Patent Publication Number: US-2023157689-A1

Title: Articulating pituitary rongeur for use with a cannula

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This U.S. non-provisional patent application claims the benefit of and/or priority under 35 U.S.C. § 119(e) to U.S. provisional patent application Ser. No. 63/282,444 filed Nov. 23, 2021 titled “Articulating Pituitary Rongeur,” the entire contents of which is specifically incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to instruments for spine procedures and, more particularly, to pituitary rongeurs. 
     BACKGROUND OF THE INVENTION 
     Many people contend with spine issues due to age, disease, trauma, congenital, and acquired complications and conditions. While some spine issues can be alleviated without surgery, other spine issues necessitate surgery. Spine surgery may entail removing a vertebral disc or disc material from the vertebral disc space between vertebrae of the spine. One such medical instrument used in spine surgery is known as a pituitary rongeur. A pituitary rongeur is used to obtain and remove vertebral discs and/or vertebral tissue (vertebral disc material) from a spine. A pituitary rongeur has jaws at a distal end of a shaft assembly that is manipulated by a handle. The jaws obtain and remove portions of the vertebral disc and/or tissue. The jaws may or may not have teeth. 
     Spine procedures such as minimally invasive spine surgery, micro spine surgery, and other spine procedures often use pituitary rongeurs. These types of procedures have advantages over conventional procedures such as reduction of trauma, better post operative recovery, less pain, and the like through use of specialized surgical instruments that are introduced into the body via a separate cannula which is inserted into the body through a small incision and positioned accordingly. When a pituitary rongeur is used, it is inserted into the previously positioned cannula until the jaws of the pituitary rongeur extend beyond the distal end of the inserted cannula. The jaws of the pituitary rongeur are then manipulated to obtain vertebral disc material (e.g. vertebral discs, disc material and/or other vertebral tissue) for removal from the body. The pituitary rongeur is then removed from the cannula where the acquired disc material and/or tissue can be removed from the jaw(s). Other instruments may be used for tissue extraction. 
     Heretofore, jaws of pituitary rongeurs have been fixed in co-axial orientation relative to a longitudinal axis of the pituitary rongeur. This limits reach of the jaws and thus the ability of the jaws to obtain more vertebral disc material from a single position of the cannula. 
     In view of the above, it would be advantageous to have a medical instrument fashioned as a pituitary rongeur for removing vertebral discs, disc tissue, and/or other vertebral tissue via a cannula, such as in a minimally invasive, micro invasive, or similar spine procedure, having an operating head with jaws that can extend beyond a perimeter and longitudinal axis of the cannula. It would furthermore be advantageous to have a pituitary rongeur medical instrument for use with a cannula during a minimally invasive, micro invasive or other spine procedure that may provide better access to the vertebral disc space, greater removal of vertebral discs/disc material, greater degree of sweep, and extension beyond the longitudinal axis of the cannula and of the elongated pituitary rongeur medical instrument. Other advantages are known but not enumerated. 
     The present pituitary rongeur medical instrument addresses the above and more. 
     SUMMARY OF THE INVENTION 
     A medical instrument is formed as a pituitary rongeur having jaws that articulate radially relative to a longitudinal axis of a shaft assembly of the pituitary rongeur for obtaining and removing vertebral discs, disc tissue, and other vertebral tissue (vertebral material) from vertebral disc spaces of a spine via a cannula, particularly, but not necessarily, during minimally invasive surgery, micro surgery, or similar spine procedure. 
     In one form, a handle trigger actuates a push rod (jaws control rod) that forces a wedge surface under a superior (upper) jaw portion of the jaws forcing its closure (for obtaining vertebral material) onto an inferior (lower) jaw portion of the jaws. The wedge surface feature of the push rod has a surface that facilitates articulation of superior jaw while the superior jaw is in line with the longitudinal axis of the instrument and in any position up to 90 degrees of jaw articulation. Jaws articulation is actuated via a pull rod (articulation control rod) that has a hinged interface with the inferior jaw portion. The jaw portions are forced into an open position via an integrated leaf spring. Operation of the pituitary rongeur permits insertion down an access tube (cannula, endoscope or the like), then, once articulated, can gather disc material from outside a perimeter (radially from) of the access tube. 
     The pituitary rongeur has a handle, a shaft assembly defining a proximal end extending from the handle, a distal end, and a longitudinal axis, upper and lower jaw portions forming a jaw or jaws pivotally connected to the distal end of the shaft assembly for articulating radial movement relative to the longitudinal axis of the shaft assembly, a first (jaws) controller associated with the shaft assembly and configured to controllably close and open the jaws, and a second (articulation) controller associated with the shaft assembly and configured to controllably articulate the jaws. 
     In one form, the handle is formed by a handgrip portion configured to receive a palm of a user and a lever portion with a finger loop configured to receive one or more fingers of the user. A double leaf spring is situated on and between the handgrip portion and the lever portion to provide tension between the handgrip portion and the lever portion when the handgrip portion and the lever portion are squeezed together during use, and to automatically return the lever portion to an initial state when squeezing of the handgrip portion and the lever portion has ceased. The handgrip portion may include a thumb hold. 
     The upper and/or lower jaw portions may or may not have teeth. Preferably, but not necessarily, the jaws are normally open. 
     Further aspects of the present invention will become apparent from consideration of the drawings and the following description of a form of the invention. A person skilled in the art will realize that other forms of the invention are possible and that the details of the invention can be modified in a number of respects without departing from the inventive concept. The following drawings and description are to be regarded as illustrative in nature and not restrictive. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention and its features will be better understood by reference to the accompanying drawings, wherein: 
         FIG.  1    is a view of a medical instrument formed as an articulating pituitary rongeur fashioned in accordance with the present principles for removing vertebral discs and tissue from a vertebral disc space of a spine via a cannula; 
         FIG.  2    is an enlarged view of a shaft assembly of the articulating pituitary rongeur of  FIG.  1   ; 
         FIG.  3    is an enlarged view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    with the jaws in a co-a axial position relative to the longitudinal axis of the shaft assembly and in a normally open position; 
         FIG.  4    is another enlarged view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    with the jaws in the co-axial position relative to the longitudinal axis of the shaft assembly and in the normally open position; 
         FIG.  5    is a further enlarged view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    with the jaws in the co-axial position relative to the longitudinal axis of the shaft assembly and in the normally open position; 
         FIG.  6    is an enlarged view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    with the jaws in a radially articulated position and in the normally open position; 
         FIG.  7    is another enlarged view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    with the jaws in another radially articulated position and in the normally open position, the view illustrating the range of articulation of the jaws/jaw assembly relative to the longitudinal axis of the shaft assembly; 
         FIG.  8    is a further enlarged view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    with the jaws in the radially articulated position of  FIG.  7    but in a semi-closed position; 
         FIG.  9    is a yet further enlarged view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    with the jaws in the radially articulated position of  FIG.  7    but in a closed position; 
         FIG.  10    is an enlarged side view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    taken along line  10 - 10  of  FIG.  9    with the jaws in the radially articulated position of  FIG.  7    and in the closed position; 
         FIG.  11    is another enlarged side view of the distal end of the shaft assembly and articulating jaws of the articulating pituitary rongeur of  FIG.  1    taken along line  11 - 11  of  FIG.  9    with the jaws in the radially articulated position of  FIG.  7    and in the closed position; 
         FIG.  12    is an enlarged view of a distal end of a cannula with the jaws of the articulating pituitary rongeur of  FIG.  1    shown emerging from the distal end of the cannula, in a co-axial position with the longitudinal axis of the shaft assembly, and in the closed position; 
         FIG.  13    is a further enlarged view of the distal end of the cannula with the jaws of the articulating pituitary rongeur of  FIG.  1    shown emerging from the distal end of the cannula, in a co-axial position with the longitudinal axis of the shaft assembly, and in the closed position as depicted in  FIG.  12   ; 
         FIG.  14    is a yet further enlarged view of the distal end of the cannula with the jaws of the articulating pituitary rongeur of  FIG.  1    shown emerged from the distal end of the cannula, in a co-axial position with the longitudinal axis of the shaft assembly, and in the closed position; 
         FIG.  15    is a still further enlarged view of the distal end of the cannula with the jaws of the articulating pituitary rongeur of  FIG.  1    shown emerged from the distal end of the cannula, in a co-axial position with the longitudinal axis of the shaft assembly, and in an open position; 
         FIG.  16    is a furthermore enlarged view of the distal end of the cannula with the jaws of the articulating pituitary rongeur of  FIG.  1    shown emerged from the distal end of the cannula, and in an open and radially articulated position; 
         FIG.  17    is a yet furthermore enlarged view of the distal end of the cannula with the jaws of the articulating pituitary rongeur of  FIG.  1    shown emerged from the distal end of the cannula, and in the closed and radially articulated position; 
         FIG.  18    is a still furthermore enlarged view of the distal end of the cannula with the jaws of the articulating pituitary rongeur of  FIG.  1    shown emerged from the distal end of the cannula, in a co-axial position with the longitudinal axis of the shaft assembly, and in the closed position; 
         FIG.  19    is an additional enlarged view of the distal end of the cannula with the jaws of the articulating pituitary rongeur of  FIG.  1    shown retracting into the distal end of the cannula, in a co-axial position with the longitudinal axis of the shaft assembly, and in the closed position; 
         FIG.  20    is an enlarged sectional side view of the jaws of the articulating pituitary rongeur of  FIG.  1    in the closed position; and 
         FIG.  21    is another enlarged sectional side view of the jaws of the articulating pituitary rongeur of  FIG.  1    in an open position. 
     
    
    
     For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiment illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, any alterations and further modifications in the described embodiment, and any further applications of the principles of the invention as described herein are contemplated as would normally occur to one skilled in the art to which the invention relates. 
     DETAILED DESCRIPTION OF THE INVENTION 
     Referring to  FIG.  1   , there is shown a medical instrument formed as an articulating pituitary rongeur, generally designated  10 , for use with an access tube such as, but not limited to, a cannula, endoscope or the like (collectively, cannula), in acquiring vertebral discs, vertebral tissue, and/or other tissue or material (not shown), from a vertebral disc space (not shown) between adjacent vertebra (not shown) of a spine (not shown) during a surgical spine procedure, preferably, but not necessarily, in minimally invasive or micro invasive spine surgery. The articulating pituitary rongeur  10  is made from one or more surgical grade materials. The articulating pituitary rongeur  10  has a handle assembly  12 , a shaft assembly  24  defining a proximal end  15  extending from the handle assembly  12 , a distal end  19 , and a longitudinal axis LA. A jaw assembly or simply, jaws  34  is pivotally connected to the distal end  19  of the shaft assembly  24  for articulating radial movement of the jaws  34  relative to the longitudinal axis LA of the shaft assembly  24 , and includes a first (jaw) control shaft  28  associated with the shaft assembly  24  and configured to control opening and closing of an upper jaw portion  36  of the jaws  34  relative to a lower jaw portion  35  of the jaws  34 , and a second (articulation) controller  30  associated with the shaft assembly  24  and configured to control articulation of the jaws  34 , the nomenclature first and second being arbitrary here and throughout unless specified otherwise. 
     The handle assembly  12  is characterized by a first handle portion  13  and a second handle portion  16  pivotally connected at pivot pin  27  to an upper handle portion  26  of the first handle portion  13 . The first handle portion  13  is preferably, but not necessarily, formed to accept a palm (not shown) of a hand (not shown) of a user (not shown) and preferably, but not necessarily, includes a flange  14  extending generally outward from the first handle portion  13  and formed to receive a thumb (not shown) of the user (not shown) as a thumb rest. The second handle portion  16  has a loop  17  formed at its distal end  33  that is styled to receive the three lower fingers—i.e. middle, ring, and pinkie (not shown), of the hand (not shown) of the user (not shown). The loop  17  may accommodate other fingers. The second handle portion  16  further includes a curved notch  18  axially above the finger loop  17  that is formed to receive an index or other finger (not shown) of the user&#39;s hand (not shown). Other configurations may be used and are contemplated. 
     The handle assembly  12  is configured to be normally in an open position as depicted in  FIG.  1    with the jaws  34  also normally in an open position as also depicted in  FIG.  1   . Situated between the first handle portion  13  and the second handle portion  17  is a spring assembly  20  fashioned as a double leaf spring having a first leaf spring  21  connected to a second leaf spring  22 . Other types of springs mat be used. The first leaf spring  21  is connected to an inside of the first handle portion  13  proximal to its distal end  23 , while the second leaf spring  22  is connected to an inside of the second handle portion  16  proximal to its distal end  33 . Application of pressure to (e.g. squeezing of) the second handle portion  17  towards the first handle portion  13  against tension of the double leaf spring  20  pivots the second handle portion  17  to close the jaws  34 . Release of pressure (squeezing) against the second handle portion  17  causes the spring assembly  20  to pivot the second handle portion  17  away from the first handle portion. 
     Referring additionally to  FIG.  2   , the shaft assembly  24  includes a main or stationary shaft  25  that extends from the upper handle portion  26  to the jaws  34 . The first control shaft  28  likewise extends from the upper handle portion  26  to the jaws  34 . The first control shaft  28  is connected to the main shaft  25  by a sliding attachment such that the first control shaft  28  can translate along the main shaft  25 . The first control shaft  28  is labeled twice in  FIGS.  1  and  2    to illustrate its extension length along the main shaft  25  such that axial movement along the longitudinal axis LA of the shaft assembly  24  provides control of the closing and opening of the upper jaw portion  36  of the jaws  34  relative to the lower jaw portion  35  of the jaws  34 , and may be considered a jaw control shaft. The first control shaft  28  is connected to the second handle portion  16  via a pin  29  creating a lever/lever action there-between, whereby squeezing of the second handle portion  16  towards the first handle portion  13  pivots the second handle portion  16  on the pivot pin  27  such that the jaw control shaft  28  axially moves toward the jaws  34 , while release of squeezing of the second handle portion  16  allows the spring assembly  20  to reverse pivot the second handle portion  16  relative to the first handle portion  13  which, in turn, axially moves the jaw control shaft  28  away from the jaws  34 . Axial movement of the jaw control shaft  28  toward the jaws  34 , closes the upper jaw portion  36  onto the lower jaw portion  35 , while axial movement of the jaw control shaft  28  away from the jaws  34  allows the upper jaw portion  36  to bias itself into an open position relative to the lower jaw portion assembly  35 . 
     Referring to  FIGS.  3 - 11 ,  20 , and  21   , the lower jaw portion  35  of the jaws  34  will now be described. The lower jaw portion  35  includes a base  48  with a lower jaw  46  having a lower jaw cavity  47 . A first lower jaw assembly boss  51  extends from a first lateral side of the base  48 , and a second lower jaw assembly boss  50  extends from a second lateral side of the base  48 . As best seen in  FIGS.  5 ,  20 , and  21   , the lower jaw portion  35  is pivotally connected to the main shaft  25  by a pivot post  54 . The main shaft  25  ends in a notch  56  that defines a ledge  57 . The ledge  57  has a bore  55  while the base  48  also includes a bore  39 . The pivot post  54  extends through the base bore  39  and the ledge bore  55  such that the base  48  pivots radially on and relative to the main shaft  25  and its longitudinal axis LA or 0°, which pivots the lower jaw portion  35 , and consequently the upper jaw portion  36  since the upper jaw portion  36  is connected to the lower jaw portion  35  as described below. The base  48  and thus the lower and upper jaw portions  35 ,  36  (jaws/jaw assembly) can swivel (articulate) generally laterally +90° to −90° relative to the longitudinal axis LA of 0° (see, e.g.  FIG.  7   ). The jaws/jaw assembly may only swivel (articulate) to one lateral side and thus only from 0° to 90° and back. 
     Articulation of the jaws  34  is controlled by a second (articulation) control shaft  30  that is connected to a lateral side of the main shaft  25  so as to slide along the lateral side of the main shaft  25 . Connection may be accomplished e.g., via a dovetail configuration between the main shaft  25  and the articulation control shaft  30 . Other configurations may be used. A flange  31  is provided at a distal end of the articulation control shaft  30  that is configured to allow a user use a finger or thumb to control longitudinal movement of the articulation control shaft  30 , which in turn articulates the jaws/jaw assembly  34  to swing radially to the left or right relative to distal end of the shaft assembly  24  and its longitudinal axis LA. 
     As best seen in  FIGS.  3  and  5   , the distal end of the articulation control shaft  30  has a notch  40  that defines a flange  41 . A control pin  42  extends downward from the flange  41  and into a slot  49  of the base  48 . Longitudinal movement of the articulation control shaft  30  in one axial direction on the shaft assembly articulates the jaws/jaw assembly  34  in a first radial (lateral) direction (from 0° to either +90° or −90°), while longitudinal movement of the articulation control shaft  30  in the opposite axial direction on the shaft assembly articulates the jaws/jaw assembly  34  in a second radial (lateral) direction (from 0° to either −90° or +90°) opposite the first radial direction. The nomenclature + and − being arbitrary. 
     The upper jaw portion  36  of the jaws  34  will now be described. The upper jaw portion  36  includes an upper jaw  44  having an upper jaw cavity  45 . The upper jaw cavity  45  and the lower jaw cavity  47  receive and hold vertebral disc tissue. As best seen in  FIGS.  20  and  21   , the upper jaw portion  36  also includes a second upper jaw portion boss  58  that is pivotally coupled to the first lower jaw portion boss  50  by a pivot pin  52 . While not seen in the Figures, the upper jaw portion  36  further includes a first upper jar portion boss  59  that is pivotally coupled to the first lower jaw portion boss  51  via the pivot pin  52 . The upper jaw portion  36  further includes a flat-topped end or flange  37  situated opposite the upper jaw  44  having a lower surface  53 . The lower surface  53  is configured to contact a slanted distal end  32  of the jaw control shaft  28 . The upper jaw portion  36  is biased to be normally in an open position as depicted in at least  FIGS.  3 - 6   . 
       FIGS.  3 - 5    depict the jaws  34  in the biased normally open position. The jaw control shaft  28  is in an axially rearward position and the articulation control shaft  30  in a neutral position wherein the jaws  34  are co-axial with the longitudinal axis LA of the shaft assembly  24 .  FIGS.  6  and  7    depict two lateral views of the jaws  34  in the biased normally open position with the jaw control shaft  28  in the axially rearward position but articulated into a generally +90° position by the articulation control shaft  30  being pulled axially rearward (i.e. toward the handle  12 ).  FIG.  8    depicts the lateral view of  FIG.  7    but with the upper jaw portion  36  partially closed through axial movement of the jaw control shaft  28  towards the jaw assembly wherein the slanted distal end  32  of the jaw control shaft  28  moves under the flat-topped end or flange  37  of the upper jaw portion  36  to contact the underside  53  to push the upper jaw  44  towards the lower jaw  46 .  FIG.  9    depicts the upper jaw portion  36  fully closed through further axial movement of the jaw control shaft  28  towards the jaws  34  wherein the slanted distal end  32  of the jaw control shaft  28  further moves under the flat-topped end or flange  37  of the upper jaw portion  36  to contact the underside  53  to further push the upper jaw  44  towards and onto the lower jaw  46 .  FIG.  10    depicts the view of  FIG.  9    taken along line  10 - 10  thereof.  FIG.  11    depicts the view of  FIG.  9    taken along line  11 - 11  thereof. 
     The articulating pituitary rongeur  10  is particularly, but not necessarily, intended and configured for minimally or micro invasive spine surgery or similar spine procedure, and thus the use of a cannula (access tube or tubes).  FIGS.  12 - 19    depict one such use, inferring if not describing, others along with the present figures.  FIGS.  12 - 19    also show a sequence or method of use of the articulating pituitary rongeur  10  with an exemplary cannula  60 . The cannula  60  has a central bore  62  and a slanted distal end  61 . In the sequence or method of  FIGS.  12 - 19   , the jaws/jaw assembly  34  is shown emerging from the end  61  of the cannula  60  wherein the jaws  34 , being constrained by the cannula  60  to be in the closed position, opens ( FIGS.  12 - 15   ). The sequence or method further shows the jaws  34  articulating to a radial position relative to the longitudinal axis LA of the shaft assembly  24  ( FIG.  16   ), then closing the upper jaw/jaw portion  44  onto the lower jaw/jaw portion  46  ( FIG.  17   ). Thereafter, while still closed (after obtaining disc tissue) the jaw assembly  34  retracts back into the cannula  60  for removal for the obtained disc material ( FIGS.  18 ,  19   ). The double-headed arrow of  FIG.  12    signifies the longitudinally axial movement of (emerging from and retracting into) the pituitary rongeur  10  within the cannula  60 . 
     While the invention has been illustrated and described in what is presently considered to be the most practical and preferred embodiment, it is to be understood that the invention is not to be limited to the disclosed embodiments, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims, which scope is to be accorded the broadest interpretation so as to encompass all such modifications and equivalent structures as permitted under the law. Accordingly, the scope of the present invention should be considered in terms of the following claims and is understood not to be limited to the details of structure and operation shown and described in the specification and drawings. 
     It should be understood that while the use of the word preferable, preferably, or preferred in the description above indicates that feature so described may be more desirable, it nonetheless may not be necessary and any embodiment lacking the same may be contemplated as within the scope of the invention, that scope being defined by the claims that follow. In reading the claims it is intended that when words such as “a,” “an,” “at least one” and “at least a portion” are used, there is no intention to limit the claim to only one item unless specifically stated to the contrary in the claim. Unless specifically stated to the contrary in the claim, the language “at least one of X, Y, and Z” should be interpreted as including both the conjunctive and disjunctive forms. Specifically, the language “at least one of X, Y, and Z” is intended to encompass the following permutations of X, Y, and Z: X alone; Y alone; Z alone; X and Y; X and Z; Y and Z; and X, Y, and Z. Further, when the language “at least a portion” and/or “a portion” is used the item may include a portion and/or the entire item unless specifically stated to the contrary.