Ultrasonic spinal surgery method and associated surgical instrument
An elongate ultrasonic dissector-shaver probe has a laterally enlarged head extending distally and transversely from a distal end of a shaft and provided with sets of spiraling ribs. In a disc space preparation procedure, the probe is inserted into a spinal disc between two vertebral endplates, ultrasonic vibratory energy is conducted into the probe, and the probe is manipulated to move the laterally enlarged head in three spatial directions within the spinal disc to thereby disrupt and shred the spinal disc material into fragments extracted from the space, in part by suction and in part by using forceps to pull spinal disc fragments from the operative space or surgical site between the vertebral endplates.
1. A spinal surgery method comprising:
providing an ultrasonic probe including an elongate shaft and a laterally enlarged head at a distal end of said shaft;
conducting ultrasonic vibratory energy into said ultrasonic probe to generate a standing wave therein;
during the conducting of ultrasonic vibratory energy, inserting a distal end of an ultrasonic probe into a spinal disc between two vertebral endplates;
thereafter, also during the conducting of ultrasonic vibratory energy, manipulating said ultrasonic probe to move said laterally enlarged head alternately in a distal and a proximal direction, alternately towards left and right within said spinal disc, and alternately towards and away from the vertebral end plate surfaces to thereby disrupt and shred at least a portion of said spinal disc into fragments exhibiting a range of different sizes including segments too large to aspirate from a space occupied by said spinal disc between said vertebral endplates; and
extracting said fragments from said space, the extracting of said fragments including using forceps or graspers to pull at least some of said segments from said space.
2. The spinal surgery method defined in claim 1 wherein said laterally enlarged head includes at least one convexly arcuate edge disposed in a major plane orthogonal to a longitudinal axis of said shaft, said laterally enlarged head having largest dimensions orthogonal to said longitudinal axis located in said major plane, said laterally enlarged head tapering down in a proximal direction from said major plane to said shaft, said laterally enlarged head tapering down in a distal direction from said major plane to a free end opposite said shaft.
3. The spinal surgery method defined in claim 2 wherein said at least one convexly arcuate edge is one of two opposed mirror-symmetric convex edge segments disposed in said major plane, further comprising, during the conducting of ultrasonic vibratory energy, manipulating said ultrasonic probe to engage first one and then another of said vertebral endplates with respective ones of said two opposed mirror-symmetric convex edge segments to thereby remove disc material from surfaces of both of said vertebral endplates.
4. The spinal surgery method defined in claim 2 , further comprising, during the conducting of ultrasonic vibratory energy, manipulating said ultrasonic probe to engage at least one of said vertebral endplates with said at least one convexly arcuate edge to thereby remove disc material from a surface of said at least one of said vertebral endplates facing said space.
5. The spinal surgery method defined in claim 1 wherein the inserting of the distal end of the ultrasonic probe into the spinal disc includes, during the conducting of ultrasonic vibratory energy, manipulating the ultrasonic probe to perform an annulotomy on the spinal disc.
6. The spinal surgery method defined in claim 5 , further comprising operating an ultrasonic instrument, prior to the inserting of the distal end of the ultrasonic probe into the spinal disc and prior to the manipulating of the ultrasonic probe to perform the annulotomy, using said ultrasonic instrument to remove osteophytes from one or both of the vertebral endplates.
7. The spinal surgery method defined in claim 1 wherein the manipulating of said ultrasonic probe includes manipulating said ultrasonic probe to move said laterally enlarged head alternately towards and away from one of said vertebral endplates so as to trap disc material between said laterally enlarged probe head and said one of said vertebral endplates, whereby the trapped disc material is severed.
8. The spinal surgery method defined in claim 1 , further comprising, during the conducting of ultrasonic vibratory energy, manipulating said ultrasonic probe to engage said vertebral endplates with said laterally enlarged head and thereby remove disc material soft tissue and cartilage from surfaces of said vertebral endplates.
9. The spinal surgery method defined in claim 1 wherein said range extends from less than one millimeter to more than one centimeter.
10. The spinal surgery method defined in claim 1 wherein the extracting of said fragments includes aspirating some of said fragments from said space.
11. The spinal surgery method defined in claim 1 wherein said forceps is a Pituitary Rongeurs.