplate of the lower vertebrae to substantially match a profile of an outer contact surface of the first arthroplasty device.
3. The surgical method of claim 2 , wherein the step of removing at least a portion of the natural endplate of the lower vertebrae comprises milling at least a portion of the natural endplate of the lower vertebrae.
4. The surgical method of claim 2 , wherein the step of removing at least a portion of the natural endplate of the lower vertebrae comprises chiseling at least a portion of the natural endplate of the lower vertebrae.
5. The surgical method of claim 2 , wherein the step of removing at least a portion of the natural endplate of the lower vertebrae comprises notching at least a portion of the natural endplate of the lower vertebrae.
6. The surgical method of claim 2 , wherein the outer contact surface comprises a textured surface.
7. The surgical method of claim 1 , further comprising the step of removing at least a portion of an articular process of the lower vertebrae.
8. The surgical method of claim 1 , wherein at least a portion of the method is performed using a surgical guidance system.
9. The surgical method of claim 1 , wherein at least a portion of the method is performed using a surgical robot.
10. The surgical method of claim 1 , wherein the first surface comprises a bone ingrowth surface.
11. The surgical method of claim 1 , wherein the first surface comprises a textured surface.
12. A surgical method for creating a desired lordosis or kyphosis between a first upper vertebrae and a second lower vertebrae, comprising:
removing at least a posterior rim portion of a natural intervertebral disc from between the upper and lower vertebrae to create a disc space;
resecting at least a portion of a natural endplate and at least a portion of a natural pedicle of the lower vertebrae;
inserting a lower portion of a first arthroplasty device at least partially into the disc space, the lower portion of the first arthroplasty device including an upwardly facing lower articulation surface and a lower flexion limiter positioned anteriorly of the upwardly facing lower articulation surface, the lower flexion limiter including an upwardly protruding extension having a medial-lateral width that approximates a medial-lateral width of the lower portion, the upwardly protruding extension engaging with a recessed portion of an upper portion of the first arthroplasty device to inhibit anterior movement of the upper portion relative to the lower portion; the lower portion extending at least partially over the resected posterior rim and including a first surface that substantially matches at least a portion of the resected surface of the natural endplate and a second surface that substantially matches the resected surface of the natural pedicle; and
attaching the first arthroplasty device to the lower vertebrae with a bone fastener.
13. The surgical method of claim 12 , wherein the bone fastener extends through at least a portion of a cortical wall of the natural pedicle.
14. The surgical method of claim 12 , wherein the bone fastener extends through a central axis of the natural pedicle.
15. The surgical method of claim 12 , wherein at least a portion of the method is performed using a surgical guidance system.
16. The surgical method of claim 12 , wherein at least a portion of the method is performed using a surgical robot.
17. The surgical method of claim 12 , wherein at least a portion of the second surface comprises a textured surface.
18. The surgical method of claim 12 , wherein at least a portion of the second surface comprises an osteoconductive material.
19. The surgical method of claim 12 , wherein at least a portion of the second surface comprises an osteoinductive material.
20. The surgical method of claim 12 , wherein the step of attaching the first arthroplasty device to the lower vertebrae with a bone fastener comprises attaching the first arthroplasty device to the lower vertebrae with a bone fastener inserted along an extrapedicular pathway.