Single-use joint decortication device

Abstract

An articulating decorticator instrument configured for single use. The articulating decorticator has a metal rod mounted within a polymer sheath. The polymer sheath has a longitudinal groove configured to receive an alignment protrusion with the working channel to maintain proper alignment of the articulating decorticator relative to the working channel. The articulating decorticator can include an integrated extraction mechanism including an extraction lever pivotally connected to a handle portion of the polymer sheath. The extraction lever has an eccentric cam mechanism. When the extraction lever is pivoted toward an open position, the cam applies a force to a collar of the working channel and an opposing force to a connector pin pivotally connecting the extraction lever to the polymer sheath, thereby removing the abrasive head of the articulating decorticator from the joint.

Description

[Technical Field]

[0001] [CROSS-REFERENCE TO RELATED APPLICATIONS] This Patent Cooperation Treaty (PCT) application claims priority to U.S. Non-Provisional Patent Application No. 18 / 221,347, filed July 12, 2023, which in turn claims priority to U.S. Provisional Patent Application No. 63 / 395,270, filed August 4, 2022, the contents of both applications being incorporated herein by reference in their entirety. [Background technology]

[0002] (1) Areas of Focus

[0003] The present invention relates generally to the field of medical devices, and more particularly to a single-use joint decorticator device and method of use thereof.

[0004] (2) Description of related technology

[0005] Minimally invasive posterior sacroiliac joint fusion procedures are effective in reducing low back pain. These procedures are performed using a suite of surgical instruments, including a working channel, joint expander, joint decorticator, and implant inserter. As the demand for posterior sacroiliac joint fusion procedures increases, the availability of surgery-ready instruments often becomes a limiting factor as to how frequently these procedures can be performed. After each procedure, reusable surgical instruments must be sterilized, a process that requires an autoclave and related equipment. Autoclaving is time-consuming and expensive. Therefore, there is an unmet need for mass-produced, single-use surgical instruments that can be used surgery-ready as needed.

[0006] Another unmet need related to sacroiliac joint fusion surgery relates to extracting the sacroiliac decorticator from the joint. During surgery, the sacroiliac decorticator typically remains inside the patient's joint. A common technique for extracting a retained surgical instrument requires the surgeon to use a slide hammer attached to the proximal end of the surgical instrument. With this technique, the surgeon grasps the hammer sleeve and forcefully slides the sleeve along the hammer shaft, striking the hammer's slide stop repeatedly. However, the effectiveness of a slide hammer often depends on the slide's mass being adequate to achieve the required striking force, and a heavy slide can make the entire instrument unwieldy to use. Therefore, the hammer shaft can exhibit wobbling behavior during the extraction procedure. Because the hammer shaft is connected to the surgical instrument, which is located within the working channel, wobbling of the slide hammer can cause erratic movement of the surgical instrument and even the working channel. Even small amounts of irregular movement can significantly reduce the surgeon's control over surgical instruments, potentially injuring the patient and even displacing the working channel.

[0007] Therefore, what is needed is an improved, surgically ready articular decorticator with an integrated withdrawal mechanism that facilitates safe and efficient withdrawal of the articular decorticator from a patient's joint and removal of the articular decorticator through a working channel. Summary of the Invention

[0008] In a preferred embodiment, the systems and instruments described herein include a working channel, a joint dilator, a joint decorticator, an extraction tool, and an implant inserter. The joint decorticator has a polymer sheath with a lumen. The polymer sheath has a distal end and a proximal end and is configured to be inserted into the working channel to access the joint. A metal rod having a first end and a second end is disposed within the lumen of the polymer sheath. An abrasive head is disposed on the first end of the metal rod and extends beyond the distal end of the polymer sheath. The abrasive head has an abrasive surface used to remove cortical bone tissue within the joint. The polymer sheath has a longitudinal groove for slidably receiving an alignment protrusion of the working channel when the decorticator device is inserted. The longitudinal groove and the alignment protrusion cooperate to prevent rotation of the decorticator device relative to the working channel and the joint.

[0009] The decorticator device may include a puller lever attached to a polymer sheath. The puller lever and polymer sheath collectively define a handle of the articulating decorticator. The puller lever has a cam mechanism that retracts the decorticator device from the working channel. When the puller lever transitions from a closed position toward an open position, the cam mechanism of the puller lever applies a retraction force to the articulating decorticator, thereby retracting the abrasive head of the articulating decorticator into the working channel and withdrawing the abrasive head from the articulating decorticator.

[0010] In one embodiment, an extraction tool is provided to facilitate extraction of a decorticating device from a joint. The extraction tool can be used as a lever to simultaneously apply opposing forces to the decorticating device and working channel, causing them to move apart. In one embodiment, the extraction tool is configured to sequentially engage a first engagement surface of the decorticating device and apply a retraction force thereto, and then engage a second engagement surface of the decorticating device and apply a retraction force thereto, thereby incrementally extracting the decorticating device from the working channel.

[0011] In one embodiment, the present invention relates to a method of preparing a joint for receiving a fixation implant. A working channel is disposed within the joint, providing access to the joint. The abrasive head of a decorticator device is inserted into the working channel. A longitudinal groove with a polymer sheath receives the alignment protrusion of the working channel, thereby properly aligning the decorticator device relative to the working channel. The decorticating device is then advanced into the working channel. The abrasive head of the decorticator device is then forced into the joint, thereby abrading the cortical bone tissue within the joint. If necessary, the striking plate of the decorticator device can be struck with an impactor. The decorticator device is then extracted using an extraction lever and cam mechanism. If necessary, an extraction tool is used to complete extraction of the decorticator device. [Brief explanation of the drawings]

[0012] [Figure 1] 1A-1C illustrate one embodiment of a surgical instrumentation set for performing a sacroiliac joint fusion procedure.

[0013] [Figure 2A] FIG. 1 is a perspective view of one embodiment of a working channel.

[0014] [Figure 2B]FIG. 10 is a plan view of the same embodiment of a forceps channel.

[0015] [Figure 2C] FIG. 10 is a side view of the same embodiment of a working channel.

[0016] [Figure 3A] FIG. 1 is a perspective view of one embodiment of a joint dilator.

[0017] [Figure 3B] FIG. 10 is an exploded perspective view of the same embodiment of the joint dilator.

[0018] [Figure 3C] FIG. 10 is a side view of the same embodiment of the joint expander.

[0019] [Figure 4A] FIG. 10 is the first diagram in a sequence illustrating how to insert the joint expander into the working channel.

[0020] [Figure 4B] FIG. 10 is the second diagram in a sequence illustrating how to insert the joint expander into the working channel.

[0021] [Figure 4C] FIG. 10 is the third diagram in a sequence illustrating how to insert the joint expander into the working channel.

[0022] [Figure 4D] FIG. 10 is a perspective view illustrating a joint dilator being inserted into a working channel.

[0023] [Figure 5A] FIG. 1 is a perspective view of one embodiment of an articulating decorticator.

[0024] [Figure 5B] FIG. 1 is a plan view of one embodiment of an articulating decorticator.

[0025] [Figure 5C] FIG. 1 is a side view of one embodiment of an articulating decorticator.

[0026] [Figure 5D] FIG. 1 is an exploded perspective view of one embodiment of an articulating decorticator.

[0027] [Figure 6A] This is the first figure in the sequence illustrating how the articular decorticator can be withdrawn from the working channel using the withdrawal lever.

[0028] [Figure 6B] This is the second figure in the sequence illustrating how the articular decorticator is withdrawn from the working channel using the withdrawal lever.

[0029] [Figure 6C] This is the third figure in the sequence illustrating how the articular decorticator is withdrawn from the working channel using the withdrawal lever.

[0030] [Figure 7A] FIG. 1 is a top perspective view of one embodiment of an extraction tool.

[0031] [Figure 7B] FIG. 12 is a bottom perspective view of one embodiment of an extraction tool.

[0032] [Figure 8A] FIG. 10 is the first diagram in sequence illustrating a method using one embodiment of an extraction tool to facilitate extraction of a joint decorticator from a working channel.

[0033] [Figure 8B] This is the second figure in the sequence illustrating a method using an extraction tool to facilitate extraction of the articular decorticator from the working channel.

[0034] [Figure 8C] This is the third figure in the sequence illustrating a method using an extraction tool to facilitate extraction of the articular decorticator from the working channel.

[0035] [Figure 8D] This is the fourth figure in the sequence illustrating a method using an extraction tool to facilitate extraction of the articular decorticator from the working channel.

[0036] [Figure 8E] This is the fifth figure in the sequence illustrating a method using an extraction tool to facilitate extraction of the articular decorticator from the working channel.

[0037] [Figure 9A] This is the first figure in the sequence illustrating how to pry open the removal lever of the articulated decorticator using a removal tool.

[0038] [Figure 9B] This is the second figure in the sequence illustrating how to pry open the removal lever of the articulated decorticator using a removal tool.

[0039] [Figure 9C] This is the third figure in the sequence illustrating how to pry open the removal lever of the articulated decorticator using a removal tool.

[0040] [Figure 9D] This is the fourth figure in the sequence illustrating how to pry open the removal lever of the articulated decorticator using a removal tool.

[0041] [Figure 10] 10A-10C illustrate a further technique using an embodiment of an extraction tool to facilitate extraction of the articular decorticator from the working channel.

[0042] [Figure 11A] FIG. 1 is a perspective view of one embodiment of an implant inserter.

[0043] [Figure 11B] FIG. 1 is an exploded perspective view of one embodiment of an implant inserter.

[0044] [Figure 12A] This is the first diagram in the sequence illustrating a method for extending the length of the extraction lever of an articulated decorticator using an extraction tool.

[0045] [Figure 12B] This is the second figure in the sequence illustrating how to extend the length of the extraction lever of the articulated decorticator using an extraction tool.

[0046] [Figure 12C] This is the third figure in the sequence illustrating how to extend the length of the extraction lever of the articulated decorticator using an extraction tool.

[0047] [Figure 13A] FIG. 1 is a perspective view of one embodiment of an articulating decorticator with a dual-lever withdrawal mechanism, illustrating the shaft of the surgical instrument fully inserted into the working channel, the levers in the closed position, and the abrasive head protruding from the lumen of the working channel.

[0048] [Figure 13B] FIG. 1 is a perspective view of an articulating decorticator with a dual-lever withdrawal mechanism, illustrating the surgical instrument shaft fully inserted into the working channel, the levers in the open position, and the abrading head retracted into the lumen of the working channel.

[0049] [Figure 14A]FIG. 1 is a side perspective view of one embodiment of an articulating decorticator having a threaded handle withdrawal mechanism, illustrating the threaded handle in a closed position.

[0050] [Figure 14B] FIG. 1 is a side perspective view of an articulating decorticator having a threaded handle withdrawal mechanism, illustrating the threaded handle in an extended position.

[0051] [Figure 14C] FIG. 1 is an exploded perspective view of an articulating decorticator with a threaded handle withdrawal mechanism.

[0052] [Figure 15A] This is the first diagram in sequence illustrating a method using a threaded handle extraction mechanism, showing the shaft of the articular decorticator inserted into the working channel and the threaded handle in a closed position.

[0053] [Figure 15B] FIG. 10 is the second diagram in a sequence illustrating a method using a threaded handle extraction mechanism, showing the threaded handle in an extended position, thereby retracting the abrasion head into the working channel.

[0054] [Figure 16A] FIG. 1 is a perspective view of one embodiment of an articulating decorticator having an integrated slide hammer and mallet head.

[0055] [Figure 16B] FIG. 1 is a perspective view of one embodiment of an articulating decorticator having an integrated slide hammer and pull handle and mallet head.

[0056] [Figure 17A] FIG. 1 is a perspective view of one embodiment of an articulating decorticator with an integral slide hammer.

[0057] [Figure 17B] FIG. 1 is a perspective view of an articulating decorticator with an integral sliding hammer, showing the hammer sleeve in an operative position.

[0058] [Figure 18] FIG. 16 is a perspective view of one embodiment of an articulating decorticator having a withdrawal mechanism with a looped cable. DETAILED DESCRIPTION OF THE INVENTION

[0059] A novel and unobvious surgical instrument having an integrated extraction mechanism will now be described in terms of its best mode and preferred embodiments with reference to the drawings. In the following description, the surgical instrument will be shown from the perspective of the sacroiliac joint. However, the embodiments disclosed herein are exemplary of the invention and are not intended to limit the invention. Those skilled in the art will recognize that many variations of the following embodiments can be produced without undue experimentation and that the instruments described herein can be used in surgical procedures at sites other than the sacroiliac joint.

[0060] [Surgical instrument kit]

[0061] FIG. 1 illustrates one embodiment of a surgical instrument kit for performing minimally invasive posterior sacroiliac joint fusion. The kit includes a working channel 10, a joint dilator 20, a joint decorticator 30, an extraction tool 50, and an implant inserter 60. Those skilled in the art will appreciate that each of these instruments has a length and a longitudinal axis extending along that length. As used herein, the term "angular" and similar terms refer to rotation or rotational displacement about the longitudinal axis. In some respects, these surgical tools are similar to those disclosed in U.S. Pat. Nos. 11,020,129; 11,058,556; and 11,058,550, all of which are incorporated herein by reference in their entireties.

[0062] [Working Channel]

[0063] 2A-2C illustrate a working channel 10 according to one embodiment of the present invention. The working channel 10 has a pair of arms 12 configured to be inserted between a patient's sacrum and ilium. The arms 12 connect with the working channel 10 to define a sacral contour 14 and an ilium contour 15, respectively, and are configured to interface with the sacrum and ilium. The working channel 10 has a collar 16. The collar 16 has a flat edge 17 that aligns with the ilium contour 15, thereby providing a visual and tactile reference for the angular orientation of the working channel 10. An alignment protrusion 18 is located on the interior of the collar 16 and serves as a keyway feature to maintain a surgical instrument inserted into the working channel 10 at a predetermined angular orientation relative to the working channel.

[0064] The exemplary dual-material surgical instruments described herein significantly reduce the cost of the instruments, making them suitable for single-use. In this manner, at the end of the procedure, the surgical instruments are discarded rather than sterilized in an autoclave. This single-use feature provides a significant advantage over the state-of-the-art, allowing sacroiliac joint fusion procedures to be performed in medical facilities that do not possess autoclaves. Furthermore, by stockpiling a full set of single-use surgical instruments, medical facilities can easily ensure that surgical-ready instruments are available when needed.

[0065] The term "metal," as used herein, refers to an exemplary first material and broadly encompasses metals and metal alloys (e.g., stainless steel or titanium) suitable for human surgery. The term "polymer," as used herein, broadly encompasses various polymers suitable for human surgery, such as plastics and fiber-reinforced polymers. Polymers are described herein as exemplary second materials, which may be graphite, carbon fiber, or other suitable materials different from the first material.

[0066] [Joint expander]

[0067] 3A-3C illustrate one embodiment of the joint expander 20. The joint expander 20 has a generally cylindrical metal body 21. The metal body 21 has a beveled distal end 22 configured to spread soft tissue and slide into the gap between the sacrum and ilium. The beveled distal end 22 is blunt to minimize the possibility of inadvertently penetrating bone tissue during insertion of the joint expander 20 into the sacroiliac joint. A polymer handle 23 has an internal lumen that receives the proximal end of the metal body 21. The handle 23 may be attached to the metal body 21 using fasteners or any other attachment means known in the art. In one embodiment, the handle 23 has flats 27 that prevent the joint expander 20 from rolling when placed on a surgical tray or another support surface. Additionally, the flats 27 provide a visual and tactile reference for the angular orientation of the joint expander 20. Additionally, the flats 27 allow the joint expander 20 to be used as an impactor to impact the joint decorticator 30 into the joint. In this case, the metal body 21 functions as a handle, and the handle 23 becomes the impactor head.

[0068] The metal body 21 has a groove 24 extending along its entire length or a portion thereof, particularly its distal portion. The groove 24 is configured to receive a K-wire therein to guide the joint dilator 20 toward a predetermined location within the sacroiliac joint. At the distal end 22 of the joint dilator 20, a portion of the groove 24 may be completely enclosed to limit off-axial movement of the K-wire within the groove 24. The remainder of the groove 24 is open to allow soft tissue and fluids displaced during insertion of the joint dilator 20 to drain from the groove 24. The groove 24 may also be configured for mating placement with the alignment protrusion 18, as described below.

[0069] 4A-4C illustrate the steps in which the articular dilator 20 couples with the working channel 10 to form the overall articular dilator assembly. The groove 24 receives the alignment protrusion 18 of the working channel 10, thereby inhibiting relative rotation of the articular dilator 20 with respect to the working channel 10.

[0070] The groove 24 may have a widened portion 29 (which may be delta-shaped) to facilitate guiding the alignment projection 18 into the groove 24. The contour of the widened portion 29 is configured to guide the joint dilator 20 into the proper angular alignment with the working channel 10. If the distal end of the joint dilator 20 is advanced into the working channel 10 with the groove 24 in an angular position that is not properly aligned with the guide projection 18, the engagement between the contour of the guide projection 18 and the widened portion 29 will cause the joint dilator 20 to rotate axially until the guide projection 18 is aligned with and inserted into the groove 24. In this manner, the widened portion 29 functions as a pre-alignment mechanism that ensures that the joint dilator 20 is properly aligned with the working channel 10, thereby eliminating the need for the surgeon to manually align these surgical instruments. This pre-alignment feature therefore eliminates human error and facilitates fast and efficient insertion of the joint dilator 20 into the working channel 10.

[0071] The distal end of the joint dilator 20 has a sacral contour 25 and an ilium contour 26, which complement the sacral contour 12 and ilium contour 14 of the working channel 10. FIG. 4C illustrates that the gap between the inner surface of the arm 12 and the metal body 21 is minimized to prevent soft tissue from becoming trapped between them. In one embodiment, the sidewalls of the distal end 22 of the joint dilator 20 have a convex radius, which complements the concave radius of the inner surface of the arm 12. When the joint dilator 20 is fully inserted into the working channel 10, the handle 23 abuts the collar 16. In this configuration, the joint dilator 20 and working channel 10 collectively form a joint dilator assembly for insertion into a patient's sacroiliac joint through a posterior incision. The joint dilator 20 provides structural support to the arms 12 of the working channel 10, guiding them into position between the sacrum and ilium, respectively.

[0072] Once the arms 12 of the working channel 10 are properly inserted into the sacroiliac joint, the joint dilator 20 is withdrawn axially from the lumen of the working channel 10. Figure 4C illustrates that the handle 23 is structured such that a notch 28 is formed between the collar 16 and the handle 23. The notch 28 is configured to receive an extraction tool 50, which can be used as a lever to apply a withdrawal force to the handle 23, as will be described in more detail below.

[0073] [Joint Decorticator]

[0074] 5A and 5B illustrate an articular decorticator 30. In one embodiment, the articular decorticator 30 comprises a metal rod 32. The cross-sectional shape of the rod 32 may be circular, linear, or any other shape. An abrasive head 34 is disposed at the distal end of the metal rod 32. The abrasive head 34 has an open tip with a sharp cutting edge configured to resect bone tissue to create an implant-receiving space within the sacroiliac joint. The cutting edge includes one or more straight sections and one or more curved sections. The abrasive head 34 further includes an abrasive surface configured to scrape away the sacrum and ilium.

[0075] The articulating decorticator 30 includes a polymer sheath 36. The polymer sheath 36 has a lumen configured to receive the metal rod 32. The polymer sheath 36 can be attached to the metal rod 32 using one or more fasteners or any other fastening means known in the art. The fixed connection between the metal rod 32 and the polymer sheath 36 prevents angular displacement between these two components.

[0076] In one embodiment, the polymer sheath 36 has a longitudinal groove 38 configured to receive the alignment protrusion 18 of the working channel 10. The longitudinal groove 38 may be flared at its distal end to facilitate guiding the alignment protrusion 18 into the longitudinal groove 38. The flared end may have a delta shape, a circular shape, or any other shape that results in the distal opening of the longitudinal groove 38 being wider than the remainder of the longitudinal groove 38. This flared portion may be delta-shaped, thereby achieving a self-aligning function similar to that of the corresponding portion of the joint dilator 20 described above.

[0077] [Decorticator removal mechanism]

[0078] 5A-5D illustrate a puller lever 40 pivotally connected to the polymer sheath 36 via a connector pin 42, which serves as a pivot point for the puller lever 40. The puller lever 40 and a handle portion 41 of the polymer sheath 36 collectively define a handle for the articulating decorticator 30, which is configured to be grasped by a surgeon to move the articulating decorticator 30 during a surgical procedure. The puller lever 40 has a cam mechanism 44 disposed at its distal end. In one embodiment, the cam mechanism 44 includes two cam-shaped members separated by a distance sufficient to accommodate the width of the polymer sheath 36 upon operation of the cam mechanism 44, as described in more detail below.

[0079] An exemplary operation of one embodiment of the decorticator 30 is shown in Figures 6A-6C. Figure 6A illustrates the articulating decorticator 30 fully inserted within the working channel 10. During surgery, the working channel 10 is inserted into the patient's body such that the distal end of the working channel 10 is positioned at the intended surgical site, with the sacral contour 14 and iliac contour 15 positioned against the patient's sacrum and ilium, respectively. The collar 16 at the proximal end of the working channel 10 remains outside the patient's body.

[0080] FIG. 6A further illustrates the withdrawal lever 40 in a closed position when the articular decorticator 30 is fully inserted into the working channel 10. In this fully inserted position, the abrading head 34 extends out of the lumen of the working channel 10 and is configured to make abrasive contact with the sacrum and / or ilium of the SI joint, preferably with the respective articular surfaces of these bones. The surgeon applies an axial force to the handle of the decorticator 30 to impact the abrading head 34 into the SI joint. Optionally, the surgeon can use a striking tool, such as a mallet or joint dilator 20, to strike the proximal end of the decorticator 30, thereby impacting the abrading head 34 into the SI joint. In one embodiment, a striking platen 45 is attached to the distal end of the metal rod 32, e.g., by a threaded engagement. The striking platen 45 protrudes beyond the proximal end of the polymer sheath 36 and provides a striking surface for receiving a blow from an impactor. The force of the impact is transmitted from the impact platen 45 to the polishing head 34 via the metal rod 32 .

[0081] By forcefully inserting the abrading head 34 into the SI joint, the abrading head 34 can remain there. Removal of the abrading head 34 must be done in a controlled manner. It is not practical to remove the abrading head 34 by applying a linear force to the handle 41 of the joint decorticator 30 because the patient's body cannot exert opposing pressure.

[0082] 6A-6C illustrate that the extraction lever 40 can be used to achieve controlled extraction of the abrading head 34 from the SI joint. To remove the abrading head 34 from the SI joint, the surgeon can utilize the extraction lever 40 in the following manner: While holding the handle portion 41 of the polymer sheath 36 with one hand, the surgeon pivots the extraction lever 40 toward the open position with the other hand, as illustrated by the arrow in FIG. 6B. As the extraction lever 40 pivots about the connector pin 42, the cam mechanism 44 exerts opposing forces on the collar 16 and connector pin 42 of the working channel 10, respectively. As the cam mechanism 44 continues to move toward the open position illustrated in FIG. 6C, the cam mechanism 44 urges the connector pin 42 further away from the collar 16, thereby retracting the abrading head 34 into the working channel 10. After the abrading head 34 has been removed from the SI joint, the abrading head 34 can be safely removed from the working channel 10 by pulling on the handle 41 .

[0083] 6A illustrates that when the decorticator 30 is fully inserted into the working channel 10, the abrading head 34 is at its maximum penetration distance relative to the joint, i.e., this position is most likely to result in the abrading head 34 remaining within the joint. The cam mechanism 44 is structured to provide a maximum mechanical advantage at the beginning of rotation of the extraction lever 40, thereby applying a greater retraction force to the abrading head 34, thereby initiating the initial removal of the abrading head 34 from the joint.

[0084] In one embodiment, to reduce the possibility of mechanical damage, the extraction lever 40 includes fillets 43 at the interface between the cam-type members of the cam mechanism 44 and the handle portion 40. One skilled in the art will recognize that reinforcing these stress concentrations can reduce the likelihood of structural damage to the cam-type members (i.e., breakage of the handle portion of the extraction lever 40). Additionally, the redundancy provided by including two cam-type members allows the extraction lever 40 to function as intended even if structural damage occurs to one of the cam-type members.

[0085] [Removal tool]

[0086] 7A and 7B illustrate an extraction tool 50 that can be used to remove the abrasive head 34 of the decorticator 30 from the SI joint. The extraction tool 50 has a first pair of arms 52, a second pair of arms 54, and a body 56. The first pair of arms 52 are disposed at an angle relative to the body 56, while the second pair of arms 54 are aligned with the body 56.

[0087] 8A-8E illustrate an exemplary extraction procedure using extraction tool 50. FIG. 8A illustrates that extraction lever 40 has a notch 47 shaped to receive the terminal end of arm 52. To begin the extraction procedure, the surgeon inserts arm 52 into notch 47 so that angled arm 52 is positioned between collar 16 of working channel 10 and cam mechanism 44. FIG. 8B illustrates that angled arm 52 includes a recess 53 shaped to receive angled profile 46 of cam mechanism 44, thereby facilitating proper positioning of angled arm 52 relative to notch 47.

[0088] 8A illustrates that when angled arm 52 is fully inserted into notch 47, body 56 and straight arm 54 of extraction tool 50 are disposed at an angle relative to extraction lever 40. FIG. 8A further illustrates that when a downward force is applied to the free end of extraction tool 50, collar 16 of working channel 10 acts as a fulcrum, and the terminal end of arm 52 of extraction tool 50 applies an upward force to cam mechanism 44 at notch 47.

[0089] As shown in FIG. 7A, arm 52 includes a circular notch 55. The contour of circular notch 55 matches the outer periphery of collar 16 of working channel 10. When extraction tool 50 is orthogonal to working channel 10, circular notch 55 receives collar 16 therein, as shown in FIG. 8B. This mating engagement between circular notch 55 and collar 16 provides a tactile feedback to the surgeon that extraction tool 50 has reached its orthogonal position and signals the surgeon to cease applying downward force to extraction tool 50. At this point, abrasive head 34 is likely sufficiently removed from the sacroiliac joint to allow removal of articular decorticator 40 by normal operation of extraction lever 40 as described above, or by manually applying a linear backward force to handle 41 and extraction lever 40.

[0090] 8A and 8B further illustrate that while applying a downward force to the extraction tool 50, the surgeon may simultaneously pivot the extraction lever 40 toward its open position. In this manner, the extraction tool 50 functions as an additional lever that increases the magnitude of the opposing force applied to the collar 16 and connector pin 42, thereby increasing the magnitude of the retraction force applied to the abrading head 34 of the joint decorticator 30. Once the abrading head 34 has been partially removed from the sacroiliac joint by operation of the extraction tool 50, the extraction lever 40 can be moved to completely remove the abrading head 34 from the sacroiliac joint.

[0091] 8C-8E illustrate a method for using the extraction tool 50 to fully remove the abrading head 34 from the sacroiliac joint without moving the extraction lever 40. This method may be particularly useful if the extraction lever 40 is broken or otherwise jammed. FIG. 8C illustrates that when there is sufficient clearance between the cam mechanism 44 and the collar 16 of the working channel 10, the extraction lever 40 can be closed and the arm 52 of the extraction tool 50 can be inserted between the collar 16 and the cam mechanism 44. In this configuration, the curved edge of the cam mechanism 44 serves as an engagement surface for the arm 52. FIG. 8D illustrates that after positioning the arm 52 between the collar 16 and the cam mechanism 44, the collar 16 of the working channel 10 serves as a fulcrum for the extraction tool 50 to pivot downward.

[0092] FIG. 8E illustrates that as the distance between the cam mechanism 44 and the collar 16 increases, the extraction tool 50 can be inserted further between them and continue to be used as a lever to continue extraction of the articulating decorticator 30 from the working channel 10. The distance between the inner edges of the arms 52 is approximately the same as the diameter of the sheath 36 of the articulating decorticator 30, thereby allowing the extraction tool 50 to receive the sheath 36 between the arms 52. Additionally, the connection between the arms 52 and the body 56 has a circular contour 57 with a radius approximately the same as the radius of the sheath 36, thereby providing snap-type tactile feedback when the circular contour 57 between the arms 52 engages with the sheath 36 when the extraction tool 50 reaches a perpendicular orientation relative to the articulating decorticator 30, as shown in FIG. 8E. In this manner, the surgeon can perform the extraction procedure with confidence and use this tactile feedback to confirm that the instruments are properly oriented relative to one another and are being used as intended. Thus, the extraction tool 50 functions to allow a two-stage extraction method for removing the abrading head 34 from the sacroiliac joint.

[0093] FIGS. 9A-9D illustrate another method for facilitating removal of the abrasion head 34 and extraction of the articulating decorticator 30 using an extraction tool 50. The extraction lever 40 includes a notch 49 near its proximal end (most clearly shown in FIGS. 5A-5D). The extraction tool 50 can be used to pry the extraction lever 40 open by engaging the notch 49 and applying an upward force to the free end of the extraction tool 50. FIG. 9A illustrates that the underside of the proximal endplate 48 of the handle 41 serves as a fulcrum, allowing the arm 52 to apply force to the proximal end of the extraction lever 40. FIGS. 9A and 9B illustrate that when the angled arm 52 of the extraction tool 50 pivots about the proximal endplate 48, the extraction lever 40 opens, and the cam mechanism 44 retracts the articulating decorticator 30 from the working channel 10 in the manner previously disclosed.

[0094] 9C and 9D illustrate that to further open the extraction lever 40, the body of the extraction tool 50 can be positioned so that the proximal endplate 48 of the handle 41 is received between ridges 59 (shown in FIG. 7A ) extending along either side of the body 56. When a linear downward force is applied to the free end of the extraction tool 50, the ridges 59 hold the extraction tool 50 in engagement with the proximal endplate 48, causing the arm 52 to apply a force to the extraction lever 40. If necessary, an impactor can be used to apply a linear force to the free end of the extraction tool 50 to fully open the lever 40.

[0095] 10 illustrates yet another method by which the articular decorticator can be extracted from the working channel 10 using an extraction tool 50. The notch 49 of the extraction lever 40 and the handle 41 are configured to receive the straight arm 54 of the extraction tool 50, such that the extraction tool 50 extends perpendicularly from the longitudinal axis of the articular decorticator 30. In this configuration, the underside of the extraction tool 50 can be struck with a mallet or another impactor (e.g., the joint dilator 20) while the surgeon holds the working channel 10 stationary. The arm 54 transfers the applied striking force to the proximal end plate 48 of the handle 41, thereby removing the abrading head 34 from the sacroiliac joint and extracting the articular decorticator 30 from the working channel 10 without utilizing the cam mechanism 44 of the extraction lever 40.

[0096] [Implant Inserter]

[0097] 11A and 11B illustrate an implant inserter 60. The implant inserter 60 includes a metal core 62 terminated in two implant retaining arms 64. The implant inserter 60 further includes a polymer sleeve 66. The polymer sleeve 66 has a lumen configured to receive the metal core 62 therein. The polymer sleeve 66 can be attached to the metal core 62 using fasteners or any other means known in the art. The polymer sleeve has a handle 68 for moving the implant inserter 60. The implant inserter 60 further includes a groove 70 configured to receive the alignment protrusion 18 of the working channel 10, thereby achieving a predetermined angular alignment between the inserter 60 and the working channel 10. The groove 70 may be widened at its distal end to facilitate guiding the alignment protrusion 18 into the groove 70. The widened end may have a delta shape, a circular shape, or any other shape that results in the distal opening of the groove 70 being wider than the remainder of the groove 70. This widened portion may be delta shaped, which provides a self-aligning function similar to that of the corresponding portion of the articular dilator 20 described above.

[0098] The resting distance between the arms 64 is less than the width of the fixation implant. Therefore, to secure an implant inside the arms 64, the arms 64 must undergo elastic deformation to expand the separation distance between the arms to accommodate the width of the fixation implant. In this manner, when an implant is placed between the arms 64, the arms apply pressure to the implant, thereby firmly holding the implant between the arms. The junction where the implant retention arms 64 connect with the metal core 62 is located within a polymer sleeve 66, which thereby limits the maximum distance the arms 64 can be separated, thereby preventing the arms from over-spreading and possible structural damage.

[0099] Further embodiments of the articular decorticator

[0100] [Extraction tool as an extension of the extraction lever]

[0101] 12A-12C illustrate another method of utilizing an extraction tool 50 to facilitate removal of the abrading head 34 from the sacroiliac joint. The extraction lever 40 of the joint decorticator 30 may include an angled notch 49a near its proximal end. The notch 49a may be configured to receive an arm 52 of the extraction tool 50. In this manner, the effective length of the extraction lever 40 may be extended, thereby reducing the amount of force the surgeon must apply to transition the extraction lever 40 to its open position.

[0102] [Dual lever removal mechanism]

[0103] 13A and 13B illustrate one embodiment of an articulating decorticator 30a that includes a second extraction lever 40a pivotally connected to a handle 41 (the sheath 36 and handle 41 are not shown in FIGS. 13A and 13B). The second extraction lever 40a has a second cam mechanism 44a, which may have the same cam radius as the first cam mechanism 44 of the first extraction lever 40. The operating principle of this dual-lever embodiment is similar to that of the single-lever embodiment described with reference to FIGS. 6A-6C. However, the inclusion of the second extraction lever 40a provides several advantages. For example, the non-axial component of the force exerted by the cam mechanism 44 is countered by the opposing non-axial component exerted by the cam mechanism 44a of the second extraction lever 40a. In this manner, the resultant force applied to the articular decorticator 30a remains aligned with its central longitudinal axis, thereby improving the level of precision and control with which the surgeon manipulates the articular decorticator 30 as it withdraws the abrasion head 34 from the sacroiliac joint. Additionally, the inclusion of the second withdrawal lever 40a reduces the stress applied to the withdrawal lever 40, thereby reducing the likelihood of structural damage.

[0104] In another embodiment, the two cam mechanisms 44 and 44a are not symmetrical. That is, the cam mechanism 44 has a first radius, and the second cam mechanism 44a has a second radius, with at least a portion of the second radius being larger than any portion of the first radius. Thus, the cam mechanism 44 and the second cam mechanism 44a operate sequentially, achieving two-stage retraction of the polishing head 34.

[0105] [Pull-out mechanism with threaded handle]

[0106] 14A-14C illustrate one embodiment of an articulating decorticator 30b with a threaded pull-out handle 72. In this embodiment, the articulating decorticator 30b includes a metal rod 32 with an abrasive head 34. The metal rod 32 is disposed within a polymer sheath 36b. The articulating decorticator 30b further includes a handle sleeve 70 having a lumen 71. The sheath 36b is configured to be slidingly disposed within the handle sleeve 70 and move longitudinally therein.

[0107] 14C, in one embodiment, the distal portion of the lumen 71 can have one or more internal slots 77 configured to receive one or more pins 79 extending from the sheath 36b. In this manner, the sheath 36b and rod 32 coupled thereto can move linearly relative to the handle sleeve 70 while being restricted in relative rotation relative to one another. Alternatively, the sheath 36b can have one or more longitudinal slots on its outer surface, and the lumen of the handle sleeve 70 can include one or more protrusions configured to slidingly couple with the longitudinal slots, allowing the sheath 36b and rod 32 to move linearly relative to the handle sleeve 70 without relative rotation therebetween.

[0108] 14C further illustrates a T-handle 72. The T-handle 72 has an internal lumen 74 that rotatably receives the metal rod 32. An end plate 73 is coupled to the proximal end of the metal rod 32 to prevent the metal rod 32 from slipping out of the lumen of the T-handle 72. In this manner, the T-handle 72 can rotate relative to the rod 32 but cannot move axially relative to it. The end plate 73 can be coupled to the metal rod 32 using a threaded connection or another coupling means.

[0109] The proximal portion of the lumen 71 of the handle sleeve 70 includes internal threads (not shown in the drawings) configured to threadably couple to the external threads 75 of the T-handle 72. Figures 14A and 14B illustrate how, because the T-handle 72 is threadably coupled to the handle sleeve 70, rotation of the T-handle 72 relative to the handle sleeve 70 causes the sheath 36b, metal rod 32, and abrasive head 34 to move axially relative to the handle sleeve 70, which remains stationary.

[0110] Figure 14A illustrates a configuration of articulating decorticator 30b in which T-handle 72 is fully threaded into handle sleeve 70. In this closed configuration, the distance between abrading head 34 and the distal end of handle sleeve 70 is L1. Figure 14B illustrates a configuration of articulating decorticator 30b in which T-handle 72 is in an unthreaded position relative to handle sleeve 70. In this extended configuration, the distance between abrading head 34 and the distal end of handle sleeve 70 is L2, which is less than distance L1.

[0111] 15A illustrates that in the closed configuration, the distance between the terminal end of the abrading head and the distal end of the handle sleeve 70 exceeds the length of the working channel 10. Thus, when the joint decorticator 30b is fully inserted into the working channel 10, the abrading head 34 protrudes sufficiently from the lumen of the working channel 10 to form an implant-receiving space within the sacroiliac joint. The end plate 73 of the T-handle 72 may be configured to receive a blow from a mallet or another impactor device to force the abrading head 34 into the sacroiliac joint.

[0112] To withdraw the abrading head 34 from the sacroiliac joint, the surgeon may manually apply a linear retraction force to the T-handle 72. In some situations, applying manual force to the T-handle 72 alone may be insufficient to remove the abrading head 34. In such cases, the surgeon holds the handle sleeve 70 stationary while rotating the T-handle 72, thereby axially retracting the sheath 36b and rod 32 relative to the handle sleeve 70. As the surgeon continues to rotate the T-handle 72, the distance between the distal end of the handle sleeve 70 and the terminal end of the abrading head 34 decreases, thereby retracting the abrading head 34 into the lumen of the working channel 10, thereby removing the abrading head 34 from the sacroiliac joint.

[0113] [Integrated slide hammer extraction mechanism]

[0114] 16A and 16B illustrate one embodiment of an articulating decorticator 30c with an integrated sliding hammer extraction mechanism. In this embodiment, a metal rod 32 is fixed within a polymer sheath 36c. A hammer sleeve 80 has an internal lumen 83 that receives the proximal end of the metal rod 32. The hammer sleeve 80 is axially and angularly movable relative to the metal rod 32. An end plate 82 is coupled to the proximal end of the metal rod 32. The distal portion of the internal lumen 83 of the hammer sleeve 80 has a neck portion whose diameter is smaller than the diameter of the end plate 82. In this manner, axial retraction of the hammer sleeve 80 relative to the metal rod 32 creates a mechanical stop when the neck portion of the hammer sleeve 80 engages the end plate 82.

[0115] The sheath 36c has a stop collar 84 configured to serve as a mechanical stop for the articulating decorticator 30 when inserted into the working channel 10. One or more locking pins 86 extend from a proximal portion of the sheath 36c. The distal end of the hammer sleeve 80 has an L-shaped groove 88. FIG. 16A illustrates that the groove 88 is configured to receive the locking pin 86 therein. Once the locking pin 86 is in the groove 88, the hammer sleeve 80 can be rotated to advance the locking pin 86 into the groove 88 in the outer periphery, thereby locking the hammer sleeve 80 to the sheath 36c, as shown in FIG. 16A. In this locked configuration, the hammer sleeve 80 serves as a handle for the articulating decorticator 30c.

[0116] To remove the hammer sleeve 80 from the sheath 36c, the surgeon rotates the hammer sleeve 80 in the opposite direction until the locking pin 86 aligns with the opening of the groove 88. At this point, the surgeon can pull on the hammer sleeve 80, moving the sliding hammer into its actuated position, as shown in FIG. 16B. In this actuated position, the hammer sleeve 80 can slide along the metal rod 32 until the neck portion of the internal lumen 83 of the hammer sleeve 80 abuts against the underside of the implant 82. This striking force is transferred to the metal rod 32, which in turn pulls the abrading head 34 out of the sacroiliac joint.

[0117] [Multifunctional hammer sleeve / impactor]

[0118] FIG. 17A illustrates one embodiment of an articulating decorticator 30d. Similar to embodiment 30c, articulating decorticator 30d includes a hammer sleeve 80a. The locking mechanism of hammer sleeve 80a includes external threads 90 disposed at the proximal end of sheath 36d, which are configured to mate with internal threads 92 disposed within the distal portion of the inner lumen of hammer sleeve 80a. When threads 90 and 92 are coupled, hammer sleeve 80a is in a locked configuration, and hammer sleeve 80a functions as a handle for articulating decorticator 30d. When screws 90 and 92 are uncoupled, as shown in FIG. 17A, hammer sleeve 80a is in an actuated configuration and can be used as a sliding hammer to remove and withdraw abrading head 34 from the sacroiliac joint, as disclosed above with respect to articulating decorticator 30c.

[0119] 17A further illustrates that the hammer sleeve 80a has a mallet head 94, which allows the articular decorticator 30d (when the hammer sleeve 80a is in the closed configuration) to be used as a mallet to strike other surgical instruments, such as the articular dilator 20. An advantage of such dual functionality is that when the surgical instruments are provided as a kit, a dedicated mallet can be omitted, since the mallet head 94 of the articular decorticator 30d performs that function.

[0120] 17B illustrates one embodiment of articular decorticator 30e. This embodiment is similar to articular decorticator 30d, but mallet head 94a further includes a pull handle 96. Pull handle 96 is configured to allow a surgeon to grasp and apply axial force to pull handle 96, thereby enabling the surgeon to manually remove abrading head 34 from the patient's sacroiliac joint and remove articular decorticator 30d from working channel 10. If such attempts are unsuccessful, the surgeon can utilize the integrated sliding hammer by unscrewing hammer sleeve 80a from sheath 36d, thereby moving the hammer sleeve into an activated configuration.

[0121] [Loop-shaped cable removal mechanism]

[0122] In one embodiment, shown in FIG. 18 , a looped cable 98 may be incorporated into the proximal end of the handle 99 of the joint decorticator. To remove the abrading head 34 from the sacroiliac joint, the surgeon can grasp the looped cable 98 and apply a pulling force thereto. If the manual pulling force is insufficient to remove the abrading head 34, the surgeon can use a striking tool, such as a mallet, to strike the portion of the looped cable 98 facing the handle 99 from inside the looped cable 98. The striking force is transmitted from the looped cable 98 to the handle 99, which is connected to the abrading head 34. In this manner, the strike applied to the looped cable 98 is transmitted to the abrading head, removing it from the sacroiliac joint.

[0123] The foregoing embodiments are merely representative of sacroiliac joint fixation devices and are not intended to limit the present invention. For example, those skilled in the art will readily recognize that the dual-material construction and extraction mechanism described herein may have several embodiments and configurations. As another example, the alignment means described herein includes a groove disposed on the surgical instrument, which is configured to receive an alignment protrusion disposed on the working channel. However, those skilled in the art will recognize that these alignment means may be reversed, such that the alignment protrusion is disposed on the surgical instrument and the longitudinal groove is disposed within the working channel. Furthermore, the extraction mechanisms disclosed herein are alternative and not mutually exclusive; rather, they may be implemented in combination with one another without departing from the contemplated invention. Accordingly, it is understood that equivalents and substitutes for the specific elements and components described above are part of the invention described herein, the true scope of which is set forth in the following claims.

Claims

1. 1. A decorticator device for preparing a joint for receipt of a bone fixation implant, comprising: a polymer sheath having a lumen therein and including a distal end and a proximal end, the polymer sheath configured to be inserted into a working channel that provides access to the joint; a metal rod disposed within and fixedly disposed in the lumen of the polymer sheath, the metal rod having a first end and a second end; an abrasive head disposed on the first end of the metal rod and extending beyond the distal end of the polymer sheath, the abrasive head having an abrasive surface configured to abrade a cortical bone layer within the joint; and a longitudinal groove disposed in the polymer sheath and having an opening at the distal end thereof, the longitudinal groove configured to slidingly receive an alignment protrusion of a working channel, whereby engagement between the longitudinal groove and the alignment protrusion limits axial rotation of the decorticator device relative to the working channel, thereby maintaining the abrasion head of the decorticator device in a predetermined position relative to the joint. A decorticator device comprising:

2. 2. The decorticator device of claim 1, further comprising a pull-out lever pivotally attached to the polymer sheath, the pull-out lever having a cam mechanism configured to apply a retracting force to the working channel as the pull-out lever pivotally transitions from a closed position toward an open position, thereby retracting the polishing head of the decorticator device into the working channel.

3. 3. The decorticator device of claim 2, wherein the cam mechanism includes two cam members positioned on either side of the polymer sheath and defining a gap therebetween, the gap being configured to accommodate the polymer sheath when the pull-out lever is pivoted from the closed position toward the open position.

4. The decorticator device of claim 2, wherein the polymer sheath includes a first handle portion and the withdrawal lever includes a second handle portion, and when the withdrawal lever is in the closed position, the first handle portion and the second handle portion collectively define a handle for the decorticator device.

5. The decorticator device of claim 4 , further comprising a fillet at a connection between the cam mechanism and the second handle portion.

6. The decorticator device of claim 2 , wherein in the closed position, the cam mechanism is located on an opposite side of the metal rod relative to the pivot axis of the pull-out lever.

7. The decorticator device of claim 1 , wherein the opening of the longitudinal groove has a delta shape configured to guide the alignment protrusion of the working channel into the longitudinal groove of the polymer sheath.

8. 2. The decorticator device of claim 1, wherein the decorticator device is configured to receive an extraction tool, the extraction tool configured to simultaneously apply opposing forces to the decorticator device and the working channel, thereby retracting the polishing head of the decorticator device into the working channel.

9. 9. The decorticator device of claim 8, wherein the decorticator device has two engagement surfaces for engaging with the extraction tool, a second engagement surface located at a more distal position along the decorticator device relative to the first engagement surface, and wherein the extraction tool is configured to operably engage with the first and second engagement surfaces sequentially, thereby resulting in gradual extraction of the decorticator device from the working channel with each operable engagement.

10. The decorticator device of claim 1, wherein the polymer sheath is configured to connect to an extraction tool, whereby the extraction tool forms a side surface against the decorticator device, and wherein an extraction force is applied to the extraction tool to extract the decorticator device from the working channel.

11. 11. The decorticator device of claim 10, wherein the extraction tool has a lower surface oriented toward the distal end of the polymer sheath, and the extraction force is applied by striking the lower surface of the extraction tool with an impactor.

12. 2. The decorticator device of claim 1, further comprising a striking platen disposed at the second end of the metal rod and extending beyond the proximal end of the polymer sheath, the striking platen configured to be struck by an impactor, whereby the metal rod is configured to transmit a striking force from the striking platen to the abrading head, thereby forcing the abrading head into the joint.

13. 1. A method of preparing a joint for receipt of a bone fixation implant, comprising: inserting a working channel into the joint; inserting an abrasive head of a decorticator device into the working channel; a polymer sheath having a lumen therein, a distal end, and a proximal end, the polymer sheath configured to be inserted into the working channel to provide access to the joint; a metal rod disposed within and fixedly disposed in the lumen of the polymer sheath, the metal rod having a first end and a second end; an abrasive head disposed on the first end of the metal rod and extending beyond the distal end of the polymer sheath, the abrasive head having an abrasive surface configured to abrade a cortical bone layer within the joint; and a longitudinal groove disposed in the polymer sheath and having an opening at the distal end thereof; Provided with; aligning the longitudinal groove of the decorticator device with the alignment protrusion of the working channel; advancing the decorticator device into the working channel, wherein engagement between the longitudinal groove and the alignment protrusion limits axial rotation of the decorticator device relative to the working channel, thereby maintaining the abrading head of the decorticator device in a predetermined position relative to the joint; forcing the abrading head of the decorticator device into the joint, thereby causing the abrading head to abrade the cortical bone layer within the joint; and withdrawing the decorticator device from the working channel. A method for providing the above.

14. 14. The method of claim 13, wherein the step of withdrawing the decorticator device from the working channel includes pivotally transitioning an extraction lever from a closed position toward an open position, wherein the extraction lever is pivotally attached to the polymer sheath and has a cam mechanism configured to apply a force to the working channel as the extraction lever transitions from the closed position toward the open position, thereby retracting the abrading head of the decorticator device into the working channel.

15. 15. The method of claim 14, wherein as the extraction lever transitions from the closed position toward the open position, the polymer sheath enters a gap defined between two cam members disposed on either side of the polymer sheath and collectively defining the cam mechanism.

16. 15. The method of claim 14, wherein the step of aligning the longitudinal groove of the decorticator device with the alignment protrusion of the working channel includes moving a handle assembly of the decorticator device, wherein the handle assembly includes a first handle portion disposed in the polymer sheath and a second handle portion disposed in the pull-out lever.

17. 16. The method of claim 15, wherein transitioning the extraction lever from the closed position toward the open position causes the extraction lever to pivot about a pivot located on an opposite side of the metal rod relative to the cam mechanism.

18. 14. The method of claim 13, wherein aligning the longitudinal groove of the decorticator device with the alignment protrusion of the working channel includes positioning a delta-shaped opening of the longitudinal groove proximal to the alignment protrusion, wherein the delta-shaped opening is configured to guide the alignment protrusion of the working channel into the longitudinal groove of the polymer sheath when the decorticator device is advanced into the working channel.

19. 14. The method of claim 13, wherein the step of withdrawing the decorticator device from the working channel includes inserting an extraction tool between the working channel and a first engagement surface of the decorticator device and pressing against a free end of the extraction tool, wherein the extraction tool is configured to simultaneously apply opposing forces to the decorticator device and the working channel, thereby causing the abrasive head of the decorticator device to retract into the working channel.

20. 20. The method of claim 19, further comprising inserting the extraction tool between a second engagement surface of the decorticator device and the working channel and pressing against the free end of the extraction tool, wherein the second engagement surface is positioned at a more distal position along the decorticator device relative to the first engagement surface.

21. 14. The method of claim 13, wherein the step of extracting the decorticator device from the working channel includes connecting an extraction tool to the polymer sheath, the extraction tool having an underside oriented toward the distal end of the polymer sheath, and striking the underside of the extraction tool with an impactor.

22. 14. The method of claim 13, wherein the step of forcing the abrasive head of the decorticator device into the joint includes striking a striking platen of the decorticator device, wherein the striking platen is disposed at the second end of the metal rod and extends beyond the proximal end of the polymer sheath.

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