WO1994009726A1 - Internal fixators - Google Patents
Internal fixators Download PDFInfo
- Publication number
- WO1994009726A1 WO1994009726A1 PCT/US1993/010143 US9310143W WO9409726A1 WO 1994009726 A1 WO1994009726 A1 WO 1994009726A1 US 9310143 W US9310143 W US 9310143W WO 9409726 A1 WO9409726 A1 WO 9409726A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- adaptor
- pedicle
- vertebrae
- patient
- screw
- Prior art date
Links
- 238000000034 method Methods 0.000 claims abstract description 41
- 210000003195 fascia Anatomy 0.000 claims abstract description 18
- 210000000115 thoracic cavity Anatomy 0.000 claims abstract description 6
- 210000000988 bone and bone Anatomy 0.000 claims description 21
- 230000001054 cortical effect Effects 0.000 claims description 4
- 238000003780 insertion Methods 0.000 claims description 2
- 230000037431 insertion Effects 0.000 claims description 2
- 210000003205 muscle Anatomy 0.000 description 3
- 239000000523 sample Substances 0.000 description 3
- 238000007920 subcutaneous administration Methods 0.000 description 3
- 238000001356 surgical procedure Methods 0.000 description 3
- 238000012800 visualization Methods 0.000 description 3
- 238000002594 fluoroscopy Methods 0.000 description 2
- 208000015181 infectious disease Diseases 0.000 description 2
- 206010033675 panniculitis Diseases 0.000 description 2
- 229910001220 stainless steel Inorganic materials 0.000 description 2
- 239000010935 stainless steel Substances 0.000 description 2
- 210000004304 subcutaneous tissue Anatomy 0.000 description 2
- 206010033892 Paraplegia Diseases 0.000 description 1
- 208000027418 Wounds and injury Diseases 0.000 description 1
- 239000000560 biocompatible material Substances 0.000 description 1
- 230000006835 compression Effects 0.000 description 1
- 238000007906 compression Methods 0.000 description 1
- 238000002788 crimping Methods 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 238000002224 dissection Methods 0.000 description 1
- 238000000605 extraction Methods 0.000 description 1
- 230000004927 fusion Effects 0.000 description 1
- 238000002513 implantation Methods 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 230000004807 localization Effects 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 230000003387 muscular Effects 0.000 description 1
- 230000000630 rising effect Effects 0.000 description 1
- 238000010079 rubber tapping Methods 0.000 description 1
- 230000006641 stabilisation Effects 0.000 description 1
- 238000011105 stabilization Methods 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7041—Screws or hooks combined with longitudinal elements which do not contact vertebrae with single longitudinal rod offset laterally from single row of screws or hooks
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
- A61B17/7007—Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit around the screw or hook heads
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7002—Longitudinal elements, e.g. rods
- A61B17/701—Longitudinal elements with a non-circular, e.g. rectangular, cross-section
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
- A61B50/30—Containers specially adapted for packaging, protecting, dispensing, collecting or disposing of surgical or diagnostic appliances or instruments
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/90—Lumbar stabilizer
Definitions
- the present invention relates to percutaneous interbody fusion with subcutaneous internal fixators. More particularly, the present invention relates to percutaneous fixation of lumbar vertebrae by means of a minimally invasive technique.
- external fixators require the patient to carry a fixation assembly on the surface of the back, which is difficult from a physical and psychological point of view for a majority of patients. Moreover, the rehabilitation of paraplegic patients with external fixators has proven to be difficult. In addition, external fixators have portals in the skin which become sites for infection.
- the present invention seeks to overcome or alleviate at best some of the disadvantages of prior art internal fixators.
- a method for percutaneous fixation of a pair of lumbar vertebrae of a patient comprising the steps of:
- each pedicle screw and adaptor having a tubular body with a threaded upper end member
- the method of the present invention requires only a small incision to enable the surgeon to link the pedicle screws together.
- the fixators are located internally, thereby avoiding the disadvantages of external fixation. Since the subcutaneous fixators used in the present invention may be removed routinely after a period of rehabilitation, such as from 10 to 12 weeks, future MRI and CT visualisation of the spinal canal and the lateral recesses are then possible. In contrast, the permanent implantation of internal fixators prevents the use of MRI and CT visualisations.
- the present invention also provides a bone screw apparatus for use with a spinal fixation system which includes an elongated plate with at least one opening for providing rigid support to the system comprising: a) bone screw means having a distal threaded end configured to be surgically implanted into a patient's bone and an integral shank with a proximal threaded end portion;
- an adaptor means with a distal end portion shaped to co-operate and engage with the proximal threaded end portion of the bone screw and having a proximal end portion shaped to engage one side of the plate and extend through the opening in the plate;
- the present invention further provides a kit for percutaneous fixation of vertebrae of a patient, comprising a plurability of pedicle screws of different sizes, yet of a size to enable the distal end of each screw to be screwed into the medullary canal of each pedicle of a vertebra with the proximal end thereof lying adjacent the fascia of a patient.
- the kit may include a plurability of linkage means proportioned to lie under the skin of the patient and operable to detachably link together the proximal ends of the pedicle screws inserted into the pedicles of the vertebrae.
- the kit is a kit for percutaneous fixation of vertebrae of a patient, comprising:
- said adaptor means having a tubular body with a threaded upper end member
- said beam members and said adaptor means proportioned to lie under the skin of the patient and operable to detachably link together the proximal ends of said pedicle screws inserted into the pedicles of said vertebrae.
- Fig. 1 is a schematic view, partly in section in enlarged scale, of one of the pedicles of a lumbar vertebra into which has been inserted a pedicle screw with a beam member detachably linked to the pedicle screw;
- Fig. 2 is a schematic view, in enlarged scale, showing the subcutaneous fixation system of the present invention implanted in a patient;
- Figs. 3-8 are elevational views of various instruments used to perform the surgical procedure of the present invention.
- Fig. 9 is a plan view of a kit for carrying out the method of the present invention.
- Fig. 10 is an elevational view of a tool used to carry out the method of the present invention.
- Fig. 11 is a view in perspective of an alternative embodiment of the present invention.
- Fig. 12 is an elevational view of an alternative embodiment of the present invention.
- Fig. 13 is a partial sectional view of the alternative embodiment shown in Fig. 12.
- Fig. 14 is an elevational view of a second alternative embodiment of the present invention.
- Fig. 15 is a perspective exploded view of an alternative linkage system.
- Fig. 16 is schematic yiew illustrating an alternate embodiment of the present invention in use as part of a spinal fixation system.
- Fig. 1 schematically shows a pedicle screw 1 inserted into the medullary canal 2 of the pedicle 3 of a lumbar vertebra 4 of a patient.
- the distal end la of the pedicle screw l extends into the body 5 of the vertebra 4, while the proximal end lb lies adjacent to the lumbar fascia 20 (shown in phantom line) .
- Fastened to the proximal end lb of pedicle screw 1 is an adaptor 6 having a slot 6a therein for receiving a beam member 7, here shown in the form of a plate.
- Fig. 1 shows the pedicle screw l inserted into the pedicle 3 situated to one side of the spinous process (not shown) of the vertebra 4.
- the pedicle (not shown) lying on the other side of the spinous process is also provided with a pedicle screw and an adaptor.
- the intervertebral disc to be removed lies between the vertebra 4 shown in Fig. 1 and a lumbar vertebra adjacent thereto (Fig. 2) , which is also provided with pedicle screws inserted in the pedicles thereof, adaptors fastened to the proximal ends of the pedicle screws, and a beam member in the same manner as shown in Fig. 1.
- Fig. 2 is a schematic view of the assembly of pedicle screws, adaptors and beam members of the invention, as viewed posteriorly with part of the skin 30 and subcutaneous tissue 40 of the patient removed for ease of illustration.
- pedicle screws 1 are held in the one pair of the pedicles (not shown) of lumbar vertebra La, while the other pair of pedicle screws 1 is held in the pedicle of vertebra Lb immediately above or below lumbar vertebra La.
- the intervertebral disc D to be removed is between lumbar vertebra La and Lb as schematically indicated.
- All of the adaptors 6 are preferably flush against the lumbar fascia 20 as shown in Fig. 1.
- Pedicle screws 1, adaptors 6, and beam members 7 are all made of biocompatible material, suitably stainless steel.
- the surgical procedure for percutaneous fixation of lumbar vertebra of the invention may be carried out as follows.
- the patient is placed prone on a radiolucent table and frame (not shown) .
- the C-arm of a conventional fluoroscope is positioned for anteroposterior visualization of the lumbar vertebrae and the table is tilted away from the C-arm to permit better localization of the pedicles.
- a cannulated tubular guide 8 (Fig. 3) is maneuvered by hand or by the flexible holder 9 (Fig. 4) having its proximal end 9a secured to the table and carrying at its distal end a ring 9b for holding guide 8.
- the guide 8 is maneuvered with the holder 9 until the guide 8 is aligned with the longitudinal axis of the pedicle, after which the holder 9 is locked into place. When properly aligned, the guide 8 will appear by fluoroscopy as an opaque circle in the center of the pedicle.
- a guide wire (not shown) , suitably of 2mm outside diameter, is introduced into the guide 8 and is advanced through the skin of the patient's back, posterolaterally toward the pedicle 3.
- the guide wire is tapped with a mallet into the cortical bone at the junction of the base of the transverse process 10 (Fig. 1) and the proximal articular process 11.
- a cannulated obturator 11 Fig.
- the obturator 11 is then removed, and a cannulated drill 13 having a lumen 13a (Fig. 7) is placed over the guide wire and advance to the pedicle 3.
- a cannulated drill 13 having a lumen 13a (Fig. 7) is placed over the guide wire and advance to the pedicle 3.
- the opening of the cortex of the pedicle is enlarged to form an entrance 3a (Fig. l) into the medullary canal 3b of the pedicle 3.
- the cannulated drill 13 is removed and a blunt end pedicle screw probe 14 (Fig. 8) is manually advanced into the medullary canal 3b with a twisting motion, to crush the cancellous bone of the medullary canal 3b thus creating a tunnel or bore 3c (Fig. 1) extending from the pedicle 3 into the vertebral body 5 (Fig. 1) .
- the probe 14 or a blunt end K-wire can be inserted into the bore 3c, the position and length of the probe or K-wire being checked by anteroposterior and lateral fluoroscopy.
- the bore 3c may be tapped to receive the threads lc of the pedicle screw 1.
- a self-tapping pedicle screw may be used. Before implanting the pedicle screw 1, the bore 3c may be inspected arthroscopically to make certain that the cortex 3d (Fig. 1) of the pedicle 3 has not been violated; if it has been, the surgeon may abort the procedure.
- the length of the pedicle screw 1 to be used may be determined by the use of a K-wire.
- the K-wire can be used to measure the depth of bore 3c, and the distance between the bone and the lumbar fascia 20.
- the appropriate pedicle screw 1 is selected from the kit 50 (Fig. 9) containing a plurality of pedicle screws 1, beam members 7 and adaptors 6 in a container 51.
- the pedicle screws 1 are all of a size to enable the distal end la of each screw 1 to be screwed into the medullary canal 3b of the pedicle 3 of a lumber vertebrae with the proximal end lb thereof lying adjacent the lumbar fascia 20 of a patient, while the beam members 7 are proportioned to lie under the skin 30 of the patient and operate to detachably link together the proximal ends lb of a pair of pedicle screws 1 (Fig. 2) inserted into the pedicles 3 of the lumbar vertebrae.
- the pedicle screws 1 in kit 50 will be of different lengths and diameters. However, it is contemplated that the kit may contain pedicle screws 1 of different lengths and the same diameters.
- the beam members 7 may be of different lengths, all are sized to be received in adaptors 6, and since some beam members 7 in the kit 51 may be much longer, they can be cut to length by the surgeon.
- Adaptors 6 will comprise adaptors having a slot 6a open at one end and closed at the other, such as the upper adaptors 6 as viewed in Fig. 2, while others will have a slot 6a open at both ends, such as the lower adaptors 6 as viewed in Fig. 2.
- pedicle screw l selected is placed into the access cannula 12 and thence into the bore 3c.
- An alien wrench (not shown) may be inserted into the recess id (Fig. 1) , to drive the pedicle screw l into the bore 3c.
- pedicle screw 1 may be provi ⁇ ed with any suitable means for engaging a pedicle screw driver, such as a slot in screw 1 and a corresponding blade for the driver.
- an adaptor guide 15 (Fig. 10) having an outside diameter smaller than the inside diameter of the tubular body 6b is inserted through the access cannula 12 so that the projection 15a enters recess id (Fig. 1) , after which the access cannula 12 is removed.
- An adaptor 6 is slid over the adaptor guide 15 and is screwed in place over the eternal threads on the proximal end lb of screw l, to the position shown in Fig. 1. All of the adaptors have an internally threaded tubular body 6b extending from a slotted cap 6c, the slot 6a lying in a plane perpendicular to the tubular body 6b.
- Adaptor guide 15 may also be used as a driver for the pedicle screws, for example by providing a slot (not shown) in the distal end of guide 15 to receive a cross-bar that serves as a handle. After the pedicle screws are in place, the disc D is removed by percutaneous total discectomy. See, e.g., U.S. Patents 4,573,448, 4,545,374 and 4,678,459. Bone grafts are then packed between the vertebral plates, and the vertebrae are aligned into their desired position by compression, extension and/or angulation using a wrench (not shown) or other tool that securely grasps the proximal ends lb of the screws and/or the adaptors 6.
- the vertebrae When the vertebrae are properly aligned, they are locked in place by inserting the beam members 7 into the adaptors 6 and, in turn, locking the beam members 7 in place.
- one end of the beam member 7 is received in an adaptor 6 having a slot 6a open at one end and closed at the other, such as the upper adaptors 6 shown in Fig. 2, while the other end is received in an adaptor 6 having a slot open at both ends, such as the lower adaptors 6 shown in Fig. 2.
- a small incision (not shown) may, if necessary, be made in the patient's back adjacent the adaptor 6 having a slot 6a having two open ends.
- the beam member 7 is inserted into the subcutaneous tissue 40 via the incision and advanced through adaptors 6 until the distal end of the beam member 7 contacts the closed end of adaptor 6. If necessary, the beam members 7 may be bent to allow the beam member 7 to be received by the adaptors 6.
- Each beam member 7 is locked in place in adaptors 6 by set screws (not shown) or by crimping the adaptors 6 and the ends of the beam member 7 or by any other suitable detachable locking means, the incision is then closed.
- the adaptor cap 6 have a low profile, i.e. with a small thickness relative to its length and width.
- the cap 6c has a substantially flat top and flat underside as shown, but other configurations may be used as long as the cap 6 is proportioned to lie beneath the skin and/or the lumbar fascia 20.
- the beam members 7 are in the form of rods 16 (Fig. 11)
- the cap 6 may still be flat but a suitable cylindrical slot (not shown) will be used.
- each pedicle screw l may not align in a position that allows the beam member 7 to lock in place. Additionally, if the pedicle screw 1 is implanted at an angle into the body 5 of the vertebrae 4 the proximal end lb of each pedicle screw l may touch or be too close together to allow the beam member 7 to lock into place. In these situations an alternative to the adaptor 6 is desirable to allow for easier insertion of the beam member 7.
- An alternative embodiment of the adaptor 6 is an offset adaptor 60, as shown in Fig. 12.
- the offset adaptor 60 is an internally threaded tubular body 62 having an offset upper end portion 64 with fine threads 66. Fig.
- the offset adaptor 60 can be used with an alternate linkage system such as a plate 82, a washer 84, and a nut 86 which are described and shown in U.S. patent 5,129,899.
- an alternate linkage system as shown in Fig. 15 is used, the plate 82 is placed over the upwardly projecting screw portion 66 of the offset adaptor 60.
- the washer 84 is placed over the plate 82 and is secured by the locking nut 86 that engages the threaded screw portion 66 of the offset adaptor 60.
- the offset adaptor 60 can be of varying lengths to accommodate the distance between the proximal end lb of the pedicle screw 1 and the lumbar fascia 20 of the patient.
- Fig. 16 illustrates a pair of spaced apart plates 82 with the attachment of the offset adaptor 60, the washer 84, and the nut 86 as part of an implanted, overall spinal fixation system.
- a second alternate embodiment in the form of straight adaptor 70 as shown in Fig. 14 can be used.
- the straight adaptor 70 has a finely threaded upper end portion 76 and a body 74 that is generally hexagonal in shape, the adaptor 70 has an internally threaded portion for engagement with the external threads on the proximal end lb of the pedicle screw 1.
- the straight adaptor 70 can be of varying lengths to accommodate the distance between the proximal end lb of pedicle screw 1 and the lumbar fascia 20 of the patient. Additionally, both adaptor 60 and 70 could be of a sufficient length to be used with an external fixation system.
- the adaptors 60 and 70 may also be formed of stainless steel or other biocompatable materials.
- the guide wire may be about 10 to 12 inches long while the cannulated obturator 11 may be about 6 to about 7 inches long and about 7mm in diameter, with a lumen 11a sized to slide over the guide wire.
- the access cannula 12 may be about 5 to about 6 inches long with an inside diameter of about 7mm.
- the cannulated drill 13 also has a limen 13a sized to slide over the guide wire and will have an outside diameter somewhat smaller than the outside diameter of the pedicle screw.
- the pedicle screw 1 may have an outside diameter of about 5 to about 6.5mm and may suitably be from about 45 to about 70mm in total length, with a distal portion lc of about 20 to about 45mm carrying a bone screw in thread form and the proximal portion being threaded to receive the adaptor 6.
- the tubular body 6b of the adaptor 6 may be about 15 to about 30mm long, with a cap 6c of about 30x30mm square and about 4 to 10mm thick.
- the slot 6a must accommodate the beam member 7. Plates of about 5 to about lOmm wide by about 35 to about 90mm long are suitable, the thickness of the plates 7 being about 2 to about 5mm. Rods 16 of about 5 to about 7mm in diameter and 35 to about 9Omm long are also suitable. Anatomical variations of a particular patient may require the use of different dimensions.
- FIG. 1 shows for convenience the fixation of only two vertebrae, it is to be understood that more than two vertebrae may be fixed.
- pedicle screws 1 will be implanted in the pedicles of the three vertebrae.
- the pedicle screws rising from the LI or L3 vertebra will carry an adaptor 6 having a slot closed at one end, while the other pedicle screws will carry an adaptor 6 having a slot open at both ends.
- a longer beam member 7 is then slid through the adaptors 6 and locked into place as described above.
- the offset adaptor 60 or the straight adaptor 70 may be used in place of the adaptor 6 as seen in Fig. 16. Moreover, the surgeon may elect to fix three vertebrae even if only one disc is to be removed.
- the procedure is effected percutaneously as described above. That is, the center of each- pedicle to be implanted with a pedicle screw is located fluoroscopically, the pedicle screws are implanted percutaneously as described above and the proximal ends of the pedicle screws are linked together beneath the skin at or preferably flush with the muscle fascia as described above. If considered desirable by the surgeon, the beam members and/or the pedicle screws may be cross-linked together, such as by the use of 1.5mm cross-wires.
- kit 50 is illustrated as containing the screws, beam members and adaptors 6, the same or auxiliary kits may be provided with adaptors 60 and/or adaptors 70 and the instruments used to carry out the surgical procedure, such as the instruments shown in Figs. 3-8 and 10.
Abstract
Description
Claims
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP94901184A EP0665731A4 (en) | 1992-10-23 | 1993-10-22 | Internal fixators. |
JP6511193A JPH08502680A (en) | 1992-10-23 | 1993-10-22 | Internal fixator |
AU55862/94A AU678196B2 (en) | 1992-10-23 | 1993-10-22 | Internal fixators |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US07/965,346 | 1992-10-23 | ||
US07/965,346 US5584887A (en) | 1991-08-15 | 1992-10-23 | Percutaneous screw adapter |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1994009726A1 true WO1994009726A1 (en) | 1994-05-11 |
Family
ID=25509840
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1993/010143 WO1994009726A1 (en) | 1992-10-23 | 1993-10-22 | Internal fixators |
Country Status (6)
Country | Link |
---|---|
US (1) | US5584887A (en) |
EP (1) | EP0665731A4 (en) |
JP (1) | JPH08502680A (en) |
AU (1) | AU678196B2 (en) |
CA (1) | CA2147660A1 (en) |
WO (1) | WO1994009726A1 (en) |
Cited By (13)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0611116B1 (en) * | 1993-02-11 | 1996-07-17 | SMITH & NEPHEW RICHARDS, INC. | Spinal column retaining apparatus |
US7955355B2 (en) | 2003-09-24 | 2011-06-07 | Stryker Spine | Methods and devices for improving percutaneous access in minimally invasive surgeries |
US8002798B2 (en) | 2003-09-24 | 2011-08-23 | Stryker Spine | System and method for spinal implant placement |
US8157809B2 (en) | 2006-09-25 | 2012-04-17 | Stryker Spine | Percutaneous compression and distraction system |
US8894655B2 (en) | 2006-02-06 | 2014-11-25 | Stryker Spine | Rod contouring apparatus and method for percutaneous pedicle screw extension |
US9408716B1 (en) | 2013-12-06 | 2016-08-09 | Stryker European Holdings I, Llc | Percutaneous posterior spinal fusion implant construction and method |
US9510875B2 (en) | 2013-03-14 | 2016-12-06 | Stryker European Holdings I, Llc | Systems and methods for percutaneous spinal fusion |
US9622795B2 (en) | 2013-12-13 | 2017-04-18 | Stryker European Holdings I, Llc | Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion |
US9744050B1 (en) | 2013-12-06 | 2017-08-29 | Stryker European Holdings I, Llc | Compression and distraction system for percutaneous posterior spinal fusion |
US9827020B2 (en) | 2013-03-14 | 2017-11-28 | Stryker European Holdings I, Llc | Percutaneous spinal cross link system and method |
US10034690B2 (en) | 2014-12-09 | 2018-07-31 | John A. Heflin | Spine alignment system |
US10159579B1 (en) | 2013-12-06 | 2018-12-25 | Stryker European Holdings I, Llc | Tubular instruments for percutaneous posterior spinal fusion systems and methods |
USRE48250E1 (en) | 2012-01-16 | 2020-10-13 | K2M, Inc. | Rod reducer, compressor, distractor system |
Families Citing this family (55)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5800435A (en) * | 1996-10-09 | 1998-09-01 | Techsys, Llc | Modular spinal plate for use with modular polyaxial locking pedicle screws |
US6352537B1 (en) | 1998-09-17 | 2002-03-05 | Electro-Biology, Inc. | Method and apparatus for spinal fixation |
US7641657B2 (en) | 2003-06-10 | 2010-01-05 | Trans1, Inc. | Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae |
US7717958B2 (en) | 2000-02-16 | 2010-05-18 | Trans1, Inc. | Prosthetic nucleus apparatus |
US7014633B2 (en) | 2000-02-16 | 2006-03-21 | Trans1, Inc. | Methods of performing procedures in the spine |
US6899716B2 (en) | 2000-02-16 | 2005-05-31 | Trans1, Inc. | Method and apparatus for spinal augmentation |
US7744599B2 (en) | 2000-02-16 | 2010-06-29 | Trans1 Inc. | Articulating spinal implant |
US6740090B1 (en) | 2000-02-16 | 2004-05-25 | Trans1 Inc. | Methods and apparatus for forming shaped axial bores through spinal vertebrae |
US6558386B1 (en) | 2000-02-16 | 2003-05-06 | Trans1 Inc. | Axial spinal implant and method and apparatus for implanting an axial spinal implant within the vertebrae of the spine |
WO2004049915A2 (en) | 2000-02-16 | 2004-06-17 | Trans1 Inc. | Method and apparatus for spinal distraction and fusion |
US6575979B1 (en) | 2000-02-16 | 2003-06-10 | Axiamed, Inc. | Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae |
US6558390B2 (en) | 2000-02-16 | 2003-05-06 | Axiamed, Inc. | Methods and apparatus for performing therapeutic procedures in the spine |
US6645207B2 (en) * | 2000-05-08 | 2003-11-11 | Robert A. Dixon | Method and apparatus for dynamized spinal stabilization |
US6749614B2 (en) | 2000-06-23 | 2004-06-15 | Vertelink Corporation | Formable orthopedic fixation system with cross linking |
US6875212B2 (en) | 2000-06-23 | 2005-04-05 | Vertelink Corporation | Curable media for implantable medical device |
US6964667B2 (en) | 2000-06-23 | 2005-11-15 | Sdgi Holdings, Inc. | Formed in place fixation system with thermal acceleration |
US6899713B2 (en) | 2000-06-23 | 2005-05-31 | Vertelink Corporation | Formable orthopedic fixation system |
EP1292239B1 (en) | 2000-06-23 | 2013-02-13 | University Of Southern California | Percutaneous vertebral fusion system |
ATE271354T1 (en) * | 2001-03-09 | 2004-08-15 | Co Ligne Ag | ELONGATED IMPLANT |
US6843790B2 (en) * | 2001-03-27 | 2005-01-18 | Bret A. Ferree | Anatomic posterior lumbar plate |
US6884241B2 (en) * | 2001-09-04 | 2005-04-26 | Orthotec, Llc | Spinal assembly plate |
US20030187443A1 (en) * | 2002-03-27 | 2003-10-02 | Carl Lauryssen | Anterior bone plate system and method of use |
US7473267B2 (en) | 2003-04-25 | 2009-01-06 | Warsaw Orthopedic, Inc. | System and method for minimally invasive posterior fixation |
US7468064B2 (en) | 2003-08-21 | 2008-12-23 | Warsaw Orthopedic, Inc. | Systems and methods for positioning implants relative to bone anchors in surgical approaches to the spine |
US20050049595A1 (en) | 2003-09-03 | 2005-03-03 | Suh Sean S. | Track-plate carriage system |
US7909860B2 (en) | 2003-09-03 | 2011-03-22 | Synthes Usa, Llc | Bone plate with captive clips |
US7530993B2 (en) | 2003-10-23 | 2009-05-12 | Trans1 Inc. | Method of spinal fixation |
US7695517B2 (en) * | 2003-12-10 | 2010-04-13 | Axiomed Spine Corporation | Apparatus for replacing a damaged spinal disc |
US11419642B2 (en) | 2003-12-16 | 2022-08-23 | Medos International Sarl | Percutaneous access devices and bone anchor assemblies |
US7179261B2 (en) | 2003-12-16 | 2007-02-20 | Depuy Spine, Inc. | Percutaneous access devices and bone anchor assemblies |
US20060004398A1 (en) * | 2004-07-02 | 2006-01-05 | Binder Lawrence J Jr | Sequential dilator system |
US7854752B2 (en) | 2004-08-09 | 2010-12-21 | Theken Spine, Llc | System and method for dynamic skeletal stabilization |
US7186255B2 (en) * | 2004-08-12 | 2007-03-06 | Atlas Spine, Inc. | Polyaxial screw |
US7736380B2 (en) | 2004-12-21 | 2010-06-15 | Rhausler, Inc. | Cervical plate system |
US7628800B2 (en) | 2005-06-03 | 2009-12-08 | Warsaw Orthopedic, Inc. | Formed in place corpectomy device |
US20080243194A1 (en) * | 2005-09-26 | 2008-10-02 | The Regents Of The University Of California | Articulating instrumentation for dynamic spinal stabilization |
US8025681B2 (en) | 2006-03-29 | 2011-09-27 | Theken Spine, Llc | Dynamic motion spinal stabilization system |
US8551141B2 (en) | 2006-08-23 | 2013-10-08 | Pioneer Surgical Technology, Inc. | Minimally invasive surgical system |
US7918857B2 (en) | 2006-09-26 | 2011-04-05 | Depuy Spine, Inc. | Minimally invasive bone anchor extensions |
US8758407B2 (en) | 2006-12-21 | 2014-06-24 | Warsaw Orthopedic, Inc. | Methods for positioning a load-bearing orthopedic implant device in vivo |
US8480718B2 (en) | 2006-12-21 | 2013-07-09 | Warsaw Orthopedic, Inc. | Curable orthopedic implant devices configured to be hardened after placement in vivo |
US7771476B2 (en) | 2006-12-21 | 2010-08-10 | Warsaw Orthopedic Inc. | Curable orthopedic implant devices configured to harden after placement in vivo by application of a cure-initiating energy before insertion |
US8663328B2 (en) | 2006-12-21 | 2014-03-04 | Warsaw Orthopedic, Inc. | Methods for positioning a load-bearing component of an orthopedic implant device by inserting a malleable device that hardens in vivo |
US20080275454A1 (en) * | 2007-05-04 | 2008-11-06 | Geibel Paul T | Lumbar pedicular-facet fixation system and instrumentation |
US8353937B2 (en) * | 2007-05-22 | 2013-01-15 | Warsaw Orthopedic, Inc. | Spinal stabilization systems and methods |
DE202007007322U1 (en) * | 2007-05-23 | 2008-10-02 | Baumgart, Rainer, Prof. Dr.med., Dipl.-Ing. | Set of instruments for the minimally invasive preparation of a bone nailing |
WO2009006604A1 (en) | 2007-07-03 | 2009-01-08 | Pioneer Surgical Technology, Inc. | Bone plate system |
US8361126B2 (en) | 2007-07-03 | 2013-01-29 | Pioneer Surgical Technology, Inc. | Bone plate system |
US8414588B2 (en) | 2007-10-04 | 2013-04-09 | Depuy Spine, Inc. | Methods and devices for minimally invasive spinal connection element delivery |
KR20100080529A (en) | 2007-10-05 | 2010-07-08 | 신세스 게엠바하 | Dilation system and method of using the same |
US8672978B2 (en) | 2011-03-04 | 2014-03-18 | Zimmer Spine, Inc. | Transverse connector |
US9241807B2 (en) | 2011-12-23 | 2016-01-26 | Pioneer Surgical Technology, Inc. | Systems and methods for inserting a spinal device |
US9913728B2 (en) | 2013-03-14 | 2018-03-13 | Quandary Medical, Llc | Spinal implants and implantation system |
JP2017535403A (en) * | 2014-11-27 | 2017-11-30 | マテリアライズ・エヌ・フェー | Bone screw |
US11877779B2 (en) | 2020-03-26 | 2024-01-23 | Xtant Medical Holdings, Inc. | Bone plate system |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5129899A (en) * | 1991-03-27 | 1992-07-14 | Smith & Nephew Richards Inc. | Bone fixation apparatus |
US5171279A (en) * | 1992-03-17 | 1992-12-15 | Danek Medical | Method for subcutaneous suprafascial pedicular internal fixation |
US5196015A (en) * | 1992-04-30 | 1993-03-23 | Neubardt Seth L | Procedure for spinal pedicle screw insertion |
US5234431A (en) * | 1991-04-03 | 1993-08-10 | Waldemar Link Gmbh & Co. | Bone plate arrangement |
US5242443A (en) * | 1991-08-15 | 1993-09-07 | Smith & Nephew Dyonics, Inc. | Percutaneous fixation of vertebrae |
Family Cites Families (15)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE3414374C2 (en) * | 1984-04-16 | 1986-12-18 | Patrick Dr. 3590 Bad Wildungen Kluger | Device for setting up a spine with damaged vertebral bodies |
US4653481A (en) * | 1985-07-24 | 1987-03-31 | Howland Robert S | Advanced spine fixation system and method |
US4805602A (en) * | 1986-11-03 | 1989-02-21 | Danninger Medical Technology | Transpedicular screw and rod system |
DE8704901U1 (en) * | 1987-04-02 | 1987-07-23 | Kluger, Patrick, Dr.Med., 3590 Bad Wildungen, De | |
US4790297A (en) * | 1987-07-24 | 1988-12-13 | Biotechnology, Inc. | Spinal fixation method and system |
US4887596A (en) * | 1988-03-02 | 1989-12-19 | Synthes (U.S.A.) | Open backed pedicle screw |
CH681957A5 (en) * | 1988-11-17 | 1993-06-30 | Synthes Ag | |
GB2254394B (en) * | 1988-12-21 | 1993-03-17 | Bristol Myers Squibb Co | Coupler assembly |
US5024213A (en) * | 1989-02-08 | 1991-06-18 | Acromed Corporation | Connector for a corrective device |
US5129900B1 (en) * | 1990-07-24 | 1998-12-29 | Acromed Corp | Spinal column retaining method and apparatus |
US5092893A (en) * | 1990-09-04 | 1992-03-03 | Smith Thomas E | Human orthopedic vertebra implant |
FR2666981B1 (en) * | 1990-09-21 | 1993-06-25 | Commarmond Jacques | SYNTHETIC LIGAMENT VERTEBRAL. |
US5085660A (en) * | 1990-11-19 | 1992-02-04 | Lin Kwan C | Innovative locking plate system |
US5176678A (en) * | 1991-03-14 | 1993-01-05 | Tsou Paul M | Orthopaedic device with angularly adjustable anchor attachments to the vertebrae |
US5258031A (en) * | 1992-01-06 | 1993-11-02 | Danek Medical | Intervertebral disk arthroplasty |
-
1992
- 1992-10-23 US US07/965,346 patent/US5584887A/en not_active Expired - Lifetime
-
1993
- 1993-10-22 WO PCT/US1993/010143 patent/WO1994009726A1/en not_active Application Discontinuation
- 1993-10-22 CA CA002147660A patent/CA2147660A1/en not_active Abandoned
- 1993-10-22 JP JP6511193A patent/JPH08502680A/en active Pending
- 1993-10-22 AU AU55862/94A patent/AU678196B2/en not_active Ceased
- 1993-10-22 EP EP94901184A patent/EP0665731A4/en not_active Ceased
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5129899A (en) * | 1991-03-27 | 1992-07-14 | Smith & Nephew Richards Inc. | Bone fixation apparatus |
US5234431A (en) * | 1991-04-03 | 1993-08-10 | Waldemar Link Gmbh & Co. | Bone plate arrangement |
US5242443A (en) * | 1991-08-15 | 1993-09-07 | Smith & Nephew Dyonics, Inc. | Percutaneous fixation of vertebrae |
US5171279A (en) * | 1992-03-17 | 1992-12-15 | Danek Medical | Method for subcutaneous suprafascial pedicular internal fixation |
US5196015A (en) * | 1992-04-30 | 1993-03-23 | Neubardt Seth L | Procedure for spinal pedicle screw insertion |
Non-Patent Citations (1)
Title |
---|
See also references of EP0665731A4 * |
Cited By (41)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP0611116B1 (en) * | 1993-02-11 | 1996-07-17 | SMITH & NEPHEW RICHARDS, INC. | Spinal column retaining apparatus |
USRE46432E1 (en) | 2003-09-24 | 2017-06-13 | Stryker European Holdings I, Llc | System and method for spinal implant placement |
US7955355B2 (en) | 2003-09-24 | 2011-06-07 | Stryker Spine | Methods and devices for improving percutaneous access in minimally invasive surgeries |
US8002798B2 (en) | 2003-09-24 | 2011-08-23 | Stryker Spine | System and method for spinal implant placement |
USRE45338E1 (en) | 2003-09-24 | 2015-01-13 | Stryker Spine | System and method for spinal implant placement |
USRE45676E1 (en) | 2003-09-24 | 2015-09-29 | Stryker Spine | System and method for spinal implant placement |
US9700357B2 (en) | 2003-09-24 | 2017-07-11 | Stryker European Holdings I, Llc | Methods and devices for improving percutaneous access in minimally invasive surgeries |
USRE49432E1 (en) | 2003-11-08 | 2023-02-28 | Stryker European Operations Holdings Llc | System and method for spinal implant placement |
US10993747B2 (en) | 2003-11-08 | 2021-05-04 | Stryker European Operations Holdings Llc | Methods and devices for improving percutaneous access in minimally invasive surgeries |
USRE48376E1 (en) | 2003-11-08 | 2021-01-05 | Stryker European Operations Holdings Llc | System and method for spinal implant placement |
USRE47348E1 (en) | 2003-11-08 | 2019-04-16 | Stryker European Holdings I, Llc | System and method for spinal implant placement |
US10143502B2 (en) | 2003-11-08 | 2018-12-04 | Stryker European Holdings I, Llc | Methods and devices for improving percutaneous access in minimally invasive surgeries |
US10765488B2 (en) | 2006-02-06 | 2020-09-08 | Stryker European Holdings I, Llc | Rod contouring apparatus for percutaneous pedicle screw extension |
US10070936B2 (en) | 2006-02-06 | 2018-09-11 | Stryker European Holdings I, Llc | Rod contouring apparatus for percutaneous pedicle screw extension |
US8979851B2 (en) | 2006-02-06 | 2015-03-17 | Stryker Spine | Rod contouring apparatus for percutaneous pedicle screw extension |
US9119684B2 (en) | 2006-02-06 | 2015-09-01 | Stryker Spine | Rod contouring method for percutaneous pedicle screw extension |
US9655685B2 (en) | 2006-02-06 | 2017-05-23 | Stryker European Holdings I, Llc | Rod contouring apparatus for percutaneous pedicle screw extension |
US8894655B2 (en) | 2006-02-06 | 2014-11-25 | Stryker Spine | Rod contouring apparatus and method for percutaneous pedicle screw extension |
US9247977B2 (en) | 2006-02-06 | 2016-02-02 | Stryker European Holdings I, Llc | Rod contouring apparatus for percutaneous pedicle screw extension |
US11523810B2 (en) | 2006-09-25 | 2022-12-13 | Stryker European Operations Holdings Llc | Percutaneous compression and distraction system |
US8506574B2 (en) | 2006-09-25 | 2013-08-13 | Stryker Spine | Percutaneous compression and distraction system |
US9345463B2 (en) | 2006-09-25 | 2016-05-24 | Stryker European Holdings I, Llc | Percutaneous compression and distraction system |
US8915925B2 (en) | 2006-09-25 | 2014-12-23 | Stryker Spine | Percutaneous compression and distraction system |
US8157809B2 (en) | 2006-09-25 | 2012-04-17 | Stryker Spine | Percutaneous compression and distraction system |
US10470752B2 (en) | 2006-09-25 | 2019-11-12 | Stryker European Holdings I, Llc | Percutaneous compression and distraction system |
USRE49410E1 (en) | 2012-01-16 | 2023-02-07 | K2M, Inc. | Rod reducer, compressor, distractor system |
USRE48250E1 (en) | 2012-01-16 | 2020-10-13 | K2M, Inc. | Rod reducer, compressor, distractor system |
US9827020B2 (en) | 2013-03-14 | 2017-11-28 | Stryker European Holdings I, Llc | Percutaneous spinal cross link system and method |
US10912590B2 (en) | 2013-03-14 | 2021-02-09 | Stryker European Operations Holdings Llc | Percutaneous spinal cross link system and method |
US11779377B2 (en) | 2013-03-14 | 2023-10-10 | Stryker European Operations Holdings Llc | Systems and methods for percutaneous spinal fusion |
US9510875B2 (en) | 2013-03-14 | 2016-12-06 | Stryker European Holdings I, Llc | Systems and methods for percutaneous spinal fusion |
US10568669B2 (en) | 2013-03-14 | 2020-02-25 | Stryker European Holdings I, Llc | Systems and methods for percutaneous spinal fusion |
US9408716B1 (en) | 2013-12-06 | 2016-08-09 | Stryker European Holdings I, Llc | Percutaneous posterior spinal fusion implant construction and method |
US10159579B1 (en) | 2013-12-06 | 2018-12-25 | Stryker European Holdings I, Llc | Tubular instruments for percutaneous posterior spinal fusion systems and methods |
US9744050B1 (en) | 2013-12-06 | 2017-08-29 | Stryker European Holdings I, Llc | Compression and distraction system for percutaneous posterior spinal fusion |
US9622795B2 (en) | 2013-12-13 | 2017-04-18 | Stryker European Holdings I, Llc | Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion |
US10507046B2 (en) | 2013-12-13 | 2019-12-17 | Stryker European Holdings I, Llc | Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion |
US11622793B2 (en) | 2013-12-13 | 2023-04-11 | Stryker European Operations Holdings Llc | Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion |
US10034690B2 (en) | 2014-12-09 | 2018-07-31 | John A. Heflin | Spine alignment system |
US11419637B2 (en) | 2014-12-09 | 2022-08-23 | John A. Heflin | Spine alignment system |
US10736668B2 (en) | 2014-12-09 | 2020-08-11 | John A. Heflin | Spine alignment system |
Also Published As
Publication number | Publication date |
---|---|
JPH08502680A (en) | 1996-03-26 |
AU5586294A (en) | 1994-05-24 |
US5584887A (en) | 1996-12-17 |
EP0665731A4 (en) | 1997-01-08 |
AU678196B2 (en) | 1997-05-22 |
CA2147660A1 (en) | 1994-05-11 |
EP0665731A1 (en) | 1995-08-09 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
AU678196B2 (en) | Internal fixators | |
US5242443A (en) | Percutaneous fixation of vertebrae | |
EP0611116B1 (en) | Spinal column retaining apparatus | |
US5480440A (en) | Open surgical technique for vertebral fixation with subcutaneous fixators positioned between the skin and the lumbar fascia of a patient | |
US20210228379A1 (en) | Devices and methods for minimally invasive spinal stabilization and instrumentation | |
US7419499B2 (en) | Spinal stabilization implant and method of application | |
EP2419032B1 (en) | Interspinous spacer and facet joint fixation device | |
US5242444A (en) | Lumbosacral fixation and fusion method and device | |
EP1737369B1 (en) | Support for bone | |
US7740635B2 (en) | Minimally invasive method and apparatus for placing facet screws and fusing adjacent vertebrae | |
US20070093828A1 (en) | Devices and methods for inter-vertebral orthopedic device placement | |
US10973552B2 (en) | Surgical system for bone screw insertion and rod reduction | |
US20110245880A1 (en) | Spinal fixator and method of use thereof | |
US11234712B2 (en) | Medical access device | |
EP3503817B1 (en) | Minimally invasive surgical system | |
Arlet et al. | Correction of adolescent idiopathic thoracic scoliosis with a new type of offset apical instrumentation: preliminary results | |
Dubousset | CD Horizon: a new Cotrel-Dubousset instrumentation | |
CN116421288A (en) | Side-rear linkage spine minimally invasive puncture guiding system |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AK | Designated states |
Kind code of ref document: A1 Designated state(s): AU CA JP |
|
AL | Designated countries for regional patents |
Kind code of ref document: A1 Designated state(s): AT BE CH DE DK ES FR GB GR IE IT LU MC NL PT SE |
|
DFPE | Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101) | ||
121 | Ep: the epo has been informed by wipo that ep was designated in this application | ||
WWE | Wipo information: entry into national phase |
Ref document number: 2147660 Country of ref document: CA |
|
WWE | Wipo information: entry into national phase |
Ref document number: 1994901184 Country of ref document: EP |
|
WWP | Wipo information: published in national office |
Ref document number: 1994901184 Country of ref document: EP |
|
WWR | Wipo information: refused in national office |
Ref document number: 1994901184 Country of ref document: EP |
|
WWW | Wipo information: withdrawn in national office |
Ref document number: 1994901184 Country of ref document: EP |