WO2009076483A1

WO2009076483A1 - Adjustable table for orthopedic surgery and techniques for implanting a vertebrae implant

Info

Publication number: WO2009076483A1
Application number: PCT/US2008/086300
Authority: WO
Inventors: Scott Spann
Original assignee: Scott Spann
Priority date: 2007-12-10
Filing date: 2008-12-10
Publication date: 2009-06-18

Abstract

An adjustable table allows for improved access to a patient during surgery, such as vertebrae implant surgery. The table comprises a base, a support towers mounted in a spaced-apart relation on the base, a table for holding a patient's body, and spaced-apart pairs of body support assemblies to fix in place parts of the patient's body. The table is pivotably mounted between the support towers to be rotatable about a longitudinal axis, allowing the patient to be turned from a prone to a lateral or supine position. The spaced-apart pairs of body support assemblies are configured to clamp a part of a body to fix the position of that part, thereby holding the patient to the table when rotated, and allowing the patient's body to be fixed in a desired position.

Description

ADJUSTABLE TABLE FOR ORTHOPEDIC SURGERY AND TECHNIQUES FOR IMPLANTING A VERTEBRAE IMPLANT

CROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. Provisional Application No. 61/007,038, filed December 10, 2007, which is incorporated by reference in its entirety.

FIELD OF THE DISCLOSURE

[0002] The disclosures made herein relate generally to surgical tables for orthopedic and other surgeries, and to implants, systems and methods for implanting a vertebrae implant to repair damaged or degraded vertebrae.

SUMMARY

[0003] An adjustable table allows for improved access to a patient during surgery, such as vertebrae implant surgery. In one embodiment, an adjustable surgical table comprises a base, a pair of support towers mounted in a spaced-apart relation on the base, a table for holding a patient's body, and spaced-apart pairs of body support assemblies to fix in place parts of the patient's body. The table is pivotably mounted between the support towers to be rotatable about a longitudinal axis, allowing the patient to be turned from a prone to a lateral or supine position. The spaced-apart pairs of body support assemblies are configured to clamp a part of a body to fix the position of that part, thereby holding the patient to the table when rotated, and optionally for fixing the patient's body in a desired position. For example, with the patient positioned in the lateral position with their waist in a jack-knifed orientation, access to the L5:S1 region of their spinal region is greatly improved.

BRIEF DESCRIPTION OF THE DRAWINGS

[0004] FIG. 1 is an anterior view of a channel retractor, in accordance with an embodiment of the invention.

[0005] FIGS. 2-4 are various cross sectional views of the channel retractor of FIG. 1.

[0006] FIGS. 5 and 6 are perspective and side views of an implant for the L5:S1 spinal position, in accordance with an embodiment of the invention.

[0007] FIG. 7 is an end view of a lordotic implant with a tapered profile, in accordance with an embodiment of the invention.

[0008] FIG. 8 is a side view of an articulating multidimensional tool, in accordance with an embodiment of the invention.

[0009] FIG. 9 is a cross sectional view of the articulating multidimensional tool of FIG.

8.

[0010] FIGS. 10 and 11 are lateral and side views of an adjustable surgical table, in accordance with an embodiment of the invention.

[0011] FIG. 12 is a perspective view of a vertebrae implant, in accordance with an embodiment of the invention.

[0012] FIG. 13 is an anterior view of the implant of FIG. 12 implanted in a patient.

[0013] The figures depict various embodiments of the present invention for purposes of illustration only. One skilled in the art will readily recognize from the following discussion that alternative embodiments of the structures and methods illustrated herein may be employed without departing from the principles of the invention described herein. DETAILED DESCRIPTION

[0014] Various aspects of a channel retractor 100 in accordance with an embodiment of the present invention are shown in FIGS. 1-4. The channel retractor 100 includes a handle assembly 105 having a fϊxable articulating conduit 110 attached thereto via the conduit coupler 112. Fixable refers to the articulating conduit 110 being selectively changeable from a selectively countourable configuration (e.g., flexible) to an essentially rigid state (i.e., adequately non-flexible). The articulating conduit 110 is an elongated structure including a fϊxable outer sheath 115, a flexible inner tube 120, articulation control wires 125, an illumination optic fiber 130 (i.e., light source) and a video camera optic fiber 135. The articulation control wires 125, the illumination optic fiber 130 and the video camera optic fiber 135 extend between opposing end portions of the flexible inner tube 120. An end sleeve 140 is connected to a first end portion of the articulating conduit 110 and a coupler sleeve 142 is connected to a second end portion of the articulating conduit 110. The articulating conduit 110 is attachable to the handle assembly 105 by the conduit coupler 112. In one embodiment, the end sleeve 140 is electrically conductive and the articulation control wires 125, which are electrically conductive, are attached to the end sleeve 140. In this manner, the end cap can serve as a neuro/nerve monitoring sensor with signals being transmitted from the end sleeve 140 through one or more of the articulation control wires 125 to a suitable neuro- monitoring apparatus. Through tensioning of the articulation control wires 125, the articulating conduit 110 can be fixed (i.e., at least opposing one of the articulation control wires 125 being sufficiently tensioned) and a tip of the articulating conduit 110 (i.e., the end cap 140) can be guided. Through use of an illumination source and a camera connected to the illumination optic fiber 130 and the video camera optic fiber 135 (i.e., through the auxiliary coupler 145), respectively, the tip portion of the articulating conduit 110 can be guided to a desired position. [0015] The handle assembly 105 includes a conduit fixing lever 115 for selectively changing the articulating conduit 110 from the countourable configuration to the essentially rigid state (i.e., adequately non- flexible). The channel retractor 100 is specifically configured for accessing the L5:S1 spinal position. In accessing this spinal position, the pelvic iliac crest must be traversed by the tip portion (i.e., end sleeve 140) of the articulating conduit 110 with the tip portion (i.e., end sleeve 140) of the articulating conduit 110 being routed and positioned allowing the tip portion to be sufficiently 'docked" with a desired structure (e.g., the L5 of Sl vertebrae). In one embodiment, the tip portion of the articulating conduit 110 is selectively expandable to facilitating such docking (e.g., compression of surrounding tissue. Once is a desired location, the articulating conduit 110 is changed from the contourable configuration to the fixed (i.e., rigid configuration) through use of the conduit fixing lever 115. A retractor channel 150 is provided along a length of the flexible inner tube 120, and is accessible trough an access port 155.

[0016] In one embodiment, the articulating sheath 115 is made up of a plurality of conical faced sheath segments 160 that are in an end-to-end arrangement. A convex shaped end portion of one sheath segments 160 is engaged with a concave end portion of an immediately adjacent one of the sheath segments 160. In this manner, through tensioning of the articulation control wires 125, friction at engaged convex and concave faces of the sheath segments 160 causes the articulating sheath 115 to change from a contourable configuration to a fixed configuration.

[0017] In an alternate embodiment of the present invention, a channel retractor has a fixed shape and/or size. For example, such a channel retractor has a fixed S-shaped contour and fixed diametrical size. In this manner, a collection of different shape an/or size channel retractors can be made available.

[0018] The implant 200 shown in FIGS. 5 and 6 is well suited for being implanted at the L5:S1 spinal position. More specifically, the spinal implant 200 is well suited for being implanted in the L5:S1 spinal position through use of an implantation device such as, for example, the channel retractor 100 shown in FIGS. 1-4. However, the use of the spinal implant 100 is not unnecessarily limited to the L5:S1 spinal position. [0019] The implant 200 includes opposing end bodies 105 and a plurality of pivot links 210 pivotably connected there between by pivot pins 215. In this manner (as shown in FIG. 6), the implant 200 is articulatable between possible articulated positions (e.g., articulated configuration A shown in FIG. 6) and an inline configuration shown in FIG. 6. Articulation of the implant 200 serves to allow the implant to suitable follow contour of a guide device such as the channel retractor 100.

[0020] The implant 200 includes a number of unique features. One such feature is a grafting window 220 within which human body material can form. Another such feature is radioactive markers 225 for allowing an x-ray image to be used for positioning the implant 200. Still other unique features are the insertion/extraction port 230 and the insertion/extraction port 230 channel. The insertion/extraction port 230 and the insertion/extraction port 230 channel serve to provide structure that can be engaged with a tool for promoting insertion and/or extraction of the implant into an invasive environment. It is disclosed herein that implants in accordance with embodiments of the present invention can be various sizes and shapes. One example is the lordotic implant 250 shown in FIG. 7, which has a tapered profile.

[0021] Implants in accordance with embodiments of the present invention are preferably made from materials suitable for use in invasive environments. Examples of such materials include, but are not limited to PEEK, titanium and stainless steel. [0022] Referring now to FIG. 8 an articulating multidimensional tool (AMT) 300 in accordance with the present invention is shown. The AMT 300 is configured for performing various surgical operations at an implant insertion location. A tool attachment 305 is attachable to a handle assembly 308 of the AMT 300 via an attachment coupler 310. An attachment umbilical conduit 315 (e.g., a cable) extends between the attachment coupler 310 and a working-end (not shown) of the tool attachment 305. The attachment umbilical conduit 315 is configured for providing power, signals and the like from the AMT 300 to the working-end of the tool attachment 305. Examples of various types of tool attachments include, but are not limited to, a shearing tool attachment, a bipolar cautery tool attachment, a unipolar cautery tool attachment, and the like. It is disclosed herein that a tool attachment can include means for illumination (e.g., an optical fiber for carrying light from a light source), means for video viewing (e.g., an optical fiber for carrying image representations to a camera), means for facilitating suction (e.g., micro-Osuction), and the like. It is further disclosed herein that the working end of the tool attachment 305 is jointly configured with the channel retractor for allowing the working end of the tool attachment 305 to pass through a retractor channel of a retractor.

[0023] Still referring to FIG. 8, a tool actuator 320 is provided for actuating an attached tool attachment. A plurality of function switches 322 are provided for controlling various functionalities (e.g., illumination, camera, neuro-monitoring and the like. A sheath locking lever 325 is provided for changing the attachment umbilical conduit 315 from an articulatable configuration to a fixed configuration. The sheath rotating knob 330 is provided for rotating the tool attachment 305 and the sheath guiding knob 335 is provided for independently and/or joint articulation (i.e., guiding an end portion thereof) the attachment umbilical conduit 315. [0024] A service umbilical conduit 360 interconnects the AMT 300 to associated services (e.g., electricity, vacuum, light, etc). As shown in FIG. 9, the attachment umbilical conduit 315 includes a centrally located vacuum tubing 365, articulation control wires 365, tool attachment electronic leads 370, a illumination optic fiber 375 and video/camera optic fiber 380. In this manner, the service shearing tool attachment allows a variety of tool attachments to be used with the AMT 300. [0025] It is disclosed herein that that devices used with the AMT 300 may be cannulated for use with a K-wire extending through the retractor channel of an channel retractor conduit. [0026] Referring now to FIGS. 10 and 11, a lateral supporting spine table 400 in accordance with an embodiment of the present invention is shown. The table 400 is configured for supporting a patient 401 (FIG. 11) in effectively free space as opposed to the patient resting on his or her back on a support surface. In this manner, access to the person's internal cavity is improved.

[0027] The table 400 includes a base 405 , a frame 410 and support towers 415. The support towers 415 are mounted in spaced apart relationship on the base 405. The frame 410 is pivotably mounted between the support towers 415, thereby allowing the frame 410 to be selectively pivoted (e.g., via electric, hydraulic or pneumatic means) about a longitudinal axis Ll of the frame 410. It is disclosed herein that the towers may be vertically adjustable (e.g., via electric, hydraulic or pneumatic means) for allowing a height of the frame 410 relative to the base 405 to be selectively altered.

[0028] Attached to the frame 410 are a plurality of spaced apart pairs of body support assemblies 420 that allow selective displacement of discrete regions of the patient 401. As can be seen, rotation of the frame 410 allows the patient to be moved between prone, supine and lateral positions. Such lateral positioning refers to the rotational position of the frame 410 shown in FIG. 11. The body support assemblies 420 allow the patient to be positioned with their waist region in a "jack-knifed" (i.e., skewed) orientation. With the patient 401 positioned in the lateral position with their waist in such a jack-knifed orientation, access to the L5:S1 region of their spinal region is greatly improved.

[0029] Each body support assembly 420 includes a body support assemblies 420 slideably mounted on an adjuster mechanism 430. The adjuster mechanism 430 allows a respective cradle unit 425 to be move longitudinally with respect to the longitudinal axis Ll of the frame. The quantity and relative placement of such body support assemblies 420 can be specified for supporting the head, chest, pelvis, and legs (i.e., lower and upper extremities) of the patient 401. As shown in FIG. 11, through respective longitudinal position of spaced apart pairs of the cradle unit 425, the body is moved to the abovementioned jack-knifed position. Each cradle unit 425 is slideably and rotatably mounted on the respective adjuster mechanism 430 to allow for non-binding displacement through a given range of adjustment of the respective adjuster mechanism 430. It is disclosed herein that means such as locking collars, set screws or the like can be used to limit or prevent such sliding and rotation of each cradle unit 425.

[0030] To accommodate patients of different sizes and shaped of patients, different size and/or shape cradle units may be selectively mounted. Furthermore, each cradle unit 425 can include a resilient (e.g., inflatable) body supporting structure. Still further, to provide for unrestricted access to the patient during a surgical procedure, each cradle unit 425 can have selectively detachable segments (e.g., body engaging portions attached to a support structure by means such as threaded fasteners).

[0031] In one embodiment, all or a portion of the frame 410 and/or each cradle unit 425 is radio lucent (i.e., effectively transparent to x-rays). The base may be supported on casters for allowing ease of movement of the table 400. Additionally, one or more support structures such as, for example, steps can be attached to the base and/or support towers 415 for allowing medical personnel to stand adjacent to the table 400 in an elevated manner. Similarly, the support towers 415 can be vertically adjustable thereby allowing vertical adjustment of the frame 410 relative to the base 405.

[0032] As shown, a first control/interface panel 430 can be provided adjacent a first end of the frame 410 and a second control/interface panel 435 can be provided adjacent a second end of the frame 410. In one embodiment, the first control/interface panel 430 is configured facilitating the supply of anaesthesia and the second control/interface panel 435 is configured for providing services/tool functionalities such as, for example, vacuum, electricity, air pressure, illumination, video monitoring, nerve contact monitoring, electro-cautery, midas- rex, and the like. In such an embodiment, the first control/interface panel 430 is preferably positioned in a clean field region of the patient (i.e., adjacent their head) and the second control/interface panel 435 is preferably positioned in a non-clean field region of the patient (i.e., adjacent their feet).

[0033] It is disclosed herein that a lateral supporting spine table in accordance with the present invention can be in any number of different formats and structures. Regardless of a particular implemented format or structure, a lateral supporting spine table in accordance with the present invention will allow rotation of the patient (i.e., about their core longitudinal axis) and will allow for skewing (jack-knifing) of the patient at their waist. In some embodiments, a lateral supporting spine table in accordance with the present invention will support the patient in free space in a manner similar to that discussed above. [0034] FIG. 12 shows an implant 500 configured in accordance with an alternate embodiment of the present invention. The implant 500 is substantially the same as the implant 200 discussed above in reference to FIGS. 5 and 6, with the key difference the implant 500 does not include a grafting material window. As such, the implant 500 is well suited for applications such as, for example, disk replacement as is depicted in FIG. 13. [0035] In the preceding detailed description, reference has been made to the accompanying drawings that form a part hereof, and in which are shown by way of illustration specific embodiments in which the present invention may be practiced. These embodiments, and certain variants thereof, have been described in sufficient detail to enable those skilled in the art to practice embodiments of the present invention. It is to be understood that other suitable embodiments may be utilized and that logical, mechanical, chemical and electrical changes may be made without departing from the spirit or scope of such inventive disclosures. To avoid unnecessary detail, the description omits certain information known to those skilled in the art. The preceding detailed description is, therefore, not intended to be limited to the specific forms set forth herein, but on the contrary, it is intended to cover such alternatives, modifications, and equivalents, as can be reasonably included within the spirit and scope of corresponding claims.

Claims

What is claimed is:

1. An adjustable surgical table comprising: a base; a pair of support towers mounted in a spaced-apart relation on the base; a table for holding a patient, the table pivotably mounted between the support towers to be rotatable about a longitudinal axis; and a plurality of spaced-apart pairs of body support assemblies, each pair of body support assemblies configured to clamp a body part of a patient to fix the position of that body part.

2. The adjustable table of claim 1, wherein the table is rotatable to move a patient mounted thereon among prone, supine, and lateral positions.

3. The adjustable table of claim 1, wherein the pairs of body support assemblies are movable to fix a patient mounted thereby in a variable orientation.

4. The adjustable table of claim 1, wherein the pairs of body support assemblies are movable to fix a patient mounted thereby in a jack-knifed orientation.

5. The adjustable table of claim 1, wherein at least one of the pairs of body support assemblies are mounted on a adjuster mechanism to allow movement of the body support assemblies along the longitudinal axis of the table.

6. The adjustable table of claim 1, wherein the pairs of body support assemblies comprise a pair of body support assemblies for fixing a patient's head.

7. The adjustable table of claim 1, wherein the pairs of body support assemblies comprise a pair of body support assemblies for fixing a patient's chest.

8. The adjustable table of claim 1, wherein the pairs of body support assemblies comprise a pair of body support assemblies for fixing a patient's legs.

9. The adjustable table of claim 1, wherein one or more of the pairs of body support assemblies comprise a radio lucent portion.

10. The adjustable table of claim 1, wherein the support towers are vertically adjustable to change the height of the table relative to the base.

11. The adjustable table of claim 1 , further comprising: a first control panel including an interface for controlling a supply of anesthesia.

12. The adjustable table of claim 11, wherein the first control panel is positioned near an end of the table proximate to a pair of body support assemblies configured to support a patient's head.

13. The adjustable table of claim 1, further comprising: a control panel including an interface for controlling one or more of: vacuum, air pressure, electricity, illumination, video monitoring, nerve contact monitoring, electro-cautery, and midas-rex.

14. The adjustable table of claim 13, wherein the first control panel is positioned away from an end of the table proximate to a pair of body support assemblies configured to support a patient's head.