Methods and Systems for Repairing an Intervertebral Disc Using a Transcorporal Approach

Abstract

The invention includes a system and methods for performing surgery on a spinal disc. The system includes an implantable bone plate with an access port to accommodate a bone cutting device, a spinal repair device insertable through the access port of the bone plate configured to occupy a surgically-formed vertebral channel from an anterior surface of the host vertebral body to a site central to an end plate of the host vertebral body, a trajectory control sleeve engageable to the bone plate to direct the trajectory of a cutting device, and a cutting device engageable within the trajectory control sleeve. Methods are directed to forming a vertebral channel and restoring the vertebral body and disc with devices that both repair the bone and the disc.

1 . A spinal repair device comprising at least one lumen communicating between a proximal end of the device and a distal end of the device, the device sized and configured to occupy at least a portion of a surgically-formed transcorporal channel in a vertebral body that extends on a trajectory from a non end-plate surface to an end plate where an opening of the channel communicates into an intervertebral space, the at least one lumen sized and configured to (selectively) permit the flow therethrough of a disc replacement material. 
     
     
         2 . The spinal repair device of  claim 1  wherein the at least one lumen comprises a flow path for a liquid state disc repair material. 
     
     
         3 . The spinal repair device of  claim 1  wherein the at least one lumen comprises a flow prevention element that prevents egress of a liquid state disc repair material from the intervertebral space. 
     
     
         4 . The spinal repair device of  claim 1  wherein the at least one lumen comprises two channels, a first channel configured for liquid flow into the intervertebral space, and a second channel configured to allow liquid or gas egress from the intervertebral space. 
     
     
         5 . The spinal repair device of  claim 1  wherein the device comprises a surface portion sufficiently porous to allow in-growth of bone. 
     
     
         6 . The spinal repair device of  claim 1  comprising a biologically compatible material. 
     
     
         7 . The spinal repair device of  claim 6  comprising any of a polymer, a metal, a ceramic, or a combination thereof. 
     
     
         8 . The spinal repair device of  claim 1  comprising an osteogenic agent. 
     
     
         9 . The spinal repair device of  claim 1  comprising a porous cage. 
     
     
         10 . The spinal repair device of  claim 9  wherein a bone cell preparation is included within the porous cage. 
     
     
         11 . The spinal repair device of  claim 1  comprising a biologically absorbable material. 
     
     
         12 . The spinal repair device of  claim 1  wherein the device is linear in form, such linear form configured to occupy a linear transcorporal channel. 
     
     
         13 . The spinal repair device of  claim 1  wherein the device is arcuate in form, such arcuate form configured to occupy an arcuate transcorporal channel. 
     
     
         14 . A system for spinal disc surgery comprising:
 a spinal repair device according to  claim 1 ; and   a trajectory control apparatus adapted to attach to the non-end plate surface of the vertebral body and comprising a portion configured to hold at least a portion of a bone cutting tool such that when the apparatus is engaged to the vertebral body, the bone cutting tool is positioned to form the transcorporal channel.   
     
     
         15 . The system of  claim 14  wherein the trajectory control apparatus comprises a cutting tool holder portion and an implantable bone plate portion, the cutting tool holding portion detachably engageable to the implantable bone plate portion. 
     
     
         16 . The system of  claim 15  wherein the cutting tool holder portion comprises a sleeve that receives at least a portion of a cutting tool. 
     
     
         17 . The system of  claim 15  wherein the cutting tool holder has a bone plate engagement feature and the bone plate has a cutting tool holder engagement feature, the respective engagement features configured such that when the bone plate is attached to the vertebral body, and the cutting tool holder and the bone plate are mutually engaged, the cutting tool holder is oriented to direct a cutting tool on the trajectory. 
     
     
         18 . The system of  claim 15  wherein the bone plate portion comprises an access port configured to accommodate a cutting portion of a bone cutting tool and to accommodate through passage of the spinal repair device. 
     
     
         19 . The system of  claim 14  further comprising a bone cutting tool adapted to form the transcorporal channel, at least a portion of the bone cutting tool configured to be movably held by the trajectory control apparatus. 
     
     
         20 . The system of  claim 19 , wherein the cutting tool comprises a mechanical stop configured to limit the penetration of the cutting tool into the vertebral body. 
     
     
         21 . The system of  claim 14  further comprising an injector configured to deliver a disc replacement material through the internal cannula of the spinal repair device and into an intradiscal void. 
     
     
         22 . The system of  claim 21  further comprising
 a valve device coupled with the injector, the valve device having at least two input ports and at least one output port, the output port being in fluid communication with the injector; 
 a vacuum delivery device in fluid communication with one of the two input ports of the valve device; and 
 a reservoir device containing the disc replacement material in communication with the second of the two input ports of the valve device. 
 
     
     
         23 . The system of  claim 21  wherein the injector comprises a channel configured to allow liquid or gas egress from the intervertebral space. 
     
     
         24 . The system of  claim 21  wherein the disc replacement material comprises a flowable substance. 
     
     
         25 . The system of  claim 24  wherein the flowable substance comprises any of a liquid, a settable liquid, a liquid-to-solid phase changing material, a gel, a suspension, or a slurry. 
     
     
         26 . A spinal repair device sized and configured to occupy at least a portion of a surgically-formed transcorporal channel in a host vertebral body and at least a portion of an intervertebral space adjacent to the host vertebral body, the device comprising:
 a proximal portion sized to occupy at least a portion of the transcorporal channel, the channel having a trajectory that extends from a non-end plate surface to an end plate where a channel opening communicates into the intervertebral space; and   a distal portion sized to extend from the end plate of the host vertebral body into the intervertebral space.   
     
     
         27 . The spinal repair device of  claim 26  wherein the distal portion extends to a point where it comes into intimate contact with an endplate of an adjacent vertebral body. 
     
     
         28 . The spinal repair device of  claim 26  wherein the proximal portion is adapted to replace at least a portion of bone and the distal portion is adapted to replace at least a portion of an intervertebral disc. 
     
     
         29 . The spinal repair device of  claim 26  wherein the proximal portion and the distal portion of the spinal repair device are of different composition. 
     
     
         30 . The spinal repair device of  claim 26  wherein at least a portion of the external surface of the proximal portion of the device is sufficiently porous to allow in-growth of bone. 
     
     
         31 . The spinal repair device of  claim 26  wherein the proximal portion of the device comprises an osteogenic agent. 
     
     
         32 . The spinal repair device of  claim 26  wherein the proximal portion of the device comprises a porous cage. 
     
     
         33 . The spinal repair device of  claim 32  wherein a bone cell preparation is included within the porous cage. 
     
     
         34 . The spinal repair device of  claim 26  wherein the distal portion of the spinal repair device comprises a resilient composition. 
     
     
         35 . The spinal repair device of  claim 26  wherein the distal portion of the spinal repair device comprises a distal surface adapted to articulatingly engage the end plate of the adjacent vertebral body. 
     
     
         36 . The spinal repair device of  claim 26  wherein the device is linear in form, such linear form configured to occupy a linear transcorporal channel. 
     
     
         37 . The spinal repair device of  claim 26  wherein the device is arcuate in form, such arcuate form configured to occupy an arcuate transcorporal channel. 
     
     
         38 . The spinal repair device of  claim 26  further comprising at least one lumen communicating between an opening on the proximal end of the device and an opening on the distal end of the device, the channel comprising a flow path for a flowable disc replacement material. 
     
     
         39 . A system for spinal disc surgery comprising:
 a spinal repair according to  claim 26 ; and   a trajectory control apparatus adapted to attach to the non-end plate surface of the vertebral body and comprising a portion configured to hold at least a portion of a bone cutting tool such that when the apparatus is engaged to the vertebral body, the bone cutting tool is positioned to form the transcorporal channel.   
     
     
         40 . The system of  claim 39  wherein the trajectory control apparatus comprises a cutting tool holder and an implantable bone plate portion, the cutting tool holding portion detachably engageable to the implantable bone plate portion. 
     
     
         41 . The system of  claim 40  wherein the cutting tool holding portion comprises a sleeve that receives at least a portion of a cutting tool. 
     
     
         42 . The system of  claim 40  wherein the cutting tool holder has a bone plate engagement feature and the bone plate has a cutting tool holder engagement feature, the respective engagement features configured such that when the bone plate is attached to the vertebral body, and the cutting tool holder and the bone plate are mutually engaged, the cutting tool holder is oriented to direct a cutting tool on the trajectory. 
     
     
         43 . The system of  claim 40  wherein the bone plate portion comprises at least one access port configured to accommodate a cutting portion of a bone cutting tool and to accommodate through passage of the spinal repair device. 
     
     
         44 . The system of  claim 39  comprising two spinal repair devices, the devices configured to occupy dual surgically-formed transcorporal channels. 
     
     
         45 . The system of  claim 39  further comprising a bone cutting tool adapted to form the transcorporal channel, at least a portion of the bone cutting tool configured to be accommodated by the trajectory control apparatus. 
     
     
         46 . The system of  claim 45 , wherein the cutting tool comprises a mechanical stop configured to limit the penetration of the cutting tool into the host vertebral body. 
     
     
         47 . The system of  claim 39  further comprising a disc replacement material comprising any of a liquid, a liquid that can solidify, a liquid-to-solid phase changing material, a fabric, or a solid, or any combination of these materials.