U.S. patent application number 09/805687 was filed with the patent office on 2001-10-18 for spine distraction implant and method.
Invention is credited to Hsu, Ken Y., Zucherman, James F..
Application Number | 20010031965 09/805687 |
Document ID | / |
Family ID | 27385325 |
Filed Date | 2001-10-18 |
United States Patent
Application |
20010031965 |
Kind Code |
A1 |
Zucherman, James F. ; et
al. |
October 18, 2001 |
Spine distraction implant and method
Abstract
A spine distraction implant alleviates pain associated with
spinal stenosis and facet arthropathy by expanding the volume in
the spine canal and/or neural foramen. The implant provides a
spinal extension stop while allowing freedom of spinal flexion.
Inventors: |
Zucherman, James F.; (San
Francisco, CA) ; Hsu, Ken Y.; (San Francisco,
CA) |
Correspondence
Address: |
FLIESLER DUBB MEYER & LOVEJOY LLP
INTELLECTUAL PROPERTY LAW
FOUR EMBARCADERO CENTER, FOURTH FLOOR
SAN FRANCISCO
CA
94111-4156
US
|
Family ID: |
27385325 |
Appl. No.: |
09/805687 |
Filed: |
March 8, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09805687 |
Mar 8, 2001 |
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09306140 |
May 6, 1999 |
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6156038 |
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09306140 |
May 6, 1999 |
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09200266 |
Nov 25, 1998 |
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6183471 |
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09200266 |
Nov 25, 1998 |
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09139333 |
Aug 25, 1998 |
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5876404 |
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09139333 |
Aug 25, 1998 |
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08958281 |
Oct 27, 1997 |
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5860977 |
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08958281 |
Oct 27, 1997 |
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08778093 |
Jan 2, 1997 |
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5836948 |
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Current U.S.
Class: |
606/248 ;
606/279 |
Current CPC
Class: |
A61B 17/7065 20130101;
A61B 17/7068 20130101; A61B 17/66 20130101; A61K 31/37 20130101;
A61B 17/7071 20130101; A61B 2017/0256 20130101; A61B 17/7053
20130101 |
Class at
Publication: |
606/61 |
International
Class: |
A61B 017/56 |
Claims
We claim:
1. An implant for relieving pain associated with the spinal column
which is positionable between adjacent spinous processes of the
spinal column, comprising: a first unit including a guide and a
first wing; a second wing; said body including a groove that can
receive said second wing, said body adapted for positioning between
the adjacent spinous processes, with the first wing positionable
along side the adjacent spinous processes and the second wing
positionable along side the spinous processes and opposite to the
first wing; and a device that secures the second wing to the
guide.
2. The implant of claim 1 wherein: said first wing has upper and
lower portions; said second wing has upper and lower portions; an
upper saddle is defined among the body and the upper portions of
the first and second wings; a lower saddle is defined among the
body and the lower portions of the first and second wing; wherein
the upper width of the upper saddle is defined between the upper
portions of the first and second wings; wherein the lower width of
the lower saddle is defined between the lower portions of the first
and second wings; the implant comprising multiple second wings with
each second wing having said lower portion of a different
thickness; and wherein the lower width can be selected by choosing
said second wing with said lower portion of the desired
thickness.
3. The implant of claim 2 wherein: each second wing has said upper
portion with a different thickness; and wherein the upper width can
be selected by choosing said second wing with said upper portion of
the desired thickness.
4. The implant of claim 1 wherein: said first wing has upper and
lower portions; said second wing has upper and lower portions; an
upper saddle is defined among the body and the upper portions of
the first and second wings; a lower saddle is defined among the
body and the lower portions of the first and second wing; wherein
the upper width of the upper saddle is defined between the upper
portions of the first and second wings; wherein the lower width of
the lower saddle is defined between the lower portions of the first
and second wings; the implant comprising multiple second wings with
each second wing having said upper portion of a different
thickness; and wherein the upper width can be selected by choosing
said second wing with said portion of the desired thickness.
5. The implant of claim 1 wherein: at least one of said first wing
and said second wing include a recess in order to accommodate the
anatomical form of the vertebrae.
6. The implant of claim 1 wherein: said first wing has upper and
lower portions; said second wing has upper and lower portions; and
at least one upper portion has a recess in order to accommodate the
anatomical form of the vertebrae.
7. The implant of claim 1 wherein the spinous processes of the
spinal column extend from respective vertebral bodies and wherein:
at least one of the first and the second wings has an upper
portion; said upper portion has a recess in order to accommodate
the anatomical form of the spinal column; and wherein said recess
is located adjacent to laminae of the vertebrae.
8. The implant of claim 1 wherein: said groove is wider at the top
than the bottom in order to assist the seating of the second wing
in the groove.
9. The implant of claim 1 wherein: said body has an end that is
located distally from the first wing; and wherein said end is
bulbous.
10. The implant of claim 1 wherein: said body has an end that is
located distally from the first wing; and wherein said end is
shaped in a manner that assists in the placement of the body
between adjacent spinous processes.
11. The implant of claim 1 wherein: said body has an end that is
located distally from the first wing; and wherein said end is
pointed.
12. The implant of claim 1 wherein: said body has an end that is
located distally from the first wing; and wherein said end has
first and second sides that are provided at an angle of about
30.degree. to about 60.degree. from a longitudinal axis of the
body.
13. The implant of claim 1 wherein: said device includes a bore in
said body which is provided at an acute angle to the body.
14. The implant of claim 1 wherein: said device includes a bore in
said body which is provided at about perpendicular to the body.
15. The implant of claim 1 wherein: said device includes a first
bore in the body; said second wing has tab extending therefrom,
which tab includes a second bore there through; wherein with said
second wing is received in said groove of said body said first and
second bores are aligned; and said device includes a member that is
positioned through the first and the second bores in order to
secure the second wing to the body.
16. The implant of claim 10 wherein: said end is removable from
said body.
17. An implant for relieving pain associated with the spinal column
which is positionable between adjacent spinous processes of the
spinal column, comprising: a first unit including a guide and a
first wing; a second wing; said body including a means for engaging
said second wing along a direction from an posterior position along
a line toward an anterior position, said body adapted for
positioning between the adjacent spinous processes, with the first
wing positionable along side the adjacent spinous processes and the
second wing positionable along side the spinous processes and
opposite to the first wing; and said engaging means is operable
along a direction from an posterior position along a line toward an
anterior position.
18. The implant of claim 1 which does not limit flexion of the
spinal column while limiting extension of the spinal column.
19. The implant of claim 17 which does not limit flexion of the
spinal column while limiting extension of the spinal column.
20. The implant of claim 15 wherein: said body includes a recess
that can receive said tab of said second wing.
21. The implant of claim 1 wherein: said first wing has upper and
lower portions; said second wing has upper and lower portions; an
upper saddle is defined among the body and the upper portions of
the first and second wings; a lower saddle is defined among the
body and the lower portions of the first and second wing; wherein
the upper width of the upper saddle is defined between the upper
portions of the first and second wings; wherein the lower width of
the lower saddle is defined between the lower portions of the first
and second wings; and wherein at least one of the upper width and
the lower width is wider than a spinous process around which the
implant is positioned.
22. An implant for relieving pain associated with the spinal column
which implant is positionable between adjacent spinous processes of
the spinal column, comprising: a distracting unit including a body
and a first wing; a retaining unit including a second wing and a
tab extending from said second wing; said distracting unit defining
a groove for receiving at least a portion of said second wing and
said distraction unit also defining a recess for receiving said
tab; said body including a first bore; said tab including a second
bore; said first and second bores being alignable with the second
wing received in said groove; and a device that is positionable
through the first and second bores in order to secure the retaining
unit to the distraction unit.
23. The implant of claim 22 wherein: said first bore is threaded;
and said device is a screw.
24. The implant of claim 22: wherein said first and second bores
are alignable along a line extending from a posterior position
toward an anterior position relative to the spinal column.
25. A method of relieving pain due to the development of spinal
stenosis and the like in the spinal column including the steps of:
accessing adjacent first and second spinous processes of the spinal
column; implanting a distracting unit between the spinous
processes, which distracting unit has (1) a body that can maintain
a distraction between the first and second spinous processes and
(2) a wing which extends from said body along the spinous
processes; and securing a retaining unit to the distracting unit
along a line which is from a posterior position to an anterior
position.
26. The method of claim 25 wherein the securing step includes:
positioning the retaining unit in the distracting unit along a line
which is from a posterior position to an anterior position.
27. The method of claim 25 wherein the securing step includes:
positioning a screw through the retaining unit and the distracting
unit along a line which from a posterior position to an anterior
position in order to secure the retaining unit to the distracting
unit.
28. The method of claim 26 wherein the securing step includes:
positioning a screw through the retaining unit and the distracting
unit along a line which from a posterior position to an anterior
position in order to secure the retaining unit to the distracting
unit.
29. The method of claim 25 wherein said first and second wings have
first and second planes respectively, and the method includes
positioning said second wing relative to the first wing by moving
the second wing such that the second plane of the second wing
remains substantially parallel to the first plane of the first wing
as the second wing is moved into engagement with the distracting
unit.
30. The method of claim 30 wherein the second wing is secured to
the first wing with a fastener which moved along a line that is
substantially parallel to the second plane of the second wing in
order to secure the retaining unit to the distracting unit.
31. The method of claim 25 including the step of: distracting the
first and second spinous processes apart prior to inserting the
distracting unit between the first and second spinous
processes.
32. The method of claim of 25 wherein: said inserting step includes
using the distracting unit to distract the first and the second
spinous processes as the distracting unit is inserted between the
first and the second spinous processes.
33. The implant of claim 1 wherein: said first wing has upper and
lower portions; said second wing has upper and lower portions; an
upper saddle is defined among the body and the upper portions of
the first and second wings; a lower saddle is defined among the
body and the lower portions of the first and second wing; wherein
the upper width of the upper saddle is defined between the upper
portions of the first and second wings; wherein the lower width of
the lower saddle is defined between the lower portions of the first
and second wings; there is a height between the upper and the lower
saddles; and wherein the upper width is from about 6 mm to about 8
mm, with the lower width being from about 5 mm to about 7 mm and
the height is from about 8 mm to about 10 mm.
34. The implant of claim 1 wherein: said first wing has upper and
lower portions; said second wing has upper and lower portions; an
upper saddle is defined among the body and the upper portions of
the first and second wings; a lower saddle is defined among the
body and the lower portions of the first and second wing; wherein
the upper width of the upper saddle is defined between the upper
portions of the first and second wings; wherein the lower width of
the lower saddle is defined between the lower portions of the first
and second wings; and there is a height between the upper and the
lower saddles; and wherein a trapezoidal shape is defined between
the upper width, the lower width and the height.
35. The implant of claim 1 wherein: said first wing has upper and
lower portions; said second wing has upper and lower portions; an
upper saddle is defined among the body and the upper portions of
the first and second wings; a lower saddle is defined among the
body and the lower portions of the first and second wing; wherein
the upper width of the upper saddle is defined between the upper
portions of the first and second wings; wherein the lower width of
the lower saddle is defined between the lower portions of the first
and second wings; there is a height between the upper and the lower
saddles; and the implant has at least one of the following
combinations of dimensions: (a) an upper width of about 6 mm, a
lower width of about 5 mm and a height of about 8 mm; (b) an upper
width of about 7 mm, a lower width of about 6 mm and a height of
about 9 mm; and (c) an upper width of about 8 mm, a lower width of
about 7 mm and a height of about 1 mm.
36. The implant of claim 1 wherein: a portion of said body located
between the first and second wings defines a trapezoidal shape.
37. An implant for relieving pain associated with the spinal column
which implant is positionable between adjacent spinous processes of
the spinal column, comprising: a distracting unit including a body
and a first wing; a retaining unit including a second wing which is
securable to the body; the first and second wings having upper
portions and lower portions respectively; the upper portions of the
first and second wings and the portion of the body located there
between defining an upper saddle; the lower portions of the first
and second wings and the portion of the body located there between
defining a lower saddle; and the portion of the body located
between the first and the second saddles defining a trapezoidal
shape.
38. An implant for relieving pain associated with the spinal column
which implant is positionable between adjacent spinous processes of
the spinal column, comprising: a distracting unit including a body;
a retaining unit which is securable to the body; said distracting
unit and the retaining unit together defining a first saddle and a
second saddle, each saddle adapted for receiving a spinous process;
and wherein the first saddle has a first width and the second
saddle has a second width and wherein the first width is different
from the second width.
39. The implant of claim 38 wherein: said first saddle is for
receiving an upper spinous process and the second saddle is for
receiving a lower spinous process.
40. The implant of claim 38 wherein: a portion of the body located
between the first and the second saddles is substantially
trapezoidal shaped.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application is a continuation-in-part of the U.S.
patent application entitled SPINE DISTRACTION IMPLANT AND METHOD
having U.S. Ser. No. 08/778,093, and filed on Jan. 2, 1997.
BACKGROUND OF THE INVENTION
[0002] As the present society ages, it is anticipated that there
will be an increase in adverse spinal conditions which are
characteristic of older people. By way of example, with aging comes
increases in spinal stenosis (including but not limited to central
canal and lateral stenosis), the thickening of the bones which make
up the spinal column and facet arthropathy. Spinal stenosis is
characterized by a reduction in the available space for the passage
of blood vessels and nerves. Pain associated with such stenosis can
be relieved by medication and/or surgery. Of course, it is
desirable to eliminate the need for major surgery for all
individuals and in particular for the elderly.
[0003] Accordingly, there needs to be developed procedures and
implants for alleviating such condition which are minimally
invasive, can be tolerated by the elderly and can be performed
preferably on an outpatient basis.
SUMMARY OF THE INVENTION
[0004] The present invention is directed to providing a minimally
invasive implant and method for alleviating discomfort associated
with the spinal column.
[0005] The present invention provides for apparatus and method for
relieving pain by relieving the pressure and restrictions on the
aforementioned blood vessels and nerves. Such alleviation of
pressure is accomplished in the present invention through the use
of an implant and method which distract the spinous process of
adjacent vertebra in order to alleviate the problems caused by
spinal stenosis and facet arthropathy and the like. While the
implant and method particularly address the needs of the elderly,
the invention can be used with individuals of all ages and sizes
where distraction of the spinous process would be beneficial.
[0006] In one aspect of the invention, an implant is provided for
relieving pain comprising a device positioned between a first
spinous process and a second spinous process. The device includes a
spinal column extension stop and a spinal column flexion
non-inhibitor.
[0007] In another aspect of the invention, the implant is
positioned between the first spinous process and the second spinous
process and includes a distraction wedge that can distract the
first and second spinous processes as the implant is positioned
between the spinous processes.
[0008] In yet another aspect of the present invention, the implant
includes a device which is adapted to increasing the volume of the
spinal canal and/or the neural foramen as the device is positioned
between adjacent spinous processes.
[0009] In yet a further aspect of the present invention, a method
is presented for relieving pain due to the development of, by way
of example only, spinal stenosis and facet arthropathy. The method
is comprised of the steps of accessing adjacent first and second
spinal processes of the spinal column and distracting the processes
a sufficient amount in order to increase the volume of the spinal
canal in order to relieve pain. The method further includes
implanting a device in order to maintain the amount of distraction
required to relieve such pain.
[0010] In yet a further aspect of the invention, the method
includes implanting a device in order to achieve the desired
distraction and to maintain that distraction.
[0011] In yet a further aspect of the invention, the implant
includes a first portion and a second portion. The portions are
urged together in order to achieve the desired distraction.
[0012] In still a further aspect of the invention, the implant
includes a distracting unit and a retaining unit. The distracting
unit includes a body which can be urged between adjacent spinous
processes. The body includes a slot. After the distracting unit is
positioned, the retaining unit can fit into the slot of the
retaining unit and be secured thereto.
[0013] Other implants and methods within the spirit and scope of
the invention can be used to increase the volume of the spinal
canal thereby alleviating restrictions on vessels and nerves
associated therewith, and pain.
BRIEF DESCRIPTION OF THE FIGURES
[0014] FIGS. 1 and 2 depict an embodiment of an implant of the
invention which is adjustable in order to select the amount of
distraction required. FIG. 1 depicts the implant in a more extended
configuration than does FIG. 2.
[0015] FIGS. 3a and 3b depict side and end views of a first forked
and of the embodiment of FIG. 1.
[0016] FIGS. 4a and 4b depict side sectioned and end views of an
interbody piece of the implant of FIG. 1.
[0017] FIGS. 5a and 5b depict side and end views of a second forked
end of the embodiment of FIG. 1.
[0018] FIGS. 6, 7, 8, 9 and 10 depict apparatus and method for
another embodiment of the present invention for creating
distraction between adjacent spinous processes.
[0019] FIGS. 11, 12 and 13 depict yet a further embodiment of the
invention for creating distraction between adjacent spinous
processes.
[0020] FIGS. 14 and 15 depict a further apparatus and method of an
embodiment of the invention for creating distraction.
[0021] FIGS. 16, 16a, and 17 depict yet another embodiment of the
present invention.
[0022] FIGS. 18, 19 and 20 depict yet a further apparatus and
method of the present embodiment.
[0023] FIGS. 21 and 22 depict still a further embodiment of the
present invention.
[0024] FIGS. 23, 24 and 25 depict another embodiment of the present
invention.
[0025] FIGS. 26, 27 and 28 depict another embodiment of the
invention.
[0026] FIGS. 29 and 30 depict side elevational views of differently
shaped implants of embodiments of the present invention.
[0027] FIGS. 31, 32 and 33 depict various implant positions of an
apparatus of the present invention.
[0028] FIGS. 34 and 35 depict yet another apparatus and method of
the present invention.
[0029] FIGS. 36, 37 and 38 depict three different embodiments of
the present invention.
[0030] FIGS. 39 and 40 depict yet another apparatus and method of
an embodiment of the present invention.
[0031] FIGS. 41, 42 and 43 depict yet further embodiments of an
apparatus and method of the present invention.
[0032] FIG. 44 is still a further embodiment of an implant of the
invention.
[0033] FIG. 45 is yet another depiction of an apparatus and method
of the invention.
[0034] FIGS. 46 and 47 depict still a further apparatus and method
of an embodiment of the invention.
[0035] FIGS. 48, 49, 50 and 51 depict yet a further apparatus and
method of the invention.
[0036] FIGS. 52, 53, 54, 55a and 55b depict another apparatus and
method of the invention.
[0037] FIGS. 56, 57 and 58 depict yet a further apparatus and
method of the invention.
[0038] FIGS. 59 and 60 depict still a further embodiment of the
invention.
[0039] FIG. 61 depict another embodiment of the invention.
[0040] FIGS. 62 and 63 depict yet another embodiment of the present
invention.
[0041] FIGS. 64 and 65 depict still a further embodiment of the
present invention.
[0042] FIG. 66 depicts another embodiment of the invention.
[0043] FIGS. 67 and 68 depict yet another embodiment of the present
invention.
[0044] FIGS. 69, 70, 71 and 71a depict a further embodiment of the
present invention.
[0045] FIGS. 72 and 73 depict still another embodiment of the
invention.
[0046] FIGS. 74, 75, 76, 77, and 78 depict still other embodiments
of the invention.
[0047] FIGS. 79, 80, 80a, 81, 82, 83, 83a, 84, 85, 86 and 87 depict
still a further embodiment of the present invention.
[0048] FIGS. 88, 89, 90 and 91 depict yet another embodiment of the
present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0049] Embodiment of FIGS. 1-5a, 5b
[0050] A first embodiment of the invention is shown in FIGS. 1-5a,
5b. Implant 20 includes first and second forked ends 22 and 24,
each defining a saddle 26, 28 respectively. The forked ends 22, 24
are mated using an interbody piece 30. As can be seen in FIGS. 3a,
3b, the first forked end 22 includes a threaded shaft 32 which
projects rearwardly from the saddle 26. The threaded shaft 32 fits
into the threaded bore 34 (FIG. 4a) of the interbody piece 30.
[0051] The second forked end 24 (FIGS. 5a, 5b) includes a smooth
cylindrical shaft 36 which can fit into the smooth bore 38 of the
interbody piece 30.
[0052] FIG. 1 shows the implant 20 in a fully extended position,
while FIG. 2 shows the implant in an unextended position. In the
unextended position, it can be seen that the threaded shaft 32 of
the first forked end 22 fits inside the hollow cylindrical shaft 36
of the second forked end 24.
[0053] For purposes of implantation between adjacent first and
second spinous processes of the spinal column, the implant 20 is
configured as shown in FIG. 2. The first and second spinous
processes are exposed using appropriate surgical techniques and
thereafter, the implant 20 is positioned so that saddle 26 engages
the first spinous process, and saddle 28 engages the second spinous
process. At this point, the interbody piece 30 can be rotated by
placing an appropriate tool or pin into the cross holes 40 and upon
rotation, the saddle 26 is moved relative to the saddle 28. Such
rotation spreads apart or distracts the spinous processes with the
resultant and beneficial effect of enlarging the volume of the
spinal canal in order to alleviate any restrictions on blood
vessels and nerves.
[0054] It is noted that this implant as well as the several other
implants described herein act as an extension stop. That means that
as the back is bent backwardly and thereby placed in extension the
spacing between adjacent spinous processes cannot be reduced to a
distance less than the distance between the lowest point of saddle
26 and the lowest point of saddle 28. This implant, however, does
not inhibit or in any way limit the flexion of the spinal column,
wherein the spinal column is bent forward.
[0055] Preferably, such a device provides for distraction in the
range of about 5 mm to about 15 mm. However, devices which can
distract up to and above 22 mm may be used depending on the
characteristics of the individual patient.
[0056] With all the ligaments (such as the superspinous ligament)
and tissues associated with the spinous processes left intact, the
implant 20 can be implanted essentially floating in position in
order to gain the benefits of the aforementioned extension stop and
flexion non-inhibitor. If desired, one of the saddles 26 can be
laterally pinned with pin 29 to one of the spinous processes and
the other saddle can be loosely associated with the other spinous
processes by using a tether 31 which either pierces or surrounds
the other spinous process and then is attached to the saddle in
order to position the saddle relative to the spinous process.
Alternatively, both saddles can be loosely tethered to the adjacent
spinous process in order to allow the saddles to move relative to
the spinous processes.
[0057] The shape of the saddles, being concave, gives the advantage
of distributing the forces between the saddle and the respective
spinous process. This ensures that the bone is not resorbed due to
the placement of the implant 20 and that the structural integrity
of the bone is maintained.
[0058] The implant 20 in this embodiment can be made of a number of
materials, including but not limited to, stainless steel, titanium,
ceramics, plastics, elastics, composite materials or any
combination of the above. In addition, the modulus of elasticity of
the implant can be matched to that of bone, so that the implant 20
is not too rigid. The flexibility of the implant can further be
enhanced by providing additional apertures or perforations
throughout the implant in addition to the holes 40 which also have
the above stated purpose of allowing the interbody piece 30 to be
rotated in order to expand the distance between the saddle 26,
28.
[0059] In the present embodiment, it is understood that the spinous
processes can be accessed and distracted initially using
appropriate instrumentation, and that the implant 20 can be
inserted and adjusted in order to maintain and achieve the desired
distraction. Alternatively, the spinous process can be accessed and
the implant 20 appropriately positioned. Once positioned, the
length of the implant can be adjusted in order to distract the
spinous processes or extend the distraction of already distracted
spinous processes. Thus, the implant can be used to create a
distraction or to maintain a distraction which has already been
created.
[0060] The placement of implants such as implant 20 relative to the
spinous process will be discussed hereinbelow with other
embodiments. However, it is to be noted that ideally, the implant
20 would be placed close to the instantaneous axis of rotation of
the spinal column so that the forces placed on the implant 20 and
the forces that the implant 20 places on the spinal column are
minimized.
[0061] Further, it is noted that during the actual process of
installing or implanting the implant 20, that the method uses the
approach of extending the length of the implant 20 a first amount
and then allowing the spine to creep or adjust to this distraction.
Thereafter, implant 20 would be lengthened another amount, followed
by a period where the spine is allowed to creep or adjust to this
new level of distraction. This process could be repeated until the
desired amount of distraction has been accomplished. This same
method can be used with insertion tools prior to the installation
of an implant. The tools can be used to obtain the desired
distraction using a series of spinal distraction and spine creep
periods before an implant is installed.
[0062] Embodiment of FIGS. 6, 7, 8, 9 and 10
[0063] The embodiment of the invention shown in the above FIGS. 6,
7, 8, 9 and 10 includes distraction or spreader tool 50 which has
first and second arms 52, 54. Arms 52, 54 are pivotal about pivot
point 56 and releaseable from pivot point 56 in order to effect the
implantation of implant 58. As can be seen in FIG. 6, in
cross-section, the arms 52, 54 are somewhat concave in order to
cradle and securely hold the first spinous process 60 relative to
arm 52 and the second spinous process 62 relative to arm 54. The
distraction tool 50 can be inserted through a small incision in the
back of the patient in order to address the space between the first
spinous process 60 and the second spinous process 62. Once the tool
50 is appropriately positioned, the arms 52, 54 can be spread apart
in order to distract the spinous processes. After this has
occurred, an implant 58 as shown in FIGS. 8 and 9, or of a design
shown in other of the embodiments of this invention, can be urged
between the arms 52, 54 and into position between the spinous
processes. After this occurs, the arms 52, 54 can be withdrawn from
the spinous processes leaving the implant 58 in place. The implant
58 is urged into place using a tool 64 which can be secured to the
implant 58 through a threaded bore 66 in the back of the implant.
As can be seen in FIG. 10, the implant 58 includes saddles 68 and
70 which cradle the upper and lower spinous processes 60, 62 in
much the same manner as the above first embodiment and also in much
the same manner as the individual arms of the tool 50. The saddles
as described above tend to distribute the load between the implant
and the spinous processes and also assure that the spinous process
is stably seated at the lowest point of the respective saddles.
[0064] Embodiment of FIGS. 11, 12 and 13
[0065] Another embodiment of the apparatus and method of the
invention is shown in FIGS. 11, 12 and 13. In this embodiment, the
spreader or distraction tool 80 includes first and second arms 82,
84 which are permanently pivoted at pivot point 86. The arms
include L-shaped ends 88, 90. Through a small incision, the
L-shaped ends 88, 90 can be inserted between the first and second
spinous processes 92, 94. Once positioned, the arms 82, 84 can be
spread apart in order to distract the spinous processes. The
implant 96 can then be urged between the spinous processes in order
to maintain the distraction. It is noted that implant 96 includes
wedged surfaces or ramps 98, 100. As the implant 96 is being urged
between the spinous processes, the ramps further cause the spinous
processes to be distracted. Once the implant 96 is fully implanted,
the full distraction is maintained by the planar surfaces 99, 101
located rearwardly of the ramps. It is to be understood that the
cross-section of the implant 96 can be similar to that shown for
implant 58 or similar to other implants in order to gain the
advantages of load distribution and stability.
[0066] Embodiments of FIGS. 14, 15, 16, 16a, and 17
[0067] In FIGS. 14 and 15, yet another embodiment of the invention
is depicted. In this embodiment, the implant 110 includes first and
second conically shaped members 112, 114. Member 112 includes a
male snap connector 116 and member 114 includes a female snap
connector 118. With male snap connector 116 urged into female snap
connector 118, the first member 112 is locked to the second member
114. In this embodiment, a distraction or spreader tool 80 could be
used. Once the spinous process has been spread apart, an
implantation tool 120 can be used to position and snap together the
implant 110. The first member 112 of implant 110 is mounted on one
arm and second member 114 is mounted on the other arm of tool 120.
The member 112, 114 are placed on opposite sides of the space
between adjacent spinous processes. The members 112, 114 are urged
together so that the implant 110 is locked in place between the
spinous processes as shown in FIG. 15. It is to be noted that the
implant 110 can also be made more self-distracting by causing the
cylindrical surface 122 to be more conical, much as surface 124 is
conical, in order to hold implant 110 in place relative to the
spinous processes and also to create additional distraction.
[0068] An alternative embodiment of the implant can be seen in
FIGS. 16 and 17. This implant 130 includes first and second members
132, 134. In this particular embodiment, the implants are held
together using a screw (not shown) which is inserted through
countersunk bore 136 and engages a threaded bore 138 of the second
member 134. Surfaces 139 are flattened (FIG. 17) in order to carry
and spread the load applied thereto by the spinous processes.
[0069] The embodiment of implant 130 is not circular in overall
outside appearance, as is the embodiment 110 of FIGS. 14 and 15. In
particular, with respect to the embodiment of implant 130 of FIGS.
16 and 17, this embodiment is truncated so that the lateral side
140, 142 are flattened with the upper and lower sides 144, 146
being elongated in order to capture and create a saddle for the
upper and lower spinous processes. The upper and lower sides, 144,
146 are rounded to provide a more anatomical implant, which is
compatible with the spinous processes.
[0070] If it is desired, and in order to assure that the first
member 132 and the second member 134 are aligned, key 148 and
keyway 150 are designed to mate in a particular manner. Key 148
includes at least one flattened surface, such as flattened surface
152, which mates to an appropriately flattened surface 154 of the
keyway 150. In this manner, the first member is appropriately mated
to the second member in order to form appropriate upper and lower
saddles holding the implant 130 relative to the upper and lower
spinous processes.
[0071] FIG. 16a depicts second member 134 in combination with a
rounded nose lead-in plug 135. Lead-in plug 135 includes a bore 137
which can fit snugly over key 148. in this configuration, the
lead-in plug 135 can be used to assist in the placement of the
second member 134 between spinous processes. Once the second member
134 is appropriately positioned, the lead-in plug 135 can be
removed. It is to be understood that the lead-in plug 135 can have
other shapes such as pyramids and cones to assist in urging apart
the spinous processes and soft tissues in order to position the
second member 134.
[0072] Embodiment of FIGS. 18, 19 and 20
[0073] The implant 330 as shown in FIG. 18 is comprised of first
and second mating wedges 332 and 334. In order to implant these
wedges 332, 334, the spinous processes are accessed from both sides
and then a tool is used to push the wedges towards each other. As
the wedges are urged towards each other, the wedges move relative
to each other so that the combined dimension of the implant 330
located between the upper and lower spinous processes 336, 338
(FIG. 20), increases, thereby distracting the spinous processes. It
is noted that the wedges 332, 334 include saddle 340, 342, which
receiving the spinous processes 336, 338. These saddles have the
advantages as described hereinabove.
[0074] The first or second wedges 332, 334 have a mating
arrangement which includes a channel 344 and a projection of 346
which can be urged into the channel in order to lock the wedges
332, 334 together.
[0075] The channel 334 is undercut in order to keep the projection
from separating therefrom . Further, as in other devices described
herein, a detent can be located in one of the channel and the
projection, with a complimentary recess in the other of the channel
and the projection. Once these two snap together, the wedges are
prevented from sliding relative to the other in the channel
344.
[0076] While the above embodiment was described with respect to
wedges, the wedges could also have been designed substantially as
cones with all the same features and advantages.
[0077] Embodiments of FIGS. 21 and 22
[0078] The implant 370 is comprised of first and second distraction
cone 372, 374. These cones are made of a flexible material. The
cones are positioned on either side of the spinous processes 376,
378 as shown in FIG. 21. Using appropriate tool as shown
hereinabove, the distraction cones 372, 374 are urged together. As
they are urged together, the cones distract the spinous processes
as shown in FIG. 22. Once this has occurred, an appropriate screw
or other type of fastening mechanism 380 can be used to maintain
the position of the distraction cones 372, 374. The advantage of
this arrangement is that the implant 370 is self-distracting and
also that the implant, being flexible, molds about the spinous
processes as shown in FIG. 22.
[0079] Embodiments of FIG. 23, 24 and 25
[0080] In FIGS. 23 and 24, another embodiment of the implant 170 is
depicted. This implant is guided in place using an L-shaped guide
172 which can have a concave cross-section such as the
cross-section 52 of retraction tool 50 in FIG. 6 in order to cradle
and guide the implant 170 in position. Preferably a small incision
would be made into the back of the patient and the L-shaped guide
tool 172 inserted between the adjacent spinous processes. The
implant 170 would be mounted on the end of insertion tool 174 and
urged into position between the spinous processes. The act of
urging the implant into position could cause the spinous processes
to be further distracted if that is required. Prior to the
insertion of the L-shaped guide tool 172, a distraction tool such
as shown in FIG. 13 could be used to initially distract the spinous
processes.
[0081] Implant 170 can be made of a deformable material so that it
can be urged into place and so that it can somewhat conform to the
shape of the upper and lower spinous processes. This deformable
material would be preferably an elastic material. The advantage of
such a material would be that the load forces between the implant
and the spinous processes would be distributed over a much broader
surface area. Further, the implant would mold itself to an
irregular spinous process shape in order to locate the implant
relative to spinous processes.
[0082] With respect to FIG. 25, this implant 176 can be inserted
over a guide wire, guide tool or stylet 178. Initially, the guide
wire 178 is positioned through a small incision to the back of the
patient to a position between the adjacent spinous processes. After
this has occurred, the implant is threaded over the guide wire 178
and urged into position between the spinous processes. This urging
can further distract the spinous processes if further distraction
is required, Once the implant is in place, the guide tool 178 is
removed and the incision closed. The insertion tools of FIGS. 23
and 24 can also be used if desired.
[0083] Embodiment of FIGS. 26, 27 and 28
[0084] The embodiment shown in FIGS. 26, 27 and 28 uses an implant
similar to that depicted in FIGS. 8 and 9 with different insertion
tools. As can be seen in FIG. 26, an L-shaped distraction tool 190
is similar to L-shaped distraction tool 80 (FIG. 12), is used to
distract the first and second spinous processes 192, 194. After
this has occurred, an insertion tool 196 is placed between the
spinous processes 192, 194. Insertion tool 196 includes a handle
198 to which is mounted a square-shaped ring 200.
[0085] The distraction tool 190 can be inserted through a small
incision in the back in order to spread apart the spinous
processes. Through the same incision which has been slightly
enlarged laterally, an upper end 202 of ring 200 can be initially
inserted followed by the remainder of the ring 200. Once the ring
is inserted, the ring can be rotated slightly by moving handle 198
downwardly in order to further wedge the spinous processes apart.
Once this has been accomplished, an implant such as implant 204 can
be inserted through the ring and properly positioned using implant
handle 206. Thereafter, the implant handle 206 and the insertion
tool 196 can be removed.
[0086] Embodiments of FIGS. 29, 30, 31, 32 and 33
[0087] As can be seen in FIGS. 29 and 30, the implants 210, 212,
can have different shapes when viewed from the side. These implants
are similar to the above-referenced implants 58 (FIG. 8) and 204
(FIG. 28). These implants have cross-sections similar to that shown
in FIG. 10 which includes saddles in order to receive and hold the
adjacent spinous processes.
[0088] As can be seen in FIGS. 31, 32 and 33, these implants can be
placed in different positions with respect to the spinous process
214. Preferably as shown in FIG. 33, the implant 210 is placed
closest to the lamina 216. Being so positioned, the implant 210 is
close to the instantaneous axis of rotation 218 of the spinal
column, and the implant would experience least forces caused by
movement of the spine. Thus, theoretically, this is the optimal
location for the implant.
[0089] As can be seen in FIGS. 31 and 32, the implant can be placed
midway along the spinous process (FIG. 32) and towards the
posterior aspect of the spinous process (FIG. 31). As positioned
shown in FIG. 31, the greatest force would be placed on the implant
210 due to a combination of compression and extension of the spinal
column.
[0090] Embodiment of FIGS. 34 and 35
[0091] Another embodiment of the invention is shown in FIGS. 34 and
35. In these figures, implant 220 is comprised of a plurality of
individual leaves 222 which are substantially V-shaped. The leaves
include interlocking indentations or detents 224. That is, each
leaf includes an indentation with a corresponding protrusion such
that a protrusion of one leaf mates with an indentation of an
adjacent leaf. Also associated with this embodiment is an insertion
tool 226 which has a blunt end 228 which conforms to the shape of
an individual leaf 222. For insertion of this implant into the
space between the spinous processes as shown in FIG. 29, the
insertion tool 226 first insert a single leaf 220. After that has
occurred, the insertion tool then inserts a second leaf with the
protrusion 224 of the second leaf snapping into corresponding
indentation made by the protrusion 224 of the first leaf. This
process would reoccur with third and subsequent leaves until the
appropriate spacing between the spinous processes was built up. As
can be seen in FIG. 29, the lateral edges 229 of the individual
leaves 222 are slightly curved upwardly in order to form a saddle
for receiving the upper and lower spinous processes.
[0092] Embodiments of FIGS. 36, 37 and 38
[0093] The embodiments of FIGS. 36, 37 and 38 which include
implants 230, 232, and 234 respectively, are designed in such a
manner so the implant locks itself into position once it is
properly positioned between the spinous processes. Implant 220 is
essentially a series of truncated cones and includes a plurality of
ever expanding steps 236. These steps are formed by the conical
bodies starting with the nose body 238 followed there behind by
conical body 240. Essentially, the implant 234 looks like a fir
tree placed on its side.
[0094] The implant 230 is inserted laterally throughout the opening
between upper and lower spinous processes. The first body 238
causes the initial distraction. Each successive conical body
distracts the spinous processes a further incremental amount. When
the desired distraction has been reached, the spinous processes are
locked into position by steps 236. At this point, if desired, the
initial nose body 238 of the implant and other bodies 240 can be
broken, snapped or sawed off if desired in order to minimize the
size of the implant 230. In order for a portion of the implant 230
to be broken or snapped off, the intersection between bodies such
as body 238 and 240, which is intersection line 242, would be
somewhat weaken with the appropriate removal of material. It is
noted that only the intersection lines of the initial conical
bodies need to be so weakened. Thus, intersection line 244 between
the bodies which remain between the spinous processes would not
need to be weaker, as there would be no intention that the implant
would be broken off at this point.
[0095] FIG. 37 shows implant 232 positioned between upper and lower
spinous processes. This implant is wedge-shaped or triangular
shaped in cross-sectioned and includes bore pluralities 245 and
246. Through these bores can be placed locking pins 248 and 250.
The triangular or wedged-shaped implant can be urged laterally
between and thus distract the upper and lower spinous processes.
Once the appropriate distraction is reached, pins 248, 250 can be
inserted through the appropriate bores of the bore pluralities 245
and 246 in order to lock the spinous processes in a V-shaped valley
formed by pins 248, 250 on the one hand and the ramped surface 233,
235 on the other hand.
[0096] Turning to FIG. 38, the implant 234 has a triangular-shaped
or wedge-shaped body similar to that shown in FIG. 32. In this
embodiment, tab 252, 254 are pivotally mounted to the triangular
shaped body 234. Once the implant 234 is appropriately positioned
in order to distract the spinous processes to the desired amount,
the tabs 252, 254 rotate into position in order to hold the implant
234 in the appropriate position.
[0097] Embodiment of FIGS. 39 and 40
[0098] In the embodiment of FIGS. 39 and 40, cannula 258 is
inserted through a small incision to a position between upper and
lower spinous processes. Once the cannula is properly inserted, an
implant 260 is s pushed through the cannula 258 using an insertion
tool 262. The implant 260 includes a plurality of ribs or
indentation 264 that assist in positioning the implant 260 relative
to the upper and lower spinal processes. Once the implant 260 is in
position, the cannula 258 is withdrawn so that the implant 260
comes in contact with and wedges between the spinous processes. The
cannula 258 is somewhat conical in shape with the nose end 266
being somewhat smaller than the distal end 268 in order to effect
the insertion of the cannula into the space between the spinous
processes.
[0099] Further, a plurality of cannula can be used instead of one,
with each cannula being slightly bigger than one before. In the
method of the invention, the first smaller cannula would be
inserted followed by successively larger cannula being placed over
the previous smaller cannula. The smaller cannula would then be
withdrawn from the center of the larger cannula. Once the largest
cannula is in place, and the opening of the skin accordingly
expanded, the implant, which is accommodated by only the larger
cannula, is inserted through the larger cannula and into
position.
[0100] Embodiments of FIGS. 41, 42 and 43
[0101] The precurved implant 270 in FIGS. 41 and 42, and precurved
implant 272 in FIG. 43 have common introduction techniques which
includes a guide wire, guide tool, or stylet 274. For both
embodiments, the guide wire 274 is appropriately positioned through
the skin of the patient and into the space between the spinous
processes. After this is accomplished, the implant is directed over
the guide wire and into position between the spinous processes. The
precurved nature of the implant assist in (1) positioning the
implant through a first small incision in the patient's skin on one
side of the space between two spinous processes and (2) guiding the
implant toward a second small incision in the patient's skin on the
other side of the space between the two spinous processes. With
respect to the implant 270, the implant includes a conical
introduction nose 276 and a distal portion 278. As the nose 276 is
inserted between the spinous processes, this causes distraction of
the spinous processes. Break lines 280, 282 are established at
opposite sides of the implant 270. Once the implant is properly
positioned over the guide wire between the spinous processes, the
nose portion 276 and the distal portion 278 can be broken off along
the break lines, through the above two incisions, in order to leave
the implant 270 in position.
[0102] Although only two break lines 280, 282 are depicted,
multiple break lines can be provided on implant 270 so that the
implant can continue to be fed over the guide wire 278 until the
appropriate width of the implant 270 creates the desired amount of
distraction. As described hereinabove, the break lines can be
created by perforating or otherwise weakening the implant 270 so
that the appropriate portions can be snapped or sawed off.
[0103] With respect to the precurved implant 272, this implant is
similar in design to the implant 230 shown in FIG. 36. This implant
272 in FIG. 47, however, is precurved and inserted over a guide
wire 274 to a position between the spinous processes. As with
implant 230 in FIG. 43, once the appropriate level of this
distraction has been reached and if desired, sections of the
implant 272 can be broken, snapped or sawed off as described
hereinabove in order to leave a portion of the implant wedged
between the upper and lower spinous processes.
[0104] Embodiment of FIG. 44
[0105] A further embodiment of the invention is shown in FIG. 44.
This embodiment includes a combination insertion tool and implant
290. The insertion tool and implant 290 is in the shape of a ring
which is hinged at point 292. The ring is formed by a first
elongated and conically shaped member 294 and a second elongated
and conically shaped member 296. Members 294 and 296 terminate in
points and through the use of hinge 292 are aligned and meet.
Through similar incisions on both sides of the spinous processes,
first member and second member are inserted through the skins of
the patient and are mated together between the spinous processes.
After this has occurred, the implant 290 is rotated, for example
clockwise, so that increasingly widening portions of the first
member 292 are used to distract the first and second spinous
processes. When the appropriate level of distraction has occurred,
the remainder of the ring before and after the section which is
located between the spinous processes can be broken off as taught
hereinabove in order to maintain the desired distraction.
Alternatively, with a small enough ring, the entire ring can be
left in place with the spinous processes distracted.
[0106] Embodiment of FIG. 45
[0107] In FIG. 45, the implant 300 is comprised of a plurality of
rods or stylets 302 which are inserted between the upper and lower
spinous processes. The rods are designed much as described
hereinabove so that they may be broken, snapped or cut off. Once
these are inserted and the appropriate distraction has been
reached, the stylets are broken off and a segment of each stylet
remains in order to maintain distraction of the spinous
process.
[0108] Embodiment of FIGS. 46 and 47
[0109] Implant 310 of FIGS. 46 and 47 is comprised of a shape
memory material which coils upon being released. The material is
straightened out in a delivery tool 312. The delivery tool is in
position between upper and lower spinous processes 314, 316. The
material is then pushed through the delivery tool. As it is
released from the delivery end 318 of the delivery tool, the
material coils, distracting the spinous processes to the desired
amount. Once this distraction has been achieved, the material is
cut and the delivery tool removed.
[0110] Embodiments of FIGS. 48, 49, 50 and 51
[0111] As can be seen in FIG. 48, the implant 320 is delivered
between upper and lower spinous processes 322 and 324, by delivery
tool 326. Once the implant 320 is in place between the spinous
processes, the delivery tool is given a 90.degree. twist so that
the implant goes from the orientation as shown in FIG. 49, with
longest dimension substantially perpendicular to the spinous
processes, to the orientation shown in FIG. 50 where the longest
dimension is in line with and parallel to the spinous processes.
This rotation causes the desired distraction between the spinous
processes. Implant 320 includes opposed recesses 321 and 323
located at the ends thereof. Rotation of the implant 320 causes the
spinous processes to become lodged in these recesses.
[0112] Alternatively, the insertion tool 326 can be used to insert
multiple implants 320, 321 into the space between the spinous
processes 322, 324 (FIG. 51). Multiple implants 320, 321 can be
inserted until the appropriate amount of distraction is built up.
It is to be understood in this situation that one implant would
lock to another implant by use of, for example, a channel
arrangement wherein a projection from one of the implants would be
received into and locked into a channel of the other implant. Such
a channel arrangement is depicted with respect to the other
embodiment.
[0113] Embodiment of FIGS. 52, 53, 54, 55a and 55b
[0114] The embodiment of FIGS. 52 through 55b is comprised of a
fluid-filled dynamic distraction implant 350. This implant includes
a membrane 352 which is placed over pre-bent insertion rod 354 and
then inserted through an incision on one side of the spinous
process 356. The bent insertion rod, with the implant 350
thereover, is guided between appropriate spinous processes. After
this occurs, the insertion rod 354 is removed leaving the flexible
implant in place. The implant 350 is then connected to a source of
fluid (gas, liquid, gel and the like) and the fluid is forced into
the implant causing it to expand as shown in FIG. 54, distracting
the spinal processes to the desired amount. Once the desired amount
of distraction has occurred, the implant 350 is closed off as is
shown in FIG. 55a. The implant 350 being flexible, can mold to the
spinous processes which may be of irregular shape, thus assuring
positioning. Further, implant 350 acts as a shock absorber, damping
forces and stresses between the implant and the spinous
processes.
[0115] A variety of materials can be used to make the implant and
the fluid which is forced into the implant. By way of example only,
viscoelastic substances such as methylcellulose, or hyaluronic acid
can be used to fill the implant. Further, materials which are
initially a fluid, but later solidify, can be inserted in order to
cause the necessary distraction. As the materials solidify, they
mold into a custom shape about the spinous processes and
accordingly are held in position at least with respect to one of
two adjacent spinous processes. Thus, it can be appreciated that
using this embodiment and appropriate insertion tools the implant
can be formed about one spinous process in such a manner that the
implant stays positioned with respect to that spinous process (FIG.
55b). With such an embodiment, a single implant can be used as an
extension stop for spinous process located on either side, without
restricting flexion of the spinal column.
[0116] It is to be understood that many of the other implants
disclosed herein can be modified so that they receive a fluid in
order to establish and maintain a desired distraction much in the
manner as implant 350 receives a fluid.
[0117] Embodiment of FIGS. 56, 57 and 58
[0118] The implant 360 as shown in FIG. 56 is comprised of a shape
memory material such as a plastic or a metal. A curved introductory
tool 362 is positioned between the appropriate spinous processes as
described hereinabove. Once this has occurred, bore 364 of the
implant is received over the tool. This act can cause the implant
to straighten out. The implant is then urged into position and
thereby distracts the spinous processes. When this has occurred,
the insertion tool 362 is removed, allowing the implant to assume
its pre-straightened configuration and is thereby secured about one
of the spinous processes. Such an arrangement allows for an implant
that is an extension stop and does not inhibit flexion of the
spinous column. Alternatively, the implant can be temperature
sensitive. That is to say that the implant would be more
straightened initially, but become more curved when it was warmed
by the temperature of the patient's body.
[0119] Embodiments of FIGS. 59 and 60
[0120] In this embodiment, the implant 380 is comprised of a
plurality of interlocking leaves 382. Initially, a first leaf is
positioned between opposed spinous processes 384, 386. Then
subsequently, leafs 382 are interposed between the spinous
processes until the desired distraction has been built up. The
leaves are somewhat spring-like in order to absorb the shock and
can somewhat conform to the spinous processes.
[0121] Embodiment of FIG. 61
[0122] The implant 390 of FIG. 61 includes the placement of shields
392, 394 over adjacent spinous processes 396, 398. The shields are
used to prevent damage to the spinous processes. These shields
include apertures which receives a self-tapping screw 400, 402. In
practice, the shields are affixed to the spinous processes and the
spinous processes are distracted in the appropriate amount. Once
this has occurred, a rod 404 is used to hold the distracted
position by being screwed into each of the spinous processes
through the aperture in the shields using the screws as depicted in
FIG. 61.
[0123] Embodiment of FIGS. 62 and 63
[0124] Implant 410 of FIGS. 62, 63 is comprised of first and second
members 412, 414 which can be mated together using an appropriate
screw and threaded bore arrangement to form the implant 410. Main
member 412 and mating member 414 form implant 410. Accordingly, the
implant 410 would have a plurality of members 414 for use with a
standardized first member 412. FIGS. 62 and 64 show different types
of mating members 414. In FIG. 62, the mating member 414 includes
projections 416 and 418 which act like shims. These projections are
used to project into the space of saddles 420, 422 of the first
member 412. These projections 416, 418 can be of varying lengths in
order to accommodate different sizes of spinous processes A groove
424 is placed between the projections 416, 418 and mates with an
extension 426 of the first member 412.
[0125] As shown in FIG. 63, the projections of the embodiment shown
in FIG. 62 are removed and recesses 428, 430 are substituted
therefor. These recesses expand the area of the saddles 420, 422 in
order to accommodate larger spinous processes.
[0126] Embodiment of FIGS. 64, 65 and 66
[0127] The embodiments of FIGS. 64, 65 and 66 are similar in design
and concept to the embodiment of FIGS. 62 and 63. In FIG. 64, the
implant 500 includes the first and second members 502, 504. These
members can be secured together with appropriate screws or other
fastening means as taught in other embodiments. Implant 500
includes first and second saddles 506, 508 which are formed between
the ends of first and second members 502, 504. These saddles 506,
508 are used to receive and cradle the adjacent spinous processes.
As can be seen in FIG. 64, each saddle 506, 508 is defined by a
single projection or leg 510, 512, which extends from the
appropriate first and second members 502, 504. Unlike the
embodiment found in FIGS. 62 and 63, each of the saddles is defined
by only a single leg as the ligaments and other tissues associated
with the spinous processes can be used to ensure that the implant
is held in an appropriate position. With the configuration of FIG.
64, it is easier to position the implant relative to the spinous
processes as each saddle is defined by only a single leg and thus
the first and second members can be more easily worked into
position between the various tissues.
[0128] In the embodiment of FIG. 65, the implant 520 is comprised
of a single piece having saddles 522 and 524. The saddles are
defined by a single leg 526, 528 respectively. In order for this
implant 520 to be positioned between the spinous processes, an
incision is made between lateral sides of adjacent spinous
processes. The single leg 526 is directed through the incision to a
position adjacent to an opposite lateral side of the spinous
process with the spinous process cradled in the saddle 522. The
spinous processes are then urged apart until saddle 524 can be
pivoted into position into engagement with the other spinous
process in order to maintain the distraction between the two
adjacent spinous processes.
[0129] The embodiment of FIG. 66 is similar to that of FIG. 65 with
an implant 530 and first and second saddles 532 and 534. Associated
with each saddle is a tether 536, 538 respectively. The tethers are
made of flexible materials known in the trade and industry and are
positioned through bores in the implant 530. Once appropriately
positioned, the tethers can be tied off. It is to be understood
that the tethers are not meant to be used to immobilize one spinous
process relative to the other, but are used to guide motion of the
spinous processes relative to each other so that the implant 530
can be used as an extension stop and a flexion non-inhibitor. In
other words, the saddles 532, 534 are used to stop spinal column
backward bending and extension. However, the tethers do not inhibit
forward bending and spinal column flexion.
[0130] Embodiments of FIGS. 67, 68
[0131] The implant 550 is Z-shaped and includes a central body 552
and first and second arms 554, 556, extending in opposite
directions therefrom. The central body 552 of the implant 550
includes first and second saddles 558 and 560. The first and second
saddles 558 and 560 would receive upper and lower spinous processes
562, 568. The arms 554, 556 are accordingly located adjacent the
distal end 566 (FIG. 68) of the central body 552. The first and
second arms 554, 556, act to inhibit forward movement, migration or
slippage of the implant 550 toward the spinal canal and keep the
implant in place relative to the first and second spinal processes.
This prevents the implant from pressing down on the ligamentum
flavum and the dura. In a preferred embodiment, the central body
would have a height of about 10 mm with each of the arms 554, 556
have a height of also about 10 mm. Depending on the patient, the
height of the body could vary from about less than 10 mm to about
greater than 24 mm. As can be seen in FIGS. 67 and 68, the first
and second arms 554, 556 are additionally contoured in order to
accept the upper and lower spinous processes 556, 558. In
particular, the arms 554, 556 as can be seen with respect to arm
554 have a slightly outwardly bowed portion 568 (FIG. 68) with a
distal end 570 which is slightly inwardly bowed. This configuration
allows the arm to fit about the spinous process with the distal end
570 somewhat urged against the spinous process in order to guide
the motion of the spinous process relative to the implant. These
arms 554, 556 could if desired to be made more flexible than the
central body 552 by making arms 554, 556 thin and/or with
perforations, and/or other material different than that of the
central body 550. As with the last embodiment, this embodiment can
be urged into position between adjacent spinous processes by
directing an arm into a lateral incision so that the central body
552 can be finally positioned between spinous processes.
[0132] Embodiment of FIGS. 69, 70, 71 and 71a
[0133] FIGS. 69, 70 and 71 are perspective front, end, and side
views of implant 580 of the invention. This implant includes a
central body 582 which has first and second saddles 584, 586 for
receiving adjacent spinous processes. Additionally, the implant 580
includes first and second arms 588 and 590. The arms, as with the
past embodiment, prevent forward migration or slippage of the
implant toward the spinal canal. First arm 588 projects outwardly
from the first saddle 584 and second arm 590 projects outwardly
from the second saddle 586. In a preferred embodiment, the first
arm 588 is located adjacent to the distal end 600 of the central
body 582 and proceeds only partly along the length of the central
body 582. The first arm 588 is substantially perpendicular to the
central body as shown in FIG. 70. Further, the first arm 588, as
well as the second arm 590, is anatomically rounded.
[0134] The second arm 590, projecting from second saddle 586, is
located somewhat rearward of the distal end 600, and extends
partially along the length of the central body 582. The second arm
590 projects at a compound angle from the central body 582. As can
be seen in FIGS. 70 and 71, the second arm 590 is shown to be at
about an angle of 45.degree. from the saddle 586 (FIG. 70).
Additionally, the second arm 590 is at an angle of about 45.degree.
relative to the length of the central body 580 as shown in FIG. 71.
It is to be understood that other compound angles are within the
spirit and scope of the invention as claimed.
[0135] In a preferred embodiment, the first and second arms 588,
590 have a length which is about the same as the width of the
central body 582. Preferably, the length of each arm is about 10 mm
and the width of the central body is about 10 mm. However, the
bodies with the widths of 24 mm and greater are within the spirit
and scope of the invention, along with first and second arms
ranging from about 10 mm to greater than about 24 mm. Further, it
is contemplated that the embodiment could include a central body
having a width of about or greater than 24 mm with arms being at
about 10 mm.
[0136] It is to be understood that the embodiment of FIGS. 69, 70
and 71 as well as the embodiment of FIGS. 67 and 68 are designed to
preferably be positioned between the L4-L5 and the L5-S1 vertebral
pairs. The embodiment of FIGS. 69, 70, 71 is particularly designed
for the L5-S1 position with the arms being designed to conform to
the sloping surfaces found therebetween. The first and second arms
are thus contoured so that they lie flat against the lamina of the
vertebra which has a slight angle.
[0137] The embodiment of FIG. 69, 70, and 71 as with the embodiment
of FIGS. 67 and 68 is Z-shaped in configuration so that it may be
inserted from one lateral side to a position between adjacent
spinous processes. A first arm, followed by the central body, is
guided through the space between the spinous processes. Such an
arrangement only requires that a incision on one side of the
spinous process be made in order to successfully implant the device
between the two spinous processes.
[0138] The implant 610 of FIG. 71a is similar to that immediately
above with the first arm 612 located on the same side of the
implant as the second arm 614. The first and second saddle 616, 618
are slightly modified in that distal portion 620, 622 are somewhat
flattened from the normal saddle shape in order to allow the
implant to be positioned between the spinous processes from one
side. Once in position, the ligaments and tissues associated with
the spinous processes would hold the implant into position. Tethers
also could be used if desired.
[0139] Embodiment of FIGS. 72, 73
[0140] Implant 630 is also designed so that it can be inserted from
one side of adjacent spinous processes. This insert 630 includes a
central body 632 with the first and second arms 634, 636 extending
on either side thereof. As can be seen in FIG. 72, a plunger 638 is
positioned to extend from an end of the central body 632. As shown
in FIG. 72, the plunger 638 is fully extended and as shown in FIG.
73, the plunger 638 is received within the central body 632 of the
implant 630. With the plunger received into the implant 632, the
third and fourth arms or hooks 640, 642 can extend outwardly from
the central body 632. The third and fourth arms or hooks 640, 642
can be comprised of a variety of materials, such as for example,
shape memory metal materials or materials which have a springy
quality.
[0141] For purposes of positioning the implant 630 between adjacent
spinous processes, the plunger 638 is pulled outwardly as shown in
FIG. 72. The central body 632 is then positioned between adjacent
spinous processes and the plunger 638 is allowed to move to the
position of FIG. 73 so that the third and fourth arms 640, 642 can
project outwardly from the central body 632 in order to hold the
implant 630 in position between the spinous processes.
[0142] Plunger 638 can be spring biased to the position as shown in
FIG. 73 or can include detents or other mechanisms which lock it
into that position. Further, the third and fourth arms themselves,
as deployed, can keep the plunger in the position as shown in FIG.
73.
[0143] Embodiments of FIGS. 74, 75, 76, 77, and 78
[0144] Other embodiments of the invention are shown in FIGS. 74
through 78. FIGS. 74, 75 and 76 disclose implant 700. Implant 700
is particularly suited for implantation between the L4-L5 and L5-S1
vertebra. As can be seen in FIG. 74, the implant 700 includes a
central body 702 which has a bore 704 provided therein. Bore 704 is
used in order to adjust the modulus of elasticity of the implant so
that it is preferably approximately two times the anatomical load
placed on the vertebra in extension. In other words, the implant
700 is approximately two times stiffer than the normal load placed
on the implant. Such an arrangement is made in order to ensure that
the implant is somewhat flexible in order to reduce potential
resorption of the bone adjacent to the implant. Other modulus
values can be used and be within the spirit of the invention.
[0145] Implant 700 includes first and second saddle 706, 708 which
are used to receive and spread the load from the upper and lower
spinous processes. The saddle 706 is defined by first and second
arms 710 and 712. The second saddle 708 is defined by third and
fourth arms 714 and 716. As can be seen in FIG. 74, the first arm
710, in a preferred embodiment, is approximately two times the
length of the body 702 with the second arm being approximately less
than a quarter length of the body. Third arm 714 is approximately
one times the length of the body 702 with the fourth arm 716 being,
in this preferred embodiment, approximately one and a half times
the length of the body 702. The arms are designed in such a way
that the implant (1) can be easily and conveniently inserted
between the adjacent spinous processes, (2) will not migrate
forwardly toward the spinal canal, and (3) will hold its position
through flexion and extension as well as lateral bending of the
spinal column.
[0146] First arm 710 is in addition designed to accommodate the
shape of the vertebra. As can be seen in FIG. 74, the first arm 710
becomes narrower as it extends away from the body 702. The first
arm 710 includes a sloping portion 718 followed by a small recess
720 ending in a rounded portion 722 adjacent to the end 724. This
design is provided to accommodate the anatomical form of for
example the L4 vertebra. It is to be understood that these vertebra
have a number of surfaces at roughly 30.degree. angles and that the
sloping surfaces of this embodiment and the embodiments shown in
FIGS. 77 and 78 are designed to accommodate these surfaces. These
embodiments can be further modified in order to accommodate other
angles and shapes.
[0147] The second arm 712 is small so that it is easy to insert
between the spinous processes, yet still define the saddle 706. The
fourth arm TO 716 is larger than the third arm 714, both of which
are smaller than the first arm 710. The third and fourth arms are
designed so that they define the saddle 706, guide the spinous
processes relative to the implant 700 during movement of the spinal
column, and yet are of a size which makes the implant easy to
position between the spinous processes.
[0148] The procedure, by way of example only, for implanting the
implant 700 can be to make an incision laterally between two
spinous processes and then initially insert first arm 710 between
the spinous processes. The implant and/or appropriate tools would
be used to distract the spinous processes allowing the third leg
714 and the central body 702 to fit through the space between the
spinous processes. The third leg 714 would then come to rest
adjacent the lower spinous processes on the opposite side with the
spinous processes resting in the first and second saddle 706, 708.
The longer fourth leg 716 would then assist in the positioning of
the implant 700.
[0149] FIG. 77 includes an implant 740 which is similar to implant
700 and thus have similar numbering. The saddle 706, 708 of implant
740 have been cantered or sloped in order to accommodate the bone
structure between, by way of example, the L4-L5 and the L5-S1
vertebra. As indicated above, the vertebra in this area have a
number of sloping surfaces in the range of about 30.degree..
Accordingly, saddle 706 is sloped at less than 309 and preferably
about 20.degree. while saddle 708 is sloped at about 30.degree. and
preferably more than 30.degree..
[0150] The implant 760 as shown in FIG. 78 is similar to implant
700 in FIG. 74 and is similarly numbered. Implant 760 includes
third and fourth legs 714, 716 which have sloping portions 762, 764
which slope toward ends 766, 768 of third and fourth arm 714, 716
respectively. The sloping portions accommodate the form of the
lower vertebra against which they are positioned. In the preferred
embodiment, the sloping portions are of about 30.degree.. However,
it is to be understood that sloping portions which are
substantially greater and substantially less than 30.degree. can be
included and be within the spirit and scope of the invention.
[0151] Embodiment of FIG. 79, 80, 80a, 81, 82, 83, 83a, 84, 85 86
and 87
[0152] Another embodiment of the invention is shown in FIGS. 79-87
and includes implant 800 (FIG. 86). Implant 800 includes a
distracting unit 802 which is shown in left side, plan, and right
side views of FIGS. 79, 80 and 81. A perspective view of the
distraction unit is shown in FIG. 84. The distracting unit as can
be seen in FIG. 80 includes a distracting body 804, with
longitudinal axis 805, which body 804 has a groove 806 and a
rounded or bulbous end 808 which assist in the placement of the
distracting body between adjacent spinous process so that an
appropriate amount of distraction can be accomplished. Extending
from the distracting body 804 is a first wing 810 which in FIG. 80
is substantially perpendicular to the distracting body 804. Such
wings which are not perpendicular to the body are within the spirit
and scope of the invention First wing 810 includes a upper portion
812 and a lower portion 814. The upper portion 810 (FIGS. 79)
includes a rounded end 816 and a small recess 818. The rounded end
816 and the small recess 818 in the preferred embodiment are
designed to accommodate the anatomical form or contour of the L4
(for a L4-L5 placement) or L5 (for a L5-S1 placement) superior
lamina of the vertebra. It is to be understood that the same shape
or variations of this shape can be used to accommodate other lamina
of any vertebra. The lower portion 814 is also rounded in order to
accommodate in the preferred embodiment in order to accommodate the
vertebrae. The distracting unit further includes a threaded bore
820 which in this embodiment accepts a set screw 822 (FIG. 86) in
order to hold a second wing 824 (FIGS. 82, 83) in position as will
be discussed hereinbelow. The threaded bore 820 in this embodiment
slopes at approximately 45.degree. angle and intersects the slot
806. With the second wing 824 in position, the set screw 822 when
it is positioned in the threaded bore 820 can engage and hold the
second wing 824 in position in the slot 806.
[0153] Turning to FIGS. 82, 83 and 85, left side, plan and
perspective views of the second wing 824 are depicted. The second
wing 824 is similar in design to the first wing. The second wing
includes an upper portion 826 and a lower portion 828. The upper
portion includes a rounded end 830 and a small recess 832. In
addition, the second wing 824 includes a slot 834 which mates with
the slot 806 of the distracting unit 802. The second wing 824 is
the retaining unit of the present embodiment.
[0154] As can be seen in FIG. 83 and 86, the second wing or
retaining unit 824 includes the upper portion 826 having a first
width "a" and the lower portion 828 having a second width "b". In
the preferred embodiment, the second width "b" is larger than first
width "a" due to the anatomical form or contour of the L4-L5 or
L5-S1 laminae. As can be seen in FIG. 83a in second wing or
retaining unit 824, the widths "a" and "b" would be increased in
order to, as described hereinbelow, accommodate spinous processes
and other anatomical forms or contours which are of different
dimensions. Further, as appropriate, width "a" can be larger than
width "b". Thus, as will be described more fully hereinbelow, the
implant can include a universally-shaped distracting unit 802 with
a plurality of retaining units 824, with each of the retaining
units having different widths "a" and "b". During surgery, the
appropriately sized retaining unit 824, width with the appropriate
dimensions "a" and "b" can be selected to match to the anatomical
form of the patient.
[0155] FIG. 86 depicts an assembled implant 800 positioned adjacent
to upper and lower laminae 836, 838 (which are shown in dotted
lines) of the upper and lower vertebrae. The vertebrae 836, 838 are
essentially below the implant 800 as shown in FIG. 86. Extending
upwardly from the vertebrae 836, 838, and between the first and
second wings 810, 824, are the upper and lower spinous processes
840, 842. It is to be understood that in a preferred embodiment,
the fit of the implant between the spinous processes can be such
tha the wings do not touch the spinous processes, as shown in FIG.
86, and be within the spirit and scope of the invention.
[0156] The implant 800 includes, as assembled, an upper saddle 844
and the lower saddle 846. The upper saddle 844 has an upper width
identified by the dimension "UW". The lower saddle 846 has a lower
width identified by the dimension "LW". In a preferred embodiment,
the upper width is greater than the lower width. In other
embodiments, the "UW" can be smaller than the "LW" depending on the
anatomical requirements. The height between the upper and lower
saddles 844, 846 is identified by the letter "h". These dimensions
are carried over into FIG. 87 which is a schematic representation
of the substantially trapezoidal shape which is formed between the
upper and lower saddles. The table below gives sets of dimensions
for the upper width, lower width, and height as shown in FIG. 87.
This table includes dimensions for some variations of this
embodiment.
1 TABLE Variation 1 2 3 Upper Width 8 7 6 Lower Width 7 6 5 Height
10 9 8
[0157] For the above table, all dimensions are given in
millimeters.
[0158] For purposes of surgical implantation of the implant 800
into a patient, the patient is preferably positioned on his side
(arrow 841 points up from an operating table) and placed in a
flexed (tucked) position in order to distract the upper and lower
vertebrae.
[0159] In a preferred procedure, a small incision is made on the
midline of the spinous processes. The spinous processes are spread
apart or distracted with a spreader. The incision is spread
downwardly toward the table, and the distracting unit 802 is
preferably inserted upwardly between the spinous processes 840 and
842 in a manner that maintains the distraction of spinous
processes. The distracting unit 802 is urged upwardly until the
distracting or bulbous end 808 and the slot 806 are visible on the
other wide of the spinous process. Once this is visible, the
incision is spread upwardly away from the table and the retaining
unit or second wing 824 is inserted into the slot 806 and the screw
822 is used to secure the second wing in position. After this had
occurred, the incisions can be closed.
[0160] An alternative surgical approach requires that small
incisions be made on either side of the space located between the
spinous processes. The spinous processes are spread apart or
distracted using a spreader placed through the upper incision. From
the lower incision, the distracting unit 802 is preferably inserted
upwardly between the spinous processes 840 and 842 in a manner that
urges the spinous processes apart. The distracting unit 802 is
urged upwardly until the distracting or bulbous end 808 and the
slot 806 are visible through the second small incision in the
patient's back. Once this is visible, the retaining unit or second
wing 824 is inserted into the slot 806 and the screw 822 is used to
secure the second wing in position. After this has occurred, the
incisions can be closed.
[0161] The advantage of either of the above present surgical
procedures is that a surgeon is able to observe the entire
operation, where he can look directly down onto the spinous
processes as opposed to having to view the procedure from positions
which are to the right and to the left of the spinous processes.
Generally, the incision is as small as possible and the surgeon is
working in a bloody and slippery environment. Thus, an implant that
can be positioned directly in front of a surgeon is easier to
insert and assemble than an implant which requires the surgeon to
shift from side to side. Accordingly, a top-down approach, as an
approach along a position to anterior line is preferred so that all
aspects of the implantation procedure are fully visible to the
surgeon at all times. This aides in the efficient location of (i)
the distracting unit between the spinous processes, (ii) the
retaining unit in the distracting unit, and (iii) finally the set
screw in the distracting unit. FIG. 80a shows an alternative
embodiment of the distracting unit 802a. This distracting unit 802a
is similar to distracting unit 802 in FIG. 80 with the exception
that the bulbous end 808a is removable from the rest of the
distracting body 804a as it is screwed into the threaded bore 809.
The bulbous end 808a is removed once the distracting unit 802a is
positioned in the patient in accordance with the description
associated with FIG. 86. The bulbous end 808a can extend past the
threaded bore 820 by about 1 cm in a preferred embodiment.
[0162] Embodiment of FIGS. 88, 89, 90 and 91
[0163] Another embodiment of the invention is shown in FIGS. 88,
89, 90 and 91. In this embodiment, the implant is identified by the
number 900. Other elements of implant 900 which are similar to
implant 800 are similarly numbered but in the 900 series. For
example, the distracting unit is identified by the number 902 and
this is in parallel with the distracting unit 802 of the implant
800. The distracting body is identified by the number 904 in
parallel with the distracting body 804 of the implant 800. Focusing
on FIG. 90, the distracting unit 902 is depicted in a perspective
view. The distracting unit includes slot 906 which is wider at the
top than at the bottom. The reason for this is that the wider upper
portion of the slot 906, which is wider than the second wing 924
(FIG. 89), is used to allow the surgeon to easily place the second
wing 924 into the slot 906 and allow the wedge-shaped slot 906 to
guide the second wing 924 to its final resting position. As can be
see in FIG. 91, in the final resting position, the largest portion
of the slot 906 is not completely filled by the second wing
924.
[0164] The end 908 of implant 900 is diferent in that it is more
pointed, having sides 909 and 911 which are provided at about
45.degree. angles (other angles, such as by way of example only,
from about 30.degree. to about 60.degree. are within the spirit of
the invention), with a small flat tip 913 so that the body 904 can
be more easily urged between the spinous processes.
[0165] The distracting unit 902 further includes a tongue-shaped
recess 919 which extends from the slot 906. Located in the
tongue-shaped recess is a threaded bore 920.
[0166] As can be seen in FIG. 89, a second wing 924 includes a
tongue 948 which extends substantially perpendicular thereto and
between the upper and lower portions 926, 928. The tab 948 includes
a bore 950. With the second wing 924 positioned in the slot 906 of
the distracting unit 902 and tab 948 positioned in recess 919, a
threaded set screw 922 can be positioned through the bore 950 and
engage the threaded bore 920 in order to secure the second wing or
retaining unit 924 to the distracting unit 902. The embodiment 900
is implanted in the same manner as embodiment 800 previously
described. In addition, as the bore 922 is substantially
perpendicular to the distracting body 904 (and not provided at an
acute angle thereto), the surgeon can even more easily secure the
screw in place from a position directly behind the spinous
processes.
[0167] Industrial Applicability
[0168] From the above, it is evident that the present invention can
be used to relieve pain caused by spinal stenosis in the form of,
by way of example only, central canal stenosis or foraminal
(lateral) stenosis. These implants have the ability to flatten the
natural curvature of the spine and open the neural foramen and the
spacing between adjacent vertebra to relieve problems associated
with the above-mentioned lateral and central stenosis.
Additionally, the invention can be used to relieve pain associated
with facet arthropathy. The present invention is minimally invasive
and can be used on an outpatient basis.
[0169] Additional aspects, objects and advantages of the invention
can be obtained through a review of the appendant claims and
figures. it is to be understood that other embodiments can be
fabricated and come within the spirit and scope of the claims.
* * * * *