CA2081801C - Surgical apparatus - Google Patents
Surgical apparatus Download PDFInfo
- Publication number
- CA2081801C CA2081801C CA002081801A CA2081801A CA2081801C CA 2081801 C CA2081801 C CA 2081801C CA 002081801 A CA002081801 A CA 002081801A CA 2081801 A CA2081801 A CA 2081801A CA 2081801 C CA2081801 C CA 2081801C
- Authority
- CA
- Canada
- Prior art keywords
- jig
- access cannula
- cannula
- disc
- bore
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00261—Discectomy
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S128/00—Surgery
- Y10S128/26—Cannula supporters
Abstract
There is described a jig for use in percutaneous decompression of a herniated disc by means of an access cannula that is percutaneously advanced into the nucleus of the disc, comprising means for removably attaching said jig to said access cannula which jig is provided with secondary means adapted to slidingly receive an accessory member, and a method of surgery using said jig.
Description
20~1~~1 Surgical Apparatus This invention relates to novel surgical apparatus.
Low back pain syndrome with sciatica secondary to herniated intervertebral discs represents a major health problem. An intervertebral disc is a structure which occupies the space between the vertebrae and acts, among other things, as a shock absorbing cushion. A normal intervertebral disc consists of two parts: a central part known as the "nucleus" and a surrounding part known as the "annulus fibrosis". The annulus fibrosis degenerates with age, as does the nucleus. Degeneration of the intervertebral disc is characterized by collagenation, in which some of the fluid content of the nucleus is lost and fragments of collagenized fibrous tissue are formed which float in the tissue fluid. At this stage of degeneration, external forces can readily increase the hydrostatic pressure on the nucleus, causing the fibres of the annulus fibrosis to rupture. Nucleus fragments protrude. This, in turn, may cause pressure on the adjacent nerve root with resultant pain. Degeneration of the disc may also be caused by other factors, for example, by accidental injury.
Several methods of treatment already exist. One method, usually referred to as "laminectomy" involves the surgical excision of the symptomatic portion of the herniated disc.
This method of treatment has been used for many years, however, typical hospitalization time is nine days.
Microsurgery has also been used in the treatment of herniated discs, in a procedure known as "microlumbar discectomy". This microsurgical procedure, although less invasive, nevertheless carries with it many of the complications associated with the older procedure, including injury to the nerve root and ducal sac, perineural scar formation, reherniation at the site of the surgery, and instability due to excess bone removal. Another method of treatment is known as chemonucleolysis, which is carried out by injection of the enzyme chymopapain into the disc structure. This procedure has many complications including severe pain and spasm, which may last up to several weeks following injection. Sensitivity reactions and anaphylactic shock occur in limited but significant numbers of patients.
A further method of treatment, automated percutaneous lumbar discectomy, utilizes a specially designed needle which is inserted into a ruptured disc space. The nucleus of the disc is removed by suction instead of open surgery.
Another method of treatment is discussed in US Patent 4,573,448 and involves the percutaneous evacuation of fragments of the herniated disc through an access cannula positioned against the annulus of the herniated disc. A
measure of safety and accuracy is added to this operative procedure by the arthroscopic visualization of the annulus and other important structures which lie in the path of the instruments, such as the spinal nerve. While this method is a considerable improvement over earlier procedures, nevertheless, this method does not enable a surgeon to directly view the resection of posterior nuclear Fragments.
That is, the internal diameter of the access cannula as described in US Patent 4,573,448 limits the design of an operating discoscope and limits the type and size of instruments that would allow for the visualization and ~Q~1~~~.
Low back pain syndrome with sciatica secondary to herniated intervertebral discs represents a major health problem. An intervertebral disc is a structure which occupies the space between the vertebrae and acts, among other things, as a shock absorbing cushion. A normal intervertebral disc consists of two parts: a central part known as the "nucleus" and a surrounding part known as the "annulus fibrosis". The annulus fibrosis degenerates with age, as does the nucleus. Degeneration of the intervertebral disc is characterized by collagenation, in which some of the fluid content of the nucleus is lost and fragments of collagenized fibrous tissue are formed which float in the tissue fluid. At this stage of degeneration, external forces can readily increase the hydrostatic pressure on the nucleus, causing the fibres of the annulus fibrosis to rupture. Nucleus fragments protrude. This, in turn, may cause pressure on the adjacent nerve root with resultant pain. Degeneration of the disc may also be caused by other factors, for example, by accidental injury.
Several methods of treatment already exist. One method, usually referred to as "laminectomy" involves the surgical excision of the symptomatic portion of the herniated disc.
This method of treatment has been used for many years, however, typical hospitalization time is nine days.
Microsurgery has also been used in the treatment of herniated discs, in a procedure known as "microlumbar discectomy". This microsurgical procedure, although less invasive, nevertheless carries with it many of the complications associated with the older procedure, including injury to the nerve root and ducal sac, perineural scar formation, reherniation at the site of the surgery, and instability due to excess bone removal. Another method of treatment is known as chemonucleolysis, which is carried out by injection of the enzyme chymopapain into the disc structure. This procedure has many complications including severe pain and spasm, which may last up to several weeks following injection. Sensitivity reactions and anaphylactic shock occur in limited but significant numbers of patients.
A further method of treatment, automated percutaneous lumbar discectomy, utilizes a specially designed needle which is inserted into a ruptured disc space. The nucleus of the disc is removed by suction instead of open surgery.
Another method of treatment is discussed in US Patent 4,573,448 and involves the percutaneous evacuation of fragments of the herniated disc through an access cannula positioned against the annulus of the herniated disc. A
measure of safety and accuracy is added to this operative procedure by the arthroscopic visualization of the annulus and other important structures which lie in the path of the instruments, such as the spinal nerve. While this method is a considerable improvement over earlier procedures, nevertheless, this method does not enable a surgeon to directly view the resection of posterior nuclear Fragments.
That is, the internal diameter of the access cannula as described in US Patent 4,573,448 limits the design of an operating discoscope and limits the type and size of instruments that would allow for the visualization and ~Q~1~~~.
simultaneous suction, irrigation and resection of the nuclear material.
The introduction of a second portal to the annulus from the opposite side of a first portal has been reported by Schreiber and his co-workers in Clinical Orthopaedics and Related Research, Number 238, page 36, January 1989.
However, this bilateral, biportal procedure has a number of disadvantages in that it increases the operating room time, the exposure time to radiation for the physician, the patient and operating room personnel and also increases post-operative morbidity by involving both sides of the back and may cause excessive removal of nuclear material which increases the possibility for stenosis of the foramen and nerve root compression.
Thus, there is a need for a percutaneous procedure to create an accessory unilateral portal in the annulus adjacent to an already positioned access cannula with a minimal additional exposure of the patient, physician and operating roam staff to radiation and without unduly prolonging time spent in the operating room. A unilateral, biportal approach would allow for continuous visualization, identification and extraction of nuclear fragments from the disc under discoscopic control. Large central herniations and partially extruded fragments may be visualized and evacuated. Such a unilateral approach to place more than one percutaneous portal in, for example, the L5-S1 vertebral joint, is also highly desirable because this procedure requires deflection of the patient's spine to enable access on the one side, causing a corresponding restriction of z~~~~~.
access an the opposite side. Moreover, by using a unilateral biportal approach, instruments do not need to traverse across the disc nucleus from a second portal remote from the symptomatic side. Therefore, the amount of non-symptomatic nuclear material removed by the unilateral approach is decreased as compared to the bilateral, biportal approach. This is important in preventing collapse of disc space, which results in nerve compression and stenosis of the spinal canal. Also, another significant benefit of the unilateral approach is that the musculature and soft tissue and disc are traumatized on only one side of the back.
Such a method of surgery is of course highly complex and we have now found an instrument which is advantageous in that it may be utilised in a method of surgery for the percutaneous decompression of a herniated disc by means of an access cannula as aforementioned.
According to the invention we provide a jig for use in percutaneous decompression of a herniated disc by means of an access cannula that is gercutaneously advanced into the nucleus of the disc, comprising means for removably attaching said jig to said access cannula which jig is provided with secondary means adapted to slidingly receive an accessory member.
The means fox removably attaching said jig to said access cannula preferably comprises a primary bore through said jig coupled with a fixing means. A variety of fixing means may be used eg, a screw protruding into the primary bore thus urging the access cannula against the wall of the ~o~~~o~
primary bore. Alternatively said fixing means may comprise spaced apart legs which legs straddle said primary bore, terminating at free ends and an open slot between said legs extending from said free end to said primary bore which legs are provided with means for urging them towards one another thus constricting the walls of the primary bore against the access cannula.
The means for urging the legs towards one another may comprise any conventional means known in the art, eg. a spring clip, a nut and bolt or they may comprise a resilient material which permits the legs to be biassed together.
Preferably however, one leg is provided with a first aperture perpendicular to the primary bore and the second leg is provided with a second coaxial aperture to said first aperture which second agerture is screw threaded such that the legs may be urged together by a screw means.
The accessory member may comprise one or more conventional surgical instruments, but especially includes a guidewire and/or an accessory cannula.
In the initial method of surgery the secondary means may comprise at least one small bore through the jig. By the term small we mean small relative to the means for attaching the jig to the access cannula.
The jig preferably has a plurality of small bores, eg.
from 2 to 10, preferably from 2 to 7 and especially 5. The jig may however be provided with only 1 small bore, When the jig is provided with a plurality of small bores said small bores are preferably arranged with their axes parallel to one another. In addition the axes of the small bores should be parallel with axis of the access cannula when attached.
According to a further feature of the invention the secondary means may comprise an auxiliary bore for guiding an accessory cannula as it is percutaneously advanced into the nucleus of the disc. The feature of this secondary means is particularly useful in the later stages of the surgical method described herein.
The axis of the auxiliary bore when said jig is attached to said access cannula is spaced from and parallel to the axis of said access cannula. The size of the auxilliary bore may be varied according to the dimensions of the accessory cannula, but generally we prefer the cannulae and thus the bore sizes to be substantially the same.
The present invention is useful in that it provides a percutaneous surgical disc procedure, comprising the steps of percutaneously entering the back of the patient in a posterolateral direction with an access cannula, advancing said access cannula through a first percutaneously created fenestration of the annulus of the disc, percutaneously entering the back of the patient in a posterolateral direction with an accessory cannula, and advancing said accessory cannula through a second percutaneously created fenestration of the annulus adjacent to and on the same side of the disc as the first fenestration. According to the invention we provide a percutaneous surgical disc procedure 2~8~~~~
as hereinbefore described.
According to the invention we provide a first jig as herinbefore described in which the secondary member is at least one small bore and a second jig as herinbefore described in which the secondary member is an auxilliary bore which jigs may be used separately or sequentially in the percutaneous decompression of a herniated disc.
We further provide a kit containing a first and second jig as hereinbefore described and optionally containing one or more cannulae and/or one or more guidewires for use in the percutaneous decompression of a herniated disc.
The present invention may be used to provide a method for the percutaneous decompression of a herniated intervertebral disc in a human patient, which comprises percutaneously entering the back of the patient in a posterolateral direction with an access cannula, advancing the access cannula into the disc through a first percutaneously created fenestration of the annulus of the disc, percutaneausly entering the back of the patient in a posterolateral direction with an accessory cannula, advancing the accessory cannula into the disc through a second percutaneously created fenestration of the annulus adjacent to and on the same side of the disc as the first fenestration, removing nuclear material through one of the cannulae and observing the removal with an endoscope through the other cannula.
In a broader sense, the present invention may be used in _8_ a method of percutaneously emplacing at least two cannulae in a patient, comprising percutaneously entering the back of the patient in a posterolateral direction with a first cannula and advancing the first cannula into the body of the patient to a position where the distal end of the first cannula is at a first predetermined location inside the body and the proximal end thereof projects beyond the outer surface of the back, securing a guide means to the proximal end of the first cannula and using the guide means to guide a second cannula as it percutaneously enters the back of the patient in a posterolateral direction and is advanced to a second predetermined location relative to said first predetermined location.
The method requires only a small incision to place the cannulae, since this biportal approach utilizes unilateral placement. The unilateral biportal approach allows for continuous discoscopic control and visualization and provides adequate channels for fluid management, which significantly enhances the visual identification of the posterior annulus. The method in accordance with the invention may be carried out under local anesthesia, thus avoiding the risk of general anesthetics.
The present invention is illustrated in terms of its preferred embodiments in the accompanying drawings, in which:
Fig.1 is a plan view of a guide wire useful in the present invention;
zos~~a.~.
Fig.2 is a plan view, partly in section, of a cannulated obturator useful in the present invention;
Fig.3 is a plan view, partly in section, of an access cannula useful in the present invention;
Fig.4 is a plan view of a trephine useful in the present invention;
Fig.S is an elevational view of a first jig useful in the present invention;
Fig.6 is a view in section, taken along lines 6-6 in Fig.5;
Fig.7 is an elevational view in section of a sealing adaptor useful in the present invention;
Fig.B is an elevational view of a second jig useful in the present invention;
Fig.9 is a view in section, taken along the lines 9-9 in Fig. B;
Fig.lO is a schematic view of a first access cannula inserted into the herniated disc;
Fig.ll is a view similar to Fig.lO showing the use of the second jig to index a second access cannula relative to the first access cannula; and Fig. l2 is a schematic view showing two access cannulae placed in the body of the patient.
In the description that follows, instruments are generally made out of suitable austenitic stainless steel, unless otherwise specified. While the surgical procedure described herein refers to decompression of intervertebral lumbar discs, it is to be understood that the procedure is not limited to lumbar discectomy and may be used in any procedure for percutaneously emplacing at least two cannulae in a patient, such as an intervertebral disc procedure or operation.
According to the method of the present invention, the patient is positioned on a radiolucent table in the appropriate prone or lateral position and guidewire 10 (Fig. l), suitably of about 0.050 in. diameter, is advanced through the skin of the back posterolaterally under fluoroscopic observation until the guidewire 10 contacts the exterior symptomatic side of the annulus fibrosis of the herniated disc. Thereafter, the cannulated obturator 20 (Fig.2), having a lumen with a diameter slightly larger than that of the guidewire 10, is passed over the guidewire 10 until the cannulated obturator 20 contacts the external surface of the annulus fibrosis of the herniated disc. The removal of the guidewire 10 at this point is optional. An access cannula 30a (Fig.3), suitably of about 0.25 in. outer diameter and having external graduations 31 of 10 mm, is then gassed over the cannulated obturator 20 and advanced to the external surface of the annulus fibrosis. At this point, the guidewire 10 is removed if not previously ~OS~S~.
removed. The inner diameter of the access cannula 30a is sized to closely fit over the cannulated obturator 20. The cannulated obturator 20 is then removed, and a 3 mm or 5 mm trephine 40 (Fig.4) is introduced through the access cannula 30a. The trephine 40 has a plurality of saw teeth 40a or other cutting members. The trephine 40 is advanced into the annulus of the disc, with rotation, creating an annular fenestration (that is, a bore) through the annulus fibrosis into the nucleus. The trephine 40 is then removed.
The cannulated obturator 20 is reintroduced into the access cannula 30a and passed into the fenestration of the annulus. Fluoroscopic guidance may be utilized. The access cannula 30a is then advanced into the fenestration of the annulus, with rotary movement. After the access cannula 30a is in the proper position, the cannulated obturator 20 is removed. The proximal end of cannula 30a projects beyond the surface of the patient's back (not shown) while the distal end is in the position shown in Fig.lO. The procedure described for placement of cannula 30a into the annulus of the disc follows the procedure described in US
Patent 4,573,448. As is known, suitable local anesthetic is used as appropriate.
Referring to Fig.lO, the procedure described above locates the distal end of the access cannula 30a adjacent the herniation 100 of the disc 101, which protrudes toward the posterior ligament 102 thus placing pressure on the nerves 103, which causes the pain characteristic of a herniated lumbar disc. First jig 50 (Figs.5,6 and 10) is slid downwardiy over the proximal end of the access cannula ~~8~~~~.
30a by passing the access cannula 30a through the central bore 51 in the first jig 50. Jig 50 is secured in place near the proximal end of cannula 30a by tightening the screw 53 thereby clamping the legs 52a and 52b to the access cannula 30a.
First jig 50 preferably has a plurality of smaller bores 55 each having a diameter substantially the same as the diameter of the guidewire 10. The axes of the bores 55 are spaced from and are preferably parallel to the axis of the large bore 51. Alternatively, jig 50 may have only one smaller bore 55. Moreover, the bores 55 may be oblique to the axis of the large bore 51.
Under fluoroscopic observation, the guidewire 10 is slid through a selected one of the small bores 55 so that the guidewire 10 will ideally be centred on the annulus fibrosis. If necessary, a second guidewire 10 is passed through another of bores 55 and advanced toward the annulus fibrosis of the disc, while under fluoroscopic observation.
Proper positioning of the guidewire on the annulus is determined by palpation and, if necessary, by fluoroscopy.
The surgeon can then evaluate the placement of the guidewires and select the guidewire best positioned to provide the second fenestration of the annulus of the disc.
having selected the desired guidewire 10, the other guidewire, if any, is removed, and the guidewire 10 is then introduced through the fibres of the annulus fibrosis for a distance of about three to about four millimetres. Jig 50 is removed, leaving the guidewire 10 and access cannula 30a in place.
Second jig 70 (Figs.8,9 and 11) is secured to access cannula 30a near the proximal end by passing access cannula 30a through bore 70a, passing the guidewire 10 through bore 70b, and clamping legs 70c together by means of screw 70d.
Cannulated obturator 20 is then advanced over the guidewire by rotary movement through the bore 70b of the second jig 70 until the cannulated obturator 20 contacts the annulus fibrosis, as shown in Fig.ll. The guidewire 10 and jig 70 are removed leaving the cannulated obturator 20 in place.
An accessory cannula 30b is passed over the cannulated obturator 20 and advanced toward the annulus fibrosis.
Accessory cannula 30b is sized to slide in the annulus between bore 70b and the other surface of cannulated obturator 20. The cannulated obturator 20 is then removed, leaving the accessory cannula 30b in place.
Although it is presently preferred to use second jig 70, it is not necessary to do so. Moreover, while the bores 70a and 70b are presently preferred to be parallel, in some cases it may be desired to have one bore oblique to the other. Also, while it is presently preferred that cannulae 30a, 30b have the same inner and outer diameters, one may have a smaller inner and/or outer diameter than the other.
The annulus fibrosis is inspected endoscopically through the accessory cannula 30b, and if satisfactory, a trephine 40 is passed through the accessory cannula 30b and a second fenestration is cut through the annulus fibrosis into the nucleus. The trephine 40 is then removed. The accessory ~n8l~d~.~
cannula 30b is advanced into the annulus. Introduction of both cannulae into the annulus of the disc under fluoroscopic observation is carried out in a manner known er se, such as described in US Patent 4,573,488.
Fragments of the herniated disc can be removed through the desired cannula 30a or 30b by inserting a trephine 40 in the desired cannula and moving it back and forth within the nucleus of the herniated disc as suction is applied.
Alternatively, the trephine can be removed and suction may be applied through the cannula itself. In another method, forceps, trimmer blades, suction punch forceps, laser lights, etc. are used to remove such fragments via one of the cannula.
Preferably, however, before removal of nuclear material, a sealing adaptor 60 (Fig.7), which is suitably comprised of silicon rubber, is attached to the proximal extremity of the access cannula 30a and accessory cannula 30b, as shown in Fig.l2 with access cannula 30a and accessory cannula 30b received in boxes 61a and 61b of sealing adaptor 60.
Insertion of access cannula 30a and accessory cannula 30b into the sealing adaptor will stop when the cannulae contact shoulders 63 and 64, respectively of bores 61a and 61b.
Nuclear evacuation through one of the cannulae 30a or 30b and simultaneous arthroscopic observation via the other of cannulae 30a or 30b is possible by sealingly passing an arthroscope (not shown) into one of bores 62a and 62b and thence into one of cannulae 30a or cannula 30b, while a tool (not shown) is inserted into the other bore and thence into the other cannula. Nuclear material may then be evacuated by a conventional powered surgical instrument (not shown) through the access cannula 30a or accessory cannula 30b while under arthroscopic observation through the other cannula. A saline solution may be passed via the arthroscope through one cannula and excess fluid may be evacuated through the other cannula. Direct visualization of the resection of the desired disc material is thus made possible.
The introduction of a second portal to the annulus from the opposite side of a first portal has been reported by Schreiber and his co-workers in Clinical Orthopaedics and Related Research, Number 238, page 36, January 1989.
However, this bilateral, biportal procedure has a number of disadvantages in that it increases the operating room time, the exposure time to radiation for the physician, the patient and operating room personnel and also increases post-operative morbidity by involving both sides of the back and may cause excessive removal of nuclear material which increases the possibility for stenosis of the foramen and nerve root compression.
Thus, there is a need for a percutaneous procedure to create an accessory unilateral portal in the annulus adjacent to an already positioned access cannula with a minimal additional exposure of the patient, physician and operating roam staff to radiation and without unduly prolonging time spent in the operating room. A unilateral, biportal approach would allow for continuous visualization, identification and extraction of nuclear fragments from the disc under discoscopic control. Large central herniations and partially extruded fragments may be visualized and evacuated. Such a unilateral approach to place more than one percutaneous portal in, for example, the L5-S1 vertebral joint, is also highly desirable because this procedure requires deflection of the patient's spine to enable access on the one side, causing a corresponding restriction of z~~~~~.
access an the opposite side. Moreover, by using a unilateral biportal approach, instruments do not need to traverse across the disc nucleus from a second portal remote from the symptomatic side. Therefore, the amount of non-symptomatic nuclear material removed by the unilateral approach is decreased as compared to the bilateral, biportal approach. This is important in preventing collapse of disc space, which results in nerve compression and stenosis of the spinal canal. Also, another significant benefit of the unilateral approach is that the musculature and soft tissue and disc are traumatized on only one side of the back.
Such a method of surgery is of course highly complex and we have now found an instrument which is advantageous in that it may be utilised in a method of surgery for the percutaneous decompression of a herniated disc by means of an access cannula as aforementioned.
According to the invention we provide a jig for use in percutaneous decompression of a herniated disc by means of an access cannula that is gercutaneously advanced into the nucleus of the disc, comprising means for removably attaching said jig to said access cannula which jig is provided with secondary means adapted to slidingly receive an accessory member.
The means fox removably attaching said jig to said access cannula preferably comprises a primary bore through said jig coupled with a fixing means. A variety of fixing means may be used eg, a screw protruding into the primary bore thus urging the access cannula against the wall of the ~o~~~o~
primary bore. Alternatively said fixing means may comprise spaced apart legs which legs straddle said primary bore, terminating at free ends and an open slot between said legs extending from said free end to said primary bore which legs are provided with means for urging them towards one another thus constricting the walls of the primary bore against the access cannula.
The means for urging the legs towards one another may comprise any conventional means known in the art, eg. a spring clip, a nut and bolt or they may comprise a resilient material which permits the legs to be biassed together.
Preferably however, one leg is provided with a first aperture perpendicular to the primary bore and the second leg is provided with a second coaxial aperture to said first aperture which second agerture is screw threaded such that the legs may be urged together by a screw means.
The accessory member may comprise one or more conventional surgical instruments, but especially includes a guidewire and/or an accessory cannula.
In the initial method of surgery the secondary means may comprise at least one small bore through the jig. By the term small we mean small relative to the means for attaching the jig to the access cannula.
The jig preferably has a plurality of small bores, eg.
from 2 to 10, preferably from 2 to 7 and especially 5. The jig may however be provided with only 1 small bore, When the jig is provided with a plurality of small bores said small bores are preferably arranged with their axes parallel to one another. In addition the axes of the small bores should be parallel with axis of the access cannula when attached.
According to a further feature of the invention the secondary means may comprise an auxiliary bore for guiding an accessory cannula as it is percutaneously advanced into the nucleus of the disc. The feature of this secondary means is particularly useful in the later stages of the surgical method described herein.
The axis of the auxiliary bore when said jig is attached to said access cannula is spaced from and parallel to the axis of said access cannula. The size of the auxilliary bore may be varied according to the dimensions of the accessory cannula, but generally we prefer the cannulae and thus the bore sizes to be substantially the same.
The present invention is useful in that it provides a percutaneous surgical disc procedure, comprising the steps of percutaneously entering the back of the patient in a posterolateral direction with an access cannula, advancing said access cannula through a first percutaneously created fenestration of the annulus of the disc, percutaneously entering the back of the patient in a posterolateral direction with an accessory cannula, and advancing said accessory cannula through a second percutaneously created fenestration of the annulus adjacent to and on the same side of the disc as the first fenestration. According to the invention we provide a percutaneous surgical disc procedure 2~8~~~~
as hereinbefore described.
According to the invention we provide a first jig as herinbefore described in which the secondary member is at least one small bore and a second jig as herinbefore described in which the secondary member is an auxilliary bore which jigs may be used separately or sequentially in the percutaneous decompression of a herniated disc.
We further provide a kit containing a first and second jig as hereinbefore described and optionally containing one or more cannulae and/or one or more guidewires for use in the percutaneous decompression of a herniated disc.
The present invention may be used to provide a method for the percutaneous decompression of a herniated intervertebral disc in a human patient, which comprises percutaneously entering the back of the patient in a posterolateral direction with an access cannula, advancing the access cannula into the disc through a first percutaneously created fenestration of the annulus of the disc, percutaneausly entering the back of the patient in a posterolateral direction with an accessory cannula, advancing the accessory cannula into the disc through a second percutaneously created fenestration of the annulus adjacent to and on the same side of the disc as the first fenestration, removing nuclear material through one of the cannulae and observing the removal with an endoscope through the other cannula.
In a broader sense, the present invention may be used in _8_ a method of percutaneously emplacing at least two cannulae in a patient, comprising percutaneously entering the back of the patient in a posterolateral direction with a first cannula and advancing the first cannula into the body of the patient to a position where the distal end of the first cannula is at a first predetermined location inside the body and the proximal end thereof projects beyond the outer surface of the back, securing a guide means to the proximal end of the first cannula and using the guide means to guide a second cannula as it percutaneously enters the back of the patient in a posterolateral direction and is advanced to a second predetermined location relative to said first predetermined location.
The method requires only a small incision to place the cannulae, since this biportal approach utilizes unilateral placement. The unilateral biportal approach allows for continuous discoscopic control and visualization and provides adequate channels for fluid management, which significantly enhances the visual identification of the posterior annulus. The method in accordance with the invention may be carried out under local anesthesia, thus avoiding the risk of general anesthetics.
The present invention is illustrated in terms of its preferred embodiments in the accompanying drawings, in which:
Fig.1 is a plan view of a guide wire useful in the present invention;
zos~~a.~.
Fig.2 is a plan view, partly in section, of a cannulated obturator useful in the present invention;
Fig.3 is a plan view, partly in section, of an access cannula useful in the present invention;
Fig.4 is a plan view of a trephine useful in the present invention;
Fig.S is an elevational view of a first jig useful in the present invention;
Fig.6 is a view in section, taken along lines 6-6 in Fig.5;
Fig.7 is an elevational view in section of a sealing adaptor useful in the present invention;
Fig.B is an elevational view of a second jig useful in the present invention;
Fig.9 is a view in section, taken along the lines 9-9 in Fig. B;
Fig.lO is a schematic view of a first access cannula inserted into the herniated disc;
Fig.ll is a view similar to Fig.lO showing the use of the second jig to index a second access cannula relative to the first access cannula; and Fig. l2 is a schematic view showing two access cannulae placed in the body of the patient.
In the description that follows, instruments are generally made out of suitable austenitic stainless steel, unless otherwise specified. While the surgical procedure described herein refers to decompression of intervertebral lumbar discs, it is to be understood that the procedure is not limited to lumbar discectomy and may be used in any procedure for percutaneously emplacing at least two cannulae in a patient, such as an intervertebral disc procedure or operation.
According to the method of the present invention, the patient is positioned on a radiolucent table in the appropriate prone or lateral position and guidewire 10 (Fig. l), suitably of about 0.050 in. diameter, is advanced through the skin of the back posterolaterally under fluoroscopic observation until the guidewire 10 contacts the exterior symptomatic side of the annulus fibrosis of the herniated disc. Thereafter, the cannulated obturator 20 (Fig.2), having a lumen with a diameter slightly larger than that of the guidewire 10, is passed over the guidewire 10 until the cannulated obturator 20 contacts the external surface of the annulus fibrosis of the herniated disc. The removal of the guidewire 10 at this point is optional. An access cannula 30a (Fig.3), suitably of about 0.25 in. outer diameter and having external graduations 31 of 10 mm, is then gassed over the cannulated obturator 20 and advanced to the external surface of the annulus fibrosis. At this point, the guidewire 10 is removed if not previously ~OS~S~.
removed. The inner diameter of the access cannula 30a is sized to closely fit over the cannulated obturator 20. The cannulated obturator 20 is then removed, and a 3 mm or 5 mm trephine 40 (Fig.4) is introduced through the access cannula 30a. The trephine 40 has a plurality of saw teeth 40a or other cutting members. The trephine 40 is advanced into the annulus of the disc, with rotation, creating an annular fenestration (that is, a bore) through the annulus fibrosis into the nucleus. The trephine 40 is then removed.
The cannulated obturator 20 is reintroduced into the access cannula 30a and passed into the fenestration of the annulus. Fluoroscopic guidance may be utilized. The access cannula 30a is then advanced into the fenestration of the annulus, with rotary movement. After the access cannula 30a is in the proper position, the cannulated obturator 20 is removed. The proximal end of cannula 30a projects beyond the surface of the patient's back (not shown) while the distal end is in the position shown in Fig.lO. The procedure described for placement of cannula 30a into the annulus of the disc follows the procedure described in US
Patent 4,573,448. As is known, suitable local anesthetic is used as appropriate.
Referring to Fig.lO, the procedure described above locates the distal end of the access cannula 30a adjacent the herniation 100 of the disc 101, which protrudes toward the posterior ligament 102 thus placing pressure on the nerves 103, which causes the pain characteristic of a herniated lumbar disc. First jig 50 (Figs.5,6 and 10) is slid downwardiy over the proximal end of the access cannula ~~8~~~~.
30a by passing the access cannula 30a through the central bore 51 in the first jig 50. Jig 50 is secured in place near the proximal end of cannula 30a by tightening the screw 53 thereby clamping the legs 52a and 52b to the access cannula 30a.
First jig 50 preferably has a plurality of smaller bores 55 each having a diameter substantially the same as the diameter of the guidewire 10. The axes of the bores 55 are spaced from and are preferably parallel to the axis of the large bore 51. Alternatively, jig 50 may have only one smaller bore 55. Moreover, the bores 55 may be oblique to the axis of the large bore 51.
Under fluoroscopic observation, the guidewire 10 is slid through a selected one of the small bores 55 so that the guidewire 10 will ideally be centred on the annulus fibrosis. If necessary, a second guidewire 10 is passed through another of bores 55 and advanced toward the annulus fibrosis of the disc, while under fluoroscopic observation.
Proper positioning of the guidewire on the annulus is determined by palpation and, if necessary, by fluoroscopy.
The surgeon can then evaluate the placement of the guidewires and select the guidewire best positioned to provide the second fenestration of the annulus of the disc.
having selected the desired guidewire 10, the other guidewire, if any, is removed, and the guidewire 10 is then introduced through the fibres of the annulus fibrosis for a distance of about three to about four millimetres. Jig 50 is removed, leaving the guidewire 10 and access cannula 30a in place.
Second jig 70 (Figs.8,9 and 11) is secured to access cannula 30a near the proximal end by passing access cannula 30a through bore 70a, passing the guidewire 10 through bore 70b, and clamping legs 70c together by means of screw 70d.
Cannulated obturator 20 is then advanced over the guidewire by rotary movement through the bore 70b of the second jig 70 until the cannulated obturator 20 contacts the annulus fibrosis, as shown in Fig.ll. The guidewire 10 and jig 70 are removed leaving the cannulated obturator 20 in place.
An accessory cannula 30b is passed over the cannulated obturator 20 and advanced toward the annulus fibrosis.
Accessory cannula 30b is sized to slide in the annulus between bore 70b and the other surface of cannulated obturator 20. The cannulated obturator 20 is then removed, leaving the accessory cannula 30b in place.
Although it is presently preferred to use second jig 70, it is not necessary to do so. Moreover, while the bores 70a and 70b are presently preferred to be parallel, in some cases it may be desired to have one bore oblique to the other. Also, while it is presently preferred that cannulae 30a, 30b have the same inner and outer diameters, one may have a smaller inner and/or outer diameter than the other.
The annulus fibrosis is inspected endoscopically through the accessory cannula 30b, and if satisfactory, a trephine 40 is passed through the accessory cannula 30b and a second fenestration is cut through the annulus fibrosis into the nucleus. The trephine 40 is then removed. The accessory ~n8l~d~.~
cannula 30b is advanced into the annulus. Introduction of both cannulae into the annulus of the disc under fluoroscopic observation is carried out in a manner known er se, such as described in US Patent 4,573,488.
Fragments of the herniated disc can be removed through the desired cannula 30a or 30b by inserting a trephine 40 in the desired cannula and moving it back and forth within the nucleus of the herniated disc as suction is applied.
Alternatively, the trephine can be removed and suction may be applied through the cannula itself. In another method, forceps, trimmer blades, suction punch forceps, laser lights, etc. are used to remove such fragments via one of the cannula.
Preferably, however, before removal of nuclear material, a sealing adaptor 60 (Fig.7), which is suitably comprised of silicon rubber, is attached to the proximal extremity of the access cannula 30a and accessory cannula 30b, as shown in Fig.l2 with access cannula 30a and accessory cannula 30b received in boxes 61a and 61b of sealing adaptor 60.
Insertion of access cannula 30a and accessory cannula 30b into the sealing adaptor will stop when the cannulae contact shoulders 63 and 64, respectively of bores 61a and 61b.
Nuclear evacuation through one of the cannulae 30a or 30b and simultaneous arthroscopic observation via the other of cannulae 30a or 30b is possible by sealingly passing an arthroscope (not shown) into one of bores 62a and 62b and thence into one of cannulae 30a or cannula 30b, while a tool (not shown) is inserted into the other bore and thence into the other cannula. Nuclear material may then be evacuated by a conventional powered surgical instrument (not shown) through the access cannula 30a or accessory cannula 30b while under arthroscopic observation through the other cannula. A saline solution may be passed via the arthroscope through one cannula and excess fluid may be evacuated through the other cannula. Direct visualization of the resection of the desired disc material is thus made possible.
Claims (14)
1. A device for use in percutaneous decompression of a herniated disc by means of an access cannula that is percutaneously advanced into the nucleus of the disc, comprising a jig having a major bore adapted to slidingly receive and fixedly attach to the access cannula and a minor bore adapted to slidingly receive and permit the percutaneous advancement of a guidewire into the nucleus of the disc.
2. A device for use in percutaneous decompression of a herniated disc by means of an access cannula that is percutaneously advanced into the nucleus of the disc, comprising a jig having a major bore for slidingly receiving the access cannula and means for clamping the jig onto the access cannula so as to prevent the cannula from sliding with respect to the major bore.
3. A device for use in percutaneous decompression of a herniated disc by means of an access cannula that is percutaneously advanced into the nucleus of the disc, comprising a jig having a first major bore for slidingly receiving the access cannula and a second major bore adapted to slidingly receive an accessory cannula, the second major bore aligned with the first major bore so that the access cannula and the accessory cannula are both oriented for percutaneous advancement towards the disc nucleus when received by the first and the second major bores respectively.
4. A device according to claim 3 wherein the first major bore is adapted to fixedly attach to the access cannula so as to prevent the access cannula from sliding through the first major bore.
5. A kit for performing a percutaneous decompression of a herniated disc, comprising an access cannula having an elongated shaft and a first jig having a first bore adapted to slidingly receive the access cannula and a second bore adapted to slidingly receive a guidewire.
6. A kit according to claim 5 further comprising a second jig having a first bore adapted to slidingly receive the access cannula and a second bore adapted to slidingly receive an accessory cannula.
7. A kit according to claim 6 wherein a distance between the first and second bores of the first jig is substantially the same as a distance between the first and second bores of the second jig.
8. A kit according to claim 5 wherein the first jig is adapted to removably attach to the access cannula when the access cannula, is received by the first bore.
9. A kit according to claim 5 ft1her comprising a guidewire capable of being received by the second bore of the first jig and of being percutaneously advanced into the nucleus of the disc.
10. A kit for performing a percetaneous decompression of a herniated disc, comprising an access cannula, and a jig having a first bore adapted to slidingly receive the access cannula and a second bore adapted to slidingly receive an accessory cannula.
11. A device for use in percutaneous decompression of a herniated disc comprising a jig having a first opening adapted to slidingly receive a shaft of an access cannula that has been percutaneously advanced to a nucleus of the disc and a second opening adapted to slidingly receive a guidewire for further advancement percutaneously to the same disc nucleus.
12. A device according to claim 11 wherein the second opening is shaped to advance the guidewire in a direction that is substantially parallel to the shaft of the access cannula when it is received by the first opening.
13. A device according to claim 11 wherein said jig further includes a plurality of openings each of which are adapted to slidingly receive a guidewire.
14. A device according to claim 11 wherein the jig has two leg members that are shaped to form the first opening and the jig has a screw assembly that is coupled to the two legs such that the screw assembly can clamp the legs to the access cannula when the access cannula is received by the opening.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US07/784,693 US5395317A (en) | 1991-10-30 | 1991-10-30 | Unilateral biportal percutaneous surgical procedure |
| US784,693 | 1991-10-30 |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2081801A1 CA2081801A1 (en) | 1993-05-01 |
| CA2081801C true CA2081801C (en) | 2003-09-16 |
Family
ID=25133245
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002081801A Expired - Lifetime CA2081801C (en) | 1991-10-30 | 1992-10-30 | Surgical apparatus |
Country Status (5)
| Country | Link |
|---|---|
| US (1) | US5395317A (en) |
| EP (1) | EP0540317A1 (en) |
| JP (1) | JP3377811B2 (en) |
| AU (1) | AU661510B2 (en) |
| CA (1) | CA2081801C (en) |
Families Citing this family (247)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US7491205B1 (en) * | 1988-06-13 | 2009-02-17 | Warsaw Orthopedic, Inc. | Instrumentation for the surgical correction of human thoracic and lumbar spinal disease from the lateral aspect of the spine |
| 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 |
| US5762629A (en) * | 1991-10-30 | 1998-06-09 | Smith & Nephew, Inc. | Oval cannula assembly and method of use |
| US5558671A (en) * | 1993-07-22 | 1996-09-24 | Yates; David C. | Impedance feedback monitor for electrosurgical instrument |
| CA2164859C (en) * | 1993-06-10 | 2005-11-29 | Gary Karlin Michelson | Apparatus and method of inserting spinal implants |
| WO1998020939A2 (en) | 1996-11-15 | 1998-05-22 | Advanced Bio Surfaces, Inc. | Biomaterial system for in situ tissue repair |
| US5954670A (en) * | 1994-10-05 | 1999-09-21 | Baker; Gary H. | Mandrel-guided tandem multiple channel biopsy guide device and method of use |
| US5562736A (en) * | 1994-10-17 | 1996-10-08 | Raymedica, Inc. | Method for surgical implantation of a prosthetic spinal disc nucleus |
| US6245072B1 (en) | 1995-03-27 | 2001-06-12 | Sdgi Holdings, Inc. | Methods and instruments for interbody fusion |
| US5766180A (en) * | 1995-07-31 | 1998-06-16 | Winquist; Robert A. | Nail extraction kit and method |
| US5772678A (en) * | 1995-10-20 | 1998-06-30 | Inlet Medical, Inc. | Retractable disposable tip reusable trocar obturator |
| US7198598B2 (en) * | 1996-03-22 | 2007-04-03 | Warsaw Orthopedic, Inc. | Devices and methods for percutaneous surgery |
| US20040176763A1 (en) * | 1996-03-22 | 2004-09-09 | Foley Kevin T. | Methods for percutaneous surgery |
| ES2224228T3 (en) | 1996-03-22 | 2005-03-01 | Sdgi Holdings, Inc. | DEVICE FOR PERCUTANEOUS SURGERY. |
| US5792044A (en) | 1996-03-22 | 1998-08-11 | Danek Medical, Inc. | Devices and methods for percutaneous surgery |
| US6679833B2 (en) | 1996-03-22 | 2004-01-20 | Sdgi Holdings, Inc. | Devices and methods for percutaneous surgery |
| US5741261A (en) * | 1996-06-25 | 1998-04-21 | Sdgi Holdings, Inc. | Minimally invasive spinal surgical methods and instruments |
| US5792167A (en) * | 1996-09-13 | 1998-08-11 | Stryker Corporation | Surgical irrigation pump and tool system |
| US6342061B1 (en) | 1996-09-13 | 2002-01-29 | Barry J. Kauker | Surgical tool with integrated channel for irrigation |
| US5984890A (en) * | 1996-09-27 | 1999-11-16 | American Home Products Corporation | Medical device for the placement of solid materials |
| US5782832A (en) * | 1996-10-01 | 1998-07-21 | Surgical Dynamics, Inc. | Spinal fusion implant and method of insertion thereof |
| US5968098A (en) * | 1996-10-22 | 1999-10-19 | Surgical Dynamics, Inc. | Apparatus for fusing adjacent bone structures |
| US6063088A (en) * | 1997-03-24 | 2000-05-16 | United States Surgical Corporation | Method and instrumentation for implant insertion |
| TW375522B (en) | 1996-10-24 | 1999-12-01 | Danek Medical Inc | Devices for percutaneous surgery under direct visualization and through an elongated cannula |
| US6190414B1 (en) | 1996-10-31 | 2001-02-20 | Surgical Dynamics Inc. | Apparatus for fusion of adjacent bone structures |
| US5964761A (en) * | 1997-07-15 | 1999-10-12 | Kambin; Parviz | Method and instruments for percutaneous arthroscopic disc removal, bone biopsy and fixation of vertebrae |
| US6175758B1 (en) | 1997-07-15 | 2001-01-16 | Parviz Kambin | Method for percutaneous arthroscopic disc removal, bone biopsy and fixation of the vertebrae |
| US6004326A (en) * | 1997-09-10 | 1999-12-21 | United States Surgical | Method and instrumentation for implant insertion |
| US6749361B2 (en) | 1997-10-06 | 2004-06-15 | Werner Hermann | Shackle element for clamping a fixation rod, a method for making a shackle element, a hook with a shackle element and a rode connector with a shackle element |
| US7641670B2 (en) * | 1998-08-20 | 2010-01-05 | Zimmer Spine, Inc. | Cannula for receiving surgical instruments |
| US6187000B1 (en) * | 1998-08-20 | 2001-02-13 | Endius Incorporated | Cannula for receiving surgical instruments |
| US7799036B2 (en) * | 1998-08-20 | 2010-09-21 | Zimmer Spine, Inc. | Method and apparatus for securing vertebrae |
| US7682370B2 (en) * | 1998-08-20 | 2010-03-23 | Zimmer Spine, Inc. | Surgical tool for use in expanding a cannula |
| ATE306213T1 (en) | 1998-12-23 | 2005-10-15 | Nuvasive Inc | DEVICES FOR CANNULATION AND NERVE MONITORING |
| CA2363254C (en) * | 1999-03-07 | 2009-05-05 | Discure Ltd. | Method and apparatus for computerized surgery |
| US6267763B1 (en) | 1999-03-31 | 2001-07-31 | Surgical Dynamics, Inc. | Method and apparatus for spinal implant insertion |
| US6689142B1 (en) * | 1999-04-26 | 2004-02-10 | Scimed Life Systems, Inc. | Apparatus and methods for guiding a needle |
| EP1194088B1 (en) * | 1999-07-02 | 2008-03-12 | Spine Solutions Inc. | Intervertebral implant |
| EP1792587B1 (en) * | 1999-09-14 | 2014-03-05 | Spine Solutions Inc. | Insert instrument for an implant between vertebrae |
| US6500180B1 (en) * | 1999-10-20 | 2002-12-31 | Sdgi Holdings, Inc. | Methods and instrumentation for distraction of a disc space |
| JP4326134B2 (en) * | 1999-10-20 | 2009-09-02 | ウォーソー・オーソペディック・インコーポレーテッド | Method and apparatus for performing a surgical procedure |
| US6764491B2 (en) | 1999-10-21 | 2004-07-20 | Sdgi Holdings, Inc. | Devices and techniques for a posterior lateral disc space approach |
| US6830570B1 (en) * | 1999-10-21 | 2004-12-14 | Sdgi Holdings, Inc. | Devices and techniques for a posterior lateral disc space approach |
| WO2001028469A2 (en) | 1999-10-21 | 2001-04-26 | Sdgi Holdings, Inc. | Devices and techniques for a posterior lateral disc space approach |
| US6287313B1 (en) | 1999-11-23 | 2001-09-11 | Sdgi Holdings, Inc. | Screw delivery system and method |
| WO2001037728A1 (en) | 1999-11-24 | 2001-05-31 | Nuvasive, Inc. | Electromyography system |
| US7641657B2 (en) * | 2003-06-10 | 2010-01-05 | Trans1, Inc. | Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae |
| US7014633B2 (en) | 2000-02-16 | 2006-03-21 | Trans1, Inc. | Methods of performing procedures in the spine |
| US7744599B2 (en) * | 2000-02-16 | 2010-06-29 | Trans1 Inc. | Articulating spinal implant |
| US6899716B2 (en) | 2000-02-16 | 2005-05-31 | Trans1, Inc. | Method and apparatus for spinal augmentation |
| US6558390B2 (en) | 2000-02-16 | 2003-05-06 | Axiamed, Inc. | Methods and apparatus for performing therapeutic procedures in the spine |
| US7547324B2 (en) * | 2000-02-16 | 2009-06-16 | Trans1, Inc. | Spinal mobility preservation apparatus having an expandable membrane |
| US20030191474A1 (en) * | 2000-02-16 | 2003-10-09 | Cragg Andrew H. | Apparatus for performing a discectomy through a trans-sacral axial bore within the vertebrae of the spine |
| US6740090B1 (en) | 2000-02-16 | 2004-05-25 | Trans1 Inc. | Methods and apparatus for forming shaped axial bores through spinal vertebrae |
| US6575979B1 (en) | 2000-02-16 | 2003-06-10 | Axiamed, Inc. | Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae |
| ES2308014T5 (en) * | 2000-02-16 | 2012-03-16 | Trans1, Inc. | Apparatus for distraction and spinal fusion |
| US6558386B1 (en) * | 2000-02-16 | 2003-05-06 | Trans1 Inc. | Axial spinal implant and method and apparatus for implanting an axial spinal implant within the vertebrae of the spine |
| US7985247B2 (en) * | 2000-08-01 | 2011-07-26 | Zimmer Spine, Inc. | Methods and apparatuses for treating the spine through an access device |
| US7056321B2 (en) | 2000-08-01 | 2006-06-06 | Endius, Incorporated | Method of securing vertebrae |
| JP2004512097A (en) * | 2000-10-24 | 2004-04-22 | エスディージーアイ・ホールディングス・インコーポレーテッド | Apparatus and method for filling osteogenic material |
| US6847849B2 (en) * | 2000-11-15 | 2005-01-25 | Medtronic, Inc. | Minimally invasive apparatus for implanting a sacral stimulation lead |
| US6971393B1 (en) | 2000-11-15 | 2005-12-06 | George Mamo | Minimally invasive method for implanting a sacral stimulation lead |
| US6899734B2 (en) | 2001-03-23 | 2005-05-31 | Howmedica Osteonics Corp. | Modular implant for fusing adjacent bone structure |
| US7066943B2 (en) * | 2001-03-30 | 2006-06-27 | Zirkle Jr Lewis G | Method and apparatus for locating and stabilizing an orthopedic implant |
| US6719794B2 (en) | 2001-05-03 | 2004-04-13 | Synthes (U.S.A.) | Intervertebral implant for transforaminal posterior lumbar interbody fusion procedure |
| US6974480B2 (en) | 2001-05-03 | 2005-12-13 | Synthes (Usa) | Intervertebral implant for transforaminal posterior lumbar interbody fusion procedure |
| US7144393B2 (en) * | 2001-05-15 | 2006-12-05 | Dipoto Gene P | Structure for receiving surgical instruments |
| US6648849B2 (en) | 2001-06-27 | 2003-11-18 | Ethicon, Inc. | Medicinal implant and device and method for loading and delivering implants containing drugs and cells |
| JP4295086B2 (en) | 2001-07-11 | 2009-07-15 | ヌバシブ， インコーポレイテッド | System and method for determining nerve proximity, nerve orientation, and pathology during surgery |
| JP2005503857A (en) | 2001-09-25 | 2005-02-10 | ヌバシブ， インコーポレイテッド | Systems and methods for performing surgical procedures and surgical diagnosis |
| DE10154163A1 (en) | 2001-11-03 | 2003-05-22 | Advanced Med Tech | Device for straightening and stabilizing the spine |
| US7169155B2 (en) * | 2001-12-14 | 2007-01-30 | Scimed Life Systems, Inc. | Methods and apparatus for guiding a needle |
| US7004947B2 (en) | 2002-06-24 | 2006-02-28 | Endius Incorporated | Surgical instrument for moving vertebrae |
| US7582058B1 (en) | 2002-06-26 | 2009-09-01 | Nuvasive, Inc. | Surgical access system and related methods |
| US6793678B2 (en) | 2002-06-27 | 2004-09-21 | Depuy Acromed, Inc. | Prosthetic intervertebral motion disc having dampening |
| US7464145B2 (en) * | 2002-07-11 | 2008-12-09 | Intelliden, Inc. | Repository-independent system and method for asset management and reconciliation |
| WO2004008949A2 (en) | 2002-07-19 | 2004-01-29 | Triage Medical, Inc. | Method and apparatus for spinal fixation |
| US6648888B1 (en) | 2002-09-06 | 2003-11-18 | Endius Incorporated | Surgical instrument for moving a vertebra |
| US8137284B2 (en) | 2002-10-08 | 2012-03-20 | Nuvasive, Inc. | Surgical access system and related methods |
| WO2004039235A2 (en) * | 2002-10-25 | 2004-05-13 | Endius Incorporated | Apparatus and methods for shielding body structures during surgery |
| US6966929B2 (en) * | 2002-10-29 | 2005-11-22 | St. Francis Medical Technologies, Inc. | Artificial vertebral disk replacement implant with a spacer |
| US7273496B2 (en) | 2002-10-29 | 2007-09-25 | St. Francis Medical Technologies, Inc. | Artificial vertebral disk replacement implant with crossbar spacer and method |
| US7083649B2 (en) | 2002-10-29 | 2006-08-01 | St. Francis Medical Technologies, Inc. | Artificial vertebral disk replacement implant with translating pivot point |
| US7497859B2 (en) * | 2002-10-29 | 2009-03-03 | Kyphon Sarl | Tools for implanting an artificial vertebral disk |
| US6979352B2 (en) * | 2002-11-21 | 2005-12-27 | Depuy Acromed | Methods of performing embolism-free vertebroplasty and devices therefor |
| US20040116777A1 (en) * | 2002-12-13 | 2004-06-17 | Jeffrey Larson | Guided retractor and methods of use |
| US7204852B2 (en) | 2002-12-13 | 2007-04-17 | Spine Solutions, Inc. | Intervertebral implant, insertion tool and method of inserting same |
| US7691057B2 (en) * | 2003-01-16 | 2010-04-06 | Nuvasive, Inc. | Surgical access system and related methods |
| US20040158254A1 (en) * | 2003-02-12 | 2004-08-12 | Sdgi Holdings, Inc. | Instrument and method for milling a path into bone |
| US7819801B2 (en) | 2003-02-27 | 2010-10-26 | Nuvasive, Inc. | Surgical access system and related methods |
| US7433005B2 (en) * | 2003-03-31 | 2008-10-07 | Sharp Kabushiki Kaisha | Liquid crystal display device having electrode units each provided with a solid part and an extending part and method of manufacturing the same |
| US7491204B2 (en) | 2003-04-28 | 2009-02-17 | Spine Solutions, Inc. | Instruments and method for preparing an intervertebral space for receiving an artificial disc implant |
| US7645232B2 (en) * | 2003-05-16 | 2010-01-12 | Zimmer Spine, Inc. | Access device for minimally invasive surgery |
| US7179232B2 (en) * | 2003-06-27 | 2007-02-20 | Depuy Acromed, Inc. | Controlled orifice sampling needle |
| US7803162B2 (en) * | 2003-07-21 | 2010-09-28 | Spine Solutions, Inc. | Instruments and method for inserting an intervertebral implant |
| CA2535452C (en) * | 2003-08-14 | 2013-04-02 | Loma Linda University Medical Center | Vascular wound closure device |
| IL157981A (en) | 2003-09-17 | 2014-01-30 | Elcam Medical Agricultural Cooperative Ass Ltd | Auto-injector |
| US8002798B2 (en) | 2003-09-24 | 2011-08-23 | Stryker Spine | System and method for spinal implant placement |
| US7955355B2 (en) | 2003-09-24 | 2011-06-07 | Stryker Spine | Methods and devices for improving percutaneous access in minimally invasive surgeries |
| AU2004275877B2 (en) | 2003-09-25 | 2008-09-04 | Nuvasive, Inc. | Surgical access system and related methods |
| US7905840B2 (en) | 2003-10-17 | 2011-03-15 | Nuvasive, Inc. | Surgical access system and related methods |
| US7731737B2 (en) * | 2003-10-24 | 2010-06-08 | Zimmer Spine, Inc. | Methods and apparatuses for fixation of the spine through an access device |
| US20050090822A1 (en) * | 2003-10-24 | 2005-04-28 | Dipoto Gene | Methods and apparatus for stabilizing the spine through an access device |
| US20050090899A1 (en) * | 2003-10-24 | 2005-04-28 | Dipoto Gene | Methods and apparatuses for treating the spine through an access device |
| US7655012B2 (en) * | 2003-10-02 | 2010-02-02 | Zimmer Spine, Inc. | Methods and apparatuses for minimally invasive replacement of intervertebral discs |
| US8313430B1 (en) | 2006-01-11 | 2012-11-20 | Nuvasive, Inc. | Surgical access system and related methods |
| US7530993B2 (en) * | 2003-10-23 | 2009-05-12 | Trans1 Inc. | Method of spinal fixation |
| US7320707B2 (en) * | 2003-11-05 | 2008-01-22 | St. Francis Medical Technologies, Inc. | Method of laterally inserting an artificial vertebral disk replacement implant with crossbar spacer |
| US7691146B2 (en) * | 2003-11-21 | 2010-04-06 | Kyphon Sarl | Method of laterally inserting an artificial vertebral disk replacement implant with curved spacer |
| US20050283237A1 (en) * | 2003-11-24 | 2005-12-22 | St. Francis Medical Technologies, Inc. | Artificial spinal disk replacement device with staggered vertebral body attachments |
| US7144368B2 (en) * | 2003-11-26 | 2006-12-05 | Synthes Spine Company, Lp | Guided retractor and methods of use |
| US7503935B2 (en) | 2003-12-02 | 2009-03-17 | Kyphon Sarl | Method of laterally inserting an artificial vertebral disk replacement with translating pivot point |
| US20050209603A1 (en) * | 2003-12-02 | 2005-09-22 | St. Francis Medical Technologies, Inc. | Method for remediation of intervertebral disks |
| US20050143826A1 (en) * | 2003-12-11 | 2005-06-30 | St. Francis Medical Technologies, Inc. | Disk repair structures with anchors |
| US7527638B2 (en) | 2003-12-16 | 2009-05-05 | Depuy Spine, Inc. | Methods and devices for minimally invasive spinal fixation element placement |
| US7666188B2 (en) | 2003-12-16 | 2010-02-23 | Depuy Spine, Inc. | Methods and devices for spinal fixation element placement |
| US7357787B2 (en) * | 2003-12-18 | 2008-04-15 | Unomedial Limited | Guiding and positioning device and a system for positioning a catheter within a vein by means of the device |
| IL160891A0 (en) | 2004-03-16 | 2004-08-31 | Auto-mix needle | |
| US7547318B2 (en) | 2004-03-19 | 2009-06-16 | Depuy Spine, Inc. | Spinal fixation element and methods |
| US7452351B2 (en) * | 2004-04-16 | 2008-11-18 | Kyphon Sarl | Spinal diagnostic methods and apparatus |
| US7824390B2 (en) | 2004-04-16 | 2010-11-02 | Kyphon SÀRL | Spinal diagnostic methods and apparatus |
| US7846171B2 (en) | 2004-05-27 | 2010-12-07 | C.R. Bard, Inc. | Method and apparatus for delivering a prosthetic fabric into a patient |
| US7434325B2 (en) | 2004-07-26 | 2008-10-14 | Warsaw Orthopedic, Inc. | Systems and methods for determining optimal retractor length in minimally invasive procedures |
| US20060052812A1 (en) * | 2004-09-07 | 2006-03-09 | Michael Winer | Tool for preparing a surgical site for an access device |
| US20060069438A1 (en) * | 2004-09-29 | 2006-03-30 | Zucherman James F | Multi-piece artificial spinal disk replacement device with multi-segmented support plates |
| US7575600B2 (en) * | 2004-09-29 | 2009-08-18 | Kyphon Sarl | Artificial vertebral disk replacement implant with translating articulation contact surface and method |
| US7481840B2 (en) * | 2004-09-29 | 2009-01-27 | Kyphon Sarl | Multi-piece artificial spinal disk replacement device with selectably positioning articulating element |
| US9622732B2 (en) | 2004-10-08 | 2017-04-18 | Nuvasive, Inc. | Surgical access system and related methods |
| US7690381B2 (en) * | 2005-02-10 | 2010-04-06 | Depuy Spine, Inc. | Intervertebral prosthetic disc and method for installing using a guidewire |
| US8911498B2 (en) * | 2005-02-10 | 2014-12-16 | DePuy Synthes Products, LLC | Intervertebral prosthetic disc |
| US20060206178A1 (en) * | 2005-03-11 | 2006-09-14 | Kim Daniel H | Percutaneous endoscopic access tools for the spinal epidural space and related methods of treatment |
| US7674296B2 (en) * | 2005-04-21 | 2010-03-09 | Globus Medical, Inc. | Expandable vertebral prosthesis |
| US7427264B2 (en) * | 2005-04-22 | 2008-09-23 | Warsaw Orthopedic, Inc. | Instruments and methods for selective tissue retraction through a retractor sleeve |
| US7608108B2 (en) * | 2005-04-29 | 2009-10-27 | Jmea Corporation | Tissue repair system |
| US8702718B2 (en) | 2005-04-29 | 2014-04-22 | Jmea Corporation | Implantation system for tissue repair |
| US7632313B2 (en) * | 2005-04-29 | 2009-12-15 | Jmea Corporation | Disc repair system |
| US20060253198A1 (en) * | 2005-05-03 | 2006-11-09 | Disc Dynamics, Inc. | Multi-lumen mold for intervertebral prosthesis and method of using same |
| US20060253199A1 (en) * | 2005-05-03 | 2006-11-09 | Disc Dynamics, Inc. | Lordosis creating nucleus replacement method and apparatus |
| US20070060935A1 (en) * | 2005-07-11 | 2007-03-15 | Schwardt Jeffrey D | Apparatus and methods of tissue removal within a spine |
| US20070149990A1 (en) * | 2005-07-11 | 2007-06-28 | Palmer Erika I | Apparatus and methods of tissue removal within a spine |
| US8328851B2 (en) * | 2005-07-28 | 2012-12-11 | Nuvasive, Inc. | Total disc replacement system and related methods |
| EP1922000A4 (en) * | 2005-08-09 | 2009-10-28 | Trans1 Inc | Exchange system for axial spinal procedures |
| US7658739B2 (en) | 2005-09-27 | 2010-02-09 | Zimmer Spine, Inc. | Methods and apparatuses for stabilizing the spine through an access device |
| US20070085065A1 (en) * | 2005-10-14 | 2007-04-19 | Ramos Francisco C | Plastic sheath for fencing |
| EP1951159B1 (en) * | 2005-11-23 | 2015-08-19 | Trinity Orthopedics | Percutaneous transpedicular access, fusion, discectomy, and stabilization system |
| US7935148B2 (en) * | 2006-01-09 | 2011-05-03 | Warsaw Orthopedic, Inc. | Adjustable insertion device for a vertebral implant |
| US20070161962A1 (en) * | 2006-01-09 | 2007-07-12 | Edie Jason A | Device and method for moving fill material to an implant |
| US8894655B2 (en) * | 2006-02-06 | 2014-11-25 | Stryker Spine | Rod contouring apparatus and method for percutaneous pedicle screw extension |
| US20070233089A1 (en) * | 2006-02-17 | 2007-10-04 | Endius, Inc. | Systems and methods for reducing adjacent level disc disease |
| US20070213583A1 (en) * | 2006-03-10 | 2007-09-13 | Kim Daniel H | Percutaneous access and visualization of the spine |
| US20070213584A1 (en) * | 2006-03-10 | 2007-09-13 | Kim Daniel H | Percutaneous access and visualization of the spine |
| US8092536B2 (en) * | 2006-05-24 | 2012-01-10 | Disc Dynamics, Inc. | Retention structure for in situ formation of an intervertebral prosthesis |
| US20070276491A1 (en) * | 2006-05-24 | 2007-11-29 | Disc Dynamics, Inc. | Mold assembly for intervertebral prosthesis |
| US8998990B2 (en) | 2006-07-24 | 2015-04-07 | DePuy Synthes Products, LLC | Intervertebral implant with keel |
| WO2008016872A2 (en) | 2006-07-31 | 2008-02-07 | Synthes (U.S.A.) | Drilling/milling guide and keel cut preparation system |
| CA2916476C (en) * | 2006-07-31 | 2018-11-13 | T.A.G. Medical Devices - Agriculture Cooperative Ltd. | Arthroscopic bone transplanting procedure, and medical instruments useful therein |
| US7918857B2 (en) * | 2006-09-26 | 2011-04-05 | Depuy Spine, Inc. | Minimally invasive bone anchor extensions |
| US8105382B2 (en) | 2006-12-07 | 2012-01-31 | Interventional Spine, Inc. | Intervertebral implant |
| US8979931B2 (en) | 2006-12-08 | 2015-03-17 | DePuy Synthes Products, LLC | Nucleus replacement device and method |
| US8900307B2 (en) | 2007-06-26 | 2014-12-02 | DePuy Synthes Products, LLC | Highly lordosed fusion cage |
| US20090216284A1 (en) * | 2007-08-27 | 2009-08-27 | Singfatt Chin | Balloon cannula system for accessing and visualizing spine and related methods |
| JP5250632B2 (en) | 2007-10-05 | 2013-07-31 | ジンテス ゲゼルシャフト ミット ベシュレンクテル ハフツング | Expansion system |
| US20090112182A1 (en) * | 2007-10-31 | 2009-04-30 | Texas Heart Institute | Method and apparatus for vascular access |
| EP2471493A1 (en) | 2008-01-17 | 2012-07-04 | Synthes GmbH | An expandable intervertebral implant and associated method of manufacturing the same |
| KR20110003475A (en) | 2008-04-05 | 2011-01-12 | 신세스 게엠바하 | Expandable intervertebral implant |
| US20090270893A1 (en) * | 2008-04-25 | 2009-10-29 | Greg Arcenio | Medical device for tissue disruption with serrated expandable portion |
| US20090270892A1 (en) * | 2008-04-25 | 2009-10-29 | Greg Arcenio | Steerable medical device for tissue disruption |
| US20090270862A1 (en) * | 2008-04-25 | 2009-10-29 | Greg Arcenio | Medical device with one-way rotary drive mechanism |
| US8876851B1 (en) | 2008-10-15 | 2014-11-04 | Nuvasive, Inc. | Systems and methods for performing spinal fusion surgery |
| CA2747660A1 (en) * | 2008-12-22 | 2010-07-01 | Synthes Usa, Llc | Orthopedic implant with flexible keel |
| WO2010075555A2 (en) | 2008-12-26 | 2010-07-01 | Scott Spann | Minimally-invasive retroperitoneal lateral approach for spinal surgery |
| US8721723B2 (en) | 2009-01-12 | 2014-05-13 | Globus Medical, Inc. | Expandable vertebral prosthesis |
| US8936598B2 (en) * | 2009-01-14 | 2015-01-20 | DePuy Synthes Products, LLC | Spinal disc preparation tool |
| US9526620B2 (en) | 2009-03-30 | 2016-12-27 | DePuy Synthes Products, Inc. | Zero profile spinal fusion cage |
| US9168047B2 (en) * | 2009-04-02 | 2015-10-27 | John T. To | Minimally invasive discectomy |
| US8287597B1 (en) | 2009-04-16 | 2012-10-16 | Nuvasive, Inc. | Method and apparatus for performing spine surgery |
| US9351845B1 (en) | 2009-04-16 | 2016-05-31 | Nuvasive, Inc. | Method and apparatus for performing spine surgery |
| US8211126B2 (en) | 2009-09-22 | 2012-07-03 | Jmea Corporation | Tissue repair system |
| 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 |
| US20110112373A1 (en) * | 2009-11-10 | 2011-05-12 | Trans1 Inc. | Soft tissue access apparatus and methods for spinal surgery |
| US9393129B2 (en) | 2009-12-10 | 2016-07-19 | DePuy Synthes Products, Inc. | Bellows-like expandable interbody fusion cage |
| US8979860B2 (en) | 2010-06-24 | 2015-03-17 | DePuy Synthes Products. LLC | Enhanced cage insertion device |
| US9592063B2 (en) | 2010-06-24 | 2017-03-14 | DePuy Synthes Products, Inc. | Universal trial for lateral cages |
| TW201215379A (en) | 2010-06-29 | 2012-04-16 | Synthes Gmbh | Distractible intervertebral implant |
| AU2011305639B2 (en) | 2010-09-20 | 2014-11-06 | Synthes Gmbh | Spinal access retractor |
| US9402732B2 (en) | 2010-10-11 | 2016-08-02 | DePuy Synthes Products, Inc. | Expandable interspinous process spacer implant |
| US8394129B2 (en) | 2011-03-10 | 2013-03-12 | Interventional Spine, Inc. | Method and apparatus for minimally invasive insertion of intervertebral implants |
| US8518087B2 (en) | 2011-03-10 | 2013-08-27 | Interventional Spine, Inc. | Method and apparatus for minimally invasive insertion of intervertebral implants |
| US8790406B1 (en) | 2011-04-01 | 2014-07-29 | William D. Smith | Systems and methods for performing spine surgery |
| AU2012299061B2 (en) | 2011-08-19 | 2017-02-23 | Nuvasive, Inc. | Surgical retractor system and methods of use |
| US8870749B2 (en) | 2011-09-02 | 2014-10-28 | Stryker Corporation | Arrangement for minimal access surgery |
| US9622779B2 (en) | 2011-10-27 | 2017-04-18 | DePuy Synthes Products, Inc. | Method and devices for a sub-splenius / supra-levator scapulae surgical access technique |
| US9198765B1 (en) | 2011-10-31 | 2015-12-01 | Nuvasive, Inc. | Expandable spinal fusion implants and related methods |
| US9808232B2 (en) | 2011-11-01 | 2017-11-07 | DePuy Synthes Products, Inc. | Dilation system |
| US9220528B2 (en) | 2011-12-03 | 2015-12-29 | Ouroboros Medical, Inc. | Tubular cutter having a talon with opposing, lateral cutting surfaces |
| US9060815B1 (en) | 2012-03-08 | 2015-06-23 | Nuvasive, Inc. | Systems and methods for performing spine surgery |
| US9888859B1 (en) | 2013-03-14 | 2018-02-13 | Nuvasive, Inc. | Directional dilator for intraoperative monitoring |
| US9265490B2 (en) | 2012-04-16 | 2016-02-23 | DePuy Synthes Products, Inc. | Detachable dilator blade |
| WO2014018098A1 (en) | 2012-07-26 | 2014-01-30 | DePuy Synthes Products, LLC | Expandable implant |
| US9131832B2 (en) | 2012-08-15 | 2015-09-15 | Stryker Corporation | Cannula arrangement for minimally invasive surgery |
| US20140067069A1 (en) | 2012-08-30 | 2014-03-06 | Interventional Spine, Inc. | Artificial disc |
| US9480855B2 (en) | 2012-09-26 | 2016-11-01 | DePuy Synthes Products, Inc. | NIR/red light for lateral neuroprotection |
| US9522070B2 (en) | 2013-03-07 | 2016-12-20 | Interventional Spine, Inc. | Intervertebral implant |
| US9277928B2 (en) | 2013-03-11 | 2016-03-08 | Interventional Spine, Inc. | Method and apparatus for minimally invasive insertion of intervertebral implants |
| US9913728B2 (en) | 2013-03-14 | 2018-03-13 | Quandary Medical, Llc | Spinal implants and implantation system |
| US9827020B2 (en) | 2013-03-14 | 2017-11-28 | Stryker European Holdings I, Llc | Percutaneous spinal cross link system and method |
| US9993353B2 (en) | 2013-03-14 | 2018-06-12 | DePuy Synthes Products, Inc. | Method and apparatus for minimally invasive insertion of intervertebral implants |
| CA2846149C (en) | 2013-03-14 | 2018-03-20 | Stryker Spine | Systems and methods for percutaneous spinal fusion |
| US9603610B2 (en) | 2013-03-15 | 2017-03-28 | DePuy Synthes Products, Inc. | Tools and methods for tissue removal |
| CN105578975A (en) | 2013-07-19 | 2016-05-11 | 欧罗波罗斯医学有限公司 | An anti-clogging device for a vacuum-assisted, tissue removal system |
| US9744050B1 (en) | 2013-12-06 | 2017-08-29 | Stryker European Holdings I, Llc | Compression and distraction system for percutaneous posterior spinal fusion |
| US9408716B1 (en) | 2013-12-06 | 2016-08-09 | Stryker European Holdings I, Llc | Percutaneous posterior spinal fusion implant construction and method |
| US10159579B1 (en) | 2013-12-06 | 2018-12-25 | Stryker European Holdings I, Llc | Tubular instruments for percutaneous posterior spinal fusion systems and methods |
| KR101441320B1 (en) * | 2014-04-07 | 2014-09-18 | 주식회사 엔도비전 | Surrical equipment set to perform spine surgery microscope of minimum invasion |
| US9980737B2 (en) | 2014-08-04 | 2018-05-29 | Medos International Sarl | Flexible transport auger |
| US9924979B2 (en) | 2014-09-09 | 2018-03-27 | Medos International Sarl | Proximal-end securement of a minimally invasive working channel |
| US10264959B2 (en) | 2014-09-09 | 2019-04-23 | Medos International Sarl | Proximal-end securement of a minimally invasive working channel |
| US10111712B2 (en) | 2014-09-09 | 2018-10-30 | Medos International Sarl | Proximal-end securement of a minimally invasive working channel |
| CA3008161C (en) | 2014-12-09 | 2023-09-26 | John A. Heflin | Spine alignment system |
| US11426290B2 (en) | 2015-03-06 | 2022-08-30 | DePuy Synthes Products, Inc. | Expandable intervertebral implant, system, kit and method |
| US10786264B2 (en) | 2015-03-31 | 2020-09-29 | Medos International Sarl | Percutaneous disc clearing device |
| US9913727B2 (en) | 2015-07-02 | 2018-03-13 | Medos International Sarl | Expandable implant |
| CN113143355A (en) | 2015-09-04 | 2021-07-23 | 美多斯国际有限公司 | Multi-shield spinal access system |
| US11439380B2 (en) | 2015-09-04 | 2022-09-13 | Medos International Sarl | Surgical instrument connectors and related methods |
| US10987129B2 (en) | 2015-09-04 | 2021-04-27 | Medos International Sarl | Multi-shield spinal access system |
| US11744447B2 (en) | 2015-09-04 | 2023-09-05 | Medos International | Surgical visualization systems and related methods |
| US11672562B2 (en) | 2015-09-04 | 2023-06-13 | Medos International Sarl | Multi-shield spinal access system |
| US10299838B2 (en) | 2016-02-05 | 2019-05-28 | Medos International Sarl | Method and instruments for interbody fusion and posterior fixation through a single incision |
| CN109688980B (en) | 2016-06-28 | 2022-06-10 | Eit 新兴移植技术股份有限公司 | Expandable and angularly adjustable intervertebral cage with articulation joint |
| EP4233801A3 (en) | 2016-06-28 | 2023-09-06 | Eit Emerging Implant Technologies GmbH | Expandable, angularly adjustable intervertebral cages |
| US10537436B2 (en) | 2016-11-01 | 2020-01-21 | DePuy Synthes Products, Inc. | Curved expandable cage |
| US10888433B2 (en) | 2016-12-14 | 2021-01-12 | DePuy Synthes Products, Inc. | Intervertebral implant inserter and related methods |
| US10398563B2 (en) | 2017-05-08 | 2019-09-03 | Medos International Sarl | Expandable cage |
| 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 |
| KR102056153B1 (en) * | 2017-11-14 | 2019-12-16 | 주식회사 엔도비전 | Bidirectional vertebral endoscopic device for surgery |
| US11446156B2 (en) | 2018-10-25 | 2022-09-20 | Medos International Sarl | Expandable intervertebral implant, inserter instrument, and related methods |
| US11013530B2 (en) | 2019-03-08 | 2021-05-25 | Medos International Sarl | Surface features for device retention |
| US11241252B2 (en) | 2019-03-22 | 2022-02-08 | Medos International Sarl | Skin foundation access portal |
| US11129727B2 (en) | 2019-03-29 | 2021-09-28 | Medos International Sari | Inflatable non-distracting intervertebral implants and related methods |
| US11813026B2 (en) | 2019-04-05 | 2023-11-14 | Medos International Sarl | Systems, devices, and methods for providing surgical trajectory guidance |
| WO2021158802A1 (en) * | 2020-02-04 | 2021-08-12 | Silin Douglas D | Compression device and related methods for using the same |
| US11426286B2 (en) | 2020-03-06 | 2022-08-30 | Eit Emerging Implant Technologies Gmbh | Expandable intervertebral implant |
| US11771517B2 (en) | 2021-03-12 | 2023-10-03 | Medos International Sarl | Camera position indication systems and methods |
| 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 |
Family Cites Families (17)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US2919692A (en) * | 1956-02-23 | 1960-01-05 | Ackermann Wolfgang | Vertebral trephine biopsy instruments |
| US3017887A (en) * | 1960-01-19 | 1962-01-23 | William T Heyer | Stereotaxy device |
| US3765034A (en) * | 1971-02-12 | 1973-10-16 | F Johnston | Femoral hip prosthesis with positioning and drill guide assembly |
| US3941127A (en) * | 1974-10-03 | 1976-03-02 | Froning Edward C | Apparatus and method for stereotaxic lateral extradural disc puncture |
| US4539476A (en) * | 1980-11-28 | 1985-09-03 | Tokyo Shibaura Denki Kabushiki Kaisha | Module for a fiber optic link |
| US4383527A (en) * | 1981-02-20 | 1983-05-17 | Howmedica, Inc. | Device for guiding the insertion of surgical wires into bone tissue |
| US4545374A (en) * | 1982-09-03 | 1985-10-08 | Jacobson Robert E | Method and instruments for performing a percutaneous lumbar diskectomy |
| US4573448A (en) * | 1983-10-05 | 1986-03-04 | Pilling Co. | Method for decompressing herniated intervertebral discs |
| US4539976A (en) * | 1984-02-08 | 1985-09-10 | Sharpe Jewett M | Endoscopic surgical instrument |
| US4580561A (en) * | 1984-05-04 | 1986-04-08 | Williamson Theodore J | Interstitial implant system |
| US4678459A (en) * | 1984-07-23 | 1987-07-07 | E-Z-Em, Inc. | Irrigating, cutting and aspirating system for percutaneous surgery |
| US4638799A (en) * | 1985-06-13 | 1987-01-27 | Moore Robert R | Needle guide apparatus for discolysis procedures |
| US4750487A (en) * | 1986-11-24 | 1988-06-14 | Zanetti Paul H | Stereotactic frame |
| US4968298A (en) * | 1988-09-12 | 1990-11-06 | Michelson Gary K | Interspace irrigator |
| US5004457A (en) * | 1988-12-02 | 1991-04-02 | The United States Of Americas As Represented By The Secretary Of The Department Of Health And Human Services | Tissue transplantation system |
| GB2234906A (en) * | 1989-08-02 | 1991-02-20 | Aesculap Skidmore Holdings | Nuclectomy instrument |
| US5047036A (en) * | 1989-11-17 | 1991-09-10 | Koutrouvelis Panos G | Stereotactic device |
-
1991
- 1991-10-30 US US07/784,693 patent/US5395317A/en not_active Expired - Lifetime
-
1992
- 1992-10-28 EP EP92309887A patent/EP0540317A1/en not_active Ceased
- 1992-10-30 CA CA002081801A patent/CA2081801C/en not_active Expired - Lifetime
- 1992-10-30 AU AU27488/92A patent/AU661510B2/en not_active Ceased
- 1992-10-30 JP JP29348092A patent/JP3377811B2/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| EP0540317A1 (en) | 1993-05-05 |
| JPH05208015A (en) | 1993-08-20 |
| US5395317A (en) | 1995-03-07 |
| AU2748892A (en) | 1993-05-06 |
| JP3377811B2 (en) | 2003-02-17 |
| AU661510B2 (en) | 1995-07-27 |
| CA2081801A1 (en) | 1993-05-01 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| CA2081801C (en) | Surgical apparatus | |
| US5762629A (en) | Oval cannula assembly and method of use | |
| WO1995022285A1 (en) | Apparatus for treating herniated discs | |
| US4573448A (en) | Method for decompressing herniated intervertebral discs | |
| US7993378B2 (en) | Methods for percutaneous spinal surgery | |
| US6033406A (en) | Method for subcutaneous suprafascial pedicular internal fixation | |
| US6969392B2 (en) | Multiportal device and method for percutaneous surgery | |
| US5730754A (en) | Nerve deflecting conduit needle and method | |
| JP4276248B2 (en) | Device used for percutaneous spinal surgery | |
| EP1124495B1 (en) | Instrument for spinal surgery | |
| US20070093841A1 (en) | Surgical drill, a set of surgical drills, a system for cutting bone and a method for removing bone | |
| Kambin et al. | Arthroscopic microdiscectomy versus nucleotomy techniques | |
| Kambin | Instruments and Surgical Approaches for Minimally Invasive Spinal Surgery Via Posterolateral Access |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| MKEX | Expiry |