Plating system with compression drill guide

Abstract

A drill guide, drill guide system and method of use is disclosed. The drill guide assembly includes one or more alignment drill tubes that are remotely alignable with corresponding fastener holes of a bone plate to which the drill guide is releasably lockable. The drill guide is configured to allow a bone hole to be drilled slightly off-center with respect to the fastener holes of the plate so that fasteners inserted in those holes may be used to compress the underlying bone segments together when the fasteners are tightened in the bone and plate. In one embodiment, the drill guide is disclosed for use in compressing and fixing adjacent vertebra as part of a spinal fusion procedure.

1 . A surgical drill guide assembly comprising: 
 a stem member releasably engageable with the guide engaging hole of the bone plate;    at least one guide barrel associated with the stem member and configured to receive a tool, the guide barrel having a longitudinal axis; and    a bone plate having at least one fixation hole configured to receive a fastener to fix the plate to a bone, and at least one guide engaging hole for engaging the drill guide;    wherein the stem member and guide barrel are configured so that when the stem member engages the bone plate the guide barrel longitudinal axis is oriented non-coaxial with the fixation hole.    
     
     
         2 . The surgical drill guide assembly of  claim 1 , where the tool is a drill bit.  
     
     
         3 . The surgical drill guide assembly of  claim 1 , where the tool is an awl, a probe or a tap.  
     
     
         4 . The surgical drill guide assembly of  claim 1 , the fixation hole further having a center point, wherein when the stem member engages the bone plate the guide barrel longitudinal axis does not intersect with the center point of the fixation hole.  
     
     
         5 . The surgical drill guide assembly of  claim 1 , the bone plate further having a longitudinal axis, the tool configured for forming a hole in bone, wherein when the tool is received within the guide barrel and engaged with bone to form a hole, the center of the hole is located a first distance from the center of the corresponding plate fixation hole.  
     
     
         6 . The surgical drill guide assembly of  claim 5 , wherein the first distance is from about 0.1 millimeters (mm) to about 0.8 mm as measured along a line substantially parallel to the plate longitudinal axis.  
     
     
         7 . The surgical drill guide assembly of  claim 5 , wherein the first distance is about 0.5 mm as measured along a line substantially parallel to the plate longitudinal axis.  
     
     
         8 . The surgical drill guide assembly of  claim 5 , wherein when the stem member engages the guide engaging hole of the bone plate, the guide barrel does not contact the plate.  
     
     
         9 . The surgical drill guide assembly of  claim 1 , wherein at least a portion of the stem member and the guide engaging hole of the bone plate comprise corresponding threads to allow the stem to be threadably engaged with the plate.  
     
     
         10 . The surgical drill guide assembly of  claim 1 , wherein the guide barrel is connected to the stem member via a hinge, the hinge allowing the guide barrel to be pivoted about the stem with respect to the plate so that when the stem is engaged with the guide engaging hole of the bone plate, the guide barrel is selectively alignable with at least two fixation holes of the bone plate to allow the tool to be inserted through the guide barrel to form a hole in bone through each fixation hole without disengaging the stem from the plate.  
     
     
         11 . The surgical drill guide assembly of  claim 1 , further comprising a second drill guide barrel.  
     
     
         12 . The surgical drill guide assembly of  claim 1 , wherein the drill guide barrel comprises first and second tool receiving recesses.  
     
     
         13 . The surgical drill guide assembly of  claim 12 , wherein each tool receiving recess has a longitudinal axis, the two axes being non-parallel.  
     
     
         14 . The surgical drill guide assembly of  claim 12 , wherein the longitudinal axes of the tool receiving recesses converge at a point located a first distance from the center of the plate hole.  
     
     
         15 . A method of installing a bone plate on at least two vertebrae, comprising the steps of: 
 (a) providing a bone plate having at least one fastener hole configured to receive a bone fastener for fixing the plate to a vertebra;    (b) providing a drill guide having a stem member and a guide barrel, the stem member configured to engage a bone plate and the guide barrel configured to receive a tool for forming a hole in bone;    (c) engaging the stem member with the bone plate so that the guide barrel is located adjacent to the at least one fastener hole;    (d) placing the bone plate on vertebrae so that the at least one fastener hole lies adjacent a vertebra; and    (e) passing the tool through the guide barrel and the fastener hole so that the tool engages the vertebra and cuts a hole in the bone underlying the fastener hole;    wherein the hole in the bone is located a first distance from the center of the fastener hole.    
     
     
         16 . The method of  claim 15 , wherein the first distance is from about 0.1 mm to about 0.8 mm.  
     
     
         17 . The method of  claim 15 , wherein the first distance is about 0.5 mm.  
     
     
         18 . The method of  claim 15 , wherein the tool is a drill bit.  
     
     
         19 . The method of  claim 15 , where the tool is an awl, a probe or a tap.  
     
     
         20 . The method of  claim 15 , further comprising the steps of 
 (f) inserting a bone screw into the hole in the bone; and    (g) tightening the screw in the hole, the screw having a head and an underside surface;    wherein the underside surface of the screw head engages an inner side surface of the fastener hole so that the screw and plate are moved longitudinally with respect to each other as the screw is screwed into the bone.    
     
     
         21 . The method of  claim 15 , wherein the stem and guide barrel are configured so that the screw and plate are moved longitudinally with respect to each other by a second distance as the screw is screwed in the bone.  
     
     
         22 . The method of  claim 21 , wherein the first and second distances are substantially equal.  
     
     
         23 . The method of  claim 21 , wherein the second distance is about 0.5 mm.  
     
     
         24 . The method of  claim 21 , wherein when the screw and plate are moved longitudinally, the associated vertebra are moved longitudinally.  
     
     
         25 . The method of  claim 24 , wherein the longitudinal movement of the screw applies a force on the associated vertebra tending to compress the disc space located between the vertebra.  
     
     
         26 . The method of  claim 15 , the bone plate further comprising a second fastener hole, the drill guide having a second guide barrel configured to receive a tool for forming a hole in bone adjacent the second fastener hole.  
     
     
         27 . The method of  claim 26 , wherein the first and second guide barrels each has first and second tool receiving recesses, the recesses each having a trajectory, the trajectories of the first and second recesses being substantially non-parallel.  
     
     
         28 . The method of  claim 15 , the bone plate further comprising a second fastener hole, the guide barrel being attached to the stem member via a pivot joint, the barrel being movable about the pivot joint to move from a first position adjacent the first fastener hole of the bone plate to a second position adjacent the second fastener hole of the bone plate.  
     
     
         29 . The method of  claim 28 , the guide barrel further having an internal shoulder configured to engage a portion of the tool inserted therethrough to limit the depth of penetration of the tool into the underlying bone to a predetermined amount.  
     
     
         30 . The method of  claim 29 , the guide barrel further having at least one longitudinal slot running along a substantial portion of a length of the guide barrel, the slot configured to allow the user to visualize the position of the tool within the guide barrel.  
     
     
         31 . The method of  claim 30 , further comprising a handle associated with the stem, the handle being pivotably adjustable with respect to the stem to allow the handle to be rotated to a desired position relative to the guide barrel.  
     
     
         32 . The method of  claim 31 , wherein the handle has a longitudinal axis that is substantially non-parallel to the longitudinal axis of the guide barrel.  
     
     
         33 . A drill guide kit, comprising: 
 a first drill guide assembly comprising a first plate-engaging stem and a first guide barrel configured to receive a tool, the first guide barrel having a longitudinal axis, the stem releasably engageable with a bone plate to position the first guide barrel adjacent a first fastener hole of the bone plate;    a second drill guide assembly comprising a second plate engaging stem and a second guide barrel configured to receive a tool, the second guide barrel having a longitudinal axis, the stem releasably engageable with the bone plate to position the second guide barrel adjacent a second fastener hole of the bone plate;    wherein the first stem and first guide barrel are configured so that when the stem member engages the bone plate the guide barrel longitudinal axis intersects the center of the fastener hole, and the second stem and second guide barrel are configured so that when the second stem member engages the bone plate the second guide barrel is substantially aligned with the fixation hole but the longitudinal axis does not intersect the center of the fixation hole.    
     
     
         34 . The drill guide kit of  claim 33 , further comprising a bone plate having at least one fixation hole and a longitudinal axis, the second guide barrel configured to receive a tool for forming a hole in bone through the fixation hole, the center of the bone hole being located a first distance from the center of the fixation hole as measured along an axis parallel to the longitudinal axis of the plate.  
     
     
         35 . The drill guide kit of  claim 34 , wherein the tool is a drill bit.  
     
     
         36 . The drill guide kit of  claim 34 , where the tool is one of an awl, a probe or a tap.  
     
     
         37 . The drill guide kit of  claim 34 , the first guide barrel configured to receive a tool for forming a hole in bone through the fixation hole, the center of the bone hole being collinear with the center of the fixation hole as measured along an axis parallel to the longitudinal axis of the bone plate.  
     
     
         38 . The drill guide kit of  claim 34 , wherein the first distance being in the range of from about 0.1 mm to about 0.8 mm.  
     
     
         39 . The drill guide kit of  claim 34 , wherein the first distance is about 0.5 mm.  
     
     
         40 . The drill guide kit of  claim 34 , wherein when the stem of at least one of the first or second drill guide assemblies engages the bone plate, the associated guide barrel does not contact the plate.  
     
     
         41 . The drill guide kit of  claim 40 , wherein the guide barrel of at least one of the first or second drill guide assemblies has a viewing recess configured to allow the user to visualize at least a portion of the tool as it is passed through the associated guide barrel.  
     
     
         42 . The drill guide kit of  claim 33 , wherein the stem of at least one of the first or second drill guide assemblies has threads configured to engage corresponding threads in the plate.  
     
     
         43 . The drill guide kit of  claim 33 , wherein the guide barrel of at least one of the first and second drill guide assemblies is connected to the associated stem member via a hinge, the hinge allowing the guide barrel to be pivoted about the stem with respect to the plate so that when the stem is engaged with the plate, the guide barrel is selectively alignable with at least two fixation holes of the bone plate to allow a drill bit inserted through the guide barrel to be used to drill holes in bone through each fixation hole without disengaging the stem from the plate.  
     
     
         44 . The drill guide kit of  claim 33 , at least one of the first and second drill guide assemblies further comprising an additional guide barrel configured to receive a tool for forming a hole in bone.  
     
     
         45 . The drill guide kit of  claim 44 , the plate further comprising a second fixation hole, wherein when the stem of the drill guide assembly is engaged with the plate the guide barrels are substantially aligned with at least a portion of the first and second fixation holes.  
     
     
         46 . A surgical system comprising: 
 a bone plate having first and second ends, a longitudinal axis, and at least one fixation hole disposed at each of the first and second ends, the fixation holes configured to receive a fastener to fix the plate to a bone, the bone plate further comprising at least one guide engaging hole for engaging the drill guide;    a drill guide comprising a stem member releasably engageable with the guide engaging hole of the bone plate, and a guide barrel associated with the stem member and configured to receive a tool, the guide barrel having a longitudinal axis;    wherein the guide barrel is configured so that when the stem member engages the bone plate the guide barrel longitudinal axis does not intersect the center of the fixation hole.    
     
     
         47 . The surgical system of  claim 46 , the tool further configured to form a hole in bone, wherein when the tool is received within the guide barrel and engages bone to form a hole, the hole is collinear with the longitudinal axis of the guide barrel.  
     
     
         48 . The surgical system of  claim 47 , wherein the tool is a drill bit.  
     
     
         49 . The surgical system of  claim 47 , where the tool is one of an awl, a probe or a tap.  
     
     
         50 . The surgical system of  claim 46 , further comprising a plurality of bone fasteners, each fastener having a head portion with an underside surface configured to engage a portion of a corresponding fixation hole.  
     
     
         51 . The surgical system of  claim 50 , wherein when the bone plate is placed over first and second bone segments so that the fixation hole in the first end of the plate overlies the first bone segment and the fixation hole in the second end of the plate overlies the second bone segment, the drill guide is selectively engageable with the plate to drill a hole in the bone through at least one fixation hole.  
     
     
         52 . The surgical system of  claim 51 , wherein when the plate is fixed to the first bone segment using a fastener inserted into the fixation hole at the first end of the plate, the drill guide is engageable with the plate to allow a hole to be formed in the bone underlying the fixation hole at the second end of the plate so that a fastener inserted into the hole will contact a portion of the fixation hole.  
     
     
         53 . The surgical system of  claim 52 , wherein the underside surface of the fastener head portion engages a side portion of the fixation hole before the fastener is fully seated in the fixation hole.  
     
     
         54 . The surgical system of claim,  53 , wherein when the fastener head portion engages the side portion of the fastener hole, further tightening of the fastener causes the fastener to move longitudinally along a longitudinal axis of the plate.  
     
     
         55 . The surgical system of  claim 54 , wherein the further tightening of the fastener causes the first bone segment to move relative to the second bone segment.