Method and apparatus for minimally invasive insertion of intervertebral implants
A dilation introducer for orthopedic surgery is provided for minimally invasive access for insertion of an intervertebral implant. The dilation introducer may be used to provide an access position through Kambin's triangle from a posterolateral approach. A first dilator tube with a first longitudinal axis is provided. A second dilator tube may be introduced over the first, advanced along a second longitudinal axis parallel to but offset from the first. A third dilator tube may be introduced over the second, advanced along a third longitudinal axis parallel to but offset from both the first and the second. An access cannula may be introduced over the third dilator tube. With the first, second, and third dilator tubes removed, surgical instruments may pass through the access cannula to operate on an intervertebral disc and/or insert an intervertebral implant.
1. An access device for accessing an intervertebral disc, the access device comprising:
a) an outer cannula having a first substantially tubular portion that is elongate along a longitudinal direction, a first proximal end portion, a first distal end portion opposite the first proximal end portion along the longitudinal direction, a first outer surface that extends between the first proximal end portion and the first distal end portion along the longitudinal direction, and a first longitudinal throughbore defining a first inner surface, wherein the outer cannula has a length along the longitudinal direction configured to extend from an incision to a vertebra that partially defines a Kambin's Triangle,
b) an inner cannula having a second substantially tubular portion that is elongate along a central axis that is oriented along the longitudinal direction, and a flange that extends out from the second substantially tubular portion along a radial direction that is perpendicular to the longitudinal direction, the flange extending along the longitudinal direction along greater than half a length of the inner cannula, the length of the inner cannula defined along the longitudinal direction, the second substantially tubular portion further having a second proximal end portion, a second distal end portion opposite the second proximal end portion along the longitudinal direction, and a second longitudinal throughbore defining a second inner surface, wherein the inner cannula defines a second outer surface that extends about the second substantially tubular portion and the flange, the central axis is disposed between the second outer surface at the flange and the second outer surface at the tubular portion with respect to the radial direction, and the central axis is spaced further from the second outer surface at the flange than it is from the second outer surface at the tubular portion along the radial direction,
wherein the second outer surface of the inner cannula is configured to substantially nest within the first inner surface of the outer cannula, such that the outer cannula surrounds an entirety of the inner cannula in a plane that is oriented perpendicular to the central axis,
wherein the outer cannula defines a flange that extends radially out from only a single side of the first outer surface at the first substantially tubular portion, and the flange of the outer cannula receives the flange of the inner cannula, and
wherein the outer cannula is radially aligned with the first substantially tubular portion.
2. The device of claim 1 , wherein the second outer surface of the inner cannula substantially nests within the first inner surface of the outer cannula so that the second distal end portion of the inner cannula extends distally past the first distal end of the outer cannula.
3. The device of claim 1 , wherein the second proximal end portion of the inner cannula comprises a stop adapted to abut the first proximal end portion of the outer cannula, the stop being adapted to prevent excessive distal movement of the inner cannula.
4. The device of claim 3 , wherein the stop extends substantially radially about the second proximal end portion of the inner cannula.
5. The device of claim 4 , wherein the stop further comprises a textured radial surface adapted for gripping.
6. The device of claim 1 , wherein the flange has an arcuate transverse cross-section.
7. The device of claim 1 , wherein the arcuate transverse cross-section of the flange defines an outer surface of the flange having a curvature substantially similar to a curvature of the first inner surface of the outer cannula.
8. The device of claim 1 , wherein the inner and outer cannulas further comprise stop members.
9. The device of claim 1 , wherein the second substantially tubular portion is enclosed in its entirety in the plane that is oriented perpendicular to the central axis.