TWI468143B - Minimally invasive spinal stabilization system - Google Patents

Description

Minimally invasive spinal fixation component

The present invention relates to a spinal fixation assembly, and more particularly to a minimally invasive invasive spinal fixation assembly and method of implantation thereof.

Every year, 13 million people go to see a doctor for chronic back pain, and an estimated 2.4 million Americans become chronically disabled. About 25 percent of people with back pain have problems with herniated disks. In the United States, there are approximately 450 cases per 100,000 disc herniations requiring surgical procedures such as discectomy.

Referring to Fig. 1A, in the past, when the intervertebral disc 8 has been detached or punctured, discectomy (Fig. 1A) was performed. When a surgeon performs a discectomy, an incision is usually performed on the patient's back, which corresponds to the affected area of the spine 2. The muscles and ligaments are moved aside to expose the problematic disc 8 . The surgeon uses various surgical instruments to first separate the vertebrae 4 sandwiched between the intervertebral discs 8, and then completely remove the intervertebral disc 8. After the discectomy, the spine in the area of application is separated approximately the height of the removed disc (Fig. 1B), followed by an artificial disc placed at the separation. The spinal fixation device (Fig. 1C) is used to stabilize and/or straighten the spine 2 between the healing procedures following the above procedure. In some cases, the clinician implants the patient's autologous bone to fill the separation to complete the binding, as shown in Figure 1D, to restore the stability of the spine 2. Alternatively, spinal fusion or other treatment may be performed after discectomy to strengthen and straighten Spinal cord procedure.

While discectomy is often performed using minimally invasive devices and procedures, providing the necessary minimally invasive spinal stabilization and other spinal related procedures remains challenging. The use of modified minimally invasive spinal fixation devices and methods is necessary to minimize patient risk, trauma and recovery time, and to reduce overall costs in the procedure.

In accordance with the present invention, a minimally invasive invasive spinal fixation assembly is presented. The minimally invasive invasive spinal fixation assembly provides a series of relative fixation of the vertebrae, including a fixation rod and a plurality of vertebral screws, each vertebral screw including a top portion and a threaded end, the top portion configured to receive a portion of the fixation rod, the thread end from One of the top ends of the top extends and is configured to engage one of the vertebrae. The assembly further includes a fastener including a plurality of external threads configured to engage a plurality of corresponding threads formed on an inner surface of the top portion. The fixing rod is fixed to the top through the fastener, and the top portion includes a separation area. The separation region includes a portion of the top portion, the portion of the top portion being structurally weaker than the remainder of the top portion for defining a position, the first portion of the top portion being easily accessible when sufficient force is supplied to at least a first portion of the top portion This location is separated from the rest of the top.

The minimally invasive invasive spinal fixation assembly can include one or more of the following features: The fixation rod is configured to receive a suture. The fixing rod is a hollow tube. Each vertebral screw includes a first end and an open second end, the second end being disposed relative to the first end. The top is substantially tubular and consists of a single piece. The single piece has a first opening and a second opening, the first opening extending from the second end to a position along an axial direction of the top, the position being adjacent and spatially separated from the first end, the second opening With respect to the opposite side of the first opening at the top, the second opening extends from the second end to a position along one of the axial directions of the top, the position being adjacent and spatially separated from the first end. The first and second openings are fully aligned to form a transverse passageway that passes through the passageway. A cap can be configured to engage the second end of the top of the pedicle screw. The cap includes a hollow cylindrical body and a pair of ends, the body having an open end for receiving a second end of the top portion therein, the opposite end including a central cap opening. The first end includes an inner surface having an annular projection, and the top portion includes an annular groove adjacent to the second end, configured to engage the annular projection to thereby disassemble the cap The ground is fixed to the second end of the top.

The minimally invasive invasive spinal fixation assembly can include one or more of the following features: a U-shaped vertebral screw stabilizer. The stabilizer includes a grip portion, an annular base and a pair of legs, the annular base extending from one side of the grip portion and having a diameter substantially equal to the diameter of the top, the butt joint from one of the annular bases The side extensions are configured to individually conform to the shape of the first and second openings of the top and are receivable therein. A cap can be configured to close the second end of the apical screw top, the cap including a cap opening through which the butt joint of the pedicle screw stabilizer can be accepted. A portion of the edge of the cap corresponding to the opening of the cap has a shape that conforms to a cross-sectional shape of one of the pins. The minimally invasive invasive spinal fixation assembly further includes a vertebral screw breaking device that is received in an interior space of the top of the vertebral screw to urge the second end of the top along a predetermined annular separation line on the top, from the top The first end separates the predetermined annular separation line between the first end and the second end of the top.

The minimally invasive invasive spinal fixation assembly can include one or more of the following features: a lead and a guiding tool for maintaining a suture, the guiding tool including a first elongated arm and a second elongated arm pivoted. The first extension arm terminates at a first end of a male suture guide, and the second extension arm terminates at a first end of a female suture guide. The male suture guide and the female suture guide are used to guide the lead to the female suture guide from the male suture when the first and second extension arms are moved from an open position to a closed position. The open position is that the male suture guide is separated from the female suture guide, and the closed position is adjacent to the female suture guide. The lead includes a tip and an opening that urges the lead into the female stitch guide, the opening being formed adjacent the tip. The first and second extension arms are received in the hollow interior space at the top of the pedicle screw and through the first and second openings. This series of vertebrae includes at least two vertebrae. The minimally invasive invasive spinal fixation component is performed through a plurality of discrete wounds, the length of the wound substantially corresponding to a cross-sectional diameter of the top.

According to the present invention, a pedicle screw for spinal fixation is provided, comprising a top end and a threaded end, the top portion including a first end and an open second end, the second end being opposite to the first end, the thread end being from the first end One end extends. The top is tubular and consists of a single piece having a first opening and a second opening, the first opening extending along the axial direction of the top from the second end to a position, the position Adjacent and separated from the first end, the second opening is located on an opposite side of the top with respect to the first opening, and the second opening extends from the second end to a position along one of the axial directions of the top, adjacent to each other and spatially separated At the first end. The first and second openings are completely aligned to form a lateral direction Cross the passage and cross the passage through the top.

The pedicle screw can include one or more of the following features: the distance between the first end and the second end of the top is in the range of 40 mm to 120 mm. The distance between the first end and the second end of the top is in the range of 50 mm to 80 mm. The top portion includes a separation region between the first end and the second end, the separation region including a portion of the top portion, the portion of the top portion being structurally weaker than the remaining portion of the top portion for defining a position, When sufficient force is applied to the second end, at least a portion of the second end can be easily separated from the top at the location. The separation region includes an annular groove between the first end and a midpoint, the midpoint being between the first end and the second end, the annular groove is for providing a predetermined separation line when a sufficient force is applied At the second end, at least a portion of the second end can be easily separated from the top along a predetermined separation line. The force is a torque that is centered on one of the longitudinal axes of the top. The vertebral screw further includes a removable cap for closing the second end of the top, wherein the top portion includes an annular groove adjacent to the second end for engaging a corresponding annular edge, the annular edge being located One of the inner surfaces of the cap. The first end of the top is for the threaded end to be multi-axis rotatable relative to the top.

According to the present invention, there is provided a suture guiding assembly comprising a lead and a guiding tool for maintaining a suture, the guiding tool comprising a first elongated arm and a second elongated arm pivoted, the first lengthening The arm terminates at a first end of a male suture guide and the second extension arm terminates at a first end of a female suture guide. The male suture guide and the female suture guide are used to guide the lead to the female stitch guide from the male suture when the first and second extension arms are moved from the open position to the closed position. In the open position, the male suture guide is separated from the female suture guide, and the closed position is the male suture guide and the mother. The sutures are guided adjacent.

The suture leader assembly can include one or more of the following features: the lead includes a tapered tip and an eyelet that projects from the tapered tip. The male suture guide includes a cylindrical shank for detachably engaging the eyelet of the lead, and the female suture guide includes a cylindrical housing for detachably engaging the tapered tip of the lead and guiding The tool is adapted to support the male suture guide and the female suture guide, and the tapered tip is at least partially received between the housings when the guiding tool is in the closed position. The housing includes a first housing opening and a second housing opening, the lead is inserted into the housing through the first housing opening, and the lead is withdrawn from the housing through the second housing opening. The shape of the second housing opening substantially conforms to the shape of the lead. The first housing opening is smaller than the widest portion of the lead. The lead includes a tapered tip, and when the guiding tool is moved from the open position to the closed position, the tapered tip of the lead is driven through the first housing opening while preventing retraction from the first housing opening. The first and second extension arms are at an angle. This angle is between 90 and 180 degrees.

Referring to Fig. 2, the minimally invasive spinal fixation assembly 20 used to stabilize the spine 2 includes a fixation rod 200, a pedicle screw 300, and a fastener 500 (not shown in Fig. 2, see Fig. 5). The fixation rod 200 has a sufficient length to extend across the vertebra 4 to stabilize the vertebra 4. The pedicle screw 300 is used to fasten the fixation rod 200 to each corresponding vertebra 4. A fastener 500 on each vertebral screw 300 is used to fasten the fixation rod 200 to the pedicle screw 300. Each vertebral screw 300 is implanted through a small skin incision into the vertebral root 6 of the corresponding vertebra 4, the skin incision having a length substantially corresponding to the cross-sectional dimension of the vertebral screw 300. In the illustrated embodiment, for example, the slit is 1 cm or less, and the fixing rod 200 is 1 cm or A skin incision of less than 1 cm is assembled to the pedicle screw 300, as discussed further below.

Referring to Fig. 3, the fixing rod 200 has a structure for accommodating a suture space, where the suture is defined as an elongated gut, nylon thread or fiber, such as a thread or a metal wire. In the illustrated embodiment, the fixed rod 200 is a hollow tube including a first end 212, a second end 214, and an inner passage 210. The second end 214 is opposite the first end 212 and the inner passage 210 extends between the first end 212 and the second end 214. In this embodiment, the fixed bar 200 can accommodate a suture in the inner channel 210.

The fixed rod 200 is relatively long compared to its cross-sectional dimension. In the illustrated embodiment, the fixation rod 200 is cylindrical, having a diameter of 5.5 mm, the axial length of which corresponds to the total length of the stabilized spine 2. For example, to stabilize two adjacent vertebrae 4, the length of the fixation rod is approximately 60.0 mm long. To stabilize a series of four adjacent vertebrae 4, the length of the rod is approximately 150.0 mm long. The fixation rod 200 can be formed of an implantable material and formed of a material having sufficient strength and stiffness to stabilize the spine while also having sufficient plasticity to cause the fixation rod 200 to form a curved shape. For example, the fixing rod 200 may be formed of a titanium alloy such as titanium hexaluminum tetravanadium (Ti ₆ Al ₄ V).

Referring to Figure 4, an axial vertebral screw 300 is used to secure the fixation rod 200 to each corresponding vertebra 4. Each vertebral screw 300 can be implanted through a skin incision of 1 cm or less and screwed into the vertebral root of the corresponding vertebra 4, which is under the skin and at a depth of about 5 cm from the average male muscle. To this end, each vertebral screw 300 includes an elongated top portion 302 and a threaded end 304.

The top portion 302 is substantially tubular and is comprised of a single piece. The top portion 302 includes a closed first end 306 and an open second end 308, the second end 308 being opposite the first end 306. The top portion 302 is provided with a first axially extending opening 310 that extends from the second end 308 to the first end 306 and is separate from the first end 306. The top portion 302 also carries a second axially extending opening 312 that is located on one side of the top portion 302 relative to the first opening 310. The second opening 312 is mirrored to the first opening 310 and the second opening 312 extends from the second end 308 to the first end 306 and is separate from the first end 306. The first and second openings 310, 312 are fully aligned to form a transverse passage 316 through the top 302. Thus, the top 302 is substantially U-shaped.

The top portion 302 is axially longer relative to its cross-sectional dimension. For example, in the illustrated embodiment, the distance d1 between the first end 306 and the second end 308 ranges from 4 cm to 12 cm, whereas the top 302 has a diameter of approximately 1 cm. In another embodiment, the distance d1 may range from 5 cm to 8 cm.

The top portion 302 is provided with an annular separation region 318 that is located between the first end 306 and the second end 308. In the illustrated embodiment, the separation region 318 is located between the first end 306 and a midpoint P between the first end and the second end 306, 308. Thus, the top portion 302 is divided into two portions by the separation region 318. A ventral side 322 extends between the first end 306 and the separation region 318; a back side 324 extends between the separation region 318 and the second end 308. The separation region 318 is one of the top regions 302, and the separation region 318 is relatively weak in structure compared to the other regions on the top to define a circumferential line along which the back side portion 324 is applied. The force of the back side 324 and the ventral side 322 Easy to separate. In the illustrated embodiment, the separation region 318 is a circumferentially extending V-shaped groove 320. In certain embodiments, the spinal fixation assembly 20 can include a screw fracture tool 800 configured to provide longitudinal axis torsion of the top portion 302, thereby selectively separating the back side portion 324 from the ventral portion 322 at the groove 320. , will be further explained below. It will be appreciated that even if a bending force is provided, the back side portion 324 can be separated, and the use of torsion forces will cause less damage to the surrounding tissue than the bending force.

The inner surface of the ventral portion 322 is provided with threads 326 that are configured to engage threads 508 on the outer surface 506 of the corresponding fastener 500, as further described below. Further, a retention groove 332 is formed on the outer surface of the top portion 302 and adjacent to the second end 308. The retention groove 332 is sized and disposed to receive a corresponding annular ridge 610 formed on the inner surface of the screw cap 600, as further described below.

The threaded end 304 of the pedicle screw 300 extends outwardly from the first end 306 of the top portion 302. More specifically, the threaded end 304 includes a base 342 and a handle 344 that is supported in the first end 306 of the top 302 and the handle 344 extends from the base 342. The first end 306 of the top portion 302 is configured to allow the threaded end 304 to be rotated three-dimensionally relative to the top portion 302. The handle 344 has an external thread 348 and terminates at a top end 346. In addition, the threaded end 304 includes a passage aperture 350 that opens into the base 342, extends through the handle 344 and opens into the top end 346.

Referring to Figure 5, fastener 500 is a cylindrical member having external threads 508 formed on outer surface 506. The threads 508 are configured to engage threads 326 formed on the inner surface of the ventral side portion 322 of the apical screw top 302. In the illustrated embodiment, the fastener 500 is a set screw that is configured with a first end 502 for receiving a drive tool. For example, the first end 502 includes a hexagonal header 510 adapted to receive a hex wrench or a shaped portion 892 of an actuator 850 (described in detail below). In use, the fastener 500 is secured to the ventral side portion 322 of the pedicle screw top 302 to maintain the position of the fixation rod 200 relative to the vertebral screw 300.

Referring to Figure 4, the spine fixation assembly 20 further includes a removable screw cap 600 having a suitable shape and size to fasten the second end 308 of the pedicle screw top 302 for supporting and stabilizing the top 302. The second end 308, and when the stabilization tool 700 is inserted into the hollow interior of the vertebral screw 300, can be used to guide the direction of the stabilization tool 700 (described in detail below). The screw cap 600 is a hollow cylinder having an open first end 602, a closed second end 604, and a side wall 606, the second end 604 being opposite the first end 602, and the side wall 606 being at the first end 602 and the second end 604 Extended between. The open first end 602 is sized to receive the second end 308 of the pedicle screw top 302 therein.

The sidewall 606 of the screw cap 600 is provided with a first axially extending cap opening 612 that extends from the first end 602 to the second end 604 and is separate from the second end 604. The side wall 606 of the screw cap is also provided with a second axially extending cap opening 614 that is positioned on the opposite side of the side wall 606 relative to the first cap opening 612. The second cap opening 614 is mirrored at the first cap opening 612, and the second cap opening 614 extends from the first end 602 to the second end 604 and is separate from the second end 604. The first and second cap openings 612, 614 are fully aligned to form a transverse through passage 616 through the screw cap 600. When the screw cap 600 is placed on the vertebral screw top At the second end 308 of the portion 302, the screw cap 600 laterally traverses the channel 616 to align with the pedicle screw passage 316.

The screw cap 600 includes an inwardly projecting annular ridge 610 formed on the inner surface of the side wall 606, sized and positioned for engaging a retention groove formed in the second end 308 of the vertebral screw 332. The annular ridge 610 extends about the inner perimeter of the sidewall and engages the retention groove 332 to maintain the screw cap 600 on the second end 308 of the pedicle screw.

Additionally, the second end 604 of the screw cap 600 includes a central opening 618. The central opening 618 is of an irregular shape and includes a substantially circular central portion 622 and an elongated portion 624, each elongated portion 624 being disposed opposite the central portion 622 and staggered with the central portion. In the illustrated embodiment, the central portion 622 has a suitable shape and size for the surgical tool to pass through the screw cap 600 into the interior space of the top 302 of the pedicle screw. In addition, the elongated portion 624 has a suitable shape and size for receiving the securing tool foot 712 of the securing tool 700 (described in detail below) when the stabilizing tool 700 is inserted into the interior of the pedicle screw 300. It should be noted that the elongated portion 624 of the central opening 618 is disposed along the circumference of the second end 604 for superposition on the first and second cap openings 612, 614, respectively. Such a configuration ensures that after assembly of the pedicle screw 300, the cap 600 and the stabilization tool 700, the securing tool feet 712 of the stabilization tool 700 can be respectively aligned with the first and second openings 310, 312 of the top 302 of the pedicle screw, further below discuss.

The spinal fixation assembly 20 further includes a stabilization tool 700 that is a hollow cylinder and that includes an open first end 702, a closed second end 704, and a sidewall 706. The second end 704 is opposite to the first end 702, the side wall 706 Extending between the first end 702 and the second end 704. The sidewall 706 is configured to have an outer diameter corresponding to the outer diameter of the top 302 of the vertebral screw and an diametrically opposed opening 708, 710 that extends axially from the first end 702 to adjacent the second end 704. The openings 708, 710 cause the side wall 706 to be substantially U-shaped, including a securing tool foot 712 that is coupled to the side wall 706 by an annular base portion 714. The grip portion 716 is disposed between the base portion 714 and the second end 704, the second end 704 having a larger outer diameter than the base portion 714. The grip portion 716 includes surface features, such as axially extending grooves 718, to increase grip. Additionally, the second end 704 includes a central opening (not depicted in Figure 4) to allow the tools to be inserted therein.

When the stabilization tool 700 is assembled to the cap 600 and the pedicle screw 300, the stabilization tool foot 712 is positioned in the opening 310, 312 of the top 302 of the vertebral screw (see Figure 4A). During implantation of the spinal fixation assembly 20, the stabilization tool 700 is used to position the fixation rod 200 in the interior space of the top 302 of the pedicle screw. Further, the securing tool 700 is used to maintain the position of the fixed bar 200 when the fastener 500 is used to fasten the ventral portion of the fixation rod 200 to the top of the vertebral screw. After implantation, the stabilization tool 700 is used to reinforce the dorsal portion 324 during separation of the dorsal side 324 from the ventral side 322, as discussed further below.

Referring to Figures 6A through 6C, the spinal fixation assembly 20 further includes a screw fracture tool 800 that is disposed in the interior space of the top 302 of the vertebral screw once the ventral portion 322 of the pedicle screw and the fixation rod 200 are properly positioned. Placed and secured to each other, a screw breaking tool 800 is used to remove the dorsal portion 324 of the top 302 of the pedicle screw. Screw breaking tool 800 A sleeve 820 and a T-actuator 850 are included, the actuator 850 having a suitable shape and size that can be received in the sleeve 820 (Fig. 6A). The sleeve 820 is a hollow cylinder including an open first end 802, a second end 804, and a side wall 806. The second end 804 is opposite the first end 802 and the sidewall 806 extends between the first end 802 and the second end 804. A pair of grooves 814 (only one groove 814 is shown) extend from the first end 802 toward a central portion of the sleeve 820. Trench 814 divides first end 802 into two portions 802a, 802b. The grip region 810 is placed on the second end 804 with a larger outer diameter than the sidewall 806, and the grip region 810 includes surface features, such as axially extending grooves 818, for increased grip. Additionally, the second end 804 includes a central opening 812 into which a tool, including an actuator 850, can be inserted. The axial length of the sleeve 820 is longer than the axial length of the assembled vertebral screw 300, cap 600, and stabilization tool 700.

The actuator 850 includes a handle 854 having a first end 856 and a second end 858. The grip 852 is secured to the second end 858 such that the actuator 850 is a T-shape. The first end 856 of the handle includes a flared portion 890 and a shaped portion 892 that extends from the flared portion 890 (as depicted in Figure 6B). The outer section of the shaped portion 892 has surface features that enable it to engage the stem 510 of the fastener 500. For example, in the illustrated embodiment, the shaped portion 892 has a hexagonal cross-section for engaging the hexagonal column header 510 of the fastener 500. The flared portion 890 has an outer dimension that is larger than the inner space of the side wall 806 of the cannula and the top 302 of the pedicle screw. When the actuator 850 is disposed in the sleeve 820 and the flared portion 890 protrudes from the first end 802 of the sleeve, the sleeve 820 can be inserted into the top 302 of the pedicle screw, for example, to fasten the fastener 500 To vertebral screw 302 top. At least a portion of the flared portion 890 is placed in the first end of the sleeve 820 by pulling the actuator up or down into the sleeve 820 and rotating the grip 810, the flared portion 890 causing the ends 802a Slightly separated from 802b. Through this action, the outer wall of the cannula 820 is compressed toward the dorsal portion 324 at the top of the vertebral screw. Since the sleeve 820 is frictionally engaged with the top 302 of the pedicle screw, the torsion is applied to the dorsal portion 324 at the top of the vertebral screw by rotation along the downward longitudinal axis of the grip 810. When sufficient force is applied, the dorsal portion 324 of the apex screw top 302 can be separated from the ventral portion 322 along the separation region 318 (as depicted in Figure 6C).

Referring to Figure 7, a suture guide assembly 900 is used to implant the fixation rod 200 on top of the individual vertebral screws 302, as discussed further below. The suture leader assembly 900 includes a guide tool 980 having a pair of extension arms 982, 984 that are coupled to the first end 988 and the second end 990 of the extension arms 982, 984 via a pivot pin 986. between. The first end 988 of each extension arm 982, 984 is formed as a finger ring 992 for manual actuation of the guiding tool 980, and the second end 990 of each extension arm 982, 984 is configured to have a suture guide 940, 960 . During the priming process, the guiding tool 980 performs a scissoring motion with the pivot pin 986 as the axis.

The first and second extension arms 982, 984 of the guiding tool 980 have dimensions that can be received into the hollow interior space of the vertebral screw top 302 and are elongated along the axial length of the pedicle screw top 302. In addition, the guiding tool 980 operates in a scissoring action, and the first elongating arm 982 and the second elongating arm 984 are in an open position (as shown in Figures 7 and 22-23) and in a closed position (as shown in Fig. 24). Move between shows), add 982, 984 points in the open position Dividing from a first distance, the elongated arms 982, 984 are separated into a second distance in the closed position, the first distance being greater than the second distance. When the guiding tool 980 is inserted into the pedicle screw 300, the first and second elongate arms 982, 984 have dimensions that can pass through the apical screw top first and second openings 310, 312, as discussed further below. In some embodiments, the first and second extension arms 982', 984' can be angled. For example, the extension arms 982', 984' can have an angle between the pivot pin 986' and the second end 990' of the extension arm such that the second end 990' is not located in the plane defined by the finger ring 992' (eg, Figure 39 shows). The angle of the extension arm can be in the range of 90-180 degrees.

The suture guiding assembly 900 also includes a lead 920 for fixing the suture 1216, the male suture guide 940, the female suture guide 960, and the male suture guide 940 is mounted on the first extension arm of the guiding tool 980. At one end of the 982, the female stitch guide 960 is mounted at one end of the second extension arm 984 of the guiding tool 980.

Referring to Figure 7, detail A, lead 920 includes a tapered tip 922 having a vertex 926. In addition, lead 920 includes an eyelet 924 that protrudes from tip 922 opposite side 928 of vertex 926. The aperture of the aperture 924 is smaller than the diameter of the side 928. In use, the suture 1216 is secured to the lead 920 using the eyelet 924, as discussed further below.

The male suture guide 940 includes a base 946 and a cylindrical shank 942 that is received and supported by a second end 990 of the guiding tool extension arm 982. The cylindrical shank 942 is axially coupled to the base 946. End extension. The shank 942 is configured to releasably attract the lead eye 924. In particular, the shank 942 includes an axially extending opening 948 that has a suitable size for receiving the aperture 924 when the aperture 924 is pushed. The shank 942 also includes a transverse opening 950 that extends across the shank 942 transversely to the shaft The diameter of the opening 948 is made and intersects the axial opening 948. Thus, when the eyelet 924 of the lead 920 is received between the axial openings 948 and has a suture 1216 attached to the lead 920, the suture 1216 is free to pass along the lateral opening 950 without being obstructed. The position of the suture 1216 hangs outwardly from the lateral opening 950.

Referring to Figure 7, detail B, the female suture guide 960 includes a base 968 and a hollow cylindrical housing 962. The base 968 is received and supported by the second end 990 of the guiding tool extension arm 984. Body 962 extends from the axial end of pedestal 968. The housing 962 is configured to receive a tip 922 from the male suture guide 940 and releasably secure the tapered tip therein. In particular, the housing 962 includes a first housing opening 966 such that the tapered tip of the lead 920 passes through the inner hollow portion of the inserted housing 962 and a second housing opening 964 The lead 920 is passed through a portion that is drawn from the housing 962. The first housing opening 966 is located at an axial end of the housing and is substantially cylindrical and has a smaller diameter than the leading side 928 of the lead. The second housing opening 964 is located on a side of the housing 962 having a size and shape that substantially conforms to the tip end 922 of the lead 920. In the illustrated embodiment, the second housing opening 964 includes a triangular portion through which the lead 920 including the tapered tip can pass and be removed from the housing 962.

In use, the leads are supported on the first elongate arm 982 of the guiding tool 980, particularly the axial opening 948 of the shank 942 of the male suture leader 940. The male suture guide 940 is configured to support the lead 920 and to transport the lead 920 to the female suture guide 960 when moving the first extension arm 982 and the second extension arm 984 to the closed position of the guiding tool. In the closed position, the male suture guide 940 contacts or nearly touches each other with the female suture guide 960. Thus, the lead 920 disposed on the side of the male stitch guide 940 facing the female stitch guide 960 is advanced into the female stitch guide 960. In particular, when the guiding tool 980 is moved to the closed position, the tip 922 is inserted into the first housing opening 966 and inserted first by the apex 926 therein. While the diameter of the first housing opening 966 is less than the outer diameter of the tip side edge 928, the housing 962 is relatively weak in construction such that the tip end 922 of the lead 920 can pass through the first housing opening 966. Since the first housing opening 966 is different in size from the tip side 928, the lead 920 can be prevented from being withdrawn from the housing 962 through the first opening 966. A lead 920 located between the housing 962 of the female stitch guide 960 is now secured to the second end 990 of the second extension arm 984 of the guiding tool 980. When the guiding tool 980 is opened, the lead 920 follows the second extended arm. 984 moves. Thus, by using the guiding tool 980, the suture 1216 can be affixed to the first elongate arm 982 through the additional lead 920 to the male suture guide 940, and then the suture 1216 can be made by simply operating the guiding tool 980. The female suture guide 960 is delivered to the second extension arm 984. Since the guiding tool extension arms 982, 984 are conformable to be disposed between the pedicle screw tops 302, and each vertebral screw top 302 includes axially extending openings 310, 312, after implantation of the pedicle screw 300 within the spinal column, the suture can be Subcutaneous and submuscular is delivered between adjacent vertebral screws 300. This feature is very important in the method of using the spinal fixation assembly 20, as discussed further below.

Referring to Figures 8A through 8E, an alternative embodiment of the male suture guide 1340 is illustrated. For example, in FIG. 8A, the male suture guide 1340a can be formed integrally with the suture lead, including a base 1346a for being supported on the second end of the guiding tool extension arm 982. The seat 1346a includes an opening 1342a to which the suture can be secured. Male stitch The guide 1340a also includes a tapered tip 1322a for urging the suture guide 1340a into the opening of the corresponding female suture guide 960. Figures 8B through 8E illustrate other alternative embodiments of the male suture guide 1340, wherein like numerals represent like structures. In these alternative embodiments, it can be seen that the base 1346 can be formed to have a larger outer diameter (Fig. 8B) or a non-cylindrical shape (8B, 8D, 8E) as compared to the tip end 1322. ). Further, the tip end 1322 is not limited to a conical shape (8B, 8C, 8D map).

Referring to Figures 9A through 9D, an alternative embodiment of the female suture guide 1360 is illustrated. For example, in FIG. 9A, the female suture guide 1360a includes a base 1362a for supporting the second end of the guiding tool extension arm 984. In the present embodiment, the base 1362a also serves as a housing portion, including a first housing opening 1366a and a second housing opening 1364a. The lead tip 922 (1322) is inserted through the first housing opening 1366a. In the hollow interior of the seat 1362a, the lead 920 is drawn from the base 1362a through the second housing opening 1364a. Figures 9B through 9D illustrate other alternative embodiments of the female suture guide 1360, wherein like numerals represent like structures. In these alternative embodiments, it can be seen that the first housing opening 1366 and the second housing opening 1364 can be formed into different shapes (9B, 9C, 9D views), for example, corresponding to the male stitch line. The guiding structure and/or the lead is inserted into the female suture guide 1360 and/or extracted from the female suture guide 1360.

Referring to Figures 10 through 11, a minimally invasive multifunctional positioning guide chisel 1400 is used to prepare each vertebrae implanted, as described below. The minimally invasive multi-function positioning guide chisel 1400 includes an elongated shaft 1402 that terminates at one end of a grip 1420 and ends at a cutting tip 1408. The cutting tip 1408 has a drill portion 1416 and a tapping portion 1414, a drill bit The portion 1416 is located at the front end of the cutting portion, and the tapping portion 1414 is disposed between the drill portion 1416 and the shaft 1402. In addition, an axially extending passage aperture 1418 extends from the grip 1420 to the cutting tip 1408 and has a size that can accommodate the K-wire 1200.

Referring to Figures 12 through 39, an embodiment of using the spinal fixation assembly 20 for a minimally invasive procedure to achieve stabilization of the spine is described.

In the first step, a vertebral screw 300 is implanted into a portion of the vertebra 4 of each spine 2 for stabilizing the vertebra 4 (Figs. 12-20). Implantation of the vertebral screw 300 includes the following steps:

Step 1a: Provide a slit through which the skin 10 covering the vertebra 4 is placed. In general, the length of the incision corresponds to the outer diameter of the vertebral screw 300 and may be slightly smaller than the outer diameter of the vertebral screw 300 due to the flexibility of the skin. In the illustrated embodiment, the pedicle screw 300 is about 1 cm in diameter, so an incision of about 1 cm is necessary to accommodate the pedicle screw 300.

Step 1b: Referring to Figure 12, the vertebra 4 is prepared to receive the pedicle screw 300 by forming a threaded bore in the vertebral root 6. The minimally invasive multi-function positioning guide chisel 1400 (described in detail in the U.S. Patent Application Serial No. 13/161,698, incorporated herein by reference) is inserted into the incision and is used to locate the vertebral root 6 and form a thread. The tunnel is in it. Use an imaging device, such as a C-arm or a fluoroscope, to confirm the correct position.

Step 1c: Referring to Figure 13, a Kirschner wire 1200 is inserted to pass the Kirschner wire 1200 through the axial passage perforation 1418 of the minimally invasive multifunctional positioning guide chisel and into the desired implantation site in the vertebra 4.

Step 1d: Referring to Figure 14, the minimally invasive multi-function positioning guide chisel 1400 is removed from the incision leaving the K-wire 1200 in place.

Step 1e: Referring to Figures 15 through 16, a series of dilation sleeves 1202, 1204 are inserted into the incisions on the Kirschner wire 1200, the dilatation sleeves starting from a relatively small diameter sleeve 1202, and each successive sleeve The tube has a slightly larger outer diameter. Even though only two cannulas 1202, 1204 are shown here, six to eight cannulas can be used to dilate the skin 10, muscles, and other soft tissue around the K-wire 1200, creating space for insertion of the pedicle screw 300 to the body. Inside (figure 15). The K-wire 1200 is used to stabilize and align each expansion sleeve 1202, 1204 as it expands. After the expansion is completed, the expansion sleeves 1202, 1204 are removed leaving the K-wire 1200 in place (Fig. 16).

Step 1f: Referring to Figures 17 to 18, the pedicle screw 300 is implanted along the K-wire 1200 into the pre-tapping threaded bore of the vertebra. Specifically, the pedicle screw 300 is loaded onto the Kirschner wire 1200 such that the Kirschner wire 1200 is received in the axial passage perforation 350 of the handle and the interior space of the top 302 of the pedicle screw. The Kirschner wire 1200 is used to stabilize and align the shank 344 of the pedicle screw such that the threads 348 on the handle 344 engage and screw onto the threaded bore. In the illustrated embodiment, a drive tool is used to rotate the pedicle screw 300 and tighten the pedicle screw into the bore of the vertebra 4. As shown, when the handle 344 is fully screwed to the vertebra 4, a portion of the top 302 of the vertebral screw protrudes outside of the incision than the skin 10.

Step 1g: Referring to Figure 19, the drive tool is removed from the incision with the Kirschner wire 1200, leaving the pedicle screw 300 in place.

Step 1h: Repeat the aforementioned implantation of vertebral screws with reference to Fig. 20. Steps 1a to 1g of 300 are used to stabilize each vertebra 4. In the illustrated embodiment, each of the four vertebrae 4 is implanted by vertebral screws (300a, 300b, 300c, 300d), and the four vertebrae 4 are stabilized.

Referring to Fig. 21, the second step includes aligning the tops 302 of the individual vertebral screws with an alignment tool 1214 such that the longitudinal axes of the pedicle screws 300 are parallel to each other and the vertebral screws 300 are vertically aligned with each other. In Fig. 21, a reference coordinate is defined such that the x-axis substantially corresponds to the longitudinal axis of the spine 2 and is in the horizontal direction, the y-axis is transverse and perpendicular to the x-axis, and corresponds to the front and rear directions of the spine 2. In the second step, the individual vertebral screw tips 302 are aligned with each other such that the first and second vertebral screw openings 310, 312 are opened along the x-axis such that the lateral opening 318 of the individual vertebral screws is aligned with the x-axis.

The third step includes joining the pedicle screws 300 by subcutaneously passing through a suture 1216 through the individual pedicle screw tops 302. Connecting the pedicle screw 300 includes the following steps:

Step 3a: Referring to Figures 22 to 23, the suture 1216 is inserted into the topmost portion of the vertebral screw 300a using the suture guiding tool 980 such that the front end of the suture passes from the second end 308 of the top to the first end 306, through the pedicle screw The interior space of the top 302 (for example, along the y-axis).

Step 3b: Referring to Figures 24 through 25, the guiding tool 980 is activated to guide the suture 1216 from the first end 306 of the top of the vertebral screw 300a, along the x-axis to the adjacent vertebral screw 300b, and to make it substantially parallel to The longitudinal axis of the spine 2. In particular, by the lead 920 from the male suture guide 940 to the female suture guide 960 (Fig. 24), the guiding tool 980 is activated from the open position to the closed position, with the suture 1216 adjacent the pedicle screws 300a, 300b. Transferred between. The suture 1216 is then guided to the open position by the activation suture It is moved to the adjacent pedicle screw 300b.

Step 3c: Referring to Figure 26, the suture guiding tool 980 is withdrawn from the top of the vertebral screws 300a, 300b, and the suture 1216 is now attached to the topmost of the vertebral screws 300a and the adjacent vertebral screws 300b. At this time, the lead wire 920 is conveyed back to the male suture guide 940, and steps 3a to 3b are prepared to be performed again in the vertebral screws 300b and 300c.

Step 3d: Referring to Figure 27, steps 3a through 3c are repeated until each vertebral screw 300a, 300b, 300c, 300d is subcutaneously subcutaneously connected to the muscle by suture 1216. Although the joining step reveals from the top of 300a to the top of 300d, it is not limited thereto. For example, the method can include performing from the extreme tail to the top of the vertebral screw 300.

The fourth step includes passing the suture front end 1216a through the small passage slit (1 cm or less) and withdrawing the suture front end 1216a itself. The small channel incision is located at the end of the apical screw 300d. Pulling out the suture includes the following steps:

Step 4a: Referring to Figures 28 through 29, a compass tool 1218 is provided for withdrawing the suture 1216 itself. The compass tool 1218 includes a footing 1220 and a curved swivel leg 1222 that is configured to hold a suture lead 920 that is configured to receive the suture lead 920 and one end of the footing 1220 For the axis of rotation, the suture lead 920 is rotated relative to the footing 1220. As shown in FIG. 28, the footing 1220 holds a suture lead 920 adjacent the pedicle screw 300. In a subsequent step, the footing 1220 is inserted into the extreme end of the pedicle screw 300d, and the rotating foot 1222 is rotated relative to the footing 1220 (clockwise in the figure) such that the rotating foot 1222 passes through the channel incision. Thus, the suture lead 920 is from the base 1220 One end moves to one end of the swivel foot 1222 in a manner similar to the use of the suture leader assembly 900. The swivel foot 1222 is then rotated relative to the footing 1220 (counterclockwise in the figure) for withdrawing the suture 1216 from the channel incision (Fig. 29).

Referring to Figures 30 and 31, the fifth step includes providing a fixed rod 200. In particular, the fixation rod 200 has at least a length that spans all of the implanted pedicle screws 300a to 300d at the same time. In some embodiments, the individual protruding pedicle screw second end 308 can serve as a template for cutting a predetermined reserve length (Fig. 30). Further, the fixed rod 200 may have a curvature corresponding to the spine 2 (shown by a broken line). In particular, the bending of the fixation rod 200 can be flexed by the line defined by the upper surface of the second end of the vertebral screw 300 to be adjusted externally prior to implantation into the body.

Referring to Fig. 32, the sixth step includes passing the suture 1216 through the hollow inner passage of the fixation rod 200 such that the size and shape of the fixation rod 200 passes under the skin and under the muscle and wraps around the suture 1216.

The seventh step includes transporting the fixation rod 200 along the suture 1216 into the body and through each individual vertebral screw top 302 such that the fixation rod 200 is seated in the transverse channel 316 adjacent to each individual The first end 306 of the apical screw top 302.

The eighth step includes removing the suture 1216 body itself, leaving the fixation rod 200 between a series of pedicle screws 300.

The ninth step includes securing the fixation rod 200 to each of the vertebral screws 300. The following steps are used to secure the fixation rod 200 to a vertebral screw 300:

Step 9a: Referring to Figure 33, the fixation rod 200 is secured to the pedicle screw by the cap 600 to the apical screw top second end 308 300, followed by insertion of the stabilization tool 700, the stabilization tool 700 is passed through the cap 600 and to the pedicle screw top 302. After assembly is complete, the stabilizing tool foot 712 is securely seated on the fixed rod 200 between the first and second openings 310, 312 of the top 302 of the vertebral screw, and in a subsequent step ( The position of the fixed rod 200 is maintained in 9b).

Step 9b: Referring to Figure 34, the fastener 500 is used to drive the fastener 500 into the top 302 of the vertebral screw for securing the fixation rod 200 to the vertebral screw 300 such that the external thread 508 of the fastener 500 engages the corresponding thread 326. The thread 326 is located on the inner surface of the top 302 of the vertebral screw. Thus, the fixation rod 200 is maintained between the fastener 500 and the first end 306 of the pedicle screw 300.

Step 9c: Referring to Figures 35 and 36, steps 9a to 9b are repeated until the fixation rod 200 is secured to each of the vertebral screws 300a to 300d.

The 10th step includes removing the dorsal portion 324 of the top of the pedicle screw from the holder of the top 302 of each vertebral screw. The removal step includes the following steps:

Step 10a: Referring to Figures 37 to 38, a torque is applied to the dorsal portion 324 using the screw breaking tool 800 such that the dorsal portion 324 separates from the first end of the vertebral screw along an annular separation region 318 and is extracted by itself. Separate back side portion 324.

The 11th step involves suturing all minimally invasive incisions.

In conclusion, the present invention has been disclosed in the above preferred embodiments, and is not intended to limit the present invention. Those having ordinary skill in the art to which the present invention pertains can be made in various ways without departing from the spirit and scope of the invention. Change and retouch. Therefore, the scope of the invention is defined by the scope of the appended claims.

2‧‧‧Spine

4‧‧‧ vertebrae

6‧‧‧ vertebral root

8‧‧‧Intervertebral disc

10‧‧‧ skin

20‧‧‧ Spinal fixation components

200‧‧‧Fixed rod

210‧‧‧Internal passage

212, 306, 502, 602, 702, 802, 856, 988‧‧‧ first end

214, 308, 604, 704, 804, 858, 990, 990'‧‧‧ second end

300‧‧‧ pedicle screw

302‧‧‧ top

304‧‧‧Threaded end

310, 312, 612, 614, 708, 710, 948, 950, 964, 966, 1342a, 1364, 1364a, 1366, 1366a‧‧

316, 616‧‧‧ crossing passage

318‧‧‧Separation area

320, 332, 718, 814, 818, 1422‧‧‧ trenches

322‧‧‧ ventral side

324‧‧‧ Back side

326, 348, 508, 1426, 1430‧‧ thread

342‧‧‧Base

344, 854‧‧ ‧ handle

346‧‧‧Top

350, 1418‧‧‧ channel perforation

500‧‧‧fasteners

506‧‧‧ outer surface

510‧‧‧Tube

600, 1428‧‧‧ caps

606, 706, 806‧‧‧ side walls

610‧‧‧Round bulge

618, 812‧‧‧ central opening

622‧‧‧Central Part

624‧‧‧Slim part

700‧‧‧Steady tools

712‧‧‧Sturdy tool feet

714‧‧‧base part

716‧‧‧ grip part

800‧‧‧screw breaking tool

810‧‧‧ grip area

820, 1202, 1204‧‧‧ casing

850‧‧‧Actuator

852, 1420‧‧ ‧ grip

890‧‧‧ flared section

892‧‧‧ stereotypes

900‧‧‧Sewing guide assembly

920‧‧‧ lead

922, 1322, 1322a‧‧‧ cutting-edge

924‧‧ ‧ eyelet

Vertex 926‧‧‧

928‧‧‧ side

940, 960, 1340, 1340a, 1340b, 1340c, 1340d, 1360a, 1360b, 1360c, 1360d‧‧‧ suture guidance

942‧‧‧handle

946, 968, 1346, 1346a, 1362a‧‧ pedestal

962‧‧‧Shell

980‧‧‧Guide Tools

982, 982’, 984, 984’ ‧ ‧ long arms

992, 992’ ‧ ‧ ring

986‧‧‧ pivot pin

1200‧‧‧Kerns needle

1216‧‧‧ stitching

1216a‧‧‧ front end

1218‧‧‧ compass tool

1220‧‧‧ footing

1222‧‧‧Rotating feet

1400‧‧‧ minimally invasive multi-function positioning guide chisel

1402‧‧‧ shaft

1408‧‧‧ cutting tip

1414‧‧‧Tapping section

1416‧‧‧Drill part

Figures 1A-1D illustrate the steps of repairing the herniated disc.

Figure 2 is a perspective view of a minimally invasive spinal fixation assembly implanted in a series of four adjacent vertebrae.

Figure 3 is a side elevational view of the fixation rod used in the spinal fixation assembly of Figure 2.

Figure 4 is a perspective view of the vertebral screw assembly including the pedicle screw, cap and stabilizing tool used in the spinal fixation assembly of Figure 2.

Figure 4A is a cross-sectional view of the vertebral screw assembly along section line 4a-4a in Figure 4.

Figure 5 is a perspective view of the fastener used in the spinal fixation assembly of Figure 2.

Figure 6A is an exploded view of the fracture tool used in implanting the spinal fixation assembly of Figure 2.

Fig. 6B is an enlarged view showing a portion of the fracture tool designated as 6B in Fig. 6A.

Figure 6C is a schematic view showing the use of a fracture tool to separate the top of the pedicle screw into two parts.

Figure 7 shows a perspective view of the guiding tool assembly.

8A-8E illustrate an alternate embodiment of the male suture guide of the guide tool assembly of FIG.

Figure 9A-9D shows the mother stitch guide of the guiding tool assembly in Fig. 7. An alternative embodiment.

Figure 10 is a side elevational view of the minimally invasive multi-function positioning guide chisel used in the spinal fixation system of Figure 2.

Figure 11 is a detailed enlarged view of the tip of the minimally invasive multifunctional positioning guide chisel in Figure 10.

Figures 12-14 illustrate schematic views of the use of a minimally invasive multifunctional positioning guide chisel to form a vertebral screw hole and implant a gram needle into the vertebra.

Figure 15 depicts the expansion of soft tissue near the gram needle.

Figure 16 shows the gram needle in place after expansion is complete and the expansion cannula is removed.

Figure 17 depicts the insertion of a vertebral screw along the gram needle.

Figures 18-19 illustrate the implantation of vertebral screws in the vertebrae.

Figure 20 depicts a repeating pedicle screw implantation procedure in which a pedicle screw is implanted into a plurality of adjacent vertebrae.

Figure 21 illustrates the alignment of the apical screw top with an alignment tool.

Figures 22-29 illustrate the use of a guide tool assembly to pass a suture through the subcutaneous and subcutaneous muscles to the individual first end of the implanted pedicle screw.

Figures 30-31 illustrate the portion of the vertebral screw exposed to the template for pre-positioning the vertebral screw fixation rod prior to implantation.

Figure 32 illustrates the placement of the fixation rod along the suture through the top of the individually implanted vertebral screw.

Figure 33 shows the assembly of a cap and stabilizer on top of the vertebral screw.

Figure 34 illustrates the attachment of a fastener to the fastener through the cap and stabilizer to secure the pedicle screw.

Figure 35 depicts the steps of repeating Figure 34 on each vertebral screw.

Figures 36-37 illustrate the use of a fracture tool to break the dorsal portion of the top of each vertebral screw.

Figure 38 depicts the implanted spinal fixation assembly.

Figure 39 illustrates a perspective view of another embodiment of a guide tool assembly.

2‧‧‧Spine

4‧‧‧ vertebrae

20‧‧‧ Spinal fixation components

200‧‧‧Fixed rod

300‧‧‧ pedicle screw

Claims (26)

A minimally invasive invasive spinal fixation assembly for providing a series of relative fixation of a spinal column, the minimally invasive spinal fixation assembly comprising: a fixation rod; a plurality of vertebral screws, each vertebral screw comprising: a top configured to receive the fixation a portion of the rod, the top portion including a first end and an open second end, the second end being disposed relative to the first end, and a threaded end extending from the first end of the top and configured for use To engage one of the vertebrae; a fastener comprising a plurality of external threads, the external threads being configured to engage a plurality of corresponding threads formed on an inner surface of the top; a cap configured to Engaging the second end of the top of the vertebral screw, the cap comprising: a hollow cylindrical body having a first end, a second end, and a side wall, the hollow cylindrical body The first end of the hollow cylindrical body is opposite to the first end of the hollow cylindrical body, the first end of the hollow cylindrical body is for receiving the second end of the top portion, the second end of the hollow cylindrical body a central opening extending between the first end and the second end of the hollow cylindrical body, the side wall including an inner surface having an annular ridge, the top portion including a retention groove a groove, the retention groove being adjacent to the second end of the top portion, configured to engage the annular ridge, whereby the cap is detachably fixed to the second end of the top portion, The side wall has a first cap opening extending axially and a second cap opening extending from the first end of the hollow cylindrical body to the second end, and the hollow cylinder The second end of the shaped body is separated, the second cap opening is located on the opposite side of the side wall with respect to the first cap opening, and the first cap opening is completely aligned with the second cap opening; wherein The fixing rod is fixed to the top portion through the fastener, and the top portion includes a separation region, the separation portion dividing the top portion into a ventral side portion and a back side portion, the ventral side portion at the first end and the Extending between the separation regions, the back side portion extending between the separation region and the second end, and the separation region includes a portion of the top portion, the portion of the top portion being structurally more than the remainder of the top portion Weak, to define a position, the back side portion can be easily separated from the ventral side portion when sufficient force is supplied to the back side portion. The minimally invasive invasive spinal fixation assembly of claim 1, wherein the fixation rod is configured to receive a suture. The minimally invasive invasive spinal fixation assembly of claim 1, wherein the fixation rod is a hollow tube. The minimally invasive invasive spinal fixation assembly of claim 1, wherein the top portion is substantially tubular and is comprised of a single piece having a first opening along an axis of the top The direction extends from the second end to a position that is adjacent and spatially separated from the first end, and a second opening that is located on an opposite side of the top with respect to the first opening, the second opening Extending from the second end along one of the axial directions of the top To a position, the position is adjacent and spatially separated from the first end, the first and second openings being completely aligned to form a transverse passageway through which the passageway passes. The minimally invasive invasive spinal fixation assembly of claim 4, further comprising a U-shaped vertebral screw stabilizer, the stabilizer comprising a grip portion; an annular base portion from one of the grip portions Side extending, the annular base portion has a diameter substantially equal to the diameter of the top portion; and a securing tool foot extending from a side of the annular base portion, the stabilizing tool foot configured to conform to the first portion of the top portion The second opening is shaped and can be received therein. The minimally invasive spinal fixation assembly of claim 5, further comprising a cap configured to close the second end of the vertebral screw top, the cap comprising a cap opening, the vertebral root The stabilizing tool foot of the screw stabilizer can be accepted through the opening. A minimally invasive invasive spinal fixation assembly according to claim 6 wherein a portion of the edge corresponding to the opening of the cap has a shape that conforms to a cross-sectional shape of the securing tool foot. The minimally invasive invasive spinal fixation assembly of claim 4, further comprising a vertebral screw breaking device received in an inner space of the top of the vertebral screw to urge the second end of the top along One of the top annular separation lines is separated from the first end of the top, the predetermined annular separation line being located between the first end and the second end of the top. The minimally invasive spinal fixation assembly of claim 4, further comprising a suture guiding assembly, the suture guiding assembly comprising a lead for maintaining a suture; and a guiding tool, including a first extension arm and a second extension arm pivoted, the first extension arm terminating at a first end of a male suture guide, the second extension arm terminating at one of the female suture guides One end, wherein the male suture guide and the female suture guiding system are configured to enable the lead to move from the first and the second elongated arm in an open position and a closed position The wire guide is conveyed to the mother stitch guide, the open position being the male stitch guide being separated from the female stitch guide, the closed position being the male stitch guide and the female stitch The line guides are adjacent. The minimally invasive invasive spinal fixation assembly of claim 9, wherein the lead comprises: a tip that facilitates insertion of the lead into the female suture guide; and an opening formed adjacent the tip. The minimally invasive spinal fixation assembly of claim 9, wherein the first and second extension arms are received in the hollow interior of the vertebral screw and pass through the first and the first Two openings. A vertebral screw for spinal fixation, comprising: a top portion including a first end and an open second end, the second end being opposite the first end; a threaded end extending from the first end And a removable cap for closing the second end of the top, wherein the top portion includes a retention groove adjacent to the second end for engaging a corresponding annular edge, the ring The edge is located on an inner surface of the cap, and the cap is wrapped Included: a hollow cylindrical body having a first end, a second end, and a side wall, the second end of the hollow cylindrical body being opposite the first end of the hollow cylindrical body, The first end of the hollow cylindrical body receives the second end of the top portion, the second end of the hollow cylindrical body includes a central opening, the side wall is the first of the hollow cylindrical body Extending between the end and the second end, having a first cap opening extending axially and a second cap opening extending from the first end of the hollow cylindrical body to the first a second end, and is separated from the second end of the hollow cylindrical body, the second cap opening is located on the opposite side of the side wall with respect to the first cap opening, and the first cap opening and the second cap The cap opening is fully aligned; wherein the top is tubular and consists of a single piece having a first opening extending from the second end to a position along an axial direction of the top, Position adjacent and separated from the first end, and a second opening a second opening extending from the second end to a position along an axial direction of the top, the position being adjacent to and spatially separated from the first opening, with respect to the first opening being located on an opposite side of the top The first and second openings are completely aligned to form a transverse passageway through which the passageway passes. The vertebral screw of claim 12, wherein the distance between the first end and the second end of the top is in the range of 40 mm to 120 mm. The vertebral screw according to claim 12, wherein the The distance between the first end and the second end of the top is in the range of 50 mm to 80 mm. The vertebral screw of claim 12, wherein the top portion includes a separation region between the first end and the second end, the separation region including a portion of the top portion, the portion of the top portion being compared The remainder of the top portion is structurally weak to define a position at which at least a portion of the second end can be easily separated from the top when a sufficient force is supplied to the second end. The vertebral screw of claim 15, wherein the separation region comprises a V-shaped groove between the first end and a midpoint, the midpoint being between the first end and the second end The V-shaped groove is for providing a predetermined separation line, and when a sufficient force is applied to the second end, at least a portion of the second end can be easily separated from the top along the predetermined separation line. A pedicle screw according to claim 15, wherein the force is a torsion force centered on one of the longitudinal axes of the top. The vertebral screw of claim 12, wherein the first end of the top portion is configured to enable the threaded end to be multi-axially rotatable relative to the top portion. A suture guiding assembly comprising: a lead for maintaining a suture, the lead comprising a tapered tip and an eyelet protruding from the tapered tip, the eyelet securing the stitch to the lead And a guiding tool comprising a first extension arm and a second extension arm pivoted, the first extension arm terminating at a first end of a male suture guide, the first The second extension arm terminates at a first end of a female suture guide, wherein the male suture guide and the female suture guide are used to cause the lead to be in the first and second extension arms When the open position and a closed position are moved, the male suture guide can be guided to the female suture guide, and the open position is that the male suture guide is separated from the female suture guide. The closed position is such that the male suture guide is adjacent to the female suture guide. The suture guide assembly of claim 19, wherein the male suture guide includes a cylindrical shank for detachably engaging the eyelet of the lead, the female suture guide comprising a cylindrical housing for detachably engaging the tapered tip of the lead, the guiding tool for supporting the male suture guide and the female suture guiding when the guiding tool is in the closed position The tapered tip can be at least partially received between the housings. The suture guiding assembly of claim 20, wherein the housing comprises a first housing opening and a second housing opening, the lead is inserted into the housing through the first housing opening The lead is drawn from the housing through the second housing opening. The suture guiding assembly of claim 21, wherein the shape of the second housing opening substantially conforms to the shape of the lead. The suture guide assembly of claim 21, wherein the first housing opening is smaller than the widest portion of the lead. The suture guide assembly of claim 23, wherein the tapered tip of the lead is driven through the first housing opening when the guiding tool is moved from the open position to the closed position, At the same time, it can be prevented from being withdrawn from the first housing opening. a suture guiding assembly according to claim 19, wherein The first and the second elongated arm are at an angle. The suture guiding assembly of claim 25, wherein the angle is between 90 degrees and 180 degrees.