Methods and apparatus for tools in axially oriented bores through spinal vertebrae

Abstract

One or more tools for use in shaped axially oriented bores extending from an accessed posterior or anterior target point are formed in the cephalad direction through vertebral bodies and intervening discs, if present, in general alignment with a visualized, trans-sacral axial instrumentation/fusion (TASIF) line in a minimally invasive, low trauma, manner. An anterior axial instrumentation/fusion line (AAIFL) or a posterior axial instrumentation/fusion line (PAIFL) that extends from the anterior or posterior target point, respectively, in the cephalad direction following the spinal curvature through one or more vertebral body is visualized by radiographic or fluoroscopic equipment. In one embodiment, curved anterior or posterior TASIF axial bores are formed in axial or parallel or diverging alignment with the visualized AAIFL or PAIFL, respectively, employing bore forming tools that can be manipulated from proximal portions thereof that are located outside the patient's body to adjust the curvature of the anterior or posterior TASIF axial bores as they are formed in the cephalad direction. Further bore enlarging tools are employed to enlarge one or more selected section of the anterior or posterior TASIF axial bore(s), e.g., the cephalad bore end or a disc space, so as to provide a recess therein that can be employed for various purposes, e.g., to provide anchoring surfaces for spinal implants inserted into the anterior or posterior TASIF axial bore(s).

1 . An apparatus configured for insertion in to a series of adjacent vertebrae located within a spine having an anterior aspect, a posterior aspect and an axial aspect from an anterior or posterior sacral target point of a sacral vertebra extending in the axial aspect through the series of adjacent vertebrae, wherein the axial aspect is curved in the posterior-anterior plane due to curvature of the spinal column, the vertebrae separated by intact or damaged spinal discs, the apparatus comprising:
 a sheath extending between a sheath proximal end and a sheath distal end, the sheath having a sheath lumen at least partially extending through a trans-sacral axial bore from the accessed sacral target point cephalad and axially through one or more vertebral bodies of the series of adjacent vertebrae and any intervertebral spinal discs; and   a tool sized to fit within the axial bore, the tool adapted to be inserted from the accessed sacral target point to a selected location along the axial bore, the tool operable from within a section of the axial bore, the tool comprising deployment/retraction means for deploying the tool between a retracted locked position and a deployed locked position.   
     
     
         2 . The apparatus of  claim 1 , wherein the retracted locked position comprises a radially retracted locked position. 
     
     
         3 . The apparatus of  claim 1 , wherein the retracted locked position comprises an axially retracted locked position. 
     
     
         4 . The apparatus of  claim 1 , wherein the deployed locked position comprises a radially deployed locked position. 
     
     
         5 . The apparatus of  claim 1 , wherein the deployed locked position comprises an axially deployed locked position. 
     
     
         6 . The apparatus of  claim 1 , further comprising rotating means for rotating the tool from the sheath distal end. 
     
     
         7 . The apparatus of  claim 6 , the rotating means configured for removal of vertebral bone or disc material. 
     
     
         8 . The apparatus of  claim 1 , wherein the tool further comprises at least one filament attached to the shaft distal end. 
     
     
         9 . The apparatus of  claim 1 , wherein the tool further comprises at least one wire attached to the shaft distal end. 
     
     
         10 . The apparatus of  claim 1 , wherein the tool further comprises at least one abrading cable attached to the shaft distal end. 
     
     
         11 . The apparatus of  claim 8 , wherein the at least one cable is formed of a length of woven or braided metal or fabric tending to spring outward when unrestrained. 
     
     
         12 . The apparatus of  claim 1 , wherein the tool further comprises:
 a cutting blade extending from the sheath distal end;   a mechanism controlled from the sheath proximal end, the mechanism enabling movement of the cutting blade between an axially aligned position and a radially pivoted position.