JP2020529248A - 骨アンカー又は他の取り付け点を使用して近位隣接椎間後弯変形のリスクを低減するためのシステム及び方法 - Google Patents
骨アンカー又は他の取り付け点を使用して近位隣接椎間後弯変形のリスクを低減するためのシステム及び方法 Download PDFInfo
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Abstract
Description
(1) 外科的方法であって、
主要構造体を患者の脊椎に取り付けることであって、前記主要構造体は、最上部の機器が装着された椎骨(UIV)と最下部の機器が装着された椎骨(LIV)との間に延在する、取り付けることと、
可撓性の長手方向延長部を第1の取り付け点に取り付けることであって、前記第1の取り付け点は、前記主要構造体の前記UIVよりも上位に配置されている、取り付けることと、
前記延長部を前記患者の脊椎に対して位置決めすることと、
前記延長部を第2の取り付け点に取り付けることであって、前記第2の取り付け点は、前記主要構造体の前記UIVに配置されているか又は前記UIVよりも下位に配置されている、取り付けることと、を含む、外科的方法。
(2) 前記第1の取り付け点が、前記主要構造体の前記UIVよりも上位に配置された椎骨に埋め込まれた骨アンカーを含む、実施態様1に記載の方法。
(3) 前記第1の取り付け点が、前記主要構造体の前記UIVよりも少なくとも2レベル上位の椎骨レベルである、実施態様1に記載の方法。
(4) 前記第2の取り付け点が、前記主要構造体の剛性脊椎ロッドを含む、実施態様1に記載の方法。
(5) 前記延長部が硬さを有し、前記硬さは、前記主要構造体の前記UIVよりも上位の患者の解剖学的構造の硬さよりも高く、かつ前記主要構造体の硬さよりも低い、実施態様1に記載の方法。
(7) 前記延長部が、前記脊椎の屈曲を完全に防止することなく、そのような屈曲を制限する、実施態様1に記載の方法。
(8) 前記主要構造体が装着された椎骨が、互いに融合されるか、又はそのような融合のために準備され、前記延長部によって前記主要構造体が延在している椎骨は、融合されないか、又は融合のために準備されない、実施態様1に記載の方法。
(9) 前記主要構造体が、それぞれの骨アンカーによって第1及び第2の椎骨に取り付けられた剛性脊椎ロッドを含む、実施態様1に記載の方法。
(10) 一次切開部を形成することを更に含み、前記主要構造体は、前記一次切開部を通して埋め込まれている、実施態様1に記載の方法。
(12) 前記延長部がポリマーテザーを含む、実施態様1に記載の方法。
(13) 前記延長部が、前記患者の脊椎に伸展力を加える、実施態様1に記載の方法。
(14) 前記第1の取り付け点が肋骨である、実施態様1に記載の方法。
(15) 前記第1の取り付け点が、前記患者の軟組織構造である、実施態様1に記載の方法。
(17) 前記延長部は、前記延長部がねじ込まれている骨アンカーによって前記第1の取り付け点に取り付けられている、実施態様1に記載の方法。
(18) 前記延長部を前記第1の取り付け点に取り付けることは、前記延長部が骨アンカーからドライバ器具のシャフトを通って延在している状態で、前記骨アンカーを骨に打ち込むことを含む、実施態様1に記載の方法。
(19) 前記延長部を位置決めすることは、前記延長部を、前記主要構造体が埋め込まれている一次切開部よりも上位に配置された二次切開部に通すことを含む、実施態様1に記載の方法。
(20) 前記延長部を位置決めすることが、前記延長部を前記二次切開部に通し、次いで前記延長部を前記主要構造体に向かって下位方向に押す及び/又は引っ張ることと、前記延長部を、前記二次切開部と前記主要構造体との中間に配置された皮膚及び/又は軟組織の下に通すことと、を含む、実施態様19に記載の方法。
(22) 前記延長部を位置決めすることが、挿入器具を前記二次切開部に通すことと、前記延長部を前記挿入器具に連結することと、前記挿入器具及びそれに連結された前記延長部を、前記二次切開部と前記主要構造体との中間に配置された皮膚及び/又は軟組織の下で、前記主要構造体に向かって下位方向に押すことと、を含む、実施態様19に記載の方法。
(23) 前記延長部を位置決めすることは、前記主要構造体が埋め込まれている一次切開部を通して前記延長部を挿入することと、前記第1の取り付け点と前記一次切開部との中間に配置された皮膚及び/又は軟組織の下で前記延長部を誘導しながら、前記延長部を、前記第1の取り付け点に向かう上位方向に通すことと、を含む、実施態様1に記載の方法。
(24) 前記延長部が、コネクタによって前記第2の取り付け点に取り付けられている、実施態様1に記載の方法。
(25) 前記コネクタが、前記延長部を、前記主要構造体の脊椎ロッド又は骨ネジに締め付ける、実施態様24に記載の方法。
(27) 前記延長部を位置決めすることは、前記延長部を、前記主要構造体が埋め込まれている一次切開部から、前記第1の取り付け点まで上方に通すことを含み、前記延長部は前記患者の皮膚及び/又は軟組織の下を通り、前記延長部を前記第1の取り付け点に取り付けることが、前記延長部に取り付けられたフックを前記第1の取り付け点に引っ掛けること、又は前記延長部に取り付けられたクランプを前記第1の取り付け点に締め付けることを含む、実施態様1に記載の方法。
(28) 前記延長部が前記第1の取り付け点及び前記第2の取り付け点に取り付けられているとき、前記延長部のいかなる部分も、前記患者の脊椎の任意の椎弓板の前方に配置されていない、実施態様1に記載の方法。
(29) 外科的方法であって、
患者に一次切開部を形成することと、
前記一次切開部を介して前記患者の脊椎に主要構造体を取り付けることと、
前記一次切開部よりも上位の位置において、前記患者に二次切開部を形成することと、
骨アンカーに細長い可撓性テザーが取り付けられた状態で、前記二次切開部を通して前記骨アンカーを挿入することと、
前記骨アンカーを第1の取り付け点において骨に打ち込み、それによって、前記テザーの一部が前記二次切開部を通って前記患者の外部の位置まで延在している間に、前記テザーを前記第1の取り付け点に取り付けることと、
前記一次切開部と前記二次切開部との中間に配置された軟組織の下で前記テザーを掘進させることと、
前記一次切開部を介して前記テザーを前記主要構造体に取り付けることと、を含む、外科的方法。
(30) 前記テザーを掘進させることが、前記二次切開部を通して挿入器具を挿入することと、前記器具を前記一次切開部に向かって下方に押すことと、を含む、実施態様29に記載の方法。
(32) 前記テザーが、前記挿入器具に取り付けられ、かつ前記挿入器具と同じ経路に沿って運ばれ、それによって、前記テザーが前記第1の取り付け点と前記主要構造体との間の前記患者の脊椎に沿って延在するように、前記テザーを位置決めする、実施態様30に記載の方法。
(33) 外科用システムであって、
剛性脊椎固定ロッドと、前記脊椎ロッドを第1及び第2の椎骨に取り付けるように構成された第1及び第2の骨アンカーとを含む、主要構造体と、
テザーアンカーに取り付けられた細長い可撓性テザーと、
前記テザーが前記テザーアンカーから延在している間に前記テザーアンカーを骨に打ち込むためのドライバ器具と、
前記テザーを前記主要構造体の前記脊椎ロッドに締め付けるように構成されたコネクタと、を備える、外科用システム。
Claims (33)
- 外科的方法であって、
主要構造体を患者の脊椎に取り付けることであって、前記主要構造体は、最上部の機器が装着された椎骨(UIV)と最下部の機器が装着された椎骨(LIV)との間に延在する、取り付けることと、
可撓性の長手方向延長部を第1の取り付け点に取り付けることであって、前記第1の取り付け点は、前記主要構造体の前記UIVよりも上位に配置されている、取り付けることと、
前記延長部を前記患者の脊椎に対して位置決めすることと、
前記延長部を第2の取り付け点に取り付けることであって、前記第2の取り付け点は、前記主要構造体の前記UIVに配置されているか又は前記UIVよりも下位に配置されている、取り付けることと、を含む、外科的方法。 - 前記第1の取り付け点が、前記主要構造体の前記UIVよりも上位に配置された椎骨に埋め込まれた骨アンカーを含む、請求項1に記載の方法。
- 前記第1の取り付け点が、前記主要構造体の前記UIVよりも少なくとも2レベル上位の椎骨レベルである、請求項1に記載の方法。
- 前記第2の取り付け点が、前記主要構造体の剛性脊椎ロッドを含む、請求項1に記載の方法。
- 前記延長部が硬さを有し、前記硬さは、前記主要構造体の前記UIVよりも上位の患者の解剖学的構造の硬さよりも高く、かつ前記主要構造体の硬さよりも低い、請求項1に記載の方法。
- 前記延長部が、脊椎運動制限の程度を有し、前記脊椎運動制限の程度は、前記主要構造体の前記UIVよりも上位の患者の解剖学的構造の脊椎運動制限の程度よりも大きく、かつ前記主要構造体の脊椎運動制限の程度よりも小さい、請求項1に記載の方法。
- 前記延長部が、前記脊椎の屈曲を完全に防止することなく、そのような屈曲を制限する、請求項1に記載の方法。
- 前記主要構造体が装着された椎骨が、互いに融合されるか、又はそのような融合のために準備され、前記延長部によって前記主要構造体が延在している椎骨は、融合されないか、又は融合のために準備されない、請求項1に記載の方法。
- 前記主要構造体が、それぞれの骨アンカーによって第1及び第2の椎骨に取り付けられた剛性脊椎ロッドを含む、請求項1に記載の方法。
- 一次切開部を形成することを更に含み、前記主要構造体は、前記一次切開部を通して埋め込まれている、請求項1に記載の方法。
- 前記一次切開部が、前記主要構造体の前記UIVに上位で隣接している椎骨(UIV+1)よりも下位の位置で終端する、請求項10に記載の方法。
- 前記延長部がポリマーテザーを含む、請求項1に記載の方法。
- 前記延長部が、前記患者の脊椎に伸展力を加える、請求項1に記載の方法。
- 前記第1の取り付け点が肋骨である、請求項1に記載の方法。
- 前記第1の取り付け点が、前記患者の軟組織構造である、請求項1に記載の方法。
- 前記延長部が、フック又はクランプによって前記第1の取り付け点に取り付けられている、請求項1に記載の方法。
- 前記延長部は、前記延長部がねじ込まれている骨アンカーによって前記第1の取り付け点に取り付けられている、請求項1に記載の方法。
- 前記延長部を前記第1の取り付け点に取り付けることは、前記延長部が骨アンカーからドライバ器具のシャフトを通って延在している状態で、前記骨アンカーを骨に打ち込むことを含む、請求項1に記載の方法。
- 前記延長部を位置決めすることは、前記延長部を、前記主要構造体が埋め込まれている一次切開部よりも上位に配置された二次切開部に通すことを含む、請求項1に記載の方法。
- 前記延長部を位置決めすることが、前記延長部を前記二次切開部に通し、次いで前記延長部を前記主要構造体に向かって下位方向に押す及び/又は引っ張ることと、前記延長部を、前記二次切開部と前記主要構造体との中間に配置された皮膚及び/又は軟組織の下に通すことと、を含む、請求項19に記載の方法。
- 前記延長部を位置決めすることが、挿入器具を、前記一次切開部を通じて前記二次切開部に向かう上位方向に通すことと、前記延長部を前記挿入器具と接触させることと、前記挿入器具を使用して前記延長部を下位方向に引っ張ることと、を含む、請求項19に記載の方法。
- 前記延長部を位置決めすることが、挿入器具を前記二次切開部に通すことと、前記延長部を前記挿入器具に連結することと、前記挿入器具及びそれに連結された前記延長部を、前記二次切開部と前記主要構造体との中間に配置された皮膚及び/又は軟組織の下で、前記主要構造体に向かって下位方向に押すことと、を含む、請求項19に記載の方法。
- 前記延長部を位置決めすることは、前記主要構造体が埋め込まれている一次切開部を通して前記延長部を挿入することと、前記第1の取り付け点と前記一次切開部との中間に配置された皮膚及び/又は軟組織の下で前記延長部を誘導しながら、前記延長部を、前記第1の取り付け点に向かう上位方向に通すことと、を含む、請求項1に記載の方法。
- 前記延長部が、コネクタによって前記第2の取り付け点に取り付けられている、請求項1に記載の方法。
- 前記コネクタが、前記延長部を、前記主要構造体の脊椎ロッド又は骨ネジに締め付ける、請求項24に記載の方法。
- 前記延長部が第1の延長部を含み、前記方法が、第2の延長部を、前記第1の延長部に対して脊椎正中線の対側に配置することを更に含む、請求項1に記載の方法。
- 前記延長部を位置決めすることは、前記延長部を、前記主要構造体が埋め込まれている一次切開部から、前記第1の取り付け点まで上方に通すことを含み、前記延長部は前記患者の皮膚及び/又は軟組織の下を通り、前記延長部を前記第1の取り付け点に取り付けることが、前記延長部に取り付けられたフックを前記第1の取り付け点に引っ掛けること、又は前記延長部に取り付けられたクランプを前記第1の取り付け点に締め付けることを含む、請求項1に記載の方法。
- 前記延長部が前記第1の取り付け点及び前記第2の取り付け点に取り付けられているとき、前記延長部のいかなる部分も、前記患者の脊椎の任意の椎弓板の前方に配置されていない、請求項1に記載の方法。
- 外科的方法であって、
患者に一次切開部を形成することと、
前記一次切開部を介して前記患者の脊椎に主要構造体を取り付けることと、
前記一次切開部よりも上位の位置において、前記患者に二次切開部を形成することと、
骨アンカーに細長い可撓性テザーが取り付けられた状態で、前記二次切開部を通して前記骨アンカーを挿入することと、
前記骨アンカーを第1の取り付け点において骨に打ち込み、それによって、前記テザーの一部が前記二次切開部を通って前記患者の外部の位置まで延在している間に、前記テザーを前記第1の取り付け点に取り付けることと、
前記一次切開部と前記二次切開部との中間に配置された軟組織の下で前記テザーを掘進させることと、
前記一次切開部を介して前記テザーを前記主要構造体に取り付けることと、を含む、外科的方法。 - 前記テザーを掘進させることが、前記二次切開部を通して挿入器具を挿入することと、前記器具を前記一次切開部に向かって下方に押すことと、を含む、請求項29に記載の方法。
- 前記一次切開部を介して前記挿入器具の先端を把持することと、前記挿入器具を前記一次切開部を通して引っ張ることと、を更に含む、請求項30に記載の方法。
- 前記テザーが、前記挿入器具に取り付けられ、かつ前記挿入器具と同じ経路に沿って運ばれ、それによって、前記テザーが前記第1の取り付け点と前記主要構造体との間の前記患者の脊椎に沿って延在するように、前記テザーを位置決めする、請求項30に記載の方法。
- 外科用システムであって、
剛性脊椎固定ロッドと、前記脊椎ロッドを第1及び第2の椎骨に取り付けるように構成された第1及び第2の骨アンカーとを含む、主要構造体と、
テザーアンカーに取り付けられた細長い可撓性テザーと、
前記テザーが前記テザーアンカーから延在している間に前記テザーアンカーを骨に打ち込むためのドライバ器具と、
前記テザーを前記主要構造体の前記脊椎ロッドに締め付けるように構成されたコネクタと、を備える、外科用システム。
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AU2018309721B2 (en) | 2023-08-03 |
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EP3661438A1 (en) | 2020-06-10 |
US20200015862A1 (en) | 2020-01-16 |
JP7330944B2 (ja) | 2023-08-22 |
CN111050674B (zh) | 2023-11-10 |
US11207107B2 (en) | 2021-12-28 |
CN111050674A (zh) | 2020-04-21 |
WO2019028037A1 (en) | 2019-02-07 |
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