Methods and instrumentation for vertebral interbody fusion

Abstract

Methods and instrumentation for vertebral interbody fusion are provided. Sleeve assemblies can be provided with a reduced width portion adjacent the distal end to limit the amount of retraction of the surrounding vascular and neural structures required for the procedure. A sleeve assembly can be provided with a guide sleeve removably engaged to a guide sleeve housing. The guide sleeve can be removed during surgery to improve the surgeon's viewing of the operative site while the guide sleeve housing maintains disc space distraction. Methods and instruments for inserting and using the guide sleeve housing are also provided.

1 .- 35 . (canceled) 
     
     
         36 . A spinal instrument assembly, comprising:
 a guide sleeve housing having a distal portion and a proximal portion, and wherein said guide sleeve housing is positionable in an operative position with respect to a spinal disc space;   a guide sleeve having a distal end portion and a proximal end portion, said distal end portion of said guide sleeve removably engaged to said proximal portion of said guide sleeve housing; and   a distractor tip centrally located relative to said guide sleeve housing and including upper and lower distraction surfaces defining a distraction height therebetween to maintain distraction of the spinal disc space.   
     
     
         37 . The spinal instrument assembly of  claim 36 , wherein said guide sleeve housing defines a working channel in which said distractor tip is centrally located. 
     
     
         38 . The spinal instrument assembly of  claim 36 , wherein said distractor tip is rotatable from a reduced height configuration whereby said upper and lower distraction surfaces are oriented away from vertebral endplates of the spinal disc space to a distraction configuration whereby said upper and lower distraction surfaces are oriented toward the vertebral endplates of the spinal disc space. 
     
     
         39 . The spinal instrument assembly of  claim 38 , wherein said distractor is engaged with said guide sleeve housing when in said distraction configuration and disengaged from said guide sleeve housing when in said reduced height configuration. 
     
     
         40 . The spinal instrument assembly of  claim 36 , wherein said guide sleeve housing is removably engaged to a housing inserter. 
     
     
         41 . The spinal instrument assembly of  claim 40 , wherein said housing inserter and said guide sleeve housing are positionable over a proximal end of a distractor shaft extending from said distractor tip and movable therealong to position said guide sleeve housing in said operative position. 
     
     
         42 . The spinal instrument assembly of  claim 36 , wherein said proximal portion of said guide sleeve housing has an inner wall defining a chamber and said distal portion defines working channel ports extending therethrough and positioned in communication with said chamber. 
     
     
         43 . The spinal instrument assembly of  claim 42 , wherein said inner wall defines a groove therein. 
     
     
         44 . The spinal instrument assembly of  claim 43 , wherein:
 said distractor tip is part of a central distractor, said central distractor including a housing engaging portion having an actuatable finger;   said central distractor has a reduced height configuration whereby said upper and lower distraction surfaces are oriented away from vertebral endplates of a spinal disc space when said finger is not actuated; and   said central distractor is rotatable to a distraction configuration whereby said upper and lower distraction surfaces are oriented toward the vertebral endplates of the spinal disc space when said finger is actuated and received in said groove thereby coupling said guide sleeve housing to said central distractor.   
     
     
         45 . The spinal instrument assembly of  claim 43 , wherein said guide sleeve housing is removably engaged to a housing inserter, said housing inserter having an actuatable finger positionable in said groove to removably engage said housing inserter to said guide sleeve housing. 
     
     
         46 . The spinal instrument assembly of  claim 45 , wherein said housing inserter and said guide sleeve housing are positionable over an end portion of a distractor shaft extending from said distractor tip and movable therealong to position said guide sleeve housing in said operative position. 
     
     
         47 . The spinal instrument assembly of  claim 45 , wherein said finger is removed from said groove to disengage said housing inserter from said guide sleeve housing when said guide sleeve housing is positioned in said operative position. 
     
     
         48 . The spinal instrument assembly of  claim 36 , wherein said distractor tip is withdrawable from the spinal disc space and said guide sleeve housing when said guide sleeve housing is positioned in said operative position. 
     
     
         49 . The spinal instrument assembly of  claim 36 , wherein said guide sleeve has a first length extending proximally from said guide sleeve housing when engaged thereto;
 wherein said guide sleeve housing has a second length extending proximally from the operative site; and   wherein a ratio of said first length to said second length is more than about 2:1.   
     
     
         50 . A guide sleeve assembly for defining a protected passageway to a disc space, comprising:
 a guide sleeve housing having a distal portion, a proximal portion and a chamber extending therethrough between said distal and proximal portions; and   a guide sleeve having a distal end portion, a proximal end portion, and first and second working channels extending therethrough between said distal and proximal end portions, said distal end portion of said guide sleeve removably engaged to said proximal portion of said guide sleeve housing with said first and second working channels positioned in communication with said chamber.   
     
     
         51 . The guide sleeve assembly of  claim 50 , wherein said chamber of said guide sleeve housing includes a proximal chamber portion and a distal chamber portion, said distal chamber portion including first and second working channel ports aligned with respective ones of said first and second working channels of said guide sleeve. 
     
     
         52 . The guide sleeve assembly of  claim 51 , wherein said first and second working channel ports of said guide sleeve housing are in lateral communication with one another along said distal chamber portion. 
     
     
         53 . The guide sleeve assembly of  claim 52 , wherein said first and second working channels of said guide sleeve are in lateral communication with one another. 
     
     
         54 . The guide sleeve assembly of  claim 52 , wherein said first and second working channel ports form an oval shaped working channel port through said distal portion of said guide sleeve housing. 
     
     
         55 . The guide sleeve assembly of  claim 51 , wherein said guide sleeve housing includes a medial wall in said distal chamber portion extending between said first and second working channel ports. 
     
     
         56 . The guide sleeve assembly of  claim 55 , wherein said guide sleeve housing does not include a medial wall in said proximal chamber portion. 
     
     
         57 . The guide sleeve assembly of  claim 51 , wherein said guide sleeve housing includes a central distractor including a distractor tip extending distally from said distal portion and positioned between said first and second working channel ports. 
     
     
         58 . The guide sleeve assembly of  claim 50 , further comprising a central distractor including a distractor tip extending distally from said distal portion of said guide sleeve housing. 
     
     
         59 . The guide sleeve assembly of  claim 58 , wherein said central distractor is centrally located at least partially within said chamber of said guide sleeve housing. 
     
     
         60 . The guide sleeve assembly of  claim 58 , wherein said distractor tip includes upper and lower distraction surfaces defining a distraction height therebetween; and
 wherein said distractor tip is rotatable from a reduced height configuration whereby said upper and lower distraction surfaces are oriented away from vertebral endplates of the disc space to a distraction configuration whereby said upper and lower distraction surfaces are oriented toward vertebral endplates of the disc space.   
     
     
         61 . The guide sleeve assembly of  claim 58 , wherein said guide sleeve housing includes a pair of lateral flanges extending distally from said distal portion and positioned on opposite lateral sides of said guide sleeve housing. 
     
     
         62 . The guide sleeve assembly of  claim 61 , wherein said lateral flanges each have upper and lower distracting surfaces defining a distraction height therebetween; and
 wherein said upper and lower distracting surfaces of said lateral flanges each include a plurality of teeth.   
     
     
         63 . The guide sleeve assembly of  claim 58 , wherein said distractor tip of said central distractor is removable from said guide sleeve housing. 
     
     
         64 . The guide sleeve assembly of  claim 50 , wherein said distal end portion of said guide sleeve is removably positioned within a proximal portion of said chamber in said guide sleeve housing. 
     
     
         65 . The guide sleeve assembly of  claim 50 , wherein said distal portion of said guide sleeve housing includes spikes extending distally therefrom and adapted to engage vertebral bone. 
     
     
         66 . The guide sleeve assembly of  claim 50 , wherein said proximal portion of said guide sleeve housing has a first width transverse to a spinal column axis and said distal portion has a second width transverse to the spinal column axis, said first width being greater than said second width. 
     
     
         67 . The guide sleeve assembly of  claim 50 , wherein said guide sleeve includes an actuator having an actuator member at a distal end thereof, said actuator member rotatable between a first rotational position wherein said actuator member engages said guide sleeve housing to said guide sleeve and a second rotational position wherein said guide sleeve housing is disengaged from said guide sleeve. 
     
     
         68 . The guide sleeve assembly of  claim 67 , wherein said proximal portion of said guide sleeve housing has an inner wall defining a groove therein, said actuator member positionable in said groove to engage said guide sleeve housing to said guide sleeve. 
     
     
         69 . The guide sleeve assembly of  claim 67 , wherein said guide sleeve includes an actuator housing extending between said distal end portion and said proximal end portion, said actuator rotatably received in said actuator housing with said actuator member positioned adjacent said distal end and a handle positioned adjacent said proximal end. 
     
     
         70 . The guide sleeve assembly of  claim 50 , wherein:
 said guide sleeve has a first length extending proximally from said guide sleeve housing when engaged thereto;   said guide sleeve housing having a second length extending proximally from the operative site; and   a ratio of said first length to said second length is more than about 2:1.