referring to fig1 , a measuring device and distractor 10 is shown in fig1 inserted within the space between adjacent vertebrae v 1 , v 2 after a pain - generating or diseased intervertebral disc is removed . although the measuring device and distractor 10 is described herein as an intervertebral measuring device for selecting an optimal size arthroplasty for a patient undergoing a tdr or spinal fusion procedure , it is understood that the device 10 is not limited to use with this type of procedure and may be used in connection with a variety of other medical procedures , including , but not limited to , hip , knee and shoulder arthroplasty procedures . the measuring device and distractor 10 preferably includes a housing 12 . the housing 12 is preferably hollow and has a proximal end 12 a and a distal end 12 b . the housing 12 is preferably made from titanium , stainless steel or any other biologically suitable material that is safe for use within the body of a patient . two elongated rods — a posterior rod 20 and an anterior rod 30 - are mounted within the housing 12 so that each rod may be rotated relative to and slide longitudinally within the housing . each rod 20 , 30 may , for example , be supported by one or more bearings or sleeves ( not shown ) mounted on the housing 12 . one end of each rod 20 , 30 preferably extends outwardly from the proximal end 12 a of the housing 12 and terminates in a handle or knob 22 , 32 , which the surgeon may use to turn the rod or slide the rod longitudinally . the rods 20 , 30 are preferably made from titanium , stainless steel or any other biologically suitable material that is safe for use within the body of a patient . the opposing or distal end of the posterior rod 20 is coupled to and engages a pair of opposing posterior distracting members or pulls 28 a , 28 b . the posterior distracting members 28 a , 28 b project outwardly from the housing 12 , preferably in a direction that is generally perpendicular to the longitudinal axis of the rod 20 . the first posterior distracting member 28 a preferably extends upwardly through the top 12 c of the housing 12 in a direction toward the superior vertebrae v 1 as illustrated in fig1 . the second posterior distracting member 28 b preferably extends downwardly through the bottom 12 d of the housing 12 in a direction toward the inferior vertebrae v 2 as illustrated in fig1 . the top 12 c and bottom 12 d of the housing 12 are at least partially relieved to permit the distracting members 28 a , 28 b to extend outwardly therethrough and slide longitudinally with the posterior rod 20 as the rod is moved longitudinally relative to the housing 12 . the distracting members 28 a , 28 b are coupled to the distal end of the posterior rod 20 in a conventional manner that permits rod 20 to rotate relative to the distracting members 28 a , 28 b , while also permitting the distracting members 28 a , 28 b to move longitudinally with the posterior rod 20 as the rod is moved longitudinally relative to the housing 12 . the posterior rod 20 preferably includes a plurality of teeth about its circumference to form a gear ( e . g ., a circular pinion ) at least in proximity to the location where the rod engages the distracting members 28 a , 28 b . the distracting members 28 a , 28 b also include a plurality of teeth on at least one surface to form a gear ( e . g ., a rack ) for meshing engagement with the teeth ( circular pinion ) on the posterior rod 20 to convert rotational movement of the rod 20 into linear movement of the distracting members 28 a , 28 b toward or away from the adjacent vertebrae . in other words , rotation of the posterior rod 20 in one direction will cause the first posterior distracting member 28 a to extend or move upwardly through the top 12 c of the housing 12 and simultaneously cause the second posterior distracting member 28 b to extend or move downwardly through the bottom 12 d of the housing . in contrast , rotation of the posterior rod 20 in the opposite direction will cause the first posterior distracting member 28 a to retract or move downwardly into the top 12 c of the housing 12 and simultaneously cause the second posterior distracting member 28 b to retract or move upwardly into the bottom 12 d of the housing . similarly , the opposing or distal end of the anterior rod 30 is coupled to and engages a pair of opposing anterior distracting members or pulls 38 a , 38 b . like the posterior distracting members 28 a , 28 b , the anterior distracting members 38 a , 38 b also project outwardly from the housing 12 , preferably in a direction that is generally perpendicular to the longitudinal axis of the rod 30 . like the first posterior distracting member 28 a , the first anterior distracting member 38 a preferably extends upwardly through the top 12 c of the housing 12 in a direction toward the superior vertebrae v 1 as illustrated in fig1 . like the second posterior distracting member 28 b , the second anterior distracting member 38 b preferably extends downwardly through the bottom 12 d of the housing 12 in a direction toward the inferior vertebrae v 2 as illustrated in fig1 . the top 12 c and bottom 12 d of the housing 12 are at least partially relieved to permit the distracting members 38 a , 38 b to extend outwardly therethrough and slide longitudinally with the anterior rod 30 as the rod is moved longitudinally relative to the housing 12 . the anterior distracting members 38 a , 38 b are coupled to the distal end of the anterior rod 30 in a conventional manner that permits rod 30 to rotate relative to the distracting members 38 a , 38 b , while also permitting the distracting members 38 a , 38 b to move longitudinally with the anterior rod 30 as the rod is moved longitudinally relative to the housing 12 . like the posterior rod 20 , the anterior rod 30 preferably includes a plurality of teeth about its circumference to form a gear ( e . g ., a circular pinion ) at least in proximity to the location where the rod engages the anterior distracting members 38 a , 38 b . the distracting members 38 a , 38 b also include a plurality of teeth on at least one surface to form a gear ( e . g ., a rack ) for meshing engagement with the teeth ( circular pinion ) on the anterior rod 30 to convert rotational movement of the rod 30 into linear movement of the distracting members 38 a , 38 b toward or away from the adjacent vertebrae . in other words , rotation of the anterior rod 30 in one direction will cause the first anterior distracting member 38 a to extend or move upwardly through the top 12 c of the housing 12 and simultaneously cause the second anterior distracting member 38 b to extend or move downwardly through the bottom 12 d of the housing . in contrast , rotation of the anterior rod 30 in the opposite direction will cause the first anterior distracting member 38 a to retract or move downwardly into the top 12 c of the housing 12 and simultaneously cause the second anterior distracting member 38 b to retract or move upwardly into the bottom 12 d of the housing . a plurality of spaced apart graduations ( not shown ) are preferably provided near the proximal end of each rod 20 , 30 to provide a visual indication of and correspond to the distance that the distracting members 28 a , 28 b , 38 a , 38 b are displaced as the rod is rotated in use . in this manner , the device 10 may be used to measure the anterior and posterior disc heights before and after intervertebral distraction to aid the surgeon in selecting the correct sized arthroplasty or fusion device for the spine of the patient undergoing the procedure . like the rods 20 , 30 , the distracting members 28 a , 28 b , 38 a , 38 b are preferably made from titanium , stainless steel or any other biologically suitable material that is safe for use within the body of a patient . a ruler or linear scale 36 having a plurality of spaced apart graduations or markings is preferably mounted on or otherwise connected to the anterior rod 30 in proximity to the handle 32 . a position indicator 26 is preferably mounted on or otherwise connected to the posterior rod in proximity to the handle 22 . as the rods 20 , 30 are moved longitudinally relative to one another , the distance between the distal end of the posterior rod 20 and the distal end of the anterior rod 30 is indicated by particular graduation on the ruler 36 that is aligned with the position of the position indicator 26 . in this manner , the device 10 may be utilized to measure the depth of the vertebral endplate to select the correct sized arthroplasty or fusion device that will cover the maximum amount of the outer rim of the vertebral endplate . the end of the first posterior and anterior distracting members 28 a , 38 a that extends out of the top 12 c of the housing 12 engages a superior side load sensor plate 40 a , which is shown adjacent to the superior vertebrae v 1 in fig1 . the end of the distracting members may include a rounded head as is shown at the end of distracting member 28 a . the proximal end of the superior side load sensor plate 40 a is pivotally connected via a hinge or pin 46 a to the distal end of a first scissor member , lever or link 42 a , which terminates at its proximal end with a handle 48 a . similarly , the end of the second posterior and anterior distracting members 28 b , 38 b that extends out of the bottom 12 d of the housing 12 engages an inferior side load sensor plate 40 b , which is shown adjacent to the inferior vertebrae v 2 in fig1 . the end of the distracting members may include a rounded head as is shown at the end of distracting member 28 b . the proximal end of the inferior side load sensor plate 40 b is pivotally connected via a hinge or pin 46 b to the distal end of a second scissor member , lever or link 42 b , which terminates at its proximal end with a handle 48 b . the two scissor members 42 a , 42 b and pivot pins 44 , 46 a , 46 b may be made from aluminum , stainless steel , titanium or any other suitable material that is biologically safe for use in medical procedures . the two scissor members 42 a , 42 b intersect and are pivotally connected to one another via pin or hinge 44 to form a scissor - like configuration . when the handles 48 a , 48 b are squeezed or otherwise moved toward one another by the surgeon , the scissor members 42 a , 42 b pivot about pin 44 causing the distal ends of the scissor members ( and the pivotally connected load sensor plates 40 a , 40 b ) to spread or otherwise move away from each other . a semi - circular protractor 49 having a plurality of spaced apart graduations or markings is positioned on the housing 12 proximate to the pivot pin 44 to measure the angular orientation of the two scissor members 42 a , 42 b . this angular orientation corresponds to the angular orientation or intervertebral angle of affected vertebral endplates when the handles 48 a , 48 b are squeezed together to pivot the load sensor plates 40 a , 40 b against the endplates of the superior and inferior vertebrae v 1 , v 2 . in this manner , the device 10 may be used to determine the intervertebral angle , which will provide for the correct spinal segment alignment in the case of fusion devices or for the maximum range of motion in the case of tdr . a transducer 50 a , 50 b that converts force into a measurable electrical output , such as a conventional low - profile load sensor or load cell , is preferably mounted on each load sensor plate 40 a , 40 b to measure ligament tension when the surgeon is distracting ( spreading ) the affected intervertebral segment v 1 , v 2 using the device 10 . the transducer may be constructed from stainless steel or other biologically safe material . the transducer 50 a , 50 b may be bonded or otherwise attached to the load sensor plate 40 a , 40 b in a conventional manner . each transducer 50 a , 50 b is preferably coated or covered with a thin layer of sterile plastic or other biologically safe material to protect the sensor and maintain sterility . wiring 51 a , 51 b , such as conventional shielded cabling , provides an electrical connection between the transducer 50 a , 50 b and a display ( not shown ) that provides signal processing and a visual indication of the force ( preferably in newtons ) being applied by the device 10 during distraction of the affected vertebral segment v 1 , v 2 . the wiring 51 a , 51 b preferably extends from the sensor 50 a , 50 b through the housing 12 and out the proximal end 12 a of the housing , where the wiring may be connected to the display . in this manner , the device 10 may be used to measure ligament tension and aid the surgeon in determining whether the appropriate amount of tension is being applied during distraction ( spreading ) of the intervertebral segment . the measuring device and distractor 10 may be used by a surgeon as follows to selecting an optimal size arthroplasty for a patient undergoing a tdr or spinal fusion procedure . first , the patient may be positioned in a supine , neutral position on an operating table . using an anterior approach , the surgeon exposes and removes the degenerative or diseased intervertebral disc , leaving a hollow intervertebral disc space between the adjacent vertebrae v 1 , v 2 . referring to fig2 , in step 100 , the measuring device and distractor 10 is then inserted intraoperatively within the body of the patient until the distal end 12 b of the housing 12 is positioned within the intervertebral disc space at the affected vertebral segment . the distracting pulls 28 a , 28 b , 38 a , 38 b should be sufficiently retracted to avoid interference with the vertebral endplates . in step 110 , the vertebral endplate distance or depth is then measured by sliding the posterior rod 20 longitudinally until the distracting member 28 a is positioned at the posterior edge or margin of the vertebral endplate . the anterior rod 30 is then moved longitudinally until the distracting member 38 b is positioned at the anterior edge or margin of the vertebral endplate . the endplate depth corresponds to the particular graduation on the ruler 36 on the anterior rod 30 that is aligned with the position indicator 26 on the posterior bar 20 . knowing the vertebral endplate depth will allow the surgeon to select the optimal sized arthroplasty or fusion device that will cover the maximum amount of the outer rim of the vertebral endplate . the posterior and anterior rods 20 , 30 may optionally be locked in place within the housing 12 to restrict longitudinal movement of the bars , while permitting rotational movement . next , the surgeon will measure the pre - distraction anterior and posterior disc heights using the device 10 in step 120 . to measure the posterior disc height , the surgeon will grasp the handle 22 and turn the posterior rod 20 , causing the first and second posterior distracting members 28 a , 28 b to move outwardly until the respective load sensor plates 40 a , 40 b contact the posterior edge of the vertebral endplates . the posterior disc height corresponds to the particular graduation on the circumference of the posterior rod 20 indicating the amount of rotation of the rod . similarly , to measure the anterior disc height , the surgeon will grasp the handle 32 and turn the anterior rod 30 , causing the first and second anterior distracting members 38 a , 38 b to move outwardly until the respective load sensor plates 40 a , 40 b contact the anterior edge of the vertebral endplates . the anterior disc height corresponds to the particular graduation on the circumference of the anterior rod 20 indicating the amount of rotation of the rod . the surgeon may also measure the intervertebral angle in step 130 by squeezing the handles 48 a , 48 b on the proximal end of scissor members 42 a , 42 b . this causes the scissor members 42 a , 42 b to pivot about pivot pin 44 until the respective load sensor plates 40 a , 40 b contact the vertebral endplates . the angular orientation of the two scissor members 42 a , 42 b is then measured using the graduations on the protractor 49 , which corresponds to the angular orientation or intervertebral angle of affected vertebral endplates . in this manner , the device 10 may be used to determine the intervertebral angle , which will provide for the correct spinal segment alignment in the case of fusion devices or for the maximum range of motion in the case of tdr . after the pre - distraction measurements are taken , the surgeon may distract ( spread ) the intervertebral segment in step 150 by turning the posterior and anterior rods 20 , 30 , which causes the distracting members 28 a , 28 b , 38 a , 38 b to move outwardly . the transducers 50 a , 50 b located on the load sensor plates 40 a , 40 b measure the amount of force or tension being applied to the ligaments during distraction in step 140 , which the surgeon can monitor on a display electrically connected to the transducers via wires 51 a , 51 b . in step 150 , the surgeon stops distracting the intervertebral segment when the desired tension is indicated on the display . this will minimize or eliminate circumstances where insufficient or excessive tension is applied to the ligaments during distraction , resulting in improper sizing of the arthroplasty or fusion device for the particular patient . when the desired ligament tension is attained and distraction discontinued , the surgeon then uses the device 10 to measure the post - distraction posterior and anterior disc heights ( step 160 ) and intervertebral angle ( step 170 ) in the manner indicated above . the device 10 is then removed from the patient and , in step 180 , the surgeon may use the measured endplate depth or distance , the pre - and post - distraction posterior and anterior disc heights , and the pre - and post - distraction intervertebral angle to select the optimal sized arthroplasty or fusion device for the particular patient undergoing the tdr or spinal fusion procedure . having described and illustrated the principles of this application by reference to one or more preferred embodiments , it should be apparent that the preferred embodiment ( s ) may be modified in arrangement and detail without departing from the principles disclosed herein and that it is intended that the application be construed as including all such modifications and variations insofar as they come within the spirit and scope of the subject matter disclosed herein .
a method and device for determining an optimal size of an intervertebral implant to be inserted within an intervertebral space between two vertebrae in a patient , comprising inserting a distractor into the intervertebral space . the vertebral endplate depth is measured by moving a posterior rod on the distractor longitudinally to a position at the posterior margin of the vertebral endplate and moving an anterior rod on the distractor to a position at the anterior margin of the vertebral endplate . the force applied during distraction is measured using at least one transducer mounted on the distractor and the intervertebral space is distracted by rotating the posterior and anterior rods on the distractor until the measured force reaches a predetermined value . the posterior height of the intervertebral space is measured based on the amount that the posterior rod is rotated and the anterior height of the intervertebral space is measured based on the amount that the anterior rod is rotated . the intervertebral angle is measured based on the angular orientation of two pivotally connected handles on the distractor .