Surgical systems and methods for treating vertebral segments having non-uniform pedicles

Abstract

A surgical system (100) for adjusting a segment of a spinal column comprises: a rack arm (29) extending in a longitudinal direction from a first end (29A) to a second end (29B); and a sliding body portion (30) including a ratchet mechanism (31) selectively engageable with the spline portion (29S) of the rack arm. The system may include a first actuator (32) for translating the sliding body along the rack arm in a longitudinal direction. The system may include first and second connecting towers (10) extending along first and second axes, respectively, the first and second axes each being transverse to the longitudinal direction. The system may also include a second actuator (40) including a threaded screw for adjusting the first attachment tower along the first axis. In some embodiments, the second actuator is configured to raise and lower the first connection tower in a sagittal plane.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application incorporates U.S. patent application No. 16 / 487,057, filed on August 19, 2019, and entitled “SURGICAL SYSTEM”. Technical Field

[0003] The present disclosure generally relates to medical devices for treating spinal disorders. Various embodiments may include a surgical system and method for correcting spinal disorders associated with vertebral segments having uneven pedicles. Background Art

[0004] Spinal disorders (such as degenerative disc disease, herniated discs, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumors, and fractures) may be caused by factors including trauma, disease, and degenerative conditions caused by injury and aging. Spinal disorders often result in symptoms including pain, nerve damage, and partial or complete loss of mobility.

[0005] Non-surgical treatments (such as medication, rehabilitation and exercise) may be effective, but may not relieve the symptoms associated with these conditions. Surgical treatments for these spinal conditions include correction, ligament release, subtotal corpectomy, discectomy, laminectomy, fusion, fixation and implantable prostheses. Corrective treatments for vertebral positioning and alignment can use spinal implants (including spinal constructs and intervertebral devices) to stabilize the treatment section of the spine. In some cases, surgical instruments can be used to manipulate spinal implants to compress and traction the vertebrae. The present disclosure describes improvements to these prior arts. Summary of the invention

[0006] The technology of the present disclosure generally relates to a system and method for treating the human spine.

[0007] In a first aspect, the present disclosure relates to a surgical system for adjusting a segment of a spine. For example, the system may include: a rack arm extending from a first end to a second end in a longitudinal direction; and a sliding body portion, the sliding body portion including a ratchet mechanism that can selectively engage with a spline portion of the rack arm. For example, the system may include a first actuator for translating the sliding body along the rack arm in the longitudinal direction. For example, the system may include a first connecting tower and a second connecting tower, the first connecting tower and the second connecting tower extending along a first axis and a second axis, respectively, the first axis and the second axis each being transverse to the longitudinal direction. For example, the system may also include a second actuator, the second actuator including a threaded screw for adjusting the first connecting tower along the first axis. In some embodiments, for example, the second actuator is configured to raise and lower the first connecting tower in a sagittal plane.

[0008] In a second aspect, the present disclosure relates to a surgical system for adjusting a segment of a spine. For example, the system may include a ratchet having a rack arm extending in a longitudinal direction and a sliding body portion that can move along the length of the rack arm in the longitudinal direction. In some embodiments, for example, the sliding body portion may include a pawl that can engage with the rack arm. For example, the system may also include an adjustment mechanism having a threaded actuator. For example, the system may also include a first angled assembly that is coupled to the adjustment mechanism; and a second angled assembly that is coupled to the sliding body portion. For example, the system may also include a first connection tower that is configured to be coupled to a first bone fastener, and the first connection tower may extend along a first axis transverse to the longitudinal direction and be pivotally coupled to the first angled assembly. For example, the system may also include a second connection tower that is configured to be coupled to a second bone fastener, and the second connection tower may extend along a second axis transverse to the longitudinal direction and be pivotally coupled to the sliding body portion. In various embodiments, for example, the threaded actuator is configured to translate the first connecting tower relative to the rack arm in a sagittal plane.

[0009] In a third aspect, for example, the present disclosure relates to a method for adjusting a segment of a spine. The method may include the step of receiving a surgical system. For example, the system includes a rack arm extending from a first end to a second end in a longitudinal direction, the rack arm including a spline portion. For example, the system may also include a sliding body portion, the sliding body portion including a ratchet mechanism having a first actuator and a pawl that can selectively engage with the spline portion of the rack arm. For example, in various embodiments, the first actuator includes a rotatable gear meshed with the spline portion for translating the sliding body along the rack arm in the longitudinal direction. For example, the system may also include a first connecting tower extending along a first axis transverse to the longitudinal direction and coupled to the rack arm; and a second connecting tower extending along a second axis transverse to the longitudinal direction and coupled to the sliding body portion. For example, the system may also include a second actuator including a threaded screw for adjusting the first connecting tower along the first axis. For example, the method may further include the steps of implanting a first bone fastener system in a first vertebra and implanting a second bone fastener system in a second vertebra. For example, the method may further include the steps of attaching the first connection tower to the first fastening system and attaching the second connection tower to the second bone fastener system. The method may further include the step of manipulating the first vertebra by adjusting the second actuator to move the first vertebra in the sagittal plane.

[0010] The details of one or more aspects of the present disclosure are set forth in the following drawings and description. Other features, objectives, and advantages of the techniques described in the present disclosure will be apparent from the description and drawings, and from the claims. BRIEF DESCRIPTION OF THE DRAWINGS

[0011] Figure 1 is a first front perspective view of the surgical system.

[0012] Figure 2 is a second front perspective view of the surgical system.

[0013] Figure 3 is a rear perspective view of the surgical system.

[0014] Figure 4 is an exploded parts view of a surgical system.

[0015] Figure 5 It is a perspective view of the adjustment mechanism.

[0016] Figure 6 is an exploded parts view of the adjustment mechanism.

[0017] Figure 7is a first perspective view of a first surgical system and a second surgical system for treating the spine.

[0018] Figure 8 is a second perspective view of a first surgical system and a second surgical system for treating the spine.

[0019] Fig. 9 is a third perspective view of a first surgical system and a second surgical system for treating the spine.

[0020] Fig.10 is a first perspective view of a plurality of surgical systems for treating the spine.

[0021] Fig.11 is a second perspective view of a plurality of surgical systems for treating the spine.

[0022] Fig.12 A reference diagram illustrating various planes and directions related to the human body. DETAILED DESCRIPTION

[0023] Exemplary embodiments of the systems and associated methods of use disclosed herein are discussed in terms of medical devices for treating musculoskeletal disorders, and more specifically, for example, in terms of surgical systems and methods for correcting spinal disorders. In various embodiments, the surgical systems of the present invention include surgical instruments that allow vertebral manipulation to treat spinal disorders as described herein, for managing lordotic and / or kyphotic restoration. In various embodiments, the surgical instruments allow parallel traction and / or compression of vertebral tissue. In various embodiments, for example, the surgical instruments allow adjustment of vertebral bodies having uneven pedicles in the sagittal plane.

[0024] In various embodiments, the surgical system of the present invention can be used with a method for correcting complex spinal deformities. In various embodiments, the surgical system of the present invention can be used with a method for treating degenerative spinal disorders and / or employed with a transforaminal lumbar intervertebral fusion procedure. In various embodiments, the surgical system of the present invention is configured for use with a sagittal adjustment screw (SAS), a fixed axis screw (FAS), and / or a multi-axial screw (MAS). In various embodiments, for example, the surgical system of the present invention includes a plurality of traction devices (such as, for example, at least one traction device disposed along the side of a vertebra) to perform a method for treating a spinal disorder (such as spondylolisthesis). In various embodiments, the surgical system of the present invention includes a plurality of traction devices to treat degenerative spinal disorders, for example, for arrangement along the side of a vertebra, the side of the vertebra being oriented for traction, compression, and adjustment of the spacing and / or inclination angle between vertebrae in the entire sagittal plane and / or coronal plane. In various embodiments, the surgical system of the present invention includes a micro-metering traction device and / or a compressor to facilitate angle reduction. For example, various embodiments may provide up to + / - 36 degrees of lordotic and / or kyphotic restoration.

[0025] In various embodiments, the surgical system of the present invention includes a surgical instrument connected to an adapter for use with a FAS. In various embodiments, the surgical system includes an angulation module configured to connect to the adapter and include an arm for connecting to an extender. In various embodiments, the angulation module is configured for individual angulation of the extender within a range of + / - 20 degrees. In various embodiments, a compressor / tractor can be used for parallel traction. In various embodiments, the surgical instrument includes a compressor / tractor having a reversible ratchet having an intermediate, freely movable position.

[0026] In various embodiments, the adapter is used with a surgical method that includes the steps of inserting the adapter into the surgical site and sliding the sleeve along the extender. In various embodiments, the method includes the step of fixing the sleeve to the extender. In various embodiments, the method includes the step of connecting the compressor / retractor to the adapter. In various embodiments, the method includes the step of connecting the angled module to the adapter, the compressor / retractor and the extender. In various embodiments, the method includes the step of fixing the angled module, the compressor / retractor and the adapter with a locking element. In various embodiments, the method includes the step of pulling and / or compressing the posterior ligament. In various embodiments, the method includes the step of actuating a rack and pinion mechanism provided with the compressor / retractor to facilitate pulling or compressing. In various embodiments, the method includes the step of correcting the vertebral angle using the angled module. In various embodiments, the method includes the step of manually correcting the vertebra using the angled module to manipulate the extender, for example, by pivoting the extender. In various embodiments, the method includes the step of using the angled module to maintain or fix the corrected vertebral angle relative to the compressor / retractor during compression or pulling using the compressor / retractor.

[0027] In various embodiments, the surgical system of the present invention includes a surgical instrument connected to an adapter, which is used together with a SAS. In various embodiments, the surgical system of the present invention is used together with surgical techniques for implanting spinal implants (such as, for example, spinal rods and set screws). In various embodiments, spinal rods and set screws can be implanted percutaneously. In various embodiments, the spinal rod can be shortened relative to the screw head. In various embodiments, the surgical system of the present invention is used together with surgical techniques for releasing screw head mobility. In various embodiments, the surgical system of the present invention is used together with surgical techniques for releasing the pressure applied during spinal rod reduction. In various embodiments, the surgical system of the present invention is used together with surgical techniques for traction of the posterior ligament. In various embodiments, the surgical system includes a manual winglet or a T25 driver, which engages a compressor / tractor for performing compression or traction of the vertebra.

[0028] In various embodiments, the surgical system of the present invention includes a surgical instrument configured to compress or traction and restore spinal curvature. In various embodiments, the surgical system of the present invention includes instruments and tools for correcting sagittal deformity and rebalancing the body spine. In various embodiments, the surgical system of the present invention is used to treat degenerative deformities of the spine in the sagittal plane, such as spondylolisthesis and / or degenerative kyphosis. In various embodiments, the surgical system of the present invention is used to treat excessive kyphosis, flat back, including the disease of causing body imbalance and loss of alignment between body parts. In various embodiments, the surgical system of the present invention can be used to reduce scoliosis in the coronal plane by selectively adjusting the compression and / or traction side at the opposite side of the coronal deformity. In addition, during the coronal reduction, the selected vertebra can be derotated in sections. In various embodiments, the surgical system of the present invention provides a selected correction amount to apply the selected balance to the spine, and provides control and adjustment of the correction amount in controlled increments. In various embodiments, the surgical system of the present invention includes a series of tools and instruments that allow the type of correction applied to be customized and the stability of the correction to be controlled using posterior instruments.

[0029] In various embodiments, one or all of the components of the surgical system are disposable, peel-and-strip, pre-packaged sterile devices for use with spinal constructs. One or all of the components of the surgical system are reusable. The surgical system can be configured as a kit with a variety of sizes and configurations.

[0030] In various embodiments, the present disclosure can be used to treat spinal disorders, such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumors and fractures. In various embodiments, the present disclosure can be used together with other skeletons and bone-related applications (including applications associated with diagnosis and treatment). In various embodiments, the disclosed surgical system and method are alternatively used to perform surgical treatment on patients in prone or supine positions, and / or various surgical methods are used to reach the spine, including the posterior and / or posterior midline and other body regions. The present disclosure can also be alternatively used together with the procedures for treating the lumbar, cervical, thoracic, sacral and pelvic regions of the spine. The systems and methods of the present disclosure can also be used in animals, bone models and other non-living substrates, such as, for example, for training, testing and demonstration.

[0031] By referring to the following detailed description of the embodiments in conjunction with the accompanying drawings, the present disclosure can be more easily understood, and the accompanying drawings form a part of the present disclosure. It should be understood that the present application is not limited to the specific devices, methods, conditions or parameters described and / or shown herein, and the terms used herein are only for describing specific embodiments by way of example, rather than for limiting. In various embodiments, as used in the specification, and including the appended claims, the singular forms "one" and "the" include plural numbers, and references to specific numerical values ​​include at least the specific value, unless the context clearly specifies otherwise. The range may be expressed as "about" or "approximately" a specific value and / or "about" or "approximately" another specific value in this article. When expressing such a range, another embodiment includes from one specific value and / or to another specific value. Similarly, when a value is expressed as an approximate value by using the antecedent "about", it should be understood that a specific value forms another embodiment. It should also be understood that all spatial references (such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right) are only for illustrative purposes and can be changed within the scope of the present disclosure. For example, references to "upper" and "lower" are relative and are used only in the context of another situation and are not necessarily "upper" and "lower".

[0032] As used in the specification and including the appended claims, "treatment" of a disease or condition refers to the performance of a procedure that may include administering one or more drugs to a patient (normal or abnormal human or other mammal), using an implantable device, and / or using an instrument for treating the disease (such as, for example, a microdiscectomy instrument for removing bulging or protruding discs and / or bone spurs) in an effort to alleviate the signs or symptoms of the disease or condition. Relief may occur before the signs or symptoms of the disease or condition appear, or after they appear. Thus, treatment includes preventing a disease or adverse condition (e.g., preventing a patient who may be susceptible to the disease but has not yet been diagnosed with the disease from developing the disease). In addition, treatment does not require complete relief of signs or symptoms, does not require a cure, and specifically includes procedures that have only a minimal effect on the patient. Treatment may include inhibiting the disease, such as stopping its development, or alleviating the disease, such as causing the disease to regress. For example, treatment may include reducing acute or chronic inflammation; alleviating and relieving pain and promoting the regrowth of new ligaments, bones and other tissues; as an adjunct to surgery; and / or any repair procedure. Furthermore, as used in the specification and appended claims, the term "tissue" includes soft tissue, ligament, tendon, cartilage and / or bone, unless specifically stated otherwise.

[0033] The following discussion includes a description of a surgical system and related methods of using the surgical system according to the principles of the present disclosure.Alternative embodiments are disclosed.Reference is made to exemplary embodiments of the present disclosure illustrated in the accompanying drawings.

[0034] The components of the surgical system 100 may be fabricated from bio-acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics, and bone materials and / or composites thereof. For example, the components of the surgical system 100 may be fabricated, individually or collectively, from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, grade 5 titanium, superelastic titanium alloys, cobalt-chromium alloys, superelastic metal alloys (e.g., Nitinol, superelastic metals), ceramics and composites thereof, such as calcium phosphates (e.g., SKELITE TM ), thermoplastics such as polyaryletherketone (PAEK) (including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK)), carbon-PEEK composites, PEEK-BaSO4 polymer rubber, polyethylene terephthalate (PET), fabrics, silicones, polyurethanes, silicone-polyurethane copolymers, polymer rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermosetting elastomers, elastomeric composites, rigid polymers (including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy resins), bone materials (including autografts, Allografts, xenografts or transgenic cortical bone and / or corticomedullary bone) and tissue growth or differentiation factors, partially resorbable materials (such as, for example, composites of metal and calcium-based ceramics, composites of PEEK and calcium-based ceramics, composites of PEEK and resorbable polymers), fully resorbable materials (such as, for example, calcium-based ceramics, such as calcium phosphate, tricalcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium sulfate), or other resorbable polymers, such as polyaetide, polyglycolide, polytyrosine carbonate, polycaprolactone, and combinations thereof.

[0035] The various components of the surgical system 100 may have material composites including the above materials to achieve various desired properties, such as strength, stiffness, elasticity, compliance, biomechanical properties, durability, and radiolucency or imaging preference. The components of the surgical system 100 may also be made of heterogeneous materials, such as a combination of two or more of the above materials, either individually or collectively. The components of the surgical system 100 may be integrally formed, integrally connected, or include fastening elements and / or instruments, as described herein.

[0036] The surgical system 100 can be used, for example, with minimally invasive procedures, including percutaneous techniques, micro-openings, and open surgical techniques, to deliver and introduce instruments and / or components of spinal constructs at surgical sites (e.g., segments of the spine) in the patient. In various embodiments, one or more of the components of the surgical system 100 are configured to engage with spinal constructs attached to vertebrae to manipulate tissue and / or correct spinal disorders (such as, for example, sagittal deformities), as described herein. In various embodiments, the surgical system 100 can be used with surgical procedures (such as, for example, corpectomy, discectomy, and / or fracture / trauma treatment, scoliosis, and spondylolisthesis), and can include fusion and / or fixation using implants to restore the mechanical support function of the vertebrae. In addition, in some cases, the surgical system 100 can be referred to as a compressor / traction device 100.

[0037] As used herein, it should be understood that the term "coronal plane" includes any segmental plane in an anatomical position that passes generally vertically through the human body and is approximately perpendicular to both the median (or sagittal) plane and the horizontal (or axial or transverse) plane (typically dividing the human body into anterior and posterior segments), and also includes any segmental plane in an anatomical position that passes generally vertically through the human body, is approximately perpendicular to the horizontal (or axial or transverse) plane, and is generally angularly oriented from the median (or sagittal) plane at an orientation angle ranging from greater than zero degrees up to and including ninety degrees.

[0038] In addition, as used herein, it should be understood that the term "sagittal plane" includes any segmental plane in an anatomical position that passes generally vertically through a human body in a prone position and is approximately perpendicular to both the coronal plane and the horizontal (or axial or transverse) plane (typically dividing the human body into left and right segments), and also includes any segmental plane in an anatomical position that passes generally vertically through a human body in a prone position, is approximately perpendicular to the horizontal (or axial or transverse) plane, and is generally angularly oriented from the coronal plane at an orientation angle ranging from greater than zero degrees up to and including ninety degrees.

[0039] For ease of explanation, spatially relative terms such as "below," "under," "lower," "above," "upper," etc. are used to explain the positioning of one element relative to a second element. These terms are intended to cover different orientations of the device in addition to orientations that are different from those depicted in the figures. Further, terms such as "first," "second," etc. are also used to describe various elements, regions, sections, and portions, and are also not intended to be limiting. Throughout the specification, similar terms refer to similar elements.

[0040] Figures 1 to 3 Various perspective views of the surgical system 100 are illustrated, and Figure 4An exploded parts view of the surgical system 100 is illustrated. Various components of the surgical system 100 may be combined with any of the surgical components and methods disclosed in U.S. Patent Application No. 16 / 487,057, filed on August 19, 2019, entitled “SURGICAL SYSTEM,” which is incorporated herein by reference in its entirety unless the context clearly dictates otherwise. For example, the surgical system 100 may include an implant support, such as, for example, a connection tower 10 (which may be functionally similar to the extender disclosed by U.S. Patent Application No. 16 / 487,057).

[0041] Rough reference Figures 1 to 4 , the connection tower 10 can be capable of engaging with a bone fastener system 2 (such as, for example, a fixed axis screw or a multi-axial screw) or a fastener element (such as a receiver coupled to a fixed axis screw or a multi-axial screw). In the illustrated embodiment, the connection tower 10 is configured to be coupled to the receiver 4 and to be decoupled from the receiver. In various embodiments, the receiver 4 may include a lower cavity configured to be coupled to the bone screw and a first arm and a second arm, the first arm and the second arm defining a U-shaped channel therebetween for receiving a spinal rod (not illustrated). In some embodiments, for example, the receiver 4 may be referred to as a tulip-shaped head connector, which is configured to impact onto the bone screw 6 by pushing the receiver 4 onto the bone screw 6.

[0042] In various embodiments, the connection tower 10 may include a first leg 11 and a second leg 12 opposite the first leg 11, the first leg and the second leg extending in a longitudinal direction and defining a channel 13 or hole therebetween. For example, the channel 13 may be configured to allow auxiliary surgical instruments and / or spinal hardware (such as a spinal rod) to extend therethrough (not illustrated). As will be explained in further detail below, the connection tower 10 may be independently maneuverable to provide counter-torque for various maneuvers and manipulations of the vertebrae during surgical treatment, for example, to pull and / or compress, pull and / or push, raise and / or lower, twist and / or otherwise align the vertebrae.

[0043] In various embodiments, the surgical tool 100 may include a rack 29 extending between a first end 29A and a second end 29B in a first direction (eg, a longitudinal direction) (see FIG. Figure 6 ). In addition, the spline portion 29S may extend along a portion of the rack 29 between the first end 29A and the second end 29B. The rack 29 may be configured to connect to an adjacent connecting tower 10 and facilitate relative movement of the connecting tower 10 in a longitudinal direction along the longitudinal axis A1 (see Figure 6For example, the rack 29 may be configured to connect to adjacent connection towers 10 and facilitate relative movement of the connection towers 10 along the longitudinal axis A1.

[0044] In an example embodiment, the first connecting tower 10 can be coupled to a sliding body 30 that can facilitate movement of the first connecting tower 10 along the longitudinal axis A1. The sliding body 30 can include a ratchet mechanism 31 that includes a rotating key 32 (or actuator 32) that can engage with the splines 29S of the rack 29 in a bidirectional and / or two-way ratchet configuration. In some embodiments, the ratchet mechanism 31 can include various gears that can be toothed, however, the ratchet mechanism 31 does not have to include teeth and / or gears. In various embodiments, the rotating key 32 includes a gear surface that can engage with the splines 29S of the rack 29 to axially and / or incrementally translate the sliding body 30 and facilitate traction and / or compression, as described herein. For example, in some embodiments, the ratchet mechanism 31 can optionally include a pawl 39 that allows incremental translation of the sliding body 30 relative to the rack 29 in a first direction while also preventing axial translation of the sliding body 30 in an opposite direction. Thus, distraction of vertebral tissue connected to the connection tower 10 via the bone fastener 2 can be performed. In some embodiments, and depending on the orientation, the ratchet mechanism 31 can be configured to move the sliding body portion 30 (and the first connection tower 10) back and forth along the longitudinal axis A1, which corresponds to the cranial / caudal direction of the coronal plane (see Figures 7 and 8 Orientation and reference diagrams of surgical device 100 in Fig.12 ). Thus, in some embodiments, the ratchet mechanism 31 may be referred to as a "crown plane actuator."

[0045] In an example embodiment, the adjustment mechanism 40 can be coupled to the rack 29 adjacent the second end 29B. In various embodiments, the adjustment mechanism 40 can be restricted from moving in the longitudinal direction along the axis A1. In addition, the adjustment mechanism 40 can be coupled to the second adjustment tower 10 (as opposed to the first adjustment tower 10 coupled to the sliding body 30) and configured to raise and lower the second adjustment tower 10 in the vertical direction along the vertical axis A2 (see Figure 6 In some embodiments, and depending on the orientation, the connecting tower 10 can be configured to raise and lower the second adjustment tower 10 in a vertical direction corresponding to the ventral / dorsal direction of the sagittal plane (see Figures 7 and 8 Orientation and reference diagrams of surgical device 100 in Fig.12 ). Therefore, in some embodiments, the adjustment mechanism 40 may be referred to as a "sagittal plane actuator". Figure 5 to Figure 6 Further details regarding the adjustment mechanism 40 are explained in detail.

[0046] In an example embodiment, the sliding body 30 and the adjustment mechanism 40 may each be coupled to an angled assembly 20. Each angled assembly 20 may in turn be coupled to a corresponding connecting tower 10. In various embodiments, the angled assembly 20 may include a first pivot link 21 (also referred to as a lateral link assembly) that allows the corresponding connecting tower 10 to pivot about a first pivot point 22 (also referred to as a lateral pivot point) such as a pin or hinge. In various embodiments, the first pivot point 22 may be coupled to a second pivot link 25 or alternatively may be directly connected to the connecting tower 10 (not illustrated). In an example embodiment, the first pivot link 21 may allow the connecting tower 10 to pivot about the first pivot point to a position from a normal position NP (see Figure 1 ) to an angular position AP within an angular range of about + / - 0 degrees to about 20 degrees (see Figure 1 ), in which normal position NP the corresponding connecting tower 10 extends vertically and substantially perpendicularly to the main extension direction of the rack 29. In this way, and depending on the orientation, the first pivot link 21 can allow the corresponding connecting tower 10 to pivot along a transverse plane (see Figures 7 and 8 Orientation and reference diagrams of surgical device 100 in Fig.12 ).

[0047] In various embodiments, the angled assembly 20 may include a second pivot link 25 (also referred to as a crown link assembly) that allows the corresponding connecting tower 10 to pivot about a first pivot point 26 (also referred to as a crown pivot point) such as a pin or hinge. In an exemplary embodiment, the second pivot link 25 may allow the connecting tower 10 to pivot about the second pivot point to a position from the normal position NP (see Figure 3 ) within an angle range of approximately + / -20 degrees (see Figure 3 ), in which the corresponding connecting tower 10 extends substantially perpendicularly to the main extension direction of the rack 29 (compare Figure 3 NP and AP in ).

[0048] In this manner, and depending on the orientation, the first pivot link 21 may allow the corresponding connecting tower 10 to pivot along the coronal plane (see Figures 7 and 8 Orientation and reference diagrams of surgical device 100 in Fig.12 ). In various embodiments, the second pivot point 26 can be secured to a middle portion of the connection tower 10 and / or adjacent to an inner portion of the connection tower.

[0049] Rough reference Figure 5 to Figure 6 , showing the adjustment mechanism 40. As disclosed above, the adjustment mechanism 40 can be configured to move the corresponding connection tower 10 along the vertical axis A2, which corresponds to the ventral / dorsal direction of the sagittal plane (see Figure 6 )(See Figures 7 and 8 Orientation and reference diagrams of surgical device 100 in Fig.12 ). For example, the adjustment mechanism 40 may include a main body portion 41 having a rectangular shape, the main body portion including an arm 45 extending therefrom for coupling with the angled assembly 20. In various embodiments, the arm 45 may include a coupling hole 45X configured to cooperate with the coupling protrusion 45Z (see Figure 4 ). In an example embodiment, the coupling hole 45X is substantially rectangular and includes curved notches and / or chamfers at its corners that correspond to the curved notches and / or chamfers at the corners of the coupling protrusion 45Y. At least one advantage of this configuration may be that the rectangular shape and chamfered / notched corners of the coupling hole 45X and coupling protrusion 45Y allow for slight relative angulation of the attached angled components of approximately + / - 5 degrees in all directions (in addition to the angular ranges explained above with respect to the first pivot link 21 and the second pivot link 25).

[0050] In an example embodiment, the body portion 41 may include a hole 42 at its upper end through which an adjustment screw 49 may extend. The adjustment screw 49 may include a knob portion 48 at a first end, a stop feature 49Z at a second end, and a threaded body portion 47 therebetween. Additionally, the adjustment screw 49 may extend through a threaded hole 29Z adjacent to the second end 29B of the rack 29. Furthermore, the rack 29 may include a first pivot point in the form of a protrusion 29X. In at least some embodiments, the first protrusion 29X may take the shape of a circular pin and be disposed on the same side surface as the spline 29S so that it may form a pivotable connection point between the rack 29 and the second slot 43 of the body portion 41.

[0051] like Figure 5 As best shown, a portion of the rack 29 may be disposed in a first slot 44 along a first side of the body portion 41, and the protrusion 29X may be disposed in a second slot 43 along a second side of the body portion 41. In addition, the support block 46 may have a cross shape, wherein the first protrusion is disposed in the first slot 44 and the second protrusion is disposed in the second slot 43, while the stop feature 49Z restrains the above components in the appropriate position. In this way, the adjustment mechanism 40 can be restricted from moving in the longitudinal direction along the axis A1 while allowing relative movement in the vertical direction along the axis A2. In operation, an end user (such as a surgeon) can rotate the adjustment screw 49 by turning the knob portion 48, thereby causing relative movement of the adjustment mechanism 40 relative to the rack 29. For example, rotation of the adjustment screw 49 can facilitate and / or enable movement of adjacent connecting towers 10 in a vertical direction corresponding to the ventral / dorsal direction of the sagittal plane (see Figures 7 and 8 Orientation and reference diagrams of surgical device 100 in Fig.12). In various embodiments, the adjustment screw 49 may allow for approximately + / - 30 mm of adjustment in the vertical direction. In at least one embodiment, the turning knob 48 may allow for approximately + / - 20 mm of adjustment in the vertical direction. Additionally, in various embodiments, for example, the slot 42 may be elliptical in shape and the stop feature 49Z may be spherical in shape, such that the point of contact between the stop feature 49Z and the support block 46 may accommodate changes in the position of the adjustment screw 49 and / or the turning knob 48. At least one advantage of this configuration may be that the rack 29 may allow for an additional + / - 10° of angular adjustment about the protrusion 29x relative to the sagittal plane.

[0052] Rough reference Figures 7 to 11 , various methods of operating the surgical system 100 and / or multiple surgical systems 100 will be disclosed. Figures 7 to 9 A first surgical system and a second surgical system 100 for treating a spondylolisthesis condition are illustrated, and Figure 10 to Figure 11 A plurality of surgical systems 100 for treating scoliotic conditions are illustrated. Although not specifically illustrated, the surgical system 100 may also be employed with surgical procedures such as, for example, discectomy, laminectomy, fusion, laminectomy, lamina retraction, foraminatomy, facectomy, decompression, spinal nucleus or disc replacement, and bone grafting and implantable prostheses including plates, rods, and bone engaging fasteners. Those skilled in the art will readily appreciate how implementations according to the principles of the present disclosure may be broadly employed to treat the spine and / or other bony anatomies of human or non-human patients.

[0053] Figures 7 to 9Illustrated is the use of an example embodiment to correct the lumbar spondylolisthesis of the vertebral segment between the first vertebra V1 and the second vertebra V2, wherein the pedicle portions of the vertebrae V1 and V2 are uneven, for example, when the patient is in a prone position, the pedicle portions of V1 and V2 are arranged at different relative heights from the operating table. In the first step, the surgeon can obtain access to the surgical site including the vertebra V in any appropriate manner (such as through incision and contraction tissue). In various embodiments, the surgical system 100 can be used for any existing surgical method or technique, including open surgery, small incision surgery, minimally invasive surgery and percutaneous surgery implantation, whereby vertebrae V1 and V2 can be entered through a small incision, cannula or cannula, thereby providing access to the target area. In various embodiments, an incision can be formed in the patient's body, and a cutting instrument (not shown) can produce a surgical path for implanting the selected components of the surgical system 100. In at least some embodiments, a preparation instrument (not shown) may optionally be used to prepare and / or clean the various surfaces of the vertebrae V1, V2, and to aspirate and irrigate the surgical area on an as-needed basis. In a second step, the surgeon may install a bone fastener (e.g., a bone fastener system 2) to a selected portion of the human spine. In at least some specific implementations, a guide hole or the like may be drilled in a non-injured or non-diseased area of ​​the vertebrae V1, V2 for receiving a bone fastener (e.g., a bone fastener system 2). In an exemplary embodiment, the surgeon has installed two bone screws 6 in the opposite pedicle portions of the first vertebra V1, and has installed two bone screws 6 in the opposite pedicle portions of the second vertebra V2.

[0054] In a third step, the surgeon may connect a corresponding connection tower 10 to each bone fastener system 2. For example, the surgeon may utilize the first system 100 by connecting the first connection tower 10 to the first bone fastener system 2 of vertebra V1 and connecting the second connection tower 10 to the second bone fastener system 2 of vertebra V2. Similarly, the surgeon may utilize the second system 100 by connecting the third connection tower 10 to the third bone fastener system 2 of vertebra V1 and connecting the fourth connection tower 10 to the fourth bone fastener system 2 of vertebra V2. In this manner, each system 100 uses one of the connection towers 10 to connect to the pedicle portion of the first vertebra V1 and uses the other connection tower 10 to connect to the pedicle portion of the second vertebra. Still for example, the first system 100 may be connected to the left pedicle portion of the vertebrae V1, V2 and the second system 100 may be connected to the right pedicle portion of the vertebrae V1, V2. Additionally, in a fourth step, the surgeon may raise and / or lower the corresponding connection tower via the adjustment mechanism 40 on an as-needed basis according to the patient's specific anatomy to facilitate coupling to any of the various bone fastener systems 2 .

[0055] In the fifth step, and depending on the specific condition of the patient, the surgeon can traction the intervertebral disc space between the vertebrae V1, V2 by rotating the actuator key 32 of the ratchet mechanism 31. In doing so, the sliding body portion 30 can move away from the adjustment mechanism 40 along the longitudinal axis A1, as explained above. As a result, the intervertebral disc space between the vertebrae V1, V2 may become enlarged and / or pulled open. In addition, those skilled in the art will readily appreciate that, depending on which corresponding system 100 is used, the surgeon can selectively cause traction of the intervertebral disc space adjacent to the left pedicle and / or adjacent to the right pedicle. Similarly, if the surgeon determines that the intervertebral disc space adjacent to the left pedicle and adjacent to the right pedicle should be pulled, the surgeon can rotate each actuator key 32.

[0056] In a sixth step, the surgeon may raise and / or lower the vertebrae V1, V2 on an as-needed basis by rotating the knob portion 48 and the adjustment screw of the adjustment mechanism 40. Fig. 9 , the surgeon may rotate the first knob 48 and the adjustment screw 49 of the first system 100 to raise the corresponding pedicle portion of the vertebra V1 in the sagittal plane so that the corresponding pedicle portion may be aligned with (or better aligned with) the natural position of the vertebra V2. If necessary, the surgeon may repeat this step by rotating the second knob 48 and the adjustment screw 49 of the second system 100 to raise the corresponding pedicle portion of the vertebra V1 in the sagittal plane so that the corresponding pedicle portion may be aligned with (or better aligned with) the natural position of the vertebra V2.

[0057] In the seventh step, the surgeon may optionally further manipulate the position of the vertebrae V1, V2 in the transverse plane via the angulation of the first link assembly 21 of the angulation assembly 20. In the seventh step, the surgeon may optionally further manipulate the position of the vertebrae V1, V2 in the sagittal plane via the second link assembly 25. It should be understood that since the angulation assembly 20 allows pivoting in the transverse plane and the sagittal plane, manipulating the vertebrae V1, V2 during steps three to seven can be relatively safe and / or smooth. In the eighth step, the surgeon may optionally repeat any of the above steps to safely manipulate the vertebrae V1, V2 until the target alignment is achieved. For example, the surgeon may incrementally perform any of the above steps to control the traction of the intervertebral disc space and / or the adjustment of the vertebrae V1, V2. In the ninth optional step, the surgeon may optionally install an intervertebral implant between adjacent vertebrae V1, V2 to facilitate the fusion process. In the tenth optional step, the surgeon may optionally install a spinal rod that connects adjacent receivers 4 to maintain the alignment obtained by performing the above steps.

[0058] Figure 10 to Figure 11The use of an example device to correct scoliosis of a vertebral segment of a human spine including vertebrae V1 to V8 is illustrated. In this example, a surgeon can correct the spinal curvature by iteratively manipulating sub-portions of vertebrae V1 to V8. In some embodiments, correction of scoliosis can be achieved by compressing the corresponding vertebrae V1 to V8 at the apex of the curve of the corresponding vertebrae and traction on the other side of the corresponding vertebrae on a segment-by-segment basis. The procedure can produce the target result of straightening the spine by creating a wedge-shaped portion of the intervertebral disc space along the coronal plane so that the target segment of the spine becomes straight.

[0059] The surgical procedure may include multiple surgical systems 100 that selectively engage and / or are coupled to the selected pedicle portions of the selected vertebrae V1 to V8. In addition, the surgical procedure may include any of steps one to eight as explained above, wherein the ultimate goal is to restore and / or correct spinal curvature. Similarly, the surgeon may optionally perform step nine to install an intervertebral implant to facilitate the fusion process, and / or perform step ten to connect adjacent receivers 4 to maintain the spinal alignment obtained via performing the aforementioned steps.

[0060] After completing the procedures described herein, the surgical instruments, components, and non-implanted components of the surgical system 100 can be removed and the incision closed. In various embodiments, surgical navigation, microsurgery, and image guidance techniques can be used to access, visualize, and repair spinal degeneration or damage with the aid of the surgical system 100. In various embodiments, the surgical system 100 can include one or more plates, connectors, and / or bone fasteners for use with individual vertebral segments (see Figures 7 to 9 ) or multiple vertebral segments together (see Figure 10 to Figure 11 ). Fig.12 A reference diagram illustrating various planes and directions related to the human body.

[0061] It should be understood that various modifications may be made to the embodiments disclosed in the present invention. Therefore, the above description should not be understood as limiting, but only as an illustration of various embodiments. Those skilled in the art will be able to envision other modifications within the scope and essence of the claims attached hereto.

[0062] As used herein, the term "about" may be used to modify any quantitative representation that is permissible to vary without resulting in a change in the basic function to which it relates. For example, the adjustment screw 49 may allow for + / -30 mm of adjustment in the vertical direction as disclosed herein, but may allow for variations of several digits (such as 5 mm) as long as the function of the adjustment screw is not substantially changed, which is still within the scope of the present invention.

Claims

1. A surgical system for adjusting a segment of a spine, the surgical system comprising: a rack arm extending in a longitudinal direction from a first end to a second end, the rack arm including a spline portion; a sliding body portion including a ratchet mechanism having a first actuator and a pawl selectively engageable with the spline portion of the rack arm, the first actuator including a rotatable gear meshing with the spline portion, the rotatable gear being configured to translate the sliding body in the longitudinal direction along the rack arm; a first connecting tower extending along a first axis transverse to the longitudinal direction and coupled to the rack arm; a second connecting tower extending along a second axis transverse to the longitudinal direction and coupled to the sliding body portion; and A second actuator includes a threaded screw configured to adjust the first connection tower along the first axis. 2 . The system of claim 1 , wherein the second actuator is configured to raise and lower the first connection tower in a sagittal plane.

3. The system according to claim 1, further comprising: an adjustment mechanism comprising a body portion having a slot extending in the longitudinal direction, wherein the protrusion of the rack arm is movably arranged in the slot so as to form a pivot point of the rack arm in the sagittal plane, wherein the first connecting tower is coupled to the rack arm adjacent the second end and is restrained from moving in the longitudinal direction, and Wherein the second actuator is further configured as a freely rotatable actuator, the freely rotatable actuator being configured to raise and lower the protrusion within the slot in the sagittal plane. 4 . The system of claim 1 , wherein at least one of the first link tower and the second link tower is coupled to the rack arm via an angled assembly.

5. The system of claim 4, wherein each angle assembly includes a first linkage assembly configured to facilitate pivoting in a transverse plane.

6. The system of claim 5, wherein each angled assembly includes a second linkage assembly configured to facilitate pivoting in the coronal plane.

7. The system of claim 1, wherein the first connection tower is configured to distract the intervertebral disc space between adjacent vertebrae in a coronal plane.

8. The system of claim 1, wherein at least one of the first connection tower and the second connection tower is configured to couple to a bone fastener system.

9. The system of claim 1, wherein at least one of the first connection tower and the second connection tower is configured to couple to a polyaxial bone fastener system.

10. The system of claim 1, wherein at least one of the first connection tower and the second connection tower is configured to couple to a receiver of a bone fastener system.

11. A surgical system for adjusting a segment of a spine, the surgical system comprising: a ratchet wheel including a rack arm extending in a longitudinal direction and a sliding body portion movable in the longitudinal direction along a length of the rack arm, the sliding body portion including a pawl engageable with the rack arm; an adjustment mechanism, the adjustment mechanism comprising a threaded actuator; a first angled assembly coupled to the adjustment mechanism; a second angled assembly coupled to the sliding body portion; a first connection tower configured to be coupled to a first bone fastener, the first connection tower extending along a first axis transverse to the longitudinal direction and pivotably coupled to the first angled assembly; and a second connecting tower configured to be coupled to a second bone fastener, the second connecting tower extending along a second axis transverse to the longitudinal direction and pivotably coupled to the sliding body portion, Wherein the threaded actuator is configured to translate the first connecting tower relative to the rack arm in a sagittal plane.

12. The surgical system according to claim 11 further comprises a rotatable actuator comprising a plurality of teeth capable of engaging with teeth of corresponding sizes of the spline portion of the rack arm, the rotatable actuator being configured to move the sliding body portion forward and backward along the rack arm when the rotatable key rotates.

13. The surgical system of claim 12, wherein: The adjustment mechanism also includes a body portion including a first slot in a first side surface of the body portion and a second slot in a second side surface of the body portion; The rack arm includes a protrusion movably disposed within the first slot; and One end portion of the rack arm is movably disposed in the second slot.

14. The surgical system of claim 13, wherein the adjustment mechanism is constrained from movement in the longitudinal direction.

15. The surgical system of claim 13, wherein the threaded actuator is a screw-type actuator that engages a correspondingly sized threaded hole extending through the rack arm.

16. A method for adjusting a segment of a spine, the method comprising: A surgical system is received, the system comprising: a rack arm extending in a longitudinal direction from a first end to a second end, the rack arm including a spline portion; a sliding body portion including a ratchet mechanism having a first actuator and a pawl selectively engageable with the spline portion of the rack arm, the first actuator including a rotatable gear meshing with the spline portion and configured to translate the sliding body in the longitudinal direction along the rack arm; a first connecting tower extending along a first axis transverse to the longitudinal direction and coupled to the rack arm; a second connecting tower extending along a second axis transverse to the longitudinal direction and coupled to the sliding body portion; and a second actuator comprising a threaded screw configured to adjust the first connection tower along the first axis; implanting a first bone fastener system in a first vertebra; implanting a second bone fastener system in a second vertebra; attaching the first connection tower to the first fastener system; attaching the second connection tower to the second bone fastener system; and The first vertebra is manipulated by adjusting the second actuator to move the first vertebra in a sagittal plane.

17. The method according to claim 16, further comprising: The intervertebral disc space between the first vertebra and the second vertebra is distracted by moving the sliding body portion along the rack arm as the first actuator rotates.

18. The method according to claim 17, further comprising: At least one of the first connection tower and / or the second connection tower is adjusted to manipulate the lordotic orientation of the first vertebra and the second vertebra.

19. The method according to claim 17, further comprising: At least one of the first articulation tower and / or the second articulation tower is adjusted to manipulate the kyphotic orientation of the first vertebra and the second vertebra.

20. The method according to claim 16, further comprising: After the step of manipulating the first vertebra, a rod is secured to the first connector of the first bone fastener system and the second connector of the second bone fastener system.

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