Systems and methods for single location 360 degree

Abstract

A method of single position 360 degree cervical fusion includes positioning a patient in a lateral position on an operating table, orienting and maintaining the patient's spine at a desired sagittal plane alignment, performing anterior cervical disc fusion (ACDF), reorienting and maintaining the patient's head to facilitate posterior approach, and performing posterior fixation. Devices and systems configured to facilitate performing a single-position 360-degree cervical fusion method are also provided.

Description

[0001] Cross-reference to related applications. This application claims the benefit and priority of U.S. Provisional Patent Application No. 63 / 522,848, filed June 23, 2023, and U.S. Provisional Patent Application No. 63 / 656,692, filed June 6, 2024, the entire contents of each of which are hereby incorporated herein by reference. Technical Field

[0002] This disclosure relates to spinal surgery, and more specifically to systems and methods for single-position 360-degree cervical fusion. Background Technology

[0003] Currently, 360-degree cervical fusion is a multi-step procedure, which first involves performing anterior cervical discectomy (ACDF) with the patient in a supine position. ACDF typically involves performing discectomy within the intervertebral disc space, inserting a bone graft into the intervertebral disc space, and attaching a surgical plate to the anterior side of the spine to cross the intervertebral disc space and provide stability during spinal fusion. After completing ACDF, the patient is repositioned to a prone position. While the patient is in the prone position, screws are fixed to the vertebrae to provide additional stability during spinal fusion.

[0004] In more complex cervical fusion procedures, a 540-degree approach (in which the patient is repositioned from supine to prone and then back to supine during the procedure) or a 720-degree approach (in which the patient is repositioned from supine to prone, back to supine, and then back to prone during the procedure) may be required.

[0005] As currently performed, the time required to complete 360-degree (and even 540-degree and 720-degree) cervical fusion is significant, including approximately 30 to 60 minutes for patient repositioning (e.g., from supine to prone). Furthermore, patient injury may occur during repositioning. Summary of the Invention

[0006] As used herein, terms including “generally,” “about,” “substantially,” etc., mean covering up to and including a variation of up to and including 10% (e.g., manufacturing tolerances, material tolerances, usage tolerances and environmental tolerances, measurement variations, design variations and / or other variations and tolerances). Furthermore, any or all aspects described herein may be used in conjunction with any or all other aspects described herein to a consistent degree.

[0007] According to aspects of the present disclosure, a method of unit placement 360 degree cervical fusion is provided. The method includes positioning a patient in a lateral decubitus position on an operating table, orienting and holding a spine of the patient in a desired sagittal plane alignment, performing an anterior cervical discectomy fusion (ACDF), re-orienting and holding a head of the patient to facilitate posterior access, and performing a posterior fixation.

[0008] Performing the posterior fixation can include a transfacet screw fixation or any other suitable posterior fixation, such as a lateral mass screw fixation or a pedicle screw fixation.

[0009] In aspects where a transfacet screw fixation is performed, such fixation can be performed with or without fusion. In aspects where fusion is performed, the fusion can include removing facet joint cartilage, decorticating a facet joint surface, and / or delivering an orthobiologic to a transfacet joint space.

[0010] In an aspect of the present disclosure, at least a portion of the ACDF is performed by a surgeon using a handheld tool, and at least a portion of the posterior fixation is performed by a surgical robot and / or using a robotically guided tool. In such aspects, the surgeon can be positioned on an anterior side of the patient (for the at least a portion of the ACDF), and the surgical robot can be positioned on a posterior side of the patient (for the at least a portion of the posterior fixation).

[0011] In another aspect of the present disclosure, the ACDF includes installing an anterior steel plate held by a plurality of screws.

[0012] In yet another aspect of the present disclosure, a navigation component is attached to the anterior steel plate and utilized during the posterior fixation, such as to facilitate trajectory planning and / or navigation.

[0013] In yet another aspect of the present disclosure, the method further includes airplaning the operating table prior to performing the ACDF and / or prior to performing the posterior fixation.

[0014] In still another aspect of the present disclosure, a manipulation device attached to the head of the patient is used to facilitate orienting the spine of the patient, holding the spine of the patient, re-orienting the head of the patient, and holding the head of the patient.

[0015] In another aspect of the present disclosure, positioning the patient in a lateral decubitus position on an operating table includes extending an upward arm of the patient along the patient's body, and extending a downward arm of the patient forward from the body and bent at the elbow such that a lower portion of the downward arm of the patient extends toward the head.

[0016] In another aspect of the disclosure, posterior fixation includes at least one of planning a trajectory of at least one screw or using navigation to install the at least one screw.

[0017] In yet another aspect of the disclosure, performing the ACDF includes retracting the wound with the first retractor blade and the second retractor blade arranged in a vertical orientation.

[0018] In yet another aspect of the disclosure, the method further includes providing an additional support to a posterior side of the patient during at least a portion of the ACDF. The additional support can be removed after the at least a portion of the ACDF.

[0019] In another aspect of the disclosure, positioning the patient on the surgical table includes positioning the patient offset from a longitudinal axis of the surgical table.

[0020] In yet another aspect of the disclosure, positioning the patient on the surgical table includes securing the patient relative to the surgical table.

[0021] According to the present disclosure, there are also provided apparatuses and systems configured to facilitate performance of some or all aspects of the unit location 360 degree cervical fusion detailed above.

[0022] According to the present disclosure, there is also provided a manipulation device configured to facilitate positioning and maintaining a spine of a patient. The manipulation device includes a first frame assembly and a second frame assembly. The first frame assembly includes a base frame configured to engage a torso of the patient to secure the base frame relative to the torso of the patient. The second frame assembly is coupled to the first frame assembly and includes a support frame and a head frame coupled to the support frame and configured to engage a head of the patient to secure the head frame relative to the head of the patient. The support frame is movable relative to the base frame in at least two degrees of freedom, and the head frame is movable relative to the support frame in at least one degree of freedom.

[0023] In an aspect of the disclosure, the support frame is configured to pivot relative to the base frame to enable the head and neck of the patient to pivot relative to the torso of the patient, and to translate relative to the base frame to enable the head and neck of the patient to extend or compress relative to the torso of the patient.

[0024] In another aspect of the disclosure, the support frame is configured to lock relative to the base frame for at least one of: maintaining a position of the head and neck of the patient relative to the torso of the patient or maintaining an extension or compression of the head and neck of the patient relative to the torso of the patient.

[0025] In another aspect of the present disclosure, the head frame is configured to pivot relative to the support frame to enable the patient’s head to pivot forward or rearward relative to the patient’s neck.

[0026] In yet another aspect of the present disclosure, the head frame is configured to lock relative to the support frame to hold the patient’s head relative to the patient’s neck.

[0027] In yet another aspect of the present disclosure, the second frame assembly further includes an outer frame coupling the support frame with the first frame assembly.

[0028] In still another aspect of the present disclosure, the first frame assembly further includes a pair of links coupling the outer frame with the base frame.

[0029] In another aspect of the present disclosure, the outer frame includes at least one mounting extension configured to enable mounting of the outer frame to a patient support. In such aspects, the outer frame can include a plurality of mounting extensions, wherein at least one of the plurality of mounting extensions is configured to enable mounting of the outer frame to the patient support in an offset position.

[0030] In yet another aspect of the present disclosure, the manipulation device further includes an adjustable bolster assembly coupled to the second frame assembly. The adjustable bolster assembly includes a bolster movable relative to the second frame assembly.

[0031] According to the present disclosure, there is provided a surgical scout scope including a body defining a first end portion and a second end portion. The first end portion of the body is configured to operably couple to an objective end of a surgical microscope having a first viewing direction. The second end portion of the body is angularly disposed relative to the first end portion of the body and has a second viewing direction angularly disposed relative to the first viewing direction. At least one optical element is disposed within the body and is configured to relay a field of view in the second viewing direction to the objective end of the surgical microscope to enable visualization of the field of view by the surgical microscope.

[0032] In an aspect of the present disclosure, the first end portion of the body is configured to releasably engage the surgical microscope at the objective end of the surgical microscope.

[0033] In another aspect of the present disclosure, the first end portion of the body is physically connected to the second end portion of the body or wirelessly connected to the second end portion of the body.

[0034] In yet another aspect of the present disclosure, the second viewing direction is angularly disposed at an angle of about 90 degrees relative to the first viewing direction.

[0035] According to the present disclosure, a support assembly for supporting a patient in a lateral decubitus position on an operating table is provided, the support assembly comprising a mount configured for positioning on the operating table and a first support rotatably coupled to the mount. The first support comprises a body having a plurality of independently adjustable segments such that a height of each of the plurality of independently adjustable segments can be independently adjusted.

[0036] In an aspect of the present disclosure, the support assembly further comprises a strap attached to the first support and configured to secure a patient’s head to the first support.

[0037] In another aspect of the present disclosure, the support assembly further comprises as recited in claim 35, further comprising a second support pivotably coupled to the first support, the second support defining an elongated configuration.

[0038] According to the present disclosure, a method of one-level 360 degree cervical fusion is provided, the method comprising positioning a patient in a lateral decubitus position on an operating table, performing an anterior cervical discectomy fusion (ACDF), and performing a posterior fixation. The posterior fixation comprises from a first approach to a facet joint, preparing for or inserting an interpositional into the facet joint. The posterior fixation further comprises from a second, different approach to the facet joint, performing a transfacetal screw fixation.

[0039] In aspects of the present disclosure, the method can include any of the features detailed with respect to the method described above, and vice versa.

[0040] In another aspect of the present disclosure, at least one first instrument is used for the first approach and at least one second instrument is used for the second approach. In aspects, the first instrument and the second instrument are coupled to one another with at least one degree of freedom.

[0041] In yet another aspect of the present disclosure, the first approach is adjacent to an opposing bony surface of the facet joint and the second approach is transverse to the facet joint. BRIEF DESCRIPTION OF DRAWINGS

[0042] The above and other aspects and features of the present disclosure will become more apparent from the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like elements throughout.

[0043] Figure 1 is a perspective view of a surgical operating room configured for performing a one-level 360 degree cervical fusion procedure in accordance with aspects of the present disclosure;

[0044] Figure 2 is a flowchart of a method of performing a one-level 360 degree cervical fusion procedure in accordance with aspects of the present disclosure;

[0045] Figure 3 is a flowchart of a first portion of a method according to aspects of the present disclosure; Figure 2

[0046] Figure 4 is a top view schematic illustration of a patient positioned on an operating table in a lateral decubitus position to perform a one-location 360 degree cervical fusion procedure according to aspects of the present disclosure;

[0047] Figure 5A is a front side schematic illustration of a patient positioned on an operating table in a lateral decubitus position to perform a one-location 360 degree cervical fusion procedure according to aspects of the present disclosure;

[0048] Figure 5B is a side perspective view of another operating table configured for performing a one-location 360 degree cervical fusion procedure according to aspects of the present disclosure;

[0049] Figure 6 is a magnified side view showing the patient’s chin positioned in an upward orientation such that the patient’s head is extended according to aspects of the present disclosure;

[0050] Figure 7A is a schematic illustration of a patient including a manipulation device secured to the patient to enable adjustment of the position of the patient’s head and / or neck according to aspects of the present disclosure;

[0051] Figure 7B and Figure 7C are a front perspective view and a side view, respectively, of another manipulation device secured to a patient to enable adjustment of the position of the patient’s head and / or neck according to aspects of the present disclosure;

[0052] Figure 8 is a flowchart of a second portion of a method according to aspects of the present disclosure; Figure 2

[0053] Figure 9 and Figure 10 are images taken during performance of an ACDF according to aspects of the present disclosure;

[0054] Figure 11 is a perspective view showing intervertebral disc replacement during performance of an ACDF according to aspects of the present disclosure;

[0055] Figure 12 and Figure 13 are other images taken during performance of an ACDF according to aspects of the present disclosure;

[0056] Figure 14 is an x-ray image showing a portion of the patient’s spine after completion of an ACDF according to aspects of the present disclosure;​​

[0057] Figure 15 is a flowchart of a third portion of the method of Figure 2

[0058] Figure 16 is a magnified side view of a patient in accordance with aspects of the present disclosure, with the patient’s chin disposed in a downward orientation such that the patient’s head is in a flexed position;

[0059] Figure 17 is an image taken during preparation of a robotic transforaminal screw fixation in accordance with aspects of the present disclosure;

[0060] Figure 18 and Figure 19 is a screenshot showing robotic trajectory planning for transforaminal screw fixation in accordance with aspects of the present disclosure;

[0061] Figures 20A-20E is a perspective view showing step-by-step tool positioning and utilization during transforaminal screw fixation in accordance with aspects of the present disclosure;

[0062] Figures 21-23 are x-ray images showing left lateral transforaminal screws, plate and screws, and right lateral transforaminal screws of an ACDF after completion of a unilateral 360-degree cervical fusion procedure in accordance with aspects of the present disclosure, respectively;

[0063] Figure 24A and Figure 24B is a side view of a coupling assembly provided in accordance with aspects of the present disclosure, wherein a first portal and a second portal of the coupling assembly are disposed in different first and second positions relative to each other, respectively;

[0064] Figure 25 shows Figure 24A and Figure 24B the coupling assembly of

[0065] Figure 26 is a magnified view of a patient’s spinal anatomy including an insert disposed within a facet joint and a screw extending through the facet joint and engaged with the insert;

[0066] Figure 27A and Figure 27B are cross-sectional views of the screw and insert of Figure 26 disengaged from and engaged with each other, respectively;

[0067] Figure 28 ​A surgical endoscope provided in accordance with this disclosure is shown, demonstrating an ergonomic microscopic visualization of the patient’s spinal anatomy.

[0068] Figure 29 yes Figure 28 A magnified view of the distal portion of the surgical endoscope, showing an ergonomic microscopic visualization of the patient's spinal anatomy;

[0069] Figure 30 This is a schematic diagram of the visualization system provided in this disclosure, illustrating an ergonomic visualization of the spinal anatomy of a patient.

[0070] Figure 31 This is a top-down view of the patient being supported by multiple support devices and placed on the operating table in a lateral decubitus position.

[0071] Figure 32 yes Figure 31 A side view diagram showing how the multiple support devices support the patient in a lateral decubitus position on the operating table;

[0072] Figure 33 yes Figure 31 Side view of the adjustable head and neck support and adjustable arm support of the multiple support devices;

[0073] Figure 34 yes Figure 31 A side view of the rear cushion of the multiple support devices;

[0074] Figure 35 and Figure 36 This is a top view of another operating device provided in accordance with this disclosure;

[0075] Figure 37A and Figure 37B yes Figure 35 and Figure 36 A side view of the operating device;

[0076] Figure 38A and Figure 38B yes Figure 35 and Figure 36 Front view of the adjustable cushion assembly of the control device;

[0077] Figures 39A-39C The use of screws and inserts installed from a common access position, according to various aspects of this disclosure, is demonstrated to prepare for and perform facet joint fixation.

[0078] Figure 40A and Figure 4 B illustrates other aspects of this disclosure that are configured to facilitate the preparation and execution of facet joint fixation from a common access position;

[0079] Figures 41A-41C Facet joint fixation is prepared and performed using screws and inserts installed from a common entry location, according to yet other aspects of the present disclosure;

[0080] Figure 42 Facet joint fixation is prepared and performed using screws and inserts installed from different entry locations, according to yet other aspects of the present disclosure;

[0081] Figure 43 Facet joint fixation is prepared and performed using screws and inserts installed from different entry locations, according to yet other aspects of the present disclosure; and

[0082] Figure 44A andFacet joint fixation is prepared from different approach directions and with different tools, according to the present disclosure. Figure 44B DETAILED DESCRIPTION

[0083] The systems and methods of the present disclosure enable a one-location 360 degree cervical fusion procedure to be performed, thus significantly reducing the time to complete the procedure (e.g., by avoiding the need to reposition the patient) and reducing the risks associated with the procedure (e.g., the likelihood of injuring the patient during repositioning). Further, suitable clearance, visibility, and workspace are provided for both the surgeon and the surgical robot, thus facilitating the performance of the 360 degree cervical fusion.

[0084] Referring to Figure 1 , a surgical operating room is shown configured for performing a one-location 360 degree cervical fusion procedure according to the present disclosure. The surgical operating room includes a patient “P” disposed on a surgical table 10, a surgeon “S”, a surgical robot “R”, a plurality of surgical tools 100, 150 (e.g., any of the tools detailed herein), and a surgical navigation system 306.

[0085] In aspects, the surgical navigation system 306 includes an imaging device 312, such as an x-ray imaging device. The imaging device 312 can define an annularly extending housing that encloses an image capture assembly 314. The image capture assembly 314 can include an x-ray source (or other imaging emitting portion) and an x-ray receiver (or other imaging receiving portion) mounted substantially opposite one another on a track of the image capture assembly 314. The source and receiver of the image capture assembly 314 are operable to rotate (e.g., 360 degrees) within the annularly extending housing of the imaging device 312 during image acquisition, thereby causing the source and receiver of the image capture assembly 314 to rotate along the track of the image capture assembly 314 to enable image data to be captured at various different circumferential positions. More particularly, the imaging components of the image capture assembly 314 can rotate about a central point or axis, thereby allowing image data of the patient “P” to be acquired from multiple directions and / or in multiple planes. In this way, the imaging device 312 collects suitable image data to enable various views and / or three-dimensional models, such as a three-dimensional x-ray model, to be generated. The views and / or three-dimensional models can be used to facilitate surgical planning, such as for determining end tip positions, angles, depths, and / or trajectories of surgical tools (e.g., surgical instruments, surgical hardware, etc.) relative to one another and / or the patient anatomy.

[0086] In aspects, the surgical navigation system 306 can be configured for fluoroscopy imaging to generate substantially real-time images (e.g., three-dimensional images) of the patient “P”. In such configurations, the position of the image capture assembly 314 can be used in conjunction with a tracking system 316 to determine the position of the image capture assembly 314 and the image data relative to the patient “P”. The tracking system 316 can include various portions associated with or included with the surgical navigation system 306. The tracking system 316 can include, for example, an optical tracking system and / or an electromagnetic (EM) tracking system. The tracking system 316 and information used by the surgical navigation system 306 can be used to track one or more tracking devices in real-time to display the position of one or more items (e.g., patient tracking devices, imaging device tracking devices 320, surgical tool tracking devices, etc.) in real-time three-dimensional images to allow such items to be tracked relative to one another, the patient “P”, and / or other components.

[0087] With continued reference to Figure 1 , the navigation components including the emitter array 304 Figure 13 are fixed relative to the patient “P” to enable a known reference position to be determined, for example, in three-dimensional space, relative to the patient “P”. The emitter array is configured to generate signals that can be detected by the sensor array 302 of the surgical navigation system 306. One or more of the surgical tools 100, 150 can also include an emitter array (see, e.g., component 2052 Figure 20D), the emitter array is configured to generate a signal that can be detected by the sensor array 302 of the surgical navigation system 306 such that, in conjunction with known reference positions, the three-dimensional spatial position and / or trajectory of the one or more surgical tools 100, 150 relative to the patient "P" can be displayed and / or tracked to facilitate surgical planning and / or navigation.

[0088] More particularly, image data (e.g., x-ray image data) obtained using the one or more imaging devices 312 is transmitted to the computer 318, in which the image data can be forwarded to the computer 308 for saving the image data, generating images from the image data (e.g., various 2D images, 3D models, etc.), digitally manipulating the generated images, printing the generated images, and / or displaying the image data (e.g., on the monitor 310). In particular, with respect to display, the processor of the computer 308 of the surgical navigation system 306 is configured to output the image data for display on the monitor 310 while tracking, in real-time, the position of the one or more surgical tools 100, 150 (including surgical instruments, surgical hardware (e.g., screws, plates, rods, etc.), and / or other suitable surgical tools) relative to each other, the patient "P", and / or other suitable reference points.

[0089] Thus, as detailed above, the surgical navigation system 306 can enable surgical planning, e.g., determining and mapping the orientation, position, angle, depth, trajectory, etc. of the one or more surgical tools, and / or can facilitate navigation of the one or more surgical tools during use, e.g., in accordance with the determined surgical planning. Although exemplary tracking and imaging devices are detailed above, other suitable tracking and / or imaging devices are also contemplated.

[0090] The surgical robot "R" can include one or more robotic arms, each configured to hold and / or manipulate one or more surgical tools. Each robotic arm of the surgical robot "R" can further include position sensors configured to enable determination of the position and / or orientation of the one or more surgical tools connected thereto. Each robotic arm of the surgical robot "R" can be actively driven by a surgeon to manipulate the corresponding surgical tool, or can be automatically driven based on instructions to perform a particular surgical task or a portion thereof. Such instructions can include, for example, manipulating the surgical tool along a determined trajectory, manipulating the surgical tool to a determined position, manipulating the surgical tool to a determined depth, etc., and / or actuating, deploying, driving, etc. the surgical tool a determined amount and / or to a determined position.

[0091] Further reference is made to Figure 2 The method of unit position 360-degree cervical fusion provided in accordance with the present disclosure is generally identified by reference numeral 200. Although reference is made herein to Figure 1The configuration of the operating room was considered, along with any other suitable operating room configurations.

[0092] The single-position 360-degree cervical fusion method 200 includes positioning and supporting the patient in a lateral decubitus position (as indicated at 210), performing anterior cervical disc fusion (ACDF) (as indicated at 220), and performing transface screw fixation (as indicated at 230). As an alternative or supplementary option to transface screw fixation, any other suitable posterior fixation, such as lateral mass screw fixation or pedicle screw fixation, may be performed. Therefore, although transface screw fixation has been described in detail herein, it should be understood that other suitable posterior fixations may be performed. Further, transface screw fixation (or other suitable posterior fixation) can be performed with or without fusion and may include removal of facet joint cartilage, stripping of the cortex of the facet joint surface, and / or delivery of a flowable orthopedic biological agent to the transface joint space. In various respects, stripping of the facet joint cortex can be performed from multiple trajectories (see, for example...). Figure 25 It can be performed using tools such as surgical bone drills, files, and / or other suitable tools (depending on the trajectory used).

[0093] The following describes in detail each of portions 210, 220, and 230 of method 200, as well as the components and systems configured to facilitate the execution of method 200. Any or all of portions 210, 220, and 230 of method 200 may be performed with the assistance of imaging (e.g., fluorescence imaging) and / or surgical navigation (as detailed above).

[0094] Turn Figures 3-6 Position and support the patient in a lateral decubitus position 210 (see also...) Figure 2 The initial procedure involves placing the patient "P" in a lateral decubitus position on the operating table 10, as indicated at 330. The patient "P" may be placed in either a left or right lateral decubitus position, depending on factors such as surgeon preference, anatomical considerations, and / or other factors. The surgeon "S" is positioned anterior to the patient "P," while the surgical robot "R" is positioned posterior to the patient "P." If necessary, the patient "P" may be laterally offset from the center of the longitudinal axis "L" (extending between the head and foot ends of the operating table 10), for example, closer to the surgical robot "R," to ensure accessibility of the arms of the surgical robot "R," for example, to facilitate the execution of cross-face screw fixation 230 ( Figure 2 ).

[0095] Further, placing the patient "P" in a lateral decubitus position on the surgical table 10 (as indicated at 330) includes positioning the upward arm of the patient "P" to extend along the upward side of the patient "P's" body, while the downward arm of the patient "P" is positioned to extend forward from the patient "P's" body and to be bent at the elbow, such that the lower portion of the patient "P's" downward arm extends toward the head. This configuration facilitates access to the patient "P", particularly from the front, to facilitate performing the ACDF and to avoid collisions between the surgeon "S" and / or the surgical tools and the arms of the patient "P". However, other arm positions are also contemplated.

[0096] Once the patient "P" is positioned on the table 10 at 230, as detailed above, or in connection with positioning the patient "P" on the table 10 at 230, the spine of the patient "P" is oriented in a desired sagittal plane alignment. As indicated at 340, the desired sagittal plane alignment can be achieved, for example, by positioning the head and neck of the patient "P" to achieve a neutral position as desired to maintain normal cervical lordosis (see, e.g., FIG. 3B). Further, as also indicated at 340, achieving the desired sagittal plane alignment can include inclining the chin of the patient "P" upward, for example, such that the head of the patient "P" is in an extended position "E" to provide sufficient anterior clearance (see, e.g., FIG. 3B) for performing the ACDF without interference from the head of the patient "P". Figure 5A Figure 6 Imaging (e.g., fluoroscopy) with, for example, the surgical navigation system 316 (see, e.g., FIG. 3A) can be used to facilitate the alignment of the patient "P" and / or to confirm the correct alignment of the patient "P". Figure 1

[0097] To facilitate positioning the patient "P" as detailed above and / or to maintain the positioning of the patient "P" as detailed above, the support 12, such as a pillow (e.g., a pillow), a bolster, and / or other suitable support, is utilized as desired, as indicated at 350.

[0098] Once the patient "P" is properly positioned on the surgical table 10, supported and / or padded as desired (see, e.g., 330-350), the patient "P" is secured in place, as indicated at 360. Any suitable restraint 14 (e.g., a strap, a cloth, a mechanical frame structure, and / or any other suitable component or combination thereof) can be used to secure the patient "P" in place.

[0099] Prior to, subsequent to, or in connection with placing, positioning, and securing the patient "P" as detailed above, a drape and / or other sterile barrier is used to properly prepare a sterile surgical field. Further, intubation is completed, if not already prepared.

[0100] With particular reference to Figure 5A ​​In aspects, to facilitate positioning of the patient “P” to perform the ACDF, the surgical table 10 can include an adjustment mechanism 16 configured to tilt the patient support surface of the surgical table 10. For example, the adjustment mechanism 16 can enable the patient support surface of the surgical table 10 to roll (tilt left and right about the longitudinal axis “L”) to provide a better gap and / or approach for performing the ACDF (e.g., to facilitate use of a microscope during the ACDF). Additionally or alternatively, the adjustment mechanism 16 can enable the patient support surface of the surgical table 10 to tilt forward and backward (e.g., between a neutral position, a Trendelenburg position, and an anti-Trendelenburg position). Height adjustment of the surgical table 10 using the adjustment mechanism 16 is also contemplated, e.g., to reposition the surgical table 10 based on the height of the surgeon “S,” based on whether the surgeon “S” prefers to approach standing or sitting, etc. Tilt and / or height adjustment of the surgical table 10 using the adjustment mechanism 16 can be powered, e.g., via one or more motors of the adjustment mechanism 16.

[0101] Referring to Figure 5B , another surgical table 500 is shown that is provided in accordance with the present disclosure and configured to facilitate positioning of the patient “P.” The surgical table 500 includes a patient support surface 510 that is operably mounted between first and second supports 522, 524 of a table frame 520 to enable the patient support surface 510 to roll, tilt forward and backward, and / or be height adjusted relative to the first and second supports 522, 524 of the table frame 520. Adjustment of the surgical table 500 can be powered, e.g., via one or more motors, and in such aspects, can be controlled by a processor to achieve precise placement and / or movement of the patient support surface 510. The table frame 520 of the surgical table 500 can further include a manipulation device mount 526 configured to enable mounting of a manipulation device 750 thereto, as detailed below. In aspects, the manipulation device mount 526 can be electromechanically mounted to the manipulation device 750 to enable powered and controlled manipulation of the manipulation device 750.

[0102] Continuing to refer to Figure 5B In aspects, the table frame 520 of the surgical table 500 further includes a support extension 530 that is joined to and extends from the patient support surface 510 to support a portion of the patient “P” that extends beyond the patient support surface 510, e.g., an arm of the patient “P.” An additional cushion 540 can be used to support the patient “P” on the surgical table 500, e.g., to support the head of the patient “P” between the manipulation device 750 and the patient support surface 510. To the extent consistent, the surgical table 500 can include any of the features of the surgical table 10 ( Figure 5A ), and vice versa.

[0103] Referring to Figure 7A In aspects, to facilitate positioning of the head and neck of the patient "P", such as to the positions detailed above or elsewhere herein, a manipulation device 700 can be utilized. The manipulation device 700 includes a base frame 710 configured to mount to the body of the patient "P" and a movable frame 720 configured to attach to the head of the patient "P". The movable frame 720 includes one or more first (e.g., flexion / extension) joints 722 configured to enable the movable frame 720 to pivot relative to the base frame 710, thereby enabling the head of the patient "P" to move between a neutral position, a flexion position, and an extension position. The movable frame 720 can additionally or alternatively include one or more second (e.g., left / right) joints 724 configured to enable the movable frame 720 to pivot relative to the base frame 710, thereby enabling the head of the patient "P" to move laterally to a desired position.

[0104] As detailed above, the manipulation device 700 enables the head and neck of the patient "P" to be moved controllably to a desired position. The manipulation device 700 is further configured to selectively maintain or lock the position of the head and neck of the patient "P" once the desired position is reached. In aspects, the manipulation device 700 is manually actuated, e.g., via a knob or direct movement of the movable frame 720 relative to the base frame 710, and the movable frame 720 is manually lockable relative to the base frame 710. In other aspects, the manipulation device 700 is motorized to enable the head and neck of the patient "P" to be positioned and held in the desired position powered.

[0105] Referring to Figure 7B And Figure 7C In accordance with the present disclosure, another manipulation device 750 is provided. The manipulation device 750 includes a shoulder frame 760 (e.g., a shoulder support, which can include padding for patient comfort) configured to sit on the shoulder of the patient "P", a securing device 770 (e.g., a strap) configured to secure the shoulder frame 760 relative to the patient "P", and a movable frame 780 configured to attach to the head of the patient "P". The movable frame 780 can be configured as a Mayfield frame that mounts to the skull of the patient "P". More specifically, the movable frame 780 includes a first frame 782 pivotably connected to the shoulder frame 760 on either side of the head of the patient "P" about a first joint 784. The first frame 782 extends over the head of the patient "P". The movable frame 780 further includes a second frame 786 pivotably connected to the first frame 782 on either side of the head of the patient "P" via a second joint 788. The second frame 788 extends circumferentially around the head of the patient "P".

[0106] The second frame 788 includes a mounting portion 789 configured to enable mounting of the manipulating device 750 to a surgical table, e.g., to the manipulating device mount 526 of the surgical table 500 (see Figure 5B ). Additionally or alternatively, the shoulder frame 760 can include a robotic mount 762 configured to enable mounting of a robotic surgical device "R" thereto (see Figure 17 ), thus defining a support location and / or reference point that is fixed relative to the patient "P". To the extent consistent, the manipulating device 750 can include any features of the manipulating device 700 (see Figure 7A ), and vice versa.

[0107] With reference to Figures 8-14 , performing an ACDF 220 (see also Figure 2 ) includes making an incision 810 (e.g., a transverse or longitudinal incision along the neck), retractorizing a wound 820, decompressing an intervertebral disc space 830, resecting and removing tissue 840, performing an intervertebral disc replacement 850, performing an anterior plating 860, and closing the anterior wound 870. The ACDF can be performed with the surgeon "S" (see Figure 1 and Figure 3 ) in a standing or sitting position. In aspects, the surgeon "S" (see Figure 1 and Figure 3 ) can utilize a microscope to facilitate visualization.

[0108] With respect to making the transverse incision 810, a standard transverse incision can be made. Additionally, muscle tissue and other tissue are transected as necessary to expose the vertebral bodies to be fused.

[0109] Next, the wound is retractorized 820. With reference to Figure 8 and Figure 9 , the wound retractorization can be implemented using suitable retractor blades 922, 924 that are vertically oriented (vertically oriented with respect to the surgeon "S" (see Figure 1 and Figure 3 ); laterally spanning the patient "P"). One such retractor blade is a top retractor blade 922, while the other retractor blade is a bottom retractor blade 924. Such positioning facilitates visibility of the surgical site. More specifically, the wound retractorization can be performed by inserting the top retractor blade 922 and the bottom retractor blade 924, and connecting a retractor brace 926 to the retractor blades 922, 924 to enable movement of the retractor blades 922, 924 to effectuate the necessary retraction. The retractor brace 926 is secured to the surgical table 10 (see Figure 3The table support arms 928 or other suitable supports (e.g., a cloth strip) of the retractor assembly 920 can be used to maintain the position of the retractor components 922, 924, 926 relative to the patient "P," for example, to counteract gravity. In aspects, a surgical assistant positioned on the posterior side of the patient "P" (e.g., on the opposite side of the surgical table 10 from the surgeon "S" (see Figure 3 ) can facilitate insertion, positioning, and holding of the retractor components 922, 924, 926, for example, by reaching around the patient "P."

[0110] With continuing reference to Figure 8 and Figure 9 , decompressing the intervertebral disc space 830 can include dilating the intervertebral disc space of interest with the distractor 940. In the case of using the distractor 940, the cradle 942 associated with the distractor 940 can be positioned below the incision (e.g., closer to the surgical table 10 ( Figure 3 ) to maintain visibility. At this point in time, prior to this point in time, or at any other suitable point in time, a microscope (not shown) can be positioned on, for example, the surgical table 10 ( Figure 3 ) to facilitate visualization of the intervertebral disc and the intervertebral disc space of interest.

[0111] With reference to Figure 8 and Figure 10 , resecting and removing tissue 840 includes resecting the anterior longitudinal ligament, a discectomy, decompression of the neural elements, and / or removal of the anterior osteophytes. This can be done with any suitable surgical tool 1000 (e.g., a manually operated tool operated by the surgeon "S" ( Figure 3 ) and, in particular, those that enable resecting and removing tissue 840 without interference or impingement by the downwardly-aimed arms of the patient "P." For example, a tool 1000 having a pencil grip, a rotatable grip, or other grip without a significant downwardly-projecting portion can be desirable.

[0112] With reference to Figure 8 , Figure 11 and Figure 12 , performing a disc replacement 850 can initially include distracting and trialing to determine the size of the intervertebral disc space. Once the size of the intervertebral disc space is determined, an intervertebral disc replacement 1110 (e.g., a bone graft, an implant, or other suitable replacement) is inserted into place with any suitable tool 1120 (e.g., a manually operated tool operated by the surgeon "S" ( Figure 3 ) and, in particular, those that enable resecting and removing tissue 840 without interference or impingement by the downwardly-aimed arms of the patient "P." For example, a tool 1000 having a pencil grip, a rotatable grip, or other grip without a significant downwardly-projecting portion can be desirable. Figure 3 Figure 5A ​), to counteract forces associated with testing and impaction of the intervertebral disc replacement, thereby avoiding movement of the patient "P". In aspects, the support 12 ( Figure 3 and Figure 5A ) are added, repositioned, and / or adjusted to provide additional support on the posterior side of the patient "P". The additional support can be removed upon completion of the intervertebral disc replacement 850, upon completion of the anterior plating 860, or at any other suitable point in time. In aspects utilizing a graft or other implant, the graft or implant can be inserted through the tube, through a screw having a hollow interior, and / or through a delivery instrument such as a malleable delivery tool capable of accessing the intervertebral disc space, for example, through a tortuous path for insertion.

[0113] Turning to Figure 13 and Figure 14 , in conjunction with Figure 8 , once the intervertebral disc replacement 850 is completed, the anterior plating 860 is performed, in which an anterior surgical plate 1310 is attached to the intervertebral disc replacement 1110 and to the vertebrae on either side of the intervertebral disc replacement 1110 using suitable surgical screws 1320. In view of the lateral positioning of the patient "P" and the gravitational considerations that follow, the correct alignment of the anterior surgical plate 1310 relative to the patient "P" (e.g., the spinal anatomy) is maintained during the anterior plating 860. The anterior plating 860 can be performed with a manual manipulation tool, for example, operated by the surgeon "S" (not shown). Figure 3

[0114] With specific reference to Figure 13 , in aspects, once the anterior plating 860 is completed, a navigation component including an emitter array 304 is installed on the anterior surgical plate 1310. Since the anterior surgical plate 1310 is fixed to the spine of the patient "P", the fixation of the emitter array 304 to the anterior surgical plate 1310 (and / or the surgical screws 1320) provides a fixed reference point relative to the spine of the patient "P" to facilitate surgical planning and / or surgical navigation, for example, for performing the transface screw fixation 230 ( Figure 2 ), as detailed above. In such aspects, the surgical plate 1310 (and / or the surgical screws 1320) can include suitable features, for example, threaded recesses, keyholes, tabs, and / or other mechanical features, to enable releasable fixation of the emitter array 304 relative to the anterior surgical plate 1310. In other aspects, other reference navigation components are utilized.

[0115] With reference again to Figure 8 , to complete the ACDF procedure 220, the anterior incision is closed, as indicated at 870. The closure of the anterior incision 870 can include suturing.

[0116] With reference to Figures 15-20E , in conjunction with​Figure 2 After completing the ACDF procedure 220, the unitary 360-degree cervical fusion method 200 next includes performing a transface screw fixation (as indicated at 230). Since the unitary 360-degree cervical fusion method 200 involves maintaining the patient “P” in a lateral decubitus position, the patient does not need to be turned over or substantially repositioned. However, and with reference to Figure 15 and Figure 16 Performing the transface screw fixation 230 can initially include, as indicated at 1510, repositioning the head of the patient “P” such that the head of the patient “P” is in a flexed position “F” or otherwise positioned to facilitate a posterior approach. For example, positioning the head of the patient “P” in the flexed position “F” can facilitate the posterior approach by helping to ensure that the skull does not interfere with the transface screw insertion detailed below. Figure 6 Figure 2 and Figure 8 The repositioning described above can be performed manually using the manipulation device 700

[0117] In aspects, once the desired position for the transface screw fixation 230 has been achieved, the patient “P” is resecured to the surgical table 10 Figure 7A Further, if needed, the surgical table 10 Figure 3 is tilted and / or height-adjusted (e.g., as detailed above) to achieve the desired position for the transface screw fixation 230. Figure 3

[0118] Turning to Figure 15 and Figure 17 The transface screw fixation 230 next includes positioning a robotic system, as indicated at 1520. With respect to positioning the robotic system 1520, the robotic system “R” is positioned on the surgical table 10 on the posterior side of the patient “P” or otherwise relative to the surgical table. Further, the robotic system “R” can be attached to the spine of the patient “P” using the spinous process clamp 1710 and the coupler 1720, for example, at T1 to C7. In aspects, at least a portion of the spinous process clamp 1710 and / or the coupler 1720 is formed of a radiolucent material to enable visualization and / or identification of the same on x-ray images. Thus, either or both of these components 1710, 1720 can be used as a reference point during surgical planning and / or navigation. Once the robotic system “R” is positioned and / or facilitated to be positioned as detailed above, imaging scans and registration can also be performed.

[0119] With reference to Figure 15 , Figure 18 and Figure 19 ​​, transface screw fixation 230 next includes planning a robotic trajectory, as indicated at 1530. Robotic trajectory planning 1530 includes adjusting the segment line to ensure clear view of the target facet joint. The trajectory is chosen to leave enough inferior and superior articular processes above and below the screw, and to perforate the facet. Further, the trajectory and / or delivery depth is chosen to target the bottom of the intervertebral disc space, avoid penetrating or at least over-penetrating the anterior or ventral surface of the superior articular process, and attempt to maintain a substantially perpendicular orientation relative to the facet surface. In Figure 18 and Figure 19 , an exemplary trajectory 1800 is illustrated in axial view and lateral view, respectively.

[0120] With respect to robotic trajectory planning 1530, and more specifically, in axial view (see Figure 18 ), the trajectory 1800 is determined such that the screw is positioned straight or slightly angled to ensure sufficient bone fixation and to enable maximizing the diameter and length of the screw utilized. In lateral view (see Figure 19 ), the trajectory 1800 is made substantially perpendicular to the facet joint to ensure robust tightening of the joint. High angles should be avoided as they can cause reachability issues for the arms of the surgical robot "R" ( Figure 17 ). Further, trajectory alignment at the skin level can be done to minimize incision size and to enhance cosmetic results.

[0121] Turning to Figures 20A-20E , with the robotic trajectory planned at 1530, robotic transface screw installation can be performed, as indicated at 1540. More specifically, initially, the arm guide 2010 is sent to the pre-planned trajectory (see Figure 20A ); the scalpel 2020 is inserted through the arm guide 2010 to make an incision through the skin "K" to the bone level "B" (see Figure 20B ); the cannula 2030 and dilator 2040 are inserted through the arm guide 2010 to assess the profile of the bone and the trajectory (see Figure 20C ); the dilator 2040 is withdrawn from the cannula 2030, leaving the cannula 2030 in place; the surgical drill 2050 is inserted through the cannula 2030, accelerated and advanced into the bone to perforate the facet (see Figure 10 D), using navigation (e.g., via navigation component 3052, or using another depth control method); then, the surgical drill 2050 is removed from the cannula 2030 (leaving the cannula in place); and the screwdriver 2060, including the screw 2070 (see Figure 21 and Figure 23 ) held thereon, is inserted through the cannula 2030 to deliver the screw 2070 (see Figure 21 and Figure 23propel to a desired (e.g., pre-planned) depth (see Figure 20E As noted above, some or all of the above can be performed by a robot and / or using one or more robotically guided tools. Alternatively, some or all of the above can be performed with a hand-held instrument.

[0122] The above process is repeated as necessary to install all of the screws 2070 associated with the transfacet screw installation 1540. Referring back to Figure 15 Upon completion of the transfacet screw installation 1540, the posterior approach wound is closed, as indicated at 1550, e.g., using sutures.

[0123] Figures 21-23 Results of the unit placement 360-degree cervical fusion method 200 (see Figure 2 ) according to the above detailed summary of the present disclosure are demonstrated. More specifically, in connection with Figure 2 , Figure 21 An installed left screw 2070 of the transfacet fixation 230 is demonstrated, Figure 22 A screw 1320 and a plate 1310 of the ACDF 220 are demonstrated, and Figure 23 An installed right screw 2070 of the transfacet fixation 230 is demonstrated.

[0124] Referring to Figure 24A and Figure 24B , a coupling assembly 2400 (identified generally by reference numeral 2400) provided in accordance with the present disclosure is shown. The coupling assembly 2400 includes a first portal 2410 and a second portal 2420 coupled to one another by a coupling arm 2430. More specifically, the second portal 2420 is engaged with the coupling arm 2430, while the first portal 2410 is coupled to the coupling arm 2430 by a pin-slot engagement including a transverse pin 2412 extending from the first portal 2410 that is received within an arcuate slot 2432 defined within the coupling arm 2430, although other coupling mechanisms are also contemplated. In aspects, the coupling arm 2430 defines a clevis configuration including first and second spaced apart arm portions configured to receive the first portal 2410 therebetween, with each arm portion defining a slot 2432 configured to receive the pin 2412 or a portion of the pin 2412.

[0125] The lateral pin 2412 is arcuately slotted in two perpendicular planes by the arcuate slot 2432, thereby fixing the trajectory of the first portal 2410 and the second portal 2420 relative to each other in the two perpendicular planes. However, the lateral pin 2412 is configured to slide along the arcuate slot 2432, thereby causing the first portal 2410 to move relative to the second portal 2420 about an arc defined by the arcuate slot 2432 and within a third perpendicular plane. The arc defined by the arcuate slot 2432 can have a circular arc angle about a center disposed on the longitudinal axis of the second portal 2420, such that the first portal 2410 is movable relative to the second portal 2420 to change a trajectory angle defined between the first portal 2410 and the longitudinal axis (e.g., trajectory) of the second portal 2420 .

[0126] A locking mechanism 2440 (e.g., set screw, mechanical latch, etc.) can be provided to selectively lock the position of the first portal 2410 along the coupling arm 2430, thereby locking the trajectory of the first portal 2410 and the second portal 2420 relative to each other in the third perpendicular plane. In aspects, the locking mechanism 2440 locks the trajectory at a fixed trajectory angle ; in other aspects, the locking mechanism 2440 locks the trajectory within a fixed trajectory range about the trajectory angle , such as plus or minus 2 degrees, plus or minus 5 degrees, etc.

[0127] Either or both of the first portal 2410 and the second portal 2420 can define elongated cannulas 2414, 2424 (as shown), which are configured to receive surgical tools, devices, and / or materials therethrough, can define collars, which are configured to receive surgical tools, devices, and / or materials therethrough, and / or can define any other suitable configuration for receiving or otherwise coupling to surgical tools, devices, and / or materials to guide the surgical tools, devices, and / or materials along the defined trajectory to the surgical site.

[0128] In aspects, the second portal 2420 includes a collar 2426 configured to slidably receive the cannula 2424, thereby enabling the cannula 2424 to be adjusted longitudinally along its longitudinal axis and relative to the first portal 2410 and the coupling arm 2430. In such aspects, a locking mechanism 2428 (e.g., set screw, mechanical latch, etc.) is provided to selectively lock the cannula 2424 relative to the collar 2426 and thus the coupling arm 2430. As an alternative or supplement to enabling the cannula 2424 to slide, the collar 2426 can include a joint 2429 configured to permit the cannula 2424 to be mono-axially, multi-axially, or infinitely pivoted relative to the collar 2426, thus enabling the second portal 2420 to be further repositioned relative to the first portal 2410. In aspects, a locking mechanism 2428 (e.g., set screw, mechanical latch, etc.) or a separate locking mechanism can be provided to lock the joint 2429, thereby fixing the position of the cannula 2424 relative to the coupling arm 2430.

[0129] Further reference is made to Figure 25 The coupling assembly 2400 can be used to direct surgical tools, devices, and / or materials to a surgical site, such as a posterior portion of a patient’s spinal anatomy, such as facet joints “FJ” and / or posterior bone surfaces. More specifically, in accordance with the present disclosure and as detailed above, the coupling assembly 2400 can be used to facilitate a one-site 360-degree cervical fusion.

[0130] In aspects, the first portal 2410 is configured to receive a first surgical instrument 2510 to direct the first surgical instrument to the facet joint “FJ”. The first surgical instrument 2510 can be used to decorticate the joint “FJ”, and / or the first surgical instrument 2510 or another surgical instrument can be inserted through the first portal 2410 to deliver a component 2700 (such as a device or material, e.g., graft material, a mechanical cage, etc.) to the joint “FJ”. Figure 26 The first (and / or another) surgical instrument 2510 can be a robotic surgical instrument connected to a robotic arm of a surgical robotic system, although handheld instruments, table-mounted instruments, and / or other instruments are also contemplated.

[0131] The second surgical instrument 2520 can be inserted through the second portal 2420, such that the angular orientation of the first instrument 2510 and the second instrument 2520 relative to one another is fixed (or constrained) due to the coupling of the first portal 2410 and the second portal 2420, e.g., in accordance with the positions of the first portal 2410 and the second portal 2420. The second surgical instrument 2520 can be a robotic surgical instrument connected to a robotic arm of a surgical robotic system, although handheld instruments, table-mounted instruments, and / or other instruments are also contemplated.

[0132] Further reference is made to Figure 26, the second surgical instrument 2520 can be used to, for example, introduce a facet screw 2600 through the facet joint "FJ" to secure the facet joint "FJ." In aspects, the facet screw 2600 is configured to engage the component 2700 previously delivered to the joint "FJ." The coupling assembly 2400 facilitates guiding the second surgical instrument 2520 to deliver the facet screw 2600 through the facet joint in accordance with the surgical plan. More specifically, the coupling assembly 2400 can be adjusted to fix the trajectory of the second portal 2420 (and thus the second surgical instrument 2520 and the facet screw 2600) at 90 degrees in the coronal plane relative to the trajectory of the first portal 2410 (and thus the first surgical instrument 2510) such that the alignment of the first surgical instrument 2510 at the interarticular gap of the facet joint "FJ" aligns the facet screw 2600 perpendicular to the interarticular gap of the facet joint "FJ." However, other trajectory angles .

[0133] In aspects, the trajectory angle of the second portal 2420 relative to the first portal 2410 may be determined using one or more navigation and / or image guidance tools of, for example, the surgical navigation system 306 Figure 1 . For example, the first surgical instrument 2510 can be inserted through the first portal 2410 and positioned at the target site. The navigation and / or image guidance device can then be inserted through the second portal 2420 or otherwise positioned to determine the target trajectory of the second portal 2420. The second portal 2420 can then be adjusted relative to the first portal 2410 and locked in place (or within a range of positions) such that, upon insertion of the second surgical instrument 2520 through the second portal 2420, the second portal 2420 guides the second surgical instrument 2520 to the target location along the determined trajectory.

[0134] Referring to Figure 27A and Figure 27BIn various respects, the component 2700 disposed within the joint space, such as graft material, mechanical cage, etc., can be configured to receive the transverse screw 2600 (and / or other bone screws) and hold it in place once the screw 2600 has passed through the component 2700. For example, the component 2700 may include a passage 2710 configured to expand and engage the screw 2600 after it has been inserted through it. Alternatively, the component 2700 may be configured to cause the passage 2710 to collapse to engage the screw 2600 after it has been inserted through it. Other suitable locking mechanisms configured to retain the screw 2600 are also contemplated. Regardless of the particular locking mechanism, locking can be passive, for example, in which the component 2700 is configured to engage the screw 2600 in response to insertion of the screw 2600, or locking can be active, for example, in which the component 2700 is configured to engage the screw 2600 at, for example, an actuator 2720 (e.g., capable of entering through a first inlet 2410) (see...). Figures 24A-25 )) Actuation locking mechanism after engagement screw 2600.

[0135] Turning Figure 28 and Figure 29 As described above, the surgical microscope 2800 can be used to facilitate visualization during ACDF procedures. The surgical microscope 2800 allows for an ergonomic positioning of the surgeon relative to the patient when the surgical site is oriented upwards and away from the floor, such as during an ACDF procedure when the patient is in a supine position. However, when the patient is in a lateral decubitus position, the microscope 2800 may need to be repositioned so that the viewing direction is substantially parallel to the floor. In this configuration, the length of the microscope 2800 requires the surgeon to extend their arm (horizontally) to reach the surgical site while simultaneously viewing it through the microscope 2800, which is not an ergonomic position.

[0136] The surgical endoscope 2900 provided in this disclosure improves the surgeon’s ergonomics by repositioning and redirecting the observation direction of the microscope 2800 to a suitable angle (fixed or adjustable) (e.g., 90 degrees), but other suitable angles and angle ranges are also envisioned, such as from about 45 degrees to about 135 degrees.

[0137] The surgical scope 2900 includes a housing 2910 configured to releasably engage the objective end 2810 of the microscope 2800 at a first, open end 2920 of the housing 2910 of the surgical scope 2900 and extend from the first, open end 2920 to a second, open end 2930 of the housing 2910 of the surgical scope 2900. The second, open end 2930 is disposed at a fixed or adjustable angle relative to the first, open end 2920, thus defining the angle of change in the viewing direction of the microscope 2800 when utilizing the surgical scope 2900. The housing 2910 can define a lateral width (in a direction along and / or across the surgical table 10) that is equal to or less than the same width of the housing of the microscope 2800 at the objective end 2810 of the microscope, thus providing sufficient space around the surgical scope 2900 for the surgeon to maneuver his arms to perform surgical tasks at the surgical site.

[0138] Within the housing 2910, the surgical scope 2900 includes one or more optical elements 2940 (such as mirrors, prisms, lenses, etc.) and / or electronic optical elements (such as cameras, image sensors, etc.) configured to relay the field of view in the viewing direction of the second, open end 2930 of the housing 2910 of the surgical scope 2900 to the first, open end 2920 of the housing 2910 of the surgical scope 2900, and thus to the objective end 2810 of the microscope 2800, such that the surgeon can view the field of view in the viewing direction of the second, open end 2930 of the housing 2910 of the surgical scope 2900 through the ocular 2830 at the viewing end 2820 of the microscope 2800 (at any suitable magnification of the microscope 2800). Thus, the surgeon can stand closer to the surgical site, thus reducing or eliminating the need for the surgeon to reach toward the surgical site, and enabling the surgeon to stand upright in an ergonomic position.

[0139] Turning to Figure 30 , as a physical connection of the surgical scope 2900 to the microscope 2800 (as opposed to a wireless connection) Figure 28 and Figure 29As an alternative, a surgical endoscope 3000 can be provided to wirelessly connect to a microscope 2800 and / or another suitable device, such as a display screen 3100, display glasses 3200, etc. The surgical endoscope 3000 includes an image capture section 3010, which can be configured for positioning on the operating table 10. In various respects, the image capture section 3010 is movably mounted on a base 3020, which is configured to allow adjustment of the height of the image capture section 3010 and / or the angle of its observation direction. The image capture section 3010 includes one or more cameras, image sensors, etc., configured to capture images (e.g., video) of the surgical site. The image capture section 3010 further includes a wireless interface (not shown) configured to wirelessly transmit captured images (e.g., video) to a receiver section 3030 of the surgical endoscope 3000 and / or directly to another device (e.g., a display screen 3100, display glasses 3200, etc.) via WiFi, Bluetooth, infrared (IR) communication, and / or any other wireless transmission method. The receiver section 3030 (if provided) is configured to reproduce the image captured by the image capture section 3010 at the objective end 2810 of the microscope 2800, allowing the surgeon to view the captured image through the eyepiece 2830 at the observation end 2820 of the microscope 2800. The receiver section 3030 can be configured to releasably engage the microscope at the objective end 2810 of the microscope 2800.

[0140] refer to Figures 31-34 Similar to the reference above Figures 3-6 In detail, the patient "P" can be supported in a lateral decubitus position on the operating table 10 to facilitate the performance of one or more surgical tasks, such as ACDF. Multiple supports 3110, 3140, and 3170 can be provided to support the patient "P" in a lateral decubitus position.

[0141] Support component 3110 (e.g.) Figure 32 and Figure 33 (As shown) includes a body 3112 rotatably coupled to a mounting 3114 configured for positioning on the operating table 10, such that the body 3112 is rotatable relative to the mounting 3114 and the operating table 10 about an axis perpendicular to the patient support surface defined by the operating table 10. Therefore, the head and neck of the patient “P” can rotate forward or backward relative to the torso of the patient “P”.

[0142] The body 3112 of the support 3110 is configured to support at least a portion of the head and neck of the patient "P" and can include a plurality of segments 3116, 3118 arranged longitudinally relative to a longitudinal axis of the patient "P" such that the first segment 3116 supports the head (or more of the head) of the patient "P" and the second segment 3118 supports the neck (or more of the neck) of the patient "P." Although two segments 3116, 3118 are detailed, more than two segments 3116, 3118 are also contemplated.

[0143] The first segment 3116 and the second segment 3118 are independently adjustable, e.g., via adjustment mechanisms 3117, 3119, to independently vary the height of the first segment 3116 and the second segment 3118, thus enabling the head and / or neck of the patient "P" to be selectively positioned relative to one another and / or the torso of the patient "P." The adjustment mechanisms 3117, 3119 can include a ratchet, lead screw, telescoping mechanism, pneumatic bladder, motor, and / or any other suitable mechanism that enables the height of the first segment 3116 and the second segment 3118 to be selectively adjusted, respectively.

[0144] In aspects, the adjustment mechanisms 3117, 3119 are automatically adjustable to set the first segment 3116 and the second segment 3118 to a selected height, e.g., via a computer-controlled motor of the adjustment mechanisms 3117, 3119. More particularly, during the course of a surgical procedure, different heights of the first segment 3116 and the second segment 3118 can be needed to reposition the patient "P" to facilitate performance of one or more tasks of the surgical procedure. In such aspects, user input to a computer controlling the motor of the adjustment mechanisms 3117, 3119 (e.g., of a step or state of the procedure to be performed) enables the first segment 3116 and the second segment 3118 to be automatically adjusted to the selected height for that portion of the procedure. As another example, different heights of the first segment 3116 and the second segment 3118 can be needed for different patient anatomies, and thus, user input to a computer controlling the motor of the adjustment mechanisms 3117, 3119 (e.g., of the patient or patient anatomy) enables the first segment 3116 and the second segment 3118 to be automatically adjusted to the appropriate height.

[0145] The support 3110 can further include a strap 3120 configured to secure the head of the patient "P" to the support 3110. The strap 3120 can be attached to opposite sides of the body 3112 at opposite sides thereof, or can be provided in any other suitable manner. Additionally or alternatively, the first section 3116 of the body 3112 includes an ear hole 3130 formed as a bore, a cutout, a recess, and / or in any other suitable manner such that the ear hole 3130 receives at least a portion of an ear of the patient "P" to more comfortably and stably support the head of the patient "P" on the support 3110.

[0146] With continued reference to Figure 32 and Figure 33 , the support 3140 includes an elongate body 3142 defining an elongate recess 3144 configured to receive at least a portion of an arm of the patient "P" (e.g., an upper arm of the patient "P"). The support 3140 further includes a base 3146 and a pivot 3150 pivotably coupling the base 3146 and the body 3142 to one another. The base 3146 is configured for positioning on or in engagement with the surgical table 10 such that the body 3142 is pivotable about the pivot 3150 and relative to the base 3146 and the surgical table 10 about an axis that is perpendicular to a patient support surface defined by the surgical table 10. In this manner, a lower arm of the patient "P" can be moved toward or away from a torso of the patient "P" as needed to provide an operating space, provide clearance, enable visualization, etc., to facilitate performance of a surgical procedure.

[0147] With reference to Figure 31 , Figure 32 and Figure 34 , the support 3170 is configured to support a posterior side of the patient "P". In aspects, the support 3170 includes a body 3172 having one or more reinforcing members 3174, e.g., made of a more robust material than that forming the body 3172, thus providing additional structural support for supporting the patient "P". Additionally, the support 3170 can be secured to the surgical table 10, e.g., via a clamp 3176 or in any other suitable manner. Securing the support 3170 to the surgical table 10 and / or providing additional structural support to the support 3170 ensures proper support of the posterior side of the patient "P" and maintains the patient "P" in position on the surgical table 10, e.g., with the posterior side of the patient "P" disposed lower than the anterior side of the patient "P" when the surgical table 10 is tilted on its side.

[0148] With reference to Figures 35-37B As noted above, the manipulation devices 700, 750 can be provided to facilitate positioning of the head and neck of the patient "P" Figures 7A-7C ) and / or the arms of the patient "P" Figures 7A-7C) to facilitate access to a location conducive to performing an ACDF as detailed above. Manipulation device 3500, detailed below, can include any features of manipulation devices 700, 750 (e.g., of FIGS. 7A-7B and 8A-8B), unless explicitly contradicted herein. Figures 7A-7C

[0149] Manipulation device 3500 includes one or more base supports 3510 configured to engage a torso of a patient, an outer frame 3520 coupled to and extending from base supports 3510 to encircle a head and neck of the patient, an inner frame 3530 coupled to and disposed within outer frame 3520, one or more mounting extensions 3540, and an adjustable pillow assembly 3550. Manipulation device 3500 is detailed below with outer frame 3520 as a fixed reference; however, it is also contemplated that other components of manipulation device 3500 can be fixed and / or that all components of manipulation device 3500 can be movable, e.g., as in the case where manipulation device 3500 is disassembled from a support and worn by a patient to facilitate post-surgical recovery and / or for other purposes.

[0150] One or more base supports 3510 of manipulation device 3500 can include, for example, a pair of spaced-apart shoulder supports configured to engage a shoulder of a patient such that base supports 3510 are substantially fixed relative to a torso of the patient. Each base support 3510 is coupled to a link 3512. In aspects, each base support 3510 is pivotably coupled to a corresponding link 3512 via a pivot 3514, e.g., about an axis substantially parallel to a frontal plane of the patient and substantially perpendicular to a median plane of the patient.

[0151] Outer frame 3520 of manipulation device 3500 includes a pair of substantially parallel, spaced-apart outer frame legs 3522 each defining a first end portion 3523a and a second end portion 3523b. First end portions 3523a of outer frame legs 3522 are connected to one another by a crossbar 3524 of outer frame 3520. Second end portions 3523b of outer frame legs 3522 are connected to respective base supports 3510 via links 3512. More specifically, in aspects, second end portions 3523b of outer frame legs 3522 are coupled to links 3512 via a slider mechanism 3526 that enables base supports 3510 to slide toward and away from outer frame 3520. As an alternative to links 3512 coupling base supports 3510 and outer frame legs 3522 to one another, base supports 3510 and outer frame legs 3522 can be coupled directly to one another or in any other suitable manner that enables base supports 3510 to pivot and / or slide relative to outer frame legs 3522.

[0152] Continuing to refer to​Figures 35-37B The inner frame 3530 of the manipulation device 3500 includes a pair of substantially parallel, spaced-apart inner frame legs 3532 each defining a first end portion 3533a and a second end portion 3533b. The first end portions 3533a of the inner frame legs 3532 pivotably support the head frame 3534 therebetween, e.g., about a pivot 3535, thus enabling the head frame 3534 to pivot relative to the inner frame legs 3532. The head frame 3534 (also referred to as a head ring) is configured to engage the head of the patient and extend circumferentially thereabout. The second end portions 3533b of the inner frame legs 3532 are coupled to the corresponding outer frame legs 3522 via a pin-slot mechanism 3536 that enables the inner frame legs 3532 to pivot and slide relative to the outer frame 3510.

[0153] The above detailed configurations of the manipulation device 3500 enable, e.g., via the pivotable connection of the base support 3510 with the outer frame 3520, the entire head and neck of the patient to pivot forward or rearward relative to the torso of the patient; e.g., via the pivotable connection of the inner frame 3530 with the outer frame 3520, the upper portion of the head and neck of the patient to pivot forward or rearward relative to the torso of the patient; e.g., via the pivotable connection of the head frame 3534 with the inner frame legs 3532, the head of the patient to pivot forward or rearward relative to the neck of the patient; and e.g., via the slidable connection of the link 3512 with the outer frame 3520 and / or the slidable connection of the inner frame 3530 with the outer frame 3520, the head and neck of the patient to stretch or compress relative to the torso of the patient. With respect to such stretching, traction can be applied to the head frame 3534, e.g., as indicated by force vector “V”, to provide the stretching. The traction can be maintained, whereby the stretching is maintained, or the manipulation device 3500 can be locked to maintain the stretching.

[0154] In aspects, the pivot axis about which the head frame 3534 pivots relative to the inner frame legs 3532, the pivot axis about which the inner frame legs 3532 pivot relative to the outer frame 3510, and the pivot axis about which the base support 3510 pivots relative to the outer frame 2510 are substantially parallel to one another (see Figure 37A and Figure 37B ). Further, in aspects, suitable locking mechanisms (e.g., ratchets, set screws, clamps, latches, spline connectors, and / or other suitable locking mechanisms) can be provided to selectively lock one or more of the above detailed ranges of motion of the manipulation device 3500, thus enabling selective manipulation and subsequent fixed positioning of the patient.

[0155] Still referring to Figures 35-37B, one or more mounting extensions 3540 enable mounting of the manipulation device 3500 to a surgical table, bed, or other support (including a Mayfield® positioner), with the outer frame 3520 fixed relative to the surgical support. More specifically, the one or more mounting extensions 3540 engage with and extend from the crossbar 3524 of the outer frame 3520 to enable connection with a mount 3560 (see Figure 35 ) of the support. In aspects, a plurality of mounting extensions 3540 are provided, including a mounting extension 3540 aligned along a central longitudinal axis of the manipulation device 3500, and one or more mounting extensions 3540 offset on a first side of the central longitudinal axis of the manipulation device 3500 and / or offset on a second, opposite side of the central longitudinal axis of the manipulation device 3500. Thus, with respect to a mount 3560 (see Figure 35 ) of a surgical support centered on a longitudinal axis of the support, the manipulation device 3500 can be used with the patient centered on the longitudinal axis of the support, offset on one side of the longitudinal axis of the support, or offset on the other side of the longitudinal axis of the support. As noted above, positioning the patient offset from the longitudinal axis of the support can be advantageous in robotically-assisted ACDF procedures and / or other procedures utilizing a robot, for example, positioning the patient closer to the surgical robot “R” to ensure accessibility of the arms of the surgical robot “R” (see Figure 1 ).

[0156] In aspects, the manipulation device 3500 (e.g., its base support 3510, outer frame 3520, and / or head frame 3534) can provide mounting points for mounting one or more surgical components, for example: a navigation component, such as a transmitter array of a navigation system; a surgical retractor assembly; a surgical robot, surgical robot or tool port; or a surgical robot or tool holder; and / or the like.

[0157] In aspects, the manipulation device 3500 can be mounted to a surgical support and extend from one end or side of the support such that the manipulation device 3500 supports at least a portion of the patient without the support being beneath the patient (or without the support directly otherwise directly supporting that portion of the patient). Further as noted above, the manipulation device 3500 can be detached from the support to enable the manipulation device 3500 to be worn by the patient, for example, to facilitate surgical recovery and / or for other purposes.

[0158] Referring to Figure 38A and Figure 38B in conjunction with Figure 35As described above, the manipulation device 3500 includes an adjustable bolster assembly 3550. The adjustable bolster assembly 3550 is configured to rotate a bolster 3552 about a longitudinal axis of the patient (or an axis substantially parallel to the longitudinal axis of the patient) to enable the bolster 3552 to be positioned to support the patient at different locations around the patient. In aspects, the bolster 3552 is further configured to translate along the longitudinal axis of the patient (or an axis substantially parallel to the longitudinal axis of the patient) to support the patient at different locations along the patient. In aspects, the bolster 3552 can include an inflatable bladder 3554a connected to a port 3554b configured to be connected to a fluid source to enable the bolster 3552 to be selectively inflated (and deflated) into a desired configuration.

[0159] The bolster assembly 3550 further includes an arm 3556 and a base 3558 defining a substantially C-shaped configuration. The arm 3556 supports the bolster 3552 thereon and includes a track 3557. The base 3558 slidably supports the arm 3556 and includes a guide 3559 received within the track 3557 to constrain slidable movement of the arm 3556 relative to the base 3558 along a defined path (e.g., an arc). Thus, the arm 3556 can be moved relative to the base 3558 (with the guide 3559 moving along the track 3557), thereby repositioning the bolster 3552 relative to the base 3558. In aspects, the base 3558 is engaged with the outer frame 3520 of the manipulation device 3500 such that repositioning the bolster 3552 relative to the base 3558 repositions the bolster 3552 relative to the outer frame 3520. In aspects, a locking mechanism is provided to selectively lock the bolster 3552 in place relative to the outer frame 3520.

[0160] Reference is made to Figures 39A-39C In aspects, a single access location can be used to provide access to introduce surgical tools, devices, and / or materials to the surgical site (e.g., a posterior portion of the patient’s spinal anatomy, such as facet joints “FJ” and / or posterior bone surfaces). More particularly, the cannula 3900 can be configured to admit a first surgical instrument 3910 through its longitudinal lumen 3902 to, for example, introduce a trans-facet screw 3930 through a facet bone of an adjacent vertebral body “V” to secure a facet joint “FJ”. The cannula 3900 can be oriented substantially transverse to the facet joint “FJ” for screw insertion, although other orientations are also contemplated.

[0161] The cannula 3900 also enables passage of a second surgical instrument 3920 configured to prepare an opposing bone surface of the facet joint “FJ”, such as to roughen, blood, decorticate, etc., to facilitate insertion of an insert 3940 (e.g., a bone graft, a bone screw, etc.) into the prepared bone surface. Figure 39Cinserted into the facet joint "FJ." The second surgical instrument 3920 can be inserted with the first surgical instrument 3910, before the first surgical instrument 3910 is inserted, or after the first surgical instrument 3910 is removed. Thus, the insert 3940 can be prepared for the facet joint "FJ," and / or the insert 3940 can be installed (e.g., using the screws 3930 ( Figure 39B and Figure 39C ) either before or after the screw fixation. In other aspects, the insert installation is performed as an alternative to the screw fixation.

[0162] The second surgical instrument 3920 includes a shaft 3932 and an end effector 3934 disposed at a distal end of the shaft 3932. The end effector 3934 can be configured as a rasp, a file, a burr, and / or other suitable surgical instrument configured to prepare a bone surface for insertion of graft material or other suitable insert. In aspects, the shaft 3932 includes a movable portion 3936 disposed along a length of the shaft and / or connecting the shaft 3932 with the end effector 3934. The movable portion 3936 can include a flexible shape memory material configured to permit insertion of the shaft 3932 through the cannula 3900 in a constrained configuration of the shaft 3932 (see Figure 39A ), and return to an unconstrained configuration (see Figure 39B ) as the shaft 3932 is extended from the cannula 3990, in which at least a portion of the shaft 3932 extends beyond an outer peripheral volume defined by the cannula 3900. In the unconstrained configuration ( Figure 39B ), for example, the movable portion 3936 of the shaft 3932 can include one or more angles and / or bends such that the end effector assembly 3934 is laterally displaced relative to the cannula 3900, thus enabling access to opposing bone surfaces of the facet joint "FJ." As an alternative to a shape memory material, the movable portion 3936 can include one or more joints configured to passively or actively (e.g., through steering) enable movement of the movable portion 3936 from the constrained configuration to the unconstrained configuration. In aspects, the shaft 3932 is substantially linear in the constrained configuration.

[0163] Steering Figure 40A and Figure 40B , in aspects, the cannula 3900 can include features that facilitate positioning of the second surgical instrument 3920 to access opposing bone surfaces of the facet joint "FJ." More specifically, as Figure 40AAs shown, the cannula 3900 may define a window 4010 that passes through the sidewall 4020 of the cannula and is configured to communicate with the longitudinal lumen 3902, so that the end effector 3934 and shaft 3932 of the second surgical instrument 3920 can pass through the window 4010 and exit the longitudinal lumen 3902 of the cannula 3900. This facilitates the advancement of the end effector 3934 to a position laterally spaced from the cannula 3900, for example, to reach the opposing bone surface of the facet joint “FJ”.

[0164] like Figure 40B As shown, in addition to, for example, a longitudinal lumen 3902 formed by a first tube, the cannula 3900 may additionally or alternatively include, for example, a second longitudinal lumen 4002 formed by a second tube. The second longitudinal lumen 4002 may be fixed relative to the longitudinal lumen 3902 in an orientation substantially parallel to it or at an angle to it. The longitudinal lumen 3902 allows the first surgical instrument 3910 ( Figure 39A The second surgical instrument 3920 can pass through the longitudinal lumen 4002, as detailed above. In providing aspects of the second lumen 4002, the second surgical instrument 3920 can be movable between a constrained and unconstrained configuration, as detailed above, or it can be fixed, thereby positioning the second lumen 4002 relative to the first lumen 3902 to access the opposing bone surfaces of the facet joint “FJ”.

[0165] In various respects, a third surgical instrument similar to the second surgical instrument 3920 may be provided to install an insert (e.g., graft material) within a facet joint “FJ”, for example, by lateral insertion between opposing bone surfaces. That is, the third surgical instrument does not have an end effector for preparing the bone surface like the second surgical instrument 3920, but instead includes an end effector configured to install the insert (e.g., deploy graft material).

[0166] refer to Figures 41A-41C Another configuration is detailed, in which a single access position is used to provide an entry point for guiding surgical instruments, devices, and / or materials to the surgical site (e.g., the posterior portion of the patient's spinal anatomy, such as the facet joint "FJ" and / or the posterior bone surface of an adjacent vertebral body "V"). More specifically, the cannula 4100 can be configured to allow a first surgical instrument 4110 to pass through its longitudinal lumen 4102 to, for example, drill through the facet bone of one of the vertebral bodies "V" that defines the facet joint "FJ," thus providing an entry point to the facet joint "FJ." Thereafter, a second surgical instrument 4130 can be inserted through a borehole in the longitudinal lumen 4102 and the vertebral body "V" to access the facet joint "FJ."

[0167] The second surgical instrument 4130 includes a shaft 4132 and an end effector 4134, which can be configured as a rasp, a file, a bone drill, and / or other suitable surgical instrument configured to prepare a bone surface for insertion of graft material or other suitable insert. In aspects, the shaft 4132 includes a movable portion 4136 disposed along a length of the shaft and / or connecting the shaft 4132 with the end effector 4134. The movable portion 4136 can include, for example, one or more pivot joints configured to permit the end effector 4134 to pivot between alignment configurations in which the end effector 4134 is substantially aligned with the shaft 4132 to facilitate insertion of the second surgical instrument 4130 through the cannula 4100, a bore in the vertebral body "V," and into the facet joint "FJ" to prepare the opposing bone surface. Thereafter, in aspects, the screw 3930 Figure 39B and Figure 39C ) can be inserted through the cannula 4100, the bore in the vertebral body "V," the facet joint "FJ," and the opposing bone of the other vertebral body "V" to complete fixation. In other aspects, the screw 3930 Figure 39B and Figure 39C is omitted.

[0168] In general reference Figures 39A-41C , in aspects, the screws can be installed on either side or both sides of the vertebral body and can be installed in a spaced apart orientation or in a cross or intersecting orientation relative to one another. Further, in aspects, at least a portion of the screws are cannulated to define a central passage and fenestrated openings to permit insertion of graft material through the screws into the facet joint "FJ." The screws can additionally or alternatively include washers, plates, and / or any other features for positioning at the head of the screw to inhibit backout. For example, a plate on the head of the screw can be configured to contact the spinous process and / or can provide an anti-rotation tab configured to engage the bone to inhibit backout of the screw.

[0169] With continuing reference Figures 39A-41C , any or all of the surgical instruments detailed can be handheld surgical instruments or can be robotic surgical instruments. Further, navigation can be used with the handheld surgical instruments and / or the robotic surgical instruments to facilitate screw fixation and / or implant installation.

[0170] Turning to Figure 42In various respects, instead of a single access point, multiple access points can be used to guide surgical instruments, devices, and / or materials to the posterior portions of the patient's spinal anatomy, such as the facet joint "FJ" and / or the posterior bone surface. For example, a first surgical instrument 4210 can be inserted through a first cannula 4200 positioned at a first location and orientation to introduce a transfacet screw 4220 through the facet bone of an adjacent vertebral body "V," thereby fixing the facet joint "FJ," and a second surgical instrument 4230 can be inserted through a second cannula 4205 positioned at a second location and orientation to enable preparation of the opposing bone surfaces of the facet joint "FJ," such as roughening, bleeding, cortical stripping, etc. The second cannula 4205 can also be used to insert an insert (e.g., graft material) into the facet joint "FJ," although the insert can alternatively be installed via the first cannula 4200.

[0171] In all respects, the first cannula 4200 and the second cannula 4205 can be connected via a coupling assembly 4240 configured to lock the first cannula 4200 and the second cannula 4205 relative to each other in a fixed orientation, similar to the above description. Figures 24A-25 Detailed. Alternatively, the first cannula 4200 and the second cannula 4205 (and / or the first surgical instrument 4210 and the second surgical instrument 4230) may engage with the robotic arm of the surgical robot to lock their orientation relative to each other. Further, the orientation of one of the first cannula 4200 or the second cannula 4205 (and / or the first surgical instrument 4210 or the second surgical instrument 4230) may be used as a reference for navigating the other.

[0172] refer to Figure 43 The cannula assembly 4300 provided according to this disclosure includes a first cannula 4310 and a second cannula 4320 pivotally coupled to the first cannula 4310 about a pivot 4330. More specifically, the second cannula 4320 is pivotable relative to the first cannula 4310 about the pivot 4330 between an alignment orientation and an angular orientation, wherein in the alignment orientation the first cannula 4310 and the second cannula 4320 are substantially parallel or coaxial with each other, and in the angular orientation the second cannula 4320 is angled relative to the first cannula 4310 and protrudes beyond the external dimensions of the first cannula 4310 at least at its distal end.

[0173] The first cannula 4310 can be configured to allow passage of a first surgical instrument to introduce a transfacial screw 4340 through the facet joints of adjacent vertebrae “V1” and “V2”, thereby fixing the facet joint “FJ”. Therefore, the first cannula 4310 can be oriented substantially transversely to the facet joint “FJ” for screw insertion, but other orientations are also contemplated.

[0174] As noted above, the second cannula 4320 can be pivoted relative to the first cannula 4310, thus providing an angled orientation for insertion of a second surgical instrument 4350 configured to prepare the opposing bone surfaces of the facet joint "FJ", e.g., roughen, bleed, decorticate, etc., to facilitate insertion of an insert (e.g., graft material) into the facet joint "FJ". More particularly, the second cannula 4320 can be oriented so that the second surgical instrument 4350 can access the facet joint "FJ". The insert can be provided through the second cannula 4320, the first cannula 4310, or in another other suitable manner. The second surgical instrument 4350 can be configured as a bur, a rasp, a bone drill, and / or other suitable surgical instrument configured to prepare the bone surfaces for insertion of graft material or other suitable insert. In aspects, the pivot 4330 can be selectively locked to fix the orientation of the first cannula 4310 and the second cannula 4320 relative to one another.

[0175] With continued reference to Figure 43 , and without being limited to use of the cannula assembly 4300, in aspects, navigation can be used to plan the preparation of the opposing bone surfaces of the facet joint "FJ" so that the surgical robot can operate the second surgical instrument 4350 to perform the preparation. The installed screws, the cannula 4310, the cannula 4320, and / or other suitable references can be used to facilitate the navigation. More particularly, boundaries along the bone surfaces and / or depth boundaries can be defined, and thereafter, the second surgical instrument 4350 is navigated and controlled by the robot to prepare the bone surfaces within the defined boundaries. For example, a first boundary "Bl" can be defined on the first region of the first vertebral body "Vl", while a second boundary "B2" is defined on the second region of the second vertebral body "V2". The first boundary "Bl" and the second boundary "B2" can have different depths from one another and / or varying depths themselves. Thus, the second surgical instrument 4350 is navigated and controlled by the robot to precisely prepare the bone surfaces according to the defined boundaries "Bl", "B2".

[0176] With reference to Figure 44A , and Figure 44B , depending on whether only an insert (e.g., a graft) is used for transfacetal fixation, or whether both an insert and a screw are used for transfacetal fixation, the trajectory and surgical instrument used to prepare the surfaces around the facet joint "FJ" can vary. For example, as shown in Figure 44A , with only an insert, a relatively larger surgical instrument 4410 (e.g., a surgical bone drill having a first diameter) is used to drill a defect in the bone at an angle (or a steeper angle) relative to the facet joint "FJ". On the other hand, as shown in Figure 44BAs shown, in cases where both an insert and a screw are utilized, a relatively smaller surgical instrument 4420 (e.g., a surgical bone drill having a second, smaller diameter) is used to drill a defect in the bone that is substantially parallel (or at a shallow angle relative to) the facet joint “FJ”. In aspects, the relatively larger surgical instrument 4410 is a bone drill having a diameter of about 7.5 mm (or about 6 mm to about 10 mm), and / or the relatively smaller surgical instrument 4420 is a bone drill having a diameter of about 2 mm (or about 1.5 mm to about 3.0 mm).

[0177] Aspects of the disclosure can be further described by reference to the following numbered paragraphs:

[0178] 1. A method of stand-alone 360-degree cervical fusion, comprising: positioning a patient in a lateral decubitus position on an operating table; orienting and maintaining the patient’s spine in a desired sagittal plane alignment; performing an anterior cervical discectomy fusion (ACDF); re-orienting and maintaining the patient’s head to facilitate posterior access; and performing a posterior fixation.

[0179] 2. The method of paragraph 1, wherein the posterior fixation comprises a transfacetal screw fixation.

[0180] 3. The method of paragraph 2, wherein the transfacetal screw fixation is performed with fusion.

[0181] 4. The method of paragraph 3, wherein the fusion comprises removal of facet joint cartilage and decortication of the facet joint surface.

[0182] 5. The method of paragraph 4, wherein the fusion further comprises delivery of a flowable orthobiologic to the transfacetal joint space.

[0183] 6. The method of paragraph 2, wherein the transfacetal screw fixation is performed without fusion.

[0184] 7. The method of paragraph 1, wherein the posterior fixation comprises at least one of a lateral mass screw fixation or a pedicle screw fixation.

[0185] 8. The method of any of paragraphs 1-7, wherein at least a portion of the ACDF is performed by a surgeon using a handheld tool, and wherein at least a portion of the posterior fixation is performed using at least one of: a surgical robot or at least one robotically guided tool.

[0186] 9. The method of paragraph 8, wherein the surgeon is positioned on an anterior side of the patient and the surgical robot is positioned on a posterior side of the patient.

[0187] 10. The method of any of paragraphs 1-9, wherein the ACDF includes installing an anterior cervical plate held by a plurality of screws.

[0188] 11. The method of paragraph 10, further comprising attaching a navigation component to the anterior cervical plate and utilizing the navigation component during the posterior fixation.

[0189] 12. The method of any of paragraphs 1-11, further comprising side-tilting the surgical table in the case of at least one of: prior to performing the ACDF or prior to performing the posterior fixation.

[0190] 13. The method of any of paragraphs 1-12, wherein a manipulation device attached to the patient is used to orient the patient’s spine, hold the patient’s spine, re-orient the patient’s head, and hold the patient’s head.

[0191] 14. The method of any of paragraphs 1-13, wherein positioning the patient in a lateral decubitus position on the surgical table includes extending the patient’s upper arm along the patient’s body and extending the patient’s lower arm forward from the body and bent at the elbow such that a lower portion of the patient’s lower arm extends toward the head.

[0192] 15. The method of any of paragraphs 1-14, wherein performing the posterior fixation includes at least one of: planning a trajectory of at least one screw or using navigation to install at least one screw.

[0193] 16. The method of any of paragraphs 1-15, wherein performing the ACDF includes retracting the wound with a first retractor blade and a second retractor blade arranged in a vertical orientation.

[0194] 17. The method of any of paragraphs 1-16, further comprising providing an additional support to a posterior side of the patient during at least a portion of the ACDF.

[0195] 18. The method of paragraph 17, further comprising removing the additional support after the at least a portion of the ACDF.

[0196] 19. The method of any of paragraphs 1-18, wherein positioning the patient on the surgical table includes positioning the patient offset from a longitudinal axis of the surgical table.

[0197] 20. The method of any of paragraphs 1-19, wherein positioning the patient on the surgical table includes securing the patient relative to the surgical table.

[0198] 21. A manipulation device configured to facilitate positioning and maintaining a spine of a patient, the manipulation device comprising: a first frame assembly comprising a base frame configured to engage a torso of the patient to secure the base frame relative to the torso of the patient; and a second frame assembly coupled to the first frame assembly, the second frame assembly comprising a support frame and a head frame coupled to the support frame and configured to engage a head of the patient to secure the head frame relative to the head of the patient, wherein the support frame is movable relative to the base frame in at least two degrees of freedom, and wherein the head frame is movable relative to the support frame in at least one degree of freedom.

[0199] 22. The manipulation device of paragraph 21, wherein the support frame is configured to pivot relative to the base frame to enable the head and neck of the patient to pivot relative to the torso of the patient and is configured to translate relative to the base frame to enable the head and neck of the patient to extend or compress relative to the torso of the patient.

[0200] 23. The manipulation device of paragraph 22, wherein the support frame is configured to lock relative to the base frame for at least one of: maintaining a position of the head and neck of the patient relative to the torso of the patient or maintaining an extension or compression of the head and neck of the patient relative to the torso of the patient.

[0201] 24. The manipulation device of any of paragraphs 21 to 23, wherein the head frame is configured to pivot relative to the support frame to enable the head of the patient to pivot forward or backward relative to the neck of the patient.

[0202] 25. The manipulation device of paragraph 24, wherein the head frame is configured to lock relative to the support frame to maintain the head of the patient relative to the neck of the patient.

[0203] 26. The manipulation device of any of paragraphs 21 to 25, wherein the second frame assembly further comprises an outer frame coupling the support frame with the first frame assembly.

[0204] 27. The manipulation device of paragraph 26, wherein the first frame assembly further comprises a pair of links coupling the outer frame with the base frame.

[0205] 28. The manipulation device of paragraph 26 or 27, wherein the outer frame comprises at least one mounting extension configured to enable mounting of the outer frame to a patient support.

[0206] 29. The manipulation device of paragraph 26, wherein the outer frame includes a plurality of mounting extensions, at least one of the plurality of mounting extensions configured to enable mounting of the outer frame to the patient support in an offset position.

[0207] 30. The manipulation device of any of paragraphs 21 to 29, further comprising an adjustable bolster assembly coupled to the second frame assembly, wherein the adjustable bolster assembly includes a bolster movable relative to the second frame assembly.

[0208] 31. A surgical borescope comprising: a body defining a first end portion and a second end portion, the first end portion of the body configured to be operably coupled to an objective end of a surgical microscope having a first viewing direction, the second end portion of the body angularly disposed relative to the first end portion of the body and having a second viewing direction angularly disposed relative to the first viewing direction; and at least one optical element disposed within the body and configured to relay a field of view in the second viewing direction to the objective end of the surgical microscope to enable visualization of the field of view through the surgical microscope.

[0209] 32. The surgical borescope of paragraph 31, wherein the first end portion of the body is configured to releasably engage the surgical microscope at the objective end of the surgical microscope.

[0210] 33. The surgical borescope of paragraph 31 or 22, wherein the first end portion of the body is one of: physically connected to the second end portion of the body or wirelessly connected to the second end portion of the body.

[0211] 34. The surgical borescope of any of paragraphs 31 to 33, wherein the second viewing direction is angularly disposed at about 90 degrees relative to the first viewing direction.

[0212] 35. A support assembly for supporting a patient in a lateral decubitus position on an operating table, the support assembly comprising: a mount configured for positioning on the operating table; and a first support rotatably coupled to the mount, the first support including a body having a plurality of independently adjustable segments to enable independent adjustment of a height of each of the plurality of independently adjustable segments.

[0213] 36. The support assembly of paragraph 35, further comprising a strap attached to the first support and configured to strap a head of the patient to the first support.

[0214] 37. The support assembly of paragraph 35 or 36, further comprising a second support member pivotably coupled to the first support member, the second support member defining the elongate configuration.

[0215] 38. A method of unit stand 360 degree cervical fusion, comprising: positioning a patient in a lateral decubitus position on an operating table; performing an anterior cervical discectomy fusion (ACDF); and performing a posterior fixation, wherein the posterior fixation comprises: from a first approach to a facet joint, at least one of: preparing for insertion of an insert into the facet joint or inserting the insert into the facet joint; and from a second, different approach to the facet joint, performing a trans-facet screw fixation.

[0216] 39. The method of paragraph 38, wherein at least one first instrument is used for the first approach and at least one second instrument is used for the second approach, the first and second instruments being coupled to one another with at least one degree of freedom.

[0217] 40. The method of paragraph 38 or 39, wherein the first approach is adjacent to an opposing bony surface of the facet joint, and wherein the second approach is transverse to the facet joint.

[0218] While several aspects of the present disclosure have been disclosed in detail above and illustrated in the drawings, it will be understood by those skilled in the art that the present disclosure is not limited to the aspects specifically disclosed. Rather, this disclosure is intended to cover all modifications and alternative methods of practicing the present disclosure that are within the scope and spirit of the disclosure as defined by the appended claims. For example, the above-described aspects (and / or aspects thereof) can be used in combination with each other. Thus, the above-described aspects (and / or aspects thereof) are not mutually exclusive, and the combinations of the aspects (and / or aspects thereof) are contemplated in the present disclosure. Accordingly, the application is not to be restricted except in the spirit of the disclosure.

Claims

1. A manipulation device (700, 750, 3500) configured to facilitate positioning and maintaining a patient's spine, the manipulation device (700, 750, 3500) comprising: A first frame assembly, comprising a base frame (710, 760, 3510) configured to engage the patient's torso to secure the base frame (710, 760, 3510) relative to the patient's torso. as well as A second frame assembly is connected to the first frame assembly, the second frame assembly including a support frame (780, 3530) and a head frame (786, 3534), the head frame being connected to the support frame (780, 3530) and configured to engage the patient's head to secure the head frame relative to the patient's head. The support frame (780, 3530) is capable of moving relative to the base frame (710, 760, 3510) with at least two degrees of freedom, and The head frame (786, 3534) is movable relative to the support frame (780, 3530) with at least one degree of freedom.

2. The operating device (700, 750, 3500) according to claim 1, wherein, The support frame (780, 3530) is configured to pivot relative to the base frame (710, 760, 3510) so that the patient's head and neck can pivot relative to the patient's torso, and is configured to translate relative to the base frame (710, 760, 3510) so that the patient's head and neck can extend or compress relative to the patient's torso.

3. The operating device (700, 750, 3500) according to claim 2, wherein, The support frame (780, 3530) is configured to lock relative to the base frame (710, 760, 3510) for at least one of: maintaining the position of the patient's head and neck relative to the patient's torso or maintaining the extension or compression of the patient's head and neck relative to the patient's torso.

4. The operating device (700, 750, 3500) according to any one of claims 1 to 3, wherein, The head frame (786, 3534) is configured to pivot relative to the support frame (780, 3530) so that the patient's head can pivot forward or backward relative to the patient's neck.

5. The operating device (700, 750, 3500) according to claim 4, wherein, The head frame (786, 3534) is configured to lock relative to the support frame (780, 3530) to hold the patient's head relative to the patient's neck.

6. The operating device (700, 750, 3500) according to any one of claims 1 to 5, wherein, The second frame component further includes an outer frame (3520) that connects the support frame (780, 3530) to the first frame component.

7. The operating device (700, 750, 3500) according to claim 6, wherein, The first frame assembly further includes a pair of links (3512) connecting the outer frame (3520) to the base frame (710, 760, 3510).

8. The operating device (700, 750, 3500) according to claim 6 or 7, wherein, The outer frame (3520) includes at least one mounting extension (3540) configured to mount the outer frame (3520) to a patient support.

9. The operating device (700, 750, 3500) according to any one of claims 6 to 8, wherein, The outer frame (3520) includes a plurality of mounting extensions (3540), at least one of which is configured to allow the outer frame (3520) to be mounted to the patient support at an offset position.

10. The operating device (700, 750, 3500) according to any one of claims 1 to 9, further comprising an adjustable cushion assembly (3550) coupled to the second frame assembly, wherein, The adjustable pillow assembly (3550) includes a pillow (3552) that is movable relative to the second frame assembly.

11. A surgical endoscope (2900, 3000), comprising: A body (2910) defining a first end portion (2920) and a second end portion (2930), the first end portion (2920) of the body (2910) being configured to be operatively coupled to the objective end (2810) of a surgical microscope (2800) having a first observation direction, the second end portion (2930) of the body (2910) being angled relative to the first end portion (2920) of the body (2910) and having a second observation direction angled relative to the first observation direction; as well as At least one optical element (2940) is disposed within the body (2910) and configured to relay the field of view in the second observation direction to the objective end (2810) of the surgical microscope (2800) so that the field of view can be visualized by the surgical microscope (2800).

12. The surgical endoscope (2900, 3000) according to claim 11, wherein, The first end portion (2920) of the body (2910) is either physically connected to the second end portion (2930) of the body (2910) or wirelessly connected to the second end portion (2930) of the body (2910).

13. The surgical endoscope (2900, 3000) according to claim 11 or 12, wherein, The second observation direction is set at an angle of approximately 90 degrees relative to the first observation direction.

14. A support assembly for supporting a patient in a lateral decubitus position on an operating table, the support assembly comprising: Mounting component (3114), which is configured for positioning on an operating table; as well as A first support member (3110) is rotatably connected to the mounting member (3114). The first support member (3110) includes a body (3112) having a plurality of independently adjustable sections (3116, 3118) to allow independent adjustment of the height of each of the plurality of independently adjustable sections (3116, 3118).

15. The support component of claim 14, further comprising at least one of the following: A band (3120) is attached to the first support (3110) and configured to secure the patient's head to the first support (3110); or A second support member (3140) is pivotally connected to the first support member (3110), and the second support member (3140) defines an elongated configuration.

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