U.S. patent application number 16/333062 was filed with the patent office on 2019-08-29 for bone anchor, instruments, and methods for use.
The applicant listed for this patent is Wayne GRAY, MIRUS LLC, Noah ROTH. Invention is credited to Wayne Gray, Ryan O'Flaherty, Noah Roth, Kevin R. Strauss, Antonio Terrell, Clint Walker.
Application Number | 20190262044 16/333062 |
Document ID | / |
Family ID | 61619291 |
Filed Date | 2019-08-29 |
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United States Patent
Application |
20190262044 |
Kind Code |
A1 |
Roth; Noah ; et al. |
August 29, 2019 |
BONE ANCHOR, INSTRUMENTS, AND METHODS FOR USE
Abstract
Disclosed herein is a surgical instrument configured for
attachment to a surgical device. The surgical instrument includes a
distal region having a curved internal surface configured to mate
with a curved external surface of the surgical device, a rotational
locking feature that limits rotational movement of the instrument
with respect to the surgical device, and an axial locking feature
that limits axial movement of the blade with respect to the
surgical device. Methods of using the surgical instruments include
sliding the axial locking feature past a corresponding axial
locking feature on the surgical device, locking the axial locking
feature to the corresponding axial locking feature on the surgical
device (thereby limiting axial movement of the elongated blade with
respect to the surgical device), adjusting the position of the
surgical device using the surgical instrument, and disengaging the
axial locking feature (for example, by using a disengagement
instrument).
Inventors: |
Roth; Noah; (Atlanta,
GA) ; Gray; Wayne; (Atlanta, GA) ; Strauss;
Kevin R.; (Atlanta, GA) ; O'Flaherty; Ryan;
(Atlanta, GA) ; Walker; Clint; (Atlanta, GA)
; Terrell; Antonio; (Atlanta, GA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ROTH; Noah
GRAY; Wayne
MIRUS LLC |
Atlanta
Atlanta
Atlanta |
GA
GA
GA |
US
US
US |
|
|
Family ID: |
61619291 |
Appl. No.: |
16/333062 |
Filed: |
September 18, 2017 |
PCT Filed: |
September 18, 2017 |
PCT NO: |
PCT/US17/51985 |
371 Date: |
March 13, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
62395656 |
Sep 16, 2016 |
|
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|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/70 20130101;
A61F 2/44 20130101; A61B 17/7076 20130101; A61B 17/7083 20130101;
A61B 17/864 20130101; A61B 17/80 20130101; A61B 17/863 20130101;
A61B 17/7035 20130101 |
International
Class: |
A61B 17/70 20060101
A61B017/70; A61B 17/80 20060101 A61B017/80; A61B 17/86 20060101
A61B017/86 |
Claims
1. An elongated blade configured to attach to a surgical device,
the elongated blade comprising; a distal region having a curved
internal surface configured to mate with a curved external surface
of the surgical device, a rotational locking feature on the curved
internal surface that limits rotational movement of the elongated
blade with respect to the surgical device, an axial locking feature
on the curved internal surface that limits axial movement of the
blade with respect to the surgical device.
2. The elongated blade of claim 1, wherein the elongated blade is
curved in at least one transverse cross-section.
3. The elongated blade of claim 1, wherein the thickness of the
walls of the blade ranges from about 1 millimeters to about 4
millimeters.
4. The elongated blade of claim 1, wherein the rotational locking
feature comprises a longitudinally extending protrusion.
5. The elongated blade of claim 4, wherein the longitudinally
extending protrusion comprises angled longitudinally extending
surfaces.
6. The elongated blade of claim 4, wherein the longitudinally
extending protrusion is substantially cylindrical.
7. The elongated blade of claim 5, wherein the longitudinally
extending protrusion comprises at least one flat proximal or distal
surface.
8. The elongated blade of claim 4, further comprising a plurality
of longitudinally extending protrusions.
9. The elongated blade of claim 1, wherein the axial locking
feature comprises a laterally extending ridge.
10. The elongated blade of claim 9, wherein the distal region of
the elongated blade further comprises a living hinge, and the
laterally extending ridge is positioned at a distal portion of the
living hinge.
11. The elongated blade of claim 10, wherein the living hinge
comprises an elongated tab cut into a sidewall of the distal region
of the elongated blade.
12. The elongated blade of claim 9, wherein the laterally extending
ridge comprises angled surfaces.
13. The elongated blade of claim 12, wherein the proximal surface
of the laterally extending ridge creates an acute angle with a
sidewall of the living hinge in at least one longitudinal cross
section.
14. The elongated blade of claim 12, wherein the distal surface of
the laterally extending ridge creates an obtuse angle with a
sidewall of the living hinge in at least one longitudinal cross
section.
15. The elongated blade of claim 1, wherein a proximal region of
the blade comprises at least one fixation feature configured to be
attached to one or more surgical instruments.
16. The elongated blade of claim 15, wherein the fixation feature
comprises a thru-hole, a thru-slot, a notch, a groove, or a
cut-out.
17. The elongated blade of claim 1, wherein the elongated blade is
formed of MoRe.
18. The elongated blade of claim 1, wherein the elongated blade is
a first elongated blade, and further comprising a second elongated
blade configured to attach to the same surgical device as the first
elongated blade, thereby creating a path for surgical access to the
surgical device.
19. The elongated blade of claim 18, wherein the first and second
elongated blades are joined by a permanent connection positioned
between a proximal region of the first elongated blade and a
proximal region of the second elongated blade.
20. The elongated blade of claim 18, wherein the first and second
elongated blades are joined by a non-permanent connection
positioned between a proximal region of the first elongated blade
and a proximal region of the second elongated blade.
21. The elongated blade of claim 1, wherein the elongated blade is
engaged with a bone anchor, the bone anchor comprising attachment
features configured to mate with at least one of the axial locking
feature or the rotational locking feature of the elongated
blade.
22. The elongated blade of claim 21, wherein the bone anchor
further comprises a distal set of threads terminating with cutting
edges.
23. The elongated blade of claim 21, wherein the elongated blade is
further engaged with a disengagement instrument, the disengagement
instrument comprising a projecting member configured to push the
axial locking feature away from bone anchor.
24. A method of using the elongated blade of claim 1, the method
comprising, sliding the axial locking feature of the elongated
blade past a corresponding axial locking feature on the surgical
device, locking the axial locking feature of the elongated blade to
the corresponding axial locking feature on the surgical device,
thereby limiting axial movement of the elongated blade with respect
to the surgical device, adjusting the position of the surgical
device using the elongated blade, and disengaging the axial locking
feature.
25. The method of claim 24, wherein sliding the axial locking
feature of the elongated blade past a corresponding axial locking
feature on the surgical device comprises flexing a living hinge
outwardly from the surface of the elongated blade.
26. The method of claim 25, further comprising returning the living
hinge to its original position after sliding the axial locking
feature of the elongated blade past the corresponding axial locking
feature on the surgical device.
27. The method of claim 24, wherein locking the axial locking
feature of the elongated blade to the corresponding axial locking
feature on the surgical device further comprises engaging angled
surfaces of the axial locking feature of the elongated blade to
complementary angled surfaces of the axial locking feature of the
surgical device.
28. The method of claim 24, further comprising sliding the
rotational locking feature of the elongated blade into or onto a
complementary rotational locking feature on the surgical
device.
29. The method of claim 24, wherein the surgical device is a bone
anchor, and wherein adjusting the position of the surgical device
using the elongated blade further comprises cutting the bone with a
cutting edge of a distal set of threads of the bone anchor.
30. The method of claim 24, wherein disengaging the axial locking
feature comprises using a disengagement instrument.
31. The method of claim 30, wherein using a disengagement
instrument comprises pushing the axial locking feature away from
the surgical device.
Description
RELATED APPLICATIONS
[0001] This application claims the benefit of priority to U.S.
Provisional Application No. 62/395,656, filed Sep. 16, 2016, which
is hereby incorporated by reference in its entirety.
FIELD
[0002] The bone anchor and methods of use disclosed herein pertain
to the field of orthopedic surgery, and more specifically, spinal
surgery.
BACKGROUND
[0003] Spinal fusion is a common surgical procedure used to correct
numerous disease states including degenerative disorders, trauma,
instability, and deformity. A frequent method of fusion entails the
use of bone screws placed through various sections of the vertebral
body including the body, pedicle, facets, lamina, lateral masses,
and/or transverse processes. These screws are then linked rigidly
with a rod, plate or other fixation device to immobilize the
vertebral segments.
[0004] Due to the variation in a patient's anatomy and differences
in screw placement technique, screws are often not perfectly
aligned which makes securement of a spinal rod more difficult. To
solve this, many screws that have a threaded shank portion
incorporate an articulating tulip or receiver connected to the
proximal end of the shank portion, such as in a polyaxial or
multi-axial bone screw. Polyaxial bone screws allow for a variation
in the angulation of the tulip/receiver relative to the shank
portion in order to allow the tulip/receiver to more closely align
for receiving a fixation device such as a fixation rod within the
tulip/receiver. Some bone screws allow for the lateral translation
of the tulip/receiver relative to its point of fixation. Further
alignment may be accomplished by contouring of the spinal rod
itself to compensate for any remaining misalignment. For example,
if a spinal rod is employed, the rod can be bent to conform to the
patient anatomy and location of the tulip/receiver to securely
attach thereto.
[0005] While developments to decrease the overall invasiveness of
spinal surgical methods are desirable, conventional surgeries still
utilize certain invasive steps, such as tapping or undertapping. A
tapping procedure is performed as follows: a bone access needle is
used to generate an access hole in the bone. The inner shaft of the
bone access needle is removed, and a guidewire is inserted a
guidewire thru the inner hole of the bone needle. The remaining
portion of the bone access needle is removed while taking care to
ensure the guidewire does not move within the bone. A small
diameter tap is inserted by rotating the tap into the bone. The
smallest diameter tap is removed by turning it outwardly, and a
slightly larger size tap is inserted and removed in the same
fashion to widen the hole. The taps get progressively larger until
the hole is the appropriate for the bone anchor. Undertapping
procedures are similar to tapping procedures, except that the last
tap used is slightly smaller in diameter than the actual bone
anchor. Tapping and undertapping procedures lengthen the duration
of the surgery. Conventional spinal surgeries also utilize
relatively bulky devices. Developments to decrease the overall
invasiveness of spinal surgical methods are therefore needed.
SUMMARY
[0006] The instruments and devices described below remedy some of
the aforementioned discrepancies in the field of spinal surgery.
The elongated blades disclosed herein are configured to attach to a
surgical device, such as a bone anchor. Two blades can be used
together to create a path through the patient's skin and to the
surgical instrument. An exemplary elongated blade includes a distal
region having a curved internal surface that is configured to mate
with a curved external surface of the surgical device, a rotational
locking feature on the curved internal surface that limits
rotational movement of the blade with respect to the surgical
device, and an axial locking feature on the curved internal surface
that limits axial movement of the blade with respect to the
surgical device. The blade is curved in at least one transverse
cross-section. the walls of the blade are from 1 millimeters to 4
millimeters. In some embodiments, the blade is formed of molybdenum
rhenium (MoRe).
[0007] In some embodiments, the rotational locking feature includes
one or more longitudinally extending protrusions. The
longitudinally extending protrusion can include angled
longitudinally extending surfaces, or it can be substantially
cylindrical. In some embodiments, the longitudinally extending
protrusion comprises at least one flat proximal or distal
surface.
[0008] In some embodiments, the axial locking feature comprises a
laterally extending ridge. The laterally extending ridge can be
positioned at a distal portion of a living hinge. The living hinge
can be an elongated tab cut into a sidewall of the distal region of
the blade. In some embodiments, the laterally extending ridge can
include angled surfaces. For example, the proximal surface of the
laterally extending ridge can create an acute angle with a sidewall
of the living hinge in at least one longitudinal cross section,
and/or the distal surface of the laterally extending ridge can
create an obtuse angle with the sidewall of the living hinge in at
least one longitudinal cross section.
[0009] A proximal region of the blade can include at least one
fixation feature configured to be attached to one or more surgical
instruments. The fixation features can be, for example, thru-holes,
thru-slots, notches, grooves, cut-outs, or a combination thereof.
The proximal region can also include a permanent or non-permanent
connection to the proximal region of a second elongated blade. As a
pair, the first and second elongated blades, which attach to the
same surgical device, create a path for surgical access to the
device.
[0010] Methods of using the elongated blades are also disclosed
herein. The methods include: sliding the axial locking feature of
the elongated blade past a corresponding axial locking feature on
the surgical device, locking the axial locking feature of the
elongated blade to the corresponding axial locking feature on the
surgical device, thereby limiting axial movement of the elongated
blade with respect to the surgical device, adjusting the position
of the surgical device using the elongated blade, and disengaging
the axial locking feature (using a disengagement instrument, for
example). In some embodiments of the method, sliding the axial
locking feature of the elongated blade past a corresponding axial
locking feature on the surgical device includes flexing a living
hinge outwardly from the surface of the elongated blade, and
returning the living hinge to its original position after sliding
the axial locking feature of the elongated blade past the
corresponding axial locking feature on the surgical device. In some
embodiments of the method, locking the axial locking feature of the
elongated blade to the corresponding axial locking feature on the
surgical device further includes engaging angled surfaces of the
axial locking feature of the elongated blade to complementary
angled surfaces of the axial locking feature of the surgical
device. Some embodiments of the method also include sliding the
rotational locking feature of the elongated blade into or onto a
complementary rotational locking feature on the surgical device. In
some embodiments, the disengagement instrument comprises a
projecting member that pushes the axial locking feature away from
the surgical device.
DESCRIPTION OF DRAWINGS
[0011] FIG. 1 is an exploded perspective view of one embodiment of
a bone anchor and spinal rod.
[0012] FIG. 2 is a side cross-sectional view of the bone anchor of
FIG. 1.
[0013] FIG. 3 is an enlarged view of the proximal region of the
bone anchor and tulip housing of FIG. 1.
[0014] FIG. 4 is an enlarged exploded perspective view of the
proximal region of the bone anchor of FIG. 1.
[0015] FIG. 5 is an enlarged exploded perspective view of the
proximal region of the bone anchor of FIG. 1, rotated to show the
attachment features on the external surface of the tulip
housing.
[0016] FIG. 6 is a side view of a threaded shank.
[0017] FIG. 7 is a perspective view of the threaded shank shown in
FIG. 6.
[0018] FIG. 8 is a perspective view of a bone anchor and a pair of
blades.
[0019] FIG. 9 is a perspective view of a bone anchor and the distal
region of a blade.
[0020] FIG. 10 is a side view of an assembled blade and bone
anchor.
[0021] FIG. 11 is a side cross sectional view of an assembled blade
and bone anchor.
DETAILED DESCRIPTION
[0022] The following description of certain examples of the
inventive concepts should not be used to limit the scope of the
claims. Other examples, features, aspects, embodiments, and
advantages will become apparent to those skilled in the art from
the following description. As will be realized, the device and/or
methods are capable of other different and obvious aspects, all
without departing from the spirit of the inventive concepts.
Accordingly, the drawings and descriptions should be regarded as
illustrative in nature and not restrictive.
[0023] For purposes of this description, certain aspects,
advantages, and novel features of the embodiments of this
disclosure are described herein. The described methods, systems,
and apparatus should not be construed as limiting in any way.
Instead, the present disclosure is directed toward all novel and
nonobvious features and aspects of the various disclosed
embodiments, alone and in various combinations and sub-combinations
with one another. The disclosed methods, systems, and apparatus are
not limited to any specific aspect, feature, or combination
thereof, nor do the disclosed methods, systems, and apparatus
require that any one or more specific advantages be present or
problems be solved.
[0024] Features, integers, characteristics, compounds, chemical
moieties, or groups described in conjunction with a particular
aspect, embodiment or example of the invention are to be understood
to be applicable to any other aspect, embodiment or example
described herein unless incompatible therewith. All of the features
disclosed in this specification (including any accompanying claims,
abstract, and drawings), and/or all of the steps of any method or
process so disclosed, may be combined in any combination, except
combinations where at least some of such features and/or steps are
mutually exclusive. The invention is not restricted to the details
of any foregoing embodiments. The invention extends to any novel
one, or any novel combination, of the features disclosed in this
specification (including any accompanying claims, abstract, and
drawings), or to any novel one, or any novel combination, of the
steps of any method or process so disclosed.
[0025] It should be appreciated that any patent, publication, or
other disclosure material, in whole or in part, that is said to be
incorporated by reference herein is incorporated herein only to the
extent that the incorporated material does not conflict with
existing definitions, statements, or other disclosure material set
forth in this disclosure. As such, and to the extent necessary, the
disclosure as explicitly set forth herein supersedes any
conflicting material incorporated herein by reference. Any
material, or portion thereof, that is said to be incorporated by
reference herein, but which conflicts with existing definitions,
statements, or other disclosure material set forth herein will only
be incorporated to the extent that no conflict arises between that
incorporated material and the existing disclosure material.
[0026] As used in the specification and the appended claims, the
singular forms "a," "an" and "the" include plural referents unless
the context clearly dictates otherwise. Ranges may be expressed
herein as from "about" one particular value, and/or to "about"
another particular value. When such a range is expressed, another
aspect includes from the one particular value and/or to the other
particular value. Similarly, when values are expressed as
approximations, by use of the antecedent "about," it will be
understood that the particular value forms another aspect. It will
be further understood that the endpoints of each of the ranges are
significant both in relation to the other endpoint, and
independently of the other endpoint.
[0027] "Optional" or "optionally" means that the subsequently
described event or circumstance may or may not occur, and that the
description includes instances where said event or circumstance
occurs and instances where it does not.
[0028] Throughout the description and claims of this specification,
the word "comprise" and variations of the word, such as
"comprising" and "comprises," means "including but not limited to,"
and is not intended to exclude, for example, other additives,
components, integers or steps. "Exemplary" means "an example of"
and is not intended to convey an indication of a preferred or ideal
aspect. "Such as" is not used in a restrictive sense, but for
explanatory purposes.
[0029] The terms "proximal" and "distal" are orientations that
indicate the positioning of a surgical device. As used herein, the
terms "distal" and "distally" indicate a direction farther from a
practitioner performing a surgical procedure. "Proximal" and
"proximally" indicate a direction closer to a practitioner
performing the procedure. For example, the shank of a bone anchor
is distal to the ball head of an anchor.
[0030] FIG. 1 shows an exploded perspective view of one embodiment
of a bone anchor 2. FIG. 2 shows a side cross sectional view of the
embodiment shown in FIG. 1. The bone anchor 2 includes a tulip
housing 4 having a through hole 8 and a distal radially expandable
portion 6. The tulip housing 4 captures the ball head 14 of
threaded shank 10, creating a polyaxial feature. Particularly, the
ball head 14 is positioned within through hole 8 of the distal
radially expandable portion 6 of the tulip housing 4. The bone
anchor 2 further includes a pressure cap 16. The pressure cap 16 is
also positioned within the through hole 8, proximally adjacent to
the ball head 14. The distal end of the pressure cap 16 includes a
bearing surface 18 for interfacing with the ball head 14, creating
a ball and socket device. Bone anchor 2 further includes a
retaining ring 20 which limits radial expansion of the radially
expandable portion 6. This limitation of radial expansion prevents
movement of the pressure cap 16 and the proximal ball head 14 out
of the through hole 8. The bone anchor 2 is used in conjunction
with a spinal rod 3, which is placed between the sidewalls 30 of
the tulip housing 4 and locked into place with a set screw/locking
cap 5. The set screw/locking cap 5 forces the spinal rod 3 against
the pressure cap 16 and the pressure cap 16 against the ball head
14, which is prevented from being pushed out of the bottom of the
tulip housing 4 by the retaining ring 20 positioned around the
distal radially expandable portion 6. The shank 10 also includes a
distal threaded portion 12 for inserting into the bone.
[0031] FIG. 3 shows an enlarged cross-sectional view of a proximal
portion of one embodiment of a bone anchor 2. The bone anchor 2
includes a compression mechanism for bringing the pressure cap 16
into close contact with ball head 14, creating a friction fit that
increases the amount of force needed to manipulate the tulip
housing 4. The compression mechanism can include a compressing
component 24 that exerts a distally oriented force onto the
pressure cap 16. In the embodiment shown in FIG. 3, the compressing
component 24 is a pin that extends through a hole 28 in the
sidewall 30 of the tulip housing 4. The compressing component 24
exerts a lateral force onto a ramped surface 26 of pressure cap 16.
The lateral force is translated to a distally oriented force by the
ramped surface 26, limiting proximal movement of the pressure cap
16 and the proximal ball head 14 within the through hole 8. The
compression mechanism is not limited to the embodiment shown. For
example, the compression mechanism could include other types of
compressing components, including, but not limited to, screws,
springs, or wedges.
[0032] FIG. 4 shows an enlarged exploded view of the proximal tulip
housing 4 seen first in FIG. 1. As shown in FIGS. 3 and 4, the
proximal surface 32 of the pressure cap 16 narrows to create a
saddle 34 for spinal rod 3. The saddle 34 shown in the embodiment
of FIGS. 3 and 4 is substantially V-shaped in cross section,
widening as it extends in a proximal direction. The V-shape
advantageously enables the bone anchor 2 to accept spinal rods 3 of
different diameters. For example, the saddle 34 can accept spinal
rods 3 that range from about 3.5 millimeters to about 4.5
millimeters in diameter, including about 3.5 millimeters, about 3.6
millimeters, about 3.7 millimeters, about 3.8 millimeters, about
3.9 millimeters, about 4.0 millimeters, about 4.1 millimeters,
about 4.2 millimeters, about 4.3 millimeters, about 4.4
millimeters, and about 4.5 millimeters. Other sizes of spinal rods
3 are also contemplated. The substantially V-shaped saddle 34 can
be rounded at its narrowest, distal-most location 38, or it can
narrow to a point at its distal-most location 38. The concave
bearing surface 18 of pressure cap 16 can be shaped to center ball
head 14. For example, in the embodiment shown in FIG. 3, bearing
surface 18 takes a frustoconical shape. In other embodiments,
bearing surface 18 could be, for example, conical or
semispherical.
[0033] Tulip housing 4 includes a distally located radially
expandable portion 6. The radially expandable portion 6 expands to
enable the insertion of the pressure cap 16 and the ball head 14
into the through hole 8, despite their larger diameters (discussed
in greater detail below). The embodiment shown in FIG. 4, for
example, includes multiple tabs 40 separated by relief slots 42.
The tabs 40 flex outwardly to allow pressure cap 16 and ball head
14 to be pushed proximally through the distal end of the radially
expandable portion 6. The pressure cap 16 and ball head 14 are then
translated proximally within the through hole 8, creating a space
at the distal end of the through hole 8. The external retaining
ring 20 is then positioned over the outside of radially expandable
portion 6, causing it to radially contract. With the external
retaining ring 20 in place within the lateral groove 44 around the
outside of the radially expandable portion 6 (see FIG. 3), the
pressure cap 16 and ball head 14 are translated distally to their
final position. Lateral groove 44 is bounded at its distal end by a
laterally extending locking feature 46 positioned near the distal
end of radially expandable portion 6. The laterally extending
locking feature 46 of radially expandable portion 6 mates with a
corresponding laterally extending locking feature 48 on the
retaining ring 20 to prevent its displacement.
[0034] When the radially expandable portion 6 is in an expanded
state, the smallest inner diameter of the radially expandable
portion 6 is larger than the largest outer diameter of the ball
head 14, enabling passage of the ball head 14 for a bottom-up
assembly. However, when radially expandable portion 6 is in a
contracted state (due to the constriction by the retaining ring
20), the same smallest inner diameter is smaller than the largest
outer diameter of the ball head 14, which prevents it from being
expelled distally from the tulip housing 4. In other words,
retaining ring 20 prevents the radially expandable portion 6 from
expanding, and the assembly remains intact. With the ball head 14
captured, for example, having from about a 0.0001 inch to about a
0.04 inch lateral interference, maximum angulation of the threaded
shank 10 is achieved. The conical angulation can be, for example,
up to 75 degrees (from about 0 degrees to about 75 degrees).
Angulation is dependent on the diameter of the ball head 14, the
diameter of the neck 50, the diameter of the through hole 8, and
the amount of material on the underside of the tulip housing
(adjacent the through hole 8).
[0035] The proximal portion 52 of the tulip housing 4 has a
smallest inner diameter that is smaller than the largest outer
diameters of the ball head 14, the pressure cap 16, and the threads
of the threaded shank 10, preventing these items from being
proximally translated within the through hole 8. The bottom-up
assembly (wherein the pressure cap 16 and ball head 14 are inserted
into the tulip housing 4 through the distal end of the through hole
8) is advantageous because it allows the tulip housing 4 to be
smaller and therefore less invasive. In some embodiments, the tulip
housing 4 can be from about 5% to about 15% smaller than
conventionally used tulip housings. The diameter of ball head 14
(as well as most major diameter sizes of the bone anchor) is larger
than the narrowest path through the tulip housing 4, so it is not
possible to assemble from the top as with conventional bone anchors
and polyaxial screws. In one embodiment, the largest outer diameter
of the tulip housing 4 is from about 9.9 millimeters to about 11.9
millimeters.
[0036] The tulip housing 4 can include attachment features that
assist with engagement to other devices, such as one or more blades
(e.g., blades 66, 68 shown in FIG. 8) and/or other surgical
instruments (such as, for example, rod reduction instruments,
instruments to compress the screws/vertebral body onto an interbody
device, and/or instruments to distract the screws/vertebral body
for nerve decompression prior to locking the rod in place). The
tulip housing 4 can include a plurality of longitudinally extending
indentations 54. For example, the tulip housing 4 can include four
longitudinally extending indentations 54, with two indentations 54
being arranged on each sidewall 30 of the tulip housing 54 (as in
the embodiment shown in FIG. 5). The longitudinally extending
indentations 54 can be silo-shaped, and can limit rotational and
translational forces when mated to longitudinally extending
protrusions on an engaged instrument. This disclosure contemplates
that the tulip housing 4 can include more or less than four
longitudinally extending indentations 54, which are provided only
as an example in some of the figures. Alternatively, the tulip
housing 4 could include one or more longitudinally extending
protrusions that limit rotational forces when mated to
longitudinally extending indentations on an engaged instrument. The
longitudinally extending protrusions can be positioned
circumferentially around the external surface of the tulip housing.
In the embodiment shown in FIG. 5, each longitudinally extending
indentation 54 has a curved longitudinally extending surface. The
indentations 54 break through the external surface of the tulip
housing 4 such that in a cross-sectional view, less than a
360-degree circle is formed by the external surface of tulip
housing 4. In other embodiments, a longitudinally extending
indentation 54 can have multiple longitudinally extending surfaces
that meet each other at angles. The tulip housing 4 can also
include attachment features that resist axial forces, such as the
laterally extending indentation 56, or undercut lip, shown in FIG.
5. The laterally extending indentation 56 is positioned distally
from the proximal-most surface 58 of the tulip housing 4, and is
configured to mate with laterally extending protrusions on an
engaged instrument. Alternatively, the tulip housing 4 could
include laterally extending protrusions that limit axial forces
when mated to laterally extending indentations on an engaged
instrument. The surfaces of the laterally extending indentations or
protrusions can be rounded or angled.
[0037] Some or all of the components of the bone anchor 2 can be
formed of a metal material. For example, in some embodiments the
tulip housing 4, shank 10, pressure cap 16, retaining ring 20,
and/or pins 24 are formed of molybdenum rhenium (MoRe). The use of
MoRe in surgical implants is described elsewhere, for example, in
International Patent Application Publication No. WO 2017/003926,
published Jan. 5, 2017, and entitled "Molybdenum alloys for medical
devices", U.S. Patent Application Publication No. 2016/0237541,
published Aug. 18, 2016, and entitled "Improved Metal Alloy For
Medical Devices", and U.S. Pat. No. 7,488,444 to Furst et al.,
issued Feb. 10, 2009, and entitled "Metal alloys for medical
devices", which are incorporated by reference in its entirety and
for all purposes.
[0038] The use of MoRe enables the design of smaller, less invasive
components. MoRe as a material is highly resistant to fatigue,
which enables the design of thinner walls. MoRe is not notch
sensitive, which enables the design of notches and angled surfaces.
The notches enable, for example, the inclusion of tabs 40 that lend
flexibility of the radially expanding portion 6. Angled surfaces
can be advantageous, for example, to prevent sliding between
interlocking mechanisms (such as sliding between the interlocking
features 46, 48 on the radially expanding portion 6 and retaining
ring 20, or sliding between the indentations 56, 58 on tulip
housing 4 and their counterparts on engaged instruments). Angled
corners also take up less space than rounded corners, which again
enables the design of smaller devices.
[0039] Various embodiments of the shank 10 are shown in FIGS. 1 and
6. FIG. 7 shows a perspective view of the shank 10 shown in FIG. 6.
The embodiments shown in FIGS. 1 and 6 include a distal threaded
portion 12 having a distal set of threads 60 that cut into bone as
the screw is rotated. The distal set of threads 60 extends to meet
the distal end 64 of the shank 10 (i.e., the channel depth of the
distal set of threads 60 at the distal end 64 of shank 10 is
greater than zero), and can terminate with a cutting edge. In the
embodiment shown in FIG. 1, the distal threaded portion 12 includes
a proximal set of threads 62 with a pitch that is smaller than the
pitch of the distal set of threads 60. The proximal set of threads
62 are a quad lead and the distal set of threads 60 are a dual
lead. The proximal set of threads 62 can extend distally for at
least 10 millimeters. In the embodiment shown in FIG. 6, the distal
and proximal sets of threads 60, 62 have equivalent pitch and lead.
The pitch is therefore constant throughout the threaded region. The
threaded region is dual lead. The major and minor diameters of the
threaded region of the threaded shank 10 narrow as they approach
distal end 64 of the shank 10. This narrowing maintains an equal
distance between the major and minor diameter of the screw thread,
which improves thread pull-out and provides consistent bone
engagement for the entirety of the screw thread. The minor diameter
of the distal threaded portion 12 can be sized to create the
greatest flank overlap and surface area in order to maximize
purchase and pullout strength. In some embodiments, the minor
diameter is cylindrical in cross-section. The minor diameter,
depending on major diameter, can be sized to match standard gauge
needle diameters (which is often the first step of a spinal
procedure). Alternatively, a drill, awl, or probe could be used to
create the initial hole. In doing so, the bone anchor is capable of
being used without the need to tap or undertap, a common procedural
step. In one embodiment, only a pilot hole, which matches the minor
diameter of the threaded shank, is necessary for bone anchor
insertion.
[0040] Instruments for use with a bone anchor are also disclosed
herein. FIG. 8 shows an exploded perspective view of bone anchor 2
with first and second blades 66, 68. Blades 66, 68 are partially
curved, thin walled members. The blades are configured to be
attached to the bone anchor 2 before or during a surgical
procedure, and detached at the end of the surgical procedure. FIG.
8 shows the use of a pair of blades, but in some embodiments, a
single blade can be joined to a bone anchor 2, or more than two
blades can be joined to a bone anchor 2. During a procedure, blades
attach to tulip housing 4 and extend proximally away from the spine
and above the surface of the skin, providing a channel for surgical
access and enabling manipulation of tulip housing 4. A pair of
blades, such as the pair 66, 68, can be joined at a proximal region
71 via a permanent or non-permanent connection positioned between
the two blades (not shown).
[0041] Adjacent pairs of blades define a path between adjacent bone
anchors 2 along the spine of the patient during the surgery (not
shown). A longitudinal member, such as a spinal rod 3, can be
passed or threaded between one pair of blades 66, 68 and an
adjacent pair of blades along the spine. The proximal regions 71 of
the blades 66, 68 can include fixation features 73, such as
through-holes, through-slots, notches, grooves, or cut-outs, for
attachment to other surgical instruments. The blades can be made of
disposable or reusable materials. Materials used to make blades 66,
68 can include but are not limited to: MoRe, stainless steel,
polypropylene, polycarbonate, titanium or a titanium alloy, carbon
fiber, and aluminum. In some embodiments, the walls of the blades
range from about 1 millimeter to about 4 millimeters.
[0042] FIG. 9 shows an enlarged view of distal region 70 of the
embodiment of blade 66 seen in FIG. 8. Distal region 70 has a
curved internal surface 72 that is configured to mate with the
curved external surface 74 of tulip housing 4. For example, the
curved internal surface 72 includes rotational locking features 76
(which limit rotational movement of the blade with respect to the
bone anchor) and an axial locking feature 78 (that limits axial
movement of the blade with respect to the surgical device). The
rotational locking features 76 can be, for example, one or more
longitudinally extending protrusions, or silos, configured to mate
with the longitudinally extending indentations 54 on the proximal
region 52 of tulip housing 4, described above. During a procedure,
the blade 66 slides distally around the external surface 74 of
tulip housing 4 such that longitudinally extending protrusions 76
slide into the longitudinally extending indentations 54 of the
tulip housing 4. The longitudinally extending protrusions 76, which
are located around the diameter, prevent the blade 66 from rotating
relative to the tulip housing 4 about all three axes and from
translating about all three axes except proximally. Proximal
translation is addressed by the axial locking feature discussed
below. The longitudinally extending protrusions 76 can be
substantially cylindrical, as shown in FIG. 9, or they can have
angled longitudinally extending surfaces. In some embodiments, the
longitudinally extending protrusions 76 can include at least one
flat proximal or distal surface 80 for further restricting axial
movement of the blade 66 with respect to the tulip housing 4.
[0043] The curved internal surface 72 can also include an axial
locking feature 78, which limits axial movement of the blade with
respect to the bone anchor 2. In the embodiment shown in FIG. 9,
the axial locking feature is a laterally extending ridge with
angled surfaces. The laterally extending ridge 78 is positioned on
the inside of distal portion of a living hinge 82, which is an
elongated tab cut into the sidewall 84 of blade 66. Living hinge 82
can be seen in totality from the side view of blade 66 shown in
FIG. 10, which shows the outer surface 86 of the distal region 70
of blade 66. Living hinge 82 can flex outwardly as blade 66 slides
distally over the tulip housing 4, enabling angled surfaces of the
laterally extending ridge 78 to catch within the laterally
extending indentation 56 of the tulip housing 4 as living hinge 82
returns to its original position (see cross-sectional view in FIG.
11). The proximal surface 88 of the laterally extending ridge 78
creates an acute angle with a sidewall of the living hinge 82. The
distal surface 90 of the laterally extending ridge 78 creates an
obtuse angle with a sidewall of the living hinge 82. The
interaction of the angled surfaces of ridge 78 with the angled
surfaces of indentation 56 (the axial locking feature of bone
anchor 2) enable the blade 66 to slide over the tulip housing 4 as
a distally exerted force is applied (i.e., when blade 66 is pushed
inward). However, when the blade is pulled back toward the
practitioner, the proximal surface 88 of ridge 78 catches on the
distal surface of indentation 56, such that the ridge 78 must be
disengaged manually from indentation 56 using a separate
disengagement instrument.
[0044] In some embodiments, a disengagement instrument can, for
example, have two handles with two extensions protruding distally
from the handles. The handles and both extensions can be held in an
open position by springs, for example. One distally protruding
extension contains a pin member which mates with a hole located in
the sidewall 84 of blade 66, positioned above the skin of the
patient during the procedure. The second distally protruding
extension is inserted down the length of the interior portion of
the elongated blade 66, and has a projecting member. Compressing
the handles thrusts the projecting member outward, thus disengaging
the elongated member from the bone anchor (for example, by pushing
flexing living hinge 82 outwardly and thereby pushing axial locking
feature 78 away from the bone anchor 2). With the handles still
compressed, the disengagement instrument holds onto the elongated
blade 66 during removal from the surgical site to ensure the
elongated blade does not fall back into the surgical site for
safety to the patient.
[0045] Methods of assembling bone anchors are disclosed herein. The
bone anchors disclosed herein are assembled by inserting pressure
cap 16 into a through hole 8 at a distal end of a tulip housing 4,
inserting a proximal ball head 14 of a bone anchor 2 into the
through hole 8 at the distal end of the tulip housing 4, and
positioning a retaining ring 20 around a distal radially expandable
portion 6 of the tulip housing 4 (thereby preventing distal
movement of the pressure cap 16 and the proximal ball head 14 out
of the through hole 8). The radially expandable distal portion 6
expands to allow for the passage of pressure cap 16 and ball head
14 as they are inserted into the through hole 8. The expansion is
possible because tabs 40 of the radially expandable portion 6 flex
outwardly during the passage of the ball head 14 and pressure cap
16, which have larger diameters. Positioning the retaining ring 20
limits further expansion of the distal radially expandable portion
6 of tulip housing 4, preventing distal movement of the ball head
14 out of through hole 8. The method of assembling the bone anchor
2 further comprises activating a compression mechanism that forces
the pressure cap 16 into close contact with the ball head 14. In
some embodiments, activating a compression mechanism includes
inserting a compressing component 24 through a sidewall 28 of the
metal tulip housing 4.
[0046] The bone anchors described herein can be inserted without
tapping or undertapping. Methods of inserting the bone anchors
include inserting a bone access needle into a bone to create a
needle hole space, inserting a guidewire through the bone access
needle within the needle hole space, removing the bone access
needle, screwing a cannulated bone anchor into the needle hole
space over the guidewire, and removing the guidewire. No tapping or
undertapping steps are performed, reducing the duration and the
invasiveness of the procedure. In some embodiments of the method,
the bone anchor is screwed into the needle hole space without first
widening the needle hole space. In other embodiments, the needle
hole space is widened to create a pilot hole prior to screwing in
the bone anchor. The bone can be a pedicle in some embodiments. The
bone access needle can be a pedicle access needle, or, in some
embodiments, a Jamshidi needle. The minor diameter of the distal
threaded portion 12 of the bone anchor 2 can be chosen to
approximately match the outer diameter of the bone access needle
(and therefore, the needle hole space). The method of inserting the
bone anchor can also include inserting a spinal rod 3 between the
sidewalls 30 of two adjacent tulip housings 4, and locking the
spinal rod 3 into place using set screws 5 (an exploded perspective
view of these components is shown in FIG. 1).
* * * * *