US20040176775A1 - Methods and instrumentation for vertebral interbody fusion - Google Patents
Methods and instrumentation for vertebral interbody fusion Download PDFInfo
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- US20040176775A1 US20040176775A1 US10/804,900 US80490004A US2004176775A1 US 20040176775 A1 US20040176775 A1 US 20040176775A1 US 80490004 A US80490004 A US 80490004A US 2004176775 A1 US2004176775 A1 US 2004176775A1
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- distractor
- extending
- disc space
- curvature
- distal end
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Abstract
Methods and instrumentation particularly adapted for disc space preparation for insertion of implants from an anterior approach to the spine are provided. The instruments include a guide sleeve defining a channel having overlapping cylindrical working channel portions and lateral non-distracting extensions extending from reduced thickness wall portions. The guide sleeve has an overall reduced width configuration. A pair of distractors are provided. A first distractor includes a shaft and distal tip, and the second distractor includes a shaft and distal tip. The first and second distractors can be used with the guide sleeve. Methods using the disclosed instruments are also provided.
Description
- The present application is a divisional of U.S. patent application Ser. No. 09/965,018 filed on Sep. 27, 2001; which is a continuation-in-part of U.S. patent application Ser. No. 09/756,492 filed Jan. 8, 2001, and now issued as U.S. Pat. No. 6,648,895; which is a continuation-in-part of U.S. patent application Ser. No. 09/498,426, filed Feb. 4, 2000, and now issued as U.S. Pat. No. 6,575,981; which claims the benefit of the filing date of Provisional application Serial No. 60/118,793, filed Feb. 4, 1999.
- The present invention relates generally to surgical procedures for spinal stabilization and more specifically to instrumentation adapted for inserting a spinal implant within the intervertebral disc space between adjacent vertebra. More particularly, while aspects of the invention may have other applications, the present invention is especially suited for disc space preparation and implant insertion into a disc space from an anterior surgical approach to the spine.
- Various surgical methods have been devised for the implantation of fusion devices into the disc space. Both anterior and posterior surgical approaches have been used for interbody fusions. In 1956, Ralph Cloward developed a method and instrumentation for anterior spinal interbody fusion of the cervical spine. Cloward surgically removed the disc material and placed a tubular drill guide with a large foot plate and prongs over an alignment rod and then embedded the prongs into adjacent vertebrae. The drill guide served to maintain the alignment of the vertebrae and facilitated the reaming out of bone material adjacent the disc space. The reaming process created a bore to accommodate a bone dowel implant. The drill guide was thereafter removed following the reaming process to allow for the passage of the bone dowel which had an outer diameter significantly larger than the reamed bore and the inner diameter of the drill guide. The removal of the drill guide left the dowel insertion phase completely unprotected.
- More recent techniques have advanced this concept and have provided further protection for sensitive tissue during disc space preparation and dowel insertion. Such techniques have been applied to an anterior approach to the lumbar spine.
- An initial opening or openings are made in the disc space and the height of the disc space is distracted to approximate normal height. Typically, a first distractor is inserted with a height estimated by radiological examination. If additional distraction is required, the first distractor is removed and a second, larger distractor is inserted. However, since the positioning of the distractors is performed without the benefit of protective guide sleeves, the switching of distractors increases the potential for damage to neurovascular structures and may correspondingly increase the time of the procedure.
- For bilateral procedures, a double barrel sleeve may be inserted over the distractors, with a central extension extending into the disc space to maintain distraction. One limitation on guide sleeve placement is the amount of neurovascular retraction that must be achieved to place the guide sleeves against the disc space. For some patients, a double barrel sleeve may not be used because there is insufficient space adjacent the disc space to accept the sleeve assembly. Thus, there remains a need for guide sleeves requiring less neurovascular retraction for proper placement and providing greater protection to adjacent tissue.
- While the above-described techniques are advances, improvement is still needed to reduce the procedure time by utilization of improved instruments and techniques, to reduce the potential for damage to sensitive tissue adjacent the disc space, and to limit the amount of vessel retraction necessary to utilize the protective instrumentation. The present invention is directed to this need and provides more effective methods and instrumentation for achieving the same.
- The present invention relates to methods and instrumentation for vertebral interbody fusion. The instruments include distractors having tips inserted into the disc space that conform to the anatomical configuration of the disc space. Such distractors are self-centering in the disc space both laterally and in the cephalad/caudal directions, and better maintain their position after insertion. Thus, subsequent procedures performed in the disc space based upon positioning of the distractors are more symmetrical about the spinal column axis and also more uniform between the adjacent vertebral endplates.
- In another aspect of the invention, a surgical instrument assembly for distracting a spinal disc space is provided. The assembly includes a first distractor that has a first shaft extending between a proximal end and a distal end and a first distractor tip defining a distraction height that extends from the distal end of the first shaft. The assembly further includes a second distractor having a second shaft extending between a proximal end and a distal end and a second distractor tip extending defining a distraction height. Each of the first and second distractor tips are self-centering in the disc space both laterally and in the cephalad/caudal directions, and better maintain their position after insertion. In one embodiment, there is provided a guide sleeve having a working channel extending between a proximal end and a distal end the sleeve. The first and second distractors are received in the working channel of the guide sleeve.
- Related objects, advantages, aspects, forms, and features of the present invention will be apparent from the following description.
- FIG. 1a is a perspective view of a distractor according to the present invention.
- FIG. 1b is an enlarged front view of the tip of the distractor of FIG. 1a.
- FIG. 1c is an enlarged side view of the tip of the distractor of FIG. 1a.
- FIG. 2a is a perspective view of a distractor according to another aspect of the present invention.
- FIG. 2b is an enlarged front view of the tip of the distractor of FIG. 2a.
- FIG. 2c is an enlarged side view of the tip of the distractor of FIG. 2a.
- FIG. 2d is an elevation view of a distractor clip.
- FIG. 3 is a perspective view of a guide sleeve according to another aspect of the present invention.
- FIG. 4 is a front view of the guide sleeve of FIG. 3.
- FIG. 5 is a side view of the guide sleeve of FIG. 3.
- FIG. 6 is a perspective view of a guide sleeve assembly according to another aspect of the present invention.
- FIG. 7 is an enlarged end view of the distal end of the guide sleeve assembly of FIG. 6.
- FIG. 8 is an enlarged end view of the proximal end of the guide sleeve assembly of FIG. 6.
- FIG. 9 is an anterior to posterior view of a guide sleeve assembly according to FIG. 3, the guide sleeve assembly is positioned in relation to a pair of adjacent vertebral bodies and blood vessels.
- FIG. 10 is a partial cross-sectional view of the disc space through line10-10 of FIG. 9.
- FIG. 11 is a perspective view of the guide sleeve assembly during insertion of the distractors into the disc space.
- FIGS. 11a and 11 b are front and rear elevation views, respectively, of a distractor driver cap for driving the distractors into the disc space.
- FIGS. 12a-12 b are perspective views of the
guide sleeve assembly 150 with an impactor cap disposed thereon prior to seating the guide sleeve. - FIG. 13 is a perspective view of the guide sleeve assembly with an impactor cap disposed thereon.
- FIG. 14 is a perspective view of the guide sleeve assembly with a slap hammer disposed on one of the distractors.
- FIGS. 15a-15 b are a perspective view and an end view, respectively, of the guide sleeve assembly with a distractor removed.
- FIGS. 16a-16 b are a perspective view and an end view, respectively, of the guide sleeve assembly with a reamer disposed adjacent a distractor.
- FIGS. 17a-17 c are a perspective view, detail view and end view, respectively, of the guide sleeve assembly with a tap disposed adjacent a distractor.
- FIGS. 18a-18 c are a perspective view, detail view and end view, respectively, of the guide sleeve assembly with an implant disposed adjacent a distractor.
- FIGS. 19a-19 c are perspective views and an end view, respectively, of the guide sleeve assembly showing withdrawal of the other distractor.
- FIGS. 20a-20 b are a perspective view and an end view, respectively, of the guide sleeve assembly with a reamer disposed adjacent an implant.
- FIGS. 21a-21 c are a perspective view, detail view and end view, respectively, of the guide sleeve assembly with a tap disposed adjacent an implant.
- FIGS. 22a-22 c are a perspective view, detail view and end view, respectively, of the guide sleeve assembly with an implant disposed adjacent an implant.
- FIG. 23a is an elevational view of another embodiment first distractor according to the present invention.
- FIG. 23b is an elevational view of the distractor of FIG. 23a rotated 90 degrees about its longitudinal axis.
- FIG. 23c is a right end view of the distractor of FIG. 23b.
- FIG. 24a is an elevational view of another embodiment second distractor according to the present invention.
- FIG. 24b is an elevational view of the distractor of FIG. 24a rotated 90 degrees about its longitudinal axis.
- FIG. 24c is a right end view of the distractor of FIG. 24b.
- FIGS. 25a and 25 b show the assembly of the distractors of FIGS. 23a-c and FIGS. 24a-c in side-by-side relation.
- FIG. 26a is an elevational view another embodiment guide sleeve according to the present invention.
- FIG. 26b is an elevational view in partial section of the guide sleeve of FIG. 26a rotated 90 degrees about its longitudinal axis.
- FIG. 26c is a left end view of the guide sleeve of FIG. 26b.
- FIGS. 27a and 27 b are a top perspective view and a bottom perspective view of a distractor driver cap according to a further aspect of the present invention.
- FIG. 27c is a cross-sectional view taken through
line 27 c-27 c of FIG. 27a. - FIG. 27d is a left end elevational view of the distractor driver cap of FIG. 27a.
- FIG. 28 shows a distractor assembly secured to the distractor driver cap of FIGS. 27a-27 d.
- FIG. 29 is an elevational view of a reamer having application in the present invention.
- FIG. 30a is an elevational view of reamer plug according to another aspect of the present invention.
- FIG. 30b is a left end view of the reamer plug of FIG. 30a.
- FIG. 31 is an elevational view of an implant adjuster having application in the present invention.
- FIG. 32a is an elevational view of an implant holder according to the present invention.
- FIG. 32b is an elevational view of the implant holder of FIG. 32a rotated 90 degrees about its longitudinal axis.
- FIG. 33 is an elevational view of an outer sleeve for receiving the implant holder of FIG. 32a.
- FIG. 34 is a perspective view of a wrench usable with the outer sleeve and implant holder shaft of FIGS. 33 and 32a, respectively.
- FIGS. 35a-35 c illustrate various steps in locating and marking the midline of the disc space at a subject vertebral level.
- FIGS. 36a-36 c illustrate various steps in performing a discectomy at the subject vertebral level.
- FIG. 37 is a perspective view of a starter distractor set with various sized distractor tips for use therewith.
- FIG. 38 illustrates insertion of a distractor/guide sleeve assembly into the disc space with the distractor driver cap of FIGS. 27a-27 d secured thereto.
- FIG. 39 illustrates insertion of the guide sleeve into the disc space using an impactor cap.
- FIGS. 40a-40 c illustrate removal of a first distractor from the guide sleeve after insertion of the distractor/guide sleeve assembly into the disc space.
- FIGS. 41a-41 b illustrate reaming a first implant insertion location in the disc space through the guide sleeve.
- FIGS. 42a-42 b illustrate insertion of a reamer plug in the reamed first implant insertion location and reaming a second implant insertion location in the disc space through the guide sleeve.
- FIGS. 43a-43 b illustrate securement of an implant to the implant holder of FIG. 32a using the driver sleeve.
- FIGS. 44a-44 c illustrate insertion of the implant into the second implant insertion location in the disc space through the guide sleeve.
- FIG. 45 illustrates implants inserted into the disc space at the first implant location and the second implant location.
- FIG. 46 is a perspective view of a distractor tip according to another aspect of the present invention.
- FIG. 47 is a plan view of the distractor tip of FIG. 46.
- FIG. 48 is a cross-sectional view through line48-48 of FIG. 47.
- FIG. 49 is an elevational view of the lateral side of the distractor tip of FIG. 46.
- FIG. 50 is an elevational view of the medial side of the distractor tip of FIG. 46.
- FIG. 51 is a cross-sectional view through line51-51 of FIG. 50.
- FIG. 52 is an elevational view of the proximal end of the distractor tip of FIG. 46.
- FIGS. 53a-53 c illustrate an axial view, an anterior-posterior view, and a lateral view of a pair of vertebral bodies and the spinal disc space therebetween.
- FIG. 54 is an axial view of a spinal disc space with the distractor tip of FIG. 46 positioned therein.
- FIG. 55 is an elevational view looking in the anterior to posterior direction of a spinal disc space with the distractor tip of FIG. 46 positioned therein.
- FIG. 56 is an elevational view looking in the medial to lateral direction of a spinal disc space with the distractor tip of FIG. 46 positioned therein.
- For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device, and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates.
- The present invention relates to methods and instrumentation for performing vertebral interbody fusion. Specifically, although aspects of the present invention may have other uses either alone or in combination, the instruments and methods disclosed herein are particularly useful for anterior lumbar interbody fusion. However, the surgical instruments and methods according to the present invention are not limited to such an approach, and may find application in, but without limitation, lateral and anterior-lateral approaches to the spine as well. Also, the surgical instruments and methods of the present invention may find application at all vertebral segments of the spine, and in areas other than spinal surgery.
- Referring now to FIGS. 1a-c, there is shown a convex or first
disc space distractor 50 according to one aspect of the present invention.Distractor 50 includes aproximal end 53 configured for engagement with conventional tools and handles (not shown) used in operative procedures on the spine. Ashaft 54 is joined with adistractor tip 56. In the illustrated embodiment,shaft 54 has a hollow interior and aclip hole 55 communicating with the hollow interior; however, the present invention also contemplates asolid shaft 54. Also, while an integral shaft and head are shown,head 56 may be removably attached toshaft 54. One such removable attachment is more fully disclosed in U.S. patent application entitled METHOD AND INSTRUMENTATION FOR VERTEBRAL INTERBODY FUSION, Ser. No. 09/287,917, filed Apr. 7, 1999, which is incorporated herein by reference in its entirety (hereinafter referred to as the '917 patent application.)Distractor tip 56 is designed such that it can be inserted in a disc space to establish a first working distraction height 72 (see FIG. 1b). More specifically,distractor tip 56 has a rounded leadingedge 62 that extends to opposinginclined surfaces surfaces planar surfaces tip 62 are oppositeconvex surfaces - Planar surfaces60 and 61 extend in a substantially parallel alignment along a longitudinal axis A of
distractor 50 and define height 72 therebetween. It should be understood that theinclined surfaces distractor tip 56 into the disc space and to initially distract the disc space to at least a height 72. If first distraction height 72 is sufficient, further procedures as known in the art may then be carried out to accomplish implant insertion. While a specific distractor has been described in detail, it is contemplated that other known distractor configurations may be substituted for the same without deviating from the scope of this invention. - Referring now to FIGS. 2a-c, there is shown a second
disc space distractor 80 according to one aspect of the present invention.Distractor 80 includes aproximal end 83 configured for engagement with conventional tools and handles (not shown). Ashaft 84 is joined with adistractor tip 86. In the illustrated embodiment,shaft 84 has a hollow interior and ahole 85 communicating therewith. While an integral shaft and head are shown,head 86 may be removably attached toshaft 84, as similarly described with respect to the removable attachments disclosed in the '917 patent application. Similar todistractor tip 56 ofdistractor 50,distractor tip 86 is designed such that it can be inserted in a disc space to establish a first working distraction height 72′ (see FIG. 2b) that is preferably the substantially the same as working height 72. More specifically,distractor tip 86 has a rounded leadingedge 92 that extends to opposinginclined surfaces surfaces - Planar surfaces90 and 91 extend substantially parallel to longitudinal axis B of
distractor 80 to define height 72′ therebetween. Extending betweenplanar surfaces convex surface 94 and a recessed area defined by oppositeconcave surface 96. Along thedistractor shaft 84, there is defined aconcave surface 98 that is adjacent to and coplanar withconcave surface 96 ofdistal tip 86 to define a concave surface extending along the length ofdistractor 80. In the illustrated embodiment,surface 98 has aslot 87 formed therein communicating with the hollow interior ofshaft 84; however, it the present invention also contemplates asolid shaft 84 and ashaft 84 withoutslot 87. As explained more fully below,concave surfaces convex surface distractor 50 to reside therein whendistractors Concave surfaces - It should be understood that the
inclined surfaces distractor tip 86 into the disc space, and to distract the disc space and maintain disc space distraction to at least a height 72, 72′. To further aid in distractor insertion, in FIG. 2d there is shown adistractor clip 75 having across member 76 withfirst clip member 77 andsecond clip member 78 extending therefrom.Clip members holes distractor 50 todistractor 80.Clip 75 prevents splaying and maintains the relative positioning ofdistractors second distractor 80 has asecond width 74 that is less than afirst width 70 offirst distractor 50. - Specifically, but without limitation, the distractor heads56, 86 may be formed with heights 72 ranging from 6 mm to 24 mm. Preferably, height 72 of the next sized distractor increases or decreases in 2 mm increments. Other variations and may be provided as long as the working distractor height provided approximates the disc height in a normal spine and accommodates insertion of an implant into the disc space as more fully described below.
- Referring now to FIG. 3, there is shown a
guide sleeve 100 that is useful with thedistractors Guide sleeve 100 has awall 110 defining a workingchannel 130 having a figure eight shaped cross-section (FIG. 9) extending in a substantially unobstructed manner from aproximal end 102 to adistal end 104.Sleeve 100 includesupper windows wall 110 on at least one side ofsleeve 100 for engagement by a removal tool to removesleeve 100. Thesleeve 100 also includes lowerelongated visualization window 112 centered about the longitudinal axis L with anelongated slot 111 extendingproximally window 112.Window 112 provides the surgeon with the ability to visualize the instruments inserted inguide sleeve 100 as well as the openings in the disc space and vertebral bodies, without entirely removing instrumentation fromguide sleeve 100. The reduce width ofsleeve 100 allows the use of onewindow 112 for visualization of implant insertion into its respective bilateral location in the disc space, and separate windows along each insertion path are not necessary. However, it should be understood that any number of visualization windows and configurations thereof are contemplated herein, such as those described in the '917 patent application. The present invention also contemplates that covers may be used for visualization windows, as described in greater detail in the '917 patent application. - At
proximal end 102 is provided aflange ring 155.Flange ring 155 strengthenssleeve 100 and provides a load transfer member to facilitate transfer of a driving force tosleeve 100, as described more fully below. Adjacentdistal end 104, the material thickness along the exterior outer edge ofwall 110 is reduced in order to provide a reducedthickness wall portion 114 and an opposite reduced thickness wall portion (not shown). The reduced thickness wall portions define a smaller cross-sectional area for thesleeve 100 as well as a reduced width extending transverse to the longitudinal axis L. The reduced cross-sectional area and smaller width ofguide sleeve 100 reduces the amount of vasculature and neural tissue retraction adjacent the disc space that would otherwise be required to place a similarly sized guide sleeve without the width reduction. -
Distal end 104 includes a pair offlanges wall 110 on opposite sides of workingchannel 130.Flanges Flanges thickness wall portions 114 described above. In a preferred embodiment,flanges distal end 104 includesspikes flanges third spike 126 and afourth spike 128 positionedopposite spikes flanges guide sleeve 100 in a fixed position relative to the vertebral bodies. - Referring to FIGS. 4 and 5,
guide sleeve 100 is shown in front and side views, respectively, to further illustrate an additional aspect of the invention. Aproximal end 102 theguide sleeve 100 has a maximum width W1. Atdistal end 104 ofsleeve 100,wall 110 has a reduced wall thickness atside walls side walls Side walls wall 110 and taper to the full wall thickness ofwall 110 at the termination ofside walls wall 110 decreases the amount of vasculature and neural tissue retraction in the area adjacent the disc space. The desirable reduction in width is accomplished with little reduction in the required strength of the device sincedistractors side flanges guide sleeve 100. - There are also shown in FIGS. 4 and 9 a first working
channel portion 107, defined about axis L1, and a secondworking channel portion 109, defined about axis L2. These workingchannel portions sleeve 100. There is no wall or other structure separating workingchannel portions channel portion 107 is that portion of workingchannel 130 about axis L1 between longitudinal axis L and inside surface of 116 ofguide sleeve 100. Similarly, workingchannel portion 109 is that portion of workingchannel 130 about axis L2 between longitudinal axis L and insidesurface 116. Thus, workingchannel portions channel - Referring now to FIG. 6, there is illustrated a distractor/
guide sleeve assembly 150 that includesdistractors channel 130 ofguide sleeve 100 in side-by-side relation.Distractors sleeve 100 with each distractor substantially occupying all or a portion of a corresponding one of workingchannel portions channel 130. Eachdistractor proximal end 102 todistal end 104 of theguide sleeve 100.Flange ring 155 is in the form of a flange extending about theproximal end 102 ofguide sleeve 100 and contacts a driving cap positioned ondistractors sleeve 100 anddistractors assembly 150. - Referring now to FIG. 7, there is illustrated an end view at
distal end 104 of theassembly 150 showingdistractors shaft 54 ofdistractor 50 is received withinconcave portion 98 ofdistractor shaft 84. As also illustrated in this view,concave portion 96 ofdistractor tip 86 is coextensive withconcave surface 98 to form a concave surface that extends the length of thedistractor 80. The concave surface ofdistractor 80 has a radius of curvature R that is preferably about one half the diameter of the cage or implant to be inserted into the disc space. For example, an 18 mm diameter implant requires use of adistractor 80 having a radius of curvature R of about 9 mm. - When
distractor 50 is removed fromguide sleeve 100, there is defined a cylindrical working space through the workingchannel 130 adjacent and along the recessed areas ofdistractor 80. The cylindrical working space includes that portion of the workingchannel 130 betweenconcave surfaces wall 116 of theguide sleeve 100. Thus, the working space occupies substantially all of workingchannel portion 107, (FIG. 4) and a portion of workingchannel portion 109. The area of the portion of the workingchannel portion 109 occupied by the cylindrical working space is indicated in FIG. 7 by the hatched area A, and is hereinafter referred to as the overlap region. This overlap region A allows operative procedures to be performed in the working space adjacent thedistractor 80 using conventionally sized tools and implements while providing aguide sleeve 100 of reduced overall width. The amount of width reduction achieved is approximately the maximum width of overlap region A. It should be understood thatshaft 84 need not have a recessed area to provide a cylindrical working space in the disc space, but rather can be provided with a reduced diameter or size that maintains access to the overlap region A in the disc space. - In FIG. 8 there is shown a top view of the
guide sleeve assembly 150, looking down on proximal ends 53, 83 of thedistractors proximal end 102 ofguide sleeve 100. In one embodiment, there is provided adjacentproximal end 53 of distractor 50 alocking segment 140 formed with and extending from thedistractor shaft 54. Lockingsegment 140 has afirst projection 142 and asecond projection 144. First andsecond projections corresponding notches concave surface 98 ofshaft 84 ofdistractor 80 to prevent rotation ofdistractors distractors distractor clip 75 can be used to couple thedistractors distractors - The present invention contemplates that access to the disc space has heretofore been provided by known surgical techniques and therefore will not be further described herein. The use of intraoperative templates for providing access to the disc space is known in the art. One example of a procedure for gaining access to the disc space is disclosed in the '917 patent application. Another reference including techniques for template positioning and disc space distraction using a starter distractor to initially distract the disc space is the surgical technique brochure entitledReduced Profile Instrumentation published in 1999 by Sofamor Danek, said brochure being incorporated by reference herein in its entirety (hereinafter the Danek brochure.) The present invention also contemplates the use and application of other procedures for gaining access to the disc space in conjunction with the procedures and instruments discussed below as would occur to those skilled in the art. The templates contemplated herein define the area necessary for placement of implants and instruments having a specific configuration and size. While in a preferred embodiment, templates are provided for cylindrical implants having diameters ranging from 16 mm to 24 mm, it is contemplated that other diameters of implant and templates for use therewith may be used and other shapes, such as, but without limitation, squares and rectangles.
- Access to an anterior portion of the spinal column is achieved by known methods. Blood vessels, particularly the aorta, vena cava, and branches thereof are mobilized to provide space for bilateral implant placement. The template is inserted into the body and advanced until the pins are disposed adjacent a disc space. The circumference of the template is selected to correspond to the circumference needed for bilateral placement of a pair of implants. More specifically, the area of the template closely approximates the below. In this alternate technique,
clip 75 may be used to coupledistractors distractors distractors guide sleeve 100 need not necessarily be used, and tissue to the surgical site is retracted by other means while the disc space is distracted bydistractors distractors - Referring to FIG. 9, a cross section through
guide sleeve 100, withdistractors Sleeve 100 is inserted into a disc space D between two adjacent vertebra V1 and V2. Disposedadjacent guide sleeve 100 arevessels sleeve 100,flanges guide sleeve 100 extend into the disc space where the surgical procedures are being performed.Flanges sleeve 100 inhibit contact between vessels and tissue surrounding the disc space and the tools used during the surgical procedure.Spikes - Various tools and implements are usable with
guide sleeve 100 anddistractors channel 130 ofguide sleeve 100. Several of these tools are disclosed in the Danek brochure and in the '917 patent application, while other tools are known to those skilled in the art to which the present invention relates. - In accordance with a preferred method of using the apparatus of the present invention, reference will now be made to FIGS. 11 through 22. In FIG. 11, the sleeve assembly is assembled and prepared for insertion through the skin and to the disc space.
Distractor driver cap 250 of FIGS. 11a and 11 b is positioned onproximal end distractors Driver cap 250 includes abody 252 having T-shapedslots flanged posts distractors Opposite slots windows posts windows upper portions slots driver cap 250 todistractors - In use,
distractor cap 250contacts flange ring 155 withdistractors sleeve 100 such thatdistractor tips flanges distractor cap 250 is transmitted toflange ring 155, and drivessleeve 100 towards the disc space along withdistractors distractors guide sleeve 100,distractor cap 250 is secured to proximal ends 53, 83 anddistractor tips Distractor cap 250 is then removed andsleeve 100 placed over the inserteddistractors distractors distractor tips - In FIG. 12a, an
impactor cap 160 is disposed aboutproximal end 102 ofsleeve 100 overflange ring 155.Sleeve 100 is now relatively free to move with respect todistractors impactor cap 160 to drivesleeve 100 towards the disc space andposition flanges distractor tips flanges distractor sleeve 100. - As shown in greater detail and enlarged FIG. 13,
impactor cap 160 is positioned around and contacts theflange ring 155.Flange ring 155 is preferably of uniform size and shape for varioussized guide sleeves 100, thus providing a modular attachment to each of the various sized guide sleeves for asingle impactor cap 160.Impactor cap 160 has ahollow interior 161 for receiving proximal ends 53, 83.Hollow interior 161 has a depth d sufficient to allow movement ofguide sleeve 100 into the disc space while the position ofdistractors - In FIG. 14, a
slap hammer 165 is engaged todistractor 50 in order towithdrawal distractor 50 from the disc space. In FIG. 15a thedistractor 50 is removed from the workingchannel 130 ofsleeve 110 using theslap hammer 165. Thedistractor tip 86 ofconcave distractor 80 remains disposed in the disc space to maintain the disc space distraction height during subsequent operative steps. In an alternate embodiment, it is contemplated thatshaft 84 ofdistractor 80 is removably connected to tip 86, in which case the shaft may be withdrawn while leavingtip 86 in place. In a further embodiment,shaft 84 has a reduced size to accommodate insertion and rotation of devices into overlap region A of the disc space. With a removable or smaller diameter shaft, only tip 86 requires a recessed area. - In FIG. 15b, the withdrawn
distractor 50 leaves a working space comprised of workingchannel portion 109 and an overlap portion, indicated by hatched area A. Thus, theconcave surfaces distractor 80 and insidesurface 116 ofsleeve 110 define a substantially cylindrical working space for completion of further operative procedures as described further below. The working space defines a substantially circular cross section alongguide sleeve 100 that is adapted for receiving surgical tools therethrough to prepare the disc space for insertion of an implant. The overlapping configuration ofdistractors guide sleeve 100. - In FIGS. 16a-16 b, there is shown a
reamer 170 disposed throughguide sleeve 110. A cuttinghead 171 has cutting edges as known in the art to ream the disc space. As shown in FIG. 16b,reamer 170 is positioned within the working spaceadjacent distractor 80, whiledistractor tip 86 maintains the disc space distraction.Concave surface 98 ofshaft 84 ofdistractor 80 and theinside surface 116 ofsleeve 110 acts as a guide for insertion and/or withdrawal ofreamer 170. The depth of reaming can be controlled with adepth stop 172 and verified via fluoroscopy - In FIGS. 17a-17 c, the
reamer 170 is withdrawn and replaced by atapping tool 175 with ahead 176 to prepare the space for a threaded implant. As shown in FIGS. 17b and 17 c, tappingtool 175 is positioned within the working space adjacent theconcave distractor 80, whiledistractor tip 86 maintains the disc space distraction. Theconcave surface 98 ofshaft 84 ofdistractor 80 and insidesurface 116 ofsleeve 110 acts as a guide for insertion oftapping tool 175. Tappingtool 175 has adepth stop 178 to control the tapping depth in the disc space. Depth and sagittal alignment can also be verified via fluoroscopy during tapping. - In FIGS. 18a-18 c, the
tapping tool 175 is withdrawn and replaced by animplant insertion device 190 with a threadedimplant 200 engaged on a distal end thereof. Threadedimplant 200 andinsertion device 190 may be any one of the types and configuration disclosed in a first pending PCT Application No. PCT/US00/00590 filed on Jan. 11, 2000 and a second PCT Application No. PCT/US00/00604, also filed Jan. 11, 2000; each claiming priority to U.S. Provisional Application No. 60/115, 388, filed Jan. 11, 1999, each of said above referenced PCT applications being incorporated by reference herein in its entirety. Further, the implants of the present invention may be any other known implant and insertion device, so long as at least one implant has at least one recessed side wall. The implants may be formed of any biocompatible material.Concave surface 98 ofshaft 84 ofdistractor 80 and insidesurface 116 ofsleeve 110 acts as a guide for insertion of the implant into the disc space. -
Inserter 190 includes athumbscrew 191 having a threaded shaft (not shown) extending throughinserter 190 tocouple implant 200 thereto via an internally threaded opening in a slotted end 201 (FIG. 19) ofimplant 200. T-handle 192 is used to rotateimplant 200 and thread it into the disc space, as shown in the enlarged view of FIG. 18b. As shown more clearly in the enlarged view of FIG. 18c,implant 200 is inserted so that aconcave face 202 is disposed towardconcave surface 96 ofdistractor 80. This positioning ofconcave face 202 can be confirmed by providing alignment markings oninsertion device 190 andsleeve 100. Further,insertion device 190 includes countersink marking 193 to provide an indication of the countersink ofimplant 200 into the disc space. To facilitate implant rotation,inserter 190 can be provided with a movable slide at its distal end that occupies the recessed area ofconcave surface 202 providing a round construct for threading. Whileimplant 200 is threaded into place,distractor tip 86 maintains the disc space distraction. - In FIGS. 19a-19 b, when
implant 200 is placed in the desired position, andimplant inserter 190 is removed fromguide sleeve 100,distractor tip 86 is withdrawn from the disc space. Preferably, aslap hammer 165 is engaged todistractor 80 in order to withdrawdistractor tip 86 from the disc space anddistractor 80 fromguide sleeve 100. As shown in FIGS. 19b-19 c,distractor 80 is removed from workingchannel 130 ofsleeve 110.Implant 200 remains disposed in the disc space to maintain the disc space distraction height during subsequent operative steps. The withdrawndistractor 80 leaves a working space comprised of workingchannel portion 107 and an overlap region A. Thus,concave surface 202 ofimplant 200 and insidesurface 116 ofsleeve 110 define a cylindrical working space in the disc space for further procedures as described below. The working space defines a circular cross section that is adapted for receiving conventionally sized surgical tools to prepare the disc space for insertion of a second implantadjacent implant 200, while providing a reduced overall width. - In FIGS. 20a-20 b, the above described
reamer 170 is disposed throughguide sleeve 110. Cuttinghead 171 has threads as known in the art to ream the disc space. As shown in FIG. 20b,reamer 170 is positioned within the working space adjacent theconcave surface 201 ofimplant 200, whileimplant 200 maintains the disc space distraction. Theconcave surface 201 ofimplant 200 and insidesurface 116 ofsleeve 110 acts as a guide for insertion and operation ofreamer 170. - In FIGS. 21a-21 c,
reamer 170 is withdrawn and replaced by the above-describedtapping tool 175 withhead 176 to prepare the space for a second threaded implant. As shown in FIGS. 21b and 21 c,head 176 of tappingtool 175 is positioned within the working space adjacentconcave surface 201 ofimplant 200, whileimplant 200 maintains the disc space distraction. Theconcave surface 201 and insidesurface 116 ofsleeve 110 acts as a guide for insertion oftapping tool 175. - In FIGS. 22a-22 c, the tapping tool is withdrawn and replaced by the above described
implant insertion device 190, with a threadedimplant 210 engaged on a distal end thereof. Threadedimplant 210 may either have a circular cross-section, such as that shown in solid lines in enlarged FIGS. 22b and 22 c, or have a cross-section identical to implant 200 with aconcave surface 202 as shown in hidden lines. In either event,concave surface 201 ofimplant 200 acts as a guide for threading ofimplant 210 into the disc space. - If an implant like that of
implant 200 is used, it is preferred to positionimplant 210 so that itsconcave surface 212′ is disposed towardsconcave surface 202 ofimplant 200, forming acavity 215′ therebetween as indicated in dashed lines in FIG. 22c. The cavity may then be packed with bone growth promoting material. T-handle 192 is used to rotateimplant 210 and thread it into the disc space, as shown in FIG. 22b, adjacent to implant 200. If a circular implant similar to that shown in FIG. 22c is used,implant 210 is nested withinconcave surface 201 ofimplant 200. Bone growth material can be placed incavity 204 ofimplant 200 and incavity 213 ofimplant 210. - The present invention further contemplates instruments and methods particularly suited for inserting threaded fusion devices into a disc space between vertebrae from an anterior approach to the lumbar region of the spine. It is further contemplated that these threaded devices can be self-tapping and tapered to establish lordosis between the vertebral endplates when inserted in the disc space therebetween. Examples of such cages are provided in U.S. Pat. Nos. 5,669,909 and 5,782,919, each of which is incorporated herein by reference in its entirety. While the instruments and methods described below are contemplated for use with tapered, threaded fusion devices and for use in an anterior approach to the lumbar region of the spine, aspects of the instruments and methods may also have application in other approaches to the spine and in the insertion of other types and shapes of implants into the disc space.
- Referring now to FIGS. 23a-23 c, there is shown another embodiment of a convex or first
disc space distractor 350 that is, except as described hereinbelow, similar in many respects tofirst distractor 50 of FIGS. 1a-1 c.Distractor 350 includes aproximal end 353, ashaft 354 extending along longitudinal axis A1, and adistractor tip 356 at the distal end ofshaft 354.Proximal end 353 includes aflanged post 353 a having aproximal flange 355 a on the end of the post defining alip 365 a thereabout. Ahole 367 a is provided in the proximal face offlange 355 a and configured to attachdistractor 350 to conventional tools such as a distractor puller. - In the illustrated embodiment,
shaft 354 has ahollow interior 357 to reduce its weight; however, the present invention also contemplates asolid shaft 354. Also, while an integral shaft and tip are shown,distractor tip 356 may be removably attached toshaft 354.Distractor tip 356 can be provided with a roundedleading edge 362 that extends between amedial side 358 and an oppositelateral side 359 ofdistractor 350. Preferably, for reasons described further below, the transition betweenleading end 362 andmedial side 358 is relatively abrupt such thatleading edge 362 remains extended to its most distal-most point at the transition therebetween. A gradual arcuate transition is provided betweenlateral side 359 andleading edge 362.Distractor tip 356 also includes opposing vertebral contactingsurfaces serrations 372 to engage the vertebral endplates and resist movement ofdistractor tip 356 in the disc space.Distractor tip 356 is designed such that it can be inserted in a disc space to establish a distraction height 372 (see FIG. 23a) between the vertebral endplates.Distractor tip 356 is preferably made from aluminum or other radiolucent material, and includes aradiographic marker 351 to allow the surgeon to determine and monitordistractor tip 356 during insertion into the disc space.Shaft 354 andflanged post 353 a, and in thealternative tip 356, can be made from stainless steel or other acceptable material for surgical instruments. -
Distractor 350 further includes aprojection 374 that is cylindrically shaped, although other shapes are also contemplated, that extends medially frommedial side 358. The significance ofprojection 374 will be discussed further below. A color-codedmarker 352 is provided inshaft 354 to give the surgeon an indication of the size ofdistractor tip 356. - Referring now to FIGS. 24a-24 c, there is shown a second
disc space distractor 380 that is, except as described hereinbelow, similar in many respects tosecond distractor 80 of FIGS. 2a-2 c.Distractor 380 includes aproximal end 383, ashaft 384 extending along axis B1, and adistractor tip 386 at the distal end ofshaft 384.Proximal end 383 includes aflanged post 383 a having aproximal flange 385 a on the end of the post defining alip 395 a thereabout. Ahole 397 a is provided in the proximal face offlange 385 a that is configured to attachdistractor 350 to conventional tools such as a distractor puller. - In the illustrated embodiment,
shaft 384 has ahollow interior 387 to reduce its weight; however, the present invention also contemplates asolid shaft 384. Also, while an integral shaft and tip are shown,distractor tip 386 may be removably attached toshaft 384.Distractor tip 386 can be provided with a roundedleading edge 392 that extends between amedial side 388 and an oppositelateral side 389 ofdistractor 380. Preferably, for reasons described further below, the transition betweenleading end 392 andmedial side 388 is relatively abrupt such thatleading edge 382 remains extended to its most distal-most point at the transition therebetween. A gradual arcuate transition is provided betweenlateral side 389 andleading edge 392.Distractor tip 386 also includes opposing vertebralendplate contacting surfaces serrations 392 to engage the vertebral endplates and resist movement ofdistractor tip 386 in the disc space.Distractor tip 386 is designed such that it can be inserted in a disc space to establish adistraction height 372′ (see FIG. 24a) between the vertebral endplates.Distractor tip 386 is preferably made from aluminum or other radiolucent material, and includes aradiographic marker 381 to allow the surgeon to determine and monitordistractor tip 386 during insertion into the disc space.Shaft 384 andproximal end 386, and in thealternative tip 386, can be made from stainless steel or other acceptable material for surgical instruments. - Extending along
medial side 388 ofdistractor 380 extending from leadingedge 392 to proximal flange 385 is a recessed area defined by a scalloped orconcave surface 394. In the illustrated embodiment,concave surface 394 has awindow 399 formed therein communicating with thehollow interior 387 ofshaft 384. In a manner similar to that discussed above with respect todistractors concave surface 394 mates with the convexmedial surface 358 offirst distractor 350 whendistractors medial sides distractors adjacent distractors - To aid in distractor insertion,
distractor 380 includes anotch 396 formed in the adjacent the proximal end ofshaft 384 sized to receiveprojection 374 as shown in FIGS. 25a and 25 b.Notch 396 has a proximally facing opening 398 that allowsprojection 374 to be top-loaded therein from the proximal direction and withdrawn therefrom in the distal direction whendistractors Projection 374 and notch 396 resist rotation ofdistractors distractors - Specifically, but without limitation, the
distractor tips heights - Referring now to FIGS. 26a-26 c, there is shown a
guide sleeve 400 that receivesdistractors Guide sleeve 400 is similar to guidesleeve 100 and can also receivedistractors Guide sleeve 400 has a wall defining a workingchannel 430 having a figure eight shaped cross-section. Workingchannel 430 extends in a substantially unobstructed manner from aproximal end 402 to adistal end 404.Distal end 404 is concave to match the contour of the anterior aspect of the vertebral bodies against which it is positioned.Sleeve 400 also includes anelongated visualization window 412 centered about the longitudinal axis L6 with a taperedportion 411 extending proximally fromwindow 412 and blending intowall 410. As discussed above with respect towindow 112 ofguide sleeve 100,window 412 provides the surgeon with the ability to visualize the instruments inserted in workingchannel 430 ofguide sleeve 400 as well as the openings in the disc space and vertebral bodies. - Adjacent
distal end 404, the material thickness along the lateraledge portions wall 410 is reduced in order to provide a reducedthickness wall portion 414 and an opposite reducedthickness wall portion 415 in a manner similar to that discussed above with respect to guidesleeve 100.Guide sleeve 400 includes a pair offlanges distal end 404 on opposite sides of workingchannel 430.Flanges thickness wall portions sleeve 100 andflanges flanges flanges -
Guide sleeve 400 also includes a first workingchannel portion 407, defined about axis L7, and a secondworking channel portion 409, defined about axis L8. These workingchannel portions sleeve 400. There is no wall or other structure separating workingchannel portions sleeve 100 and workingchannel portions channel portions channel - A
sleeve cap 455 is provided atproximal end 402 and is welded, integrally formed with, or otherwise attached to wall 410 ofsleeve 400.Sleeve cap 455 includes aproximal groove 406 formed therein adjacentproximal end 402 that defines aproximal end ring 407 aroundsleeve 400.Sleeve cap 455 also includes acircumferential ring member 408 extending therearound and positioned distally ofproximal groove 406. As described further below,sleeve cap 455 facilitates connection of driving caps tosleeve 400 and the assembly ofdistractors sleeve 400. - A side-loading
distractor driver cap 550 is shown in FIG. 27a-27 d.Distractor driver cap 550 includes abody 552 having anupper portion 554 and a lower attachingportion 556. Attachingportion 556 has aside opening 558 that communicates with adistractor securing portion 560 and asleeve securing portion 562 provided in the interior of attachingportion 556.Distractor securing portion 560 andsleeve securing portion 562 are configured to allowdistractor driver cap 550 to be side-loaded throughside opening 558 onto the distractor assembly 450 (FIG. 28) to assembledistractors sleeve 400. -
Distractor securing portion 560 includes adistractor slot 564 having afirst ledge 568 therearound formed byupper extension 567.Distractor slot 564 is configured to receiveproximal flanges flange posts distractors Lips flange posts first ledge 568 formed arounddistractor slot 564.Sleeve securing portion 562 includes asleeve slot 566 having asecond ledge 570 therearound formed by abottom extension 572.Sleeve slot 566 is configured to receiveproximal end ring 407 ofsleeve 400 withbottom extension 572 positioned inproximal groove 406 whendistractors sleeve 400 as shown in FIG. 28.Distractor driver cap 550 securesdistractors distractors sleeve 400 formingdistractor assembly 450. This allows the surgeon to insertdistractor assembly 450 through skin and tissue to the disc space withoutdistractors sleeve 400 moving relative to one another. Preferably,distractor tips flanges flanges - Referring to FIG. 27c,
upper portion 554 is preferably solid to deliver a driving force to theproximal flanges distractors distractor driver cap 550 is properly positioned ondistractors upper portion 554 in communication withdistractor securing portion 560. A spring-biasedplunger 576 has anub 578 extending intodistractor securing portion 560. When one of theproximal flanges spring 580 compresses andplunger 576 is pushed intowell 574. Depending on the side from whichdistractor driver cap 550 is loaded, one of theholes nub 578 andspring 580 pushes nub 578 into the corresponding hole 567 a, 597 a. This creates a clicking sound and an audible indication thatdistractor driver cap 550 is properly seated on thedistractors - In FIG. 29, there is shown a
reamer 470 positionable through a selected one of the workingportions guide sleeve 400.Reamer 470 includes a cuttinghead 471 attached to the distal end of ashaft 474. Cuttinghead 471 has cuttingblades 476 extending in a helical pattern from abody 478 configured to ream a cylindrical hole in a disc space.Body 478 has elongatedopenings 480 formed therethrough along eachcutting blade 476 that communicate with a hollow interior defined bybody 478. Aport 482 inshaft 474 provides access to the interior ofbody 478 for material removal therefrom. An opening (not shown) in the distal end ofbody 478 can also be provided for this purpose. The depth of reaming can be monitored and controlled with a depth stop, such asdepth stop 172 of FIG. 16a, anddepth markings 484 onshaft 474. Aconnector 486, such as a Hudson type connector, is provided at the proximal end ofshaft 474 for connection with a T-handle driving tool. - Referring now to FIGS. 30a-30 b, a
reamer plug 600 is illustrated. Reamer plug 600 has ashaft 602 and aplug 604 at the distal end ofshaft 602. Ahandle 606 is provided at the proximal end ofshaft 602.Shaft 602 is generally cylindrical but includes aconcave surface 612 extending along a medial side thereof to accommodate rotation of a tool therebeside. Handle 606 has a scallopedportion 608 connected toshaft 602.Scalloped portion 608 has acavity 614 formed aroundshaft 602 that receives the proximal end ofguide sleeve 400 whenreamer plug 600 is fully inserted therein toclock shaft 604 against the sidewall ofguide sleeve 400. Handle 606 further includes a laterally extendingportion 610 that extends away fromshaft 602 oppositeconcave surface 612 that facilitates insertion and removal ofplug 604 into the reamed disc space location. The scallopedportion 608 and laterally extendingportion 610 provide clear access to one of the workingchannel portions guide sleeve 400 whenreamer plug 600 is disposed in the other workingchannel portion - Referring now to FIG. 31, there is shown an
implant adjuster 620.Implant adjuster 620 has ashaft 622 extending between aproximal end 624 and adistal end 626. As discussed further below,distal end 626 has animplant engaging portion 628 configured to engage an implant that has been implanted into the disc space to provide adjustment of the final alignment of the implant.Proximal end 624 can be provided with a Hudson-type connector connectable to a T-handle or the like to apply a rotational force to the implant throughimplant adjuster 600. - Referring now FIGS. 32a-32 b, there is illustrated an
implant holder 650.Implant holder 650 includes ashaft 652 extending between a proximal 654 and adistal end 656.Shaft 652 includes a threadedportion 664 adjacentproximal end 654.Distal end 656 includes an implant engaging portion having a pair offingers 658 extending from anend section 668. Ashoulder 666 is provided between atapered section 662 andend section 668.Projections 672 extend distally from a distal end wall ofend section 668. Aslit 670 extends between theprojections 672 proximally along the center axis C ofimplant holder 650 for a distance d, biasingimplant holder 650 to a position that is disengaged with the implant.Flats 674 are provided adjacent the proximal end ofshaft 652 to provide an indication of the orientation offingers 658. - Referring now to FIG. 33, an
implant driver sleeve 680 is provided.Driver sleeve 680 includes acylindrical member 682 having a hollow interior sized to receiveimplant holder 650 therethrough.Cylindrical member 682 includes threads (not shown) formed in its hollow interior configured to mate withthreads 664 onimplant holder 650.Cylindrical member 682 has aproximal end 684 with ahex nut 686 secured thereto.Cylindrical member 682 further includes adistal end 688 having abushing 690 secured thereto. It is preferred thatbushing 690 is made from a lubricious plastic material such as DELRIN and is press fit ontodistal end 688. In FIG. 34, awrench 695 is provided with ahandle 696 and an open-sidedhex driving head 697 sized to engagehex nut 686 ofimplant driver sleeve 680.Implant holder 650 has a sufficient length such thatdistal end 656 extends distally fromdistal end 688 ofdriver sleeve 680, andproximal end 654 ofimplant holder 650 extends proximally fromproximal end 684 ofdriver sleeve 680. - To secure an
implant 800 to implantholder 650 as shown in FIGS. 43a-43 b,implant holder 650 is placed throughdriver sleeve 680 and secured thereto by partially mating the proximal end ofthreads 664 onto the distal end of the inner thread ofcylindrical member 682. A T-handle 674 is secured to a connector atproximal end 654 ofimplant holder 650.Implant 800 is held in position by a vise and the implant can be pre-packed with bone growth material through a proximal end opening of the implant.Implant holder 650 is then positioned withfingers 658 aroundimplant 800, andprojections 672 can be received in the end opening of the implant. Preferably,fingers 658 are configured to mate with flats or other surfaces provided on the sidewalls ofimplant 800.Implant holder 650 is threaded proximally with respect todriver sleeve 680 so that bushing 690 contacts taperedportion 662, and taperedportion 662 is pulled proximally into the distal end opening ofdriver sleeve 680.Implant holder 650 can be held to prevent its rotation withhandle 674 whiledriver sleeve 650 is rotated withwrench 695. The force exerted on taperedportion 662 ofimplant holder 650 moves implantholder 650 to an engaged position with theimplant 800 by causingslit 670 to narrow andfingers 658 to be pushed towards one another to firmly gripimplant 800 therebetween.Plastic bushing 690 prevents jamming ofimplant holder 650 withdriver sleeve 680, and also facilitates disassembly ofouter sleeve 680 fromimplant holder 650 to releaseimplant 800 afterimplant 800 is inserted in the disc space. - Referring now to FIGS. 35a to 45, an example of a preferred surgical technique employing the instruments of FIGS. 23a-34 in an anterior approach to the spine to insert a
first implant 800 and asecond implant 800′ bi-laterally in the disc space (as shown in FIG. 45) will now be described. It will be understood however, that the instruments of FIGS. 23a-34 can also have application in other approaches to the spine and with other types of implants mentioned herein. - Referring now to FIGS. 35a-35 c, the disc space between the L5 and S1 level of the spine has been accessed through an anterior exposure. The middle sacral artery is typically ligated and divided with this approach. It is also contemplated that the L4-L5 level of the spine could be accessed with the iliolumbar and segmental vessels identified and ligated if necessary. The center of the disc space is identified and marked with a
template shaft 700 and centeringpin 705. Accurate identification of the midline can be made with the assistance of anterior/posterior and lateral fluoroscopy. Marks M are made at the midline both cephalad and caudal to centeringpin 705 on the vertebral bodies. - The centering
pin 705 is then removed, and as shown in FIG. 36a an appropriatesized template 710 is attached toshaft 700 and positioned so thatnotch 712 aligns with marks M. The lateral margins of the block discectomy are marked by sharply incising the annulus with cuttinginstrument 715. As shown in FIGS. 36b and 36 c,template 710 is removed and an en bloc discectomy is typically performed to create an opening 0 that provides adequate space for insertion ofdistractors material removal instrument 720, such as a pituitary rongeur, can be used to remove the nucleus pulposous to provide room in the disc space for the distractors and theimplants 800. The anterior osteophytes on the vertebral bodies can also be removed to ensure accurate seating of the distal end ofguide sleeve 400 against the vertebral bodies. Curettes can be used to remove the cartilaginous endplates. The discectomy is performed under direct vision, and lateral fluoroscopy can be used to confirm the extent of disc removal in the posterior portion of the disc space. The lateral margins of the discectomy should not be exceeded so that the anterolateral annulus remains intact to enhance the stability of the construct. - If necessary, sequential distraction of the disc space can be carried out using starter distractor set725 as shown in FIG. 37. Starter distractor set 725 includes a number of distractor tips of increasing
height distractor assembly 450. - Referring now to FIG. 38,
distractor assembly 450 is then assembled withdistractor driver cap 550 as discussed above. The distractor tips ofdistractors distractor assembly 450 is placed at midline M.Distractor driver cap 550 is then impacted until the distractor tips are fully seated in the disc space. The radiographic markers in the tips can be used to verify positioning during seating.Distractor assembly 450 should remain parallel to the endplates during seating, and the intact anterolateral annulus will act to center thedistractor assembly 450 and resist lateral migration during impaction. Thedistractor driver cap 550 is then removed to de-coupledistractors guide sleeve 400. - Referring now to FIG. 39, an
impactor cap 730 is secured to guidesleeve 400 and theguide sleeve 400 is impacted untilflanges sleeve 400 is positioned against the vertebral bodies whiledistractors distractor driver cap 550.Impactor cap 730 is then removed. As shown in FIG. 40a, an instrument remover such asslap hammer 165 is secured tofirst distractor 350.First distractor 350 is then removed, and a cylindrical working channel is provided throughguide sleeve 400 to the disc space along the recessed area defined byconcave surface 394 ofsecond distractor 380 as shown in FIGS. 40b and 40 c. - Referring now to FIGS. 41a and 41 b,
reamer 470 is positioned in the working channel to ream a cylindrical hole in the disc space at a first disc space location to prepare it for insertion ofimplant 800. Preferably, thereamer 470 creates a hole that is sized to correspond to the height of the leading end of the implant to be inserted into the disc space.Reamer 470 is attached to a depth stop, such as the depth stop 172 discussed above, and T-handle 674. The appropriate depth stop setting is selected based on preoperative templating using axial CT or MR images, and should reflect the length ofimplant 800 and the desired countersink ofimplant 800 in the disc space. The depth of reaming in the disc space can be verified with fluoroscopy. - Referring now to FIG.
42a reaming plug 600 is inserted into the reamed first disc space location created withreamer 470.First implant 800 is preferably not inserted into the first disc space location after the first disc space location is reamed. The taperedfirst implant 800 acts to distract the disc space to establish the lordotic angle between the endplates. Reaming of the second disc space location could be problematic iffirst implant 800 was inserted into the first disc space location before the second disc space location is reamed. Thusreamer plug 600 maintains the disc space distraction whiledistractor 380 is removed.Reamer 470 is then used to ream a second disc space location adjacent the first disc space location for insertion ofsecond implant 800′.Plug 604 is sized such that sufficient space exists in the disc space for cuttinghead 471 to rotate with the shaft ofreamer 470 positioned along concave surface ofshaft 602. Handle 606 engages the proximal end ofsleeve 400 toclock shaft 602 against the inner side of the wall ofguide sleeve 400 to keepreamer plug 600 from interfering withreamer 470 and also from interfering with insertion ofsecond implant 800′. - As discussed above,
second implant 800′ is engaged to an implant inserter by engaging theimplant holder 650 to implant 800′ withdriver sleeve 680 as shown in FIGS. 43a and 43 b. As shown in FIGS. 44a-44 c,second implant 800′ is threaded into the second disc space location withreamer plug 600 inserted at the first disc space location.Second implant 800′ preferably includes self-tapping threads, and is tapered to establish the desired lordotic angle between the endplates. Aftersecond implant 800′ is inserted into the second disc space location,implant holder 650 anddriver sleeve 680 are removed. Reamer plug 600 is withdrawn from the first disc space location, andfirst implant 800 is inserted into the first disc space location as shown in FIG. 45 with the implant inserter. When inserted,implants implant adjuster 620 can be inserted into the proximal end opening of theimplants implants - While the use of threaded implants has been primarily discussed for use with the instruments of the present invention, the present invention likewise contemplates using push-in type implants and/or expandable implants in the disc space with the instruments described herein. Also, while it is preferred that the present invention be utilized for insertion of two implants at bilateral locations within the disc space, insertion of a single implant into the disc space is also contemplated.
- Of course, the present invention makes use of depth stops and other devices for measuring and controlling the depth of the various procedures performed in the disc space. These devices and procedures are more fully explained in the Danek brochure and in the '917 patent application. Additionally, the present invention is not limited to use with the tools and instruments described above, and guide
sleeve 100 anddistractors - Distractor tips according to another aspect of the present invention will be described with reference to FIGS. 46-56. The distractor tip of FIGS. 46-56 has application with side-by-side cylindrical distractor shafts, with side-by-side reduced profile distractors, with first and second distractors spaced from one another, or with a single distractor inserted in isolation in the disc space. Referring now to FIGS. 46-52,
distractor tip 900 is configured to generally correspond to the anatomical geometry of the vertebral endplates E1 and E2, and, in particular, the endplate curvatures C1, C2 and C3, as will be described further below.Distractor tip 900 is self-locating in the spinal disc space to the location where its geometrical configuration most closely matches that of the vertebral endplates, and any tendency fordistractor tip 900 to move after it is positioned in the disc space is thus reduced.Distractor tip 900 can also be provided with teeth to further resist movement ofdistractor tip 900 after it is inserted in the disc space. -
Distractor tip 900 includes abody 902 positionable in the spinal disc space between adjacent vertebrae V1, V2 as shown in FIGS. 54-56.Distractor tip 900 can also be provided with anend wall 904 which extends frombody 902 in the cephalad and caudal directions.End wall 904 has inner wall surfaces 904 a, 904 b oriented towardbody 902 which can contact the vertebrae V1, V2, respectively, outside the disc space to limit the insertion depth ofbody 904 into the disc space as shown in FIG. 56.End wall 904 has aproximal face 904 c oppositeinner surfaces bore 910 is provided indistractor tip 900 extending distally fromproximal face 904 c. Bore 910 can be threaded or otherwise configured to allowdistractor tip 900 to be coupled to a distractor shaft. Removable distractor tips provide modularity so that various sized tips can be used with a single shaft. Such tips can also be color-coded so that the appropriately sized tip can be readily selected along with the other color-coded surgical instruments and implants to be used in procedures employing that particular tip. It is also contemplated thatdistractor tip 900 can be provided withoutend wall 904, and a distractor shaft is coupled directly tobody 902. It is further contemplated thatdistractor tip 900 could be integrally formed with a distractor shaft as a single unit. -
Distractor tip 900 can be provided with distalradiographic marker 906 and one or more proximalradiographic markers 908.Radiographic markers proximal markers 908 are provided on either side ofbore 910. Radiographic markers can be located in a horizontal plane defined bycentral axis 912 so that the markers are located in the vertical center of the disc space whendistractor tip 900 is inserted therein.Distractor tip 900 can thus be made from aluminum or other radiolucent material, andmarkers distractor tip 900 during insertion into the disc space. Also, the surgeon can radiographically or monitor an implant or instruments located besidedistractor tip 900 without interference fromdistractor tip 900. -
Distractor tip 900 hascentral axis 912 extending therethrough between a leadingdistal end 900 a ofdistractor tip 900 and an opposite trailingproximal end 900 b. As used herein, distal refers to a position located away from the surgeon asdistractor tip 900 is inserted into the disc space and proximal refers to the direction oriented towards the surgeon asdistractor tip 900 is inserted in the disc space.Central axis 912 is centrally located between alateral surface 914 and amedial surface 916 ofdistractor tip 900.Lateral surface 914 is positioned adjacent to or toward the lateral edges of the vertebral endplates whendistractor tip 900 is inserted in the disc space.Medial surface 916 is located adjacent to or on the central spinal column axis extending through the middle of the vertebral endplate whendistractor tip 900 is inserted in the disc space. -
Distractor tip 900 further includes a proximalupper surface 918 and a proximallower surface 920. Each of theproximal surfaces end wall 904 towarddistal end 900 a to an upperdistal surface 922 and a lowerdistal surface 924, respectively. In the illustrated embodiment,proximal surfaces central axis 912. The proximal upper and lower surfaces can include a number ofteeth lateral surface 914 andmedial surface 916.Teeth proximal surfaces teeth distractor tip 900 in the disc space and provide solid anchorage with respect to the vertebral endplates. Distal upper andlower surfaces central axis 912 from their junction with respective adjacent proximal upper and lower surfaces so thatdistractor tip 900 has a reducedheight 926 atdistal end 900 a that is less than aheight 928 at proximal upper andlower surfaces - In the illustrated embodiment of FIG. 51,
medial surface 916 has a convexly arcuate profile between upperproximal surface 918 and lowerproximal surface 920. Other profile shapes are also contemplated, including a linear medial surface or a concave medial surface.Distal end 900 a includes a generally lineardistal end surface 932 that extends generally transverse tocentral axis 912.Lateral surface 914 is described further below. - With reference to FIGS. 53a-53 c, the vertebral endplate anatomical geometry will be discussed with reference to vertebrae V1 and V2 positioned on opposite sides of a disc space D. It is contemplated that vertebrae V1, V2 form part of the lumbar or sacral region of the spine; however, the principles of the present invention also have application in the cervical and thoracic regions of the spine. Vertebra V1 has an endplate E1 and vertebra V2 has an endplate E2. Endplate E1 has a cortical rim around its perimeter that surrounds a concave portion of cancellous or thin cortical bone in the middle of endplate E1. When
distractor tip 900 is used in an anterior approach to the spine,distal end surface 932 is located in the posterior region of endplates E1 and E2 withdistractor tip 900 inserted into the disc space. - The junction of the cortical rim and concave portion of the endplate defines a curvature C1 in the axial plane between the lateral portion of the cortical rim and the posterior portion of the cortical rim. In the coronal plane of FIG. 53b, endplate E1 has an inner cortical rim curvature C2 at the junction between the concave portion and the cortical rim. In the sagittal plane of FIG. 53c, the inner cortical rim of endplate E1 has a curvature C3 at the junction between the concave portion and the cortical rim along the posterior portion of the cortical rim. End plate E2 has inner cortical rim at the junctions between its concave portion and cortical rim defining similar curvatures.
- As shown in FIG. 47 and FIG. 54,
body 902 includes afirst transition surface 930 betweendistal end surface 932 andlateral surface 914 having a configuration that takes into account the vertebral endplate anatomy.First transition surface 930 has a curvature C1′ in the axial plane that generally conforms to curvature C1 in the axial plane of the inner cortical rim where it transitions between the lateral portion of the cortical rim and the posterior portion of the cortical rim. In one specific embodiment, curvature C1′ is defined by a radius of curvature of 9 millimeters. -
Lateral surface 914 has a proximal portion 914 a extending generally parallel withcentral axis 912. At a distance X1 fromdistal end surface 932,lateral surface 914 bends at an angle A1 from proximal portion 914 a towardscentral axis 912 to form a taperedportion 914 c that blends into thecurved transition surface 930. In one specific embodiment, this distance X is 10 millimeters and angle A1 is 10 degrees.Medial surface 916 can be similarly configured with a taper angle A1 to form a taperedportion 916 a. Medialtapered surface 916 a extends further distally than lateral taperedsurface 914 c, and blends intodistal end surface 932 by radius R1.Tapered surfaces distal end 900 a. - As shown in FIG. 51,
lateral surface 914 has a generally linearcentral region 914 b. Extending from this central region between the upper and lowerproximal surfaces distal surfaces central region 914 b. In one specific embodiment, height X2 is 3 millimeters, and curvature C2′ is defined by a radius of curvature of 8 millimeters. - As shown in FIGS. 48-49, upper and lower third transition surfaces936 a, 936 b extend from
distal end surface 932 to distalupper surface 922 and distallower surface 924. Upper and lower third transition surfaces 936 a, 936 b also extend fromfirst transition surface 930 to the respective upper and lowerdistal surfaces distal end surface 932 into the upper and lowerdistal surfaces first transition surface 930 into the upper and lowerdistal surfaces distal end surface 932 and a radius of curvature of 2 millimeters alongfirst transition surface 930. -
Distractor tip 900 having the above features generally corresponds to the anatomical geometry of the vertebral endplates E1 and E2, and, in particular, the endplate curvatures C1, C2 and C3. As such,distractor tip 900 is self-locating in the spinal disc space to the location where its geometrical configuration most closely matches that of the vertebral endplates. Furthermore, uponinsertion distractor tip 900 will be located in the disc space in contact with the inner cortical rim, and any tendency fordistractor tip 900 to move laterally or distally in the disc space is resisted by contact between the cortical rim andbody 904. - While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.
Claims (38)
1. A spinal disc space distractor, comprising:
a body positionable in a spinal disc space between adjacent vertebrae, said body having a distal end surface, a proximal end and a central axis extending therebetween, said body including:
a lateral surface extending generally in the direction of said central axis;
a medial surface opposite said lateral surface and extending generally in the direction of said central axis;
an upper surface extending generally in the direction of said central axis;
a lower surface opposite said upper surface and extending generally in the direction of said central axis;
a first transition surface extending between said distal end surface and said lateral surface, said first transition surface having a first curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the axial plane;
a second upper transition surface extending between said lateral surface and said upper surface and a second lower transition surface extending between said lateral surface and said lower surface, said second upper and lower transition surfaces each having a second curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the coronal plane; and
a third upper transition surface extending between said distal end surface and said upper surface and a third lower transition surface extending between said distal end surface and said lower surface, said third upper and lower transition surfaces each having a third curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the sagittal plane.
2. The distractor of claim 1 , wherein said third upper transition surface extends between said first transition surface and said upper surface and said third lower transition surface extends between said first transition surface and said lower surface.
3. The distractor of claim 1 , wherein said upper and lower surfaces each include a plurality of teeth formed therein.
4. The distractor of claim 1 , wherein said upper surface includes a proximal portion and a distal portion and said lower surface includes a proximal portion and a distal portion, said proximal portions being generally parallel with one another and said distal portions tapering toward one another from said proximal portions toward said distal end surface.
5. The distractor of claim 1 , wherein the distractor includes a proximal end wall adjacent said proximal end and said body extends distally from said proximal end wall.
6. The distractor of claim 5 , wherein said proximal end wall includes an inner surface extending above said upper surface and an inner surface extending below said lower surface, said inner surfaces contacting adjacent vertebrae to limit insertion depth of said body in the spinal disc space.
7. The distractor of claim 5 , wherein said proximal end wall and said body include a bore extending distally therein from said proximal end wall.
8. The distractor of claim 7 , further comprising a shaft attachable to said bore.
9. The distractor of claim 1 , wherein said body is made from radiolucent material and said body further includes at least one radiographic marker.
10. The distractor of claim 1 , wherein said distal end surface is linear and orthogonal to said central axis.
11. The distractor of claim 1 , wherein said lateral surface includes a central linear region extending parallel to the central axis, said second upper and lower transition surfaces extending between said central region and said upper surface and said lower surface, respectively.
12. A spinal disc space distractor, comprising:
a body positionable in a spinal disc space between adjacent vertebrae, said body having a central axis extending therethrough, said body including:
a distal end surface;
a lateral surface extending generally in the direction of said central axis;
a medial surface opposite said lateral surface and extending generally in the direction of said central axis;
an upper surface extending generally in the direction of said central axis;
a lower surface opposite said upper surface and extending generally in the direction of said central axis; and
at least a first transition surface extending between said distal end surface and said lateral surface, said first transition surface having a first curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the axial plane.
13. The distractor of claim 12 , wherein said body further includes a second upper transition surface extending between said lateral surface and said upper surface and a second lower transition surface extending between said lateral surface and said lower surface, said second upper and lower transition surfaces each having a second curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the coronal plane.
14. The distractor of claim 13 , wherein said lateral surface includes a central linear region extending parallel to the central axis, said second upper and lower transition surfaces extending between said central region and said upper surface and said lower surface, respectively.
15. The distractor of claim 13 , wherein said first curvature is defined by a radius of curvature of 9 millimeters and said second curvature is defined by a radius of curvature of 8 millimeters.
16. The distractor of claim 13 , a third upper transition surface extending between said distal end surface and said upper surface and a third lower transition surface extending between said distal end surface and said lower surface, said third upper and lower transition surfaces each having a third curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the sagittal plane.
17. The distractor of claim 16 , wherein said third upper transition surface extends between said first transition surface and said upper surface and said third lower transition surface extends between said first transition surface and said lower surface.
18. The distractor of claim 12 , wherein said upper surface includes a proximal portion and a distal portion and said lower surface includes a proximal portion and a distal portion, said proximal portions being generally parallel with one another and said distal portions tapering toward one another from said proximal portions toward said distal end surface.
19 The distractor of claim 12 , wherein said first curvature is defined by a radius of curvature of 9 millimeters.
20. A surgical instrument assembly for distracting a spinal disc space, comprising:
a first shaft extending between a proximal end and a distal end;
a first distractor tip extending from the distal end of said first shaft, said first distractor tip including opposite first and second surfaces defining a first distraction height;
a second distractor including:
a second shaft extending between a proximal end and a distal end;
a second distractor tip extending from the distal end of said second shaft, said second distractor tip including opposite first and second surfaces defining a second distraction height substantially equal to said first distraction height;
a guide sleeve defining a working channel extending between a proximal end and a distal end, wherein said first and second distractors are received in said working channel of said guide sleeve; and
a distractor driver cap coupled to the proximal end of said first and second distractors and said guide sleeve, said distractor driver cap having a side opening wherein said distractor driver cap is side-loaded onto said first and second distractors and said guide sleeve.
21. The assembly of claim 20 , wherein said second distractor includes a recessed area extending along a medial side thereof.
22. The assembly of claim 21 , wherein said recessed area is a concave surface.
23. The assembly of claim 21 , wherein said recessed area is configured to permit rotation of a surgical instrument positioned adjacent thereto.
24. The assembly of claim 20 , wherein said first distractor tip is integrally formed with said first shaft and said second distractor tip is integrally formed with said second shaft.
25. The assembly of claim 20 , wherein:
said first distractor includes a convex surface along said medial side thereof; and
said second distractor includes a convex surface along said medial side thereof.
26. The assembly of claim 20 , wherein a distal end of said guide sleeve includes a pair of opposite flanges extending distally therefrom.
27. The assembly of claim 20 , wherein said working channel includes a first working channel portion for receiving said first distractor and a second working channel portion for receiving said second distractor.
28. The assembly of claim 27 , wherein said first working channel portion and said second working channel portion form a figure eight shape.
29. The assembly of claim 20 , wherein said guide sleeve includes a sleeve cap at said proximal end of said guide sleeve, said sleeve cap including a proximal end ring engageable to said distractor driver cap.
30. The assembly of claim 29 , wherein said first distractor includes a first flange on its proximal end defining a lip therearound and said second distractor includes a second flange on its proximal end defining a lip therearound, said driver cap including a distractor slot slidably receiving said first and second flanges therein.
31. The assembly of claim 30 , wherein said distractor driver cap includes a guide sleeve slot slidably receiving said proximal end ring.
32. The assembly of claim 20 , wherein said first distractor includes a first flange on its proximal end defining a lip therearound and said second distractor includes a second flange on its proximal end defining a lip therearound, said driver cap including a distractor slot slidably receiving said first and second flanges therein.
33. The assembly of claim 32 , wherein said first flange includes a proximal face having a hole therein and said second flange includes a proximal face having a hole therein, said distractor driver cap including a spring-biased plunger positionable in a corresponding one of said holes when said distractor driver cap is properly positioned thereon.
34. The assembly of claim 20 , wherein:
said first distractor includes a projection extending from a medial side of said first shaft;
said second distractor includes a notch formed in a medial side of said second shaft, wherein when said first and second distractors are positioned in said guide sleeve said projection is received in said notch to prevent relative movement between said first and second distractors.
35. The assembly of claim 34 , wherein in said projection is cylindrically shaped.
36. The assembly of claim 20 , wherein each of said first and second distractor tips includes:
a distal surface;
a lateral surface;
a first transition surface extending between said distal end surface and said lateral surface, said first transition surface having a first curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the axial plane.
37. The assembly of claim 36 , wherein each of said first and second distractor tips further includes a second upper transition surface extending between said lateral surface and said upper surface and a second lower transition surface extending between said lateral surface and said lower surface, said second upper and lower transition surfaces each having a second curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the coronal plane.
38. The assembly of claim 37 , wherein each of said first and second distractor tips further includes a third upper transition surface extending between said distal end surface and said upper surface and a third lower transition surface extending between said distal end surface and said lower surface, said third upper and lower transition surfaces each having a third curvature generally corresponding to the curvature of the inner portion of the cortical rim of the vertebral endplates in the sagittal plane.
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US10/804,900 US20040176775A1 (en) | 1999-02-04 | 2004-03-19 | Methods and instrumentation for vertebral interbody fusion |
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US11879399P | 1999-02-04 | 1999-02-04 | |
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US09/756,492 US6648895B2 (en) | 2000-02-04 | 2001-01-08 | Methods and instrumentation for vertebral interbody fusion |
US09/965,018 US6743234B2 (en) | 1999-02-04 | 2001-09-27 | Methods and instrumentation for vertebral interbody fusion |
US10/804,900 US20040176775A1 (en) | 1999-02-04 | 2004-03-19 | Methods and instrumentation for vertebral interbody fusion |
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Cited By (75)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20050251192A1 (en) * | 2004-03-31 | 2005-11-10 | Shluzas Alan E | Access device having discrete visualization locations |
US20060058808A1 (en) * | 2004-09-08 | 2006-03-16 | Susanne Schneid | Surgical instrument |
US20060217807A1 (en) * | 2005-03-28 | 2006-09-28 | Peterman Marc M | Spinal device including lateral approach |
US20060217806A1 (en) * | 2005-03-28 | 2006-09-28 | Peterman Marc M | Spinal system and method including lateral approach |
US20070288007A1 (en) * | 1999-02-04 | 2007-12-13 | Burkus J K | Methods and instrument for vertebral interbody fusion |
US20080221586A1 (en) * | 2007-02-09 | 2008-09-11 | Alphatec Spine, Inc. | Curviliner spinal access method and device |
US7666227B2 (en) | 2005-08-16 | 2010-02-23 | Benvenue Medical, Inc. | Devices for limiting the movement of material introduced between layers of spinal tissue |
US20100121388A1 (en) * | 2006-04-20 | 2010-05-13 | Eric Flickinger | Monorail System |
US20110144469A1 (en) * | 2008-05-07 | 2011-06-16 | Patraicia Connolly | Bacterial/Cellular Recognition Impedance Algorithm |
US20110213375A1 (en) * | 2006-07-17 | 2011-09-01 | Arthrosurface, Inc. | Tibial Resurfacing System and Method |
US20120029639A1 (en) * | 2010-07-29 | 2012-02-02 | Warsaw Orthopedic, Inc. | Interbody spinal implants and insertion techniques |
US8366773B2 (en) | 2005-08-16 | 2013-02-05 | Benvenue Medical, Inc. | Apparatus and method for treating bone |
US8454617B2 (en) | 2005-08-16 | 2013-06-04 | Benvenue Medical, Inc. | Devices for treating the spine |
US8523872B2 (en) | 2002-12-03 | 2013-09-03 | Arthrosurface Incorporated | Tibial resurfacing system |
US8535327B2 (en) | 2009-03-17 | 2013-09-17 | Benvenue Medical, Inc. | Delivery apparatus for use with implantable medical devices |
US8540717B2 (en) | 2000-05-01 | 2013-09-24 | Arthrosurface Incorporated | System and method for joint resurface repair |
US8556902B2 (en) | 2002-12-03 | 2013-10-15 | Arthrosurface Incorporated | System and method for retrograde procedure |
US8591583B2 (en) | 2005-08-16 | 2013-11-26 | Benvenue Medical, Inc. | Devices for treating the spine |
US8663230B2 (en) | 2002-12-03 | 2014-03-04 | Arthrosurface Incorporated | Retrograde delivery of resurfacing devices |
US8685105B2 (en) * | 2004-03-29 | 2014-04-01 | Nuvasive, Inc. | Systems and methods for spinal fusion |
US8814873B2 (en) | 2011-06-24 | 2014-08-26 | Benvenue Medical, Inc. | Devices and methods for treating bone tissue |
US8864827B2 (en) | 2000-05-01 | 2014-10-21 | Arthrosurface Inc. | System and method for joint resurface repair |
US8926615B2 (en) | 2002-12-03 | 2015-01-06 | Arthrosurface, Inc. | System and method for retrograde procedure |
US8951258B2 (en) | 2013-03-01 | 2015-02-10 | Warsaw Orthopedic, Inc. | Spinal correction system and method |
US8961614B2 (en) | 2004-11-22 | 2015-02-24 | Arthrosurface, Inc. | Articular surface implant and delivery system |
US9044343B2 (en) | 2002-12-03 | 2015-06-02 | Arthrosurface Incorporated | System for articular surface replacement |
US9055955B2 (en) | 2000-05-01 | 2015-06-16 | Arthrosurface Inc. | Bone resurfacing system and method |
US9066716B2 (en) | 2011-03-30 | 2015-06-30 | Arthrosurface Incorporated | Suture coil and suture sheath for tissue repair |
US9168152B2 (en) | 2008-02-29 | 2015-10-27 | Nuvasive, Inc. | Implants and methods for spinal fusion |
US9186261B2 (en) | 2007-03-07 | 2015-11-17 | Nuvasive, Inc. | System and methods for spinal fusion |
US9198765B1 (en) | 2011-10-31 | 2015-12-01 | Nuvasive, Inc. | Expandable spinal fusion implants and related methods |
US9204873B2 (en) | 2000-05-01 | 2015-12-08 | Arthrosurface Incorporated | System and method for joint resurface repair |
US9283076B2 (en) | 2009-04-17 | 2016-03-15 | Arthrosurface Incorporated | Glenoid resurfacing system and method |
USD754346S1 (en) | 2009-03-02 | 2016-04-19 | Nuvasive, Inc. | Spinal fusion implant |
US9351745B2 (en) | 2003-02-24 | 2016-05-31 | Arthrosurface Incorporated | Trochlear resurfacing system and method |
US9357989B2 (en) | 2000-05-01 | 2016-06-07 | Arthrosurface Incorporated | System and method for joint resurface repair |
US9358029B2 (en) | 2006-12-11 | 2016-06-07 | Arthrosurface Incorporated | Retrograde resection apparatus and method |
US9468448B2 (en) | 2012-07-03 | 2016-10-18 | Arthrosurface Incorporated | System and method for joint resurfacing and repair |
US9492200B2 (en) | 2013-04-16 | 2016-11-15 | Arthrosurface Incorporated | Suture system and method |
US9662126B2 (en) | 2009-04-17 | 2017-05-30 | Arthrosurface Incorporated | Glenoid resurfacing system and method |
US9788963B2 (en) | 2003-02-14 | 2017-10-17 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US9861492B2 (en) | 2014-03-07 | 2018-01-09 | Arthrosurface Incorporated | Anchor for an implant assembly |
US10085783B2 (en) | 2013-03-14 | 2018-10-02 | Izi Medical Products, Llc | Devices and methods for treating bone tissue |
CN108742821A (en) * | 2018-03-27 | 2018-11-06 | 李莉 | A kind of minimally invasive plate osteosynthesis sets nail guider |
US20180338783A1 (en) * | 2017-05-25 | 2018-11-29 | Warsaw Orthopedic, Inc | Spinal implant system and method |
US10624748B2 (en) | 2014-03-07 | 2020-04-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
US10888433B2 (en) | 2016-12-14 | 2021-01-12 | DePuy Synthes Products, Inc. | Intervertebral implant inserter and related methods |
US10940016B2 (en) | 2017-07-05 | 2021-03-09 | Medos International Sarl | Expandable intervertebral fusion cage |
US10945743B2 (en) | 2009-04-17 | 2021-03-16 | Arthrosurface Incorporated | Glenoid repair system and methods of use thereof |
US10966840B2 (en) | 2010-06-24 | 2021-04-06 | DePuy Synthes Products, Inc. | Enhanced cage insertion assembly |
US10973652B2 (en) | 2007-06-26 | 2021-04-13 | DePuy Synthes Products, Inc. | Highly lordosed fusion cage |
US11160663B2 (en) | 2017-08-04 | 2021-11-02 | Arthrosurface Incorporated | Multicomponent articular surface implant |
US11273050B2 (en) | 2006-12-07 | 2022-03-15 | DePuy Synthes Products, Inc. | Intervertebral implant |
US11344424B2 (en) | 2017-06-14 | 2022-05-31 | Medos International Sarl | Expandable intervertebral implant and related methods |
US11382671B2 (en) | 2019-06-25 | 2022-07-12 | Warsaw Orthopedic, Inc. | Surgical instrument and method |
US11426290B2 (en) | 2015-03-06 | 2022-08-30 | DePuy Synthes Products, Inc. | Expandable intervertebral implant, system, kit and method |
US11426286B2 (en) | 2020-03-06 | 2022-08-30 | Eit Emerging Implant Technologies Gmbh | Expandable intervertebral implant |
US11446156B2 (en) | 2018-10-25 | 2022-09-20 | Medos International Sarl | Expandable intervertebral implant, inserter instrument, and related methods |
US11446155B2 (en) | 2017-05-08 | 2022-09-20 | Medos International Sarl | Expandable cage |
US11452607B2 (en) | 2010-10-11 | 2022-09-27 | DePuy Synthes Products, Inc. | Expandable interspinous process spacer implant |
US11478358B2 (en) | 2019-03-12 | 2022-10-25 | Arthrosurface Incorporated | Humeral and glenoid articular surface implant systems and methods |
US11497536B2 (en) * | 2018-03-28 | 2022-11-15 | Warsaw Orthopedic, Inc. | Surgical instrument and method |
US11497619B2 (en) | 2013-03-07 | 2022-11-15 | DePuy Synthes Products, Inc. | Intervertebral implant |
US11510788B2 (en) | 2016-06-28 | 2022-11-29 | Eit Emerging Implant Technologies Gmbh | Expandable, angularly adjustable intervertebral cages |
US11596523B2 (en) | 2016-06-28 | 2023-03-07 | Eit Emerging Implant Technologies Gmbh | Expandable and angularly adjustable articulating intervertebral cages |
US11602438B2 (en) | 2008-04-05 | 2023-03-14 | DePuy Synthes Products, Inc. | Expandable intervertebral implant |
US11607321B2 (en) | 2009-12-10 | 2023-03-21 | DePuy Synthes Products, Inc. | Bellows-like expandable interbody fusion cage |
US11607319B2 (en) | 2014-03-07 | 2023-03-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
US11612491B2 (en) | 2009-03-30 | 2023-03-28 | DePuy Synthes Products, Inc. | Zero profile spinal fusion cage |
US11654033B2 (en) | 2010-06-29 | 2023-05-23 | DePuy Synthes Products, Inc. | Distractible intervertebral implant |
US11712276B2 (en) | 2011-12-22 | 2023-08-01 | Arthrosurface Incorporated | System and method for bone fixation |
US11737881B2 (en) | 2008-01-17 | 2023-08-29 | DePuy Synthes Products, Inc. | Expandable intervertebral implant and associated method of manufacturing the same |
US11752009B2 (en) | 2021-04-06 | 2023-09-12 | Medos International Sarl | Expandable intervertebral fusion cage |
US11850160B2 (en) | 2021-03-26 | 2023-12-26 | Medos International Sarl | Expandable lordotic intervertebral fusion cage |
US11911287B2 (en) | 2010-06-24 | 2024-02-27 | DePuy Synthes Products, Inc. | Lateral spondylolisthesis reduction cage |
Families Citing this family (53)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6206922B1 (en) * | 1995-03-27 | 2001-03-27 | Sdgi Holdings, Inc. | Methods and instruments for interbody fusion |
US6478800B1 (en) | 2000-05-08 | 2002-11-12 | Depuy Acromed, Inc. | Medical installation tool |
US7552729B2 (en) * | 2001-03-05 | 2009-06-30 | The United States Of America As Represented By The Secretary Of The Army | Intubation device and method |
WO2004026187A1 (en) | 2002-09-19 | 2004-04-01 | Malan De Villiers | Intervertebral prosthesis |
ZA200506026B (en) | 2003-01-31 | 2006-11-29 | Spinalmotion Inc | Intervertebral prosthesis placement instrument |
WO2004066865A2 (en) * | 2003-01-31 | 2004-08-12 | Spinalmotion, Inc. | Spinal midline indicator |
WO2004084742A1 (en) | 2003-03-24 | 2004-10-07 | Theken Surgical Llc | Spinal implant adjustment device |
JP2006521899A (en) * | 2003-03-31 | 2006-09-28 | デピュイ・スパイン・インコーポレイテッド | Method and apparatus for inserting an artificial disc |
EP2161008B1 (en) | 2003-05-27 | 2014-12-24 | Simplify Medical, Inc. | Method for assembling a prosthetic disc for intervertebral insertion |
US7575599B2 (en) | 2004-07-30 | 2009-08-18 | Spinalmotion, Inc. | Intervertebral prosthetic disc with metallic core |
US10052211B2 (en) | 2003-05-27 | 2018-08-21 | Simplify Medical Pty Ltd. | Prosthetic disc for intervertebral insertion |
US7300441B2 (en) * | 2003-08-20 | 2007-11-27 | Sdgi Holdings, Inc. | Technique and instrumentation for preparation of vertebral members |
US20050240197A1 (en) * | 2004-04-23 | 2005-10-27 | Kmiec Stanley J Jr | Device and method for inserting, positioning and removing an implant |
US7033363B2 (en) | 2004-05-19 | 2006-04-25 | Sean Powell | Snap-lock for drill sleeve |
US7585326B2 (en) | 2004-08-06 | 2009-09-08 | Spinalmotion, Inc. | Methods and apparatus for intervertebral disc prosthesis insertion |
US20060036261A1 (en) * | 2004-08-13 | 2006-02-16 | Stryker Spine | Insertion guide for a spinal implant |
US7799081B2 (en) | 2004-09-14 | 2010-09-21 | Aeolin, Llc | System and method for spinal fusion |
US8083797B2 (en) | 2005-02-04 | 2011-12-27 | Spinalmotion, Inc. | Intervertebral prosthetic disc with shock absorption |
US20070244562A1 (en) * | 2005-08-26 | 2007-10-18 | Magellan Spine Technologies, Inc. | Spinal implants and methods of providing dynamic stability to the spine |
US20070050028A1 (en) * | 2005-08-26 | 2007-03-01 | Conner E S | Spinal implants and methods of providing dynamic stability to the spine |
US8236058B2 (en) * | 2005-09-27 | 2012-08-07 | Fabian Henry F | Spine surgery method and implant |
US9271843B2 (en) | 2005-09-27 | 2016-03-01 | Henry F. Fabian | Spine surgery method and implant |
US20070123904A1 (en) * | 2005-10-31 | 2007-05-31 | Depuy Spine, Inc. | Distraction instrument and method for distracting an intervertebral site |
US20070123903A1 (en) * | 2005-10-31 | 2007-05-31 | Depuy Spine, Inc. | Medical Device installation tool and methods of use |
US7867237B2 (en) * | 2005-10-31 | 2011-01-11 | Depuy Spine, Inc. | Arthroplasty revision device and method |
US8377072B2 (en) * | 2006-02-06 | 2013-02-19 | Depuy Spine, Inc. | Medical device installation tool |
AU2007238092A1 (en) | 2006-04-12 | 2007-10-25 | Spinalmotion, Inc. | Posterior spinal device and method |
JP5139418B2 (en) * | 2006-04-14 | 2013-02-06 | ブラックストーン メディカル,インコーポレイティド | System and method for percutaneous facet joint fixation |
US8303601B2 (en) | 2006-06-07 | 2012-11-06 | Stryker Spine | Collet-activated distraction wedge inserter |
US7985230B2 (en) * | 2006-07-27 | 2011-07-26 | Warsaw Orthopedic, Inc. | System and method of harvesting osteochondral plugs |
US8070754B2 (en) | 2007-05-31 | 2011-12-06 | Fabian Henry F | Spine surgery method and instrumentation |
US20090043391A1 (en) | 2007-08-09 | 2009-02-12 | Spinalmotion, Inc. | Customized Intervertebral Prosthetic Disc with Shock Absorption |
US8758441B2 (en) | 2007-10-22 | 2014-06-24 | Spinalmotion, Inc. | Vertebral body replacement and method for spanning a space formed upon removal of a vertebral body |
EP2219561A4 (en) * | 2007-11-19 | 2012-02-08 | Magellan Spine Technologies Inc | Spinal implants and methods |
US8764833B2 (en) | 2008-03-11 | 2014-07-01 | Spinalmotion, Inc. | Artificial intervertebral disc with lower height |
US9034038B2 (en) | 2008-04-11 | 2015-05-19 | Spinalmotion, Inc. | Motion limiting insert for an artificial intervertebral disc |
US20090270873A1 (en) * | 2008-04-24 | 2009-10-29 | Fabian Henry F | Spine surgery method and inserter |
US20090276051A1 (en) | 2008-05-05 | 2009-11-05 | Spinalmotion, Inc. | Polyaryletherketone Artificial Intervertebral Disc |
US9220603B2 (en) | 2008-07-02 | 2015-12-29 | Simplify Medical, Inc. | Limited motion prosthetic intervertebral disc |
WO2010009151A2 (en) | 2008-07-17 | 2010-01-21 | Spinalmotion, Inc. | Artificial intervertebral disc placement system |
WO2010009153A1 (en) | 2008-07-18 | 2010-01-21 | Spinalmotion, Inc. | Posterior prosthetic intervertebral disc |
US20100274298A1 (en) * | 2009-04-22 | 2010-10-28 | Schiff David C M | Casper pin apparatus and method of use |
US9204906B2 (en) | 2009-10-22 | 2015-12-08 | Nuvasive, Inc. | Posterior cervical fusion system and techniques |
US10098674B2 (en) | 2009-10-22 | 2018-10-16 | Nuvasive, Inc. | System and method for posterior cervical fusion |
EP3403601A1 (en) * | 2011-12-19 | 2018-11-21 | Rotation Medical, Inc. | Apparatus for forming pilot holes in bone and delivering fasteners therein for retaining an implant |
US20140200668A1 (en) * | 2013-01-15 | 2014-07-17 | X-Spine Systems, Inc. | Implant system having a multifunctional inserter and complementary implant |
US9707099B2 (en) * | 2013-03-15 | 2017-07-18 | NuTech Spine, Inc. | Anterior lumbar fusion method and device |
FR3010628B1 (en) | 2013-09-18 | 2015-10-16 | Medicrea International | METHOD FOR REALIZING THE IDEAL CURVATURE OF A ROD OF A VERTEBRAL OSTEOSYNTHESIS EQUIPMENT FOR STRENGTHENING THE VERTEBRAL COLUMN OF A PATIENT |
FR3012030B1 (en) * | 2013-10-18 | 2015-12-25 | Medicrea International | METHOD FOR REALIZING THE IDEAL CURVATURE OF A ROD OF A VERTEBRAL OSTEOSYNTHESIS EQUIPMENT FOR STRENGTHENING THE VERTEBRAL COLUMN OF A PATIENT |
US10918422B2 (en) | 2017-12-01 | 2021-02-16 | Medicrea International | Method and apparatus for inhibiting proximal junctional failure |
US11883303B2 (en) | 2019-12-30 | 2024-01-30 | Vertebration, Inc. | Spine surgery method and instrumentation |
US20230270436A1 (en) * | 2022-02-25 | 2023-08-31 | Life Spine, Inc. | Vertebral Disc Auger |
WO2023177741A1 (en) * | 2022-03-18 | 2023-09-21 | Toetal Solutions Inc. | Interphalangeal joint implant methods and apparatus |
Citations (45)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4501266A (en) * | 1983-03-04 | 1985-02-26 | Biomet, Inc. | Knee distraction device |
US5015255A (en) * | 1989-05-10 | 1991-05-14 | Spine-Tech, Inc. | Spinal stabilization method |
US5055104A (en) * | 1989-11-06 | 1991-10-08 | Surgical Dynamics, Inc. | Surgically implanting threaded fusion cages between adjacent low-back vertebrae by an anterior approach |
US5431658A (en) * | 1994-02-14 | 1995-07-11 | Moskovich; Ronald | Facilitator for vertebrae grafts and prostheses |
US5484437A (en) * | 1988-06-13 | 1996-01-16 | Michelson; Gary K. | Apparatus and method of inserting spinal implants |
US5489307A (en) * | 1993-02-10 | 1996-02-06 | Spine-Tech, Inc. | Spinal stabilization surgical method |
US5514180A (en) * | 1994-01-14 | 1996-05-07 | Heggeness; Michael H. | Prosthetic intervertebral devices |
US5556399A (en) * | 1995-02-14 | 1996-09-17 | Huebner; Randall J. | Bone-harvesting drill apparatus and method for its use |
US5569205A (en) * | 1994-07-14 | 1996-10-29 | Hart; Charles C. | Multiport trocar |
US5571109A (en) * | 1993-08-26 | 1996-11-05 | Man Ceramics Gmbh | System for the immobilization of vertebrae |
US5609636A (en) * | 1994-05-23 | 1997-03-11 | Spine-Tech, Inc. | Spinal implant |
US5741253A (en) * | 1988-06-13 | 1998-04-21 | Michelson; Gary Karlin | Method for inserting spinal implants |
US5759185A (en) * | 1994-10-24 | 1998-06-02 | Smith & Nephew, Inc. | Surgical instrument |
US5766252A (en) * | 1995-01-24 | 1998-06-16 | Osteonics Corp. | Interbody spinal prosthetic implant and method |
US5772661A (en) * | 1988-06-13 | 1998-06-30 | Michelson; Gary Karlin | Methods and instrumentation for the surgical correction of human thoracic and lumbar spinal disease from the antero-lateral aspect of the spine |
US5785710A (en) * | 1988-06-13 | 1998-07-28 | Sofamor Danek Group, Inc. | Interbody spinal fusion implants |
US5797909A (en) * | 1988-06-13 | 1998-08-25 | Michelson; Gary Karlin | Apparatus for inserting spinal implants |
US5865847A (en) * | 1997-03-06 | 1999-02-02 | Sulzer Spine-Tech Inc. | Lordotic spinal implant |
US5865834A (en) * | 1991-12-13 | 1999-02-02 | Mcguire; David A. | Coring reamer |
US5885299A (en) * | 1994-09-15 | 1999-03-23 | Surgical Dynamics, Inc. | Apparatus and method for implant insertion |
US5899901A (en) * | 1991-05-18 | 1999-05-04 | Middleton; Jeffrey Keith | Spinal fixation system |
US5968098A (en) * | 1996-10-22 | 1999-10-19 | Surgical Dynamics, Inc. | Apparatus for fusing adjacent bone structures |
US6004326A (en) * | 1997-09-10 | 1999-12-21 | United States Surgical | Method and instrumentation for implant insertion |
US6033405A (en) * | 1994-09-15 | 2000-03-07 | Surgical Dynamics, Inc. | Apparatus and method for implant insertion |
US6042582A (en) * | 1997-05-20 | 2000-03-28 | Ray; Charles D. | Instrumentation and method for facilitating insertion of spinal implant |
US6056749A (en) * | 1999-03-15 | 2000-05-02 | Spineology, Inc. | Method and device for fixing and correcting spondylolisthesis anteriorly |
US6059790A (en) * | 1997-08-29 | 2000-05-09 | Sulzer Spine-Tech Inc. | Apparatus and method for spinal stabilization |
US6063088A (en) * | 1997-03-24 | 2000-05-16 | United States Surgical Corporation | Method and instrumentation for implant insertion |
US6083225A (en) * | 1996-03-14 | 2000-07-04 | Surgical Dynamics, Inc. | Method and instrumentation for implant insertion |
US6086595A (en) * | 1997-08-29 | 2000-07-11 | Sulzer Spine-Tech Inc. | Apparatus and method for spinal stabilization |
US6113602A (en) * | 1999-03-26 | 2000-09-05 | Sulzer Spine-Tech Inc. | Posterior spinal instrument guide and method |
US6123705A (en) * | 1988-06-13 | 2000-09-26 | Sdgi Holdings, Inc. | Interbody spinal fusion implants |
US6156595A (en) * | 1997-10-08 | 2000-12-05 | Sawada; Shigeki | Method of fabricating a Bi-CMOS IC device including a self-alignment bipolar transistor capable of high speed operation |
US6159214A (en) * | 1996-07-31 | 2000-12-12 | Michelson; Gary K. | Milling instrumentation and method for preparing a space between adjacent vertebral bodies |
US6171339B1 (en) * | 1998-05-19 | 2001-01-09 | Sulzer Spine-Tech Inc. | Multi-lumen spinal implant guide and method |
US6174311B1 (en) * | 1998-10-28 | 2001-01-16 | Sdgi Holdings, Inc. | Interbody fusion grafts and instrumentation |
US6210412B1 (en) * | 1988-06-13 | 2001-04-03 | Gary Karlin Michelson | Method for inserting frusto-conical interbody spinal fusion implants |
US6224599B1 (en) * | 1999-05-19 | 2001-05-01 | Matthew G. Baynham | Viewable wedge distractor device |
US6224607B1 (en) * | 1999-01-25 | 2001-05-01 | Gary K. Michelson | Instrumentation and method for creating an intervertebral space for receiving an implant |
US6258125B1 (en) * | 1998-08-03 | 2001-07-10 | Synthes (U.S.A.) | Intervertebral allograft spacer |
US6277122B1 (en) * | 1999-10-15 | 2001-08-21 | Sdgi Holdings, Inc. | Distraction instrument with fins for maintaining insertion location |
US6447512B1 (en) * | 2000-01-06 | 2002-09-10 | Spinal Concepts, Inc. | Instrument and method for implanting an interbody fusion device |
US6575981B1 (en) * | 1999-02-04 | 2003-06-10 | Sdgi Holdings, Inc. | Methods and instrumentation for vertebral interbody fusion |
US6582437B2 (en) * | 1999-08-26 | 2003-06-24 | Sdgi Holdings, Inc. | Devices and methods for implanting fusion cages |
US6648895B2 (en) * | 2000-02-04 | 2003-11-18 | Sdgi Holdings, Inc. | Methods and instrumentation for vertebral interbody fusion |
Family Cites Families (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7534254B1 (en) | 1988-06-13 | 2009-05-19 | Warsaw Orthopedic, Inc. | Threaded frusto-conical interbody spinal fusion implants |
US5269772A (en) | 1992-01-24 | 1993-12-14 | Wilk Peter J | Laparoscopic cannula assembly and associated method |
CA2238117C (en) | 1997-05-30 | 2006-01-10 | United States Surgical Corporation | Method and instrumentation for implant insertion |
FR2767675B1 (en) | 1997-08-26 | 1999-12-03 | Materiel Orthopedique En Abreg | INTERSOMATIC IMPLANT AND ANCILLARY OF PREPARATION SUITABLE FOR ALLOWING ITS POSITION |
WO1999052453A2 (en) | 1998-04-09 | 1999-10-21 | Sdgi Holdings, Inc. | Method and instrumentation for vertebral interbody fusion |
EP1609445A1 (en) | 1999-01-11 | 2005-12-28 | SDGI Holdings, Inc. | Intervertebral spacers with side wall accessible interior cavity |
-
2001
- 2001-09-27 US US09/965,018 patent/US6743234B2/en not_active Expired - Fee Related
-
2004
- 2004-03-19 US US10/804,900 patent/US20040176775A1/en not_active Abandoned
Patent Citations (53)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4501266A (en) * | 1983-03-04 | 1985-02-26 | Biomet, Inc. | Knee distraction device |
US5797909A (en) * | 1988-06-13 | 1998-08-25 | Michelson; Gary Karlin | Apparatus for inserting spinal implants |
US6123705A (en) * | 1988-06-13 | 2000-09-26 | Sdgi Holdings, Inc. | Interbody spinal fusion implants |
US6080155A (en) * | 1988-06-13 | 2000-06-27 | Michelson; Gary Karlin | Method of inserting and preloading spinal implants |
US5484437A (en) * | 1988-06-13 | 1996-01-16 | Michelson; Gary K. | Apparatus and method of inserting spinal implants |
US6210412B1 (en) * | 1988-06-13 | 2001-04-03 | Gary Karlin Michelson | Method for inserting frusto-conical interbody spinal fusion implants |
US5505732A (en) * | 1988-06-13 | 1996-04-09 | Michelson; Gary K. | Apparatus and method of inserting spinal implants |
US5785710A (en) * | 1988-06-13 | 1998-07-28 | Sofamor Danek Group, Inc. | Interbody spinal fusion implants |
US6096038A (en) * | 1988-06-13 | 2000-08-01 | Michelson; Gary Karlin | Apparatus for inserting spinal implants |
US5772661A (en) * | 1988-06-13 | 1998-06-30 | Michelson; Gary Karlin | Methods and instrumentation for the surgical correction of human thoracic and lumbar spinal disease from the antero-lateral aspect of the spine |
US5741253A (en) * | 1988-06-13 | 1998-04-21 | Michelson; Gary Karlin | Method for inserting spinal implants |
US5015255A (en) * | 1989-05-10 | 1991-05-14 | Spine-Tech, Inc. | Spinal stabilization method |
US5055104A (en) * | 1989-11-06 | 1991-10-08 | Surgical Dynamics, Inc. | Surgically implanting threaded fusion cages between adjacent low-back vertebrae by an anterior approach |
US5899901A (en) * | 1991-05-18 | 1999-05-04 | Middleton; Jeffrey Keith | Spinal fixation system |
US5865834A (en) * | 1991-12-13 | 1999-02-02 | Mcguire; David A. | Coring reamer |
US5947971A (en) * | 1993-02-10 | 1999-09-07 | Sulzer Spine-Tech Inc. | Spinal stabilization surgical apparatus |
US5489307A (en) * | 1993-02-10 | 1996-02-06 | Spine-Tech, Inc. | Spinal stabilization surgical method |
US5899908A (en) * | 1993-02-10 | 1999-05-04 | Sulzer Spine-Tech Inc. | Spinal drill tube guide |
US5720748A (en) * | 1993-02-10 | 1998-02-24 | Spine-Tech, Inc. | Spinal stabilization surgical apparatus |
US5571109A (en) * | 1993-08-26 | 1996-11-05 | Man Ceramics Gmbh | System for the immobilization of vertebrae |
US5514180A (en) * | 1994-01-14 | 1996-05-07 | Heggeness; Michael H. | Prosthetic intervertebral devices |
US5431658A (en) * | 1994-02-14 | 1995-07-11 | Moskovich; Ronald | Facilitator for vertebrae grafts and prostheses |
US5609636A (en) * | 1994-05-23 | 1997-03-11 | Spine-Tech, Inc. | Spinal implant |
US5569205A (en) * | 1994-07-14 | 1996-10-29 | Hart; Charles C. | Multiport trocar |
US5885299A (en) * | 1994-09-15 | 1999-03-23 | Surgical Dynamics, Inc. | Apparatus and method for implant insertion |
US6033405A (en) * | 1994-09-15 | 2000-03-07 | Surgical Dynamics, Inc. | Apparatus and method for implant insertion |
US5759185A (en) * | 1994-10-24 | 1998-06-02 | Smith & Nephew, Inc. | Surgical instrument |
US5766252A (en) * | 1995-01-24 | 1998-06-16 | Osteonics Corp. | Interbody spinal prosthetic implant and method |
US5556399A (en) * | 1995-02-14 | 1996-09-17 | Huebner; Randall J. | Bone-harvesting drill apparatus and method for its use |
US6224595B1 (en) * | 1995-02-17 | 2001-05-01 | Sofamor Danek Holdings, Inc. | Method for inserting a spinal implant |
US6083225A (en) * | 1996-03-14 | 2000-07-04 | Surgical Dynamics, Inc. | Method and instrumentation for implant insertion |
US6159214A (en) * | 1996-07-31 | 2000-12-12 | Michelson; Gary K. | Milling instrumentation and method for preparing a space between adjacent vertebral bodies |
US5968098A (en) * | 1996-10-22 | 1999-10-19 | Surgical Dynamics, Inc. | Apparatus for fusing adjacent bone structures |
US5865847A (en) * | 1997-03-06 | 1999-02-02 | Sulzer Spine-Tech Inc. | Lordotic spinal implant |
US6120506A (en) * | 1997-03-06 | 2000-09-19 | Sulzer Spine-Tech Inc. | Lordotic spinal implant |
US6063088A (en) * | 1997-03-24 | 2000-05-16 | United States Surgical Corporation | Method and instrumentation for implant insertion |
US6042582A (en) * | 1997-05-20 | 2000-03-28 | Ray; Charles D. | Instrumentation and method for facilitating insertion of spinal implant |
US6059790A (en) * | 1997-08-29 | 2000-05-09 | Sulzer Spine-Tech Inc. | Apparatus and method for spinal stabilization |
US6086595A (en) * | 1997-08-29 | 2000-07-11 | Sulzer Spine-Tech Inc. | Apparatus and method for spinal stabilization |
US6004326A (en) * | 1997-09-10 | 1999-12-21 | United States Surgical | Method and instrumentation for implant insertion |
US6156595A (en) * | 1997-10-08 | 2000-12-05 | Sawada; Shigeki | Method of fabricating a Bi-CMOS IC device including a self-alignment bipolar transistor capable of high speed operation |
US6171339B1 (en) * | 1998-05-19 | 2001-01-09 | Sulzer Spine-Tech Inc. | Multi-lumen spinal implant guide and method |
US6258125B1 (en) * | 1998-08-03 | 2001-07-10 | Synthes (U.S.A.) | Intervertebral allograft spacer |
US6174311B1 (en) * | 1998-10-28 | 2001-01-16 | Sdgi Holdings, Inc. | Interbody fusion grafts and instrumentation |
US6224607B1 (en) * | 1999-01-25 | 2001-05-01 | Gary K. Michelson | Instrumentation and method for creating an intervertebral space for receiving an implant |
US6575981B1 (en) * | 1999-02-04 | 2003-06-10 | Sdgi Holdings, Inc. | Methods and instrumentation for vertebral interbody fusion |
US6056749A (en) * | 1999-03-15 | 2000-05-02 | Spineology, Inc. | Method and device for fixing and correcting spondylolisthesis anteriorly |
US6113602A (en) * | 1999-03-26 | 2000-09-05 | Sulzer Spine-Tech Inc. | Posterior spinal instrument guide and method |
US6224599B1 (en) * | 1999-05-19 | 2001-05-01 | Matthew G. Baynham | Viewable wedge distractor device |
US6582437B2 (en) * | 1999-08-26 | 2003-06-24 | Sdgi Holdings, Inc. | Devices and methods for implanting fusion cages |
US6277122B1 (en) * | 1999-10-15 | 2001-08-21 | Sdgi Holdings, Inc. | Distraction instrument with fins for maintaining insertion location |
US6447512B1 (en) * | 2000-01-06 | 2002-09-10 | Spinal Concepts, Inc. | Instrument and method for implanting an interbody fusion device |
US6648895B2 (en) * | 2000-02-04 | 2003-11-18 | Sdgi Holdings, Inc. | Methods and instrumentation for vertebral interbody fusion |
Cited By (176)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8579909B2 (en) | 1999-02-04 | 2013-11-12 | Warsaw Orthopedic, Inc | Methods and instrument for vertebral interbody fusion |
US20070288007A1 (en) * | 1999-02-04 | 2007-12-13 | Burkus J K | Methods and instrument for vertebral interbody fusion |
US8540717B2 (en) | 2000-05-01 | 2013-09-24 | Arthrosurface Incorporated | System and method for joint resurface repair |
US9204873B2 (en) | 2000-05-01 | 2015-12-08 | Arthrosurface Incorporated | System and method for joint resurface repair |
US8864827B2 (en) | 2000-05-01 | 2014-10-21 | Arthrosurface Inc. | System and method for joint resurface repair |
US9055955B2 (en) | 2000-05-01 | 2015-06-16 | Arthrosurface Inc. | Bone resurfacing system and method |
US9357989B2 (en) | 2000-05-01 | 2016-06-07 | Arthrosurface Incorporated | System and method for joint resurface repair |
US8556902B2 (en) | 2002-12-03 | 2013-10-15 | Arthrosurface Incorporated | System and method for retrograde procedure |
US10076343B2 (en) | 2002-12-03 | 2018-09-18 | Arthrosurface Incorporated | System for articular surface replacement |
US8523872B2 (en) | 2002-12-03 | 2013-09-03 | Arthrosurface Incorporated | Tibial resurfacing system |
US9044343B2 (en) | 2002-12-03 | 2015-06-02 | Arthrosurface Incorporated | System for articular surface replacement |
US8926615B2 (en) | 2002-12-03 | 2015-01-06 | Arthrosurface, Inc. | System and method for retrograde procedure |
US8663230B2 (en) | 2002-12-03 | 2014-03-04 | Arthrosurface Incorporated | Retrograde delivery of resurfacing devices |
US10555817B2 (en) | 2003-02-14 | 2020-02-11 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US11207187B2 (en) | 2003-02-14 | 2021-12-28 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10433971B2 (en) | 2003-02-14 | 2019-10-08 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US11432938B2 (en) | 2003-02-14 | 2022-09-06 | DePuy Synthes Products, Inc. | In-situ intervertebral fusion device and method |
US10492918B2 (en) | 2003-02-14 | 2019-12-03 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US11096794B2 (en) | 2003-02-14 | 2021-08-24 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10420651B2 (en) | 2003-02-14 | 2019-09-24 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10575959B2 (en) | 2003-02-14 | 2020-03-03 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10583013B2 (en) | 2003-02-14 | 2020-03-10 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US9814589B2 (en) | 2003-02-14 | 2017-11-14 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10405986B2 (en) | 2003-02-14 | 2019-09-10 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US9814590B2 (en) | 2003-02-14 | 2017-11-14 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10376372B2 (en) | 2003-02-14 | 2019-08-13 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10639164B2 (en) | 2003-02-14 | 2020-05-05 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10786361B2 (en) | 2003-02-14 | 2020-09-29 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US10085843B2 (en) | 2003-02-14 | 2018-10-02 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US9808351B2 (en) | 2003-02-14 | 2017-11-07 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US9801729B2 (en) | 2003-02-14 | 2017-10-31 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US9925060B2 (en) | 2003-02-14 | 2018-03-27 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US9788963B2 (en) | 2003-02-14 | 2017-10-17 | DePuy Synthes Products, Inc. | In-situ formed intervertebral fusion device and method |
US9931211B2 (en) | 2003-02-24 | 2018-04-03 | Arthrosurface Incorporated | Trochlear resurfacing system and method |
US9351745B2 (en) | 2003-02-24 | 2016-05-31 | Arthrosurface Incorporated | Trochlear resurfacing system and method |
US11337819B2 (en) | 2003-02-24 | 2022-05-24 | Arthrosurface Incorporated | Trochlear resurfacing system and method |
US10624749B2 (en) | 2003-02-24 | 2020-04-21 | Arthrosurface Incorporated | Trochlear resurfacing system and method |
US8814940B2 (en) | 2004-03-29 | 2014-08-26 | Nuvasive, Inc. | Systems and methods for spinal fusion |
US9474627B2 (en) | 2004-03-29 | 2016-10-25 | Nuvasive, Inc. | Systems and methods for spinal fusion |
US9180021B2 (en) | 2004-03-29 | 2015-11-10 | Nuvasive, Inc. | Systems and methods for spinal fusion |
US9744053B2 (en) | 2004-03-29 | 2017-08-29 | Nuvasive, Inc. | Systems and methods for spinal fusion |
US8685105B2 (en) * | 2004-03-29 | 2014-04-01 | Nuvasive, Inc. | Systems and methods for spinal fusion |
US20050251192A1 (en) * | 2004-03-31 | 2005-11-10 | Shluzas Alan E | Access device having discrete visualization locations |
US8048084B2 (en) | 2004-09-08 | 2011-11-01 | Aesculap Ag | Surgical instrument |
US20060058808A1 (en) * | 2004-09-08 | 2006-03-16 | Susanne Schneid | Surgical instrument |
US8961614B2 (en) | 2004-11-22 | 2015-02-24 | Arthrosurface, Inc. | Articular surface implant and delivery system |
US20060217806A1 (en) * | 2005-03-28 | 2006-09-28 | Peterman Marc M | Spinal system and method including lateral approach |
US20060217807A1 (en) * | 2005-03-28 | 2006-09-28 | Peterman Marc M | Spinal device including lateral approach |
US7749269B2 (en) | 2005-03-28 | 2010-07-06 | Warsaw Orthopedic, Inc. | Spinal system and method including lateral approach |
US7763078B2 (en) | 2005-03-28 | 2010-07-27 | Warsaw Orthopedic, Inc. | Spinal device including lateral approach |
US7776095B2 (en) | 2005-03-28 | 2010-08-17 | Warsaw Orthopedic, Inc. | Spinal system and method including lateral approach |
US7988734B2 (en) | 2005-03-28 | 2011-08-02 | Warsaw Orthopedic, Inc. | Spinal system and method including lateral approach |
US9259326B2 (en) | 2005-08-16 | 2016-02-16 | Benvenue Medical, Inc. | Spinal tissue distraction devices |
US8961609B2 (en) | 2005-08-16 | 2015-02-24 | Benvenue Medical, Inc. | Devices for distracting tissue layers of the human spine |
US8057544B2 (en) | 2005-08-16 | 2011-11-15 | Benvenue Medical, Inc. | Methods of distracting tissue layers of the human spine |
US8808376B2 (en) | 2005-08-16 | 2014-08-19 | Benvenue Medical, Inc. | Intravertebral implants |
US9044338B2 (en) | 2005-08-16 | 2015-06-02 | Benvenue Medical, Inc. | Spinal tissue distraction devices |
US8591583B2 (en) | 2005-08-16 | 2013-11-26 | Benvenue Medical, Inc. | Devices for treating the spine |
US8979929B2 (en) | 2005-08-16 | 2015-03-17 | Benvenue Medical, Inc. | Spinal tissue distraction devices |
US7967865B2 (en) | 2005-08-16 | 2011-06-28 | Benvenue Medical, Inc. | Devices for limiting the movement of material introduced between layers of spinal tissue |
US8801787B2 (en) | 2005-08-16 | 2014-08-12 | Benvenue Medical, Inc. | Methods of distracting tissue layers of the human spine |
US7967864B2 (en) | 2005-08-16 | 2011-06-28 | Benvenue Medical, Inc. | Spinal tissue distraction devices |
US7963993B2 (en) | 2005-08-16 | 2011-06-21 | Benvenue Medical, Inc. | Methods of distracting tissue layers of the human spine |
US7955391B2 (en) | 2005-08-16 | 2011-06-07 | Benvenue Medical, Inc. | Methods for limiting the movement of material introduced between layers of spinal tissue |
US9326866B2 (en) | 2005-08-16 | 2016-05-03 | Benvenue Medical, Inc. | Devices for treating the spine |
US7785368B2 (en) | 2005-08-16 | 2010-08-31 | Benvenue Medical, Inc. | Spinal tissue distraction devices |
US8366773B2 (en) | 2005-08-16 | 2013-02-05 | Benvenue Medical, Inc. | Apparatus and method for treating bone |
US9066808B2 (en) | 2005-08-16 | 2015-06-30 | Benvenue Medical, Inc. | Method of interdigitating flowable material with bone tissue |
US8454617B2 (en) | 2005-08-16 | 2013-06-04 | Benvenue Medical, Inc. | Devices for treating the spine |
US8556978B2 (en) | 2005-08-16 | 2013-10-15 | Benvenue Medical, Inc. | Devices and methods for treating the vertebral body |
US9788974B2 (en) | 2005-08-16 | 2017-10-17 | Benvenue Medical, Inc. | Spinal tissue distraction devices |
US7670374B2 (en) | 2005-08-16 | 2010-03-02 | Benvenue Medical, Inc. | Methods of distracting tissue layers of the human spine |
US7670375B2 (en) | 2005-08-16 | 2010-03-02 | Benvenue Medical, Inc. | Methods for limiting the movement of material introduced between layers of spinal tissue |
US10028840B2 (en) | 2005-08-16 | 2018-07-24 | Izi Medical Products, Llc | Spinal tissue distraction devices |
US7666226B2 (en) | 2005-08-16 | 2010-02-23 | Benvenue Medical, Inc. | Spinal tissue distraction devices |
US8882836B2 (en) | 2005-08-16 | 2014-11-11 | Benvenue Medical, Inc. | Apparatus and method for treating bone |
US7666227B2 (en) | 2005-08-16 | 2010-02-23 | Benvenue Medical, Inc. | Devices for limiting the movement of material introduced between layers of spinal tissue |
US20100121388A1 (en) * | 2006-04-20 | 2010-05-13 | Eric Flickinger | Monorail System |
US8790403B2 (en) * | 2006-04-20 | 2014-07-29 | K2M, Inc. | Monorail system |
US11471289B2 (en) | 2006-07-17 | 2022-10-18 | Arthrosurface Incorporated | Tibial resurfacing system and method |
US20110213375A1 (en) * | 2006-07-17 | 2011-09-01 | Arthrosurface, Inc. | Tibial Resurfacing System and Method |
US10624752B2 (en) | 2006-07-17 | 2020-04-21 | Arthrosurface Incorporated | Tibial resurfacing system and method |
US11273050B2 (en) | 2006-12-07 | 2022-03-15 | DePuy Synthes Products, Inc. | Intervertebral implant |
US11642229B2 (en) | 2006-12-07 | 2023-05-09 | DePuy Synthes Products, Inc. | Intervertebral implant |
US11660206B2 (en) | 2006-12-07 | 2023-05-30 | DePuy Synthes Products, Inc. | Intervertebral implant |
US11712345B2 (en) | 2006-12-07 | 2023-08-01 | DePuy Synthes Products, Inc. | Intervertebral implant |
US11432942B2 (en) | 2006-12-07 | 2022-09-06 | DePuy Synthes Products, Inc. | Intervertebral implant |
US11497618B2 (en) | 2006-12-07 | 2022-11-15 | DePuy Synthes Products, Inc. | Intervertebral implant |
US10959740B2 (en) | 2006-12-11 | 2021-03-30 | Arthrosurface Incorporated | Retrograde resection apparatus and method |
US9358029B2 (en) | 2006-12-11 | 2016-06-07 | Arthrosurface Incorporated | Retrograde resection apparatus and method |
US10045788B2 (en) | 2006-12-11 | 2018-08-14 | Arthrosurface Incorporated | Retrograde resection apparatus and method |
US20080221586A1 (en) * | 2007-02-09 | 2008-09-11 | Alphatec Spine, Inc. | Curviliner spinal access method and device |
US8152714B2 (en) | 2007-02-09 | 2012-04-10 | Alphatec Spine, Inc. | Curviliner spinal access method and device |
US10426629B2 (en) | 2007-02-21 | 2019-10-01 | Benvenue Medical, Inc. | Devices for treating the spine |
US9642712B2 (en) | 2007-02-21 | 2017-05-09 | Benvenue Medical, Inc. | Methods for treating the spine |
US10575963B2 (en) | 2007-02-21 | 2020-03-03 | Benvenue Medical, Inc. | Devices for treating the spine |
US8968408B2 (en) | 2007-02-21 | 2015-03-03 | Benvenue Medical, Inc. | Devices for treating the spine |
US10285821B2 (en) | 2007-02-21 | 2019-05-14 | Benvenue Medical, Inc. | Devices for treating the spine |
US9186261B2 (en) | 2007-03-07 | 2015-11-17 | Nuvasive, Inc. | System and methods for spinal fusion |
US9486329B2 (en) | 2007-03-07 | 2016-11-08 | Nuvasive, Inc. | System and methods for spinal fusion |
US11638652B2 (en) | 2007-03-07 | 2023-05-02 | Nuvasive, Inc. | Systems and methods for spinal fusion |
US9918852B2 (en) | 2007-03-07 | 2018-03-20 | Nuvasive, Inc. | System and methods for spinal fusion |
US11622868B2 (en) | 2007-06-26 | 2023-04-11 | DePuy Synthes Products, Inc. | Highly lordosed fusion cage |
US10973652B2 (en) | 2007-06-26 | 2021-04-13 | DePuy Synthes Products, Inc. | Highly lordosed fusion cage |
US11737881B2 (en) | 2008-01-17 | 2023-08-29 | DePuy Synthes Products, Inc. | Expandable intervertebral implant and associated method of manufacturing the same |
US10842646B2 (en) | 2008-02-29 | 2020-11-24 | Nuvasive, In.C | Implants and methods for spinal fusion |
US9168152B2 (en) | 2008-02-29 | 2015-10-27 | Nuvasive, Inc. | Implants and methods for spinal fusion |
US9907672B1 (en) | 2008-02-29 | 2018-03-06 | Nuvasive, Inc. | Implants and methods for spinal fusion |
US11617655B2 (en) | 2008-04-05 | 2023-04-04 | DePuy Synthes Products, Inc. | Expandable intervertebral implant |
US11701234B2 (en) | 2008-04-05 | 2023-07-18 | DePuy Synthes Products, Inc. | Expandable intervertebral implant |
US11707359B2 (en) | 2008-04-05 | 2023-07-25 | DePuy Synthes Products, Inc. | Expandable intervertebral implant |
US11712341B2 (en) | 2008-04-05 | 2023-08-01 | DePuy Synthes Products, Inc. | Expandable intervertebral implant |
US11712342B2 (en) | 2008-04-05 | 2023-08-01 | DePuy Synthes Products, Inc. | Expandable intervertebral implant |
US11602438B2 (en) | 2008-04-05 | 2023-03-14 | DePuy Synthes Products, Inc. | Expandable intervertebral implant |
US20110144469A1 (en) * | 2008-05-07 | 2011-06-16 | Patraicia Connolly | Bacterial/Cellular Recognition Impedance Algorithm |
USD797934S1 (en) | 2009-03-02 | 2017-09-19 | Nuvasive, Inc. | Spinal fusion implant |
USD754346S1 (en) | 2009-03-02 | 2016-04-19 | Nuvasive, Inc. | Spinal fusion implant |
US8535327B2 (en) | 2009-03-17 | 2013-09-17 | Benvenue Medical, Inc. | Delivery apparatus for use with implantable medical devices |
US11612491B2 (en) | 2009-03-30 | 2023-03-28 | DePuy Synthes Products, Inc. | Zero profile spinal fusion cage |
US11478259B2 (en) | 2009-04-17 | 2022-10-25 | Arthrosurface, Incorporated | Glenoid resurfacing system and method |
US9662126B2 (en) | 2009-04-17 | 2017-05-30 | Arthrosurface Incorporated | Glenoid resurfacing system and method |
US10945743B2 (en) | 2009-04-17 | 2021-03-16 | Arthrosurface Incorporated | Glenoid repair system and methods of use thereof |
US10478200B2 (en) | 2009-04-17 | 2019-11-19 | Arthrosurface Incorporated | Glenoid resurfacing system and method |
US9283076B2 (en) | 2009-04-17 | 2016-03-15 | Arthrosurface Incorporated | Glenoid resurfacing system and method |
US11607321B2 (en) | 2009-12-10 | 2023-03-21 | DePuy Synthes Products, Inc. | Bellows-like expandable interbody fusion cage |
US10966840B2 (en) | 2010-06-24 | 2021-04-06 | DePuy Synthes Products, Inc. | Enhanced cage insertion assembly |
US11911287B2 (en) | 2010-06-24 | 2024-02-27 | DePuy Synthes Products, Inc. | Lateral spondylolisthesis reduction cage |
US11872139B2 (en) | 2010-06-24 | 2024-01-16 | DePuy Synthes Products, Inc. | Enhanced cage insertion assembly |
US11654033B2 (en) | 2010-06-29 | 2023-05-23 | DePuy Synthes Products, Inc. | Distractible intervertebral implant |
US20120029639A1 (en) * | 2010-07-29 | 2012-02-02 | Warsaw Orthopedic, Inc. | Interbody spinal implants and insertion techniques |
US11452607B2 (en) | 2010-10-11 | 2022-09-27 | DePuy Synthes Products, Inc. | Expandable interspinous process spacer implant |
US9066716B2 (en) | 2011-03-30 | 2015-06-30 | Arthrosurface Incorporated | Suture coil and suture sheath for tissue repair |
US9314252B2 (en) | 2011-06-24 | 2016-04-19 | Benvenue Medical, Inc. | Devices and methods for treating bone tissue |
US8814873B2 (en) | 2011-06-24 | 2014-08-26 | Benvenue Medical, Inc. | Devices and methods for treating bone tissue |
US9198765B1 (en) | 2011-10-31 | 2015-12-01 | Nuvasive, Inc. | Expandable spinal fusion implants and related methods |
US9655744B1 (en) | 2011-10-31 | 2017-05-23 | Nuvasive, Inc. | Expandable spinal fusion implants and related methods |
US11712276B2 (en) | 2011-12-22 | 2023-08-01 | Arthrosurface Incorporated | System and method for bone fixation |
US9468448B2 (en) | 2012-07-03 | 2016-10-18 | Arthrosurface Incorporated | System and method for joint resurfacing and repair |
US10307172B2 (en) | 2012-07-03 | 2019-06-04 | Arthrosurface Incorporated | System and method for joint resurfacing and repair |
US11191552B2 (en) | 2012-07-03 | 2021-12-07 | Arthrosurface, Incorporated | System and method for joint resurfacing and repair |
US8951258B2 (en) | 2013-03-01 | 2015-02-10 | Warsaw Orthopedic, Inc. | Spinal correction system and method |
US11497619B2 (en) | 2013-03-07 | 2022-11-15 | DePuy Synthes Products, Inc. | Intervertebral implant |
US11850164B2 (en) | 2013-03-07 | 2023-12-26 | DePuy Synthes Products, Inc. | Intervertebral implant |
US10085783B2 (en) | 2013-03-14 | 2018-10-02 | Izi Medical Products, Llc | Devices and methods for treating bone tissue |
US9492200B2 (en) | 2013-04-16 | 2016-11-15 | Arthrosurface Incorporated | Suture system and method |
US11648036B2 (en) | 2013-04-16 | 2023-05-16 | Arthrosurface Incorporated | Suture system and method |
US10695096B2 (en) | 2013-04-16 | 2020-06-30 | Arthrosurface Incorporated | Suture system and method |
US11607319B2 (en) | 2014-03-07 | 2023-03-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
US9861492B2 (en) | 2014-03-07 | 2018-01-09 | Arthrosurface Incorporated | Anchor for an implant assembly |
US11766334B2 (en) | 2014-03-07 | 2023-09-26 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
US9962265B2 (en) | 2014-03-07 | 2018-05-08 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
US10624748B2 (en) | 2014-03-07 | 2020-04-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
US10624754B2 (en) | 2014-03-07 | 2020-04-21 | Arthrosurface Incorporated | System and method for repairing articular surfaces |
US9931219B2 (en) | 2014-03-07 | 2018-04-03 | Arthrosurface Incorporated | Implant and anchor assembly |
US10575957B2 (en) | 2014-03-07 | 2020-03-03 | Arthrosurface Incoporated | Anchor for an implant assembly |
US11083587B2 (en) | 2014-03-07 | 2021-08-10 | Arthrosurface Incorporated | Implant and anchor assembly |
US11426290B2 (en) | 2015-03-06 | 2022-08-30 | DePuy Synthes Products, Inc. | Expandable intervertebral implant, system, kit and method |
US11510788B2 (en) | 2016-06-28 | 2022-11-29 | Eit Emerging Implant Technologies Gmbh | Expandable, angularly adjustable intervertebral cages |
US11596523B2 (en) | 2016-06-28 | 2023-03-07 | Eit Emerging Implant Technologies Gmbh | Expandable and angularly adjustable articulating intervertebral cages |
US11596522B2 (en) | 2016-06-28 | 2023-03-07 | Eit Emerging Implant Technologies Gmbh | Expandable and angularly adjustable intervertebral cages with articulating joint |
US10888433B2 (en) | 2016-12-14 | 2021-01-12 | DePuy Synthes Products, Inc. | Intervertebral implant inserter and related methods |
US11446155B2 (en) | 2017-05-08 | 2022-09-20 | Medos International Sarl | Expandable cage |
US20180338783A1 (en) * | 2017-05-25 | 2018-11-29 | Warsaw Orthopedic, Inc | Spinal implant system and method |
US10736672B2 (en) * | 2017-05-25 | 2020-08-11 | Warsaw Orthopedic, Inc. | Spinal implant system and method |
US11344424B2 (en) | 2017-06-14 | 2022-05-31 | Medos International Sarl | Expandable intervertebral implant and related methods |
US10940016B2 (en) | 2017-07-05 | 2021-03-09 | Medos International Sarl | Expandable intervertebral fusion cage |
US11160663B2 (en) | 2017-08-04 | 2021-11-02 | Arthrosurface Incorporated | Multicomponent articular surface implant |
CN108742821A (en) * | 2018-03-27 | 2018-11-06 | 李莉 | A kind of minimally invasive plate osteosynthesis sets nail guider |
US11497536B2 (en) * | 2018-03-28 | 2022-11-15 | Warsaw Orthopedic, Inc. | Surgical instrument and method |
US11446156B2 (en) | 2018-10-25 | 2022-09-20 | Medos International Sarl | Expandable intervertebral implant, inserter instrument, and related methods |
US11478358B2 (en) | 2019-03-12 | 2022-10-25 | Arthrosurface Incorporated | Humeral and glenoid articular surface implant systems and methods |
US11382671B2 (en) | 2019-06-25 | 2022-07-12 | Warsaw Orthopedic, Inc. | Surgical instrument and method |
US11426286B2 (en) | 2020-03-06 | 2022-08-30 | Eit Emerging Implant Technologies Gmbh | Expandable intervertebral implant |
US11806245B2 (en) | 2020-03-06 | 2023-11-07 | Eit Emerging Implant Technologies Gmbh | Expandable intervertebral implant |
US11850160B2 (en) | 2021-03-26 | 2023-12-26 | Medos International Sarl | Expandable lordotic intervertebral fusion cage |
US11752009B2 (en) | 2021-04-06 | 2023-09-12 | Medos International Sarl | Expandable intervertebral fusion cage |
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