WO2016154030A1

WO2016154030A1 - Dural protecting rongeur

Info

Publication number: WO2016154030A1
Application number: PCT/US2016/023205
Authority: WO
Inventors: Bruce Frankel; Evald Mark SEMLER
Original assignee: Musc Foundation For Research Development
Priority date: 2015-03-20
Filing date: 2016-03-18
Publication date: 2016-09-29

Abstract

A surgical rongeur includes a base member that is elongate along a first longitudinal axis between a distal end and a proximal end. The base member includes a footplate that that extends upwards from the first longitudinal axis at the distal end of the base member. The footplate includes a first cutting surface that faces the proximal end of the base member. The footplate further includes a distal surface opposite the first cutting surface. The rongeur also includes an upper member disposed on top of the base member and elongate along a second longitudinal axis. The upper member includes a second cutting surface that is configured to mate with the first cutting surface. The upper member is configured to slide relative to the base member along the second longitudinal axis. Additionally, the rongeur includes at least one retractable flange disposed on a surface of the footplate.

Description

DURAL PROTECTING RONGEUR

CROSS REFERENCED APPLICATIONS

[0001] This present application derives priority from provisional application 62/135,918 filed March 20, 2015, which is incorporated herein by reference in its entirety.

BACKGROUND

[0002] Surgical rongeurs, such as Kerrison Rongeurs, are instruments that are used for gouging out portions of bone. Specifically, Kerrison Rongeurs may be used as a bone punch during neurosurgical and spinal procedures. When Kerrison Rongeurs are used to remove bone, there is a risk that a portion of the dura will creep between the cutting blades. Dural creep may result in a dural tear that may cause severe complications.

SUMMARY

[0003] As described herein, a surgical rongeur includes a base member that is elongate along a first longitudinal axis between a distal end and a proximal end. The base member includes a footplate that that extends upwards from the first longitudinal axis at the distal end of the base member. The footplate includes a first cutting surface that faces the proximal end of the base member. The footplate further includes a distal surface opposite the first cutting surface. The rongeur also includes an upper member disposed on top of the base member and elongate along a second longitudinal axis. The upper member includes a second cutting surface that is configured to mate with the first cutting surface. The upper member is configured to slide relative to the base member along the second longitudinal axis. Additionally, the rongeur includes at least one retractable flange disposed on the distal surface of the footplate.

[0004] In accordance with one embodiment, a method of removing a portion of bone using a surgical rongeur. The surgical rongeur includes a base member that is elongate along a first longitudinal axis between a distal end and a proximal end. The base member includes a footplate that that extends upwards from the first longitudinal axis at the distal end of the base member. The footplate includes a first cutting surface that faces the proximal end of the base member. The footplate further includes a distal surface opposite the first cutting surface. The rongeur also includes an upper member disposed on top of the base member and elongate along a second longitudinal axis. The upper member includes a second cutting surface that is configured to mate with the first cutting surface. The upper member is configured to slide relative to the base member along the second longitudinal axis. Additionally, the rongeur includes at least one retractable flange disposed on the distal surface of the footplate. The method includes positioning the at least one retractable flange so as to push dura away from the first and second cutting surfaces, engaging the portion of bone with the first and second cutting surfaces, and removing the portion of bone.

BRIEF DESCRIPTION OF THE DRAWINGS

[0005] The foregoing summary, as well as the following detailed description of embodiments of the application, will be better understood when read in conjunction with the appended drawings. For the purposes of illustrating the methods and systems of the present application, there is shown in the drawings preferred embodiments. It should be understood, however, that the application is not limited to the precise methods and systems shown. In the drawings:

[0006] Fig. 1 is a side view of a known surgical rongeur;

[0007] Fig. 2 is an in situ view of a surgical rongeur being used to remove a portion of bone;

[0008] Fig. 3 is a perspective view of a surgical rongeur that includes a retractable flange in the form of a cable loop;

[0009] Figs. 4 and 5 are perspective views of a surgical rongeur that includes a rib and a retractable flange in the form of a cable loop;

[0010] Fig. 6 is a perspective view of a surgical rongeur that includes a rib and a retractable flange in the form of a pair of cables;

[0011] Fig. 7 is a perspective view of a surgical rongeur that includes a retractable flange in the form of a cable loop with wires that retract into the footplate;

[0012] Fig. 8 is a perspective view of a surgical rongeur that includes a rib and retractable flange in the form of a pair of paddles;

[0013] Fig. 9 is a perspective view of a surgical rongeur that includes paddles that actuate by translating sideways;

[0014] Fig. 10 is a perspective view of a surgical rongeur that includes paddles that actuate by rotating sideways;

[0015] Fig. 11 is a perspective view of a surgical rongeur that includes a single paddle that actuates by translating upwards; [0016] Figs. 12a-12c are perspective views of a surgical ronguer that includes paddles that actuate by rotating outward, the paddles being separately controllable via two triggers, respectively;

[0017] Figs 12d and 12e are exploded perspective views of the surgical ronguer shown in Figs. 8a-8c;

[0018] Figs 13a and 13b are side views of a surgical ronguer with a single trigger.

[0019] Figs 14a-c Kerrison with lateral sliding tabs;

[0020] Figs. 15a-15c Views of the clip assembly shown in Figs. 14a-14c.

DETAILED DESCRIPTION

[0019] Certain terminology is used in the following description for convenience only and is not limiting. The words "proximally" and "distally" refer to directions toward and away from, respectively, the individual operating the display unit. The words "up", "down",

"longitudinal", "lateral," and "transverse" designate directions in the drawings to which reference is made. The terminology includes the above-listed words, derivatives thereof and words of similar import.

[0020] Referring again to Fig. 1 , a surgical rongeur 10 includes a base member 12 that is elongate along a first longitudinal axis Li between a handle portion 14, attached to a proximal end 16 of the base member 12, and a footplate 18 disposed at a distal end 20 of the base member. Handle portion 14 includes a grip 22. Handle portion 14 may be integral with base member 12. Footplate 18 extends upwards from the first longitudinal axis Li and includes a first cutting surface 24 that faces the proximal end 16 of the base member. First cutting surface 24 may extend at an obtuse angle relative to the first longitudinal axis Li. Footplate 18 includes a distal surface 26 that is disposed opposite the first cutting surface 24. For example, first cutting surface 24 and distal surface 26 may extend parallel, or approximately parallel, to one another, such that distal surface 26 also extends at an obtuse angle relative to the first longitudinal axis Li.

[0021] Rongeur 10 also includes an upper member 28 disposed on top of base member 12. Upper member 28 is elongate along a second longitudinal axis L₂ between a proximal end 30 and a distal end 32. Second longitudinal axis L₂ is parallel, or approximately parallel to first longitudinal axis Li. Distal end 32 includes a second cutting surface 34 that is configured to mate with first cutting surface 24 of the base member 12. Specifically, first and second cutting surfaces 24, 34 extend parallel, or approximately parallel, to each other. A lever 36 is pivotably attached to the proximal end 30 of the upper member 28 and the handle portion 14. A first pivot pin (not shown) attaches the lever 36 to the upper member 28 and a second pivot pin 38 attached the lever 36 to the handle portion 14. A damper 40, such as a spring, may be disposed between the handle portion 14 and the lever 36.

[0022] With reference to Fig. 2, in use, lever 36 may be actuated so as to effect movement of the upper member 28 in relation to the base member 12. Specifically, and with reference to Fig. 2, as lever 36 pivots toward handle portion 14, upper member 28 slides towards the footplate 18 of the base member 12 such that first and second cutting surfaces 24, 34 together engage a portion of a bone B so as to remove the portion of the bone B.

[0023] When rongeur 10 engages bone B, there is a risk that dura D will creep around the distal surface 26 of the base member 12, and in between the cutting surfaces 24, 34, which may result in a dural tear. With reference now to Figs. 3-7, at least one retractable flange may be disposed on the distal surface 26 of the base member 12 so as to minimize the risk of dural creep by pushing the dura away from the cutting surfaces 24, 34. In some embodiments, the at least one retractable flange may extend wider than the distal surface 26, so as to more evenly distribute force between the dura and the rongeur, relative to rongeurs that do not include at least one retractable flange.

[0024] With reference now to Fig. 3, base member 12 defines a recess 42 into which a retractable flange 50 is disposed. The retractable flange 50 comprises a cable 52 that defines a loop 54 that extends from the distal surface 26 of the base member 12. Cable 52 may be actuated at a proximal end of the rongeur 10, such as at proximal end 16 of the base member 12, so as to enlarge and contract the loop 54 in lateral and transverse directions relative to longitudinal axes Li, L₂. For example, as cable 52 shifts within recess 42 towards the distal surface 26, loop 54 expands from a starting position so as to push dura D away from cutting surfaces 24, 34. After cutting surfaces 24, 34 engage bone B, cable 52 may be shifted towards the proximal end of the rongeur 10 so as to contract the loop 54 back to the starting position either before or after bone B is removed.

[0025] Figs. 4 and 5 also shows a cable 52 that defines a loop 54 and functions similarly to the cable 52 shown in Fig. 3. However, base member 12 in Fig. 4 includes a rib 56 that extends from the distal surface 26. For example, rib 56 may extend distally from the distal surface 26 parallel to longitudinal axes L_1; L₂. Rib 56 defines a recess 58 into which at least part of the loop 54 is disposed. As cable 52 shifts towards the distal end of the rongeur 10, rib 56 exerts an upward force on loop 54, causing loop 54 to expand laterally in relation to longitudinal axes Li, L₂, rather than both laterally and transversely. [0026] Fig. 6 functions similarly to the cable 52 shown in Figs. 4 and 5. However, in Fig. 6, two separate cables 52a, 52b are disposed within recesses 42, 58. These two cables 52 are each separately controllable such that either or both may be actuated so as to expand cables 52a, 52b laterally. Separate control of cables 52a, 52b may be desirable in certain surgical fields where lateral expansion of cable 52a, 52b is only desirable in one direction. In alternative embodiments, a retractable flange 50 having a loop 54 (as shown in Figs. 4 and 5) may have similar functionality to that described in relation to Fig. 6 by affixing loop 54 to rib 56 such that one side of the loop 54 is separately moveable in relation to the other side.

[0027] The embodiment shown in Fig. 7 also provides for separately controllable cables 52a, 52b that are at least partially enclosed within an enclosure 57 that extends up from rib 56. Cables 52a, 52b may be separated, as shown in Fig. 6, or they may be contiguous as shown in Figs. 4 and 5. Whether separated or contiguous, cables 52a, 52b are each separately controllable such that either or both may be actuated so as to expand cables 52a, 52b laterally. For example, the cables 52a, 52b may be located on and expand from a lateral surface 53 of the enclosure 57. Cables 52a, 52b may be contractable so as to be fit entirely within enclosure 57 so as to not extend laterally from the distal end of the ronguer 10.

[0028] Like Figs. 6 and 7, Fig. 8 shows a pair of retractable flanges 50a, 50b that are separately controllable. Flanges 50a, 50b each include paddles 60a, 60b mounted at a distal end of cables 52a, 52b, respectively. Paddles 60a, 60b are configured to rotate laterally to provide similar functionality to the expanding loop 54 and cables 52 described above. Specifically, paddles 60a, 60b may be rotated laterally outwardly in relation to longitudinal axes L_1; L₂ so as to expand and push dura away from the cutting surfaces 24, 34. After cutting surfaces 24, 34 engage bone B, paddles 60 may be rotated inwardly toward longitudinal axes L_1; L₂, so as to contract, either before or after bone B is removed.

[0029] Fig. 8 also shows an alternative embodiment of recess 42 in which cables 52a, 52b are enclosed along the surface of the base member 12 opposite the upper member 28.

Enclosing cables 52a, 52b may prevent debris from inhibiting movement of the cables 52a, 52b within the recess 42. Recess 42 may be a single enclosed recess (not shown), or recess 42 may include a pair of sides 42a, 42b, for each cable 52a, 52b, or portion thereof.

[0030] Similar to Fig. 8, the embodiment of Fig. 9 also includes paddles 60a, 60b connected to cables 52a, 52b. Paddles 60a, 60b translate laterally outwardly in relation to longitudinal axes L_1; L₂ so as to expand and push dura away from the cutting surfaces 24, 34. After cutting surfaces 24, 34 engage bone B, paddles 60 may be translated inwardly toward longitudinal axes L_1; L₂, so as to contract, either before or after bone B is removed. Paddles 60a, 60b and cables 52a, 52b may be configured to be separately controllable or to be actuated in unison.

[0031] The embodiment of Fig. 10 includes paddles 60a, 60b connected to cables 52a, 52b. Like Fig. 8, paddles 60a, 60b rotate laterally outwardly in relation to longitudinal axes L_1; L₂ so as to expand and push dura away from the cutting surfaces 24, 34. After cutting surfaces 24, 34 engage bone B, paddles 60 may be rotate inwardly toward longitudinal axes L_1; L₂, so as to contract, either before or after bone B is removed. Paddles 60a, 60b and cables 52a, 52b are configured to be actuated in unison.

[0032] The embodiment of Fig. 1 1 includes a single paddle 60 that forms part of a distal tip of a flexible flange. Instead of being actuated by cables, paddle 60 translates upwards and away from the distal end of the ronguer 10. Specifically, the distal end of paddle 60 translates upward in relation to longitudinal axes L_1; L₂ so as to push dura away from the cutting surfaces 24, 34. After cutting surfaces 24, 34 engage bone B, paddle 60 may be retracted downwardly toward longitudinal axes L_1; L₂, so as to contract, either before or after bone B is removed.

[0033] With reference now to Figs. 12a-e, actuation of the embodiments shown in Figs. 3-10 will now be described. Similar to the description above in relation to Figs. 1 and 2, a lever 136 may be actuated so as to effect movement of the upper member 128 in relation to the base member 1 12. Specifically, and with reference to Fig. 2, as lever 136 pivots toward handle portion 114, upper member 128 slides towards the footplate 1 18 of the base member 1 12 such that first and second cutting surfaces 124, 134 together engage a portion of a bone B so as to remove the portion of the bone B.

[0034] In addition to the basic bone cutting functionality, triggers 150a, 150b are each separately controllable so as to effect movement of paddles 60a, 60b and/or cables 52a, 52b. For example, when both triggers 150a, 150b are in a forward position relative to handle portion 1 14 (as shown in Fig. 12a), paddles 60a, 60b are rotated laterally inward in a contracted position such that the outer surfaces correspond to the outer surface of the footplate 1 18. When both triggers 150a, 150b are in a rearward position relative to handle portion 1 18 (as shown in Fig. 12b), paddles 60a, 60b are rotated laterally outward in an expanded position so as to extend past the outer surface of the footplate 118. If one trigger 150a is in the forward position, while the other trigger 150b is in the rearward position (as shown in Fig. 12c), paddle 60a is rotated laterally outward while paddle 60b is rotated laterally inward. Triggers 150a, 150b may connect to paddles 60a, 60b via cables 52a, 52b and cams 154a, 154b.

[0035] Turning now to Figs. 13a and 13b, a single trigger 150 may instead be employed for any of the embodiments described in relation to Figs. 3-11. Single trigger 150 uses a wire (not shown), or in the case of the embodiment of Fig. 1 1, a flexible flange 61, to connect to paddles 60a, 60b, cables 52a, 52b, or loop 54. Cables 52a, 52b and loop 54 may be integral with the wire connected to trigger 150. In a forward position relative to handle 1 14, paddles 60a, 60b, cables 52a, 52b, or loop 54 are contracted. In a rearward position relative to handle 1 14, paddles 60a, 60b, cables 52a, 52b, or loop 54 are expanded outwardly. With single trigger 150, laterally expanding paddles 60a, 60b and/or cables 52a, 52b move in unison.

[0038] With respect to Figs. 14 and 15, the device consists of a handle 1 14, a lever 136, a base member 112, and footplate 118. The base member 1 12 defines recesses 42a and 42b into elongated members 52a and 52b are disposed. Elongated members 52a and 52b have flanges 60a and 60b extending from the distal end. Elongated members 52a and 52b may be actuated at a proximal end of the rongeur 10, by actuation of lever 136 toward handle 1 14. As lever 136 is moved toward handle 114, elongated members 52a and 52b travel distally in recesses 42a and 42b. The distal ends of the elongated members 52a and 52b are removeably coupled with a clip 180 by a gated spring 160 that will open if the upper member 128 applies a force above a certain threshold to the gated spring 160. This would occur if the flanges 60a and 60b were obstructed from sliding in recesses 42a and 42b until they reached the footplate 1 18. If there is no obstruction, the gated spring 160 will push the elongated members 52a and 52b in the distal direction until flanges 60a and 60b reach the footplate 1 18 of the base member 1 12, effectively expanding the width of the foot plate 118. Notches 161a and 161b on the clip 180 allow for the clip 180 to grab the elongated members 52a and 52b when they return to their starting proximal position.

[0036] In some embodiments, a single trigger may be used to both actuate the paddle 60 or paddles 60a, 60b and/or cable 52 or cables 52a, 52b as well as the first and second cutting surfaces 24, 34. Structurally, such embodiments may similar to the rongeur 10 shown in Fig. 1. However, paddle 60 or paddles 60a, 60b and/or cable 52 or cables 52a, 52b are configured such that initial actuation of lever 36 actuates paddle 60 or paddles 60a, 60b and/or cable 52 or cables 52a, 52b so as to push dura away from the cutting surfaces 24, 34. As lever 36 continues to be squeezed towards grip 22, lever 36 causes cutting surfaces 24, 34 to engage and cut bone B. After bone B is cut, release of lever 36 causes paddle 60 or paddles 60a, 60b and/or cable 52 or cables 52a, 52b to retract.

[0037] In some embodiments, all or a portion of the rongeur 10 may detachable and/or disposable. Specifically, paddle 60 or paddles 60a, 60b and/or cable 52 or cables 52a, 52b may be removeable and/or disposable from rongeur 10. Additionally, a portion of the body of ronguer 10, along with paddle 60 or paddles 60a, 60b and/or cable 52 or cables 52a, 52b may be removeable and/or disposable. Cutting surfaces 24, 34 may also be detachable and/or disposable.

[0038] While the foregoing description and drawings represent a preferred

embodiment, it will be understood that various additions, modifications, combinations and/or substitutions can be made therein without departing from the spirit and scope of the invention as defined in the accompanying claims. In particular, it will be clear to those skilled in the art that the invention can be embodied in other specific forms, structures, arrangements, proportions, and with other elements, materials, and components, without departing from the spirit or essential characteristics thereof. One skilled in the art will appreciate that the invention can be used with many modifications of structure, arrangement, proportions, materials, and components, which are particularly adapted to specific environments and operative requirements without departing from the principles of the invention. In addition, features described herein can be used singularly or in combination with other features. For example, features described in connection with one component can be used and/or interchanged with features described in another component. The presently disclosed embodiment is therefore to be considered in all respects as illustrative and not restrictive, the scope of the invention being indicated by the appended claims, and not limited to the foregoing description.

Claims

What is Claimed:

1. A surgical rongeur comprising:

a base member that is elongate along a first longitudinal axis between a distal end and a proximal end, the base member including a footplate that that extends upwards from the first longitudinal axis at the distal end of the base member, the footplate including a first cutting surface that faces the proximal end of the base member, the footplate further including a distal surface opposite the first cutting surface;

an upper member disposed on top of the base member and elongate along a second longitudinal axis, the upper member including a second cutting surface that is configured to mate with the first cutting surface, wherein the upper member is configured to slide relative to the base member along the second longitudinal axis; and

at least one retractable flange disposed on a surface of the footplate.

2. The surgical rongeur of claim 1, wherein the at least one retractable flange is located on a lateral surface of the footplate.

3. The surgical rongeur of claim 1 wherein the at least one retractable flange is located on the distal surface of the footplate.

4. The surgical rongeur of claim 1, wherein the at least one retractable flange is a cable loop configured to expand and contract in lateral and transverse directions relative to the first longitudinal axis.

5. The surgical rongeur of claim 1 , further comprising a rib that extends from the distal surface, the rib defining a recess, and the at least one retractable flange is a cable loop that is at least partially disposed in the recess, the cable loop configured to expand and contract laterally relative to the first longitudinal axis.

6. The surgical rongeur of claim 1, further comprising a rib that extends from the distal surface, the rib defining a recess, and the at least one retractable flange includes a pair of cables that are at least partially disposed in the recess, each of the cables being separately controllable so as to enlarge and contract laterally relative to the first longitudinal axis.

7. The surgical rongeur of claim 1, wherein the at least one retractable flange is includes a pair of paddles that are configured to rotate laterally relative to the first longitudinal axis.

8. The surgical rongeur of claim 7, further comprising a rib that extends from the distal surface, the rib defining a recess in which the pair of paddles are partially disposed.

9. The surgical rongeur of claim 1, wherein the first longitudinal axis and the second longitudinal axis are parallel to each other.

10. The surgical rongeur of claim 1 , further comprising a handle portion that is attached to the base member and a lever that is pivotably attached to the upper member and the base member.

1 1. The surgical rongeur of claim 1 further comprising a single trigger that (1) actuates the upper member to slide relative to the base member along the second longitudinal axis; and (2) actuates the at least one retractable flange.

12. The surgical rongeur of claim 1 , wherein at least a portion of the rongeur is detachable and disposable.

13. A method of removing a portion of bone using a surgical rongeur, the surgical rongeur comprising a base member that is elongate along a first longitudinal axis between a distal end and a proximal end, the base member including a footplate that that extends upwards from the first longitudinal axis at the distal end of the base member, the footplate including a first cutting surface that faces the proximal end of the base member, the footplate further including a distal surface opposite the first cutting surface; an upper member disposed on top of the base member and elongate along a second longitudinal axis, the upper member including a second cutting surface that is configured to mate with the first cutting surface, wherein the upper member is configured to slide relative to the base member along the second longitudinal axis; and at least one retractable flange disposed on a surface of the footplate, the method comprising:

positioning the at least one retractable flange so as to push dura away from the first and second cutting surfaces; engaging the portion of bone with the first and second cutting surfaces; and

removing the portion of bone.

14. The method of claim 13, further comprising a step of returning the at least one retractable flange to a starting position.

15. The method of claim 14, wherein the step of returning the at least one retractable flange to the starting position occurs before the step of removing the bone.

16. The method of claim 13, wherein the at least one retractable flange is a cable loop, and the step of positioning includes expanding the cable loop in lateral and transverse directions relative to the first longitudinal axis.

17. The method of claim 13, wherein the surgical rongeur further comprises a rib that extends from the distal surface, the rib defining a recess, and the at least one retractable flange is a cable loop that is at least partially disposed in the recess, and the step of positioning includes expanding the cable loop laterally relative to the first longitudinal axis.

18. The method of claim 13, wherein the surgical rongeur further comprises a rib that extends from the distal surface, the rib defining a recess, and the at least one retractable flange includes a pair of cables that are at least partially disposed in the recess, and the step of positioning includes separately controlling each cable so as to laterally expand each cable relative to the first longitudinal axis.

19. The method of claim 13, wherein the at least one retractable flange is a pair of paddles, and the step of positioning includes laterally rotating at least one of the paddles relative to the first longitudinal axis.

20. The surgical rongeur of claim 13 wherein the steps of positioning, engaging, and removing, are all performed using a single trigger.