Surgery – Instruments – Cutting – puncturing or piercing
Patent
1996-07-18
1998-05-19
Buiz, Michael
Surgery
Instruments
Cutting, puncturing or piercing
604272, A61B 1732
Patent
active
057529698
DESCRIPTION:
BRIEF SUMMARY
The present invention relates to an instrument for the surgical treatment of an intervertebral disc by the anterior route, in particular by percutaneous nucleotomy, advantageously of use in the treatment by the coelioscopic surgical treatment of the lumbar disc situated between the fifth lumbar vertebra and the sacrum (commonly termed disc L5-S1).
The treatment of intervertebral discs has recently developed owing to, among other techniques, the techniques of percutaneous surgery which has in particular the advantage of being "non-invasive". Indeed, this surgery has created not only on the part of the patients but also on the part of hospital or medical protection authorities a very high interest. This interest is principally due to the very appreciable improvement in the post operational conditions and to a considerable reduction in the time spent in hospital. On the other hand, this surgery is relatively costly as concerns equipment and requires a more intense surgical specialization both in the operating theatre and of the specially trained surgeons.
The principle of percutaneous nucleotomy consists in puncturing the disc so as to lower the intradiscal pressure and possible withdrawing the degenerated discal contents without need of a truly surgical approach. Heretofore only a postero-lateral approach under radioscopic control was employed, the patient being placed in the ventral or possibly lateral decubitus position. The nucleus is removed either by means of a forceps (the most frequent case), or by means of a laser (technique at present under development) or with the use of a motorized system for fragmenting the disc and aspirating the debris.
The indications are mainly the nerve compressions by intraspinal discal protrusions or hernias. The sciaticas and non-excluded discal hernias are also indicated provided the patient is young and the posterior annulus is healthy.
Most often, it concerns the last three lumbar discs: L3-L4 and above all L4-L5 and L5-S1, the hernia of the latter two discs being responsible for most of the "common" discal sciaticas. Notwithstanding the fact that many technical points remain controversial (need for a discoscopy, manual or automated discectomy, etc.), there is a more or less general consensus as concerns the technique of a percutaneous approach of the lumbar discs; up to the present time all the authors consider that the puncturing of the disc must be effected by the postero-lateral route under radioscopic control. The penetration of the treatment device occurs at the postero-lateral angle of the disc, by avoiding the spinal nerve, which implies the use of local anaesthesia.
Surgeons generally acknowledge the interest of this operating technique owing to the relative ease of access it affords, in particular for the lumbar discs L3-L4 and L4-L5. On the other hand, approaching the disc L5-S1, the disc concerned in almost half the operations on lumbar discs, is more difficult owing to the much less superficial character of this spinal segment and to the necessity to pass round the iliac wing. This is why various specific artifices have been proposed for approaching the disc L5-S1: curved instrument, inclination of the spine etc. But there appears to be a relatively high rate of considerable technical difficulties or even failures. These difficulties moreover result in an increase in the duration of the intervention, of the irradiation of the patients and the impossibility of the use of instruments of large calibre.
An object of the invention is therefore to solve this problem by proposing a solution which is both simple and effective.
According to the invention, the surgical treatment instrument comprises a guide-needle, at least two rectilinear concentric telescopic tubes adapted to be mounted on the guide-needle, and an outer work tube concentric with the aforementioned tubes. The latter are slidable in this outer tube which is provided at its apical end adapted to penetrate the disc to be treated, with a means for separating the vertebrae adjacent this disc and maintai
REFERENCES:
patent: 4345596 (1982-08-01), Young
patent: 5431661 (1995-07-01), Koch
patent: 5484442 (1996-01-01), Sloane, Jr. et al.
Beurier Jacques Pierre
Cunci Olivier
Buiz Michael
Rasche Patrick W.
Sofamor S.N.C.
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