FIELD OF THE INVENTION

The present invention relates to minimally-invasive surgery. More particularly the present invention relates to minimally-invasive spinal surgery.

BACKGROUND OF THE INVENTION

Spinal fusion procedures may involve the remove of a herniated disk and cleaning all of the debris out of the disk space prior to introducing an implant such as a cage or the like and grafting material. To perform such procedures as minimally-invasive surgery (MIS), it can be difficult, if not impossible to remove all of the fragments of the disk or any other debris that might impede the proper insertion and placement of one or more implants and, optionally grafting material. One of the major causes of this difficulty is that access ports or other tubes used to allow the surgeon to access the surgical site place significant restrictions on the mobility of the instruments being used by the surgeon to remove the disk, disk fragments and debris.

U.S. Patent Application Publication No. 2014/0243604 provides a surgical access tube that is provided with oppositely positioned weakened distal portions that can be removed to afford lateral intrusions of the spinous process and facet, respectively, to allow placement of the access tube over the spinous process and facet during a surgical procedure. The break-away, weakened distal portions simplify the fitting of the access tube, making it easier to use than previous tubes that the surgeons had previously used after selectively resecting some portion of the distal end of the tube not having the weakened sections. A weakened proximal portion may also be provided to improve a range of angles for surgical instruments working through the access tube. The weakened proximal section is limited to a height of about 15-20 mm and weakened sections converge from a wider base opening (either at the distal end or proximal end of the access tube) to an arc base, presumably to avoid crack propagation and maintain rigidity of the access tube. Due to the limited height and sweep angle defined by the weakened proximal section, angulation of instruments is limited to only about 25 degrees, possibly up to 30 degrees. Further, the tube must be installed in a predetermined orientation relative to the spinous process and facet and therefore does not allow the tube to be rotated about its longitudinal axis, thereby further limiting the ability to angulate instruments inserted therethrough. It would be desirable to provide solutions that would allow a greater range of angulation of instruments used in an access tube.

U.S. Pat. No. 7,594,888 discloses expandable ports that can be used in minimally invasive surgery. The expandable ports are typically enclosed along the lengths thereof, even after expansion, but some embodiments, such as in FIGS. 17, 18, 29 and 23 result in proximal and distal gaps at the location of expansion. Such gaps are merely the result of the mechanism used to expand the tube. Further, these embodiments retain an impediment such as a mechanism intermediate the proximal and distal gaps which would limit angulation much in the same way described above that angulation is limited in U.S. Patent Application Publication No. 2014/0243604.

There is a need for improved products and methods that allow greater mobility of surgical instruments during MIS surgery, particularly MIS spine surgery.

There is a need for improved products and methods that provide greater, more consistent visibility during MIS surgery, eliminating or significantly reducing shadows and “dead spots” in the visibility field.

SUMMARY OF THE INVENTION

According to one aspect of the present invention, a method of performing minimally invasive surgery includes: inserting an access port through the skin of a patient and positioning the access port so that a distal end of the access port enters or is in contact with an intervertebral disk, wherein the access port includes an elongate, tubular main body portion and a slot extending over a length of said main body portion in a lengthwise direction, wherein said slot extends through a wall of the main body portion, from an outside surface of the main body portion to an inside surface of the main body portion. An instrument is inserted through the access port such that a distal end portion of the instrument extends into the intervertebral disk. The instrument is manipulated to pass a shaft portion of the instrument through at least a portion of the slot, wherein the instrument is manipulatable so as to angle the shaft relative to a longitudinal axis of the access port from a minimal angle of zero degrees to a maximum angle greater than forty-five degrees and to any angle therebetween.

In at least one embodiment, the method further includes fixing at least a portion of the access port to a stationary object.

In at least one embodiment, the access port includes a ring portion at a proximal end portion thereof, the ring portion including a connector extending therefrom, wherein the ring portion is fixed to the stationary object by the connector.

In at least one embodiment, the main body portion is rotatable relative to the ring portion, the method further comprising rotating the main body portion relative to the ring portion to further increase the range of motion of the instrument.

In at least one embodiment, the access port is inserted from a location posterior of the intervertebral disk.

In at least one embodiment, the access port is inserted from a location lateral of the intervertebral disk.

In at least one embodiment, the access port, when positioned so as to enter or contact the intervertebral disk, can be rotated about its longitudinal axis and be positioned where the distal end enters or is in contact with the intervertebral disk.

In at least one embodiment, the access port can be rotated by up to ninety degrees about its longitudinal axis and be positioned where the distal end enters or is in contact with the intervertebral disk.

In another aspect of the present invention, a method of performing minimally invasive surgery includes: forming an opening through skin of a patient; manipulating fascia and other tissues underlying the skin to provide a minimally invasive opening leading to an intervertebral disk; inserting an access port through the minimally invasive opening and advancing the access portion to a position where a distal end of the access port enters or is in contact with the intervertebral disk, wherein the access port includes an elongate, tubular main body portion and a slot extending over a length of the main body portion in a lengthwise direction, wherein the slot extends through a wall of the main body portion, from an outside surface of the main body portion to an inside surface of the main body portion. An instrument is inserted through the access port such that a distal end portion of the instrument extends into the intervertebral disk; and the instrument is manipulated to pass a shaft portion of the instrument through at least a portion of the slot.

In at least one embodiment, the method further includes inserting a K-wire or other guide through the opening through the skin, prior to inserting the access port.

In at least one embodiment, the method further includes successively inserting dilators of successively increasing diameter to increase the size of opening leading to the intervertebral disk, prior to inserting the access port.

In at least one embodiment, the opening through the skin is formed by making an incision having a length in the range of 15 mm to 18 mm.

In at least one embodiment, the access port, when positioned so as to enter or contact the intervertebral disk, can be rotated about its longitudinal axis and be positioned where the distal end enters or is in contact with the intervertebral disk.

In at least one embodiment, the access port can be rotated by up to ninety degrees about its longitudinal axis and be positioned where the distal end enters or is in contact with the intervertebral disk.

According to another aspect of the present invention, an access port is configured and dimensioned for use in minimally invasive surgery. The access port includes: an elongate, tubular main body portion; a connector configured to fix at least a portion of the access port to a stationary object; and a slot extending over a length of said main body portion in a lengthwise direction, wherein the slot has a length and a width and extends through a wall of the main body portion, from an outside surface of the main body portion to an inside surface of the main body portion; and wherein the width of the slot is substantially constant over at least a third of the length of the slot.

In at least one embodiment, the slot extends a full length of the main body portion, from a proximal end to a distal end of the main body portion.

In at least one embodiment, the width of the slot is substantially constant over the entire length of the slot.

In at least one embodiment, the slot allows an instrument inserted into the main body portion to be angled relative to a longitudinal axis of the main body portion by an angle greater than thirty degrees.

In at least one embodiment, the access port further includes a ring portion at a proximal end of the access port, wherein the connector is rigidly fixed to the ring portion.

In at least one embodiment, the ring portion is integral with the main body portion.

In at least one embodiment, the main body portion has a first outside diameter and the ring portion has a second outside diameter, and wherein the second outside diameter is greater than the first outside diameter.

In at least one embodiment, the slot extends through the ring portion.

In at least one embodiment, the main body portion is rotatable relative to the ring portion, about a longitudinal axis of the main body portion.

In at least one embodiment, the slot is a first slot, and wherein the ring portion comprises a second slot that aligns with the first slot when the ring portion is mounted on the main body portion.

In at least one embodiment, the first slot has a first width and the second slot has a second width, wherein the second width is greater than the first width to allow the second slot to remain aligned with the first slot upon rotation of the main body portion relative to the ring portion.

In at least one embodiment, the slot is tapered such that the slot has a first width along a proximal portion thereof and a second width along a distal portion thereof, wherein the first width is greater than the second width.

In at least one embodiment, the connector is substantially aligned with a longitudinal axis of the main body portion.

In at least one embodiment, the connector is substantially perpendicular to a longitudinal axis of the main body portion.

In at least one embodiment, a distal end portion of the main body portion is tapered.

In at least one embodiment, the main body portion comprises a groove extending circumferentially in an outer surface of a proximal end portion of the main body portion; wherein the ring portion comprises a ledge extending radially inward from an inner surface of the ring portion; and wherein the ledge mates with the groove upon mounting the ring portion to the main body portion.

In at least one embodiment, the main body portion comprises a groove extending circumferentially in an outer surface of a proximal end portion of the main body portion and at least one cutout in the outer surface extending to a proximal end of the main body and communicating with the groove; wherein the ring portion comprises at least one tab extending radially inward from an inner surface of the ring portion, the at least one tab being configured and dimensioned to slide through the at least one cutout, respectively; wherein, upon mounting the ring portion to the main body portion, the at least one tab passes through the at least one cutout and into the groove; and wherein upon rotating the ring portion relative to the main body portion, the at least one tab is prevented from passing back out of the at least one cutout.

In at least one embodiment, the access port further includes at least one lighting implement extending to at least an inner wall surface of the main body portion in an annulus of the main body portion.

In at least one embodiment, the access port further includes at least one light port extending from an outside surface of the access port to an inside surface of the access port; and at least one lighting implement extending into the at least one light port to illuminate at least a portion of the main body portion in an annulus of the main body portion.

In at least one embodiment, the at least one light port extends through the ring portion.

In at least one embodiment, the access port further includes at least one longitudinally extending cutout in an inner wall of the main body portion; and at least one light strip mounted in the at least one longitudinally extending cutout, respectively.

In at least one embodiment, the at least one light strip is flush with the inner wall of the main body portion.

In at least one embodiment, the access port further includes at least one slot extending through a wall of the main body portion and communicating with the at least one cutout, respectively, wherein the at least one slot is configured and dimensioned to allow the at least one light strip to be inserted therethrough and installed in the at least one cutout, respectively.

In at least one embodiment, the access port is provided in combination with an instrument extending through the access port, wherein a distal end of the instrument extends distally of a distal end of the access port and a shaft of the instrument extends through the slot, to provide increased range of motion of the distal end of the instrument.

In at least one embodiment, the access port is configured and dimensioned for use in minimally invasive spine surgery.

In at least one embodiment, the access port includes a light guide assembly installed in a proximal end portion of the tubular main body portion, wherein the light guide assembly includes a fiber optic cable having optical fibers. The optical fibers are fanned out over an inner circumference of the proximal end portion of the tubular opening of the main body to provide even lighting throughout the tubular opening and a surgical target targeted by a distal end opening of the tubular opening.

In at least one embodiment, the light guide assembly further includes a split compression ring. The optical fibers are adhered or otherwise attached to the split compression ring and terminate at or proximal of a distal end of the split compression ring.

According to another aspect of the present invention, a light guide assembly is provided that includes a fiber optic cable having optical fibers, and a split compression ring. The optical fibers are fanned out over an outer circumference of the split compression ring and attached thereto. The optical fibers terminate at or proximal of a distal end of the split compression ring.

In at least one embodiment, the split compression ring is configured and dimensioned to form a compression fit with a tubular opening of an access port.

According to another aspect of the present invention, a method of performing minimally invasive surgery includes: inserting an access port through the skin of a patient and positioning the access port adjacent or into a surgical target location, wherein the access port includes an elongate, tubular main body portion and a slot extending over a length of the main body portion in a lengthwise direction, wherein the slot extends through a wall of the main body portion, from an outside surface of the main body portion to an inside surface of the main body portion; inserting an instrument through the access port such that a distal end portion of the instrument extends into the surgical target location; and manipulating the instrument to pass a shaft portion of the instrument through at least a portion of the slot.

In at least one embodiment, the method further includes fixing at least a portion of the access port to a stationary object.

In at least one embodiment, the access port includes a ring portion at a proximal end portion thereof, the ring portion including a connector extending therefrom, wherein the ring portion is fixed to the stationary object by the connector.

In at least one embodiment, the main body portion is rotatable relative to the ring portion, the method further comprising rotating the main body portion relative to the ring portion to further increase the range of motion of the instrument.

In at least one embodiment, the surgical target location is in the spine of the patient.

In at least one embodiment, the surgical target location is an intervertebral disk space.

These and other advantages and features of the invention will become apparent to those persons skilled in the art upon reading the details of the devices and methods as more fully described below.

