Transiliac-Transsacral Lumbar Spine Access Method
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Solution Overview
Problem
Current surgical techniques for accessing the L5-S1 disc space are invasive and unreliable, often requiring extensive dissection and compromising the sacral pedicle, which can lead to weakened fixation and surgery-induced pain.
Innovation Solution
A minimally-invasive method involving percutaneous formation of a bony pathway through the iliac and sacral alae, aligning parallel to the coronal plane of the L5-S1 disc space, allowing for precise access and intervention with bone penetration instrumentation, guide instruments, and curvilinear frames to direct surgical paths for disc excision and fusion.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If traditional posterior or anterior surgical approaches are used to access L5-S1 disc space, then adequate access for disc excision and fusion can be achieved, but extensive dissection and tissue trauma are required
Solution Approach 1:
The surgical approach is segmented into distinct phases: initial percutaneous needle insertion through skin and soft tissue, followed by sequential advancement through muscle layers, sacral ala, and into the disc space. Each phase uses specialized instruments (guide needles, dilators, reamers) that work through a staged process, minimizing the need for extensive open dissection while maintaining reliable access to the target site
Solution Approach 2:
A percutaneous transsacral approach is used as an intermediary method to access the L5-S1 disc space. Instead of directly exposing the disc through large incisions and extensive dissection, the approach uses a guided needle pathway through the sacral ala as a mediator, allowing instrument delivery through a small incision while maintaining accurate positioning and minimizing soft tissue disruption
2Strength
If bone screws are placed in sacral pedicles for fixation, then stable anchor points are created, but the sacral pedicle structure is compromised and weakened
Solution Approach 1:
The fixation strategy extracts the requirement for pedicle screw placement by using an interbody fusion approach instead. The focus shifts from anchoring into the pedicles to achieving stability through disc space preparation, bone grafting, and implant placement within the interbody space, thereby eliminating the need to compromise pedicle integrity while still providing stable fixation
Solution Approach 2:
Instead of the conventional approach of first securing pedicle screws for fixation and then performing disc excision, the invention inverts the sequence by first preparing the disc space and performing interbody fusion, then adding fixation elements. This reversal allows the primary stabilizing mechanism to be the interbody construct rather than pedicle anchors, preserving pedicle integrity
3Ease of operation
If extensive perineural dissection and bone preparation are performed, then adequate exposure for spinal fixation is achieved, but the spine is further weakened and surgery-induced pain syndromes may result
Solution Approach 1:
The percutaneous transsacral approach allows the surgical instruments to serve themselves by being self-guiding through pre-established pathways. The needle and subsequent instruments follow a predetermined trajectory through the sacral ala to the disc space, eliminating the need for extensive manual dissection and bone preparation while maintaining adequate exposure for the intended intervention
Solution Approach 2:
The invention replaces the mechanical system of open dissection and manual bone preparation with a guided percutaneous system. Instead of using forceful mechanical separation of tissues and extensive bone removal, the approach uses a precisely guided needle pathway with sequential dilators and reamers that create the necessary access through controlled, minimal-trauma mechanisms
4Reliability
If S1 pedicles are approached to access L5-S1 disc space, then disc access can be achieved, but the approach is difficult and unreliable with limited tool manipulation
Solution Approach 1:
The approach transitions from the conventional posterior or anterior dimensions to a transsacral dimension for accessing the L5-S1 disc space. By utilizing the sacral ala as a window and approaching through a lateral-to-medial trajectory, the method creates a new dimensional pathway that provides direct access to the disc space with more favorable angles for instrument manipulation and better reliability
Data Source
AI summary
This disclosure is directed to minimally-invasive devices, methods and systems for treating vertebral diseases and injuries using multiple therapeutic procedures through small access portals of sufficient dimension that minimize trauma to the patient. More particularly, disclosed herein are devices, methods and systems for an intraosseous transiliac-transsacral surgical approach through the iliac ala and sacral ala that can be used for a variety of surgical procedures within the lumbar spine.