Source: http://www.google.com/patents/US20080287996?dq=7,446,777
Timestamp: 2016-10-27 09:24:56
Document Index: 478143150

Matched Legal Cases: ['arts 130', 'art 130', 'art 150', 'art 130', 'art 150', 'art 130', 'art 130', 'art 150', 'arts 130', 'arts 130', 'arts 130', 'arts 130', 'arts 130', 'art 130', 'art 150']

Patent US20080287996 - Method and device for treating scoliosis - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsThis invention relates to a spinal facet cap for treating scoliosis, the facet cap comprising a shim portion for inserting into a facet joint of a spine, and an alignment portion for maintaining alignment of the shim portion within the facet joint. The invention also provides a method for treating scoliosis,...http://www.google.com/patents/US20080287996?utm_source=gb-gplus-sharePatent US20080287996 - Method and device for treating scoliosisAdvanced Patent SearchTry the new Google Patents, with machine-classified Google Scholar results, and Japanese and South Korean patents.Publication numberUS20080287996 A1Publication typeApplicationApplication numberUS 12/068,850Publication dateNov 20, 2008Filing dateFeb 12, 2008Priority dateFeb 16, 2001Also published asCA2437575A1, CA2437575C, US7371238, US8070777, US20020151895, US20060200137, WO2002065954A1Publication number068850, 12068850, US 2008/0287996 A1, US 2008/287996 A1, US 20080287996 A1, US 20080287996A1, US 2008287996 A1, US 2008287996A1, US-A1-20080287996, US-A1-2008287996, US2008/0287996A1, US2008/287996A1, US20080287996 A1, US20080287996A1, US2008287996 A1, US2008287996A1InventorsDonald A. Soboleski, Gerald A.B. Saunders, Daniel P. BorschneckOriginal AssigneeSoboleski Donald A, Saunders Gerald A B, Borschneck Daniel PExport CitationBiBTeX, EndNote, RefManPatent Citations (99), Referenced by (24), Classifications (14), Legal Events (3) External Links: USPTO, USPTO Assignment, EspacenetMethod and device for treating scoliosis
US 20080287996 A1Abstract
1. The outer cortex of the lamina and spinous processes is removed so that raw cancellous bone is exposed. 2. Posterior facet joints are destroyed and usually autogenous bone graft added. Graft is usually placed along the entire fusion area. The fusion extends from one vertebra above the superior end-vertebra involved in the curvature to two below the inferior end-vertebra of the curve. 3. Spinal instrumentation is applied. A distraction rod allows the spine to be ‘jacked’ up on the concave side of the curve. A compression assembly may be used on the convex side of the curve to ‘pull’ the curve straight. Anchors, laminar hooks, and/or wires are placed around the lamina to provide fixation for the rods. [0009] Yet other surgical procedures involve memory metal implants (Sanders, A Memory Metal Based Scoliosis Correction System, CIP-Data Koninklijke Bibliotheek, Den Haag, 1993), fusion of vertebra anteriorly, using anterior cages (e.g., Harms cage, from DePuy-AcroMed Inc.). Nevertheless, it is clear that available procedures have drawbacks including the requirement for substantial prosthetic implants (see Mohaideen et al., Pediatr. Radiol. 30:110-118 (2000) for a review) and complicated surgical procedures, often only partly correct scoliotic deformities, and result in reduced flexibility of the spine.
[0041] In one aspect, the invention provides a prosthetic device for treating scoliosis by substantially or completely correcting asymmetry between left and right facet joints of vertebrae. The prosthetic device, generally referred to as a spinal facet cap, is surgically implanted into a spinal facet joint at any level in the spine. Surgically implanting one or more spinal facet cap(s) is carried out with minimal or no modification of the facet joint(s) involved; thus, the invention provides for the correction of left-right asymmetry of facet joints while preserving the facet joints. In this respect the invention is unlike any known procedures for treating scoliosis.
[0044] In some embodiments, the opposed surfaces are parallel (i.e., coplanar), such that the shim portion is of substantially uniform thickness. In other embodiments, the opposed surfaces are not coplanar, such that the shim portion is not of uniform thickness and is generally wedge-shaped. In embodiments where the opposed surfaces are not coplanar, the surfaces can be sloped along a common axis so as to form a simple angle. The angle separating the opposed surfaces can be, for example, from 0� (coplanar) to about 40�, preferably about 0� to about 20�. In other embodiments, the slopes of the opposed surfaces form a compound angle in which the slopes are not aligned on a common axis. It will be appreciated that the direction of slope is appropriately chosen to correct a facet joint for a given abnormality of curvature (e.g., kyphosis, lordosis, etc.).
[0051] In FIG. 3F there is shown another embodiment of a spinal facet cap according to the invention in which the shim portion 80 has an alignment portion comprising a facet hook 88 on the edge of the surface 87 that engages the superior facet, substantially opposite the tongue 82, and another facet hook 84 on the edge of the surface 86 that engages the inferior facet, toward the tongue 82. In further embodiments, only one of either facet hook 84 or facet hook 88 is present. The facet hook can vary in the extent of the curvature of the hook and thus the extent to which the hook encompasses the inferior/superior facet. For example, in some embodiments the curvature of the facet hook can be reduced so that the hook extends from the shim portion in a 90� arc, whereas in other embodiments the hook extends from the shim portion in a 180� arc.
[0052] Although not shown in the drawings, it will be appreciated that embodiments of the invention such as those shown in FIGS. 3A to 3D and 3F can be provided with an orifice passing through the shim portion, for accepting a pin, screw, or the like driven through at least one of the inferior and superior facets, to thereby contribute to maintaining alignment of the spinal facet cap. In particular, in the embodiment of FIG. 3F, each of the facet hook 84, shim portion 80, and facet hook 88 can be provided with an orifice, the three orifices having a common longitudinal axis, so as to accommodate a pin or screw disposed through the facet hook 84, the inferior facet, the shim portion 80, the superior facet, and the facet hook 88. Also not shown in the figures are embodiments in which the shin, portion is sloped in the opposite direction to that shown (i.e., a directive relative to the tongue 18 in FIG. 3A).
[0055] In a further embodiment, the distance between facet hooks, and/or the angle of the shim portion (i.e., the extent to which the shim portion is wedge-shaped) can be adjusted. An example of this embodiment is shown in FIG. 5. FIG. 5A shows this embodiment, denoted by reference numeral 120, in side and plan views, which comprises two parts 130 and 150. FIG. 5B shows part 130 in side and plan views, and FIG. 5C shows part 150 in side and plan views. Part 130 comprises a plate 134, an inferior facet hook 132 disposed on a first surface of the plate 134, and a tongue 140 and two rows of teeth 138 disposed on the opposite surface of the plate 134. An orifice 136 accommodates a cortical screw (not shown). Part 150 comprises a plate 154, a superior facet hook 152 disposed on a first surface of the plate 154, and two rows of teeth 158 disposed on the opposite surface of the plate 154. A longitudinal opening 156 is provided in the plate 154, for accepting the tongue 140 of part 130 in a sliding fit. As can be seen from FIG. 5A, part 130 mates with part 150 such that tongue 140 fits in opening 156 and teeth 138 mesh with teeth 158, and the inferior and superior facet hooks 132 and 152 are opposed. When mated, plates 134 and 154 comprise the shim portion. Preferably, the teeth comprising each set of teeth 138 and 158 are asymmetrical, such that meshing of the two sets of teeth forms a ratchet that allows parts 130 and 150 to slide relative to each other in one direction, but not the other. Preferably, such ratchet allows parts 130 and 150 to slide in a direction which brings the inferior and superior facet hooks closer together, and prevents the facet hooks from sliding further apart. Thus, to use this embodiment to correct a facet joint, parts 130 and 150 are first mated such that the facet hooks are farthest apart, and the so-assembled facet cap is inserted into a facet joint of a patient. The distance between the facet hooks is then reduced by sliding parts 130 and 150 together, to fit the facet joint being corrected and to provide the desired amount of correction. In variations of this embodiment, either or both of plates 134 and 154 can be wedge-shaped, so that as parts 130 and 150 slide relative to each other, the amount of shim provided to a facet joint can be adjusted. Further, such wedge-shape of part 130 and/or part 150 can be tapered in any direction relative to the facet hook, so as to provide correction for any type of facet joint asymmetry (e.g., lordosis, kyphosis, etc.). It will be appreciated that the facet hooks in this embodiment could be substituted for ridges, bosses, etc, as discussed in respect of the alignment portion of the above embodiments.
[0062] Pre-operative planning is based on the standard standing radiograph of the spine. The most accessible inferior vertebral body demonstrating tilting relative to pelvis is identified. The inferior tilting of the vertebra is measured to determine the appropriate thickness of the shim portion and distance between facet hooks of the facet cap. The next superior adjacent facet may also be targeted as a sight for correction. More superiously in the spine the apex of the scoliotic curve is identified. A measurement of the interior tilt of this vertebra is obtained along the concave aspect of the scoliotic curvature. A facet cap having a shim of appropriate thickness and distance between facet hooks is placed at this level and the next superior adjacent facet may also be targeted.
[0063] The patient is placed prone, supported by bolsters over ASIS and upper chest with care to keep pressure off the abdomen. After preparing the skin the back is draped to expose the midline of the back.
[0064] A midline incision is made over the spinous processes over the appropriate levels (see pre-operative planning). The linea between the left and right paravertebral muscles is dissected down to the spinous processes. Localization of the vertebral levels is checked by AP radiograph. The paravertebral muscles are then reflected laterally along the lamina to the facet joints. Care is taken to maintain the integrity of the facet ligaments. Further soft tissue dissection is then performed to expose the transverse processes.
[0065] The facet joint, which is to receive the facet cap, is then stripped of the joint capsule and posterior pericapsular ligament. Care is taken to leave the facet cartilage intact. The contra lateral facet joint is then stripped of ligament and capsule. The facet joint cartilage on the contra lateral facet joint is excised to bleeding subchondral bone. A laminar spreader is placed between the superior and inferior transverse processes on the side of the spine to receive the facet cap. The laminar spreader is distracted to open the space in the ipslateral facet joint. The facet cap is then placed in the facet joint and laminar spreader removed. Correct placement of the facet cap should allow for maintenance of the distraction created by the laminar spreader. The bone is then decorticated, autologus bone graft placed along both sides of the transverse processes, facet and lamina. AP and lateral radiographs are taken to assess position and affect of the facet cap. The paravertebral muscle is then approximated and skin closed.
[0066] Male patient 16 years old with 70 degree thoracic curve and 95 degree neuromuscular kypho-scoliosis (Kingston, Ontario, Canada). The pre-operative plan for facet cap placement was to assess the possibility of seating a facet cap like that of FIG. 3F in the lumbar facet joint between the L1 and L2 lumbar vertebrae.
[0067] The posterior spine was prepared in the standard fashion, described above. After the L1-L2 lumbar vertebrae facet was stripped of the capsule the joint was inspected. No space was available to open the facet joint so that the facet cap could be inserted. However, it is expected that could the facet joint have been opened, the facet position could be altered to allow the facet cap to be seated.
[0068] Female patient 14 years old with 54 degree King II idiopathic scoliosis (Kingston, Ontario, Canada). The pre-operative plan was for facet cap placement in the L1-L2 lumbar facet joint, and the T6-T7 thoracic facet joint. The use of laminar spreader distraction between the facet joint aided in facet joint alignment, as did the addition of a small metal dissector into the joint for space creation and facet cap placement.
[0069] The posterior spine was prepared in the standard fashion as described above. After the L1-L2 lumbar vertebrae facet was stripped of the capsule, a blunt osteotome was placed in the inferior joint and wedged the joint open. Concurrently a laminar spreader was placed between L1 and L2 and distracted. These two manoeuvres opened the facet joint and subjectively corrected the scoliosis in this segment. However, the facet cap like that of FIG. 3B could not be inserted because it was the wrong size for this patient. In particular, the facet hook pattern (radius) of the superior and inferior facet hooks of the facet cap was too narrow and the overall length of the facet cap too long. It is expected that changing the radius of the facet hooks to a range of about 5 mm to about 1 cm, and the overall length of the facet cap to a range of about 1.5 cm to about 2.5 cm would have been appropriate. The thoracic facet was addressed, and it was found that the superior facet hook obscured implantation of the facet cap in this patient and the facet cap could not be inserted. It is expected that rotation of the inferior facet hook by about 30 degrees from parallel to the facet cap to the right, for right insertion, and to the left for left insertion, would have facilitated implantation of the facet cap in this patient.
[0070] Female patient 16 years old with 45 degree thoracic curve and 95 degree kyphosis neuromuscular kypho-scoliosis (Kingston, Ontario, Canada). The pre-operative plan was to place modified facet caps (FIGS. 9A and 9B) into the L2-L3 lumbar facet joint and T7-T8 thoracic facet joint.
[0071] The posterior spine was prepared in the standard fashion, described above. Using the technique described above the L2-L3 facet joint was opened and a facet cap like that shown in FIG. 9B was inserted. This is shown in FIG. 10B, where reference numeral 400 refers to the facet cap, with superior facet hook 410 and inferior facet hook 420 partially visible. Also shown in FIG. 10B are several Moss� Miami (DePuy-AcroMed Inc.) laminar hooks 430 placed around vertebral laminae, for use with rods for the standard corrective procedure. The facet cap subjectively corrected the scoliosis at this level. The T7-T8 facet joint was prepared and a facet cap like that shown in FIG. 9A was inserted, as shown in FIG. 10A where reference numeral 300 denotes the facet cap. The inferior facet hook 320 can be seen clearly. Also visible are several Moss� Miami (DePuy-AcroMed Inc.) laminar hooks 330 placed around vertebral laminae, for use with rods for the standard corrective procedure. The facet cap subjectively corrected the scoliosis at this level. Dimensions of the facet caps used in this example are provided in the below table.
[0072] Variants to the embodiments described above will be apparent to those skilled in the art. Such variants are within the scope of the present invention and are covered by the below claims.
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