WO2000019915A1 - Vertebral endplate decorticator and osteophyte resector - Google Patents
Vertebral endplate decorticator and osteophyte resector Download PDFInfo
- Publication number
- WO2000019915A1 WO2000019915A1 PCT/US1999/023157 US9923157W WO0019915A1 WO 2000019915 A1 WO2000019915 A1 WO 2000019915A1 US 9923157 W US9923157 W US 9923157W WO 0019915 A1 WO0019915 A1 WO 0019915A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- burr
- handle
- instrument
- vertebral
- osteophyte
- Prior art date
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
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/142—Surgical saws ; Accessories therefor with reciprocating saw blades, e.g. with cutting edges at the distal end of the saw blades
- A61B17/144—Surgical saws ; Accessories therefor with reciprocating saw blades, e.g. with cutting edges at the distal end of the saw blades with cutting edges at the side of the saw blades
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1659—Surgical rasps, files, planes, or scrapers
-
- 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
Definitions
- the present invention relates to devices used for minimally invasive spinal surgery and more particularly to devices used for endplate decortication and for osteophyte resection during minimally invasive surgery.
- the endplates of the adjacent vertebrae are first preferably decorticated to encourage the growth of bone and cause bone fusion by exposing cancellous bone. Additionally, osteophytes projecting outwardly from the sides of the vertebrae should be removed during surgery as they may damage nerves or other soft tissues .
- curettes, scrapers or other filing instruments are used for osteophyte resection and chisels or drills are used for removing bone cortical tissue. It is not possible to leverage conventional curettes or scrapers against the vertebrae while operating these devices since these devices must move freely back and forth against the osteophyte to wear it down.
- Conventional decortication systems are also limited. In particular, when decorticating with a chisel or drill, substantially all of the cortical tissue is typically removed during the procedure. It would instead be preferable to provide decortication in the form of deep scratches on the vertebral endplates, thereby not removing all cortical tissue.
- An advantage of not removing all cortical tissue is that the vertebrae will retain sufficient structural support to hold an intervertebral insert firmly in position.
- access to a patient ' s intervertebral space can be provided through a cannulated percutaneous posterolateral approach.
- An example of such minimally invasive surgery is described in the Applicant's provisionally filed patent application entitled “Minimally Invasive Spinal Surgery Systems", filed June 9th, 1998, (Attorney Docket No. 18608-000600), incorporated herein by reference in its entirety.
- a disadvantage of present endplate decorticators and osteophyte resectors is the difficulty of firmly holding these devices against the vertebral surface being resected or decorticated during operation. As such devices can not be firmly leveraged against vertebral bones, the abrasion effectiveness of existing devices is somewhat limited. This disadvantage of existing endplate decorticators and osteophyte resectors is especially pronounced in the area of minimally invasive surgery. In particular, due to their large and bulky size, existing endplate decorticators and osteophyte resectors are not adapted to be received through percutaneously inserted cannulae into the patient's intervertebral space. Rather, existing decorticators and resectors are typically dimensioned such that they can only be used during highly invasive surgical procedures, such as when access to the patient ' s intervertebral space is accomplished by open spinal surgery.
- endplate decorticators and osteophyte resectors An additional disadvantage of existing endplate decorticators and osteophyte resectors is that these exist as two very different devices. It would instead be desirable to provide a single device offering the combined benefits of endplate decorticators and osteophyte resectors.
- the present invention provides an instrument which can be used as a vertebral endplate decorticator and/or as an osteophyte resector and is preferably dimensioned to be received through a percutaneously inserted cannula into a patient's back.
- the present invention includes a eccentric support structure projecting laterally from the instrument and having a surface for contacting vertebral bone with a stationary surface during use, and wherein the eccentric support can be leveraged or pivoted against vertebral bone structures, thereby enhancing its resection or decortication effect, while being firmly locked into position during operation.
- the present device is adapted to be easily locked into position without interfering with resection or decortication.
- the present instrument can be easily manipulated within the cannula so that it can be held tightly in place against one or the other of two adjacent vertebrae, thereby positioning it to decorticate or resect the opposite vertebra, as desired.
- the present instrument comprises a rotatable burr connected to a distal end of rotatable driving rod.
- An elongated handle surrounds the driving rod and the eccentric support projects radially outward from the end of the handle proximal the rotatable burr.
- the eccentric support projects outwardly to a distance greater than the radius of the rotating burr and is disposed on one side of the burr.
- the burr is dumbbell -shaped and is supported by a collar which is disposed around the narrow center portion of the dumbbell -shaped burr.
- the collar is preferably integrally formed together with the eccentric support.
- the collar provides support to the burr, (while minimizing torque on the driving rod) , such that the burr can be held firmly against a vertebral surface, thereby increasing decortication or resection effectiveness.
- a tab or other structure projects radially outwardly from the collar, between the two lobes of the dumbbell burr, to provide the support surface for engaging bone and providing the desired pivot point.
- the tab will also preferably be formed integrally with the elongated handle.
- the handle defines the axis about which the burr rotates and the eccentric support operates as a fulcrum which is spaced apart from, and preferably opposite to, the contact area between the rotating burr and the bone.
- the burr is generally cylindrical in shape. An advantage of such a cylindrically-shaped burr is its large abrasive surface.
- an advantage of the present instrument is that by rotating its handle, the eccentric support can be wedged against a first vertebra such that the rotating burr is held tightly against an adjacent second vertebra, thus producing an effective system for decorticating or resecting the surface of the second vertebra.
- the eccentric support may have one or more teeth or other similar gripping structures thereon to assist in firmly holding the instrument against the first vertebral surface while operating on the second vertebral surface.
- FIG. 1 is a side perspective view of a first embodiment of the present instrument .
- Fig. 2 is a side perspective view of the integrally- formed handle, eccentric support and collar of the instrument of Fig. 1.
- Fig. 3 is a side perspective view of the rotating burr and driving rod of the instrument of Fig. 1.
- Fig. 4 is a top plan view of the instrument of Fig.
- FIG. 5A is an axial sectional view taken along line
- Fig. 5B is a side elevation view corresponding to
- Fig. 5A Fig. 6 is a view corresponding to Fig. 4 but with the eccentric support of the instrument rotated to a second position.
- Fig. 6B is a side elevation view corresponding to Fig. 6A.
- Fig. 7 is a side elevation view of a second embodiment of the present invention.
- Fig. 8 is a side perspective view of a third embodiment of the present instrument .
- Fig. 9 is an end view of the instrument of Fig. 8.
- Fig. 10 is a partially cut away view corresponding to Fig. 7, but with a flexible shaft and driving rod.
- Fig. 1 shows a side perspective view of a first embodiment of the present invention.
- instrument 10 comprises a dumbbell -shaped burr 12 which is axially connected to driving rod 14. Rotation of driving rod 14 causes rotation of burr 12, thereby providing effective endplate decortication when burr 12 is held against a vertebral endplate, as will be explained.
- Driving rod 14 is mounted to be freely rotatable within an elongated handle 16.
- Handle 16 is connected to, or is preferably integrally formed together with, eccentric support 18.
- Eccentric support 18 is connected to, or is preferably integrally formed together with, collar 20 which supports dumbbell -shaped burr 12 as shown.
- a plurality of gripping teeth 15 project from eccentric support 18 as shown.
- Fig. 2 shows a side perspective view of handle 16, eccentric support 18, collar 20 and teeth 15 which may preferably be integrally formed together from a single piece of metal such as stainless steel.
- Fig. 3 shows the burr 12 and attached driving rod 14 as removed from the handle 16, support 18, and collar 20 of Fig. 2.
- Burr 12 may preferably be formed of carbide steel or stainless steel .
- Driving rod 14 may preferably be formed of stainless steel.
- the surface of dumbbell -shaped burr 12 is preferably abrasive such that spinning burr 12 can be used to decorticate a vertebral endplate or to resect a vertebral osteophyte.
- Endplate decortication is useful in promoting bone growth when inserting an intervertebral fusion cage or insert between adjacent vertebrae.
- Osteophyte resection is useful in preventing damage to nerves or other soft tissues.
- the surface of spinning burr 12 is a finely abrasive surface is used such that the device is ideally suited for osteophyte resection.
- the surface of spinning burr 12a is a coarsely abrasive surface is used such that the device is ideally suited for endplate decortication .
- instrument 10 can preferably be received through cannula 30, and positioned in intervertebral space 40, (such as when performing minimally invasive spinal surgery) .
- cannula 30 may be received in a posterolateral approach into the intervertebral space 40, as shown.
- Fig. 4 further shows the patient's spinous process 42 and transverse processes 44 for perspective.
- burr 12 is shown as initially positioned in intervertebral space 40 between adjacent vertebrae 41 and 43, positioned therebelow and thereabove respectively.
- Support 18 is positioned to one side of instrument 10 such that instrument 10 is freely movable in intervertebral space 40 between vertebrae 41 and 43.
- handle 16 By subsequently rotating handle 16 in direction Rl , support 18 rotates to the position shown in Figs. 6A and 6B, such that support 18 is thereby pushed firmly against vertebra 41, with teeth 15 projecting into the surface of vertebra 41, as shown.
- instrument 10 pivots about contact region 19 between support 18 and vertebra 41 such that burr 12 is firmly held in position against vertebrae 43, as shown.
- support 18 being wedged against vertebrae 41 in this manner, more abrasive force can be applied to the surface of vertebra 43, (such that it can be decorticated or resected more efficiently) , than could be applied m the absence of the pivoting support 18 being wedged against vertebra 41.
- support 18 is firmly wedged against vertebra 41, the likelihood of instrument 10 slipping such that burr 12 shifts position across the surface of vertebra 43 during decortication is substantially reduced. The likelihood of slippage is further reduced by rotating burr 12 in direction Rl .
- handle 16 could conversely be rotated in an opposite direction such that support 18 instead rests against vertebrae 43, thereby enabling burr 12 to be forced more firmly against vertebrae 41 while support 18 is anchored m position against the surface of vertebra 43.
- rotating burr 12a has spiral cutting teeth 13 disposed thereon. Spiral cutting teeth 13 advantageously increase the abrasion effectiveness of the present invention.
- instrument 50 is provided.
- a driving rod 54 mounted to rotate freely in handle 56 is provided.
- a generally cylindrical-shaped burr 52 is axially connected to driving rod 54.
- An advantage of such a generally cylindrical- shaped burr 52 is its large contact surface when it is held against a vertebral endplate.
- Handle 56 is preferably formed integral with an eccentric support 58 which projects outwardly beyond the radius of burr 52 as shown. Gripping teeth 59 are also provided.
- the manner of operation of instrument 50 is substantially identical to that of instrument 10 as set forth above, with handle 56 being rotated such that support 58 rests against a first vertebral surface while burr 52 decorticates or resects a second opposite vertebral surface.
- driving rod 14a can be flexible and be housed within a flexible shaft 16a.
- an elongated flexible region 25 can be provided, (shown here as a comparatively short region for ease of illustration) , providing serpentine flexing of the device as it is manipulated m a cannula.
- the present invention also encompasses designs m which a rigid handle and/or driving rod are hinged, (preferably proximal the rotating burr) , to produce flexing of the device about its generally longitudinally extending central axis, thereby also facilitating manipulation of the device.
Abstract
Description
Claims
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU64146/99A AU6414699A (en) | 1998-10-07 | 1999-10-06 | Vertebral endplate decorticator and osteophyte resector |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/168,306 | 1998-10-07 | ||
US09/168,306 US6030401A (en) | 1998-10-07 | 1998-10-07 | Vertebral enplate decorticator and osteophyte resector |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2000019915A1 true WO2000019915A1 (en) | 2000-04-13 |
Family
ID=22610969
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1999/023157 WO2000019915A1 (en) | 1998-10-07 | 1999-10-06 | Vertebral endplate decorticator and osteophyte resector |
Country Status (3)
Country | Link |
---|---|
US (1) | US6030401A (en) |
AU (1) | AU6414699A (en) |
WO (1) | WO2000019915A1 (en) |
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US6030401A (en) | 2000-02-29 |
AU6414699A (en) | 2000-04-26 |
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