Devices and methods for vertebral stabilization

Abstract

Devices, systems and methods for the treatment of spinal instability and/or stenosis of the spinal canal and neural foramina. In one embodiment, a functional spinal unit (FSU) of a subject is approached through a lateral or antero-lateral corridor, and both an anterior and posterior column of the FSU are manipulated, implanted and/or otherwise surgically treated through the same intra-abdominal surgical corridor. A method is disclosed to reach the posterior aspect of the FSU, wherein the intra-abdominal surgical corridor is extended posterior to the psoas major muscle and through the thoraco-lumbar fascia in order to reach the transverse process and/or facet joint. Multiple trajectories for bone screw fixation of the vertebral bone are additionally disclosed. In another embodiment, the FSU is approached through the above corridor and a second posterior skin incision and corridor. The combination of the corridors provided circumferential access to the FSU.

1 .- 20 . (canceled) 
     
     
         21 . A method for stabilizing a functional spinal unit of a subject, the functional spinal unit comprising a superior vertebral bone, an immediately inferior vertebral bone, and an intervertebral disc space disposed there between, the method comprising:
 forming a skin incision in the subject, the skin incision positioned anterior to a first coronal plane, wherein the first coronal plane: (i) defines a vertical plane of the subject, (ii) comprises at least a portion of a posterior wall of the superior vertebral bone and (iii) divides the functional spinal unit into an anterior segment and a posterior segment;   forming a surgical corridor, the surgical corridor extending from the skin incision and traversing at least a portion of an abdominal cavity of the subject;   extending a first branch of the surgical corridor to the posterior segment of the functional spinal unit, the first branch extending posterior to the first coronal plane and posterior to at least a segment of a psoas muscle, the psoas muscle positioned ipsilateral to the skin incision;   forming an entry point in an outer bony surface of a lateral wall of a first pedicle of at least one of the superior vertebral bone or the inferior vertebral bone, the entry point located between a first nerve positioned immediately below the first pedicle and a second nerve positioned above the first pedicle, wherein the lateral wall is positioned posterior to the first coronal plane and ipsilateral to the skin incision; and   advancing a first fastener through the entry point and into a posterior segment of the vertebral bone comprising the first pedicle, the first fastener traversing a trajectory having both anterior to posterior and lateral to medial components.   
     
     
         22 . The method of  claim 21 , wherein at least a portion of the surgical corridor traverses an anterior layer of a thoracolumbar fascia positioned ipsilateral to the skin incision. 
     
     
         23 . The method of  claim 22 , wherein the advancing the first fastener comprises advancing the first fastener through a lamina segment of the superior vertebral bone. 
     
     
         24 . The method of  claim 23 , wherein the advancing the first fastener comprises advancing the first fastener through a lamina segment of the inferior vertebral bone. 
     
     
         25 . A method for treatment of a functional spinal unit of a subject, the functional spinal unit comprising a superior vertebral bone, an inferior vertebral bone and an intervertebral disc space disposed there between, the method comprising:
 forming a first skin incision in the subject, the first skin incision positioned anterior to a first coronal plane, wherein the first coronal plane: (i) defines a plane of the subject that extends from an anterior-most point of a right transverse process of the inferior vertebral bone to an anterior-most point of a left transverse process of the inferior vertebral bone; and (ii) divides the functional spinal unit into an anterior segment and a posterior segment;   forming a first surgical corridor extending from the first skin incision and traversing at least a portion of an abdominal cavity of the subject;   advancing an orthopedic implant through at least a segment of the first surgical corridor and at least partially into the intervertebral disc space of the functional spinal unit;   extending a first branch of the first surgical corridor onto the posterior segment of the functional spinal unit, the first branch extending posterior to the first coronal plane and traversing an anterior layer of a thoracolumbar fascia, wherein the thoracolumbar fascia is positioned ipsilateral to the first skin incision;   forming a second skin incision in a posterior aspect of the subject;   forming a second surgical corridor extending from the second skin incision to a lamina portion of at least one of the superior vertebral bone or the inferior vertebral bone; and   connecting the first and second surgical corridors within the subject.   
     
     
         26 . Apparatus configured for treatment of a functional spinal unit of a subject, the functional spinal unit comprising a superior vertebral bone, an inferior vertebral bone, and an intervertebral disc space disposed there between, the apparatus comprising:
 a first fastener configured for fastening to at least one vertebral bone structure;   a second fastener configured for fastening to at least one vertebral bone structure; and   an orthopedic implant; and   wherein the first fastener, second fastener, and the orthopedic implant are configured to be implanted within the subject by at least:
 formation of a first skin incision in the subject, the first skin incision positioned anterior to a first coronal plane, wherein the first coronal plane: (i) defines a plane of the subject that extends from an anterior-most point of a right transverse process of the inferior vertebral bone to an anterior-most point of a left transverse process of the inferior vertebral bone; and (ii) divides the functional spinal unit into an anterior segment and a posterior segment; 
 formation of a first surgical corridor extending from the first skin incision and traversing at least a portion of an abdominal cavity of the subject; 
 advancement of the orthopedic implant through at least a segment of the first surgical corridor and at least partially into the intervertebral disc space of the functional spinal unit; 
 extension of a first branch of the first surgical corridor onto the posterior segment of the functional spinal unit, the first branch extending posterior to the first coronal plane and traversing an anterior layer of a thoracolumbar fascia, wherein the thoracolumbar fascia is positioned ipsilateral to the first skin incision; 
 formation of a second skin incision in a posterior aspect of the subject; 
 formation a second surgical corridor extending from the second skin incision to a lamina portion of at least one of the superior vertebral bone or the inferior vertebral bone; 
 connection the first and second surgical corridors within the subject to form a combined surgical corridor; 
 advancement of the first fastener through a first pedicle of the inferior vertebral bone, the first pedicle positioned ipsilateral to the skin incision, wherein the first fastener is configured to traverse the first pedicle in an anterio-lateral to posterio-medial direction; and 
 advancement of the second fastener through a second pedicle of the superior vertebral bone, the second pedicle configured to be positioned ipsilateral to the skin incision, wherein the second fastener further configured to traverse the second pedicle in an anterio-lateral to posterio-medial direction.