Methods and apparatus for accessing and treating the facet joint

Abstract

Methods and systems are disclosed for accessing and treating the interior of the facet joint for vertebral distraction and immobilization. The systems include a number of tools that facilitate access to the facet joint, distraction of the articulating decortication of the articulating surfaces, and delivery of implants and agents into the facet joint for fusion.

What is claimed is: 
     
         1 . A method of minimally invasively accessing a facet joint to deliver an implant between a first and second articulating subchondral surface of the facet joint, the method comprising:
 accessing the facet joint from a posterior-lateral approach with a facet access tool, the facet access tool comprising:
 an elongate handle having a proximal end and a distal end; and 
 a blade disposed at the distal end of the handle, the blade comprising a flat leading edge; 
   decorticating the facet joint with a decortication apparatus; and   delivering an implant between the first and second articulating subchondral surfaces of the facet joint via an implant introducer comprising an elongate shaft having a proximal end and a distal end opposite the proximal end.   
     
     
         2 . The method of  claim 1 , wherein the decortication apparatus comprises a flat, flexible, spatula-shaped rasp configured to decorticate at least one of the articulating surfaces. 
     
     
         3 . The method of  claim 2 , wherein the decortication apparatus further comprises a shaft attached to the rasp and includes a distal, beveled surface. 
     
     
         4 . The method of  claim 1 , wherein the decortication apparatus comprises a flat device with a rolled cutting surface configured to decorticate at least one of the articulating surfaces. 
     
     
         5 . The method of  claim 1 , wherein the implant comprises bone allograft. 
     
     
         6 . An apparatus for minimally invasively accessing an interior region of a facet joint to deliver an implant from a posterior-lateral approach, the facet joint comprising first and second articulating subchondral surfaces defining first and second boundaries of a facet cavity, the facet joint further comprising a facet capsule defining a third boundary of the facet cavity, the apparatus comprising:
 a facet access tool comprising:
 an elongate handle having a proximal end and a distal end; and 
 a blade disposed at the distal end of the handle, the blade comprising a flat leading edge; 
   a decortication apparatus configured to decorticate at least one of the first and second articulating subchondral surfaces; and   an implant introducer comprising an elongate shaft having a proximal end and a distal end opposite the proximal end, wherein the introducer delivers an implant between the first and second articulating subchondral surfaces of the facet joint.   
     
     
         7 . The apparatus of  claim 6 , wherein the decortication apparatus comprises: a flat, flexible, spatula-shaped rasp configured to decorticate at least one of the articulating surfaces. 
     
     
         8 . The apparatus of  claim 7 , wherein the decortication apparatus further comprises a shaft attached to the rasp and includes a distal, beveled surface. 
     
     
         9 . The apparatus of  claim 6 , wherein the decortication apparatus comprises: a flat device with a rolled cutting surface configured to decorticate at least one of the articulating surfaces. 
     
     
         10 . The apparatus of  claim 6 , further comprising an implant, wherein the implant comprises bone allograft. 
     
     
         11 . A method of minimally invasively delivering an implant to a facet joint with the apparatus of  claim 6  between the first and second articulating subchondral surfaces of the facet joint from a posterior-lateral approach, the method comprising:
 accessing the facet joint with the facet access tool; 
 decorticating the facet joint with the decortication apparatus; and 
 delivering the implant into the facet joint via the introducer. 
 
     
     
         12 . The method of  claim 11 , wherein the decortication apparatus comprises a flat, flexible, spatula-shaped rasp configured to decorticate at least one of the articulating surfaces. 
     
     
         13 . The method of  claim 12 , wherein the decortication apparatus further comprises a shaft attached to the rasp and includes a distal, beveled surface. 
     
     
         14 . The method of  claim 11 , wherein the decortication apparatus comprises a flat device with a rolled cutting surface configured to decorticate at least one of the articulating surfaces. 
     
     
         15 . The method of  claim 11 , wherein the implant comprises bone allograft.