U.S. patent number 3,916,907 [Application Number 05/481,637] was granted by the patent office on 1975-11-04 for spreader instrument for use in performing a spinal fusion.
Invention is credited to Wendell C. Peterson.
United States Patent |
3,916,907 |
Peterson |
November 4, 1975 |
Spreader instrument for use in performing a spinal fusion
Abstract
A spreader instrument for use in spinal fusion surgery for
separating adjacent vertebral bodies having a common bone assembly
receiving hole pre-formed therein includes two elongated members
pivotally attached intermediate their ends. A pair of
partial-circularly shaped plates are attached to the pivoted
members, extending outwardly from adjacent opposite free ends of
the respective members. The plates are oriented with their concave
faces toward each other to be adapted to be inserted into the
pre-formed holes within the vertebral bodies. The plates engage the
walls of the pre-formed hole in the bodies and spreads or separates
the bodies as the members are pivoted, permitting a cylindrically
shaped bone assembly to be axially inserted between the
semi-circular plates into the hole in the vertebral bodies.
Inventors: |
Peterson; Wendell C.
(Albuquerque, NM) |
Family
ID: |
23912774 |
Appl.
No.: |
05/481,637 |
Filed: |
June 21, 1974 |
Current U.S.
Class: |
606/90; 600/219;
29/239; 81/302; 606/86R |
Current CPC
Class: |
A61F
2/446 (20130101); A61B 17/025 (20130101); A61F
17/00 (20130101); A61B 17/2812 (20130101); A61F
2250/0063 (20130101); A61B 2017/0256 (20130101); A61F
2230/0069 (20130101); Y10T 29/53683 (20150115); A61F
2/442 (20130101); A61F 2002/2839 (20130101); A61F
2002/30225 (20130101); A61F 2002/30599 (20130101); A61F
2220/0041 (20130101); A61F 2002/30433 (20130101) |
Current International
Class: |
A61B
17/28 (20060101); A61B 17/88 (20060101); A61F
2/44 (20060101); A61B 17/02 (20060101); A61F
2/00 (20060101); A61F 2/28 (20060101); A61M
024/00 () |
Field of
Search: |
;128/20,345,33R,354,341
;81/302 ;29/223,239 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Other References
"Lumbar Intervertebral Disc Surgery," Surgery, Nov. 1952, Vol. 32,
No. 5, p. 852..
|
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Layton; Henry S.
Attorney, Agent or Firm: Bachand; Richard A.
Claims
What is claimed is:
1. A spreader for separating vertebral bodies having a hole
pre-formed therein to receive a cylindrical plug comprising, two
pivotally attached elongated members, and two frustro-conically
shaped curved plates, each rigidly attached to a respective one of
said members, each of said plates having a first outside radius to
engage the wall of said hole, and having a second inside radius
smaller than said first radius for passing the bone plug, said
first and second radii being upon a common center line oriented at
an angle of approximately 30.degree. from an axis along said
respective elongated member.
2. The spreader of claim 1 further comprising biasing means between
said members to urge said plates in a direction toward each
other.
3. The spreader of claim 1 wherein said plates are mounted with
their centerline axes oriented at an angle with respect to the axis
of said members, and are disposed on said elongated members to be
symmetrical about a centerline axis with respect to each other when
the interior faces of said plates are separated by a distance
approximately equal to the diameter of said plug.
4. The spreader of claim 3 wherein the material of which the
spreader is formed is stainless steel.
5. A spreader for separating two vertebral bodies having a
pre-formed bone plug receiving hole, comprising:
a pair of elongated members,
pivot means medially interconnecting said pair of elongated
members,
a pair of frustro-conically shaped arcuate plates, each rigidly
attached to and outstanding from adjacent an end of a respective
one of said members, each plate being of inside radius of
approximately 5/8 of an inch to pass said bone plug and of outside
radius of approximately 1/2 of an inch to engage one of said
vertebral bodies, the center line axis of each of said plates
defining an angle of about 30.degree. with respect to the axis of
the elongated member upon which it is mounted.
6. The spreader of claim 5 wherein each of said pair of arcuate
plates is of approximately 3/4 of an inch in length.
7. The spreader of claim 5 wherein each of said elongated members
are bent at an angle of about 30.degree. upon its axis.
8. The spreader of claim 7 further comprising biasing means between
said elongated members normally urging said plates together.
9. The spreader of claim 8 wherein the material of which the
spreader is formed is stainless steel.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates to surgical instruments, and more
particularly to a spreader instrument for use in performing a
surgical fusion between adjacent vertebral bodies.
2. Description of the Prior Art
In performing the surgical procedure widely known as a spinal
fusion, two or more vertebral bodies are fused together by grafting
a bone section or a bone assembly made of a plurality of bone
sections between each pair of vertebrae to be fused. Although such
fusions may be performed either anteriorily or posteriorily, the
invention has particular application to the anteriorily performed
procedure.
Ordinarily, in performing the operation, when the two vertebral
bodies to be fused are reached and exposed, and the area between
them is cleaned of the disc and other materials, such as those
which may have been extruded from the disc, a hole is drilled along
a centerline between the two vertebrae. The hole defines a
cylindrical cavity within the vertebrae extending almost to the
nerve bundles within the spinal column with each half of the
cylindrically shaped hole being located in a respective one of the
vertebrae. (The particular drilling methods are well known, and
therefore are not described herein in detail.) A bone section is
then obtained and inserted into the hole to ultimately form a
unitary structure with the two vertebrae.
The bone section used for such grafts is commonly obtained either
from a leg bone, whereby a single piece may be obtained which is
often large enough to suffice as the intervertebral connection, or
more frequently, from the patient's illium bone. Usually, however,
when the illium bone is used for the graft, it is necessary to
utilize two or more bone sections to obtain a bone assembly of
sufficient largeness to complete the graft. The bone sections are
fastened together, generally by a stainless wire passed in a figure
8 pattern through a hole in the bone sections.
Once the donor bone assembly is prepared, it is inserted into the
hole previously formed in the vertebral bodies by manually
manipulating the two bodies and forcing them apart a distance
sufficient to easily receive the donor bone assembly, then
inserting the assembly and releasing the vertebral bodies to return
to their usual position, thereby clamping the bone assembly between
them. It can be seen that, at best, separating the vertebral bodies
in this manner is difficult and inconvenient, considering
especially that the operation is being performed several inches
below an anterior incision into the patient's stomach area.
To further illustrate the difficulties encountered, in one of the
methods for separating the vertebral bodies, the head and feet of
the patient are physically pulled in opposite directions, thereby
separating, among other things, the vertebrae to be fused. This is
inconvenient, and requires the assistance of at least two persons
in addition to the surgeon. Special apparatus is also required for
fastening to the patient to aid in applying the traction necessary
to separate the vertebrae.
Surgical instruments have also been proposed to selectively
separate the desired vertebrae, but, in general, such instruments
heretofore advanced are unsatisfactory. For example, one apparatus
proposed includes a pair of claw sets, one set being required for
each vertebral body. The claws are operated to engage the outside
walls of the vertebral bodies, with the claws digging into the
vertebral bodies. They are then manipulated to pull the bodies
apart to allow the bone section to be inserted.
The fusion portion of the operation is then completed by fixing
clamps or staples across the intervertebral space between the two
fused vertebrae to keep the vertebrae fixed with respect to each
other and to constrain the bone assembly within the hole in which
it is disposed. The three bodies, i.e., the two vertebrae and the
donor bone assembly are then allowed to heal together to unite into
a single bone structure.
SUMMARY OF THE INVENTION
In light of the above, it is an object of the invention to provide
an instrument for separating or spreading a pair of vertebral
bodies to be fused and to permit a donor bone assembly to be
inserted into a hole pre-formed in the vertebrae.
In accordance with the present invention, a surgical instrument is
presented to separate a pair of adjacent vertebral bodies to be
fused, to allow a bone assembly to be inserted into a pre-formed
hole therein. The spreader instrument includes two elongated
members intermediately pivotally attached to be rotateable each
upon the other. At one end of each of the elongated members is a
thin, arcuate plate adapted to be inserted into a pre-formed hole
in the vertebral bodies to be fused. The plates are mounted about a
common axis with their concave sides facing each other. Each plate
has a first radius on its inside wall of approximately that of bone
assembly to be inserted and a second smaller radius on its outside
wall of approximately that of the pre-formed hole in the vertebrae.
The plates can then be located within the pre-formed hole to engage
its walls, and to enable a bone assembly of slightly larger
diameter than the diameter of the pre-formed hole to be inserted
into the pre-formed hole without interference.
BRIEF DESCRIPTION OF THE DRAWING
A preferred embodiment of the invention is illustrated in the
accompanying drawing wherein:
FIG. 1 is a perspective view of the two vertebral bodies which have
been prepared for insertion of a bone assembly therebetween.
FIG. 2 is a perspective view of a typical unitary bone section for
insertion between the vertebral bodies of FIG. 1.
FIG. 3 is a perspective view of a spreader instrument in accordance
with a preferred embodiment of the invention, for use in spreading
the vertebrae of FIG. 1 to enable the bone section of FIG. 2 to be
inserted therebetween.
FIG. 4 is a perspective view, partially cut away, showing the
arcuately shaped plates of the spreader of FIG. 3.
FIG. 5 is a frontal view of the vertebral bodies of FIG. 1 after
completion of the surgical fusion procedure employing the spreader
instrument of the invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Typically, in the performance of a spinal fusion operation, an
incision is made into the patient to expose the vertebral bodies to
be fused. An anterior view of a pair of such vertebral bodies 10
and 11 is shown in FIG. 1. During the operation, a common hole 12
having a top portion 13 and bottom portion 14, is formed by
well-known techniques into the vertebrae 10 and 11, after the space
15 between the bodies 10 and 11 has been cleaned and the disc and
other matters therebetween removed.
Thereafter, a bone plug or assembly 17, as shown in FIG. 2, is
inserted into the previously formed hole 12 defined by the recesses
13 and 14. The cylindrically shaped bone assembly 17 includes two
bone sections 18 and 19, obtained, for example, from the illium
bone, in a well-known manner. The bone sections 18 and 19 are
fastened together by a stainless steel screw 21 or other fastening
means, such as a wire or the like (not shown), and are typically
made in circular shape, as shown, with a diameter slightly larger
than the diameter of the hole 12 of the vertebral bodies 10 and 11.
For instance, the diameter of the bone plug 17 can conveniently be
5/8 of an inch, and the diameter of the hole 12 can be 1/2 of an
inch. Thus, when the bone section 17 is inserted into the hole 12,
the corners 25, 26, 27, and 28 of the vertebral bodies 10 and 11
tend to cut or bear upon the bone assembly 17, thereby promoting
the fusion thereto as well as immobilizing the vertebral bodies and
increasing their stability.
To insert the bone assembly 17 into the hole within the vertebral
bodies 10 and 11, the spreader instrument 30, in accordance with a
preferred embodiment of the invention, as shown in FIG. 3, is
employed. The spreader 30 includes two elongated members 31 and 32,
which are pivoted with respect to each other about a point 35
intermediate the ends of the members. The members 31 and 32 are
arranged so that the extremities do not crisscross at the pivot
point 35. That is, the ends upon which the plates 37 and 38 are
carried are caused to separate when the opposite, or handle ends 45
and 46 are moved together. At one end of the respective members 31
and 32, arcuate shaped plates 37 and 38 are attached or formed. The
plates 37 and 38 may, as shown, be mounted at an angle of perhaps
30 degrees with respect to the members 31 and 32 to ease operation
from above the incision.
The rotational position of the plates 37 and 38, as shown by the
arrows 42 and 43, is controlled by the handle portion 45 and 46 of
the elongated members 31 and 32. A biasing spring 50 is included
between the members to urge them toward a normal closed position of
the spreader 30. Also, a locking clip or other such device (not
shown) may be easily included between the members 45 and 46 to
allow the position of the spreader to be maintained at a desired
opening angle.
Because the spreader is used in areas having small access thereto,
the handle portion, including the elongated members 45 and 46, may
be bent slightly along its axis (bend not shown) to ease operation
in such areas, for example, to an angle about 30 degrees.
The construction of the arcuate plates 37 and 38 is shown in more
detail in FIG. 4. The plates 37 and 38 are of generally
frusto-conical sections having bases 52 and 53 extending over a
larger arc distance than the tips 55 and 56. Additionally, the
inner radius, indicated by the arrows 60 and 61 are made to conform
to the radius of the bone plug assembly 17 of FIG. 2. Thus, for
example, if the radius of the bone assembly 17 in FIG. 2 is 5/8 of
an inch, the inner radii, indicated by the arrows 60 and 61, are
also made of radius equal to 5/8 of an inch.
On the other hand, the outside radii of the plates 37 and 38 are
made to conform to the radius of the hole 12 as defined by the
recesses 13 and 14 in the vertebral bodies 10 and 11. Thus, if the
hole 12 in the vertebral bodies 10 and 11 has a radius of
approximately 1/2 of an inch, the radii indicated by the arrows 63
and 64 will also be of 1/2 of an inch.
This radius variance between the inner and outer surfaces of the
plates 37 and 38 greatly facilitates the use of the spreader, since
the surfaces precisely conform to the curves of the vertebral
bodies and plug used in connection therewith. Furthermore, the
different radii facilitates easy withdrawal of the spreader 30 from
within the holes of the vertebral body 10 after the bone assembly
17 has been inserted, since all of the surfaces are conforming,
with no corners or other areas of particular contact which might
tend to bind.
It should be emphasized that the length of the plates 37 and 38
should be selected to be sufficiently long as to enable the
vertebral bodies to be spread upon insertion into the holes 12 and
13 therein, but not so long as to present the possibility of
cutting into the spinal cord lying directly beneath the hole 12. It
has been found, for example, that a length of approximately 3/4 of
an inch is generally sufficient.
The plates 37 and 38 are oriented upon the members 31 and 32 in a
manner such that they are essentially complementary about a common
centerline axis when they are separated a distance just sufficient
to receive the bone plug or assembly 17. Thus, as the plug 17 is
inserted, its centerline axis will coincide with the center of the
inside radii of each of the plates 37 and 38. Likewise, in this
position, the outside radii of the plates 37 and 38 will each have
a radius located at a common endpoint with the other, defining a
diameter equal to the desired diameter of the hole 12 to receive
the bone plug 17.
In operation, the elongated members 31 and 32 are manipulated by
the handles 45 and 46 to spread the plates 37 and 38 within the
holes 13 and 14 of the vertebral bodies 10 and 11. The vertebral
bodies 10 and 11 are thereby spread or separated a distance
sufficient to allow the bone assembly 17 to be inserted in the hole
area 12. After the bone assembly 17 has been inserted into place,
the spreader 30 is removed from the hole 12, and the vertebral
bodies 10 and 11 are allowed to recede to their original positions
to clamp the bone assembly 17 therebetween.
Finally, as shown in FIG. 5, to complete the surgical fusion, a
means to restrain movement between the vertebral bodies 10 and 11
and to constrain the bone assembly 17 within the holes in the
vertebral bodies is placed. Such means can conveniently be
elongated staples or clamps 61 and 62, which extend across the hole
of the vertebral bodies 10 and 11. The staples 61 and 62 are
fastened at their respective ends into the vertebral bodies 10 and
11.
The spreader 30, in accordance with the invention, can be made of
any suitable material, such as stainless steel or the like, such
materials for surgical instruments of the type hereof being well
known in the art.
Although the invention has been described and illustrated with a
certain degree of particularity, it is understood that the present
disclosure has been made only by way of example and that numerous
changes in the details of construction and the combination and
arrangement of parts may be resorted to without departing from the
spirit and scope of the invention and hereinafter claimed.
* * * * *