Abstract: This invention relates to methods and instruments for performing a surgical procedure in a disc space between adjacent vertebrae. The instruments include a distractor and a cutting instrument. In one embodiment the distractor includes a body portion and a pair of flanges extending along opposite sides of the body portion such that a slot is formed between the flanges and the body portion. The cutting instrument is positionable over the body portion and into the slots of the distractor so that the flanges are positioned between the cutting instrument and the adjacent tissue.

Abstract: An implant composed substantially of cortical bone is provided for use in cervical Smith-Robinson vertebral fusion procedures. The implant is derived from allograft or autograft cortical bone sources, is machined to form a symmetrically or asymmetrically shaped (e.g. a substantially “D”-shaped) implant having a canal running therethrough according to methods of this invention, and inserted into the space between adjacent cervical vertebrae to provide support and induce fusion of the adjacent vertebrae. Osteogenic, osteoinductive or osteoconductive materials may be packed into the canal of the implant to expedite vertebral fusion and to allow autologous bony ingrowth.

Abstract: Systems and methods for stabilizing the spine are provided. For stabilizing the L5-S1 junction, the system includes a plate (7) that has a generally triangular shape with an upper node (8a) and a pair of lower nodes (9a, 10a). The upper node (8a) has a hole (8) through the plate (7) to receive a screw (11) for passage into the L5 vertebra. The lower nodes (9a, 10a) each include a hole (9,10) through the plate (7) to receive screws (12, 13) for passage into the S1 vertebra. The system further includes a plate (7) having a retaining element (32) for preventing backout of screws inserted through the plate (9). Instruments and methods for attaching the plate to the spinal column are also provided.

Abstract: This invention relates to methods and instruments for performing a surgical procedure in a disc space between adjacent vertebrae. A cannula is inserted to create a working channel through the skin and tissue of a patient using a transforaminal approach to the disc space. A viewing element is used to visualize working end of the cannula and the disc space. A facetectomy is performed through the working channel to access the disc space. The disc space is prepared with various instruments, such as distractors, shims, chisels and distractor-cutters that extend through the working channel. At least implant is inserted into the disc space. The procedure allows bi-lateral support of the adjacent vertebrae with the at least one implant inserted via a unitary, minimally invasive approach to disc space.

Abstract: Methods and instrumentation for surgical procedures relating to preparation of vertebral bodies and a disc space for insertion of spinal implants is disclosed. One instrument is a shim having a blade and a shaft having a first end connected with the blade. The blade is inserted into a distracted disc space to maintain distraction during subsequent procedures. Another instrument is a driver for driving the blade of the shim into the distracted disc space. Various methods contemplate the use of these instruments to maintain disc space distraction during disc space preparation for receiving an implant.

Abstract: This invention provides a vertebral implant for impaction in a disc space to restore and/or maintain desired disc space height and spinal orientation. The implant has an elongated basis body having a generally lens-shape provided by convex upper and lower surfaces. Bearing surfaces are provided on the cross-edge surfaces of the endwalls. Grooves are provided in the upper and lower surfaces positioned between the bearing surfaces. The implant can be prepared from a wide variety of materials including metallic materials, synthetic materials, polymeric materials, ceramic materials, and composite materials including reinforced materials i.e. glass, fiber, and/or carbon fiber reinforced materials (CFRP). These preferred materials for fabricating implants in the present invention reduce costs, increase service life and provide excellent physiological compatibility. The non-metallic material can be selected to be either a substantially permanent material, a biodegradable material or a bioerodable material.

Abstract: Methods and instrumentation for surgical procedures relating to preparation of vertebral bodies and a disc space for insertion of spinal implants is disclosed. The instruments and methods are particularly adapted for a posterior approach to the spine. One instrument is a shim having a blade and a shaft having a first end connected with the blade. The blade is inserted into a distracted disc space to maintain distraction during subsequent procedures. In one embodiment, the shaft can be bent away from the operative field. In another embodiment, the shim is used in an endoscopically assisted approach to the spine. Another instrument is a driver for driving the blade of the shim into the distracted disc space. Various methods contemplate the use of these instruments to maintain disc space distraction during disc space preparation for receiving an implant.

Abstract: A method and instrumentation particularly adapted for disc space preparation from an anterior approach to the spine. In one aspect, an expandable template is provided having guides to guide a cutting device for bilateral formation of openings in the disc space. In another aspect, an improved guide member is provided for guiding a cutting tool. Still further, the invention provides an improved double barrel guide sleeve with a central distraction extension and lateral non-distracting extensions. Optionally, the guide sleeve includes windows and covers to selectively cover the windows. An improved reamer with an internal chamber and optional modular coupling is also provided. A depth stop is provided to selectively engage a tool shaft and a guide sleeve to control tool penetration into the disc space. A method of using the disclosed instruments is also provided.

Abstract: Laterally expanding vertebral spacer devices are provided for repairing damaged vertebral discs. The vertebral spacer devices maintain the height of a distracted vertebral disc space while providing stability to the spine. In one form of the invention, a vertebral spacer device is provided with a first arm movably coupled to a second arm. The first and second arms are laterally expandable from a first width for insertion into the disc space to a second width after insertion into the disc space. The first and second arms also define a cavity therebetween for placement of bone growth material.

Abstract: Systems and methods for stabilizing the spine are provided. For stabilizing the L5-S1 junction, the system includes a plate that has a generally triangular shape with an upper node and a pair of lower nodes. The upper node has a hole through the plate to receive a screw for passage into the L5 vertebra. The lower nodes each include a hole through the plate to receive screws for passage into the S1 vertebra. The system further includes a plate having a retaining element for preventing backout of screws inserted through the plate. Instruments and methods for attaching the plate to the spinal column are also provided.

Abstract: An expandable interbody fusion device in one embodiment includes a cylindrical body (10) defining a hollow interior (17) for receiving bone graft or bone substitute material. The body (10) is divided into a number of branches (24, 26, 40 and 41) connected to one another at a fixed end (20) and separated at an expandable end (18). The expandable cage may be inserted in its substantially cylindrical form and may be expanded by movement of an expansion member (50) to establish lordosis of the spine. The present invention provides an expansion member (50) that interacts with the interior surfaces of the device to maintain the cage in the expanded condition and provide a large internal chamber (17) for receiving bone in-growth material. Methods for insertion of the fusion device are also disclosed.

Abstract: A method and instrumentation particularly adapted for disc space preparation from an anterior approach to the spine. In one aspect, an expandable template is provided having guides to guide a cutting device for bilateral formation of openings in the disc space. In another aspect, an improved guide member is provided for guiding a cutting tool. Still further, the invention provides an improved double barrel guide sleeve with a central distraction extension and lateral non-distracting extensions. Optionally, the guide sleeve includes windows and covers to selectively cover the windows. An improved reamer with an internal chamber and optional modular coupling is also provided. A depth stop is provided to selectively engage a tool shaft and a guide sleeve to control tool penetration into the disc space. A method of using the disclosed instruments is also provided.

Abstract: Laterally expanding vertebral spacer devices are provided for repairing damaged vertebral discs. The vertebral spacer devices maintain the height of a distracted vertebral disc space while providing stability to the spine. In one form of the invention, a vertebral spacer device is provided with a first arm movably coupled to a second arm. The first and second arms are laterally expandable from a first width for insertion into the disc space to a second width after insertion into the disc space. The first and second arms also define a cavity therebetween for placement of bone growth material.

Abstract: An expandable interbody fusion device in one embodiment includes a cylindrical body (10) defining a hollow interior (17) for receiving bone graft or bone substitute material. The body (10) is divided into a number of branches (24, 26, 40 and 41) connected to one another at a fixed end (20) and separated at an expandable end (18). The expandable cage may be inserted in its substantially cylindrical form and may be expanded by movement of an expansion member (50) to establish lordosis of the spine. The present invention provides an expansion member (50) that interacts with the interior surfaces of the device to maintain the cage in the expanded condition and provide a large internal chamber (17) for receiving bone in-growth material. Methods for insertion of the fusion device are also disclosed.

Abstract: This invention relates to methods and instruments for performing disc space preparation and implant insertion from a unilateral approach to the spine through a posterior lateral opening to the disc space. The instruments include spreaders, distractors, reamers, scrapers, cutters, chisels, rasps, pushers and implant inserters. A surgical procedure is provided that allows bilateral support of the adjacent vertebrae with at least one interbody fusion device inserted into the disc space via a unilateral approach. Implants for insertion into the disc space are also provided.

Abstract: This invention relates to implants formed from donor bone for use in lumbar interbody fusion procedures and instruments for performing such procedures. The implants are formed to include a concave surface formed from a portion of the medullary canal of a long bone. The concaved surface defines a recess in the implant that serves as a depot for osteogenic material. Specific instruments for inserting the implants prepared according to this invention and for preparing the intervertebral space to receive the implants are also provided.

Abstract: Surgical techniques and instruments are provided for preparing a disc space for implantation of a vertebral fusion device or implant. In accordance with one embodiment of the technique, a surgical instrument assembly is provided having an outer sleeve with distraction fingers at one end to maintain distraction of a disc space. A switching sleeve having a pair of rotatable distractors is coupled within the outer sleeve, and the sleeves are placed over a dilator until the distractor heads are placed within the disc space. The dilator is withdrawn and the disc space distracted by rotating the distractors of the switching sleeve. The switching sleeve is uncoupled from the outer sleeve and the fingers of the outer sleeve are then inserted into the disc space. The switching sleeve and dilator are then removed and the outer sleeve defines a channel therethrough that allows insertion of implants at bilateral locations within the disc space without movement or manipulation of the outer sleeve.

Abstract: A percutaneous surgical system includes a plurality of tissue retractors configured to maintain a working space within soft tissue. The tissue retractors include a prong on their inner surfaces for engaging a ring member. The ring member maintains the position of the tissue retractors while also defining a number of channels inside the ring member. In one embodiment, the ring member includes concentric inner and outer walls connected by support walls. The inner wall defines an inner bore for supporting a working channel sleeve for the introduction of working instruments. A plurality of outer channels are defined between the inner, outer and support walls for the introduction of ancillary instruments to the surgical site. A manipulation tool is also provided that engages each tissue retractor for positioning the retractor within the patient.

Abstract: Laterally expanding vertebral spacer devices are provided for repairing damaged vertebral discs. The vertebral spacer devices maintain the height of a distracted vertebral disc space while providing stability to the spine. In one form of the invention, a vertebral spacer device is provided with a first arm movably coupled to a second arm. The first and second arms are laterally expandable from a first width for insertion into the disc space to a second width after insertion into the disc space. The first and second arms also define a cavity therebetween for placement of bone growth material.

Abstract: This invention relates to implants formed from donor bone for use in lumbar interbody fusion procedures and instruments for performing such procedures. The implants are formed to include a concave surface formed from a portion of the medullary canal of a long bone. The concaved surface defines a recess in the implant that serves as a depot for osteogenic material. Specific instruments for inserting the implants prepared according to this invention and for preparing the intervertebral space to receive the implants are also provided.