Methods and devices for spinal fixation element placement

Abstract

Minimally invasive methods and devices are provided for positioning a spinal fixation element in relation to adjacent spinal anchors. In an exemplary embodiment, the device is a percutaneous access device that can be coupled to a spinal anchor, and the method includes the step of positioning a spinal fixation element through at least one sidewall opening of at least two percutaneous access devices such that the spinal fixation element extends in a lengthwise orientation that is substantially transverse to the longitudinal axis of each percutaneous access device. The spinal fixation element can then be advanced in the lengthwise orientation to seat the spinal fixation element in or adjacent to the receiver heads of at least two adjacent spinal anchors. A fastening element or other closure mechanism can then be applied to each spinal anchor to engage the spinal fixation element within the receiver heads of the adjacent anchors.

1 - 25 . (canceled)  
   
   
       26 . A tool set for implanting a spinal rod in a patient; said tool set comprising: 
 a) a pair of end guide tools;    b) each of said end guide tool being adapted to attach at a lower end thereof to a respective spinal implant bone screw; and    c) each of said end guide tools including a longitudinal guide channel extending upwardly from said lower end thereof; each of said channels being sized and shaped to be adapted to receive opposite ends of the rod for operably guiding the rod ends toward respective bone screws.    
   
   
       27 . The tool set according to  claim 26  wherein said tool set further includes: 
 a) at least one intermediate guide tool;    b) each of said intermediate guide tools including attachment structure adapted for attachment to a respective bone screw; and    c) each of said intermediate guide tools including a longitudinal pass through slot extending from a bottom thereof upward and being adapted to receive therethrough and guide the rod to a bone screw attached to a respective intermediate guide tool.    
   
   
       28 . The tool set according to  claim 26  wherein: 
 a) said longitudinal guide channel is part of an open pathway that extends from near a bottom of a respective end guide tool to a top thereof; said pathway opening radially outward along the entire length thereof.    
   
   
       29 . The tool set according to  claim 28  wherein: 
 a) each said end guide tool has a cutout region between said longitudinal guide channel and said guide tool lower end; said cutout being open in the rear so as to define a pass through slot sized and shaped to be adapted to allow passage therethrough of one end of the rod after the rod has been guided to near a bone screw by said channel.    
   
   
       30 . A bone screw and rod seating assembly comprising: 
 a) a bone screw having a shank for implanting in a bone and a head with a channel adapted to receive a rod;    b) said bone screw head including a first attachment structure thereon;    c) an elongate guide tool having a radially outward facing channel extending parallel to an axis thereof and upwardly from near a bottom of said guide tool; said channel sized and shaped to receive a first end of a rod and operably guide said rod first end to said bone screw head; said guide tool being sized to partially extend above a patient's skin so as to allow percutaneous manipulation of said guide tool by a surgeon; and    d) said guide tool bottom including a second attachment structure thereon; said first and second attachment structures being mateable to releaseably secure said guide tool to said bone screw head.    
   
   
       31 . A bone screw and rod seating assembly comprising: 
 a) a bone screw having a shank for implanting in a bone and a head with channel adapted to receive a rod;    b) said bone screw head including a first attachment structure thereon;    c) an elongate guide tool having a radially pass through slot extending upwardly from near a bottom thereof; said slot being sized and shaped to receive a rod therethrough and operably guide said rod to said bone screw head; said guide tool being sized to partially extend above a patient's skin so as to allow percutaneous manipulation of said guide tool by a surgeon; and    d) said guide tool bottom including a second attachment structure thereon; said first and second attachment structures being mateable to releaseably secure said guide tool to said bone screw head.    
   
   
       32 . A tool set for implanting a spinal rod in a patient; said tool set comprising: 
 a) a pair of end guide tools;    b) each of said end guide tools being adapted to attach at a lower end thereof to a respective spinal implant bone screw; and    c) each of said end guide tools including a longitudinal guide channel extending upwardly from said lower end thereof; each of said channels being sized and shaped to be adapted to receive opposite ends of the rod for operably guiding the rod ends toward respective bone screws.    
   
   
       33 . The tool set according to  claim 32  wherein said tool set further includes: 
 a) at least one intermediate guide tool;    b) each of said intermediate guide tools including attachment structure adapted for attachment to a respective bone screw; and    c) each of said intermediate guide tools including a longitudinal pass through slot extending from a bottom thereof upward and being adapted to receive therethrough and guide the rod to a bone screw attached to a respective intermediate guide tool.    
   
   
       34 . A bone screw and rod seating assembly comprising: 
 a) a bone screw having a shank for implanting in a bone and a head with a channel adapted to receive a rod;    b) said bone screw head including a first attachment structure thereon;    c) an elongate guide tool having a radially outward facing channel extending parallel to an axis thereof and upwardly from near a bottom of said guide tool; said channel sized and shaped to receive a first end of a rod and operably guide said rod first end to said bone screw head; said guide tool being sized to partially extend above a patient's skin so as to allow percutaneous manipulation of said guide tool by a surgeon; and    d) said guide tool bottom including a second attachment structure thereon; said first and second attachment structures being mateable to releaseably secure said guide tool to said bone screw head.    
   
   
       35 . A bone screw and rod seating assembly comprising: 
 a) a bone screw having a shank for implanting in a bone and a head with channel adapted to receive a rod;    b) said bone screw head including a first attachment structure thereon;    c) an elongate guide tool having a radially pass through slot extending upwardly from near a bottom thereof; said slot being sized and shaped to receive a rod therethrough and operably guide said rod to said bone screw head; said guide tool being sized to partially extend above a patient's skin so as to allow percutaneous manipulation of said guide tool by a surgeon; and    d) said guide tool bottom including a second attachment structure thereon; said first and second attachment structures being mateable to releaseably secure said guide tool to said bone screw head.    
   
   
       36 . A tool for implanting spinal implants in a patient; said tool comprising: 
 a) said tool being adapted to attach at a lower end thereof to a first spinal implant; and    b) said tool including a radially outwardly opening and longitudinal guide channel extending the entire length thereof; said channel being sized and shaped to be adapted to receive an end of a rod like second implant for operably guiding the second implant toward said first implant.    
   
   
       37 . The tool according to  claim 36  including: 
 a) a lower portion that is sized and shaped to be located beneath a patient's skin during use and an upper portion located outside of the patient during use; and b) said lower portion having attachment structure thereon adapted to removably attach said tool to said first implant.    
   
   
       38 . The tool according to  claim 38  in combination with said first implant.  
   
   
       39 . The tool and implant combination according to  claim 38  wherein: 
 a) said first implant is a bone screw.    
   
   
       40 . The tool and implant according to  claim 38  wherein: 
 a) said first implant is a hook.    
   
   
       41 . The tool and implant combination according to  claim 38  wherein: 
 a) said bone screw has an upper head with a rod receiving channel therein;    b) said attachment structure being configured to attach said tool to said head such that said tool longitudinal channel aligns with said head rod receiving channel, such that a rod received in said tool channel is guided downwardly by said tool to be received in said head tool receiving channel.