Methods and apparatuses for delivering a rod to a plurality of pedicle screws

Abstract

Embodiments include a system that facilitates placement of a rod through receiving portions of screws placed along the spine. The system includes a rod and a cable detachably connectable to the rod to pull the rod through the receiving portions of the screws. Some embodiments include methods and devices for inserting a rod into a plurality of screws and for ex situ templating of a rod. These can include connecting a cable to a rod, inserting the cable through the plurality of screws, and using the cable to pull the rod into position. The methods of ex situ templating of the rod can include contacting a templating member to each of the screws so that a portion of the templating members replicate the relative positioning of the screws and shaping a rod to match the relative positioning of the portion of the templating members.

What is claimed is: 
     
         1 . A system to facilitate placement of a rod through receiving portions of screws placed along the spine, comprising:
 a rod sized and shaped to be inserted into the receiving portions of the spinal screws;   a pulling cable detachably connectable to the rod; and   a delivery tube comprising a body having a delivery lumen with a proximal receiving portion configured to receive the pulling cable and a curved distal delivery portion configured to direct the advance of the pulling cable and rod through the receiving portions of the spinal screws.   
     
     
         2 . The system of  claim 1 , further comprising a penetrating member integral with or connected to the pulling cable configured to direct the pulling cable through the receiving portions of the screws. 
     
     
         3 . The system of  claim 1 , wherein the cable features markings to facilitate placement of the rod through the receiving portions of the screws. 
     
     
         4 . The system of  claim 1 , further comprising a flexible tube having an internal diameter sized to allow the passage of the cable, the flexible tube being configured to advance through the delivery lumen of the delivery tube and the receiving portions of the plurality of pedicle screws to provide a pre-established path to facilitate insertion of the cable. 
     
     
         5 . The system  claim 1 , further comprising a penetrating member removal sleeve configured to redirect the penetrating member out of the patient's body. 
     
     
         6 . The system  claim 5 , further comprising:
 a plurality of pedicle screws; and   a plurality of extension sleeves removably attachable to each of the pedicle screws, the delivery tube being positioned proximate a first extension sleeve extending from a first pedicle screw and the penetrating member removal sleeve being positioned proximate a second extension sleeve extending from a second pedicle screw; and   wherein the system is configured to advance the cable through the delivery lumen of the delivery tube, through the receiving portions of the plurality of pedicle screws, and out of the patient through the penetrating member removal sleeve.   
     
     
         7 . The system of  claim 6 , further comprising a hook or deflecting member configured to be advanced into one or more of the extension sleeves to facilitate the advance of the penetrating member. 
     
     
         8 . The system of  claim 1 , wherein the cable has features to facilitate placement of the rod through the receiving portions of the screws. 
     
     
         9 . The system of  claim 8 , wherein the cable features comprise measurement markings. 
     
     
         10 . The system of  claim 1 , further comprising a rod puller configured to engage the cable and facilitate pulling of the rod into position within the receiving portions of the screws. 
     
     
         11 . A system for making a spinal construct, comprising:
 a plurality of spinal screws, wherein each spinal screw includes having a receiving portion;   a rod sized and shaped to be inserted into the receiving portions of the spinal screws;   a plurality of extension sleeves comprising an elongate member configured to extend out of a patient from a corresponding spinal screw when the spinal screws are placed within the patient;   a pulling cable that is detachably connectable to the rod;   a penetrating member integral with or connected the pulling cable; and   a delivery tube comprising a body having a delivery lumen with a proximal receiving portion and a curved distal delivery portion, the proximal receiving portion configured to receive the penetrating member and the curved distal delivery portion configured to direct the advance of the penetrating member; and   a penetrating member removal sleeve configured to redirect the penetrating member out of the patient's body;   wherein the cable and rod are directed along a path through the receiving portions of the spinal screws when the spinal screws are placed within the patient and contact the penetrating member removal sleeve out of the patient's body, the cable being configured to pull the rod into a desired location within the receiving portions.   
     
     
         12 . The system of  claim 11 , wherein the cable features markings to facilitate placement of the rod through the receiving portions of the screws. 
     
     
         13 . The system of  claim 11 , further comprising a flexible tube having an internal diameter sized to allow the passage of the cable, the flexible tube being configured to advance through the delivery lumen of the delivery tube and the receiving portions of the plurality of pedicle screws to provide a pre-established path to facilitate insertion of the cable. 
     
     
         14 . The system of  claim 11 , further comprising a hook or deflecting member configured to be advanced into one or more of the extension sleeves to facilitate the advance of the penetrating member. 
     
     
         15 . The system of  claim 11 , wherein the cable has features to facilitate placement of the rod through the receiving portions of the screws. 
     
     
         16 . The system of  claim 15 , wherein the cable features comprise measurement markings. 
     
     
         17 . The system of  claim 11 , further comprising a rod puller configured to engage the cable and facilitate pulling of the rod into position within the receiving portions of the screws. 
     
     
         18 . A method of delivering a rod to a plurality of spinal screws, comprising:
 inserting a penetrating member through a delivery tube comprising a body having a delivery lumen with a proximal receiving portion and a curved distal delivery portion configured to direct the penetrating member toward receiving portion of a first pedicle screw of a plurality spinal screws. implanted into a plurality of adjacent vertebrae.   advancing the penetrating member through receiving portions of each of the plurality spinal screws;   contacting a penetrating member penetrating member removal sleeve proximate a second pedicle screw to redirect the penetrating member out of the patient's body;   pulling the penetrating member to advance a cable and a rod through the receiving portions of each of the screws into a desired location within the receiving portions, wherein the rod is detachably connected to a first end of the cable and the penetrating member is coupled with a second end of the cable.   
     
     
         19 . The method of  claim 18 , further advancing a flexible tube having an internal diameter through the delivery lumen of the delivery tube and the receiving portions of the plurality of pedicle screws to provide a pre-established path to facilitate insertion of the penetrating member through the internal diameter. 
     
     
         20 . The method of  claim 18 , further comprising a hook or deflecting member configured to facilitate the advance of the penetrating member.