United States Patent [19]
`United States Patent
`[19]
`Michelson
`Michelson
`
`[54] METHODS AND INSTRUMENTATION FOR
`[54] METHODS AND INSTRUMENTATION FOR
`THE SURGICAL CORRECTION OF HUMAN
`THE SURGICAL CORRECTION OF HUMAN
`THORACIC AND LUMBAR SPINAL DISEASE
`THORACIC AND LUMBAR SPINAL DISEASE
`FROM THE ANTERO-LATERAL ASPECT OF
`FROM THE ANTERO-LATERAL ASPECT OF
`THE SPINE
`THE SPINE
`
`[76]
`Inventor: Gary Karlin Michelson, 438 Sherman
`[76] Inventor: Gary Karlin Michelson, 438 Sherman
`Canal, Venice, Calif. 90291
`Canal, Venice, Calif. 90291
`
`[21] Appl. No.: 394,836
`[21] Appl. No.: 394,836
`[22]
`Filed:
`Feb. 27, 1995
`[22]
`Filed:
`Feb. 27, 1995
`
`Related U.S. Application Data
`Related US. Application Data
`
`[63]
`[63]
`
`Continuation—in—part of Ser. No. 74,781, Jun. 10, 1993,
`Continuation-in-part of Ser. No. 74,781, Jun. 10, 1993,
`which is a continuation—in—part of Ser. No. 698,674, May 10,
`which is a continuation-in-part of Ser. No. 698,674, May 10,
`1991, which is a division of Ser. No. 205,935, Jun. 13, 1988,
`1991, which is a division of Ser. No. 205,935, Jun. 13, 1988,
`Pat. No. 5,015,247, and a continuation—in—part of Ser. No.
`Pat. No. 5,015,247, and a continuation-in-part of Ser. No.
`219,626, Mar. 28, 1994.
`219,626, Mar. 28, 1994.
`Int. Cl.5 ................................................... .. A61B 17/56
`[51]
`Int. Cl.6 ................................................... .. A61B 17/56
`[51]
`[52] U.S. Cl.
`............................................... .. 606/61; 623/17
`[52] US. Cl. ............................................... .. 606/61; 623/17
`[58] Field of Search ......................... .. 606/60, 61, 72-79;
`[58] Field of Search ......................... .. 606/60, 61, 72—79;
`623/16, 17
`623/16, 17
`
`[56]
`[56]
`
`References Cited
`References Cited
`U.S. PATENT DOCUMENTS
`U.S. PATENT DOCUMENTS
`4/1985 Roux .
`Re. 31,865
`4/1985 Roux .
`Re. 31,865
`3/1995 McGuire et al.
`.
`Re. 34,871
`3/1995 McGuire et a1. .
`Re. 34,871
`8/1977 Shen .
`D. 245,259
`8/1977 Shen .
`D. 245,259
`11/1980 Zahn.
`D. 257,511
`D. 257,511 11/1980 Zahn.
`350,420 10/1886 Dillon.
`350,420 10/1886 Dillon.
`1,137,585
`4/1915 Craig.
`1,137,585
`4/1915 Craig.
`2,065,659
`12/1936 Cullen.
`2,065,659 12/1936 Cullen.
`2,181,746
`11/1939 Siebrandt.
`2,181,746 11/1939 Siebrandt.
`2,243,718
`5/1941 Moreira .
`2,243,718
`5/1941 Moreira .
`2,372,622
`3/1945 Fassio .
`2,372,622
`3/1945 Fassio .
`2,514,665
`7/1950 Myller.
`2,514,665
`7/1950 Myller.
`2,537,070
`1/1951 Longfellow .
`2,537,070
`1/1951 Longfellow .
`2,543,780
`3/1951 Hipps et al.
`.
`2,543,780
`3/1951 Hipps et a1. .
`2,677,369
`5/1954 Knowles .
`2,677,369
`5/1954 Knowles .
`2,774,350 12/1956 Cleveland .
`2,774,350 12/1956 Cleveland .
`2,789,558
`4/1957 Rush.
`2,789,558
`4/1957 Rush.
`2,832,343
`4/1958 Mose .
`2,832,343
`4/1958 Mose .
`2,842,131
`7/1958 Smith.
`2,842,131
`7/1958 Smith.
`3,128,768
`4/1964 Giestauts .
`3,128,768
`4/1964 Giestauts .
`3,298,372
`1/1967 Feinberg .
`3,298,372
`1/1967 Feinberg .
`
`US005772661A
`US005772661A
`[11] Patent Number:
`[11] Patent Number:
`[45] Date of Patent:
`[45] Date of Patent:
`
`5,772,661
`5,772,661
`Jun. 30, 1998
`Jun. 30, 1998
`
`2/1969 Lumb.
`3,426,364
`2/1969 Lumb.
`3,426,364
`12/1969 Morrison.
`3,486,505
`3,486,505 12/1969 Morrison.
`
`(List continued on next page.)
`(List continued on next page.)
`FOREIGN PATENT DOCUMENTS
`FOREIGN PATENT DOCUMENTS
`0 260 044
`3/1988 European Pat. Off.
`.
`0 260 044 3/1988 European Pat. Off. .
`0 307 241
`3/1989 European Pat. Off.
`.
`0 307 241
`3/1989 European Pat. Off. .
`0 599 419 A2
`6/1994 European Pat. Off.
`.
`0 599 419 A2 6/1994 European Pat. Off. .
`0 179 695
`4/1986
`France .
`0 179 695 4/1986 France .
`2 581 336
`11/1986
`France .
`2 581 336 11/1986 France .
`1961531
`7/1970 Germany .
`1961531
`7/1970 Germany .
`3101333 A1
`12/1981 Germany .
`3101333 A1 12/1981 Germany .
`3132520 A1
`6/1982 Germany .
`3132520 A1 6/1982 Germany .
`3505567 A1
`6/1986 Germany .
`3505567 A1 6/1986 Germany .
`106 101
`7/1939
`Sweden .
`106 101
`7/1939 Sweden .
`
`Primary Examiner—Michael A. Brown
`Primary Examiner—Michael A. BroWn
`Attorney, Agent, or Firm—Lewis Anten, Esq.; Amedeo
`Attorney, Agent, or Firm—LeWis Anten, Esq.; Amedeo
`Ferraro, Esq.
`Ferraro, Esq.
`[57]
`[57]
`
`ABSTRACT
`ABSTRACT
`
`An improved method and instrumentation for performing
`An improved method and instrumentation for performing
`spinal surgery, including discectomy, interbody fusion and
`spinal surgery, including discectomy, interbody fusion and
`rigid internal fixation of the spine, from the lateral aspect of
`rigid internal ?xation of the spine, from the lateral aspect of
`the spine is disclosed. The surgical procedure can be per-
`the spine is disclosed. The surgical procedure can be per
`formed through a very small incision. The instrumentation
`formed through a very small incision. The instrumentation
`of the present invention, all of which is inserted from a
`of the present invention, all of Which is inserted from a
`lateral position into the spine in the preferred embodiment,
`lateral position into the spine in the preferred embodiment,
`comprises a guide pin, a distractor, an extended outer sleeve,
`comprises a guide pin, a distractor, an extended outer sleeve,
`an inner sleeve an adjustable drill and an implant driver. The
`an inner sleeve an adjustable drill and an implant driver. The
`distractor of the present invention is driven into the disc for
`distractor of the present invention is driven into the disc for
`spacing apart and realigning the adjacent vertebrae. It further
`spacing apart and realigning the adjacent vertebrae. It further
`functions as an alignment rod for inserting the extended
`functions as an alignment rod for inserting the extended
`outer sleeve which is a hollow tubular member capable of
`outer sleeve Which is a holloW tubular member capable of
`maintaining said spacing and alignment of two adjacent
`maintaining said spacing and alignment of tWo adjacent
`vertebrae and defines a protected space through which
`vertebrae and de?nes a protected space through Which
`subsequent
`instruments which may include, but are not
`subsequent instruments Which may include, but are not
`limited to, a drill and a diameter reducing inner sleeve may
`limited to, a drill and a diameter reducing inner sleeve may
`be passed, as well as a spinal implant. The remainder of the
`be passed, as Well as a spinal implant. The remainder of the
`surgical procedure consisting of the removal of spinal mate-
`surgical procedure consisting of the removal of spinal mate
`rial across the disc, fusion, and rigid internal stabilization via
`rial across the disc, fusion, and rigid internal stabilization via
`the implant may all be performed via the closed space within
`the implant may all be performed via the closed space Within
`the extended outer sleeve.
`the extended outer sleeve.
`
`87 Claims, 14 Drawing Sheets
`87 Claims, 14 Drawing Sheets
`
`
`
`\\\.
`
`
`
`MSD 1148
`|PR2013—00506
`
`|PR2013—00508
`
`

`
`5,772,661
`5,772,661
`Page 2
`Page 2
`
`.
`
`U.S. PATENT DOCUMENTS
`US. PATENT DOCUMENTS
`9/1971 Gilbert.
`3,604,487
`
`9/1971 61111611. 9/1971 Hahn ~
`
`3,604,487 316051123
`9/1971 Hahn ~
`35059123
`1/1973 Halloran.
`3,709,219
`3232mm
`373337513
`3/1973 Hahn .
`3,720,959
`8/1973 Sherwin .
`3,750,652
`3,848,601
`11/1974 Ma ............................................ 606/61
`3,848,601 11/1974 Ma .......................................... .. 606/61
`3,855,638 12/1974 Pilliar.
`3,855,638 12/1974 P111161.
`3,867,728
`2/1975 Stubstad et al.
`.
`3,867,728
`2/1975 81111161611 6161. .
`3,875,595
`4/1975 Froning ................................... .. 623/17
`3,875,595
`4/1975 P1611111g ................................... .. 623/17
`3,892,232
`7/1975 Neufeld .
`378927232
`7/1975 Neufeld _
`3,905,047
`9/1975 Long .
`3,905,047
`9/1975 Long _
`3,915,151
`10/1975 Kraus .
`3,915,151 10/1975 Kraus.
`3,948,262
`4/1976 Zaffaroni.
`3,948,262
`4/1976 Zaffaroni.
`3,952,334
`4/1976 Bokros et al.
`.
`3,952,334
`4/1976 Bokros et al. .
`3,987,499
`10/1976 Scharbach et al.
`.
`3,987,499 10/1976 Scharbach et al. .
`4,016,651
`4/1977 Kawahara et al.
`.
`4,016,651
`4/1977 Kawahara et al. .
`4,051,905
`10/1977 Kleine .
`4,051,905 10/1977 Kleine -
`4,059,115
`11/1977 Jumashev et al.
`.
`4,059,115 11/1977 JllIIlaSheV 6161. .
`4,070,514
`1/1978 Entherly et al. .
`4,070,514
`1/1978 Entherly et al. .
`Kawahara Ct 8.1.
`.
`Kawahara Ct 8.1. .
`4,124,026
`11/1978 Berner et al.
`.
`4,142,517
`3/1979 Stravropoulos et al.
`
`
`21123’??? 1111222 21121161211161 4:168:326 9/1979 BIOCIIICT; 6161..
`4,168,326
`9/1979 Broemeretal..
`4,175,555
`11/1979 Herbert.
`4,175,555 11/1979 Herbert.
`4,177,524 12/1979 Grell et al.
`.
`4,177,524 12/1979 616116161. .
`471817457
`1/1980 Holmes~
`4,181,457
`171980 Holmes 7
`4,206,516
`6/1980 Pilliar.
`4,206,516
`6/1980 P111161.
`4,222,128
`9/1980 Tomonaga et al.
`.
`4,222,128
`9/1980 T61116116g6 6161. .
`4,237,948 12/1980 Jones et al.
`7
`472377948 12/1980 Jones et aL _
`4,259,072
`3/1981 Hirabayashi et al.
`.
`4,259,072
`3/1981 H1161>6y661116161 .
`4,262,369
`4/1981 Roux .
`4,262,369
`4/1981 Roux _
`4,271,832
`6/1981 Evans et al.
`.
`4,271,832
`6/1981 Evans et al. .
`4,289,123
`9/1981 Dunn .
`4,289,123
`9/1981 D111111 .
`4,293,962 10/1981 Fuson .
`4,293,962 10/1981 P116611 .
`4,309,777
`1/1982 Patil .
`4,309,777
`1/1982 P6111 .
`4,328,593
`5/1982 Sutter et al.
`.
`4,328,593
`5/1982 Sutter et al. .
`4,333,469
`6/1982 Jeffcoat et al.
`.
`4,333,469
`6/1982 Jeffcoat et al. .
`4,341,206
`7/1982 Perrett et al.
`.
`4,341,206
`7/1982 Perrett et al. .
`4,349,921
`9/1982 Kuntz .
`4,349,921
`9/1982 K11111Z .
`4,356,572
`11/1982 Guillemin et al.
`.
`4,356,572 11/1982 Guillemin et al. .
`4,401,112
`8/1983 Rezaian .
`4,401,112
`8/1983 R6Z61611 .
`4,405,319
`9/1983 Cosentino.
`4,405,319
`9/1983 Cosentino.
`4,423,721
`1/1984 Otte et al.
`.
`4,423,721
`1/1984 0116 6161..
`4,439,152
`3/1984 Small .
`4,439,152
`3/1984 8111611 .
`4,450,834
`5/1984 Fischer.
`4,450,834
`5/1984 Fischer.
`4,484,570
`11/1984 Sutter et al.
`.
`4,484,570 11/1984 Sutter et al. .
`4,492,226
`1/1985 Be1ykheta1..
`4,492,226
`1/1985 Belykh 6161..
`4,501,269
`2/1985 Bagby .
`4,501,269
`2/1985 Bagby .
`4,507,115
`3/1985 Kambara et al.
`.
`4,507,115
`3/1985 Kambara et al. .
`4,530,360
`7/1985 Duarte.
`4,530,360
`7/1985 D116116.
`4,535,374
`8/1985 Jacobson ................................. .. 606/61
`4,535,374
`8/1985 Jacobson ................................. .. 606/61
`4,535,485
`8/1985 Ashman et al.
`.
`4,535,485
`8/1985 Ashman et al. .
`4,542,539
`9/1985 Rowe, Jr. et al.
`.
`4,542,539
`9/1985 Rowe, Jr. et al. .
`4,545,374 10/1985 Jacobson .
`4,545,374 10/1985 Jacobson.
`4,547,390 10/1985 Ashman et al.
`.
`4,547,390 10/1985 Ashman et al. .
`4,552,200
`11/1985 Sinha et al.
`.
`4,552,200 11/1985 Sinha et al. .
`4,553,273
`11/1985 Wu .
`4,553,273 11/1985 Wu .
`4,554,914
`11/1985 Kapp et al.
`.
`4,554,914 11/1985 Kapp et al. .
`4,570,623
`2/1986 Ellison et al.
`.
`4,570,623
`2/1986 Ellison et al. .
`4,570,624
`2/1986 Wu .
`4,570,624
`2/1986 Wu .
`4,599,086
`7/1986 Doty.
`4,599,086
`7/1986 D61y.
`4,600,000
`7/1986 Edwards.
`4,600,000
`7/1986 Edwards.
`4,604,995
`8/1986 Stephens .
`4,604,995
`8/1986 Stephens.
`4,608,052
`8/1986 Van Kampen et al.
`.
`4,608,052
`8/1986 Van Kampen et al. .
`4,611,581
`9/1986 Steffee .
`4,611,581
`9/1986 Steffee.
`4,628,921
`12/1986 Rousso.
`4,628,921 12/1986 R611666 .
`4,634,720
`1/1987 Dorman et al.
`.
`4,634,720
`1/1987 Dorman et al. .
`4,636,217
`1/1987 Ogilvie et al.
`.
`4,636,217
`1/1987 Ogilvie et al. .
`4,636,526
`1/1987 Dorman et al..
`4,636,526
`1/1987 Dorman et al..
`
`2/1987 Lin et al.
`.
`4,645,503
`2/1987 Lin et al. .
`4,645,503
`3/1987 C k
`.
`4,653,486
`4655 777
`471987 Dflnflr.
`
`
`3:222:47‘: Z132; 4,661,536 4/1987 D61111611 6161. .
`4,661,536
`4/1987 Dorrnan et al
`49665920
`571987 Campbell 7
`4,665,920
`5/1987 c6111pb611 .
`4 677 883
`771987 Lee
`12212:; 71222121...
`4’677’972
`7 1987 T
`'.
`9
`9
`/
`°‘“fi°‘*
`'
`’
`’
`9/1987 Du“ 67119 ~
`1693721
`9/1987 Ducheyne ~
`416931721
`9/1987 519895 ~
`4590390
`9/1987 Ste?es -
`416961290
`4,698,375
`10/1987 D0009“ 6191 ~
`466986375 10/1987 Dorman e191- -
`4,710,075
`12/1987 Davlson .
`4,710,075 12/1987 Davison .
`4,713,004 12/1987 Llnkow et al.
`.
`4,713,004 12/1987 Linkow et al. .
`4,714,469
`12/1987 Kenna .
`4,714,469 12/1987 Kenna.
`4,721,103
`1/1988 Freedland.
`4,721,103
`1/1988 Freedland.
`4,736,738
`4/1988 Lipovsek et al.
`.
`4,736,738
`4/1988 Lipovsek et al. .
`4,743,256
`5/1988 Brantigan .
`4,743,256
`5/1988 Brantigan .
`4,743,260
`5/1933 Burton .
`4,743,260
`5/1988 131111011 _
`4,759,766
`7/1988 Buettner—Janz et al.
`.
`4 759 766
`7 1988 B116111161-J611Z 6161. .
`4,759,769
`7/1988 Hedman et al.
`7
`4:759:769 72988 Hedman et a1__
`4,790,303
`12/1988 Steffee .
`477907303 12/1988 Steffee _
`4
`Harms et al.
`.
`HannS et a1~ '
`4’830’000
`571989 Shun
`’
`’
`.'
`12333; 32323 1132:1112?“
`::’::’;;
`373:3 Egigfilfan‘
`4’851’008
`7/1989 J h
`'
`'
`’
`’
`9
`9
`9 “S9” "
`7/1989 JOhnSO“ "
`478517008
`4,863,477
`9/1989 Monson.
`4,863,477
`9/1989 Monson .
`4865503
`9/1989 N911“ -
`418651603
`9/1989 N911“ -
`4,877,020 10/1989 V1011 3
`468776020 10/1989 Vwh -
`4,878,915
`11/1989 Brantlgan ................................ .. 623/17
`4,878,915 11/1989 Brantigan ................................ .. 623/17
`4,903,882
`2/1990 Long .
`4,903,882
`2/1990 Long
`4,904,260
`2/1990 Ray 6191 ~
`4,904,260
`2/1990 Ray et al. .
`4,904,261
`2/1990 DoVe et al.
`.
`4,904,261
`2/1990 Dove et al. .
`4,911,718
`3/1990 Lee et al.
`.
`4,911,718
`3/1990 L66 6161. .
`4,913,144
`4/1990 Del Medico .
`4,913,144
`4/1990 D61 MediCO .
`4,936,848
`6/1990 Babgy .
`4,936,848
`6/1990 Babgy .
`4,943,291
`7/1990 Tanguy .
`4,943,291
`7/1990 Tanguy .
`4,955,885
`9/1990 Meyers .
`4,955,885
`9/1990 Meyers .
`4,955,908
`9/1990 Frey et al.
`.
`4,955,908
`9/1990 Frey et al. .
`4,957,495
`9/1990 Kluger.
`4,957,495
`9/1990 K111g61.
`4,960,420 10/1990 Goble et al.
`.
`4,960,420 10/1990 Goble et al. .
`4,961,740 10/1990 Ray et al.
`.
`4,961,740 10/1990 R6y 6161. .
`4,968,316
`11/1990 Hergenroeder.
`4,968,316 11/1990 Hergenroeder.
`4,969,888
`11/1990 Scholten et al.
`.
`4,969,888 11/1990 86116116116161.
`4,987,904
`1/1991 Wilson .
`4,987,904
`1/1991 W116611 .
`5,015,247
`5/1991 Michelson.
`5,015,247
`5/1991 Michelson.
`5,015,255
`5/1991 Kuslich.
`5,015,255
`5/1991 Kuslich .
`5,026,373
`6/1991 Ray ...................................... .. 606/61
`5,026,373
`6/1991 R6y ......................................... .. 606/61
`5,055,104 10/1991 Ray .
`5,055,104 10/1991 R6y .
`5,059,193
`10/1991 Kuslich .
`5,059,193 10/1991 Kuslich .
`5,071,437 12/1991 Steffee.
`5,071,437 12/1991 8161166 .
`5,084,050
`1/1992 Draenert.
`5,084,050
`1/1992 Draenert.
`5,102,414
`4/1992 Kirsch .
`5,102,414
`4/1992 Kirsch .
`5,116,304
`5/1992 Cadwell .
`5,116,304
`5/1992 CadWell .
`5,122,130
`6/1992 Keller.
`5,122,130
`6/1992 Keller.
`5,123,926
`6/1992 Pisharodi .
`5,123,926
`6/1992 Pisharodi .
`5,192,327
`3/1993 Brantigan .
`5,192,327
`3/1993 Brantigan .
`5,258,031
`11/1993 Salib et al. .
`5,258,031 11/1993 8611b 6161. .
`5,263,953
`11/1993 Bagby .
`5,263,953 11/1993 Bagby .
`5,306,309
`4/1994 Wagner et al.
`.
`5,306,309
`4/1994 Wagner et al. .
`5,364,399
`11/1994 Lowery et al.
`.
`5,364,399 11/1994 L6w61y 6161. .
`5,370,662 12/1994 Stone et al.
`.
`5,370,662 12/1994 816116 6161. .
`5,393,036
`2/1995 Sheridan.
`5,393,036
`2/1995 Sheridan.
`5,396,880
`3/1995 Kagan ................................... .. 604/280
`5,396,880
`3/1995 Kagan ................................... .. 604/280
`5,397,364
`3/1995 Kozak et al.
`.
`5,397,364
`3/1995 KoZak et al. .
`5,425,772
`6/1995 Brantigan.
`5,425,772
`6/1995 Brantigan.
`5,435,723
`7/1995 O’Brien.
`5,435,723
`7/1995 0’1311611 .
`5,489,307
`2/1996 Kuslich et al.
`.
`5,489,307
`2/1996 Kuslich et al. .
`5,489,308
`2/1996 Kuslich et al.
`.
`5,489,308
`2/1996 Kuslich et al. .
`5,571,109
`11/1996 Bertagnoli.
`5,571,109 11/1996 Bertagnoli.
`
`

`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 1 0f 14
`Sheet 1 of 14
`
`5,772,661
`5,772,661
`
`FIG. 1
`
`30
`
`40
`
`60
`
`FIG. 2
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 2 0f 14
`Sheet 2 of 14
`
`5,772,661
`5,772,661
`
`FIG. 3
`
`FIG. 4
`FIG. 4
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 3 0f 14
`Sheet 3 of 14
`
`5,772,661
`5,772,661
`
`106
`
`107
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 4 0f 14
`Sheet 4 of 14
`
`5,772,661
`5,772,661
`
`T7
`
`D
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 5 0f 14
`Sheet 5 of 14
`
`5,772,661
`5,772,661
`
`T7
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 6 0f 14
`Sheet 6 of 14
`
`5,772,661
`5,772,661
`
`244
`244
`
`248’\5
`
`158
`
`L'l
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 7 0f 14
`Sheet 7 of 14
`
`5,772,661
`5,772,661
`
`260
`
`258
`
`252
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 8 0f 14
`Sheet 8 of 14
`
`5,772,661
`5,772,661
`
`T7
`
`T7
`
`T8
`
`
`
` 8 4 1
`
`__ J 7
`
`252
`
`FIG. 16
`
`
`
`4 1
`
`FIG. 17
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 9 0f 14
`Sheet 9 of 14
`
`5,772,661
`5,772,661
`
`FIG. 18
`
`312
`
`l
`
`s
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 10 0f 14
`Sheet 10 of 14
`
`5,772,661
`5,772,661
`
`
`
`4 /.\\\i / T 344D
`342 l 344a Q—
`
`352
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 11 0f 14
`Sheet 11 of 14
`
`5,772,661
`5,772,661
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 12 0f 14
`Sheet 12 of 14
`
`5,772,661
`5,772,661
`
`Jlrawtznpxca --
`“n\I:n“n‘
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 13 0f 14
`Sheet 13 of 14
`
`5,772,661
`5,772,661
`
`FIG. 30A
`
`FIG. 32
`
`FIG. 30
`
`

`
`U.S. Patent
`U.S. Patent
`
`Jun. 30, 1998
`Jun. 30, 1998
`
`Sheet 14 0f 14
`Sheet 14 of 14
`
`5,772,661
`5,772,661
`
`1090
`
`FIG. 33
`FIG. 33
`
`L5
`
`FIG. 34
`FIG. 34
`
`

`
`1
`1
`METHODS AND INSTRUMENTATION FOR
`METHODS AND INSTRUMENTATION FOR
`THE SURGICAL CORRECTION OF HUMAN
`THE SURGICAL CORRECTION OF HUMAN
`THORACIC AND LUMBAR SPINAL DISEASE
`THORACIC AND LUMBAR SPINAL DISEASE
`FROM THE ANTERO-LATERAL ASPECT OF
`FROM THE ANTERO-LATERAL ASPECT OF
`THE SPINE
`THE SPINE
`RELATED APPLICATIONS
`RELATED APPLICATIONS
`
`This application is a continuation in part of copending
`This application is a continuation in part of copending
`U.S. application Ser. No. 08/074,781 filed on Jun. 10, 1993,
`US. application Ser. No. 08/074,781 ?led on Jun. 10, 1993,
`which is a continuation in part of U.S. application Ser. No.
`Which is a continuation in part of US. application Ser. No.
`07/698,674 filed on May 10, 1991 which is a divisional of
`07/698,674 ?led on May 10, 1991 Which is a divisional of
`application Ser. No. 07/205,935 filed on Jun. 13, 1988, now
`application Ser. No. 07/205,935 ?led on Jun. 13, 1988, now
`U.S. Pat. No. 5,015,247 all of which are incorporated herein
`US. Pat. No. 5,015,247 all of Which are incorporated herein
`by reference. This application is also a continuation in part
`by reference. This application is also a continuation in part
`of copending U.S. application Ser. No. 08/219,626 filed on
`of copending US. application Ser. No. 08/219,626 ?led on
`Mar. 28, 1994 which is incorporated herein by reference.
`Mar. 28, 1994 Which is incorporated herein by reference.
`BACKGROUND OF THE INVENTION
`BACKGROUND OF THE INVENTION
`1. Field of the Invention
`1. Field of the Invention
`The present invention relates generally to instrumentation
`The present invention relates generally to instrumentation
`and methods of performing surgical procedures on the
`and methods of performing surgical procedures on the
`human thoracic and lumbar spine along the lateral aspect of
`human thoracic and lumbar spine along the lateral aspect of
`the spine and from a true lateral or anterolateral approach,
`the spine and from a true lateral or anterolateral approach,
`and specifically to the surgical correction of thoracic and
`and speci?cally to the surgical correction of thoracic and
`lumbar disc disease and spinal deformities where concomi-
`lumbar disc disease and spinal deformities Where concomi
`tant fusion is desired.
`tant fusion is desired.
`2. Description of the Related Art
`2. Description of the Related Art
`As regards the thoracic spine, it may be afflicted with a
`As regards the thoracic spine, it may be afflicted With a
`variety of ailments, some so severe as to require surgical
`variety of ailments, some so severe as to require surgical
`intervention. A disc herniation may compress the spinal cord
`intervention. A disc herniation may compress the spinal cord
`and/or nerve roots and cause pain, loss of function, and even
`and/or nerve roots and cause pain, loss of function, and even
`complete paralysis of the legs with loss of bowel and bladder
`complete paralysis of the legs With loss of boWel and bladder
`control. The correct treatment for such conditions is the
`control. The correct treatment for such conditions is the
`removal of the offending discal tissue. However, this has
`removal of the offending discal tissue. HoWever, this has
`proven both difficult and quite dangerous. When the discs of
`proven both difficult and quite dangerous. When the discs of
`the thoracic spine are approached posteriorly (from behind)
`the thoracic spine are approached posteriorly (from behind)
`the spinal cord is in the way. To approach the same hernia-
`the spinal cord is in the Way. To approach the same hernia
`tion anteriorly (from the front) requires the very formidable
`tion anteriorly (from the front) requires the very formidable
`procedure of thoracotomy (cutting open the chest) and
`procedure of thoracotomy (cutting open the chest) and
`moving the heart and lungs out of the way.
`moving the heart and lungs out of the Way.
`Quite recently surgeons have begun performing these
`Quite recently surgeons have begun performing these
`procedures from a lateral approach to the spine (from the
`procedures from a lateral approach to the spine (from the
`side) using ?ber optic vieWing instruments called thoras
`side) using fiber optic viewing instruments called thoras-
`copes and numerous small surgical openings through the
`copes and numerous small surgical openings through the
`chest Wall (portals) through Which various surgical
`chest wall (portals)
`through which various surgical
`instruments, such as burrs, rongeurs and curettes, may be
`instruments, such as burrs, rongeurs and curettes, may be
`placed to remove these disc herniations while avoiding
`placed to remove these disc herniations While avoiding
`formal thoracotomy. Because the discs are very narrow in
`formal thoracotomy. Because the discs are very narroW in
`the thoracic spine and the surgeon is approaching the spine
`the thoracic spine and the surgeon is approaching the spine
`laterally, there is very little space in which to work as the
`laterally, there is very little space in Which to Work as the
`disc is entered in order to get to the back of the disc space.
`disc is entered in order to get to the back of the disc space.
`Therefore, the amount of disc removal may be limited. In the
`Therefore, the amount of disc removal may be limited. In the
`alternative, the surgeon might remove the pedicle to gain
`alternative, the surgeon might remove the pedicle to gain
`access to the spinal canal risking further weakening of the
`access to the spinal canal risking further Weakening of the
`already diseased area.
`already diseased area.
`Sometimes, for a variety of reasons including the removal
`Sometimes, for a variety of reasons including the removal
`of disc material, the thoracic spine may become unstable
`of disc material, the thoracic spine may become unstable
`(too much motion) at any given level. Historically, this has
`(too much motion) at any given level. Historically, this has
`been treated by fusion, the joining together permanently of
`been treated by fusion, the joining together permanently of
`the unstable vertebrae via a bridge of bone so as to eliminate
`the unstable vertebrae via a bridge of bone so as to eliminate
`all motion at that location. Fusions about the thoracic spine
`all motion at that location. Fusions about the thoracic spine
`have been performed either anteriorly or posteriorly, either
`have been performed either anteriorly or posteriorly, either
`procedure being a rather large surgical undertaking.
`procedure being a rather large surgical undertaking.
`Stability of the spine is required for fusion to occur. For
`Stability of the spine is required for fusion to occur. For
`this reason, and for
`the purpose of correcting spinal
`this reason, and for the purpose of correcting spinal
`
`10
`10
`
`15
`15
`
`20
`20
`
`25
`25
`
`30
`30
`
`35
`35
`
`40
`40
`
`45
`45
`
`50
`50
`
`55
`55
`
`60
`60
`
`65
`65
`
`5,772,661
`5,772,661
`
`2
`2
`deformity, it is often necessary to use hardware to rigidly
`deformity, it is often necessary to use hardWare to rigidly
`internally ?Xate (stabiliZe) the spine. To date, the only
`internally fixate (stabilize) the spine. To date,
`the only
`benefit the use of the thorascope has provided in this regard
`bene?t the use of the thorascope has provided in this regard
`is to allow the previous thoracotomy incision to be some-
`is to alloW the previous thoracotomy incision to be some
`what smaller.
`What smaller.
`So to date the following problems remain even utilizing
`So to date the folloWing problems remain even utiliZing
`the most recent technology as regards the surgical treatment
`the most recent technology as regards the surgical treatment
`of thoracic disc disease:
`of thoracic disc disease:
`Firstly, the working space within the disc itself to access
`Firstly, the Working space Within the disc itself to access
`the herniation which is more posterior is quite limited.
`the herniation Which is more posterior is quite limited.
`Secondly, multiple or long incisions through the chest are
`Secondly, multiple or long incisions through the chest are
`still required.
`still required.
`Thirdly, when fusion is required a major surgical under-
`Thirdly, When fusion is required a major surgical under
`taking with its considerable risks is required.
`taking With its considerable risks is required.
`Fourthly, the installation of hardware affixed to the spine
`Fourthly, the installation of hardWare af?Xed to the spine
`still requires a thoracotomy, albeit a smaller one if visual-
`still requires a thoracotomy, albeit a smaller one if visual
`ization is assisted via the thorascope.
`iZation is assisted via the thorascope.
`Fifthly, when, as is often the case, the patient requires all
`Fifthly, When, as is often the case, the patient requires all
`three, that is, discectomy (excision, in part or whole, of an
`three, that is, discectomy (excision, in part or Whole, of an
`intervertebral disc), fusion, and the application of hardware
`intervertebral disc), fusion, and the application of hardWare
`to the spine, those procedures are performed as serially (one
`to the spine, those procedures are performed as serially (one
`after the other) combined surgical procedures With added
`after the other) combined surgical procedures with added
`surgical times, complications, morbidities, and mortalities.
`surgical times, complications, morbidities, and mortalities.
`As regards to the human lumbar spine, the treatment of
`As regards to the human lumbar spine, the treatment of
`discal disease with neural compression has generally been
`discal disease With neural compression has generally been
`from a posterior (from behind) approach. This is sensible as
`from a posterior (from behind) approach. This is sensible as
`the lumbar discs are generally quite large and it is only those
`the lumbar discs are generally quite large and it is only those
`protrusions occurring posteriorly which compress the neural
`protrusions occurring posteriorly Which compress the neural
`elements which are themselves posterior to the discs. These
`elements Which are themselves posterior to the discs. These
`posterior approaches have included both true posterior
`posterior approaches have included both true posterior
`approaches and posterolateral approaches to the discs.
`approaches and posterolateral approaches to the discs.
`Further, such approaches have been made via open incisions
`Further, such approaches have been made via open incisions
`or through percutaneous stab wounds. In the latter case,
`or through percutaneous stab Wounds. In the latter case,
`instruments are inserted through the stab wounds and moni-
`instruments are inserted through the stab Wounds and moni
`tored by the use of radiographic imaging or the use of an
`tored by the use of radiographic imaging or the use of an
`endoscopic viewing device. While it
`is possible to also
`endoscopic vieWing device. While it is possible to also
`decompress a posterior disc herniation in the lumbar spine
`decompress a posterior disc herniation in the lumbar spine
`from an anterior approach (from the front) doing so requires
`from an anterior approach (from the front) doing so requires
`the removal of a very substantial portion or all of the disc
`the removal of a very substantial portion or all of the disc
`material in the front and mid portions of the disc thus leaving
`material in the front and mid portions of the disc thus leaving
`that disc incompetent and that spinal segment generally
`that disc incompetent and that spinal segment generally
`unstable. Therefore, such an anterior approach to the lumbar
`unstable. Therefore, such an anterior approach to the lumbar
`spine has been reserved for those instances where a fusion
`spine has been reserved for those instances Where a fusion
`is to be performed in conjunction with, and following such
`is to be performed in conjunction With, and folloWing such
`a disc removal.
`a disc removal.
`As regards to fusion, the application of bone or bone like
`As regards to fusion, the application of bone or bone like
`substances between bones to induce bony bridging, such
`substances betWeen bones to induce bony bridging, such
`procedures have been performed outside the vertebral bodies
`procedures have been performed outside the vertebral bodies
`and/or between the vertebral bodies. The latter being known
`and/or betWeen the vertebral bodies. The latter being knoWn
`as an interbody fusion. Such interbody fusions have been
`as an interbody fusion. Such interbody fusions have been
`performed from posterior, posterolateral and anterior. The
`performed from posterior, posterolateral and anterior. The
`adjective applying specifically to the direction from which
`adjective applying speci?cally to the direction from Which
`the bone grafts enter the intervertebral space. Interbody
`the bone grafts enter the intervertebral space. Interbody
`fusion from the posterior approach while still in use has been
`fusion from the posterior approach While still in use has been
`associated with significant complications generally related
`associated With signi?cant complications generally related
`to the fact that the delicate dural sac and the spine nerves
`to the fact that the delicate dural sac and the spine nerves
`cover the back of the disc space and are thus clearly in harms
`cover the back of the disc space and are thus clearly in harms
`way with such an approach. The posterolateral approach has
`Way With such an approach. The posterolateral approach has
`generally been utilized as a compliment to percutaneous
`generally been utiliZed as a compliment to percutaneous
`discectomy and has consisted of pushing tiny fragments of
`discectomy and has consisted of pushing tiny fragments of
`morsalized bone down through a tube and into the disc
`morsaliZed bone doWn through a tube and into the disc
`space.
`space.
`Anterior interbody spinal fusion is performed from a
`Anterior interbody spinal fusion is performed from a
`straight anterior position as regards the path of entry of the
`straight anterior position as regards the path of entry of the
`fusion material into the intervertebral space. Such an ante-
`fusion material into the intervertebral space. Such an ante
`rior position is achieved in one of two ways. First, by a
`rior position is achieved in one of tWo Ways. First, by a
`
`

`
`5,772,661
`5,772,661
`
`3
`3
`straight anterior approach Which requires that the peritoneal
`straight anterior approach which requires that the peritoneal
`cavity, which contains the intestines and other organs, be
`cavity, Which contains the intestines and other organs, be
`punctured twice, once through the front and once through
`punctured tWice, once through the front and once through
`the back on the way to the front of the spine; or secondly, by
`the back on the Way to the front of the spine; or secondly, by
`starting on the front of the abdomen off to one side and
`starting on the front of the abdomen off to one side and
`dissecting behind the peritoneal cavity on the way to the
`dissecting behind the peritoneal cavity on the Way to the
`front of the spine. Regardless of which approach to the front
`front of the spine. Regardless of Which approach to the front
`of the spine is used, and apart from the obvious dangers
`of the spine is used, and apart from the obvious dangers
`related to the dense anatomy and vital structures in that area,
`related to the dense anatomy and vital structures