CA2144535A1 - Tool and method for derotating scoliotic spine - Google Patents
Tool and method for derotating scoliotic spineInfo
- Publication number
- CA2144535A1 CA2144535A1 CA002144535A CA2144535A CA2144535A1 CA 2144535 A1 CA2144535 A1 CA 2144535A1 CA 002144535 A CA002144535 A CA 002144535A CA 2144535 A CA2144535 A CA 2144535A CA 2144535 A1 CA2144535 A1 CA 2144535A1
- Authority
- CA
- Canada
- Prior art keywords
- tool
- rod
- derotation
- arm member
- scoliotic
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
- 238000000034 method Methods 0.000 title claims abstract description 44
- 230000008878 coupling Effects 0.000 claims description 17
- 238000010168 coupling process Methods 0.000 claims description 17
- 238000005859 coupling reaction Methods 0.000 claims description 17
- 210000001331 nose Anatomy 0.000 description 20
- 210000003739 neck Anatomy 0.000 description 12
- 206010039722 scoliosis Diseases 0.000 description 5
- 206010023509 Kyphosis Diseases 0.000 description 3
- 101150107341 RERE gene Proteins 0.000 description 3
- 241000282320 Panthera leo Species 0.000 description 2
- 230000007423 decrease Effects 0.000 description 2
- 210000000887 face Anatomy 0.000 description 2
- 210000003128 head Anatomy 0.000 description 2
- 210000000115 thoracic cavity Anatomy 0.000 description 2
- 241000934653 Dero Species 0.000 description 1
- 206010062575 Muscle contracture Diseases 0.000 description 1
- YFONKFDEZLYQDH-OPQQBVKSSA-N N-[(1R,2S)-2,6-dimethyindan-1-yl]-6-[(1R)-1-fluoroethyl]-1,3,5-triazine-2,4-diamine Chemical compound C[C@@H](F)C1=NC(N)=NC(N[C@H]2C3=CC(C)=CC=C3C[C@@H]2C)=N1 YFONKFDEZLYQDH-OPQQBVKSSA-N 0.000 description 1
- 238000005452 bending Methods 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 208000006111 contracture Diseases 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 201000002972 idiopathic scoliosis Diseases 0.000 description 1
- 210000004705 lumbosacral region Anatomy 0.000 description 1
- 230000007935 neutral effect Effects 0.000 description 1
- 230000000399 orthopedic effect Effects 0.000 description 1
- 210000000278 spinal cord Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
- A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
- A61B17/7077—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation for moving bone anchors attached to vertebrae, thereby displacing the vertebrae
- A61B17/7079—Tools requiring anchors to be already mounted on an implanted longitudinal or transverse element, e.g. where said element guides the anchor motion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
- A61B2017/0256—Joint distractors for the spine
Abstract
A tool (64) and method for derotating a scoliotic spine (30) while it is being manipulated from a scoliotic configuration to a kyphotic configuration. The tool (64) is used to apply a derotating force to the convex side (36) of the scoliotic spine (30). The method uses the tool (64) to reduce the derotation of a scoliotic spine (30).
Description
2 ~ 5 ~ ~ PCr/US93/08694 -TOOL AND METHOD FOR DEROTATING SCOLIOTIC SPINE
Field ofthe Invention The present invention relates to tools and methods for llealing spinal dero. ",ilies, particularly the spinal condition known as scoliosis.
Bacl.ground of the Invention The normal spine when viewed in an anterior posterior direction is straight.
The same spine, when viewed from the lateral view has a series of curvatures. The thoracic curvature has a convexity posteriorly (in the sagittal plane). The lumbar spine has a curvature with the convexity directed anteriorly. Scoliosis traditionally, has been disc~lssed as a side bending (in the coronal plane) of the normally straight spine when viewed from the anterior-posterior direction. Dependir~ on the etiology, there may be just one primary curve having smaller secondary cG"")ensdlory curves, or there may be several primary curves. The sl;ll.,ess of the curve varies between individuals dependent upon the amount of bone d~ro"",ly and lig~m~ntous contracture that has occurred over a period of time. Harrington's first appalal~ls for ~ligninp; the spine was a straight rod ~tt~çlled at a single site top and bottom. This did an excellent job of str~ight~ning the lateral curvature (coronal plane) but ignored the normal sagittal plane curvatures of the spine. This resulted in a worsening of the spinal ~lignm~nt in the sagittal plane in many cases.
20 Scoliosis now is fully app,eciated to be a d~;rollllily of the spine in three planes. This derolmily results in the appeal~nce of (1) a lateral bend on the anterior posterior view, (2) a loss of the normal convexity posterior curvature of the thoracic area or a str~ight~nin~ of the spine on the lateral view and (3) a rotational deÇoll"ily of the apical vertebra wherein the transverse process of the apical vertebra on the 2~4 PCr/US93/08694 convex side rotates posteriorly and the transverse process of the apical vertebra on the concave side rotates anteriorly.
Cotrel attempted to deal with all three aspects of this d~;rullllily by ch~ ¢
the insl~ ..e~ ;Qn with the Cotrel-Dubousset (C-D) t~-h.~ e. The C-D
hl ,ll~n~ l;on for the correction and stnbili7~tion of spinal defullllily was introduced to the Scoliosis Research Society in 1984. The C-D instrn~ nl~AI;on was subsequçntly modified by Texas Scottish Rite Hospital (TSRH) in 1985. Both the C-D and TSRH insll.~ A~;on include a curved rod dçci~ned with multiple hooks for ~tt~nhm~nt to the spine. The rod is first applied to the concave side of the curve.
10 The instrl~ l;on allows rotation belween the hooks and the rod so that the rod is placed in the spine in a scoliotic position, that is with the curvature of the rod m~tçhing the curvature of the derc.llll.Ly. The rod is then rotated 90 degrees converting the scoliosis into kyphosis. This helps decrease the lateral curvature of the spine in the anterior posterior direction and also helps increase the insufficient curvature in the sagittal plane. It initially was hoped that this also would reduce the rotation of the apical vertebra. The results in this last case have been d;sappo;llling.
Since this teçhnique still relies primarily on a single rod pulling in a single direction for correction, it is underst~n~?ble how this cannot effectively derotate the vertebra.
In view of the shortcomings of the ~sling procedures for lle&l;i~g scoliotic spines, there is a need for improvements which will allow practitioners to apply forces lifting the concave side while ~im~llt~neously con~press;i-g the convex side, thus hl~pall;ng a derotational torque while at the same time col~e~l;ng both saggital and coronal plane derul-ll;ly.
Sullllllaly ofthe Invention The present invention is a method and appa~ s for delu~alh~g a scoliotic spine at the same time that lateral curvature of the derolllled spine is treated, e.g., by using the Cotrel-Dubousset teçhnique and in,ll.. ~.. l~l;on. A method and tool formed in accorda ~ce with the present invention enables the practitioner to derotate the vertebrae around the apical vertebra. A method and tool formed in accordance30 with the present invention has the added advantage of complf~...ç~.l;ng existing techniques for ll~lh~g a scoliotic spine.
A method carried out in accordance with the present invention is used to treat a scoliotic spine that can be described as having a convex side and a concave side.
The concave side refers to the inside of the lateral curvature and the convex side refers to the exterior of the lateral curvature. The method involves the steps of conl-ec~ g a derotation rod to the scoliotic spine. The derotation rod has a scoliotic 3 Pcr/US93/08694 -configuration and a kyphotic configuration. The derotation rod is in its scoliotic configuration when it is initially affixed to the spine. The kyphotic confi~lration is the position that the derotation rod occupies after the method is completed. The kyphotic confi~lration is de,;~-ed to remove the lateral curvature as well as introduce kyphosis S back into the spine. Mer the der~lalion rod is conl-ecled to the scoliotic spine, it is rotated from its scoliotic col~lgula~ion to its kyphotic ccillrigulalion. This rotation of the rod pulls the spine to reduce the lateral curvature, and also pulls the spine in a posterior direction. In acc~ldance with the present invention, the rotational dcro,,,,,ly of the scoliotic spine is reduced during this r~tali"g step by applying a pushing force 10 in an anterior direction to the convex side of the scoliotic spine while pulling posteriorily on the concave side. This cor.,binalion of two forces acting ~im~lit~q~neously is needed to achieve a derotation ofthe apical vertebra.
In one embo~lim~nt~ the force on the convex side of the scoliotic spine is created by se;u~i"~ a tool to the derotation rod and mqnuqlly biasing the tool in the 15 desired direction.
Such a tool in~l~ldes a first arm -.elnbel that incl~ldes a first handle end and a first nose end opposite the first handle end. The first handle end and the first nose end are conl~e~;led by a first neck. The tool also includes a second arm ~ lbc;r having a second handle end and a second nose end opposite the second handle end, the second 20 handle end and the- second nose end being con~-e~,led by a second neck. The first arm ...ç...hel and the second arm ",embel are pivotally conl-ecled at the first neck and the second neck. A first coupling ".~..hel is secured to the first nose end for securing the first arm ",e...ber to a derotation rod. A second coupling ...~.nbel is provided on the second nose end for securing the second arm "-e--lber to a force ;-"pa- Iing rod. The 25 force in~p~ Ling rod is used to apply force in an anterior direction to the convex side of the scoliotic spine.
In one embodiment of the tool, an qdjustm~nt bolt is secured to the first arm "e",ber and slidably en~es the second arm l.~....h~r near the first and second handle ends. The adjllstm~nt bolt carries an inner adjustmçnt nut and an outer adjllctm~nt 30 nut. The inner and outer ndjllstm~nt nuts are on opposite sides of the second arm member.
In still another embodiment of the tool formed in accordance with the present invention, the second nose end includes an integral force i",p~ling rod ~qttqc~ed thereto.
Wo 94/06362 PCr/US93/08694 5~
. i Brief Des.;liplion of the Drawings The folegoing aspects and many of the ~ttçndAnt advantages of this invention will beco.nc more readily appl~;aled as the same beco..~es better understood by rer~ ce to the following det~qiled descliplion, when taken in conjunction with the 5 acc~ pq~ g dldwings, whele~:
FIGURE 1 is a pe,~e~ live view from the concave and posterior sides of a scoliotic spine carrying TSRH instn..n~nl~l;on in its scoliotic confi~lration;
FIGURE 2 is a plan view in the caudal direction of the apical vertebra of the scoliotic spine in FIGURE 1 in its derollned confi~lration (solid lines) and a normal 10 configuration (ghost lines);
FIGURE 3 is a perspective view from the concave and posterior side of the scoliotic spine in FIGURE 1 ca"ying TSRH instnlme.,l~l;ol- in the kyphotic configuration;
FIGURE 4 is a plan view in the caudal direction of the apical vertebra of the 15 scoliotic spine in FIGURE 1 in its scoliotic ccsn~igu~alion (ghost lines) and its treated confi~lration after the TSRH instn....~ ;on is rotated from its scoliotic configuration to its kyphotic configuration;
FIGIJRE 5 is a pe.~ecli~e view from the concave and posterior side of the scoliotic spine of FIGURE 1 with a tool formed in accordallce with the present 20 invention ~tt~ched to the TSRH insl,~,el-t~l;on;
FIGORE 6 is a perspective view from the concave and posterior side of the scoliotic spine of FIGURE S after the derotation rod has been rotated to place the TSRH instn-.~ l;on in its kyphotic configuration and the spine has been derotated in accordance with the present invention;
FIGURE 7 is a plan view in the caudal direction of the apical vertebra of the scoliotic spine in FIGURE 6 showing its scoliotic configuration (ghost lines) and its de.-~laled configuration (solid lines);
FIGURE 8 is a pe,~,ecli~e view of a tool used to derotate a scoliotic spine formed in acco- dance with the present invention;
FIGURE 9 is a pc. ~e~ e view of a portion of the tool formed in accorda~lce with the present invention att~ched to a derotation rod and positioned adjac~nt a .
scollotlc spme;
FIGI~RE 10 is a pt,~e~ e view of a portion of the tool of FIGURE 8 showing the hooks for ~ttAçhment to a derotation rod and a force il"~ lh~g rod; and FIGURE 11 is a pel ~pecli~e view of a portion of a second embodiment of the tool forrned in accordance with the present invention.
W O 94/06362 ~ J ~ ~ PC~r/US93/08694 Detailed Des~ )tion ofthe Fl~f~,.led Embodiment In the following desc.iplion of the method and tool for dt;r~t~ling a scolioti spine formed in acco-~nce with the present invention, the method and tool are des.,.il,ed in conjunction with Cotrel-Dubousset insl~ ..e~ ;on (he.t;illaller ere--ed to as C-D in,ll~n~ ;on) which was dcvcloped between 1978 and 1983 and Texas Scottish Rite Hospital Universal Spinal Inslll,...P~...l~l;on which was developed ~e~ g in 1985 (TSRHin~ .n~nl~l;on). The C-D i........... ,l-.... ~nl~l;on and technique are desc-il,ed in detail in Cotrel-Dubousset I,~h "~t~tion in t*e Treatment of Idiopathic Scoliosis by Francis Denis, M.D., Orthopedic Clinics of North 10 America--Vol. 19, No. 2, April 1988 and Cotrel-Dubousset I~L,h~ ,. "tation, Richard A. Balderston, pages 113-126; Spinal Instrumentation, editors Howard S. An and Jerome M. Cotler, 1992. The TSRH instn~ ion and teçtm;~ue are described in detail in the Texas ScoJtish Rite Hospital Universal Spinal Instrumentation System by Charles E. Johnston et al., pages 127-165; Spinal I,~h....... ,,~tion, editors Howard 15 S. An and Jerome M. Cotler, 1992. The subject matter of these publications is e~,ressly ~col~o.aled herein by lererel-ce.
Rt;r~;---ng to ~IGURE 1, scoliotic spine 30 incllldes an a~no--nal lateral curvature 32. Lateral curvature 32 is c~ eled around an apical vertebra 34 which lies at the apex of the curvature. Lateral curvature 32 has a convex side 36 and a concave 20 side 38. Concave side 3B is the inside surface of lateral curvature 32 and convex side 36 is the outer surface of lateral curvature 32. In scoliotic spine 30, apical vertebra 34 and four or five vertebrae on each side of apical vertebra 34 are rotated into lateral curvature 32 such that the transverse processes 40 on concave side 36 are tli~pl~Ced in an anterior direction and transverse processes 42 on convex side 36 are 25 displaced in the posterior direction.
TSRH inst~ P~ ;on incll~des derotation rod 44 which has a scoliotic configuration and a kyphotic configuration. In FIGURE 1, derotation rod 44 is in its scoliotic configuration and is secured to concave side 38 of scoliotic spine 30 around apical vertebra 34 using two basic types of hooks. The two basic types of hooks are a 30 pedicle hook and a laminar hook. The hooks are de~ ;g.~ed to achieve secure ancho,ing on the pedicle, the lamina, and the transverse processes of various vertebrae. The number of hooks, the types, and their location will be dete,-...nPd by the practitioner depe~din~ on the particular patient's needs. Derotation rod44 inc1l~des a superior end 46 which incllldes a squared head 48. Squared head 48 is 35 engdgPd by wrench 50. Wrench 50 is relied upon to rotate derotation rod 44 in the dire.ilion of arrow 52 as described below in more detail.
Wo 94/06362 Pcr/us93/08694 2 S.~ i~35 -6-The TSRH teçhniq~le involves sL~1dard exposure of the scoliotic spine allowing eYrosure of the transverse processes of the upper end ve. Iebl c and of the inferior aspect ofthe lamina ofthe lower end ~e~lebl~e. After exposure, ~!æ~P.m~nt of laminar and pedicle hooks is carried out according to conve.ltional protocol. The 5 p~blic?tion~ efelled to above provide ~lidqrce to the skilled artisan of operative p~ ni~ for ~1a~m~nt of the hooks, as well as a des~ ion of the actual instr~ ;on of the spine. After the hooks are inserted in the spine, a derotationrod is contoured and then inse~led into the placed hooks. The derotation rod is contoured to have a scoliotic configuration which tends to match the lateral curvature 10 of the scoliotic spine on its concave side. After the rod is inse~led into the hooks in accordance with the TSRH teçhn;que, it is rotated such that the curvature of the rod is ~ p1?ced applo~;~nAlely 90 in the posterior direction into the lateral curvature of the spine. Rotation of the delola~ion rod str~igh~çns the spine by pulling the concavity out of the lateral curvature.
Referring additionally to FIGURE 2, in its normal configuration 54, shown in ghost lines, transverse processes 40 and 42 of apical vertebra 34 are in a neutral position. When the scoliotic defo. .,lalion occurs, transverse process 42 is displaced in the posterior direction while transverse process 40 is d;splaced in the anteriordirection. This "rotation" of apical vertebra 34 is in the direction of arrow 56. The 20 rotated scoliotic configuration 58 of apical vertebra 34 is shown in solid lines. When scoliotic spine30 is treated in accoldal1ce with the TSRHtechnique, derotation rod 44 is rotated by wrench 50 in the direction of arrow 52 in FIGURE 1 to shift the curvature of derotation rod 44 90 in the posterior direction. This position is shown in FIGURE 3. Rotation of derotation rod 44 pulls lateral curvature 32 in the direction 25 of concave side 38 and thus str~ightçn~ the spine. Shifting the curvature in the derotation rod 90 in the posterior direction also pulls the concave side of thescoliotic spine in the posterior direction.
Refe,~ g additionally to FIGURE4, scoliotic configurationS8 of apical vertebra34 prior to rotation of derotation rod 44 is shown in ghost lines with 30 transverse process 42 displaced in the posterior direction and the transverseprocess 40 di~pl.lced in the anterior direction. After derotation rod 44 is rotated 90 in the posterior direction, lateral curvature32 is reduced; however, refw~;ng toFIGllRE 4, the full line illustration of apical vertebra 34 shows treated configuration 60 and how apical vertebra 34 continues to have transverse process 42 35 d;s~lzced in the posterior direction and transverse process 40 di~'r^ed in the anterior direction. FIGURE 4 also illustrates how concave side 38 is pulled in the direction of W O 94/06362 2 1 4 I S ~ ~` PC~r/US93/08694 arrow62 (i.e., posterior direction) and kyphosis is r~i"l,~,d~lced into the spine.
Unrc.,lul~alely, the TSRHterhn:~ue does little to reduce the rotation of apical - vertebra 34.
Refe.li,~ to FIGURES 5, 6 and 7, derotation of the spine is carried out in 5 a~c~ldal~ce with the present invention by e,~ i"g force in an ~Ite~ior direction on convex side36 of scoliotic spine30 during rol~lion of derotation rod44. This "derotation" force is provided without insl,... ~!n1~l;on of convex side 36 of scoliotic spine 30. Less insl~ l;on during 1,~l............ -1 means less risk of d~m~e to the spinal cord. The method carried out in accordance with the present invention 10 achieves effective derotation of apical vertebra 34 and the vertebrae ~dj~cent apical vertebra 34. The method uses a tool 64 which is secured to the derotation rod and inr1ndes a force i"")a,ling rod or means for ~tt~h..~ to a force in,p~ling rod. The force imps ling rod is used to apply an external force in an anterior direction on the convex side of the scoliotic spine during rotation of the derotation rod used in the 15 TSRH techni1ue Before de3c,il,.l~g the method in more detail, tool 64 is desc-il,ed below.
Rere,.,ng to FIGURE8, tool64 formed in accordance with the present invention rese."b!es a pair of pliers or a pair of scissors. As described above, tool 64 is dç~i~ed to be secured to a derotation rod and a force i",l~a. ling rod which is used 20 to exert force on the convex side of a scoliotic spine during rotation of the derotation rod. Tool 64 includes two elongate arm ",e."bt,~ 66 and 68. First elongate arm member 66 inrl~des a handle 70, nose 72, and neck 74. Handle 70 is conl-ecled toneck 74 by an elbow 76. Elbow 76 forms an obtuse angle between handle 70 and neck 74. The opposite end of neck 74 is ~tt~ched to nose 72 by another elbow 78.25 Elbow 78 forms an obtuse angle between nose 72 and neck 74. Second elongate arm m~,...bel 68 is subst~nti~lly a mirror image of first elongate arm ",c".l,e~ 66. Second elongate arm .,.e.lll,er68 inrludes handle80, nose82, neck84, elbow86, and elbow 88 that are subs~ ly idçn~ic-~l to handle 70, nose 72, neck 74, elbow 76, and elbow 78 of first elongate arm l~c~ber 66.
Neck 74 and neck 84 are pivotally col-l-ecled to each other at their pivot point 90. Accoldingly, first elongate arm ...e",ber 66 is pivoted to second elongate arm ...~ ..bç~ 68 in much the same way the arms of a pair of pliers are conl-e~iled. As with a pair of pliers, when the handles 70 and 80 are brought closer together, the Ce between noses 72 and 82 increases. Conversely, when the ~l;cl~ce between handles 70 and 80 h~ct~ases, the l;sl~nce b~t~n~el- noses 72 and 82 decreases.
Handles 70 and 80, necks 74 and 84, and noses 72 and 82 are generally tubular in the WO 94/06362 Pcr/us93/08694 2~ 4~5~ -8-embodiment illustrated in FIGURE 8. Pivot point 90 illustrated in FIGURE 8 bel~neen elongate arm ...~;...~,e~66 and 68 is a tongue and groove configurationElongate arm ncl..ber 68 includes a channel 92 m~rhined through its center Elongate arrn ..c.-.bcu 66 inçh~des a narrowed tongue portion 94 which is received 5 within channel 92 and is rolalably fixed therein by a pivot pin which passes through each arrn l~c~--ber in a direction pel~,e~-d;c~ r to chaMel 92 While this is oneembodiment of pivot conneclion 90, it should be understood that other types of pivot comlc~;lions will be suitable.
In the illustrated embodiment, handles 70 and 80 are textured for ease of 10 gripping Secured to handle 70 adjacçnt elbow 76 is an ~djustment bolt 96 ~ stm~nt bolt 96 is pcl~ç~ cul~r to handle 70 and also passes through handle 80 adj~çent elbow 86. ~justment bolt 96 int~1~ldes threads 98 and carries an inner adjuctm~ont nut 100 and an outer adju~l...e.~1 nut 102 Inner ~justm~nt nut 100 and outer adj.Js~ 1 nut 102 are positioncd on oppos;le sides of handle 80 The spacing between handle 80 and handle 70 can be ndjustcd by the positions of inner ~djustmçnt nut 100 and outer adjustment nut 102 Furthermore, iMer ~juctmpnt nut 100 and outer adjustment nut 102 can be used to anchor or fix the relative position of handles70 and 80 Naturally, this also fixes the distance bel~,en nose 72 and nose 82 Referring additionally to FIGURES 9 and 10, in the illustrated embodiment, nose 72 and nose 82 are each provided with coupling members 104 and 106, l~spe~ ely Coupling member 104 inchldes a shaft 108 and two spaced-apart tips 110 Coupling member 104 in~l~ldes a channel 112 that separates shaft 108 from 2S tips 110 Channel 112 is dimensioned to rotatably receive derotation rod44 Tips 110 are spaced apart sufficiently to enable eyebolt 116 to pass between them Eyebolt 116 incllldes a cube shaped body 118 with a bore 120 extçn~lin~ through opposing faces 122 and 124 of body 118 Bore 120 is sized to rotatably receive derotation rod 44 E~tçntling from a surface 126 of eyebolt 116 that joins faces 122 and 124 is a threaded bolt 128 Bolt 128 receives nut 130 which is sized so that it cannot pass belweell tips 110 When eyebolt 116 is positioned between tips 110 and shaft 108, bore 120 lines up with channel 112 and bolt 128 extends between tips 110 Nut 130 threads onto bolt 128 and draws body 118 against the inside surface of tips 110 to eyebolt 116 in coupling ...en.ber 104 Body 1 18 and bolt 128 are sized so 35 that eyebolt 116 is secured in coupling ..-~,.nber 104, yet derotation rod 44 is free to rotate w094/06362 - 2~ 4~ PCr/US93/08694 g In the embodiment illustrated ~n FIGURES 9 and 10, nose82 incl~des coup!ing ,~ Ser 106 which is identical to collpling r..e..~ber 104 for ~.,u,;ng force illl~a.l;ng rod 132. Force ;"~ ng rod 132 has a diz~pt~ s~b ~....l;Ally id~ntic~l to de,olal;on rod 44, however, it is generally shorter than delotalion rod 44.
Referring to FIGURE 11, in an alternative emborlim~nt~ tool 134 is identic.~l to tool 64, except nose 136 that is opposite nose 138 in~ludes an inverted coupling n,t",ber 140 that is opened downward so that it will receive force ill,?~lhlg rod 132 from below. Tool 134, which incl-lde~ inverted collpl~ .c~..l çr 140 is able to exert force on the force hllp~~ g rod 132 in an anterior d;,e~l;on without requiring that force hllp~~ g rod 132 be independçntly secured to coupling ~ .llber 140.
Rere";~,g to FIGURES 5, 6, 7 and 9, tool 64 des_,il,ed above can be used in accordance with the method carried out in accordance with the present invention, as desc,;l,ed below. First, scoliotic spine 30 must be provided with the TSRH in~ll.. -~l;on in accordance with conventional teçhniques Thereafter, tool 64 is ~tt~ched to derotation rod 44 using coupling .. ~.. bçl 104 in co"-bil,dlion with eyebolt 116 described above with ,~;re,ence to FIGURE 10. After tool 64 is rotatably secured to derotation rod 44, force hll~l;llg rod 132 is secured to couplh-g n.t;",ber 106. Alternatively, force ;,.1?&l1;~ rod 132 can be secured to coupling "~e",l)er 106 before tool 64 is secured to derotation rod 44. Force ;,.,?a,lh~g rod 132 has a curvature to match lateral curvature 32 of scoliotic spine 30 on convex side 36.
Spacing between coupling members 104 and 106 should be adjusted using adjustm~ntbolt96, inner adjl~stmçnt nutlOO, and outer adjustment nutlO2 so that force illlpa~ g rod 132 rests on transverse processes42. Mer tool 64 is secured to derotation rod 44, derotation rod 44 is rotated by wrench 50 in the direction ofarrow 144. Tool 64 is m~m~lly biased in the direction of arrow 146 to exert force in the anterior direction on convex side 36 of scoliotic spine 30. This force pushes transverse processes 42 in the anterior direction and derotates the scoliotic spine.
Rere"ing specifically to FIGURE 7, the ghost line depiction of apical vertebra 34 shows the scoliotic position 158 identical to the ghost line depiction in FIGURE 4. Solid line 160 depiction in FIG~RE 7 shows the treated position 160 ofapical vertebra 34 after treatment by the method and tool of the present invention.
Arrow 148 in~1ic~tes the direction of the displacemçnt and derotation of apical vertebra 34. The relative position of derotation rod 44 and tool 64 after derotation of scoliotic spine 30 is shown in FIGURE 6. FIGURE 7 illustrates how the method andtool formed in accordance with the present invention are able to "derotate" apical W O 94/06362 ~ ~ 5 PC~r/US93/08694 ~ ~4~ ~ ~o vertebra 34 and the vellebl..c ~dj~cent thereto in conjunction with red~lcin~ lateral curvature of the spine.
The method and tool formed in acc~-dance with the present invention allow active force to be applied to the convex side of a scoliotic spine in an anterior 5 direction which allows the p.aclilioner to effectively derotate the spine at the same tirne that the lateral curvature of the scoliotic spine is being treated. The method and tool formed in accord~-ce with the present invention allow the practitioner to achieve derotation that in the past have not been achievable. The method and tool are uniquely co...p~;ble with e~;s~ g techniques and should be capable of use by 10 practitioners with reasonable amounts of training.
While the p,erel,ed embodiment of the invention has been illustrated and described, it will be appreciated that various çh~n~çs can be made therein without depa, lh~g from the spirit and scope of the invention.
Field ofthe Invention The present invention relates to tools and methods for llealing spinal dero. ",ilies, particularly the spinal condition known as scoliosis.
Bacl.ground of the Invention The normal spine when viewed in an anterior posterior direction is straight.
The same spine, when viewed from the lateral view has a series of curvatures. The thoracic curvature has a convexity posteriorly (in the sagittal plane). The lumbar spine has a curvature with the convexity directed anteriorly. Scoliosis traditionally, has been disc~lssed as a side bending (in the coronal plane) of the normally straight spine when viewed from the anterior-posterior direction. Dependir~ on the etiology, there may be just one primary curve having smaller secondary cG"")ensdlory curves, or there may be several primary curves. The sl;ll.,ess of the curve varies between individuals dependent upon the amount of bone d~ro"",ly and lig~m~ntous contracture that has occurred over a period of time. Harrington's first appalal~ls for ~ligninp; the spine was a straight rod ~tt~çlled at a single site top and bottom. This did an excellent job of str~ight~ning the lateral curvature (coronal plane) but ignored the normal sagittal plane curvatures of the spine. This resulted in a worsening of the spinal ~lignm~nt in the sagittal plane in many cases.
20 Scoliosis now is fully app,eciated to be a d~;rollllily of the spine in three planes. This derolmily results in the appeal~nce of (1) a lateral bend on the anterior posterior view, (2) a loss of the normal convexity posterior curvature of the thoracic area or a str~ight~nin~ of the spine on the lateral view and (3) a rotational deÇoll"ily of the apical vertebra wherein the transverse process of the apical vertebra on the 2~4 PCr/US93/08694 convex side rotates posteriorly and the transverse process of the apical vertebra on the concave side rotates anteriorly.
Cotrel attempted to deal with all three aspects of this d~;rullllily by ch~ ¢
the insl~ ..e~ ;Qn with the Cotrel-Dubousset (C-D) t~-h.~ e. The C-D
hl ,ll~n~ l;on for the correction and stnbili7~tion of spinal defullllily was introduced to the Scoliosis Research Society in 1984. The C-D instrn~ nl~AI;on was subsequçntly modified by Texas Scottish Rite Hospital (TSRH) in 1985. Both the C-D and TSRH insll.~ A~;on include a curved rod dçci~ned with multiple hooks for ~tt~nhm~nt to the spine. The rod is first applied to the concave side of the curve.
10 The instrl~ l;on allows rotation belween the hooks and the rod so that the rod is placed in the spine in a scoliotic position, that is with the curvature of the rod m~tçhing the curvature of the derc.llll.Ly. The rod is then rotated 90 degrees converting the scoliosis into kyphosis. This helps decrease the lateral curvature of the spine in the anterior posterior direction and also helps increase the insufficient curvature in the sagittal plane. It initially was hoped that this also would reduce the rotation of the apical vertebra. The results in this last case have been d;sappo;llling.
Since this teçhnique still relies primarily on a single rod pulling in a single direction for correction, it is underst~n~?ble how this cannot effectively derotate the vertebra.
In view of the shortcomings of the ~sling procedures for lle&l;i~g scoliotic spines, there is a need for improvements which will allow practitioners to apply forces lifting the concave side while ~im~llt~neously con~press;i-g the convex side, thus hl~pall;ng a derotational torque while at the same time col~e~l;ng both saggital and coronal plane derul-ll;ly.
Sullllllaly ofthe Invention The present invention is a method and appa~ s for delu~alh~g a scoliotic spine at the same time that lateral curvature of the derolllled spine is treated, e.g., by using the Cotrel-Dubousset teçhnique and in,ll.. ~.. l~l;on. A method and tool formed in accorda ~ce with the present invention enables the practitioner to derotate the vertebrae around the apical vertebra. A method and tool formed in accordance30 with the present invention has the added advantage of complf~...ç~.l;ng existing techniques for ll~lh~g a scoliotic spine.
A method carried out in accordance with the present invention is used to treat a scoliotic spine that can be described as having a convex side and a concave side.
The concave side refers to the inside of the lateral curvature and the convex side refers to the exterior of the lateral curvature. The method involves the steps of conl-ec~ g a derotation rod to the scoliotic spine. The derotation rod has a scoliotic 3 Pcr/US93/08694 -configuration and a kyphotic configuration. The derotation rod is in its scoliotic configuration when it is initially affixed to the spine. The kyphotic confi~lration is the position that the derotation rod occupies after the method is completed. The kyphotic confi~lration is de,;~-ed to remove the lateral curvature as well as introduce kyphosis S back into the spine. Mer the der~lalion rod is conl-ecled to the scoliotic spine, it is rotated from its scoliotic col~lgula~ion to its kyphotic ccillrigulalion. This rotation of the rod pulls the spine to reduce the lateral curvature, and also pulls the spine in a posterior direction. In acc~ldance with the present invention, the rotational dcro,,,,,ly of the scoliotic spine is reduced during this r~tali"g step by applying a pushing force 10 in an anterior direction to the convex side of the scoliotic spine while pulling posteriorily on the concave side. This cor.,binalion of two forces acting ~im~lit~q~neously is needed to achieve a derotation ofthe apical vertebra.
In one embo~lim~nt~ the force on the convex side of the scoliotic spine is created by se;u~i"~ a tool to the derotation rod and mqnuqlly biasing the tool in the 15 desired direction.
Such a tool in~l~ldes a first arm -.elnbel that incl~ldes a first handle end and a first nose end opposite the first handle end. The first handle end and the first nose end are conl~e~;led by a first neck. The tool also includes a second arm ~ lbc;r having a second handle end and a second nose end opposite the second handle end, the second 20 handle end and the- second nose end being con~-e~,led by a second neck. The first arm ...ç...hel and the second arm ",embel are pivotally conl-ecled at the first neck and the second neck. A first coupling ".~..hel is secured to the first nose end for securing the first arm ",e...ber to a derotation rod. A second coupling ...~.nbel is provided on the second nose end for securing the second arm "-e--lber to a force ;-"pa- Iing rod. The 25 force in~p~ Ling rod is used to apply force in an anterior direction to the convex side of the scoliotic spine.
In one embodiment of the tool, an qdjustm~nt bolt is secured to the first arm "e",ber and slidably en~es the second arm l.~....h~r near the first and second handle ends. The adjllstm~nt bolt carries an inner adjustmçnt nut and an outer adjllctm~nt 30 nut. The inner and outer ndjllstm~nt nuts are on opposite sides of the second arm member.
In still another embodiment of the tool formed in accordance with the present invention, the second nose end includes an integral force i",p~ling rod ~qttqc~ed thereto.
Wo 94/06362 PCr/US93/08694 5~
. i Brief Des.;liplion of the Drawings The folegoing aspects and many of the ~ttçndAnt advantages of this invention will beco.nc more readily appl~;aled as the same beco..~es better understood by rer~ ce to the following det~qiled descliplion, when taken in conjunction with the 5 acc~ pq~ g dldwings, whele~:
FIGURE 1 is a pe,~e~ live view from the concave and posterior sides of a scoliotic spine carrying TSRH instn..n~nl~l;on in its scoliotic confi~lration;
FIGURE 2 is a plan view in the caudal direction of the apical vertebra of the scoliotic spine in FIGURE 1 in its derollned confi~lration (solid lines) and a normal 10 configuration (ghost lines);
FIGURE 3 is a perspective view from the concave and posterior side of the scoliotic spine in FIGURE 1 ca"ying TSRH instnlme.,l~l;ol- in the kyphotic configuration;
FIGURE 4 is a plan view in the caudal direction of the apical vertebra of the 15 scoliotic spine in FIGURE 1 in its scoliotic ccsn~igu~alion (ghost lines) and its treated confi~lration after the TSRH instn....~ ;on is rotated from its scoliotic configuration to its kyphotic configuration;
FIGIJRE 5 is a pe.~ecli~e view from the concave and posterior side of the scoliotic spine of FIGURE 1 with a tool formed in accordallce with the present 20 invention ~tt~ched to the TSRH insl,~,el-t~l;on;
FIGORE 6 is a perspective view from the concave and posterior side of the scoliotic spine of FIGURE S after the derotation rod has been rotated to place the TSRH instn-.~ l;on in its kyphotic configuration and the spine has been derotated in accordance with the present invention;
FIGURE 7 is a plan view in the caudal direction of the apical vertebra of the scoliotic spine in FIGURE 6 showing its scoliotic configuration (ghost lines) and its de.-~laled configuration (solid lines);
FIGURE 8 is a pe,~,ecli~e view of a tool used to derotate a scoliotic spine formed in acco- dance with the present invention;
FIGURE 9 is a pc. ~e~ e view of a portion of the tool formed in accorda~lce with the present invention att~ched to a derotation rod and positioned adjac~nt a .
scollotlc spme;
FIGI~RE 10 is a pt,~e~ e view of a portion of the tool of FIGURE 8 showing the hooks for ~ttAçhment to a derotation rod and a force il"~ lh~g rod; and FIGURE 11 is a pel ~pecli~e view of a portion of a second embodiment of the tool forrned in accordance with the present invention.
W O 94/06362 ~ J ~ ~ PC~r/US93/08694 Detailed Des~ )tion ofthe Fl~f~,.led Embodiment In the following desc.iplion of the method and tool for dt;r~t~ling a scolioti spine formed in acco-~nce with the present invention, the method and tool are des.,.il,ed in conjunction with Cotrel-Dubousset insl~ ..e~ ;on (he.t;illaller ere--ed to as C-D in,ll~n~ ;on) which was dcvcloped between 1978 and 1983 and Texas Scottish Rite Hospital Universal Spinal Inslll,...P~...l~l;on which was developed ~e~ g in 1985 (TSRHin~ .n~nl~l;on). The C-D i........... ,l-.... ~nl~l;on and technique are desc-il,ed in detail in Cotrel-Dubousset I,~h "~t~tion in t*e Treatment of Idiopathic Scoliosis by Francis Denis, M.D., Orthopedic Clinics of North 10 America--Vol. 19, No. 2, April 1988 and Cotrel-Dubousset I~L,h~ ,. "tation, Richard A. Balderston, pages 113-126; Spinal Instrumentation, editors Howard S. An and Jerome M. Cotler, 1992. The TSRH instn~ ion and teçtm;~ue are described in detail in the Texas ScoJtish Rite Hospital Universal Spinal Instrumentation System by Charles E. Johnston et al., pages 127-165; Spinal I,~h....... ,,~tion, editors Howard 15 S. An and Jerome M. Cotler, 1992. The subject matter of these publications is e~,ressly ~col~o.aled herein by lererel-ce.
Rt;r~;---ng to ~IGURE 1, scoliotic spine 30 incllldes an a~no--nal lateral curvature 32. Lateral curvature 32 is c~ eled around an apical vertebra 34 which lies at the apex of the curvature. Lateral curvature 32 has a convex side 36 and a concave 20 side 38. Concave side 3B is the inside surface of lateral curvature 32 and convex side 36 is the outer surface of lateral curvature 32. In scoliotic spine 30, apical vertebra 34 and four or five vertebrae on each side of apical vertebra 34 are rotated into lateral curvature 32 such that the transverse processes 40 on concave side 36 are tli~pl~Ced in an anterior direction and transverse processes 42 on convex side 36 are 25 displaced in the posterior direction.
TSRH inst~ P~ ;on incll~des derotation rod 44 which has a scoliotic configuration and a kyphotic configuration. In FIGURE 1, derotation rod 44 is in its scoliotic configuration and is secured to concave side 38 of scoliotic spine 30 around apical vertebra 34 using two basic types of hooks. The two basic types of hooks are a 30 pedicle hook and a laminar hook. The hooks are de~ ;g.~ed to achieve secure ancho,ing on the pedicle, the lamina, and the transverse processes of various vertebrae. The number of hooks, the types, and their location will be dete,-...nPd by the practitioner depe~din~ on the particular patient's needs. Derotation rod44 inc1l~des a superior end 46 which incllldes a squared head 48. Squared head 48 is 35 engdgPd by wrench 50. Wrench 50 is relied upon to rotate derotation rod 44 in the dire.ilion of arrow 52 as described below in more detail.
Wo 94/06362 Pcr/us93/08694 2 S.~ i~35 -6-The TSRH teçhniq~le involves sL~1dard exposure of the scoliotic spine allowing eYrosure of the transverse processes of the upper end ve. Iebl c and of the inferior aspect ofthe lamina ofthe lower end ~e~lebl~e. After exposure, ~!æ~P.m~nt of laminar and pedicle hooks is carried out according to conve.ltional protocol. The 5 p~blic?tion~ efelled to above provide ~lidqrce to the skilled artisan of operative p~ ni~ for ~1a~m~nt of the hooks, as well as a des~ ion of the actual instr~ ;on of the spine. After the hooks are inserted in the spine, a derotationrod is contoured and then inse~led into the placed hooks. The derotation rod is contoured to have a scoliotic configuration which tends to match the lateral curvature 10 of the scoliotic spine on its concave side. After the rod is inse~led into the hooks in accordance with the TSRH teçhn;que, it is rotated such that the curvature of the rod is ~ p1?ced applo~;~nAlely 90 in the posterior direction into the lateral curvature of the spine. Rotation of the delola~ion rod str~igh~çns the spine by pulling the concavity out of the lateral curvature.
Referring additionally to FIGURE 2, in its normal configuration 54, shown in ghost lines, transverse processes 40 and 42 of apical vertebra 34 are in a neutral position. When the scoliotic defo. .,lalion occurs, transverse process 42 is displaced in the posterior direction while transverse process 40 is d;splaced in the anteriordirection. This "rotation" of apical vertebra 34 is in the direction of arrow 56. The 20 rotated scoliotic configuration 58 of apical vertebra 34 is shown in solid lines. When scoliotic spine30 is treated in accoldal1ce with the TSRHtechnique, derotation rod 44 is rotated by wrench 50 in the direction of arrow 52 in FIGURE 1 to shift the curvature of derotation rod 44 90 in the posterior direction. This position is shown in FIGURE 3. Rotation of derotation rod 44 pulls lateral curvature 32 in the direction 25 of concave side 38 and thus str~ightçn~ the spine. Shifting the curvature in the derotation rod 90 in the posterior direction also pulls the concave side of thescoliotic spine in the posterior direction.
Refe,~ g additionally to FIGURE4, scoliotic configurationS8 of apical vertebra34 prior to rotation of derotation rod 44 is shown in ghost lines with 30 transverse process 42 displaced in the posterior direction and the transverseprocess 40 di~pl.lced in the anterior direction. After derotation rod 44 is rotated 90 in the posterior direction, lateral curvature32 is reduced; however, refw~;ng toFIGllRE 4, the full line illustration of apical vertebra 34 shows treated configuration 60 and how apical vertebra 34 continues to have transverse process 42 35 d;s~lzced in the posterior direction and transverse process 40 di~'r^ed in the anterior direction. FIGURE 4 also illustrates how concave side 38 is pulled in the direction of W O 94/06362 2 1 4 I S ~ ~` PC~r/US93/08694 arrow62 (i.e., posterior direction) and kyphosis is r~i"l,~,d~lced into the spine.
Unrc.,lul~alely, the TSRHterhn:~ue does little to reduce the rotation of apical - vertebra 34.
Refe.li,~ to FIGURES 5, 6 and 7, derotation of the spine is carried out in 5 a~c~ldal~ce with the present invention by e,~ i"g force in an ~Ite~ior direction on convex side36 of scoliotic spine30 during rol~lion of derotation rod44. This "derotation" force is provided without insl,... ~!n1~l;on of convex side 36 of scoliotic spine 30. Less insl~ l;on during 1,~l............ -1 means less risk of d~m~e to the spinal cord. The method carried out in accordance with the present invention 10 achieves effective derotation of apical vertebra 34 and the vertebrae ~dj~cent apical vertebra 34. The method uses a tool 64 which is secured to the derotation rod and inr1ndes a force i"")a,ling rod or means for ~tt~h..~ to a force in,p~ling rod. The force imps ling rod is used to apply an external force in an anterior direction on the convex side of the scoliotic spine during rotation of the derotation rod used in the 15 TSRH techni1ue Before de3c,il,.l~g the method in more detail, tool 64 is desc-il,ed below.
Rere,.,ng to FIGURE8, tool64 formed in accordance with the present invention rese."b!es a pair of pliers or a pair of scissors. As described above, tool 64 is dç~i~ed to be secured to a derotation rod and a force i",l~a. ling rod which is used 20 to exert force on the convex side of a scoliotic spine during rotation of the derotation rod. Tool 64 includes two elongate arm ",e."bt,~ 66 and 68. First elongate arm member 66 inrl~des a handle 70, nose 72, and neck 74. Handle 70 is conl-ecled toneck 74 by an elbow 76. Elbow 76 forms an obtuse angle between handle 70 and neck 74. The opposite end of neck 74 is ~tt~ched to nose 72 by another elbow 78.25 Elbow 78 forms an obtuse angle between nose 72 and neck 74. Second elongate arm m~,...bel 68 is subst~nti~lly a mirror image of first elongate arm ",c".l,e~ 66. Second elongate arm .,.e.lll,er68 inrludes handle80, nose82, neck84, elbow86, and elbow 88 that are subs~ ly idçn~ic-~l to handle 70, nose 72, neck 74, elbow 76, and elbow 78 of first elongate arm l~c~ber 66.
Neck 74 and neck 84 are pivotally col-l-ecled to each other at their pivot point 90. Accoldingly, first elongate arm ...e",ber 66 is pivoted to second elongate arm ...~ ..bç~ 68 in much the same way the arms of a pair of pliers are conl-e~iled. As with a pair of pliers, when the handles 70 and 80 are brought closer together, the Ce between noses 72 and 82 increases. Conversely, when the ~l;cl~ce between handles 70 and 80 h~ct~ases, the l;sl~nce b~t~n~el- noses 72 and 82 decreases.
Handles 70 and 80, necks 74 and 84, and noses 72 and 82 are generally tubular in the WO 94/06362 Pcr/us93/08694 2~ 4~5~ -8-embodiment illustrated in FIGURE 8. Pivot point 90 illustrated in FIGURE 8 bel~neen elongate arm ...~;...~,e~66 and 68 is a tongue and groove configurationElongate arm ncl..ber 68 includes a channel 92 m~rhined through its center Elongate arrn ..c.-.bcu 66 inçh~des a narrowed tongue portion 94 which is received 5 within channel 92 and is rolalably fixed therein by a pivot pin which passes through each arrn l~c~--ber in a direction pel~,e~-d;c~ r to chaMel 92 While this is oneembodiment of pivot conneclion 90, it should be understood that other types of pivot comlc~;lions will be suitable.
In the illustrated embodiment, handles 70 and 80 are textured for ease of 10 gripping Secured to handle 70 adjacçnt elbow 76 is an ~djustment bolt 96 ~ stm~nt bolt 96 is pcl~ç~ cul~r to handle 70 and also passes through handle 80 adj~çent elbow 86. ~justment bolt 96 int~1~ldes threads 98 and carries an inner adjuctm~ont nut 100 and an outer adju~l...e.~1 nut 102 Inner ~justm~nt nut 100 and outer adj.Js~ 1 nut 102 are positioncd on oppos;le sides of handle 80 The spacing between handle 80 and handle 70 can be ndjustcd by the positions of inner ~djustmçnt nut 100 and outer adjustment nut 102 Furthermore, iMer ~juctmpnt nut 100 and outer adjustment nut 102 can be used to anchor or fix the relative position of handles70 and 80 Naturally, this also fixes the distance bel~,en nose 72 and nose 82 Referring additionally to FIGURES 9 and 10, in the illustrated embodiment, nose 72 and nose 82 are each provided with coupling members 104 and 106, l~spe~ ely Coupling member 104 inchldes a shaft 108 and two spaced-apart tips 110 Coupling member 104 in~l~ldes a channel 112 that separates shaft 108 from 2S tips 110 Channel 112 is dimensioned to rotatably receive derotation rod44 Tips 110 are spaced apart sufficiently to enable eyebolt 116 to pass between them Eyebolt 116 incllldes a cube shaped body 118 with a bore 120 extçn~lin~ through opposing faces 122 and 124 of body 118 Bore 120 is sized to rotatably receive derotation rod 44 E~tçntling from a surface 126 of eyebolt 116 that joins faces 122 and 124 is a threaded bolt 128 Bolt 128 receives nut 130 which is sized so that it cannot pass belweell tips 110 When eyebolt 116 is positioned between tips 110 and shaft 108, bore 120 lines up with channel 112 and bolt 128 extends between tips 110 Nut 130 threads onto bolt 128 and draws body 118 against the inside surface of tips 110 to eyebolt 116 in coupling ...en.ber 104 Body 1 18 and bolt 128 are sized so 35 that eyebolt 116 is secured in coupling ..-~,.nber 104, yet derotation rod 44 is free to rotate w094/06362 - 2~ 4~ PCr/US93/08694 g In the embodiment illustrated ~n FIGURES 9 and 10, nose82 incl~des coup!ing ,~ Ser 106 which is identical to collpling r..e..~ber 104 for ~.,u,;ng force illl~a.l;ng rod 132. Force ;"~ ng rod 132 has a diz~pt~ s~b ~....l;Ally id~ntic~l to de,olal;on rod 44, however, it is generally shorter than delotalion rod 44.
Referring to FIGURE 11, in an alternative emborlim~nt~ tool 134 is identic.~l to tool 64, except nose 136 that is opposite nose 138 in~ludes an inverted coupling n,t",ber 140 that is opened downward so that it will receive force ill,?~lhlg rod 132 from below. Tool 134, which incl-lde~ inverted collpl~ .c~..l çr 140 is able to exert force on the force hllp~~ g rod 132 in an anterior d;,e~l;on without requiring that force hllp~~ g rod 132 be independçntly secured to coupling ~ .llber 140.
Rere";~,g to FIGURES 5, 6, 7 and 9, tool 64 des_,il,ed above can be used in accordance with the method carried out in accordance with the present invention, as desc,;l,ed below. First, scoliotic spine 30 must be provided with the TSRH in~ll.. -~l;on in accordance with conventional teçhniques Thereafter, tool 64 is ~tt~ched to derotation rod 44 using coupling .. ~.. bçl 104 in co"-bil,dlion with eyebolt 116 described above with ,~;re,ence to FIGURE 10. After tool 64 is rotatably secured to derotation rod 44, force hll~l;llg rod 132 is secured to couplh-g n.t;",ber 106. Alternatively, force ;,.1?&l1;~ rod 132 can be secured to coupling "~e",l)er 106 before tool 64 is secured to derotation rod 44. Force ;,.,?a,lh~g rod 132 has a curvature to match lateral curvature 32 of scoliotic spine 30 on convex side 36.
Spacing between coupling members 104 and 106 should be adjusted using adjustm~ntbolt96, inner adjl~stmçnt nutlOO, and outer adjustment nutlO2 so that force illlpa~ g rod 132 rests on transverse processes42. Mer tool 64 is secured to derotation rod 44, derotation rod 44 is rotated by wrench 50 in the direction ofarrow 144. Tool 64 is m~m~lly biased in the direction of arrow 146 to exert force in the anterior direction on convex side 36 of scoliotic spine 30. This force pushes transverse processes 42 in the anterior direction and derotates the scoliotic spine.
Rere"ing specifically to FIGURE 7, the ghost line depiction of apical vertebra 34 shows the scoliotic position 158 identical to the ghost line depiction in FIGURE 4. Solid line 160 depiction in FIG~RE 7 shows the treated position 160 ofapical vertebra 34 after treatment by the method and tool of the present invention.
Arrow 148 in~1ic~tes the direction of the displacemçnt and derotation of apical vertebra 34. The relative position of derotation rod 44 and tool 64 after derotation of scoliotic spine 30 is shown in FIGURE 6. FIGURE 7 illustrates how the method andtool formed in accordance with the present invention are able to "derotate" apical W O 94/06362 ~ ~ 5 PC~r/US93/08694 ~ ~4~ ~ ~o vertebra 34 and the vellebl..c ~dj~cent thereto in conjunction with red~lcin~ lateral curvature of the spine.
The method and tool formed in acc~-dance with the present invention allow active force to be applied to the convex side of a scoliotic spine in an anterior 5 direction which allows the p.aclilioner to effectively derotate the spine at the same tirne that the lateral curvature of the scoliotic spine is being treated. The method and tool formed in accord~-ce with the present invention allow the practitioner to achieve derotation that in the past have not been achievable. The method and tool are uniquely co...p~;ble with e~;s~ g techniques and should be capable of use by 10 practitioners with reasonable amounts of training.
While the p,erel,ed embodiment of the invention has been illustrated and described, it will be appreciated that various çh~n~çs can be made therein without depa, lh~g from the spirit and scope of the invention.
Claims (15)
1. A method for reducing rotational deformity of a scoliotic spine having a convex side and a concave side, the method comprising the steps:
connecting a derotation rod to the scoliotic spine using multiple hooks, the derotation rod having a scoliotic configuration and a kyphotic configuration;
rotating the derotation rod from its scoliotic configuration to its kyphotic configuration; and reducing the rotational deformity of the scoliotic spine by applying force to the convex side of the scoliotic spine in an anterior direction during the rotating step.
connecting a derotation rod to the scoliotic spine using multiple hooks, the derotation rod having a scoliotic configuration and a kyphotic configuration;
rotating the derotation rod from its scoliotic configuration to its kyphotic configuration; and reducing the rotational deformity of the scoliotic spine by applying force to the convex side of the scoliotic spine in an anterior direction during the rotating step.
2. The method of Claim 1, further comprising, after the connecting step, securing a tool to the derotation rod for applying a force to the convex side of the scoliotic spine in an anterior direction during the rotating step.
3. The method of Claim 2, wherein the reducing step further comprises displacing the convex side of the scoliotic spine in an anterior direction during the rotating step.
4. The method of Claim 3, wherein during the rotating step the tool is manually biased in a direction opposite the direction the derotation rod is rotated.
5. A tool for applying force in an anterior direction on a convex side of a scoliotic spine during rotation of a derotation rod attached to a concave side of the scoliotic spine, the application of the force reducing rotational deformity of the scoliotic spine, the tool comprising:
first arm member including a first handle end and a first nose end opposite the first handle end, the first handle end and the first nose end connected by a first neck;
second arm member including a second handle end and a second nose end opposite the second handle end, the second handle end and second nose end connected by a second neck;
pivotal connection securing the first neck to the second neck;
first coupling member secured to the first nose end for securing the first arm member to the derotation rod; and second coupling member secured to the second nose end for securing the second arm member to a force imparting rod.
first arm member including a first handle end and a first nose end opposite the first handle end, the first handle end and the first nose end connected by a first neck;
second arm member including a second handle end and a second nose end opposite the second handle end, the second handle end and second nose end connected by a second neck;
pivotal connection securing the first neck to the second neck;
first coupling member secured to the first nose end for securing the first arm member to the derotation rod; and second coupling member secured to the second nose end for securing the second arm member to a force imparting rod.
6. The tool of Claim 5, wherein the first coupling member includes a channel for receiving the derotation rod and two spaced apart fingers.
7. The tool of Claim 5, further comprising an adjustment bolt secured to the first arm member and slidably engaging the second arm member, the adjustmentbolt carrying an inner adjustment nut and an outer adjustment nut, the inner and outer adjustment nuts being on opposite sides of the second arm member.
8. The tool of Claim 5, wherein the first arm member and the second arm member are pivoted to each other in a scissor-like manner.
9. The tool of Claim 8, wherein the pivotal connection is a tongue and groove arrangement.
10. A tool for applying force in an anterior direction on a convex side of a scoliotic spine during rotation of a derotation rod attached to a concave side of the scoliotic spine, the application of the force reducing rotational deformity of the scoliotic spine, the tool comprising:
first arm member including a first handle end and a first nose end opposite the first handle end, the first handle end and the first nose end connected by a first neck;
second arm member including a second handle end and a second nose end opposite the second handle end, the second handle end and second nose end connected by a second neck;
pivotal connection securing the first neck to the second neck;
first coupling member secured to the first nose end for securing the first arm member to the derotation rod; and a force imparting rod secured to the second nose end.
first arm member including a first handle end and a first nose end opposite the first handle end, the first handle end and the first nose end connected by a first neck;
second arm member including a second handle end and a second nose end opposite the second handle end, the second handle end and second nose end connected by a second neck;
pivotal connection securing the first neck to the second neck;
first coupling member secured to the first nose end for securing the first arm member to the derotation rod; and a force imparting rod secured to the second nose end.
11. The tool of Claim 10, wherein the first coupling member includes a channel for receiving the derotation rod and two spaced apart fingers.
12. The tool of Claim 10, further comprising an adjustment bolt secured to the first arm member and slidably engaging the second arm member, the adjustmentbolt carrying an inner adjustment nut and an outer adjustment nut, the inner and outer adjustment nuts being on opposite sides of the second arm member.
13. The tool of Claim 10, wherein the force imparting rod is shaped to the contour of a convex side of the scoliotic spine.
14. The tool of Claim 10, wherein the first arm member and the second arm member are pivoted to each other in a scissor-like manner.
15. The tool of Claim 14, wherein the pivotal connection is a tongue and groove arrangement.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US07/949,103 | 1992-09-21 | ||
| US07/949,103 US5281223A (en) | 1992-09-21 | 1992-09-21 | Tool and method for derotating scoliotic spine |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2144535A1 true CA2144535A1 (en) | 1994-03-31 |
Family
ID=25488601
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002144535A Abandoned CA2144535A1 (en) | 1992-09-21 | 1993-09-13 | Tool and method for derotating scoliotic spine |
Country Status (11)
| Country | Link |
|---|---|
| US (2) | US5281223A (en) |
| EP (1) | EP0663809A1 (en) |
| JP (1) | JPH09510628A (en) |
| KR (1) | KR950703902A (en) |
| CN (1) | CN1084732A (en) |
| AU (1) | AU4922493A (en) |
| CA (1) | CA2144535A1 (en) |
| MX (1) | MX9305776A (en) |
| TR (1) | TR28257A (en) |
| WO (1) | WO1994006362A1 (en) |
| ZA (1) | ZA936652B (en) |
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- 1992-09-21 US US07/949,103 patent/US5281223A/en not_active Expired - Lifetime
-
1993
- 1993-09-09 ZA ZA936652A patent/ZA936652B/en unknown
- 1993-09-13 EP EP93921584A patent/EP0663809A1/en not_active Withdrawn
- 1993-09-13 KR KR1019950701093A patent/KR950703902A/en not_active Application Discontinuation
- 1993-09-13 WO PCT/US1993/008694 patent/WO1994006362A1/en not_active Application Discontinuation
- 1993-09-13 CA CA002144535A patent/CA2144535A1/en not_active Abandoned
- 1993-09-13 JP JP6508267A patent/JPH09510628A/en active Pending
- 1993-09-13 AU AU49224/93A patent/AU4922493A/en not_active Abandoned
- 1993-09-15 TR TR00833/93A patent/TR28257A/en unknown
- 1993-09-21 MX MX9305776A patent/MX9305776A/en not_active Application Discontinuation
- 1993-09-21 CN CN93117708A patent/CN1084732A/en active Pending
- 1993-11-03 US US08/148,674 patent/US5385565A/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| TR28257A (en) | 1996-03-20 |
| JPH09510628A (en) | 1997-10-28 |
| WO1994006362A1 (en) | 1994-03-31 |
| CN1084732A (en) | 1994-04-06 |
| EP0663809A1 (en) | 1995-07-26 |
| US5385565A (en) | 1995-01-31 |
| US5281223A (en) | 1994-01-25 |
| AU4922493A (en) | 1994-04-12 |
| ZA936652B (en) | 1994-04-26 |
| MX9305776A (en) | 1994-05-31 |
| KR950703902A (en) | 1995-11-17 |
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| Date | Code | Title | Description |
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| FZDE | Discontinued |