Percutaneous access devices and bone anchor assemblies

Abstract

A percutaneous access device includes an inner tube and an outer tube disposed about at least a portion of the inner tube. The outer tube may be sized to span from a skin incision in a patient to a site proximate the spine of the patient. The distal end of the outer tube may be adapted to releasably engage a bone anchor. The inner tube may be adjustable relative to the outer tube between a first position and a second position in which the distal end of the inner tube contacts the bone anchor. A bone anchor assembly includes a bone anchor having a distal bone engaging portion and a receiving member having a recess for receiving a spinal fixation element. The proximal end of the receiving member may have an arcuate groove formed on an exterior surface thereof to facilitate connection of an instrument to the receiving member.

1 - 46 . (canceled) 
     
     
         47 . A surgical system for implanting an implantable rod adjacent a bone of a spine of a patient, the surgical system comprising:
 a) an implantable anchor comprising:
 i) a head comprising a first attachment structure and a rod receiving channel; and 
 ii) a distal portion distally extending from the head and configured to be received in an anchoring fashion in the bone; and 
   b) an elongated guide tool comprising:
 i) a proximal end comprising a proximal opening extending around a longitudinal axis of the elongated guide tool; 
 ii) a distal end opposite the proximal end, the distal end comprising a distal opening extending around the longitudinal axis of the elongated guide tool, the distal and proximal openings opening in opposite directions from each other; 
 iii) a wall comprising an interior surface; 
 iv) a channel radially inward of the wall, the interior surface of the wall defining the channel; 
 v) a side opening through the wall to the channel, the side opening extending longitudinally along the elongated guide tool from the distal opening toward the proximal opening; and 
 vi) a second attachment structure distal the proximal end and releasably attachable to the first attachment structure so as to releasably attach the head to the elongated guide tool near the distal end. 
   
     
     
         48 . The surgical system of  claim 47 , wherein the implantable anchor comprises a threaded bone screw. 
     
     
         49 . The surgical system of  claim 48 , wherein the threaded bone screw comprises a polyaxial bone screw. 
     
     
         50 . The surgical system of  claim 47 , wherein the distal portion comprises a threaded shank. 
     
     
         51 . The surgical system of  claim 47 , wherein the second attachment structure is received in the first attachment structure. 
     
     
         52 . The surgical system of  claim 47 , wherein the first attachment structure comprises a recess defined in a cylindrical outer surface of the head. 
     
     
         53 . The surgical system of  claim 52 , wherein the second attachment structure comprises a projection that is received in the recess. 
     
     
         54 . The surgical system of  claim 53 , wherein the distal end of the elongated guide tool is configured to pass distally over the head of the implantable anchor to releasably attach the head to the elongated guide tool, the projection biasing radially inward to be received in the recess as the second attachment structure releasably attaches with the first attachment structure. 
     
     
         55 . The surgical system of  claim 47 , wherein the second attachment structure projects radially inward from the wall. 
     
     
         56 . The surgical system of  claim 47 , wherein the distal end of the elongated guide tool further comprises first and second spaced-apart members, the second attachment structure is supported on the first spaced-apart member, and the distal end of the elongated guide tool is configured to pass distally over the head of the implantable anchor to releasably attach the head to the elongated guide tool. 
     
     
         57 . The surgical system of  claim 56 , wherein the second attachment structure points radially inward and the first spaced-apart member biases radially inward to force the second attachment structure into the first attachment structure as the distal end of the elongated guide tool is distally passed over the head of the implantable anchor. 
     
     
         58 . The surgical system of  claim 57 , wherein the first and second spaced-apart members are forced apart from each other as the distal end of the elongated guide tool is distally passed over the head of the implantable anchor. 
     
     
         59 . The surgical system of  claim 47 , wherein the elongated guide tool further comprises a first thread proximal the second attachment structure. 
     
     
         60 . The surgical system of  claim 59 , wherein the head of the implantable anchor further comprises a third thread, the third thread being located in the rod receiving channel, and the first thread is proximal the third thread when the head is releasably attached to the elongated guide tool. 
     
     
         61 . A surgical system for implanting an implantable rod adjacent a bone of a spine of a patient, the surgical system comprising:
 a) an implantable anchor comprising:
 i) a head comprising a first attachment structure and a rod receiving channel, the first attachment structure comprising a recess; and 
 ii) a distal portion distally extending from the head and configured to be received in an anchoring fashion in the bone; and 
   b) an elongated guide tool comprising:
 i) a proximal end; 
 ii) a distal end opposite the proximal end; 
 iii) a wall extending longitudinally between the proximal end and the distal end, the wall comprising an interior surface; 
 iv) a longitudinally extending channel radially inward of the wall, the interior surface of the wall defining the channel; and 
 v) a second attachment structure distal the proximal end and releasably attachable to the first attachment structure so as to releasably attach the head to the elongated guide tool near the distal end, the second attachment structure comprising first and second spaced-apart members, each of the first and second spaced-apart members being a cantilevered portion of the, wall, wherein the first spaced-apart member comprises a projection that is received in the recess. 
   
     
     
         62 . The surgical system of  claim 61 , wherein the distal end of the elongated guide tool is configured to pass distally over the head of the implantable anchor to releasably attach the head to the elongated guide tool, the projection biasing radially inward into the recess as the second attachment structure releasably attaches with the first attachment structure. 
     
     
         63 . The surgical system of  claim 61 , wherein the projection points radially inward and the first spaced-apart member biases radially inward to force the projection into the recess as the distal end of the elongated guide tool is distally passed over the head of the implantable anchor. 
     
     
         64 . The surgical system of  claim 63 , wherein the first and second spaced-apart members are forced apart from each other as the distal end of the elongated guide tool is distally passed over the head of the implantable anchor. 
     
     
         65 . The surgical system of  claim 61 , wherein the recess is defined in a cylindrical outer surface of the head. 
     
     
         66 . The surgical system of  claim 61 , wherein the wall has a cylindrical configuration. 
     
     
         67 . The surgical system of  claim 61 , wherein the elongated guide tool further comprises a side opening through the wall to the channel, the side opening extending longitudinally along the elongated guide tool from the distal end towards the proximal end. 
     
     
         68 . The surgical system of  claim 67 , wherein the proximal end further comprises a proximal opening extending around a longitudinal axis of the elongated guide tool. 
     
     
         69 . The surgical system of  claim 61 , wherein the implantable anchor comprises a threaded bone screw. 
     
     
         70 . The surgical system of  claim 69 , wherein the threaded bone screw comprises a polyaxial bone screw. 
     
     
         71 . The surgical system of  claim 61 , wherein the distal portion comprises a threaded shank. 
     
     
         72 . The surgical system of  claim 61 , wherein for the first spaced-apart member to be a cantilevered portion of the wall, the first spaced-apart member comprises a free end, an attached end opposite the free end, a first free side extending from the free end to the attached end, and a second free side opposite the first free side and extending from the free end to the attached end, the attached end being a continuous and uninterrupted extension of the wall, and the free end and the first and second free sides not being attached to any other portion of the wall. 
     
     
         73 . The surgical system of  claim 61 , wherein the elongated guide tool further comprises a first thread proximal the second attachment structure. 
     
     
         74 . The surgical system of  claim 73 , wherein the head of the implantable anchor further comprises a third thread, the third thread being located in the rod receiving channel, and the first thread is proximal the third thread when the head is releasably attached to the elongated guide tool. 
     
     
         75 . A surgical system for implanting an implantable rod adjacent a bone of a spine of a patient, the surgical system comprising:
 a) an implantable anchor comprising:
 i) a head comprising a first attachment structure and a rod receiving channel, the first attachment structure comprising a recess; and 
 ii) a distal portion distally extending from the head and configured to be received in an anchoring fashion in the bone; and 
   b) an elongated guide tool comprising:
 i) a proximal end; 
 ii) a distal end opposite the proximal end; 
 iii) a wall extending longitudinally between the proximal end and the distal end, the wall comprising an interior surface; 
 iv) a longitudinally extending channel radially inward of the wall, the interior surface of the wall defining the channel; and 
 v) a second attachment structure distal the proximal end and releasably attachable to the first attachment structure so as to releasably attach the head to the elongated guide tool near the distal end, the second attachment structure comprising a projection, wherein the distal end of the elongated guide tool is configured to pass distally over the head of the implantable anchor to releasably attach the head to the elongated guide tool, the projection biasing radially inward into the recess as the second attachment structure releasably attaches with the first attachment structure.