Methods and surgical kits for minimally-invasive facet joint fusion

Abstract

Disclosed herein are methods and surgical kits that can be used to fuse facet joints via a minimally invasive procedure (including an arthroscopic or percutaneous procedure). An exemplary method includes creating an incision; locating a facet joint with a distal end of a pin; sliding a substantially hollow drill guide over said pin wherein said drill guide comprises a proximal end, a distal end; removing said pin from within said drill guide; inserting a drill bit into said drill guide; drilling a hole into a bone of said facet joint; removing said drill bit; inserting a facet joint bone plug into said hole using a bone plug inserter having a raised portion at or near is proximal end, wherein said raised portion prevents over-insertion of said bone plug; and removing said drill guide.

1 . A method comprising:
 creating an incision;   locating a facet joint with a distal end of a pin wherein said facet joint is formed between two opposing bones and said pin comprises said distal end and a proximal end;   sliding a substantially hollow drill guide over said pin wherein said drill guide comprises a proximal end, a distal end, and a handle wherein said handle is nearer to the proximal end of the drill guide than to the distal end, said distal end comprises opposed teeth that can be inserted into said facet joint and;   removing said pin from within said drill guide;   inserting a drill bit into said drill guide;   drilling a hole into a bone of said facet joint;   removing said drill bit;   inserting a facet joint bone plug into said hole using a bone plug inserter having a raised portion at or near is proximal end, wherein said raised portion prevents over-insertion of said bone plug; and   removing said drill guide.   
     
     
         2 . A method according to  claim 1  wherein the distal end of the drill guide comprises two opposed teeth. 
     
     
         3 . A method according to  claim 1  wherein the distal end of said drill guide comprises a plurality of teeth, wherein the plurality of teeth comprises two opposed teeth and one or more smaller teeth disposed between said two opposed teeth. 
     
     
         4 . A method according to  claim 1  further comprising confirming the location of said pin at said facet joint. 
     
     
         5 . A method according to  claim 4  wherein said confirming is accomplished with at least one x-ray. 
     
     
         6 . A method according to  claim 1  wherein said drill guide comprises a marking that indicates the rotational orientation of said opposed teeth. 
     
     
         7 . A method according to  claim 1  wherein said drilling comprises grinding the bone and compacting some of the drilled bone within said hole. 
     
     
         8 . A method comprising:
 creating an incision;   locating a facet joint with a distal end of a pin wherein said facet joint is formed between two opposing bones and said pin comprises said distal end and a proximal end;   sliding a substantially hollow spatula over said pin wherein said spatula comprises a proximal end, a distal end and a body wherein said distal end comprises a planar wedge;   adjusting the rotation of said planar wedge until said planar wedge enters said facet joint;   sliding a substantially hollow drill guide over said spatula wherein said drill guide comprises a proximal end, a distal end, and a handle wherein said handle is nearer to the proximal end of the drill guide than to the distal end, said distal end comprises opposed teeth that can be inserted into said facet joint;   removing said spatula from within said drill guide;   inserting a drill bit into said drill guide;   drilling a hole into a bone of said facet joint;   removing said drill bit;   inserting a facet joint bone plug into said hole using a bone plug inserter having a raised portion at or near its proximal end, wherein said raised portion prevents over-insertion of said bone plug; and;   removing said drill guide; and   closing said incision wherein said pin has also been removed prior to said closing of said incision.   
     
     
         9 . A method according to  claim 8  wherein the distal end of the drill guide comprises two opposed teeth. 
     
     
         10 . A method according to  claim 8  wherein said distal end of said drill guide comprises a plurality of teeth, wherein the plurality of teeth comprises two opposed teeth and one or more smaller teeth disposed between said two opposed teeth. 
     
     
         11 . A method according to  claim 8  further comprising confirming the location of said pin at said facet joint. 
     
     
         12 . A method according to  claim 11  wherein said confirming is accomplished with at least one x-ray. 
     
     
         13 . A method according to  claim 8  wherein said body of said spatula comprises a marking that can indicate the orientation of said planar wedge. 
     
     
         14 . A method according to  claim 13  wherein when said spatula further comprises a marking and wherein when said marking on said drill guide is matched or aligned with said marking on said spatula, the orientation of said opposed teeth is in approximately the same plane defined by said planar wedge. 
     
     
         15 . A method according to  claim 14  further comprising the step of aligning said markings on said spatula and said drill guide. 
     
     
         16 . A method according to  claim 8  wherein said inserting of said facet joint bone plug into said hole comprises sliding an inserter instrument into said drill guide wherein said inserter instrument has a proximal end and a distal end and a facet joint bone plug associated with said distal end; and
 disengaging the facet joint bone plug from said distal end of said inserter instrument into said drilled hole. 
 
     
     
         17 . A method according to  claim 8  further comprising tapping said spatula further into said facet joint following the initial inserting of said planar wedge into said facet joint. 
     
     
         18 . A method according to  claim 8  further comprising tapping said drill guide following said aligning of said markings so that said opposed teeth of said drill guide engage facet joint bone to secure the orientation of said drill guide until said removing of said drill guide. 
     
     
         19 . A method according to  claim 8  further comprising tapping said facet joint bone plug into said facet joint following said inserting. 
     
     
         20 . A method according to  claim 8  wherein said drilling comprises grinding the bone and compacting some of the drilled bone within said hole. 
     
     
         21 . A method comprising:
 creating an incision;   locating a facet joint with a spinal pin;   accessing said facet joint with a substantially hollow spatula wherein said spatula comprises a proximal end, a distal end, and a body wherein said distal end comprises a planar wedge and said accessing comprises sliding said substantially hollow spatula over said spinal pin while adjusting the rotation of said planar wedge until said planar wedge enters said facet joint;   sliding a substantially hollow drill guide over said spatula wherein said drill guide comprises a proximal end, a distal end, and a handle wherein said handle is nearer to the proximal end of said drill guide than to said distal end and wherein said distal end comprises opposed teeth;   removing said spinal pin and said spatula from within said drill guide;   inserting a drill bit into said drill guide;   drilling a hole into a bone of said facet joint;   removing said drill bit;   sliding an inserter instrument into said drill guide wherein said inserter instrument has a proximal end and a distal end, wherein a facet joint bone plug is associated with said distal end and wherein said proximal end comprises a raised portion that prevents over-insertion of said facet joint bone plug;   disengaging the facet joint bone plug from said distal end of said inserter instrument into said drilled hole; and   removing said drill guide.   
     
     
         22 . A method according to  claim 21  further comprising confirming the location of said spinal pin at said facet joint. 
     
     
         23 . A method according to  claim 22  wherein said confirming is accomplished with at least one x-ray. 
     
     
         24 . A method according to  claim 21  further comprising tapping said spatula further into said facet joint following the initial entry of said planar wedge into said facet joint. 
     
     
         25 . A method according to  claim 21  further comprising tapping said drill guide so that said opposed teeth of said drill guide engage facet joint bone to secure the orientation of said drill guide until said removing of said drill guide. 
     
     
         26 . A method according to  claim 21  further comprising tapping said facet joint bone plug into said hole following said facet joint bone plug's disengagement from said inserter instrument. 
     
     
         27 . A method according to  claim 21  wherein said spatula and said drill guide each further comprises a marking, wherein when said marking on said drill guide is matched or aligned with said marking on said spatula, the orientation of said opposed teeth is in approximately the same plane defined by said planar wedge. 
     
     
         28 . A method according to  claim 27  further comprising the step of matching or aligning said markings on said spatula and said drill guide. 
     
     
         29 . A method according to  claim 21  wherein said distal end of said drill guide comprises two opposed teeth. 
     
     
         30 . A method according to  claim 21  wherein said distal end of said drill guide comprises a plurality of teeth, wherein said plurality of teeth comprises two opposed teeth and one or more smaller teeth disposed between said two opposed teeth. 
     
     
         31 . A method according to  claim 21  wherein said drilling comprises grinding the bone and compacting some of the drilled bone within said hole. 
     
     
         32 . A surgical kit comprising:
 a substantially hollow spatula comprising a proximal end, a distal end, and a body wherein said distal end comprises a planar wedge; and a   a drill guide comprising a proximal end, a distal end, and a handle wherein said handle is nearer to the proximal end of said drill guide than to said distal end and wherein said distal end comprises opposed teeth;   a spinal pin;   a drill bit;   a bone plug inserter comprising a proximal end and a distal end, wherein the distal end is configured to interact with a bone plug and wherein said proximal end comprises a raised portion that prevents over-insertion of said bone plug;   a bone plug holder; and   wherein all components of said kit can be stored and sterilized in a single autoclavable tool box.   
     
     
         33 . The surgical kit of  claim 29  wherein said spatula and said drill guide each further comprises a marking, wherein when said marking on said drill guide is matched or aligned with said marking on said spatula, the orientation of said opposed teeth is in approximately the same plane defined by said planar wedge. 
     
     
         34 . The surgical kit of  claim 30  wherein said marking on said spatula indicates the rotation of said planar wedge. 
     
     
         35 . The surgical kit of  claim 29  further comprising one or more tools selected from the group consisting of a spinal needle, an impacter, a hammer, a drill, a reamer, a dilator and a bone plug. 
     
     
         36 . The surgical kit of  claim 29  further comprising a bone plug. 
     
     
         37 . The surgical kit of  claim 32  wherein the drill bit is configured to grind the bone and compact some of the drilled bone within the hole.