Methods and apparatus for accessing and treating the facet joint
Methods and systems are disclosed for accessing and treating the interior of the facet joint for vertebral distraction and immobilization. The systems include a number of tools that facilitate access to the facet joint, distraction of the articulating decortication of the articulating surfaces, and delivery of implants and agents into the facet joint for fusion.
1. A surgical system for facet joint immobilization, the facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule, the surgical system comprising:
a facet access tool configured to pierce through the facet capsule and into the facet cavity to generate a minimally invasive slit-shaped aperture in the facet capsule, the facet access tool comprising:
a blade sized and shaped to pierce through the facet capsule; and
a shaft attached to the blade and including a distal beveled surface sized and shaped to allow the blade to access the facet joint;
a distraction apparatus, comprising:
an elongate tube;
an upper pivoting member mounted to the tube via a hinge; and
a lower pivoting member mounted to the tube via the hinge,
wherein distal tips of the pivoting members are configured to be delivered through the minimally invasive slit-shaped aperture in the facet capsule and into the facet cavity, and wherein proximal ends of the pivoting members are configured to be manually pressed inward toward the elongate tube to cause the distraction apparatus to expand at the distal tips to distract the first and second articulating subchondral surfaces of the facet joint a predetermined distance;
a decortication apparatus slidably received within the tube of the distraction apparatus and configured to be articulated outward from the distal tips and reciprocated back and forth within the tube to decorticate at least one of the first and second articulating subchondral surfaces; and
an introducer consisting of:
only one, single, elongate shaft configured for insertion through the tube of the distraction apparatus, the shaft comprising:
a proximal end; and
a distal end opposite the proximal end; and
a single tip extending distally outward from the distal end of the single elongate shaft,
wherein the introducer is configured to be delivered through the minimally invasive slit-shaped aperture in the facet capsule and into the facet cavity to deliver an implant between the first and second articulating subchondral surfaces of the facet joint to immobilize the joint at said predetermined distance.
2. The surgical system as recited in claim 1 , wherein the decortication apparatus comprises:
a flat, flexible, spatula-shaped rasp configured to decorticate at least one of the articulating surfaces; and
a shaft attached to the rasp and having a distal, beveled surface.
3. The surgical system as recited in claim 1 , wherein the implant comprises bone allograft.
4. The surgical system as recited in claim 1 , further comprising a delivery system configured to deliver an agent to the facet joint.