Methods and instruments for endoscopic interbody surgical techniques

A method of restoring disc height between adjacent vertebrae of a patient, the method comprising:

• inserting a cannula through tissue of the patient in one of a posterior or postero-lateral approach to create a working channel to the disc space;
• distracting the disc space to a disc space height with a distractor extending through the working channel into the disc space;
• inserting an instrument through the working channel, wherein inserting the instrument includes inserting a shim through the working channel, the shim having a distal blade with a height corresponding to the distracted disc space height;
• positioning a distal portion of the instrument adjacent a distal portion of the distractor in the disc space, wherein positioning the distal portion of the instrument in the disc space includes positioning the blade of the shim adjacent the distractor, the blade contacting the endplates of the adjacent vertebrae;
• removing the distractor from the disc space after inserting the shim;
• inserting a second distractor through the working channel into the disc space to increase the disc space height;
• removing the shim from the disc space after inserting the second distractor;
• inserting a second shim through the working channel, the second shim having a blade with a height corresponding to the increased disc space height;
• and
• performing a procedure in the disc space.

A method of restoring disc height between adjacent vertebrae of a patient, the method comprising:

• inserting a cannula through tissue of the patient in one of a posterior or postero-lateral approach to create a working channel to the disc space;
• distracting the disc space to a disc space height with a distractor extending through the working channel into the disc space;
• inserting an instrument through the working channel, wherein inserting the instrument includes inserting a shim through the working channel, the shim having a distal blade with a height corresponding to the distracted disc space height, wherein inserting the shim includes driving the shim into the disc space with a driver positioned about a shaft extending from the blade of the shim;
• positioning a distal portion of the instrument adjacent a distal portion of the distractor in the disc space, wherein positioning the distal portion of the instrument in the disc space includes positioning the blade of the shim adjacent the distractor, the blade contacting the endplates of the adjacent vertebrae;
• and
• performing a procedure in the disc space.

A method of preparing a disc space for insertion of an implant between adjacent vertebral endplates of a patient, the method comprising:

• inserting a cannula through tissue of the patient in one of a posterior or postero-lateral approach to create a working channel to the disc space;
• distracting the disc space to a disc space height by positioning a distractor in the disc space, the distractor being attached to a stem that extends through the working channel, the distractor including a body portion extending between a leading end and a trailing end, the body portion including an upper surface for contacting one of the adjacent vertebral endplate and an opposite lower surface for contacting the other of the adjacent vertebral endplates and opposite first and second sidewalls extending between the upper and lower surfaces, wherein the distractor includes a first flange and a second flange each extending proximally from the leading end of the body portion towards the trailing end, the first flange forming a slot with the first sidewall and the second flange forming a slot with the second sidewall;
• providing a cutter including an upper member with an upper cutting edge and a lower member with a lower cutting edge and a pair of opposite sidewalls extending between the upper and lower members;
• and
• cutting the adjacent vertebral end plates to form an implant insertion location while maintaining distraction with the distractor, wherein cutting the adjacent vertebral endplates includes advancing the cutter over the body portion of the distractor such that each sidewall of the cutter is received in a respective one of the slots.

A method of restoring disc height between adjacent vertebrae of a patient, the method comprising:

• inserting a cannula through tissue of the patient in one of a posterior or postero-lateral approach to create a working channel to the disc space;
• distracting the disc space to a disc space height with a distractor extending through the working channel into the disc space;
• inserting an instrument through the working channel, wherein inserting the instrument includes inserting a shim through the working channel, the shim having a distal blade with a height corresponding to the distracted disc space height;
• positioning a distal portion of the instrument adjacent a distal portion of the distractor with the distractor positioned more toward the center of the working channel than the instrument, wherein positioning the distal portion of the instrument includes positioning the blade of the shim adjacent the distractor in the disc space, the blade contacting the endplates of the adjacent vertebrae;
• and
• performing a procedure in the disc space.