Methods and instruments for endoscopic interbody surgical techniques

Abstract

This invention relates to methods and instruments for performing a surgical procedure in a disc space between adjacent vertebrae. A cannula is inserted to create a working channel through the skin and tissue of a patient using a transforaminal approach to the disc space. A viewing element is used to visualize working end of the cannula and the disc space. A facetectomy is performed through the working channel to access the disc space. The disc space is prepared with various instruments, such as distractors, shims, chisels and distractor-cutters that extend through the working channel. At least implant is inserted into the disc space. The procedure allows bi-lateral support of the adjacent vertebrae with the at least one implant inserted via a unitary, minimally invasive approach to disc space.

1 - 37 . (canceled) 
     
     
         38 . A method for inserting at least one interbody fusion device in a disc space between adjacent vertebrae, comprising:
 creating a working channel to the disc space by placing a cannula through the skin and tissue of a patient using a transforaminal approach to the disc space;   preparing the disc space through the working channel for bi-lateral placement of the at least one interbody fusion device, wherein preparing the disc space includes inserting the distractor tool through the working channel, wherein the distractor tool includes a distal blade with a height corresponding to the disc space height; and   inserting at least one interbody fusion device into the disc space through the working channel along the unitary transforaminal approach so that the at least one interbody fusion device is positioned bi-laterally in the disc space to support the adjacent vertebrae.   
     
     
         39 . The method according to  claim 38 , further comprising inserting a viewing element through the working channel; and preparing the disc space includes preparing the disc space with the viewing element in the working channel. 
     
     
         40 . The method according to  claim 39 , wherein inserting the viewing element includes inserting the viewing element into the working channel to directly visualize the disc space. 
     
     
         41 . The method according to  claim 39 , wherein creating a working channel includes:
 inserting a first dilator through the skin and tissue of the patient;   sequentially inserting at least one more dilator over the first dilator;   inserting the cannula over the last inserted dilator; and removing the dilators so that the cannula defines the working channel.   
     
     
         42 . The method according to  claim 41 , further comprising connecting the cannula to a table based arm. 
     
     
         43 . The method according to  claim 38 , wherein inserting at least one interbody fusion device comprises inserting a first interbody fusion device through the cannula at a first bi-lateral location in the disc space opposite the cannula and inserting a second interbody fusion device through the cannula at a second bi-lateral location in the disc space adjacent the cannula. 
     
     
         44 . The method according to  claim 38 , wherein preparing the disc space includes inserting the curved shaft of the chisel into the cannula and moving the upper and lower cutting edges along vertebral endplates to prepare a cavity extending bilaterally across the adjacent vertebrae to receive the at least one interbody fusion device. 
     
     
         45 . The method according to  claim 38 , wherein preparing the disc space includes inserting a shim though the working channel to maintain distraction of the disc space. 
     
     
         46 . A method for inserting at least one interbody fusion device in a disc space between adjacent vertebrae, comprising:
 creating a working channel to the disc space by placing a cannula through the skin and tissue of a patient using a transforaminal approach to the disc space;   preparing the disc space through the working channel for bi-lateral placement of the at least one interbody fusion device, wherein preparing the disc space includes inserting a chisel in the disc space, the chisel having upper and lower cutting edges to remove a portion of the vertebral endplates, the chisel comprises a curved shaft defining a curvilinear cutting path; and   inserting at least one interbody fusion device into the disc space through the working channel along the unitary transforaminal approach so that the at least one interbody fusion device is positioned bi-laterally in the disc space to support the adjacent vertebrae.   
     
     
         47 . The method according to  claim 46 , wherein preparing the disc space includes inserting the curved shaft of the chisel into the cannula and moving the upper and lower cutting edges along vertebral endplates to prepare a cavity extending bilaterally across the adjacent vertebrae to receive the at least one interbody fusion device. 
     
     
         48 . The method according to  claim 46 , further comprising inserting a viewing element through the working channel; and preparing the disc space includes preparing the disc space with the viewing element in the working channel. 
     
     
         49 . The method according to  claim 46 , wherein creating a working channel includes:
 inserting a first dilator through the skin and tissue of the patient;   sequentially inserting at least one more dilator over the first dilator;   inserting the cannula over the last inserted dilator; and   removing the dilators so that the cannula defines the working channel.   
     
     
         50 . The method according to  claim 46 , wherein preparing the disc space includes inserting a shim though the working channel to maintain distraction of the disc space. 
     
     
         51 . A method for inserting at least one interbody fusion device in a disc space comprising a single cavity between adjacent vertebrae, comprising:
 creating a working channel to the disc space by placing a cannula through the skin and tissue of a patient using a unitary transforaminal approach to the disc space;   preparing the disc space through the working channel for bi-lateral placement of the at least one interbody fusion device, wherein preparing the disc space includes inserting a chisel in the disc space, the chisel having upper and lower cutting edges to remove a portion of the vertebral endplates, the chisel comprises a curved shaft defining a curvilinear cutting path; and   inserting at least one interbody fusion device into the disc space through the working channel along the unitary transforaminal approach so that the at least one interbody fusion device is positioned bi-laterally in the disc space to support the adjacent vertebrae.   
     
     
         52 . The method according to  claim 51 , further comprising inserting a viewing element through the working channel; and preparing the disc space includes preparing the disc space with the viewing element in the working channel. 
     
     
         53 . The method according to  claim 52 , wherein inserting the viewing element includes inserting the viewing element into the working channel to directly visualize the disc space. 
     
     
         54 . The method according to  claim 52 , wherein creating a working channel includes:
 inserting a first dilator through the skin and tissue of the patient;   sequentially inserting at least one more dilator over the first dilator;   inserting the cannula over the last inserted dilator; and   removing the dilators so that the cannula defines the working channel.   
     
     
         55 . The method according to  claim 51 , further comprising connecting the cannula to a table based arm. 
     
     
         56 . The method according to  claim 51 , wherein inserting at least one interbody fusion device comprises inserting a first interbody fusion device through the cannula at a first bi-lateral location in the disc space opposite the cannula and inserting a second interbody fusion device through the cannula at a second bi-lateral location in the disc space adjacent the cannula. 
     
     
         57 . The method according to  claim 51 , wherein preparing the disc space includes inserting the curved shaft of the chisel into the cannula and moving the upper and lower cutting edges along vertebral endplates to prepare a cavity extending bilaterally across the adjacent vertebrae to receive the at least one interbody fusion device. 
     
     
         58 . The method according to  claim 51 , wherein preparing the disc space includes inserting a shim though the working channel to maintain distraction of the disc space.