US9795396B2

US PATENT 9,795,396 B2     METHODS OF FUSING A SACROILIAC JOINT

One implementation of the present disclosure may take the form of a sacroiliac joint fusion system including a joint implant, an anchor element and a delivery tool. The joint implant includes a distal end, a proximal end, a body extending between the proximal and distal ends, and a first bore extending non-parallel to a longitudinal axis of the body. The anchor element includes a distal end and a proximal end and is configured to be received in the first bore. The delivery tool includes an implant arm and an anchor arm. The implant arm includes a proximal end and a distal end. The distal end of the implant arm is configured to releasably couple to the proximal end of the joint implant such that a longitudinal axis of the implant arm is substantially at least one of coaxial or parallel with the longitudinal axis of the body of the joint implant. The anchor arm includes a proximal end and a distal end. The distal end of the anchor arm is configured to engage the proximal end of the anchor element. The anchor arm is operably coupled to the implant arm in an arrangement such that the longitudinal axis of the anchor element is generally coaxially aligned with a longitudinal axis of the first bore when the distal end of the implant arm is releasably coupled with the proximal end of the joint implant and the distal end of the anchor arm is engaged with the proximal end of the anchor element. The arrangement is fixed and nonadjustable.

CLAIMS

What is claimed is: 

1. A method of fusing a sacroiliac joint comprising a sacrum and an ilium, the method comprising:

a) delivering a joint implant non-transversely into a sacroiliac joint space, the joint implant comprising a first planar member coupled to and extending generally perpendicularly with an intra-articular member, the joint implant being oriented in the sacroiliac joint space such that the intra-articular member is generally coplanar with a joint plane of the sacroiliac joint space; and

b) causing an anchor element to be delivered into a sacroiliac joint region in a proximal-to-distal trajectory relative to the joint implant such that the anchor element extends into at least one of the sacrum or the ilium. 

2. The method of claim 1, wherein the joint implant further comprises at least one void within the joint implant. 

3. The method of claim 2, wherein the void is a passageway extending through the joint implant, the passageway comprising at least one opening defined on an outer surface of the joint implant. 

4. The method of claim 3, wherein the at least one opening includes a first and a second opening, the first and second openings being defined on different surfaces of the joint implant. 

5. The method of claim 4, wherein the different surfaces include an implant proximal region surface and a longitudinally extending surface which extends generally along a length of the joint implant between an implant proximal end and an implant distal end. 

6. The method of claim 3, wherein the anchor element extends at least partially through the at least one opening. 

7. The method of claim 3, wherein the passageway comprises a longitudinal axis which is disposed in a transverse relation to a joint implant longitudinal axis. 

8. The method of claim 1, wherein, when the joint implant is oriented in the sacroiliac joint space such that the intra-articular element is generally coplanar with the joint plane, the first planar member is configured to extend into at least one of the sacrum or the ilium. 

9. The method of claim 8, wherein the first planar member extends into both the sacrum and the ilium. 

10. The method of claim 8, wherein the joint implant further comprises at least one passageway extending through the joint implant and comprising at least one opening defined on an outer surface of the joint implant, wherein the anchor extends at least partially through the passageway such that the anchor extends into the at least one of the sacrum or the ilium. 

11. The method of claim 1, wherein the first planar member and the intra-articular member are coupled together at relative midpoints such that the first planar member extends outward from each of opposing faces of the intra-articular member about a same distance. 

12. The method of claim 1, wherein the first planar member and the intra-articular member are coupled together to form a cross-shape cross-section. 

13. The method of claim 1, wherein the first planar member and the intra-articular member are coupled together to form a T-shape cross-section. 

14. The method of claim 1, wherein the first planar member comprises a pair of opposing planar faces extending between a pair of side edges, the pair of opposing planar faces and the pair of side edges extending a length of the implant, the intra-articular member comprising a body extending between a pair of longitudinal ends, the body and the pair of longitudinal ends extending the length of the implant, one of the pair of longitudinal ends of the intra-articular member being coupled to one of the pair of opposing planar faces. 

15. The method of claim 1, wherein, in delivering the joint implant into the sacroiliac joint space, the joint implant gains access to the sacroiliac joint space via a caudal access. 

16. The method of claim 15, wherein the joint implant is implanted in a caudal region of the sacroiliac joint space. 

17. The method of claim 15, wherein the caudal region is bounded on an inferior side by an inferior boundary segment and on a superior side by a laterally extending portion of a posterior boundary segment. 

18. The method of claim 1, wherein, in delivering the joint implant into the sacroiliac joint space, a longitudinal edge of the intra-articular member is generally parallel to an inferior sacroiliac joint space boarder while a distal end of the joint implant is oriented towards an anterior sacroiliac joint space boarder. 

19. The method of claim 1, wherein, in delivering the joint implant into a sacroiliac joint space, a longitudinal edge of the intra-articular member is generally immediately adjacent an inferior sacroiliac joint space boarder while a distal end of the joint implant is oriented towards: 1) an anterior sacroiliac joint space boarder; 2) a superior sacroiliac joint space boarder; or 3) somewhere between 1 and 2. 

20. The method of claim 1, wherein, in delivering the joint implant into the sacroiliac joint space, the joint implant passes through a posterior inferior access region. 

21. The method of claim 1, wherein the joint implant is configured to receive two anchor elements via two discreet passageways. 

22. The method of claim 1, wherein, upon causing an anchor element to be delivered into a sacroiliac joint region, the anchor element is positioned in a predetermined relation to a bore in the joint implant. 

23. The method of claim 22, wherein the predetermined relation includes the anchor element being positioned within the bore of the joint implant. 

24. The method of claim 1, wherein the proximal-to-distal trajectory includes the anchor element extending through a bore in the joint implant. 

25. The method of claim 1, wherein the proximal-to-distal trajectory includes the anchor element extending generally parallel to a longitudinal axis of the joint implant. 

26. The method of claim 1, wherein the joint implant further comprises a bore extending generally across and between opposite faces of a portion of the joint implant, the anchor element extending through the bore. 

27. The method of claim 26, wherein the portion of the joint implant comprises a proximal portion of the joint implant. 

28. A method of fusing a sacroiliac joint comprising a sacrum and an ilium, the method comprising:

a) delivering a joint implant non-transversely into a sacroiliac joint space, the joint implant comprising a first planar member coupled to and extending generally perpendicularly with an intra-articular member, the joint implant being oriented in the sacroiliac joint space such that the intra-articular member is generally coplanar with a joint plane of the sacroiliac joint space; and

b) causing an anchor element to be delivered into a sacroiliac joint region in a preselected trajectory such that the anchor element extends into at least one of the sacrum or the ilium,

wherein the joint implant further comprises a bore extending generally across and between opposite faces of the intra-articular member, the anchor element extending adjacent the implant and not through the bore. 

29. A method of fusing a sacroiliac joint comprising a sacrum and an ilium, the method comprising:

a) delivering a joint implant non-transversely into a sacroiliac joint space, the joint implant comprising a first planar member coupled to and extending generally perpendicularly with an intra-articular member, the joint implant being oriented in the sacroiliac joint space such that the intra-articular member is generally coplanar with a joint plane of the sacroiliac joint space;

b) causing an anchor element to be delivered into a sacroiliac joint region in a preselected trajectory such that the anchor element extends into at least one of the sacrum or the ilium;

c) grasping a delivery tool comprising an implant arm and an anchor arm coupled to the implant arm;

d) coupling a proximal end of the joint implant to a distal end of the implant arm;

e) using the delivery tool to deliver the joint implant non-transversely into the sacroiliac joint space; and

f) with the distal end of the implant arm still coupled to the proximal end of the joint implant, employing the anchor arm to guide the anchor element when the anchor element is being driven generally transverse to the joint plane through the sacrum or the ilium,

wherein the joint implant, the implant arm and the anchor arm have an as-manufactured configuration that limits the anchor arm to properly align the anchor element for delivery generally transverse to the joint implant in only a single orientation when the joint implant is coupled to the implant arm, and

wherein, in delivering the joint implant into the sacroiliac joint space, the implant arm is positioned at least one of superior or cephalad of a sciatic notch. 

30. A method of fusing a sacroiliac joint comprising a sacrum and an ilium, the method comprising:

a) delivering a joint implant non-transversely into a sacroiliac joint space, the joint implant comprising a first planar member coupled to and extending generally perpendicularly with an intra-articular member, the joint implant being oriented in the sacroiliac joint space such that the intra-articular member is generally coplanar with a joint plane of the sacroiliac joint space; and

b) causing an anchor element to be delivered into a sacroiliac joint region in a preselected trajectory such that the anchor element extends into at least one of the sacrum or the ilium,

wherein, in delivering the joint implant into the sacroiliac joint space, the joint implant passes through a posterior inferior access region, and

wherein the posterior inferior access region includes a superior end that is between about 0 mm to about 40 mm inferior a posterior inferior overhang of a posterior superior iliac spine. 

31. The method of claim 30, wherein the posterior inferior access region further includes an inferior end that is about at an intersection of a posterior inferior iliac spine with a lateral anterior curved boundary of the sacrum. 

32. A method of fusing a sacroiliac joint comprising a sacrum and an ilium, the method comprising:

a) delivering a joint implant non-transversely into a sacroiliac joint space, the joint implant comprising a first planar member coupled to and extending generally perpendicularly with an intra-articular member, the joint implant being oriented in the sacroiliac joint space such that the intra-articular member is generally coplanar with a joint plane of the sacroiliac joint space; and

b) causing an anchor element to be delivered into a sacroiliac joint region in a preselected trajectory such that the anchor element extends into at least one of the sacrum or the ilium,

wherein the joint implant further comprises a bore extending generally across and between opposite faces of the intra-articular member, the anchor element extending through the bore, and

wherein the anchor element is driven into the sacrum before entering the bore. 

33. A method of fusing a sacroiliac joint comprising a sacrum and an ilium, the method comprising:

a) delivering a joint implant non-transversely into a sacroiliac joint space, the joint implant comprising a first planar member coupled to and extending generally perpendicularly with an intra-articular member, the joint implant being oriented in the sacroiliac joint space such that the intra-articular member is generally coplanar with a joint plane of the sacroiliac joint space; and

b) causing an anchor element to be delivered into a sacroiliac joint region in a preselected trajectory such that the anchor element extends into at least one of the sacrum or the ilium,

wherein the anchor element is driven into the sacrum just lateral a lateral edge of a S2 foramen. 

34. A method of fusing a sacroiliac joint comprising a sacrum and an ilium, the method comprising:

a) delivering a joint implant non-transversely into a sacroiliac joint space, the joint implant comprising a bore, a first planar member, and an intra-articular member coupled to and extending generally perpendicularly with an intra-articular member, the joint implant being oriented in the sacroiliac joint space such that the intra-articular member is generally coplanar with a joint plane of the sacroiliac joint space; and

b) causing an anchor element to be delivered into a sacroiliac joint region such that the anchor element extends into at least one of the sacrum or the ilium,

wherein, upon the anchor element being delivered, at least a portion of the anchor element is in a predetermined orientation relative to a bore in the joint implant. 

35. The method of claim 34, wherein the predetermined orientation comprises the at least a portion of the anchor element being positioned within the bore. 

36. The method of claim 34, wherein the anchor element is delivered in a proximal-to-distal trajectory. 

37. The method of claim 34, wherein the bore extends generally across and between opposite faces of a proximal portion of the joint implant. 

38. The method of claim 34, wherein the predetermined orientation comprises the anchor element being substantially parallel with a longitudinal axis of the joint implant. 

39. The method of claim 34, wherein the predetermined orientation comprises the anchor element being substantially non-parallel with a longitudinal axis of the joint implant. 

40. The method of claim 39, wherein the longitudinal axis of the joint implant is curved and a longitudinal axis of the anchor is linear. 

41. The method of claim 34, wherein the bore extends across the joint implant and non-parallel to a longitudinal axis of the joint implant. 

42. The method of claim 41, wherein, upon the anchor element being delivered, the anchor element is not positioned within the bore. 

43. A method of fusing a sacroiliac joint comprising a sacrum and an ilium, the method comprising:

a) delivering a joint implant non-transversely into a sacroiliac joint space, the joint implant comprising a first planar member coupled to and extending generally perpendicularly with an intra-articular member, the joint implant being oriented in the sacroiliac joint space such that the intra-articular member is generally coplanar with a joint plane of the sacroiliac joint space; and

b) causing a first anchor element to be delivered into the sacrum or the ilium in a first orientation relative to the joint implant. 

44. The method of claim 43, wherein the first orientation comprises at least a portion of the first anchor element being positioned superior to a top surface of the first planar member. 

45. The method of claim 44, wherein, upon causing the first anchor element to be delivered into the sacrum or the ilium, the at least a portion of the first anchor element passes through a passageway extending through the joint implant.

46. The method of claim 43, wherein the first orientation comprises at least a portion of the first anchor element being positioned inferior to a bottom surface of the first planar member. 

47. The method of claim 46, wherein, upon causing the first anchor element to be delivered into the sacrum or the ilium, the at least a portion of the first anchor element passes through a passageway extending through the joint implant.

48. The method of claim 43, wherein the at least a portion of the first anchor element passes through a passageway extending through the joint implant. 

49. The method of claim 43, further comprising: c) causing a second anchor element to be delivered into the sacrum or the ilium in a second orientation relative to the joint implant. 

50. The method of claim 49, wherein, upon causing the first anchor element and the second anchor element to be delivered into the sacrum or the ilium, at least a portion of the first anchor element passes through a first passageway extending through the joint implant and at least a portion of the second anchor element passes through a second passageway extending through the joint implant. 

51. The method of claim 50, wherein the first passageway and the second passageway are spaced apart from one another such that the at least a portion of the first anchor element is deliverable adjacent a first side of the intra-articular member and the at least a portion of the second anchor element is deliverable adjacent a second side of the intra-articular member. 

52. The method of claim 51, wherein, upon delivering the joint implant non-transversely into the sacroiliac joint space, the joint implant is oriented such that the first side of the intra-articular member opposes the sacrum and the second side of the intra-articular member opposes the ilium. 

53. The method of claim 50, wherein, the first passageway and the second passageway are spaced apart from one another such that the at least a portion of the first anchor element is deliverable superior to a top surface of the first planar member and the at least a portion of the second anchor element is deliverable inferior to a bottom surface of the first planar member. 

54. The method of claim 43, wherein the joint implant further comprises a second planar member coupled to and extending generally perpendicularly with the intra-articular member. 

55. The method of claim 54, wherein the first and second planar members are generally coplanar with each other. 

56. The method of claim 55, wherein the intra-articular member comprises a top surface and a bottom surface opposite the top surface, wherein the first and second planar members are coupled to the intra-articular member, respectively, at about a midpoint between the top surface and the bottom surface. 

57. The method of claim 54, wherein the intra-articular member further comprises at least one void therein, wherein the at least one void is a passageway extending through the intra-articular member. 

58. The method of claim 43, wherein the joint implant extends a length between a first end and a second end opposite the first end, wherein the second end of the joint implant tapers to a terminal end so as to ease delivery into the sacroiliac joint space. 

59. The method of claim 43, wherein the joint implant extends a length between a first end and a second end opposite the first end, wherein the joint implant further comprises an anti-migration element coupled to the first end. 

60. The method of claim 59, wherein the anti-migration element comprises an enlarged terminal portion. 

61. The method of claim 43, further comprising: removing an amount of cartilage from within the sacroiliac joint space prior to delivering the joint implant non-transversely into the sacroiliac joint space. 

62. The method of claim 43, further comprising: advancing a drill bit into the sacroiliac joint space to produce an implant receiving space for the subsequent delivery of the joint implant. 

63. The method of claim 43, further comprising: advancing an end of a broach into the sacroiliac joint space to produce an implant receiving space for the subsequent delivery of the joint implant. 

64. The method of claim 43, wherein, when the joint implant is oriented in the sacroiliac joint space such that the intra-articular element is generally coplanar with the joint plane, the first planar member is configured to extend into at least one of the sacrum or the ilium. 

65. The method of claim 64, wherein the first planar member extends into both the sacrum and the ilium. 

66. The method of claim 65, wherein the intra-articular member comprises at least three aperture elements which communicate between opposite surfaces of the planar member, the at least three aperture elements aligned along a length extending between a distal end and proximal end of the intra-articular member. 

67. The method of claim 43, wherein the first planar member and the intra-articular member are coupled together at relative midpoints such that the first planar member extends outward from each of opposing faces of the intra-articular member about a same distance. 

68. The method of claim 43, wherein the first planar member and the intra-articular member are coupled together to form a cross-shape cross-section. 

69. The method of claim 43, wherein the first planar member and the intra-articular member are coupled together to form a T-shape cross-section. 

70. The method of claim 43, wherein the first planar member comprises a pair of opposing planar faces extending between a pair of side edges, the pair of opposing planar faces and the pair of side edges extending a length of the implant, the intra-articular member comprising a body extending between a pair of longitudinal ends, the body and the pair of longitudinal ends extending the length of the implant, one of the pair of longitudinal ends of the intra-articular member being coupled to one of the pair of opposing planar faces. 

71. The method of claim 43, wherein, in delivering the joint implant into the sacroiliac joint space, the joint implant gains access to the sacroiliac joint space via a caudal access. 

72. The method of claim 71, wherein the joint implant is implanted in a caudal region of the sacroiliac joint space. 

73. The method of claim 71, wherein the caudal region is bounded on an inferior side by an inferior boundary segment and on a superior side by a laterally extending portion of a posterior boundary segment. 

74. The method of claim 43, wherein, in delivering the joint implant into the sacroiliac joint space, a longitudinal edge of the intra-articular member is generally parallel to an inferior sacroiliac joint space boarder while a distal end of the joint implant is oriented towards an anterior sacroiliac joint space boarder. 

75. The method of claim 43, wherein, in delivering the joint implant into a sacroiliac joint space, a longitudinal edge of the intra-articular member is generally immediately adjacent an inferior sacroiliac joint space boarder while a distal end of the joint implant is oriented towards: 1) an anterior sacroiliac joint space boarder; 2) a superior sacroiliac joint space boarder; or 3) somewhere between 1 and 2. 

76. The method of claim 43, wherein, in delivering the joint implant into the sacroiliac joint space, the joint implant passes through a posterior inferior access region. 

77. The method of claim 43, wherein the intra-articular member comprises a generally cylindrical body. 

78. The method of claim 43, wherein the intra-articular member comprises a cross section selected from at least one of a circle, oval, triangular, rectangular, square or diamond configuration. 

79. The method of claim 43, wherein the joint implant comprises an end cap having an end cap perimeter selected from at least one of a circle, oval, square or rectangle configuration. 

80. The method of claim 43, wherein the first anchor element is selected from at least one of a threaded member, barbed member or locking member. 

81. The method of claim 43, further comprising: inserting a guide wire into the sacroiliac joint space and advancing a cannulated probe having a distal spatulate tip over the guide wire and into the sacroiliac joint space. 

82. The method of claim 43, further comprising: aligning a drill jig having a pattern of drill guide holes such that at least one of the drill guide holes is coplanar with the sacroiliac joint space and drilling a plurality of bores at the sacroiliac joint in a spaced apart predetermined pattern to produce an implant receiving space for the subsequent delivery of the joint implant. 

83. The method of claim 43, further comprising: aligning a drill jig having a pattern of drill guide holes such that the pattern of drill guide holes is coplanar with the sacroiliac joint space and drilling a plurality of bores within the sacroiliac joint space spaced apart in a predetermined pattern such that each of the plurality of bores removes an amount of cartilage from within the sacroiliac joint space prior to delivering the joint implant non-transversely into the sacroiliac joint space to produce an implant receiving space for the subsequent delivery of the joint implant. 

84. The method of claim 43, further comprising: positioning a broach jig up to the sacroiliac joint, the broach jig comprising a broach guide hole and configured to guide a broach into the sacroiliac joint space and advancing a distal end of a broach into the sacroiliac joint space to produce an implant receiving space for the subsequent delivery of the joint implant.