Systems and methods for prone lateral spinal surgery

Abstract

Internal fixation systems and methods for prone lateral spinal surgery on a patient. The system includes a lateral lumbar interbody fusion (LLIF) retractor and a posterior compressor / distractor including a posterior distractor rack assembly having a rack and a posterior distractor carriage assembly configured to operably engage the posterior distractor rack assembly. The posterior distractor rack assembly includes a first swivel tube subassembly having a first swivel tube and the posterior distractor carriage assembly includes a second swivel tube subassembly having a second swivel tube. The first and second swivel tubes are each configured to receive a pedicle screw and a screw tower therein. The first and second swivel tube subassemblies are configured to move and position relative to each other such that a surgeon can access the disc space of a patient from the left and right sides without the need for a bolster.

Description

[0001] Statement on Government Interests

[0002] none.

[0003] Cross-reference to related applications

[0004] This application claims the benefit of U.S. Provisional Patent Application No. 63 / 299,279, filed January 13, 2022, and U.S. Provisional Patent Application No. 63 / 306,785, filed February 4, 2022, both of which are incorporated herein by reference in their entirety. Background Technology

[0005] This invention relates generally to spinal surgery, and more specifically to systems and methods for prone lateral spinal surgery.

[0006] Prone lateral surgery of the thoracic and lumbar spine allows simultaneous anterior and posterior access to the spine without requiring intraoperative patient repositioning. This makes procedures that might otherwise require intraoperative rotation more efficient while maintaining equivalent safety.

[0007] Nevertheless, the current common approach for prone lateral surgery does require work to be performed prior to patient positioning. A pad is typically positioned on the side opposite the surgeon to prevent patient and spinal movement during the prone portion of the surgery.

[0008] exist Figure 1A and Figure 1B The image illustrates an exemplary preoperative preparation for performing prone lateral surgery using existing and conventional techniques, where the patient is prepared and covered, with a pad on the patient's right side. This setup allows the surgeon to access the left side of the patient's spine.

[0009] Using a pad has significant drawbacks. First, the surgeon and / or surgical staff must position the pad in a specific location before the patient is seated. If the pad is initially misplaced, the surgeon and staff may have to roll the patient face down, or even roll the patient back off the table. This can be frustrating and time-consuming, and could even lead to nerve damage if there is significant pressure on nerve components. Second, because the pad covers one side of the abdomen, its placement restricts the surgeon's access to the spine. Therefore, the surgeon must choose which side to access before positioning, and if the spine cannot be accessed from the open / planned side, it is not easy to switch to the other side. The surgeon cannot safely and effectively access both sides of the patient's spine using current techniques. Summary of the Invention

[0010] The following is a simplified overview of the innovations to provide a basic understanding of certain aspects of the invention. This summary is not a complete overview of the invention. Its purpose is neither to identify key or essential elements of the invention nor to define its scope. Its sole purpose is to introduce some concepts of the invention in a simplified form as a prelude to the more detailed description that follows.

[0011] Various embodiments of the present invention include an internal fixation system and a surgical method for prone lateral spinal surgery using the internal fixation system. This surgical method eliminates the need for a pad to prevent patient and spinal movement during the prone portion of the procedure, as pads have the aforementioned disadvantages.

[0012] In one embodiment, the internal fixation system for spinal surgery on a patient includes a lateral lumbar interbody fusion (LLIF) retractor having a lateral lumbar interbody fusion retractor adapter; a posterior compressor / traction device; an A-arm configured to be mounted on an operating table; and a B-arm configured to engage one end of the A-arm 104 mounted on the table and engage the posterior compressor / traction device.

[0013] In another embodiment, the internal fixation system for spinal surgery on a patient includes: a lateral lumbar endofusion (LLIF) retractor having a lateral lumbar interbody fusion retractor adapter; a posterior compressor / traction device including a posterior traction rack assembly comprising a rack having a plurality of ridges on at least one surface; a posterior traction bracket assembly configured to operatively engage the posterior traction rack assembly and including an opening configured to receive the rack passing through therethrough; and a pinion assembly configured to operatively engage the posterior traction rack assembly and the posterior traction bracket assembly. The posterior traction rack assembly and the posterior traction bracket assembly are movable relative to each other.

[0014] In yet another embodiment, the internal fixation system for spinal surgery performed on a patient includes: at least two canned pedicle screws that can be inserted through corresponding pedicles of the patient's spine; a traction frame 20 configured to operatively connect the at least two canned screws to each other; and means for mounting the internal fixation system to an operating table.

[0015] These and other features and advantages will become apparent upon reading the detailed description and related figures below. It is understood that both the foregoing general description and the detailed description below are explanatory in nature and not as restrictive as claimed. Attached Figure Description

[0016] These and other features, aspects, and advantages of the invention will be better understood with reference to the following description, the appended claims, and the accompanying drawings, in which:

[0017] Figure 1A This is an exemplary preoperative preparation for performing a prone lateral surgery on a patient using existing and conventional techniques, showing a cushion on the patient's right side;

[0018] Figure 1B yes Figure 1A The diagram illustrates an exemplary preoperative preparation, showing the surgeon touching the patient's left side (i.e., without a pad);

[0019] Figure 2 This is a schematic diagram of the placement of an insertion column of an internal fixation system according to a first embodiment of the present invention, which is inserted into the patient's spine during surgery;

[0020] Figure 3 This is according to the invention, used during prone lateral spinal surgery. Figure 2 Top-down view of the internal fixed system environment;

[0021] Figure 4 According to the present invention, a method for use with a lateral retractor during prone lateral spinal surgery. Figure 2 Top view of the internal fixation system, in which the lateral retractor is connected to the traction device of the internal fixation system;

[0022] Figure 5 This is a top view of the placement of the insertion column of the internal fixation system according to a second embodiment of the present invention, which is inserted into the patient's spine during surgery.

[0023] Figure 6 yes Figure 5 The detailed diagram shows the distal end of the pedicle screw inserted into the patient's vertebral body;

[0024] Figure 7 This is a top perspective view of an internal fixation system according to a third embodiment of the present invention, used during surgery with the patient's spine attached.

[0025] Figure 8 yes Figure 7 Left-side view of the internal fixing system;

[0026] Figure 9 yes Figure 7 Right-side view of the internal fixed system;

[0027] Figure 10 yes Figure 7 A head-to-tail view of the internal fixation system;

[0028] Figure 11 yes Figure 7A head-to-tail view of the internal fixation system;

[0029] Figure 12 yes Figure 7 Rear view of the internal fixing system;

[0030] Figure 13 yes Figure 7 Top-view perspective of the internal fixing system;

[0031] Figure 13A yes Figure 13 Detailed diagram of the first part;

[0032] Figure 13B yes Figure 13 Detailed diagram of the second part;

[0033] Figure 14A yes Figure 7 Exploded perspective view of the rear compressor / traction unit of the internal fixation system;

[0034] Figure 14B yes Figure 7 Top view of the rear compressor / traction unit of the internal fixation system;

[0035] Figure 14C yes Figure 7 Front view of the rear compressor / traction unit of the internal fixation system;

[0036] Figure 14D yes Figure 7 Side view of the rear compressor / traction unit of the internal fixation system;

[0037] Figure 15A yes Figure 14A Exploded perspective view of the rear traction bracket assembly of the rear compressor / traction unit;

[0038] Figure 15B It is the assembled Figure 15A Top-view perspective of the rear traction device bracket assembly;

[0039] Figure 15C yes Figure 15A Top view of the rear traction bracket assembly;

[0040] Figure 15D yes Figure 15A Front view of the rear traction bracket assembly;

[0041] Figure 15E yes Figure 15A Side view of the rear traction bracket assembly;

[0042] Figure 16A yes Figure 15ARear view of the rear traction bracket assembly;

[0043] Figure 16B yes Figure 16A A detailed diagram of a portion, as shown by the dashed lines;

[0044] Figure 16C yes Figure 15A A top plan view of the rear traction bracket assembly, showing its spring linkage assembly in the locked position;

[0045] Figure 16D yes Figure 15A A top plan view of the rear traction bracket assembly, showing its spring linkage assembly in the unlocked position;

[0046] Figure 16E yes Figure 15A A top plan view of the rear traction bracket assembly, showing its spring linkage assembly in the unlocked position;

[0047] Figure 17A yes Figure 15A Top perspective view of the bracket hub of the rear traction device bracket assembly;

[0048] Figure 17B yes Figure 17A A front view of the bracket hub;

[0049] Figure 17C yes Figure 17A Side view of the bracket hub;

[0050] Figure 17D yes Figure 17A Top view of the bracket hub;

[0051] Figure 17E yes Figure 17A A bottom view of the bracket hub;

[0052] Figure 17F It is along Figure 17C The line 17F in the middle is cut off Figure 17A and Figure 17C A cross-sectional view of the bracket hub;

[0053] Figure 17G yes Figure 17B A detailed diagram of a portion, as shown by the dashed lines;

[0054] Figure 17H yes Figure 17C A detailed diagram of a portion, as shown by the dashed lines;

[0055] Figure 18A yes Figure 15A A bottom-view perspective view of the pawl of the rear traction bracket assembly;

[0056] Figure 18B yes Figure 18A Side view of the pawl;

[0057] Figure 18C yes Figure 18A A frontal view of the pawl;

[0058] Figure 18D yes Figure 18A Top view of the bracket hub;

[0059] Figure 19A It is used with Figure 18A A top-view perspective view of the ratchet pin used together with the pawl;

[0060] Figure 19B yes Figure 19A A frontal plan view of the pin;

[0061] Figure 19C yes Figure 19A Side view of the ratchet pin;

[0062] Figure 20A It is used with Figure 18A Top-view perspective of a torsion spring used together with a pawl;

[0063] Figure 20B yes Figure 20A A front view of a torsion spring;

[0064] Figure 20C yes Figure 20A A side view of a torsion spring;

[0065] Figure 21A yes Figure 15A Exploded perspective view of the first rotating tube assembly of the rear traction bracket assembly;

[0066] Figure 21B yes Figure 21A Top view of the rotary tube assembly;

[0067] Figure 21C yes Figure 21A Side view of the rotary tube assembly;

[0068] Figure 21D yes Figure 21A A front view of the rotary tube assembly;

[0069] Figure 22A yes Figure 21A Top-view perspective of the arm of the rotary tube assembly;

[0070] Figure 22B yes Figure 22A Side view of the arm;

[0071] Figure 22C yes Figure 22A Rear view of the arm;

[0072] Figure 22D It is along Figure 22C The line 22D-22D is intercepted. Figure 22A and 22C Cross-sectional view of the arm;

[0073] Figure 23A yes Figure 21A A bottom-view perspective view of the rotary hub of the rotary tube assembly;

[0074] Figure 23B yes Figure 23A A front view of the rotary hub;

[0075] Figure 23C yes Figure 23A Side view of the rotary hub;

[0076] Figure 23D yes Figure 23A Top view of the rotary hub;

[0077] Figure 23E yes Figure 23A Rear view of the rotary hub;

[0078] Figure 23F It is along Figure 23B The line 23F-23F is cut off. Figure 23A and Figure 23B A cross-sectional view of the rotary hub;

[0079] Figure 23G yes Figure 23B A detailed diagram of a portion, as shown by the dashed lines;

[0080] Figure 23H It is along Figure 23E The line 23H-23H is cut off. Figure 23A and Figure 23E A cross-sectional view of the rotary hub;

[0081] Figure 24A yes Figure 21A Top-view perspective of the rotary tube pin of the rotary tube assembly;

[0082] Figure 24B yes Figure 24A A front view of the rotary pin;

[0083] Figure 24C yes Figure 24A Side view of the rotary pin;

[0084] Figure 25A yes Figure 21AA bottom-view perspective view of the rotary tube assembly;

[0085] Figure 25B yes Figure 25A Side view of the rotary tube;

[0086] Figure 25C yes Figure 25A A front view of the rotary tube;

[0087] Figure 25D yes Figure 25A Top-view perspective of the rotary tube;

[0088] Figure 26A yes Figure 21A Top-view perspective of the tulip-shaped rod of the rotary tube assembly;

[0089] Figure 26B yes Figure 26A A front view of the tulip-shaped rotating tube rod;

[0090] Figure 26C yes Figure 26A Side view of the tulip-shaped rotating tube in the middle;

[0091] Figure 27A yes Figure 21A Top-view perspective of the compression spring of the rotary tube assembly;

[0092] Figure 27B yes Figure 27A A front view of a compression spring;

[0093] Figure 27C yes Figure 27A A side view of a compression spring;

[0094] Figure 28A yes Figure 15A Top perspective view of the cam pin of the rear traction device bracket assembly;

[0095] Figure 28B yes Figure 28A A front view of the cam pin;

[0096] Figure 28C yes Figure 28A Top view of the cam pin;

[0097] Figure 28D yes Figure 28A Side view of the cam pin;

[0098] Figure 29A yes Figure 15A Top perspective view of the top cam link of the rear traction bracket assembly;

[0099] Figure 29B yes Figure 29A A front view of the top cam link;

[0100] Figure 29C yes Figure 29A Side view of the top cam link;

[0101] Figure 29D yes Figure 29A Top view of the top cam link;

[0102] Figure 29E yes Figure 29A Rear view of the top cam link;

[0103] Figure 30A yes Figure 15A A bottom-view perspective view of the top cam link of the rear traction bracket assembly;

[0104] Figure 30B yes Figure 30A A front view of the bottom cam link;

[0105] Figure 30C yes Figure 30A Side view of the bottom cam link;

[0106] Figure 30D yes Figure 30A Top view of the bottom cam link;

[0107] Figure 30E yes Figure 30A Rear view of the bottom cam link;

[0108] Figure 31A yes Figure 14A Exploded perspective view of the rear traction rack assembly of the rear compressor / traction unit;

[0109] Figure 31B yes Figure 31A A top plan view of the rear traction rack assembly, showing its spring linkage assembly in the unlocked position;

[0110] Figure 31C yes Figure 31A A top plan view of the rear traction rack assembly, showing its spring linkage assembly in the locked position;

[0111] Figure 31D yes Figure 31A Side view of the rear traction rack assembly;

[0112] Figure 32A yes Figure 31A Top perspective view of the rack and rack hub of the rear traction rack assembly;

[0113] Figure 32Byes Figure 32A A bottom-view perspective of the rack and rack hub;

[0114] Figure 32C yes Figure 32A A front view of the rack and rack hub;

[0115] Figure 32D yes Figure 32A Top view of the rack and rack hub;

[0116] Figure 32E yes Figure 32A Rear view of the rack and rack hub;

[0117] Figure 32F yes Figure 32A Side view of the rack and rack hub;

[0118] Figure 32G It is along Figure 32D The line cut from 32G to 32G Figure 32A and Figure 32D Cross-sectional views of the rack and rack hub;

[0119] Figure 32H It is along Figure 32F The line 32H-32H is cut off. Figure 32A and Figure 32F Cross-sectional views of the rack and rack hub;

[0120] Figure 32I yes Figure 32H A detailed diagram of a portion, as shown by the dashed lines;

[0121] Figure 32J yes Figure 32C A detailed view of a portion, as shown by the dashed lines;

[0122] Figure 32K yes Figure 32F A detailed view of a portion, as shown by the dashed lines;

[0123] Figure 33A yes Figure 14A Exploded perspective view of the pinion assembly of the rear compressor / traction unit;

[0124] Figure 33B yes Figure 33A Side view of the pinion assembly;

[0125] Figure 33C It is along Figure 33B The line 33C-33C is cut off. Figure 33A and Figure 33B A cross-sectional view of the pinion assembly;

[0126] Figure 33D yes Figure 33A A bottom view of the pinion assembly;

[0127] Figure 34A yes Figure 33A Top-view perspective of the column of the small gear assembly;

[0128] Figure 34B yes Figure 34A The front view of the column;

[0129] Figure 34C yes Figure 34A A bottom view of the column;

[0130] Figure 34D yes Figure 34A Side view of the column;

[0131] Figure 34E It is along Figure 33D The line 34E-34E is cut off. Figure 34A and Figure 34D A cross-sectional view of the column;

[0132] Figure 34F yes Figure 32F A detailed view of a portion, as shown by the dashed lines;

[0133] Figure 35A yes Figure 33A Side view of the knob of the small gear assembly;

[0134] Figure 35B yes Figure 34A Side view of the knob;

[0135] Figure 35C yes Figure 35A A bottom view of the knob;

[0136] Figure 35D yes Figure 35A A perspective view of the knob from below;

[0137] Figure 35E It is along Figure 35A The line 35E-35E is cut off. Figure 34A A cross-sectional view of the knob;

[0138] Figure 35F It is along Figure 35A The line cut off at 35F-35F in the middle Figure 34A A cross-sectional view of the knob;

[0139] Figure 35G It is along Figure 35C The line cut from 35G to 35G Figure 34A and Figure 34C A cross-sectional view of the knob;

[0140] Figure 36A yes Figure 33A Top-view perspective of the gears in the small gear assembly;

[0141] Figure 36B yes Figure 36A A front view of the gear;

[0142] Figure 36C yes Figure 36A A side view of the gear;

[0143] Figure 37A yes Figure 33A Top-view perspective of the pin of the small gear assembly;

[0144] Figure 37B yes Figure 36A The front view of the pin; and

[0145] Figure 37C yes Figure 36A Side view of the pin. Detailed Implementation

[0146] The innovative subject matter will now be described with reference to the accompanying drawings, wherein the same reference numerals are used to denote similar elements. In the following description, numerous specific details are set forth for purposes of explanation, thereby providing a thorough understanding of the invention. However, it will be apparent that the invention may be practiced without these specific details.

[0147] This article discloses an internal fixation system and method for prone lateral spinal surgery without the use of a pad.

[0148] Removing the pad during prone lateral spinal surgery saves time and allows surgeons to access either side of the spine within the same patient without repositioning. This is particularly advantageous for patients with multi-grade disc degeneration and secondary scoliosis, as different grades are often more easily accessed from one side or the other.

[0149] To eliminate the pad, an internal fixation system according to the invention is used to directly control spinal movement.

[0150] Advantageously, the internal fixation system of the present invention facilitates surgical access from both the right and left sides of the patient.

[0151] The internal fixation system of this invention also provides surgeons with a gentler and safer way to manipulate the patient's spine and to apply traction across the patient's intervertebral disc space.

[0152] Furthermore, the internal fixation system of the present invention facilitates greater stability and eliminates surgical steps, providing surgeons with more space and improved visibility.

[0153] Figures 2-4 An internal fixation system 10 according to a first embodiment of the present invention is shown. The internal fixation system 10 includes at least two insertion columns 12, 14, having respective distal ends 12a, 14a and proximal ends 12b, 14b. The distal ends 12a, 14a are configured for insertion through corresponding pedicles of the patient's spine S, such as... Figures 2-4 As shown. Figure 4 As shown, the internal fixation system 10 is directly mounted to the operating table T using a table mount 16 (or other mounting device), which also serves to position the lateral retractor 18 for prone spinal access. By connecting the lateral retractor 18 to screws internally fixed to the bone (i.e., the patient's spine), the lateral retractor 18 becomes more stable, minimizing retractor movement and providing additional mechanical advantages.

[0154] In this embodiment, the surgeon first inserts a guide suture into the patient's vertebral bone using fluorescent or stereoscopic navigation guidance. Then, the surgeon inserts a cannula onto the guide suture.

[0155] Then, using the active and passive traction frame 20, the cannulation columns 12, 14 are operatively connected to each other at or near their respective proximal ends (see...). Figure 3 and Figure 4 ).

[0156] Active traction can be used to minimize the risk of endplate damage before or during discectomy work. During the trial phase, as the intervertebral disc space is expanded to select an implant of appropriate size, the traction frame 20 gradually expands in both height and relative angle, and maintains this traction after the trial piece is removed. Using a traction device during the disc preparation, trial, and implant insertion phases of lateral interbody fusion surgery reduces the risk of endplate damage and implant subsidence. By reducing subsidence, the height of the intervertebral foramen can be better maintained.

[0157] During the procedure, changes in the angle and position of the insertion columns 12 and 14 can be interpreted using stereotactic navigation to show how much the surgeon has altered the overall and segmental spinal alignment of the patient.

[0158] After performing prone lateral surgery, if columns have been used, guide sutures are used to insert cannulas 12 and 14. The cannulas are then removed, and pedicle screws (i.e., inserted cannulas) are used. Figure 5 and 6 The implanted cannulation screw (as shown) replaces the cannulation column, as is commonly done during prone lateral surgery. The screw tower can be used in conjunction with the cannulation pedicle screws to facilitate their implantation, after which the screw tower can be removed.

[0159] Figure 5 and Figure 6 The diagram illustrates an internal fixation system 50 according to a second embodiment of the invention, which is generally similar to internal fixation system 10. However, in this embodiment, internal fixation system 50 includes at least two cannulated pedicle screws 52, 54 (instead of the cannulated columns of the first embodiment), each cannulated pedicle screw having a corresponding distal end 52a, 54a and a proximal end 52b, 54b. The distal ends 52a, 54a are configured to be inserted through the corresponding pedicle P of the patient's spine S, such as... Figure 5 and Figure 6 As shown. Figure 4 As shown, the internal fixation system 50 is directly mounted to the operating table T using a table mount 16 (or other mounting device), which also serves to position the lateral retractor 18 for prone spinal access.

[0160] In this embodiment, the surgeon first inserts a guide suture into the patient's vertebral bone using fluorescent or stereoscopic navigation guidance. Then, the surgeon inserts each cannulation screw 52, ​​54, and the corresponding screw towers 62, 64 are removably attached to the cannulation screws on the guide suture.

[0161] Then, using the active and passive traction frame 20, the cannulated pedicle screw towers 62, 64 are operatively connected to each other at their respective proximal ends (see...). Figure 3 and Figure 4 ).

[0162] Active traction can be used to minimize the risk of endplate damage before or during discectomy work. During the trial procedure, as the intervertebral disc space is expanded to select an implant of appropriate size, the traction frame 20 gradually expands in both height and relative angle, and maintains this traction force after the trial piece is removed.

[0163] During the procedure, changes in the angles and positions of cannulation screws 52, 54 and screw towers 62, 64 can be interpreted using stereotactic navigation to indicate to the surgeon how much the overall and segmental spinal alignment of the patient has changed.

[0164] After performing the prone lateral surgery, screws 62 and 64 were removed from the pedicle screws 52 and 54.

[0165] This embodiment inserts the final cannulation screws 52 and 54 without the need for an intermediate post. This saves steps, simplifies the procedure, and thus facilitates a reduction in surgical time and the risk of any adverse events.

[0166] Figures 7-13BAn internal fixation system 100 according to a third embodiment of the present invention is shown. In this embodiment, the internal fixation system 100 includes an L-post 102 mounted on an operating table (not shown) and a desktop-mounted A-arm 104. A B-arm 106 engages one end of the desktop-mounted A-arm 104 via a B-arm lateral connector 108 and a distal clamp 110 on one end of the A-arm 104. The B-arm 106 also includes a B-arm posterior connector 112 that engages with a posterior compressor / traction device 114. The internal fixation system 100 also includes a lateral lumbar interbody fusion (LLIF) retractor 116 having a lateral lumbar interbody fusion retractor adapter 118. Figures 7-13B An internal fixation system 100 for use with a patient’s spine S is shown.

[0167] During the surgical technique according to this embodiment, the surgeon inserts cannula implants (e.g., cannula pedicle screws 52, 54 and corresponding screw towers 62, 64, such as...). Figure 5 The cannulated pedicle screws 52, 54 and corresponding screw towers 62, 64 are inserted into the vertebrae of the patient's spine S and connected to the compressor / traction device 114 (i.e., the corresponding rotary tubes 162, 262 are slid onto the cannulated pedicle screws 52, 54 and corresponding screw towers 62, 64). A fixation cap or fixation screw is then used to lock the traction device to the cannulated implant. The cap / fixation screw is shown inside the tulip portion 55 of the pedicle screw 52, ​​just above the rod analogue that extends from the traction tower / rotary tube 162 into the pedicle screw 52. The lateral retractor 116 is positioned according to standard technique and connected to the operating table using the table arm A 104. The compressor / traction device 114 is then connected to the connector (distal clamp 110) on the table arm A and locked in place using the B arm 106 and the B arm lateral connector 108 (see [link to relevant documentation]). Figures 7-8 Once the implant is in place, the cap is removed, and the retractor is removed. The rod is then inserted into the vertebra, and the cap / screw is positioned to complete the assembly. If used, screw towers 62 and 64 are removed. The lateral retractor 116 becomes more stable by connecting it to screws internally fixed to the bone (i.e., the patient's spine), minimizing retractor movement and providing additional mechanical advantages. Using the compressor / retractor 114 during the disc preparation, testing, and implant insertion phases of lateral interbody fusion surgery reduces the risk of endplate damage and implant subsidence. Reduced subsidence allows for better maintenance of intervertebral foramen height.

[0168] Figures 14A-37C The diagram shows a rear compressor / traction device 114 and its components according to various embodiments of the present invention.

[0169] Figures 14A-14DA rear compressor / traction unit 114 is shown, which includes a rear traction unit rack assembly 120, a rear traction unit bracket assembly 122, and a pinion assembly 124. These assemblies operate together such that the rear traction unit rack assembly 120 and the rear traction unit bracket assembly 122 move relative to each other. Each of these assemblies and their corresponding components will be described below.

[0170] The rear puller rack assembly 120 includes a rack 126 having a plurality of ridges 126a on at least one surface. The rear puller bracket assembly 122 includes a spring link assembly 127 having markings to indicate its locked and unlocked positions (L and U, respectively), a pawl 128, a hole 129, and an opening 130 sized to receive the rack 126 passing through it. In the illustrated embodiment, the opening 130 is rectangular. The pinion assembly 124 includes a knob 132 and a post 135 descending from the knob 132. The gear 134 circumferentially engages the post 135 and includes ridges 134a on its surface that intersect with the ridges 126a on the rack 126, as discussed further below. The hole 129 of the rear puller bracket assembly 122 is sized to receive the post 135 and the gear 134 of the pinion assembly 124 (see [link to previous section]). Figure 14A The rear compressor / traction unit 114 also includes two rotary tube assemblies 136, 138, configured to move and position relative to each other. One rotary tube assembly 138 is part of the rear traction unit bracket assembly 122, while the other rotary tube assembly 136 is part of the rear traction unit rack assembly 120 (see [link to relevant documentation]). Figures 14A-14D As discussed further below, rotary tube assembly 138 includes rotary tube 162, and rotary tube assembly 136 includes rotary tube 262.

[0171] To assemble the rear compressor / retractor 114 for surgery, the pinion 124's post 135 and the surrounding gear 134 are inserted into the hole 129. Then, the spring link assembly 127 of the rear retractor bracket assembly 122 (i.e., moved to its unlocked position U) is deployed, and the rack 126 of the rear retractor rack assembly 120 slides into the opening 130 of the rear retractor bracket assembly 122 (see...). Figures 14B-14CAs rack 126 travels through opening 130 and rear retractor bracket assembly 122, ridge 126a operably contacts pawl 128 and interlocks with ridge 134a on gear 134 of pinion assembly 124. This causes knob 132 of pinion assembly 124 to rotate smoothly, and the distance between the two rotary tube assemblies 136, 138 increases. Once the desired distance between the two rotary tube assemblies 136, 138 is reached (i.e., based on patient measurements and other surgical parameters), spring link 127 moves to its locked position L to secure the rear compressor / retractor 114 in this position.

[0172] Now for reference Figures 15A-15E The diagram shows components of a rear retractor bracket assembly 122. The rear retractor bracket assembly 122 includes a rotary tube assembly 138 having an arm or rod 140 extending therefrom, and a bracket hub 142. The arm 140 includes a hole 140a formed at one end and an annular groove 141 formed at the opposite end, as discussed further below. Formed within the bracket hub 142 are holes 129 for receiving a post 135 / gear 134 and an opening 130 for receiving a rack 126 (both described above), and a cavity 144 configured to receive the arm 140 therein. The cavity 144 includes an opening 144a surrounded by an annular end 143 of the bracket hub 142. A first plurality of teeth 145 extend from the annular end 143. A compression spring 146 is fitted onto the arm 140 of the rotary tube assembly 138 and extends into the cavity 144 together with the arm 140. The second plurality of teeth 147 are provided on one end of the rotary tube assembly 138, close to and surrounding the arm 140, and configured to removably engage the first plurality of teeth 145 (i.e., interlock with the first plurality of teeth 145).

[0173] The spring link assembly 127 of the rear traction bracket assembly 122 includes a top cam link 148, a bottom cam link 150, and a cam pin 152. The cam pin is configured to connect the top cam link and the bottom cam links 148 and 150 together on opposite surfaces of the bracket hub 142 through a cam hole 154 formed in the bracket hub 142. The cam pin 152 includes a first end 152a configured to engage a drill hole 148a formed in the top cam link 148. The cam pin 152 also includes a second end 152b configured to engage a drill hole 150a formed in the bottom cam link 150. The cam pin 152 is also configured to engage a groove 141 of the rotary tube assembly arm 140 when inserted into the cavity 144. The pawl 128 engages with a torsion spring 156 and a ratchet pin 158 located within a ratchet hole 160 formed in the bracket hub 142, thereby enabling the pawl 128 to move.

[0174] Figures 16A-16DThe rear retractor bracket assembly 122 is further shown. When the spring linkage assembly 127 is positioned in its unlocked position U ( Figure 16A , 16B 16D and 16E, and Figure 14B , 15B (and 15C), the rotary tube assembly 138 is positioned at a distance from the bracket hub 142. When the spring link assembly 127 moves to its locked position L (i.e., by rotation of the top cam link and bottom cam links 148, 150), the cam pin 152 rotates. This rotation of the cam pin 152 causes the rotary tube assembly arm 140 to move inward (i.e., pull it further into the cavity 144) due to the engagement of the cam pin 152 with the groove 141 of the rotary tube assembly arm 140. This, in turn, causes the second plurality of teeth 147 (on the rotary tube assembly 138) to removably engage (i.e., interleaved) the first plurality of teeth 145, thereby locking the rotary tube assembly 138 to the bracket hub 142 (see 14C). Figure 15B and 16C The intersection of the swivel tube assembly 138 and the bracket hub 142 allows the angle between the swivel tube 162 to be adjustable to accommodate the angle of the pedicle screw. This intersection also allows a single compressor / traction device 114 for access on the right and left sides (i.e., access to the patient's intervertebral disc space) because it allows for 360° rotation.

[0175] Figures 17A-17H The bracket hub 142 is further shown, including a hole 129, an opening 130, a cam pin hole 154, and a ratchet hole 160. Figure 17F A cavity 144 is shown, which is configured to receive a rotating tube assembly arm 140 therein. Figure 17G One embodiment is shown in which the angle formed between the annular end 143 and the adjacent portion of the bracket hub 142 is 141°. Other angles are also possible in other embodiments. Figure 17H One embodiment is shown in which the angle between adjacent teeth formed in the first plurality of teeth 145 is 90°. Other angles are also possible in other embodiments.

[0176] Figures 18A-18D The pawl 128 of the rear traction bracket assembly 122 is further shown. The pawl 128 includes a first member and a second member 128a, 128b rotatably connected by a hinge 128c (or other bending device). A bore 128d extends through a portion of the second member 128b and is sized to receive a pin 158 passing through it. Figures 19A-19C The image further illustrates pin 158.

[0177] Figures 20A-20CA torsion spring 156 is further shown. The torsion spring 156 includes arms 156a and 156b that engage with a first member and a second member 128a and 128b respectively with a pawl 128, and a helical spring 156c located between and connecting the arms 156a and 156b. The helical spring 156c defines an opening 156d sized to receive a pin 158 passing through it.

[0178] Figures 21A-21D The rotary tube assembly 138 is further illustrated in these figures. In these figures, the rotary tube assembly 138 is shown as a right-handed version, but it should be understood that a left-handed version of the rotary tube assembly 138 would be a mirror image of those shown in these figures. The rotary tube assembly 138 includes a rotary tube 162 having a first end and second ends 162a, 162b, and is sized to receive an insertion pedicle screw 52 and a screw tower 62 therein, as discussed above. Figure 13 As shown in the diagram. The second end 162b includes an extension member 164 with a hole 164a, the hole being sized to receive the end of the rotary tube tulip-shaped rod 166 therein. The rotary tube assembly 138 includes a rotary tube hub 168 having a first portion 168a and a second portion 168b, the first portion 168a being configured to engage the first end 162a of the rotary tube, and the second portion 168b having a second plurality of teeth 147 formed thereon and being configured to receive the end of the rotary tube assembly arm 140 having a hole 140a therein. Figures 22A-22D The image further illustrates the rotary tube assembly arm 140.

[0179] Figures 23A-23H The image further illustrates a rotary hub 168. A first portion 168a is generally annular and defines a circular opening 172 therethrough. A second portion 168b is also generally annular and defines a cavity 174 therein, the cavity being sized to receive the end of a rotary tube assembly arm 140 having an orifice 140a therein. Figures 24A-24C The rotary pin 170 is further shown in the image. Figures 25A-25D The rotary tube 138 is further shown in the diagram.

[0180] Figures 26A-26C The diagram further illustrates a rotary tulip-shaped rod 166. The rotary tulip-shaped rod 166 includes a longitudinal axis AA and a rounded or dome-shaped end 166a. The rotary tulip-shaped rod 166 is configured to insert into a slot in the engagement screw tower 62 when engaging a slot therein. The rounded end 166a has a dome shape to exclude sharp edges or corners that could hook, snag, and / or tear / damage adjacent soft tissue of the patient. In the illustrated embodiment, the dome-shaped end 166a and the longitudinal axis AA form a first angle of 30° between them. Other angles are possible in other embodiments.

[0181] Figures 27A-27C The compression spring 146 is further shown in the image. Figures 28A-28D The image further shows the cam pin 152. The ends 152a and 152b of the cam pin 152 are configured to have a D-shaped cross section and insertably engage the corresponding holes 148a and 150a of the top cam link and bottom cam link 148 and 150 of the spring link assembly 127.

[0182] Figures 29A-29E The image further shows a top cam link 148, which includes a D-shaped drilled hole 148a for receiving the end 152a of the cam pin 152 therein. Figure 29E As shown, the top cam link 148 also includes a first edge 148b, a second edge 148c spaced apart from the first edge 148b, and a third edge 148d spaced apart from the second edge 148c. In the illustrated embodiment, the first and second edges 148b and 148c form a first angle of 23° between them, and the second and third edges 148c and 148d form a second angle of 103° between them. Other angles are possible in other embodiments.

[0183] Figures 30A-30E The image further shows a bottom cam link 150, which is formed as a mirror image of the top cam link 148. The bottom cam link 150 includes a D-shaped bore 150a for receiving the end 152b of the cam pin 152 therein. Figure 30E As shown, the bottom cam link 150 also includes a first edge 150b, a second edge 150c spaced apart from the first edge 150b, and a third edge 150d spaced apart from the second edge 150c. In the illustrated embodiment, the first and second edges 150b and 150c form a first angle of 23° between them, and the second and third edges 150c and 150d form a second angle of 103° between them. Other angles are possible in other embodiments.

[0184] Figures 31A-31D The rear traction rack assembly 120 and its components are further shown. Where applicable, the components of the rear traction rack assembly 120 have been assigned more than 200 reference numerals to correspond to the same / corresponding components in the rear traction bracket assembly 122 which have more than 100 reference numerals, and have the same or similar structure and function.

[0185] The rear traction rack assembly 120 includes a rotary tube assembly 136. Although the rotary tube assembly 136 is shown as a left-handed version in these figures, it should be understood that the right-handed version of the rotary tube assembly 136 would be a mirror image of those shown in these figures. The rotary tube assembly 136 includes a rotary tube 262, a rotary tube tulip-shaped rod 266, a rotary tube hub 268, an arm or rod 240 extending therefrom, and a rack hub 242. The arm 240 includes an annular groove 241 formed in its end, as discussed further below. Formed within the rack hub 242 is a cavity 244 configured to receive the arm 240 therein. The cavity 244 includes an opening 244a surrounded by an annular end 243 of the rack hub 242. A third plurality of teeth 245 extend from the annular end 243. A compression spring 246 is fitted onto the arm 240 of the rotary tube assembly 136 and extends into the cavity 244 together with the arm 240. A fourth plurality of teeth 247 is provided on one end of the rotary tube assembly 136, close to and surrounding the arm 240, and configured to removably engage with a third plurality of teeth 245 (i.e., interleaved with the third plurality of teeth 245).

[0186] The rear retractor rack assembly 120 also includes a spring link assembly 227 marked with indicators to show its locked and unlocked positions (L and U, respectively). The spring link assembly 227 includes a top cam link 248, a bottom cam link 250, and a cam pin 252. The cam pin is configured to connect the top cam link 248 and the bottom cam link 250 together on opposite surfaces of the rack hub 242 through a cam hole 254 formed in the rack hub 242. The cam pin 252 has the same structure as the cam pin 152 of the rear retractor bracket assembly 122 described above, including a first end and a second end configured to engage bores formed in the top and bottom cam links 248 and 250. The cam pin 252 is also configured to engage a groove 241 of the rotary tube assembly arm 240 when inserted into the cavity 244.

[0187] The operation of the rear retractor rack assembly 120 is similar to that of the rear retractor bracket assembly 122 described above. When the spring linkage assembly 227 is positioned in its unlocked position U (see... Figure 31CThe rotary tube assembly 136 is positioned at a distance from the rack hub 242. When the spring link assembly 227 moves to its locked position L (i.e., by rotation of the top cam link and bottom cam links 248, 250), the cam pin 252 rotates. This rotation of the cam pin 252 causes the rotary tube assembly arm 240 to move inward (i.e., pull it further into the cavity 124) due to the engagement of the cam pin 252 with the groove 241 of the rotary tube assembly arm 240. This, in turn, causes the second plurality of teeth 247 (on the rotary tube assembly 136) to removably engage (i.e., interleave) the first plurality of teeth 245, thereby locking the rotary tube assembly 136 to the rack hub 242 (see [link to relevant documentation]). Figure 31B The intersection of the rotary tube assembly 136 and the rack hub 242 allows the angle between the rotary tubes 262 to be adjusted to accommodate the angle of the pedicle screws. This intersection also allows a single compressor / traction device 114 for access on the right and left sides (i.e., access to the patient's intervertebral disc space) because it allows for 360° rotation.

[0188] Figures 32A-32K Further illustration shows the rack 126 and rack hub 242 of the rear traction rack assembly 120. The rack 242 includes a cylindrical member 202 defining a threaded bore 202a therethrough, and having a plurality of teeth 203 at both ends. A cavity 244 is formed as a through bore in the rack hub 242, extending perpendicularly to the threaded bore 202a, as shown below. Figures 32A-32C , Figure 32G and Figure 32H As shown. Figure 32G One embodiment is shown in which the angle between the wall formed in the cylindrical member 202 and the threaded hole 202a is 120°. The cylindrical member 202 is configured to engage the rear connector 112 of the B-arm (see [link]). Figure 13 and 13B The cylindrical member 202 and the teeth 203 at both ends are designed to facilitate access to the right and left sides (i.e., access to the patient's intervertebral disc space) by using a single rack 126 and a single compressor / tractioner 114, as it allows the surgeon to rotate or flip the rack depending on the side of the access.

[0189] Figure 32H One embodiment is shown in which the angle formed between the annular end 243 and the adjacent portion of the rack hub 242 is 141°. Other angles are possible in other embodiments.

[0190] Figure 32I One embodiment is shown in which the angle between adjacent ridges 126a formed on the rack 126 is 40°. Other angles are also possible in other embodiments.

[0191] Figure 32J One embodiment is shown in which the angle between adjacent teeth formed in the fifth plurality of teeth 203 is 90°. Other angles are also possible in other embodiments.

[0192] Figure 32K One embodiment is shown in which the angle between adjacent teeth formed in the third plurality of teeth 245 is 90°. Other angles are also possible in other embodiments.

[0193] Figures 33A-37C Further illustration shows a pinion assembly 124 and its components. As described above, the pinion assembly 124 includes a knob 132, a post 135 engaging the knob 132 (i.e., via a cavity 132a inserted into the knob 132), and a gear 134 having ridges 134a on its surface that intersect with ridges 126a on the rack 126. The gear 134 also includes a drilled hole 134b configured to receive the post 135 passing through it. The post 135 includes a head 135a, a rod portion 135b descending from the head 135a, and a hole 135c formed in the rod portion 135b. The pinion assembly 124 also includes a pin 131 that insertably engages the hole 132b and the post hole 135c formed in the knob 132. The pin 131 thereby secures the post 135 to the knob 132.

[0194] If the rotary tubes 162, 262 of the corresponding rotary tube assemblies 138, 136 or the implants (e.g., intervertebral screws / rods) themselves use stereo navigation / reference points for tracking, their positions after the lateral implant insertion can be compared with their relative positions at the initial placement, and such comparison data can be used to calculate the alignment changes achieved through the lateral implant placement.

[0195] In the case of multi-level instruments, implants can be placed, and the system can be used for traction across multiple levels without needing to reposition the traction device for lateral surgery at subsequent levels.

[0196] Generally, any combination of the features, components, and methods disclosed herein is possible. The steps of the method can be performed in any physically feasible order.

[0197] Those skilled in the art will understand that various changes and modifications can be made to the illustrated embodiments without departing from the spirit of the invention. All such modifications and changes are intended to fall within the scope of the invention, except where limited by the scope of the appended claims.

Claims

1. An internal fixation system for spinal surgery on a patient, comprising: A lateral lumbar interbody fusion retractor, the lateral lumbar interbody fusion retractor having a lateral lumbar interbody fusion retractor adapter; Rear compressor / traction unit; A-arm, the A-arm being configured to be mounted on the operating table; as well as B-arm, which is configured to engage with one end of A-arm mounted on the platform and engage the rear compressor / traction unit. The rear compressor / traction device includes Rear traction rack assembly; A rear traction device bracket assembly, the rear traction device bracket assembly being configured to operatively engage the rear traction device rack assembly; and A pinion assembly configured to operatively engage the rear traction rack assembly and the rear traction bracket assembly; Thus, the rear traction rack assembly and the rear traction bracket assembly are movable relative to each other; The rear retractor rack assembly includes a rack having a plurality of ridges on at least one surface, and the rear retractor bracket assembly includes an opening configured to receive the rack passing through it. The rear traction rack assembly includes a first rotary tube assembly with a first rotary tube, the rear traction bracket assembly includes a second rotary tube assembly with a second rotary tube, and the first rotary tube and the second rotary tube are each configured to receive a pedicle screw and a screw tower therein. The first rotary tube assembly and the second rotary tube assembly are configured to move and be positioned relative to each other; The second rotary tube assembly has a first arm extending therefrom and a bracket hub, the bracket hub including a first cavity configured to receive the first arm therein, wherein the first cavity includes a first opening surrounded by a first annular end having a first plurality of teeth extending therefrom, and wherein the second rotary tube assembly includes a second plurality of teeth adjacent to and surrounding the arm, the second plurality of teeth being configured to removably engage the first plurality of teeth.

2. The internal fixing system according to claim 1, characterized in that, The B-arm includes a lateral connector, wherein the A-arm includes a distal clamp located at one end of the A-arm, the distal clamp being configured to engage with the lateral connector of the B-arm, and wherein the B-arm also includes a rear connector configured to engage with the rear compressor / tractioner.

3. The internal fixing system according to claim 1, characterized in that, The first rotary tube assembly has a second arm extending therefrom and a rack hub, the rack hub including a second cavity configured to receive the second arm therein, wherein the second cavity includes a second opening surrounded by a second annular end having a third plurality of teeth extending therefrom, and wherein the first rotary tube assembly includes a fourth plurality of teeth adjacent to and surrounding the second arm, the fourth plurality of teeth being configured to removably engage the third plurality of teeth.

4. The internal fixing system according to claim 3, characterized in that, The first arm includes a first annular groove formed in its end portion, wherein the rear retractor bracket assembly includes a bracket hub having a first spring link assembly having a first top cam link, a first bottom cam link, and a first cam pin configured to connect the first top cam link and the first bottom cam link together on opposite surfaces of the bracket hub through a first cam hole formed in the bracket hub.

5. The internal fixing system according to claim 4, characterized in that, The first cam pin is configured to engage with a first groove of the first arm when inserted into the first cavity, wherein rotation of the first top cam link and the first bottom cam link causes rotation of the first cam pin and inward movement of the first arm into the first cavity, which in turn causes the second plurality of teeth on the second rotary tube assembly to removably engage with the first plurality of teeth and lock the second rotary tube assembly to the bracket hub, thereby allowing the angle between the first rotary tube and the second rotary tube to be adjusted to accommodate the angle of the pedicle screw, and thereby allowing the compressor / traction device to rotate for access to both the right and left sides of the patient's intervertebral disc space.

6. The internal fixing system according to claim 5, characterized in that, The second arm includes a second annular groove formed in its end, wherein the rear traction rack assembly includes a rack hub having a second spring link assembly having a second top cam link, a second bottom cam link, and a second cam pin, the second cam pin being configured to connect the second top cam link and the second bottom cam link together on opposite surfaces of the rack hub through a second cam hole formed in the rack hub.

7. The internal fixing system according to claim 6, characterized in that, The second cam pin is configured to engage with the second groove of the second arm when inserted into the second cavity, wherein rotation of the second top cam link and the second bottom cam link causes rotation of the second cam pin and inward movement of the second arm into the second cavity, which in turn causes the fourth plurality of teeth on the first rotary tube assembly to removably engage with the third plurality of teeth and lock the first rotary tube assembly to the rack hub, thereby allowing the angle between the first rotary tube and the second rotary tube to be further adjusted to accommodate the angle of the pedicle screw, and thereby allowing the compressor / traction device to be further rotated for access to both the right and left sides of the patient's intervertebral disc space.

8. The internal fixing system according to claim 1, characterized in that, The pinion assembly includes a knob, a post extending downward from the knob, and a gear that circumferentially engages with the post and has ridges that intersect with ridges on the rack, wherein the rear traction bracket assembly includes a hole sized to receive the post and the gear of the pinion assembly therein.

9. An internal fixation system for spinal surgery on a patient, comprising: A lateral lumbar interbody fusion retractor, the lateral lumbar interbody fusion retractor having a lateral lumbar interbody fusion retractor adapter; as well as Rear compressor / traction unit, the rear compressor / traction unit includes A rear traction rack assembly, the rear traction rack assembly including a rack having a plurality of ridges on at least one surface thereon; A rear traction device bracket assembly configured to operatively engage the rear traction device rack assembly, and including an opening configured to receive the rack passing through therethrough; as well as A pinion assembly configured to operatively engage the rear traction rack assembly and the rear traction bracket assembly; Thus, the rear traction rack assembly and the rear traction bracket assembly are movable relative to each other; The rear traction rack assembly includes a first rotary tube assembly having a first rotary tube, and the rear traction bracket assembly includes a second rotary tube assembly having a second rotary tube, wherein the first rotary tube and the second rotary tube are each configured to receive a pedicle screw and a screw tower therein, and wherein the first rotary tube assembly and the second rotary tube assembly are configured to move and position relative to each other. The second rotary tube assembly has a first arm extending therefrom and a bracket hub, the bracket hub including a first cavity configured to receive the first arm therein, wherein the first cavity includes a first opening surrounded by a first annular end having a first plurality of teeth extending therefrom, and wherein the second rotary tube assembly includes a second plurality of teeth adjacent to and surrounding the arm, the second plurality of teeth being configured to removably engage the first plurality of teeth, thereby removably locking the second rotary tube assembly to the first bracket hub, thereby allowing the angle between the first rotary tube and the second rotary tube to be adjusted to accommodate the angle of the pedicle screw, and thereby allowing the compressor / traction device to rotate for access to both the right and left sides of the patient's intervertebral disc space.

10. The internal fixing system according to claim 9, characterized in that, The first rotary tube assembly has a second arm extending therefrom and a rack hub, the rack hub including a second cavity configured to receive the second arm therein, wherein the second cavity includes a second opening surrounded by a second annular end having a third plurality of teeth extending therefrom, and wherein the first rotary tube assembly includes a fourth plurality of teeth adjacent to and surrounding the second arm, the fourth plurality of teeth being configured to removably engage the third plurality of teeth, thereby removably locking the first rotary tube assembly to the rack hub, thereby allowing the angle between the first rotary tube and the second rotary tube to be further adjusted to accommodate the angle of the pedicle screw, and thereby allowing the compressor / traction device to be further rotated to provide access to both the right and left sides of the patient's intervertebral disc space.

11. The internal fixing system according to claim 9, characterized in that, The pinion assembly includes a knob, a post extending downward from the knob, and a gear that circumferentially engages with the post and has ridges that intersect with ridges on the rack, wherein the rear traction bracket assembly includes a hole sized to receive the post and the gear of the pinion assembly therein.

Images