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WO2009101539A2 - Dispositif de distraction interépineux percutané - Google Patents

Dispositif de distraction interépineux percutané Download PDF

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Publication number
WO2009101539A2
WO2009101539A2 PCT/IB2009/050202 IB2009050202W WO2009101539A2 WO 2009101539 A2 WO2009101539 A2 WO 2009101539A2 IB 2009050202 W IB2009050202 W IB 2009050202W WO 2009101539 A2 WO2009101539 A2 WO 2009101539A2
Authority
WO
WIPO (PCT)
Prior art keywords
cannulae
distraction device
introducer
rods
interspinous
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IB2009/050202
Other languages
English (en)
Other versions
WO2009101539A3 (fr
Inventor
Gianfranco Bidoia
Alberto Alexandre
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
EUROPEAN NEUROSURGICAL INSTITUTE Srl
LEADER MEDICA Srl
Original Assignee
EUROPEAN NEUROSURGICAL INSTITUTE Srl
LEADER MEDICA Srl
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by EUROPEAN NEUROSURGICAL INSTITUTE Srl, LEADER MEDICA Srl filed Critical EUROPEAN NEUROSURGICAL INSTITUTE Srl
Publication of WO2009101539A2 publication Critical patent/WO2009101539A2/fr
Publication of WO2009101539A3 publication Critical patent/WO2009101539A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7071—Implants for expanding or repairing the vertebral arch or wedged between laminae or pedicles; Tools therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A61B17/7065—Devices with changeable shape, e.g. collapsible or having retractable arms to aid implantation; Tools therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length

Definitions

  • the human spinal column is an organ which, due to its extreme complexity and the workload it is required to withstand, for example, situations of stress, age, occupation, physical environment, traumatic and/or pathological situations, can be subject to various pathologies, ranging from ordinary to serious, of a temporary or chronic nature.
  • surgery can be performed, both for correction by removal of tissue (in the case of slipped discs, for example) and by the contribution and/or insertion of external elements.
  • surgery is performed with the insertion of homologous bone tissue, in other cases with bone tissue of other origin, also animal, previously treated in order to avoid as far as possible problems of rejection.
  • surgery is performed with artificial elements of various origin, for example of synthetic origin, the latter being reabsorbable or non-reabsorbable, or of mineral origin, for example, but not exclusively, titanium, stainless steel, various types of metal alloys, all having the necessary characteristic of biocompatibility and non-toxicity.
  • the first system is the traditional system also called "open", technique, indicating that the parts to be treated can be directly seen from the outside.
  • This system begins with a fairly large artificial opening made by cutting through the various outer tissues until the area to be treated is reached; this opening is obtained by artificial mechanical means, scalpels and/or other cutting instruments, and is kept open by other artificial means of various types, such as dilators and/or retractors or other systems dedicated to this function, in any case all systems that originate outside the human body.
  • the operating instruments in the required number, directly reach the parts to be treated without having to follow particular channels which substantially limit their use, dimension, form and any other parameter necessary for the purpose.
  • the second system is that of laparoscopic or minimally invasive surgery, cloned from traditional thoracic/abdominal surgery, performed by introducing special cannulae (trocars), normally with round section, percutaneously through the various tissues near the spinal column until reaching the part to be treated. Since the external cutaneous tissue cannot be seen directly, it is displayed externally by electronic systems such as the miniaturised TV cameras and internal lighting systems which normally enter the above-mentioned cannulae and project the image on external monitors.
  • the surgical instruments for performing the various operations required during and through to completion of surgery are inserted via said entry channels. The choice of said instruments obviously depends on the number, form and dimension of the artificial access paths.
  • the disadvantages are: greater specialisation is required, loss of tactile contact with certain areas, replaced only by greater visibility, higher costs of the equipment and greater deterioration thereof, dimensional limits of the equipment, since they have to pass through rigid tubes, reduced mobility of the instruments which can only follow predefined paths.
  • interspinous retractor devices exist, hereinafter called distraction devices, measuring 8 mm, 9 mm, 10 mm, 11 mm and up to even 12 mm, rarely 13 mm.
  • a further problem consists in the fact that the distraction devices currently marketed have fixed sizes, normally in steps of one millimetre, without the possibility of obtaining all the intermediate sizes, which are very useful in numerous cases in which said intermediate sizes are necessary, or at least useful, for improving the surgical result.
  • a new interspinous distraction device has been studied having the following objectives: the possibility of using it in laparoscopic or minimally invasive surgery, percutaneously, both directly on the part to be treated and/or laterally, i.e.
  • a distraction device that adapts to the majority of needs, since it can expand from an initial size at least, but not limited, to the additional percentage as previously highlighted, without having to change the system described previously; - provide a distraction device, the expansion of which comprises all those intermediate sizes that may be necessary; provide a distraction device which in the event of breakage can be easily re-set to its initial dimension, thus maintaining or preserving a sufficient expansion; - provide a distraction device which can be used according to the surgical techniques and systems known in the state of the art.
  • Table 1 shows the device with ogival head; with cutting head; with video camera and light source.
  • Table 2 shows a further solution with cutting head.
  • Table 3 shows the device with working heads, with expander measurer.
  • Table 4 shows the device with expandable interspinous distraction device and related details.
  • Table 5 shows in detail the expandable interspinous distraction device.
  • the new device that can be used in laparoscopic or minimally invasive surgery comprises in its essential parts: one or more percutaneous entry cannulae (1), of appropriate size and suitable for the passage of the various instruments (2 - 3 - 7 - 9 - 13 - 14 - 15 ) for achieving the object of the invention; one or more guide cannulae (1) of appropriate diameter, either of the disposable or re-usable type, made of materials suitable for medical use, of preferably curved form, but acceptable also in other forms, for example straight, which can reach the area to be treated; one or more introducer rods (2 - 3) adapted at the outset or adaptable elastically to the cannula/cannulae as per the preceding point, slightly longer than the same and terminating in a preferably ogival tip (4), from sharp, for example, to three-quarters (6C), or in other shapes which are suitable for the purpose of passing or favouring the passage through human tissue and
  • the tip of the introducer rod which, as said, is preferably ogival, can have, preferably sliding and/or retracting inside it, a sharp tip or a cutting blade (5) or any other shape suitable for cutting and/or perforating more easily, for example, fibrous or tougher tissue such as scar tissue, once it is pushed out of its seat inside the introducer rod (6b), said seat having the function of preventing said end causing undesired lesions.
  • one single specific introducer rod can have said type of end, but of the fixed and not sliding type (4 - 6C).
  • One or more of these introducer rods can be provided at their end (9) with a system for measuring the interspinous space, in which the distraction device is then inserted.
  • This system can be preferably, but not only, of the "pantograph" type with a reading system outside the guide cannula (19), which can be correlated, among other possibilities, with rotation of the expansion system of the measuring device (9).
  • Said measuring device once it has performed its function, can be returned to its original dimension so that it can be extracted from and through the guide cannula (1).
  • One or more of these introducer rods can be fitted at their end with an interspinous distraction device of the expandable type (10 - 11).
  • the expansion of said distraction device (10 - 11) can be performed preferably mechanically, but also pneumatically or in any other way deemed suitable for the purpose. Said expansion can be obtained by passing directly through the guide cannula (1) with the introducer rod (7). Said expandable interspinous distraction device will have a system for fitting (e.g.: 12) to the end part of the introducer rod (7) and detaching from it as required by the operator once the necessary expansion has been obtained.
  • Said distraction device can also be controlled after its introduction into the interspinous cavity, if and where it is clinically necessary to reduce or increase its dimension, as required by the operator.
  • the above-mentioned distraction device can for example have a "pantograph” (11) or “double wedge” (10) form, although it is not limited to these configurations. In any case, it must be able to modify one or more of its dimensions, as required, and maintain them once one of these dimensions has been reached.
  • Various elements fixed or movable (20 - 21), can be provided on and connected to the distraction device, suitable for ensuring that said distraction device maintains the required interspinous position, whether lateral and/or antero-posterior.
  • Other elements that can pass through the guide cannula/cannulae during surgery could be, among others, optical elements, with or without lighting (13), for connection to video systems in order to transfer the image of the internal part to the outside, instruments (14) suitable for cutting, pushing, scraping or any other surgical function necessary for obtaining a cavity or freeing a cavity from foreign elements or elements not necessary or deemed as such by the operator.
  • Said elements wholly or partly, can be disposable or re-usable and made of materials that comply with the technical and product specifications intended for said purpose.

Landscapes

  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Neurology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un nouveau dispositif destiné à l'application d'un dispositif de distraction interépineux. Ledit dispositif comprend les éléments suivants : une ou plusieurs canules d'entrée percutanées (1), de dimension appropriée et adaptées au passage des divers instruments tels que (2 - 3 - 7 - 9 -13 -14 -15) ; et une ou plusieurs tiges d'introduction (2 - 3) adaptées dès le départ ou pouvant être adaptées élastiquement à ladite ou auxdites canules, et légèrement plus longues que celles-ci. Lesdites tiges s'achèvent en une pointe de préférence en ogive (4), de forme pointue, par exemple, jusqu'aux trois-quarts (6C), ou présentant d'autres formes adaptées à l'objectif qui consiste à passer ou à favoriser le passage à travers des tissus humains.
PCT/IB2009/050202 2008-02-12 2009-01-20 Dispositif de distraction interépineux percutané Ceased WO2009101539A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT000042A ITPD20080042A1 (it) 2008-02-12 2008-02-12 Distrattore interspinoso per via percutanea
ITPD2008A000042 2008-02-12

Publications (2)

Publication Number Publication Date
WO2009101539A2 true WO2009101539A2 (fr) 2009-08-20
WO2009101539A3 WO2009101539A3 (fr) 2009-12-23

Family

ID=40291791

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IB2009/050202 Ceased WO2009101539A2 (fr) 2008-02-12 2009-01-20 Dispositif de distraction interépineux percutané

Country Status (2)

Country Link
IT (1) ITPD20080042A1 (fr)
WO (1) WO2009101539A2 (fr)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ITRM20100236A1 (it) * 2010-05-11 2011-11-12 Meddev Sagl Dispositivo divaricatore interspinoso
WO2012083101A1 (fr) * 2010-12-17 2012-06-21 Synthes Usa, Llc Méthodes et systèmes d'expansion peu invasive de l'arc postérieur
WO2013038350A1 (fr) 2011-09-12 2013-03-21 Medical Intellectual Property S.R.L. Jeu d'instruments pour l'implantation d'un espaceur interépineux percutané et procédé d'utilisation de cet ensemble
EP2938295A4 (fr) * 2012-12-31 2016-12-14 Lanx Inc Implants inter-épineux avec espaceur à hauteur ajustable
US9561060B2 (en) 2007-11-02 2017-02-07 Zimmer Biomet Spine, Inc. Interspinous implants with adjustable height spacer
US20210145417A1 (en) * 2019-11-20 2021-05-20 Boston Scientific Scimed, Inc. Needle biopsy device

Family Cites Families (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AU7139994A (en) * 1988-06-13 1995-01-03 Karlin Technology, Inc. Apparatus and method of inserting spinal implants
DE69723832T2 (de) * 1996-02-22 2004-04-08 SDGI Holding, Inc., Wilmington Vorrichtung zur intervertebralen fusion
US6712819B2 (en) * 1998-10-20 2004-03-30 St. Francis Medical Technologies, Inc. Mating insertion instruments for spinal implants and methods of use
US6004326A (en) * 1997-09-10 1999-12-21 United States Surgical Method and instrumentation for implant insertion
US7008431B2 (en) * 2001-10-30 2006-03-07 Depuy Spine, Inc. Configured and sized cannula
CN101031245A (zh) * 2004-06-16 2007-09-05 华沙整形外科股份有限公司 治疗脊柱结构的外科器械及方法

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9561060B2 (en) 2007-11-02 2017-02-07 Zimmer Biomet Spine, Inc. Interspinous implants with adjustable height spacer
ITRM20100236A1 (it) * 2010-05-11 2011-11-12 Meddev Sagl Dispositivo divaricatore interspinoso
WO2011141869A1 (fr) 2010-05-11 2011-11-17 Meddev Sagl Dispositif écarteur intervertébral
WO2012083101A1 (fr) * 2010-12-17 2012-06-21 Synthes Usa, Llc Méthodes et systèmes d'expansion peu invasive de l'arc postérieur
US9724135B2 (en) 2010-12-17 2017-08-08 DePuy Synthes Products, Inc. Methods and systems for minimally invasive posterior arch expansion
US10413336B2 (en) 2010-12-17 2019-09-17 DePuy Synthes Products, Inc. Methods and systems for minimally invasive posterior arch expansion
WO2013038350A1 (fr) 2011-09-12 2013-03-21 Medical Intellectual Property S.R.L. Jeu d'instruments pour l'implantation d'un espaceur interépineux percutané et procédé d'utilisation de cet ensemble
WO2013038349A1 (fr) 2011-09-12 2013-03-21 Medical Intellectual Property S.R.L. Espaceur interépineux percutané faiblement invasif
EP2938295A4 (fr) * 2012-12-31 2016-12-14 Lanx Inc Implants inter-épineux avec espaceur à hauteur ajustable
US20210145417A1 (en) * 2019-11-20 2021-05-20 Boston Scientific Scimed, Inc. Needle biopsy device
CN114364326A (zh) * 2019-11-20 2022-04-15 波士顿科学国际有限公司 针活检装置

Also Published As

Publication number Publication date
WO2009101539A3 (fr) 2009-12-23
ITPD20080042A1 (it) 2009-08-13

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