Transpedicular access to intervertebral spaces and related spinal fusion systems and methods
According to some embodiments, a method of accessing an intervertebral space of a patient's spine in a minimally invasive manner compromises creating a passage from a posterior end of a pedicle of a vertebral member using a probe, advancing the probe through the pedicle and to a main body portion of the vertebral member, advancing the probe through a superior endplate of the vertebral member and into the intervertebral space and enlarging the passage using at least one tap to create an enlarged passage from a posterior of the pedicle to the intervertebral space. In some embodiments, the enlarged passage traverses at least three cortical layers of the vertebral member.
1. A method of fusing a first vertebra to a second vertebra, said second vertebra being immediately adjacent and above the first vertebra, the method comprising:
creating a passage from a posterior end of a pedicle of the first vertebra through a superior endplate of the first vertebra, such that the passage extends into an intervertebral space located generally between the first and second vertebrae;
removing native tissue located within the intervertebral space by advancing a tissue removal tool through the passage and selectively moving said tissue removal tool within the intervertebral space;
delivering at least one of an implant and a grafting material through the passage, wherein said at least one of the implant and the grafting material is configured to promote fusion between the superior endplate of the first vertebra and an inferior endplate of the second vertebra; and
advancing a first bone screw through the passage, such that a distal end of the first bone screw extends at least partially into the intervertebral space, wherein the distal end of the first bone screw terminates within the intervertebral space;
wherein the first bone screw comprises threads along its length, wherein at least some of the threads of the first bone screw, once the first bone screw has been fully advanced through the passage, engage a cortex of the posterior end of the pedicle, a cortex of a shaft of the pedicle and a cortex of the superior endplate of the first vertebra.
2. The method of claim 1 , wherein the passage created through the first vertebra is generally linear.
3. The method of claim 1 , wherein the method is performed minimally invasively.
4. The method of claim 1 , wherein the at least one of the implant and the grafting material comprises an expandable implant.
5. The method of claim 1 , wherein removing native material comprises removing at least one of disc material and a surface of an endplate of the first vertebra or the second vertebra.
6. The method of claim 1 , wherein the tissue removal tool comprises an expandable head portion, said head portion being configured to assume a collapsed positioned during advancement through the passage and being configured to selectively assume an expanded position within the intervertebral space.
7. The method of claim 1 , further comprising inserting an access device within the passage to facilitate the movement of tools or devices through the passage.
8. The method of claim 1 , further comprising inserting a second bone screw through the second vertebra.
9. The method of claim 8 , further comprising connecting the first bone screw to the second bone screw using a rod or other connector.
10. The method of claim 8 , wherein the second bone screw does not extend through an endplate of the second vertebra.
11. The method of claim 1 , further comprising inserting a facet implant in at least one of the facet joints between the first and second vertebrae to fuse the first and second vertebrae at the at least one of the facet joints.
12. The method of claim 11 , wherein the facet implant is configured to selectively distract adjacent surfaces of the first and second vertebrae.
13. The method of claim 11 , further comprising securing the first bone screw to at least a portion of the facet implant.
14. A method of fusing a first vertebra to a second vertebra, said second vertebra being immediately adjacent and above the first vertebra, the method comprising:
creating a passage from a posterior end of a first pedicle of the first vertebra through a superior endplate of the first vertebra, such that the passage extends into an intervertebral space located generally between the first and second vertebrae;
advancing a first bone screw through the passage, such that a distal end of the first bone screw extends at least partially into the intervertebral space, wherein the distal end of the first bone screw terminates within the intervertebral space;
inserting a facet implant in a facet joint between the first and second vertebrae, said facet joint being adjacent the first pedicle;
wherein the first and second portions of the facet implant are fixed to one another to prevent relative movement between the first and second portions;
rigidly attaching the first portion of the facet implant to the first bone screw to prevent relative movement between the facet implant and the first bone screw; and
attaching the second portion of the facet implant to the second vertebra.
15. The method of claim 14 , further comprising delivering at least one of an implant and grafting material within the intervertebral space through the passage.
16. The method of claim 14 , wherein attaching the second portion of the facet implant to the second vertebra comprises securing the second portion to the lamina of the second vertebra using at least one screw.