US PATENT 9,833,320 B2 METHODS OF FUSING A SACROILIAC JOINT
Systems for and methods of fusing a sacroiliac joint are provided which may include an implant adapted to be inserted into the joint space defined by the bones of a sacrum and an ilium and a delivery tool for inserting the implant into the sacroiliac joint. The method may include delivering the implant into the SI joint in a first position and transitioning the implant from the first position to a second position in situ. The implant may be configured such that in the second position the implant generally mimics a shape of the joint space of the sacroiliac joint. The implant may further include an actuation mechanism configured to cause the implant to transition from the first position to the second position. The actuation mechanism may include a hydraulic, pneumatic, geared or screwed mechanical arrangement.
CLAIMS
The invention claimed is:
1. A method of fusing a sacroiliac joint including: bone material including a sacrum and an ilium; a joint space defined between the sacrum and the ilium and defining a joint plane; an extra-articular space including an extra-articular recess access region; and an articular region including a posterior inferior access region, a superior boundary segment, an anterior boundary segment, a caudal region, and a cranial region, the method comprising:
positioning an implant adjacent the sacroiliac joint,
the implant comprising a proximal end, a distal end generally opposite the proximal end, first and second lateral sides extending between the proximal and distal ends, and a member near the distal end configured to displace from a first position to a second position,
wherein the first position is such that the member is generally recessed within the implant such that a lateral side surface of the member is generally flush with the first lateral side, and
wherein the second position is such that the member extends from the first lateral side such that the lateral side surface of the member is offset from the first lateral side;
delivering the implant into the sacroiliac joint in the first position via a posterior approach such that the first and second lateral sides are generally positioned in the joint plane; and
transitioning the implant from the first position to the second position.
2. The method of claim 1, wherein, in the second position, the implant generally mimics a shape of the joint space of the sacroiliac joint.
3. The method of claim 1, wherein, in the second position, the implant substantially fills the joint space of the sacroiliac joint.
4. The method of claim 1, wherein, in the second position, the member is positioned at least partially within the cranial region of the sacroiliac joint.
5. The method of claim 1, wherein, in the second position, the member is positioned generally within the joint plane.
6. The method of claim 1, wherein the implant further comprises: a body extending between the distal and proximal ends; and a first keel extending outwardly from the body and extending at least partially between the distal and proximal ends.
7. The method of claim 6, wherein the implant further comprises: a second keel extending outwardly from the body and extending at least partially between the distal and proximal ends.
8. The method of claim 7, wherein the first and second keel are on opposite sides of the implant.
9. The method of claim 8, wherein the first and second keels are generally coplanar with each other.
10. The method of claim 9, wherein the first and second keels are centrally positioned on the body of the implant between the first and second lateral sides.
11. The method of claim 1, wherein the implant further comprises: a body extending between the distal and proximal ends; and a void extending through the body.
12. The method of claim 11, wherein the void is rectangular.
13. The method of claim 1, wherein the member is displaceably supported on the implant via a rail arrangement.
14. The method of claim 1, further comprising an actuation mechanism configured to cause the member to transition from the first position to the second position.
15. The method of claim 14, wherein the actuation mechanism is actuatable via an access at the proximal end.
16. The method of claim 15, wherein the step of transitioning the implant from the first position to the second position comprises actuating the actuation mechanism at the proximal end of the implant.
17. The method of claim 15, wherein the actuation mechanism includes a hydraulic, pneumatic, geared or screwed mechanical arrangement.
18. The method of claim 1, wherein the member is positioned proximal of a distal tip of the implant.
19. The method of claim 1, wherein the implant further comprises a planar body extending between the distal and proximal ends, the planar body comprising a pair of first planar faces opposite each other, the member being planar and comprising a pair of second planar faces opposite each other, the first pair of planar faces being generally parallel with the second pair of planar faces.
20. The method of claim 19, wherein the implant further comprises at least one keel extending outwardly from at least one of the pair of first planar faces.
21. The method of claim 1, wherein the implant further comprises a planar body having a sacral facing surface and an ilium facing surface, the sacral facing surface configured to oppose the sacrum and the ilium facing surface configured to oppose the ilium when the implant is delivered into the sacroiliac joint.
22. The method of claim 1, wherein delivering the implant into the sacroiliac joint in the first position via a posterior approach comprises positioning the distal end of the implant adjacent the anterior boundary segment of the sacroiliac joint.
23. The method of claim 1, wherein in transitioning the implant from the first position to the second position the member extends towards the superior boundary segment of the sacroiliac joint.
24. The method of claim 1, wherein delivering the implant into the sacroiliac joint in the first position via a posterior approach comprises delivering the implant into the caudal region through the posterior inferior access region of the sacroiliac joint.
25. The method of claim 1, wherein delivering the implant into the sacroiliac joint in the first position via a posterior approach comprises delivering the implant into the extra-articular space through the extra-articular recess access region.
26. The method of claim 1, wherein the member is a rectangular member having oppositely oriented bone engaging surface having a plurality of ridges thereon to operatively engage the sacrum or the ilium.
27. The method of claim 1, wherein the second position comprises the lateral side surface of the member being generally parallel to the first lateral side.
28. A method of fusing a sacroiliac joint including: bone material including a sacrum and an ilium; a joint space defined between the sacrum and the ilium and defining a joint plane; an extra-articular space including an extra-articular recess access region; and an articular region including a posterior inferior access region, a superior boundary segment, an anterior boundary segment, a caudal region, and a cranial region, the method comprising:
positioning an implant adjacent the sacroiliac joint,
the implant comprising a proximal end, a distal end generally opposite the proximal end, first and second lateral sides extending between the proximal and distal ends, a portion of the first lateral side configured to displace from a first position to a second position,
wherein the first position is such that the portion is generally flush with another portion of the first lateral side, and
wherein the second position is such that the portion extends from the first lateral side such that the portion is offset from the another portion of the first lateral side;
delivering the implant into the sacroiliac joint in the first position such that the first and second lateral sides are generally positioned in the joint plane; and
transitioning the implant from the first position to the second position.
29. The method of claim 28, wherein, in the second position, the portion comprises a surface between the distal and proximal ends which is transverse to the another portion of the first lateral side surface such that an angle is formed between the portion surface and the another portion of the first lateral side surface.
30. The method of claim 28, wherein delivering the implant into the sacroiliac joint in the first position comprises delivering the implant via a delivery axis; and wherein transitioning the implant from the first position to the second position comprises a transition vector; and wherein the implant comprises at least one protrusion supported off of and extending outwardly from the implant between the first and second lateral sides and comprising a protrusion vector; wherein each the delivery axis, transition vector and protrusion vector comprise directions which are generally perpendicular to one another.
31. The method of claim 30, wherein a magnitude of the transition vector is substantially greater than a magnitude of the protrusion vector relative to an implant longitudinal axis.
32. The method of claim 30, wherein the protrusion comprises at least one keel having a length extending between the distal and proximal ends, the length being generally perpendicular to the protrusion vector direction.
33. The method of claim 32, wherein the implant further comprises a body between distal and proximal ends and a void extending through the body, the at least one keel being supported by the implant at a distal end region and proximal end region, wherein a portion of the length of the at least one keel bridges the void.
34. The method of claim 32, the at least one keel further comprising a top surface, a bottom surface opposite the top surface, wherein each of the top and bottom surfaces extends outwardly from the body along the protrusion vector and lengthwise along the length, wherein a maximum protrusion vector is greater than a thickness between the top and bottom surfaces.
35. The method of claim 33, the body further comprising a support element located between the distal and proximal ends and connecting between the first and second lateral sides wherein the at least one keel is further supported by the implant at the support element.
36. The method of claim 30, further comprising an actuation mechanism configured to cause the portion to transition from the first position to the second position.
37. The method of claim 36, wherein the actuation mechanism is actuatable via an access at the proximal end.
38. The method of claim 37, wherein the step of transitioning the implant from the first position to the second position comprises actuating the actuation mechanism at the proximal end of the implant.
39. The method of claim 37, wherein the actuation mechanism includes a hydraulic, pneumatic, geared or screwed mechanical arrangement.
40. The method of claim 39, wherein the implant further comprises a locking mechanism configured to be employed when in the second position to prevent movement of the portion such that it does not transition back to the first position.
41. The method of claim 39, wherein the geared or screwed mechanical arrangement further comprises at least one of the following components: a spur, helical, rack, bevel, miter, worm ratchet or pawl gear.
42. The method of claim 28, wherein the implant further comprises a body between distal and proximal ends and a void extending through the body and when the implant is in the first position the void is generally occluded and in the second position the void is generally open.
43. The method of claim 42, wherein the body further comprises a second void extending through the body, wherein the void is generally open when the implant is in either the first position or the second position.
44. A method of fusing a sacroiliac joint including: bone material including a sacrum and an ilium; a joint space defined between the sacrum and the ilium and defining a joint plane; an extra-articular space including an extra-articular recess access region; and an articular region including a posterior inferior access region, a superior boundary segment, an anterior boundary segment, a caudal region, and a cranial region, the method comprising:
positioning an implant adjacent the sacroiliac joint,
the implant comprising a first portion and a second portion opposite the first portion, the first and second portions being in cooperation with one another, the implant configured to displace from a first position to a second position, the implant comprising an actuation mechanism configured to cause the implant to transition from the first position to the second position,
wherein the actuation mechanism is actuatable via an access at a proximal end of the implant,
wherein the first position is such that the first portion is located immediately adjacent the second portion, and
wherein the second position is such that the first portion is separated from the second portion;
delivering the implant into the sacroiliac joint in the first position; and
transitioning the implant from the first position to the second position,
wherein the step of transitioning the implant from the first position to the second position comprises actuating the actuation mechanism at the proximal end of the implant.
45. The method of claim 44, wherein delivering the implant into the sacroiliac joint in the first position comprises delivering the implant such that the first and second portions are generally positioned in the joint plane.
46. The method of claim 45, wherein, in the second position, the implant generally mimics a shape of the joint space of the sacroiliac joint.
47. The method of claim 45, wherein, in the second position, the implant substantially fills the joint space of the sacroiliac joint.
48. The method of claim 45, wherein, in the second position, the first portion is positioned at least partially within the cranial region of the sacroiliac joint.
49. The method of claim 45, wherein, in the second position, the first portion is positioned generally within the joint plane.
50. A method of fusing a sacroiliac joint including: bone material including a sacrum and an ilium; a joint space defined between the sacrum and the ilium and defining a joint plane; an extra-articular space including an extra-articular recess access region; and an articular region including a posterior inferior access region, a superior boundary segment, an anterior boundary segment, a caudal region, and a cranial region, the method comprising:
positioning an implant adjacent the sacroiliac joint,
the implant comprising a first portion and a second portion opposite the first portion, the first and second portions being in cooperation with one another, the implant configured to displace from a first position to a second position,
wherein the first position is such that the first portion is located immediately adjacent the second portion, and
wherein the second position is such that the first portion is separated from the second portion;
delivering the implant into the sacroiliac joint in the first position; and
transitioning the implant from the first position to the second position,
wherein the first and second portions being in cooperation with one another is via a piston system arrangement comprising a piston housing and piston displaceably received therein.
51. The method of claim 50, wherein the implant further comprises a conduit having an opening defined on a surface of the implant and being in communication with the piston housing.
52. The method of claim 50, wherein the implant further comprises a gasket at an interface between the piston housing and the piston.
53. The method of claim 51, wherein the step of transitioning the implant from the first position to the second position comprises actuating the piston system arrangement with a pressurized medium via the conduit.
54. The method of claim 44, wherein delivering the implant into the sacroiliac joint in the first position comprises delivering the implant via a delivery axis; and wherein transitioning the implant from the first position to the second position comprises a transition vector; and wherein the implant comprises at least one protrusion supported off of and extending outwardly from the implant and comprising a protrusion vector; wherein each the delivery axis, transition vector and protrusion vector comprise directions which are generally perpendicular to one another.
55. The method of claim 54, wherein the first and second portions being in cooperation with one another is via a piston system arrangement comprising a piston housing and piston displaceably received therein.
56. The method of claim 55, wherein the piston comprises a longitudinal axis, the piston longitudinal axis being generally parallel to the transition vector.
57. The method of claim 56, wherein the step of transitioning the implant from the first position to the second position comprises actuating the piston system arrangement with a pressurized medium via an opening into the piston housing.
58. The method of claim 44, wherein the implant further comprises a proximal end region, a distal end region generally opposite the proximal end region, and a longitudinal axis, the distal end region comprising a first lateral side, a second lateral side opposite the first lateral side, a first surface extending between the first and second lateral sides, and a second surface opposite the first surface and extending between the first and second lateral sides, wherein each of the first and second surfaces taper toward an extreme distal end and each comprises a maximum height between the first and second lateral sides which is substantially greater than a maximum thickness defined between the first and second surfaces, the maximum thickness extending perpendicular to the longitudinal axis.
59. The method of claim 44, wherein the implant further comprises a proximal end region, a distal end region generally opposite the proximal end region, and a longitudinal axis, the proximal end region comprising a first lateral side, a second lateral side opposite the first lateral side, a first surface extending between the first and second lateral sides, and a second surface opposite the first surface and extending between the first and second lateral sides, wherein each of the first and second surfaces comprise a maximum height between the first and second lateral sides which is substantially greater than a maximum thickness defined between the first and second surfaces, the maximum thickness extending perpendicular to the longitudinal axis.