CA2118811A1 - Cervical discectomy instruments - Google Patents
Cervical discectomy instrumentsInfo
- Publication number
- CA2118811A1 CA2118811A1 CA002118811A CA2118811A CA2118811A1 CA 2118811 A1 CA2118811 A1 CA 2118811A1 CA 002118811 A CA002118811 A CA 002118811A CA 2118811 A CA2118811 A CA 2118811A CA 2118811 A1 CA2118811 A1 CA 2118811A1
- Authority
- CA
- Canada
- Prior art keywords
- tube
- base member
- handle members
- proximal end
- 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.)
- Abandoned
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
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
-
- 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
-
- 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
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
-
- 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
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/320708—Curettes, e.g. hollow scraping instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00261—Discectomy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00469—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for insertion of instruments, e.g. guide wire, optical fibre
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A61B17/2841—Handles
- A61B2017/2845—Handles with a spring pushing the handle back
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M2025/0175—Introducing, guiding, advancing, emplacing or holding catheters having telescopic features, interengaging nestable members movable in relations to one another
Landscapes
- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- General Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Dentistry (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Pathology (AREA)
- Surgical Instruments (AREA)
- Paper (AREA)
- Massaging Devices (AREA)
- Orthopedics, Nursing, And Contraception (AREA)
- Radiation-Therapy Devices (AREA)
- Prostheses (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
- Pyrane Compounds (AREA)
Abstract
Arthroscopic cervical dissectomy instruments include a push knob (10) for a guide wire (12), a pair of telescopically mounted dilator tubes (30, 50), one (30) of which includes a water port (44) so that the tube provides the additional function of an irrigation tube, a ligament cutter (60), a continuous suction punch (80), a cervical osteotone (110), a cervical cureet (120), a nucleus extractor (130) and a cureet nucleus extractor (140). The dilator tubes (30, 50), the ligament cutter (60), and the continuous suction punch (80) are all centrally bored to receive the guide wire (12). All of the instruments are of arthroscopic proportions and each instrument, exclusive of its handle, is slidably insertable through the bore of the largest in diameter dilator tube (30). The largest in diameter dilator tube (30) serves as a dilator, an irrigation tube, and as the main sheath through which the other tools are inserted.
Description
WO g3/04652 PCI'/US~2/07735 211881~
CE:RVICAL DI~;CECTOMY IN8TR~ENT~
Technic,al Field This invention relates to arthroscopic surgical instruments. More particularly,,it relates to miniature tools having utility in cervical discectomy.
Backqround Art Neck pain is sometimes caused by the pressure of a ligament bearing against the spinal cord. The pressure can be surgically relieved by debulking, i.e., removing some of the nucleus beneath the ligament so that the ligament can return to its normal position.
Nucleus debulking has heretofore been performed conventionally, i.e~, a relatively large incision is made and the surgeon cuts through the membrane tha~ overlies the ligament and through the ligament in order to reach the nucleus. The nucleus is cut and ~ufficient amounts thereof are removed to thereby remo~e the pressure that was the source of the pain.
The tool usually employed to debulk the nucleus is known as a punch tool because it operates something like a paper punch, i.e., a shearing action accomplishes the desired WO93/~K52 PCT/US92/07735 ~ 2 cutting. More particularly, a typical punch tool has an elongate neck and the shearing mechanism is positioned at the distal end of that neck. A pair of handle members~ at the proximal end of the neck are squeezed by the surgeon and the squeezing action causes a first part of the shearing mechanism to slide with respect to a stationary second part of that mechanism, and nucleus matter betw~en said parts is sheared from the main body of nucleus matter.
The cervical discectomy punches of the type just described operate in a batch mode, i.e., they shear a single piece of tissue for each entry to the surgical site through an incision. After each shearing action, the punch must be withdrawn, an irrigation tool must be inserted to irrigate the site and place the sheared piece of nucleus into suspension, the irrigation tool must be withdrawn, a suction tool must be inserted to vacuum the irrigation fluid and the sheared piece, the suction tool must be withdrawn, and the punch inserted for another shearing action. Thus, a surgeon might be required to make dozens of entries and exits through an incision in the course of a surgical procedure when using a conventional, one bite punch instrument. Such multiple entries, exits, and re-entries obviously extend theitime required to perform the surgical procedure, and tire the surgeon and surgical assistants.
W093/~2 PCT/US92/07735 211v~ ~1 It is well known that arthroscopic surgical techniques require much smaller incisions and thus permit much faster patient recovery, thereby reducing the length of hospital stays and saving the expenses associated therewith, but arthroscopic tools capable of performing cervical discectomys do not appear in the prior art.-The prior art, when considered as a whole, neitherteaches nor suggests to those of ordinary skill in this field how the conventional punch could be improved, or how the debulking procedure could be performed arthroscopically.
Disclosure of Invention A novel set of miniature tools is provided for use by arthroscopic surgeons so that cervical discectsmy can be performed arthroscopically for the first time.
- A first tool enables the physician to properly set a guide wire, known as a K wire after the first initial of its inventor's name, in the nucleus to be debulked. The K wire guides all of the instruments used subsequently in the surgical procedure to the site of the procedure. Heretofore, arthroscopic ~urgeons had no means for facilitation of K wire insertion between vertebrae.
A second and third tool are provided to facilitate the initial dilation of the arthroscopic incision; moreover, the second tool is the main sheath throuqh which all other tools WO93/~K52 PCT/US92/07735 2li~sl~
are inserted throughout the course of the surgical procedure and also serves as the irrigation tool so that the operation site can be irrigated with saline solution as needed.
A fourth tool is a ligament cutter: it is inserted through the bore of the main sheath after the third tool has been removed therefrom and said fourth tool performs the function its name expresses. More particularlyj it cuts through the membrane that overlies the ligament and it further cuts a passageway through the ligament to expose the nucleus material thereunder.
The set further includes a novel punch tool having a continuous suction port. The novel punch tool enables the physician to complete an entire debulking procedure, i.e., to perform repeated shearing actions, with a single insertion through an incision. The punch is inserted a single ti~e, and the physician squeezes the handle members thereof as many times as needed so that the shearing members slice off as many pieces of nucleus material as required. The pieces of excised matter are continuously removed from the site by a continuous suction that withdraws irrigation fluid and surgical debris from the site. The suction means is provided in the form of an elongate suction bore that is formed in the neck of the punch; a suction port to which a cannula is releasably secured is positioned at the proximal end of the suction bore, and an opposite end of the cannula is W093/~52 PCT/US92/07735 2 11O~
detachably secured to a collection tank that is in fluid communication with a source of negative pressure. Suitable means are provided 80 that the physician can control~the flow rate of the irrigation fluid through the suction bore.
An arthroscopic cervical osteotone, an arthroscopic cervical cureet, a batch-type nucleus extractor, and a second type of cureet are also disclosed; all of these tools are insertable through the main sheath as and if needed. The second type of cureet tool has a handle arrangement like the novel continuous suction punch to facilitate its use.
Thus it is apparent that the primary object of this invention is to provide arthroscopic surgeons with the tools they need to perform cervical discectomys.
A more specific object is to provi~e a continuous suction punch to facilitate performance of arthroscopic procedures.
These and other important objects, features and advantages of the invention will become apparent as this description proceeds.
The invention accordingly comprises the features of construction, combination of elements and arrangement of parts that will be exemplified in the construction hereinafter set forth, and the scope of the invention will be indicated in the claims.
W093/~52 PCT/US92/07735 ,æl~8l~
Brief DescriPtion of the Drawinqs For a fuller understanding of the nature and objects of the invention, reference should be made to the fallowing detailed description, taken in connection with the accompanying drawings, in which:
Fig. 1 is a side elevational view of a novel K-wire push knob showing a length of K-wire retained therewithin;
Fig. 2 is a side elevational view of a novel dilator tube having a water port;
Fig. 3 is a side elevational view of a novel dilator tube;
Fig. 4 is a side elevational view showing the tubes of Figs. 2 and 3 in their assembled configuration;
Fig. 5 is a side elevational view of a novel ligament cutter;
Fig. 6 is a side elevational view of the novel cervical continuous suction punch;
Fig. 7 is a æide elevational view of a novel cervical osteotone member;
Fig. 8 is a side elevational view of a novel cervical cureet;
Fig. 9 is a side elevational view of a batch-type punch tool of arthroscopic dimensions that may be employed in lieu of the continuous suction punch of Fig. 6; and W093/~652 PCT/US92/07735 21~8~ i ~
Fig. 10 is a side elevational view a cureet tool having handle members like the handle members of the punch of Fig.
6.
Similar reference numerals refer to similar parts throughout the several views of the drawings.
Best Modes for CarrYinq Out the_Invention Referring first to Fig. 1, there it will be seen that the novel K wire push knob is denoted 10 as a whole; the K
wire is denoted 12. The proximal end 14 of K wire 12 is received within bore 16 that is formed in push knob 10. More particularly, the push knob includes a boss 18 and a knurled base 20; bore 16 extends the entire length of the boss and part of the length of the base as shown. A set screw 22 having a knurled head screw threadedly engages an internally threaded radial bore formed in a reduced diameter part 21 of base 20, said radial bore intersecting bore 16 so that the leading end of the set screw bears against the K wire when the set screw is advanced to releasably retain the guide wire within bore 16.
After the arthroscopic incision has been made, the push knob is grasped by the physician and the distal end of the K
wire is inserted into the ligament at the point where the underlying nucleus is to be debulked. The push knob 10 is then removed from the K wire by loosening set screw 22;
W093/~52 PCT/US92/07735 ~as~ 8 penetration of the distal end of the K wire into the ligament retains it in position throughout the remainder of the surgical procedure.
K wire 12 is preferably about 140mm in length, and the overall length of push knob 10 is 24mm. The reduced diameter part 21 of base 20 is 8mm in length and the balance of base 20 is 12mm in length.
The incision is then dilated in a novel way. The dilator tube 30 of Fig. 2 and the dilator tube 50 of Fig. 3 are releasably coupled together as a preparatory step to the dilation. Once coupled together, they are threaded over the K
wire so that they are properly positioned. More particularly, tubular part 52 of dilator tube S0 is slidably, i.e., telescopically, inserted into the hollow bore of the tubular part 32 of dilator tube 30. The resulting assembly is depicted in Fig. 4 and this assembly is guided to the site by the K wire, i.e., the bore of tubular part 52 axially receives said K wire. Note that the distal end 54 of tubular part 52 is tapered and extends beyond the distal end 34 of tubular part 32. Note further that the proximal end 36 of base 38 of tube 30 is slidably received within circular recess 56 formed in knurled base 58 of tube 50 and that boss 59 of base 58 is slidably received within a complementally W093/~K52 PCT/USg2/0773~
2 1 1 ~
formed recess 40 formed in base 38 of tube 30. It should be noted that boss 59 extends from a bottom wall of recess 56. This provides a double lock between tubes 30 and 50.
The tapered distal end 54 of tube 50 performs the initial dilation; the taper is provided to avoid tearing the ligament as it passes through~ After tube 50 has been advanced, then tube 30 is similarly advanced, i.e., it is advanced to the left as denoted by the directional arrow 42 in Fig. 4. This further dilates the incision.
Tube 30 further includes a water port 44 having an inlet means adapted to be engaged by a cannula, not shown; the opposite end of the cannula is detachably secured to a source of saline solution under positive pressure. Suitable valving means are provided so that the physician can control the flow rate of saline solution to port 44. Port 44 is in open fluid communication with bore 46 of tubular part 32 so that saline solution flowing from the source thereof is delivered to the site of the surgical procedure under the direction and control of the surgeon.
After dilator tube 30 has been advanced as indicated by directional arrow 42 to complete the dilation of the incision, dilator tube 50 is then slidingly decoupled therefrom and withdrawn. Dilator tube 30 is then used as the main sheath through the bore 46 of which other instruments are inserted as the surgical procedure progresses, i.e., main W093/~s2 PCT/USg2/07735 2 1 ~ ~ 8 ~
sheath 30 remains in position, as does K wire 12, until the surgical process of debulking the disc is undertaken.
The inside diameter of main sheath 30, i.e., the diameter of bore 46, is 2.5mm, and the outside diameter of sheath 30 is 3mm. The overall length of main sheath 30 is 81mm. The length of tubular part 52 of dilator tube 50 is 92mm, including the lOmm length of boss 59. Rece~s 40 formed in base 38 of main sheath 30 is also lOmm in depth to receive said boss 59.
The ligament cutter 60 of Fig. 5 is next employed; it has an overall length of 104mm and it includes a tubular part 62, having an outside diameter Gf 2.4mm, said tubular part 62 having a leading end 64; leading end 64 has a cookie cutter-style cutting edge. Tool 60 further includes a proximal end having a lOmm in length knurled base 66, a boss - 68 having about the same length, and a bore 70 for receiving the K wire. The ligament cutter 60 is used by threading it onto the K wire, i.eO, by aligning ~aid wire with bore 70 at the leading end of the cutter and by advancing the cutter through bore 46 of main sheath 30 toward the surgical site.
The physician then oscillates the cutter 60 about ! its longitudinal axis of rotation as indicated by double-headed directional arrow 72; this aotion causes cutting edge 64 to slice through the membrane overlying the ligament and continued oscillation and advancement of the cutter enable it W093/~52 PCT/US9210773~
to cut a passageway through the ligament and into the underlying nucleus. The cutter and K-wire are withdrawn after the passageway has been formed, but main sheath 30 re~ains in position.
Debulking of the nucleus may now be undertaken; the preferred tool for performing the debulking procedure is depicted in Fig. 6 and is denoted as a whole by the reference numeral 80.
This illustrative embodiment of the novel cervical continuous suction punch 80 includes an elongate neck 82 having a pair of shearing members collectively denoted 84 at the distal end thereof. Shearing members 84 are known in larger punch tools of the type used in conventional, i.e., non-arthroscopic surgery, and thus their construction need not be described. A novel handle means 86 in the form of a pair of handle members 88 and 90 is integrally formed with neck 82 at the proximal end thereof and said handle members depend therefrom; the members are pivotally mounted about pivot point 89, and member 90 has a thumb~receiving loop 91.
A strip 92 of spring steel or other ~uitable material biases handle members 88 and 90 apart from one another as indicated by arrow 93, i.e., the physician must overcome the bias to squeeze said handle members toward one another. Shear members 84 are spaced apart from one another when punch 10 is in repose and ultimately converge toward one another when said WO93~s2 PCT/US92~0773 8~ ~ 12 handle members are squeezed; a diverging motion precedes the converging motion, but, again, the particular operation of the shearing members is well known and need not be described here.
A coil spring 94 or other suitable bias means is employed to urge the handle members 88 and 90 toward one another as indicated by converging arrows 95; thus, spring steel member 92 and coil spring member 94 are first and second bias means, respectively, that oppose one another. The strength of the opposing bias means is substantially equal.
This unique arrangement of parts removes play from the handle means 86 and insures that the handle members 88 and 90 will always return to their respective positions of repose when said handle members are released.
A bore 96 is formed in neck 82 and provides fluid communication ~etween shears 84 and suction port 98 at the proximal end of punch tool 80. Bore 96 extends into port 98 as shown; port 98 provides a mounting means to which a first end of a cannula, not shown, or other suitable flexible tube means is detachably secured when the novel punch 80 is in use. The second end of the cannula is detachably secured to an unillustrated collection receptacle that is in fluid communication with an undepicted source of negative pressure.
The site of the surgical procedure is irrigated during the nucleus-shearing process by caus_ng irrigation fluid to WO93/Q~52 PCT/US92/0773~
13 211~8I ~
flow into water port 44 in main sheath 30; the inside diameter of the main sheath is sufficient to receive neck 82 of punch tool 80 and to allow sufficient space thereabout to allow the irrigation fluid to flow freely to the surgical siteO Thus, as each piece of nucleus is sheared by shears 84, releasing the squeezing motion imparted to handle members 86 and 88 opens the shears and releases the excised pieces into the irrigation fluid.
Suitable means are provided to permit the physician to control the amount of negative pressure supplied to port 98 and thus the flow rate of irrigation fluid and surgical debris flowing therethrough in the direction of arrow lO0.
Thus, a single insertion of neck 82 through the bore of main sheath 30 is the only insertion needed to complete the entire debulking procedure. Irrigation fluid is introduced through water port 44 throughout the entire debulking procedure, and the suction applied to port 98 is similarly continuous throughout said procedure.
Neck 82 is preferably about lO5mm in length, exclusive of handle 86; said handle 86 has a length, measured from the neck 82 to the lowermost end of handle member 88, of about 85mm. The outside diameter of neck 82 is 2.5mm, and the length of the movable part of the shear members 84 is 4mm.
Fig. 7 depicts a cervical osteotone llO that may also be inserted through main sheath 30 if chiseling of a vertebrae WO 93/04652 PCr/US~2/07735 2118~ ~ 14 is required at any stage of the procedure. Osteotone 110 includes a solid rod 112 having a chisel edge 114 formed in its leading end and a knurled base member 116 fixedly-secured to its proximal end. The overall length of osteotone 110 is 125 mm; the length of rod 112 is 105 mm. The lateral extent of chisel edge 114 is 2.3mm so that the tool is easily insertable through the bore of ~he main sheath.
A novel cervical cureet or scoop member 120 is depicted in Fig. 8; its rod part 122 and knurled base 124 have the same dimensions as the corresponding parts of the osteotone of Fig. 7. A scoop means 126 is formed in the leading end of rod 22; it has the same construction as a conventional scoop means of the type used in non-arthroscopic surgery, but is only 2.2mm in length. Cureet 120 is employed to scoop up the bone fragments created by bone chisel 110.
The punch tool 130 of Fig. 9 is like the tool of Fig. 6 in all respects except that it lacks suction port 98 and thus does not perform continuous vacuuming of the surgic:al site.
It is suitable for use where the amount of debulking is limited. Neck 132 thereof is 105mm in length, has an outside diameter of 2.4mm, but has no bore formed therein; chear members 84 and the rest of the parts are similar to the parts of the punch shown in Fig. 6, as indicated by the common reference numerals.
W093/~52 PCT/US92/07735 2 11~811 Similarly, the cureet 140 of Fig. 10 has a construction like that of the punch tool of Fig. 9, but it has a distal end with scoop means 142 that is activated by squeezing handles 88 and 90. Its neck 148 is also 105mm in length and 2.4mm in outside diameter and it can also be inserted through the bore of main sheath 30.
All of the dimensions disclosed herein are believed to be quite critical although small deviations therefrom still fall within the scope of this important invention. The dimensions allow cervical discectomy to be performed by arthroscopic instruments. The inside and outside diameters of the dilator tubes and the outside diameters of the members insertable through the main sheath 30 are critical because they enable the arthroscopic procedur~s disclosed herein.
This in~ention is clearly new and useful. Moreover, it was not obvious to those of ordinary skill in this art at the ti~e it was made, in view of the prior art considered as a whole as required by law~
This invention pioneers the art of arthroscopic cervical discectomy instruments. Accordingly, the claims that follow are entitled to broad interpretation, as a matter of law, to protect from piracy the heart or essence of this breakthrough invention.
It will thus be seen that the objects sPt forth above, and those made apparent from the foregoing description, are W093/~2 PCT/US92/07735 r ~
CE:RVICAL DI~;CECTOMY IN8TR~ENT~
Technic,al Field This invention relates to arthroscopic surgical instruments. More particularly,,it relates to miniature tools having utility in cervical discectomy.
Backqround Art Neck pain is sometimes caused by the pressure of a ligament bearing against the spinal cord. The pressure can be surgically relieved by debulking, i.e., removing some of the nucleus beneath the ligament so that the ligament can return to its normal position.
Nucleus debulking has heretofore been performed conventionally, i.e~, a relatively large incision is made and the surgeon cuts through the membrane tha~ overlies the ligament and through the ligament in order to reach the nucleus. The nucleus is cut and ~ufficient amounts thereof are removed to thereby remo~e the pressure that was the source of the pain.
The tool usually employed to debulk the nucleus is known as a punch tool because it operates something like a paper punch, i.e., a shearing action accomplishes the desired WO93/~K52 PCT/US92/07735 ~ 2 cutting. More particularly, a typical punch tool has an elongate neck and the shearing mechanism is positioned at the distal end of that neck. A pair of handle members~ at the proximal end of the neck are squeezed by the surgeon and the squeezing action causes a first part of the shearing mechanism to slide with respect to a stationary second part of that mechanism, and nucleus matter betw~en said parts is sheared from the main body of nucleus matter.
The cervical discectomy punches of the type just described operate in a batch mode, i.e., they shear a single piece of tissue for each entry to the surgical site through an incision. After each shearing action, the punch must be withdrawn, an irrigation tool must be inserted to irrigate the site and place the sheared piece of nucleus into suspension, the irrigation tool must be withdrawn, a suction tool must be inserted to vacuum the irrigation fluid and the sheared piece, the suction tool must be withdrawn, and the punch inserted for another shearing action. Thus, a surgeon might be required to make dozens of entries and exits through an incision in the course of a surgical procedure when using a conventional, one bite punch instrument. Such multiple entries, exits, and re-entries obviously extend theitime required to perform the surgical procedure, and tire the surgeon and surgical assistants.
W093/~2 PCT/US92/07735 211v~ ~1 It is well known that arthroscopic surgical techniques require much smaller incisions and thus permit much faster patient recovery, thereby reducing the length of hospital stays and saving the expenses associated therewith, but arthroscopic tools capable of performing cervical discectomys do not appear in the prior art.-The prior art, when considered as a whole, neitherteaches nor suggests to those of ordinary skill in this field how the conventional punch could be improved, or how the debulking procedure could be performed arthroscopically.
Disclosure of Invention A novel set of miniature tools is provided for use by arthroscopic surgeons so that cervical discectsmy can be performed arthroscopically for the first time.
- A first tool enables the physician to properly set a guide wire, known as a K wire after the first initial of its inventor's name, in the nucleus to be debulked. The K wire guides all of the instruments used subsequently in the surgical procedure to the site of the procedure. Heretofore, arthroscopic ~urgeons had no means for facilitation of K wire insertion between vertebrae.
A second and third tool are provided to facilitate the initial dilation of the arthroscopic incision; moreover, the second tool is the main sheath throuqh which all other tools WO93/~K52 PCT/US92/07735 2li~sl~
are inserted throughout the course of the surgical procedure and also serves as the irrigation tool so that the operation site can be irrigated with saline solution as needed.
A fourth tool is a ligament cutter: it is inserted through the bore of the main sheath after the third tool has been removed therefrom and said fourth tool performs the function its name expresses. More particularlyj it cuts through the membrane that overlies the ligament and it further cuts a passageway through the ligament to expose the nucleus material thereunder.
The set further includes a novel punch tool having a continuous suction port. The novel punch tool enables the physician to complete an entire debulking procedure, i.e., to perform repeated shearing actions, with a single insertion through an incision. The punch is inserted a single ti~e, and the physician squeezes the handle members thereof as many times as needed so that the shearing members slice off as many pieces of nucleus material as required. The pieces of excised matter are continuously removed from the site by a continuous suction that withdraws irrigation fluid and surgical debris from the site. The suction means is provided in the form of an elongate suction bore that is formed in the neck of the punch; a suction port to which a cannula is releasably secured is positioned at the proximal end of the suction bore, and an opposite end of the cannula is W093/~52 PCT/US92/07735 2 11O~
detachably secured to a collection tank that is in fluid communication with a source of negative pressure. Suitable means are provided 80 that the physician can control~the flow rate of the irrigation fluid through the suction bore.
An arthroscopic cervical osteotone, an arthroscopic cervical cureet, a batch-type nucleus extractor, and a second type of cureet are also disclosed; all of these tools are insertable through the main sheath as and if needed. The second type of cureet tool has a handle arrangement like the novel continuous suction punch to facilitate its use.
Thus it is apparent that the primary object of this invention is to provide arthroscopic surgeons with the tools they need to perform cervical discectomys.
A more specific object is to provi~e a continuous suction punch to facilitate performance of arthroscopic procedures.
These and other important objects, features and advantages of the invention will become apparent as this description proceeds.
The invention accordingly comprises the features of construction, combination of elements and arrangement of parts that will be exemplified in the construction hereinafter set forth, and the scope of the invention will be indicated in the claims.
W093/~52 PCT/US92/07735 ,æl~8l~
Brief DescriPtion of the Drawinqs For a fuller understanding of the nature and objects of the invention, reference should be made to the fallowing detailed description, taken in connection with the accompanying drawings, in which:
Fig. 1 is a side elevational view of a novel K-wire push knob showing a length of K-wire retained therewithin;
Fig. 2 is a side elevational view of a novel dilator tube having a water port;
Fig. 3 is a side elevational view of a novel dilator tube;
Fig. 4 is a side elevational view showing the tubes of Figs. 2 and 3 in their assembled configuration;
Fig. 5 is a side elevational view of a novel ligament cutter;
Fig. 6 is a side elevational view of the novel cervical continuous suction punch;
Fig. 7 is a æide elevational view of a novel cervical osteotone member;
Fig. 8 is a side elevational view of a novel cervical cureet;
Fig. 9 is a side elevational view of a batch-type punch tool of arthroscopic dimensions that may be employed in lieu of the continuous suction punch of Fig. 6; and W093/~652 PCT/US92/07735 21~8~ i ~
Fig. 10 is a side elevational view a cureet tool having handle members like the handle members of the punch of Fig.
6.
Similar reference numerals refer to similar parts throughout the several views of the drawings.
Best Modes for CarrYinq Out the_Invention Referring first to Fig. 1, there it will be seen that the novel K wire push knob is denoted 10 as a whole; the K
wire is denoted 12. The proximal end 14 of K wire 12 is received within bore 16 that is formed in push knob 10. More particularly, the push knob includes a boss 18 and a knurled base 20; bore 16 extends the entire length of the boss and part of the length of the base as shown. A set screw 22 having a knurled head screw threadedly engages an internally threaded radial bore formed in a reduced diameter part 21 of base 20, said radial bore intersecting bore 16 so that the leading end of the set screw bears against the K wire when the set screw is advanced to releasably retain the guide wire within bore 16.
After the arthroscopic incision has been made, the push knob is grasped by the physician and the distal end of the K
wire is inserted into the ligament at the point where the underlying nucleus is to be debulked. The push knob 10 is then removed from the K wire by loosening set screw 22;
W093/~52 PCT/US92/07735 ~as~ 8 penetration of the distal end of the K wire into the ligament retains it in position throughout the remainder of the surgical procedure.
K wire 12 is preferably about 140mm in length, and the overall length of push knob 10 is 24mm. The reduced diameter part 21 of base 20 is 8mm in length and the balance of base 20 is 12mm in length.
The incision is then dilated in a novel way. The dilator tube 30 of Fig. 2 and the dilator tube 50 of Fig. 3 are releasably coupled together as a preparatory step to the dilation. Once coupled together, they are threaded over the K
wire so that they are properly positioned. More particularly, tubular part 52 of dilator tube S0 is slidably, i.e., telescopically, inserted into the hollow bore of the tubular part 32 of dilator tube 30. The resulting assembly is depicted in Fig. 4 and this assembly is guided to the site by the K wire, i.e., the bore of tubular part 52 axially receives said K wire. Note that the distal end 54 of tubular part 52 is tapered and extends beyond the distal end 34 of tubular part 32. Note further that the proximal end 36 of base 38 of tube 30 is slidably received within circular recess 56 formed in knurled base 58 of tube 50 and that boss 59 of base 58 is slidably received within a complementally W093/~K52 PCT/USg2/0773~
2 1 1 ~
formed recess 40 formed in base 38 of tube 30. It should be noted that boss 59 extends from a bottom wall of recess 56. This provides a double lock between tubes 30 and 50.
The tapered distal end 54 of tube 50 performs the initial dilation; the taper is provided to avoid tearing the ligament as it passes through~ After tube 50 has been advanced, then tube 30 is similarly advanced, i.e., it is advanced to the left as denoted by the directional arrow 42 in Fig. 4. This further dilates the incision.
Tube 30 further includes a water port 44 having an inlet means adapted to be engaged by a cannula, not shown; the opposite end of the cannula is detachably secured to a source of saline solution under positive pressure. Suitable valving means are provided so that the physician can control the flow rate of saline solution to port 44. Port 44 is in open fluid communication with bore 46 of tubular part 32 so that saline solution flowing from the source thereof is delivered to the site of the surgical procedure under the direction and control of the surgeon.
After dilator tube 30 has been advanced as indicated by directional arrow 42 to complete the dilation of the incision, dilator tube 50 is then slidingly decoupled therefrom and withdrawn. Dilator tube 30 is then used as the main sheath through the bore 46 of which other instruments are inserted as the surgical procedure progresses, i.e., main W093/~s2 PCT/USg2/07735 2 1 ~ ~ 8 ~
sheath 30 remains in position, as does K wire 12, until the surgical process of debulking the disc is undertaken.
The inside diameter of main sheath 30, i.e., the diameter of bore 46, is 2.5mm, and the outside diameter of sheath 30 is 3mm. The overall length of main sheath 30 is 81mm. The length of tubular part 52 of dilator tube 50 is 92mm, including the lOmm length of boss 59. Rece~s 40 formed in base 38 of main sheath 30 is also lOmm in depth to receive said boss 59.
The ligament cutter 60 of Fig. 5 is next employed; it has an overall length of 104mm and it includes a tubular part 62, having an outside diameter Gf 2.4mm, said tubular part 62 having a leading end 64; leading end 64 has a cookie cutter-style cutting edge. Tool 60 further includes a proximal end having a lOmm in length knurled base 66, a boss - 68 having about the same length, and a bore 70 for receiving the K wire. The ligament cutter 60 is used by threading it onto the K wire, i.eO, by aligning ~aid wire with bore 70 at the leading end of the cutter and by advancing the cutter through bore 46 of main sheath 30 toward the surgical site.
The physician then oscillates the cutter 60 about ! its longitudinal axis of rotation as indicated by double-headed directional arrow 72; this aotion causes cutting edge 64 to slice through the membrane overlying the ligament and continued oscillation and advancement of the cutter enable it W093/~52 PCT/US9210773~
to cut a passageway through the ligament and into the underlying nucleus. The cutter and K-wire are withdrawn after the passageway has been formed, but main sheath 30 re~ains in position.
Debulking of the nucleus may now be undertaken; the preferred tool for performing the debulking procedure is depicted in Fig. 6 and is denoted as a whole by the reference numeral 80.
This illustrative embodiment of the novel cervical continuous suction punch 80 includes an elongate neck 82 having a pair of shearing members collectively denoted 84 at the distal end thereof. Shearing members 84 are known in larger punch tools of the type used in conventional, i.e., non-arthroscopic surgery, and thus their construction need not be described. A novel handle means 86 in the form of a pair of handle members 88 and 90 is integrally formed with neck 82 at the proximal end thereof and said handle members depend therefrom; the members are pivotally mounted about pivot point 89, and member 90 has a thumb~receiving loop 91.
A strip 92 of spring steel or other ~uitable material biases handle members 88 and 90 apart from one another as indicated by arrow 93, i.e., the physician must overcome the bias to squeeze said handle members toward one another. Shear members 84 are spaced apart from one another when punch 10 is in repose and ultimately converge toward one another when said WO93~s2 PCT/US92~0773 8~ ~ 12 handle members are squeezed; a diverging motion precedes the converging motion, but, again, the particular operation of the shearing members is well known and need not be described here.
A coil spring 94 or other suitable bias means is employed to urge the handle members 88 and 90 toward one another as indicated by converging arrows 95; thus, spring steel member 92 and coil spring member 94 are first and second bias means, respectively, that oppose one another. The strength of the opposing bias means is substantially equal.
This unique arrangement of parts removes play from the handle means 86 and insures that the handle members 88 and 90 will always return to their respective positions of repose when said handle members are released.
A bore 96 is formed in neck 82 and provides fluid communication ~etween shears 84 and suction port 98 at the proximal end of punch tool 80. Bore 96 extends into port 98 as shown; port 98 provides a mounting means to which a first end of a cannula, not shown, or other suitable flexible tube means is detachably secured when the novel punch 80 is in use. The second end of the cannula is detachably secured to an unillustrated collection receptacle that is in fluid communication with an undepicted source of negative pressure.
The site of the surgical procedure is irrigated during the nucleus-shearing process by caus_ng irrigation fluid to WO93/Q~52 PCT/US92/0773~
13 211~8I ~
flow into water port 44 in main sheath 30; the inside diameter of the main sheath is sufficient to receive neck 82 of punch tool 80 and to allow sufficient space thereabout to allow the irrigation fluid to flow freely to the surgical siteO Thus, as each piece of nucleus is sheared by shears 84, releasing the squeezing motion imparted to handle members 86 and 88 opens the shears and releases the excised pieces into the irrigation fluid.
Suitable means are provided to permit the physician to control the amount of negative pressure supplied to port 98 and thus the flow rate of irrigation fluid and surgical debris flowing therethrough in the direction of arrow lO0.
Thus, a single insertion of neck 82 through the bore of main sheath 30 is the only insertion needed to complete the entire debulking procedure. Irrigation fluid is introduced through water port 44 throughout the entire debulking procedure, and the suction applied to port 98 is similarly continuous throughout said procedure.
Neck 82 is preferably about lO5mm in length, exclusive of handle 86; said handle 86 has a length, measured from the neck 82 to the lowermost end of handle member 88, of about 85mm. The outside diameter of neck 82 is 2.5mm, and the length of the movable part of the shear members 84 is 4mm.
Fig. 7 depicts a cervical osteotone llO that may also be inserted through main sheath 30 if chiseling of a vertebrae WO 93/04652 PCr/US~2/07735 2118~ ~ 14 is required at any stage of the procedure. Osteotone 110 includes a solid rod 112 having a chisel edge 114 formed in its leading end and a knurled base member 116 fixedly-secured to its proximal end. The overall length of osteotone 110 is 125 mm; the length of rod 112 is 105 mm. The lateral extent of chisel edge 114 is 2.3mm so that the tool is easily insertable through the bore of ~he main sheath.
A novel cervical cureet or scoop member 120 is depicted in Fig. 8; its rod part 122 and knurled base 124 have the same dimensions as the corresponding parts of the osteotone of Fig. 7. A scoop means 126 is formed in the leading end of rod 22; it has the same construction as a conventional scoop means of the type used in non-arthroscopic surgery, but is only 2.2mm in length. Cureet 120 is employed to scoop up the bone fragments created by bone chisel 110.
The punch tool 130 of Fig. 9 is like the tool of Fig. 6 in all respects except that it lacks suction port 98 and thus does not perform continuous vacuuming of the surgic:al site.
It is suitable for use where the amount of debulking is limited. Neck 132 thereof is 105mm in length, has an outside diameter of 2.4mm, but has no bore formed therein; chear members 84 and the rest of the parts are similar to the parts of the punch shown in Fig. 6, as indicated by the common reference numerals.
W093/~52 PCT/US92/07735 2 11~811 Similarly, the cureet 140 of Fig. 10 has a construction like that of the punch tool of Fig. 9, but it has a distal end with scoop means 142 that is activated by squeezing handles 88 and 90. Its neck 148 is also 105mm in length and 2.4mm in outside diameter and it can also be inserted through the bore of main sheath 30.
All of the dimensions disclosed herein are believed to be quite critical although small deviations therefrom still fall within the scope of this important invention. The dimensions allow cervical discectomy to be performed by arthroscopic instruments. The inside and outside diameters of the dilator tubes and the outside diameters of the members insertable through the main sheath 30 are critical because they enable the arthroscopic procedur~s disclosed herein.
This in~ention is clearly new and useful. Moreover, it was not obvious to those of ordinary skill in this art at the ti~e it was made, in view of the prior art considered as a whole as required by law~
This invention pioneers the art of arthroscopic cervical discectomy instruments. Accordingly, the claims that follow are entitled to broad interpretation, as a matter of law, to protect from piracy the heart or essence of this breakthrough invention.
It will thus be seen that the objects sPt forth above, and those made apparent from the foregoing description, are W093/~2 PCT/US92/07735 r ~
3 8 ~ 16 ?
efficiently attained and since certain changes may be made in the above construction without departing from the scope of the invention, it is intended that all matters cont~ined in the foregoing construction or shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
It is also to be understood that the following claims are intended to cover all of the generic and specific features of the invention herein described, and all statements of the scope of the invention which, as a matter of language, might be said to fall therebetween.
Now that the invention has been described,
efficiently attained and since certain changes may be made in the above construction without departing from the scope of the invention, it is intended that all matters cont~ined in the foregoing construction or shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
It is also to be understood that the following claims are intended to cover all of the generic and specific features of the invention herein described, and all statements of the scope of the invention which, as a matter of language, might be said to fall therebetween.
Now that the invention has been described,
Claims
WHAT IS CLAIMED IS:
1. A push knob for a guide wire, comprising:
a base member;
a boss means formed at a leading end of said base member;
a bore means formed in said boss means and in at least a part of said base member;
an internally threaded radial bore formed in said base member; and a set screw that screw threadedly engages said radial bore and that bears against a guide wire received within said bore means when said set screw is advanced.
5. A dilator tube, comprising:
an elongate tube;
a base member fixedly secured to a proximal end of said tube;
an annular recess of predetermined depth and predetermined diameter formed in a distal end of said base member;
a boss means of predetermined diameter extending from said distal end of said base member, said boss means being circumscribed by said annular recess;
said predetermined diameter of said boss means being less than the predetermined diameter of said annular recess; and said elongate tube having a tapered distal end to facilitate its insertion through an incision in the substantial absence of trauma to tissue.
6. A pair of dilator tubes, comprising:
a first dilator tube of predetermined length;
a base member secured to a proximal end of said first tube;
said first tube and said base member having a common bore formed therein;
a water port formed in said base member, said water port having a bore formed therein in fluid communication with the bore common to said first tube and said base member;
a recess of predetermined depth and predetermined diameter formed in a proximal end of said base member;
a second dilator tube having a predetermined length greater than the predetermined length of said first dilator tube;
said second tube having an outside diameter less than said common bore so that said first tube telescopically receives said second tube;
a base member secured to a proximal end of said second tube;
an annular recess of predetermined depth and predetermined diameter formed in a distal end of said second tube base member;
a boss member of predetermined diameter extending from said distal end of said second tube base member, said boss member being circumscribed by said annular recess;
said boss member configured and dimensioned to be slidingly received and press fit within the annular recess formed in the proximal end of the first tube base member to form a first lock;
the proximal end of said first tube base member being slidingly received and press fit within the annular recess formed in the second tube base member to form a second lock when said first tube slidingly receives said second tube;
whereby a double lock is provided to lock the first tube base member to the second tube base member.
7. An arthroscopic ligament cutter including a tubular part having a sharp distal end for cutting tissue upon rotation of said tubular part, a knurled base member fixedly secured to a proximal end of said tubular part for facilitating manual rotation of said tubular part, a boss member secured to a distal end of said base member, and a common bore formed in said tubular part, said boss member, and said base member so that a guide wire is slidingly received within said common bore to position and guide said ligament cutter.
8. An arthroscopic tool, comprising:
an elongate tubular neck having a distal end and a proximal end;
a handle means disposed at said proximal end of said elongate tubular neck in depending relation therefrom;
said handle means including a pair of handle members;
said pair of handle members being pivotally mounted to one another at a first end thereof and being spaced apart from one another at a second end thereof when in repose;
a pivot point about which said handle members pivot when an externally applied force is imparted thereto;
an elongate bore formed in said tubular neck, said elongate bore having a distal end and a proximal end coextensive with the distal end and the proximal end of said elongate tubular neck;
a suction port formed at said proximal end of said elongate bore;
a first bias means for urging said handle members away from one another with a first predetermined level of force;
said first bias means being disposed between the handle members of said pair of handle members;
a second bias means for urging said handle members toward one another with a second predetermined level of force;
said second bias means being disposed between the handle members of said pair of handle members;
said first and second predetermined levels of force being substantially equal to one another; and said first bias means positioned between said second bias means and said pivot point;
said first bias means being a strip of spring steel and said second bias means being a coil spring;
whereby suction applied to said suction port draws irrigation fluid and surgical debris into said distal end of said elongate bore so that said fluid and debris are continuously vacuumed from a surgical site during a surgical procedure; and whereby said first and second bias means substantially eliminate play between said handle members throughout their entire range of motion; and whereby said handle members are under a substantially constant level of bias throughout said entire range of motion.
11. A cervical osteotone, comprising an elongate solid rod having a longitudinal extent of about 105mm, a knurled base member having a longitudinal extent of about 20mm secured to a proximal end of said rod, and a chisel head formed in a distal end of said rod, said chisel head having a breadth of about 2.3mm, whereby said osteotone is slidingly insertable into an arthroscopic sheath.
12. A cervical cureet, comprising an elongate solid rod having a longitudinal extent of about 105mm, a knurled base member having a longitudinal extent of about 20mm secured to a proximal end of said rod, and a scoop member formed in a distal end of said rod, and said scoop member having a longitudinal extent of about 2.2mm, whereby said cureet is slidingly insertable into an arthroscopic sheath.
13. A nucleus extractor, comprising:
an elongate neck having an outside diameter of about 2.4mm;
a handle means secured to a proximal end of said neck, said handle means depending from said proximal end;
said handle means including a pair of pivotally mounted handle members;
a pivot point about which said handle members pivot when an externally applied force is imparted thereto;
a first bias means disposed between said handle members for urging said handle members to pivot away from one another;
a second bias means disposed between said handle members for urging said handle members to pivot toward one another;
Said first bias means positioned between said pivot point and said second bias means;
said first and second bias means having substantially equal strengths so that each opposes the other with substantially equal force when the extractor is in repose; and a shearing means disposed at a distal end of said neck, said shearing means being operated by manipulation of said handle members;
whereby said neck is slidably insertable into an arthroscopic sheath.
14. A cureet nucleus extractor, comprising:
an elongate neck having a longitudinal extent of about 105mm and an outside diameter of about 2.4mm;
a handle means depending from a proximal end of said neck;
said handle means including a pair of pivotally mounted handle members;
a pivot point about which said handle members pivot when an externally imparted force is applied thereto;
a first bias means disposed between said handle members for urging said handle members to pivot away from one another;
a second bias means disposed between said handle members for urging said handle members to pivot toward one another;
said first bias means positioned between said pivot point and said second bias means;
said first and second bias means having substantially equal strengths so that each opposes the other with substantially equal force when the extractor is in repose; and a scoop means disposed at a distal end of said neck, said scoop means being operated by manipulation of said handle members;
whereby said neck is slidably insertable into an arthroscopic sheath.
1. A push knob for a guide wire, comprising:
a base member;
a boss means formed at a leading end of said base member;
a bore means formed in said boss means and in at least a part of said base member;
an internally threaded radial bore formed in said base member; and a set screw that screw threadedly engages said radial bore and that bears against a guide wire received within said bore means when said set screw is advanced.
5. A dilator tube, comprising:
an elongate tube;
a base member fixedly secured to a proximal end of said tube;
an annular recess of predetermined depth and predetermined diameter formed in a distal end of said base member;
a boss means of predetermined diameter extending from said distal end of said base member, said boss means being circumscribed by said annular recess;
said predetermined diameter of said boss means being less than the predetermined diameter of said annular recess; and said elongate tube having a tapered distal end to facilitate its insertion through an incision in the substantial absence of trauma to tissue.
6. A pair of dilator tubes, comprising:
a first dilator tube of predetermined length;
a base member secured to a proximal end of said first tube;
said first tube and said base member having a common bore formed therein;
a water port formed in said base member, said water port having a bore formed therein in fluid communication with the bore common to said first tube and said base member;
a recess of predetermined depth and predetermined diameter formed in a proximal end of said base member;
a second dilator tube having a predetermined length greater than the predetermined length of said first dilator tube;
said second tube having an outside diameter less than said common bore so that said first tube telescopically receives said second tube;
a base member secured to a proximal end of said second tube;
an annular recess of predetermined depth and predetermined diameter formed in a distal end of said second tube base member;
a boss member of predetermined diameter extending from said distal end of said second tube base member, said boss member being circumscribed by said annular recess;
said boss member configured and dimensioned to be slidingly received and press fit within the annular recess formed in the proximal end of the first tube base member to form a first lock;
the proximal end of said first tube base member being slidingly received and press fit within the annular recess formed in the second tube base member to form a second lock when said first tube slidingly receives said second tube;
whereby a double lock is provided to lock the first tube base member to the second tube base member.
7. An arthroscopic ligament cutter including a tubular part having a sharp distal end for cutting tissue upon rotation of said tubular part, a knurled base member fixedly secured to a proximal end of said tubular part for facilitating manual rotation of said tubular part, a boss member secured to a distal end of said base member, and a common bore formed in said tubular part, said boss member, and said base member so that a guide wire is slidingly received within said common bore to position and guide said ligament cutter.
8. An arthroscopic tool, comprising:
an elongate tubular neck having a distal end and a proximal end;
a handle means disposed at said proximal end of said elongate tubular neck in depending relation therefrom;
said handle means including a pair of handle members;
said pair of handle members being pivotally mounted to one another at a first end thereof and being spaced apart from one another at a second end thereof when in repose;
a pivot point about which said handle members pivot when an externally applied force is imparted thereto;
an elongate bore formed in said tubular neck, said elongate bore having a distal end and a proximal end coextensive with the distal end and the proximal end of said elongate tubular neck;
a suction port formed at said proximal end of said elongate bore;
a first bias means for urging said handle members away from one another with a first predetermined level of force;
said first bias means being disposed between the handle members of said pair of handle members;
a second bias means for urging said handle members toward one another with a second predetermined level of force;
said second bias means being disposed between the handle members of said pair of handle members;
said first and second predetermined levels of force being substantially equal to one another; and said first bias means positioned between said second bias means and said pivot point;
said first bias means being a strip of spring steel and said second bias means being a coil spring;
whereby suction applied to said suction port draws irrigation fluid and surgical debris into said distal end of said elongate bore so that said fluid and debris are continuously vacuumed from a surgical site during a surgical procedure; and whereby said first and second bias means substantially eliminate play between said handle members throughout their entire range of motion; and whereby said handle members are under a substantially constant level of bias throughout said entire range of motion.
11. A cervical osteotone, comprising an elongate solid rod having a longitudinal extent of about 105mm, a knurled base member having a longitudinal extent of about 20mm secured to a proximal end of said rod, and a chisel head formed in a distal end of said rod, said chisel head having a breadth of about 2.3mm, whereby said osteotone is slidingly insertable into an arthroscopic sheath.
12. A cervical cureet, comprising an elongate solid rod having a longitudinal extent of about 105mm, a knurled base member having a longitudinal extent of about 20mm secured to a proximal end of said rod, and a scoop member formed in a distal end of said rod, and said scoop member having a longitudinal extent of about 2.2mm, whereby said cureet is slidingly insertable into an arthroscopic sheath.
13. A nucleus extractor, comprising:
an elongate neck having an outside diameter of about 2.4mm;
a handle means secured to a proximal end of said neck, said handle means depending from said proximal end;
said handle means including a pair of pivotally mounted handle members;
a pivot point about which said handle members pivot when an externally applied force is imparted thereto;
a first bias means disposed between said handle members for urging said handle members to pivot away from one another;
a second bias means disposed between said handle members for urging said handle members to pivot toward one another;
Said first bias means positioned between said pivot point and said second bias means;
said first and second bias means having substantially equal strengths so that each opposes the other with substantially equal force when the extractor is in repose; and a shearing means disposed at a distal end of said neck, said shearing means being operated by manipulation of said handle members;
whereby said neck is slidably insertable into an arthroscopic sheath.
14. A cureet nucleus extractor, comprising:
an elongate neck having a longitudinal extent of about 105mm and an outside diameter of about 2.4mm;
a handle means depending from a proximal end of said neck;
said handle means including a pair of pivotally mounted handle members;
a pivot point about which said handle members pivot when an externally imparted force is applied thereto;
a first bias means disposed between said handle members for urging said handle members to pivot away from one another;
a second bias means disposed between said handle members for urging said handle members to pivot toward one another;
said first bias means positioned between said pivot point and said second bias means;
said first and second bias means having substantially equal strengths so that each opposes the other with substantially equal force when the extractor is in repose; and a scoop means disposed at a distal end of said neck, said scoop means being operated by manipulation of said handle members;
whereby said neck is slidably insertable into an arthroscopic sheath.
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US07/758,013 | 1991-09-12 | ||
US07/758,013 US5269797A (en) | 1991-09-12 | 1991-09-12 | Cervical discectomy instruments |
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CA2118811A1 true CA2118811A1 (en) | 1993-03-18 |
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CA002118811A Abandoned CA2118811A1 (en) | 1991-09-12 | 1992-09-14 | Cervical discectomy instruments |
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Families Citing this family (235)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5171279A (en) | 1992-03-17 | 1992-12-15 | Danek Medical | Method for subcutaneous suprafascial pedicular internal fixation |
FR2714285B1 (en) * | 1993-12-24 | 1996-03-15 | Impact | Device for performing a percutaneous nucleotomy. |
US5643229A (en) * | 1994-07-22 | 1997-07-01 | Sinaiko; Edwin S. | Suction tube apparatus |
US5693064A (en) * | 1994-11-04 | 1997-12-02 | Arnold; James E. | Dermal punch for hair transplantation and methods |
CA2159685C (en) * | 1994-10-07 | 2007-07-31 | Scott W. Larsen | Endoscopic surgical instruments useful for spinal procedures |
WO1996013214A1 (en) * | 1994-10-31 | 1996-05-09 | Boston Scientific Corporation | Biopsy needle |
US5873886A (en) * | 1995-04-04 | 1999-02-23 | United States Surgical Corporation | Surgical cutting apparatus |
US5879365A (en) * | 1995-04-04 | 1999-03-09 | United States Surgical Corporation | Surgical cutting apparatus |
US5693011A (en) * | 1995-04-27 | 1997-12-02 | Surgical Dynamics, Inc. | Surgical suction cutting instrument |
DE19515626C2 (en) * | 1995-04-28 | 2000-04-06 | Wolf Gmbh Richard | Instrument for positioning at least one working sleeve |
US5817034A (en) | 1995-09-08 | 1998-10-06 | United States Surgical Corporation | Apparatus and method for removing tissue |
US5857982A (en) * | 1995-09-08 | 1999-01-12 | United States Surgical Corporation | Apparatus and method for removing tissue |
EP0891156B1 (en) * | 1996-03-22 | 2004-07-14 | SDGI Holdings, Inc. | Device for percutaneous surgery |
US7198598B2 (en) * | 1996-03-22 | 2007-04-03 | Warsaw Orthopedic, Inc. | Devices and methods for percutaneous surgery |
US6679833B2 (en) | 1996-03-22 | 2004-01-20 | Sdgi Holdings, Inc. | Devices and methods for percutaneous surgery |
US5792044A (en) * | 1996-03-22 | 1998-08-11 | Danek Medical, Inc. | Devices and methods for percutaneous surgery |
DE69726491T2 (en) * | 1996-05-09 | 2004-10-28 | Olympus Optical Co., Ltd. | Bone surgery tool to hold a cavity, surgical tool to hold a cavity, system for endoscopic surgery using a tool to hold a cavity |
US7069087B2 (en) * | 2000-02-25 | 2006-06-27 | Oratec Interventions, Inc. | Apparatus and method for accessing and performing a function within an intervertebral disc |
US6726685B2 (en) | 2001-06-06 | 2004-04-27 | Oratec Interventions, Inc. | Intervertebral disc device employing looped probe |
US6832997B2 (en) | 2001-06-06 | 2004-12-21 | Oratec Interventions, Inc. | Electromagnetic energy delivery intervertebral disc treatment devices |
US6733496B2 (en) | 2001-06-06 | 2004-05-11 | Oratec Interventions, Inc. | Intervertebral disc device employing flexible probe |
US6126682A (en) | 1996-08-13 | 2000-10-03 | Oratec Interventions, Inc. | Method for treating annular fissures in intervertebral discs |
TW375522B (en) * | 1996-10-24 | 1999-12-01 | Danek Medical Inc | Devices for percutaneous surgery under direct visualization and through an elongated cannula |
EP0873145A2 (en) | 1996-11-15 | 1998-10-28 | Advanced Bio Surfaces, Inc. | Biomaterial system for in situ tissue repair |
US6068630A (en) * | 1997-01-02 | 2000-05-30 | St. Francis Medical Technologies, Inc. | Spine distraction implant |
US5976146A (en) * | 1997-07-11 | 1999-11-02 | Olympus Optical Co., Ltd. | Surgical operation system and method of securing working space for surgical operation in body |
JPH1176247A (en) * | 1997-07-11 | 1999-03-23 | Olympus Optical Co Ltd | Surgical operation system |
US6175758B1 (en) | 1997-07-15 | 2001-01-16 | Parviz Kambin | Method for percutaneous arthroscopic disc removal, bone biopsy and fixation of the vertebrae |
US5938685A (en) * | 1997-09-05 | 1999-08-17 | Boston Scientific Corporation | Locking handle for surgical instruments |
US6383145B1 (en) | 1997-09-12 | 2002-05-07 | Imagyn Medical Technologies California, Inc. | Incisional breast biopsy device |
US6551253B2 (en) | 1997-09-12 | 2003-04-22 | Imagyn Medical Technologies | Incisional breast biopsy device |
US6142955A (en) | 1997-09-19 | 2000-11-07 | United States Surgical Corporation | Biopsy apparatus and method |
JP2002506672A (en) | 1998-03-19 | 2002-03-05 | オーレイテック インターヴェンションズ インコーポレイテッド | Catheter for delivering energy to the surgical site |
US6187000B1 (en) | 1998-08-20 | 2001-02-13 | Endius Incorporated | Cannula for receiving surgical instruments |
US7641670B2 (en) | 1998-08-20 | 2010-01-05 | Zimmer Spine, Inc. | Cannula for receiving surgical instruments |
US7799036B2 (en) | 1998-08-20 | 2010-09-21 | Zimmer Spine, Inc. | Method and apparatus for securing vertebrae |
WO2000038574A1 (en) | 1998-12-23 | 2000-07-06 | Nuvasive, Inc. | Nerve surveillance cannulae systems |
US20050203334A1 (en) * | 1999-01-26 | 2005-09-15 | Lonky Neal M. | Vacuum instrument for laparotomy procedures |
US6641575B1 (en) * | 1999-01-26 | 2003-11-04 | Neal M. Lonky | Surgical vacuum instrument for retracting, extracting, and manipulating tissue |
CA2591678C (en) * | 1999-03-07 | 2008-05-20 | Active Implants Corporation | Method and apparatus for computerized surgery |
US6159179A (en) * | 1999-03-12 | 2000-12-12 | Simonson; Robert E. | Cannula and sizing and insertion method |
DE69917683T2 (en) * | 1999-06-16 | 2005-07-07 | Joimax Gmbh | DEVICE FOR DECOMPRESSION OF DETACHED WASHERS |
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 |
US6214010B1 (en) * | 1999-11-04 | 2001-04-10 | Thompson Surgical Instruments, Inc. | Rongeur surgical instrument |
JP4854900B2 (en) | 1999-11-24 | 2012-01-18 | ヌバシブ, インコーポレイテッド | EMG measurement method |
US8915894B1 (en) | 2000-01-24 | 2014-12-23 | Meditech Development Incorporated | Vacuum cup for delivery of agents during vacuum treatment |
US8409214B2 (en) | 2009-01-22 | 2013-04-02 | Meditech Development Incorporated | Portable regulated vacuum pump for medical procedures |
DE10003050C2 (en) * | 2000-01-25 | 2002-03-07 | Copf Jun | Surgical dilatation instrument and spacer for use with such |
CA2415072C (en) | 2000-06-30 | 2011-05-31 | Stephen Ritland | Polyaxial connection device and method |
US7056321B2 (en) | 2000-08-01 | 2006-06-06 | Endius, Incorporated | Method of securing vertebrae |
US7985247B2 (en) | 2000-08-01 | 2011-07-26 | Zimmer Spine, Inc. | Methods and apparatuses for treating the spine through an access device |
US6712773B1 (en) | 2000-09-11 | 2004-03-30 | Tyco Healthcare Group Lp | Biopsy system |
US6692434B2 (en) | 2000-09-29 | 2004-02-17 | Stephen Ritland | Method and device for retractor for microsurgical intermuscular lumbar arthrodesis |
US7166073B2 (en) | 2000-09-29 | 2007-01-23 | Stephen Ritland | Method and device for microsurgical intermuscular spinal surgery |
NZ526081A (en) * | 2000-11-13 | 2006-06-30 | Frank H Boehm | Device and method for lumbar interbody fusion |
US6929606B2 (en) | 2001-01-29 | 2005-08-16 | Depuy Spine, Inc. | Retractor and method for spinal pedicle screw placement |
WO2002060330A1 (en) * | 2001-01-29 | 2002-08-08 | Stephen Ritland | Retractor and method for spinal pedicle screw placement |
US6638276B2 (en) | 2001-06-06 | 2003-10-28 | Oratec Interventions, Inc. | Intervertebral disc device employing prebent sheath |
EP1417000B1 (en) | 2001-07-11 | 2018-07-11 | Nuvasive, Inc. | System for determining nerve proximity during surgery |
US8021399B2 (en) | 2005-07-19 | 2011-09-20 | Stephen Ritland | Rod extension for extending fusion construct |
WO2003026482A2 (en) | 2001-09-25 | 2003-04-03 | Nuvasive, Inc. | System and methods for performing surgical procedures and assessments |
ATE495709T1 (en) | 2001-09-28 | 2011-02-15 | Stephen Ritland | CONNECTING ROD FOR A POLYAXIAL SYSTEM WITH SCREW OR HOOK |
US7824410B2 (en) | 2001-10-30 | 2010-11-02 | Depuy Spine, Inc. | Instruments and methods for minimally invasive spine surgery |
US6916330B2 (en) * | 2001-10-30 | 2005-07-12 | Depuy Spine, Inc. | Non cannulated dilators |
US7008431B2 (en) | 2001-10-30 | 2006-03-07 | Depuy Spine, Inc. | Configured and sized cannula |
EP1545353B1 (en) * | 2002-02-20 | 2010-08-11 | Stephen Ritland | Pedicle screw connector apparatus |
US20030187431A1 (en) * | 2002-03-29 | 2003-10-02 | Simonson Robert E. | Apparatus and method for targeting for surgical procedures |
US6966910B2 (en) | 2002-04-05 | 2005-11-22 | Stephen Ritland | Dynamic fixation device and method of use |
US7682375B2 (en) * | 2002-05-08 | 2010-03-23 | Stephen Ritland | Dynamic fixation device and method of use |
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 |
US9259144B2 (en) * | 2002-07-11 | 2016-02-16 | Nuvasive, Inc. | Surgical access system and related methods |
US6648888B1 (en) | 2002-09-06 | 2003-11-18 | Endius Incorporated | Surgical instrument for moving a vertebra |
US7074226B2 (en) * | 2002-09-19 | 2006-07-11 | Sdgi Holdings, Inc. | Oval dilator and retractor set and method |
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 |
US20040106997A1 (en) * | 2002-11-01 | 2004-06-03 | Lieberson Robert E. | Apparatus and method for creating a surgical channel |
US7691057B2 (en) | 2003-01-16 | 2010-04-06 | Nuvasive, Inc. | Surgical access system and related methods |
US7090680B2 (en) * | 2003-02-12 | 2006-08-15 | Bonati Alfred O | Method for removing orthopaedic hardware |
US20040158257A1 (en) * | 2003-02-12 | 2004-08-12 | Bonati Alfred O. | Extractor tube for removing orthopaedic hardware |
CA2516791C (en) | 2003-02-25 | 2011-12-13 | Stephen Ritland | Adjustable rod and connector device and method of use |
US7819801B2 (en) | 2003-02-27 | 2010-10-26 | Nuvasive, Inc. | Surgical access system and related methods |
US7641659B2 (en) * | 2003-03-13 | 2010-01-05 | Zimmer Spine, Inc. | Spinal access instrument |
US7465304B1 (en) | 2003-04-14 | 2008-12-16 | Spine Design, Inc. | Anterior cervical facet discectomy surgery kit and method for its use |
US7645232B2 (en) | 2003-05-16 | 2010-01-12 | Zimmer Spine, Inc. | Access device for minimally invasive surgery |
WO2004110247A2 (en) | 2003-05-22 | 2004-12-23 | Stephen Ritland | Intermuscular guide for retractor insertion and method of use |
US7811303B2 (en) * | 2003-08-26 | 2010-10-12 | Medicine Lodge Inc | Bodily tissue dilation systems and methods |
US7905840B2 (en) | 2003-10-17 | 2011-03-15 | Nuvasive, Inc. | Surgical access system and related methods |
WO2005030318A1 (en) | 2003-09-25 | 2005-04-07 | Nuvasive, Inc. | Surgical access system and related methods |
US20050090899A1 (en) * | 2003-10-24 | 2005-04-28 | Dipoto Gene | Methods and apparatuses for treating the spine through an access device |
US7731737B2 (en) * | 2003-10-24 | 2010-06-08 | Zimmer Spine, Inc. | Methods and apparatuses for fixation of 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 |
US20050090822A1 (en) * | 2003-10-24 | 2005-04-28 | Dipoto Gene | Methods and apparatus for stabilizing the spine through an access device |
US7588575B2 (en) | 2003-10-21 | 2009-09-15 | Innovative Spinal Technologies | Extension for use with stabilization systems for internal structures |
US7645282B2 (en) * | 2003-11-20 | 2010-01-12 | Osseus, Llc | Method and device for cutting surgical wire or cable |
WO2005060837A2 (en) * | 2003-12-18 | 2005-07-07 | Depuy Spine, Inc. | Surgical retractor systems, illuminated cannulae, and methods of use |
US20050137600A1 (en) * | 2003-12-23 | 2005-06-23 | Jacobs Andrew M. | Articular cartilage repair implant delivery device and method of use |
DE102004006521A1 (en) * | 2004-02-10 | 2005-09-08 | Horst Drs. Dekkers | Set of surgical instruments for spine surgery |
US7909843B2 (en) | 2004-06-30 | 2011-03-22 | Thompson Surgical Instruments, Inc. | Elongateable surgical port and dilator |
US20060004398A1 (en) * | 2004-07-02 | 2006-01-05 | Binder Lawrence J Jr | Sequential dilator system |
US7434325B2 (en) | 2004-07-26 | 2008-10-14 | Warsaw Orthopedic, Inc. | Systems and methods for determining optimal retractor length in minimally invasive procedures |
EP3205371B1 (en) * | 2004-08-03 | 2019-09-25 | DePuy Synthes Products, Inc. | Telescopic percutaneous tissue dilation systems and related methods of producing |
US9387313B2 (en) | 2004-08-03 | 2016-07-12 | Interventional Spine, Inc. | Telescopic percutaneous tissue dilation systems and related methods |
US20060052812A1 (en) * | 2004-09-07 | 2006-03-09 | Michael Winer | Tool for preparing a surgical site for an access device |
EP1799130A1 (en) * | 2004-09-14 | 2007-06-27 | Uromedica, Inc. | Implantation tool for adjustable implantable genitourinary device |
US7455639B2 (en) | 2004-09-20 | 2008-11-25 | Stephen Ritland | Opposing parallel bladed retractor and method of use |
US7666189B2 (en) * | 2004-09-29 | 2010-02-23 | Synthes Usa, Llc | Less invasive surgical system and methods |
WO2006042241A2 (en) | 2004-10-08 | 2006-04-20 | Nuvasive, Inc. | Surgical access system and related methods |
US9055981B2 (en) | 2004-10-25 | 2015-06-16 | Lanx, Inc. | Spinal implants and methods |
WO2006047562A2 (en) * | 2004-10-25 | 2006-05-04 | Lins Robert E | Interspinous distraction devices and associated methods of insertion |
US8241330B2 (en) | 2007-01-11 | 2012-08-14 | Lanx, Inc. | Spinous process implants and associated methods |
US7594888B2 (en) * | 2004-10-29 | 2009-09-29 | Depuy Spine, Inc. | Expandable ports and methods for minimally invasive surgery |
US20060217664A1 (en) * | 2004-11-15 | 2006-09-28 | Hattler Brack G | Telescoping vascular dilator |
US7569061B2 (en) | 2004-11-16 | 2009-08-04 | Innovative Spinal Technologies, Inc. | Off-axis anchor guidance system |
US20060224044A1 (en) * | 2005-03-31 | 2006-10-05 | Depuy Spine, Inc. | Surgical retractors and methods of use |
US20060241566A1 (en) * | 2005-04-11 | 2006-10-26 | Orthox, Llc | Nucleus Extraction from Spine Intervertebral Disc |
US7427264B2 (en) * | 2005-04-22 | 2008-09-23 | Warsaw Orthopedic, Inc. | Instruments and methods for selective tissue retraction through a retractor sleeve |
US20070055259A1 (en) * | 2005-08-17 | 2007-03-08 | Norton Britt K | Apparatus and methods for removal of intervertebral disc tissues |
WO2007038429A1 (en) | 2005-09-27 | 2007-04-05 | Endius, Inc. | Methods and apparatuses for stabilizing the spine through an access device |
US8066730B2 (en) * | 2005-11-14 | 2011-11-29 | Scapa Flow, Llc | Medical dilator system or dilator device |
US20070162062A1 (en) * | 2005-12-08 | 2007-07-12 | Norton Britt K | Reciprocating apparatus and methods for removal of intervertebral disc tissues |
US7918792B2 (en) * | 2006-01-04 | 2011-04-05 | Depuy Spine, Inc. | Surgical retractor for use with minimally invasive spinal stabilization systems and methods of minimally invasive surgery |
US7758501B2 (en) | 2006-01-04 | 2010-07-20 | Depuy Spine, Inc. | Surgical reactors and methods of minimally invasive surgery |
US7981031B2 (en) | 2006-01-04 | 2011-07-19 | Depuy Spine, Inc. | Surgical access devices and methods of minimally invasive surgery |
US7955257B2 (en) * | 2006-01-05 | 2011-06-07 | Depuy Spine, Inc. | Non-rigid surgical retractor |
US7842038B2 (en) * | 2006-05-04 | 2010-11-30 | Warsaw Orthopedic, Inc. | Method for using retractable stylet and cannula combination to form an opening in bone |
US8167899B2 (en) * | 2006-05-04 | 2012-05-01 | Warsaw Orthopedic, Inc. | Retractable stylet and cannula combination |
US20070265633A1 (en) * | 2006-05-11 | 2007-11-15 | Moon Jon K | Implement and method to extract nucleus from spine intervertebral disc |
US8092536B2 (en) | 2006-05-24 | 2012-01-10 | Disc Dynamics, Inc. | Retention structure for in situ formation of an intervertebral prosthesis |
US7959564B2 (en) | 2006-07-08 | 2011-06-14 | Stephen Ritland | Pedicle seeker and retractor, and methods of use |
WO2008070863A2 (en) | 2006-12-07 | 2008-06-12 | Interventional Spine, Inc. | Intervertebral implant |
US9232959B2 (en) | 2007-01-02 | 2016-01-12 | Aquabeam, Llc | Multi fluid tissue resection methods and devices |
US9265532B2 (en) | 2007-01-11 | 2016-02-23 | Lanx, Inc. | Interspinous implants and methods |
US8398640B2 (en) | 2007-03-23 | 2013-03-19 | John Riley Hawkins | Volume measuring intervertebral tool system and method |
US20080255651A1 (en) * | 2007-04-12 | 2008-10-16 | Medtronic Vascular, Inc. | Telescoping Stability Sheath and Method of Use |
US8900307B2 (en) | 2007-06-26 | 2014-12-02 | DePuy Synthes Products, LLC | Highly lordosed fusion cage |
KR20100080529A (en) | 2007-10-05 | 2010-07-08 | 신세스 게엠바하 | Dilation system and method of using the same |
CN101909548B (en) | 2008-01-17 | 2014-07-30 | 斯恩蒂斯有限公司 | An expandable intervertebral implant and associated method of manufacturing the same |
WO2009111736A1 (en) | 2008-03-06 | 2009-09-11 | Aquabeam Llc | Tissue ablation and cautery with optical energy carried in fluid stream |
JP5441997B2 (en) | 2008-04-05 | 2014-03-12 | 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 | Expandable intervertebral implant |
US20100023006A1 (en) * | 2008-07-23 | 2010-01-28 | Ellman Alan G | RF intervertebral disc surgical system |
AU2009329873A1 (en) | 2008-12-26 | 2011-11-03 | Scott Spann | Minimally-invasive retroperitoneal lateral approach for spinal surgery |
US9526620B2 (en) | 2009-03-30 | 2016-12-27 | DePuy Synthes Products, Inc. | Zero profile spinal fusion cage |
EP2413825A4 (en) | 2009-03-31 | 2013-12-11 | Lanx Inc | Spinous process implants and associated methods |
US9393129B2 (en) | 2009-12-10 | 2016-07-19 | DePuy Synthes Products, Inc. | Bellows-like expandable interbody fusion cage |
US8986334B2 (en) * | 2010-02-04 | 2015-03-24 | Nico Corporation | Tissue removal device with tissue grip |
US8486097B2 (en) * | 2010-02-04 | 2013-07-16 | Nico Corporation | Tissue cutting device |
US9282979B2 (en) | 2010-06-24 | 2016-03-15 | DePuy Synthes Products, Inc. | Instruments and methods for non-parallel disc space preparation |
US8979860B2 (en) | 2010-06-24 | 2015-03-17 | DePuy Synthes Products. LLC | Enhanced cage insertion device |
WO2012003175A1 (en) | 2010-06-29 | 2012-01-05 | Synthes Usa, Llc | Distractible intervertebral implant |
US8562610B2 (en) | 2010-07-13 | 2013-10-22 | Warsaw Orthopedic, Inc. | Compliant device and method for cutting an intervertebral disc |
US9402732B2 (en) | 2010-10-11 | 2016-08-02 | DePuy Synthes Products, Inc. | Expandable interspinous process spacer implant |
US9155503B2 (en) | 2010-10-27 | 2015-10-13 | Cadwell Labs | Apparatus, system, and method for mapping the location of a nerve |
US20120191083A1 (en) | 2011-01-20 | 2012-07-26 | Hansen Medical, Inc. | System and method for endoluminal and translumenal therapy |
US20120197320A1 (en) * | 2011-01-28 | 2012-08-02 | Laser Spine Surgical Center, LLC | Foraminoplasty Device |
US9445825B2 (en) | 2011-02-10 | 2016-09-20 | Wright Medical Technology, Inc. | Expandable surgical device |
US8790406B1 (en) | 2011-04-01 | 2014-07-29 | William D. Smith | Systems and methods for performing spine surgery |
US8834507B2 (en) | 2011-05-17 | 2014-09-16 | Warsaw Orthopedic, Inc. | Dilation instruments and methods |
WO2013028571A1 (en) | 2011-08-19 | 2013-02-28 | Lanx, Inc. | Surgical retractor system and methods of use |
US8753344B2 (en) * | 2011-09-23 | 2014-06-17 | Smith & Nephew, Inc. | Dynamic orthoscopic sensing |
US11812923B2 (en) | 2011-10-07 | 2023-11-14 | Alan Villavicencio | Spinal fixation device |
US9198765B1 (en) | 2011-10-31 | 2015-12-01 | Nuvasive, Inc. | Expandable spinal fusion implants and related methods |
US9028522B1 (en) | 2011-11-15 | 2015-05-12 | Seaspine, Inc. | Tissue dilator and retractor system and method of use |
CN104203078B (en) | 2012-02-29 | 2018-04-20 | 普罗赛普特生物机器人公司 | The cutting tissue of automated image guiding and processing |
US9186444B2 (en) | 2012-05-07 | 2015-11-17 | Meditech Development Incorporated | Portable regulated pressure devices for medical procedures |
US8940052B2 (en) | 2012-07-26 | 2015-01-27 | DePuy Synthes Products, LLC | Expandable implant |
US20140067069A1 (en) | 2012-08-30 | 2014-03-06 | Interventional Spine, Inc. | Artificial disc |
US9295401B2 (en) | 2012-11-27 | 2016-03-29 | Cadwell Laboratories, Inc. | Neuromonitoring systems and methods |
US10231867B2 (en) | 2013-01-18 | 2019-03-19 | Auris Health, Inc. | Method, apparatus and system for a water jet |
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 |
US10098585B2 (en) | 2013-03-15 | 2018-10-16 | Cadwell Laboratories, Inc. | Neuromonitoring systems and methods |
WO2014201165A1 (en) | 2013-06-11 | 2014-12-18 | Auris Surgical Robotics, Inc. | System for robotic assisted cataract surgery |
US10426661B2 (en) | 2013-08-13 | 2019-10-01 | Auris Health, Inc. | Method and apparatus for laser assisted cataract surgery |
US9788856B2 (en) | 2014-03-11 | 2017-10-17 | Stryker European Holdings I, Llc | Endoscopic surgical systems and methods |
US10258228B2 (en) * | 2014-08-08 | 2019-04-16 | K2M, Inc. | Retraction devices, systems, and methods for minimally invasive spinal surgery |
US11426290B2 (en) | 2015-03-06 | 2022-08-30 | DePuy Synthes Products, Inc. | Expandable intervertebral implant, system, kit and method |
US10433793B1 (en) | 2015-03-27 | 2019-10-08 | Cadwell Laboratories, Inc. | Methods and systems for simultaneous review of brain activity and physical manifestations of users |
US20160287279A1 (en) | 2015-04-01 | 2016-10-06 | Auris Surgical Robotics, Inc. | Microsurgical tool for robotic applications |
US9913727B2 (en) | 2015-07-02 | 2018-03-13 | Medos International Sarl | Expandable implant |
US9949749B2 (en) | 2015-10-30 | 2018-04-24 | Auris Surgical Robotics, Inc. | Object capture with a basket |
US10231793B2 (en) | 2015-10-30 | 2019-03-19 | Auris Health, Inc. | Object removal through a percutaneous suction tube |
US9955986B2 (en) | 2015-10-30 | 2018-05-01 | Auris Surgical Robotics, Inc. | Basket apparatus |
US11510788B2 (en) | 2016-06-28 | 2022-11-29 | Eit Emerging Implant Technologies Gmbh | Expandable, angularly adjustable intervertebral cages |
WO2018002715A2 (en) | 2016-06-28 | 2018-01-04 | Eit Emerging Implant Technologies Gmbh | Expandable and angularly adjustable articulating intervertebral cages |
US10974027B2 (en) | 2016-07-29 | 2021-04-13 | Cephea Valve Technologies, Inc. | Combination steerable catheter and systems |
US10933216B2 (en) | 2016-08-29 | 2021-03-02 | Cephea Valve Technologies, Inc. | Multilumen catheter |
US10537436B2 (en) | 2016-11-01 | 2020-01-21 | DePuy Synthes Products, Inc. | Curved expandable cage |
US11241297B2 (en) | 2016-12-12 | 2022-02-08 | Cadwell Laboratories, Inc. | System and method for high density electrode management |
US10888433B2 (en) | 2016-12-14 | 2021-01-12 | DePuy Synthes Products, Inc. | Intervertebral implant inserter and related methods |
US9935395B1 (en) | 2017-01-23 | 2018-04-03 | Cadwell Laboratories, Inc. | Mass connection plate for electrical connectors |
KR102545869B1 (en) | 2017-03-28 | 2023-06-23 | 아우리스 헬스, 인코포레이티드 | shaft operating handle |
US10285574B2 (en) | 2017-04-07 | 2019-05-14 | Auris Health, Inc. | Superelastic medical instrument |
EP3606400B1 (en) | 2017-04-07 | 2022-03-09 | Auris Health, Inc. | Patient introducer alignment |
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 |
US11331091B2 (en) * | 2017-11-14 | 2022-05-17 | Endovision Co., Ltd. | Surgical instrument set for use during unilateral biportal endoscopy |
US11517239B2 (en) | 2018-04-05 | 2022-12-06 | Cadwell Laboratories, Inc. | Systems and methods for processing and displaying electromyographic signals |
US11596337B2 (en) | 2018-04-24 | 2023-03-07 | Cadwell Laboratories, Inc | Methods and systems for operating an intraoperative neurophysiological monitoring system in conjunction with electrocautery procedures |
US11253182B2 (en) | 2018-05-04 | 2022-02-22 | Cadwell Laboratories, Inc. | Apparatus and method for polyphasic multi-output constant-current and constant-voltage neurophysiological stimulation |
WO2019236450A1 (en) | 2018-06-07 | 2019-12-12 | Auris Health, Inc. | Robotic medical systems with high force instruments |
WO2020005854A1 (en) | 2018-06-28 | 2020-01-02 | Auris Health, Inc. | Medical systems incorporating pulley sharing |
US11443649B2 (en) | 2018-06-29 | 2022-09-13 | Cadwell Laboratories, Inc. | Neurophysiological monitoring training simulator |
EP3806772A4 (en) | 2018-08-15 | 2022-03-30 | Auris Health, Inc. | Medical instruments for tissue cauterization |
EP3806758A4 (en) | 2018-08-17 | 2022-04-06 | Auris Health, Inc. | Bipolar medical instrument |
US11185684B2 (en) | 2018-09-18 | 2021-11-30 | Cadwell Laboratories, Inc. | Minimally invasive two-dimensional grid electrode |
CN112770689A (en) | 2018-09-26 | 2021-05-07 | 奥瑞斯健康公司 | Systems and apparatus for suction and irrigation |
WO2020076447A1 (en) | 2018-10-08 | 2020-04-16 | Auris Health, Inc. | Systems and instruments for tissue sealing |
US11446156B2 (en) | 2018-10-25 | 2022-09-20 | Medos International Sarl | Expandable intervertebral implant, inserter instrument, and related methods |
US11517245B2 (en) | 2018-10-30 | 2022-12-06 | Cadwell Laboratories, Inc. | Method and system for data synchronization |
US11471087B2 (en) | 2018-11-09 | 2022-10-18 | Cadwell Laboratories, Inc. | Integrity verification system for testing high channel count neuromonitoring recording equipment |
US11317841B2 (en) | 2018-11-14 | 2022-05-03 | Cadwell Laboratories, Inc. | Method and system for electrode verification |
US11529107B2 (en) | 2018-11-27 | 2022-12-20 | Cadwell Laboratories, Inc. | Methods for automatic generation of EEG montages |
US11950863B2 (en) | 2018-12-20 | 2024-04-09 | Auris Health, Inc | Shielding for wristed instruments |
US11128076B2 (en) | 2019-01-21 | 2021-09-21 | Cadwell Laboratories, Inc. | Connector receptacle |
WO2020154100A1 (en) | 2019-01-25 | 2020-07-30 | Auris Health, Inc. | Vessel sealer with heating and cooling capabilities |
WO2020197625A1 (en) | 2019-03-25 | 2020-10-01 | Auris Health, Inc. | Systems and methods for medical stapling |
WO2020263629A1 (en) | 2019-06-27 | 2020-12-30 | Auris Health, Inc. | Systems and methods for a medical clip applier |
WO2020263949A1 (en) | 2019-06-28 | 2020-12-30 | Auris Health, Inc. | Medical instruments including wrists with hybrid redirect surfaces |
US11896330B2 (en) | 2019-08-15 | 2024-02-13 | Auris Health, Inc. | Robotic medical system having multiple medical instruments |
EP4034349A1 (en) | 2019-09-26 | 2022-08-03 | Auris Health, Inc. | Systems and methods for collision detection and avoidance |
WO2021064536A1 (en) | 2019-09-30 | 2021-04-08 | Auris Health, Inc. | Medical instrument with capstan |
US11737835B2 (en) | 2019-10-29 | 2023-08-29 | Auris Health, Inc. | Braid-reinforced insulation sheath |
US11950872B2 (en) | 2019-12-31 | 2024-04-09 | Auris Health, Inc. | Dynamic pulley system |
US11439419B2 (en) | 2019-12-31 | 2022-09-13 | Auris Health, Inc. | Advanced basket drive mode |
US11426286B2 (en) | 2020-03-06 | 2022-08-30 | Eit Emerging Implant Technologies Gmbh | Expandable intervertebral implant |
US11839969B2 (en) | 2020-06-29 | 2023-12-12 | Auris Health, Inc. | Systems and methods for detecting contact between a link and an external object |
WO2022003493A1 (en) | 2020-06-30 | 2022-01-06 | Auris Health, Inc. | Robotic medical system with collision proximity indicators |
US11357586B2 (en) | 2020-06-30 | 2022-06-14 | Auris Health, Inc. | Systems and methods for saturated robotic movement |
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 |
WO2022231613A1 (en) * | 2021-04-30 | 2022-11-03 | Aok Innovations, Llc | Body cavity access device |
US11963692B2 (en) | 2021-04-30 | 2024-04-23 | Aok Innovations, Llc | Body cavity access device |
Family Cites Families (38)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2112873A (en) * | 1936-11-07 | 1938-04-05 | Wright Jerauld | Tool |
US2532141A (en) * | 1947-07-09 | 1950-11-28 | Eaton Mfg Co | Split ring expander |
GB843744A (en) * | 1957-10-17 | 1960-08-10 | Wilbur Raymond Koehn | Surgical apparatus incorporating a catheter tube |
US3875938A (en) * | 1973-08-22 | 1975-04-08 | Eli K Mellor | Multi-mode cannulating apparatus |
AR196829A1 (en) * | 1973-12-06 | 1974-02-19 | Halpern D | SURGICAL INSTRUMENT FOR BIOPSIES |
US3921640A (en) * | 1974-03-22 | 1975-11-25 | Int Paper Co | Disposable surgical instruments |
US4368734A (en) * | 1978-01-27 | 1983-01-18 | Surgical Design Corp. | Surgical instrument |
DE3025785C2 (en) * | 1980-07-08 | 1984-08-16 | Storz, Karl, 7200 Tuttlingen | Dilator, method for its use and device for carrying out the method |
DE3030579C2 (en) * | 1980-08-13 | 1983-03-31 | B. Braun Melsungen Ag, 3508 Melsungen | IV catheters |
US4396021A (en) * | 1980-12-15 | 1983-08-02 | Baumgartner George C | Surgical instrument and process |
US4512344A (en) * | 1982-05-12 | 1985-04-23 | Barber Forest C | Arthroscopic surgery dissecting apparatus |
US4545374A (en) * | 1982-09-03 | 1985-10-08 | Jacobson Robert E | Method and instruments for performing a percutaneous lumbar diskectomy |
DE3248067A1 (en) * | 1982-12-24 | 1984-07-05 | B. Braun Melsungen Ag, 3508 Melsungen | Atraumatic spinal cannula |
US4499899A (en) * | 1983-01-21 | 1985-02-19 | Brimfield Precision, Inc. | Fiber-optic illuminated microsurgical scissors |
US4662371A (en) * | 1983-01-26 | 1987-05-05 | Whipple Terry L | Surgical instrument |
DE8316034U1 (en) * | 1983-06-01 | 1983-09-29 | Richard Wolf Gmbh, 7134 Knittlingen | Scissor handle for exchangeable pliers bits |
US4573448A (en) * | 1983-10-05 | 1986-03-04 | Pilling Co. | Method for decompressing herniated intervertebral discs |
US4712545A (en) * | 1984-04-05 | 1987-12-15 | Acufex Microsurgical, Inc. | Surgical instrument |
US4630616A (en) * | 1984-06-15 | 1986-12-23 | Berkley And Company, Inc. | Bone marrow needle |
US4678459A (en) * | 1984-07-23 | 1987-07-07 | E-Z-Em, Inc. | Irrigating, cutting and aspirating system for percutaneous surgery |
DE3508013A1 (en) * | 1984-07-28 | 1986-02-06 | Peter 7730 Villingen-Schwenningen Krebs | COMBINATION NEEDLE FOR THE AXILLAERE PLEXUS-BRACHIALIS-ANESTHESIA |
US4699611A (en) * | 1985-04-19 | 1987-10-13 | C. R. Bard, Inc. | Biliary stent introducer |
US4674502A (en) * | 1985-09-27 | 1987-06-23 | Coopervision, Inc. | Intraocular surgical instrument |
DE8702446U1 (en) * | 1987-02-18 | 1987-10-08 | Kothe, Lutz, 7760 Radolfzell, De | |
JPS6431701U (en) * | 1987-08-20 | 1989-02-27 | ||
US4863430A (en) * | 1987-08-26 | 1989-09-05 | Surgical Dynamics, Inc. | Introduction set with flexible trocar with curved cannula |
US4862891A (en) * | 1988-03-14 | 1989-09-05 | Canyon Medical Products | Device for sequential percutaneous dilation |
DE8806359U1 (en) * | 1988-05-13 | 1988-07-14 | Karl Storz Gmbh & Co, 7200 Tuttlingen, De | |
US4986825A (en) * | 1988-10-11 | 1991-01-22 | Concept, Inc. | Surgical cutting instrument |
US4990148A (en) * | 1989-01-13 | 1991-02-05 | Codman & Shurtleff, Inc. | Thin footplate rongeur |
US5025797A (en) * | 1989-03-29 | 1991-06-25 | Baran Gregory W | Automated biopsy instrument |
US5154694A (en) * | 1989-06-06 | 1992-10-13 | Kelman Charles D | Tissue scraper device for medical use |
US5057085A (en) * | 1989-11-24 | 1991-10-15 | Medical Device Technologies, Inc. | Stabilized aspiration biopsy needle assembly |
AU6835990A (en) * | 1990-01-12 | 1991-08-01 | Laserscope | Instrumentation clamp |
US5052085A (en) * | 1990-03-30 | 1991-10-01 | Gau Shwu Jing | Structure of clothes clip |
US5158543A (en) * | 1990-10-30 | 1992-10-27 | Lazarus Harrison M | Laparoscopic surgical system and method |
US5217479A (en) * | 1991-02-14 | 1993-06-08 | Linvatec Corporation | Surgical cutting instrument |
US5071410A (en) * | 1991-03-14 | 1991-12-10 | Pazell John A | Arthroscopic surgery system |
-
1991
- 1991-09-12 US US07/758,013 patent/US5269797A/en not_active Expired - Lifetime
-
1992
- 1992-09-14 EP EP01105835A patent/EP1101471B1/en not_active Expired - Lifetime
- 1992-09-14 AT AT92920314T patent/ATE210407T1/en not_active IP Right Cessation
- 1992-09-14 WO PCT/US1992/007735 patent/WO1993004652A1/en active IP Right Grant
- 1992-09-14 DE DE69232289T patent/DE69232289T2/en not_active Expired - Lifetime
- 1992-09-14 DE DE69233382T patent/DE69233382T2/en not_active Expired - Lifetime
- 1992-09-14 JP JP50552193A patent/JPH07502419A/en active Pending
- 1992-09-14 AU AU26598/92A patent/AU663338B2/en not_active Ceased
- 1992-09-14 EP EP92920314A patent/EP0603313B1/en not_active Expired - Lifetime
- 1992-09-14 RU RU94016166A patent/RU2121813C1/en not_active IP Right Cessation
- 1992-09-14 CA CA002118811A patent/CA2118811A1/en not_active Abandoned
-
1993
- 1993-08-17 US US08/108,036 patent/US5472426A/en not_active Expired - Lifetime
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US5269797A (en) | 1993-12-14 |
WO1993004652A1 (en) | 1993-03-18 |
DE69232289T2 (en) | 2002-08-08 |
DE69233382D1 (en) | 2004-08-19 |
EP1101471B1 (en) | 2004-07-14 |
EP0603313A1 (en) | 1994-06-29 |
ATE210407T1 (en) | 2001-12-15 |
DE69233382T2 (en) | 2005-08-04 |
EP0603313A4 (en) | 1995-12-06 |
EP1101471A2 (en) | 2001-05-23 |
AU2659892A (en) | 1993-04-05 |
EP1101471A3 (en) | 2002-01-16 |
EP0603313B1 (en) | 2001-12-12 |
US5472426A (en) | 1995-12-05 |
RU2121813C1 (en) | 1998-11-20 |
DE69232289D1 (en) | 2002-01-24 |
AU663338B2 (en) | 1995-10-05 |
JPH07502419A (en) | 1995-03-16 |
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EEER | Examination request | ||
FZDE | Discontinued |