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 . An elongate guide tool in combination with a spinal bone anchor implant, the guide tool being reversibly attachable to the bone anchor implant for guiding a rod into a receiver of the bone anchor implant, the receiver having upwardly extending and opposed arms, the guide tool comprising:
 a) a body with a longitudinally extending through-bore extending from a top opening to a bottom opening, the through-bore being sized and shaped for receiving a closure top therethrough;   b) a laterally extending pass-through slot extending upwardly from the bottom opening and joined with the through-bore, the pass-through slot defining a pair of spaced opposed legs and being sized and shaped so as to receive the rod therethrough, the pass-through slot being alignable with a U-shaped channel of the bone anchor implant receiver located between the arms thereof; and   c) a first inwardly projecting attachment structure located along a lower portion of the guide tool that is sized and shaped to cooperatively engage a second attachment structure of the bone anchor implant receiver when the guide tool is secured to the bone anchor implant, the bone anchor implant receiver having an abutment surface, thereby preventing rotation of the guide tool relative to the receiver; and wherein   d) when the pass-through slot and the U-shaped channel are aligned, the rod is transferable from the guide tool to the receiver, and after which the guide tool can be removed off the receiver.   
     
     
         48 . The bone anchor implant according to  claim 47 , wherein the bone anchor implant is a polyaxial screw. 
     
     
         49 . The bone anchor implant according to  claim 47 , wherein the bone anchor implant is a fixed screw. 
     
     
         50 . The bone anchor implant according to  claim 47 , wherein the bone anchor implant is cannulated. 
     
     
         51 . An elongate guide tool in combination with a spinal bone anchor implant, the guide tool being reversibly attachable to the bone anchor implant for guiding a rod into a receiver of the bone anchor implant, the receiver having upwardly extending and opposed arms, the guide tool comprising:
 a) a body with a longitudinally extending through-bore extending from a top opening to a bottom opening, the through-bore being sized and shaped for receiving a closure top therethrough;   b) a laterally extending pass-through slot extending upwardly from the bottom opening and joined with the through-bore, the pass-through slot defining a pair of spaced opposed legs and being sized and shaped so as to receive the rod therethrough, the pass-through slot being alignable with a U-shaped channel of the bone anchor implant receiver located between the arms thereof; and   c) a first inwardly projecting attachment structure near the bottom opening that is sized and shaped to cooperatively engage a second attachment structure of the bone anchor implant receiver when the guide tool is secured to the bone anchor implant, wherein the second attachment structure is a radiused horizontal pair of notches circumferentially located on and opening onto an exterior surface of the arms near an upper end thereof and on both sides thereof, the bone anchor implant receiver having an abutment surface, thereby preventing rotation of the guide tool relative to the receiver; wherein   d) when the pass-through slot and the U-shaped channel are aligned, the rod is transferable from the guide tool to the receiver, and after which the guide tool can be removed from the receiver.   
     
     
         52 . The bone screw implant according to  claim 51 , wherein the bone anchor implant is a polyaxial screw. 
     
     
         53 . The bone screw implant according to  claim 51 , wherein the bone anchor implant is a fixed screw. 
     
     
         54 . The bone screw implant according to  claim 51 , wherein the bone anchor implant is cannulated. 
     
     
         55 . An elongate guide tool in combination with a spinal bone anchor, the guide tool being reversibly attachable to the bone anchor for guiding a rod into a receiver of the bone anchor the guide tool comprising:
 a) a body with a longitudinally extending through-bore extending from a top opening to a bottom opening, the through-bore being sized and shaped for receiving a tool and a closure top therethrough;   b) a laterally extending pass-through slot extending upwardly from the bottom opening and joined with the through-bore, the pass-through slot defining a pair of spaced opposed legs and being sized and shaped so as to have the rod positioned therebetween, the pass-through slot being alignable with a U-shaped channel between upright arms of the bone anchor receiver; and   c) a first inwardly projecting attachment structure near the bottom opening and on each spaced opposed leg that is sized and shaped to cooperatively engage a second attachment structure of the bone anchor receiver when the guide tool is secured to the bone anchor, wherein the second attachment structure is a radiused groove located on an exterior of each upright arm of the receiver and near a top thereof, the bone anchor receiver having an abutment surface, thereby preventing rotation of the guide tool relative to the receiver; wherein   d) when the pass-through slot and the U-shaped channel are aligned, the rod is transferable from the guide tool to the bone anchor, and the closure remains spaced apart from the receiver groove.   
     
     
         56 . An elongate guide tool in combination with a spinal bone implant, the guide tool being reversibly attachable to the bone implant for guiding a rod into a receiver of the bone implant, the receiver having upwardly extending and opposed arms, the guide tool comprising:
 a) a body with a longitudinally extending through-bore extending from a top opening to a bottom opening, the through-bore being sized and shaped for receiving a tool and a closure top therethrough;   b) a laterally extending pass-through slot extending upwardly from the bottom opening and joined with the through-bore, the pass-through slot defining a pair of spaced opposed legs and being sized and shaped so as to have the rod positioned therethrough, the pass-through slot being alignable with a U-shaped channel of the bone implant receiver located between the arms thereof; and   c) a first inwardly projecting attachment structure located along a lower portion of the guide tool that is sized and shaped to cooperatively engage a second attachment structure of the bone implant receiver when the guide tool is secured to the bone implant, the bone implant receiver having an abutment surface, thereby preventing rotation of the guide tool relative to the receiver; and wherein   d) when the pass-through slot and the U-shaped channel are aligned, the rod is transferable from the guide tool to the receiver, and after which the guide tool can be removed from the receiver.   
     
     
         57 . The bone implant according to  claim 56 , wherein the bone implant is a cannulated polyaxial screw. 
     
     
         58 . The bone implant according to  claim 56 , wherein the bone implant is a cannulated fixed screw. 
     
     
         59 . An elongate guide tool in combination with a spinal implant, the guide tool being reversibly attachable to the implant for guiding a rod into a receiver of the implant, the receiver having upwardly extending and opposed arms, the guide tool comprising:
 a) a body with a longitudinally extending through-bore extending from a top opening to a bottom opening, the through-bore being sized and shaped for receiving a closure top therethrough;   b) a laterally extending pass-through slot extending upwardly from the bottom opening and joined with the through-bore, the pass-through slot defining a pair of spaced opposed legs and being sized and shaped so as to receive the rod therethrough, the pass-through slot being alignable with a U-shaped channel of the implant receiver located between the arms thereof; and   c) a first inwardly projecting attachment structure near the bottom opening that is sized and shaped to cooperatively engage a second attachment structure of the implant receiver when the guide tool is secured to the implant, wherein the second attachment structure is a radiused horizontal pair of grooves circumferentially located on and cut into an exterior surface of the receiver arms near an upper end thereof and on both sides thereof, the implant receiver having an abutment surface, thereby preventing rotation of the guide tool relative to the receiver; wherein   d) when the pass-through slot and the U-shaped channel are aligned, the rod is transferable from the guide tool to the implant receiver.   
     
     
         60 . The implant according to  claim 59 , wherein the guide tool can be rotated off the implant receiver. 
     
     
         61 . A receiver for a bone anchor and comprising:
 a) a pair of laterally spaced upstanding arms having external surfaces extending from a front side to a back side of the receiver and respective upper surfaces, the arms forming a rod-receiving channel therebetween; and   b) at least one arm having a laterally opening slot formed on a respective external surface and located near the respective upper surface, the slot being sized and shaped to extending radially, circumferentially, and horizontally with respect to the respective external surface, the slot extending to one of the front and back sides of the receiver, the slot having an abutment surface.   
     
     
         62 . A guide tool assembly for implanting a spinal rod in a bone anchor, the tool assembly comprising:
 a) a first tool having an overall length and a lower end snapped onto the bone anchor, said first tool having a central opening extending the entire overall length, and a channel opening radially outward along a lower length of said first tool, so as to form a pass-through passageway for receiving the rod therein; and   b) a second tool configured to push the rod down into the bone anchor.   
     
     
         63 . A guide tool assembly for use with a spinal implant bone anchor and an associated rod, the guide tool assembly comprising:
 a) an elongate body having an overall length and a longitudinal axis with a central opening along the overall length of the elongate body, the elongate body having an outer surface and a channel with a lateral opening extending through the outer surface and along a portion of the length of the elongate body upwardly from a bottom of the body, the channel and the channel opening being sized and shaped for receiving the rod;   b) an opposed spinal implant bone anchor engaging structure near the bottom of the body engaging a bone anchor head; and   c) an elongate rod pushing member having an overall length; wherein   d) the guide tool assembly configured to insert the bone anchor, to manipulate the head of the bone anchor, to insert the rod, to guide the rod to the bone anchor head, and to reduce the rod down into the head by pushing the rod pushing member down on the rod; and wherein   e) the assembly configured to be removable from the bone anchor after the rod has been secured to the head of the bone anchor.   
     
     
         64 . The guide tool assembly of  claim 63 , wherein
 a) the opposed spinal implant bone anchor engaging structure is flexible.   
     
     
         65 . The guide tool assembly of  claim 63 , including
 a) a screw driver to insert the bone anchor.   
     
     
         66 . A guide tool assembly for use with a spinal implant bone screw and an associated rod, the guide tool assembly comprising:
 a) an elongate body having a central opening along an overall length thereof, the body having an outer surface and a channel with a lateral opening extending through the outer surface and along at least a portion of the overall length of the body upwardly from a bottom of the body, the channel and the channel opening being sized and shaped for receiving the rod;   b) an opposed spinal implant engaging structure near the bottom of the body and configured to flexibly engage a head of the bone screw; and   c) a second elongate member having an overall length and being translationally disposed with respect to at least a portion of the flexible engaging structure and configured to cooperate with the guide tool assembly to insert the rod into the bone screw head.   
     
     
         67 . The guide tool assembly of  claim 66 , wherein
 a) at least a portion of the elongate body outer surface is threaded.   
     
     
         68 . In a bone anchor having a head with first and second opposed arms defining a channel therebetween and a shank pivotable with respect to the head, the improvement wherein:
 a) the shank is cannulated; and   b) the first arm has an outward facing slot, the slot formed in and extending horizontally and circumferentially about a periphery of the first arm, the slot remaining open and uncovered when a closure is in the channel.