CA2117220A1 - Method and instruments for performing arthroscopic spinal surgery - Google Patents
Method and instruments for performing arthroscopic spinal surgeryInfo
- Publication number
- CA2117220A1 CA2117220A1 CA002117220A CA2117220A CA2117220A1 CA 2117220 A1 CA2117220 A1 CA 2117220A1 CA 002117220 A CA002117220 A CA 002117220A CA 2117220 A CA2117220 A CA 2117220A CA 2117220 A1 CA2117220 A1 CA 2117220A1
- Authority
- CA
- Canada
- Prior art keywords
- cannula
- tissue
- further characterised
- working space
- instrument
- 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.)
- Abandoned
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
- A61B17/1606—Chisels; Rongeurs; Punches; Stamps of forceps type, i.e. having two jaw elements moving relative to each other
- A61B17/1608—Chisels; Rongeurs; Punches; Stamps of forceps type, i.e. having two jaw elements moving relative to each other the two jaw elements being linked to two elongated shaft elements moving longitudinally relative to each other
- A61B17/1611—Chisels; Rongeurs; Punches; Stamps of forceps type, i.e. having two jaw elements moving relative to each other the two jaw elements being linked to two elongated shaft elements moving longitudinally relative to each other the two jaw elements being integral with respective elongate shaft elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1684—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the shoulder
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1675—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the knee
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00261—Discectomy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
- A61B2017/292—Handles transmission of forces to actuating rod or piston details of linkages or pivot points connection of actuating rod to handle, e.g. ball end in recess
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/320072—Working tips with special features, e.g. extending parts
- A61B2017/320078—Tissue manipulating surface
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/32—Joints for the hip
- A61F2/36—Femoral heads ; Femoral endoprostheses
- A61F2/3662—Femoral shafts
Abstract
ABSTRACT
METHODS AND INSTRUMENTS FOR PERFORMING
ARTHROSCOPIC SPINAL SURGERY
A method and apparatus for performing an arthroscopic spinal laminectomy or similar surgical procedure includes a plurality of cannulas which are individually inserted, in a predetermined sequence, into predetermined areas of a patient's spinal column.
The first inserted cannula has a tissue manipulating surface thereon which is used to create a working space adjacent a predetermined area of the patient's spinal column. A viewing device is inserted through this cannula and the fluid used in association therewith is used to maintain the working space. The second and third cannulas are larger in size and are working cannulas in that they provide passageways for instruments used in the surgical procedure. The second and third cannulas are utilised by the surgeon to sequentially remove a portion of the ligaments flavum necessary to expose the desired area of the patient's spinal bone and, if necessary, to remove any portion of bone necessary to expose the nerve and disc area. The nerves are then moved and the sequestered portion of the disc is removed, all utilising the cannulas as passageways to perform the surgical procedure. In addition to a cannula which has a tissue manipulating surface thereon, the invention includes a rongeur having a cross section shaped to pass through a cannula and with a suction connection therefor so that whatever body tissue and/or bone fragments are cut by the rongeur may be removed by suction through the passageways created by the cannula.
METHODS AND INSTRUMENTS FOR PERFORMING
ARTHROSCOPIC SPINAL SURGERY
A method and apparatus for performing an arthroscopic spinal laminectomy or similar surgical procedure includes a plurality of cannulas which are individually inserted, in a predetermined sequence, into predetermined areas of a patient's spinal column.
The first inserted cannula has a tissue manipulating surface thereon which is used to create a working space adjacent a predetermined area of the patient's spinal column. A viewing device is inserted through this cannula and the fluid used in association therewith is used to maintain the working space. The second and third cannulas are larger in size and are working cannulas in that they provide passageways for instruments used in the surgical procedure. The second and third cannulas are utilised by the surgeon to sequentially remove a portion of the ligaments flavum necessary to expose the desired area of the patient's spinal bone and, if necessary, to remove any portion of bone necessary to expose the nerve and disc area. The nerves are then moved and the sequestered portion of the disc is removed, all utilising the cannulas as passageways to perform the surgical procedure. In addition to a cannula which has a tissue manipulating surface thereon, the invention includes a rongeur having a cross section shaped to pass through a cannula and with a suction connection therefor so that whatever body tissue and/or bone fragments are cut by the rongeur may be removed by suction through the passageways created by the cannula.
Description
2117~20 METHOD AND INSTRUMENTS FOR PERFORMING
ARTHROSCOPIC SPINAL SURGERY
This invention relates to a method and instruments to perform 5 an arthroscopic spinal procedure and, more specifically, a laminectomy, although the techniques and instruments disclosed are also useful in performing spinal fusions.
It is the present practice in performing laminectomies on the 10 cpine, whether in the cervical, thoracic, or lumbar regions, to follow a procedure in which there is some dissection of muscle and tissue by the surgeon. Although every attempt is made to minimise such dissection, the fact remains that it is necessary and it is a major factor in determining rehabilitation time for the patient which can 15 range anywhere from six weeks to three months.
The present invention is specifically directed to applying the arthroscopic surgical techniques used on knees and shoulders to spinal surgery and, more specifically, to laminectomies. By utilising 20 arthroscopic techniques, muscle dissection is maintained at an absolute minimum and in many instances there may be no such dissection and the only invasion of the body will be the three small stab wounds necessary to insert the cannulas which provide the passageways for the procedure. The utilisation of arthroscopic ~ ;
25 concepts in spinal surgery requires instruments not heretofore available. Specifically, a cannula is utilised which has a tissue manipulating or moving edge thereon which is used to create a space for subsequently used instruments. Also, since all of the surgical steps must be performed by utilising cannulas as 30 instrument passageways, it was necessary to develop new instrumentation which would pass through cannulas and yet still perform the necessary tissue and bone removal, nerve movement, and the final retraction of the herniated portion of the disc.
US Patent No.4,545,374 describes a method and instruments for performing a percutaneous lumbar diskectomy. In this patent the lumbar region of the spinal column is accessed by laterally inserting a cannula through the patient's side. This technique has minimum ::
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. . , . .
ARTHROSCOPIC SPINAL SURGERY
This invention relates to a method and instruments to perform 5 an arthroscopic spinal procedure and, more specifically, a laminectomy, although the techniques and instruments disclosed are also useful in performing spinal fusions.
It is the present practice in performing laminectomies on the 10 cpine, whether in the cervical, thoracic, or lumbar regions, to follow a procedure in which there is some dissection of muscle and tissue by the surgeon. Although every attempt is made to minimise such dissection, the fact remains that it is necessary and it is a major factor in determining rehabilitation time for the patient which can 15 range anywhere from six weeks to three months.
The present invention is specifically directed to applying the arthroscopic surgical techniques used on knees and shoulders to spinal surgery and, more specifically, to laminectomies. By utilising 20 arthroscopic techniques, muscle dissection is maintained at an absolute minimum and in many instances there may be no such dissection and the only invasion of the body will be the three small stab wounds necessary to insert the cannulas which provide the passageways for the procedure. The utilisation of arthroscopic ~ ;
25 concepts in spinal surgery requires instruments not heretofore available. Specifically, a cannula is utilised which has a tissue manipulating or moving edge thereon which is used to create a space for subsequently used instruments. Also, since all of the surgical steps must be performed by utilising cannulas as 30 instrument passageways, it was necessary to develop new instrumentation which would pass through cannulas and yet still perform the necessary tissue and bone removal, nerve movement, and the final retraction of the herniated portion of the disc.
US Patent No.4,545,374 describes a method and instruments for performing a percutaneous lumbar diskectomy. In this patent the lumbar region of the spinal column is accessed by laterally inserting a cannula through the patient's side. This technique has minimum ::
. . . ~ ~........... .
- . . .
. . , . .
2 ' 2117220 utilisation and will not permit the removal of approximately 80 percent of herniated discs in which the disc is sequestered and for that reason it has not been utilised to any substantial extent in performing spinal laminectomies.
The present invention relates to a method and instruments for arthroscopicaily accessing a predetermined area of a patient's spinal column and for subsequently performing desired surgical procedures thereon.
Another pùrpose of the invention is to provide a cannula for use in the surgical procedure described having a tissue moving or manipulating surface at one end thereof which is utilised to create a working space for subsequently applied instruments.
According to the invention we provide a cannula for performing an arthroscopic spinal surgical procedure comprising a tubular body member having an interior instrument passage and a tissue manipulating surface at the end thereof which will be inserted into a patient's body to an area adjacent the spinal column, said tissue manipulating surface extending radially outwardly from said tubular bodymember. ;
Another purpose of the invention is to provide rongeur cutting instruments having a cross sectional area of a size and shape to ~-pass through cannulas for use in per~orming spinal surgical procedures utilising arthroscopic techniques.
According to the invention we further provide an instrument for use in an arthroscopic spinal surgical procedure to both sever and remove pieces of tissue and/or bone by suction, including a body having a suction connection at one end thereof, a handle member attached to said body pro~imate said suction connection, said body having a rongeur cuUing element at the opposite end thereof, and a suction passage between said suction connection and said rongeur cuUing element, a sleeve coaxially mounted on said body for axial movement relative at one end thereof which cooperates with said body rongeur cutting element, a second handle member connected :: `.
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, 3. Z117220 to said sleeve and pivotally connected to said first handle mernber .
for causing movement of said sleeve, the exterior of said sleeve through a major portion of its length having a size and shape to pass through a cannula for positioning within a working space adjacent a patient's spinal column. `
Thus we further provide apparatus for use in performing an arthrosocpic spinal surgical procedure including a cannula having a body member with an internal generally cylindrical bore, a rongeur 10 having a generally cylindrical cross section of a size to pass through said cannula, said rongeur having relatively movable cutting elements and a pair of pivotal handles for effecting relative movement of said cutting elements.
Another purpose of the invention is to provide a Kerison rongeur having suction capabilities for removing tissue and/or bone in the described surgical process.
Another purpose of the invention is to provide a surgical cutting instrument having a cross section shape and size adapted for use in surgical techniques in which the instrument must pass through a cannula and all subsequent manipulation thereof must be done through the cannula.
Another purpose of the invention is a method of arthroscopically performing a spinal laminectomy utilising a plurality of cannulas, each of which provide instrument passages whereby the entire laminectomy may be performed with minimum body ~
invasion and only requiring three small stab-type wounds for the :
insertion of the cannulas.
According to the invention we provide a method for :
arthroscopically accessing a predetermined area of a patient's spinal column including the steps of:
inserting a first cannula into a predetermined position relative to a patient's spine, inserting ~luid utilising viewing means through said first cannula, moving muscle and/or tissue through manipulation of the _ .... . ~ . . ., .... . ; .
, .- . ~ .
.
`.. ~ . , 4' ' 2117220 first cannula to create a working space and utilising the fluid associated with the viewing means to maintain the working space, inserting a second cannula into a predetermined position relative to the first cannula, inserting a cutting instrument through the second cannula and into the working space to incise the ligamentum flavum adjacent the working space to expose bone in the predetermined area of the patient's spine, ~: .
inserting a third cannula into a predetermined position relative to the first and second cannulas, and thereafter conducting a surgical procedure on the spinal column by manipulating instruments through said second and third cannulas.
Another purpose of the invention is a method of performing a spinal laminectomy in which a plurality of cannulas are utilised and in which the initially inserted cannula has a tissue manipulating or moving surface thereon which is used to create a working space for -the subsequently utilised instruments which will pass through the other cannulas.
~ ~
We further provide a methocl of performing an arthroscopic ~ : :
laminectomy in a predetermined area of a patient's spinal column :~-including the steps of:
inserting a first cannula having a tissue manipulating surface : .
thereon into a predetermined position relative to a patient's spine, inserting a fluid utilising viewing means through said first cannula, ~ :
moving muscle and tissue through manipulation of the first cannula and its tissue manipulating surface to create a working space adjacent the spinal column and utilising the fluid associated with the viewing means to maintain the working space, inserting a second cannula into a predetermined position relative to the first cannula, inserting a cutting instrument through the second cannula and into the working space to incise the ligamentum flavum adjacent the working space, inserting a cutting/suction instrument through the second cannula and into the working space to remove a portion of the .
' .: : . ~ . ' ' ~ ~ . ` . " ' ~ ` ' ' " ' ' . .' .
" ` : ' . . ; ` '.~' `, :- : , ~ : . ' ' ' ~: , ' : .' '' tll7220 ligamentum flavum sufficient to expose the nerve and disc area of the spinal column, inserting a nerve moving instrument through the second cannula and into the working space to move sufficient nerves to 5 expose the spinal column disc area, inserting a third cannula into a predetermined position relative to the first and second cannulas, and inserting a grasping instrument through the third cannula to grasp and remove a herniated portion of the spinal disc.
Another purpose of the invention is to provide techniques for performing spinal laminectomies requiring the absolute minimum tissue and muscle dissection.
Another purpose of the invention is to provide a surgical technique for obtaining access to a predetermined area of the spinal column utilising a plurality of cannulas as the instrument passages.
Other purposes will appear in the ensuing specification, drawings and claims.
The invention is illustrated diagrammatically in the following ~
drawings wherein: ~-Figure 1 is a diagrammatic illustration of a portion of the lumbar region of the spinal column illustrating the initial step in the describedsurgical procedure;
Figure 2 is a partial transverse section through the spinal column illustrating the second step in the described surgical procedure;
Figure 3 is a transverse section, similar to Figure 2, illustrating a further step in the described surgical procedure;
Figure 4 is a transverse section, similar to Figures 2 and 3, illustrating yet a further step in the described surgical procedure;
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The present invention relates to a method and instruments for arthroscopicaily accessing a predetermined area of a patient's spinal column and for subsequently performing desired surgical procedures thereon.
Another pùrpose of the invention is to provide a cannula for use in the surgical procedure described having a tissue moving or manipulating surface at one end thereof which is utilised to create a working space for subsequently applied instruments.
According to the invention we provide a cannula for performing an arthroscopic spinal surgical procedure comprising a tubular body member having an interior instrument passage and a tissue manipulating surface at the end thereof which will be inserted into a patient's body to an area adjacent the spinal column, said tissue manipulating surface extending radially outwardly from said tubular bodymember. ;
Another purpose of the invention is to provide rongeur cutting instruments having a cross sectional area of a size and shape to ~-pass through cannulas for use in per~orming spinal surgical procedures utilising arthroscopic techniques.
According to the invention we further provide an instrument for use in an arthroscopic spinal surgical procedure to both sever and remove pieces of tissue and/or bone by suction, including a body having a suction connection at one end thereof, a handle member attached to said body pro~imate said suction connection, said body having a rongeur cuUing element at the opposite end thereof, and a suction passage between said suction connection and said rongeur cuUing element, a sleeve coaxially mounted on said body for axial movement relative at one end thereof which cooperates with said body rongeur cutting element, a second handle member connected :: `.
. . ... : . . ~ . . . .
~ `-' "' . ' . ' " ' i ~ : :.' .. . .
' ~ '.: ; . .
, 3. Z117220 to said sleeve and pivotally connected to said first handle mernber .
for causing movement of said sleeve, the exterior of said sleeve through a major portion of its length having a size and shape to pass through a cannula for positioning within a working space adjacent a patient's spinal column. `
Thus we further provide apparatus for use in performing an arthrosocpic spinal surgical procedure including a cannula having a body member with an internal generally cylindrical bore, a rongeur 10 having a generally cylindrical cross section of a size to pass through said cannula, said rongeur having relatively movable cutting elements and a pair of pivotal handles for effecting relative movement of said cutting elements.
Another purpose of the invention is to provide a Kerison rongeur having suction capabilities for removing tissue and/or bone in the described surgical process.
Another purpose of the invention is to provide a surgical cutting instrument having a cross section shape and size adapted for use in surgical techniques in which the instrument must pass through a cannula and all subsequent manipulation thereof must be done through the cannula.
Another purpose of the invention is a method of arthroscopically performing a spinal laminectomy utilising a plurality of cannulas, each of which provide instrument passages whereby the entire laminectomy may be performed with minimum body ~
invasion and only requiring three small stab-type wounds for the :
insertion of the cannulas.
According to the invention we provide a method for :
arthroscopically accessing a predetermined area of a patient's spinal column including the steps of:
inserting a first cannula into a predetermined position relative to a patient's spine, inserting ~luid utilising viewing means through said first cannula, moving muscle and/or tissue through manipulation of the _ .... . ~ . . ., .... . ; .
, .- . ~ .
.
`.. ~ . , 4' ' 2117220 first cannula to create a working space and utilising the fluid associated with the viewing means to maintain the working space, inserting a second cannula into a predetermined position relative to the first cannula, inserting a cutting instrument through the second cannula and into the working space to incise the ligamentum flavum adjacent the working space to expose bone in the predetermined area of the patient's spine, ~: .
inserting a third cannula into a predetermined position relative to the first and second cannulas, and thereafter conducting a surgical procedure on the spinal column by manipulating instruments through said second and third cannulas.
Another purpose of the invention is a method of performing a spinal laminectomy in which a plurality of cannulas are utilised and in which the initially inserted cannula has a tissue manipulating or moving surface thereon which is used to create a working space for -the subsequently utilised instruments which will pass through the other cannulas.
~ ~
We further provide a methocl of performing an arthroscopic ~ : :
laminectomy in a predetermined area of a patient's spinal column :~-including the steps of:
inserting a first cannula having a tissue manipulating surface : .
thereon into a predetermined position relative to a patient's spine, inserting a fluid utilising viewing means through said first cannula, ~ :
moving muscle and tissue through manipulation of the first cannula and its tissue manipulating surface to create a working space adjacent the spinal column and utilising the fluid associated with the viewing means to maintain the working space, inserting a second cannula into a predetermined position relative to the first cannula, inserting a cutting instrument through the second cannula and into the working space to incise the ligamentum flavum adjacent the working space, inserting a cutting/suction instrument through the second cannula and into the working space to remove a portion of the .
' .: : . ~ . ' ' ~ ~ . ` . " ' ~ ` ' ' " ' ' . .' .
" ` : ' . . ; ` '.~' `, :- : , ~ : . ' ' ' ~: , ' : .' '' tll7220 ligamentum flavum sufficient to expose the nerve and disc area of the spinal column, inserting a nerve moving instrument through the second cannula and into the working space to move sufficient nerves to 5 expose the spinal column disc area, inserting a third cannula into a predetermined position relative to the first and second cannulas, and inserting a grasping instrument through the third cannula to grasp and remove a herniated portion of the spinal disc.
Another purpose of the invention is to provide techniques for performing spinal laminectomies requiring the absolute minimum tissue and muscle dissection.
Another purpose of the invention is to provide a surgical technique for obtaining access to a predetermined area of the spinal column utilising a plurality of cannulas as the instrument passages.
Other purposes will appear in the ensuing specification, drawings and claims.
The invention is illustrated diagrammatically in the following ~
drawings wherein: ~-Figure 1 is a diagrammatic illustration of a portion of the lumbar region of the spinal column illustrating the initial step in the describedsurgical procedure;
Figure 2 is a partial transverse section through the spinal column illustrating the second step in the described surgical procedure;
Figure 3 is a transverse section, similar to Figure 2, illustrating a further step in the described surgical procedure;
Figure 4 is a transverse section, similar to Figures 2 and 3, illustrating yet a further step in the described surgical procedure;
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6 ' 2117220 . : `
Figure 5 is a side view, in part section, illustrating a Kerison rongeur cutting instrument having a suction connection thereon;
. ~
Figure 6 is a view along plane 6~ of Figure 5;
Figure 7 is an enlarged partial perspective illustrating a portion of the instrument of Figures 5 and 6;
Figure 8 is an enlarged section along plane 8~ of Figure 5;
-, Figure 9 is a side view of a cannula having a tissue manipulating surface thereon; and Figure 10 is an enlarged partial top view of the tissue manipulating surface of the cannula of Figure 9.
The invention will be described specifically in connection with - n a iaminectomy in the lumbar region of the spine. It should be ~ -understood that the surgical technique described, as well as the -disclosed instruments, may be used in performing spinal laminectomies utilising arthroscopic techniques on the cervical and thoracic areas of the spine, as well as performing other surgical procedures, more specifically, spinal fusions. ~ -In spinal laminectomies as this surgical procedure is currently performed, it is necessary to have some dissection of tissue and ~ ~ ~
muscle to access the hemiated disc. Even though every effort is ~ -made to minimise such dissection, it is necessary in order to obtain ~ ~
access to the disc and to insert the instruments necessary for `
30 removal of the sequestered portion of the disc. It is the dissection of the muscle and tissue and the associated ~rauma which determines the patient rehabilitation time. The less invasive the procedure, the quicker the patient will retum to full activity. Rehabilitation time is meant tc include not only time in the hospital, but the time before 35 the patient can retum to full time work or other activity.
It is present-day practice to perform arthroscopic surgical procedures on certain areas of the body, specifically the knee and 7' ~17~2~ . ~
shoulder, and these procedures, since they involve minimal invasion of the body, usually by puncture wounds, may be done on an outpatient basis, eliminating time spent in the hospital, and also substantially reducing the rehabilitation time before the patient 5 returns to full time activity. The present invention is speGifically directed to utilising the concepts of arthroscopic surgery in performing spinal laminectomies and/or fusions. Before describing the surgical procedure, certain instruments which were not heretofore available will be described, which will lead to a fuller 10 understanding of the surgical techniques.
In Figures 9 and 10 there is a cannula having a body 10 which is cylindrical in form and may be of a size utilised in arthroscopic knee and shoulder surgery. Body 10 has an internal cylindrical 15 passageway 12 to accommodate a viewing scope and the fluid necessary for proper utilisation of the scope. The body 10 may have an enlarged end 14 and a threaded end 16 for use in attaching the desired viewing instrumentation. Of specific importance in the cannula of Figures 9 and 10 is the interior end 18 which will be 20 inserted into the patient's body in the desired location. There is a cuUing edge 20 which may be termed a tissue manipulation or moving edge as it will perform more in the nature of tissue ~ .
movement than it will tissue cutting or dissection. The edge 20 extends both radially and axially of the body 10. Looking 25 particularly at Figure 10 it should be noted that the arcuate edge 20 extends radially outwardly of opposite sides of the body 10 and has walls 22 which extend from the end 20 to the body and provide strength and integrity to the tip or cutting edge. As shown particularly in the side view of Figure 9, the cutting edge 20 bends 30 substantially radially beyond the circumference of the body with the exterior surface of the end flowing smoothly from the body to the cutting edge 20. There is a wall 24 which in part provides the opening connecting passageway 12 with the end of the cannula. By movement of the cannula once inserted, the surgeon can utilise the 35 edge or surface 20 to manipulate the tissue and muscle as will be described subsequently herein.
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' . . . : , . ;:.
; .
.
. ... . ..
... . . . .,.. , . .. ~
,, . ,., .. ,~,;, ,; . .-~ . -8 '211 7220 Figures 5 through 8 disclose a Kerison rongeur suction punch.
Kerison rongeur instruments are known in the art, as are suction instruments, which are commonly used in a number of surgical procedures. The instrument of Figures 5 through 8 combines a Kerison rongeur with a suction adapter so that particles removed by the cutting action of the instrument may be eliminated from the working area. Of particular importance is the fact that the cross sectional area of the Kerison rongeur is of a size and shape to pass through a cannula. In this connection, the invention encompasses ~.
other types of surgical cutting instruments which do not have suction connections therefor, but which have a cross sectional area of a size and shape so that they may pass through working cannulas to reach the area of interest for the surgeon.
In Figures 5 through 8 the instrument has a body 30 which has a suction connection 32 at one end thereof and a cutting tip 34 at :
the opposite end thereof. The body 30, which is cylindrical in a major portion of its length, has an axially extending passage 36 which connects to the suction attachment 32 and, as particularly shown in Figures 7 and 8, is radially offset from the axis of the body. :
Body 30 has a recess 38 adjacent the cutting end 34 to form a -trough 40 which functions as a receptacle for severed tissue and/or bone prior to such particles being drawn through the suction - - `-passage 36. Body 32 is attached to a fixed handle element 42 by a pair of fastening elements 44 which connect the platform portion 46 ~.
of the fixed handle 4~ to the underside of the body.
Coaxially mounted on body 30 is a movable sleeve 48 which has a cutting edge 50 at one end thereof which cooperates with the cutting edge 34 to sever pieces of tissue and/or bone upon coaxial movement of the sleeve 48 relative to the body. Sleeve 48, as :
particularly shown in Figures 7 and 8, has a round cross section :
throughout a major porlion of its length so that it may be received .
within a cannula to perform certain surgical procedures while so positioned. Sleeve 48 has an enlarged portion 52, illustrated in Figure 8, and which, as shown, may be generally square in cross section, but could be otherwise. The enlarged portion 52 is pivotally attached through a slot 54 to an arm 56 of a movable handle 58.
. . , , .
~: .
%1 1 7220 Handle 58 and the fixed handle 42 are pivotally attached together, for example by a screw connection 60. A pair of cooperating and interconnected leaf springs 62 and 64 bias the handles 42 and 58 to the open position of Figure 5. When the handles are squeezed together, against the action of leaf springs 62 and 64, sleeve 48 will ~ -slide to the right, in the direction of arrow 66, so that the cutting edges 50 and 34 are brought together. These edges are sharp and the bringing together of these edges, as in a typical Kerison rongeur type of cutting action, will sever whatever is positioned between them.
Of importance in the instrument of Figures 5 through 8 is the fact that the cross section of sleeve 48 and that portion of the instrument where the cuUing action occurs is round or circular so that it will loosely fit within a working cannula. All functions of the - -instrument are performed while it is so positioned and it is thus necessary that the cross section of the major portion of the pistol d grip Kerison rongeur suction punch described match the interior of the cannula. Suction attached to fitting 32 is effective to remove any particles which are severed by the described cutting action.
The surgical procedure is illustrated on a step-by-step basis in Figures 1 through 4. As indicated earlier, the procedure will be described in connection with an arthroscopic spinal laminectomy, although the techniques desuibed essentially provide arthroscopic access to an area of the spine and a fusion or other procedure may also be performed using 1he instruments and techniques described.
In Figure 1 the outer skin of the patient is indicated at 70 and muscle and other tissue is indicated at 72. The bone of the spinal column is indicated at 74 and spinal discs are indicated at 76. The initial step in the procedure is to insert a cannula 78 which is of the type illustrated in Figures 9 and 10 through the skin, tissue, and muscle into an area adjacent the spinal column. A viewing scope will be passed through the cannula and fluid will be supplied from a source 80 along a line 82 so that fluid passes through the cannula 80 to an area 84 at the end of the inserted cannula. The surgeon may utilise a \/iewing screen 86 to have a full picture of the area in which the interior end of the cannula is working. The purpose of the cutting or tissue moving end of the cannula is so that the surgeon may manipulate it to create the working space 84. This is done by moving muscle and/or tissue rather than cutting it and the pressure of the fluid which is utilised in the viewing scope, which is of a type conventional in arthroscopic surgery, will maintain the space once it ~-has been created. The pressure of the fluid within space 84 will keep or maintain the muscle and tissue away from the area in which the surgeon wishes to work.
Once the space 84 has been created as described, a second :
cannula 88, having an internal diameter slightly greater than the cannula 78, is inserted as illustrated particularly in Figure 2. The space 84 which was created as described above exposes the ligamentum flavum illustrated at 90 in Figure 2 and the next step in the procedure is for the surgeon to insert a cutting tool, such as that illustrated at 92, having a cutting end 94 through working cannula 88. Ligamentum flavum is an elastic tissue which spans the space between adjacent vertebrae as particularly illustrated in Figure 2.
The cutting element or curette 92 will incise the ligamentum flavum, for example by making a slit at the superior edge of the inferior :
lamina. Once this slit has been made, the Kerison rongeur suction punch 95 illustrated in Figures 5 - 8 will be inserted through cannula 88, as illustrated in Figure 3, to remove sufficient portions of the ligamentum flavum to expose the bone beneath it. In some instances it may be necessary to use the Kerison rongeur suction punch to actually remove portions of bone, as what is required is that the ligamentum flavum and/or bone be removed to a sufficient extent to expose the spinal nerves indicated generally at 96. Note particularly the opening 98 in the ligamentum flavum in Figure 3.
At this point in the procedure the disc is accessible to the surgeon and the herniated portion of the disc indicated at 100 can be removed. The first step in removing the sequestered fragment 100 of the disc is to move nerves 96. This is done by inserting an instrument 102, illustrated in Figure 4, through cannula 88 and gently slipping the hooked end 104 beneath the nerves and moving the nerves a sufficient distance to provide complete access to the sequestered portion 100 of the disc. Once the nerves have been so . : ~ , , .
. . .
- - .:. :
:
.
. . . . ..
moved, a third cannula 105 is utilised. This cannula may be inserted at any point in the procedure once the nerves and bone have been exposed by removal of the necessary portion of the `
ligamentum flavum. Cannula 105, again a working cannula and of 5 essentially the same internal diameter as cannula 88, will provide an access passage for a grabbing or clamping instrument 106 which has an operating end 108 of the type to grasp the sequestered portion 100 of the herniated disc and remove it. The herniated portion of the disc is then withdrawn through cannula 105. The 10 relative positions of the three cannulas will vary depending upon the exact location of the damaged area of the spinal column. The positions shown in Figures 1 - 4 are merely illustrative.
Approximately 80 percent of herniated discs are sequestered 15 which means that the herniated portion has actually broken away from the body of the disc. Even in those instances in which the herniated portion is not sequestered, it still may be removed as described. In some instances it may be necessary, prior to removing the hemiated portion of the disc, to use a knife again 20 inserted through the third cannula 105, to excise any tissue which may be overlying the disc. The important point, however, is that all of the described steps in the surgical procedure are performed arthroscopically through the described cannula passages and the various tools which may be necessary to first expose the nerves, 25 then move the nerves, and then grasp the hemiated portion of the disc, will all be utilised in the cannula passages described.
Once the steps described above have been completed and the hemiated portion of the disc has been removed, all that remains is 30 for the surgeon to withdraw the cannulas and suture the puncture wounds which were the only invasions of the body necessary for the entire surgical procedure.
Of importance in the procedure described is the minimal 35 movement of body tissue and muscle and the lack of any incising or cutting of body tissue and muscle. This substantially reduces rehabilitation time and will permit the operation to be performed on an outpatient basis~
``' ' ; . : ~`
: . ' :~.
12 117%20 Although the procedure has been described in connection with `
a laminectomy, it should be clear to one s.~llled in the art that once the area of the bone is exposed as described, bone particles and/or bone segments for a fusion may also be inserted through a cannula and properly positioned for that type of procedure. Again, the procedure is not limited to access of the lumbar region of the spine, but may be equally utilised in the cervical or thoracic areas of the ;
spine.
Whereas the preferred form of the invention has been shown and described herein, it should be realised that there may be many modifications, substitutions and alterations thereto.
`` . , ~ ' : ,,,`':
~ . . .
~ ,, ~ ,,,., ' ' ~, ...
Figure 5 is a side view, in part section, illustrating a Kerison rongeur cutting instrument having a suction connection thereon;
. ~
Figure 6 is a view along plane 6~ of Figure 5;
Figure 7 is an enlarged partial perspective illustrating a portion of the instrument of Figures 5 and 6;
Figure 8 is an enlarged section along plane 8~ of Figure 5;
-, Figure 9 is a side view of a cannula having a tissue manipulating surface thereon; and Figure 10 is an enlarged partial top view of the tissue manipulating surface of the cannula of Figure 9.
The invention will be described specifically in connection with - n a iaminectomy in the lumbar region of the spine. It should be ~ -understood that the surgical technique described, as well as the -disclosed instruments, may be used in performing spinal laminectomies utilising arthroscopic techniques on the cervical and thoracic areas of the spine, as well as performing other surgical procedures, more specifically, spinal fusions. ~ -In spinal laminectomies as this surgical procedure is currently performed, it is necessary to have some dissection of tissue and ~ ~ ~
muscle to access the hemiated disc. Even though every effort is ~ -made to minimise such dissection, it is necessary in order to obtain ~ ~
access to the disc and to insert the instruments necessary for `
30 removal of the sequestered portion of the disc. It is the dissection of the muscle and tissue and the associated ~rauma which determines the patient rehabilitation time. The less invasive the procedure, the quicker the patient will retum to full activity. Rehabilitation time is meant tc include not only time in the hospital, but the time before 35 the patient can retum to full time work or other activity.
It is present-day practice to perform arthroscopic surgical procedures on certain areas of the body, specifically the knee and 7' ~17~2~ . ~
shoulder, and these procedures, since they involve minimal invasion of the body, usually by puncture wounds, may be done on an outpatient basis, eliminating time spent in the hospital, and also substantially reducing the rehabilitation time before the patient 5 returns to full time activity. The present invention is speGifically directed to utilising the concepts of arthroscopic surgery in performing spinal laminectomies and/or fusions. Before describing the surgical procedure, certain instruments which were not heretofore available will be described, which will lead to a fuller 10 understanding of the surgical techniques.
In Figures 9 and 10 there is a cannula having a body 10 which is cylindrical in form and may be of a size utilised in arthroscopic knee and shoulder surgery. Body 10 has an internal cylindrical 15 passageway 12 to accommodate a viewing scope and the fluid necessary for proper utilisation of the scope. The body 10 may have an enlarged end 14 and a threaded end 16 for use in attaching the desired viewing instrumentation. Of specific importance in the cannula of Figures 9 and 10 is the interior end 18 which will be 20 inserted into the patient's body in the desired location. There is a cuUing edge 20 which may be termed a tissue manipulation or moving edge as it will perform more in the nature of tissue ~ .
movement than it will tissue cutting or dissection. The edge 20 extends both radially and axially of the body 10. Looking 25 particularly at Figure 10 it should be noted that the arcuate edge 20 extends radially outwardly of opposite sides of the body 10 and has walls 22 which extend from the end 20 to the body and provide strength and integrity to the tip or cutting edge. As shown particularly in the side view of Figure 9, the cutting edge 20 bends 30 substantially radially beyond the circumference of the body with the exterior surface of the end flowing smoothly from the body to the cutting edge 20. There is a wall 24 which in part provides the opening connecting passageway 12 with the end of the cannula. By movement of the cannula once inserted, the surgeon can utilise the 35 edge or surface 20 to manipulate the tissue and muscle as will be described subsequently herein.
.
' . . . : , . ;:.
; .
.
. ... . ..
... . . . .,.. , . .. ~
,, . ,., .. ,~,;, ,; . .-~ . -8 '211 7220 Figures 5 through 8 disclose a Kerison rongeur suction punch.
Kerison rongeur instruments are known in the art, as are suction instruments, which are commonly used in a number of surgical procedures. The instrument of Figures 5 through 8 combines a Kerison rongeur with a suction adapter so that particles removed by the cutting action of the instrument may be eliminated from the working area. Of particular importance is the fact that the cross sectional area of the Kerison rongeur is of a size and shape to pass through a cannula. In this connection, the invention encompasses ~.
other types of surgical cutting instruments which do not have suction connections therefor, but which have a cross sectional area of a size and shape so that they may pass through working cannulas to reach the area of interest for the surgeon.
In Figures 5 through 8 the instrument has a body 30 which has a suction connection 32 at one end thereof and a cutting tip 34 at :
the opposite end thereof. The body 30, which is cylindrical in a major portion of its length, has an axially extending passage 36 which connects to the suction attachment 32 and, as particularly shown in Figures 7 and 8, is radially offset from the axis of the body. :
Body 30 has a recess 38 adjacent the cutting end 34 to form a -trough 40 which functions as a receptacle for severed tissue and/or bone prior to such particles being drawn through the suction - - `-passage 36. Body 32 is attached to a fixed handle element 42 by a pair of fastening elements 44 which connect the platform portion 46 ~.
of the fixed handle 4~ to the underside of the body.
Coaxially mounted on body 30 is a movable sleeve 48 which has a cutting edge 50 at one end thereof which cooperates with the cutting edge 34 to sever pieces of tissue and/or bone upon coaxial movement of the sleeve 48 relative to the body. Sleeve 48, as :
particularly shown in Figures 7 and 8, has a round cross section :
throughout a major porlion of its length so that it may be received .
within a cannula to perform certain surgical procedures while so positioned. Sleeve 48 has an enlarged portion 52, illustrated in Figure 8, and which, as shown, may be generally square in cross section, but could be otherwise. The enlarged portion 52 is pivotally attached through a slot 54 to an arm 56 of a movable handle 58.
. . , , .
~: .
%1 1 7220 Handle 58 and the fixed handle 42 are pivotally attached together, for example by a screw connection 60. A pair of cooperating and interconnected leaf springs 62 and 64 bias the handles 42 and 58 to the open position of Figure 5. When the handles are squeezed together, against the action of leaf springs 62 and 64, sleeve 48 will ~ -slide to the right, in the direction of arrow 66, so that the cutting edges 50 and 34 are brought together. These edges are sharp and the bringing together of these edges, as in a typical Kerison rongeur type of cutting action, will sever whatever is positioned between them.
Of importance in the instrument of Figures 5 through 8 is the fact that the cross section of sleeve 48 and that portion of the instrument where the cuUing action occurs is round or circular so that it will loosely fit within a working cannula. All functions of the - -instrument are performed while it is so positioned and it is thus necessary that the cross section of the major portion of the pistol d grip Kerison rongeur suction punch described match the interior of the cannula. Suction attached to fitting 32 is effective to remove any particles which are severed by the described cutting action.
The surgical procedure is illustrated on a step-by-step basis in Figures 1 through 4. As indicated earlier, the procedure will be described in connection with an arthroscopic spinal laminectomy, although the techniques desuibed essentially provide arthroscopic access to an area of the spine and a fusion or other procedure may also be performed using 1he instruments and techniques described.
In Figure 1 the outer skin of the patient is indicated at 70 and muscle and other tissue is indicated at 72. The bone of the spinal column is indicated at 74 and spinal discs are indicated at 76. The initial step in the procedure is to insert a cannula 78 which is of the type illustrated in Figures 9 and 10 through the skin, tissue, and muscle into an area adjacent the spinal column. A viewing scope will be passed through the cannula and fluid will be supplied from a source 80 along a line 82 so that fluid passes through the cannula 80 to an area 84 at the end of the inserted cannula. The surgeon may utilise a \/iewing screen 86 to have a full picture of the area in which the interior end of the cannula is working. The purpose of the cutting or tissue moving end of the cannula is so that the surgeon may manipulate it to create the working space 84. This is done by moving muscle and/or tissue rather than cutting it and the pressure of the fluid which is utilised in the viewing scope, which is of a type conventional in arthroscopic surgery, will maintain the space once it ~-has been created. The pressure of the fluid within space 84 will keep or maintain the muscle and tissue away from the area in which the surgeon wishes to work.
Once the space 84 has been created as described, a second :
cannula 88, having an internal diameter slightly greater than the cannula 78, is inserted as illustrated particularly in Figure 2. The space 84 which was created as described above exposes the ligamentum flavum illustrated at 90 in Figure 2 and the next step in the procedure is for the surgeon to insert a cutting tool, such as that illustrated at 92, having a cutting end 94 through working cannula 88. Ligamentum flavum is an elastic tissue which spans the space between adjacent vertebrae as particularly illustrated in Figure 2.
The cutting element or curette 92 will incise the ligamentum flavum, for example by making a slit at the superior edge of the inferior :
lamina. Once this slit has been made, the Kerison rongeur suction punch 95 illustrated in Figures 5 - 8 will be inserted through cannula 88, as illustrated in Figure 3, to remove sufficient portions of the ligamentum flavum to expose the bone beneath it. In some instances it may be necessary to use the Kerison rongeur suction punch to actually remove portions of bone, as what is required is that the ligamentum flavum and/or bone be removed to a sufficient extent to expose the spinal nerves indicated generally at 96. Note particularly the opening 98 in the ligamentum flavum in Figure 3.
At this point in the procedure the disc is accessible to the surgeon and the herniated portion of the disc indicated at 100 can be removed. The first step in removing the sequestered fragment 100 of the disc is to move nerves 96. This is done by inserting an instrument 102, illustrated in Figure 4, through cannula 88 and gently slipping the hooked end 104 beneath the nerves and moving the nerves a sufficient distance to provide complete access to the sequestered portion 100 of the disc. Once the nerves have been so . : ~ , , .
. . .
- - .:. :
:
.
. . . . ..
moved, a third cannula 105 is utilised. This cannula may be inserted at any point in the procedure once the nerves and bone have been exposed by removal of the necessary portion of the `
ligamentum flavum. Cannula 105, again a working cannula and of 5 essentially the same internal diameter as cannula 88, will provide an access passage for a grabbing or clamping instrument 106 which has an operating end 108 of the type to grasp the sequestered portion 100 of the herniated disc and remove it. The herniated portion of the disc is then withdrawn through cannula 105. The 10 relative positions of the three cannulas will vary depending upon the exact location of the damaged area of the spinal column. The positions shown in Figures 1 - 4 are merely illustrative.
Approximately 80 percent of herniated discs are sequestered 15 which means that the herniated portion has actually broken away from the body of the disc. Even in those instances in which the herniated portion is not sequestered, it still may be removed as described. In some instances it may be necessary, prior to removing the hemiated portion of the disc, to use a knife again 20 inserted through the third cannula 105, to excise any tissue which may be overlying the disc. The important point, however, is that all of the described steps in the surgical procedure are performed arthroscopically through the described cannula passages and the various tools which may be necessary to first expose the nerves, 25 then move the nerves, and then grasp the hemiated portion of the disc, will all be utilised in the cannula passages described.
Once the steps described above have been completed and the hemiated portion of the disc has been removed, all that remains is 30 for the surgeon to withdraw the cannulas and suture the puncture wounds which were the only invasions of the body necessary for the entire surgical procedure.
Of importance in the procedure described is the minimal 35 movement of body tissue and muscle and the lack of any incising or cutting of body tissue and muscle. This substantially reduces rehabilitation time and will permit the operation to be performed on an outpatient basis~
``' ' ; . : ~`
: . ' :~.
12 117%20 Although the procedure has been described in connection with `
a laminectomy, it should be clear to one s.~llled in the art that once the area of the bone is exposed as described, bone particles and/or bone segments for a fusion may also be inserted through a cannula and properly positioned for that type of procedure. Again, the procedure is not limited to access of the lumbar region of the spine, but may be equally utilised in the cervical or thoracic areas of the ;
spine.
Whereas the preferred form of the invention has been shown and described herein, it should be realised that there may be many modifications, substitutions and alterations thereto.
`` . , ~ ' : ,,,`':
~ . . .
~ ,, ~ ,,,., ' ' ~, ...
Claims (22)
1. A cannula for performing an arthroscopic spinal surgical procedure comprising a tubular body member having an interior instrument passage and a tissue manipulating surface at the end thereof which will be inserted into a patient's body to an area adjacent the spinal column, said tissue manipulating surface extending radially outwardly from said tubular body member.
2. A cannula according to claim 1 further characterised in that said tissue manipulating surface has an arcuate sharp end.
3. A cannula according to claim 2 further characterised in that said arcuate sharp end has exterior portions extending outwardly from opposite sides of said tubular body.
4. A cannula according to claim 2 further characterised in that said arcuate sharp end is at the termination of a gradually outwardly curved portion which extends radially outwardly from said tubular body member.
5. A cannula according to claim 4 further characterised in that said tubular body member terminates rearwardly of said arcuate sharp end.
6. An instrument for use in an arthroscopic spinal surgical procedure to both sever and remove pieces of tissue and/or bone by suction, including a body having a suction connection at one end thereof, a handle member attached to said body proximate said suction connection, said body having a rongeur cutting element at the opposite end thereof, and a suction passage between said suction connection and said rongeur cutting element, a sleeve coaxially mounted on said body for axial movement relative at one end thereof which cooperates with said body rongeur cutting element, a second handle member connected to said sleeve and pivotally connected to said first handle member for causing movement of said sleeve, the exterior of said sleeve through a major portion of its length having a size and shape to pass through a cannula for positioning within a working space adjacent a patient's spinal column.
7. An instrument according to claim 6 further characterised in that said first handle member has a platform thereon, with said body member being attached to and supported by said platform.
8. An instrument according to claim 6 further characterised in that said axially movable sleeve has an enlarged portion which is movably connected to said second handle.
9. An instrument according to claim 6 further characterised in that said sleeve has a circular cross section.
10. An instrument according to claim 6 further characterised in that said suction passage is radially offset from the axis of said body.
11. Apparatus for use in performing an arthroscopic spinal surgical procedure including a cannula having a body member with an internal generally cylindrical bore, a rongeur having a generally cylindrical cross section of a size to pass through said cannula, said rongeur having relatively movable cutting elements and a pair of pivotal handles for effecting relative movement of said cutting elements.
12. The apparatus according to claim 11 further characterised in that said cutting elements are relatively axially movable,
13. The apparatus according to claim 11 further characterised in that said rongeur includes a suction connection and a suction passage connecting said suction connection and said movable cutting elements for removal of tissue and/or bone severed thereby.
14. A method for arthroscopically accessing a predetermined area of a patient's spinal column including the steps of:
inserting a first cannula into a predetermined position relative to a patient's spine, inserting fluid utilising viewing means through said first cannula, moving muscle and/or tissue through manipulation of the first cannula to create a working space and utilising the fluid associated with the viewing means to maintain the working space, inserting a second cannula into a predetermined position relative to the first cannula, inserting a cutting instrument through the second cannula and into the working space to incise the ligamentum flavum adjacent the working space to expose bone in the predetermined area of the patient's spine, inserting a third cannula into a predetermined position relative to the first and second cannulas, and thereafter conducting a surgical procedure on the spinal column by manipulating instruments through said second and third cannulas.
inserting a first cannula into a predetermined position relative to a patient's spine, inserting fluid utilising viewing means through said first cannula, moving muscle and/or tissue through manipulation of the first cannula to create a working space and utilising the fluid associated with the viewing means to maintain the working space, inserting a second cannula into a predetermined position relative to the first cannula, inserting a cutting instrument through the second cannula and into the working space to incise the ligamentum flavum adjacent the working space to expose bone in the predetermined area of the patient's spine, inserting a third cannula into a predetermined position relative to the first and second cannulas, and thereafter conducting a surgical procedure on the spinal column by manipulating instruments through said second and third cannulas.
15. A method according to claim 14 wherein said first cannula has an outwardly directed tissue moving surface at one end thereof.
16. A method according to claim 15 further characterised in that said cannula tissue moving surface extends radially from one end of said cannula.
17. A method according to claim 14 further characterised in that the predetermined area of the patient's spinal column is in the lumbar region.
18. A method according to claim 14 further characterised in that the surgical procedure performed through the use of the inserted cannulas is a laminectomy.
19. A method of performing an arthroscopic laminectomy in a predetermined area of a patient's spinal column including the steps of:
inserting a first cannula having a tissue manipulating surface thereon into a predetermined position relative to a patient's spine, inserting a fluid utilising viewing means through said first cannula, moving muscle and tissue through manipulation of the first cannula and its tissue manipulating surface to create a working space adjacent the spinal column and utilising the fluid associated with the viewing means to maintain the working space, inserting a second cannula into a predetermined position relative to the first cannula, inserting a cutting instrument through the second cannula and into the working space to incise the ligamentum flavum adjacent the working space, inserting a cutting/suction instrument through the second cannula and into the working space to remove a portion of the ligamentum flavum sufficient to expose the nerve and disc area of the spinal column, inserting a nerve moving instrument through the second cannula and into the working space to move sufficient nerves to expose the spinal column disc area, inserting a third cannula into a predetermined position relative to the first and second cannulas, and inserting a grasping instrument through the third cannula to grasp and remove a herniated portion of the spinal disc.
inserting a first cannula having a tissue manipulating surface thereon into a predetermined position relative to a patient's spine, inserting a fluid utilising viewing means through said first cannula, moving muscle and tissue through manipulation of the first cannula and its tissue manipulating surface to create a working space adjacent the spinal column and utilising the fluid associated with the viewing means to maintain the working space, inserting a second cannula into a predetermined position relative to the first cannula, inserting a cutting instrument through the second cannula and into the working space to incise the ligamentum flavum adjacent the working space, inserting a cutting/suction instrument through the second cannula and into the working space to remove a portion of the ligamentum flavum sufficient to expose the nerve and disc area of the spinal column, inserting a nerve moving instrument through the second cannula and into the working space to move sufficient nerves to expose the spinal column disc area, inserting a third cannula into a predetermined position relative to the first and second cannulas, and inserting a grasping instrument through the third cannula to grasp and remove a herniated portion of the spinal disc.
20. A method according to claim 19 further characterised in that the tissue manipulating surface on the first cannula is at the interior end thereof and extends radially outwardly from the first cannula.
21. A method according to claim 20 further characterised in that the first cannula tissue manipulating surface has a sharp curved end thereon which is wider than the body of the cannula and extends radially outwardly from the body of the cannula.
22. A method according to claim 19 further characterised in that the cutting/suction instrument inserted through the second cannula has a rongeur cutting means thereon.
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US028,244 | 1993-03-09 | ||
US08/028,244 US5439464A (en) | 1993-03-09 | 1993-03-09 | Method and instruments for performing arthroscopic spinal surgery |
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CA2117220A1 true CA2117220A1 (en) | 1994-09-10 |
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CA002117220A Abandoned CA2117220A1 (en) | 1993-03-09 | 1994-03-08 | Method and instruments for performing arthroscopic spinal surgery |
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EP (1) | EP0614647A3 (en) |
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Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9867626B2 (en) | 2012-08-03 | 2018-01-16 | Boss Instruments Ltd., Inc. | Push button Rongeur |
US10507027B2 (en) | 2012-08-03 | 2019-12-17 | Boss Instruments, Ltd., Inc. | Push button rongeur |
CN111658120A (en) * | 2020-07-01 | 2020-09-15 | 李华 | Novel orthopedic surgery forceps |
Families Citing this family (279)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CA2144211C (en) * | 1994-03-16 | 2005-05-24 | David T. Green | Surgical instruments useful for endoscopic spinal procedures |
JPH10503105A (en) * | 1994-07-22 | 1998-03-24 | ユニバーシティ オブ ワシントン | Stereotactic implantation method |
US5885299A (en) | 1994-09-15 | 1999-03-23 | Surgical Dynamics, Inc. | Apparatus and method for implant insertion |
AU696997B2 (en) * | 1994-09-15 | 1998-09-24 | Howmedica Osteonics Corp. | Conically-shaped anterior fusion cage and method of implantation |
US5562695A (en) * | 1995-01-10 | 1996-10-08 | Obenchain; Theodore G. | Nerve deflecting conduit needle and method |
US5601561A (en) * | 1995-01-17 | 1997-02-11 | W. L. Gore & Associates, Inc. | Guided bone rasp |
US5782919A (en) | 1995-03-27 | 1998-07-21 | Sdgi Holdings, Inc. | Interbody fusion device and method for restoration of normal spinal anatomy |
US6206922B1 (en) * | 1995-03-27 | 2001-03-27 | Sdgi Holdings, Inc. | Methods and instruments for interbody fusion |
EP1504732B1 (en) * | 1995-03-27 | 2007-05-23 | Warsaw Orthopedic, Inc. | Spinal fusion implant |
US6245072B1 (en) | 1995-03-27 | 2001-06-12 | Sdgi Holdings, Inc. | Methods and instruments for interbody fusion |
US5681337A (en) * | 1995-06-07 | 1997-10-28 | Bray Jr.; Robert S. | Bone shaver |
US5782830A (en) * | 1995-10-16 | 1998-07-21 | Sdgi Holdings, Inc. | Implant insertion device |
US6679833B2 (en) | 1996-03-22 | 2004-01-20 | Sdgi Holdings, Inc. | Devices and methods for percutaneous surgery |
US20040176763A1 (en) * | 1996-03-22 | 2004-09-09 | Foley Kevin T. | Methods for percutaneous surgery |
US5792044A (en) | 1996-03-22 | 1998-08-11 | Danek Medical, Inc. | Devices and methods for percutaneous surgery |
US7198598B2 (en) * | 1996-03-22 | 2007-04-03 | Warsaw Orthopedic, Inc. | Devices and methods for percutaneous surgery |
ES2224228T3 (en) | 1996-03-22 | 2005-03-01 | Sdgi Holdings, Inc. | DEVICE FOR PERCUTANEOUS SURGERY. |
US5766177A (en) * | 1996-04-02 | 1998-06-16 | Oceaneering International, Inc. | Rongeur |
EP1340467B1 (en) * | 1996-05-09 | 2006-01-25 | Olympus Corporation | A cavity retaining tool for general surgery |
US5741261A (en) * | 1996-06-25 | 1998-04-21 | Sdgi Holdings, Inc. | Minimally invasive spinal surgical methods and instruments |
US6342061B1 (en) | 1996-09-13 | 2002-01-29 | Barry J. Kauker | Surgical tool with integrated channel for irrigation |
US5792167A (en) * | 1996-09-13 | 1998-08-11 | Stryker Corporation | Surgical irrigation pump and tool system |
US5782832A (en) * | 1996-10-01 | 1998-07-21 | Surgical Dynamics, Inc. | Spinal fusion implant and method of insertion thereof |
US6063088A (en) * | 1997-03-24 | 2000-05-16 | United States Surgical Corporation | Method and instrumentation for implant insertion |
US5968098A (en) * | 1996-10-22 | 1999-10-19 | Surgical Dynamics, Inc. | Apparatus for fusing adjacent bone structures |
TW375522B (en) | 1996-10-24 | 1999-12-01 | Danek Medical Inc | Devices for percutaneous surgery under direct visualization and through an elongated cannula |
US6190414B1 (en) | 1996-10-31 | 2001-02-20 | Surgical Dynamics Inc. | Apparatus for fusion of adjacent bone structures |
US5800549A (en) * | 1997-04-30 | 1998-09-01 | Howmedica Inc. | Method and apparatus for injecting an elastic spinal implant |
US5976146A (en) | 1997-07-11 | 1999-11-02 | Olympus Optical Co., Ltd. | Surgical operation system and method of securing working space for surgical operation in body |
JPH1176247A (en) * | 1997-07-11 | 1999-03-23 | Olympus Optical Co Ltd | Surgical operation system |
US6175758B1 (en) | 1997-07-15 | 2001-01-16 | Parviz Kambin | Method for percutaneous arthroscopic disc removal, bone biopsy and fixation of the vertebrae |
US6004326A (en) * | 1997-09-10 | 1999-12-21 | United States Surgical | Method and instrumentation for implant insertion |
US6206826B1 (en) | 1997-12-18 | 2001-03-27 | Sdgi Holdings, Inc. | Devices and methods for percutaneous surgery |
US6440138B1 (en) * | 1998-04-06 | 2002-08-27 | Kyphon Inc. | Structures and methods for creating cavities in interior body regions |
US6126660A (en) * | 1998-07-29 | 2000-10-03 | Sofamor Danek Holdings, Inc. | Spinal compression and distraction devices and surgical methods |
US7641670B2 (en) * | 1998-08-20 | 2010-01-05 | Zimmer Spine, Inc. | Cannula for receiving surgical instruments |
US6187000B1 (en) * | 1998-08-20 | 2001-02-13 | Endius Incorporated | Cannula for receiving surgical instruments |
US7799036B2 (en) * | 1998-08-20 | 2010-09-21 | Zimmer Spine, Inc. | Method and apparatus for securing vertebrae |
US6086586A (en) * | 1998-09-14 | 2000-07-11 | Enable Medical Corporation | Bipolar tissue grasping apparatus and tissue welding method |
CA2363254C (en) | 1999-03-07 | 2009-05-05 | Discure Ltd. | Method and apparatus for computerized surgery |
US6159179A (en) | 1999-03-12 | 2000-12-12 | Simonson; Robert E. | Cannula and sizing and insertion method |
US6267763B1 (en) | 1999-03-31 | 2001-07-31 | Surgical Dynamics, Inc. | Method and apparatus for spinal implant insertion |
US7615076B2 (en) | 1999-10-20 | 2009-11-10 | Anulex Technologies, Inc. | Method and apparatus for the treatment of the intervertebral disc annulus |
US6592625B2 (en) | 1999-10-20 | 2003-07-15 | Anulex Technologies, Inc. | Spinal disc annulus reconstruction method and spinal disc annulus stent |
US7935147B2 (en) | 1999-10-20 | 2011-05-03 | Anulex Technologies, Inc. | Method and apparatus for enhanced delivery of treatment device to the intervertebral disc annulus |
US7052516B2 (en) | 1999-10-20 | 2006-05-30 | Anulex Technologies, Inc. | Spinal disc annulus reconstruction method and deformable spinal disc annulus stent |
US7951201B2 (en) | 1999-10-20 | 2011-05-31 | Anulex Technologies, Inc. | Method and apparatus for the treatment of the intervertebral disc annulus |
US8128698B2 (en) | 1999-10-20 | 2012-03-06 | Anulex Technologies, Inc. | Method and apparatus for the treatment of the intervertebral disc annulus |
US6500180B1 (en) * | 1999-10-20 | 2002-12-31 | Sdgi Holdings, Inc. | Methods and instrumentation for distraction of a disc space |
JP4326134B2 (en) * | 1999-10-20 | 2009-09-02 | ウォーソー・オーソペディック・インコーポレーテッド | Method and apparatus for performing a surgical procedure |
US8632590B2 (en) | 1999-10-20 | 2014-01-21 | Anulex Technologies, Inc. | Apparatus and methods for the treatment of the intervertebral disc |
US7004970B2 (en) | 1999-10-20 | 2006-02-28 | Anulex Technologies, Inc. | Methods and devices for spinal disc annulus reconstruction and repair |
US6764491B2 (en) | 1999-10-21 | 2004-07-20 | Sdgi Holdings, Inc. | Devices and techniques for a posterior lateral disc space approach |
WO2001028469A2 (en) | 1999-10-21 | 2001-04-26 | Sdgi Holdings, Inc. | Devices and techniques for a posterior lateral disc space approach |
US6830570B1 (en) * | 1999-10-21 | 2004-12-14 | Sdgi Holdings, Inc. | Devices and techniques for a posterior lateral disc space approach |
US6287313B1 (en) | 1999-11-23 | 2001-09-11 | Sdgi Holdings, Inc. | Screw delivery system and method |
US6319257B1 (en) | 1999-12-20 | 2001-11-20 | Kinamed, Inc. | Inserter assembly |
US6805695B2 (en) | 2000-04-04 | 2004-10-19 | Spinalabs, Llc | Devices and methods for annular repair of intervertebral discs |
US6402750B1 (en) * | 2000-04-04 | 2002-06-11 | Spinlabs, Llc | Devices and methods for the treatment of spinal disorders |
WO2002002022A1 (en) | 2000-06-30 | 2002-01-10 | Stephen Ritland | Polyaxial connection device and method |
US7985247B2 (en) * | 2000-08-01 | 2011-07-26 | Zimmer Spine, Inc. | Methods and apparatuses for treating the spine through an access device |
US7056321B2 (en) | 2000-08-01 | 2006-06-06 | Endius, Incorporated | Method of securing vertebrae |
US7166073B2 (en) | 2000-09-29 | 2007-01-23 | Stephen Ritland | Method and device for microsurgical intermuscular spinal surgery |
US6692434B2 (en) | 2000-09-29 | 2004-02-17 | Stephen Ritland | Method and device for retractor for microsurgical intermuscular lumbar arthrodesis |
JP2004512097A (en) * | 2000-10-24 | 2004-04-22 | エスディージーアイ・ホールディングス・インコーポレーテッド | Apparatus and method for filling osteogenic material |
US20050080486A1 (en) | 2000-11-29 | 2005-04-14 | Fallin T. Wade | Facet joint replacement |
US6579319B2 (en) | 2000-11-29 | 2003-06-17 | Medicinelodge, Inc. | Facet joint replacement |
US6565605B2 (en) | 2000-12-13 | 2003-05-20 | Medicinelodge, Inc. | Multiple facet joint replacement |
US6419703B1 (en) | 2001-03-01 | 2002-07-16 | T. Wade Fallin | Prosthesis for the replacement of a posterior element of a vertebra |
EP1355578A1 (en) * | 2001-01-29 | 2003-10-29 | Stephen Ritland | Retractor and method for spinal pedicle screw placement |
US6929606B2 (en) * | 2001-01-29 | 2005-08-16 | Depuy Spine, Inc. | Retractor and method for spinal pedicle screw placement |
US7090698B2 (en) | 2001-03-02 | 2006-08-15 | Facet Solutions | Method and apparatus for spine joint replacement |
US6899734B2 (en) | 2001-03-23 | 2005-05-31 | Howmedica Osteonics Corp. | Modular implant for fusing adjacent bone structure |
US7144393B2 (en) * | 2001-05-15 | 2006-12-05 | Dipoto Gene P | Structure for receiving surgical instruments |
AU2002327801B2 (en) | 2001-09-28 | 2008-03-06 | Stephen Ritland | Connection rod for screw or hook polyaxial system and method of use |
US6991632B2 (en) * | 2001-09-28 | 2006-01-31 | Stephen Ritland | Adjustable rod and connector device and method of use |
US7824410B2 (en) | 2001-10-30 | 2010-11-02 | Depuy Spine, Inc. | Instruments and methods for minimally invasive spine surgery |
US6916330B2 (en) * | 2001-10-30 | 2005-07-12 | Depuy Spine, Inc. | Non cannulated dilators |
US7008431B2 (en) * | 2001-10-30 | 2006-03-07 | Depuy Spine, Inc. | Configured and sized cannula |
DE10154163A1 (en) | 2001-11-03 | 2003-05-22 | Advanced Med Tech | Device for straightening and stabilizing the spine |
US6761723B2 (en) * | 2002-01-14 | 2004-07-13 | Dynamic Spine, Inc. | Apparatus and method for performing spinal surgery |
CA2475200C (en) | 2002-02-20 | 2011-02-15 | Stephen Ritland | Pedicle screw connector apparatus and method |
US20030187431A1 (en) * | 2002-03-29 | 2003-10-02 | Simonson Robert E. | Apparatus and method for targeting for surgical procedures |
US6966910B2 (en) | 2002-04-05 | 2005-11-22 | Stephen Ritland | Dynamic fixation device and method of use |
ATE552789T1 (en) * | 2002-05-08 | 2012-04-15 | Stephen Ritland | DYNAMIC FIXATION DEVICE |
US6972005B2 (en) * | 2002-05-10 | 2005-12-06 | Boehm Jr Frank H | Dual chamber syringe and dual lumen needle |
US7004947B2 (en) | 2002-06-24 | 2006-02-28 | Endius Incorporated | Surgical instrument for moving vertebrae |
US6648888B1 (en) | 2002-09-06 | 2003-11-18 | Endius Incorporated | Surgical instrument for moving a vertebra |
WO2004039235A2 (en) * | 2002-10-25 | 2004-05-13 | Endius Incorporated | Apparatus and methods for shielding body structures during surgery |
US7273496B2 (en) | 2002-10-29 | 2007-09-25 | St. Francis Medical Technologies, Inc. | Artificial vertebral disk replacement implant with crossbar spacer and method |
US7083649B2 (en) | 2002-10-29 | 2006-08-01 | St. Francis Medical Technologies, Inc. | Artificial vertebral disk replacement implant with translating pivot point |
US7497859B2 (en) | 2002-10-29 | 2009-03-03 | Kyphon Sarl | Tools for implanting an artificial vertebral disk |
US6966929B2 (en) | 2002-10-29 | 2005-11-22 | St. Francis Medical Technologies, Inc. | Artificial vertebral disk replacement implant with a spacer |
US7465304B1 (en) | 2003-04-14 | 2008-12-16 | Spine Design, Inc. | Anterior cervical facet discectomy surgery kit and method for its use |
US7645232B2 (en) * | 2003-05-16 | 2010-01-12 | Zimmer Spine, Inc. | Access device for minimally invasive surgery |
US8262571B2 (en) | 2003-05-22 | 2012-09-11 | Stephen Ritland | Intermuscular guide for retractor insertion and method of use |
US20070270898A1 (en) * | 2003-06-20 | 2007-11-22 | Lillehei Kevin O | Surgical Cannula |
US7226451B2 (en) * | 2003-08-26 | 2007-06-05 | Shluzas Alan E | Minimally invasive access device and method |
WO2005018466A2 (en) | 2003-08-26 | 2005-03-03 | Endius, Inc. | Access systems and methods for minimally invasive surgery |
AU2004270128B2 (en) * | 2003-09-03 | 2010-12-23 | Kyphon Sarl | Devices for creating voids in interior body regions and related methods |
DE10342002A1 (en) | 2003-09-05 | 2005-04-14 | Karl Storz Gmbh & Co. Kg | Medical instrument for the preparation of tissue |
US7955355B2 (en) | 2003-09-24 | 2011-06-07 | Stryker Spine | Methods and devices for improving percutaneous access in minimally invasive surgeries |
US8002798B2 (en) | 2003-09-24 | 2011-08-23 | Stryker Spine | System and method for spinal implant placement |
US7632294B2 (en) * | 2003-09-29 | 2009-12-15 | Promethean Surgical Devices, Llc | Devices and methods for spine repair |
US7731737B2 (en) * | 2003-10-24 | 2010-06-08 | Zimmer Spine, Inc. | Methods and apparatuses for fixation of the spine through an access device |
US20050090899A1 (en) * | 2003-10-24 | 2005-04-28 | Dipoto Gene | Methods and apparatuses for treating the spine through an access device |
US7655012B2 (en) * | 2003-10-02 | 2010-02-02 | Zimmer Spine, Inc. | Methods and apparatuses for minimally invasive replacement of intervertebral discs |
US20050090822A1 (en) * | 2003-10-24 | 2005-04-28 | Dipoto Gene | Methods and apparatus for stabilizing the spine through an access device |
US7320707B2 (en) | 2003-11-05 | 2008-01-22 | St. Francis Medical Technologies, Inc. | Method of laterally inserting an artificial vertebral disk replacement implant with crossbar spacer |
US7691146B2 (en) | 2003-11-21 | 2010-04-06 | Kyphon Sarl | Method of laterally inserting an artificial vertebral disk replacement implant with curved spacer |
US7503935B2 (en) | 2003-12-02 | 2009-03-17 | Kyphon Sarl | Method of laterally inserting an artificial vertebral disk replacement with translating pivot point |
US20050209603A1 (en) | 2003-12-02 | 2005-09-22 | St. Francis Medical Technologies, Inc. | Method for remediation of intervertebral disks |
US7588590B2 (en) | 2003-12-10 | 2009-09-15 | Facet Solutions, Inc | Spinal facet implant with spherical implant apposition surface and bone bed and methods of use |
US7527638B2 (en) | 2003-12-16 | 2009-05-05 | Depuy Spine, Inc. | Methods and devices for minimally invasive spinal fixation element placement |
US7666188B2 (en) | 2003-12-16 | 2010-02-23 | Depuy Spine, Inc. | Methods and devices for spinal fixation element placement |
EP1706041B1 (en) | 2003-12-18 | 2015-11-18 | DePuy Spine, Inc. | Surgical retractor systems, illuminated cannulas, and methods of use |
US8562649B2 (en) | 2004-02-17 | 2013-10-22 | Gmedelaware 2 Llc | System and method for multiple level facet joint arthroplasty and fusion |
US8353933B2 (en) | 2007-04-17 | 2013-01-15 | Gmedelaware 2 Llc | Facet joint replacement |
US7993373B2 (en) | 2005-02-22 | 2011-08-09 | Hoy Robert W | Polyaxial orthopedic fastening apparatus |
US7588578B2 (en) | 2004-06-02 | 2009-09-15 | Facet Solutions, Inc | Surgical measurement systems and methods |
US8764801B2 (en) | 2005-03-28 | 2014-07-01 | Gmedelaware 2 Llc | Facet joint implant crosslinking apparatus and method |
US7909843B2 (en) * | 2004-06-30 | 2011-03-22 | Thompson Surgical Instruments, Inc. | Elongateable surgical port and dilator |
US7434325B2 (en) | 2004-07-26 | 2008-10-14 | Warsaw Orthopedic, Inc. | Systems and methods for determining optimal retractor length in minimally invasive procedures |
CA2574977C (en) | 2004-07-29 | 2010-01-26 | X-Sten, Corp. | Spinal ligament modification devices |
US20060052812A1 (en) * | 2004-09-07 | 2006-03-09 | Michael Winer | Tool for preparing a surgical site for an access device |
US7455639B2 (en) | 2004-09-20 | 2008-11-25 | Stephen Ritland | Opposing parallel bladed retractor and method of use |
US7481840B2 (en) | 2004-09-29 | 2009-01-27 | Kyphon Sarl | Multi-piece artificial spinal disk replacement device with selectably positioning articulating element |
AU2005295589B2 (en) | 2004-10-15 | 2009-12-03 | Baxano, Inc. | Devices and methods for tissue removal |
US7738968B2 (en) | 2004-10-15 | 2010-06-15 | Baxano, Inc. | Devices and methods for selective surgical removal of tissue |
US7959577B2 (en) | 2007-09-06 | 2011-06-14 | Baxano, Inc. | Method, system, and apparatus for neural localization |
US8048080B2 (en) | 2004-10-15 | 2011-11-01 | Baxano, Inc. | Flexible tissue rasp |
US8430881B2 (en) | 2004-10-15 | 2013-04-30 | Baxano, Inc. | Mechanical tissue modification devices and methods |
US7738969B2 (en) | 2004-10-15 | 2010-06-15 | Baxano, Inc. | Devices and methods for selective surgical removal of tissue |
US8221397B2 (en) | 2004-10-15 | 2012-07-17 | Baxano, Inc. | Devices and methods for tissue modification |
US7938830B2 (en) | 2004-10-15 | 2011-05-10 | Baxano, Inc. | Powered tissue modification devices and methods |
US20110190772A1 (en) | 2004-10-15 | 2011-08-04 | Vahid Saadat | Powered tissue modification devices and methods |
US8062300B2 (en) | 2006-05-04 | 2011-11-22 | Baxano, Inc. | Tissue removal with at least partially flexible devices |
US8617163B2 (en) | 2004-10-15 | 2013-12-31 | Baxano Surgical, Inc. | Methods, systems and devices for carpal tunnel release |
US20100331883A1 (en) | 2004-10-15 | 2010-12-30 | Schmitz Gregory P | Access and tissue modification systems and methods |
US7578819B2 (en) | 2005-05-16 | 2009-08-25 | Baxano, Inc. | Spinal access and neural localization |
US8257356B2 (en) | 2004-10-15 | 2012-09-04 | Baxano, Inc. | Guidewire exchange systems to treat spinal stenosis |
US9247952B2 (en) | 2004-10-15 | 2016-02-02 | Amendia, Inc. | Devices and methods for tissue access |
US7887538B2 (en) | 2005-10-15 | 2011-02-15 | Baxano, Inc. | Methods and apparatus for tissue modification |
US9101386B2 (en) | 2004-10-15 | 2015-08-11 | Amendia, Inc. | Devices and methods for treating tissue |
US8021392B2 (en) | 2004-11-22 | 2011-09-20 | Minsurg International, Inc. | Methods and surgical kits for minimally-invasive facet joint fusion |
US20060111779A1 (en) * | 2004-11-22 | 2006-05-25 | Orthopedic Development Corporation, A Florida Corporation | Minimally invasive facet joint fusion |
US20060195091A1 (en) * | 2005-02-15 | 2006-08-31 | Mcgraw J K | Percutaneous spinal stabilization device and method |
US20060206178A1 (en) * | 2005-03-11 | 2006-09-14 | Kim Daniel H | Percutaneous endoscopic access tools for the spinal epidural space and related methods of treatment |
US7722647B1 (en) | 2005-03-14 | 2010-05-25 | Facet Solutions, Inc. | Apparatus and method for posterior vertebral stabilization |
US20060224044A1 (en) * | 2005-03-31 | 2006-10-05 | Depuy Spine, Inc. | Surgical retractors and methods of use |
US7674296B2 (en) * | 2005-04-21 | 2010-03-09 | Globus Medical, Inc. | Expandable vertebral prosthesis |
US7427264B2 (en) * | 2005-04-22 | 2008-09-23 | Warsaw Orthopedic, Inc. | Instruments and methods for selective tissue retraction through a retractor sleeve |
US7632313B2 (en) | 2005-04-29 | 2009-12-15 | Jmea Corporation | Disc repair system |
US8506646B2 (en) * | 2005-04-29 | 2013-08-13 | Warsaw Orthopedic, Inc. | Multi-purpose medical implant devices |
US7608108B2 (en) | 2005-04-29 | 2009-10-27 | Jmea Corporation | Tissue repair system |
US8702718B2 (en) | 2005-04-29 | 2014-04-22 | Jmea Corporation | Implantation system for tissue repair |
US8092464B2 (en) * | 2005-04-30 | 2012-01-10 | Warsaw Orthopedic, Inc. | Syringe devices and methods useful for delivering osteogenic material |
WO2007008611A2 (en) * | 2005-07-11 | 2007-01-18 | Kyphon Inc. | Curette system |
JP4988735B2 (en) | 2005-07-19 | 2012-08-01 | リットランド、ステファン | Rod extension for elongating fusion structures |
WO2007016683A2 (en) | 2005-07-29 | 2007-02-08 | X-Sten, Corp. | Device for resecting spinal tissue |
US7909830B2 (en) * | 2005-08-25 | 2011-03-22 | Synthes Usa, Llc | Methods of spinal fixation and instrumentation |
US8236058B2 (en) | 2005-09-27 | 2012-08-07 | Fabian Henry F | Spine surgery method and implant |
US7658739B2 (en) | 2005-09-27 | 2010-02-09 | Zimmer Spine, Inc. | Methods and apparatuses for stabilizing the spine through an access device |
US9271843B2 (en) | 2005-09-27 | 2016-03-01 | Henry F. Fabian | Spine surgery method and implant |
US8092456B2 (en) | 2005-10-15 | 2012-01-10 | Baxano, Inc. | Multiple pathways for spinal nerve root decompression from a single access point |
US20080051812A1 (en) * | 2006-08-01 | 2008-02-28 | Baxano, Inc. | Multi-Wire Tissue Cutter |
US20080086034A1 (en) | 2006-08-29 | 2008-04-10 | Baxano, Inc. | Tissue Access Guidewire System and Method |
US8366712B2 (en) | 2005-10-15 | 2013-02-05 | Baxano, Inc. | Multiple pathways for spinal nerve root decompression from a single access point |
US8062298B2 (en) | 2005-10-15 | 2011-11-22 | Baxano, Inc. | Flexible tissue removal devices and methods |
US20070123890A1 (en) * | 2005-11-04 | 2007-05-31 | X-Sten, Corp. | Tissue retrieval devices and methods |
US7918792B2 (en) * | 2006-01-04 | 2011-04-05 | Depuy Spine, Inc. | Surgical retractor for use with minimally invasive spinal stabilization systems and methods of minimally invasive surgery |
US7981031B2 (en) | 2006-01-04 | 2011-07-19 | Depuy Spine, Inc. | Surgical access devices and methods of minimally invasive surgery |
US7758501B2 (en) * | 2006-01-04 | 2010-07-20 | Depuy Spine, Inc. | Surgical reactors and methods of minimally invasive surgery |
US7955257B2 (en) * | 2006-01-05 | 2011-06-07 | Depuy Spine, Inc. | Non-rigid surgical retractor |
US20070161962A1 (en) * | 2006-01-09 | 2007-07-12 | Edie Jason A | Device and method for moving fill material to an implant |
US7935148B2 (en) * | 2006-01-09 | 2011-05-03 | Warsaw Orthopedic, Inc. | Adjustable insertion device for a vertebral implant |
US8894655B2 (en) * | 2006-02-06 | 2014-11-25 | Stryker Spine | Rod contouring apparatus and method for percutaneous pedicle screw extension |
US20070233089A1 (en) * | 2006-02-17 | 2007-10-04 | Endius, Inc. | Systems and methods for reducing adjacent level disc disease |
US20070213584A1 (en) * | 2006-03-10 | 2007-09-13 | Kim Daniel H | Percutaneous access and visualization of the spine |
US20070213583A1 (en) * | 2006-03-10 | 2007-09-13 | Kim Daniel H | Percutaneous access and visualization of the spine |
KR101387163B1 (en) | 2006-04-11 | 2014-04-29 | 신세스 게엠바하 | Minimally invasive fixation system |
US7942830B2 (en) | 2006-05-09 | 2011-05-17 | Vertos Medical, Inc. | Ipsilateral approach to minimally invasive ligament decompression procedure |
US20070299459A1 (en) * | 2006-06-26 | 2007-12-27 | X-Sten Corp. | Percutaneous Tissue Access Device |
US7959564B2 (en) | 2006-07-08 | 2011-06-14 | Stephen Ritland | Pedicle seeker and retractor, and methods of use |
USD620593S1 (en) | 2006-07-31 | 2010-07-27 | Vertos Medical, Inc. | Tissue excision device |
US7918857B2 (en) * | 2006-09-26 | 2011-04-05 | Depuy Spine, Inc. | Minimally invasive bone anchor extensions |
US8979931B2 (en) | 2006-12-08 | 2015-03-17 | DePuy Synthes Products, LLC | Nucleus replacement device and method |
CA2675037A1 (en) | 2007-01-10 | 2008-07-17 | Facet Solutions, Inc. | Taper-locking fixation system |
US8070754B2 (en) | 2007-05-31 | 2011-12-06 | Fabian Henry F | Spine surgery method and instrumentation |
US7922767B2 (en) | 2007-07-07 | 2011-04-12 | Jmea Corporation | Disk fusion implant |
US20090216284A1 (en) * | 2007-08-27 | 2009-08-27 | Singfatt Chin | Balloon cannula system for accessing and visualizing spine and related methods |
US8057486B2 (en) * | 2007-09-18 | 2011-11-15 | Bioness Inc. | Apparatus and method for inserting implants into the body |
JP5250632B2 (en) | 2007-10-05 | 2013-07-31 | ジンテス ゲゼルシャフト ミット ベシュレンクテル ハフツング | Expansion system |
US8192436B2 (en) | 2007-12-07 | 2012-06-05 | Baxano, Inc. | Tissue modification devices |
US7962206B2 (en) * | 2008-01-10 | 2011-06-14 | Arkady Glukhovsky | Methods for implanting electronic implants within the body |
CA2781407A1 (en) | 2008-01-14 | 2009-07-23 | Michael P. Brenzel | Apparatus and methods for fracture repair |
US8437938B2 (en) * | 2008-01-15 | 2013-05-07 | GM Global Technology Operations LLC | Axle torque based cruise control |
US20090270873A1 (en) | 2008-04-24 | 2009-10-29 | Fabian Henry F | Spine surgery method and inserter |
US8398641B2 (en) | 2008-07-01 | 2013-03-19 | Baxano, Inc. | Tissue modification devices and methods |
US8409206B2 (en) | 2008-07-01 | 2013-04-02 | Baxano, Inc. | Tissue modification devices and methods |
US9314253B2 (en) | 2008-07-01 | 2016-04-19 | Amendia, Inc. | Tissue modification devices and methods |
CA2730732A1 (en) | 2008-07-14 | 2010-01-21 | Baxano, Inc. | Tissue modification devices |
US8163022B2 (en) | 2008-10-14 | 2012-04-24 | Anulex Technologies, Inc. | Method and apparatus for the treatment of the intervertebral disc annulus |
USD619252S1 (en) | 2008-10-23 | 2010-07-06 | Vertos Medical, Inc. | Tissue modification device |
USD610259S1 (en) | 2008-10-23 | 2010-02-16 | Vertos Medical, Inc. | Tissue modification device |
USD611146S1 (en) | 2008-10-23 | 2010-03-02 | Vertos Medical, Inc. | Tissue modification device |
USD621939S1 (en) | 2008-10-23 | 2010-08-17 | Vertos Medical, Inc. | Tissue modification device |
USD635671S1 (en) | 2008-10-23 | 2011-04-05 | Vertos Medical, Inc. | Tissue modification device |
USD619253S1 (en) | 2008-10-23 | 2010-07-06 | Vertos Medical, Inc. | Tissue modification device |
US8721723B2 (en) | 2009-01-12 | 2014-05-13 | Globus Medical, Inc. | Expandable vertebral prosthesis |
US8936598B2 (en) * | 2009-01-14 | 2015-01-20 | DePuy Synthes Products, LLC | Spinal disc preparation tool |
JP5582619B2 (en) | 2009-03-13 | 2014-09-03 | バクサノ,インク. | Flexible nerve position determination device |
US8167640B2 (en) * | 2009-03-19 | 2012-05-01 | Bioness Inc. | Flexible connector for implantable electrical stimulation lead |
US9168047B2 (en) * | 2009-04-02 | 2015-10-27 | John T. To | Minimally invasive discectomy |
US8636803B2 (en) | 2009-04-07 | 2014-01-28 | Spinal Stabilization Technologies, Llc | Percutaneous implantable nuclear prosthesis |
US8343035B2 (en) * | 2009-04-20 | 2013-01-01 | Spine View, Inc. | Dilator with direct visualization |
EP2432407B1 (en) | 2009-05-20 | 2013-04-17 | Synthes GmbH | Patient-mounted retractor |
US8394102B2 (en) | 2009-06-25 | 2013-03-12 | Baxano, Inc. | Surgical tools for treatment of spinal stenosis |
US8211126B2 (en) | 2009-09-22 | 2012-07-03 | Jmea Corporation | Tissue repair system |
US8652153B2 (en) | 2010-01-11 | 2014-02-18 | Anulex Technologies, Inc. | Intervertebral disc annulus repair system and bone anchor delivery tool |
WO2011088172A1 (en) | 2010-01-15 | 2011-07-21 | Brenzel Michael P | Rotary-rigid orthopaedic rod |
CN102821707B (en) | 2010-01-20 | 2016-02-03 | 康文图斯整形外科公司 | For bone close to the device and method with bone cavity preparation |
US8986334B2 (en) * | 2010-02-04 | 2015-03-24 | Nico Corporation | Tissue removal device with tissue grip |
CN105361942B (en) | 2010-03-08 | 2018-01-09 | 康文图斯整形外科公司 | For fixing the device and method of bone implant |
US8535318B2 (en) | 2010-04-23 | 2013-09-17 | DePuy Synthes Products, LLC | Minimally invasive instrument set, devices and related methods |
US8512383B2 (en) | 2010-06-18 | 2013-08-20 | Spine Wave, Inc. | Method of percutaneously fixing a connecting rod to a spine |
US8202274B2 (en) | 2010-06-18 | 2012-06-19 | Spine Wave, Inc. | Apparatus and method for detecting a connecting rod during percutaneous surgery |
US8394108B2 (en) | 2010-06-18 | 2013-03-12 | Spine Wave, Inc. | Screw driver for a multiaxial bone screw |
US8777954B2 (en) | 2010-06-18 | 2014-07-15 | Spine Wave, Inc. | Pedicle screw extension for use in percutaneous spinal fixation |
US8454664B2 (en) | 2010-06-18 | 2013-06-04 | Spine Wave, Inc. | Method for fixing a connecting rod to a thoracic spine |
US9445825B2 (en) | 2011-02-10 | 2016-09-20 | Wright Medical Technology, Inc. | Expandable surgical device |
AU2012262698B2 (en) | 2011-05-27 | 2016-07-21 | Synthes Gmbh | Minimally invasive spinal fixation system including vertebral alignment features |
US20130072934A1 (en) * | 2011-09-19 | 2013-03-21 | Mehmet Aygun | Bone cutter with vacuum or impulsive system |
US9622779B2 (en) | 2011-10-27 | 2017-04-18 | DePuy Synthes Products, Inc. | Method and devices for a sub-splenius / supra-levator scapulae surgical access technique |
US9808232B2 (en) | 2011-11-01 | 2017-11-07 | DePuy Synthes Products, Inc. | Dilation system |
US9220528B2 (en) | 2011-12-03 | 2015-12-29 | Ouroboros Medical, Inc. | Tubular cutter having a talon with opposing, lateral cutting surfaces |
US9265490B2 (en) | 2012-04-16 | 2016-02-23 | DePuy Synthes Products, Inc. | Detachable dilator blade |
US9480855B2 (en) | 2012-09-26 | 2016-11-01 | DePuy Synthes Products, Inc. | NIR/red light for lateral neuroprotection |
US9737294B2 (en) | 2013-01-28 | 2017-08-22 | Cartiva, Inc. | Method and system for orthopedic repair |
AU2014209124A1 (en) | 2013-01-28 | 2015-09-17 | Cartiva, Inc. | Systems and methods for orthopedic repair |
US9827020B2 (en) | 2013-03-14 | 2017-11-28 | Stryker European Holdings I, Llc | Percutaneous spinal cross link system and method |
US20140277467A1 (en) | 2013-03-14 | 2014-09-18 | Spinal Stabilization Technologies, Llc | Prosthetic Spinal Disk Nucleus |
US9295479B2 (en) | 2013-03-14 | 2016-03-29 | Spinal Stabilization Technologies, Llc | Surgical device |
CA2846149C (en) | 2013-03-14 | 2018-03-20 | Stryker Spine | Systems and methods for percutaneous spinal fusion |
US9295500B2 (en) | 2013-06-12 | 2016-03-29 | Spine Wave, Inc. | Screw driver with release for a multiaxial bone screw |
CN105578975A (en) | 2013-07-19 | 2016-05-11 | 欧罗波罗斯医学有限公司 | An anti-clogging device for a vacuum-assisted, tissue removal system |
US10159579B1 (en) | 2013-12-06 | 2018-12-25 | Stryker European Holdings I, Llc | Tubular instruments for percutaneous posterior spinal fusion systems and methods |
US9744050B1 (en) | 2013-12-06 | 2017-08-29 | Stryker European Holdings I, Llc | Compression and distraction system for percutaneous posterior spinal fusion |
US9408716B1 (en) | 2013-12-06 | 2016-08-09 | Stryker European Holdings I, Llc | Percutaneous posterior spinal fusion implant construction and method |
WO2015089357A2 (en) | 2013-12-12 | 2015-06-18 | Conventus Orthopaedics, Inc. | Tissue displacement tools and methods |
US9730684B2 (en) | 2014-07-07 | 2017-08-15 | Warsaw Orthopedic, Inc. | Multiple spinal surgical pathways systems and methods |
US9980737B2 (en) | 2014-08-04 | 2018-05-29 | Medos International Sarl | Flexible transport auger |
US10264959B2 (en) | 2014-09-09 | 2019-04-23 | Medos International Sarl | Proximal-end securement of a minimally invasive working channel |
US10111712B2 (en) | 2014-09-09 | 2018-10-30 | Medos International Sarl | Proximal-end securement of a minimally invasive working channel |
US9924979B2 (en) | 2014-09-09 | 2018-03-27 | Medos International Sarl | Proximal-end securement of a minimally invasive working channel |
DE102014113634A1 (en) * | 2014-09-22 | 2016-03-24 | Aesculap Ag | Modular surgical instrument of the one-way design |
US9901457B2 (en) | 2014-10-16 | 2018-02-27 | Jmea Corporation | Coiling implantable prostheses |
US10314714B2 (en) | 2014-11-04 | 2019-06-11 | Spinal Stabilization Technologies Llc | Percutaneous implantable nuclear prosthesis |
EP3215069B1 (en) | 2014-11-04 | 2023-03-08 | Spinal Stabilization Technologies LLC | Percutaneous implantable nuclear prosthesis |
CA3008161C (en) | 2014-12-09 | 2023-09-26 | John A. Heflin | Spine alignment system |
US10786264B2 (en) | 2015-03-31 | 2020-09-29 | Medos International Sarl | Percutaneous disc clearing device |
EP3344156B1 (en) | 2015-09-01 | 2020-01-08 | Spinal Stabilization Technologies LLC | Implantable nuclear prosthesis |
US11744447B2 (en) | 2015-09-04 | 2023-09-05 | Medos International | Surgical visualization systems and related methods |
US11672562B2 (en) | 2015-09-04 | 2023-06-13 | Medos International Sarl | Multi-shield spinal access system |
US10987129B2 (en) | 2015-09-04 | 2021-04-27 | Medos International Sarl | Multi-shield spinal access system |
CN113143355A (en) | 2015-09-04 | 2021-07-23 | 美多斯国际有限公司 | Multi-shield spinal access system |
US11439380B2 (en) | 2015-09-04 | 2022-09-13 | Medos International Sarl | Surgical instrument connectors and related methods |
US10299838B2 (en) | 2016-02-05 | 2019-05-28 | Medos International Sarl | Method and instruments for interbody fusion and posterior fixation through a single incision |
US10631881B2 (en) | 2017-03-09 | 2020-04-28 | Flower Orthopedics Corporation | Plating depth gauge and countersink instrument |
WO2019010252A2 (en) | 2017-07-04 | 2019-01-10 | Conventus Orthopaedics, Inc. | Apparatus and methods for treatment of a bone |
AU2019384660A1 (en) | 2018-09-04 | 2021-03-25 | Spinal Stabilization Technologies, Llc | Implantable nuclear prosthesis, kits, and related methods |
US11013530B2 (en) | 2019-03-08 | 2021-05-25 | Medos International Sarl | Surface features for device retention |
US11241252B2 (en) | 2019-03-22 | 2022-02-08 | Medos International Sarl | Skin foundation access portal |
US11129727B2 (en) | 2019-03-29 | 2021-09-28 | Medos International Sari | Inflatable non-distracting intervertebral implants and related methods |
US11813026B2 (en) | 2019-04-05 | 2023-11-14 | Medos International Sarl | Systems, devices, and methods for providing surgical trajectory guidance |
CN114901201A (en) * | 2019-11-12 | 2022-08-12 | 守路者外科手术有限责任公司 | System, method and computer program product for improved microsurgical use cases |
US11883303B2 (en) | 2019-12-30 | 2024-01-30 | Vertebration, Inc. | Spine surgery method and instrumentation |
CN111134768B (en) * | 2020-01-14 | 2021-07-27 | 常州市第一人民医院 | Adjustable vertebral lamina rongeur special for orthopedics department |
US11771517B2 (en) | 2021-03-12 | 2023-10-03 | Medos International Sarl | Camera position indication systems and methods |
Family Cites Families (41)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
FR903E (en) * | 1902-05-14 | 1903-04-23 | De Pezzer Michel | Surgical instrument system for prostate operations |
US2068721A (en) * | 1932-11-18 | 1937-01-26 | Wappler Frederick Charles | Method for electrosurgical severance of adhesions |
US2031682A (en) * | 1932-11-18 | 1936-02-25 | Wappler Frederick Charles | Method and means for electrosurgical severance of adhesions |
US2919692A (en) * | 1956-02-23 | 1960-01-05 | Ackermann Wolfgang | Vertebral trephine biopsy instruments |
US3752161A (en) * | 1971-08-02 | 1973-08-14 | Minnesota Mining & Mfg | Fluid operated surgical tool |
US4016881A (en) * | 1973-07-04 | 1977-04-12 | Centre De Recherche Industrielle Du Quebec | Instrument for use in laparoscopic tubal cauterization |
CA1018419A (en) * | 1973-07-04 | 1977-10-04 | Gerald Turp | Instrument for laparoscopic tubal cauterization |
CH587664A5 (en) * | 1974-09-05 | 1977-05-13 | Fischer Fa F L | |
US3996921A (en) * | 1975-04-17 | 1976-12-14 | Pharmacia Inc. | Method and apparatus for endoscopy |
US4461281A (en) * | 1977-06-15 | 1984-07-24 | Carson Robert W | Arthroscopic surgical apparatus and method |
DE2808911C2 (en) * | 1978-03-02 | 1979-11-08 | B. Braun Melsungen Ag, 3508 Melsungen | Punch to remove bone and cartilage |
US4418692A (en) * | 1978-11-17 | 1983-12-06 | Guay Jean Louis | Device for treating living tissue with an electric current |
DE3013384A1 (en) * | 1980-04-05 | 1981-10-15 | Günter van Dr.med. 4000 Düsseldorf Endert | CANNULA |
US4545374A (en) * | 1982-09-03 | 1985-10-08 | Jacobson Robert E | Method and instruments for performing a percutaneous lumbar diskectomy |
US4662371A (en) * | 1983-01-26 | 1987-05-05 | Whipple Terry L | Surgical instrument |
US4573448A (en) * | 1983-10-05 | 1986-03-04 | Pilling Co. | Method for decompressing herniated intervertebral discs |
US4580563A (en) * | 1983-10-24 | 1986-04-08 | Gross R Michael | Arthroscopic surgical instrument and method |
US4722338A (en) * | 1983-12-12 | 1988-02-02 | Daniel Farley | Medical instrument for removing bone |
US4539976A (en) * | 1984-02-08 | 1985-09-10 | Sharpe Jewett M | Endoscopic surgical instrument |
US4712545A (en) * | 1984-04-05 | 1987-12-15 | Acufex Microsurgical, Inc. | Surgical instrument |
US4655216A (en) * | 1985-07-23 | 1987-04-07 | Alfred Tischer | Combination instrument for laparoscopical tube sterilization |
US4644951A (en) * | 1985-09-16 | 1987-02-24 | Concept, Inc. | Vacuum sleeve for a surgical appliance |
US4733663A (en) * | 1986-07-02 | 1988-03-29 | Farley Daniel K | Medical instrument for removing bone |
US4723546A (en) * | 1986-06-17 | 1988-02-09 | Zagorski Joseph B | Apparatus for arthroscopic surgery |
US5019081A (en) * | 1986-12-10 | 1991-05-28 | Watanabe Robert S | Laminectomy surgical process |
US4785826A (en) * | 1987-03-02 | 1988-11-22 | Ward John L | Biopsy instrument |
US5089000A (en) * | 1987-09-18 | 1992-02-18 | John M. Agee | Surgical method and instrument therefor |
DE3824910C2 (en) * | 1988-07-22 | 1994-06-09 | Wolf Gmbh Richard | Arthroscopy hook punch |
US4990148A (en) * | 1989-01-13 | 1991-02-05 | Codman & Shurtleff, Inc. | Thin footplate rongeur |
US5061269A (en) * | 1989-02-07 | 1991-10-29 | Joseph J. Berke | Surgical rongeur power grip structure and method |
US5160318A (en) * | 1989-02-23 | 1992-11-03 | Linvatec Corporation | Surgical cutting instrument with ceramic coating on an inner tubular member |
US5061238A (en) * | 1989-02-23 | 1991-10-29 | Linvatec Corporation | Surgical cutting instrument with titanium nitride coating on an inner tubular member |
DE3917328A1 (en) * | 1989-05-27 | 1990-11-29 | Wolf Gmbh Richard | BIPOLAR COAGULATION INSTRUMENT |
US5092872A (en) * | 1989-07-28 | 1992-03-03 | Jacob Segalowitz | Valvulotome catheter |
DE3937700C2 (en) * | 1989-11-13 | 1998-02-19 | Sutter Hermann Select Med Tech | Bipolar coagulation forceps with switch |
US5122134A (en) * | 1990-02-02 | 1992-06-16 | Pfizer Hospital Products Group, Inc. | Surgical reamer |
DE69123982T2 (en) * | 1990-11-20 | 1997-12-04 | Innerdyne Medical Inc | STRETCH MAINTENANCE GUIDE ELEMENT AND DILATATOR |
US5147357A (en) * | 1991-03-18 | 1992-09-15 | Rose Anthony T | Medical instrument |
US5217451A (en) * | 1991-05-24 | 1993-06-08 | Dexide, Inc. | Gear activated trocar assembly |
US5133719A (en) * | 1991-06-27 | 1992-07-28 | Frederick Winston | Disk plow and methods therefor |
US5152772A (en) * | 1991-07-10 | 1992-10-06 | Sewell Jr Frank | Sphincterotomy catheter and method |
-
1993
- 1993-03-09 US US08/028,244 patent/US5439464A/en not_active Expired - Fee Related
-
1994
- 1994-03-08 EP EP94301639A patent/EP0614647A3/en not_active Withdrawn
- 1994-03-08 CA CA002117220A patent/CA2117220A1/en not_active Abandoned
- 1994-03-08 AU AU57623/94A patent/AU5762394A/en not_active Abandoned
- 1994-03-09 JP JP6038480A patent/JPH06296620A/en active Pending
Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9867626B2 (en) | 2012-08-03 | 2018-01-16 | Boss Instruments Ltd., Inc. | Push button Rongeur |
US10507027B2 (en) | 2012-08-03 | 2019-12-17 | Boss Instruments, Ltd., Inc. | Push button rongeur |
US11317926B2 (en) | 2012-08-03 | 2022-05-03 | Boss Instruments, Ltd., Inc. | Push button rongeur |
CN111658120A (en) * | 2020-07-01 | 2020-09-15 | 李华 | Novel orthopedic surgery forceps |
CN111658120B (en) * | 2020-07-01 | 2022-05-03 | 李华 | Orthopedic operation forceps |
Also Published As
Publication number | Publication date |
---|---|
AU5762394A (en) | 1994-09-15 |
JPH06296620A (en) | 1994-10-25 |
US5439464A (en) | 1995-08-08 |
EP0614647A3 (en) | 1994-12-28 |
EP0614647A2 (en) | 1994-09-14 |
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