US PATENT 9,757,154 B2
SYSTEMS AND METHODS FOR FUSING A SACROILIAC JOINT AND ANCHORING AN ORTHOPEDIC APPLIANCE
An orthopedic anchoring system for attaching a spinal stabilization system and concomitantly fusing a sacroiliac joint is disclosed that includes a delivery tool and an implant assembly for insertion into a joint space of a sacroiliac joint. The implant assembly may be secured using anchors inserted through bores within the implant body and into the underlying sacrum and/or ilium. The implant body may also include an attachment fitting reversibly attached to a guide to provide attachment fittings for elements of the spinal stabilization system. The implant assembly may be releasably coupled to an implant arm of the delivery tool such that the implant arm is substantially aligned with the insertion element of the implant assembly. An anchor arm used to insert the anchor may be coupled to the implant arm in a fixed and nonadjustable arrangement such that the anchor is generally aligned with a bore within the implant assembly.
CLAIMS
What is claimed is:
1. A method for performing surgery at a treatment area within a patient having a lumbar spine and a pelvis, the treatment area comprising at least a portion of the pelvis, the pelvis comprising a sacrum, a first ilium, a second ilium, a first sacroiliac joint and a second sacroiliac joint each having an articular region, a caudal portion, a cranial portion, and an extra-articular region, the method comprising:
positioning a distal end of a joint implant adjacent the first sacroiliac joint with a delivery tool,
the joint implant comprising a body extending along a longitudinal axis between a proximal end and the distal end, the joint implant further comprising a bore extending through the joint implant in a particular relationship to the longitudinal axis, the particular relationship of the bore being non-parallel to the longitudinal axis, the body comprising a sacral facing surface and an ilium facing surface disposed opposite of sacral facing surface,
the delivery tool comprising a tool proximal end and a tool distal end opposite the tool proximal end, the tool distal end releasably coupled with the proximal end of joint implant;
delivering the joint implant non-transversely into the first sacroiliac joint via a posterior approach such that the sacral facing surface of the joint implant generally opposes the sacrum and the ilium facing surface generally opposes the first ilium;
coupling a first portion of a spanning member to a first coupling element connected to the joint implant, a second portion of the spanning member configured to be coupled to a second coupling element;
securing an arrangement between the spanning member and the joint implant; and
decoupling the proximal end of joint implant with the tool distal end of the delivery tool,
wherein the delivery tool further comprises an alignment guide configured to guide an elongate member through the bore of the joint implant.
2. The method of claim 1, further comprising delivering the elongate member through the bore of the joint implant.
3. The method of claim 1, wherein the joint implant further comprises an attachment element at the proximal end of the joint implant, the first coupling element coupled to the attachment element, wherein at least a portion of the attachment element forms a plate that is generally perpendicular to the longitudinal axis of the joint implant, wherein the attachment element comprises another bore, the bore and the another bore configured to permit insertion of elongate member therethrough.
4. The method of claim 3, further comprising: delivering the elongate member through the bore and the another bore and into at least one of the sacrum or the first ilium.
5. The method of claim 3, wherein the attachment element comprises an additional bore configured to permit insertion of an anchor therethrough.
6. The method of claim 1, wherein the joint implant further comprises a first planar fin and a second planar fin, the first planar fin extending outward from the sacral facing surface and extending linearly on the sacral facing surface between the proximal and distal ends, the second planar fin extending outward from the ilium facing surface and extending linearly on the ilium facing surface between the proximal and distal ends.
7. A method for performing surgery at a treatment area within a patient having a lumbar spine and a pelvis, the treatment area comprising at least a portion of the pelvis, the pelvis comprising a sacrum, a first ilium, a second ilium, a first sacroiliac joint and a second sacroiliac joint each having an articular region, a caudal portion, a cranial portion, and an extra-articular region, the method comprising:
positioning a distal end of a joint implant adjacent the first sacroiliac joint with a delivery tool,
the joint implant comprising a body extending along a longitudinal axis between a proximal end and the distal end, the joint implant further comprising a bore extending through the joint implant in a particular relationship to the longitudinal axis, the particular relationship of the bore being non-parallel to the longitudinal axis, the body comprising a sacral facing surface and an ilium facing surface disposed opposite of the sacral facing surface,
the delivery tool comprising a tool proximal end and a tool distal end opposite the tool proximal end, the tool distal end releasably coupled with the proximal end of joint implant;
delivering the joint implant non-transversely into the first sacroiliac joint via a posterior approach such that the sacral facing surface of the joint implant generally opposes the sacrum and the ilium facing surface generally opposes the first ilium;
coupling a first portion of a spanning member to a first coupling element connected to the joint implant, a second portion of the spanning member configured to be coupled to a second coupling element;
securing an arrangement between the spanning member and the joint implant;
decoupling the proximal end of joint implant with the tool distal end of the delivery tool; and
delivering an elongate member through the bore of the joint implant.
8. The method of claim 1, wherein the joint implant further comprises an attachment element at the proximal end of the joint implant, the first coupling element coupled to the attachment element, wherein at least a portion of the attachment element forms a plate that is generally perpendicular to the longitudinal axis of the joint implant, wherein the attachment element comprises another bore, the bore and the another bore configured to permit insertion of elongate member therethrough.
9. The method of claim 8, further comprising: delivering the elongate member through the bore and the another bore and into at least one of the sacrum or the first ilium.
10. The method of claim 8, wherein the attachment element comprises an additional bore configured to permit insertion of an anchor therethrough.
11. The method of claim 7, wherein the joint implant further comprises a first planar fin and a second planar fin, the first planar fin extending outward from the sacral facing surface and extending linearly on the sacral facing surface between the proximal and distal ends, the second planar fin extending outward from the ilium facing surface and extending linearly on the ilium facing surface between the proximal and distal ends.
12. The method of claim 7, wherein an attachment element is permanently attached at a fixed position and angle to the proximal end of the body of the joint implant, wherein the angle formed between the attachment element and the body of the joint implant ranges from about 30 degrees to about 120 degrees.
13. The method of claim 12, wherein the attachment element and the body of the joint implant are formed as a continuous structure.
14. The method of claim 7, wherein the attachment element and the body of the joint implant are attached in a hinged attachment, wherein the angle formed between the attachment element and the body of the joint implant ranges from about 30 degrees to about 120 degrees.
15. A method for performing surgery at a treatment area within a patient having a lumbar spine and a pelvis, the treatment area comprising at least a portion of the pelvis, the pelvis comprising a sacrum, a first ilium, a second ilium, a first sacroiliac joint and a second sacroiliac joint each having an articular region, a caudal portion, a cranial portion, and an extra-articular region, the method comprising:
positioning a distal end of a joint implant adjacent the first sacroiliac with a delivery tool,
the joint implant comprising a body extending along a longitudinal axis between a proximal end and the distal end, the body comprising a sacral facing surface and an ilium facing surface disposed opposite of the sacral facing surface, wherein the joint implant further comprises an attachment element at the proximal end of the joint implant, and a first coupling element coupled to the attachment element, wherein at least a portion of the attachment element forms a plate that is generally perpendicular to the longitudinal axis of the joint implant, wherein the attachment element comprises a first bore and the joint implant comprises a second bore, the first and second bores configured to permit insertion of an anchor therethrough,
the delivery tool comprising a tool proximal end and a tool distal end opposite the tool proximal end, the tool distal end releasably coupled with the proximal end of joint implant;
delivering the joint implant non-transversely into the first sacroiliac joint via a posterior approach such that the sacral facing surface of the joint implant generally opposes the sacrum and the ilium facing surface generally opposes the first ilium;
coupling first portion of a spanning member to the first coupling element connected to the joint implant, a second portion of the spanning member configured to be coupled to a second coupling element;
securing an arrangement between the spanning member and the joint implant; and
decoupling the proximal end of joint implant with the tool distal end of the delivery tool.
16. The method of claim 15, further comprising: delivering the anchor through the first and the second bores and into at least one of the sacrum or the first ilium.
17. The method of claim 16, wherein the attachment element comprises a third bore configured to permit insertion of another anchor therethrough.
18. The method of claim 17, further comprising: delivering the another anchor through the third bore and into at least one of the sacrum or the first ilium.
19. The method of claim 15, wherein the joint implant further comprises a first planar fin and a second planar fin, the first planar fin extending outward from the sacral facing surface and extending linearly on the sacral facing surface between the proximal and distal ends, the second planar fin extending outward from the ilium facing surface and extending linearly on the ilium facing surface between the proximal and distal ends.
20. A method for performing surgery at a treatment area within a patient having a lumbar spine and a pelvis, the treatment area comprising at least a portion of the pelvis, the pelvis comprising sacrum, a first ilium, a second ilium, a first sacroiliac joint and a second sacroiliac joint each having an articular region, a caudal portion, a cranial portion, and an extra-articular region, the method comprising:
positioning a distal end of a joint implant adjacent the first sacroiliac joint with a delivery tool, the joint implant comprising a body extending along a longitudinal axis between a proximal end and the distal end, the joint implant further comprising an attachment element at the proximal end of the joint implant, and a bore extending therethrough dimensioned to receive a mechanical fastener, the body comprising a sacral facing surface and an ilium facing surface disposed opposite of the sacral facing surface, wherein the sacral facing surface and the ilium facing surface are generally planar surfaces that are generally parallel to each other, wherein at least one of the sacral or ilium facing surfaces further comprises a first fin projecting generally perpendicularly therefrom and extending between the joint implant proximal and distal ends,
the delivery tool comprising a tool proximal end and a tool distal end opposite the tool proximal end, the tool distal end releasably coupled with the proximal end of joint implant;
forming a first fin receiving channel into at least one of the sacrum or the first ilium;
delivering the joint implant non-transversely into the first sacroiliac joint via a posterior approach such that the sacral facing surface of the joint implant generally opposes the sacrum and the ilium facing surface generally opposes the first ilium,
wherein the step of delivering the joint implant non-transversely into the first sacroiliac joint further comprises delivering the first fin within the first fin receiving channel;
coupling a first portion of a spanning member to a first coupling element coupled to the attachment element of the joint implant, a second portion of the spanning member configured to be coupled to a second coupling element,
wherein the attachment element comprises a first and second bore and wherein the first coupling element further comprises a coupling portion configured to join with the spanning member, the coupling portion being offset from the joint implant longitudinal axis;
securing an arrangement between the spanning member and the joint implant;
decoupling the proximal end of joint implant with the tool distal end of the delivery tool; and
driving the mechanical fastener through the bore and into engagement with at least one of the sacrum or the first ilium.
21. The method of claim 20, the step of positioning the distal end of the joint implant adjacent the first sacroiliac joint further comprises aligning the attachment element plate such that it extends medially from the first sacroiliac joint so that at least one of the first and second bores is aligned over the sacrum and the coupling portion is medially offset from the longitudinal axis of the joint implant.
22. The method of claim 20, wherein the mechanical fastener is configured to pass through one of the first or second bores of the attachment element when driving the mechanical fastener through the bore and into engagement with the at least one of the sacrum or the first ilium.
23. A method for performing surgery at a treatment area within a patient having a lumbar spine and a pelvis, the treatment area comprising at least a portion of the pelvis, the pelvis comprising a sacrum, a first ilium, a second ilium, a first sacroiliac joint and a second sacroiliac joint each having an articular region, a caudal portion, a cranial portion, and an extra-articular region, the method comprising:
positioning a distal end of a joint implant adjacent the first sacroiliac joint with a delivery tool, the joint implant comprising a body extending along a longitudinal axis between a proximal end and the distal end, the body comprising a sacral facing surface, an ilium facing surface disposed opposite of the sacral facing surface, a first fin extending off of at least one of the sacral or ilium facing surfaces and extending linearly along a length generally parallel to the longitudinal axis between the proximal and distal ends, and a second fin extending off of at least one of the sacral or ilium facing surfaces and extending between the proximal and distal ends,
the delivery tool comprising a tool proximal end and a tool distal end opposite the tool proximal end, the tool distal end releasably coupled with the proximal end of joint implant;
delivering the joint implant non-transversely into the first sacroiliac joint via a posterior approach such that the sacral facing surface of the joint implant generally opposes the sacrum and the ilium facing surface generally opposes the first ilium;
coupling a first portion of a spanning member to a first coupling element connected to the joint implant, a second portion of the spanning member configured to be coupled to a second coupling element;
securing an arrangement between the spanning member and the joint implant; and
decoupling the proximal end of joint implant with the tool distal end of the delivery tool.
24. The method of claim 23, wherein the first and second fins are generally parallel to each other.
25. The method of claim 23, wherein the first fin extends off of the sacral facing surface and the second fin extends off of the ilium facing surface.
26. The method of claim 23, wherein the first and second fins are non-spiral threads.
27. The method of claim 23, wherein the body of the joint implant further comprises a first bore extending therethrough in a non-parallel relation to the longitudinal axis, and an attachment element at the proximal end of the joint implant, the first coupling element coupled to the attachment element, wherein at least a portion of the attachment element forms a plate that is generally perpendicular to the longitudinal axis of the joint implant, wherein the attachment element comprises a second bore, the first and second bores configured to permit insertion of an anchor therethrough.
28. The method of claim 27, further comprising: delivering the anchor through the first bore and the second bore and into at least one of the sacrum or the first ilium.
29. The method of claim 27, wherein the attachment element comprises an additional bore configured to permit insertion of another anchor therethrough.
30. A method for performing surgery at a treatment area within a patient having a lumbar spine and a pelvis, the treatment area comprising at least a portion of the pelvis, the pelvis comprising a sacrum, a first ilium, a second ilium, a first sacroiliac joint and a second sacroiliac joint each having an articular region, a caudal portion, a cranial portion, and an extra-articular region, the method comprising:
positioning a distal end of a joint implant adjacent the first sacroiliac joint with a delivery tool, the joint implant comprising a body extending along a longitudinal axis between a proximal end and the distal end, the body comprising a sacral facing surface and an ilium facing surface disposed opposite of the sacral facing surface, the sacral facing surface and the ilium facing surface are generally planar surfaces that are generally parallel to each other,
the delivery tool comprising a tool proximal end and a tool distal end opposite the tool proximal end, the tool distal end releasably coupled with the proximal end of joint implant;
delivering the joint implant non-transversely into the first sacroiliac joint via a posterior approach such that the sacral facing surface of the joint implant generally opposes the sacrum and the ilium facing surface generally opposes the first ilium;
coupling a first portion of a spanning member to a first coupling element connected to the joint implant, a second portion of the spanning member configured to be coupled to a second coupling element;
securing an arrangement between the spanning member and the joint implant; and
decoupling the proximal end of joint implant with the tool distal end of the delivery tool.
31. The method of claim 30, wherein the joint implant further comprising a first planar fin and a second planar fin, the first planar fin extending outward from the sacral facing surface and extending linearly on the sacral facing surface between the proximal and distal ends, the second planar fin extending outward from the ilium facing surface and extending linearly on the ilium facing surface between the proximal and distal ends.
32. The method of claim 25, wherein the first and second planar fins are parallel to each other.
33. The method of claim 30, wherein the body of the joint implant further comprises a first bore extending therethrough in a non-parallel relation to the longitudinal axis, and an attachment element at the proximal end of the joint implant, the first coupling element coupled to the attachment element, wherein at least a portion of the attachment element forms a plate that is generally perpendicular to the longitudinal axis of the joint implant, wherein the attachment element comprises a second bore, the first and second bores configured to permit insertion of an anchor therethrough.
34. A method for performing surgery at a treatment area within a patient having a lumbar spine and a pelvis, the treatment area comprising at least a portion of the pelvis, the pelvis comprising a sacrum, a first ilium, a second ilium, a first sacroiliac joint and a second sacroiliac joint each having an articular region, a caudal portion, a cranial portion, and an extra-articular region, the method comprising:
positioning a distal end of a joint implant adjacent the first sacroiliac joint with a delivery tool, the joint implant comprising a body extending along a longitudinal axis between a proximal end and the distal end, the joint implant further comprising an attachment element at the proximal end of the joint implant, and a bore extending therethrough dimensioned to receive a mechanical fastener, the body comprising a sacral facing surface and an ilium facing surface disposed opposite of the sacral facing surface, wherein at least one of the sacral or ilium facing surfaces further comprises a first fin projecting generally perpendicularly therefrom and extending between the joint implant proximal and distal ends,
the delivery tool comprising a tool proximal end and a tool distal end opposite the tool proximal end, the tool distal end releasably coupled with the proximal end of joint implant;
delivering the joint implant non-transversely into the first sacroiliac joint via a posterior approach such that the sacral facing surface of the joint implant generally opposes the sacrum and the ilium facing surface generally opposes the first ilium;
coupling a first portion of a spanning member to a first coupling element coupled to the attachment element of the joint implant, a second portion of the spanning member configured to be coupled to a second coupling element, wherein the attachment element comprises a first and second bore and wherein the first coupling element further comprises a coupling portion configured to join with the spanning member, the coupling portion being offset from the joint implant longitudinal axis;
securing an arrangement between the spanning member and the joint implant;
decoupling the proximal end of joint implant with the tool distal end of the delivery tool; and
driving the mechanical fastener through the bore and into engagement with at least one of the sacrum or the first ilium.
35. The method of claim 34, wherein the sacral facing surface and the ilium facing surface are generally planar surfaces that are generally parallel to each other.
36. The method of claim 34, further comprising forming a first fin receiving channel into at least one of the sacrum or the first ilium.
37. The method of claim 36, wherein the step of delivering the joint implant non-transversely into the first sacroiliac joint further comprises delivering the first fin within the first fin receiving channel.