Percutaneous transverse connector system

Abstract

A system and method for stabilizing a spine of an animal subject involving a transverse rod installation instrument assembly for inserting a transverse rod on the spine of a subject percutaneously comprising: a first rod clamp extender mounted on a ipsilateral rod clamp and a second rod clamp extender mounted on a contralateral rod clamp wherein the ipsilateral rod clamp and the contralateral rod clamp are secured to a vertebra at the ipsilateral and contralateral pedicle; and a pivoting installation instrument pivotably mounted to the first rod clamp extender and the second rod clamp extender to pass a transverse rod percutaneously through a head portion of the ipsilateral side rod clamp and to the head portion of the contralateral rod clamp after passing through a spinous process of the vertebra through pivot axis A such that the transverse rod is secured at the head portion of the ipsilateral rod clamp and the head portion of the contralateral rod clamp.

Claims

1. A transverse rod installation instrument assembly for inserting a transverse rod on a spine of a subject percutaneously comprising: an ipsilateral rod clamp; a contralateral rod clamp; a first rod clamp extender configured to be mounted on the ipsilateral rod clamp and a second rod clamp extender configured to be mounted on the contralateral rod clamp when the ipsilateral rod clamp and the contralateral rod clamp are secured to a vertebra at an ipsilateral and a contralateral pedicle of the vertebra; and a pivoting installation instrument configured to be pivotably mounted to the first rod clamp extender and the second rod clamp extender to pass a transverse rod percutaneously through a head portion of the ipsilateral rod clamp and to a head portion of the contralateral rod clamp after passing through a spinous process of the vertebra along arc A on radius R such that the transverse rod is secured at the head portion of the ipsilateral rod clamp and the head portion of the contralateral rod clamp, wherein the head portion is superior to a longitudinal rod receiving section having an upper surface and a lower surface and having a tightening screw through its upper surface for securing the longitudinal rod receiving section to a longitudinal rod when positioned therein, and positioned between the transverse rod receiving section and the longitudinal rod receiving section is a polyaxial head to allow for freedom of movement when positioning the transverse rod in the transverse rod receiving section.

2. The transverse rod installation instrument assembly of claim 1 wherein the first rod clamp extender has a cylinder with a pair of opposing arms that extends superior to the cylinder wherein at the bottom of the cylinder is a docking ring for engaging with a bolt on a pair of opposing wings of the ipsilateral rod clamp when the cylinder of the first rod clamp extender is positioned over the pair of opposing wings.

3. The transverse rod installation instrument assembly of claim 2 wherein the pair of opposing arms on the first rod clamp extender includes a hole in each arm of the pair wherein the hole in each arm of the pair of opposing arms aligns.

4. The transverse rod installation instrument assembly of claim 3 wherein the second rod clamp extender has a cylinder with a pair of opposing arms that extends superior to the cylinder wherein at the bottom of the cylinder is a docking ring for engaging with the bolts on a pair of opposing wings of the contralateral rod clamp when the cylinder of the second rod clamp extender is positioned over the pair of opposing wings.

5. The transverse rod installation instrument assembly of claim 4 wherein the pair of opposing arms on the second rod clamp extender includes a hole in each arm of the pair wherein the hole in each arm of the pair aligns.

6. The transverse rod installation instrument assembly of claim 5 wherein the first rod clamp extender and the second rod clamp extender are secured together with a bolt that fits through each hole in each arm of the pair of opposing arms of the first rod clamp extender and each hole in each arm of the pair of opposing arms of the second rod clamp extender such that the bolt passes first through an arm of a first rod clamp extender and then through an arm of the second rod clamp extender before passing through the opposing arm of the first rod clamp extender and then the opposing arm of the second rod clamp extender.

7. The transverse rod installation instrument assembly of claim 6 wherein the pivoting installation instrument pivotably mounted to the first rod clamp extender and the second rod clamp extender is secured to the first rod clamp extender and the second rod clamp extender via the bolt.

8. The transverse rod installation instrument assembly of claim 2 wherein inside the docking ring is an internal groove for securing the bolt on the side of the wing of the ipsilateral or contralateral rod clamp when the ipsilateral or contralateral rod clamp is in use to stabilize the extender onto the ipsilateral or contralateral rod clamp.

9. A method for inserting a transverse spinal rod on a spine of a subject comprising: providing the assembly of claim 1; attaching the ipsilateral rod clamp to an ipsilateral pedicle of a vertebra; attaching the contralateral rod clamp to a contralateral pedicle of the vertebra; mounting the first rod clamp extender on the ipsilateral rod clamp and mounting the second rod clamp extender on the contralateral rod clamp; pivotally mounting the pivoting installation instrument to the first rod clamp extender and the second rod clamp extender; passing a transverse rod percutaneously through a head portion of the ipsilateral rod clamp and to a head portion of the contralateral rod clamp after passing through a spinous process of the vertebra along arc A on radius R such that the transverse rod is secured at the head portion of the ipsilateral rod clamp and a head portion of the contralateral rod clamp, wherein the head portion is superior to a longitudinal rod receiving section having an upper surface and a lower surface and having a tightening screw through its upper surface for securing the longitudinal rod receiving section to a longitudinal rod when positioned therein, and positioned between the transverse rod receiving section and the longitudinal rod receiving section is a polyaxial head to allow for freedom of movement when positioning the transverse rod in the transverse rod receiving section.

10. The method of claim 9 wherein the transverse rod is connected to a handle with a flexible section that is removable from the transverse rod for allowing the transverse rod to be positioned in a guide tube of a transverse rod passer.

11. The method of claim 9 wherein the tightening screw is tightened for securing a longitudinal rod in the longitudinal rod receiving section.

12. The method of claim 9 further comprising disconnecting from the first rod clamp extender and the second rod clamp extender the pivoting installation instrument.

Description

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

(1) The accompanying drawings in the attachment, which are incorporated into and form a part of the specification, illustrate one or more embodiments of the present invention and, together with the description, serve to explain the principles of the invention. The drawings are only for the purpose of illustrating one or more preferred embodiments of the invention and are not to be construed as limiting the invention. In the drawings:

(2) FIG. 1A-C is an illustration of a rod clamp and rod clamp assembly according to one embodiment of the present invention from different view;

(3) FIG. 2 is a stabilizing tower to slide over wings of a rod clamp according to one embodiment of the present invention;

(4) FIG. 3A-G illustrates a transverse rod passer system according to one embodiment of the present invention;

(5) FIG. 4 illustrates a transverse rod installment instrument assembly according to one embodiment of the present invention;

(6) FIG. 5 illustrates a transverse rod passer assembly in association with a spinous process of a vertebra according to one embodiment of the present invention;

(7) FIG. 6 illustrates a transverse rod through the spinous process of a vertebra in association with the transverse rod passer assembly according to one embodiment of the present invention; and

(8) FIG. 7 illustrates a transverse rod associated with rod clamps and bony structure of a vertebra according to one embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

(9) As used herein a or an means one or more.

(10) One aspect of one embedment of a present invention provides for a system and method for placement of a transverse connector on the spine of an animal subject (e.g. human) wherein minimal if any muscle dissection is required.

(11) A set of innovative instruments and method of using the same that allow precise placement of a transverse rod across the vertebrae to a transverse rod connector through a percutaneous route.

(12) According to one embodiment of the present invention a method for spinal fusion of adjacent vertebral bodies is provided wherein an installation instrument for guiding a transverse rod to connect with a rod clamp through a minimally invasive incision is discussed. The method further provides that the transverse rod is passed through the head of an ipsilateral rod clamp and inserted through spinous process before connecting with the head of a contralateral rod clamp.

(13) An aspect of the present invention provides a transverse rod installation instrument for transcutaneous placement of a transverse rod wherein the installation instrument is mounted to rod clamp extensions whose position is secured in an animal subject.

(14) One aspect of one embodiment of the present invention is a minimally invasive method to stabilize bony structures.

(15) One aspect provides for a method to connect two (2) or more rod clamps with a connecting element.

(16) A method to attach a transverse rod inserter on an installation instrument to the extensions and guiding the transverse rod into a desired position relative to the rod clamps.

(17) A fixed geometric relationship to guide the transverse rod into a position proximate to the rod clamps.

(18) According to one embodiment of the present invention an installation instrument is mounted to the rod clamp extension element in spatial relation to the anchors about a pivot point. The instrument is rotated about the pivot point to guide the transverse rod to the desired location.

(19) According to another embodiment of the present invention an installation instrument assembly is provided having an ispilateral rod clamp extension designed to slide onto the wings of an ipsilateral rod clamp and a contralateral rod clamp extension designed to slide onto the wings of a contralateral rod clamp. The rod clamp extensions each have an arm with a hole at the end of the arm through which the two rod clamp extensions are secured together. The installation instrument mounts to the ipsilateral and contralateral rod clamp extension arms when the rod clamp extensions are mounted to rod clamps positioned on either side of the spinous process of a vertebra. In this position, the two arms will overlap slightly when the rod clamp extensions are properly positioned on the rod clamps to allow the holes at the end of each arm to overlap. The installation assembly is held together with a fastener that passes through all four holes of the arms including the holes of the arms and the holes at the attachment ends of the installation instrument which sandwich the two holes of the arms to connect the installation instrument assembly together. The rod clamps to which the rod clamp extension are mounted are positioned on either side of spinous process and the rod clamps are secured to a pedicle of a vertebra structure with pedicle screws. The installation instrument is pivotable about a pivot axis that is formed by a line that runs through the holes of the side arms and holes of the attachment ends when assembled. The installation instrument is moveable with respect to the rod clamps to position a transverse brace through the spinous process of the vertebra and secure the ends of the transverse rod to the head of the ipsilateral and contralateral rod clamps.

(20) Referring now to FIG. 1A rod clamp assembly 100 having a pair of opposing wings 104 that extend from clamp 101 includes a tightening screw 105 which locks the clamp 101 to the longitudinal rod 102 (not shown). There is a polyaxial head 109 which allows for freedom of movement when positioning the rod passer. Referring now to FIG. 1B, a tightening screw 105 sits in the superior portion of the clamp 101 and acts to close down on the longitudinal rod on the medial side of the rod but can secure the rod on the lateral side of the rod as well. As shown by the arrows at the wings, the poilyaxial head also allows for rotation. Bolts 111 are positioned on the side of the wings and are used to secure the extenders (not shown) when the extenders are positioned over the wings. Referring now to FIG. 1C, the clamp 101 is secured to a longitudinal rod 102. The longitudinal rod 102 is secured to a bony structure such as a vertebra with a pedicle screw inserted into a pedicle of the vertebra. The longitudinal rod 102 is positioned in the clamp 101. Once pedicle screws and longitudinal rods are placed, a site is identified on the rod clamp 100 where the transverse connector will be connected, for example at head 107 of rod clamp assembly 100. The head 107 has threads and below the threads a transverse rod trough which is located superior to the clamp 101. FIG. 1C is a side view of the rod clamp and wings. The wings 104 create a space 103 along the length L of the rod clamp as illustrated. A portion of the wind of the rod clamp assembly is located extracorporeal. An empty portion at the head 107 of rod clamp assembly is identified where the transverse connector will be attached and secured with set screws. The set screws are introduced through the distal opening of the rod clamp assembly.

(21) Facial openings are made is the skin and muscle and a standard nasal speculum is used to visualize the rod clamp 100 and longitudinal rod 102.

(22) Referring now to FIG. 2, a stabilizing tower 201 is placed on the wings 104 of the rod clamp assembly 100 and passes down the rod clamp wings 104. Opening 202 in stabilizing tower 201 is used to insert screw driver for tightening screw 105 of FIG. 1B. Once the clamp is seated on the longitudinal rod for example, the rod clamp sits as deep as possible against the longitudinal rod. The tightening screw 105 on the rod clamp 101 is tightened to prevent the rod clamp 101 from becoming disengaged from the longitudinal rod 102. In the case of a spinal fusion there would be two rod clamps with a first rod clamp secured on a left pedicle of vertebra V and a second rod clamp secured on a right pedicle of vertebra V as is shown in FIG. 5.

(23) The stabilizing tower is removed from the rod clamp wings. Referring now to FIG. 3A-3G, rod clamp extender/extension 303A having arm 301A with a hole 302A is placed over the wings of a rod clamp assembly 100. Rod clamp extender/extension cylinder 303B having arm 301B with a hole 302B is placed over the wings of a second rod clamp attached to a different part of the bony structure. Hole 302A is aligned with hole 302B having a bolt that fits in hole 302A while hole 302A.sup.1 is aligned with hole 302B.sup.1 having a bolt that fits in hole 302A.sup.1 and also with attachment end 315 of FIG. 3D and attachment end 313 of FIG. 3D of installation instrument 307 of FIG. 3D such that rod clamp extension 303A, rod clamp extension cylinder 303B and installment instrument 307 can be secured together by nut 305 at the end of rod 304 of FIG. 3C as is illustrated for the assembly in FIG. 4. An awl 329 of FIG. 3E having a handle 317, a flexible shaft (for example a spring) 319 and a tip portion 321 is inserted through the guide tube 309 of instrument 307 as illustrated in FIG. 3D. The flexible shaft permits the shaft 319 of the awl to flex during insertion in guide tube 309. FIG. 3B identifies the interior of the extender of either 303A or 303B. There is a docking ring 306 for locking the extender onto the bolt 111 of wing 104 when the assembly is in use and the rod is passed through the spinous process. An internal grove 310 secures the bolt 111 to stabilize the extender onto the wing of the rod clamp. FIG. 3F illustrate a transverse rod connected to a handle with a flexible section. The handle and flexible section are removeable from the transverse rod. The portion of 324 that is flexible for allowing the transverse rod to be positioned in guide tube 309. FIG. 3G illustrates a cross sectional view 316 of the extenders in position over the rod clamp wings. The groove 317 at the bottom of the extenders slide over the bolts 111. Once the extenders are securely seated, the docking ring 306 locks the extender onto the rod clamp wings.

(24) Referring now to FIG. 4, the installation instrument assembly 307 attached to the arms of rod clamp extender is illustrated. The pivot Axis P about which the installation instrument pivots is illustrated. The arms 301A and 301B join and may be connected to attachment end 315 and attachment end 313 with connector of FIG. 3C. Alternative installment instrument 307 can be used with end 305 securing section 304 in place.

(25) A skin and facial incision is made for when the awl 329 enters the skin on the Ipsilateral side of the body and the guide tube 309 is advanced until the spinous process is encountered. Referring now to FIG. 5, with firm pressure the awl 329 positioned in guide tube 309 is advanced through the spinous process along arc A on radius R. Visual confirmation through the contralateral rod clamp will confirm that the awl has passed through the spinous process. The guide tube 309 sits in the tranverse rod trough of 107 which is superior to 101 but leaves adequate space at the bottom for the awl 329 to pass through.

(26) Referring now to FIG. 6, the guide tube 309 follows the same trajectory as the awl is then swung out, the awl is removed and a permanent transverse rod 324 of the appropriate length (confirmed on fluoroscopy) is inserted in the guide tube 309 of the traverse rod passer. The guide tube 309 of the transverse rod passer is again advanced through arc A over radius R until the transverse rod 323 is appropriately seated in the head portion 107 of the rod clamps 101. The installation instrument is removed. The rod clamp extension is removed and wings 104 are broken off above section 107 leaving behind the transverse rod anchor 703 located superior to the clamp 101 with the transverse rod and the longitudinal rod in position secured to the bony structures of the pedicle and the spinous process.

(27) Referring now to FIG. 7, transverse rod anchor 703 secured to the transverse rod 323 via set screws (not shown) with clamp 101 secured to longitudinal rod 102 with longitudinal rod 102 secured to the vertebrae by pedicle screws (not shown) is illustrated.

(28) Although the invention has been described in detail with particular reference to these preferred embodiments, other embodiments can achieve the same results. Variations and modifications of the present invention will be obvious to those skilled in the art and it is intended to cover in the appended claims all such modifications and equivalents. The entire disclosures of all references, applications, patents, and publications cited above are hereby incorporated by reference.