# US 12,758,397 B2 · Method and apparatus for minimally invasive insertion of intervertebral implants

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- Number: US 12,758,397 B2
- Document ID: US12758397B2
- Status: Granted
- Kind: B2
- Application number: 18/051,168
- Filed: 2022-10-31
- Published: 2023-05-25
- Granted: 2026-10-13
- Earliest claimed: 2011-03-10
- Assignees: DePuy Synthes Products, Inc.
- Applicants: DePuy Synthes Products, Inc.
- Inventors: Rudolf Morgenstern Lopez; Robert Flower; Christopher Warren
- Web page: https://patentgrep.com/patent/US12758397B2

## CPC

- A61F 2/4611: {of spinal prostheses}
- A61B 17/1757: {for the spine}
- A61B 17/3417: {Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating (syringe needles A61M5/32; dilators A61M29/00)}
- A61B 17/3421: {Cannulas}
- A61B 17/3468: {for implanting or removing devices, e.g. prostheses, implants, seeds, wires (devices for implanting seeds A61M37/0069)}
- A61B 17/8858: {laterally or radially expansible (inflatable A61B17/8855)}
- A61F 2/447: {substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section}
- A61M 29/00: Dilators with or without means for introducing media, e.g. remedies
- A61B 2017/00261: {Discectomy}
- A61B 2017/3447: {Linked multiple cannulas}
- A61B 2017/3449: {whereby the instrument channels merge into one single channel}
- A61F 2002/30281: {wedge-shaped}
- A61F 2002/30387: {Dovetail connection}
- A61F 2002/3039: {with possibility of relative movement of the rib within the groove}
- A61F 2002/30397: {Limited lateral translation of the rib within a larger groove}
- A61F 2002/304: {with additional means for limiting said sliding}
- A61F 2002/30433: {using additional screws, bolts, dowels, rivets or washers e.g. connecting screws}
- A61F 2002/30507: {using a threaded locking member, e.g. a locking screw or a set screw}
- A61F 2002/30522: {releasable, e.g. using a releasable ratchet}
- A61F 2002/30538: {for adjusting angular orientation}
- A61F 2002/3055: {for adjusting length}
- A61F 2002/30556: {for adjusting thickness}
- A61F 2002/30579: {with mechanically expandable devices, e.g. fixation devices}
- A61F 2002/30601: {telescopic}
- A61F 2002/30827: {Plurality of grooves}
- A61F 2002/30841: {Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes}
- A61F 2002/30878: {with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts}
- A61F 2002/30904: {serrated profile, i.e. saw-toothed}
- A61F 2/4603: {for insertion or extraction of endoprosthetic joints or of accessories thereof}
- A61F 2002/4627: {with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument}
- A61F: FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS (dental prosthetics A61C)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- A61M: DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY (introducing media into or onto the bodies of animals A61D7/00; means for inserting tampons A61F13/26; devices for administering food or medicines orally A61J; containers for collecting, storing or administering blood or medical fluids A61J1/05); DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY (surgery A61B; chemical aspects of surgical articles A61L); DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR {(Electrotherapy, e.g. producing anaesthesia by the use of alternating or intermittent currents A61N1/36021)}

## Abstract

A dilation introducer for orthopedic surgery is provided for minimally invasive access for insertion of an intervertebral implant. The dilation introducer may be used to provide an access position through Kambin's triangle from a posterolateral approach. A first dilator tube with a first longitudinal axis is provided. A second dilator tube may be introduced over the first, advanced along a second longitudinal axis parallel to but offset from the first. A third dilator tube may be introduced over the second, advanced along a third longitudinal axis parallel to but offset from both the first and the second. An access cannula may be introduced over the third dilator tube. With the first, second, and third dilator tubes removed, surgical instruments may pass through the access cannula to operate on an intervertebral disc and/or insert an intervertebral implant.

## Claims

### Claim 1

A method for performing orthopedic surgery, comprising:
introducing a guide member along a trajectory toward a Kambin's triangle;
determining that a nerve has been stimulated with an electrical current during the introducing step when the guide member approaches or comes into contact with the nerve,
performing a foraminoplasty to remove bone from a superior border of a vertebra so as to enlarge the Kambin's triangle;
after the performing step, inserting an intervertebral implant into an intervertebral space through the Kambin's triangle while avoiding the nerve; and
expanding the intervertebral implant.

### Claim 2 (depends on 1)

The method of claim 1, wherein the guide member comprises a dilator tube, the method further comprising after the determining step and prior to the inserting step, driving the dilator tube through the Kambin's triangle toward the intervertebral space.

### Claim 3 (depends on 2)

The method of claim 2, further comprising inserting at least one additional dilator tube over the dilator tube.

### Claim 4 (depends on 3)

The method of claim 3, further comprising inserting an access cannula over an outermost one of the at least one additional dilator tube.

### Claim 5 (depends on 4)

The method of claim 4, further comprising removing the dilator tube and the at least one additional dilator tube.

### Claim 6 (depends on 5)

The method of claim 5, wherein the inserting step comprises inserting the intervertebral implant through the access cannula into the intervertebral space.

### Claim 7 (depends on 1)

The method of claim 1, wherein the guide member comprises a guide wire.

### Claim 8 (depends on 7)

The method of claim 7, further comprising after the determining step and prior to the inserting step, driving the guide wire through the Kambin's triangle toward the intervertebral space.

### Claim 9 (depends on 7)

The method of claim 7, further comprising driving at least one dilator tube over the guide wire through the Kambin's triangle, and driving an access tube over the at least one dilator tube.

### Claim 10 (depends on 9)

The method of claim 9, wherein the inserting step comprises inserting the intervertebral implant through the access tube into the intervertebral space.

### Claim 11 (depends on 10)

The method of claim 10, further comprising removing the at least one dilator tube and the guide wire prior to the inserting step.

### Claim 12 (depends on 1)

The method of claim 1, wherein the determining step comprises visually observing a visual indication that the guide member is approaching the nerve.

### Claim 13 (depends on 12)

The method of claim 12, wherein the determining step comprises observing movement of a leg of a patient.

### Claim 14 (depends on 12)

The method of claim 12, wherein the determining step removes the visual indication.

### Claim 15 (depends on 1)

The method of claim 1, further comprising attaching a pedicle screw to a pedicle of a vertebra.