U.S. patent application number 11/635907 was filed with the patent office on 2007-04-12 for facet joint prosthesis measurement and implant tools.
Invention is credited to Teena M. Augostino, Richard J. Broman, Leonard JR. Tokish.
Application Number | 20070079517 11/635907 |
Document ID | / |
Family ID | 34966239 |
Filed Date | 2007-04-12 |
United States Patent
Application |
20070079517 |
Kind Code |
A1 |
Augostino; Teena M. ; et
al. |
April 12, 2007 |
Facet joint prosthesis measurement and implant tools
Abstract
The present invention provides tools and methods designed to aid
in the placement of facet joint prostheses at virtually all spinal
levels. One aspect of the present invention is a measurement tool
for installing a cephalad facet joint prosthesis including a
fixation measurement element and a support arm element. This
measurement tool assists in the selection and/or configuration of a
cephalad facet joint prosthesis for implantation in a patient.
Another aspect is a measurement tool for installing a caudal facet
joint prosthesis including a stem element and a trial caudal
bearing surface element. This measurement tool assists in the
selection and/or configuration of a caudal facet joint prosthesis
for implantation in a patient. Yet another aspect is a measurement
tool holder including a measurement surface connected to a holder
element. This tool holder assists in determining the measurements
obtained with the caudal facet joint prosthesis measurement
tool.
Inventors: |
Augostino; Teena M.;
(Redmond, WA) ; Broman; Richard J.; (Monroe,
WA) ; Tokish; Leonard JR.; (Issaquah, WA) |
Correspondence
Address: |
SHAY LAW GROUP, LLP
2755 CAMPUS DRIVE
SUITE 210
SAN MATEO
CA
94403
US
|
Family ID: |
34966239 |
Appl. No.: |
11/635907 |
Filed: |
December 8, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11278349 |
Mar 31, 2006 |
|
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11635907 |
Dec 8, 2006 |
|
|
|
10831651 |
Apr 22, 2004 |
7051451 |
|
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11278349 |
Mar 31, 2006 |
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Current U.S.
Class: |
33/512 |
Current CPC
Class: |
A61F 2250/0098 20130101;
A61F 2002/30616 20130101; A61F 2002/3071 20130101; A61B 17/7001
20130101; A61F 2/4684 20130101; A61F 2002/4658 20130101; A61F
2002/4662 20130101; A61F 2250/0087 20130101; A61F 2/4611 20130101;
A61F 2002/3085 20130101; A61F 2250/0097 20130101; A61F 2002/4659
20130101; A61F 2002/30617 20130101; A61F 2/4657 20130101; A61F
2/4405 20130101; A61F 2002/3008 20130101; A61F 2002/4668
20130101 |
Class at
Publication: |
033/512 |
International
Class: |
G01B 1/00 20060101
G01B001/00 |
Claims
1. A system for conducting surgery on a spine of a patient, the
system comprising: a frame comprising: a first anchoring feature
attachable to a first bone portion of the patient; a second
anchoring feature attachable to a second bone portion of the
patient, wherein the first and second bone portions are spaced
apart from each other; a first registration feature shaped to guide
a surgical instrument, wherein the surgical instrument comprises a
measurement tool configured to measure a displacement between the
first registration feature and a bony landmark of the spine; and a
bridging structure configured to couple the first and second
anchoring features and the first registration feature together such
that the second anchoring feature is positionable at any of a
variety of positions with respect to the first anchoring feature,
wherein the first and second anchoring features are configured to
be attached to pedicles of the spine.
2. A system for conducting surgery on a spine of a patient, the
system comprising: a frame comprising: a first anchoring feature
attachable to a first bone portion of the patient; a second
anchoring feature attachable to a second bone portion of the
patient, wherein the first and second bone portions are spaced
apart from each other; a first registration feature shaped to guide
at least one surgical instrument, the first registration feature
comprising a guide post that is receivable by a corresponding bore
of the surgical instrument, the guide post having a non-circular
cross section selected to substantially prevent rotation of the
surgical instrument about an axis of the guide post; and a bridging
structure configured to couple the first and second anchoring
features and the first registration feature together such that the
second anchoring feature is positionable at any of a variety of
positions with respect to the first anchoring feature, wherein the
first and second anchoring features are configured to be attached
to pedicles of the spine.
3. A method for measuring a bony landmark on a spine of a patient,
the method comprising: attaching a frame to a first bone portion
and a second bone portion of the spine, wherein the first and
second bone portions are spaced apart from each other; registering
a measurement tool with respect to the frame; and guiding the
registered measurement tool with the frame to measure at least one
of a position of the bony landmark, and an orientation of the bony
landmark.
4. The method of claim 3, wherein the frame comprises a first
registration feature, wherein registering the measurement tool with
respect to the frame comprises coupling the measurement tool to the
first registration feature.
5. The method of claim 4, wherein the frame further comprises a
second registration feature, wherein attaching the frame to the
first and second bone portions comprises: positioning the first and
second registration features on opposite sides of a sagittal plane
of the patient to guide instrumentation to enable performance of
two distinct measurement functions substantially symmetrically
across the sagittal plane.
6. The method of claim 3, further comprising replacing at least a
portion of a facet of a vertebra of a spine of the patient with at
least one prosthesis.
7. A method for measuring a bony landmark on a spine of a patient
through the use of a system comprising a frame having an external
anchoring feature, and a stationary external support comprising a
fixed end and a grip, the method comprising: attaching the fixed
end to a stationary structure; positioning the frame at a desired
location with respect to the spine; attaching the grip to the
external anchoring feature to restrict motion of the frame;
registering a measurement tool with respect to the frame; and
guiding the registered measurement tool with the frame to measure
at least one of a position of the bony landmark, and an orientation
of the bony landmark.
8. The method of claim 7, wherein the frame comprises a first
registration feature, wherein registering the measurement tool with
respect to the frame comprises coupling the measurement tool to the
first registration feature.
9. The method of claim 8, wherein the frame further comprises a
bridging structure that movably couples the first registration
feature to the external anchoring feature, the method further
comprising: manipulating the bridging structure to move the first
registration feature with respect to the external anchoring
feature; and locking the bridging structure to restrict further
motion of the first registration feature with respect to the
external anchoring feature.
10. The method of claim 7, further comprising replacing at least a
portion of a facet of a vertebra of a spine of the patient with at
least one prosthesis.
Description
CROSS-REFERENCE
[0001] This application is a continuation of pending application
Ser. No. 11/278,349, filed Mar. 31, 2006; which is a continuation
of application Ser. No. 10/831,651, filed Apr. 22, 2004, now U.S.
Pat. No. 7,051,451; these applications are incorporated by
reference as if fully set forth herein.
FIELD OF INVENTION
[0002] This invention relates to prostheses, systems, and methods
for treating various types of spinal pathologies, and in particular
relates to the sizing and attachment of prostheses to spinal
vertebrae.
BACKGROUND OF THE INVENTION
[0003] The human spinal column 10, as shown in FIG. 1, is comprised
of a series of thirty-three stacked vertebrae 12 divided into five
regions. The cervical region includes seven vertebrae, known as
C1-C7. The thoracic region includes twelve vertebrae, known as
T1-T12. The lumbar region contains five vertebrae, known as L1-L5.
The sacral region is comprised of five vertebrae, known as S1-S5,
while the coccygeal region contains four vertebra, known as
Co1-Co4.
[0004] FIG. 2 depicts a superior plan view of a normal human lumbar
vertebra 12. Although human lumbar vertebral vary somewhat
according to location, they share many common features. Each
vertebra 12 includes a vertebral body 14. Two short bones, the
pedicles 16, extend backward from each side of the vertebral body
14 to form a vertebral arch 18.
[0005] At the posterior end of each pedicle 16, the vertebral arch
18 flares out into broad plates of bone known as the laminae 20.
The laminae 20 fuse with each other to form a spinous process 22.
The spinous process 22 serves for muscle and ligamentous
attachment. A smooth transition from the pedicles 16 to the laminae
20 is interrupted by the formation of a series of processes.
[0006] Two transverse processes 24 thrust out laterally on each
side from the junction of the pedicle 16 with the lamina 20. The
transverse processes 24 serve as levers for the attachment of
muscles to the vertebrae 12. Four articular processes, two superior
26 and two inferior 28, also rise from the junctions of the
pedicles 16 and the laminae 20. The superior articular processes 26
are sharp oval plates of bone rising upward on each side of the
vertebrae, while the inferior processes 28 are oval plates of bone
that jut downward on each side.
[0007] The superior and inferior articular processes 26 and 28 each
have a natural bony structure known as a facet. The superior
articular facet 30 faces upward, while the inferior articular facet
31 (see FIG. 3) faces downward. When adjacent vertebrae 12 are
aligned, the facets 30 and 31, capped with a smooth articular
cartilage, interlock to form a facet joint 32, also known as a
zygapophyseal joint.
[0008] The facet joint 32 is composed of a superior half and an
inferior half. The superior half is formed by the vertebral level
below the joint 32, and the inferior half is formed by the
vertebral level above the joint 32. For example, in the L4-L5 facet
joint, the superior half of the joint 32 is formed by bony
structure on the L5 vertebra (i.e., a superior articular surface
and supporting bone 26 on the L5 vertebra), and the inferior half
of the joint 32 is formed by bony structure on the L4 vertebra
(i.e., an inferior articular surface and supporting bone 28 on the
L4 vertebra).
[0009] An intervertebral disc 34 between each adjacent vertebrae 12
permits gliding movement between the vertebrae 12. The structure
and alignment of the vertebrae 12 thus permit a range of movement
of the vertebrae 12 relative to each other.
[0010] Back pain, particularly in the "small of the back" or
lumbosacral (L4-S1) region, is a common ailment. In many cases, the
pain severely limits a person's functional ability and quality of
life. Such pain can result from a variety of spinal
pathologies.
[0011] Through disease or injury, the laminae, spinous process,
articular processes, or facets of one or more vertebral bodies can
become damaged, such that the vertebrae no longer articulate or
properly align with each other. This can result in an undesired
anatomy, loss of mobility, and pain or discomfort.
[0012] For example, the vertebral facet joints can be damaged by
either traumatic injury or by various disease processes. These
disease processes include osteoarthritis, ankylosing spondylolysis,
and degenerative spondylolisthesis. The damage to the facet joints
often results in pressure on nerves, also called "pinched" nerves,
or nerve compression or impingement. The result is pain, misaligned
anatomy, and a corresponding loss of mobility. Pressure on nerves
can also occur without facet joint pathology, e.g., a herniated
disc.
[0013] One type of conventional treatment of facet joint pathology
is spinal stabilization, also known as intervertebral
stabilization. Intervertebral stabilization prevents relative
motion between the vertebrae. By preventing movement, pain can be
reduced. Stabilization can be accomplished by various methods.
[0014] One method of stabilization is spinal fusion. Another method
of stabilization is fixation of any number of vertebrae to
stabilize and prevent movement of the vertebrae. Another type of
conventional treatment is decompressive laminectomy. This procedure
involves excision of some or all of the laminae to relieve
compression of nerves.
[0015] These traditional treatments are subject to a variety of
limitations and varying success rates. None of the described
treatments, however, puts the spine in proper alignment or returns
the spine to a desired anatomy. In addition, stabilization
techniques, by holding the vertebrae in a fixed position,
permanently limit a person's mobility.
[0016] Artificial facet joint prostheses have been proposed as an
alternative to spinal fusion. Examples of such prostheses may be
found in U.S. Pat. No. 6,610,091; U.S. Patent Appl. Publ. No.
2002/0123806 A1; U.S. Patent Appl. Publ. No. 2003/0028250 A1; and
U.S. Patent Appl. Publ. No. 2005/0131406 A1, the disclosures of
which are incorporated herein by reference. The prostheses and
methods described therein help establish a desired anatomy to a
spine and return a desired range of mobility to an individual. Such
prostheses and methods also help lessen or alleviate spinal pain by
relieving the source of nerve compression or impingement.
SUMMARY OF THE INVENTION
[0017] What is needed are methods and tools for facilitating the
sizing, orientation and implant of spine prostheses such as
artificial facet joint prostheses. The present invention provides
tools and methods designed to aid in the placement of facet joint
prostheses at virtually all spinal levels including, but not
limited to, L1-L2, L2-L3, L3-L4, L4-L5, L5-S1, T11-T12, and
T12-L1.
[0018] For the sake of description herein, the tools and prostheses
that embody features of the invention are identified as either
"cephalad" or "caudal" with relation to the portion of a given
natural facet joint they replace. As previously described, a
natural facet joint, such as facet joint 32 (FIG. 3), has a
superior half and an inferior half. In anatomical terms, the
superior half of the joint is formed by the vertebral level below
the joint, which can thus be called the "caudal" portion of the
facet joint because it is closer to the feet of the person. The
inferior half of the facet joint is formed by the vertebral level
above the joint, which can thus be called the "cephalad" portion of
the facet joint because it is closer to the head of the person.
Thus, the prosthesis and tool that are used in the replacement of
the caudal portion of a natural facet joint (i.e., the superior
half) will be called a "caudal" prosthesis. Likewise, the
prosthesis and tool that are used in the replacement of the
cephalad portion of a natural facet joint (i.e., the inferior half)
will be called a "cephalad" prosthesis.
[0019] Because the specific features of a patient's spinal anatomy
can vary significantly from patient to patient (and can also vary
within the various spinal levels of an individual patient or even
vary between the facet joints in a single vertebral level), a
prosthesis suitable for implantation into a patient will desirably
be configured or tailored to accommodate the specific features of
the patient's spinal anatomy. For example, the size, spacing and
orientation of the pedicles, lamina and associated spinal anatomy,
as well as the size, spacing and orientation of the individual
facet joints to be replaced, can vary widely depending upon the
level and/or patient to be treated.
[0020] In order to accommodate such variations in anatomy, a
configurable and/or modular prosthesis system (comprising multiple
configurable and/or interchangeable components of varying shapes
and/or sizes) may be used to tailor the prosthesis to the varying
anatomical demands of a given patient. Once the surgical site has
been prepared, the prosthesis can be assembled and/or configured
from components chosen by the physician based on anatomical
measurements of the treatment site during the surgery. The
disclosed invention desirably facilitates such measurements of the
treated anatomy.
[0021] In one aspect, the present invention provides a measurement
tool for configuring and installing a cephalad facet joint
prosthesis including a fixation measurement element and a support
arm element. This measurement tool assists in the selection of a
cephalad facet joint prosthesis for implantation in a patient. The
measurement tool can be used in the determination of the dimensions
of a cephalad facet joint prosthesis. Particularly, this
measurement tool can be used to determine the length of the
fixation element and support arm element of the cephalad facet
joint prosthesis.
[0022] In some embodiments, the connection between the fixation
measurement element and support arm element is a polyaxially
adjustable connection. In one embodiment, the fixation measurement
element has indentations which control the vertical movement of the
support arm element. The indentations on the fixation measurement
element can also permit the determination of the length of the
fixation element of a cephalad facet joint prosthesis.
[0023] In one embodiment, the support arm element supports a trial
facet joint bearing surface. The bearing surface is intended to
predict the location of the facet joint bearing surface of an
actual prosthesis intended for implantation in a patient.
[0024] The fixation measurement element in one embodiment is
adapted and configured to permit measurements for determination of
the length of the fixation element of a cephalad facet joint
prosthesis for implantation in a patient. In another embodiment,
the fixation measurement element includes markings to assist in the
determination of the length of the fixation element of a cephalad
facet joint prosthesis.
[0025] In another aspect, the present invention provides a caudal
facet joint prosthesis measurement system including a stem element
and a trial caudal bearing surface element connected to each other
by a fastener or fastening mechanism. This measurement tool assists
in the selection of a caudal facet joint prosthesis for
implantation in a patient. The measurement tool can be used in the
determination of the dimensions of a caudal facet joint prosthesis.
Particularly, this measurement tool can be used to determine the
length of the fixation element of the caudal facet joint prosthesis
to be implanted in a patient. Also, this tool can be used to
determine the angle between the artificial facet joint element and
fixation element of the caudal facet joint prosthesis. If desired,
the mechanism can permit motion between the elements for alignment
purposes and also allow locking of the chosen
configuration/orientation once determined.
[0026] In one embodiment, the fastener used in the caudal facet
joint prosthesis measurement tool is a screw. Examples of other
suitable fasteners could include stems, posts, threads, polyaxial
mechanisms, splines, tapers, press fits, bayonet, cap screws, ball
detents, friction fits, cams, collets and/or clamps. In certain
embodiments, the fastener permits vertical movement of the trial
caudal bearing surface element along the stem element. In other
embodiments, the fastener permits rotation of the trial caudal
bearing surface element in different planes with respect to the
stem element. These planes can include movement along the axial and
median planes.
[0027] In another embodiment, the stem element is adapted and
configured to permit measurement of the length of a fixation
element of a caudal facet joint prosthesis to be implanted in a
patient. In yet another embodiment, the stem element of the
measurement tool includes markings to permit the measurement of the
length of the fixation element.
[0028] In one of the embodiments, the measurement tool for the
caudal facet joint prosthesis is adapted and configured to permit
measurement of the angle between the artificial facet joint element
and fixation element of a caudal facet joint prosthesis to be
implanted in a patient. The angle measurements can include
measurements in the median, horizontal and frontal planes (such
measurements could also include measurements relative to the
coronal, sagittal and/or axial planes, if desired). In one
embodiment, to facilitate the determination of the angle
measurement, the trial caudal bearing surface element is adapted
and configured to interact with a measurement tool holder.
[0029] In one aspect, the invention is a measurement tool holder
including a measurement surface connected to a holder element. This
tool holder assists in determining the angle measurements obtained
with the caudal facet joint prosthesis measurement tool. The caudal
facet joint prosthesis measurement tool can be placed in the tool
holder and the angle between the artificial facet joint element and
fixation element of a caudal facet joint prosthesis can be
determined.
[0030] In one embodiment, the measurement tool holder is adapted
and configured to hold the measurement tool for the caudal facet
joint prosthesis. In yet another embodiment, the measurement
surface of the tool holder includes two plates at right angles to
each other. The plates can include markings to permit determination
of the angle measurements, preferably in the horizontal and median
planes.
[0031] Another aspect of the invention provides a method for
determining the dimensions of a cephalad facet joint prosthesis to
be implanted in a patient. The method includes the steps of forming
a hole at a location in the vertebra and placing a fixation
measurement element of a cephalad facet joint prosthesis
measurement tool into the hole. Further optional steps include the
steps of obtaining a first length measurement to determine length
of a fixation element of a cephalad facet joint prosthesis to be
implanted in a patient; and obtaining a second length measurement
for determining the length of a support arm element of the cephalad
facet joint prosthesis. In various embodiment, the measurement tool
can be used in conjunction with a caudal prosthesis or other
implanted device, or can be used in conjunction with the caudal
joint surface or other natural anatomical landmark.
[0032] Yet another aspect of the invention provides a method for
determining the dimensions of a caudal facet joint prosthesis to be
implanted in a patient. The method includes the steps of forming a
hole at a location in the vertebra and placing a caudal facet joint
prosthesis measurement tool into the hole. Further optional steps
include the steps of obtaining a length measurement which indicates
the length of a fixation element of a caudal facet joint prosthesis
to be implanted in a patient; and obtaining an angle measurement
which indicates the angle between a artificial facet joint element
and a fixation element of the caudal facet joint prosthesis. In an
alternate embodiment, the external surfaces of the measurement tool
could incorporate calibrated markings allowing angle measurements
to be determined without an associated measurement fixture.
BRIEF DESCRIPTION OF THE DRAWINGS
[0033] FIG. 1 is a lateral elevation view of a normal human spinal
column;
[0034] FIG. 2 is a superior plan view of a normal human lumbar
vertebra;
[0035] FIG. 3 is a lateral elevation view of adjoining normal human
lumbar vertebrae L4 and L5;
[0036] FIG. 4 is a perspective view of one embodiment of a cephalad
facet joint prosthesis for replacing the inferior half of a natural
facet joint on a superior vertebral body;
[0037] FIGS. 5A and 5B are views of one embodiment of a measurement
tool for installing a cephalad facet joint prosthesis;
[0038] FIGS. 6A, 6B and 6c are views of one embodiment of an
installed measurement tool for a cephalad facet joint
prosthesis;
[0039] FIG. 7 is a perspective view of one embodiment of a caudal
prosthesis for replacing the superior half of a natural facet joint
on an inferior vertebral body;
[0040] FIGS. 8A and 8B are views of one embodiment of a measurement
tool for installing a caudal facet joint prosthesis;
[0041] FIGS. 9A-D are views of one embodiment of a measurement tool
holder for holding a measurement tool for a caudal facet joint
prosthesis; and
[0042] FIGS. 10A and 10B are views of one embodiment of an
installed measurement tool for a caudal facet joint prosthesis.
DETAILED DESCRIPTION OF THE INVENTION
[0043] Although the disclosure presented herein provides details to
enable those skilled in the art to practice various embodiments of
the invention, the physical embodiments disclosed herein merely
exemplify the invention which may be embodied in other specific
structures. Accordingly, while preferred embodiments of the
invention are described below, details of the preferred embodiments
may be altered without departing from the invention. All
embodiments that fall within the meaning and scope of the appended
claims, and equivalents thereto, are intended to be embraced by the
claims.
[0044] FIGS. 5 and 6 depict one embodiment of a measurement tool
for installing a cephalad facet joint prosthesis. The measurement
tool can be used to assist in the installation of cephalad facet
joint prostheses such as those described in U.S. Patent Pub. US
2005/0131406 A1 (Reiley et al. ) or other cephalad facet joint
prostheses. 100451 For purposes of illustrating the invention, one
example of a cephalad facet joint prosthesis that is suitable for
use with the measurement tools and methods described herein is
depicted in FIG. 4. FIG. 4 shows an artificial cephalad facet joint
prosthesis 40 configured to replace the inferior articulating
process of a facet joint, such as after the surgical removal of the
articulating process. When the cephalad prosthesis 40 is attached
to a vertebra, the artificial facet joint element 44 articulates
with the superior half of the facet joint 32. In this example,
prosthesis 40 includes an artificial facet joint element 44
connected to a fixation element 52 via a polyaxial connection 41
that permits facet joint element 44 and fixation element 52 to be
rotated with respect to each other around more than one axis. A
fixing nut 48 is threadably engaged with the outer periphery of
base 42 above the artificial facet joint element 44. Similarly, a
set screw 46 is threadably engaged with the inner periphery of base
42 above the artificial facet joint element 44. The artificial
facet joint element 44 includes a support arm 72 and a facet joint
bearing surface 74.
[0045] As shown in FIGS. 5A and 5B, a measurement tool 400 suitable
for use in installing and configuring the prosthesis of FIG. 4
includes a support arm element 401 and a fixation measurement
element 402 via a polyaxial connection element 403. The polyaxial
connection element 403 permits movement of the support arm element
401 along the fixation measurement element 402 in multiple axes.
The connection 403 permits vertical movement of the support arm
element 401 along the fixation measurement element 402 (or fixation
element) and also permits horizontal movement of the support arm
element 401 relative to the fixation measurement element 402. In
this manner, the measurement tool contains aspects of the actual
prosthesis. Measurement tools optimized to aid in the implantation
of other spine prostheses may have other features containing
aspects of those prostheses.
[0046] The fixation measurement element 402 is adapted and
configured to permit measurement of the length of a fixation
element of a cephalad facet joint prosthesis to be installed in a
patient. Preferably, markings are present on the fixation
measurement element 402 which permit the determination of this
length measurement. Typically, a hole is formed in the vertebra of
the patient at a location wherein the cephalad facet prosthesis is
intended to be installed and the measurement tool 400 is placed in
this hole. The tool 400 is adjusted to a position similar to that
of the cephalad facet joint prosthesis, and then the penetration
depth of the fixation measurement element 402 into the hole is
determined. This penetration depth assists the user in choosing the
length of the fixation element required to attach the cephalad
facet joint prosthesis to the vertebra.
[0047] In one embodiment, the fixation measurement element 402
includes indentations such as those depicted in FIG. SA. The
indentations provide stops for the vertical movement of the support
arm 401 along the fixation measurement element 402. The
indentations can also permit the determination of the length of the
fixation element 52 of a cephalad facet joint prosthesis 40 to be
installed in a patient. The indentations may be formed at intervals
corresponding to various fixation stems or screw lengths contained
in a modular component kit.
[0048] Similarly, another length measurement can be obtained using
the support arm element 401. Once the measurement tool 400 is
placed into the hole drilled in the vertebra, the support arm is
positioned into a location wherein the artificial facet joint
element 44 of the cephalad facet joint prosthesis 40 would be
located. The distance between the fixation measurement element 402
and the putative location of facet joint bearing surface 74 of the
cephalad facet joint prosthesis 40 is measured along the support
arm element 401. This measurement is used to select the length of
the support arm 72 of the cephalad facet joint prosthesis 40 to be
implanted in a patient. Alternatively, the measurement could
correspond to a color coding or number/letter designation that is
used to determine the appropriate correspondingly-identified
prosthesis.
[0049] In one embodiment, a trial facet joint bearing surface 404
can be attached to the support arm element 401. The trial facet
joint bearing surface 404 may be placed in the location that the
actual cephalad facet joint prosthesis 40 would be placed and then
the length measurement can be obtained which can be used to select
the length of the support arm 72 of the cephalad facet joint
prosthesis 40. Once again, the relationship between the measurement
tool's fixation measurement element, support arm element and trial
facet joint bearing surface corresponds to aspects of the actual
facet joint prosthesis whose implant the tool is assisting. Other
measurement tools and methods having aspects corresponding to other
spine implant features are within the scope of this invention.
[0050] Another aspect of the invention is a method of using the
measurement tool 400 to measure the dimensions of a cephalad facet
joint prosthesis 40 to be used in total facet joint replacement.
The cephalad prosthesis 40 is typically attached to a vertebra to
replace the articulating function of the cephalad portion of the
natural facet joint. FIG. 6 shows different views of a measurement
tool 400 placed into a vertebra. In one embodiment, for obtaining
the measurements, the cephalad measurement tool 400 can be placed
in one vertebra and a caudal facet joint prosthesis 600 can be
placed in the inferior adjoining vertebra, as depicted in FIG. 6.
The caudal facet joint prosthesis can be a trial prosthesis or the
actual prosthesis. When the measurement tool 400 is used with a
caudal facet joint prosthesis, it is preferred that the support arm
element 401 bear a trial facet joint bearing surface 404. To obtain
the length measurements, a hole is formed in the location where the
actual cephalad prosthesis 40 is to be placed and into this hole
the measurement tool 400 is placed. The tool is placed in the hole
at a depth that is similar to the depth at which actual cephalad
prosthesis 40 is to be placed. The support arm 401 is moved
horizontally and/or vertically with respect to the fixation
measurement element 402 and placed at about the same location that
the artificial facet joint element 44 would be placed. If the
measurement tool 400 includes a trial cephalad facet joint bearing
surface 404 and is used in combination with a caudal facet joint
prosthesis, the trial facet joint bearing surface 404 is placed in
the bearing surface of the caudal prosthesis prior to taking the
measurements. In one embodiment, as shown in FIGS. 5B and 6B, to
determine the length of the support arm 72 of the actual cephalad
prosthesis, a window on the trial facet joint bearing surface 404
can be used to read the length from the support arm element 401. As
mentioned above, the length of the fixation element 52 can be
determined from the fixation measurement element 402. Markings
and/or indentations on the fixation measurement element 402 can be
used to determine the required length of the fixation element
52.
[0051] FIGS. 8-10 depict one embodiment of a measurement tool for
installing a caudal facet joint prosthesis. The measurement tool
can be used to assist in the installation of caudal joint
prostheses such as those described in U.S. Patent Appl. Publ. No.
2005/0131406 A1 or other caudal facet joint prostheses.
[0052] One embodiment of a caudal facet joint prosthesis that is
suitable for use with the measurement tool described herein is
depicted in FIG. 7. FIG. 7 shows an artificial caudal facet joint
prosthesis 100 configured to replace the superior portion of a
natural facet joint, such as after the surgical removal of the
articulating process forming the superior portion of the facet
joint. Prosthesis 100 includes an artificial facet joint element
104 connected to a fixation element 116 via a polyaxial connection
115 that permits facet joint element 104 and fixation element 116
to be rotated with respect to each other around more than one axis.
The polyaxial connection 115 of caudal prosthesis 100 includes a
base 112 connected to a support arm 102 of facet joint element 104.
The artificial facet joint element 104 includes a bearing surface
118. A fixing nut 108 is threadably engaged with the outer
periphery of base 112 above the artificial facet joint element 104.
Similarly, a set screw 106 is threadably engaged with the inner
periphery of base 112 above the artificial facet joint element
104.
[0053] A measurement tool 700 suitable for use with the caudal
facet joint prosthesis shown in FIG. 7 is shown in FIGS. 8A and 8B.
Measurement tool 700 includes a stem element 701 connected to a
trial caudal bearing surface 702 via a fastener 703. Thus,
measurement tool 700 contains aspects of the caudal facet joint
prosthesis whose implant the tool is assisting. In the embodiment
depicted in FIG. 8A, the fastener 703 is a set screw. In other
embodiments other suitable fasteners can be employed, including,
but not limited to, stems, posts, threads, polyaxial mechanisms,
splines, cap screws, ball detents, friction fits, tapers, press
fits, bayonet, cams, collets and/or clamps.
[0054] The stem element 701 is adapted and configured to obtain
length measurements which would correspond to the length of the
fixation element 116 of the caudal facet joint prosthesis 100. The
stem element can include markings and/or indentations to assist in
obtaining the measurements. If desired, multiples stem elements of
varying diameters can be utilized in a similar fashion to size
and/or determine the diameter and dimensions of the hole.
[0055] The trial caudal bearing surface 702 helps determine the
relative positions of, and the angle between, the prosthesis's
fixation element and its bearing surface. The trial caudal bearing
surface 702 is capable of movement along multiple planes and can
rotate relative to the stem element 701 via a lockable ball-joint.
If desired, an alternate embodiment of the bearing surface 702 can
move vertically (not shown) along the stem element 701, to permit
sizing of the stem element. Other planes of movement can include
the median, horizontal and frontal planes. In another embodiment,
the caudal bearing surface 702 is connected to a handle 704. The
handle 704 allows the user to move the caudal bearing surface 702
into the desired location and also position it in the right plane.
Typically, the handle 704 permits movement of the caudal bearing
surface 702 in various planes for alignment. Also, the handle 704
can permit the user to place the stem 701 of the tool into the hole
drilled in the vertebra.
[0056] In one alternate embodiment, the handle 704 can comprise a
radiopaque material with the handle 704 used for fluoroscopic
alignment of the caudal bearing surface 702. In this embodiment,
the handle 704 and upper end plate of the caudal vertebral body
(not shown) can be examined in a medial-lateral image (using
non-invasive and/or fluoroscopic imagine apparatus) of the surgical
area. A comparison of the orientation of the handle 704 and the
orientation of the upper end plate can be made to determine the
desired alignment and positioning of the caudal bearing surface. In
one embodiment, the orientation of the handle and the upper end
plate can be parallel or nearly parallel.
[0057] Another aspect of the invention is a measurement tool holder
for use with the caudal measurement tool described above or another
measurement tool. One embodiment of the measurement tool holder is
depicted in FIGS. 9A-D. In this embodiment, the measurement tool
holder 800 includes a measurement surface 801 and a holder element
802. In one embodiment, the measurement surface 801 includes two
plates attached to each other at a right angle. The measurement
surface 801 is adapted and configured to measure the angle between
the caudal bearing surface 702 and stem 701. This angle measurement
is typically used by a user to select, assembly and/or configure a
caudal prosthesis for implantation into a patient, such as caudal
prosthesis 100 of FIG. 7. For example, the selected caudal
prosthesis may have an angle measurement between its bearing
surface 118 and its fixation element 116 similar to the angle
measurement obtained from the caudal measurement tool 700 and
measurement tool holder 800. Alternatively, the prosthesis may be
configurable to orient its fixation element and its bearing surface
to match the measured angle.
[0058] In one embodiment, the tool holder's measurement surface 801
includes markings to assist in obtaining the desired angle
measurements. Also, the top surface of the measurement surface 801
may have a holder element 802 attached thereto. The holder element
802 can be, for example, a square or rectangular block with a
portion of the block cut out to fit the caudal bearing surface 702
of the caudal measurement tool 700. The portion of the holder
element 802 that holds the caudal bearing surface 702 is cut out in
a shape that is suitable for holding the caudal bearing surface
702. Thus, the shape of the cut out portion of the holder element
802 will vary depending on the shape of the caudal bearing surface
702 to be used with the measurement holder 800.
[0059] One aspect of the invention is a method for using the caudal
measurement tool 700 in combination with, for example, the
measurement tool holder 800 described above or with the cephalad
measurement tool 400 described above. In one embodiment, a hole is
formed at a suitable location in the vertebra (such as by drilling)
wherein a caudal prosthesis 100 is intended to be placed. This
location typically is the best location for the placement of the
caudal prosthesis based on the condition of the bone, easy access
to the location, etc. Into this hole the caudal measurement tool
700 is placed in a manner as shown in FIGS. 10A and 10B.
[0060] The caudal measurement tool 700 may be placed into the hole
using the handle 704. The handle 704 and the set screw 703 are used
to place the measurement tool at the required depth and also to
place the caudal bearing surface 702 at the required angle. To
obtain the appropriate angle of the caudal bearing surface 702 with
respect to the stem 701, the fastener 703 is loosened and the
caudal bearing surface 702 is positioned at the appropriate angle.
Once the appropriate angle is obtained (typically based on
orientation relationships with anatomical landmarks, which can
include the orientation of the cephalad bearing surface as well as
anatomical positioning and/or intervening anatomical features), the
fastener 703 is tightened to maintain the angle for measurement
purposes. In one embodiment, the caudal measurement tool 700 is
used in combination with a cephalad prosthesis (such as cephalad
prosthesis 40 described above) or a cephalad measurement tool (such
as tool 400 described above). When used in combination with a
cephalad prosthesis or a cephalad measurement tool, the caudal
bearing surface 702 is placed in contact with the facet joint
bearing surface of the cephalad prosthesis or the trial facet joint
bearing surface. Then, the position of the caudal bearing surface
702 is adjusted by manipulating the fastener 703 (as described
above) to get good articulation with the facet joint bearing
surface or the trial facet joint bearing surface.
[0061] After the caudal measurement tool 700 is appropriately
placed, the length and angle measurements are obtained. Preferably,
the caudal measurement tool 700 is removed from the hole to take
the measurements. One of the measurements that can be obtained with
the caudal measurement tool 700 is the fixation length measurement.
This measurement is obtained from the stem element 701 and
indicates the length of the fixation element 116 of the caudal
prosthesis to be implanted in a patient. Also, the caudal
measurement tool 700 can be used to obtain an angle measurement
between the caudal bearing surface 702 (or alignment fixation
measurement) and stem element 701. This measurement may be obtained
by placing the caudal measurement tool 700 into a measurement tool
holder (such as holder 800 described above) and reading the angle,
such as from a measuring surface 801. When used with the caudal
prosthesis 100 of FIG. 7, this angle measurement is used to
determine the angle between the artificial facet joint element 104
and fixation element 116 of the caudal prosthesis 100. In one
alternate embodiment, the caudal bearing surface is positioned and
secured to the vertebral body first, and then the cephalad bearing
surface is positioned and secured relative to the caudal bearing
surface.
[0062] One aspect of the invention is a method for selecting
suitable caudal and/or cephalad prostheses from a set of prostheses
for implantation into a patient. In one embodiment, the cephalad
measurement tool 400 is used to obtain the two length measurements
from the fixation measurement 402 and support arm 401. A user uses
these measurements to select a suitable cephalad prosthesis 40 for
implantation in a patient. The selected prosthesis preferably has a
fixation element 52 length and support arm 72 length that are
similar to the support arm 401 and fixation measurement 402 length
measurements, respectively, obtained from the cephalad measurement
tool 400. The term "similar" is used to herein to mean values that
correspond to each other but are not necessarily identical. In
another embodiment, the caudal measurement tool 700 is used to
obtain length and angle measurements and a user uses these
measurements to select a suitable cephalad prosthesis for
implantation in a patient. The selected prosthesis preferably has a
stem 701 length similar to the length measurement from the caudal
tool 700 and has an angle between the artificial facet joint
element and fixation element similar to the angle measurement
obtained from the tool.
[0063] While preferred embodiments of the invention have been
illustrated and described, it will be appreciated that various
changes can be made therein without departing from the spirit and
scope of the invention. Moreover, while the present inventions have
been described for use with a modular prosthesis system, it should
be understood that the present inventions have utility in
conjunction with the measurement and placement of other prosthesis
systems, including single component, multi-component and
custom-made prosthesis, with varying results. Further, the trailing
system described herein can comprise single or multi-component
tools and devices.
[0064] All publications and patent applications mentioned in this
specification are herein incorporated by reference to the same
extent as if each individual publication or patent application was
specifically and individually indicated to be incorporated by
reference.
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