Abstract:
An interbody insertion tool and cage for use during an interbody spinal fusion procedure is disclosed. In one aspect, the tool comprises a rod centrally located within the tool that has the ability to remain attached to the cage to aid in: coupling the tool to the cage, release of the tool from the cage, alignment of additional hardware, and insertion of materials within the hollow of the cage.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims priority under 35 U.S.C. §119(e) to U.S. Provisional Application Patent Application No. 61/745,922, filed on Dec. 26, 2012, which is hereby incorporated by reference in its entirety. 
     
    
     BACKGROUND 
       [0002]    1. Field 
         [0003]    The field of the invention relates to spinal surgery, and more particularly to methods, systems, and devices for spinal surgical procedures involving interbody fusions. 
         [0004]    2. Description of the Related Art 
         [0005]    Spinal surgery may be used to alleviate back pain and correct spinal disorders due to various causes including spinal disease, abnormalities, or trauma. Surgeons use spinal fusion during some forms of spinal surgery to join two or more vertebrae of a patient&#39;s spine. The procedure may include supplementary bone tissue in conjunction with the body&#39;s natural bone growth processes to fuse the vertebrae. Additionally, an interbody fusion cage (or spine cage) may be used in spinal fusion to maintain foraminal height and decompression. By fusing and/or aligning the spinal vertebrae, surgeons can reduce back pain and promote healing in the patient. 
         [0006]    Surgeons often encounter difficulty in the surgical procedures for installing spine cages. Disadvantages associated with prior art reduction methods and devices include complicated procedures and patient trauma. Thus, methods, systems, and devices for improved interbody fusion are desired. 
       SUMMARY OF CERTAIN EMBODIMENTS 
       [0007]    The present application relates to a tool used during spinal surgical procedures involving interbody fusions. Such procedures may include, but are not limited to, anterior lumbar interbody fusion (ALIF), oblique lumbar interbody fusion (OLIF), direct lateral interbody fusion (sometimes referred to as an XLIF or DLIF), posterior lumbar interbody fusion (PLIF) and transverse lumbar interbody fusion (TLIF). These procedures may also involve cervical interbody procedures most commonly in, but not limited to, anterior cervical discectomy fusion surgery (ACDF). During the procedure, a surgeon inserts and secures an interbody device into a void inside of the vertebra, which could be an implant sometimes called a vertebral replacement device (VBR) or between adjacent vertebra in the disc space which could be an implant commonly called a cage, so as to restrict motion in that vertebral segment of the spine. For simplicity, all devices used in the previously mentioned procedures, will be referred to as a “cage” herein. Disclosed herein is a novel tool and cage design for use during an interbody spinal fusion procedure. One embodiment of the tool described herein comprises a rod centrally located within the tool that has the ability to remain attached to the cage to aid in: coupling the tool to the cage, release of the tool from the cage, alignment of additional hardware, and insertion of materials within the hollow of the cage. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]      FIG. 1  is an exploded perspective view of one embodiment of an interbody insertion tool. 
           [0009]      FIG. 2  illustrates the tool of  FIG. 1  in various cage attachment portion configurations. 
           [0010]      FIG. 3A  is an elevational view of another embodiment of an interbody insertion tool engaged with a spinal cage. 
           [0011]      FIG. 3B  is a cross sectional view of the tool and spinal cage taken along line A-A of  FIG. 3A . 
           [0012]      FIGS. 4A-4C  are elevational views of a fixed tube welded component illustrated in  FIG. 1 .  FIG. 4D  is a cross-sectional view of the component taken along line A-A of  FIG. 4C . 
           [0013]      FIGS. 5A and 5B  are elevational views of an anterior inner rod component illustrated in  FIG. 1 . 
           [0014]      FIGS. 6A-6D  are elevational views of a main body component illustrated in  FIG. 1 . 
           [0015]      FIGS. 6E and 6F  are elevational views of the main body component illustrated in  FIG. 1 .  FIG. 6G  is a cross-sectional view of the main body component taken along line A-A of  FIG. 6E .  FIG. 6H  is a detail view of section B of  FIG. 6F . 
           [0016]      FIGS. 7A-7C  are elevational views of a locking head component illustrated in  FIG. 1 .  FIG. 7D  is a cross-sectional view of the locking head component taken along line A-A of  FIG. 7B .  FIG. 7E  is a detail view of section B of  FIG. 7D .  FIG. 7F  is a perspective view of the locking head component illustrated in  FIG. 1 . 
           [0017]      FIGS. 8A-8C  are elevational views of a thumb roller component illustrated in  FIG. 1 .  FIG. 8D  is a cross-sectional view of the thumb roller component taken along line A-A of  FIG. 8B .  FIG. 8E  is a perspective view of the thumb roller component illustrated in  FIG. 1 . 
           [0018]      FIGS. 9A-9C  are elevational views of an inner plug component illustrated in  FIG. 1 .  FIG. 9D  is a cross-sectional view of the inner plug component taken along line A-A of  FIG. 9A . 
           [0019]      FIGS. 10A-10D  are elevational views of a threaded T-handle component illustrated in  FIG. 1 .  FIG. 10E  is a detail view of section A of  FIG. 10C . FIG.  1 OF is a perspective view of the threaded T-handle component illustrated in  FIG. 1 . 
           [0020]      FIGS. 11A and 11B  are elevational views of a knurled nut component illustrated in  FIG. 1 .  FIG. 11C  is a cross-sectional view of the knurled nut component taken along line A-A of  FIG. 11B . 
           [0021]      FIGS. 12A-12C  are elevational views of an anterior insertion tool component illustrated in  FIG. 1 .  FIG. 12D  is a cross-sectional view of the anterior insertion tool component taken along line A-A of  FIG. 12A .  FIG. 12E  is a cross-sectional view of the anterior insertion tool component taken along line B-B of  FIG. 12B .  FIG. 12F  is a cross-sectional view of the anterior insertion tool component taken along line C-C of  FIG. 12C . 
           [0022]      FIGS. 13A-13C  are elevational views of a lateral insertion tool component illustrated in  FIG. 1 .  FIG. 13D  is a cross-sectional view of the lateral insertion tool component taken along line A-A of  FIG. 13A .  FIG. 13E  is a cross-sectional view of the lateral insertion tool component taken along line B-B of  FIG. 13B .  FIG. 13F  is a cross-sectional view of the lateral insertion tool component taken along line C-C of  FIG. 13C . 
           [0023]      FIGS. 14A-14C  are elevational views of an oblique insertion tool component illustrated in  FIG. 1 .  FIG. 14D  is a cross-sectional view of the oblique insertion tool component taken along line A-A of  FIG. 14A .  FIG. 14E  is a cross-sectional view of the oblique insertion tool component taken along line B-B of  FIG. 14B .  FIG. 14F  is a cross-sectional view of the oblique insertion tool component taken along line C-C of  FIG. 14C . 
           [0024]      FIGS. 15A and 15B  are elevational views of an oblique and lateral inner rod component illustrated in  FIG. 1 . 
           [0025]      FIG. 16A  is a perspective view of one embodiment of a spinal cage assembly for use with the interbody insertion tool of  FIG. 1 .  FIGS. 16B-16D  are elevational views of the cage assembly of  FIG. 16A .  FIG. 16E  is a cross-sectional view of the cage assembly taken along line A-A of  FIG. 16B .  FIGS. 16F-16J  are elevational views of the cage assembly of  FIG. 16A .  FIG. 16K  is a cross-sectional view of the cage assembly taken along line A-A of  FIG. 16J .  FIG. 16L  is a detail view of section B of  FIG. 16H . 
           [0026]      FIG. 17A  is an elevational view of another embodiment of a spinal cage assembly for use with the interbody insertion tool of  FIG. 1 .  FIG. 17B  is a cross-sectional view taken along line C-C of  FIG. 17A . 
           [0027]      FIG. 18A  is an elevational view of yet another embodiment of a spinal cage assembly for use with the interbody insertion tool of  FIG. 1 .  FIG. 18B  is a cross-sectional view taken along line C-C of  FIG. 18A . 
           [0028]      FIG. 19A  is an elevational view of still another embodiment of a spinal cage assembly for use with the interbody insertion tool of  FIG. 1 .  FIG. 19B  is a cross-sectional view taken along line D-D of  FIG. 19A .  FIG. 19C  is a detail view of section G of  FIG. 19B .  FIG. 19D  is a cross-sectional view taken along line E-E of  FIG. 19A .  FIG. 19E  is a detail view of section F of  FIG. 19D . 
           [0029]      FIG. 20A  is a perspective view of a spinal cage assembly marker pin according to one embodiment.  FIGS. 20B and 20C  are perspective views of the marker pin of  FIG. 20A . 
           [0030]      FIG. 21A  is a perspective view of a spinal cage assembly marker ring according to one embodiment.  FIGS. 21B and 21C  are perspective views of the marker ring of  FIG. 21  A. 
       
    
    
     DETAILED DESCRIPTION 
       [0031]    Any feature or combination of features described herein are included within the scope of the present invention provided that the features included in any such combination are not mutually inconsistent as will be apparent from the context, this description, and the knowledge of one skilled in the art. In addition, any feature or combination of features may be specifically excluded from any embodiment of the present invention. For purposes of summarizing the present invention, certain aspects, advantages, and novel features of the present invention are described herein. Of course, it is to be understood that not necessarily all such aspects, advantages, or features will be present in any particular embodiment of the present invention. 
         [0032]    In reference to the disclosure herein, for purposes of convenience and clarity only, directional terms, such as top, bottom, left, right, up, down, upper, lower, over, above, below, beneath, rear, and front may be used. Such directional terms should not be construed to limit the scope of the invention in any manner. It is to be understood that embodiments presented herein are by way of example and not by way of limitation. The intent of the following detailed description, although discussing exemplary embodiments, is to be construed to cover all modifications, alternatives, and equivalents of the embodiments as may fall within the spirit and scope of the invention. 
       Tool and Cage System 
       [0033]    Disclosed herein is a novel tool and cage design for use during an interbody spinal fusion procedure.  FIG. 1  illustrates an exploded view of an exemplary embodiment of the tool.  FIG. 3A  illustrates the tool of  FIG. 1  in an assembled condition, and  FIG. 3B  illustrates a cross section. The tool includes a cage attachment portion, a coupling portion, and a handle portion. The cage attachment portion of the tool is selected based upon the surgery to be performed (e.g., ALIF, OLIF, PLIF, TLIF, cervical interbody or any other procedure that involves an implant placed inside the disc space or vertebral body). The fully assembled tool, such as the embodiment illustrated in  FIG. 3A , has both a proximal and a distal end, the proximal end being located on the handle portion and the distal end being located on the cage attachment portion. Items  3 ,  5 ,  6 ,  9 , and  10  comprise the handle portion of the tool, items  1 ,  4 ,  7 ,  8 , and  12  comprise the coupling portion of the tool, and items  2  and  13 - 16  selectively comprise the cage attachment portion of the tool. 
         [0034]    During a spinal fusion operation, the surgeon may use the tool to insert a cage between vertebral bodies. The cage attachment portion of the tool is such that the cage securely couples to the tool to distribute the insertion force across the body of the cage. After the surgeon has inserted the cage into the spinal column, the surgeon may remove most of the tool from the cage by manipulating the coupling portion of the tool. When the most of the tool is removed in this manner, a rod from the cage attachment portion (e.g., inner rod  2  or  16 ) slides out of the tool, remaining engaged to the cage. With the rod remaining engaged to the cage, the surgeon is able to use it as an alignment reference for additional hardware used later in the procedure to secure the cage in place. Further, the rod may be cannulated to provide a fluidic connection between the proximal end of the rod and the interior of the cage. This allows the surgeon to inject a biologic or other therapeutic material directly into the operative site to improve patient healing and post-operative recovery. Thus, use of the tool has several benefits, including, but not limited to, secure coupling of the tool to the cage, the quick-release of the tool from the cage, the ability to precisely align additional hardware using the inner rod, and the ability to insert materials directly within the hollow of the cage. 
         [0035]    Referring simultaneously to  FIGS. 1 and 3B , the cage attachment portion of the tool may alternatively include an anterior inner rod  2  with an anterior insertion tool  13  or an oblique and lateral inner rod  16  with either a lateral insertion tool  14  or an oblique insertion tool  15  (depending on the surgical procedure to be performed). Assuming an ALIF procedure, a proximal end of anterior inner rod  2  is inserted through a fixed tube  1 . A locking head  4  on the coupling portion of the tool is moved into the coupling position to allow anterior inner rod  2  to pass through the coupling portion of the tool and engage a thumb roller  5  in the handle portion of the tool. A slot  42  on an outer surface of the anterior inner rod  2  aligns with an interface  50  (between the locking head  4  and the fixed tube  1 ) where locking balls  7  are present. With the anterior inner rod  2  engaged to the thumb roller  5 , the locking head  4  may be released. A spring  8  moves the locking head  4  into a locked position in which locking balls  7  protrude from the inner surface of the fixed tube  1 , engage the slot  42  and lock the anterior inner rod  2  to the handle portion and coupling portion of the tool. As mentioned, anterior inner rod  12  may be cannulated to provide a fluidic connection to the interior of a cage  100 . Anterior insertion tool  13  may then be slid over anterior inner rod  2 , a proximal end of the anterior insertion tool  13  engaging the keyed distal end of the fixed tube  1 . The anterior insertion tool  13  includes a threaded outer surface  30  near its proximal end to secure via knurled nut  12 . 
         [0036]    Distal ends of the anterior inner rod  2  and the anterior insertion tool  13  are formed to engage the cage  100  used in the spinal fusion. An anvil  20 , located on the distal end of anterior insertion tool  13 , distributes forces applied to the cage and stabilizes the cage-tool interface. The distal end of anterior insertion tool  13  includes an alignment reference  21  to align the cage  100  to the tool and to prevent rotation. An outer surface of the distal end of the anterior inner rod  2  is threaded so as to engage a threaded inner surface of the cage. In the fully assembled tool, the thumb roller  5  allows the surgeon to screw on and unscrew the cage from the tool. 
         [0037]    The handle portion of the tool includes a main body  3 , a thumb roller  5 , an inner plug  6 , and a threaded t-handle  10 , held together by a dowel pin  9 . The main body  3  has a proximal and distal end, and an inner and outer surface. The main body  3  may be cylindrical in shape, with an inner surface cavity to allow coaxial insertion of the thumb roller  5  and the inner plug  6 . The thumb roller  5  and the inner plug  6  are inserted at the proximal end of the main body  3 . A distal end of the thumb roller  5  includes a cavity to engage the anterior inner rod  2 . To secure the thumb roller  5  within the main body  3 , the inner plug  6  is inserted and secured via the dowel pin  9 . The main body  3  further includes at least one opening  25  to allow the surgeon to manipulate the housed thumb roller  5 . 
         [0038]    The main body  3  also includes holes for both liquid drainage and other hardware (e.g., dogpoint set screw  11 , dowel pin  9 , or threaded t-handle  10 ). The outer surface of the main body  3  may be formed so as to improve the surgeon&#39;s grip. The inner plug  6  may include a transaxial threaded hole that aligns with a hole in the main body  3  to allow insertion of the threaded t-handle  10 . The threaded t-handle  10  shown here is cylindrical in shape, having rounded ends and a threaded segment along a portion of its length to engage the threaded hole of inner plug  6 . 
         [0039]    The coupling portion of the tool is located between the cage attachment portion and the handle portion. The coupling portion includes the fixed tube  1 , the locking head  4 , locking balls  7 , the spring  8 , and the knurled nut  12 . The fixed tube  1  includes a proximal end and a distal end, and an inner and outer surface. The distal end of the fixed tube  1  is keyed to contact a portion of the cage attachment portion of the tool (e.g., anterior insertion tool  13 , lateral insertion tool  14 , or oblique insertion tool  15 ). The proximal end of the fixed tube  1  is inserted through the knurled nut  12 , the locking head  4 , and the spring  8  and then into the distal end of main body  3 . Locking balls  7  are provided so as to be positioned at an interface  50  between the fixed tube  1  and the locking head  4 . The fixed tube  1  is secured to the main body  3  via dogpoint set screws  11 . A flange  35  on the fixed tube  1  secures the knurled nut  12  so that knurled nut  12  may rotate and slide along a distance of the fixed tube  1  but does not slide off distal end of fixed tube  1  due to shoulder  40  contact with flange  35 . Knurled nut  12  includes an outer, knurled surface and an inner, threaded surface to secure insertion tool  13 . 
         [0040]    The fixed tube  1  further includes an alignment notch  22 . Locking head  4  is rotatably secured and aligned to fixed tube  1  via a dogpoint set screw  11  engaged to the alignment notch  22 . The alignment notch  22  allows the locking head  4  to slide between a first, locked position and a second, coupling position. The spring  8  is disposed between the locking head  4  and the main body  3  to force locking head  4  into the default locked position. In the locked position, an inner surface of the locking head  4  forces the locking balls  7  to protrude from the inner surface of the fixed tube  1  into the slot  42  on the inner rod  2 . By sliding the locking head  4  against the force of the spring  8 , a surgeon may move the locking head  4  into the coupling position. In the coupling position, a recess  60  within the inner surface of the locking head  4  allows the locking balls  7  to recede out of the slot  42 . 
         [0041]      FIG. 2  illustrates the tool in various cage attachment portion configurations. Although not illustrated, the cage may include internal channels in fluid communication with the distal end of a cannulated rod  2  or  16  to guide and/or route any injected or implanted therapeutic or other substance to a desired location in or around the cage. These channels may lead into both the interior cavity of the cage and or to the exterior of the cage so that the fluid can be introduced inside the cage or to immediate area outside of the cage. 
         [0042]      FIGS. 4A-21C  illustrate more detailed views of the various components of the interbody insertion tool of  FIG. 1 , as well as embodiments of spinal cage assemblies that can be used with the interbody insertion tool.  FIGS. 4A-4C  are elevational views of a fixed tube welded component illustrated in  FIG. 1 .  FIG. 4D  is a cross-sectional view of the component taken along line A-A of  FIG. 4C .  FIGS. 5A and 5B  are elevational views of an anterior inner rod component illustrated in  FIG. 1 .  FIGS. 6A-6D  are elevational views of a main body component illustrated in  FIG. 1 .  FIGS. 6E and 6F  are elevational views of the main body component illustrated in  FIG. 1 .  FIG. 6G  is a cross-sectional view of the main body component taken along line A-A of  FIG. 6E .  FIG. 6H  is a detail view of section B of  FIG. 6F .  FIGS. 7A-7C  are elevational views of a locking head component illustrated in  FIG. 1 .  FIG. 7D  is a cross-sectional view of the locking head component taken along line A-A of  FIG. 7B .  FIG. 7E  is a detail view of section B of  FIG. 7D .  FIG. 7F  is a perspective view of the locking head component illustrated in  FIG. 1 .  FIGS. 8A-8C  are elevational views of a thumb roller component illustrated in  FIG. 1 .  FIG. 8D  is a cross-sectional view of the thumb roller component taken along line A-A of  FIG. 8B .  FIG. 8E  is a perspective view of the thumb roller component illustrated in  FIG. 1 .  FIGS. 9A-9C  are elevational views of an inner plug component illustrated in  FIG. 1 .  FIG. 9D  is a cross-sectional view of the inner plug component taken along line A-A of  FIG. 9A .  FIGS. 10A-10D  are elevational views of a threaded T-handle component illustrated in  FIG. 1 .  FIG. 10E  is a detail view of section A of  FIG. 10C . FIG.  1 OF is a perspective view of the threaded T-handle component illustrated in  FIG. 1 .  FIGS. 11A  and  11 B are elevational views of a knurled nut component illustrated in  FIG. 1 .  FIG. 11C  is a cross-sectional view of the knurled nut component taken along line A-A of  FIG. 11B .  FIGS. 12A-12C  are elevational views of an anterior insertion tool component illustrated in  FIG. 1 .  FIG. 12D  is a cross-sectional view of the anterior insertion tool component taken along line A-A of  FIG. 12A .  FIG. 12E  is a cross-sectional view of the anterior insertion tool component taken along line B-B of  FIG. 12B .  FIG. 12F  is a cross-sectional view of the anterior insertion tool component taken along line C-C of  FIG. 12C .  FIGS. 13A-13C  are elevational views of a lateral insertion tool component illustrated in  FIG. 1 .  FIG. 13D  is a cross-sectional view of the lateral insertion tool component taken along line A-A of  FIG. 13A .  FIG. 13E  is a cross-sectional view of the lateral insertion tool component taken along line B-B of  FIG. 13B .  FIG. 13F  is a cross-sectional view of the lateral insertion tool component taken along line C-C of  FIG. 13C .  FIGS. 14A-14C  are elevational views of an oblique insertion tool component illustrated in  FIG. 1 .  FIG. 14D  is a cross-sectional view of the oblique insertion tool component taken along line A-A of  FIG. 14A .  FIG. 14E  is a cross-sectional view of the oblique insertion tool component taken along line B-B of  FIG. 14B .  FIG. 14F  is a cross-sectional view of the oblique insertion tool component taken along line C-C of  FIG. 14C .  FIGS. 15A and 15B  are elevational views of an oblique and lateral inner rod component illustrated in  FIG. 1 . 
         [0043]      FIG. 16A  is a perspective view of one embodiment of a spinal cage assembly for use with the interbody insertion tool of  FIG. 1 .  FIGS. 16B-16D  are elevational views of the cage assembly of  FIG. 16A .  FIG. 16E  is a cross-sectional view of the cage assembly taken along line A-A of  FIG. 16B .  FIGS. 16F-16J  are elevational views of the cage assembly of  FIG. 16A .  FIG. 16K  is a cross-sectional view of the cage assembly taken along line A-A of  FIG. 16J .  FIG. 16L  is a detail view of section B of  FIG. 16H .  FIG. 17A  is an elevational view of another embodiment of a spinal cage assembly for use with the interbody insertion tool of  FIG. 1 .  FIG. 17B  is a cross-sectional view taken along line C-C of  FIG. 17A .  FIG. 18A  is an elevational view of yet another embodiment of a spinal cage assembly for use with the interbody insertion tool of  FIG. 1 .  FIG. 18B  is a cross-sectional view taken along line C-C of  FIG. 18A .  FIG. 19A  is an elevational view of still another embodiment of a spinal cage assembly for use with the interbody insertion tool of  FIG. 1 .  FIG. 19B  is a cross-sectional view taken along line D-D of  FIG. 19A .  FIG. 19C  is a detail view of section G of  FIG. 19B .  FIG. 19D  is a cross-sectional view taken along line E-E of  FIG. 19A .  FIG. 19E  is a detail view of section F of  FIG. 19D . 
         [0044]      FIG. 20A  is a perspective view of a spinal cage assembly marker pin according to one embodiment.  FIGS. 20B and 20C  are perspective views of the marker pin of  FIG. 20A .  FIG. 21A  is a perspective view of a spinal cage assembly marker ring according to one embodiment.  FIGS. 21B and 21C  are perspective views of the marker ring of  FIG. 21  A. 
         [0045]    The above-described embodiments have been provided by way of example, and the present invention is not limited to these examples. Multiple variations and modifications to the disclosed embodiments will occur, to the extent not mutually exclusive, to those skilled in the art upon consideration of the foregoing description. Additionally, other combinations, omissions, substitutions and modifications will be apparent to the skilled artisan in view of the disclosure herein. Accordingly, the present invention is not intended to be limited by the disclosed embodiments.