Systems and methods for prone lateral spinal surgery

Abstract

An internal fixation system and method for prone lateral spinal surgery on a patient. The system includes a lateral lumbar interbody fusion (LLIF) retractor and a posterior compression / distractor including a posterior distractor rack assembly having a rack and a posterior distractor mount assembly configured to operably engage the posterior distractor rack assembly. The posterior distractor rack assembly includes a first swivel tube subassembly having a first swivel tube, and the posterior distractor mount assembly includes a second swivel tube subassembly having a second swivel tube. The first and second swivel tubes are each configured to receive a pedicle screw and a screw tower therein. The first and second swivel tube subassemblies are configured to move and position relative to one another, thereby allowing a surgeon to access the patient's disc space from the left and right sides without the need for a bolster.

Description

[Technical field]

[0001] Statement regarding government involvement Not applicable.

[0002] Cross-filing of related applications This application claims the benefit of U.S. Provisional Patent Application No. 63 / 299,279, filed January 13, 2022, and U.S. Provisional Patent Application No. 63 / 306,785, filed February 4, 2022, both of which are incorporated by reference in their entireties.

[0003] The present invention relates generally to spinal surgery, and more particularly to systems and methods for prone lateral spinal surgery. [Background technology]

[0004] Prone lateral surgery to the thoracic and lumbar spine allows for simultaneous ventral and dorsal approach to the spine without the need to reposition the patient intraoperatively, streamlining procedures that might otherwise require intraoperative inversion while maintaining comparable safety.

[0005] Yet current approaches to prone lateral surgery require work to be done prior to positioning the patient: a bolster is usually placed on the opposite side of the surgeon to prevent movement of the patient and spine during the prone portion of the procedure.

[0006] An example of pre-operative preparation for prone lateral surgery using existing conventional techniques is shown in Figures 1A and 1B, where the patient has been prepped and draped, with a bolster on the patient's right side. This positioning allows the surgeon to access only the left side of the patient's spine. Summary of the Invention [Problem to be solved by the invention]

[0007] The use of bolsters has several significant drawbacks. First, the surgeon and / or surgical staff must be available to position the bolster in a specific location before the patient is positioned. If the bolster is initially positioned incorrectly, the surgeon and / or staff may have to roll the patient while prone or even roll the patient back off the table. This can be stressful and time consuming, and may even lead to nerve damage if there is a high degree of compression of neural elements. Second, the placement of the bolster limits the surgeon's access to the spine because the bolster covers one side of the abdomen. Thus, the surgeon must choose which side to access prior to positioning and cannot easily change to the other side if spine access from the free / predetermined side is not possible. Using current technology, the surgeon is unable to safely and efficiently access both sides of the patient's spine. [Means for solving the problem]

[0008] The following presents a simplified summary of the invention in order to provide a basic understanding of some aspects of the invention. This summary is not an extensive overview of the invention. It is not intended to identify key or critical elements of the invention or to delineate the scope of the invention. Its sole purpose is to present some concepts of the invention in a simplified form as a prelude to the more detailed description that is presented later.

[0009] Various embodiments of the present invention include an internal fixation system and a surgical method for prone lateral spinal surgery using the internal fixation system that does not require the use of a bolster to prevent patient and spinal movement during the prone portion of the procedure due to the disadvantages of bolsters as discussed above.

[0010] In one embodiment, an internal fixation system for spinal surgery on a patient includes a lateral lumbar interbody fusion (LLIF) retractor having a LLIF retractor adapter, a posterior compression / distractor, an A-arm configured to be attached to a surgical table, and a B-arm configured to engage one end of the A-arm attached to the table and to engage the posterior compression / distractor.

[0011] In another embodiment, an internal fixation system for a spinal procedure on a patient includes a lateral lumbar interbody fusion (LLIF) retractor having a LLIF retractor adapter 118, and a posterior compression / distractor including a posterior distractor rack assembly including a rack having a plurality of ridges on at least one surface, a posterior distractor mount assembly configured to operably engage with the posterior distractor rack assembly and including an opening configured to receive the rack therethrough, and a pinion assembly configured to operably engage with the posterior distractor rack assembly and the posterior distractor mount assembly. The posterior distractor rack assembly and the posterior distractor mount assembly are movable relative to one another.

[0012] In yet another embodiment, an internal fixation system for spinal surgery on a patient comprises at least two cannulated pedicle screws insertable through respective pedicles of the patient's spine, a distraction frame 20 configured to operably connect the at least two cannulated screws to one another, and means for mounting the internal fixation system to a surgical table.

[0013] These and other features and advantages will become apparent from a reading of the following detailed description and a review of the associated drawings. It is to be understood that both the foregoing general description and the following detailed description are explanatory only and are not restrictive of the aspects claimed.

[0014] These and other features, aspects, and advantages of the present invention will become better understood with reference to the following description, appended claims, and accompanying drawings. [Brief description of the drawings]

[0015] [Figure 1A] FIG. 1 is a schematic diagram of an example of pre-operative preparation for prone lateral surgery on a patient using existing conventional techniques, showing a bolster on the patient's right side. [Figure 1B] FIG. 1B is a schematic diagram of the example preoperative preparation shown in FIG. 1A , showing the left side of the patient with surgeon access (i.e., no bolster). [Diagram 2] FIG. 2 is a schematic diagram of the arrangement of cannulated posts of an internal fixation system according to a first embodiment of the invention being inserted into a patient's spine during surgery. [Diagram 3] FIG. 3 is a top peripheral view of the internal fixation system of FIG. 2 being used during prone lateral spinal surgery in accordance with the present invention. [Figure 4] FIG. 3 is a top peripheral view of the internal fixation system of FIG. 2 being used with a lateral retractor during prone lateral spinal surgery in accordance with the present invention, with the lateral retractor and the distractor of the internal fixation system connected; [Diagram 5] FIG. 13 is a top peripheral view of the placement of a cannulated pedicle screw of an internal fixation system according to a second embodiment of the present invention into a patient's spine during surgery. [Figure 6] FIG. 6 is a detailed view of FIG. 5 showing the distal end of the cannulated pedicle screw being inserted into the patient's vertebral body. [Figure 7] FIG. 13 is a top perspective view of an internal fixation system according to a third embodiment of the present invention being used on a patient's spine during surgery. [Figure 8] FIG. 8 is a left side view of the internal fixation system of FIG. [Figure 9] FIG. 8 is a right side view of the internal fixation system of FIG. [Figure 10] FIG. 8 is a cranial to caudal view of the internal fixation system of FIG. 7. [Figure 11]FIG. 8 is a caudal to cranial view of the internal fixation system of FIG. 7. [Figure 12] FIG. 8 is a posterior view of the internal fixation system of FIG. [Figure 13] FIG. 8 is a top perspective view of the internal fixation system of FIG. [Figure 13A] FIG. 14 is a detailed view of the first portion of FIG. 13. [Figure 13B] FIG. 14 is a detailed view of the second portion of FIG. 13. [Figure 14A] FIG. 8 is a top perspective exploded view of the posterior compression / distractor of the internal fixation system of FIG. [Figure 14B] FIG. 8 is a top plan view of the posterior compression / distractor of the internal fixation system of FIG. [Figure 14C] FIG. 8 is a front elevation view of the posterior compression / distractor of the internal fixation system of FIG. [Figure 14D] FIG. 8 is a side elevational view of the posterior compressor / distractor of the internal fixation system of FIG. [Figure 15A] FIG. 14B is a top perspective exploded view of the posterior distractor mounting assembly of the posterior compressor / distractor of FIG. 14A. [Figure 15B] 15B is a top perspective view of the posterior distractor mounting assembly of FIG. 15A in an assembled state. [Figure 15C] FIG. 15B is a top plan view of the posterior distractor mounting assembly of FIG. 15A. [Figure 15D] FIG. 15B is a front elevation view of the posterior distractor mounting assembly of FIG. 15A. [Figure 15E] FIG. 15B is a side elevational view of the posterior distractor mounting assembly of FIG. 15A. [Figure 16A] FIG. 15B is a rear elevation view of the posterior distractor mounting assembly of FIG. 15A. [Figure 16B] FIG. 16B is a detailed view of the portion of FIG. 16A indicated by the dashed line. [Figure 16C] FIG. 15B is a top plan view of the posterior distractor mounting assembly of FIG. 15A showing its spring lever assembly in a locked position. [Figure 16D] FIG. 15B is a top plan view of the posterior distractor mounting assembly of FIG. 15A showing its spring lever assembly in an unlocked position. [Figure 16E] FIG. 15B is a bottom plan view of the posterior distractor mounting assembly of FIG. 15A showing its spring lever assembly in an unlocked position. [Figure 17A] 15B is a top perspective view of the mounting hub of the posterior distractor mounting assembly of FIG. 15A. [Figure 17B] FIG. 17B is a front elevation view of the mounting hub of FIG. 17A. [Figure 17C] FIG. 17B is a side elevational view of the mounting hub of FIG. 17A. [Figure 17D] FIG. 17B is a top plan view of the mounting hub of FIG. 17A. [Figure 17E] FIG. 17B is a bottom plan view of the mounting hub of FIG. 17A. [Figure 17F] 17F is a cross-sectional view of the mounting hub of FIGS. 17A and 17C taken along line 17F of FIG. 17C. [Figure 17G] FIG. 17C is a detailed view of the portion of FIG. 17B indicated by the dashed line. [Figure 17H] FIG. 17D is a detailed view of a portion of FIG. 17C indicated by dashed lines. [Figure 18A] FIG. 15B is a bottom perspective view of the ratchet pole of the posterior distractor mounting assembly of FIG. 15A. [Figure 18B] FIG. 18B is a side elevational view of the ratchet pole of FIG. 18A. [Figure 18C] FIG. 18B is a front plan view of the ratchet pole of FIG. 18A. [Figure 18D] FIG. 18B is a top plan view of the mounting hub of FIG. 18A. [Figure 19A] FIG. 18B is a top perspective view of a ratchet pin for use with the ratchet pole of FIG. 18A. [Figure 19B] FIG. 19B is a front plan view of the ratchet pin of FIG. 19A. [Figure 19C] FIG. 19B is a side elevational view of the ratchet pin of FIG. 19A. [Figure 20A] FIG. 18B is a top perspective view of a torsion spring for use with the ratchet pawl of FIG. 18A. [Figure 20B] FIG. 20B is a front plan view of the torsion spring of FIG. 20A. [Figure 20C] FIG. 20B is a side elevational view of the torsion spring of FIG. 20A. [Figure 21A] 15B is a top perspective exploded view of the first swivel tube subassembly of the posterior distractor mounting assembly of FIG. 15A. FIG. [Figure 21B] FIG. 21B is a top plan view of the swirl tube subassembly of FIG. 21A. [Figure 21C] FIG. 21B is a side elevational view of the swirl tube subassembly of FIG. 21A. [Figure 21D] FIG. 21B is a front elevation view of the swirl tube subassembly of FIG. 21A. [Figure 22A] FIG. 21B is a top perspective view of the arm of the swirl tube subassembly of FIG. 21A. [Figure 22B] FIG. 22B is a side elevational view of the arm of FIG. 22A. [Figure 22C] FIG. 22B is a rear elevational view of the arm of FIG. 22A. [Figure 22D] 22D is a cross-sectional view of the arm of FIGS. 22A and 22C taken along line 22D-22D of FIG. 22C. [Figure 23A] FIG. 21B is a bottom perspective view of the swirl tube hub of the swirl tube subassembly of FIG. 21A. [Figure 23B] FIG. 23B is a front elevational view of the swirl tube hub of FIG. 23A. [Figure 23C] FIG. 23B is a side elevational view of the swirl tube hub of FIG. 23A. [Figure 23D] FIG. 23B is a top plan view of the swirl tube hub of FIG. 23A. [Figure 23E] FIG. 23B is a rear elevational view of the swirl tube hub of FIG. 23A. [Figure 23F] 23F is a cross-sectional view of the swirl tube hub of FIGS. 23A and 23B taken along line 23F-23F of FIG. 23B. [Figure 23G] FIG. 23C is a detailed view of a portion of FIG. 23B indicated by dashed lines. [Figure 23H] 23H is a cross-sectional view of the swirl tube hub of FIGS. 23A and 23E taken along line 23H-23H of FIG. 23E. [Figure 24A] FIG. 21B is a top perspective view of the swirl tube pin of the swirl tube subassembly of FIG. 21A. [Figure 24B] FIG. 24B is a front elevational view of the swivel tube pin of FIG. 24A. [Figure 24C] FIG. 24B is a side elevational view of the swivel tube pin of FIG. 24A. [Figure 25A] FIG. 21B is a bottom elevational view of the swirl tube of the swirl tube subassembly of FIG. 21A. [Figure 25B] FIG. 25B is a side elevational view of the swirl tube of FIG. 25A. [Figure 25C] FIG. 25B is a front elevational view of the swirl tube of FIG. 25A. [Figure 25D] FIG. 25B is a top perspective view of the swirl tube of FIG. 25A. [Figure 26A] FIG. 21B is a top perspective view of the swirl tube tulip rod of the swirl tube subassembly of FIG. 21A. [Figure 26B] FIG. 26B is a front elevational view of the swirl tube tulip rod of FIG. 26A. [Figure 26C] FIG. 26B is a side elevational view of the swirl tube tulip rod of FIG. 26A. [Figure 27A] FIG. 21B is a top perspective view of the compression spring of the swivel tube subassembly of FIG. 21A. [Figure 27B] FIG. 27B is a front elevational view of the compression spring of FIG. 27A. [Figure 27C] FIG. 27B is a side elevational view of the compression spring of FIG. 27A. [Figure 28A] FIG. 15B is a top perspective view of the cam pin of the posterior distractor mounting assembly of FIG. 15A. [Figure 28B] FIG. 28B is a front elevational view of the cam pin of FIG. 28A. [Figure 28C] FIG. 28B is a top plan view of the cam pin of FIG. 28A. [Figure 28D] FIG. 28B is a side elevational view of the cam pin of FIG. 28A. [Figure 29A] FIG. 15B is a top perspective view of the upper cam lever of the posterior distractor mounting assembly of FIG. 15A. [Figure 29B] FIG. 29B is a front elevational view of the upper cam lever of FIG. 29A. [Figure 29C] FIG. 29B is a side elevational view of the upper cam lever of FIG. 29A. [Figure 29D] FIG. 29B is a top plan view of the upper cam lever of FIG. 29A. [Figure 29E] FIG. 29B is a rear elevational view of the upper cam lever of FIG. 29A. [Figure 30A]FIG. 15B is a bottom perspective view of the upper cam lever of the posterior distractor mounting assembly of FIG. 15A. [Figure 30B] FIG. 30B is a front elevational view of the lower cam lever of FIG. 30A. [Figure 30C] FIG. 30B is a side elevational view of the lower lever of FIG. 30A. [Figure 30D] FIG. 30B is a top plan view of the lower cam lever of FIG. 30A. [Figure 30E] FIG. 30B is a rear elevational view of the lower cam lever of FIG. 30A. [Figure 31A] FIG. 14B is a top perspective exploded view of the posterior distractor rack assembly of the posterior compression / distractor of FIG. 14A. [Figure 31B] FIG. 31B is a top plan view of the posterior distractor rack assembly of FIG. 31A showing its spring lever assembly in an unlocked position. [Figure 31C] FIG. 31B is a top plan view of the posterior distractor rack assembly of FIG. 31A showing its spring lever assembly in a locked position. [Figure 31D] FIG. 31B is a side elevational view of the posterior distractor rack assembly of FIG. 31A. [Figure 31E] FIG. 31B is a view of the posterior distractor rack assembly of FIG. 31A. [Figure 32A] FIG. 31B is a top perspective view of the rack and rack hub of the posterior distractor rack assembly of FIG. 31A. [Figure 32B] FIG. 32B is a bottom perspective view of the rack and rack hub of FIG. 32A. [Figure 32C] FIG. 32B is a front elevational view of the rack and rack hub of FIG. 32A. [Fig. 32D] FIG. 32B is a top plan view of the rack and rack hub of FIG. 32A. [Figure 32E] FIG. 32B is a rear elevational view of the rack and rack hub of FIG. 32A. [Fig. 32F] FIG. 32B is a side elevational view of the rack and rack hub of FIG. 32A. [Fig. 32G] 32G is a cross-sectional view of the rack and rack hub of FIGS. 32A and 32D taken along line 32G-32G of FIG. 32D. [Fig. 32H]32H is a cross-sectional view of the rack and rack hub of FIGS. 32A and 32F taken along line 32H-32H of FIG. 32F. [Fig. 32I] FIG. 32C is a detailed view of a portion of FIG. 32H indicated by a dashed line. [Fig. 32J] FIG. 32D is a detailed view of a portion of FIG. 32C indicated by dashed lines. [Figure 32K] FIG. 32F is a detailed view of a portion of FIG. 32F indicated by dashed lines. [Figure 33A] FIG. 14B is a top perspective exploded view of the pinion assembly of the posterior compression / distractor of FIG. 14A. [Figure 33B] FIG. 33B is a side elevational view of the pinion assembly of FIG. 33A. [Figure 33C] FIG. 33C is a cross-sectional view of the pinion assembly of FIGS. 33A and 33B taken along line 33C-33C of FIG. 33B. [Figure 33D] FIG. 33B is a bottom plan view of the pinion assembly of FIG. 33A. [Figure 34A] FIG. 33B is a top perspective view of the post of the pinion assembly of FIG. 33A. [Figure 34B] FIG. 34B is a front elevational view of the support column of FIG. 34A. [Figure 34C] FIG. 34B is a bottom elevational view of the support column of FIG. 34A. [Fig. 34D] FIG. 34B is a side elevational view of the support column of FIG. 34A. [Figure 34E] 34E is a cross-sectional view of the support pillar of FIGS. 34A and 34D taken along line 34E-34E of FIG. 33D. [Fig. 34F] FIG. 32F is a detailed view of a portion of FIG. 32F indicated by dashed lines. [Figure 35A] FIG. 33B is a front elevational view of the knob of the pinion assembly of FIG. 33A. [Figure 35B] FIG. 34B is a side elevational plan view of the knob of FIG. 34A. [Figure 35C] FIG. 35B is a bottom plan view of the knob of FIG. 35A. [Figure 35D] FIG. 35B is a bottom perspective view of the knob of FIG. 35A. [Figure 35E] 35E is a cross-sectional view of the knob of FIG. 34A taken along line 35E-35E of FIG. 35A. [Fig. 35F]35F is a cross-sectional view of the knob of FIG. 34A taken along line 35F-35F of FIG. 35A. [Figure 35G] 35G is a cross-sectional view of the knob of FIGS. 34A and 34C taken along line 35G-35G of FIG. 35C. [Figure 36A] FIG. 33B is a top perspective view of the gears of the pinion assembly of FIG. 33A. [Figure 36B] FIG. 36B is a front elevational view of the gear of FIG. [Figure 36C] FIG. 36B is a side elevational view of the gear of FIG. 36A. [Figure 37A] FIG. 33B is a top perspective view of the pin of the pinion assembly of FIG. 33A. [Figure 37B] FIG. 36B is a front plan view of the pin of FIG. 36A. [Figure 37C] FIG. 36B is a side elevational view of the pin of FIG. 36A. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0016] The present invention will now be described with reference to the drawings, in which like reference numerals are used to refer to like elements throughout. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of the present invention. However, it will be apparent that the present invention may be practiced without these specific details.

[0017] Disclosed herein are internal fixation systems and methods for prone lateral spinal surgery without the use of a bolster.

[0018] Eliminating the bolster from prone lateral spine surgery saves time and allows the surgeon to access either side of the spine in the same patient without repositioning, which is particularly advantageous for patients with multiple disc degeneration and secondary scoliosis deformity, since it is often easier to access the various levels from one side or the other in such patients.

[0019] To eliminate the bolster, the internal fixation system of the present invention is used to directly control spinal motion.

[0020] Advantageously, the internal fixation system of the present invention facilitates surgical approach from both the right and left sides of the patient.

[0021] The internal fixation system of the present invention also provides a gentle and safe method for the surgeon to manipulate the patient's spine and distract the patient's disc space.

[0022] Additionally, the internal fixation system of the present invention promotes greater stability, eliminates some surgical steps, and provides the surgeon with more space and improved visibility.

[0023] An internal fixation system 10 according to a first embodiment of the present invention is shown in Figures 2-4. The internal fixation system 10 includes at least two cannulated posts 12, 14 having respective distal ends 12a, 14a and proximal ends 12b, 14b. The distal ends 12a, 14a are configured to be inserted through respective pedicles of a patient's spine S, as shown in Figures 2-4. As shown in Figure 4, the internal fixation system 10 is attached directly to an operating table T using a table mount 16 (or other attachment means), which is also used to position a lateral retractor 18 for prone spinal access. By connecting the lateral retractor 18 to screws that are internally fixed to bone (i.e., the patient's spine), the lateral retractor 18 is more stable and retractor movement is minimized, providing an additional mechanical advantage.

[0024] In this embodiment, the surgeon first inserts a guidewire into the patient's vertebrae using fluoroscopy or stereotactic navigation guidance. The surgeon then inserts a cannulated post over the guidewire.

[0025] The cannulated struts 12, 14 are then operatively connected to one another at or near their respective proximal ends using an active or passive distraction frame 20 (see Figures 3 and 4).

[0026] Active distraction can be utilized prior to or during the discectomy procedure to minimize the risk of endplate intrusion. During the trialing step, as the disc space is being expanded to select the appropriately sized implant, the distraction frame 20 gradually expands in both height and relative angulation and maintains the distraction after the trial is removed. The use of distractors during the disc preparation, trialing, and implant insertion portions of the lateral interbody fusion procedure reduces the risk of endplate intrusion and implant subsidence. By reducing subsidence, foraminal height is better maintained.

[0027] Intraoperatively, changes in the angulation and position of the cannulated struts 12, 14 can be interpreted by stereotactic navigation to inform the surgeon of how significantly the patient's global and regional spinal alignment has changed.

[0028] After the prone lateral procedure is performed, if posts were used, the cannulated posts 12, 14 are cannulated with guidewires, the cannulated posts are removed and replaced with cannulated pedicle screws (i.e., the cannulated screws shown implanted in Figures 5 and 6) as would normally be implanted during the prone lateral procedure. Screw towers may be used in conjunction with the cannulated pedicle screws to facilitate screw implantation, after which the screw towers are removed.

[0029] An internal fixation system 50 according to a second embodiment of the present invention is shown in Figures 5 and 6 and is generally similar to the internal fixation system 10. However, in this embodiment, the internal fixation system 50 has at least two cannulated pedicle screws 52, 54 (instead of the cannulated posts of the first embodiment) having respective distal ends 52a, 54a and proximal ends 52b, 54b. The distal ends 52a, 54a are configured to be inserted through respective pedicles P of the patient's spine S, as shown in Figures 5 and 6. This internal fixation system 50 is attached directly to a surgical table T using a table mount 16 (or other attachment means), as shown in Figure 4, which is also used to position the lateral retractor 18 for prone spinal access.

[0030] In this embodiment, the surgeon first inserts a guidewire into the patient's vertebrae using fluoroscopy or stereotactic navigation guidance. The surgeon then inserts each cannulated screw 52, ​​54 with its respective screw tower 62, 64 removably attached thereto over the guidewire.

[0031] The cannulated pedicle screw towers 62, 64 are then operatively connected to one another at their respective proximal ends using the active and passive distraction frame 20 (see Figures 3 and 4).

[0032] Active distraction can be used prior to or during the discectomy procedure to minimize the risk of endplate intrusion. During the trialing step, as the disc space is being expanded to select the appropriately sized implant, the distraction frame 20 gradually expands in both height and relative angulation and maintains that distraction after the trial is removed.

[0033] Intraoperatively, changes in the angulation and position of the cannulated screws 52, 54 and screw towers 62, 64 can be interpreted with stereotactic navigation to inform the surgeon of how significantly the patient's global and regional spinal alignment has changed.

[0034] After the prone lateral procedure has been performed, the screw towers 62,64 are removed from the cannulated pedicle screws 52,54.

[0035] This embodiment does not require the use of an intermediate post to insert the final cannulated screws 52, 54. This saves a step and simplifies the procedure, thus helping to reduce surgical time and the risk of adverse events.

[0036] An internal fixation system 100 according to a third embodiment of the present invention is shown in Figures 7-13B. In this embodiment, the internal fixation system 100 includes a table-mounted L-post 102 for an operating table (not shown) and an A-arm 104 that is also mounted to the table. A B-arm 106 engages one end of the A-arm 104 that is mounted to the table via a B-arm lateral connector 108 at one end of the A-arm 104 and an A-arm distal clamp 110. The B-arm 106 further includes a B-arm posterior connector 112 that engages with a posterior compression / distractor 114. The internal fixation system 100 further includes a lateral lumbar interbody fusion (LLIF) retractor 116 having a LLIF retractor adaptor 118. Figures 7-13B show the internal fixation system 100 in use on a spine S of a patient.

[0037] During a surgical procedure according to this embodiment, the surgeon inserts the cannulated implants (e.g., the cannulated pedicle screws 52, 54 and their respective screw towers 62, 64 as shown in FIG. 5) into the vertebrae of the patient's spine S and connects them together to the compressor / distractor 114 (i.e., sliding the respective pivot tubes 162, 262 over the cannulated pedicle screws 52, 54 and their respective screw towers 62, 64). The distractor is then locked to the cannulated implants using a set cap or set screw. The cap / set screw is shown inside the tulip portion 55 of the pedicle screw 52, ​​just above the rod-like thing that extends from the distractor tower / pivot tube 162 into the pedicle screw 52. The lateral retractor 116 is positioned according to standard techniques and connected to the operating table using the table arm A104. The compression / distractor 114 is then connected to the platform arm A connector (distal clamp 110) and locked into place using the B arm 106 and B arm lateral connector 108 (see Figures 7-8). Once the implant is in place, the cap is removed and the distractor is removed. The rods are then inserted into the vertebrae and the locking cap / set screws are placed to complete the construct. If used, the screw towers 62, 64 are then removed. By connecting the lateral retractor 116 to screws that are fixed internally to the bone (i.e., the patient's spine), the lateral retractor 116 is more stable, minimizing retractor movement and providing an additional mechanical advantage. The use of the compression / distractor 114 during the disc preparation, trialing, and implant insertion portions of the lateral interbody fusion procedure reduces the risk of endplate penetration and implant subsidence. By reducing subsidence, hole height is better maintained.

[0038] A posterior compressor / distractor 114 and its components according to various embodiments of the present invention are shown in Figures 14A-37C.

[0039] 14A-14D show the posterior compressor / distractor 114, which includes a posterior distractor rack assembly 120, a posterior distractor mounting assembly 122, and a pinion assembly 124. These assemblies cooperate to allow the posterior distractor rack assembly 120 and the posterior distractor mounting assembly 122 to move relative to one another. Each of these assemblies and their components are described below.

[0040] The posterior distractor rack assembly 120 includes a rack 126 having a plurality of ridges 126a on at least one surface. The posterior distractor mounting assembly 122 includes a spring lever assembly 127 having indicia indicating its locked and unlocked positions (L and U, respectively), a ratchet pawl 128, a hole 129, and an opening 130 sized to receive the rack 126 therethrough. In the illustrated embodiment, the opening 130 is rectangular. The pinion assembly 124 includes a knob 132 and a post 135 depending from the knob 132. A gear 134 circumferentially engages the post 135, and the gear 134 includes ridges 134a on its surface that mesh with the ridges 126a of the rack 126, as will be described further below. The bore 129 of the posterior distractor mount assembly 122 is sized to receive therein the post 135 and gear 134 of the pinion assembly 124 (see FIG. 14A). The posterior compressor / distractor 114 further includes two pivot tube subassemblies 136, 138 configured to be moved and positioned relative to one another. One pivot tube subassembly 138 is part of the posterior distractor mount assembly 122 and the other pivot tube subassembly 136 is part of the posterior distractor rack assembly 120 (see FIGS. 14A-14D). As described further below, the pivot tube subassembly 138 includes a pivot tube 162 and the pivot tube subassembly 136 includes a pivot tube 262.

[0041] To assemble the posterior compressor / distractor 114 for surgery, the post 135 of the pinion assembly 124 and the surrounding gear 134 are inserted into the hole 129. The spring lever assembly 127 of the posterior distractor mounting assembly 122 is then deployed (i.e., moved to its unlocked position U) and the rack 126 of the posterior distractor rack assembly 120 is slid into the opening 130 of the posterior distractor mounting assembly 122 (see FIGS. 14B-14C). As the rack 126 advances through the opening 130 and the posterior distractor mounting assembly 122, the ridge 126a operatively contacts the ratchet pole 128 and meshes with the ridge 134a of the gear 134 of the pinion assembly 124, thereby smoothly rotating the knob 132 of the pinion assembly 124 and increasing the distance between the two pivot tube subassemblies 136, 138. Once the desired distance between the two pivot tube subassemblies 136, 138 is reached (i.e., based on patient measurements and other surgical parameters), the spring lever 127 is moved to a locked position L to lock the posterior compressor / distractor 114 in this position.

[0042] Reference is now made to Figures 15A-15E, which illustrate the components of the posterior distractor mounting assembly 122. The posterior distractor mounting assembly 122 includes a pivot tube subassembly 138 having an arm or rod 140 extending therefrom and a mounting hub 142. The arm 140 includes a bore 140 formed in one end and an annular groove 141 formed in an opposite end, as described further below. The mounting hub 142 defines a bore 129 for receiving the post 135 / gear 134, an opening 130 for receiving the rack 126 (both described above), and a cavity 144 configured to receive the arm 140 therein. The cavity 144 includes an opening 144a surrounded by an annular end 143 of the mounting hub 142. A first plurality of teeth 145 extend from the annular end 143. A compression spring 146 fits over arm 140 of swivel tube subassembly 138 and enters cavity 144 with arm 140. A second plurality of teeth 147 is provided on one end of swivel tube subassembly 138 adjacent and surrounding arm 140 and configured to releasably engage (i.e., mesh with) the first plurality of teeth 145.

[0043] The spring lever assembly 127 of the posterior distractor mounting assembly 122 includes an upper cam lever 148, a lower cam lever 150, and a cam pin 152 configured to connect the upper cam lever 148 and the lower cam lever 150 on each opposing surface of the mounting hub 142 through cam holes 154 formed therein. The cam pin 152 includes a first end 152a configured to engage with a hole 148a formed in the upper cam lever 148. The cam pin 152 also includes a second end 152b configured to engage with a hole 150a formed in the lower cam lever 150. The cam pin 152 is also configured to engage with the groove 141 of the pivot tube subassembly arm 140 when inserted into the cavity 144. The ratchet pawl 128 engages with a torsion spring 156 and a ratchet pin 158 located within a ratchet hole 160 formed in the mounting hub 142 to allow movement of the ratchet pawl 128.

[0044] 16A-16D further illustrate the posterior distractor mounting assembly 122. When the spring lever assembly 127 is in the unlocked position U (FIGS. 16A, 16B, 16D, and 16E, as well as 14B, 15B, and 15C), the pivot tube subassembly 138 is spaced apart from the mounting hub 142. When the spring lever assembly 127 is moved to the locked position L (i.e., by rotation of the upper and lower cam levers 148, 150), the cam pin 152 rotates. This rotation of the cam pin 152 causes the pivot tube subassembly arm 140 to move inward (i.e., pulling it further into the cavity 144) because the cam pin 152 is engaged with the groove 141 of the pivot tube subassembly arm 140. This then causes the second plurality of teeth 147 (of the swivel tube subassembly 138) to releasably engage (i.e., interlock) with the first plurality of teeth 145, thereby locking the swivel tube subassembly 138 to the mounting hub 142 (see FIGS. 15B and 16C). This connection of the swivel tube subassembly 138 to the mounting hub 142 allows the angle between the swivel tubes 162 to be adjusted to accommodate the angle of the pedicle screws. This connection also allows for a single compressor / distractor 114 to be used for both right and left side approaches (i.e., to the patient's disc space) since it allows for 360° of rotation.

[0045] 17A-17H further show the mounting hub 142 including the hole 129, the opening 130, the cam pin hole 154, and the ratchet hole 160. FIG. 17F shows the cavity 144, which is configured to receive the swivel tube subassembly arm 140 therein. FIG. 17G shows an embodiment in which the angle formed between the annular end 143 and the adjacent portion of the mounting hub 142 is 141°. Other angles are possible in other embodiments. FIG. 17H shows an embodiment in which the angle formed between adjacent ones of the first plurality of teeth 145 is 90°. Other angles are possible in other embodiments.

[0046] 18A-18D further illustrate the ratchet pole 128 of the posterior distractor mounting assembly 122. The ratchet pole 128 includes first and second members 128a, 128b rotatably connected by a hinge 128c (or other bending means). A bore 128d extends through a portion of the second member 128b and is sized to receive a ratchet pin 158 therethrough. The ratchet pin 158 is further illustrated in FIGS. 19A-19C.

[0047] Torsion spring 156 is further shown in Figures 20A-20C. Torsion spring 156 includes arms 156a, 156b that engage first and second members 128a, 128b, respectively, of ratchet pole 128, and a coil spring 156c between and connecting arms 156a, 156b. Coil spring 156c defines an opening 156d dimensioned to receive ratchet pin 158 therethrough.

[0048] The swivel tube subassembly 138 is further shown in Figures 21A-21D. Although the swivel tube subassembly 138 is shown as a right-handed version in these figures, it should be understood that a left-handed version of the swivel tube subassembly 138 would be a mirror image of that shown in these figures. The swivel tube subassembly 138 includes a swivel tube 162 having first and second ends 162a, 162b and sized to receive the cannulated pedicle screw 52 and screw tower 62 therein, as described above and shown in Figure 13. The second end 162b includes an extension member 164 with a bore 164a sized to receive one end of a swivel tube tulip rod 166 therein. The swirl tube subassembly 138 includes a swirl tube hub 168 having a first portion 168a configured to engage the swirl tube first end 162a and a second portion 168b having a second plurality of teeth 147 formed thereon and configured to receive an end of a swirl tube subassembly arm 140 having a bore 140a. The swirl tube subassembly arm 140 is further shown in Figures 22A-22D.

[0049] The swivel tube hub 168 is further shown in Figures 23A-23H. The first portion 168a is generally annular and defines a circular opening 172 therethrough. The second portion 168b is also generally annular and defines a cavity 174 sized to receive the end of the swivel tube subassembly arm 140 having the bore 140a. The swivel tube pin 170 is further shown in Figures 24A-24C. The swivel tube 138 is further shown in Figures 25A-25D.

[0050] The swivel tube tulip rod 166 is further shown in Figures 26A-26C. The swivel tube tulip rod 166 includes a longitudinal axis AA and a rounded or domed end 166a. The swivel tube tulip rod 166 is configured to insertably engage a slot in the screw tower 62 when engaged with the screw tower 62. The rounded end 166a is dome shaped to eliminate sharp edges or corners that may snag, scratch and / or tear / damage adjacent soft tissue of the patient. In the illustrated embodiment, the domed end 166a and the longitudinal axis AA form a first angle of 30° therebetween. Other angles are possible in other embodiments.

[0051] The compression spring 146 is further shown in Figures 27A-27C. The cam pin 152 is further shown in Figures 28A-28D. Ends 152a, 152b of the cam pin 152 have a D-shaped cross-section and are configured to insertably engage holes 148a, 150a in the upper and lower cam levers 148, 150, respectively, of the spring lever assembly 127.

[0052] The upper cam lever 148 is further shown in Figures 29A-29E and includes a D-shaped hole 148a for receiving an end 152a of the cam pin 152 therein. As shown in Figure 29E, the upper cam lever 148 also includes a first edge 148b, a second edge 148c spaced apart from the first edge 148b, and a third edge 148d spaced apart from the second edge 148c. In the embodiment shown, the first and second edges 148b, 148c form a first angle therebetween of 23° and the second and third edges 148c, 148d form a second angle therebetween of 103°. Other angles are possible in other embodiments.

[0053] The lower cam lever 150 is further shown in Figures 30A-30E and is formed as a mirror image of the upper cam lever 148. The lower cam lever 150 includes a D-shaped hole 150a for receiving an end 152b of the cam pin 152 therein. As shown in Figure 30E, the lower cam lever 150 also includes a first edge 150b, a second edge 150c spaced apart from the first edge 150b, and a third edge 150d spaced apart from the second edge 150c. In the embodiment shown, the first and second edges 150b, 150c form a first angle therebetween of 23° and the second and third edges 150c, 150d form a second angle therebetween of 103°. Other angles are possible in other embodiments.

[0054] 31A-31D further illustrate the posterior distractor rack assembly 120 and its components. Where applicable, the components of the posterior distractor rack assembly 120 are assigned reference numbers in the 200 range to match same / corresponding components of the posterior distractor mounting assembly 122 that have reference numbers in the 100 range and have the same or similar structure and function.

[0055] The posterior distractor rack assembly 120 includes a swivel tube subassembly 136. The swivel tube subassembly 136 is shown as a left hand version in these figures, however, it should be understood that a right hand version of the swivel tube subassembly 136 would be a mirror image of that shown in these figures. The swivel tube subassembly 136 includes a swivel tube 262, a swivel tube tulip rod 266, a swivel tube hub 268, an arm or rod 240 extending therefrom, and a rack hub 242. The arm 240 includes an annular groove 241 formed in one end thereof, as described further below. A cavity 244 is formed within the rack hub 242 that is configured to receive the arm 240 therein. The cavity 244 includes an opening 244a surrounded by an annular end 243 of the rack hub 242. A third plurality of teeth 245 extend from the annular end 243. A compression spring 246 fits over arm 240 of swivel tube subassembly 136 and enters cavity 244 with arm 240. A fourth plurality of teeth 247 is provided on one end of swivel tube subassembly 136 adjacent and surrounding arm 240 and configured to releasably engage (i.e., mesh with) the third plurality of teeth 245.

[0056] The posterior distractor rack assembly 120 further includes a spring lever assembly 227 having indicia indicating its locked and unlocked positions (L and U, respectively). The spring lever assembly 227 includes an upper cam lever 248, a lower cam lever 250, and a cam pin 252 configured to connect the upper cam lever 248 and the lower cam lever 250 on each opposing surface of the rack hub 242 through cam holes 254 formed therein. The cam pin 252 has the same structure as the cam pin 152 of the posterior distractor mounting assembly 122 described above and includes first and second ends configured to engage holes formed in the upper and lower cam levers 248, 250. The cam pin 252 is also configured to engage the groove 241 of the pivot tube subassembly arm 240 when inserted into the cavity 244.

[0057] The posterior distractor rack assembly 120 operates similarly to the operation of the posterior distractor mount assembly 122 described above. When the spring lever assembly 227 is in its unlocked position U (see FIG. 31C), the pivot tube subassembly 136 is spaced from the rack hub 242. When the spring lever assembly 227 is moved to its locked position L (i.e., by rotation of the upper and lower cam levers 248, 250), the cam pin 252 rotates. This rotation of the cam pin 252 causes the pivot tube subassembly arm 240 to move inward (i.e., pulling it further into the cavity 124) because the cam pin 252 is engaged with the groove 241 of the pivot tube subassembly arm 240. This then causes the second plurality of teeth 247 (of the pivot tube subassembly 136) to releasably engage (i.e., interlock) with the first plurality of teeth 245, thereby locking the pivot tube subassembly 136 to the rack hub 242 (see FIG. 31B). This connection of the pivot tube subassembly 136 with the rack hub 242 allows the angle between the pivot tubes 262 to be adjusted to correspond to the angle of the pedicle screws. This connection also allows for a single compression / distractor 114 to be used for both right and left side approaches (i.e., to the patient's disc space) since it allows for 360° of rotation.

[0058] 32A-32K further illustrate the rack 126 and rack hub 242 of the posterior distractor rack assembly 120. The rack 242 includes a cylindrical member 202 defining a threaded hole 202a therethrough with a fifth plurality of teeth 203 at each end. A cavity 244 is formed in the rack hub 242 as a through hole and extends perpendicular to the threaded hole 202a as shown in FIGS. 32A-32C, 32G, and 32H. FIG. 32G illustrates an embodiment in which the angle formed between the wall of the cylindrical member 202 and the threaded hole 202a is 120°. The cylindrical member 202 is configured to engage with the B-arm posterior connector 112 (see FIGS. 13 and 13B). The configuration of the cylindrical member 202 and the teeth 203 on both ends facilitates the use of a single rack 126 and a single compressor / distractor 114 for both right-sided and left-sided approaches (i.e., to the patient's disc space) by allowing the surgeon to rotate or flip the rack depending on the side of the approach.

[0059] 32H shows an embodiment in which the angle formed between the annular end 243 and the adjacent portion of the rack hub 242 is 141°. Other angles are possible in other embodiments.

[0060] 32I shows an embodiment in which the angle formed between adjacent ones of the ridges 126a of the rack 126 is 40°. Other angles are possible in other embodiments.

[0061] 32J illustrates an embodiment in which the angle formed between adjacent ones of the fifth plurality of teeth 203 is 90°. Other angles are possible in other embodiments.

[0062] 32K illustrates an embodiment in which the angle formed between adjacent ones of the third plurality of teeth 245 is 90°. Other angles are possible in other embodiments.

[0063] 33A-37C further illustrate pinion assembly 124 and its components. As described above, pinion assembly 124 includes knob 132, post 135 that engages knob 132 (i.e., via insertion into cavity 132a formed in knob 132), and gear 134 that includes ridges 134a on its surface that mate with ridges 126a of rack 126. Gear 134 also includes hole 134b configured to receive post 135 therethrough. Post 135 includes head 135a, shaft 135b depending from head 135a, and hole 135c formed in shaft 135b. Pinion assembly 124 further includes pin 131 that insertably engages hole 132b formed in knob 132, and post hole 135c. The pin 131 thereby secures the post 135 to the knob 132 .

[0064] If the swivel tubes 162, 262 of each swivel tube subassembly 138, 136 or the implants (e.g., intervertebral screws / rods, see reference) themselves are tracked using stereotactic navigation / fiducial marks, their positions after lateral implant insertion can be compared to their relative positions at initial placement, and such comparison data can be used to calculate the change in alignment achieved by lateral implant placement.

[0065] With multilevel instrumentation, implants can be positioned and distracted across multiple levels using this system without the need to reposition the distractor for lateral surgery at a later level.

[0066] In general, any combination of the disclosed features, components, and methods described herein is possible. The method steps may be performed in any order that is physically possible.

[0067] Those skilled in the art will recognize that various changes and modifications can be made to the illustrated embodiments without departing from the spirit of the invention, and all such changes and modifications are intended to be within the scope of the present invention except as limited by the appended claims.

Claims

1. 1. An internal fixation system for a spinal procedure on a patient, comprising: a lateral lumbar interbody fusion (LLIF) retractor 116 having a LLIF retractor adapter 118; a posterior compressor / distractor 114; an A-arm 104 configured to be attached to a surgical table; and a B-arm (106) configured to engage one end of an A-arm (104) attached to the platform and to engage the posterior compressor / distractor (114).

2. 2. The internal fixation system of claim 1, wherein the B arm includes a lateral connector, the A arm includes a distal clamp at one end of the A arm configured to engage the B arm lateral connector, and the B arm further includes a B arm posterior connector configured to engage the posterior compressor / distractor.

3. The posterior compression / distractor 114 is a posterior distractor rack assembly 120; a posterior distractor mount assembly 122 configured for operative engagement with the posterior distractor rack assembly 120; a pinion assembly 124 configured to operatively engage the posterior distractor rack assembly 120 and the posterior distractor mount assembly 122; The internal fixation system of claim 1 , whereby said posterior distractor rack assembly (120) and said posterior distractor mounting assembly (122) are movable relative to one another.

4. The internal fixation system of claim 3, wherein the posterior distractor rack assembly (120) includes a rack (126) having a plurality of ridges (126a) on at least one surface, and the posterior distractor mounting assembly (122) includes an opening (130) configured to receive the rack therethrough.

5. 5. The internal fixation system of claim 4, wherein the posterior distractor rack assembly includes a first swivel tube subassembly having a first swivel tube and the posterior distractor mounting assembly includes a second swivel tube subassembly having a second swivel tube, the first and second swivel tubes each configured to receive a pedicle screw and a screw tower therein.

6. The internal fixation system of claim 5 , wherein the first and second swivel tube subassemblies (136, 138) are configured to be moved and positioned relative to one another.

7. 7. The internal fixation system of claim 6, wherein the second swivel tube subassembly (138) has a first arm (140) extending therefrom and a mounting hub (142) including a first cavity (144) configured to receive the first arm (140) therein, the first cavity (144) including a first opening (144a) surrounded by a first annular end (143) having a first plurality of teeth (145) extending therefrom, and the second swivel tube subassembly (138) includes a second plurality of teeth (147) proximate and surrounding the arm (140), the second plurality of teeth (147) configured to releasably engage the first plurality of teeth (145).

8. 8. The internal fixation system of claim 7, wherein the first swivel tube subassembly (136) has a second arm (240) extending therefrom and a rack hub (242) including a second cavity (244) configured to receive the second arm (240) therein, the second cavity (244) including a second opening (244a) surrounded by a second annular end (243) having a third plurality of teeth (245) extending therefrom, and the first swivel tube subassembly (136) includes a fourth plurality of teeth (247) proximate and surrounding the second arm (240), the fourth plurality of teeth (247) configured to releasably engage with the third plurality of teeth (245).

9. 10. The internal fixation system of claim 8, wherein the first arm includes a first annular groove formed at one end thereof, and the posterior distractor mounting assembly includes a mounting hub having a first spring lever assembly having a first upper cam lever and a first lower cam lever, the first spring lever assembly having a first cam pin configured to connect the first upper cam lever and the first lower cam lever on each opposing surface of the mounting hub through a first cam hole formed therein.

10. 10. The internal fixation system of claim 9, wherein the first cam pin 152 is configured to engage the first groove 141 of the first arm 140 when inserted into the first cavity 144, and rotation of the first upper cam lever 148 and the first lower cam lever 150 causes rotation of the first cam pin 152 and inward movement of the first arm 140 into the first cavity 144, which in turn releasably engages the second plurality of teeth 147 of the second pivot tube subassembly 138 with the first plurality of teeth 145 and locks the second pivot tube subassembly 138 to the mounting hub 142, thereby allowing an angle between the first pivot tube 262 and the second pivot tube 162 to be adjusted to correspond to a pedicle screw angle and wherein the compressor / distractor 114 is rotatable for use with both right and left sided approaches to a patient's disc space.

11. 11. The internal fixation system of claim 10, wherein the second arm 240 includes a second annular groove 241 formed in one end thereof, and the posterior distractor rack assembly 120 includes a rack hub 242 having a second spring lever assembly 227 having a second upper cam lever 248, a second lower cam lever 250, and a second cam pin 252 configured to connect the second upper cam lever 248 and the second lower cam lever 250 on each opposing surface of the rack hub 242 through second cam holes 254 formed therein.

12. 12. The internal fixation system of claim 11, wherein the second cam pin 252 is configured to engage the second groove 241 of the second arm 240 when inserted into the second cavity 244, and rotation of the second upper cam lever 248 and the lower cam lever 250 causes rotation of the second cam pin 252 and inward movement of the second arm 240 into the second cavity 244, which in turn releasably engages the fourth plurality of teeth 247 of the first pivot tube subassembly 136 with the third plurality of teeth 245 and locks the first pivot tube subassembly 136 to the rack hub 242, thereby allowing the angle between the first pivot tube 262 and the second pivot tube 162 to be further adjustable to correspond to a pedicle screw angle and thereby allowing the compressor / distractor 114 to be further rotated for use with both right and left sided approaches to the patient's disc space.

13. 5. The internal fixation system of claim 4, wherein the pinion assembly includes a knob, a post depending from the knob, and a gear having a ridge circumferentially engaging the post and meshing with the ridge of the rack, and the posterior distractor mounting assembly includes a hole sized to receive the post and gear of the pinion assembly therein.

14. 1. An internal fixation system for a spinal procedure on a patient, comprising: a lateral lumbar interbody fusion (LLIF) retractor 116 having a LLIF retractor adapter 118; A posterior compression / distractor 114, a posterior distractor rack assembly 120 including a rack 126 having a plurality of ridges 126a on at least one surface; a posterior distractor mount assembly 122 configured for operative engagement with the posterior distractor rack assembly 120 and including an opening 130 configured to receive the rack 126 therethrough; and a pinion assembly 124 configured to operatively engage the posterior distractor rack assembly 120 and the posterior distractor mount assembly 122; and a posterior compression / distractor 114 comprising: An internal fixation system whereby the posterior distractor rack assembly 120 and the posterior distractor mounting assembly 122 are movable relative to one another.

15. 15. The internal fixation system of claim 14, wherein the posterior distractor rack assembly includes a first swivel tube subassembly having a first swivel tube, the posterior distractor mounting assembly includes a second swivel tube subassembly having a second swivel tube, the first and second swivel tubes each configured to receive a pedicle screw and a screw tower therein, and the first swivel tube subassembly and the second swivel tube subassembly are configured to be moved and positioned relative to one another.

16. The second swirl tube subassembly 138 has a first arm 140 extending therefrom and a mounting hub 142 including a first cavity 144 configured to receive the first arm 140 therein, the first cavity 144 including a first opening 144a surrounded by a first annular end 143 having a first plurality of teeth 145 extending therefrom, the second swirl tube subassembly 138 including a second plurality of teeth 147 adjacent and surrounding the arm 140, the second plurality of teeth 147 being 16. The internal fixation system of claim 15, wherein the first and second pivot tube subassembly 138 are configured to releasably engage the first plurality of teeth 145 such that the second pivot tube subassembly 138 can be releasably locked to the first mounting hub 142, the angle between the first and second pivot tubes 262, 162 can be adjusted to correspond to a pedicle screw angle, and the compressor / distractor 114 can be rotated for use with both right and left sided approaches to a patient's disc space.

17. The first swirl tube subassembly 136 has a second arm 240 extending therefrom and a rack hub 242 including a second cavity 244 configured to receive the second arm 240 therein, the second cavity 244 including a second opening 244a surrounded by a second annular end 243 having a third plurality of tines 245 extending therefrom, the first swirl tube subassembly 136 including a fourth plurality of tines 247 adjacent and surrounding the arm 240, the fourth plurality of tines 247 being configured to 17. The internal fixation system of claim 16, wherein the first pivot tube subassembly 136 is configured to releasably engage with a third plurality of teeth 245, thereby allowing the first pivot tube subassembly 136 to be releasably locked to the rack hub 242, allowing the angle between the first pivot tube 262 and the second pivot tube 162 to be further adjusted to correspond to a pedicle screw angle, and allowing the compressor / distractor 114 to be further rotated for use with both right and left sided approaches to the patient's disc space.

18. 15. The internal fixation system of claim 14, wherein the pinion assembly includes a knob 132, a post 135 depending from the knob 132, and a gear 134 circumferentially engaging the post 135 and having a ridge 134a that meshes with the ridge 126a of the rack 126, and the posterior distractor mounting assembly 122 includes a hole 129 sized to receive the post 135 and the gear 134 of the pinion assembly 124 therein.

19. 1. An internal fixation system for a spinal procedure on a patient, comprising: at least two cannulated pedicle screws 52, 54 insertable through respective pedicles of the patient's spine; a distraction frame 20 configured to operably connect the at least two cannulated screws to one another; and means for attaching said internal fixation system to a surgical table.

20. The internal fixation system of claim 19, further comprising at least two screw towers 62, 64 configured for releasable engagement with respective said cannulated pedicle screws.

Images