Stabilizing a spinal anatomical structure

Abstract

Methods and devices for stabilizing spinal anatomical structures. Some example methods may include introducing a curved segment of an elongate fastener placement rod adjacent to a spinal anatomical structure, providing a fastener at the leading end of the curved segment, and/or securing the fastener in place with respect to the spinal anatomical structure.

1 . A method for stabilizing a spinal anatomical structure, comprising:
 introducing, into a body, a curved segment of an elongate, fastener placement rod approximate to, adjacent to or on a spinal anatomical structure, the curved segment having a leading end;   providing, at the leading end of the curved segment of the fastener placement rod, a fastener approximate to, adjacent to or on the spinal anatomical structure; and   securing the fastener with respect to the spinal anatomical structure.   
   
   
       2 . The method of  claim 1 , wherein the fastener is secured with respect to the spinal anatomical structure utilizing at least one flexible line. 
   
   
       3 . The method of  claim 2 , wherein the at least one flexible line extends from the fastener, through at least a portion of the spinal anatomical structure to a separate securing point within the body. 
   
   
       4 . The method of  claim 3 , further comprising securing the at least one flexible line at the separate securing point by a second fastener. 
   
   
       5 . The method of  claim 4 , wherein the step of securing the at least one flexible line at the separate securing point by the second fastener comprises crimping the second fastener to the flexible line. 
   
   
       6 . The method of  claim 5 , wherein the crimping step comprises introducing a crimping mechanism extending from an elongate rod of a crimping tool through an incision in the body and adjacent to the second fastener. 
   
   
       7 . The method of  claim 3 , wherein the at least one flexible line comprises a suture. 
   
   
       8 . The method of  claim 3 , wherein the at least one flexible line comprises a cable. 
   
   
       9 . The method of  claim 2 , wherein the flexible line is provided attached to the fastener approximate to, adjacent to or on the spinal anatomical structure, and the method includes a step of passing the flexible line from the fastener and at least through the portion of the spinal anatomical structure to the separate securing point within the body. 
   
   
       10 . The method of  claim 9 , wherein the passing step is performed utilizing a gripper at a leading end of an elongate gripper rod which pulls the flexible line from the fastener and at least through the portion of the spinal anatomical structure to the separate securing point within the body. 
   
   
       11 . The method of  claim 10 , wherein the elongate fastener placement rod and elongate gripper rod extend from a hand-held guidance and positioning device. 
   
   
       12 . The method of  claim 11 , further comprising forming a hole through the portion of the spinal anatomical structure prior to the pulling step. 
   
   
       13 . The method of  claim 12 , wherein the hole forming step is performed by an elongate drill rod extending from the hand-held guidance and positioning device. 
   
   
       14 . The method of  claim 13 , wherein the elongate gripper rod and elongate drill rod are guided by a guide tube extending from the hand-held guidance and positioning device. 
   
   
       15 . The method of  claim 10 , wherein the elongate gripper rod extends from the hand-held guidance and positioning device along an axis that runs adjacent to or through the leading end of the curved segment of the fastener placement rod. 
   
   
       16 . The method of  claim 9 , further comprising forming a hole through the portion of the spinal anatomical structure prior to the passing step. 
   
   
       17 . The method of  claim 2 , wherein
 the spinal anatomical structure is a first spinal anatomical structure;   the flexible line is provided attached to the fastener approximate to, adjacent to or on the spinal anatomical structure; and   the method includes a step of passing the flexible line from the fastener and at least through the portion of the first spinal anatomical structure, through at least a portion of a second anatomical structure to the separate securing point within the body, thereby stabilizing at least the first and second spinal anatomical structures with respect to each other.   
   
   
       18 . The method of  claim 17 , wherein the first spinal anatomical structure is an intervertebral disc and the second spinal anatomical structure is a vertebra. 
   
   
       19 . The method of  claim 17 , wherein the first spinal anatomical structure is a first vertebra and the second spinal anatomical structure is a second vertebra. 
   
   
       20 . The method of  claim 17 , wherein the first spinal anatomical structure is a vertebra and the second spinal anatomical structure is an intevertebral disc. 
   
   
       21 . The method of  claim 17 , wherein the first spinal anatomical structure is a first spinous process and the second spinal anatomical structure is a second spinous process. 
   
   
       22 . The method of  claim 17 , wherein the first spinal anatomical structure is a first ligament segment and the second spinal anatomical structure is a second ligament segment. 
   
   
       23 . The method of  claim 22 , wherein the first and second ligament segments are torn or severed segments of the same ligament. 
   
   
       24 . The method of  claim 17 , wherein the first spinal anatomical structure is a ligament and the second spinal anatomical structure is a vertebra. 
   
   
       25 . The method of  claim 17 , wherein the first spinal anatomical structure is a ligament and the second spinal anatomical structure is an intevertebral disc. 
   
   
       26 . The method of  claim 17 , wherein the first spinal anatomical structure is a vertebra and the second spinal anatomical structure is a ligament. 
   
   
       27 . The method of  claim 17 , wherein the first spinal anatomical structure is an intervertebral disc and the second spinal anatomical structure is a ligament. 
   
   
       28 . The method of  claim 17 , wherein the method includes a step of passing the flexible line from the fastener and at least through the portion of the first spinal anatomical structure, through at least a portion of a second anatomical structure, and through at least a portion of a third anatomical structure to the separate securing point within the body, thereby stabilizing at least the first, second and third spinal anatomical structures with respect to each other. 
   
   
       29 . The method of  claim 28 , wherein at least two of the first, second and third spinal anatomical structures comprise spinous processes. 
   
   
       30 . The method of  claim 28 , wherein at least two of the first, second and third spinal anatomical structures comprise facets. 
   
   
       31 . The method of  claim 17 , wherein the drawing step further comprises passing the flexible line through an implant. 
   
   
       32 . The method of  claim 31 , wherein the implant comprises a graft. 
   
   
       33 . The method of  claim 31 , wherein the implant comprises a disc implant. 
   
   
       34 . The method of  claim 31 , wherein the implant comprises a scaffold. 
   
   
       35 . The method of  claim 17 , wherein the first spinal anatomical structure is a spinous process and the second spinal anatomical structure is at least one of a pedicle and bone of a facet joint. 
   
   
       36 . The method of  claim 17 , wherein the first spinal anatomical structure is at least one of a pedicle and bone of a facet joint and the second spinal anatomical structure is a spinous process. 
   
   
       37 . The method of  claim 17 , wherein the first spinal anatomical structure is a first side of a cervical spine and the second anatomical structure is a second side of the cervical spine. 
   
   
       38 . The method of  claim 17 , wherein the method further comprises passing the flexible line through a tubular implant positioned between the first and second spinal anatomical structures. 
   
   
       39 . The method of  claim 17 , wherein the first spinal anatomical structure is a first facet and the second spinal anatomical structure is a second facet. 
   
   
       40 . The method of  claim 3 , further comprising a step of tensioning at least a portion of the flexible line extending between the fastener and the separate securing point. 
   
   
       41 . The method of  claim 3 , wherein the spinal anatomical structure comprises annulus fibrosus. 
   
   
       42 . The method of  claim 3 , wherein the spinal anatomical structure comprises nucleus pulposus. 
   
   
       43 . The method of  claim 3 , wherein the flexible line extends through an intervertebral disc and through an adjacent vertebra. 
   
   
       44 . The method of  claim 3 , wherein the flexible line extends through adjacent vertebrae and an intervertebral disc between the adjacent vertebrae. 
   
   
       45 . The method of  claim 3 , wherein the flexible line extends through two vertebrae and a disc positioned between but not adjacent to each of the two vertebrae. 
   
   
       46 . The method of  claim 3 , wherein the flexible line extends through an upper spinous process and through a lower spinous process. 
   
   
       47 . The method of  claim 3 , wherein the flexible line extends through a vertebra and to or though a disc implant. 
   
   
       48 . The method of  claim 3 , wherein the flexible line extends through the spinal anatomical structure to or through a graft. 
   
   
       49 . The method of  claim 3 , wherein the flexible line extends through the spinal anatomical structure and through or to a disc implant or a vertebral implant. 
   
   
       50 . The method of  claim 49 , wherein the spinal anatomical structure comprises annulus fibrosus. 
   
   
       51 . The method of  claim 49 , wherein the spinal anatomical structure comprises a vertebra. 
   
   
       52 . The method of  claim 49 , wherein the spinal anatomical structure comprises a facet. 
   
   
       53 . The method of  claim 3 , wherein the flexible line extends through two severed portions of a spinal ligament. 
   
   
       54 . The method of  claim 3 , wherein the flexible line extends through two portions of a spinal ligament. 
   
   
       55 . The method of  claim 54 , wherein the flexible line further extends through a vertebra adjacent to at least one of the two portions of the spinal ligament. 
   
   
       56 . The method of  claim 54 , wherein the flexible line further extends through an intervertebral disc. 
   
   
       57 . The method of  claim 3 , wherein the flexible line extends to or through a stabilization rod or plate. 
   
   
       58 . The method of  claim 57 , wherein the spinal anatomical structure is a spinous process. 
   
   
       59 . The method of  claim 3 , wherein the flexible line extends through at least one portion of a spinal ligament and through or to a ligament graft. 
   
   
       60 . The method of  claim 1 , wherein at least a portion of the elongate fastener placement rod is hollow. 
   
   
       61 . The method of  claim 60 , wherein the portion of the elongate fastener placement rod that is hollow opens onto the leading end of the curved segment of the fastener placement rod. 
   
   
       62 . The method of  claim 61 , wherein the step of providing, at the leading end of the curved segment of the fastener placement rod, a fastener approximate to, adjacent to or on the spinal anatomical structure, includes a step of sending the fastener through the portion of the elongate faster placement rod that is hollow to the leading end of the curved segment. 
   
   
       63 . The method of  claim 62 , wherein sending step further comprises sending a flexible line with the fastener through the portion of the elongate fastener placement rod that is hollow to the leading end of the curved segment, wherein the fastener is secured in place utilizing at least a portion of flexible line. 
   
   
       64 . The method of  claim 1 , wherein the step of providing, at the leading end of the curved segment of the fastener placement rod, a fastener approximate to, adjacent to or on the spinal anatomical structure, is preceded by a step of engaging the fastener with the leading end of the curved segment of the fastener placement rod. 
   
   
       65 . The method of  claim 1 , further comprising a step of engaging the fastener with the leading end of the curved segment of the fastener placement rod. 
   
   
       66 . The method of  claim 65 , wherein the engaging step includes a step of disposing at least a portion of the fastener within the leading end of the curved segment of the fastener placement rod. 
   
   
       67 . The method of  claim 65 , further comprising a step of disengaging the fastener from the leading end of the curved segment of the fastener placement rod while the fastener is approximate to, adjacent to or on the spinal anatomical structure. 
   
   
       68 . The method of  claim 1 , wherein the introducing step comprises introducing the curved segment of an elongate, fastener placement rod through an incision in the skin as part of a minimally invasive procedure. 
   
   
       69 . The method of  claim 1 , wherein the spinal anatomical structure comprises at least one of bone, vertebral body, nucleus pulposus, muscle, tendon and cartilage. 
   
   
       70 . The method of  claim 1 , wherein the spinal anatomical structure comprises at least one bone taken from a group consisting of: transverse process, pedicle, facet, spinous process, posterior arch, odontoid process, posterior tubercle, lateral articular process, uncinate process, anterior tubercle, carotid tubercle, odontoid process, lamina and vertebral body. 
   
   
       71 . The method of  claim 1 , wherein the spinal anatomical structure comprises at least one ligament taken from a group consisting of: anterior longitudinal ligament, posterior longitudinal ligament, interspinous ligament, supraspinous ligament, ligamentum flavum, intertransverse ligament, facet capsulary ligament, ligamentum nuchae, ligament of the sacrum and ligament of the coccyx spine. 
   
   
       72 . A method for stabilizing a spinal anatomical structure, comprising:
 connecting a flexible line and a fastener;   introducing, through an incision in the body, a curved segment of an elongate, fastener placement rod approximate to, adjacent to or on a spinal anatomical structure, the curved segment having a leading end;   providing, at the leading end of the curved segment of the fastener placement rod, the fastener and attached flexible line at a fastener placement point that is approximate to, adjacent to or on the spinal anatomical structure, the providing step including passing the fastener and attached flexible line through the curved segment of the elongate fastener placement rod to the leading end;   passing the connected flexible line from approximate the fastener placement point through at least a portion of the spinal anatomical structure to a securing point;   tensioning the flexible line between the fastener placement point and the securing point; and   securing the flexible line at the securing point.   
   
   
       73 . The method of  claim 72  wherein the step of securing the flexible line at the securing point comprises a step of tying the flexible line. 
   
   
       74 . The method of  claim 72  wherein the step of securing the flexible line at the securing point comprises a step of fastening the flexible line at the securing point using another fastener. 
   
   
       75 . The method of  claim 74  wherein the step of fastening the flexible line at the securing point using another fastener comprises crimping the other fastener to the flexible line. 
   
   
       76 . The method of  claim 72  wherein the flexible line comprises a suture. 
   
   
       77 . The method of  claim 72  wherein the flexible line comprises a cable. 
   
   
       78 . The method of  claim 72  wherein the passing step is performed utilizing a gripper at a leading end of an elongate gripper rod to pull the connected flexible line from approximate the fastener placement point through at least the portion of the spinal anatomical structure to the securing point. 
   
   
       79 . The method of  claim 78  wherein the elongate fastener placement rod and the elongate gripper rod extend from a hand-held guidance and positioning device. 
   
   
       80 . The method of  claim 79  further comprising forming a hole through the portion of the spinal anatomical structure prior to the pulling step. 
   
   
       81 . The method of  claim 80  wherein the hole forming step is performed by an elongate drill rod extending from the hand-held guidance and positioning device. 
   
   
       82 . The method of  claim 81  wherein the elongate gripper rod and the elongate drill rod are guided by a guide tube extending from the hand-held guidance and positioning device. 
   
   
       83 . The method of  claim 72 , wherein the spinal anatomical structure comprises annulus fibrosus. 
   
   
       84 . The method of  claim 72 , wherein the flexible line extends through an intervertebral disc and through an adjacent vertebra. 
   
   
       85 . The method of  claim 72 , wherein the flexible line extends through adjacent vertebrae and an intervertebral disc between the adjacent vertebra. 
   
   
       86 . The method of  claim 72 , wherein the flexible line extends through two vertebrae and a disc positioned between but not adjacent to each of the two vertebrae. 
   
   
       87 . The method of  claim 72 , wherein the flexible line extends through an upper spinous process and through a lower spinous process. 
   
   
       88 . The method of  claim 72 , wherein the flexible line extends through a vertebra and to or though a disc implant. 
   
   
       89 . The method of  claim 72 , wherein the flexible line extends through the spinal anatomical structure to or through a graft. 
   
   
       90 . The method of  claim 72 , wherein the flexible line extends through the spinal anatomical structure and through or to a disc implant or a vertebral implant. 
   
   
       91 . The method of  claim 90 , wherein the spinal anatomical structure comprises annulus fibrosus. 
   
   
       92 . The method of  claim 90 , wherein the spinal anatomical structure comprises a vertebra. 
   
   
       93 . The method of  claim 90 , wherein the spinal anatomical structure comprises a facet. 
   
   
       94 . The method of  claim 72 , wherein the flexible line extends through two severed portions of a spinal ligament. 
   
   
       95 . The method of  claim 72 , wherein the flexible line extends through two portions of a spinal ligament. 
   
   
       96 . The method of  claim 95 , wherein the flexible line further extends through a vertebra adjacent to at least one of the two portions of the spinal ligament. 
   
   
       97 . The method of  claim 95 , wherein the flexible line further extends through an intervertebral disc. 
   
   
       98 . The method of  claim 72 , wherein the flexible line extends to or through a stabilization rod or plate. 
   
   
       99 . The method of  claim 98 , wherein the spinal anatomical structure is a spinous process. 
   
   
       100 . The method of  claim 72 , wherein the flexible line extends through at least one portion of a spinal ligament and through or to a ligament graft. 
   
   
       101 . The method of  claim 72 , wherein
 the spinal anatomical structure is a first spinal anatomical structure; and   the method comprises a step of passing the flexible line from approximate the fastener and at least through the portion of the first spinal anatomical structure, through at least a portion of a second anatomical structure to the securing point, thereby stabilizing at least the first and second spinal anatomical structures with respect to each other.   
   
   
       102 . The method of  claim 101 , wherein the first spinal anatomical structure is an intervertebral disc and the second spinal anatomical structure is a vertebra. 
   
   
       103 . The method of  claim 101 , wherein the first spinal anatomical structure is a first vertebra and the second spinal anatomical structure is a second vertebra. 
   
   
       104 . The method of  claim 101 , wherein the first spinal anatomical structure is a vertebra and the second spinal anatomical structure is an intevertebral disc. 
   
   
       105 . The method of  claim 101 , wherein the first spinal anatomical structure is a first spinous process and the second spinal anatomical structure is a second spinous process. 
   
   
       106 . The method of  claim 101 , wherein the first spinal anatomical structure is a first ligament segment and the second spinal anatomical structure is a second ligament segment. 
   
   
       107 . The method of  claim 106 , wherein the first and second ligament segments are torn or severed segments of the same ligament. 
   
   
       108 . The method of  claim 101 , wherein the first spinal anatomical structure is a ligament and the second spinal anatomical structure is a vertebra. 
   
   
       109 . The method of  claim 101 , wherein the first spinal anatomical structure is a ligament and the second spinal anatomical structure is an intevertebral disc. 
   
   
       110 . The method of  claim 101 , wherein the first spinal anatomical structure is a vertebra and the second spinal anatomical structure is a ligament. 
   
   
       111 . The method of  claim 101 , wherein the first spinal anatomical structure is an intervertebral disc and the second spinal anatomical structure is a ligament. 
   
   
       112 . The method of  claim 101 , wherein the method includes a step of passing the flexible line from the fastener and at least through the portion of the first spinal anatomical structure, through at least a portion of a second anatomical structure, and through at least a portion of a third anatomical structure to the separate securing point within the body, thereby stabilizing at least the first, second and third spinal anatomical structures with respect to each other. 
   
   
       113 . The method of  claim 112 , wherein at least two of the first, second and third spinal anatomical structures comprise spinous processes. 
   
   
       114 . The method of  claim 112 , wherein at least two of the first, second and third spinal anatomical structures comprise facets. 
   
   
       115 . The method of  claim 101 , wherein the passing step further comprises passing the flexible line through an implant. 
   
   
       116 . The method of  claim 115 , wherein the implant comprises a graft. 
   
   
       117 . The method of  claim 115 , wherein the implant comprises a disc implant. 
   
   
       118 . The method of  claim 115 , wherein the implant comprises a scaffold. 
   
   
       119 . The method of  claim 101 , wherein the first spinal anatomical structure is a spinous process and the second spinal anatomical structure is at least one of a pedicle and bone of a facet joint. 
   
   
       120 . The method of  claim 101 , wherein the first spinal anatomical structure is at least one of a pedicle and bone of a facet joint and the second spinal anatomical structure is a spinous process. 
   
   
       121 . The method of  claim 101 , wherein the first spinal anatomical structure is a first side of a cervical spine and the second anatomical structure is a second side of the cervical spine. 
   
   
       122 . The method of  claim 101 , wherein the method further comprises passing the flexible line through a tubular implant positioned between the first and second spinal anatomical structures. 
   
   
       123 . The method of  claim 101 , wherein the first spinal anatomical structure is a first facet and the second spinal anatomical structure is a second facet. 
   
   
       124 . A method for stabilizing a spinal anatomical structure, comprising:
 a step for introducing a fastener approximate to, adjacent to or on a spinal anatomical structure using a curved end of an introducer means;   a step for passing a flexible line attached to the fastener through at least a portion of the spinal anatomical structure to a securing point; and   a step for securing the flexible line at the securing point.   
   
   
       125 . The method of  claim 124  further comprising a step for tensioning the flexible line between the fastener and the securing point.