Integral appliance assembly

Abstract

Systems, devices, and methods for performing minimally invasive spinal procedures are described herein. The systems, devices, and methods can be used to access the spinal canal percutaneously and perform spinal procedures at multiple locations along the spinal canal, for example, bilaterally and / or at multiple levels from a single access point. The systems and devices integrate various instruments for performing the procedure and can thus improve their ease of use, reduce the complexity of the procedure, and minimize the procedure time.

Description

Technical Field

[0001] This application generally relates to minimally invasive systems for accessing and treating the spinal canal. The system can include an integrated device that combines various instruments used to perform spinal procedures. Methods of treating spinal pathologies, such as spinal stenosis, using the system and the integrated device are also described herein.

[0002] [Cross - Reference to Related Applications] This application claims priority to U.S. Provisional Patent Application No. 63 / 352,997, filed on June 16, 2022, the entire contents of which are incorporated herein by reference.

Background Art

[0003] Spinal stenosis is a condition that can occur when the spinal canal narrows and compresses the spinal cord or associated nerve roots. This condition can have various etiologies. For example, spinal stenosis may be caused by spinal degeneration, which often occurs with aging, but can also be due to intervertebral disc herniation, osteoporosis, cancerous growths, or congenital conditions. Spinal stenosis can also be caused by subluxation, facet joint hypertrophy, osteophyte formation, hypoplasia of the spinal canal, degenerative spondylosis, degenerated intervertebral discs, degenerative spondylolisthesis, osteoarthritis, ossification of the spinal accessory ligaments, or hypertrophy of the ligamentum flavum. A less common cause of spinal stenosis, which typically affects patients with morbid obesity or those taking oral corticosteroids, is excessive fat in the epidural space. Excessive epidural fat compresses the dural sac, nerve roots, and the blood vessels contained therein, often resulting in back pain and leg pain, or weakness and paralysis of the legs.

[0004] Spinal stenosis can affect the cervical, thoracic, or lumbar regions of the spine. In some cases, spinal stenosis may be present in all three regions. Lumbar spinal stenosis can cause low back pain, abnormal sensations in the legs or buttocks, and loss of bladder or bowel control. Patients suffering from spinal stenosis can typically be initially treated with physical therapy, pain medications, or anti-inflammatory drugs. If these conservative treatment options fail, surgery may be required to decompress the spinal cord or nerve roots.

[0005] Conventional surgical procedures for correcting stenosis in the lumbar region generally require creating a large incision in the patient's back. Next, the muscles and other supporting structures are stripped away from the spine to expose the posterior aspect of the spinal column. In many cases, in the lamina, a portion of the vertebral arch can then be removed (laminectomy or laminotomy). This procedure is usually performed under general anesthesia. The patient may be hospitalized for approximately 5 to 7 days, depending on the patient's age and overall condition. Thereafter, the patient often requires 6 weeks to 3 months to recover from the procedure. Additionally, many patients require long-term therapy in a rehabilitation facility to regain sufficient mobility to live independently.

[0006] When spinal stenosis is caused by compression of the intervertebral foramen, the passage between the vertebrae through which the nerve passes laterally from the spinal cord to the body becomes narrow. Compression of the foramen is often due to the formation of unwanted bone, ligament, or scar tissue in the passage. Foraminotomy can relieve the symptoms of nerve compression caused by constriction of the foramen, but typically involves making an incision in the patient's back, then dissecting the muscles to expose the underlying bone and creating a small hole in the vertebra. An arthroscope can be used to visualize the foramen through this hole and remove the impinging bone or disc material. Much of the pain and physical impairment after foraminotomy or laminectomy is due to the disruption and cutting of the back muscles, blood vessels, supporting ligaments, and nerves. Also, since the back muscles and ligaments that stabilize the spine are stripped away and removed from the spine, these patients often develop spinal instability after surgery.

[0007] Minimally invasive techniques, such as percutaneous techniques, generally offer the potential for less postoperative pain and faster recovery compared to conventional open surgeries. For example, percutaneous spinal procedures can be performed using local anesthesia, thus sparing the patient the risks and recovery time required with general anesthesia. Additionally, minimally invasive techniques can be used to reduce damage to the paraspinal muscles and ligaments, thereby reducing pain and damage caused to stabilizing structures.

[0008] A variety of techniques for minimally invasive treatment of the spine have been developed. For example, microdiscectomy is one technique that involves making small incisions in the skin and deep tissues to form a portal to the spine. A microscope is then used to assist in dissection of adjacent structures prior to discectomy. The recovery time for this procedure is much shorter than that of conventional open discectomy, but this technique is not relevant for the treatment of other spinal disorders such as spinal stenosis. Arthroscopic methods using optical catheters have also been proposed for treating spinal stenosis. These devices and techniques are limited by the small size of the spinal canal, and thus the surgery can generally be difficult to perform and acquire.

[0009] Accordingly, it is useful to have other systems, devices, and methods for performing minimally invasive spinal procedures. It is also beneficial to have systems and methods for percutaneously accessing the spinal canal from a single access point and performing spinal procedures at multiple locations along the spinal canal, such as bilaterally and / or at multiple levels. Systems and devices that integrate the instruments for performing the procedure are also useful for improving ease of use, reducing the complexity of the procedure, and minimizing the procedure time. SUMMARY OF THE INVENTION

[0010] The systems and devices described herein can generally be used to access the spinal canal percutaneously and perform minimally invasive procedures on the spinal canal and / or surrounding tissue. For example, the systems and devices can be used to perform a lumbar decompression procedure percutaneously. Instead of providing an instrument kit having a plurality of separate devices and / or system components (e.g., stabilization elements) that require assembly prior to use, the system can, as described above, include an assembly that combines two or more of these devices and / or system components to improve ease of use, reduce the complexity of the procedure, and minimize the procedure time. For example, one or more of the stabilization elements such as a portal cannula, trocar, depth guide, bone auger, and portal grip can be removably coupled together to form an integrated assembly (e.g., slidably attached and / or attached via snap fit, press fit, threaded connector, and / or other types of mechanical connectors). The terms "integrated assembly" and "integrated device" are used synonymously herein when used in this specification.

[0011] The one-piece assembly can include a portal grip slidably attached to the portal cannula. The portal grip can be configured to seat against the skin surface and lock at a position along the length of the portal cannula. When locked, the portal grip can prevent further advancement of the portal cannula into the body or provide resistance thereto. Once the target depth of the portal cannula is set, a working instrument can be advanced through the portal cannula. Examples of working instruments can include manual mechanical grasping instruments such as bone augers, bone forceps, mechanical scooping devices such as tissue sculptors, electromechanical instruments such as grinders and drills, and light guidance and / or visualization devices. Other examples of working instruments can include electrical, magnetic, electromagnetic, vibration, sound, and kinetic energy delivery elements such as RF probes, ultrasonic probes, and energy delivery wires. In some instances, the working instrument can use fluid flow to modify tissue. The portal grip can also function as a fulcrum for the portal cannula.

[0012] Generally, the system for minimally invasive spinal surgery described herein can include a portal cannula having a proximal end and an outer surface. A portal grip with a housing can be slidably attached to the portal cannula. The housing of the portal grip can include a lumen and a locking assembly configured to releasably secure the portal grip at one or more positions along the length of the portal cannula. In other words, the portal grip can include a mechanism that mechanically engages with the outer surface of the cannula and / or other components of the one-piece assembly to prevent or substantially reduce axial movement of the portal grip along the cannula. The mechanical engagement can be reversible to allow adjustment as needed.

[0013] The portal grip can be configured in various ways so that it can be releasably fixed to the portal cannula. For example, at least a portion of the portal grip can be configured to rotate to releasably fix the portal grip to the portal cannula. In this case, a portion of the housing can be spherical. In other cases, the housing may include a first component coupled to a second component, and the first component can rotate relative to the second component and be configured to releasably fix the portal grip at one or more positions along the length of the portal cannula. Coupling the first component to the second component can be achieved via a threaded connection.

[0014] The locking assembly housed within the portal grip housing can also have various configurations. The locking assembly can generally be configured to be used with one hand. In addition, the locking assembly can be configured to maintain the position of the portal grip along the length of the portal cannula upon exposure of the portal cannula to fatty lipids or body fluids.

[0015] In some variations, the locking assembly can include a collet disposed concentrically around the portal cannula. The collet can be configured to compress against the outer surface of the portal cannula to prevent movement of the portal grip along the length of the portal cannula. Some variations of the collet can include a plurality of fingers spaced around the outer perimeter of the collet. The plurality of fingers can include from 2 to 6 fingers. For example, the plurality of fingers can include 2, 3, 4, 5, or 6 fingers. In some variations, it may be beneficial for the collet to include 3 fingers or 6 fingers. The plurality of fingers can be spaced symmetrically or asymmetrically around the outer perimeter of the collet.

[0016] Alternatively, the locking assembly can have a helical cam. The helical cam can be configured to tighten around the outer surface of the portal cannula to prevent movement of the portal grip along the length of the portal cannula. The toggle can be coupled to the helical cam to assist in tightening the helical cam around the outer surface of the portal cannula.

[0017] Locking of the portal grip to the portal cannula can also be achieved using a portal grip housing configured to rotate to axially align with the portal cannula. In this variation, axial alignment of the housing and the portal cannula displaces a cam rider to releasably secure the portal grip at one or more positions along the length of the portal cannula.

[0018] Instead of providing an instrument kit having a plurality of separate devices, the system described herein can include an assembly that integrates one or more kit components. The kit components can be removably coupled together, for example, by being slidably attached and / or by being attached via snap fits, interference fits, threaded connectors, and / or other types of mechanical connectors. The kit components can also be removably coupled together, for example, by magnetic forces or adhesive forces. For example, the portal cannula can be removably coupled to one or more system components. The one or more system components can include a trocar having a handle. In some variations, the proximal end of the portal cannula can include a hub having at least one fin configured to limit advancement of the trocar when the trocar is releasably coupled to the portal cannula. In other variations, the hub can be enlarged to limit advancement of the trocar when the trocar is releasably coupled to the portal cannula.

[0019] One or more system components can also include a depth guide having a proximal end and a distal end. The distal end of the depth guide may be removably coupled to the hub of the portal cannula by a tab locking feature, and the trocar handle may be removably coupled to the hub by a threaded connection. Rotation of a knob on the depth guide can provide feedback regarding the insertion depth of the working instrument.

[0020] In some variations, a system comprising an integrated instrument assembly includes a portal cannula having a proximal end and a portal grip slidably attached to the portal cannula and comprising a housing, the portal grip comprising a locking assembly configured to releasably secure the portal grip at one or more positions along the length of the portal cannula. The integrated assembly can also include a trocar removably coupled to the portal cannula and a depth guide removably coupled to the portal cannula. The proximal end of the portal cannula can include a hub configured to limit the advancement of the trocar when the trocar is releasably coupled to the portal cannula. Additionally, the depth guide can provide tactile feedback when configuring the insertion depth of one or more working instruments and / or other instruments.

[0021] Access devices for minimally invasive procedures or surgeries that include a collet as part of a retention assembly are also described herein. These access devices can include a portal cannula and a portal grip housing, and the portal grip housing can accommodate the collet. The portal grip can be slidably attached to the portal cannula. As described above, the collet can be concentrically disposed around the portal grip lumen within the housing and can have a release configuration and a retention configuration. In the retention configuration, the collet can fix the portal grip at one or more positions along the length of the portal cannula. The collet can transition from the release configuration to the retention configuration by compressing the collet against the outer surface of the portal cannula. The collet can include a plurality of fingers spaced apart around the outer periphery of the collet. The plurality of fingers can include from two to six fingers. For example, the plurality of fingers can include two, three, four, five, or six fingers. In some variations, it may be beneficial for the collet to include three or six fingers. There may also be some instances where more than six fingers are used. The plurality of fingers can be spaced symmetrically or asymmetrically around the outer periphery of the collet.

[0022] A method of accessing a patient's spinal region is also described herein. The method generally comprises percutaneously introducing a portal cannula into the spinal region, the portal cannula comprising a distal tip and a portal grip slidably attached to the portal cannula, and advancing the distal tip of the portal cannula to a target depth within the spinal region. Upon reaching the target depth, the method can further comprise sliding the portal grip along the portal cannula so as to contact the patient's skin surface, and locking the portal grip at a position on the cannula, thereby bracing the distal tip of the portal cannula at the target depth. The locking position of the portal grip can be maintained along the length of the portal cannula upon exposure to fatty lipids or body fluids, thereby increasing the lubricity of the portal cannula surface. Once the portal cannula is introduced, a trocar can be placed within the portal cannula and used to assist access to the spinal region. Upon reaching the target depth, the trocar can be removed and an operating instrument advanced through the portal cannula.

[0023] The portal grip can include a housing, and rotation of at least a portion of the housing can lock the position of the portal grip on the cannula. If a portion of the housing is spherical, the housing can include a first component coupled to a second component. In this case, locking the portal grip can include rotating the first component relative to the second component. In other cases, locking the portal grip can include rotating the housing so as to axially align the housing with the portal cannula.

[0024] When the portal grip includes a locking assembly, the locking assembly can comprise a collet arranged concentrically around the portal cannula, and locking the portal grip can include compressing the collet against the outer surface of the portal cannula. Instead of a collet, the locking assembly can include a helical cam that generally effects locking of the portal grip by tightening the helical cam around the outer surface of the portal cannula.

[0025] The methods described herein can further include unlocking the portal grip from the portal cannula. Unlocking can be accomplished in a variety of ways. For example, unlocking can be achieved by rotating at least a portion of the housing or by rotating the housing out of axial alignment with the portal cannula. Once unlocked, the portal grip can be slidably advanced or retracted along the portal cannula to a second position and then locked to the portal cannula at the second position. Locking and unlocking of the portal grip position can be achieved using one hand.

[0026] In some variations, the method can include removably coupling the portal cannula to one or more system components. The one or more system components can be a trocar, a portal grip, or a depth guide. When a depth guide is used, the method can include receiving feedback, such as tactile feedback, when using the depth guide to confirm insertion depth. Coupling of the portal cannula to one or more system components can be achieved in a variety of ways. For example, the proximal end of the portal cannula can be releasably coupled to the trocar by a threaded hub. In some instances, the proximal end of the portal cannula can be releasably coupled to the trocar by one or more magnets. Additionally or alternatively, the hub can include an outer ring that limits advancement of the trocar.

[0027] This method can be used to perform various spinal procedures. For example, the method can be used to remove a portion of other hard and / or soft tissue that exerts pressure on the patient's ligamentum flavum and / or nerves, to treat spinal stenosis, and / or to perform a laminectomy. When percutaneous access to the spinal region is obtained using the system described herein, the instrument can be advanced through the lumen of the portal cannula to perform the procedure. For example, a bone awl, bone forceps, and / or tissue sculptor can be deployed through the lumen. The method can further include accessing the spinal canal percutaneously and performing spinal procedures at multiple locations along the spinal canal, for example, at both sides and / or multiple levels, from a single access point.

Brief Description of the Drawings

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DETAILED DESCRIPTION OF THE INVENTION

[0029] Described herein are systems and devices that can be used to access the spinal canal percutaneously and perform minimally invasive procedures on the spinal canal and / or surrounding tissue. The system, as described above, may include an assembly that integrates two or more devices of a surgical instrument kit into a single assembly to improve ease of use, reduce the complexity of the procedure, and minimize the procedure time. In some variations, the integrated assembly combines two or more devices or system components used to access the spinal region. For example, one or more of a portal cannula, trocar, depth guide, and stabilization element (e.g., portal grip) may be removably coupled together (e.g., slidably attached and / or attached via snap fit, interference fit, threaded connector, magnetic, and / or other types of mechanical connectors) to form the integrated assembly. The stabilization element (e.g., portal grip) may be configured to provide a fulcrum for the portal cannula and prevent or provide resistance to further advancement of the portal cannula into the body. Once the target depth of the portal cannula is set, working instruments such as a bone auger, bone forceps, tissue sculptor, etc. can be advanced through the portal cannula.

[0030] <System> Generally, a system for minimally invasive spinal surgery as described herein can include an integrated device used to access the spinal region percutaneously. The integrated device can include a portal cannula having a proximal end, a distal end, and an outer surface. Additionally, the integrated device can include a stabilization element, such as a portal grip, having a housing slidably attached to the portal cannula. The housing of the portal grip can include a lumen and a locking assembly configured to releasably secure the portal grip at one or more positions along the length of the portal cannula. The integrated device can further include a trocar and a depth guide. For example, referring to FIGS. 1A and 1B, the system can include an integrated device 100 generally including a portal cannula 102, a portal grip 104, a trocar 106 having a handle 108, and a depth guide 110. FIG. 1A shows a perspective view of the integrated device 100. In FIG. 1B, an exploded view of the integrated device 100 is provided to show a portion of the trocar 106 disposed within the portal cannula 102 and a depth guide 110 that can be disposed at least partially within the trocar handle 108.

[0031] [Portal Cannula] The portal cannula can be a conduit through which a working instrument, such as a bone auger, bone forceps, or tissue sculptor, can be advanced to perform a spinal procedure. The portal cannula can also be a conduit through which a trocar can be slidably disposed when accessing the spinal region percutaneously, as shown in FIGS. 1A and 1B. The portal cannula can have a proximal end, a distal end, and an outer surface. The lumen can extend within the portal cannula from the proximal end to the distal end. Additionally, the portal cannula can be capable of creating a single access point through which a working instrument can be advanced to perform a spinal procedure, such as lumbar decompression. In some variations, lumbar decompression and other spinal procedures can be performed unilaterally, bilaterally, and / or at multiple levels through a single access point.

[0032] The portal cannula can be made of stainless steel, nitinol, or an alloy thereof. In some variations, the portal cannula can include a hypo tube. The coating can be disposed on the outer cannula surface and can provide the cannula with anti-fouling and / or antibacterial properties. The coating can generally include a polymeric material. Exemplary polymeric materials include, but are not limited to, hydrophilic polymers, hydrophobic polymers, and mixtures of these two types of polymers.

[0033] The working length of the portal cannula can vary depending on factors such as the specific spinal procedure being performed, the size of the patient, and / or the age of the patient, and can range from about 6 cm to about 20 cm, including all values and sub-ranges within that range. For example, the working length of the portal cannula can be about 6 cm, about 7 cm, about 8 cm, about 9 cm, about 10 cm, about 11 cm, about 12 cm, about 13 cm, about 14 cm, about 15 cm, about 16 cm, about 17 cm, about 18 cm, about 19 cm, or about 20 cm. If a greater length is required, the working length of the portal cannula can range from about 21 cm to about 35 cm, including all values and sub-ranges within that range. For example, the working length of the portal cannula can be about 21 cm, about 22 cm, about 23 cm, about 24 cm, about 25 cm, about 26 cm, about 27 cm, about 28 cm, about 29 cm, about 30 cm, about 31 cm, about 32 cm, about 33 cm, about 34 cm, or about 35 cm. Accordingly, the portal cannula can have an overall length in the range of about 6 cm to about 35 cm, including all values and sub-ranges within that range. For example, the overall length of the portal cannula can be about 6 cm, about 7 cm, about 8 cm, about 9 cm, about 10 cm, about 11 cm, about 12 cm, about 13 cm, about 14 cm, about 15 cm, about 16 cm, about 17 cm, about 18 cm, about 19 cm, about 20 cm, about 21 cm, about 22 cm, about 23 cm, about 24 cm, about 25 cm, about 26 cm, about 27 cm, about 28 cm, about 29 cm, about 30 cm, about 31 cm, about 32 cm, about 33 cm, about 34 cm, or about 35 cm.

[0034] Similarly, the outer diameter (OD) and inner diameter (ID) of the portal cannula can vary depending on factors such as the specific spinal procedure being performed, the size of the patient, and / or the age of the patient. The portal cannula may have an OD in the range of about 1.0 mm to about 30 mm, and an ID in the range of about 0.5 mm to about 29.5 mm, including all values and sub-ranges within that range. For example, the OD can be about 1.0 mm, about 1.5 mm, about 2.0 mm, about 2.5 mm, about 3.0 mm, about 3.5 mm, about 4.0 mm, about 4.5 mm, about 5.0 mm, about 5.1 mm, about 5.2 mm, about 5.3 mm, about 5.4 mm, about 5.5 mm, about 5.6 mm, about 5.7 mm, about 5.8 mm, about 5.9 mm, about 6.0 mm, about 7.0 mm, about 8.0 mm, about 9.0 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, about 16 mm, about 17 mm, about 18 mm, about 19 mm, about 20 mm, about 21 mm, about 22 mm, about 23 mm, about 24 mm, about 25 mm, about 26 mm, about 27 mm, about 28 mm, about 29 mm, or about 30 mm. The ID can be about 0.5 mm, about 1.0 mm, about 1.5 mm, about 2.0 mm, about 2.5 mm, about 3.0 mm, about 3.5 mm, about 4.0 mm, about 4.1 mm, about 4.2 mm, about 4.3 mm, about 4.4 mm, about 4.5 mm, about 4.6 mm, about 4.7 mm, about 4.8 mm, about 4.9 mm, about 5.0 mm, about 5.5 mm, about 6.0 mm, about 6.5 mm, about 7.0 mm, about 7.5 mm, about 8.0 mm, about 8.5 mm, about 9.0 mm, about 9.5 mm, about 10 mm, about 10.5 mm, about 11 mm, about 11.5 mm, about 12 mm, about 12.5 mm, about 13 mm, about 13.5 mm, about 14 mm, about 14.5 mm, about 15 mm, about 15.5 mm, about 16 mm, about 16.5 mm, about 17 mm, about 17.5 mm, about 18 mm, about 18.5 mm, about 19 mm, about 19.5 mm, about 20 mm, about 20.5 mm, about 21 mm, about 21.5 mm, about 22 mm, about 22.5 mm, about 23 mm, about 23.5 mm, about 24 mm, about 24.5 mm, about 25 mm, about 25.5 mm, about 26 mm, about 26.5 mm, about 27 mm, about 27.5 mm, about 28 mm, about 28.5 mm, about 29 mm, or about 29.5 mm.In one variant, OD can be about 5.2 mm (0.203 inches) and ID can be about 4.7 mm (0.184 inches).

[0035] The hub can be coupled or fixed to the proximal end of the portal cannula by any suitable method, for example, using a friction fit or an adhesive. In some variants, the hub can be overmolded onto the proximal end of the cannula. The hub can be made from a variety of polymeric materials or metallic materials. Exemplary polymeric materials include, but are not limited to, acrylonitrile butadiene styrene (ABS), polycarbonate, or an ABS / polycarbonate blend. Non-limiting examples of metals from which the hub can be made include stainless steel, nitinol, and alloys thereof.

[0036] The hub can include one or more features configured to limit the movement of the trocar relative to the portal cannula. Limiting the movement can be a useful safety feature when the depth guide is removed to increase the working length of the instrument (e.g., when a surgeon treats multiple spinal levels) and cannot be reattached before inserting the trocar to treat the next level. In this case, the hub can limit the advancement of the trocar, such that its penetrating tip does not damage non-target anatomical structures.

[0037] For example, the size and / or shape of the hub can provide a surface against which the trocar handle contacts to prevent further advancement of the trocar through the portal cannula. In these cases, the diameter of at least a portion of the hub can be made larger than the diameter of the distal portion of the trocar handle to create an interference fit with the trocar handle such that the movement of the trocar is restricted.

[0038] In addition to having a diameter larger than the distal portion of the trocar handle, the hub can be of various shapes. For example, the cross-sectional shape of the hub can be circular, hexagonal, or square. In some variations, the hub can include a body and a plurality of fins that extend radially outward from the body and limit the advancement of the trocar. The number of fins can range from two to six. For example, the hub can include two, three, four, five, or six fins. In some variations, more than six fins can be included. The plurality of fins can also be at various angles with respect to the hub body. Each of the plurality of fins may have the same angle with respect to the hub body, or one or more of the fins may have an angle different from one or more of the other fins. Further, the plurality of fins can be spaced symmetrically or asymmetrically around the hub body. Each of the plurality of fins can also have any length suitable for creating an interference fit with the trocar handle so that the movement of the trocar is restricted, and each of the plurality of fins can have the same or different lengths.

[0039] Referring to FIGS. 2-4, an exemplary portal cannula is shown that includes a hub having various configurations at its proximal end. The hub can include a body and one or more additional structures configured to limit the movement of the trocar. In FIG. 2(A), the portal cannula includes a cannula 200 and a hub 202 coupled to the proximal end 206 of the cannula 200 having a hexagonal cross-sectional shape. The hexagonal cross-sectional shape is better shown in the end view provided in FIG. 2(B). Alternatively, as shown in FIGS. 3(A) and (B), the hub 302 at the proximal end 306 of the cannula 300 can have a base 308 with a plurality of fins 304 extending outwardly. Although the base 308 is shown as having a hexagonal shape, it is understood that other shapes may be used. Similarly, although the base 308 is shown as having three fins 304, any suitable number of fins can be used. In a further variation, as shown in FIGS. 4(A) and (B), the hub 402 at the proximal end 406 of the cannula 400 may have a circular cross-sectional shape. A ring 404 extending circumferentially around the circular hub 402 can function as a stop to limit further movement (e.g., advancement) of the trocar.

[0040] [Portal Grip] The portal grip can be configured to hold the portal cannula and can be slidably attached to the portal cannula. In use, the portal grip can be slid along the length of the portal cannula to seat it against the skin surface and to a position that provides the target cannula length within the body. The portal grip can be locked in this position to prevent further advancement of the portal cannula into the body or to provide resistance thereto. Once the target depth of the portal cannula is set, working instruments such as a bone auger, bone forceps, tissue sculptor, etc. can be advanced through the portal cannula.

[0041] The portal grip can also function as a fulcrum for the portal cannula and, thus, can be configured to perform smooth operations (e.g., rotation) with respect to the skin surface when moving the working instrument and positioning it between the laminae. Accordingly, some variations of the portal grip can be configured to include a housing having at least a portion shaped as a sphere so that the portal grip is non-traumatic during pivoting or other movement relative to the skin. For housings having other shapes, such as square or rectangular shapes, the corners can be rounded so as to prevent damage to the skin surface. The housing of the portal grip can also include a lumen and a locking assembly configured to releasably secure the portal grip at one or more positions along the length of the portal cannula.

[0042] When the housing of the portal grip has at least a portion formed as a sphere, the housing can comprise a ball structure having a waist region. The ball structure can include a first component coupled to a second component that includes the waist region. The waist region can include an intermediate portion having a diameter smaller than the diameters at both ends of the waist region, giving the waist region an hourglass-like outer profile. The proximal end of the waist region can be configured to couple to a depth guide. The hourglass shape of the waist region can accommodate various hand positions, provide a pinky rest for comfort, and allow access to the depth guide by the thumb and index finger when the working instrument is in use. Additionally, the smaller diameter portion of the waist region can serve to fix the position of the portal grip along the portal cannula.

[0043] The hemispheres of the ball structure can have a diameter in the range of about 0.1 cm to about 10 cm, including all values and sub-ranges within that range. For example, the diameter of the ball structure can be about 0.1 cm, about 0.5 cm, about 1.0 cm, about 1.5 cm, about 2.0 cm, about 2.5 cm, about 3.0 cm, about 3.5 cm, about 4.0 cm, about 4.5 cm, about 5.0 cm, about 5.5 cm, about 6.0 cm, about 6.5 cm, about 7.0 cm, about 7.5 cm, about 8.0 cm, about 8.5 cm, about 9.0 cm, about 9.5 cm, or about 10 cm. In some variations, for example, when the portal cannula has a larger diameter, the diameter of the ball structure can be greater than 10 cm. As described above, the waist region of the ball structure can include an intermediate portion having a diameter smaller than that of its two ends. The ends of the waist region may have a diameter that coincides with the diameter of the ball structure and can thus be in the range of about 1.0 cm to about 10 cm, including all values and sub-ranges within that range. For example, the end diameter can be about 1.0 cm, about 1.5 cm, about 2.0 cm, about 2.5 cm, about 3.0 cm, about 3.5 cm, about 4.0 cm, about 4.5 cm, about 5.0 cm, about 5.5 cm, about 6.0 cm, about 6.5 cm, about 7.0 cm, about 7.5 cm, about 8.0 cm, about 8.5 cm, about 9.0 cm, about 9.5 cm, or about 10 cm. In some cases, the diameter of one or both ends of the waist region may be smaller than the diameter of the ball structure. The intermediate portion of the waist region is smaller and can have a diameter, for example, about half of the diameter of the ball structure, in the range of about 0.5 cm to about 5.0 cm, including all values and sub-ranges within that range. For example, the diameter of the intermediate portion can be about 0.5 cm, about 1.0 cm, about 1.5 cm, about 2.0 cm, about 2.5 cm, about 3.0 cm, about 3.5 cm, about 4.0 cm, about 4.5 cm, or about 5.0 cm.

[0044] The components of the portal grip can be made of the same material or different materials. For example, in some variations, the components of the portal grip may be made of a polymer and / or a metal and can include them in other ways. Exemplary polymers include, but are not limited to, acrylonitrile butadiene styrene (ABS), polycarbonate, polycarbonate / ABS blends, and copolymers thereof. When a metal is employed, the metal can be, for example, stainless steel, nitinol, and alloys thereof.

[0045] The portal grip can be configured in various ways so that it can be releasably fixed to the portal cannula. For example, at least a portion of the portal grip can be configured to rotate to releasably fix the portal grip to the portal cannula. In this case, a housing having a partially spherical shape may be useful. The housing may include a first component that is coupled to a second component, and the first component can rotate relative to the second component and be configured to releasably fix the portal grip at one or more positions along the length of the portal cannula. Coupling the first component to the second component can be achieved, for example, via a screw connection.

[0046] Referring to FIGS. 5A and 5B, the portal grip 502 of the integrated device 500 can include a ball structure 504 that includes a first component 506, a second component 508, and a waist region 510. The waist region 510 can include a first end 512, a second end 514, and an intermediate portion 516 of smaller diameter therebetween. In some cases, the first end may be the distal end of the waist region, having a diameter larger than the intermediate portion of smaller diameter but larger than the second end, which may be the proximal end of the waist region. The portal grip 502 can be slidably advanced along the portal cannula 520 to a position where it is seated against the skin surface 522. The portal grip 502 can be locked in this position and function as a fulcrum for the portal cannula 520, as further described below. In some variations, the second end of the waist region can include a plurality of ribs or other surface features (e.g., protrusions, bristles, texturing) that assist the user in gripping the second component and rotating it relative to the first component. For example, as shown in FIG. 5C, the second end 514 of the waist region 510 can be configured to include a plurality of ribs 524 that can assist the user in rotating the second component 508 relative to the first component 506 around the portal cannula 520. FIG. 5D provides a cross-sectional view of the portal grip shown in FIG. 5C, and this portal grip includes a collet 526, which is described in more detail below, that is concentrically arranged around the portal cannula 520, conforms to the outer surface of this portal cannula 520, compresses against this outer surface, and prevents movement of the portal grip 502 along the length of the portal cannula 520.

[0047] [Locking Assembly] The portal grip can include a housing that houses a locking assembly for releasably securing the portal grip to the portal cannula at one or more locations. Generally, the portal grip can be locked to the portal cannula at a location where the portal grip contacts the skin surface so that the portal grip can function as a fulcrum for the portal cannula. Additionally, the locking assembly can be configured to maintain the position of the portal grip along the length of the portal cannula, regardless of additional lubricity from exposure to adipose lipids or body fluids. The locking assembly can have various configurations and generally can be configured to be used with one hand.

[0048] In some variations, the locking assembly can include a collet configured to be disposed concentrically around the portal cannula. The collet can be configured to conform to and compress against the outer surface of the portal cannula to prevent movement of the portal grip along the length of the portal cannula. The collet can be made of, for example, a polymeric material. Non-limiting examples of polymeric materials include acrylonitrile butadiene styrene (ABS), polycarbonate, polycarbonate / ABS blends, and copolymers thereof.

[0049] In one variant, the collet is circumferentially arranged around the portal cannula, and the first portal grip component and the second portal grip component can be configured to compress against the outer surface of the cannula when rotated, for example, in a right-handed thread (rotated clockwise to tighten and counterclockwise to loosen). The ramps provided within one or both of the portal grip hemispheres can assist in collet compression. For example, referring to FIGS. 6A - 6C, the portal grip 600 can have a first component such as the proximal hemisphere 602 that includes a ramp 604 coupled to a second component such as the distal hemisphere 606 via a threaded connection 608. A clockwise rotation of the proximal hemisphere 602 relative to the distal hemisphere 606, as indicated by arrow 610, can axially translate the two hemispheres 602, 606 towards each other, as indicated by arrow 612. This axial translation can result in a ramp 604 that compresses the collet 614 circumferentially arranged around the portal cannula 618 within the portal grip lumen 603 against the outer surface 616 of the portal cannula 618, as indicated by arrow 620. As further engagement with the ramp 604 is achieved, the compression of the collet 614 against the portal cannula outer surface 616 can be increased, thereby temporarily locking the position of the portal grip 600 on the portal cannula 618.

[0050] In another variant, the locking assembly can comprise a collet having a plurality of fingers spaced apart around the outer periphery of the collet. The plurality of fingers can include from 2 to 6 fingers. For example, the plurality of fingers can include 2, 3, 4, 5, or 6 fingers. In some cases, the collet can include more than 6 fingers (e.g., 7, 8, 9, 10, or more fingers). The plurality of fingers are separated by channels and can be symmetrically or asymmetrically spaced around the outer periphery of the collet. In some variants, the collet comprises 3 fingers spaced 120 degrees apart around the outer periphery of the collet and 3 channels similarly spaced 120 degrees apart. The channels can provide a space for the collet to compress against the portal cannula. Further, the channels can include an open end and a closed end. The open ends of adjacent channels can be on opposite sides of the collet.

[0051] The length of the fingers can generally be the same as the length of the collet, which can be in the range of about 8 mm to about 20 mm, including all values and sub-ranges within that range. For example, the finger length can be about 8 mm, about 9 mm, about 10 mm, about 11 mm, about 12 mm, about 13 mm, about 14 mm, about 15 mm, about 16 mm, about 17 mm, about 18 mm, about 19 mm, or about 20 mm. In one variant, the finger length can be about 9 mm. In some variants, the length of the fingers can be shorter than the length of the channels. In some cases, the length of the fingers can be longer than 20 mm.

[0052] Referring to FIGS. 7A and 7B, the collet 700 can include a first end 706, a second end 708, and a plurality of fingers 702 separated by a plurality of channels 704. Each of the plurality of channels 704 has an open end 710 and a closed end 712. The open ends 710 of adjacent channels may be disposed on different ends of the collet. For example, the open end of a channel may be disposed on the first collet end 706, and the closed end of the channel may be disposed on or facing the second collet end 708. Similarly, the closed ends 712 of adjacent channels may be disposed on or facing different ends of the collet. One or more channels need not extend the entire length of the collet, and it should be understood that the closed ends 712 of one or more channels may be inserted from the end of the collet (as depicted in FIG. 7A).

[0053] FIGS. 7A and 7B show a collet having six fingers and six channels symmetrically spaced around the outer perimeter of the collet. In other variations, fewer channels may be used and / or they may be asymmetrically spaced. The channels can provide a space for expansion relative to the portal cannula when the collet fingers are compressed. The fingers can also help ensure that the compression force is evenly distributed over the portal cannula.

[0054] Some variations of the latching assembly can include a cam latching portion. The cam latching portion can include a split helical cam configured to tighten around the portal cannula when rotated. The split helical cam can be disposed within a notch in the housing of the portal grip and can be coupled to either a first component (e.g., proximal hemisphere) or a second component (e.g., distal hemisphere) of the portal grip. In order for the split helical cam to tighten upon application of a rotational force, the inner diameter friction of the cam against the portal cannula can be made greater than the outer diameter friction of the cam against the portal grip housing. Similar to the collet, the split helical cam can be made of, for example, a polymeric material. Non-limiting examples of polymeric materials include acrylonitrile butadiene styrene (ABS), polycarbonate, polycarbonate / ABS blend, and copolymers thereof.

[0055] An exemplary latching assembly including a split helical cam is shown in FIGS. 8(A)-(D). Referring to FIGS. 8(A) (side view) and 8(B) (top view), the helical cam 800 is shown to have a split portion 802 that forms two free ends 812, 814. When the split helical cam 800 is provided within the groove 816 of the proximal hemisphere 818 of the portal grip 804, rotation of the portal grip 804 in the direction of arrow 806 (e.g., clockwise rotation) tightens the helical cam around the portal cannula 820, thereby fixing the portal grip 804 to the portal cannula 820. The split helical cam 800 can have an inner diameter 808 and an outer diameter 810. The friction of the inner diameter 808 against the portal cannula 820 can be made greater than the friction of the outer diameter 810 against the portal grip 804 in response to rotation, as described above, and thus the ends 812, 814 of the split helical cam 800 can tighten around the portal cannula in response to the application of a rotational force.

[0056] In another variant, to assist in the rotation and clamping of the split helical cam, a toggle can be attached thereto and can rotate the cam to a locked position and an unlocked position. For example, referring to FIG. 9(A), the toggle 900 is shown fixed to the split helical cam 904. When the toggle 900 is rotated within the slot 908 in the portal grip housing 910 from position A (shown in FIGS. 9(B) and 9(D)) in the direction of arrow 906 to position B (as shown in FIGS. 9(C) and 9(E)), the split helical cam 904 can also rotate within the corresponding cam rider groove 902 in the portal grip housing 910. Assuming the helical geometry of the split helical cam 904 and the cam rider groove 902, the outer surface of the groove 902 contracts around the cam 904 as the cam 904 is rotated and progresses along the groove 902, thereby contracting and compressing the cam 904 against a portal cannula (not shown) within the central opening.

[0057] In some variants, the portal grip itself functions as a toggle lever when axially aligned with the portal cannula to releasably secure the portal grip to the portal cannula. More specifically, as shown in FIG. 10(A), when the portal grip 1000 is in a lateral orientation, the portal grip 1000 can freely slide along the portal cannula 1002 in the direction of the arrow. However, as shown in FIG. 10(B), when inverted to a vertical orientation (e.g., rotated 90 degrees), the portal grip 1000 can be locked to the portal cannula 1002. By inverting the portal grip 1000 back to the lateral orientation, the locking of the portal grip 1000 is released and the portal grip can slide along the portal cannula to another position thereon.

[0058] When the portal grip functions as a toggle lever, the locking assembly can include one or more components within the portal grip housing that can be compressed to releasably secure the portal grip to the portal cannula. In one variation, the locking assembly can comprise a cam rider, a compliance member, an inclined surface, and any one of the collets described herein. As shown in FIGS. 10(C) and (D), the cam rider can be coupled to the housing of the portal grip. In the lateral orientation provided in FIG. 10(C), the cam rider 1004 and the inclined surface 1008 are shown in their initial configurations, and for example, the compliance member depicted here as the O-ring 1006, and the collet 1010 are shown in their uncompressed configurations. As shown in FIG. 10(D), when the portal grip is rotated from a lateral to a vertical orientation, the cam rider 1004 can be displaced downwardly as indicated by arrow D. The displacement of the cam rider 1004 can then compress the O-ring 1006, displace the inclined surface 1008 downwardly, and thereby compress the collet 1010 in the direction of arrow C against the portal cannula. The internal inclined surface 1012 on the alignment guide 1014 can also serve to axially inwardly compress the collet 1010 toward the surface of the portal cannula 1002.

[0059] In another variation, the locking assembly can include a portal grip housing configured to be slidably disposed over the collet. The portal grip housing can maintain the collet in a compressed (locked) state when fully covering the collet and can release the compression to transition the collet to an unlocked state when retracted so that at least a portion of the collet is not covered by the portal grip housing. For example, referring to FIGS. 11A - 11D, the locking assembly can include a spherical portal grip housing 1100 and a collet 1102 with a plurality of jaws 1104 biased to an extended (unlocked) state. The collet 1102 includes a spring mount 1106. The locking assembly can further include a compressible spring 1108 and a waist 1110. The collet can be made of a compressible material as described above. When assembled, as shown in FIG. 11E, the spherical portal grip housing 1100 is disposed around the collet 1102 and biased by a spring 1108 on the spring mount 1106 to hold the collet jaws 1104 (here, three) in their compressed configuration. In the compressed configuration, the collet jaws 1104 can releasably secure the spherical portal grip housing 1100 to a portal cannula (not shown). If repositioning is desired, the spherical portal grip housing 1100 can be retracted in the direction of arrow R. As shown in FIG. 11F, retraction of the spherical portal grip housing 1100 can remove the compressive force from the collet jaws 1104, and as a result, the collet jaws transition to their extended state.

[0060] The locking assembly can also include a pushable portion of the portal grip, such as a push button, and a clamp. In this variation, the push button may be depressed to compress a spring, which in turn unlocks the portal grip from the portal cannula. The push button can be released to lock the portal grip thereto. For example, referring to FIGS. 12A and 12B, the portal grip 1200 can have a rectangular cross-sectional shape. The corners of the portal grip 1200 can be rounded so that its movement relative to the skin surface does not cause tissue damage. Springs 1206 and spring caps 1212 can bias the button 1202 in the non-depressed / locked state as shown in FIG. 12B. When the button 1202 is pushed in the direction of arrow 1208 to overcome the force from spring 1206, the clamp 1210 moves in the direction of arrow 1208 and also laterally to loosen the clamp 1210 around the opposite cannula inlet (not shown), thereby releasing the portal grip 1200 from the portal cannula.

[0061] [Trocar] The integrated device described herein can include a trocar slidably disposed within the lumen of the portal cannula. The trocar can comprise a cone or shaft having a proximal end, a distal end, and a distal tip that is generally sharp, and can be used to percutaneously create a tunnel through tissue to a spinal region for performing a spinal procedure. A handle can be provided at the proximal end of the cone to assist in the operation of the trocar. In some variations, the handle can be T-shaped to accommodate various hand postures and provide a more comfortable wrapped finger-controlled posture for insertion and removal of the trocar, as well as a more comfortable steering posture for insertion. After access to the spinal region is created, the trocar can be withdrawn, leaving the portal cannula in the percutaneously created passage.

[0062] The cone or shaft can be made of a metal such as, for example, stainless steel, nitinol, and / or their alloys. With respect to the trocar handle, this can be made of the same polymer as the portal grip and collet. These polymers include, but are not limited to, acrylonitrile butadiene styrene (ABS), polycarbonate, polycarbonate / ABS blend, and their copolymers.

[0063] Referring to FIG. 13, an exemplary trocar 1300 is shown that includes a cone 1302 having a proximal end 1304 and a distal end 1306. A T-shaped handle 1308 can be attached to the proximal end 1304. The distal end 1306 can include a sharp tip 1310 that penetrates tissue. In this variant, the T-shaped handle 1308 can provide a larger gripping area for improved handling of the trocar and an increase in comfort when the fingers are spread to hold the trocar. For example, the portion of the grip or knob 1312 on each side of the handle can be about 2.0 cm.

[0064] The trocar handle can be composed of a single component or multiple parts coupled to each other. In variations where the handle comprises multiple parts (e.g., two, three, four, or more), the parts can be coupled to each other via a snap fit or interference fit connection, a magnetic connection, and / or a mechanical connector, such as a threaded connector. In some variations, as shown in FIGS. 16A - 16D, the trocar handle can include two parts, namely, a housing 1602 and an insert 1604. The insert 1604 can include a plurality (e.g., two, three, four, or more) of struts 1606 that couple to (e.g., can be received within) corresponding recesses 1608 within the housing 1602. In some variations, the struts 1606 and the recesses 1608 can be coupled to each other using an interference fit. As shown in FIG. 16C, the struts 1606 can have a cross - shaped cross - sectional outer profile, although other cross - sectional shapes, such as circular, oval, triangular, square, etc., can be used as long as the struts fit snugly within the recesses 1608 or are otherwise coupled thereto. The insert and the housing can be made from polymers such as, but not limited to, acrylonitrile - butadiene - styrene (ABS), polycarbonate, polycarbonate / ABS blend, and copolymers thereof.

[0065] [Depth guide] The depth guide can be removably coupled to the hub of the portal cannula via any suitable connection, such as a snap fit or interference fit connection, a magnetic connection, and / or a mechanical connector, such as a threaded connector. The depth guide can be configured to convert rotational motion into linear motion and control the extension amount of the working instrument from the portal cannula, as further described below. The depth guide of the integrated device (see element 110 in FIG. 1B) can function by screwing or unscrewing two components to extend and contract them to a length specified by the user. Additionally, the depth guide can be made detachable to facilitate the need for additional working length.

[0066] The depth guide can include a knob and a scale scale representing the placement of the instrument relative to the distal tip of the portal cannula. The initial position of the depth guide can represent an instrument extension of 15 mm from the distal tip of the portal cannula. The instrument extension can range from about 22.5 mm to about 10 mm (which allows the instrument to translate axially by about 12.5 mm). Additionally, the depth guide can be configured to provide tactile feedback of depth by a click (e.g., audible or inaudible) every about 2.5 mm of translation (e.g., every half turn of the knob). For example, referring to FIGS. 14A-14C, a depth guide 1400 attached to the hub 1402 of the portal cannula 1404 is shown. The depth guide 1400 can include a knob 1406 and a scale scale 1408. In the initial position (shown in FIG. 14A), the scale scale 1408 can indicate that the instrument is extended about 15 mm from the distal tip of the portal cannula. When the knob 1406 is rotated counterclockwise to the maximum, the scale scale can indicate that the instrument is extended about 10 mm from the distal tip of the portal cannula (see FIG. 14B). When the knob 1406 is rotated completely clockwise so that the knob 1406 contacts the portal cannula hub 1405, the depth guide 1400 can allow for the maximum amount of instrument extension (see FIG. 14C).

[0067] Some variations of the integrated device can be configured as shown in FIGS. 17A - 17D. Referring to FIGS. 17A and 17B, the integrated device 1700 may include a portal cannula 1702 and a portal grip 1704, as described in more detail with respect to FIGS. 5C and 5D. The portal grip 1704 may be slidably attached to the portal cannula 1702 and may be held at a specific axial location along the portal cannula 1702 when in a locked configuration, for example, when a collet (1724 in FIG. 17D) is compressed against the portal cannula 1702. The portal cannula 1702 may include a hub 1706 at its proximal end 1708. A trocar 1714, which includes a handle 1716 at its proximal end and a sharp tip 1718 at its distal end, may extend through the portal cannula 1702. Further, a depth guide 1710 can be releasably coupled (e.g., attached and removed) to the hub 1706 using a connector 1712 having a proximal end 1701 and a distal end 1703. More specifically, the proximal end 1701 of the connector 1712 can be configured to releasably couple to the distal end 1705 of the depth guide 1710. The coupling can be achieved via a snap fit or interference fit connection, by a screw connection, or by a magnetic connection. As shown in FIGS. 17C and 17D, the distal end 1703 of the connector 1712 can include a detent 1720 configured to releasably couple (e.g., by a snap fit connection) to the hub 1706. A detent 1720 providing a snap fit connection is shown in FIGS. 17C and 17D, but the distal end of the connector 1712 may be removably attached to the hub 1706 in other ways, for example, by an interference fit connection, a screw connection, or a magnetic connection.

[0068] [Working instrument] Once the target depth of the portal cannula is set, the working instrument can be advanced through the portal cannula to perform a spinal procedure. As described above, examples of working instruments can include manual mechanical grasping instruments such as bone augers, bone forceps, etc., mechanical scooping devices such as tissue sculptors, electromechanical instruments such as grinders and drills, and light-guided and / or visualization devices such as endoscopes. Other examples of working instruments can include suction and irrigation catheters, sensors, monitoring devices, and electrical, magnetic, electromagnetic, vibration, sound, and kinetic energy delivery elements such as RF probes, ultrasonic probes, ablation devices, and energy delivery wires. In some cases, the working instrument can use fluid flow to modify tissue. In one variation, a working instrument for performing a laminectomy and / or removing the ligamentum flavum for the treatment of spinal stenosis is advanced. In this variation, exemplary working instruments can include a bone auger, bone forceps, and a tissue sculptor.

[0069] An integrated assembly (e.g., including a portal cannula with a removably disposed trocar therein, a portal grip slidably coupled to the portal cannula, and a depth guide attached to the portal cannula, e.g., by a snap-fit connection) and one or more working instruments may be provided together in a kit. In some variations, the kit can include some (e.g., two or more) of the components of the integrated assembly that are pre-assembled together. For example, the kit can include a pre-assembled portal cannula and portal grip together, or the kit can include a pre-assembled portal cannula and trocar, etc., together. In other variations, the integrated assembly (e.g., a portal cannula having a removably disposed trocar therein, a portal grip slidably coupled to the portal cannula, and a depth guide attached to the portal cannula) can be provided fully assembled (e.g., all components are integrated together) in the kit. In a further variation, the kit can provide the components of the integrated assembly separately so that it can be assembled immediately prior to use.

[0070] In some variations, the bone auger can be designed for safety. In such variations, the forward advancement of the bone auger can be controlled to avoid rapid and inadvertent forward penetration that can result in damage to blood vessels, nerves, and surrounding tissues. In some embodiments, the bone auger can include a rounded tip shape for safety when performing a laminectomy. The rounded tip can be polished, rough, or grooved. Additionally, the rounded tip of the bone auger can include a small flat surface at the most distal portion of the tip that is substantially perpendicular to the axis of the auger to further reduce the safety risk. Other features such as the number of grooves and the twist angle can improve the drilling efficiency during rotation of the bone auger. Further, features such as the twist angle, rake angle, and groove depth can improve material extraction. The groove design can be selected to achieve multiple objectives including, but not limited to, engaging the bone for advancement, grinding the bone to remove hard tissue, filling the hollow space between the grooves with the removed hard tissue to minimize the amount of bone fragments left at the treatment site, and minimizing the number of times washing is required.

[0071] The bone auger can include a plurality of grooves that can function as cutting edges along the perimeter of the auger. In some variations, the number of grooves can range from 1 to 100 grooves, including all values and sub-ranges within that range. In some variations, the number of grooves can range from 10 to 20 grooves. For example, the bone auger can include 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 grooves.

[0072] The grooves can have a rake angle in the range of about -30 degrees to about 30 degrees relative to the normal of the helical axis. For example, the rake angle can be about -30 degrees, about -20 degrees, about -10 degrees, about 0 degrees, about 10 degrees, about 20 degrees, or about 30 degrees.

[0073] In addition, the depth of the groove may be in the range of about 0.10 mm to about 2 mm, including all values and sub-ranges within that range. For example, the depth of the groove can be about 0.10 mm, about 0.20 mm, about 0.30 mm, about 0.40 mm, about 0.50 mm, about 0.60 mm, about 0.70 mm, about 0.80 mm, about 0.90 mm, about 1.0 mm, about 1.1 mm, about 1.2 mm, about 1.3 mm, about 1.4 mm, about 1.5 mm, about 1.6 mm, about 1.7 mm, about 1.8 mm, about 1.9 mm, or about 2.0 mm.

[0074] The plurality of grooves can also have a twist angle in the range of about 5 degrees to about 60 degrees from the central axis of the bone auger, including all values and sub-ranges within that range. For example, the twist angle can be about 5 degrees, about 10 degrees, about 15 degrees, about 20 degrees, about 25 degrees, about 30 degrees, about 35 degrees, about 40 degrees, about 45 degrees, about 50 degrees, about 55 degrees, or about 60 degrees. The twist angle can define frequency grooves that wrap around the auger shaft.

[0075] The bone auger has properties useful for core drilling bone and can be made from a variety of materials that are biocompatible and corrosion resistant. Exemplary materials can include, but are not limited to, stainless steel and its alloys. In one variation, 304L stainless steel (without heat treatment) can be used. In another variation, 17-4PH stainless steel heat treated to the H900 specification can be employed.

[0076] <Additional examples of integrated devices> Some variations of the integrated device can include a bone auger having a lumen and any one of the portal grips described herein slidably coupled to the bone auger. The bone auger can function as a portal cannula that allows a trocar, guide wire, various working instruments, or other devices used for access, diagnosis, monitoring, and / or treatment to be inserted through the bone auger lumen. In addition to the bone auger, the trocar and / or working instrument can also include a lumen. The bone auger can have threads (grooves) at its distal end as described above.

[0077] In use, the bone auger can be positioned on a guide wire within or near a target treatment area of the spine, for example, using the Seldinger technique. Prior to advancing the bone auger, one or more dilators can be advanced on the guide wire to form a tissue tract. The one or more dilators may have a cutting tip and / or threads to enable fragmentation and removal of hard tissue. In one variation, the guide wire may first be inserted and advanced into or near the target treatment area. The size of the guide wire may be selected to be small enough to pass through the calcified structure and reach the target treatment area. The bone auger can then be inserted onto the guide wire. In response to rotation, the threads of the bone auger can be used to remove bone and / or the calcified structure and create a path to the treatment area. The guide wire can then be removed, and the bone auger can be used as a portal cannula through which a working instrument, such as a tissue removal instrument, can be advanced to the target treatment zone. In some variations, a trocar is positioned within the lumen of the bone auger and its sharp tip can be used to create access to the target treatment area. The trocar may or may not include a lumen. If a lumen is present, both the bone auger and the trocar can be advanced over the guide wire to the target treatment area. The components of the integrated device described above may be provided pre-assembled in a kit or as separate components for user assembly.

[0078] For example, as shown in FIG. 15A, the bone auger 1500 can have a proximal end 1502 and a distal end 1504. The thread 1506 is provided at the distal end 1504 and can serve to generate access to the target treatment area through the bone and / or calcified structure by rotation of the bone auger 1500. The handle 1510 can be included at the proximal end 1502 of the bone auger and can be gripped to assist in rotating the bone auger 1500. As shown in FIG. 15B, which is a cross-sectional view taken along line B-B of FIG. 15A, and FIG. 15G, which is a cross-sectional view of the entire device, the bone auger 1500 can have a lumen 1508 that extends through the handle at the proximal end 1502 and through the distal end 1504. Thus, once access is generated, the working instrument can be advanced through the lumen 1508 to the target treatment area to perform a procedure or surgery. FIG. 15H provides an enlarged cross-sectional view of the distal end 1504 of the bone auger with the lumen 1508 extending therethrough. The teeth 1518 can be included at the distal tip 1520 of the bone auger to further assist in the fragmentation and penetration of hard tissue, such as bone. In some variations, the teeth 1518 can be configured to flatten as the bone auger 1500 is advanced through the hard tissue. In these cases, one or more of the teeth 1518 can have dimensions (e.g., size, shape, thickness) that allow them to transition to a flat configuration as the distal tip 1520 of the bone auger passes through the hard tissue, or one or more of the teeth 1518 can be made of a material that can be shaved down to a flat configuration as the distal tip 1520 of the bone auger progresses through the hard tissue. Although described above with the teeth 1518, in some variations, the distal tip 1520 of the bone auger can be toothless and instead can have a continuous circumferential edge. An enlarged cross-sectional view of the handle is also provided in FIG. 15I, showing the lumen 1508 extending through the handle.

[0079] The handle of the bone auger can be of various sizes and shapes. For example, the handle may have a cross-sectional shape such as T, L, or C, or can be spherical, elliptical, triangular, rectangular, or square. The bone auger handle can be made from the same polymer or a different polymer as the portal grip, collet, and trocar handle. For example, the bone auger handle can include, but is not limited to, acrylonitrile butadiene styrene (ABS), polycarbonate, polycarbonate / ABS blend, and copolymers thereof.

[0080] The handle can be composed of a single component or multiple parts joined to each other. In a variant where the handle comprises multiple parts (e.g., two, three, four, or more), the parts can be joined to each other via snap fit or interference fit connections, magnetic connections, and / or mechanical connectors, such as threaded connectors. In some variants, as shown in FIGS. 15C - 15F, the handle 1510 can include two parts, namely, a housing 1512 and an insert 1514. The insert 1514 can include a plurality (e.g., two, three, four, or more) of struts 1516 that are joined, for example, by interference fit to corresponding recesses 1518 within the housing 1512. In one variant, the struts 1516 may have a cross-shaped cross-sectional outer profile, but other cross-sectional shapes, such as circular, oval, triangular, square, etc., may be used as long as the struts can fit snugly within the recesses 1518.

[0081] In other variations, the distal end of the portal cannula can be configured with one or more features (e.g., threads) of the bone augers described herein such that the portal cannula can act as a bone auger and create a path through hard tissue structures (e.g., bone, calcified tissue). For example, as shown in FIG. 18A, the portal cannula 1800 can include threads 1802 at its distal end 1804. The portal cannula 1800 can also include a lumen 1806 that extends through the hub 1808 at the proximal end 1810 of the portal cannula and through the distal end 1804 of the portal cannula. The lumen 1806 can allow for the advancement of trocars, guidewires, various working instruments, or other devices used for access, diagnosis, monitoring, and / or treatment. In some variations, as shown in FIG. 18C, teeth 1812 can be included at the distal tip 1814 of the portal cannula to further assist in the fragmentation and / or penetration of hard tissue, such as bone, as described above with respect to the bone auger.

[0082] In some cases, the portal cannula may function as both a trocar and a bone auger and can be configured to include both a sharp tip that allows penetration of soft tissue and a subsequent thread configured to create a path through hard tissue. For example, as shown in FIG. 18D, the trocar 1816 can be disposed (e.g., concentrically) within the lumen of the portal cannula 1800. Although shown as conical, the trocar tip 1818 can be configured to have other geometric shapes, such as a pyramid shape. The trocar tip 1818 can be a temporary structure, as further described below. The threads may be initially coated and / or the space between the threads may be initially filled with any biocompatible material that can be bioabsorbable, biodegradable, or soluble, such that the portal cannula can be inserted (e.g., using the sharp trocar tip 1818) without the threads interfering with penetration through soft tissue. The bioabsorbable, biodegradable, or soluble material may contain a drug or other substance for treating the patient, such as for reducing inflammation, controlling bleeding, reducing postoperative pain, applying anesthesia, etc. These substances can be released from the material as the material is absorbed, degraded, or dissolved. The material employed can be configured to be absorbed, degraded, or dissolved within seconds to minutes (e.g., about 5 seconds to about 10 minutes) depending on the particular procedure, surgery, or tissue in the target treatment area. Exemplary biocompatible materials that can be used include, but are not limited to, one or more of metallic materials such as magnesium, zinc, and their alloys, and iron-based alloys, polymeric materials such as poly(L-lactide) and salicylic acid, and ceramic materials such as calcium phosphate.

[0083] In a further modification, the distal end of the trocar can be configured to include a sharp tip that penetrates soft tissue, similar to that described above with respect to the bone auger, and a thread positioned proximal to the sharp tip, in order to enable the crushing and removal of hard tissue and to create a path through the hard tissue structure. The threads may be initially coated and / or the space between the threads may be bioabsorbable, biodegradable, or soluble and may be initially filled with any biocompatible material that enables insertion of the trocar without preventing penetration through the soft tissue. The biocompatible material can be any of those described above with respect to the portal cannula. In other modifications, the material can be configured to break apart (e.g., crush) or be stripped away when it contacts hard tissue rather than soft tissue. When the material is removed, the threads can be exposed to engage the hard tissue. In some modifications, the tip of the trocar can be made of a softer bioabsorbable material that is initially configured to enable penetration of the trocar into the soft tissue but becomes dull when engaged with the hard tissue and can be formed within the cutting tip of the trocar.

[0084] Referring to FIGS. 19A - 19F, an exemplary trocar that can also be used as a bone awl is shown. In FIG. 19A, the trocar 1900 can include a proximal end 1902, a distal end 1904, a handle 1906 at the proximal end 1902, and a thread 1910 and a sharp tip 1908 at the distal end 1904. The sharp tip 1908 can be a temporary structure configured to be removed, for example, by destruction, fragmentation, or dissolution, after penetration through soft tissue and / or placement in the target treatment area. For example, as shown in FIGS. 19G and 19H, the sharp tip 1908 of the trocar 1900 may have a portion 1910 configured to temporarily cover the thread 1910. Although shown as being conical as described above, the sharp tip 1908 can be configured to have other geometric shapes, such as a pyramid shape. Referring to FIGS. 19B - 19D, the trocar 1900 can also include a lumen 1912 that extends through the sharp tip 1908 and through the handle 1906. The lumen 1912 can enable the advancement of a guide wire, various working instruments, or other devices used for access, diagnosis, monitoring, and / or treatment. In some variations, the sharp tip 1908 may instead be provided as part of another device that is advanced through the lumen 1912 of the trocar 1900. For example, referring to FIGS. 19E and 19F, an elongate needle 1914 may be advanced and retracted within the lumen 1912. In this variation, the sharp needle tip 1909 can also be a temporary structure configured to be removed, for example, by destruction, fragmentation, or dissolution, after penetration through soft tissue and / or placement in the target treatment area.

[0085] In another variant, the integrated device can include one or more tips (e.g., trocar tip, bone auger tip) that can be exchanged with the same or different tips. For example, the portal cannula of the integrated device can be configured to be attached at its distal end to a sharp trocar tip to penetrate soft tissue. Thereafter, the trocar tip can be exchanged (e.g., switched) for a blunt bone auger tip to assist the portal in passing through the hard tissue structure without risking damage by the sharp trocar tip. Once access to the target treatment area is created, the bone auger tip may be removed and the portal cannula reinserted. In some variants, the one or more tips can be configured to allow penetration using a trocar, bone auger, or working instrument. For example, the tip(s) can be equipped with a mechanism such as a push button, pull lever, or sliding door at the tip to open a path for the working instrument when the portal cannula reaches the target treatment area. In other variants, the tip(s) can include a softer material disposed at the center within its lumen through which the working instrument can be advanced and retracted through its lumen.

[0086] The single-piece assembly device may also be configured to allow removal of an existing depth guide and attachment of another component, such as a connector, to the top of the portal cannula, which enables multiple working instruments to be inserted into the portal cannula continuously or simultaneously. The connector can facilitate the continuous or simultaneous insertion of visual tools such as endoscopes, energy delivery devices, sensors, and / or other monitoring devices. The connector can also provide access for irrigation and aspiration catheters. For example, as shown in FIG. 20, the single-piece device can include a portal cannula 2000 that includes a connector 2002 attached via a hub 2006. The connector 2002 can include a plurality of ports 2004 configured for the continuous or simultaneous introduction of various working instruments into the portal cannula 2000 and / or for providing irrigation and / or aspiration through the portal cannula 2000. In some variations, the connector 2002 can include a control mechanism such as a valve 2008 for adjusting working parameters. In some variations, the connector can include a power source for any energy delivery device that can be used.

[0087] In some variations, the portal cannula can include two or more lumens for the simultaneous insertion of some of the working instruments and for the application of irrigation and / or aspiration. For example, a visualization device (e.g., an endoscope) may be inserted through one lumen, while irrigation and / or aspiration is deployed through a second lumen to keep the field of view open for better visualization. In some variations, one or more working instruments and / or measurement devices can be deployed simultaneously or continuously through the same or one or more different lumens as the visualization device. In some variations, the visualization device may not be used, and one or more working instruments and / or measurement devices may be advanced through one or more lumens, while a separate lumen may be used for the application of irrigation and / or aspiration.

[0088] <Method> Methods for accessing a patient's spinal region are also described herein. The method can generally include percutaneously introducing a portal cannula of an integrated assembly into the spinal region. The portal cannula can be cannulated using a trocar when introduced. The portal cannula can comprise a distal tip and a proximal hub, with a portal grip slidably disposed between the distal tip and the proximal hub. After introduction, the distal tip of the portal cannula can be advanced to a target depth within the spinal region. Upon reaching the target depth, the method can further include removing the trocar, sliding the portal grip along the portal cannula to contact the patient's skin surface, and locking the portal grip at a position on the cannula, thereby holding or bracing the distal tip of the portal cannula at the target depth. The locking position of the portal grip can be maintained along the length of the portal cannula upon exposure to fatty lipids and / or body fluids, thereby increasing the lubricity of the portal cannula surface.

[0089] The single access point created by the portal cannula can be used to perform spinal procedures at multiple spinal levels and / or on both sides of the spine. For example, after a procedure is performed on one side of the spine, the portal grip can be unlocked, the trocar can be reinserted into the portal cannula, and the portal cannula can be repositioned to the other side of the spine. The portal grip can then be slid along the portal cannula to contact the patient's skin surface again and can be relocked at this position.

[0090] The portal grip may include a housing, and rotation of at least a portion of the housing can lock the position of the portal grip on the cannula. If a portion of the housing is spherical, the housing may include a first component coupled to a second component. In this case, locking the portal grip may include rotating the first component relative to the second component. In other cases, locking the portal grip may include rotating the housing to axially align the housing with the portal cannula.

[0091] If the portal grip includes a locking assembly, the locking assembly can comprise a collet disposed concentrically around the portal cannula, and locking the portal grip can include compressing the collet against the outer surface of the portal cannula. Instead of a collet, the locking assembly can include a helical cam that generally effects locking of the portal grip by tightening the helical cam around the outer surface of the portal cannula.

[0092] The methods described herein can further include unlocking the portal grip from the portal cannula. Unlocking can be accomplished in various ways. For example, unlocking can be achieved by rotating at least a portion of the housing or by rotating the housing out of axial alignment with the portal cannula. Once unlocked, the portal grip can be slidably advanced or retracted along the cannula to a second position and then locked to the portal cannula at the second position. Both locking and unlocking the portal grip and changing the position of the portal grip can be achieved using only one hand.

[0093] In some variations, the method can include removably coupling a portal cannula to one or more system components. The one or more system components can be a trocar, a portal grip, and / or a depth guide. When a depth guide is used, the method can include receiving feedback, such as tactile feedback, when using the depth guide to confirm the insertion depth. The coupling of the portal cannula to the one or more system components can be accomplished in various ways. For example, the proximal end of the portal cannula can be releasably coupled to the trocar by a threaded hub. Additionally or alternatively, the hub can include an outer ring that limits the advancement of the trocar.

[0094] The method can be used to perform various spinal procedures. For example, the method can be used to remove a portion of a patient's ligamentum flavum, to treat spinal stenosis, and / or to perform a laminectomy. Once percutaneous access to the spinal region is obtained using the system described herein, the instrument can be advanced through the lumen of the portal cannula to perform the procedure. For example, a bone awl, a bone forceps, and / or a tissue sculptor can be deployed through the lumen. The method can further include accessing the spinal canal percutaneously and performing spinal procedures at multiple locations along the spinal canal, for example, bilaterally and / or at multiple levels, from a single access point.

[0095] In some variations, the method can include first positioning the patient on the operating or treatment table in the prone position. The patient can then be draped and prepared in a normal sterile fashion. Anesthesia can be achieved using local or regional anesthesia and IV sedation. Next, the target spinal region of the patient can be identified and marked with ink. Fluoroscopy and / or surface landmarks can also be used to identify the target region. In some cases, a contrast agent or other suitable material can be used to perform an epiduralogram, myelography, or other nerve visualization under x-ray to identify anatomical structures.

[0096] As described herein, an integrated assembly comprising a trocar, a portal grip, and a depth guide disposed within a portal cannula can then be used to access percutaneously a target spinal region, e.g., the spinal region where the ligamentum flavum is removed. The integrated device can be inserted through the skin and tunnel through tissue until it reaches the target spinal region. In some variations, the tunneling can be achieved under image guidance, e.g., under fluoroscopic guidance. Next, the trocar can be removed from the portal cannula, leaving the distal end of the portal cannula in the target region, e.g., the interlaminar space. Once the portal cannula is positioned, the portal grip can be slid downwardly along the cannula to contact the skin surface and can be locked in place. In some variations, prior to positioning the portal grip, the distal end of the portal cannula can be used as a bone awl to create a path through hard tissue structures (e.g., bone, calcified tissue). In these variations, the portal cannula can include threads at its distal end, as described above. The threads may initially be coated and / or the space between the threads may initially be filled with any biocompatible material that can be bioabsorbable, biodegradable, or soluble, such that the portal cannula can be inserted without the threads interfering with its insertion. The bioabsorbable, biodegradable, or soluble material may release a drug or other substance for treating the patient, e.g., for reducing inflammation, controlling bleeding, reducing postoperative pain, applying anesthesia, etc. These substances can be released from the material as the material is absorbed, degraded, or dissolved. The material employed can be configured to be absorbed, degraded, or dissolved within seconds to minutes (e.g., about 5 seconds to about 10 minutes) depending on the particular procedure, surgery, or tissue in the target treatment area.

[0097] Next, the working instrument is advanced through the portal cannula to perform a spinal procedure, such as a laminectomy or a vertebrectomy, and the ligamentum flavum can be resected. Examples of working instruments can include manual mechanical grasping instruments such as bone augers and bone forceps, mechanical scooping devices such as tissue sculptors, electromechanical instruments such as grinders and drills, and light-guided and / or visualization devices such as endoscopes. Other examples of working instruments can include suction and irrigation catheters, sensors, monitoring devices, and electrical, magnetic, electromagnetic, vibration, sound, and kinetic energy delivery elements such as RF probes, ultrasonic probes, ablation devices, and energy delivery wires. In some cases, the working instrument can use fluid flow to modify tissue. If the procedure is performed on both sides or at multiple vertebral levels, the portal grip may be unlocked and the portal cannula can be withdrawn so that it can be repositioned to provide access to the next spinal region. For example, when withdrawn, the trocar can be reinserted into the portal cannula and the portal cannula can be retracted but cannot be removed from the patient's back. Once repositioned in the spinal region, the trocar can be removed and then the portal grip can be slid along the portal cannula to again contact the patient's skin surface and the portal grip can be re-locked in this position. After completion of the spinal procedure, for example, after appropriate resection of the ligamentum flavum has been achieved, the portal grip may be unlocked and the portal cannula and portal grip may be removed. The wound can then be closed with a sterile dressing.

[0098] In some variations, the bone auger can be used as a portal cannula to access the target treatment area. In these variations, the bone auger and trocar can include a lumen extending through the bone auger and trocar for the passage of a guide wire, various working instruments, or other devices used for access, diagnosis, monitoring, and / or treatment, as previously described herein. For example, a bone auger including a lumen may first be used to create access through hard tissue (e.g., bone, calcified tissue), and then one or more working instruments, such as bone forceps and / or tissue sculptors, may be deployed through the lumen.

[0099] In other variations, the trocar can be used as a portal cannula in addition to providing access through soft tissue. In these variations, the trocar can include a lumen extending through the trocar for the passage of a guide wire, various working instruments, or other devices used for access, diagnosis, monitoring, and / or treatment, as previously described herein. Additionally, the trocar can include a thread proximal to its sharp tip configured to create a path through a hard tissue structure (e.g., bone, calcified tissue). In the same manner as described above for the portal cannula, the thread may first be coated and / or the space between the threads may first be filled with any biocompatible material that can be bioabsorbable, biodegradable, or soluble, such that the portal cannula can be introduced through soft tissue without the thread interfering with its insertion. Thus, when employed during a procedure or surgery, the sharp tip of the trocar is first used to penetrate the soft tissue and subsequently, with the aid of the thread, can pass through the hard tissue after removal (e.g., absorption, degradation, dissolution) of the biocompatible material. The passage through the hard tissue can, in some instances, convert the sharp tip of the trocar to a non-invasive tip (e.g., blunt or rounded tip shape) or break up (e.g., disassemble) the sharp tip.

[0100] The foregoing description has used specific nomenclature for purposes of explanation to provide a complete understanding of the invention. However, it will be apparent to those skilled in the art that specific details are not required to practice the invention. Accordingly, the foregoing description of specific embodiments of the invention has been presented for purposes of illustration and description. The description is not intended to be exhaustive or to limit the invention to the precise form disclosed, and obviously many modifications and variations are possible in light of the above teachings. The embodiments were chosen and described in order to explain the principles of the invention and its practical application, thereby enabling those skilled in the art to utilize the invention and various embodiments with various modifications as are suited to the particular use contemplated.

Claims

1. A system for minimally invasive spinal surgery, A portal cannula having a proximal end and an outer surface, A portal grip, which is slidably attached to the portal cannula and includes a housing, Equipped with, The portal grip system comprises a lumen and a locking assembly configured to releasably secure the portal grip at one or more positions along the length of the portal cannula.

2. The system according to claim 1, wherein the portal grip is configured to sit on the skin surface and provide a fulcrum for the portal cannula.

3. The system according to claim 1, wherein at least a portion of the portal grip is configured to rotate in order to releasably secure the portal grip to the portal cannula.

4. The system according to claim 1, wherein a portion of the housing is spherical.

5. The system according to claim 4, wherein the housing comprises a first component coupled to a second component.

6. The system according to claim 5, wherein the first component rotates relative to the second component and is configured to releasably fix the portal grip at one or more positions along the length of the portal cannula.

7. The system according to claim 1, wherein the locking assembly comprises collets arranged concentrically around the portal cannula.

8. The system according to claim 7, wherein the collet is configured to compress the outer surface of the portal cannula.

9. The collet comprises a plurality of fingers spaced apart around the outer circumference of the collet, The system according to claim 7, wherein the plurality of fingers include three or six fingers, and the plurality of fingers are spaced symmetrically around the outer circumference of the collet, either or both of these conditions.

10. The locking assembly comprises a helical cam, The system according to claim 1, wherein the helical cam is configured to tighten around the outer surface of the portal cannula, and further comprises a toggle coupled to the helical cam and configured to tighten the helical cam around the outer surface of the portal cannula, either or both of the above.

11. The system according to claim 1, wherein the housing is configured to rotate and axially align with the portal cannula.

12. The system according to claim 11, wherein the axial alignment of the housing and the portal cannula is achieved by displacing a cam lid to releasably fix the portal grip at one or more positions along the length of the portal cannula.

13. The system according to claim 1, wherein the portal cannula is detachably coupled to one or more system components.

14. The system according to claim 13, wherein one or more system components include a trocar having a handle.

15. The system according to claim 14, wherein the proximal end of the portal cannula comprises a hub having at least one fin configured to restrict the advancement of the trocar when the trocar is releasably coupled to the portal cannula.

16. The system according to claim 1, further comprising a depth guide having a proximal end and a distal end.

17. The system according to claim 16, wherein the distal end of the depth guide is detachably coupled to the hub by a first screw connection, and the handle of the trocar is detachably coupled to the hub by a second screw connection, either or both of the above.

18. The system according to claim 16, wherein rotation of a knob on the depth guide provides feedback regarding the insertion depth of a working instrument, the working instrument being a bone auger, bone forceps, or tissue carver.

19. The system according to claim 1, wherein the locking assembly is configured to be used with one hand.

20. The system according to claim 1, wherein the locking assembly is configured to maintain the position of the portal grip along the length of the portal cannula when the portal cannula is exposed to fatty lipids or body fluids.

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