CA2339157C - Systems and methods for placing materials into bone - Google Patents
Systems and methods for placing materials into bone Download PDFInfo
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- CA2339157C CA2339157C CA002339157A CA2339157A CA2339157C CA 2339157 C CA2339157 C CA 2339157C CA 002339157 A CA002339157 A CA 002339157A CA 2339157 A CA2339157 A CA 2339157A CA 2339157 C CA2339157 C CA 2339157C
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- instrument
- cannula
- nozzle
- bone
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4601—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
- A61B17/8816—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by the conduit, e.g. tube, along which fluid flows into the body or by conduit connections
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- A—HUMAN NECESSITIES
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
- A61B17/8822—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by means facilitating expulsion of fluid from the introducer, e.g. a screw pump plunger, hydraulic force transmissions, application of vibrations or a vacuum
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8833—Osteosynthesis tools specially adapted for handling bone cement or fluid fillers; Means for supplying bone cement or fluid fillers to introducing tools, e.g. cartridge handling means
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- A—HUMAN NECESSITIES
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/885—Tools for expanding or compacting bones or discs or cavities therein
- A61B17/8852—Tools for expanding or compacting bones or discs or cavities therein capable of being assembled or enlarged, or changing shape, inside the bone or disc
- A61B17/8855—Tools for expanding or compacting bones or discs or cavities therein capable of being assembled or enlarged, or changing shape, inside the bone or disc inflatable, e.g. kyphoplasty balloons
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- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7097—Stabilisers comprising fluid filler in an implant, e.g. balloon; devices for inserting or filling such implants
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- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00261—Discectomy
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- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
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- A61B2017/00831—Material properties
- A61B2017/00867—Material properties shape memory effect
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- A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
- A61B2050/005—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers with a lid or cover
- A61B2050/0065—Peelable cover
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/062—Measuring instruments not otherwise provided for penetration depth
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B50/30—Containers specially adapted for packaging, protecting, dispensing, collecting or disposing of surgical or diagnostic appliances or instruments
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- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
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- A—HUMAN NECESSITIES
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/28—Bones
- A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30003—Material related properties of the prosthesis or of a coating on the prosthesis
- A61F2002/3006—Properties of materials and coating materials
- A61F2002/3008—Properties of materials and coating materials radio-opaque, e.g. radio-opaque markers
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
- A61F2250/0098—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers
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- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
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- A61F2310/00353—Bone cement, e.g. polymethylmethacrylate or PMMA
Abstract
This invention is systems (10), and methods for delivering material into bone to deploy a cannula (30) through soft tissue to establish a subcutaneous path into bone. A material is introduced through the cannula (30). The system (10), and methods advance a tamping instrument (108) through the cannula (30) to urge material residing in the cannula into bone. The introducing step delivers material at a pressure no greater than about 360 psi.
Description
SYSTEMS AND METHODS
FOR PLACING MATERIALS INTO BONE
FIELD OF THE INVENTION
The invention generally relates to the treatment of bone conditions in humans and other animals.
BACKGROUND OF THE INVENTION
Injection devices similar to a household caulking gun are used to inject bone cement into bone. A typical bone cement injection device has a pistol-shaped body, which supports a cartridge containing bone cement. A trigger actuates a spring-loaded ram, which forces a vo:Lume of bone cement in a viscous condition through a suitable nozzle and into the interior of a bone targeted for treatment.
According to the teachings of U.S. Patent Nos.
4,969,888 and 5,108,404, a cavity can be first formed by compacting cancell.ous bone inside the bone, into which the bone cement is injected.
Conventional cement injection devices provide no opportunity to override the spring action and quickly terminate the flow of cement, should the cavity fill before the spring-actuated load cycle is completed. Furthermore, once the spring-actuated mechanism is triggered, conventional cement injection devices do not permit the injection volume or inject rate to be adjusted or controlled in real time, in reaction to cancellous bone volume and density conditions encountered inside bone.
In a clinical procedure called ii.
FOR PLACING MATERIALS INTO BONE
FIELD OF THE INVENTION
The invention generally relates to the treatment of bone conditions in humans and other animals.
BACKGROUND OF THE INVENTION
Injection devices similar to a household caulking gun are used to inject bone cement into bone. A typical bone cement injection device has a pistol-shaped body, which supports a cartridge containing bone cement. A trigger actuates a spring-loaded ram, which forces a vo:Lume of bone cement in a viscous condition through a suitable nozzle and into the interior of a bone targeted for treatment.
According to the teachings of U.S. Patent Nos.
4,969,888 and 5,108,404, a cavity can be first formed by compacting cancell.ous bone inside the bone, into which the bone cement is injected.
Conventional cement injection devices provide no opportunity to override the spring action and quickly terminate the flow of cement, should the cavity fill before the spring-actuated load cycle is completed. Furthermore, once the spring-actuated mechanism is triggered, conventional cement injection devices do not permit the injection volume or inject rate to be adjusted or controlled in real time, in reaction to cancellous bone volume and density conditions encountered inside bone.
In a clinical procedure called ii.
vertebroplasty, bone cement is injected at high pressure (typically, about '700 psi) into the interior of a vertebral body, without the prior formation of a cavity. Becau,se high pressure is used, there is little opportunity to quickly and accurately adjust cement flow in reaction to bone volume and density conditions encountered. Momentum generated by high pressure-induced cement flow continues to propel oement in-to the targeted bone site even after termination of' the high pressure.
As a result of the relatively high pressure that conventional procedures rely upon, coupled with the effective lack of a short response time, the targeted bone interior can suddenly overfill.
Excess filling material can be forced outside the bone interior, and into adjoining tissue regions, where the presence of filling material is not required or desired.
For these and other reasons, there is a need for new systems and methods for placing material into bones, with greater rate and volume control, a f,aster response time, and without requiring the use of high pre,ssure.
SUMMARY OF THE INVENTION
The invention provides instruments, systems, and methods, which, in use, enable greater control over the placement of materials into bone.
One aspect of the invention provides an instrument for tamping material into bone through a subcutaneous path. The instrument comprises a body having a length and a terminus. The body includes markings located along the length at increments from the terminus. The markings allow the physician to gauge the position of the instrument in the subcutaneous path, as material is being tamped into II
As a result of the relatively high pressure that conventional procedures rely upon, coupled with the effective lack of a short response time, the targeted bone interior can suddenly overfill.
Excess filling material can be forced outside the bone interior, and into adjoining tissue regions, where the presence of filling material is not required or desired.
For these and other reasons, there is a need for new systems and methods for placing material into bones, with greater rate and volume control, a f,aster response time, and without requiring the use of high pre,ssure.
SUMMARY OF THE INVENTION
The invention provides instruments, systems, and methods, which, in use, enable greater control over the placement of materials into bone.
One aspect of the invention provides an instrument for tamping material into bone through a subcutaneous path. The instrument comprises a body having a length and a terminus. The body includes markings located along the length at increments from the terminus. The markings allow the physician to gauge the position of the instrument in the subcutaneous path, as material is being tamped into II
bone. In particular, the markers allow the physician to tell at a glance the location of the terminus, in terms of how far beyond or short of the end of the subcutaneous path it is.
In one embodiment, the instrument is used by deploying a cannula to establish a subcutaneous path into bone.. A material is introduced into bone through the cannula. The terminus of the instrument is advanced through the cannula to urge material residing in the cannula into bone.
Another aspect of the invention provides an apparatus for introducing material into bone through a subcutaneous cannula. The apparatus includes a delivery device to convey the material at a low delivery pressure. As used herein, a "low delivery pressure" is equivalent to the pressure at which liquid is expressed from 1 cc syringe by the application of moderate force to the syringe piston, which amounts to a pressure that is no greater than about 360 psi.
According to this aspect of the invention, the apparatus also includes a nozzle instrument capable of advancement through the subcutaneous cannula into bone. The nozzle: comprises a proximal fitting to couple the nozzle instrument to the delivery device. The nozzle further comprises a nozzle terminus through which the material conveyed by the delivery device enters bone at the delivery pressure.
In one embodiment, the delivery device comprises a syringe.
In one embodiment, =the apparatus further includes a tamping instrument, which is capable of advancement through the subcutaneous cannula. The tamping instrument has a tamping terminus which, during the advancement, urges material residing in the subcutaneous cannula into bone.
In one embodiment, the tamping instrument includes markings to visually gauge the advancement of the tamping terminus through the subcutaneous cannula.
In one embodiment, the apparatus is used by deploying a cannula to establislh a subcutaneous path into bone. The delivery device is actuated to convey material at the delivery pressure through the nozzle terminus into bone.
Another aspect of the invention provides a tool for deployment into bone. The,tool comprises a catheter tube having a distal region and an expandable structure carried by the distal region for compacting cancellous borie. The tool also includes an introducer sleeve slidably carried by the catheter tube for movement between a retracted position spaced from the expandable structure and an advanced position overlying the expandable structure. The introducer sleeve includes a tubular main body dimensioned to compress the expandable structure when the introducer sleeve is in the advanced position. A collar extends beyond the distal region of the catheter tube when the introducer sleeve is in the advanced position. The collar is dimensioned larger than the tubular main body to releasably engage an end of a cannula.
Thus, the introducer sleeve both sizes and aligns the expandable structure for passage into the cannula through the end of the cannula.
Another aspect of the invention provides apparatus for introducing material into bone through a subcutaneous cannula. The apparatus includes a delivery device to convey the material at a low delivery pressure, i.e., a pressure no greater than about 360 psi. The apparatus also includes a nozzle instrument capable of advancement through the subcutaneous cannula into boine and comprising a proximal fitting to couple the nozzle instrument to the delivery device. The nozzle also includes a nozzle bore, through which the material conveyed by the delivery device enters bone at the delivery pressure. The apparatus further includes a stylet capable of advancement into the nozzle bore through the proximal fitting to close the nozzle bore and, with the nozzle instrument. Together, the nozzle and the stylet form a tamping instrument capable of advancement through the subcutaneous cannula to urge residual material from the subcutaneous cannula.
Another aspect of the invention provides a method for delivering materj.al into bone. The method deploys a cannula through soft tissue to establish a subcutaneous path into bone. The method introduces a material into bone through the cannula.
The method advances a tamping :Lnstrument through the cannula to urge material residing in the cannula into bone.
In one embodiment, the method delivers material at a low delivery pressure, i.e., a pressure no greater than about 360 psi.
In one embodiment, the introducing step uses a manual syringe.
The material can comprise medication or a material that sets to a hardened condition e.g., bone cement, or autograft tissue, or allograft tissue, or synthetic bone substitute, or combinations thereof.
In one embodiment, the method further includes the step of deploying a cavity forming instrument through the cannula to compress cancellous bone and form a cavity. In this embodiment, the introducing and advancing steps convey material into the cavity.
According to one broad aspect of the present invention, there is provided a system comprising an access tool sized and configured to establish an access path through soft tissue to bone having an interior volume occupied, at least in part, by cancellous bone, a void forming tool sized and configured to be introduced through the access path to form a void in cancellous bone, a nozzle sized and configured to pass through the access path and including an interior bore defining a fixed interior volume to receive and deliver a measured volume of filling material into the void, and an auxiliary tool sized and configured to be advanced through the interior bore and urge filling material from the nozzle.
According to another broad aspect of the present invention, there is provided a system comprising a cannula sized and configured to establish an access path through soft tissue to bone having an interior volume occupied, at least in part, by cancellous bone, a void forming tool sized and configured to be introduced through the cannula to form a void in cancellous bone, a nozzle that can be manipulated independent of the cannula and that is sized and configured to pass through the cannula, the nozzle including an interior bore to receive and deliver a measured volume of filling material into the void, and an auxiliary tool that can be manipulated independently of the nozzle and the cannula and that is sized and configured to be advanced through the interior bore and urge filling material from the nozzle, the auxiliary tool, when fully advanced, substantially fully occupying the entire interior bore of the nozzle.
- 6a -According to still another broad aspect of the present invention, there is provided apparatus for delivering material into bone comprising a cannula for establishing a subcutaneous path into bone and including at least one radiopaque marker, and a tamping instrument having a tamping terminus, the tamping instrument being sized and configured for manipulation independent of the cannula to enable insertion of the tamping instrument into the cannula, advancement of the tamping terminus in the cannula to urge material residing in the cannula into bone, and withdrawal of the tamping terminus from the cannula.
According to yet another broad aspect of the present invention, there is provided apparatus for delivering material into bone comprising a cannula for establishing a subcutaneous path into bone, and a tamping instrument having a tamping terminus and including at least one marking to visually gauge the advancement of the terminus relative to the distal end of the cannula, the tamping instrument being sized and configured for manipulation independent of the cannula to enable insertion of the tamping instrument into the cannula, advancement of the tamping terminus in the cannula to urge material residing in the cannula into bone, and withdrawal of the tamping terminus from the cannula.
According to a further broad aspect of the present invention, there is provided apparatus for delivering material into bone comprising a cannula for establishing a subcutaneous path into bone; and a tamping instrument for advancement through the cannula including at least one marking to visually gauge the advancement of the terminus relative to the distal end of the cannula, and comprising a body portion and a handle portion, the body portion being - 6b -sized and configured to substantially fill the cannula when the tamping instrument is fully inserted into the cannula.
According to yet a further broad aspect of the present invention, there is provided apparatus for delivering material into bone comprising a cannula for establishing a subcutaneous path into bone and including at least one radiopaque marker; and a tamping instrument for advancement through the cannula comprising a body portion and a handle portion, the body portion having a substantially constant diameter along its length.
Features and advantages of the inventions are set forth in the following Description and Drawings, as well as in the appended Claims.
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is a plane view of a kit housing a system of functional instruments, which, in use, gain subcutaneous access to the inside of a bone to compact cancellous bone and form a cavity for therapeutic purposes;
Fig. 2 is an exploded perspective view of the kit shown in Fig. 1;
Fig. 3 is a perspective view of the subcutaneous access instrument group that forms a part of the system shown in Fig. 1;
Fig. 4A is a perspective view of the cavity forming instrument that forms a part of the system shown in Fig. 1;
Fig. 4B is a section view of the catheter tube of the cavity forming instrument, taken generally along line 42-4B in Fig. 1;
- 6c -Fig. 4C is an end view of an alternative embodiment of the cavity forming instrument shown in Fig. 4A, having a prebent stylet;
Fig. 5 is a perspective view of the material introducing instrument group that forms a part of the system shown in Fig. 1;
Figs. 6 and 7 are, respectively, top and side views of a human vertebral body;
Fig. 8 is a top view of a vertebral body during insertion of a spinal needle instrument to begin a bone access procedure;
i~.
In one embodiment, the instrument is used by deploying a cannula to establish a subcutaneous path into bone.. A material is introduced into bone through the cannula. The terminus of the instrument is advanced through the cannula to urge material residing in the cannula into bone.
Another aspect of the invention provides an apparatus for introducing material into bone through a subcutaneous cannula. The apparatus includes a delivery device to convey the material at a low delivery pressure. As used herein, a "low delivery pressure" is equivalent to the pressure at which liquid is expressed from 1 cc syringe by the application of moderate force to the syringe piston, which amounts to a pressure that is no greater than about 360 psi.
According to this aspect of the invention, the apparatus also includes a nozzle instrument capable of advancement through the subcutaneous cannula into bone. The nozzle: comprises a proximal fitting to couple the nozzle instrument to the delivery device. The nozzle further comprises a nozzle terminus through which the material conveyed by the delivery device enters bone at the delivery pressure.
In one embodiment, the delivery device comprises a syringe.
In one embodiment, =the apparatus further includes a tamping instrument, which is capable of advancement through the subcutaneous cannula. The tamping instrument has a tamping terminus which, during the advancement, urges material residing in the subcutaneous cannula into bone.
In one embodiment, the tamping instrument includes markings to visually gauge the advancement of the tamping terminus through the subcutaneous cannula.
In one embodiment, the apparatus is used by deploying a cannula to establislh a subcutaneous path into bone. The delivery device is actuated to convey material at the delivery pressure through the nozzle terminus into bone.
Another aspect of the invention provides a tool for deployment into bone. The,tool comprises a catheter tube having a distal region and an expandable structure carried by the distal region for compacting cancellous borie. The tool also includes an introducer sleeve slidably carried by the catheter tube for movement between a retracted position spaced from the expandable structure and an advanced position overlying the expandable structure. The introducer sleeve includes a tubular main body dimensioned to compress the expandable structure when the introducer sleeve is in the advanced position. A collar extends beyond the distal region of the catheter tube when the introducer sleeve is in the advanced position. The collar is dimensioned larger than the tubular main body to releasably engage an end of a cannula.
Thus, the introducer sleeve both sizes and aligns the expandable structure for passage into the cannula through the end of the cannula.
Another aspect of the invention provides apparatus for introducing material into bone through a subcutaneous cannula. The apparatus includes a delivery device to convey the material at a low delivery pressure, i.e., a pressure no greater than about 360 psi. The apparatus also includes a nozzle instrument capable of advancement through the subcutaneous cannula into boine and comprising a proximal fitting to couple the nozzle instrument to the delivery device. The nozzle also includes a nozzle bore, through which the material conveyed by the delivery device enters bone at the delivery pressure. The apparatus further includes a stylet capable of advancement into the nozzle bore through the proximal fitting to close the nozzle bore and, with the nozzle instrument. Together, the nozzle and the stylet form a tamping instrument capable of advancement through the subcutaneous cannula to urge residual material from the subcutaneous cannula.
Another aspect of the invention provides a method for delivering materj.al into bone. The method deploys a cannula through soft tissue to establish a subcutaneous path into bone. The method introduces a material into bone through the cannula.
The method advances a tamping :Lnstrument through the cannula to urge material residing in the cannula into bone.
In one embodiment, the method delivers material at a low delivery pressure, i.e., a pressure no greater than about 360 psi.
In one embodiment, the introducing step uses a manual syringe.
The material can comprise medication or a material that sets to a hardened condition e.g., bone cement, or autograft tissue, or allograft tissue, or synthetic bone substitute, or combinations thereof.
In one embodiment, the method further includes the step of deploying a cavity forming instrument through the cannula to compress cancellous bone and form a cavity. In this embodiment, the introducing and advancing steps convey material into the cavity.
According to one broad aspect of the present invention, there is provided a system comprising an access tool sized and configured to establish an access path through soft tissue to bone having an interior volume occupied, at least in part, by cancellous bone, a void forming tool sized and configured to be introduced through the access path to form a void in cancellous bone, a nozzle sized and configured to pass through the access path and including an interior bore defining a fixed interior volume to receive and deliver a measured volume of filling material into the void, and an auxiliary tool sized and configured to be advanced through the interior bore and urge filling material from the nozzle.
According to another broad aspect of the present invention, there is provided a system comprising a cannula sized and configured to establish an access path through soft tissue to bone having an interior volume occupied, at least in part, by cancellous bone, a void forming tool sized and configured to be introduced through the cannula to form a void in cancellous bone, a nozzle that can be manipulated independent of the cannula and that is sized and configured to pass through the cannula, the nozzle including an interior bore to receive and deliver a measured volume of filling material into the void, and an auxiliary tool that can be manipulated independently of the nozzle and the cannula and that is sized and configured to be advanced through the interior bore and urge filling material from the nozzle, the auxiliary tool, when fully advanced, substantially fully occupying the entire interior bore of the nozzle.
- 6a -According to still another broad aspect of the present invention, there is provided apparatus for delivering material into bone comprising a cannula for establishing a subcutaneous path into bone and including at least one radiopaque marker, and a tamping instrument having a tamping terminus, the tamping instrument being sized and configured for manipulation independent of the cannula to enable insertion of the tamping instrument into the cannula, advancement of the tamping terminus in the cannula to urge material residing in the cannula into bone, and withdrawal of the tamping terminus from the cannula.
According to yet another broad aspect of the present invention, there is provided apparatus for delivering material into bone comprising a cannula for establishing a subcutaneous path into bone, and a tamping instrument having a tamping terminus and including at least one marking to visually gauge the advancement of the terminus relative to the distal end of the cannula, the tamping instrument being sized and configured for manipulation independent of the cannula to enable insertion of the tamping instrument into the cannula, advancement of the tamping terminus in the cannula to urge material residing in the cannula into bone, and withdrawal of the tamping terminus from the cannula.
According to a further broad aspect of the present invention, there is provided apparatus for delivering material into bone comprising a cannula for establishing a subcutaneous path into bone; and a tamping instrument for advancement through the cannula including at least one marking to visually gauge the advancement of the terminus relative to the distal end of the cannula, and comprising a body portion and a handle portion, the body portion being - 6b -sized and configured to substantially fill the cannula when the tamping instrument is fully inserted into the cannula.
According to yet a further broad aspect of the present invention, there is provided apparatus for delivering material into bone comprising a cannula for establishing a subcutaneous path into bone and including at least one radiopaque marker; and a tamping instrument for advancement through the cannula comprising a body portion and a handle portion, the body portion having a substantially constant diameter along its length.
Features and advantages of the inventions are set forth in the following Description and Drawings, as well as in the appended Claims.
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is a plane view of a kit housing a system of functional instruments, which, in use, gain subcutaneous access to the inside of a bone to compact cancellous bone and form a cavity for therapeutic purposes;
Fig. 2 is an exploded perspective view of the kit shown in Fig. 1;
Fig. 3 is a perspective view of the subcutaneous access instrument group that forms a part of the system shown in Fig. 1;
Fig. 4A is a perspective view of the cavity forming instrument that forms a part of the system shown in Fig. 1;
Fig. 4B is a section view of the catheter tube of the cavity forming instrument, taken generally along line 42-4B in Fig. 1;
- 6c -Fig. 4C is an end view of an alternative embodiment of the cavity forming instrument shown in Fig. 4A, having a prebent stylet;
Fig. 5 is a perspective view of the material introducing instrument group that forms a part of the system shown in Fig. 1;
Figs. 6 and 7 are, respectively, top and side views of a human vertebral body;
Fig. 8 is a top view of a vertebral body during insertion of a spinal needle instrument to begin a bone access procedure;
i~.
Figs. 9 to 11 are top views showing subsequent steps, after insertion of the spinal needle instrument shown in Fig. 8, of inserting a guide pin instrument into the vertebral body;
Fig. 12 is a perspective view showing a subsequent step, after insertion of the guide pin instrument shown in Figs. 9 to 11, which deploys an obturator instrument deployed over the guide pin instrument with aid of a hand].e;.
Fig. 13 is a top, view of the vertebral body, with the obturator instrument shown in Fig. 12 deployed;
Fig. 14 is a perspective view showing a subsequent step, after insertion of the obturator instrument shown in Fig. 12, which uses the handle shown in Fig. 12 to aid in the deployment of a cannula instrument over the obturator instrument;
Fig. 15 is a top view of the vertebral body, with the cannula instrument shown in Fig. 14 deployed;
Fig. 16 is a perspective view showing a subsequent step, after insertion of the cannula instrument shown in Fig. 14, which removes the obturator instrument from the cannula instrument, to leave the cannula instrunient and guide pin instrument in place;
Fig. 17 is a top view of the vertebral body, after the obturator removal step shown in Fig.
16, leaving the cannula instrument and guide pin instrument in place;
Fig. 18 is a perspective view showing a subsequent step, after removal of the obturator instrument shown in Fig. 16, which uses the handle shown in Fig. 14 to aid in the deployment of a drill bit instrument through the cannula instrument along i ~.
Fig. 12 is a perspective view showing a subsequent step, after insertion of the guide pin instrument shown in Figs. 9 to 11, which deploys an obturator instrument deployed over the guide pin instrument with aid of a hand].e;.
Fig. 13 is a top, view of the vertebral body, with the obturator instrument shown in Fig. 12 deployed;
Fig. 14 is a perspective view showing a subsequent step, after insertion of the obturator instrument shown in Fig. 12, which uses the handle shown in Fig. 12 to aid in the deployment of a cannula instrument over the obturator instrument;
Fig. 15 is a top view of the vertebral body, with the cannula instrument shown in Fig. 14 deployed;
Fig. 16 is a perspective view showing a subsequent step, after insertion of the cannula instrument shown in Fig. 14, which removes the obturator instrument from the cannula instrument, to leave the cannula instrunient and guide pin instrument in place;
Fig. 17 is a top view of the vertebral body, after the obturator removal step shown in Fig.
16, leaving the cannula instrument and guide pin instrument in place;
Fig. 18 is a perspective view showing a subsequent step, after removal of the obturator instrument shown in Fig. 16, which uses the handle shown in Fig. 14 to aid in the deployment of a drill bit instrument through the cannula instrument along i ~.
the guide pin instrument;
Fig. 19 is a top view of the vertebral body, as the drill bit instrumient shown in Fig. 18 is deployed with aid of the handle to open a passage into the interior volume of the vertebral body;
Fig. 20 is a perspective view showing a subsequent step, after removal of the drill bit instrument and guide pin instrument shown in Fig.
18, of deploying the cavity forming instrument into the vertebral body;
Fig. 21 is a top view of the vertebral body, as the expandable structure carried by the cavity forming instrument shown in Fig. 20 is deployed into the interior volume of the vertebral body;
Fig. 22 is a top view of the vertebral body, as the expandable structure shown in a collapsed condition in Fig. 21 is expanded to compact cancellous bone and fcsrm a cavity;
Fig. 23 is a top view of the vertebral body, after removal of the expandable structure, showing the cavity formed by compacting cancellous bone;
Fig. 24 is a perspective view of the syringe of the material introducing instrument group, shown in Fig. 5, being filled with a material selected for introduction into the cavity shown in Fig. 23;
Fig. 25 is a perspective view of the syringe shown in Fig. 24 being joined to a nozzle, which also forms a part of the material introducing instrument group shown in Fig. 5;
Fig. 26 is a perspective view showing the syringe and attached nozzle shown in Fig. 25 being deployed through the cannula instrument in preparation of introducing material into the cavity;
Figs. 27 and 28 are perspective and top views, respectively, showing the syringe and attached nozzle shown in Fig. 26 in use to inject material into the cannula instrument for passage into the cavity;
Fig. 29 is a top view of the vertebral body after a measured volume of material has been injected and the syringe and attached nozzle withdrawn from the cannula instrument;
Fig. 30 is a top view showing the deployment of a tamping instrument, which forms a part of the material introducing instrument group shown in Fig. 5, being dep:loyed in the cannula instrument;
Fig. 31 is a top view showing advancement of the tamping instrument in the cannula instrument to displace and distribute material from the cannula instrument into the cavity;
Fig. 32 is a top view of the vertebral body after removal of the tamping instrument and cannula instrument, showing the cavity, now filled with the material;
Fig. 33 is a perspective view of a reduced diameter cannula instrument and associated reduced diameter material introducing instruments, which embody features of the invention;
Fig. 34 is a perspective view of a cavity forming instrument having an expandable cavity forming structure, which, in use, is deployed using the reduced diameter cannula instrument shown in Fig. 33, the cavity forming instrument having a sliding introducer sleeve shown in its rearward position;
Fig. 35 is a perspecltive view of the cavity iI
Fig. 19 is a top view of the vertebral body, as the drill bit instrumient shown in Fig. 18 is deployed with aid of the handle to open a passage into the interior volume of the vertebral body;
Fig. 20 is a perspective view showing a subsequent step, after removal of the drill bit instrument and guide pin instrument shown in Fig.
18, of deploying the cavity forming instrument into the vertebral body;
Fig. 21 is a top view of the vertebral body, as the expandable structure carried by the cavity forming instrument shown in Fig. 20 is deployed into the interior volume of the vertebral body;
Fig. 22 is a top view of the vertebral body, as the expandable structure shown in a collapsed condition in Fig. 21 is expanded to compact cancellous bone and fcsrm a cavity;
Fig. 23 is a top view of the vertebral body, after removal of the expandable structure, showing the cavity formed by compacting cancellous bone;
Fig. 24 is a perspective view of the syringe of the material introducing instrument group, shown in Fig. 5, being filled with a material selected for introduction into the cavity shown in Fig. 23;
Fig. 25 is a perspective view of the syringe shown in Fig. 24 being joined to a nozzle, which also forms a part of the material introducing instrument group shown in Fig. 5;
Fig. 26 is a perspective view showing the syringe and attached nozzle shown in Fig. 25 being deployed through the cannula instrument in preparation of introducing material into the cavity;
Figs. 27 and 28 are perspective and top views, respectively, showing the syringe and attached nozzle shown in Fig. 26 in use to inject material into the cannula instrument for passage into the cavity;
Fig. 29 is a top view of the vertebral body after a measured volume of material has been injected and the syringe and attached nozzle withdrawn from the cannula instrument;
Fig. 30 is a top view showing the deployment of a tamping instrument, which forms a part of the material introducing instrument group shown in Fig. 5, being dep:loyed in the cannula instrument;
Fig. 31 is a top view showing advancement of the tamping instrument in the cannula instrument to displace and distribute material from the cannula instrument into the cavity;
Fig. 32 is a top view of the vertebral body after removal of the tamping instrument and cannula instrument, showing the cavity, now filled with the material;
Fig. 33 is a perspective view of a reduced diameter cannula instrument and associated reduced diameter material introducing instruments, which embody features of the invention;
Fig. 34 is a perspective view of a cavity forming instrument having an expandable cavity forming structure, which, in use, is deployed using the reduced diameter cannula instrument shown in Fig. 33, the cavity forming instrument having a sliding introducer sleeve shown in its rearward position;
Fig. 35 is a perspecltive view of the cavity iI
forming instrument shown in Fig. 34, with the introducer sleeve moved forward to overlie and compress the expandable cavity forming structure;
Fig. 36 is a perspective view of the cavity forming structure shown in Fig. 35, with the introducer sleeve (shown partially in. section) coupled to the proximal end of the cannula instrument, to guide the expandable structure compressed within the sleeve into the reduced diameter cannula instrument without damage; and Fig. 37 is a perspective view of the cavity forming structure shown in Fig. 36, after the expandable structure has been guided by the introducer sleeve into the canriula instrument and is being advanced through the cannula instrument for deployment in bone.
The invention may be embodied in several forms without departing from its spirit or essential characteristics. The scope of the invention is defined in the appended claims, rather than in the specific description preceding them. All embodi-ments that fall within the meaning and range of equivalency of the claims are therefore intended to be embraced by the claims.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Figs. 1 and 2 show a system 10 of functional instruments. In use, certain instruments of the system 10 are deployed in a purposeful manner to penetrate tissue and gain subcutaneous access to the inside of a bone. Inside bone, other instruments of the system 10 are deployed to form a cavity in cancellous bone, into which a material is placed for therapeutic purposes.
In the illustrated embodiment, the system 10 is arranged as a prepackage kit 12 in three functional instrument groups 14, 16, and 18. The first group 14 (which Fig. 3 shows outside the kit 12) comprises instruments whose purpose is to gain subcutaneous access to a bone interior. The second group 16 (which Fig. 4 shows outside the kit 12) comprises an instrument whose function is to create a cavity in cancellous bone. The third group 18 (which Fig. 5 shows outside the kit 12) comprises instruments whose function is to introduce a material into the cavity.
The kit 12 can take various forms. In the illustrated embodiment, the kit 12 comprises a sterile, wrapped assembly.
Further details of each functional instrument group 14, 16, and 18 and the kit 12 follow.
I. The Subcutaneoias Access Instrument Group The number and type of instruments in the group 14 can vary. Fig. 3 shows five representative instruments, each having a different size and function.
A. The Spinal Needle and Guide Pin As Fig. 3 shows, one: instrument comprises a conventional spinal needle assembly 20 and a guide pin instrument 26.
In use, the spinal needle assembly 20 establishes the initial subcutaneous path leading to the targeted treatment site. The guide pin instrument 26 is deployed through this path, followed by progressively larger instruments, as will be described later.
The spinal needle assembly 20 comprises a stylet 22, which is slidably deployed within a stylus 24. The stylus 24 typically has, for example, ic _ 12 _ about an eleven gauge diameter. Other gauge diameters can be used, according to the gauge.of the guide pin instrument 26 used.
In use, the guide pin instrument 26 is deployed through the subcutaneous path established by the spinal needle assembly 20, by exchange with the needle stylet 22. The guide pin instrument 26 serves to guide the establishment of the main operative pathway to the targeted treatment site.
The remaining instruments 28, 30, and 32 in the group 14 share some common features, although they are intended, in use, to perform different functions. These instruments 28, 30, and 32 are each made of a rigid, surgical grade plastic or metal material. These instruments :28, 30, and 32 each comprises an elongated, cylindrical body having a proximal end 34 and a distal end 36.
B. The Obturator Ins:trument The instrument 28 functions as an obturator. Its distal end 36 is tapered to present a penetrating surface 38. In use, the surface 38 is intended to penetrate soft tissue in response to pushing or twisting forces applied by the physician at the proximal end 34.
The proximal end :34 of the obturator instrument 28 presents a flariged surface 40, which tapers from a larger outer diameter to a smaller outer diameter in the direction of the proximal end 34. The flanged surface 40 includes an array of circumferentially spaced teeth 42.
An interior lumen 44 extends through the obturator instrument 28 from the distal end 36 to the proximal end 34. The interior lumen 44 is sized to accommodate the guide pin instrument 26, as will be described in greater detail later.
Fig. 36 is a perspective view of the cavity forming structure shown in Fig. 35, with the introducer sleeve (shown partially in. section) coupled to the proximal end of the cannula instrument, to guide the expandable structure compressed within the sleeve into the reduced diameter cannula instrument without damage; and Fig. 37 is a perspective view of the cavity forming structure shown in Fig. 36, after the expandable structure has been guided by the introducer sleeve into the canriula instrument and is being advanced through the cannula instrument for deployment in bone.
The invention may be embodied in several forms without departing from its spirit or essential characteristics. The scope of the invention is defined in the appended claims, rather than in the specific description preceding them. All embodi-ments that fall within the meaning and range of equivalency of the claims are therefore intended to be embraced by the claims.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Figs. 1 and 2 show a system 10 of functional instruments. In use, certain instruments of the system 10 are deployed in a purposeful manner to penetrate tissue and gain subcutaneous access to the inside of a bone. Inside bone, other instruments of the system 10 are deployed to form a cavity in cancellous bone, into which a material is placed for therapeutic purposes.
In the illustrated embodiment, the system 10 is arranged as a prepackage kit 12 in three functional instrument groups 14, 16, and 18. The first group 14 (which Fig. 3 shows outside the kit 12) comprises instruments whose purpose is to gain subcutaneous access to a bone interior. The second group 16 (which Fig. 4 shows outside the kit 12) comprises an instrument whose function is to create a cavity in cancellous bone. The third group 18 (which Fig. 5 shows outside the kit 12) comprises instruments whose function is to introduce a material into the cavity.
The kit 12 can take various forms. In the illustrated embodiment, the kit 12 comprises a sterile, wrapped assembly.
Further details of each functional instrument group 14, 16, and 18 and the kit 12 follow.
I. The Subcutaneoias Access Instrument Group The number and type of instruments in the group 14 can vary. Fig. 3 shows five representative instruments, each having a different size and function.
A. The Spinal Needle and Guide Pin As Fig. 3 shows, one: instrument comprises a conventional spinal needle assembly 20 and a guide pin instrument 26.
In use, the spinal needle assembly 20 establishes the initial subcutaneous path leading to the targeted treatment site. The guide pin instrument 26 is deployed through this path, followed by progressively larger instruments, as will be described later.
The spinal needle assembly 20 comprises a stylet 22, which is slidably deployed within a stylus 24. The stylus 24 typically has, for example, ic _ 12 _ about an eleven gauge diameter. Other gauge diameters can be used, according to the gauge.of the guide pin instrument 26 used.
In use, the guide pin instrument 26 is deployed through the subcutaneous path established by the spinal needle assembly 20, by exchange with the needle stylet 22. The guide pin instrument 26 serves to guide the establishment of the main operative pathway to the targeted treatment site.
The remaining instruments 28, 30, and 32 in the group 14 share some common features, although they are intended, in use, to perform different functions. These instruments 28, 30, and 32 are each made of a rigid, surgical grade plastic or metal material. These instruments :28, 30, and 32 each comprises an elongated, cylindrical body having a proximal end 34 and a distal end 36.
B. The Obturator Ins:trument The instrument 28 functions as an obturator. Its distal end 36 is tapered to present a penetrating surface 38. In use, the surface 38 is intended to penetrate soft tissue in response to pushing or twisting forces applied by the physician at the proximal end 34.
The proximal end :34 of the obturator instrument 28 presents a flariged surface 40, which tapers from a larger outer diameter to a smaller outer diameter in the direction of the proximal end 34. The flanged surface 40 includes an array of circumferentially spaced teeth 42.
An interior lumen 44 extends through the obturator instrument 28 from the distal end 36 to the proximal end 34. The interior lumen 44 is sized to accommodate the guide pin instrument 26, as will be described in greater detail later.
C. The Cannula instruiaent The instrument 30 functions as a cannula or guide sheath. The cannula instrument 30 is somewhat larger in diameter than and not as long as the obturator instrument 28. The.cannula instrument 30 includes an interior lumen 46 that extends from its distal end 36 to its proximal end 34. The interior lumen 46 is sized to accept the obturator instrument 28. The size of the interior lumen 46 permits a physician to slide and rotate the cannula instrument 30 relative to the obturator instrument 28, and vice versa, as will be described in greater detail later.
The distal end 36 of the cannula instrument 30 presents an end surface 48. In use, the end surface 48 of the cannula instrument 30 is intended to penetrate soft tissue surrounding the obturator instrument 28 in response to pushing or twisting forces applied at the proximal end 34.
The proximal end 34 carries an enlarged fitting 50. The fitting 50 tapers from a larger diameter to a smaller diameter in the direction of the proximal end 34. Like the tapered flange 40 on the obturator instrument 28, the tapered fitting 50 has an array of circumferentially spaced teeth 52.
The tapered fitting 50 of the cannula instrument 30 possesses a larger maximum outer diameter than the maximum outer diameter of the tapered flange 40 of the obturator instrument 28.
The cannula instrument 30 includes measured markings 118 along its length(see Fig. 3). The measured markings 118 gauge the depth of insertion.
The markings 118 can be placed, for example, at one centimeter intervals. As Fig. 3 shows, the markings 118 can be consecutively numbered, beginning at the distal end 36, so that the physician can ascertain i I!
.. 14 _ the insertion depth at a glance.
D. The Drill Bit Instrument The instrument 32 functions as a drill bit.
The drill bit instrument 32 has generally the same physical dimensions as the obturator instrument 28.
Like the obturator iristrument 28, the drill bit instrument 32 is intended, in use, to fit for sliding and rotational movement within the interior lumen 46 of the cannula instrument 30.
The distal end 36 of the drill bit instrument 32 includes machined cutting edges 54. In use, the cutting edges 54 are intended to penetrate hard tissue in response to rotation and longitudinal load forces applied at the proximal end 34 of the drill bit instrument 32.
The proximal end 34 presents a tapered flange 56, which is substantially identical to the flange 40 on the obturator instrument 28. Like the obturator instrument 28, the tapered flange 56 changes from a larger diameter to a smaller diameter in the direction of the proximal end 34. The tapered flange 56 of the drill bit instrument 32 also includes an array of circumferentially spaced teeth 58. The form and orientation of the teeth 58 on the drill bit instrument 32 correspond to the form and orientation of the teeth 42 on the obturator instrument 28.
E. The Handle The group includes a handle 60. The handle 60 engages the functional instruments 28, 30, and 32 in a removable, slip fit fashion to aid a physician in manipulating the instruments during use.
The handle 60 is made from a molded or cast rigid plastic or metal material. The handle 60 is shaped to be comfortably and securely grasped by a normal human hand. The shape and size to accommodate this function can, of course, vary. In the illustrated embodiment, the handle 60 is elongated along a main axis to fit comfortably across the palm of the hand.
The handle 60 includles a center post 62, which is integrally molded tci the handle 60 about its geometric center. The center post 62 extends downward to give the handle 60 a general T-shape.
The handle 60 includes two interior cavities or sockets 64 and 66 in the center post 62.
The sockets guide the attachment between the handle 60 and the instruments 28, 30, and 32. The first and second sockets 64 and 66 are. sized to present unique attachment sites for different functional instruments.
The first socket 64 includes an array of circumferentially spaced grooves 68, which, in form and orientation, match the teeth 42 and 58 at the proximal ends 34 of the obturator instrument 28 and the drill bit instrument 32. The first socket 64 accepts the tapered flange 40 or 56 of either the obturator instrument 28 or the drill bit instrument 32. The teeth 42 and 58 of either tapered flange 40 or 56 mesh in a slip-fit with the grooves 68 of the first socket 64. The running slip-fit allows longitudinal force to be applied to either instrument 28 or 32 through the handle 60. The running slip-fit also prevents relative rotation between either instrument 28 or 32 and the first socket 64, thereby permitting torsional or twisting forces to be applied to either instrument 28 or 32 by the handle 60, with an increased mechanical advantage.
The second socket 66 is larger than the first socket 64 and is sized to accept the larger tapered fitting 50 of the cannula instrument 30. The second socket 66 includes an array of circumferentially spaced grooves 70, which, in form and orientation, match the teeth 52 on the tapered fitting 50. The teeth 52 of the tapered fitting 50 mesh in a slip-fit with the grooves 70 of the second socket 66. The running slip-fit allows both longitudinal and torsional forces to be applied to the cannula instrument 30 through the handle 60, with increased mechanical advantage.
As shown in phantom lines in Fig.3, a first passage 72 extends through the top of the handle 60, through the center post 62, and into the first socket 64. The passage 72 is generally aligned with the center of the first socket 64 and is sized to pass the guide pin instrument 26 (see Fig. 12).
Likewise, as also shown in phantom lines in Fig. 3) a second passage 74 extends through the top of the handle 60, through the center post 62, and into the second socket 66. The passage 74 is generally aligned with the center of the second socket 66 and is sized to pass the either obturator instrument 28 or the drill bit instrument 32 (see Fig. 14).
Further details of the handle 60 can be found in copending U.S. Patent Serial No. 6,468,279, filed January 27, 1998, and entitled "A Slip-Fit Handle for Hand-Held Instruments that Access Interior Body Regions."
Further details regarding the use of the handle 60 and the associated instruments 26, 28, and 30 will be provided later.
II. The Cavity Forming Instrument As Fig. 4A shows, the group 16 includes an WO 00/09024 PCTlUS99/16289 instrument 76, which is deployed through the cannula instrument 30 to a location inside bone (see Fig.
20). When so deployed, the instrument 76 serves to form a cavity in cancellous bone.
The instrument 76 can be constructed in various ways. In the illustrated embodiment, the instrument 76 includes a flexible catheter tube 78 having a proximal end 80 and a distal end 82. The proximal end 80 carries a handle grip 84 to facilitate gripping and maneuvering the catheter tube 78. The materials for the: catheter tube 78 are selected to facilitate its advancement through the cannula instrument 30. The catheter tube 78 can be constructed, for example, using standard flexible, medical grade plastic materials, like vinyl, nylon, polyethylenes, ionomer, polyurethane, and polyethylene tetraphthalate (PET). The catheter tube 78 can also include more rigid materials to impart greater stiffness and thereby aid in its manipulation. More rigid materials that can be used for this purpose include stainless steel, nickel-titanium alloys (NitinolTM material), and other metal alloys.
The distal end 82 of the instrument 76 carries an expandable structure 86. In the illustrated embodiment, the expandable structure 86 is made from a polyurethane or an elastomer (e.g., silicone or nylon) material. 'rhe structure 86 has been preformed to possess a. desired shape by exposure to heat and pressure, e.g., through the use of conventional thermoforming techniques.
As Fig. 4B shows, thie catheter body 78 includes an interior lumen 88, which communicates with the interior of the structure 86. A fitting 90 on the proximal end 80 of the catheter tube 78 (see Fig. 4B) communicates with thE: lumen 88. The fitting 90 couples the lumen 88 to a source 92 of fluid, e.g., sterile saline (see Fig. 21), or a radiopaque contrast medium.
The fluid is introduced from the source 92 into the structure 86 under positive pressure, causing the structure 86 to expand. During expansion inside bone, the material selected for the structure 86 preferably resists deformation, so that the expanded shape inside bone essentially corresponds to its expanded shape outside bone, i.e., when in an open air environment. This allows the physician to select in an open air environment a structure 86 having an expanded shape desired to meet the targeted therapeutic result, with the confidence that the expanded shape inside bone will be similar in important respects. In addition to being able to expand its volume while resisting deformation inside bone, the material of the structure 86 preferable withstands abrasion, tearing, and puncture when in contact with cancellous bone.
The shape of the structure 86, when expanded inside bone, is selected by the physician, taking into account the morphology and geometry of the site to be treated. The shape of the cancellous bone to be compressed, and the local structures that could be harmed if bone were moved inappropriately, are generally understood by medical professionals using textbooks of human skeletal anatomy along with their knowledge of the site and its disease or injury. The physician is also able to select the expanded shape inside bone based upon prior analysis of the morphology of the targeted bone using, for example, plain film x-ray, fluroscopic x-ray, or MRI
or CT scanning. The expanded shape inside bone is selected to optimize the formation of a cavity that, e.g., when filled with a suitable material, provides support across the region of the bone being treated.
As one general guideline, in cases where the bone disease causing fracture (or the risk of fracture) is the loss of cancellous bone mass (as in osteoporosis), the selection of the expanded shape of the structure 86 inside bone should take into account that from 30% to 90% of the cancellous bone volume should be compacted. Another general guideline is the amount that the: targeted fractured bone region has been displaced or depressed. The expansion of the structure 86 within the cancellous bone region inside a bone can elevate or push the fractured cortical wall back to or near its anatomic position occupied before fracture occurred.
In the illustrated embodiment (see Fig.
4A), the structure 86 possesses a preformed hour-glass or peanut shape. This shape is selected in contemplation of deploying the structure 86 in a vertebral body, as will be described in greater detail later.
To facilitate deployment of the structure 86 through the cannula instrument 30, the catheter tube 78 includes a second interior lumen 94. The lumen 94 extends from a second fitting 98 on the proximal end 80 of the catheter tube 78, through the body of the cannula tube 78, and through the interior of the structure 86 to the tip end 172 of the structure 86. The lumen 94 receives a generally stiff stylet 96, which can be made from a molded plastic or stainless steel mate:rial. The stylet 96 is inserted through the fitting 98 into the lumen 94, and includes a threaded coupling 100 to secure the stylet 96 against movement. The presence of the stylet 96 serves to keep the structure 86 in the desired distally straightened condition during passage through the cannula instrument 30 into the targeted tissue region. Once the structure 86 is free of the cannula instrument 30 andinside bone, the stylet 96 can be withdrawn (shown by arrow 174 in Fig. 4A). This returns normal flexibility to the catheter tube 78 and facilitates manipulation of the structure 86 inside bone. With the stylet 96 withdrawn, the lumen 94 can also serve as a pathway for introducing rinsing liquid or to aspirate debris from the bone.
In the illustrated embodiment, the stylet 96 is biased toward a generally straight condition.
In an alternative embodiment (see Fig. 4C), a stylet 102 can have a preformed memory, to normally bend its distal region. The memory is overcome to straighten the stylet 102 when confined within the cannula instrument 30. However, as the structure 86 and distal region of the preformed stylet 102 advance free of the cannula instrument 30, to pass into the targeted region, the preformed memory bends the distal region of the stylet 102 and thereby shifts the main axis of the expandable structure 86.--The prebent stylet 102, positioned within the interior of the structure 86, aids in altering the orientation of the structure 86, bringing it into better anatomic alignment with the targeted region.
Other types of instruments that can form cavities in cancellous bone and other interior body regions are described in copending U.S. Patent Serial No. 6,440,138, entitled "Structures and Methods for Creating Cavities in Interior Body Regions," filed April 6, 1998.
III. The Material Introducing Instrument Group The group 18 includes irtstruments 104, 106, and 108 which serve to convey and compact a selected material inside the cavity formed by the structure 86. The material in the cavity provides a desired therapeutic result, e.g., rep:lacement of tissue mass, or.renewed interior suppo:rt for the bone, or the delivery of medication, or combinations thereof.
Accordingly, the material to perform this function can be selected from among, e.g., a material that sets to a hardened condition, including bone cement, autograft tissue, allograft tissue, synthetic bone substitute, as well as a medication, or combinations thereof.
In the illustrated embodiment, the group 18 comprises material injection instruments 104 and 106 and a material tamping instrument 108, which deliver.
material at a low delivery pressure, i.e., a pressure no greater than about :360 psi.
A. Low Pressure Material Injection Instruments In the illustrated embodiment, the material is injected by use of a conventional syringe 104, to which a specially designed injection nozzle 106 is coupled. A manual actuated syringe with a push plunger can be used. Alternatively, a LeVeen Inflation Syringe with threaded plunger can be used, which can be actuated manualJLy or by use of a mechanical actuator.
In the illustrated embodiment, the syringe 104 is made from a clear plastic material. The syringe 104 includes a chamber 110, which receives the material to be injected. The material is expressed from the chamber 100 by a manually advanced syringe piston 112 (see also Fig. 25).
The injection nozzle 106 connects by a threaded connector 114 to the endlof the syringe 104 9 (see also Fig. 25). In the illustrated embodiment, the nozzle 106 is made from a qenerally flexible, inert plastic material, such as such as polyethylene or an other suitable polymer. Alternatively, the nozzle 106 can be made from a generally rigid plastic or metal material.
The injection nozzle 106 is sized to be advanced through the cannula instrument 30 (see Fig.
26). The nozzle 106 includes measured markings 116 along its length. The markings 116 can be placed, for example, at one centimeter intervals, to correspond with the markings :L18 on the cannula instrument 30, so that the relative position of the nozzle 106 within the cannula instrument 30 can be gauged. The markings 118 can, e.g., include a set point 176. Alignment of the sc:t point 176 at the proximal end 34 of the canniala instrument 30, indicates that the distal end of the nozzle 106 is located in an aligned relationship with the distal end 36 of the cannula instrument 30. In this arrangement, the markings 118 are consecutively numbered with positive numbers proximally of the set point 176 and with negative numbers distally of the set point 176. The physician is thereby able to tell at a glance the location of the distal end of the nozzle 106, in terms of how far beyond or short of the distal end 36 of the cannula instrument 30 it is.
In use, the distal end of the nozzle 106 is located beyond the distal end 36 of the cannula instrument 30 within the cavity formed in the targeted tissue region. As Fig. 5 shows, the distal end of the nozzle 106, when made from a plastic material, can carry at least one radiopaque marker 208, to enable remote visualization of the nozzle position within the body. The syringe 104 ejects a predetermined volume of material into the nozzle 106 in a low pressure stream into the cavity. As the material fills the cavity, the nozzle (still ejecting material) is retracted from the cavity and into the cannula instrument 30 itself. Further details of this function and resiult will be provided later.
B. The Material Tamping Instrument The group 18 also includes a material tamping instrument 108. The tamping instrument 108 is made from generally rigid, inert plastic or metal material. The tamping instrumeint 108 is also sized to be advanced into the cannula. instrument 30 (see Fig. 30). The free end 124 of the tamping instrument 108 is ribbed or contoured to facilitate gripping the instrument 108 during use.
The tamping instrunient 108 includes measured markings 122 along its length. The markings 116 can be placed, for example, at one centimeter intervals, to correspond with the markings 118 on the cannula instrument 30, sc> that the relative position of the tamping instrument 108 within the cannula instrument 30 can be gauged. Like the nozzle 106, the markings 122 on the tamping instrument 108 includes a set point 178, which indicates when the distal end of the tamping instrument 108 aligns with the distal end 36 of the cannula instrument 30. Also like the nozzle 106, the markings 122 on the tamping instrument 108 are consecutively numbered with positive numbers proximally of -the set point 178 and with negative numbers distally of the set point 178.
The physician is thereby able to tell at a glance the location of the end of the tamping instrument 108, in terms of how far beyond or short of the distal end 36 of the cannula instrument 30 it is. As Fig. 5 also shows, the end of 'the tamping instrument 108, when made from a plasticimaterial, can carry at least one radiopaque marker 210, so that its position can be visualized from outside the body.
After withdrawal of the nozzle 106 from the cannula instrument 30, residual material is left in the cannula instrument 30. The purpose of the tamping instrument 108 is to displace the residual material out the distal end. 36 of the cannula instrument 30 and into the cavity, to thereby fill the cavity without exerting undue pressure within the bone. The tamping instrument 108 thereby serves to clear residual material from the cannula instrument 30, to assure that the desired volume of material is delivered into the cavity. The removal of residual material from the cannula instrument 30.
by the tamping instrument 108 also prevents seepage of material into surrounding tissue regions upon removal of the cannula instru:ment 30. The tamping instrument 108 also compacts the material uniformly within the cavity, again without undue pressure.
Further details of these functions and results will be discussed later.
IV. The Kit As Figs. 1 and 2 show, in the illustrated embodiment, the kit 12 includes an interior tray 126 made, e.g., from die cut cardboard, plastic sheet, or thermo-formed plastic material. The tray 126 includes spaced apart tabs 1,28, which hold the various instruments in a secure position during sterilization and storage prioz- to use.
When packaged as a sterile assembly, the kit 12 includes an inner wrap 130, which is peripherally sealed by heat or the like, to enclose the tray 126 from contact iwith the outside environment. One end of the inner wrap includes a conventional peal-away seal 132,, to provide quick access to the tray 126 at the instant of use, which preferably occurs in a sterile erivironment, such as within an operating room.
When packaged as a sterile assembly, the kit 12 also includes an outer wrap 134, which is also peripherally sealed by heat or the like, to enclosed the inner wrap 130. One end of the outer wrap includes a conventional pea:1-away seal 136, to provide access to the inner wrap 130 and its contents. The outer wrap 134 can be removed -from the inner wrap in anticipation of imminent use, without compromising sterility of the contents of the kit 12.
As Fig. 2 shows, each iinner and outer wrap 130 and 134 includes a peripherally sealed top sheet 138 and bottom sheet 140. In the illustrated embodiment, the top sheet 138 is made of transparent plastic film, like polyethylene or MYI,AR material, to allow visual identification of the contents of the kit 12. The bottom sheet 1.40 is made from a material that is permeable to ETO sterilization gas, e.g., TYVEK plastic material (available from DuPont).
In the illustrated embodiment, the tray 126 presents the instruments groups 14, 16, and 18 in an ordered, organized layout, which is arranged to aid the physician in carrying out the intended procedure. For example, the layout of the tray 126 can present the instruments groups 14, 16, and 18 in top-to-bottom order, accordinq to sequence of intended use. For example, in a typical bone access procedure (as will be demonsti-ated in greater detail later), the stylet 22 and stylus 24 of the spinal needle assembly 20 are deployed first, followed by the guide pin instrument 26, followed by the obturator instrument 28, then the cannula instrument 30, then the drill bit instrument 32, then the cavity forming instrument 76, then the syringe 104 and nozzle 106 instruments, and lastly the tamping instrument 108. Accordingly, the tray 126 packages these instruments and componeints in a top-to-bottom order, with the spinal needle: assembly 20 topmost, the guide pin instrument 26 next, the obturator instrument 28 next, and so on, with the tamping instrument 108 lowermost on the tray 126.
In this layout, the handle 60 is packaged to the side of the access instrument group 14. The tray 126 can include written labels (not shown) identifying the components contained in the kit 12.
The kit 12 also preferably includes in the tray 126 directions 144 for using the contents of the kit 12 to carry out a dlesired procedure. An exemplary procedure which thie directions 144 can describe will be explained later.
When packaged as a sterile assembly, the directions 144 can also include the statement "For Single Patient Use Only" (or comparable language) to affirmatively caution against reuse of the contents of the kit 12 whose performance characteristics and efficacy degrade after a single use. The spinal needle assembly 20, the cavity forming instrument 76, and the material introducing instruments 104, 106, and 108 should, for these reasons, be used but a single time and then discarded. The directions 144 also preferably affirmatively instruct against resterilization of at least these contents of kit 12, and also instructs the physician to dispose of at least these contents of the :kit 12 upon use in accordance with applicable biological waste procedures.
The presence of the instrument groups 14, 16, and 18 packaged in the ster9Lle kit 12 verifies to the physician that the contents are sterile and have not been subjected to prior use. The physician is thereby assured that the instrument groups meet established performance and sterility specifications.
It should be appreciated that the various instruments contained in the kit 12 can be packaged into several, smaller functional kits. For example, a first kit can package the access instrument group 14, a second kit can package the cavity forming instrument group 16, and a third kit can package the material introduction instrument group 18. Figs. 1 and 2 illustrate one of many different possible embodiments.
V. Illustrative Use of the System The following describes use of the instrument groups 14, 16, and 18 packaged in the kit 12 in the context of treating bones. This is because the instruments of the giroups 14, 16, and 18 can be advantageously used for this purpose. Still, it should be appreciated that one or more of the instrument groups, used alone or in association with other instruments, can perform other diagnostic or therapeutic functions in other interior regions of the body.
In particular, the instrument groups 14, 16, and 18 will described with regard to the treatment of human vertebra. It should be appreciated, however, their use is not limited to human vertebrae. The instrument groups 14, 16, and 18 can be used in association with hand-held instruments in the treatment of diverse human or animal bone types.
A. The Vertebral Body As Figs. 6 and 7 show, a typical vertebra 146 includes a vertebral body 148, which extends on the anterior (i.e., front or chest) side of the vertebra 146. The vertebral body 148 has the shape of an oval disk. The vertebral body 148 includes an exterior formed from compact cortical bone 150. The cortical bone 150 encloses an interior volume of reticulated cancellous, or spongy, bone 152 (also called medullary bone or trabecular bone).
The spinal cord 154 passes through the spinal canal 156 of the vertebr=a 146. The vertebral arch 158 surrounds the spinal canal 156. The pedicles 160 of the vertebral arch 158 adjoin the vertebral body 148. The spinous process 162 extends from the posterior of the vertebral arch 158, as do the left and right transverse processes 164.
B. Treatment of a Vertebral Body During a typical procedure, a patient lies on an operating table. The patient can lie face down on the table, or on either side, or at an oblique angle, depending upon the physician's preference.
The physiciari or surgical assistant removes the outer and inner wraps 130 and 134 of the kit 12, exposing the tray 126 for use. The physician acquires the spinal needle assembly 20 from the tray 126. As Fig. 8 shows, the physician introduces the spinal needle assembly 20 into soft tissue ST in the patient's back. Under radiologic or CT monitoring, the physician advances the spina.l needle assembly 20 through soft tissue down to and into the targeted vertebra 146. The physician will typically administer a local anesthetic, for example, lidocaine, through assembly 20. In some cases, the physician may prefer other forms of anesthesia.
The physician directs the spinal needle assembly 20 to penetrate the cortical bone 150 and the cancellous bone 152 of the targeted vertebral body 148. Preferably the depth of penetration is about 60% to 95% of the vertebral body 148.
Fig. 8 shows gaining access to cancellous bone through the side of the vertebral body 148, which is called postero-lateral access. However, access may be indicated through a pedicle 160, which is called transpedicular access. The type of access is based upon the objectives of the treatment or for other reasons, based upon the preference of the physician.
As Fig. 9. shows, after positioning the spinal needle assembly 20 in caLncellous bone 152, the physician holds the stylus 24 and withdraws the stylet 22. The physician acquires the guide pin instrument 26 from the tray 126. As Fig. 10 shows, while still holding the stylus 24, the physician slides the guide pin instrumeint 26 through the stylus 24 and into the cancellous bone 152. The physician now removes the stylus 24 (see Fig. 11) , leaving the guide pin instrument 26 deployed within the cancellous bone 152.
The physician next acquires the obturator instrument 28 and the handle 60 from the tray 126.
The physician slides the obturator instrument 28 over the guide pin instrument 26, distal end first.
The physician slides the guide pin instrument 26 through the first passage 72 and the first socket 64 of the handle 60. As Fig. 12 shows, the physician slides the handle 60 along thie guide pin instrument 26 toward the tapered flange 40 of the obturator instrument 28, until achieving a running slip-fit between the first socket 64 and the tapered flange 40, in the manner previously described. The obturator instrument 28 is now ready for use.
As Fig. 12 shows, lthe physician makes a small incision I in the patient's back. The physician twists the handle 60 while applying longitudinal force to the handle 60. In response, the surface 38 of the obturator instrument 28 rotates and penetrates soft tissue ST through the incision I. The physician may also gently tap the handle 60, or otherwise apply appropriate additional longitudinal force to the handle 60, to advance the obturator instrument 28 through the soft tissue along the guide pin instrument: 26 down to the entry site (see Fig. 13). The physician can also tap the handle 60 with an appropriate striking tool to advance the surface 30 of the obturator instrument 28 into the side of the vertebral body 148 to secure its position (as Fig. 13 shows).
The physician next slides the handle 60 along the guide pin instrument 26 away from the obturator instrument 28 to disengage the tapered flange 40 from the first socket 64. The physician then proceeds to slide the handle 60 completely off the guide pin instrument 26.
The physician acquires the . cannula instrument 30 from the tray 126. As Fig. 14 shows, the physician slides the cannu]La instrument 30 over the guide pin instrument 26, distal end first, and, further, over the obturator instrument 28, until contact between the end surface 48 and soft tissue tissue ST. The physician now slides the guide pin instrument 26 and obturator instrument 26 through the second passage 74 and secorid socket 66 of the handle 60. The physician slides the handle 60 toward the tapered fitting 50 of the cannula instrument 30 until a running slip-fit occurs between the second socket 66 and the tapered fitting 50, as previously described. The cannula instrument 30 is now ready for use.
As Fig. 14 shows, the physician applies appropriate twisting and longituidinal forces to the handle 60, to rotate and advance the cannula instrument 30 through soft tissue ST along the obturator instrument 28. As Fig. 15 shows, when the end surface 48 of the cannula instrument 30 contacts cortical bone, the physician caii appropriately tap the handle 60 with a striking tool to advance the end surface into the side of the vertebral body 148 to secure its position.
As Fig. 16 shows, the physician now withdraws the obturator instrument 28, sliding it off the guide pin instrument 26. This leaves the guide pin instrument 26 and the cannula instrument in place, as Fig. 17 shows. The physician next 25 slides the handle 60 along the guide pin instrument 26 away from the cannula instrument 30 to disengage the tapered fitting 50 from the second socket 66.
The physician then slides the handle 60 completely off the guide pin instrument 26.
30 The physician now acquires the drill bit instrument 32 from the tray 126. As Fig. 18 shows, the physician slides the drill bit instrument 32 over the guide pin instrument 26,. distal end first, through the cannula instrument 30 until contact between the machined surface 54 and bone tissue occurs. As Fig. 18 also shows, the physician next leads the guide pin instrument 26 through the first passage 72 and first socket 64 of the handle 60. The physician slides the handle 60 along the guide pin instrument 26 toward the tapered flange 56 of the drill bit instrument 32, until a running slip-fit occurs between the first socket, 64 and the tapered flange 56, as previously described. The drill bit instrument 32 is now ready for use.
As shown by Fig. 18, guided by X-ray (or another external visualizing sy:gtem), the physician applies appropriate twisting and longitudinal forces to the handle 60, to rotate and advance the cutting edge 54 of the drill bit instz.=ument 32 to open a passage 166 (see Fig. 19) through the bone tissue and completely into the cancellous bone 152. The drilled passage 166 preferable extends no more than 95% across the vertebral body 148.
The physician now slides the handle 60 along the guide pin instrument 26 away from the drill bit instrument 32 to disengage the tapered flange 56 from the first socket 64. The physician, further, slides the handle 60 completely off the guide pin instrument 26.
The physician can now remove the drill bit instrument 32 and the guide pin instrument 26, leaving only the cannula instrument 30 in place. The passage 166 made by the drill bit instrument 32 remains.. Subcutaneous access to the cancellous bone 152 has been accomplished.
The physician can now acquire the cavity forming instrument from the tray 126. As Fig. 20 shows, the physician can advance the expandable structure 86 through the cannula instrument 30 and passage 166 into the interior volume of the vertebral body 148, as Fig. 21 also shows. The structure 86 is in its normally collapsed and not expanded condition during deployment. The stylet 96 or 102 is inserted in the lumen. 94 of the catheter tube 78 to provide added stiffness to the structure 86 while being passed through the cannula instrument 30.
As shown in phantom lines in Fig. 20, the physician can, if desired, reconnect the handle 60 to the cannula instrument 30, to help stabilize the cannula instrument 30 while deploying the structure 86. The second passage 74 of the handle accommodates the catheter tube 78 and the structure 86, when collapsed.
As Fig. 21 shows, the structure 86 is oriented in the desired way in the passage 166. As before explained, the bent stylet 102 can aid in this task. Before, during, or after the orientation process, the stylet 96 or 102 can be withdrawn (as Fig. 21 shows), to open the lumen 94 for use to pass a rinsing liquid or negative aspiration pressure.
Sterile liquid is conveyed under pressure from the source 92 through the lumen 88 into the structure 86. As Fig. 22 shows, the structure 86 expands inside bone. Expansion of the structure 86 compresses cancellous bone 152 in the vertebral body 148.
The compression forms an interior cavity 168 in the cancellous bone 152. As Fig. 23 shows, subsequent collapse and removal of the structure 86 leaves the cavity 168 in a condition to receive a filling material.
The compaction of cancellous bone 152 can also exert interior force upon cortical bone., making it possible to elevate or push broken and compressed WO 00/09024 PCT/US99/1628.9 bone back to or near its original prefracture, or other desired, condition.
Upon formation of the cavity 168, the physician acquires the syringe 104 and injection nozzle 106 from the kit 12. As Fig. 24 shows, the physician fills the syringe chamber 110 with the desired volume of filling material 170. As Fig. 25 shows, the physician attaches the nozzle 106 to the filled syringe 104. As Fig. 26 shows, the physician inserts the nozzle 106 a selected distance beyond the distal end 36 of the cannula instrument 30 and into the cavity, guided by the markings 116.
As shown in phantom 7Lines in Fig. 26, the handle 60 can remain attached to the cannula instrument 30 to provide stability, as the second passage 74 of the handle accommodates the nozzle 106.
As Fig. 27 shows, the physician manually advances the piston 112 to cause the material 170 to flow through and out of the nos.zle 106 and into the cavity. As material 170 fills the cavity, the physician withdraws the nozzle from the cavity and into the cannula instrument: 30. The cannula instrument 30 channels the mate:rial 170 flow toward the cavity 168. As Fig. 28 shows, the cement material 170 flows in a stream into the cavity 168.
If the selected material 170 is bone cement, the cement material 171) is placed into the syringe chamber 110 shortly af-ter it is mixed from two materials (e.g., in an external mixing device), while it is in a low viscosity, relatively free flowing liquid state, like a thin pancake batter. In time (e.g., about two minutes after mixing), the consistency of the cement material 170 will change to a substantially putty-like character.
WO 00/09024 PCT/US99l16289 The physician operates the syringe 104 to expel the cement material 170 from the chamber, through the nozzle 106, first into the cavity and then into the cannula instrument 30. Typically, at the end of the syringe injection process, material 170 should extend from the cavity and occupy about 40% to 50% of the cannula instrument 30.
When a desired volume of cement is expelled from the syringe 104, the physician withdraws the nozzle 106 from the cannula instrument 30, as Fig.
29 shows. The physician may first rotate the syringe 104 and nozzle 106, to break loose the material 170 in the nozzle 106 from the ejected bolus of material 170 occupying the cannula instrument 30.
, The physician acquires the tamping instrument 108 from the kit 12. As Fig. 30 shows, the physician advances the tamping instrument 108 through the cannula instrument 30,. As phantom lines in Fig. 30 show, the handle 60 can remain attached to the cannula instrument 30 to provide stability, as the second passage 74 of the handle accommodates the tamping instrument 108.
The distal end of the tamping instrument 108 contacts the residual volume of cement material 170 in the cannula instrument 30. As Figs. 30 and 31 show, advancement of the tamping instrument 108 displaces progressively more of the residual material 170 from the cannula instrument 30, forcing it into the cavity 168. The flow of material 170 into the cavity 168, propelled by the advancement of the tamping instrument 108 in the cannula instrument 30, serves to uniformly distribute and compact the material 170 inside the cavity 168, without the application of undue pressure.
The use of the syringe: 104, nozzle 106, and the tamping instrument 108 allows the physician to exert precise control when filling the cavity with material 170. The physician can immediately adjust the volume and rate of delivery according to the particular local physiological conditions encountered. The application of low pressure (i.e., no greater than 360 psi), which is uniformly applied by the syringe 104 and the tamping instrument 108, allows the physician to respond to fill volume and flow resistance conditions in a virtually instantaneous fashion. The chance of overfilling and leakage of material 170 outside the cavity is significantly reduced.
When the physician is satisfied that the material 170 has been amply distributed inside the cavity 168, the physician withdraws the tamping instrument 1.08 from the cannula instrument 30. The physician preferably first twists the tamping instrument 108 to cleanly break contact with the material 170. The handle 60 can now be removed and the cannula instrument 30 withdrawn, as Fig. 32 shows. The incision site is sutured closed. The bone treatment procedure is concluded.
Eventually the material 170, if cement, will harden a rigid state within the cavity 168. The capability of the vertebral bc-dy 148 to withstand loads is thereby improved.
The selected material 170 can be an autograft or allograft bone graft tissue collected in conventional ways. For example, the graft material can be in paste form, as described by Dick, "Use of the Acetabular Reamer to Harvest Autogenic Bone Graft Material: A Simple r+iethod for Producing Bone Paste," Archives of Orthopaedic and Traumatic Surgery (1986), 105: 235-238, or in pellet form, as described by Bhan et al, "Percutaneous Bone Grafting for Nonunion and Delayed Union of Fractures of the Tibial Shaft," International Orthopaedics (SICOT) (1993) 17: 310-312. Alternatively, the bone graft tissue can be obtained using a Bone Graft Harvester, which is commercially available from SpineTech.
Using a funnel, the paste or pellet graft tissue material is loaded into the cannula instrument 30.
The tamping instrument 108 is then advanced into the cannula instrument 30 in the manner previously described, to displace the paste or pellet graft tissue material out of the cannula instrument 30 and into the cavity.
The selected material 170 can also comprise a granular bone material harvested from coral, e.g..
ProOsteonTM calcium carbonate granules, available from Interpore. The granules are loaded into the cannula instrument 30 using a funnel and advanced into the cavity using the tamping instrument 108.
The selected material 170 can also comprise demineralized bone matrix suspended in glycerol (e.g., GraftonTM allograft material available from Osteotech), or SRST'" calcium phosphate cement available from Novian. These viscous materials, like the bone cement previously described, can be loaded into the syringe 104 and injected into the cavity using the nozzle 106, which is inserted through the cannula instrument 30 into the cavity.
The tamping instrument 108 is used to displace residual material from the cannula instrument 30 into the cavity, as before described.
The selected material 170 can also be in sheet form, e.g. CollagraftT"' material made from calcium carbonate powder and collagen from bovine bone. The sheet can be rolled into a tube and loaded by hand into the cannula instrument 30. The tamping instrument 108 is then advanced through the cannula instrument, to push and compact the material in the cavity.
VI. Alternative Embodiments The use of low pressure delivery of material 170 frees the system 10 from the need to accommodate relatively large diameter, high pressure delivery devices. The interior diameter of the cannula instrument 30 can be downsized accordingly, thereby minimizing the dimensions of the subcutaneous pathway to gain access to the targeted bone region.
Typically, when low pressure material injection instruments are used, the largest tool that the reduced-diameter car.inula instrument must accommodate is the expandable cavity-forming structure 82. The structure 82 presents a minimal profile during deployment, as it can be collapsed and, if desired, a lubricous coating may also be applied to the exterior of the structure 82 to facilitate its passage through. the reduced-diameter cannula instrument.
A. Low Pressure Material Injection Instruments Fig. 33 exemplifies :Low pressure material injection instruments 180 and 182 that function in association with a cannula instrument 184 having a reduced interior diameter, e.g. only about 3.4 mm or less.
One instrument 180 comprises a reduced-diameter nozzle. As Fig. 33 shows, the nozzle 180 is sized to pass through the reduced-diameter cannula instrument 184, to thereby pass into bone in the manner previously shown in Fig. 26. The reduced-diameter nozzle 180 connects by a threaded connector 186 to the syringe 104. For material strength, despite its reduced dimension, the nozzle 180 is preferably formed from a rigid, metal material, e. g. , stainless steel.
As Fig. 33 shows, the reduced-diameter nozzle 180 also includes measured markings 188 along its length, as previously described. The markings 188 include a set point 190, as previously described, which aligns with the proximal end of the cannula instrument 184 when the distal ends of the cannula instrument 184 and the nozzle 180 align.
The other reduced diameter instrument 182 comprises a stylet, which is sized to pass through the interior bore of the nozz]Le 180. The stylet 182 includes a handle 192, which rests on the proximal connector 186 of the nozzle 180 when the stylet 182 is fully inserted into the nozzle 180. When the handle 192 is rested, the distal ends of the stylet 182 and nozzle 180 align. The presence of the stylet 182 inside the nozzle 180 closes the interior nozzle bore.
In use, the nozzle 7.80 is coupled to the syringe 104 and inserted through the cannula instrument 184 into the material-receiving cavity 168 formed in cancellous bone, in the same manner shown in Fig. 26. Material in the syringe 104 is injected at low pressure throucjh the noz z le 180 into the cavity 168. As before explained, as the cavity 168 progressively fills with material, the nozzle 180 is withdrawn back into the cannula instrument 184. Typically, when the injection of material is completed, material extends from the cavity 168 and occupies about 40% to 50% of the cannula instrument 184.
At this point, the nozzle 180 can be fully withdrawn from the cannula instrument 184 and unthreaded from the syringe 104. The stylet 182 can be advanced into the nozzle 180, to bring the handle 192 at rest against the co:nnector 186, thereby clearing residual material from the nozzle 180. The nozzle 180 and stylet can then be inserted as a nested unit into the cannula instrument 184. Nested together, the nozzle 180 and stylet 182 form a tamping instrument. Upon advancement through the cannula instrument 184, the riested nozzle 180 and stylet 182 displace residual material from the cannula instrument 184 into the cavity 168, in generally the same manner as previously shown in Figs. 30 and 31, thereby uniformly compacting material within the cavity 168 in a controlled fashion and without undue pressure.
Alternatively, a single-piece tamping instrument, separate from the nozzle 180, can be provided,.downsized to fit =through the reduced-diameter cannula instrument 184. In this embodiment, the stylet 182 is not necessary, unless it is desired to reclaim material from the nozzle.
B. cavity Forming Instrument Fig. 34 shows a caviity forming instrument 194 intended to be deployed through the reduced-diameter cannula instrument 184, shown in Fig. 33.
In many respects, the instrument 194 is like the instrument 76, previously described and shown in Fig. 4A, and common reference numerals will be assigned to common structural elements. The instrument 184 includes a flexible catheter tube 78 having a proximal end 80 and a distal end 82. The i proximal end 80 carries a handle grip 84, and the distal end 82 carries an expandable structure 86, which, when deployed in boneõ compacts cancellous bone and forms the cavity 168õ
Unlike the previously-described instrument 76, the instrument 194 carries; an introducer sleeve 196. The introducer sleeve :196 slides along the catheter tube 78 between the handle grip 84 and the expandable structure 86. The introducer sleeve 196 includes a tubular main body 198 with a forward collar 200 and a rear collar 202.
The introducer sleeve 196 normally occupies an advanced position on the instrument 194, as shown in Fig. 35. In this position, the main body 198 overlies and surrounds the expandable structure 86.
The main body 198 is sized to compress the structure 86 to an outside diameter that is slightly less than the interior diameter of the reduced-diameter cannula instrument 184.
As Fig. 35 shows, when the introducer sleeve 196 occupies the advanced position, the forward collar 200 extends beyond the distal end of the compressed expandable structure 82. As Fig. 36 shows, in this position, the forward collar 200 presents itself for engagement with the proximal end 204 of the cannula instrument 184. The forward collar 200 is sized to have an interior diameter that makes friction-fit engagement about the proximal end 204 of the cannula instrument 184.
As Fig. 36 shows, when it is time to deploy the expandable structure 86 through the cannula instrument 184, the physician engages the forward collar 200 of the introducer sleeve 196 in a friction fit about the proximal end 204 of the cannula instrument 184. As Fig. 37 shows, advancing the catheter tube 78 moves the compressed structure 86 through the main body 198 of the sleeve 196 and into the bore of the cannula instrument 184. The engagement of the forward collar 200 about the proximal cannula end 204 aligns the axis of the structure 86 with the axis of the cannula instrument 184, while compressing the structure 86 to a diameter smaller than the interior of the cannula instrument 184. Upon advancement of the catheter tube 78, the introducer sleeve 196 guides the structure 86 into the cannula instrument 194 without tearing or other damage.
Once the expandable structure 86 is advanced through the cannula instrument 184 and into bone, the physician can slide the introducer sleeve 196 rearward away from the proximal cannula end 204, to break the friction fit between the end 204 and the forward sleeve. As Fig. 34 shows, the rear collar 202 of the sleeve 196.is sized to make a snap fit engagement about a stem 206, which surrounds the catheter tube 78 near the handle 84. The snap fit engagement stabilizes the posiition of the sleeve 196 during subsequent use and manipulation of the cavity-forming instrument 194.
The features of the irivention are set forth in the following claims.
The distal end 36 of the cannula instrument 30 presents an end surface 48. In use, the end surface 48 of the cannula instrument 30 is intended to penetrate soft tissue surrounding the obturator instrument 28 in response to pushing or twisting forces applied at the proximal end 34.
The proximal end 34 carries an enlarged fitting 50. The fitting 50 tapers from a larger diameter to a smaller diameter in the direction of the proximal end 34. Like the tapered flange 40 on the obturator instrument 28, the tapered fitting 50 has an array of circumferentially spaced teeth 52.
The tapered fitting 50 of the cannula instrument 30 possesses a larger maximum outer diameter than the maximum outer diameter of the tapered flange 40 of the obturator instrument 28.
The cannula instrument 30 includes measured markings 118 along its length(see Fig. 3). The measured markings 118 gauge the depth of insertion.
The markings 118 can be placed, for example, at one centimeter intervals. As Fig. 3 shows, the markings 118 can be consecutively numbered, beginning at the distal end 36, so that the physician can ascertain i I!
.. 14 _ the insertion depth at a glance.
D. The Drill Bit Instrument The instrument 32 functions as a drill bit.
The drill bit instrument 32 has generally the same physical dimensions as the obturator instrument 28.
Like the obturator iristrument 28, the drill bit instrument 32 is intended, in use, to fit for sliding and rotational movement within the interior lumen 46 of the cannula instrument 30.
The distal end 36 of the drill bit instrument 32 includes machined cutting edges 54. In use, the cutting edges 54 are intended to penetrate hard tissue in response to rotation and longitudinal load forces applied at the proximal end 34 of the drill bit instrument 32.
The proximal end 34 presents a tapered flange 56, which is substantially identical to the flange 40 on the obturator instrument 28. Like the obturator instrument 28, the tapered flange 56 changes from a larger diameter to a smaller diameter in the direction of the proximal end 34. The tapered flange 56 of the drill bit instrument 32 also includes an array of circumferentially spaced teeth 58. The form and orientation of the teeth 58 on the drill bit instrument 32 correspond to the form and orientation of the teeth 42 on the obturator instrument 28.
E. The Handle The group includes a handle 60. The handle 60 engages the functional instruments 28, 30, and 32 in a removable, slip fit fashion to aid a physician in manipulating the instruments during use.
The handle 60 is made from a molded or cast rigid plastic or metal material. The handle 60 is shaped to be comfortably and securely grasped by a normal human hand. The shape and size to accommodate this function can, of course, vary. In the illustrated embodiment, the handle 60 is elongated along a main axis to fit comfortably across the palm of the hand.
The handle 60 includles a center post 62, which is integrally molded tci the handle 60 about its geometric center. The center post 62 extends downward to give the handle 60 a general T-shape.
The handle 60 includes two interior cavities or sockets 64 and 66 in the center post 62.
The sockets guide the attachment between the handle 60 and the instruments 28, 30, and 32. The first and second sockets 64 and 66 are. sized to present unique attachment sites for different functional instruments.
The first socket 64 includes an array of circumferentially spaced grooves 68, which, in form and orientation, match the teeth 42 and 58 at the proximal ends 34 of the obturator instrument 28 and the drill bit instrument 32. The first socket 64 accepts the tapered flange 40 or 56 of either the obturator instrument 28 or the drill bit instrument 32. The teeth 42 and 58 of either tapered flange 40 or 56 mesh in a slip-fit with the grooves 68 of the first socket 64. The running slip-fit allows longitudinal force to be applied to either instrument 28 or 32 through the handle 60. The running slip-fit also prevents relative rotation between either instrument 28 or 32 and the first socket 64, thereby permitting torsional or twisting forces to be applied to either instrument 28 or 32 by the handle 60, with an increased mechanical advantage.
The second socket 66 is larger than the first socket 64 and is sized to accept the larger tapered fitting 50 of the cannula instrument 30. The second socket 66 includes an array of circumferentially spaced grooves 70, which, in form and orientation, match the teeth 52 on the tapered fitting 50. The teeth 52 of the tapered fitting 50 mesh in a slip-fit with the grooves 70 of the second socket 66. The running slip-fit allows both longitudinal and torsional forces to be applied to the cannula instrument 30 through the handle 60, with increased mechanical advantage.
As shown in phantom lines in Fig.3, a first passage 72 extends through the top of the handle 60, through the center post 62, and into the first socket 64. The passage 72 is generally aligned with the center of the first socket 64 and is sized to pass the guide pin instrument 26 (see Fig. 12).
Likewise, as also shown in phantom lines in Fig. 3) a second passage 74 extends through the top of the handle 60, through the center post 62, and into the second socket 66. The passage 74 is generally aligned with the center of the second socket 66 and is sized to pass the either obturator instrument 28 or the drill bit instrument 32 (see Fig. 14).
Further details of the handle 60 can be found in copending U.S. Patent Serial No. 6,468,279, filed January 27, 1998, and entitled "A Slip-Fit Handle for Hand-Held Instruments that Access Interior Body Regions."
Further details regarding the use of the handle 60 and the associated instruments 26, 28, and 30 will be provided later.
II. The Cavity Forming Instrument As Fig. 4A shows, the group 16 includes an WO 00/09024 PCTlUS99/16289 instrument 76, which is deployed through the cannula instrument 30 to a location inside bone (see Fig.
20). When so deployed, the instrument 76 serves to form a cavity in cancellous bone.
The instrument 76 can be constructed in various ways. In the illustrated embodiment, the instrument 76 includes a flexible catheter tube 78 having a proximal end 80 and a distal end 82. The proximal end 80 carries a handle grip 84 to facilitate gripping and maneuvering the catheter tube 78. The materials for the: catheter tube 78 are selected to facilitate its advancement through the cannula instrument 30. The catheter tube 78 can be constructed, for example, using standard flexible, medical grade plastic materials, like vinyl, nylon, polyethylenes, ionomer, polyurethane, and polyethylene tetraphthalate (PET). The catheter tube 78 can also include more rigid materials to impart greater stiffness and thereby aid in its manipulation. More rigid materials that can be used for this purpose include stainless steel, nickel-titanium alloys (NitinolTM material), and other metal alloys.
The distal end 82 of the instrument 76 carries an expandable structure 86. In the illustrated embodiment, the expandable structure 86 is made from a polyurethane or an elastomer (e.g., silicone or nylon) material. 'rhe structure 86 has been preformed to possess a. desired shape by exposure to heat and pressure, e.g., through the use of conventional thermoforming techniques.
As Fig. 4B shows, thie catheter body 78 includes an interior lumen 88, which communicates with the interior of the structure 86. A fitting 90 on the proximal end 80 of the catheter tube 78 (see Fig. 4B) communicates with thE: lumen 88. The fitting 90 couples the lumen 88 to a source 92 of fluid, e.g., sterile saline (see Fig. 21), or a radiopaque contrast medium.
The fluid is introduced from the source 92 into the structure 86 under positive pressure, causing the structure 86 to expand. During expansion inside bone, the material selected for the structure 86 preferably resists deformation, so that the expanded shape inside bone essentially corresponds to its expanded shape outside bone, i.e., when in an open air environment. This allows the physician to select in an open air environment a structure 86 having an expanded shape desired to meet the targeted therapeutic result, with the confidence that the expanded shape inside bone will be similar in important respects. In addition to being able to expand its volume while resisting deformation inside bone, the material of the structure 86 preferable withstands abrasion, tearing, and puncture when in contact with cancellous bone.
The shape of the structure 86, when expanded inside bone, is selected by the physician, taking into account the morphology and geometry of the site to be treated. The shape of the cancellous bone to be compressed, and the local structures that could be harmed if bone were moved inappropriately, are generally understood by medical professionals using textbooks of human skeletal anatomy along with their knowledge of the site and its disease or injury. The physician is also able to select the expanded shape inside bone based upon prior analysis of the morphology of the targeted bone using, for example, plain film x-ray, fluroscopic x-ray, or MRI
or CT scanning. The expanded shape inside bone is selected to optimize the formation of a cavity that, e.g., when filled with a suitable material, provides support across the region of the bone being treated.
As one general guideline, in cases where the bone disease causing fracture (or the risk of fracture) is the loss of cancellous bone mass (as in osteoporosis), the selection of the expanded shape of the structure 86 inside bone should take into account that from 30% to 90% of the cancellous bone volume should be compacted. Another general guideline is the amount that the: targeted fractured bone region has been displaced or depressed. The expansion of the structure 86 within the cancellous bone region inside a bone can elevate or push the fractured cortical wall back to or near its anatomic position occupied before fracture occurred.
In the illustrated embodiment (see Fig.
4A), the structure 86 possesses a preformed hour-glass or peanut shape. This shape is selected in contemplation of deploying the structure 86 in a vertebral body, as will be described in greater detail later.
To facilitate deployment of the structure 86 through the cannula instrument 30, the catheter tube 78 includes a second interior lumen 94. The lumen 94 extends from a second fitting 98 on the proximal end 80 of the catheter tube 78, through the body of the cannula tube 78, and through the interior of the structure 86 to the tip end 172 of the structure 86. The lumen 94 receives a generally stiff stylet 96, which can be made from a molded plastic or stainless steel mate:rial. The stylet 96 is inserted through the fitting 98 into the lumen 94, and includes a threaded coupling 100 to secure the stylet 96 against movement. The presence of the stylet 96 serves to keep the structure 86 in the desired distally straightened condition during passage through the cannula instrument 30 into the targeted tissue region. Once the structure 86 is free of the cannula instrument 30 andinside bone, the stylet 96 can be withdrawn (shown by arrow 174 in Fig. 4A). This returns normal flexibility to the catheter tube 78 and facilitates manipulation of the structure 86 inside bone. With the stylet 96 withdrawn, the lumen 94 can also serve as a pathway for introducing rinsing liquid or to aspirate debris from the bone.
In the illustrated embodiment, the stylet 96 is biased toward a generally straight condition.
In an alternative embodiment (see Fig. 4C), a stylet 102 can have a preformed memory, to normally bend its distal region. The memory is overcome to straighten the stylet 102 when confined within the cannula instrument 30. However, as the structure 86 and distal region of the preformed stylet 102 advance free of the cannula instrument 30, to pass into the targeted region, the preformed memory bends the distal region of the stylet 102 and thereby shifts the main axis of the expandable structure 86.--The prebent stylet 102, positioned within the interior of the structure 86, aids in altering the orientation of the structure 86, bringing it into better anatomic alignment with the targeted region.
Other types of instruments that can form cavities in cancellous bone and other interior body regions are described in copending U.S. Patent Serial No. 6,440,138, entitled "Structures and Methods for Creating Cavities in Interior Body Regions," filed April 6, 1998.
III. The Material Introducing Instrument Group The group 18 includes irtstruments 104, 106, and 108 which serve to convey and compact a selected material inside the cavity formed by the structure 86. The material in the cavity provides a desired therapeutic result, e.g., rep:lacement of tissue mass, or.renewed interior suppo:rt for the bone, or the delivery of medication, or combinations thereof.
Accordingly, the material to perform this function can be selected from among, e.g., a material that sets to a hardened condition, including bone cement, autograft tissue, allograft tissue, synthetic bone substitute, as well as a medication, or combinations thereof.
In the illustrated embodiment, the group 18 comprises material injection instruments 104 and 106 and a material tamping instrument 108, which deliver.
material at a low delivery pressure, i.e., a pressure no greater than about :360 psi.
A. Low Pressure Material Injection Instruments In the illustrated embodiment, the material is injected by use of a conventional syringe 104, to which a specially designed injection nozzle 106 is coupled. A manual actuated syringe with a push plunger can be used. Alternatively, a LeVeen Inflation Syringe with threaded plunger can be used, which can be actuated manualJLy or by use of a mechanical actuator.
In the illustrated embodiment, the syringe 104 is made from a clear plastic material. The syringe 104 includes a chamber 110, which receives the material to be injected. The material is expressed from the chamber 100 by a manually advanced syringe piston 112 (see also Fig. 25).
The injection nozzle 106 connects by a threaded connector 114 to the endlof the syringe 104 9 (see also Fig. 25). In the illustrated embodiment, the nozzle 106 is made from a qenerally flexible, inert plastic material, such as such as polyethylene or an other suitable polymer. Alternatively, the nozzle 106 can be made from a generally rigid plastic or metal material.
The injection nozzle 106 is sized to be advanced through the cannula instrument 30 (see Fig.
26). The nozzle 106 includes measured markings 116 along its length. The markings 116 can be placed, for example, at one centimeter intervals, to correspond with the markings :L18 on the cannula instrument 30, so that the relative position of the nozzle 106 within the cannula instrument 30 can be gauged. The markings 118 can, e.g., include a set point 176. Alignment of the sc:t point 176 at the proximal end 34 of the canniala instrument 30, indicates that the distal end of the nozzle 106 is located in an aligned relationship with the distal end 36 of the cannula instrument 30. In this arrangement, the markings 118 are consecutively numbered with positive numbers proximally of the set point 176 and with negative numbers distally of the set point 176. The physician is thereby able to tell at a glance the location of the distal end of the nozzle 106, in terms of how far beyond or short of the distal end 36 of the cannula instrument 30 it is.
In use, the distal end of the nozzle 106 is located beyond the distal end 36 of the cannula instrument 30 within the cavity formed in the targeted tissue region. As Fig. 5 shows, the distal end of the nozzle 106, when made from a plastic material, can carry at least one radiopaque marker 208, to enable remote visualization of the nozzle position within the body. The syringe 104 ejects a predetermined volume of material into the nozzle 106 in a low pressure stream into the cavity. As the material fills the cavity, the nozzle (still ejecting material) is retracted from the cavity and into the cannula instrument 30 itself. Further details of this function and resiult will be provided later.
B. The Material Tamping Instrument The group 18 also includes a material tamping instrument 108. The tamping instrument 108 is made from generally rigid, inert plastic or metal material. The tamping instrumeint 108 is also sized to be advanced into the cannula. instrument 30 (see Fig. 30). The free end 124 of the tamping instrument 108 is ribbed or contoured to facilitate gripping the instrument 108 during use.
The tamping instrunient 108 includes measured markings 122 along its length. The markings 116 can be placed, for example, at one centimeter intervals, to correspond with the markings 118 on the cannula instrument 30, sc> that the relative position of the tamping instrument 108 within the cannula instrument 30 can be gauged. Like the nozzle 106, the markings 122 on the tamping instrument 108 includes a set point 178, which indicates when the distal end of the tamping instrument 108 aligns with the distal end 36 of the cannula instrument 30. Also like the nozzle 106, the markings 122 on the tamping instrument 108 are consecutively numbered with positive numbers proximally of -the set point 178 and with negative numbers distally of the set point 178.
The physician is thereby able to tell at a glance the location of the end of the tamping instrument 108, in terms of how far beyond or short of the distal end 36 of the cannula instrument 30 it is. As Fig. 5 also shows, the end of 'the tamping instrument 108, when made from a plasticimaterial, can carry at least one radiopaque marker 210, so that its position can be visualized from outside the body.
After withdrawal of the nozzle 106 from the cannula instrument 30, residual material is left in the cannula instrument 30. The purpose of the tamping instrument 108 is to displace the residual material out the distal end. 36 of the cannula instrument 30 and into the cavity, to thereby fill the cavity without exerting undue pressure within the bone. The tamping instrument 108 thereby serves to clear residual material from the cannula instrument 30, to assure that the desired volume of material is delivered into the cavity. The removal of residual material from the cannula instrument 30.
by the tamping instrument 108 also prevents seepage of material into surrounding tissue regions upon removal of the cannula instru:ment 30. The tamping instrument 108 also compacts the material uniformly within the cavity, again without undue pressure.
Further details of these functions and results will be discussed later.
IV. The Kit As Figs. 1 and 2 show, in the illustrated embodiment, the kit 12 includes an interior tray 126 made, e.g., from die cut cardboard, plastic sheet, or thermo-formed plastic material. The tray 126 includes spaced apart tabs 1,28, which hold the various instruments in a secure position during sterilization and storage prioz- to use.
When packaged as a sterile assembly, the kit 12 includes an inner wrap 130, which is peripherally sealed by heat or the like, to enclose the tray 126 from contact iwith the outside environment. One end of the inner wrap includes a conventional peal-away seal 132,, to provide quick access to the tray 126 at the instant of use, which preferably occurs in a sterile erivironment, such as within an operating room.
When packaged as a sterile assembly, the kit 12 also includes an outer wrap 134, which is also peripherally sealed by heat or the like, to enclosed the inner wrap 130. One end of the outer wrap includes a conventional pea:1-away seal 136, to provide access to the inner wrap 130 and its contents. The outer wrap 134 can be removed -from the inner wrap in anticipation of imminent use, without compromising sterility of the contents of the kit 12.
As Fig. 2 shows, each iinner and outer wrap 130 and 134 includes a peripherally sealed top sheet 138 and bottom sheet 140. In the illustrated embodiment, the top sheet 138 is made of transparent plastic film, like polyethylene or MYI,AR material, to allow visual identification of the contents of the kit 12. The bottom sheet 1.40 is made from a material that is permeable to ETO sterilization gas, e.g., TYVEK plastic material (available from DuPont).
In the illustrated embodiment, the tray 126 presents the instruments groups 14, 16, and 18 in an ordered, organized layout, which is arranged to aid the physician in carrying out the intended procedure. For example, the layout of the tray 126 can present the instruments groups 14, 16, and 18 in top-to-bottom order, accordinq to sequence of intended use. For example, in a typical bone access procedure (as will be demonsti-ated in greater detail later), the stylet 22 and stylus 24 of the spinal needle assembly 20 are deployed first, followed by the guide pin instrument 26, followed by the obturator instrument 28, then the cannula instrument 30, then the drill bit instrument 32, then the cavity forming instrument 76, then the syringe 104 and nozzle 106 instruments, and lastly the tamping instrument 108. Accordingly, the tray 126 packages these instruments and componeints in a top-to-bottom order, with the spinal needle: assembly 20 topmost, the guide pin instrument 26 next, the obturator instrument 28 next, and so on, with the tamping instrument 108 lowermost on the tray 126.
In this layout, the handle 60 is packaged to the side of the access instrument group 14. The tray 126 can include written labels (not shown) identifying the components contained in the kit 12.
The kit 12 also preferably includes in the tray 126 directions 144 for using the contents of the kit 12 to carry out a dlesired procedure. An exemplary procedure which thie directions 144 can describe will be explained later.
When packaged as a sterile assembly, the directions 144 can also include the statement "For Single Patient Use Only" (or comparable language) to affirmatively caution against reuse of the contents of the kit 12 whose performance characteristics and efficacy degrade after a single use. The spinal needle assembly 20, the cavity forming instrument 76, and the material introducing instruments 104, 106, and 108 should, for these reasons, be used but a single time and then discarded. The directions 144 also preferably affirmatively instruct against resterilization of at least these contents of kit 12, and also instructs the physician to dispose of at least these contents of the :kit 12 upon use in accordance with applicable biological waste procedures.
The presence of the instrument groups 14, 16, and 18 packaged in the ster9Lle kit 12 verifies to the physician that the contents are sterile and have not been subjected to prior use. The physician is thereby assured that the instrument groups meet established performance and sterility specifications.
It should be appreciated that the various instruments contained in the kit 12 can be packaged into several, smaller functional kits. For example, a first kit can package the access instrument group 14, a second kit can package the cavity forming instrument group 16, and a third kit can package the material introduction instrument group 18. Figs. 1 and 2 illustrate one of many different possible embodiments.
V. Illustrative Use of the System The following describes use of the instrument groups 14, 16, and 18 packaged in the kit 12 in the context of treating bones. This is because the instruments of the giroups 14, 16, and 18 can be advantageously used for this purpose. Still, it should be appreciated that one or more of the instrument groups, used alone or in association with other instruments, can perform other diagnostic or therapeutic functions in other interior regions of the body.
In particular, the instrument groups 14, 16, and 18 will described with regard to the treatment of human vertebra. It should be appreciated, however, their use is not limited to human vertebrae. The instrument groups 14, 16, and 18 can be used in association with hand-held instruments in the treatment of diverse human or animal bone types.
A. The Vertebral Body As Figs. 6 and 7 show, a typical vertebra 146 includes a vertebral body 148, which extends on the anterior (i.e., front or chest) side of the vertebra 146. The vertebral body 148 has the shape of an oval disk. The vertebral body 148 includes an exterior formed from compact cortical bone 150. The cortical bone 150 encloses an interior volume of reticulated cancellous, or spongy, bone 152 (also called medullary bone or trabecular bone).
The spinal cord 154 passes through the spinal canal 156 of the vertebr=a 146. The vertebral arch 158 surrounds the spinal canal 156. The pedicles 160 of the vertebral arch 158 adjoin the vertebral body 148. The spinous process 162 extends from the posterior of the vertebral arch 158, as do the left and right transverse processes 164.
B. Treatment of a Vertebral Body During a typical procedure, a patient lies on an operating table. The patient can lie face down on the table, or on either side, or at an oblique angle, depending upon the physician's preference.
The physiciari or surgical assistant removes the outer and inner wraps 130 and 134 of the kit 12, exposing the tray 126 for use. The physician acquires the spinal needle assembly 20 from the tray 126. As Fig. 8 shows, the physician introduces the spinal needle assembly 20 into soft tissue ST in the patient's back. Under radiologic or CT monitoring, the physician advances the spina.l needle assembly 20 through soft tissue down to and into the targeted vertebra 146. The physician will typically administer a local anesthetic, for example, lidocaine, through assembly 20. In some cases, the physician may prefer other forms of anesthesia.
The physician directs the spinal needle assembly 20 to penetrate the cortical bone 150 and the cancellous bone 152 of the targeted vertebral body 148. Preferably the depth of penetration is about 60% to 95% of the vertebral body 148.
Fig. 8 shows gaining access to cancellous bone through the side of the vertebral body 148, which is called postero-lateral access. However, access may be indicated through a pedicle 160, which is called transpedicular access. The type of access is based upon the objectives of the treatment or for other reasons, based upon the preference of the physician.
As Fig. 9. shows, after positioning the spinal needle assembly 20 in caLncellous bone 152, the physician holds the stylus 24 and withdraws the stylet 22. The physician acquires the guide pin instrument 26 from the tray 126. As Fig. 10 shows, while still holding the stylus 24, the physician slides the guide pin instrumeint 26 through the stylus 24 and into the cancellous bone 152. The physician now removes the stylus 24 (see Fig. 11) , leaving the guide pin instrument 26 deployed within the cancellous bone 152.
The physician next acquires the obturator instrument 28 and the handle 60 from the tray 126.
The physician slides the obturator instrument 28 over the guide pin instrument 26, distal end first.
The physician slides the guide pin instrument 26 through the first passage 72 and the first socket 64 of the handle 60. As Fig. 12 shows, the physician slides the handle 60 along thie guide pin instrument 26 toward the tapered flange 40 of the obturator instrument 28, until achieving a running slip-fit between the first socket 64 and the tapered flange 40, in the manner previously described. The obturator instrument 28 is now ready for use.
As Fig. 12 shows, lthe physician makes a small incision I in the patient's back. The physician twists the handle 60 while applying longitudinal force to the handle 60. In response, the surface 38 of the obturator instrument 28 rotates and penetrates soft tissue ST through the incision I. The physician may also gently tap the handle 60, or otherwise apply appropriate additional longitudinal force to the handle 60, to advance the obturator instrument 28 through the soft tissue along the guide pin instrument: 26 down to the entry site (see Fig. 13). The physician can also tap the handle 60 with an appropriate striking tool to advance the surface 30 of the obturator instrument 28 into the side of the vertebral body 148 to secure its position (as Fig. 13 shows).
The physician next slides the handle 60 along the guide pin instrument 26 away from the obturator instrument 28 to disengage the tapered flange 40 from the first socket 64. The physician then proceeds to slide the handle 60 completely off the guide pin instrument 26.
The physician acquires the . cannula instrument 30 from the tray 126. As Fig. 14 shows, the physician slides the cannu]La instrument 30 over the guide pin instrument 26, distal end first, and, further, over the obturator instrument 28, until contact between the end surface 48 and soft tissue tissue ST. The physician now slides the guide pin instrument 26 and obturator instrument 26 through the second passage 74 and secorid socket 66 of the handle 60. The physician slides the handle 60 toward the tapered fitting 50 of the cannula instrument 30 until a running slip-fit occurs between the second socket 66 and the tapered fitting 50, as previously described. The cannula instrument 30 is now ready for use.
As Fig. 14 shows, the physician applies appropriate twisting and longituidinal forces to the handle 60, to rotate and advance the cannula instrument 30 through soft tissue ST along the obturator instrument 28. As Fig. 15 shows, when the end surface 48 of the cannula instrument 30 contacts cortical bone, the physician caii appropriately tap the handle 60 with a striking tool to advance the end surface into the side of the vertebral body 148 to secure its position.
As Fig. 16 shows, the physician now withdraws the obturator instrument 28, sliding it off the guide pin instrument 26. This leaves the guide pin instrument 26 and the cannula instrument in place, as Fig. 17 shows. The physician next 25 slides the handle 60 along the guide pin instrument 26 away from the cannula instrument 30 to disengage the tapered fitting 50 from the second socket 66.
The physician then slides the handle 60 completely off the guide pin instrument 26.
30 The physician now acquires the drill bit instrument 32 from the tray 126. As Fig. 18 shows, the physician slides the drill bit instrument 32 over the guide pin instrument 26,. distal end first, through the cannula instrument 30 until contact between the machined surface 54 and bone tissue occurs. As Fig. 18 also shows, the physician next leads the guide pin instrument 26 through the first passage 72 and first socket 64 of the handle 60. The physician slides the handle 60 along the guide pin instrument 26 toward the tapered flange 56 of the drill bit instrument 32, until a running slip-fit occurs between the first socket, 64 and the tapered flange 56, as previously described. The drill bit instrument 32 is now ready for use.
As shown by Fig. 18, guided by X-ray (or another external visualizing sy:gtem), the physician applies appropriate twisting and longitudinal forces to the handle 60, to rotate and advance the cutting edge 54 of the drill bit instz.=ument 32 to open a passage 166 (see Fig. 19) through the bone tissue and completely into the cancellous bone 152. The drilled passage 166 preferable extends no more than 95% across the vertebral body 148.
The physician now slides the handle 60 along the guide pin instrument 26 away from the drill bit instrument 32 to disengage the tapered flange 56 from the first socket 64. The physician, further, slides the handle 60 completely off the guide pin instrument 26.
The physician can now remove the drill bit instrument 32 and the guide pin instrument 26, leaving only the cannula instrument 30 in place. The passage 166 made by the drill bit instrument 32 remains.. Subcutaneous access to the cancellous bone 152 has been accomplished.
The physician can now acquire the cavity forming instrument from the tray 126. As Fig. 20 shows, the physician can advance the expandable structure 86 through the cannula instrument 30 and passage 166 into the interior volume of the vertebral body 148, as Fig. 21 also shows. The structure 86 is in its normally collapsed and not expanded condition during deployment. The stylet 96 or 102 is inserted in the lumen. 94 of the catheter tube 78 to provide added stiffness to the structure 86 while being passed through the cannula instrument 30.
As shown in phantom lines in Fig. 20, the physician can, if desired, reconnect the handle 60 to the cannula instrument 30, to help stabilize the cannula instrument 30 while deploying the structure 86. The second passage 74 of the handle accommodates the catheter tube 78 and the structure 86, when collapsed.
As Fig. 21 shows, the structure 86 is oriented in the desired way in the passage 166. As before explained, the bent stylet 102 can aid in this task. Before, during, or after the orientation process, the stylet 96 or 102 can be withdrawn (as Fig. 21 shows), to open the lumen 94 for use to pass a rinsing liquid or negative aspiration pressure.
Sterile liquid is conveyed under pressure from the source 92 through the lumen 88 into the structure 86. As Fig. 22 shows, the structure 86 expands inside bone. Expansion of the structure 86 compresses cancellous bone 152 in the vertebral body 148.
The compression forms an interior cavity 168 in the cancellous bone 152. As Fig. 23 shows, subsequent collapse and removal of the structure 86 leaves the cavity 168 in a condition to receive a filling material.
The compaction of cancellous bone 152 can also exert interior force upon cortical bone., making it possible to elevate or push broken and compressed WO 00/09024 PCT/US99/1628.9 bone back to or near its original prefracture, or other desired, condition.
Upon formation of the cavity 168, the physician acquires the syringe 104 and injection nozzle 106 from the kit 12. As Fig. 24 shows, the physician fills the syringe chamber 110 with the desired volume of filling material 170. As Fig. 25 shows, the physician attaches the nozzle 106 to the filled syringe 104. As Fig. 26 shows, the physician inserts the nozzle 106 a selected distance beyond the distal end 36 of the cannula instrument 30 and into the cavity, guided by the markings 116.
As shown in phantom 7Lines in Fig. 26, the handle 60 can remain attached to the cannula instrument 30 to provide stability, as the second passage 74 of the handle accommodates the nozzle 106.
As Fig. 27 shows, the physician manually advances the piston 112 to cause the material 170 to flow through and out of the nos.zle 106 and into the cavity. As material 170 fills the cavity, the physician withdraws the nozzle from the cavity and into the cannula instrument: 30. The cannula instrument 30 channels the mate:rial 170 flow toward the cavity 168. As Fig. 28 shows, the cement material 170 flows in a stream into the cavity 168.
If the selected material 170 is bone cement, the cement material 171) is placed into the syringe chamber 110 shortly af-ter it is mixed from two materials (e.g., in an external mixing device), while it is in a low viscosity, relatively free flowing liquid state, like a thin pancake batter. In time (e.g., about two minutes after mixing), the consistency of the cement material 170 will change to a substantially putty-like character.
WO 00/09024 PCT/US99l16289 The physician operates the syringe 104 to expel the cement material 170 from the chamber, through the nozzle 106, first into the cavity and then into the cannula instrument 30. Typically, at the end of the syringe injection process, material 170 should extend from the cavity and occupy about 40% to 50% of the cannula instrument 30.
When a desired volume of cement is expelled from the syringe 104, the physician withdraws the nozzle 106 from the cannula instrument 30, as Fig.
29 shows. The physician may first rotate the syringe 104 and nozzle 106, to break loose the material 170 in the nozzle 106 from the ejected bolus of material 170 occupying the cannula instrument 30.
, The physician acquires the tamping instrument 108 from the kit 12. As Fig. 30 shows, the physician advances the tamping instrument 108 through the cannula instrument 30,. As phantom lines in Fig. 30 show, the handle 60 can remain attached to the cannula instrument 30 to provide stability, as the second passage 74 of the handle accommodates the tamping instrument 108.
The distal end of the tamping instrument 108 contacts the residual volume of cement material 170 in the cannula instrument 30. As Figs. 30 and 31 show, advancement of the tamping instrument 108 displaces progressively more of the residual material 170 from the cannula instrument 30, forcing it into the cavity 168. The flow of material 170 into the cavity 168, propelled by the advancement of the tamping instrument 108 in the cannula instrument 30, serves to uniformly distribute and compact the material 170 inside the cavity 168, without the application of undue pressure.
The use of the syringe: 104, nozzle 106, and the tamping instrument 108 allows the physician to exert precise control when filling the cavity with material 170. The physician can immediately adjust the volume and rate of delivery according to the particular local physiological conditions encountered. The application of low pressure (i.e., no greater than 360 psi), which is uniformly applied by the syringe 104 and the tamping instrument 108, allows the physician to respond to fill volume and flow resistance conditions in a virtually instantaneous fashion. The chance of overfilling and leakage of material 170 outside the cavity is significantly reduced.
When the physician is satisfied that the material 170 has been amply distributed inside the cavity 168, the physician withdraws the tamping instrument 1.08 from the cannula instrument 30. The physician preferably first twists the tamping instrument 108 to cleanly break contact with the material 170. The handle 60 can now be removed and the cannula instrument 30 withdrawn, as Fig. 32 shows. The incision site is sutured closed. The bone treatment procedure is concluded.
Eventually the material 170, if cement, will harden a rigid state within the cavity 168. The capability of the vertebral bc-dy 148 to withstand loads is thereby improved.
The selected material 170 can be an autograft or allograft bone graft tissue collected in conventional ways. For example, the graft material can be in paste form, as described by Dick, "Use of the Acetabular Reamer to Harvest Autogenic Bone Graft Material: A Simple r+iethod for Producing Bone Paste," Archives of Orthopaedic and Traumatic Surgery (1986), 105: 235-238, or in pellet form, as described by Bhan et al, "Percutaneous Bone Grafting for Nonunion and Delayed Union of Fractures of the Tibial Shaft," International Orthopaedics (SICOT) (1993) 17: 310-312. Alternatively, the bone graft tissue can be obtained using a Bone Graft Harvester, which is commercially available from SpineTech.
Using a funnel, the paste or pellet graft tissue material is loaded into the cannula instrument 30.
The tamping instrument 108 is then advanced into the cannula instrument 30 in the manner previously described, to displace the paste or pellet graft tissue material out of the cannula instrument 30 and into the cavity.
The selected material 170 can also comprise a granular bone material harvested from coral, e.g..
ProOsteonTM calcium carbonate granules, available from Interpore. The granules are loaded into the cannula instrument 30 using a funnel and advanced into the cavity using the tamping instrument 108.
The selected material 170 can also comprise demineralized bone matrix suspended in glycerol (e.g., GraftonTM allograft material available from Osteotech), or SRST'" calcium phosphate cement available from Novian. These viscous materials, like the bone cement previously described, can be loaded into the syringe 104 and injected into the cavity using the nozzle 106, which is inserted through the cannula instrument 30 into the cavity.
The tamping instrument 108 is used to displace residual material from the cannula instrument 30 into the cavity, as before described.
The selected material 170 can also be in sheet form, e.g. CollagraftT"' material made from calcium carbonate powder and collagen from bovine bone. The sheet can be rolled into a tube and loaded by hand into the cannula instrument 30. The tamping instrument 108 is then advanced through the cannula instrument, to push and compact the material in the cavity.
VI. Alternative Embodiments The use of low pressure delivery of material 170 frees the system 10 from the need to accommodate relatively large diameter, high pressure delivery devices. The interior diameter of the cannula instrument 30 can be downsized accordingly, thereby minimizing the dimensions of the subcutaneous pathway to gain access to the targeted bone region.
Typically, when low pressure material injection instruments are used, the largest tool that the reduced-diameter car.inula instrument must accommodate is the expandable cavity-forming structure 82. The structure 82 presents a minimal profile during deployment, as it can be collapsed and, if desired, a lubricous coating may also be applied to the exterior of the structure 82 to facilitate its passage through. the reduced-diameter cannula instrument.
A. Low Pressure Material Injection Instruments Fig. 33 exemplifies :Low pressure material injection instruments 180 and 182 that function in association with a cannula instrument 184 having a reduced interior diameter, e.g. only about 3.4 mm or less.
One instrument 180 comprises a reduced-diameter nozzle. As Fig. 33 shows, the nozzle 180 is sized to pass through the reduced-diameter cannula instrument 184, to thereby pass into bone in the manner previously shown in Fig. 26. The reduced-diameter nozzle 180 connects by a threaded connector 186 to the syringe 104. For material strength, despite its reduced dimension, the nozzle 180 is preferably formed from a rigid, metal material, e. g. , stainless steel.
As Fig. 33 shows, the reduced-diameter nozzle 180 also includes measured markings 188 along its length, as previously described. The markings 188 include a set point 190, as previously described, which aligns with the proximal end of the cannula instrument 184 when the distal ends of the cannula instrument 184 and the nozzle 180 align.
The other reduced diameter instrument 182 comprises a stylet, which is sized to pass through the interior bore of the nozz]Le 180. The stylet 182 includes a handle 192, which rests on the proximal connector 186 of the nozzle 180 when the stylet 182 is fully inserted into the nozzle 180. When the handle 192 is rested, the distal ends of the stylet 182 and nozzle 180 align. The presence of the stylet 182 inside the nozzle 180 closes the interior nozzle bore.
In use, the nozzle 7.80 is coupled to the syringe 104 and inserted through the cannula instrument 184 into the material-receiving cavity 168 formed in cancellous bone, in the same manner shown in Fig. 26. Material in the syringe 104 is injected at low pressure throucjh the noz z le 180 into the cavity 168. As before explained, as the cavity 168 progressively fills with material, the nozzle 180 is withdrawn back into the cannula instrument 184. Typically, when the injection of material is completed, material extends from the cavity 168 and occupies about 40% to 50% of the cannula instrument 184.
At this point, the nozzle 180 can be fully withdrawn from the cannula instrument 184 and unthreaded from the syringe 104. The stylet 182 can be advanced into the nozzle 180, to bring the handle 192 at rest against the co:nnector 186, thereby clearing residual material from the nozzle 180. The nozzle 180 and stylet can then be inserted as a nested unit into the cannula instrument 184. Nested together, the nozzle 180 and stylet 182 form a tamping instrument. Upon advancement through the cannula instrument 184, the riested nozzle 180 and stylet 182 displace residual material from the cannula instrument 184 into the cavity 168, in generally the same manner as previously shown in Figs. 30 and 31, thereby uniformly compacting material within the cavity 168 in a controlled fashion and without undue pressure.
Alternatively, a single-piece tamping instrument, separate from the nozzle 180, can be provided,.downsized to fit =through the reduced-diameter cannula instrument 184. In this embodiment, the stylet 182 is not necessary, unless it is desired to reclaim material from the nozzle.
B. cavity Forming Instrument Fig. 34 shows a caviity forming instrument 194 intended to be deployed through the reduced-diameter cannula instrument 184, shown in Fig. 33.
In many respects, the instrument 194 is like the instrument 76, previously described and shown in Fig. 4A, and common reference numerals will be assigned to common structural elements. The instrument 184 includes a flexible catheter tube 78 having a proximal end 80 and a distal end 82. The i proximal end 80 carries a handle grip 84, and the distal end 82 carries an expandable structure 86, which, when deployed in boneõ compacts cancellous bone and forms the cavity 168õ
Unlike the previously-described instrument 76, the instrument 194 carries; an introducer sleeve 196. The introducer sleeve :196 slides along the catheter tube 78 between the handle grip 84 and the expandable structure 86. The introducer sleeve 196 includes a tubular main body 198 with a forward collar 200 and a rear collar 202.
The introducer sleeve 196 normally occupies an advanced position on the instrument 194, as shown in Fig. 35. In this position, the main body 198 overlies and surrounds the expandable structure 86.
The main body 198 is sized to compress the structure 86 to an outside diameter that is slightly less than the interior diameter of the reduced-diameter cannula instrument 184.
As Fig. 35 shows, when the introducer sleeve 196 occupies the advanced position, the forward collar 200 extends beyond the distal end of the compressed expandable structure 82. As Fig. 36 shows, in this position, the forward collar 200 presents itself for engagement with the proximal end 204 of the cannula instrument 184. The forward collar 200 is sized to have an interior diameter that makes friction-fit engagement about the proximal end 204 of the cannula instrument 184.
As Fig. 36 shows, when it is time to deploy the expandable structure 86 through the cannula instrument 184, the physician engages the forward collar 200 of the introducer sleeve 196 in a friction fit about the proximal end 204 of the cannula instrument 184. As Fig. 37 shows, advancing the catheter tube 78 moves the compressed structure 86 through the main body 198 of the sleeve 196 and into the bore of the cannula instrument 184. The engagement of the forward collar 200 about the proximal cannula end 204 aligns the axis of the structure 86 with the axis of the cannula instrument 184, while compressing the structure 86 to a diameter smaller than the interior of the cannula instrument 184. Upon advancement of the catheter tube 78, the introducer sleeve 196 guides the structure 86 into the cannula instrument 194 without tearing or other damage.
Once the expandable structure 86 is advanced through the cannula instrument 184 and into bone, the physician can slide the introducer sleeve 196 rearward away from the proximal cannula end 204, to break the friction fit between the end 204 and the forward sleeve. As Fig. 34 shows, the rear collar 202 of the sleeve 196.is sized to make a snap fit engagement about a stem 206, which surrounds the catheter tube 78 near the handle 84. The snap fit engagement stabilizes the posiition of the sleeve 196 during subsequent use and manipulation of the cavity-forming instrument 194.
The features of the irivention are set forth in the following claims.
Claims (18)
1. A system comprising an access tool sized and configured to establish an access path through soft tissue to bone having an interior volume occupied, at least in part, by cancellous bone, a void forming tool sized and configured to be introduced through the access path to form a void in cancellous bone, a nozzle sized and configured to pass through the access path and including an interior bore defining a fixed interior volume to receive and deliver a measured volume of filling material into the void, and an auxiliary tool sized and configured to be advanced through the interior bore and urge filling material from the nozzle.
2. The system according to claim 1 wherein the access tool comprises a cannula.
3. The system according to claim 1 wherein the void forming tool is carried by an elongate member sized and configured to pass through the access path.
4. The system according to claim 3 wherein the elongate member comprises a catheter.
5. The system according to claim 1 wherein the void forming tool comprises an expandable body.
6. The system according to claim 5 wherein the expandable body, when expanded, assumes a non-spherical shape.
7. The system according to claim 1 wherein the nozzle comprises an elongate tube.
8. The system according to claim 1 further including a receptacle for holding a volume of filling material, and wherein the nozzle includes a connector to couple the nozzle to the receptacle.
9. The system according to claim 1 wherein the nozzle has a length and includes measured markings along the length.
10. The system according to claim 1 wherein the auxiliary tool comprises an elongate body.
11. The system according to claim 1 wherein the nozzle is made from a generally flexible material.
12. The system according to claim 1 wherein the nozzle is made from a generally rigid material.
13. The system according to claim 1 wherein the filling material comprises at least one of a flowable material that hardens to a rigid state, a bone cement, autograft material, allograft material, calcium carbonate, demineralized bone matrix material, and calcium phosphate.
14. A system comprising a cannula sized and configured to establish an access path through soft tissue to bone having an interior volume occupied, at least in part, by cancellous bone, a void forming tool sized and configured to be introduced through the cannula to form a void in cancellous bone, a nozzle that can be manipulated independent of the cannula and that is sized and configured to pass through the cannula, the nozzle including an interior bore to receive and deliver a measured volume of filling material into the void, and an auxiliary tool that can be manipulated independently of the nozzle and the cannula and that is sized and configured to be advanced through the interior bore and urge filling material from the nozzle, the auxiliary tool, when fully advanced, substantially fully occupying the entire interior bore of the nozzle.
15. The system according to claim 14 wherein the filling material comprises at least one of a flowable material that hardens to a rigid state, a bone cement, autograft material, allograft material, calcium carbonate, demineralized bone matrix material, and calcium phosphate.
16. The system according to claim 14 wherein the nozzle is made from a generally flexible material.
17. The system according to claim 14 wherein the nozzle is made from a generally rigid material.
18. The system according to claim 14 wherein the void forming tool comprises an expandable body.
Priority Applications (1)
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CA002657235A CA2657235A1 (en) | 1998-08-14 | 1999-07-26 | Systems and methods for placing materials into bone |
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US09/134,323 US6241734B1 (en) | 1998-08-14 | 1998-08-14 | Systems and methods for placing materials into bone |
US09/134,323 | 1998-08-14 | ||
PCT/US1999/016289 WO2000009024A1 (en) | 1998-08-14 | 1999-07-26 | Systems and methods for placing materials into bone |
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CA002657235A Division CA2657235A1 (en) | 1998-08-14 | 1999-07-26 | Systems and methods for placing materials into bone |
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CA2339157C true CA2339157C (en) | 2009-05-19 |
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CA002339157A Expired - Fee Related CA2339157C (en) | 1998-08-14 | 1999-07-26 | Systems and methods for placing materials into bone |
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CA002657235A Abandoned CA2657235A1 (en) | 1998-08-14 | 1999-07-26 | Systems and methods for placing materials into bone |
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JP (2) | JP4138248B2 (en) |
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CA (2) | CA2657235A1 (en) |
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Families Citing this family (656)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6241734B1 (en) * | 1998-08-14 | 2001-06-05 | Kyphon, Inc. | Systems and methods for placing materials into bone |
US20030229372A1 (en) * | 1994-01-26 | 2003-12-11 | Kyphon Inc. | Inflatable device for use in surgical protocols relating to treatment of fractured or diseased bone |
US7044954B2 (en) * | 1994-01-26 | 2006-05-16 | Kyphon Inc. | Method for treating a vertebral body |
US6716216B1 (en) * | 1998-08-14 | 2004-04-06 | Kyphon Inc. | Systems and methods for treating vertebral bodies |
US20060100635A1 (en) * | 1994-01-26 | 2006-05-11 | Kyphon, Inc. | Inflatable device for use in surgical protocol relating to fixation of bone |
US20030032963A1 (en) * | 2001-10-24 | 2003-02-13 | Kyphon Inc. | Devices and methods using an expandable body with internal restraint for compressing cancellous bone |
EP1464293B1 (en) * | 1994-01-26 | 2007-05-02 | Kyphon Inc. | Improved inflatable device for use in surgical methods relating to fixation of bone |
US6248110B1 (en) * | 1994-01-26 | 2001-06-19 | Kyphon, Inc. | Systems and methods for treating fractured or diseased bone using expandable bodies |
WO1998020939A2 (en) * | 1996-11-15 | 1998-05-22 | Advanced Bio Surfaces, Inc. | Biomaterial system for in situ tissue repair |
US20050131268A1 (en) * | 1995-06-07 | 2005-06-16 | Talmadge Karen D. | System and method for delivering a therapeutic agent for bone disease |
US20070282443A1 (en) * | 1997-03-07 | 2007-12-06 | Disc-O-Tech Medical Technologies Ltd. | Expandable element |
IL128261A0 (en) * | 1999-01-27 | 1999-11-30 | Disc O Tech Medical Tech Ltd | Expandable element |
US5972015A (en) * | 1997-08-15 | 1999-10-26 | Kyphon Inc. | Expandable, asymetric structures for deployment in interior body regions |
US6852095B1 (en) * | 1997-07-09 | 2005-02-08 | Charles D. Ray | Interbody device and method for treatment of osteoporotic vertebral collapse |
US7637948B2 (en) | 1997-10-10 | 2009-12-29 | Senorx, Inc. | Tissue marking implant |
US8668737B2 (en) | 1997-10-10 | 2014-03-11 | Senorx, Inc. | Tissue marking implant |
AU1630599A (en) * | 1997-12-08 | 1999-06-28 | Kyphon, Inc. | Systems and methods using expandable bodies to push apart cortical bone surfaces |
US6440138B1 (en) * | 1998-04-06 | 2002-08-27 | Kyphon Inc. | Structures and methods for creating cavities in interior body regions |
DE69942858D1 (en) * | 1998-06-01 | 2010-11-25 | Kyphon S A R L | DEFINABLE, PREFORMED STRUCTURES FOR ESTABLISHMENT IN REGIONS INSIDE THE BODY |
US6719773B1 (en) * | 1998-06-01 | 2004-04-13 | Kyphon Inc. | Expandable structures for deployment in interior body regions |
US20050228397A1 (en) * | 1998-08-14 | 2005-10-13 | Malandain Hugues F | Cavity filling device |
US7621950B1 (en) | 1999-01-27 | 2009-11-24 | Kyphon Sarl | Expandable intervertebral spacer |
US8361082B2 (en) | 1999-02-02 | 2013-01-29 | Senorx, Inc. | Marker delivery device with releasable plug |
US9820824B2 (en) | 1999-02-02 | 2017-11-21 | Senorx, Inc. | Deployment of polysaccharide markers for treating a site within a patent |
US7651505B2 (en) | 2002-06-17 | 2010-01-26 | Senorx, Inc. | Plugged tip delivery for marker placement |
US8498693B2 (en) | 1999-02-02 | 2013-07-30 | Senorx, Inc. | Intracorporeal marker and marker delivery device |
US6862470B2 (en) | 1999-02-02 | 2005-03-01 | Senorx, Inc. | Cavity-filling biopsy site markers |
US6725083B1 (en) | 1999-02-02 | 2004-04-20 | Senorx, Inc. | Tissue site markers for in VIVO imaging |
US7983734B2 (en) | 2003-05-23 | 2011-07-19 | Senorx, Inc. | Fibrous marker and intracorporeal delivery thereof |
US20090216118A1 (en) | 2007-07-26 | 2009-08-27 | Senorx, Inc. | Polysaccharide markers |
US6436143B1 (en) * | 1999-02-22 | 2002-08-20 | Anthony C. Ross | Method and apparatus for treating intervertebral disks |
US6159179A (en) | 1999-03-12 | 2000-12-12 | Simonson; Robert E. | Cannula and sizing and insertion method |
US6770079B2 (en) | 1999-03-16 | 2004-08-03 | American Osteomedix, Inc. | Apparatus and method for fixation of osteoporotic bone |
US6395007B1 (en) * | 1999-03-16 | 2002-05-28 | American Osteomedix, Inc. | Apparatus and method for fixation of osteoporotic bone |
US6575991B1 (en) | 1999-06-17 | 2003-06-10 | Inrad, Inc. | Apparatus for the percutaneous marking of a lesion |
ES2164548B1 (en) * | 1999-08-05 | 2003-03-01 | Probitas Pharma Sa | DEVICE FOR DOSAGE OF FRAGUABLE MASS FOR VERTEBROPLASTIA AND OTHER SIMILAR OSEOS TREATMENTS. |
US6620169B1 (en) * | 1999-08-26 | 2003-09-16 | Spineology Group, Llc. | Tools and method for processing and injecting bone graft |
US6273916B1 (en) * | 1999-09-02 | 2001-08-14 | Cook Incorporated | Method and apparatus for strengthening vertebral bodies |
US6783515B1 (en) * | 1999-09-30 | 2004-08-31 | Arthrocare Corporation | High pressure delivery system |
US6575919B1 (en) * | 1999-10-19 | 2003-06-10 | Kyphon Inc. | Hand-held instruments that access interior body regions |
US20030069545A1 (en) * | 1999-12-06 | 2003-04-10 | Arm Douglas M. | Graft delivery syringe |
US7641657B2 (en) * | 2003-06-10 | 2010-01-05 | Trans1, Inc. | Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae |
US7727263B2 (en) | 2000-02-16 | 2010-06-01 | Trans1, Inc. | Articulating spinal implant |
US6899716B2 (en) * | 2000-02-16 | 2005-05-31 | Trans1, Inc. | Method and apparatus for spinal augmentation |
US7500977B2 (en) | 2003-10-23 | 2009-03-10 | Trans1 Inc. | Method and apparatus for manipulating material in the spine |
US6790210B1 (en) | 2000-02-16 | 2004-09-14 | Trans1, Inc. | Methods and apparatus for forming curved axial bores through spinal vertebrae |
US6575979B1 (en) * | 2000-02-16 | 2003-06-10 | Axiamed, Inc. | Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae |
US7547324B2 (en) | 2000-02-16 | 2009-06-16 | Trans1, Inc. | Spinal mobility preservation apparatus having an expandable membrane |
US6558386B1 (en) * | 2000-02-16 | 2003-05-06 | Trans1 Inc. | Axial spinal implant and method and apparatus for implanting an axial spinal implant within the vertebrae of the spine |
US6740093B2 (en) | 2000-02-28 | 2004-05-25 | Stephen Hochschuler | Method and apparatus for treating a vertebral body |
US7485119B2 (en) * | 2000-03-07 | 2009-02-03 | Zimmer Technology, Inc. | Method and apparatus for reducing femoral fractures |
US7488329B2 (en) * | 2000-03-07 | 2009-02-10 | Zimmer Technology, Inc. | Method and apparatus for reducing femoral fractures |
US20030220644A1 (en) * | 2002-05-23 | 2003-11-27 | Thelen Sarah L. | Method and apparatus for reducing femoral fractures |
US7258692B2 (en) * | 2000-03-07 | 2007-08-21 | Zimmer, Inc. | Method and apparatus for reducing femoral fractures |
US20030220646A1 (en) * | 2002-05-23 | 2003-11-27 | Thelen Sarah L. | Method and apparatus for reducing femoral fractures |
ES2262642T3 (en) * | 2000-04-05 | 2006-12-01 | Kyphon Inc. | DEVICE FOR THE TREATMENT OF FRACTURED AND / OR SICK BONES. |
AU2001253183B2 (en) * | 2000-04-07 | 2006-07-27 | Kyphon Sarl | Insertion devices and method of use |
US7815649B2 (en) * | 2000-04-07 | 2010-10-19 | Kyphon SÀRL | Insertion devices and method of use |
DE10064202A1 (en) | 2000-05-25 | 2001-11-29 | Pajunk Gmbh | Device for applying bone cement and cannula for such a device |
US6749614B2 (en) | 2000-06-23 | 2004-06-15 | Vertelink Corporation | Formable orthopedic fixation system with cross linking |
US6964667B2 (en) * | 2000-06-23 | 2005-11-15 | Sdgi Holdings, Inc. | Formed in place fixation system with thermal acceleration |
CA2692387C (en) * | 2000-06-23 | 2011-02-22 | University Of Southern California | Percutaneous vertebral fusion system |
US6875212B2 (en) * | 2000-06-23 | 2005-04-05 | Vertelink Corporation | Curable media for implantable medical device |
US6899713B2 (en) | 2000-06-23 | 2005-05-31 | Vertelink Corporation | Formable orthopedic fixation system |
MXPA03000060A (en) | 2000-06-30 | 2004-09-13 | Synthes Ag | Device for injecting bone cement. |
DE10032220A1 (en) * | 2000-07-03 | 2002-01-24 | Sanatis Gmbh | Magnesium ammonium phosphate cements, their manufacture and use |
CA2415389C (en) * | 2000-07-14 | 2009-02-17 | Kyphon Inc. | Systems and methods for treating vertebral bodies |
DE60141653D1 (en) * | 2000-07-21 | 2010-05-06 | Spineology Group Llc | A STRONG, POROUS NET BAG DEVICE AND ITS USE IN BONE SURGERY |
US20080086133A1 (en) * | 2003-05-16 | 2008-04-10 | Spineology | Expandable porous mesh bag device and methods of use for reduction, filling, fixation and supporting of bone |
US6676665B2 (en) * | 2000-08-11 | 2004-01-13 | Sdgi Holdings, Inc. | Surgical instrumentation and method for treatment of the spine |
US6679886B2 (en) * | 2000-09-01 | 2004-01-20 | Synthes (Usa) | Tools and methods for creating cavities in bone |
AU2002220069B2 (en) * | 2000-10-24 | 2005-12-15 | Warsaw Orthopedic, Inc. | Methods and instruments for treating pseudoarthrosis |
AU2583702A (en) * | 2000-10-25 | 2002-05-06 | Kyphon Inc | Systems and methods for reducing fractured bone using a fracture reduction cannula |
WO2002041786A2 (en) | 2000-11-20 | 2002-05-30 | Senorx, Inc. | Tissue site markers for in vivo imaging |
US7008433B2 (en) * | 2001-02-15 | 2006-03-07 | Depuy Acromed, Inc. | Vertebroplasty injection device |
US6613018B2 (en) | 2001-02-20 | 2003-09-02 | Vita Licensing, Inc. | System and kit for delivery of restorative materials |
CA2438786A1 (en) * | 2001-02-20 | 2002-08-29 | Vita Licensing, Inc. | Biocompatible material |
US7544196B2 (en) * | 2001-02-20 | 2009-06-09 | Orthovita, Inc. | System and kit for delivery of restorative materials |
US6595998B2 (en) | 2001-03-08 | 2003-07-22 | Spinewave, Inc. | Tissue distraction device |
US6632235B2 (en) | 2001-04-19 | 2003-10-14 | Synthes (U.S.A.) | Inflatable device and method for reducing fractures in bone and in treating the spine |
US6746451B2 (en) * | 2001-06-01 | 2004-06-08 | Lance M. Middleton | Tissue cavitation device and method |
US20030050644A1 (en) * | 2001-09-11 | 2003-03-13 | Boucher Ryan P. | Systems and methods for accessing and treating diseased or fractured bone employing a guide wire |
US6706069B2 (en) | 2001-09-13 | 2004-03-16 | J. Lee Berger | Spinal grooved director with built in balloon |
US6569201B2 (en) | 2001-09-28 | 2003-05-27 | Depuy Acromed, Inc. | Hybrid composite interbody fusion device |
US7824410B2 (en) | 2001-10-30 | 2010-11-02 | Depuy Spine, Inc. | Instruments and methods for minimally invasive spine surgery |
US7008431B2 (en) | 2001-10-30 | 2006-03-07 | Depuy Spine, Inc. | Configured and sized cannula |
US6916330B2 (en) * | 2001-10-30 | 2005-07-12 | Depuy Spine, Inc. | Non cannulated dilators |
DE10154163A1 (en) | 2001-11-03 | 2003-05-22 | Advanced Med Tech | Device for straightening and stabilizing the spine |
US6752809B2 (en) * | 2001-12-04 | 2004-06-22 | K2 Medical, Llc | System and method for reinforcing bone in preparation for screw implantation |
JP4499327B2 (en) * | 2001-12-06 | 2010-07-07 | 松崎 浩巳 | Diameter expansion instrument and surgical instrument set |
US6582439B1 (en) | 2001-12-28 | 2003-06-24 | Yacmur Llc | Vertebroplasty system |
US6780191B2 (en) | 2001-12-28 | 2004-08-24 | Yacmur Llc | Cannula system |
AU2003218189A1 (en) * | 2002-03-18 | 2003-10-08 | American Osteomedix, Inc. | Minimally invasive bone manipulation device and method of use |
US20050080425A1 (en) * | 2002-03-18 | 2005-04-14 | Mohit Bhatnagar | Minimally invasive bone manipulation device and method of use |
US20040127563A1 (en) * | 2002-03-22 | 2004-07-01 | Deslauriers Richard J. | Methods of performing medical procedures which promote bone growth, compositions which promote bone growth, and methods of making such compositions |
US8449555B1 (en) * | 2002-03-27 | 2013-05-28 | Terry L. Ray | Pedicle probe |
US6960215B2 (en) * | 2002-05-08 | 2005-11-01 | Boston Scientific Scimed, Inc. | Tactical detachable anatomic containment device and therapeutic treatment system |
WO2008033873A2 (en) * | 2006-09-12 | 2008-03-20 | Vidacare Corporation | Medical procedures trays and related methods |
US11298202B2 (en) | 2002-05-31 | 2022-04-12 | Teleflex Life Sciences Limited | Biopsy devices and related methods |
US8668698B2 (en) | 2002-05-31 | 2014-03-11 | Vidacare Corporation | Assembly for coupling powered driver with intraosseous device |
US11337728B2 (en) | 2002-05-31 | 2022-05-24 | Teleflex Life Sciences Limited | Powered drivers, intraosseous devices and methods to access bone marrow |
US10973532B2 (en) | 2002-05-31 | 2021-04-13 | Teleflex Life Sciences Limited | Powered drivers, intraosseous devices and methods to access bone marrow |
DE60336939D1 (en) | 2002-05-31 | 2011-06-09 | Vidacare Corp | Device for access to bone marrow |
US7951089B2 (en) | 2002-05-31 | 2011-05-31 | Vidacare Corporation | Apparatus and methods to harvest bone and bone marrow |
WO2008033871A2 (en) | 2006-09-12 | 2008-03-20 | Vidacare Corporation | Apparatus and methods for biopsy and aspiration of bone marrow |
WO2008033872A2 (en) * | 2006-09-12 | 2008-03-20 | Vidacare Corporation | Biopsy devices and related methods |
US20070049945A1 (en) | 2002-05-31 | 2007-03-01 | Miller Larry J | Apparatus and methods to install, support and/or monitor performance of intraosseous devices |
US10973545B2 (en) | 2002-05-31 | 2021-04-13 | Teleflex Life Sciences Limited | Powered drivers, intraosseous devices and methods to access bone marrow |
US9314228B2 (en) | 2002-05-31 | 2016-04-19 | Vidacare LLC | Apparatus and method for accessing the bone marrow |
US9072543B2 (en) | 2002-05-31 | 2015-07-07 | Vidacare LLC | Vascular access kits and methods |
US8142365B2 (en) | 2002-05-31 | 2012-03-27 | Vidacare Corporation | Apparatus and method for accessing the bone marrow of the sternum |
US8690791B2 (en) | 2002-05-31 | 2014-04-08 | Vidacare Corporation | Apparatus and method to access the bone marrow |
US8641715B2 (en) | 2002-05-31 | 2014-02-04 | Vidacare Corporation | Manual intraosseous device |
US7811260B2 (en) | 2002-05-31 | 2010-10-12 | Vidacare Corporation | Apparatus and method to inject fluids into bone marrow and other target sites |
US7273523B2 (en) * | 2002-06-07 | 2007-09-25 | Kyphon Inc. | Strontium-apatite-cement-preparations, cements formed therefrom, and uses thereof |
US6730095B2 (en) * | 2002-06-26 | 2004-05-04 | Scimed Life Systems, Inc. | Retrograde plunger delivery system |
US6955678B2 (en) * | 2002-06-28 | 2005-10-18 | Smith & Nephew, Inc. | Soft tissue repair tool |
ES2277087T3 (en) * | 2002-07-09 | 2007-07-01 | Aecc Enterprises Limited | METHOD FOR REPRESENTATION WITH IMAGES THE RELATIVE MOVEMENT OF SKELETAL SEGMENTS. |
US7901407B2 (en) * | 2002-08-02 | 2011-03-08 | Boston Scientific Scimed, Inc. | Media delivery device for bone structures |
US6907884B2 (en) | 2002-09-30 | 2005-06-21 | Depay Acromed, Inc. | Method of straddling an intraosseous nerve |
US8361067B2 (en) | 2002-09-30 | 2013-01-29 | Relievant Medsystems, Inc. | Methods of therapeutically heating a vertebral body to treat back pain |
US9782572B2 (en) | 2002-09-30 | 2017-10-10 | Nordson Corporation | Apparatus and methods for treating bone structures, tissues and ducts using a narrow gauge cannula system |
US7488337B2 (en) * | 2002-09-30 | 2009-02-10 | Saab Mark A | Apparatus and methods for bone, tissue and duct dilatation |
US7258690B2 (en) | 2003-03-28 | 2007-08-21 | Relievant Medsystems, Inc. | Windowed thermal ablation probe |
US7066942B2 (en) * | 2002-10-03 | 2006-06-27 | Wright Medical Technology, Inc. | Bendable needle for delivering bone graft material and method of use |
US20040068234A1 (en) * | 2002-10-03 | 2004-04-08 | Jeff Martin | Bone graft particle delivery apparatus and method |
US7135027B2 (en) * | 2002-10-04 | 2006-11-14 | Baxter International, Inc. | Devices and methods for mixing and extruding medically useful compositions |
US20040073139A1 (en) * | 2002-10-11 | 2004-04-15 | Hirsch Joshua A. | Cannula for extracting and implanting material |
NZ539779A (en) * | 2002-11-05 | 2009-01-31 | Spineology Inc | A semi-biological intervertebral disc replacement system created by inserting tissue promoting material into a cavity in the disc |
US20060036158A1 (en) | 2003-11-17 | 2006-02-16 | Inrad, Inc. | Self-contained, self-piercing, side-expelling marking apparatus |
WO2004047689A1 (en) * | 2002-11-21 | 2004-06-10 | Sdgi Holdings, Inc. | Systems and techniques for intravertebral spinal stablization with expandable devices |
US7776042B2 (en) * | 2002-12-03 | 2010-08-17 | Trans1 Inc. | Methods and apparatus for provision of therapy to adjacent motion segments |
US20040122438A1 (en) * | 2002-12-23 | 2004-06-24 | Boston Scientific Corporation | Flex-tight interlocking connection tubing for delivery of bone cements/biomaterials for vertebroplasty |
US6889833B2 (en) * | 2002-12-30 | 2005-05-10 | Calypso Medical Technologies, Inc. | Packaged systems for implanting markers in a patient and methods for manufacturing and using such systems |
AU2004212942A1 (en) | 2003-02-14 | 2004-09-02 | Depuy Spine, Inc. | In-situ formed intervertebral fusion device |
DE60335037D1 (en) | 2003-03-14 | 2010-12-30 | Depuy Spine Inc | HYDRAULIC DEVICE FOR BONE CEMENT INJECTION IN PERCUTANEOUS VERTEBROPLASTY |
US7306610B2 (en) * | 2003-03-21 | 2007-12-11 | Cana Lab Corporation | Method and device for forming a hardened cement in a bone cavity |
US8066713B2 (en) | 2003-03-31 | 2011-11-29 | Depuy Spine, Inc. | Remotely-activated vertebroplasty injection device |
US7241283B2 (en) * | 2003-04-25 | 2007-07-10 | Ad-Tech Medical Instrument Corp. | Method for intracranial catheter treatment of brain tissue |
TWI235055B (en) * | 2003-05-21 | 2005-07-01 | Guan-Gu Lin | Filling device capable of removing animal tissues |
TW587932B (en) * | 2003-05-21 | 2004-05-21 | Guan-Gu Lin | Removable animal tissue filling device |
US7877133B2 (en) | 2003-05-23 | 2011-01-25 | Senorx, Inc. | Marker or filler forming fluid |
US9504477B2 (en) | 2003-05-30 | 2016-11-29 | Vidacare LLC | Powered driver |
US8415407B2 (en) | 2004-03-21 | 2013-04-09 | Depuy Spine, Inc. | Methods, materials, and apparatus for treating bone and other tissue |
US7112205B2 (en) * | 2003-06-17 | 2006-09-26 | Boston Scientific Scimed, Inc. | Apparatus and methods for delivering compounds into vertebrae for vertebroplasty |
WO2004112661A1 (en) * | 2003-06-20 | 2004-12-29 | Myers Thomas H | Method and apparatus for strengthening the biomechanical properties of implants |
US20050015148A1 (en) * | 2003-07-18 | 2005-01-20 | Jansen Lex P. | Biocompatible wires and methods of using same to fill bone void |
US7252686B2 (en) * | 2003-08-13 | 2007-08-07 | Boston Scientific Scimed | Methods for reducing bone compression fractures using wedges |
MXPA06002541A (en) * | 2003-09-03 | 2006-06-20 | Kyphon Inc | Devices for creating voids in interior body regions and related methods. |
US7261717B2 (en) * | 2003-09-11 | 2007-08-28 | Skeletal Kinetics Llc | Methods and devices for delivering orthopedic cements to a target bone site |
WO2005030034A2 (en) | 2003-09-26 | 2005-04-07 | Depuy Spine, Inc. | Device for delivering viscous material |
US7909833B2 (en) | 2003-09-29 | 2011-03-22 | Depuy Acromed, Inc. | Vertebroplasty device having a flexible plunger |
TW200511970A (en) * | 2003-09-29 | 2005-04-01 | Kwan-Ku Lin | A spine wrapping and filling apparatus |
US20050124999A1 (en) * | 2003-10-31 | 2005-06-09 | Teitelbaum George P. | Device and method for radial delivery of a structural element |
DE20317230U1 (en) | 2003-11-08 | 2005-03-17 | Buchholz Juergen | Instrument for the treatment of oesteopathically altered areas of human or animal bones |
US20050273002A1 (en) | 2004-06-04 | 2005-12-08 | Goosen Ryan L | Multi-mode imaging marker |
US7524103B2 (en) | 2003-11-18 | 2009-04-28 | Boston Scientific Scimed, Inc. | Apparatus for mixing and dispensing a multi-component bone cement |
KR100568071B1 (en) * | 2003-12-16 | 2006-04-05 | 주식회사 경원메디칼 | An injection apparatus of bone cement for treatment of osteoporotic bone |
EP2098181B1 (en) | 2004-01-26 | 2016-10-19 | Vidacare LLC | Manual interosseous device |
US7815642B2 (en) | 2004-01-26 | 2010-10-19 | Vidacare Corporation | Impact-driven intraosseous needle |
US20050165487A1 (en) * | 2004-01-28 | 2005-07-28 | Muhanna Nabil L. | Artificial intervertebral disc |
US7641664B2 (en) | 2004-02-12 | 2010-01-05 | Warsaw Orthopedic, Inc. | Surgical instrumentation and method for treatment of a spinal structure |
US7608092B1 (en) | 2004-02-20 | 2009-10-27 | Biomet Sports Medicince, LLC | Method and apparatus for performing meniscus repair |
US20050187556A1 (en) * | 2004-02-25 | 2005-08-25 | Synecor, Llc | Universal percutaneous spinal access system |
US9707024B2 (en) | 2004-03-09 | 2017-07-18 | Skeletal Kinetics, Llc | Use of vibration in composite fixation |
US20050209602A1 (en) * | 2004-03-22 | 2005-09-22 | Disc Dynamics, Inc. | Multi-stage biomaterial injection system for spinal implants |
US20060135959A1 (en) * | 2004-03-22 | 2006-06-22 | Disc Dynamics, Inc. | Nuclectomy method and apparatus |
EP1789088A4 (en) | 2004-03-24 | 2009-12-30 | Doctor S Res Group Inc | Methods of performing medical procedures that promote bone growth, methods of making compositions that promote bone growth, and apparatus for use in such methods |
WO2005096970A2 (en) * | 2004-03-31 | 2005-10-20 | Advanced Biomaterial Systems, Inc. | Methods and devices for cavity creation in mammalian bone tissue |
US7909873B2 (en) | 2006-12-15 | 2011-03-22 | Soteira, Inc. | Delivery apparatus and methods for vertebrostenting |
US7465318B2 (en) | 2004-04-15 | 2008-12-16 | Soteira, Inc. | Cement-directing orthopedic implants |
US7452351B2 (en) * | 2004-04-16 | 2008-11-18 | Kyphon Sarl | Spinal diagnostic methods and apparatus |
US7824390B2 (en) * | 2004-04-16 | 2010-11-02 | Kyphon SÀRL | Spinal diagnostic methods and apparatus |
WO2005102226A1 (en) * | 2004-04-26 | 2005-11-03 | Synthes Gmbh | Intervertebral prosthesis or disk prosthesis |
DE112004002841A5 (en) * | 2004-04-26 | 2008-02-28 | Synthes Gmbh | Device for manipulating and supplying hollow intervertebral disc or intervertebral disc prostheses with flowable bone cement |
US8168692B2 (en) | 2004-04-27 | 2012-05-01 | Kyphon Sarl | Bone substitute compositions and method of use |
FR2869529B1 (en) * | 2004-04-30 | 2006-06-30 | Dentak Sarl | KIT FOR PREPARING A BONE FILLING MIXTURE, CARTRIDGE SPECIALLY ADAPTED TO THIS KIT AND IMPLANTATION KIT COMPRISING SUCH KIT |
US20050244499A1 (en) * | 2004-05-03 | 2005-11-03 | Robert Diaz | Method and device for reducing susceptibility to fractures in long bones |
US20050244451A1 (en) * | 2004-05-03 | 2005-11-03 | Robert Diaz | Method and device for reducing susceptibility to fractures in vertebral bodies |
US20080255560A1 (en) * | 2004-05-21 | 2008-10-16 | Myers Surgical Solutions, Llc | Fracture Fixation and Site Stabilization System |
US8142462B2 (en) | 2004-05-28 | 2012-03-27 | Cavitech, Llc | Instruments and methods for reducing and stabilizing bone fractures |
US20060095138A1 (en) | 2004-06-09 | 2006-05-04 | Csaba Truckai | Composites and methods for treating bone |
CA2570798A1 (en) * | 2004-06-16 | 2006-01-05 | Warsaw Orthopedic, Inc. | Surgical instrumentation for the repair of vertebral bodies |
US7632284B2 (en) * | 2004-07-06 | 2009-12-15 | Tyco Healthcare Group Lp | Instrument kit and method for performing meniscal repair |
CN106963464B (en) * | 2004-07-30 | 2019-11-05 | 德普伊新特斯产品有限责任公司 | Surgical set |
US7794468B2 (en) * | 2004-08-02 | 2010-09-14 | Seidman Michael D | Middle ear reconstruction process and apparatus for performing the process |
US8038682B2 (en) | 2004-08-17 | 2011-10-18 | Boston Scientific Scimed, Inc. | Apparatus and methods for delivering compounds into vertebrae for vertebroplasty |
US20060047296A1 (en) * | 2004-08-31 | 2006-03-02 | Sdg Holdings, Inc. | Annulus replacement system and technique |
EP1793769A4 (en) | 2004-09-02 | 2009-06-24 | Crosstrees Medical Inc | Device and method for distraction of the spinal disc space |
WO2006031490A1 (en) * | 2004-09-10 | 2006-03-23 | Murphy Kieran P J | Cement delivery needle |
WO2006034436A2 (en) | 2004-09-21 | 2006-03-30 | Stout Medical Group, L.P. | Expandable support device and method of use |
US20060068362A1 (en) * | 2004-09-27 | 2006-03-30 | Ormco Corporation | Endodontic instrument with depth markers |
WO2006047652A2 (en) | 2004-10-26 | 2006-05-04 | Concept Matrix, Llc | Working channel for minimally invasive spine surgery |
US7678116B2 (en) * | 2004-12-06 | 2010-03-16 | Dfine, Inc. | Bone treatment systems and methods |
US8128658B2 (en) | 2004-11-05 | 2012-03-06 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to bone |
US7857830B2 (en) | 2006-02-03 | 2010-12-28 | Biomet Sports Medicine, Llc | Soft tissue repair and conduit device |
US9801708B2 (en) | 2004-11-05 | 2017-10-31 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US7909851B2 (en) | 2006-02-03 | 2011-03-22 | Biomet Sports Medicine, Llc | Soft tissue repair device and associated methods |
US7905903B2 (en) | 2006-02-03 | 2011-03-15 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US8303604B2 (en) | 2004-11-05 | 2012-11-06 | Biomet Sports Medicine, Llc | Soft tissue repair device and method |
US7559932B2 (en) | 2004-12-06 | 2009-07-14 | Dfine, Inc. | Bone treatment systems and methods |
US7658751B2 (en) | 2006-09-29 | 2010-02-09 | Biomet Sports Medicine, Llc | Method for implanting soft tissue |
US7749250B2 (en) | 2006-02-03 | 2010-07-06 | Biomet Sports Medicine, Llc | Soft tissue repair assembly and associated method |
US20060190042A1 (en) * | 2004-11-05 | 2006-08-24 | Arthrotek, Inc. | Tissue repair assembly |
US9017381B2 (en) | 2007-04-10 | 2015-04-28 | Biomet Sports Medicine, Llc | Adjustable knotless loops |
US7905904B2 (en) | 2006-02-03 | 2011-03-15 | Biomet Sports Medicine, Llc | Soft tissue repair device and associated methods |
US8840645B2 (en) | 2004-11-05 | 2014-09-23 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8361113B2 (en) | 2006-02-03 | 2013-01-29 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8137382B2 (en) | 2004-11-05 | 2012-03-20 | Biomet Sports Medicine, Llc | Method and apparatus for coupling anatomical features |
US20060189993A1 (en) | 2004-11-09 | 2006-08-24 | Arthrotek, Inc. | Soft tissue conduit device |
US8118836B2 (en) | 2004-11-05 | 2012-02-21 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8298262B2 (en) | 2006-02-03 | 2012-10-30 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US8088130B2 (en) | 2006-02-03 | 2012-01-03 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8998949B2 (en) | 2004-11-09 | 2015-04-07 | Biomet Sports Medicine, Llc | Soft tissue conduit device |
US8998848B2 (en) | 2004-11-12 | 2015-04-07 | Vidacare LLC | Intraosseous device and methods for accessing bone marrow in the sternum and other target areas |
US8070753B2 (en) * | 2004-12-06 | 2011-12-06 | Dfine, Inc. | Bone treatment systems and methods |
US20060122614A1 (en) * | 2004-12-06 | 2006-06-08 | Csaba Truckai | Bone treatment systems and methods |
US7717918B2 (en) | 2004-12-06 | 2010-05-18 | Dfine, Inc. | Bone treatment systems and methods |
US7722620B2 (en) | 2004-12-06 | 2010-05-25 | Dfine, Inc. | Bone treatment systems and methods |
US20090264939A9 (en) * | 2004-12-16 | 2009-10-22 | Martz Erik O | Instrument set and method for performing spinal nuclectomy |
US7935122B2 (en) * | 2004-12-23 | 2011-05-03 | Arthrocare Corporation | Cannula having asymmetrically-shaped threads |
US20070299450A1 (en) * | 2004-12-31 | 2007-12-27 | Ji-Hoon Her | Pedicle Screw and Device for Injecting Bone Cement into Bone |
PE20060861A1 (en) * | 2005-01-07 | 2006-10-25 | Celonova Biosciences Inc | IMPLANTABLE THREE-DIMENSIONAL BONE SUPPORT |
US11246913B2 (en) | 2005-02-03 | 2022-02-15 | Intarcia Therapeutics, Inc. | Suspension formulation comprising an insulinotropic peptide |
US20060184192A1 (en) * | 2005-02-11 | 2006-08-17 | Markworth Aaron D | Systems and methods for providing cavities in interior body regions |
ES2463682T3 (en) | 2005-02-22 | 2014-05-28 | Depuy Spine, Inc. | Bone cement |
EP2319439B1 (en) | 2005-02-22 | 2017-07-26 | DePuy Spine, Inc. | Materials for treating bone |
US20060235423A1 (en) * | 2005-04-01 | 2006-10-19 | Cantu Alberto R | Apparatus having at least one actuatable planar surface and method using the same for a spinal procedure |
US10357328B2 (en) | 2005-04-20 | 2019-07-23 | Bard Peripheral Vascular, Inc. and Bard Shannon Limited | Marking device with retractable cannula |
AU2006270499B2 (en) | 2005-04-29 | 2011-10-06 | Cook Biotech Incorporated | Fistula graft with deformable sheet-form material |
US8083722B2 (en) * | 2005-04-29 | 2011-12-27 | Warsaw Orthopedic, Inc | Instrumentation for injection of therapeutic fluid into joints |
US7850656B2 (en) * | 2005-04-29 | 2010-12-14 | Warsaw Orthopedic, Inc. | Devices and methods for delivering medical agents |
US8506646B2 (en) * | 2005-04-29 | 2013-08-13 | Warsaw Orthopedic, Inc. | Multi-purpose medical implant devices |
US8092464B2 (en) * | 2005-04-30 | 2012-01-10 | Warsaw Orthopedic, Inc. | Syringe devices and methods useful for delivering osteogenic material |
US20060253198A1 (en) * | 2005-05-03 | 2006-11-09 | Disc Dynamics, Inc. | Multi-lumen mold for intervertebral prosthesis and method of using same |
US20060264896A1 (en) * | 2005-05-09 | 2006-11-23 | Palmer Erika I | Minimally invasive apparatus and method for treatment of a tumor associated with a bone |
US9060820B2 (en) | 2005-05-18 | 2015-06-23 | Sonoma Orthopedic Products, Inc. | Segmented intramedullary fracture fixation devices and methods |
US8961516B2 (en) | 2005-05-18 | 2015-02-24 | Sonoma Orthopedic Products, Inc. | Straight intramedullary fracture fixation devices and methods |
US7909825B2 (en) | 2006-11-22 | 2011-03-22 | Sonoma Orthepedic Products, Inc. | Fracture fixation device, tools and methods |
US8187327B2 (en) * | 2005-05-18 | 2012-05-29 | Kyphon Sarl | Selectively-expandable bone scaffold |
ITVI20050152A1 (en) * | 2005-05-20 | 2006-11-21 | Tecres Spa | CARTRIDGE FOR CONSERVATION AND STERILE DISTRIBUTION OF A BIPHASIC COMPOUND, PARTICULARLY FOR AN ACRYLIC RESIN |
US20070049849A1 (en) * | 2005-05-24 | 2007-03-01 | Schwardt Jeffrey D | Bone probe apparatus and method of use |
US20060271196A1 (en) * | 2005-05-26 | 2006-11-30 | Saal Jeffrey A | Spinal disc annulus augmentation |
US7628800B2 (en) * | 2005-06-03 | 2009-12-08 | Warsaw Orthopedic, Inc. | Formed in place corpectomy device |
US20070005075A1 (en) * | 2005-06-17 | 2007-01-04 | Bogert Roy B | Telescoping plunger assembly |
JP4907908B2 (en) * | 2005-06-29 | 2012-04-04 | ルネサスエレクトロニクス株式会社 | Driving circuit and display device |
US9271817B2 (en) * | 2005-07-05 | 2016-03-01 | Cook Biotech Incorporated | Tissue augmentation devices and methods |
US20090254132A1 (en) * | 2005-07-07 | 2009-10-08 | Scribner Robert M | Devices and methods for the treatment of bone fracture |
US20070078463A1 (en) * | 2005-07-07 | 2007-04-05 | Malandain Hugues F | Retractable cannula and method for minimally invasive medical procedure |
US20070010846A1 (en) * | 2005-07-07 | 2007-01-11 | Leung Andrea Y | Method of manufacturing an expandable member with substantially uniform profile |
US20070010844A1 (en) * | 2005-07-08 | 2007-01-11 | Gorman Gong | Radiopaque expandable body and methods |
US20070010845A1 (en) * | 2005-07-08 | 2007-01-11 | Gorman Gong | Directionally controlled expandable device and methods for use |
WO2007008984A1 (en) * | 2005-07-11 | 2007-01-18 | Kyphon, Inc. | Systems and methods for inserting biocompatible filler materials in interior body regions |
US8021365B2 (en) * | 2005-07-11 | 2011-09-20 | Kyphon Sarl | Surgical device having interchangeable components and methods of use |
US8105236B2 (en) * | 2005-07-11 | 2012-01-31 | Kyphon Sarl | Surgical access device, system, and methods of use |
US20070006692A1 (en) * | 2005-07-11 | 2007-01-11 | Phan Christopher U | Torque limiting device |
US20070010824A1 (en) * | 2005-07-11 | 2007-01-11 | Hugues Malandain | Products, systems and methods for delivering material to bone and other internal body parts |
US20070010848A1 (en) * | 2005-07-11 | 2007-01-11 | Andrea Leung | Systems and methods for providing cavities in interior body regions |
KR20080074847A (en) * | 2005-07-11 | 2008-08-13 | 메드트로닉 스파인 엘엘씨 | Curette system |
US20070055201A1 (en) * | 2005-07-11 | 2007-03-08 | Seto Christine L | Systems and methods for providing cavities in interior body regions |
WO2007009107A2 (en) | 2005-07-14 | 2007-01-18 | Stout Medical Group, P.L. | Expandable support device and method of use |
US20070026030A1 (en) * | 2005-07-27 | 2007-02-01 | Berkeley Advanced Biomaterials, Inc. | Method of preparing rheological materials for bone and cartilage repair |
US9381024B2 (en) * | 2005-07-31 | 2016-07-05 | DePuy Synthes Products, Inc. | Marked tools |
US9918767B2 (en) | 2005-08-01 | 2018-03-20 | DePuy Synthes Products, Inc. | Temperature control system |
US8016834B2 (en) * | 2005-08-03 | 2011-09-13 | Helmut Weber | Process and device for treating vertebral bodies |
US8366773B2 (en) | 2005-08-16 | 2013-02-05 | Benvenue Medical, Inc. | Apparatus and method for treating bone |
AU2006279558B2 (en) | 2005-08-16 | 2012-05-17 | Izi Medical Products, Llc | Spinal tissue distraction devices |
US8454617B2 (en) | 2005-08-16 | 2013-06-04 | Benvenue Medical, Inc. | Devices for treating the spine |
US8777479B2 (en) | 2008-10-13 | 2014-07-15 | Dfine, Inc. | System for use in bone cement preparation and delivery |
US8540723B2 (en) | 2009-04-14 | 2013-09-24 | Dfine, Inc. | Medical system and method of use |
US9066769B2 (en) | 2005-08-22 | 2015-06-30 | Dfine, Inc. | Bone treatment systems and methods |
US7651701B2 (en) * | 2005-08-29 | 2010-01-26 | Sanatis Gmbh | Bone cement composition and method of making the same |
US20090012525A1 (en) | 2005-09-01 | 2009-01-08 | Eric Buehlmann | Devices and systems for delivering bone fill material |
US7691105B2 (en) * | 2005-09-26 | 2010-04-06 | Depuy Spine, Inc. | Tissue augmentation, stabilization and regeneration technique |
US20070093899A1 (en) * | 2005-09-28 | 2007-04-26 | Christof Dutoit | Apparatus and methods for treating bone |
CA2562580C (en) | 2005-10-07 | 2014-04-29 | Inrad, Inc. | Drug-eluting tissue marker |
CA2625264C (en) | 2005-10-13 | 2015-12-15 | Synthes (U.S.A.) | Drug-impregnated sleeve for a medical implant |
US20070123889A1 (en) * | 2005-10-14 | 2007-05-31 | Malandain Hugues F | Mechanical cavity-creation surgical device and methods and kits for using such devices |
US7371260B2 (en) * | 2005-10-26 | 2008-05-13 | Biomet Sports Medicine, Inc. | Method and instrumentation for the preparation and transplantation of osteochondral allografts |
WO2007059259A1 (en) * | 2005-11-15 | 2007-05-24 | Aoi Medical, Inc. | Inflatable device for restoring anatomy of fractured bone |
US8690884B2 (en) | 2005-11-18 | 2014-04-08 | Carefusion 2200, Inc. | Multistate-curvature device and method for delivering a curable material into bone |
USD669168S1 (en) | 2005-11-18 | 2012-10-16 | Carefusion 2200, Inc. | Vertebral augmentation needle |
US7713273B2 (en) * | 2005-11-18 | 2010-05-11 | Carefusion 2200, Inc. | Device, system and method for delivering a curable material into bone |
US7799035B2 (en) * | 2005-11-18 | 2010-09-21 | Carefusion 2200, Inc. | Device, system and method for delivering a curable material into bone |
US8360629B2 (en) | 2005-11-22 | 2013-01-29 | Depuy Spine, Inc. | Mixing apparatus having central and planetary mixing elements |
CN101312696B (en) | 2005-11-23 | 2010-12-22 | 十字桅杆药品公司 | Devices for the treatment of bone fracture |
US20070162132A1 (en) | 2005-12-23 | 2007-07-12 | Dominique Messerli | Flexible elongated chain implant and method of supporting body tissue with same |
US20070161962A1 (en) * | 2006-01-09 | 2007-07-12 | Edie Jason A | Device and method for moving fill material to an implant |
US7901409B2 (en) * | 2006-01-20 | 2011-03-08 | Canaveral Villegas Living Trust | Intramedullar devices and methods to reduce and/or fix damaged bone |
WO2007089739A2 (en) | 2006-01-27 | 2007-08-09 | Stryker Corporation | Low pressure delivery system and method for delivering a solid and liquid mixture into a target site for medical treatment |
US20080125722A1 (en) * | 2006-09-15 | 2008-05-29 | Howmedica International S. De R.L. | Syringe and stand |
US20070185495A1 (en) * | 2006-01-30 | 2007-08-09 | Howmedica International S. De R. L. | Plug-in syringe stand |
US8652171B2 (en) | 2006-02-03 | 2014-02-18 | Biomet Sports Medicine, Llc | Method and apparatus for soft tissue fixation |
US8562647B2 (en) | 2006-09-29 | 2013-10-22 | Biomet Sports Medicine, Llc | Method and apparatus for securing soft tissue to bone |
US8251998B2 (en) | 2006-08-16 | 2012-08-28 | Biomet Sports Medicine, Llc | Chondral defect repair |
US8597327B2 (en) | 2006-02-03 | 2013-12-03 | Biomet Manufacturing, Llc | Method and apparatus for sternal closure |
US9271713B2 (en) | 2006-02-03 | 2016-03-01 | Biomet Sports Medicine, Llc | Method and apparatus for tensioning a suture |
US9078644B2 (en) | 2006-09-29 | 2015-07-14 | Biomet Sports Medicine, Llc | Fracture fixation device |
US8968364B2 (en) | 2006-02-03 | 2015-03-03 | Biomet Sports Medicine, Llc | Method and apparatus for fixation of an ACL graft |
US8562645B2 (en) | 2006-09-29 | 2013-10-22 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US8574235B2 (en) | 2006-02-03 | 2013-11-05 | Biomet Sports Medicine, Llc | Method for trochanteric reattachment |
US11259792B2 (en) | 2006-02-03 | 2022-03-01 | Biomet Sports Medicine, Llc | Method and apparatus for coupling anatomical features |
US8771352B2 (en) | 2011-05-17 | 2014-07-08 | Biomet Sports Medicine, Llc | Method and apparatus for tibial fixation of an ACL graft |
US9149267B2 (en) | 2006-02-03 | 2015-10-06 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8801783B2 (en) | 2006-09-29 | 2014-08-12 | Biomet Sports Medicine, Llc | Prosthetic ligament system for knee joint |
US11311287B2 (en) | 2006-02-03 | 2022-04-26 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US10517587B2 (en) | 2006-02-03 | 2019-12-31 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US9468433B2 (en) | 2006-02-03 | 2016-10-18 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US8652172B2 (en) | 2006-02-03 | 2014-02-18 | Biomet Sports Medicine, Llc | Flexible anchors for tissue fixation |
US8506597B2 (en) | 2011-10-25 | 2013-08-13 | Biomet Sports Medicine, Llc | Method and apparatus for interosseous membrane reconstruction |
US7959650B2 (en) | 2006-09-29 | 2011-06-14 | Biomet Sports Medicine, Llc | Adjustable knotless loops |
US9538998B2 (en) | 2006-02-03 | 2017-01-10 | Biomet Sports Medicine, Llc | Method and apparatus for fracture fixation |
DE102006007263A1 (en) * | 2006-02-10 | 2007-08-16 | Karl Storz Gmbh & Co.Kg | Packaging for a medical anchor element including thread |
US20070213718A1 (en) * | 2006-02-14 | 2007-09-13 | Sdgi Holdings, Inc. | Treatment of the vertebral column |
US7520888B2 (en) * | 2006-02-14 | 2009-04-21 | Warsaw Orthopedic, Inc. | Treatment of the vertebral column |
US20070213717A1 (en) * | 2006-02-14 | 2007-09-13 | Sdgi Holdings, Inc. | Biological fusion in the vertebral column |
US20070227547A1 (en) * | 2006-02-14 | 2007-10-04 | Sdgi Holdings, Inc. | Treatment of the vertebral column |
US20070197895A1 (en) * | 2006-02-17 | 2007-08-23 | Sdgi Holdings, Inc. | Surgical instrument to assess tissue characteristics |
US8361032B2 (en) * | 2006-02-22 | 2013-01-29 | Carefusion 2200 Inc. | Curable material delivery device with a rotatable supply section |
US20070219585A1 (en) * | 2006-03-14 | 2007-09-20 | Cornet Douglas A | System for administering reduced pressure treatment having a manifold with a primary flow passage and a blockage prevention member |
US9867646B2 (en) | 2006-04-07 | 2018-01-16 | Gamal Baroud | Integrated cement delivery system for bone augmentation procedures and methods |
EP2010266A4 (en) | 2006-04-07 | 2010-07-14 | Commercialisation Des Produits | Integrated cement delivery system for bone augmentation procedures and methods |
US8676293B2 (en) | 2006-04-13 | 2014-03-18 | Aecc Enterprises Ltd. | Devices, systems and methods for measuring and evaluating the motion and function of joint structures and associated muscles, determining suitability for orthopedic intervention, and evaluating efficacy of orthopedic intervention |
EP2004072B1 (en) * | 2006-04-13 | 2013-09-11 | Cook Medical Technologies LLC | Apparatus for endoscopic resection of tissue |
ATE538740T1 (en) * | 2006-04-20 | 2012-01-15 | Depuy Spine Inc | INSTRUMENT SET FOR DISPENSING A VISCOUS BONE FILLER MATERIAL |
CA2650497C (en) | 2006-04-26 | 2015-02-10 | Illuminoss Medical, Inc. | Apparatus and methods for delivery of reinforcing materials to bone |
US7806900B2 (en) | 2006-04-26 | 2010-10-05 | Illuminoss Medical, Inc. | Apparatus and methods for delivery of reinforcing materials to bone |
WO2007127255A2 (en) | 2006-04-26 | 2007-11-08 | Illuminoss Medical, Inc. | Apparatus and methods for reinforcing bone |
WO2007131002A2 (en) | 2006-05-01 | 2007-11-15 | Stout Medical Group, L.P. | Expandable support device and method of use |
US7754005B2 (en) * | 2006-05-02 | 2010-07-13 | Kyphon Sarl | Bone cement compositions comprising an indicator agent and related methods thereof |
US7842038B2 (en) | 2006-05-04 | 2010-11-30 | Warsaw Orthopedic, Inc. | Method for using retractable stylet and cannula combination to form an opening in bone |
US8167899B2 (en) * | 2006-05-04 | 2012-05-01 | Warsaw Orthopedic, Inc. | Retractable stylet and cannula combination |
CA2652813A1 (en) | 2006-05-22 | 2007-12-06 | Orthovita, Inc. | Delivery of multicomponent compositions |
US20070276506A1 (en) * | 2006-05-25 | 2007-11-29 | Biomet Manufacturing Corp. | Demineralized osteochondral plug |
US9421302B2 (en) * | 2006-05-26 | 2016-08-23 | Baxter International Inc. | Injectable fibrin composition for bone augmentation |
US7507286B2 (en) * | 2006-06-08 | 2009-03-24 | Sanatis Gmbh | Self-foaming cement for void filling and/or delivery systems |
US20080009876A1 (en) * | 2006-07-07 | 2008-01-10 | Meera Sankaran | Medical device with expansion mechanism |
US20080027456A1 (en) * | 2006-07-19 | 2008-01-31 | Csaba Truckai | Bone treatment systems and methods |
US20080082104A1 (en) * | 2006-07-27 | 2008-04-03 | Lanx, Llc | Methods and apparatuses for facilitating percutaneous fusion |
US8480676B2 (en) * | 2006-08-07 | 2013-07-09 | Thomas R. Lyon | Bone tamp apparatus and method |
CN102274557B (en) | 2006-08-09 | 2014-12-03 | 精达制药公司 | Osmotic delivery systems and piston assemblies |
US7985228B2 (en) * | 2006-08-25 | 2011-07-26 | Kyphon Sarl | Apparatus and methods for use of expandable members in surgical applications |
US8926620B2 (en) | 2006-08-25 | 2015-01-06 | Kyphon Sarl | Apparatus and methods for use of expandable members in surgical applications |
ES2805203T3 (en) | 2006-09-12 | 2021-02-11 | Teleflex Medical Devices S A R L | Bone marrow aspiration and biopsy apparatus |
US8944069B2 (en) | 2006-09-12 | 2015-02-03 | Vidacare Corporation | Assemblies for coupling intraosseous (IO) devices to powered drivers |
AU2007297097A1 (en) | 2006-09-14 | 2008-03-20 | Depuy Spine, Inc. | Bone cement and methods of use thereof |
EP2063808A4 (en) * | 2006-09-14 | 2012-06-13 | Spineology Inc | Absorbent fabric implant |
EP1900346A1 (en) * | 2006-09-18 | 2008-03-19 | Tecres S.P.A. | Device for filling bone cavities with fluid cement, acetabular cavities in particular |
AU2007300585A1 (en) * | 2006-09-21 | 2008-04-03 | Kyphon Sarl | Diammonium phosphate and other ammonium salts and their use in preventing clotting |
US20080082051A1 (en) * | 2006-09-21 | 2008-04-03 | Kyphon Inc. | Device and method for facilitating introduction of guidewires into catheters |
US9918826B2 (en) | 2006-09-29 | 2018-03-20 | Biomet Sports Medicine, Llc | Scaffold for spring ligament repair |
US8500818B2 (en) | 2006-09-29 | 2013-08-06 | Biomet Manufacturing, Llc | Knee prosthesis assembly with ligament link |
US11259794B2 (en) | 2006-09-29 | 2022-03-01 | Biomet Sports Medicine, Llc | Method for implanting soft tissue |
US8672969B2 (en) | 2006-09-29 | 2014-03-18 | Biomet Sports Medicine, Llc | Fracture fixation device |
WO2008045212A2 (en) * | 2006-10-06 | 2008-04-17 | Kyphon Sarl | Products and methods for percutaneous material delivery |
US7963967B1 (en) * | 2006-10-12 | 2011-06-21 | Woodse Enterprises, Inc. | Bone preparation tool |
EP3095511A1 (en) | 2006-10-19 | 2016-11-23 | Depuy Spine Inc. | Sealed container |
ES2443526T3 (en) | 2006-10-23 | 2014-02-19 | C.R. Bard, Inc. | Breast marker |
US8974410B2 (en) | 2006-10-30 | 2015-03-10 | Vidacare LLC | Apparatus and methods to communicate fluids and/or support intraosseous devices |
WO2008073190A2 (en) * | 2006-11-03 | 2008-06-19 | Kyphon Sarl | Materials and methods and systems for delivering localized medical treatments |
US8388626B2 (en) * | 2006-11-08 | 2013-03-05 | Warsaw Orthopedic, Inc. | Methods of employing calcium phosphate cement compositions and osteoinductive proteins to effect vertebrae interbody fusion absent an interbody device |
EP2091445B1 (en) | 2006-11-10 | 2015-03-11 | Illuminoss Medical, Inc. | Systems for internal bone fixation |
US7879041B2 (en) | 2006-11-10 | 2011-02-01 | Illuminoss Medical, Inc. | Systems and methods for internal bone fixation |
US20080114364A1 (en) * | 2006-11-15 | 2008-05-15 | Aoi Medical, Inc. | Tissue cavitation device and method |
US8105382B2 (en) | 2006-12-07 | 2012-01-31 | Interventional Spine, Inc. | Intervertebral implant |
US8696679B2 (en) | 2006-12-08 | 2014-04-15 | Dfine, Inc. | Bone treatment systems and methods |
US9579077B2 (en) | 2006-12-12 | 2017-02-28 | C.R. Bard, Inc. | Multiple imaging mode tissue marker |
EP2101670B1 (en) | 2006-12-18 | 2013-07-31 | C.R.Bard, Inc. | Biopsy marker with in situ-generated imaging properties |
US8197491B2 (en) | 2006-12-19 | 2012-06-12 | Synthes Usa, Llc | Injectable fastener system and method |
US7771476B2 (en) | 2006-12-21 | 2010-08-10 | Warsaw Orthopedic Inc. | Curable orthopedic implant devices configured to harden after placement in vivo by application of a cure-initiating energy before insertion |
US8480718B2 (en) | 2006-12-21 | 2013-07-09 | Warsaw Orthopedic, Inc. | Curable orthopedic implant devices configured to be hardened after placement in vivo |
US20080154304A1 (en) * | 2006-12-21 | 2008-06-26 | Arthrocare Corporation | System and method for accessing a tissue structure |
US8663328B2 (en) | 2006-12-21 | 2014-03-04 | Warsaw Orthopedic, Inc. | Methods for positioning a load-bearing component of an orthopedic implant device by inserting a malleable device that hardens in vivo |
US8758407B2 (en) | 2006-12-21 | 2014-06-24 | Warsaw Orthopedic, Inc. | Methods for positioning a load-bearing orthopedic implant device in vivo |
US8109961B2 (en) * | 2006-12-27 | 2012-02-07 | Vinay Deshmukh | Bone fusion system and method |
US8147495B2 (en) * | 2007-01-16 | 2012-04-03 | Warsaw Orthopedic, Inc. | Methods and kits for treating fractures with a biological agent |
WO2008095052A2 (en) | 2007-01-30 | 2008-08-07 | Loma Vista Medical, Inc., | Biological navigation device |
US20080188858A1 (en) * | 2007-02-05 | 2008-08-07 | Robert Luzzi | Bone treatment systems and methods |
IL181211A0 (en) * | 2007-02-07 | 2007-07-04 | Nmb Medical Applic Ltd | Device and methods for strengthening long bones |
EP2124777A4 (en) | 2007-02-21 | 2013-06-05 | Benvenue Medical Inc | Devices for treating the spine |
US20080255569A1 (en) * | 2007-03-02 | 2008-10-16 | Andrew Kohm | Bone support device, system, and method |
CN101646393A (en) * | 2007-03-12 | 2010-02-10 | 基兰·P·默菲 | Method and kit for intra osseous navigation and augmentation of bone |
JP2010522046A (en) * | 2007-03-22 | 2010-07-01 | ノヴァリン・オルソペディクス・インコーポレーテッド | Segmented intramedullary structure |
US20080249604A1 (en) * | 2007-03-30 | 2008-10-09 | Brian Donovan | Apparatus and method for medical procedures within a spine |
US20080243249A1 (en) * | 2007-03-30 | 2008-10-02 | Kohm Andrew C | Devices for multipoint emplacement in a body part and methods of use of such devices |
US20090036799A1 (en) * | 2007-03-30 | 2009-02-05 | Medtronic Spinal And Biologics Business | Methods and Systems For The Diagnosis and Treatment of Medical Conditions in the Spine and Other Body Parts |
ES2438999T3 (en) * | 2007-04-03 | 2014-01-21 | Dfine, Inc. | Bone treatment systems |
WO2008124463A2 (en) | 2007-04-04 | 2008-10-16 | Vidacare Corporation | Powered drivers, intraosseous devices and methods to access bone marrow |
NZ580447A (en) | 2007-04-23 | 2011-06-30 | Intarcia Therapeutics Inc | Suspension formulations of insulinotropic peptides and uses thereof |
EP2142224B1 (en) * | 2007-04-23 | 2016-03-23 | Baxter International Inc. | Fibrin compositions containing strontium compounds |
US8062364B1 (en) | 2007-04-27 | 2011-11-22 | Knee Creations, Llc | Osteoarthritis treatment and device |
WO2008137428A2 (en) | 2007-04-30 | 2008-11-13 | Dfine, Inc. | Bone treatment systems and methods |
US20080294167A1 (en) | 2007-05-21 | 2008-11-27 | Brian Schumacher | Articulating cavitation device |
DE202007007322U1 (en) | 2007-05-23 | 2008-10-02 | Baumgart, Rainer, Prof. Dr.med., Dipl.-Ing. | Set of instruments for the minimally invasive preparation of a bone nailing |
US8900307B2 (en) | 2007-06-26 | 2014-12-02 | DePuy Synthes Products, LLC | Highly lordosed fusion cage |
US20090005816A1 (en) * | 2007-06-26 | 2009-01-01 | Denardo Andrew J | Spinal rod, insertion device, and method of using |
US9597118B2 (en) * | 2007-07-20 | 2017-03-21 | Dfine, Inc. | Bone anchor apparatus and method |
WO2009032071A2 (en) * | 2007-08-29 | 2009-03-12 | Spinemedica Corporation | Orthopaedic cement mixtures with low weight percent polyvinyl alcohol (pva) solution |
US8465515B2 (en) | 2007-08-29 | 2013-06-18 | Ethicon Endo-Surgery, Inc. | Tissue retractors |
US7883511B2 (en) * | 2007-09-12 | 2011-02-08 | Fernyhough Jeffrey C | Method and composition for use in reinforcing bone |
EP2195087A1 (en) * | 2007-09-14 | 2010-06-16 | Crosstrees Medical, Inc. | Material control device for inserting material into a targeted anatomical region |
KR100950990B1 (en) * | 2007-09-14 | 2010-04-02 | 최길운 | An apparatus for treating a bone |
US20090088788A1 (en) * | 2007-09-28 | 2009-04-02 | Steven Mouw | Methods and apparatus having multiple separately actuatable expandable members |
US8322256B2 (en) * | 2007-10-05 | 2012-12-04 | Biomet Manufacturing Corp. | System for forming a tendon-bone graft |
US8303592B2 (en) * | 2007-10-05 | 2012-11-06 | Biomet Manufacturing Corp. | System for forming a tendon-bone graft |
US20090099481A1 (en) | 2007-10-10 | 2009-04-16 | Adam Deitz | Devices, Systems and Methods for Measuring and Evaluating the Motion and Function of Joints and Associated Muscles |
US8597301B2 (en) * | 2007-10-19 | 2013-12-03 | David Mitchell | Cannula with lateral access and directional exit port |
US9427289B2 (en) | 2007-10-31 | 2016-08-30 | Illuminoss Medical, Inc. | Light source |
US8556949B2 (en) | 2007-11-14 | 2013-10-15 | DePuy Synthes Products, LLC | Hybrid bone fixation element and methods of using the same |
KR101534242B1 (en) | 2007-11-16 | 2015-07-09 | 신세스 게엠바하 | Porous containment device and associated method for stabilization of vertebral compression fractures |
US20090131867A1 (en) | 2007-11-16 | 2009-05-21 | Liu Y King | Steerable vertebroplasty system with cavity creation element |
US20090131950A1 (en) * | 2007-11-16 | 2009-05-21 | Liu Y King | Vertebroplasty method with enhanced control |
US20090299282A1 (en) * | 2007-11-16 | 2009-12-03 | Osseon Therapeutics, Inc. | Steerable vertebroplasty system with a plurality of cavity creation elements |
US9510885B2 (en) | 2007-11-16 | 2016-12-06 | Osseon Llc | Steerable and curvable cavity creation system |
US20090131886A1 (en) * | 2007-11-16 | 2009-05-21 | Liu Y King | Steerable vertebroplasty system |
US8128559B2 (en) | 2007-11-26 | 2012-03-06 | Ethicon Endo-Surgery, Inc. | Tissue retractors |
US8517931B2 (en) | 2007-11-26 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Tissue retractors |
US9457056B2 (en) * | 2007-12-04 | 2016-10-04 | Ben-Gurion University Of The Negev Research And Development Authority | Peptides comprising alternating hydrophobic and anionic amino acids for treatment of osteoporosis |
US20090182427A1 (en) * | 2007-12-06 | 2009-07-16 | Osseon Therapeutics, Inc. | Vertebroplasty implant with enhanced interfacial shear strength |
US8403968B2 (en) | 2007-12-26 | 2013-03-26 | Illuminoss Medical, Inc. | Apparatus and methods for repairing craniomaxillofacial bones using customized bone plates |
US20090177206A1 (en) * | 2008-01-08 | 2009-07-09 | Zimmer Spine, Inc. | Instruments, implants, and methods for fixation of vertebral compression fractures |
US8287538B2 (en) | 2008-01-14 | 2012-10-16 | Conventus Orthopaedics, Inc. | Apparatus and methods for fracture repair |
CN101909548B (en) | 2008-01-17 | 2014-07-30 | 斯恩蒂斯有限公司 | An expandable intervertebral implant and associated method of manufacturing the same |
WO2009099767A2 (en) | 2008-01-31 | 2009-08-13 | C.R. Bard, Inc. | Biopsy tissue marker |
US9445854B2 (en) | 2008-02-01 | 2016-09-20 | Dfine, Inc. | Bone treatment systems and methods |
US20100030220A1 (en) * | 2008-07-31 | 2010-02-04 | Dfine, Inc. | Bone treatment systems and methods |
US9161798B2 (en) * | 2008-02-01 | 2015-10-20 | Dfine, Inc. | Bone treatment systems and methods |
JP4612694B2 (en) * | 2008-02-07 | 2011-01-12 | 浩巳 松崎 | Surgical instrument set |
CA2726861C (en) | 2008-02-13 | 2014-05-27 | Intarcia Therapeutics, Inc. | Devices, formulations, and methods for delivery of multiple beneficial agents |
ES2483996T3 (en) * | 2008-02-28 | 2014-08-08 | Dfine, Inc. | Bone treatment systems and methods |
US8795365B2 (en) * | 2008-03-24 | 2014-08-05 | Warsaw Orthopedic, Inc | Expandable devices for emplacement in body parts and methods associated therewith |
CA2719490A1 (en) * | 2008-03-28 | 2009-10-01 | Spineology Inc. | Method and device for interspinous process fusion |
WO2009124269A1 (en) | 2008-04-05 | 2009-10-08 | Synthes Usa, Llc | Expandable intervertebral implant |
US9180416B2 (en) | 2008-04-21 | 2015-11-10 | Dfine, Inc. | System for use in bone cement preparation and delivery |
US7968616B2 (en) * | 2008-04-22 | 2011-06-28 | Kyphon Sarl | Bone cement composition and method |
US20090266728A1 (en) * | 2008-04-25 | 2009-10-29 | Warsaw Orthopedic, Inc. | Medical device tracking system with tray and method |
US20110125158A1 (en) | 2008-05-01 | 2011-05-26 | Ashish Dhar Diwan | Systems, methods and apparatuses for formation and insertion of tissue prostheses |
WO2009149108A1 (en) | 2008-06-02 | 2009-12-10 | Loma Vista Medical, Inc. | Inflatable medical devices |
WO2009155319A1 (en) | 2008-06-17 | 2009-12-23 | Soteira, Inc. | Devices and methods for fracture reduction |
US8277506B2 (en) | 2008-06-24 | 2012-10-02 | Carefusion 2200, Inc. | Method and structure for stabilizing a vertebral body |
KR100950989B1 (en) * | 2008-07-03 | 2010-04-02 | (주)태연메디칼 | An apparatus for percutaneous delivery of bone-filling material |
GB0813659D0 (en) | 2008-07-25 | 2008-09-03 | Smith & Nephew | Fracture putty |
US20100023065A1 (en) * | 2008-07-25 | 2010-01-28 | Welch Andrea M | Tissue access device with alignment guide and methods of use |
US9289302B2 (en) * | 2008-07-28 | 2016-03-22 | Zimmer, Inc. | Mosaicplasty constructs |
EP2316047B1 (en) * | 2008-08-18 | 2011-12-07 | Qioptiq Photonics GmbH & Co. KG | Method for producing a lens |
KR20100030153A (en) * | 2008-09-09 | 2010-03-18 | 삼성전자주식회사 | Fuel cell system and method to supply fuel the same |
US9327061B2 (en) | 2008-09-23 | 2016-05-03 | Senorx, Inc. | Porous bioabsorbable implant |
CA2738478A1 (en) | 2008-09-26 | 2010-04-01 | Sonoma Orthopedic Products, Inc. | Bone fixation device, tools and methods |
AU2009296474B2 (en) | 2008-09-26 | 2015-07-02 | Relievant Medsystems, Inc. | Systems and methods for navigating an instrument through bone |
US10028753B2 (en) | 2008-09-26 | 2018-07-24 | Relievant Medsystems, Inc. | Spine treatment kits |
US20100204795A1 (en) | 2008-11-12 | 2010-08-12 | Stout Medical Group, L.P. | Fixation device and method |
US20100211176A1 (en) | 2008-11-12 | 2010-08-19 | Stout Medical Group, L.P. | Fixation device and method |
US7805920B2 (en) * | 2008-11-13 | 2010-10-05 | The Toro Company | Lawn mower having steeply inclined exit tunnel and battery access through rear face of mower cutting deck |
US20100145340A1 (en) * | 2008-12-05 | 2010-06-10 | Kyphon Sarl | Introducer Tool for Bone Measurement |
US20100160921A1 (en) * | 2008-12-19 | 2010-06-24 | Arthrocare Corporation | Cancellous bone displacement system and methods of use |
WO2010077244A1 (en) | 2008-12-30 | 2010-07-08 | C.R. Bard Inc. | Marker delivery device for tissue marker placement |
US20100198140A1 (en) * | 2009-02-05 | 2010-08-05 | Kevin Jon Lawson | Percutaneous tools and bone pellets for vertebral body reconstruction |
WO2010094032A2 (en) | 2009-02-16 | 2010-08-19 | Aoi Medical Inc. | Trauma nail accumulator |
US20120041462A1 (en) * | 2009-02-27 | 2012-02-16 | Sae Won Meditech. Co., Ltd. | Apparatus for forming hole in spongelike bone |
CA2750494A1 (en) * | 2009-03-13 | 2010-09-16 | Wyeth Llc | Bone cement delivery systems and related kits and methods |
US8535327B2 (en) | 2009-03-17 | 2013-09-17 | Benvenue Medical, Inc. | Delivery apparatus for use with implantable medical devices |
WO2010111246A1 (en) | 2009-03-23 | 2010-09-30 | Soteira, Inc. | Devices and methods for vertebrostenting |
US9526620B2 (en) | 2009-03-30 | 2016-12-27 | DePuy Synthes Products, Inc. | Zero profile spinal fusion cage |
PL2414314T3 (en) | 2009-03-31 | 2018-02-28 | Dow Technology Investments Llc | Hydroformylation process with triphenylphosphine and a doubly open-ended bisphosphite ligand |
US8210729B2 (en) | 2009-04-06 | 2012-07-03 | Illuminoss Medical, Inc. | Attachment system for light-conducting fibers |
US8512338B2 (en) | 2009-04-07 | 2013-08-20 | Illuminoss Medical, Inc. | Photodynamic bone stabilization systems and methods for reinforcing bone |
EP2416721B1 (en) | 2009-04-09 | 2013-07-10 | Synthes GmbH | Minimally invasive spine augmentation and stabilization system |
US8821505B2 (en) * | 2009-04-24 | 2014-09-02 | Kyphon Sarl | Minimally invasive cement delivery system retainer |
US8070728B2 (en) * | 2009-05-05 | 2011-12-06 | Societe De Commercialisation Des Produits De La Recherche Appliquee Socpra Sciences Et Genie S.E.C | Cannula assembly with detachable inner and outer cannulas |
US20100298832A1 (en) | 2009-05-20 | 2010-11-25 | Osseon Therapeutics, Inc. | Steerable curvable vertebroplasty drill |
US20100305710A1 (en) | 2009-05-28 | 2010-12-02 | Biomet Manufacturing Corp. | Knee Prosthesis |
DE102009034667B8 (en) * | 2009-07-24 | 2018-07-19 | Siemens Healthcare Gmbh | Apparatus and method for instrument calibration |
US20110028981A1 (en) * | 2009-07-29 | 2011-02-03 | Warsaw Orthopedic, Inc. | Bone graft measuring apparatus and method of use |
US8747472B2 (en) * | 2009-08-14 | 2014-06-10 | Baxano Surgical, Inc. | Spinal therapy device with fixated distraction distance |
AU2010328680B2 (en) | 2009-08-19 | 2014-10-23 | Illuminoss Medical, Inc. | Devices and methods for bone alignment, stabilization and distraction |
US20110077655A1 (en) * | 2009-09-25 | 2011-03-31 | Fisher Michael A | Vertebral Body Spool Device |
US9138163B2 (en) | 2009-09-25 | 2015-09-22 | Ortho Kinematics, Inc. | Systems and devices for an integrated imaging system with real-time feedback loop and methods therefor |
CA2775676C (en) | 2009-09-28 | 2016-08-16 | Intarcia Therapeutics, Inc. | Rapid establishment and/or termination of substantial steady-state drug delivery |
US20110082338A1 (en) * | 2009-10-01 | 2011-04-07 | Tyco Healthcare Group Lp | Port fixation with varying thread pitch |
US20110106013A1 (en) * | 2009-10-30 | 2011-05-05 | DePuy Mikek, Inc. | Dual cannula system and method for partial thickness rotator cuff repair |
CA2779742A1 (en) | 2009-11-06 | 2011-05-12 | Socpra Sciences Et Genies S.E.C. | Bone cement delivery system |
US20110112507A1 (en) * | 2009-11-10 | 2011-05-12 | Carefusion 207, Inc. | Curable material delivery systems and methods |
US8226657B2 (en) | 2009-11-10 | 2012-07-24 | Carefusion 207, Inc. | Systems and methods for vertebral or other bone structure height restoration and stabilization |
US9095393B2 (en) | 2012-05-30 | 2015-08-04 | Carefusion 2200, Inc. | Method for balloon-aided vertebral augmentation |
US8894658B2 (en) | 2009-11-10 | 2014-11-25 | Carefusion 2200, Inc. | Apparatus and method for stylet-guided vertebral augmentation |
KR20120104580A (en) * | 2009-11-20 | 2012-09-21 | 니 크리에이션스, 엘엘씨 | Navigation and positioning instruments for joint repair |
US20110125264A1 (en) * | 2009-11-20 | 2011-05-26 | Knee Creations, Llc | Implantable devices for subchondral treatment of joint pain |
US8821504B2 (en) | 2009-11-20 | 2014-09-02 | Zimmer Knee Creations, Inc. | Method for treating joint pain and associated instruments |
US8951261B2 (en) | 2009-11-20 | 2015-02-10 | Zimmer Knee Creations, Inc. | Subchondral treatment of joint pain |
CN102740789A (en) * | 2009-11-20 | 2012-10-17 | 膝部创造物有限责任公司 | Instruments for targeting a joint defect |
WO2011063240A1 (en) | 2009-11-20 | 2011-05-26 | Knee Creations, Llc | Implantable devices for subchondral treatment of joint pain |
AU2010321743A1 (en) | 2009-11-20 | 2012-07-12 | Knee Creations, Llc | Coordinate mapping system for joint treatment |
US8801800B2 (en) | 2009-11-20 | 2014-08-12 | Zimmer Knee Creations, Inc. | Bone-derived implantable devices and tool for subchondral treatment of joint pain |
JP2013511356A (en) * | 2009-11-20 | 2013-04-04 | ニー・クリエイションズ・リミテッド・ライアビリティ・カンパニー | Device for variable angle approach to joints |
US8562619B2 (en) * | 2009-12-03 | 2013-10-22 | Industrial Technology Research Institute | Injectable thermoplastic polymers for biological tissue repair |
US9393129B2 (en) | 2009-12-10 | 2016-07-19 | DePuy Synthes Products, Inc. | Bellows-like expandable interbody fusion cage |
WO2011075745A2 (en) * | 2009-12-18 | 2011-06-23 | Palmaz Scientific, Inc. | Interosteal and intramedullary implants and method of implanting same |
KR101075847B1 (en) | 2009-12-21 | 2011-10-25 | 가톨릭대학교 산학협력단 | Surgical equipment for avascular necrosis of femoral head |
FR2954689B1 (en) * | 2009-12-28 | 2012-12-21 | Sterispine | DEVICE AND METHOD FOR SPINAL SURGERY. |
US20110178520A1 (en) | 2010-01-15 | 2011-07-21 | Kyle Taylor | Rotary-rigid orthopaedic rod |
CN105534561B (en) | 2010-01-20 | 2018-04-03 | 康文图斯整形外科公司 | For bone close to the device and method with bone cavity preparation |
US9220554B2 (en) | 2010-02-18 | 2015-12-29 | Globus Medical, Inc. | Methods and apparatus for treating vertebral fractures |
US20110264098A1 (en) * | 2010-02-26 | 2011-10-27 | Cobbs Charles S | Minimally invasive systems, devices, and surgical methods for performing arthrodesis in the spine |
AU2011224529C1 (en) | 2010-03-08 | 2017-01-19 | Conventus Orthopaedics, Inc. | Apparatus and methods for securing a bone implant |
KR101150283B1 (en) * | 2010-03-15 | 2012-05-24 | (주)엘앤케이바이오메드 | Injection device for bone cement |
KR101085074B1 (en) | 2010-04-20 | 2011-11-21 | 한창기전 주식회사 | Bone compression equipment for kyphoplasty |
WO2011137377A1 (en) | 2010-04-29 | 2011-11-03 | Dfine, Inc. | System for use in treatment of vertebral fractures |
US8535380B2 (en) | 2010-05-13 | 2013-09-17 | Stout Medical Group, L.P. | Fixation device and method |
WO2011142491A1 (en) * | 2010-05-14 | 2011-11-17 | (주)비엠코리아 | Medical dilator |
JP5029727B2 (en) | 2010-06-01 | 2012-09-19 | オムロン株式会社 | Semiconductor device and microphone |
US8684965B2 (en) | 2010-06-21 | 2014-04-01 | Illuminoss Medical, Inc. | Photodynamic bone stabilization and drug delivery systems |
US8979860B2 (en) | 2010-06-24 | 2015-03-17 | DePuy Synthes Products. LLC | Enhanced cage insertion device |
US9907560B2 (en) | 2010-06-24 | 2018-03-06 | DePuy Synthes Products, Inc. | Flexible vertebral body shavers |
TW201215379A (en) | 2010-06-29 | 2012-04-16 | Synthes Gmbh | Distractible intervertebral implant |
US8685052B2 (en) | 2010-06-30 | 2014-04-01 | Laurimed, Llc | Devices and methods for cutting tissue |
TWI579007B (en) * | 2010-07-02 | 2017-04-21 | 艾格諾福斯保健公司 | Use of bone regenerative material |
WO2012009486A2 (en) | 2010-07-13 | 2012-01-19 | Loma Vista Medical, Inc. | Inflatable medical devices |
US8795369B1 (en) | 2010-07-16 | 2014-08-05 | Nuvasive, Inc. | Fracture reduction device and methods |
RU2013103455A (en) | 2010-07-21 | 2014-08-27 | ЭнЭлТи Спайн ЛТД. | IMPLANTS FOR SPINAL SURGERY AND DELIVERY SYSTEM |
WO2012018612A2 (en) | 2010-07-26 | 2012-02-09 | Warsaw Orthopedic, Inc. | Calcium particle-embedded, snap-to-dough, high-viscosity bone cement |
EP2608747A4 (en) | 2010-08-24 | 2015-02-11 | Flexmedex Llc | Support device and method for use |
US9402732B2 (en) | 2010-10-11 | 2016-08-02 | DePuy Synthes Products, Inc. | Expandable interspinous process spacer implant |
US10188436B2 (en) | 2010-11-09 | 2019-01-29 | Loma Vista Medical, Inc. | Inflatable medical devices |
US9149286B1 (en) | 2010-11-12 | 2015-10-06 | Flexmedex, LLC | Guidance tool and method for use |
US8771276B2 (en) | 2010-12-01 | 2014-07-08 | Carefusion 2200, Inc. | Systems and methods for forming a cavity in, and delivering curable material into, bone |
EP2651295A4 (en) | 2010-12-13 | 2015-11-18 | Ortho Kinematics Inc | Methods, systems and devices for clinical data reporting and surgical navigation |
EP2654584A1 (en) | 2010-12-22 | 2013-10-30 | Illuminoss Medical, Inc. | Systems and methods for treating conditions and diseases of the spine |
US20120197319A1 (en) * | 2011-01-27 | 2012-08-02 | Kyphon Sarl | Inflatable bone tamp with adjustable working length |
US8961525B2 (en) * | 2011-01-28 | 2015-02-24 | Kyphon Sarl | Inflatable bone tamp with predetermined extensibility |
US20120208755A1 (en) | 2011-02-16 | 2012-08-16 | Intarcia Therapeutics, Inc. | Compositions, Devices and Methods of Use Thereof for the Treatment of Cancers |
EP2677946B1 (en) | 2011-02-22 | 2016-08-17 | Zimmer Knee Creations, Inc. | Guide systems for joint repair |
US9358372B2 (en) | 2011-03-25 | 2016-06-07 | Vention Medical Advanced Components, Inc. | Apparatus and methods for accessing and dilating bone structures using a narrow gauge cannula |
US9060878B2 (en) * | 2011-03-28 | 2015-06-23 | Ray G. Oktavec | Percutaneous biologic delivery system |
CA2831057C (en) * | 2011-04-19 | 2017-08-15 | Ao Technology Ag | Cannula and kit for evaluation and preparation of bone tissue |
US8932295B1 (en) | 2011-06-01 | 2015-01-13 | Surgical Device Exchange, LLC | Bone graft delivery system and method for using same |
US10064671B2 (en) | 2011-06-09 | 2018-09-04 | Zimmer Knee Creations, Inc. | Instruments and devices for subchondral joint repair |
US20120316571A1 (en) | 2011-06-10 | 2012-12-13 | Knee Creations, Llc | Subchondral treatment of osteoarthritis in joints |
WO2012178018A2 (en) | 2011-06-24 | 2012-12-27 | Benvenue Medical, Inc. | Devices and methods for treating bone tissue |
US8936644B2 (en) | 2011-07-19 | 2015-01-20 | Illuminoss Medical, Inc. | Systems and methods for joint stabilization |
JP2014533965A (en) | 2011-07-19 | 2014-12-18 | イルミンオス・メディカル・インコーポレイテッドIlluminOss Medical, Inc. | Apparatus and method for bone reconstruction and stabilization |
US9119646B2 (en) | 2011-08-07 | 2015-09-01 | Zimmer Knee Creations, Inc. | Subchondral treatment to prevent the progression of osteoarthritis of the joint |
US8623089B2 (en) | 2011-08-07 | 2014-01-07 | Zimmer Knee Creations, Inc. | Subchondral treatment of joint pain of the spine |
US9138187B2 (en) | 2011-08-07 | 2015-09-22 | Zimmer Knee Creations, Inc. | Treatment of subchondral bone by biochemical diagnosis to prevent the progression of osteoarthritis of the joint |
US9119639B2 (en) | 2011-08-09 | 2015-09-01 | DePuy Synthes Products, Inc. | Articulated cavity creator |
WO2013028808A1 (en) | 2011-08-23 | 2013-02-28 | Flexmedex, LLC | Tissue removal device and method |
US20130072941A1 (en) * | 2011-09-16 | 2013-03-21 | Francisca Tan-Malecki | Cement Injector and Cement Injector Connectors, and Bone Cement Injector Assembly |
US9168100B2 (en) | 2011-10-11 | 2015-10-27 | Zimmer Knee Creations, Inc. | Methods and instruments for subchondral treatment of osteoarthritis in a small joint |
US9237896B2 (en) | 2011-10-21 | 2016-01-19 | Cook Medical Technologies Llc | Ghost ring guide for assistance in percutaneous insertions |
US9357991B2 (en) | 2011-11-03 | 2016-06-07 | Biomet Sports Medicine, Llc | Method and apparatus for stitching tendons |
US9370350B2 (en) | 2011-11-10 | 2016-06-21 | Biomet Sports Medicine, Llc | Apparatus for coupling soft tissue to a bone |
US9357992B2 (en) | 2011-11-10 | 2016-06-07 | Biomet Sports Medicine, Llc | Method for coupling soft tissue to a bone |
US9381013B2 (en) | 2011-11-10 | 2016-07-05 | Biomet Sports Medicine, Llc | Method for coupling soft tissue to a bone |
EP2793722A1 (en) | 2011-12-22 | 2014-10-29 | DePuy Synthes Products, LLC | Length-adjustable vertebral body balloon |
TWI590843B (en) | 2011-12-28 | 2017-07-11 | 信迪思有限公司 | Films and methods of manufacture |
US10390877B2 (en) | 2011-12-30 | 2019-08-27 | Relievant Medsystems, Inc. | Systems and methods for treating back pain |
US9259217B2 (en) | 2012-01-03 | 2016-02-16 | Biomet Manufacturing, Llc | Suture Button |
US9155578B2 (en) | 2012-02-28 | 2015-10-13 | DePuy Synthes Products, Inc. | Expandable fastener |
WO2013149256A2 (en) | 2012-03-30 | 2013-10-03 | Zimmer Gmbh, Inc. | Surgical access systems, instruments and accessories |
WO2013155359A1 (en) * | 2012-04-11 | 2013-10-17 | Vijay Vad | Cartilage repair, preservation and growth by stimulation of bone-chondral interphase and delivery system and related methods therefor |
EP2854715A1 (en) | 2012-05-29 | 2015-04-08 | NLT Spine Ltd. | Laterally deflectable implant |
US10207027B2 (en) * | 2012-06-11 | 2019-02-19 | Globus Medical, Inc. | Bioactive bone graft substitutes |
US8939977B2 (en) | 2012-07-10 | 2015-01-27 | Illuminoss Medical, Inc. | Systems and methods for separating bone fixation devices from introducer |
US9144433B2 (en) * | 2012-07-26 | 2015-09-29 | A.M. Surgical, Inc. | Endoscopic surgical blade and method of use thereof |
WO2014045124A2 (en) | 2012-09-07 | 2014-03-27 | Zimmer Knee Creations, Inc. | Instruments for controlled delivery of injectable materials into bone |
WO2014053913A2 (en) | 2012-09-07 | 2014-04-10 | Zimmer Knee Creations, Inc. | Navigation instruments for subchondral bone treatment |
US20140074103A1 (en) * | 2012-09-07 | 2014-03-13 | Zimmer Gmbh, Inc. | Subchondral treatment of bone defects with bone-derived implant |
US10588691B2 (en) | 2012-09-12 | 2020-03-17 | Relievant Medsystems, Inc. | Radiofrequency ablation of tissue within a vertebral body |
US9937057B2 (en) * | 2012-09-24 | 2018-04-10 | Isto Technologies, Inc. | Delivery device |
US9445918B1 (en) | 2012-10-22 | 2016-09-20 | Nuvasive, Inc. | Expandable spinal fusion implants and related instruments and methods |
CA3093398C (en) | 2012-11-05 | 2022-05-24 | Relievant Medsystems, Inc. | Systems and methods for creating curved paths through bone and modulating nerves within the bone |
US9833272B2 (en) | 2012-11-16 | 2017-12-05 | Spinal Generations, Llc | Multichannel cannula and methods for using same |
US20140142584A1 (en) * | 2012-11-16 | 2014-05-22 | Spinal Generations, Llc | Multichannel cannula and methods for using same |
US9308022B2 (en) | 2012-12-10 | 2016-04-12 | Nevro Corporation | Lead insertion devices and associated systems and methods |
US9241729B2 (en) | 2012-12-14 | 2016-01-26 | DePuy Synthes Products, Inc. | Device to aid in the deployment of a shape memory instrument |
US9687281B2 (en) | 2012-12-20 | 2017-06-27 | Illuminoss Medical, Inc. | Distal tip for bone fixation devices |
US9439693B2 (en) | 2013-02-01 | 2016-09-13 | DePuy Synthes Products, Inc. | Steerable needle assembly for use in vertebral body augmentation |
US9522070B2 (en) | 2013-03-07 | 2016-12-20 | Interventional Spine, Inc. | Intervertebral implant |
US9149318B2 (en) * | 2013-03-07 | 2015-10-06 | Kyphon Sarl | Low cost inflatable bone tamp |
US9757119B2 (en) | 2013-03-08 | 2017-09-12 | Biomet Sports Medicine, Llc | Visual aid for identifying suture limbs arthroscopically |
US9913728B2 (en) | 2013-03-14 | 2018-03-13 | Quandary Medical, Llc | Spinal implants and implantation system |
US10085783B2 (en) | 2013-03-14 | 2018-10-02 | Izi Medical Products, Llc | Devices and methods for treating bone tissue |
US9918827B2 (en) | 2013-03-14 | 2018-03-20 | Biomet Sports Medicine, Llc | Scaffold for spring ligament repair |
US8945137B1 (en) | 2013-03-15 | 2015-02-03 | Surgical Device Exchange, LLC | Bone graft delivery system and method for using same |
US9668881B1 (en) | 2013-03-15 | 2017-06-06 | Surgentec, Llc | Bone graft delivery system and method for using same |
CN105555328B (en) | 2013-06-21 | 2019-01-11 | 德普伊新特斯产品公司 | film and manufacturing method |
US9724151B2 (en) | 2013-08-08 | 2017-08-08 | Relievant Medsystems, Inc. | Modulating nerves within bone using bone fasteners |
US9539041B2 (en) | 2013-09-12 | 2017-01-10 | DePuy Synthes Products, Inc. | Minimally invasive biomaterial injection system |
USD716450S1 (en) | 2013-09-24 | 2014-10-28 | C. R. Bard, Inc. | Tissue marker for intracorporeal site identification |
USD715442S1 (en) | 2013-09-24 | 2014-10-14 | C. R. Bard, Inc. | Tissue marker for intracorporeal site identification |
USD715942S1 (en) | 2013-09-24 | 2014-10-21 | C. R. Bard, Inc. | Tissue marker for intracorporeal site identification |
USD716451S1 (en) | 2013-09-24 | 2014-10-28 | C. R. Bard, Inc. | Tissue marker for intracorporeal site identification |
EP3057527B1 (en) | 2013-10-16 | 2021-09-15 | C.R. Bard, Inc. | Catheter insertion tray with integrated instructions |
AU2014362251B2 (en) | 2013-12-12 | 2019-10-10 | Conventus Orthopaedics, Inc. | Tissue displacement tools and methods |
US10136886B2 (en) | 2013-12-20 | 2018-11-27 | Biomet Sports Medicine, Llc | Knotless soft tissue devices and techniques |
US9770278B2 (en) | 2014-01-17 | 2017-09-26 | Arthrex, Inc. | Dual tip guide wire |
US9968373B1 (en) * | 2014-02-21 | 2018-05-15 | Surgentec, Llc | Handles for needle assemblies |
DE202014101197U1 (en) | 2014-03-17 | 2015-06-19 | Joline Gmbh & Co. Kg | Stamping instrument as well as this comprehensive system for the treatment of a bone or cartilage structure |
US9615822B2 (en) | 2014-05-30 | 2017-04-11 | Biomet Sports Medicine, Llc | Insertion tools and method for soft anchor |
US9700291B2 (en) | 2014-06-03 | 2017-07-11 | Biomet Sports Medicine, Llc | Capsule retractor |
US10376648B1 (en) * | 2014-08-11 | 2019-08-13 | H & M Innovations, Llc | Bone delivery apparatus and methods |
US9730707B2 (en) * | 2014-08-20 | 2017-08-15 | Kyphon SÀRL | Surgical instrument with graduated markings correlating to angulation |
US10039543B2 (en) | 2014-08-22 | 2018-08-07 | Biomet Sports Medicine, Llc | Non-sliding soft anchor |
US9814499B2 (en) | 2014-09-30 | 2017-11-14 | Arthrex, Inc. | Intramedullary fracture fixation devices and methods |
US9889085B1 (en) | 2014-09-30 | 2018-02-13 | Intarcia Therapeutics, Inc. | Therapeutic methods for the treatment of diabetes and related conditions for patients with high baseline HbA1c |
US10238507B2 (en) | 2015-01-12 | 2019-03-26 | Surgentec, Llc | Bone graft delivery system and method for using same |
US9955980B2 (en) | 2015-02-24 | 2018-05-01 | Biomet Sports Medicine, Llc | Anatomic soft tissue repair |
US11426290B2 (en) | 2015-03-06 | 2022-08-30 | DePuy Synthes Products, Inc. | Expandable intervertebral implant, system, kit and method |
US9974534B2 (en) | 2015-03-31 | 2018-05-22 | Biomet Sports Medicine, Llc | Suture anchor with soft anchor of electrospun fibers |
US20160310194A1 (en) * | 2015-04-21 | 2016-10-27 | Arthrex, Inc. | Surgical assembly and method for repairing depression fractures |
CN113598842A (en) * | 2015-06-03 | 2021-11-05 | 因塔西亚制药公司 | Implant placement and removal system |
US20160354161A1 (en) | 2015-06-05 | 2016-12-08 | Ortho Kinematics, Inc. | Methods for data processing for intra-operative navigation systems |
US11229466B2 (en) | 2018-01-12 | 2022-01-25 | KyphEZE, Inc. | Bone expansion systems and methods |
DE202016101864U1 (en) | 2016-04-08 | 2017-07-13 | Joline Gmbh & Co. Kg | Double balloon catheter |
EP3458084B1 (en) | 2016-05-16 | 2020-04-01 | Intarcia Therapeutics, Inc | Glucagon-receptor selective polypeptides and methods of use thereof |
USD860451S1 (en) | 2016-06-02 | 2019-09-17 | Intarcia Therapeutics, Inc. | Implant removal tool |
USD840030S1 (en) | 2016-06-02 | 2019-02-05 | Intarcia Therapeutics, Inc. | Implant placement guide |
JP7019616B2 (en) | 2016-06-28 | 2022-02-15 | イーアイティー・エマージング・インプラント・テクノロジーズ・ゲーエムベーハー | Expandable and angle adjustable intervertebral cage with range of motion joints |
JP6995789B2 (en) | 2016-06-28 | 2022-01-17 | イーアイティー・エマージング・インプラント・テクノロジーズ・ゲーエムベーハー | Expandable and angle adjustable intervertebral cage |
AU2017204355B2 (en) | 2016-07-08 | 2021-09-09 | Mako Surgical Corp. | Scaffold for alloprosthetic composite implant |
US10231846B2 (en) | 2016-08-19 | 2019-03-19 | Stryker European Holdings I, Llc | Bone graft delivery loading assembly |
CN109862834B (en) | 2016-10-27 | 2022-05-24 | Dfine有限公司 | Bendable osteotome with cement delivery channel |
US11026744B2 (en) | 2016-11-28 | 2021-06-08 | Dfine, Inc. | Tumor ablation devices and related methods |
EP3551100B1 (en) | 2016-12-09 | 2021-11-10 | Dfine, Inc. | Medical devices for treating hard tissues |
US10888433B2 (en) | 2016-12-14 | 2021-01-12 | DePuy Synthes Products, Inc. | Intervertebral implant inserter and related methods |
KR20190104039A (en) | 2017-01-03 | 2019-09-05 | 인타르시아 세라퓨틱스 인코포레이티드 | Methods Including Continuous Administration of GLP-1 Receptor Agonists and Co-administration of Drugs |
EP3565486B1 (en) | 2017-01-06 | 2021-11-10 | Dfine, Inc. | Osteotome with a distal portion for simultaneous advancement and articulation |
US10722384B2 (en) * | 2017-03-01 | 2020-07-28 | Nordson Corporation | Medical material mixer and transfer apparatus and method for using the same |
AU2018231031B2 (en) | 2017-03-09 | 2023-11-02 | Nevro Corp. | Paddle leads and delivery tools, and associated systems and methods |
US10631881B2 (en) | 2017-03-09 | 2020-04-28 | Flower Orthopedics Corporation | Plating depth gauge and countersink instrument |
CN110678144A (en) | 2017-03-31 | 2020-01-10 | C·R·巴德股份有限公司 | Catheterization tray system and method thereof |
US11298143B2 (en) * | 2017-04-12 | 2022-04-12 | Smith & Nephew, Inc. | Surgical drill guide systems and methods of use thereof |
US10398563B2 (en) | 2017-05-08 | 2019-09-03 | Medos International Sarl | Expandable cage |
DE102017113126A1 (en) * | 2017-06-14 | 2018-12-20 | Heraeus Medical Gmbh | Bone cement applicator with duct element and lock receptacle |
US11344424B2 (en) | 2017-06-14 | 2022-05-31 | Medos International Sarl | Expandable intervertebral implant and related methods |
WO2019010252A2 (en) | 2017-07-04 | 2019-01-10 | Conventus Orthopaedics, Inc. | Apparatus and methods for treatment of a bone |
US10940016B2 (en) | 2017-07-05 | 2021-03-09 | Medos International Sarl | Expandable intervertebral fusion cage |
US11331091B2 (en) * | 2017-11-14 | 2022-05-17 | Endovision Co., Ltd. | Surgical instrument set for use during unilateral biportal endoscopy |
WO2019159062A1 (en) * | 2018-02-13 | 2019-08-22 | Murphy Kieran P | Delivery system for delivering a drug depot to a target site under image guidance and methods and uses of same |
US11406806B2 (en) * | 2018-02-21 | 2022-08-09 | Charles P. Virden | Atraumatic trocar apparatus, system and kit |
AU2019242906A1 (en) | 2018-03-29 | 2020-10-15 | Nevro Corp. | Leads having sidewall openings, and associated systems and methods |
JP7066490B2 (en) * | 2018-04-10 | 2022-05-13 | キヤノンメディカルシステムズ株式会社 | Support information generator and support information generation program |
US11116647B2 (en) | 2018-04-13 | 2021-09-14 | Surgentec, Llc | Bone graft delivery system and method for using same |
US10687828B2 (en) | 2018-04-13 | 2020-06-23 | Surgentec, Llc | Bone graft delivery system and method for using same |
WO2019209867A1 (en) | 2018-04-24 | 2019-10-31 | C.R. Bard, Inc. | Catheterization packages and methods thereof |
US11013543B2 (en) | 2018-05-24 | 2021-05-25 | Medtronic Holding Company Sarl | Method of performing a balloon kyphoplasty procedure using a scoop cannula |
CN112334087B (en) | 2018-06-20 | 2024-01-12 | C·R·巴德股份有限公司 | Catheter insertion kit with integrated instructions for use and method therefor |
EP3813696A4 (en) | 2018-06-27 | 2022-04-13 | IlluminOss Medical, Inc. | Systems and methods for bone stabilization and fixation |
USD933219S1 (en) | 2018-07-13 | 2021-10-12 | Intarcia Therapeutics, Inc. | Implant removal tool and assembly |
US11446156B2 (en) | 2018-10-25 | 2022-09-20 | Medos International Sarl | Expandable intervertebral implant, inserter instrument, and related methods |
WO2020097339A1 (en) | 2018-11-08 | 2020-05-14 | Dfine, Inc. | Tumor ablation device and related systems and methods |
AU2020346827A1 (en) | 2019-09-12 | 2022-03-31 | Relievant Medsystems, Inc. | Systems and methods for tissue modulation |
KR102360346B1 (en) | 2019-12-31 | 2022-02-10 | (주)엘앤케이바이오메드 | Medical Needle Apparatus |
US11426286B2 (en) | 2020-03-06 | 2022-08-30 | Eit Emerging Implant Technologies Gmbh | Expandable intervertebral implant |
CA3185364A1 (en) * | 2020-07-21 | 2022-01-27 | Shankar RAJESWARAN | System and method for treatment of bone |
US11850160B2 (en) | 2021-03-26 | 2023-12-26 | Medos International Sarl | Expandable lordotic intervertebral fusion cage |
US11752009B2 (en) | 2021-04-06 | 2023-09-12 | Medos International Sarl | Expandable intervertebral fusion cage |
Family Cites Families (152)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3091237A (en) * | 1960-05-16 | 1963-05-28 | Clawson N Skinner | Facial muscle and tissue conditioning device |
DE1906284A1 (en) * | 1969-02-08 | 1970-09-03 | Dr Esfandiar Shahrestani | Endoprosthesis, especially for hip joints |
US3606086A (en) | 1969-11-10 | 1971-09-20 | Drummond Instr Co | Microdispensing device |
US3800788A (en) * | 1972-07-12 | 1974-04-02 | N White | Antral catheter for reduction of fractures |
US3893445A (en) | 1974-01-09 | 1975-07-08 | Becton Dickinson Co | Bone marrow biopsy instrument |
JPS5239596B2 (en) * | 1974-04-04 | 1977-10-06 | ||
US3875595A (en) * | 1974-04-15 | 1975-04-08 | Edward C Froning | Intervertebral disc prosthesis and instruments for locating same |
US4005527A (en) * | 1975-12-22 | 1977-02-01 | Wilson Ralph S | Depth gauge |
US4083369A (en) * | 1976-07-02 | 1978-04-11 | Manfred Sinnreich | Surgical instruments |
US4142517A (en) | 1976-07-23 | 1979-03-06 | Contreras Guerrero De Stavropo | Apparatus for extracting bone marrow specimens |
US4086914A (en) | 1977-02-11 | 1978-05-02 | Edwin Bailey Moore | Implant injector |
US4323071A (en) | 1978-04-24 | 1982-04-06 | Advanced Catheter Systems, Inc. | Vascular guiding catheter assembly and vascular dilating catheter assembly and a combination thereof and methods of making the same |
DE7819584U1 (en) | 1978-06-30 | 1978-10-12 | Howmedica International, Inc. Zweigniederlassung Kiel, 2301 Schoenkirchen | TUBE-LIKE STORAGE CONTAINER FOR MEDICAL SPRAY DEVICE |
US4254773A (en) * | 1978-11-24 | 1981-03-10 | Medex Inc. | Swivel coupling for a catheterization system |
FR2458591A1 (en) * | 1979-06-06 | 1981-01-02 | Technilor | GAS SEALING ON INTERIOR COOLING PLATES AND ON EXTERIOR WALL OF HIGH-FURNACE SHIELDS |
US4274163A (en) | 1979-07-16 | 1981-06-23 | The Regents Of The University Of California | Prosthetic fixation technique |
US4277184A (en) | 1979-08-14 | 1981-07-07 | Alan Solomon | Disposable orthopedic implement and method |
US4327736A (en) * | 1979-11-20 | 1982-05-04 | Kanji Inoue | Balloon catheter |
US4338925A (en) * | 1979-12-20 | 1982-07-13 | Jo Miller | Pressure injection of bone cement apparatus and method |
US4369772A (en) * | 1980-04-28 | 1983-01-25 | University Of Florida | Method for strengthening a fractured bone |
US4313434A (en) * | 1980-10-17 | 1982-02-02 | David Segal | Fracture fixation |
DE3142730A1 (en) * | 1981-04-01 | 1982-10-21 | Curt Dipl.-Ing. 1000 Berlin Kranz | "JOINT PROSTHESIS" |
US4367816A (en) * | 1981-06-10 | 1983-01-11 | Wilkes Kenneth R | Tear strip for gas sterilizable package and package |
US4432358A (en) * | 1982-01-22 | 1984-02-21 | Fixel Irving E | Compression hip screw apparatus |
CH657980A5 (en) | 1982-10-21 | 1986-10-15 | Sulzer Ag | DISPOSABLE BONE CEMENT SYRINGE. |
USD283840S (en) | 1983-04-08 | 1986-05-13 | Matsutani Seisakusho | Dental reamer |
CA1227902A (en) * | 1984-04-02 | 1987-10-13 | Raymond G. Tronzo | Fenestrated hip screw and method of augmented internal fixation |
US4642094A (en) | 1984-05-29 | 1987-02-10 | North Jr Walter L | Non-surgical embryo transfer device |
DE8420774U1 (en) | 1984-07-11 | 1985-09-12 | Draenert, Klaus, Dr.Med. Dr.Med.Habil., 8000 Muenchen | Device for mixing and applying bone cement |
US4637396A (en) * | 1984-10-26 | 1987-01-20 | Cook, Incorporated | Balloon catheter |
GB2181650B (en) | 1985-10-18 | 1989-09-13 | Blagoveshchensk G Med Inst | Aortic cannula |
US4892550A (en) | 1985-12-30 | 1990-01-09 | Huebsch Donald L | Endoprosthesis device and method |
US4714478A (en) * | 1986-01-17 | 1987-12-22 | Fischer William B | Prosthesis, method, and tool for installing same |
US4653487A (en) | 1986-01-29 | 1987-03-31 | Maale Gerhard E | Intramedullary rod assembly for cement injection system |
US5358486A (en) * | 1987-01-09 | 1994-10-25 | C. R. Bard, Inc. | Multiple layer high strength balloon for dilatation catheter |
US4772287A (en) * | 1987-08-20 | 1988-09-20 | Cedar Surgical, Inc. | Prosthetic disc and method of implanting |
US4931056A (en) † | 1987-09-04 | 1990-06-05 | Neurodynamics, Inc. | Catheter guide apparatus for perpendicular insertion into a cranium orifice |
US4896662A (en) * | 1987-11-30 | 1990-01-30 | Pfizer Hospital Products Group, Inc. | Sealing device for introducing cement into a bone canal |
DE3800482A1 (en) | 1988-01-11 | 1989-07-20 | List Heinz Juergen | Surgical drilling instrument |
US4909252A (en) * | 1988-05-26 | 1990-03-20 | The Regents Of The Univ. Of California | Perfusion balloon catheter |
DE8807485U1 (en) * | 1988-06-06 | 1989-08-10 | Mecron Medizinische Produkte Gmbh, 1000 Berlin, De | |
US4919153A (en) | 1988-10-11 | 1990-04-24 | Origin Medsystems, Inc. | Method and apparatus for removing pre-placed prosthetic joints and preparing for their replacement |
US5484442A (en) | 1988-10-24 | 1996-01-16 | Cook Incorporated | Intraosseous needle |
US5601559A (en) | 1988-10-24 | 1997-02-11 | Cook Incorporated | Intraosseous needle |
AU4485189A (en) | 1988-10-24 | 1990-05-14 | Cook Incorporated | Intraosseous needle assembly |
US4929238A (en) * | 1988-11-23 | 1990-05-29 | Coeur Laboratories, Inc. | Multi-pressure injector device |
US4969888A (en) † | 1989-02-09 | 1990-11-13 | Arie Scholten | Surgical protocol for fixation of osteoporotic bone using inflatable device |
US6146358A (en) | 1989-03-14 | 2000-11-14 | Cordis Corporation | Method and apparatus for delivery of therapeutic agent |
US4987892A (en) * | 1989-04-04 | 1991-01-29 | Krag Martin H | Spinal fixation device |
US5015255A (en) * | 1989-05-10 | 1991-05-14 | Spine-Tech, Inc. | Spinal stabilization method |
HU212760B (en) * | 1989-06-20 | 1997-02-28 | Denes | Method and device for the apportion of chemical materials into the vein wall |
US5290306A (en) * | 1989-11-29 | 1994-03-01 | Cordis Corporation | Puncture resistant balloon catheter |
US5176638A (en) * | 1990-01-12 | 1993-01-05 | Don Michael T Anthony | Regional perfusion catheter with improved drug delivery control |
US5116305A (en) * | 1990-02-01 | 1992-05-26 | Abiomed, Inc. | Curved intra aortic balloon with non-folding inflated balloon membrane |
US5331975A (en) * | 1990-03-02 | 1994-07-26 | Bonutti Peter M | Fluid operated retractors |
US5295994A (en) * | 1991-11-15 | 1994-03-22 | Bonutti Peter M | Active cannulas |
US5514153A (en) * | 1990-03-02 | 1996-05-07 | General Surgical Innovations, Inc. | Method of dissecting tissue layers |
US5013318A (en) | 1990-07-31 | 1991-05-07 | Special Devices Incorporated | Medical instrument for measuring depth of fastener hold in bone |
US5047035A (en) * | 1990-08-10 | 1991-09-10 | Mikhail Michael W E | System for performing hip prosthesis revision surgery |
US5102413A (en) * | 1990-11-14 | 1992-04-07 | Poddar Satish B | Inflatable bone fixation device |
US5419765A (en) † | 1990-12-27 | 1995-05-30 | Novoste Corporation | Wound treating device and method for treating wounds |
CS277533B6 (en) * | 1990-12-29 | 1993-03-17 | Krajicek Milan | Fixed osteaosynthesis appliance |
US5893840A (en) * | 1991-01-04 | 1999-04-13 | Medtronic, Inc. | Releasable microcapsules on balloon catheters |
US5254091A (en) * | 1991-01-08 | 1993-10-19 | Applied Medical Resources Corporation | Low profile balloon catheter and method for making same |
US5171248A (en) | 1991-02-27 | 1992-12-15 | Intermedics Orthopedics, Inc. | Medullary caliper |
US5176683A (en) * | 1991-04-22 | 1993-01-05 | Kimsey Timothy P | Prosthesis press and method of using the same |
JP2835789B2 (en) * | 1991-06-10 | 1998-12-14 | 富士通株式会社 | Pulse compression control method |
US5310407A (en) † | 1991-06-17 | 1994-05-10 | Datascope Investment Corp. | Laparoscopic hemostat delivery system and method for using said system |
US5514143A (en) * | 1991-11-27 | 1996-05-07 | Apogee Medical Products, Inc. | Apparatus and method for use during surgery |
US5176692A (en) * | 1991-12-09 | 1993-01-05 | Wilk Peter J | Method and surgical instrument for repairing hernia |
SE510358C2 (en) | 1992-02-20 | 1999-05-17 | Goesta Ullmark | Device for use in transplanting bone tissue material into a bone cavity |
US5312333A (en) † | 1992-04-03 | 1994-05-17 | United States Surgical Corporation | Endoscopic material delivery device |
AU4026793A (en) * | 1992-04-10 | 1993-11-18 | Cardiorhythm | Shapable handle for steerable electrode catheter |
AU673703B2 (en) | 1992-11-10 | 1996-11-21 | Seikagaku Kogyo Kabushiki Kaisha | Injector and use of the same |
US5575794A (en) † | 1993-02-12 | 1996-11-19 | Walus; Richard L. | Tool for implanting a fiducial marker |
US5383932A (en) * | 1993-04-27 | 1995-01-24 | Johnson & Johnson Professional, Inc. | Absorbable medullary plug |
US5300048A (en) * | 1993-05-12 | 1994-04-05 | Sabin Corporation | Flexible, highly radiopaque plastic material catheter |
US5423850A (en) * | 1993-10-01 | 1995-06-13 | Berger; J. Lee | Balloon compressor for internal fixation of bone fractures |
US5480400A (en) * | 1993-10-01 | 1996-01-02 | Berger; J. Lee | Method and device for internal fixation of bone fractures |
US5514137A (en) * | 1993-12-06 | 1996-05-07 | Coutts; Richard D. | Fixation of orthopedic devices |
WO1995020362A1 (en) † | 1994-01-26 | 1995-08-03 | Reiley Mark A | Improved inflatable device for use in surgical protocol relating to fixation of bone |
US6241734B1 (en) * | 1998-08-14 | 2001-06-05 | Kyphon, Inc. | Systems and methods for placing materials into bone |
EP1464293B1 (en) * | 1994-01-26 | 2007-05-02 | Kyphon Inc. | Improved inflatable device for use in surgical methods relating to fixation of bone |
US6248110B1 (en) * | 1994-01-26 | 2001-06-19 | Kyphon, Inc. | Systems and methods for treating fractured or diseased bone using expandable bodies |
US5468245A (en) | 1994-02-03 | 1995-11-21 | Vargas, Iii; Joseph H. | Biomedical cement bonding enhancer |
US5387193A (en) * | 1994-02-09 | 1995-02-07 | Baxter International Inc. | Balloon dilation catheter with hypotube |
US5380276A (en) * | 1994-02-28 | 1995-01-10 | The Kendall Company | Dual lumen catheter and method of use |
GB9407135D0 (en) | 1994-04-11 | 1994-06-01 | Aberdeen University And Plasma | Treatment of osteoporosis |
US5888220A (en) * | 1994-05-06 | 1999-03-30 | Advanced Bio Surfaces, Inc. | Articulating joint repair |
US5571189A (en) * | 1994-05-20 | 1996-11-05 | Kuslich; Stephen D. | Expandable fabric implant for stabilizing the spinal motion segment |
JPH0838618A (en) | 1994-07-29 | 1996-02-13 | Nippon Zeon Co Ltd | Balloon catheter for expanding celom and its production |
US5989260A (en) * | 1994-08-22 | 1999-11-23 | Yao; Meei-Huei | Intramedullary nail guide rod with measure scale marked thereon |
US5464254A (en) * | 1994-08-29 | 1995-11-07 | Moore Business Forms, Inc. | Fishing license protector |
US5919196A (en) * | 1995-02-16 | 1999-07-06 | Arthrex, Inc. | Method and apparatus for osteochondral autograft transplantation |
ATE204729T1 (en) * | 1995-02-17 | 2001-09-15 | Sulzer Orthopaedie Ag | DEVICE FOR ATTACHING A MEDURAL SPACE BLOCK IN THE MEDULAR SPACE OF A TUBULAR BONE |
US5782835A (en) | 1995-03-07 | 1998-07-21 | Innovasive Devices, Inc. | Apparatus and methods for articular cartilage defect repair |
US5512054A (en) * | 1995-05-16 | 1996-04-30 | American Medical Systems, Inc. | Dual action syringe |
US5599315A (en) * | 1995-12-01 | 1997-02-04 | Charles J. McPhee | Syringe actuation device |
US5728066A (en) * | 1995-12-13 | 1998-03-17 | Daneshvar; Yousef | Injection systems and methods |
US5800407A (en) | 1995-12-21 | 1998-09-01 | Eldor; Joseph | Multiple hole epidural catheter |
FR2742652B1 (en) * | 1995-12-21 | 1998-02-27 | Colorado | INTERVERTEBRAL IMPLANT, INTERSOMATIC CAGE TYPE |
WO1997039789A1 (en) | 1996-04-22 | 1997-10-30 | Medtronic, Inc. | Two-stage angled venous cannula |
US5741261A (en) * | 1996-06-25 | 1998-04-21 | Sdgi Holdings, Inc. | Minimally invasive spinal surgical methods and instruments |
US5735831A (en) | 1996-07-10 | 1998-04-07 | Cordis Corporation | Expandable flowrate catheter assembly and method of making same |
US6387087B1 (en) | 1996-12-11 | 2002-05-14 | Ronald K. Grooters | Aortic cannula |
KR20000069469A (en) * | 1996-12-13 | 2000-11-25 | 브렌트 알. 콘티탄쯔 | Preparation, storage and administration of cements |
WO1998031272A2 (en) * | 1997-01-21 | 1998-07-23 | Vasca, Inc. | Methods and systems for establishing vascular access |
US5718707A (en) * | 1997-01-22 | 1998-02-17 | Mikhail; W. E. Michael | Method and apparatus for positioning and compacting bone graft |
US6146385A (en) | 1997-02-11 | 2000-11-14 | Smith & Nephew, Inc. | Repairing cartilage |
US6010449A (en) * | 1997-02-28 | 2000-01-04 | Lumend, Inc. | Intravascular catheter system for treating a vascular occlusion |
US6475182B1 (en) * | 1997-03-12 | 2002-11-05 | Olexander Hnojewyj | Fluidic media introduction apparatus |
NZ513469A (en) | 1997-06-09 | 2003-01-31 | Kyphon Inc | Device for treating fractured or diseased bone using expandable bodies deployed asymetrically from a catheter |
US5972015A (en) * | 1997-08-15 | 1999-10-26 | Kyphon Inc. | Expandable, asymetric structures for deployment in interior body regions |
GB9714003D0 (en) * | 1997-07-02 | 1997-09-10 | Howmedica | Apparatus for impacting bone chips in a bone canal |
US6852095B1 (en) * | 1997-07-09 | 2005-02-08 | Charles D. Ray | Interbody device and method for treatment of osteoporotic vertebral collapse |
WO1999002214A1 (en) | 1997-07-09 | 1999-01-21 | Tegementa, L.L.C. | Interbody device and method for treatment of osteoporotic vertebral collapse |
US5976146A (en) | 1997-07-11 | 1999-11-02 | Olympus Optical Co., Ltd. | Surgical operation system and method of securing working space for surgical operation in body |
US6048346A (en) * | 1997-08-13 | 2000-04-11 | Kyphon Inc. | Systems and methods for injecting flowable materials into bones |
US6248100B1 (en) * | 1997-08-14 | 2001-06-19 | Scimed Life Systems, Inc. | Drainage catheter delivery system |
US6059760A (en) * | 1997-08-14 | 2000-05-09 | Medtronic, Inc. | Cannula having reverse flow tip |
US5876383A (en) | 1997-09-30 | 1999-03-02 | Grooters; Robert K. | Cannula |
US6186987B1 (en) * | 1997-09-30 | 2001-02-13 | Ronald K. Grooters | Aortic cannula with spoon-shaped lip |
US6076152A (en) * | 1997-12-17 | 2000-06-13 | Src Computers, Inc. | Multiprocessor computer architecture incorporating a plurality of memory algorithm processors in the memory subsystem |
US5997581A (en) * | 1997-12-29 | 1999-12-07 | Johnson & Johnson Professional, Inc. | Hip stem cement spacer |
US5969260A (en) * | 1998-03-30 | 1999-10-19 | Mcdonnell Douglas Corporation | Remotely interrogatable apparatus and method for detecting defects in structural members |
WO1999049819A1 (en) * | 1998-04-01 | 1999-10-07 | Parallax Medical, Inc. | Pressure applicator for hard tissue implant placement |
US6440138B1 (en) | 1998-04-06 | 2002-08-27 | Kyphon Inc. | Structures and methods for creating cavities in interior body regions |
DE69942858D1 (en) | 1998-06-01 | 2010-11-25 | Kyphon S A R L | DEFINABLE, PREFORMED STRUCTURES FOR ESTABLISHMENT IN REGIONS INSIDE THE BODY |
US6395007B1 (en) * | 1999-03-16 | 2002-05-28 | American Osteomedix, Inc. | Apparatus and method for fixation of osteoporotic bone |
US6770079B2 (en) * | 1999-03-16 | 2004-08-03 | American Osteomedix, Inc. | Apparatus and method for fixation of osteoporotic bone |
WO2000056254A1 (en) | 1999-03-24 | 2000-09-28 | Parallax Medical, Inc. | Non-compliant system for delivery of implant material |
CA2373715C (en) | 1999-05-07 | 2008-12-23 | University Of Virginia Patent Foundation | Method and system for fusing a spinal region |
US6805697B1 (en) * | 1999-05-07 | 2004-10-19 | University Of Virginia Patent Foundation | Method and system for fusing a spinal region |
ES2164548B1 (en) * | 1999-08-05 | 2003-03-01 | Probitas Pharma Sa | DEVICE FOR DOSAGE OF FRAGUABLE MASS FOR VERTEBROPLASTIA AND OTHER SIMILAR OSEOS TREATMENTS. |
US7081122B1 (en) | 1999-10-19 | 2006-07-25 | Kyphon Inc. | Hand-held instruments that access interior body regions |
US6533763B1 (en) * | 1999-12-06 | 2003-03-18 | James A. Schneiter | Harmonic flow catheter |
KR100972246B1 (en) * | 2000-06-27 | 2010-07-23 | 키폰 에스에이알엘 | Systems and methods for injecting flowable materials into bones |
US7144414B2 (en) * | 2000-06-27 | 2006-12-05 | Smith & Nephew, Inc. | Surgical procedures and instruments |
US7025771B2 (en) * | 2000-06-30 | 2006-04-11 | Spineology, Inc. | Tool to direct bone replacement material |
US6375659B1 (en) * | 2001-02-20 | 2002-04-23 | Vita Licensing, Inc. | Method for delivery of biocompatible material |
US6547432B2 (en) * | 2001-07-16 | 2003-04-15 | Stryker Instruments | Bone cement mixing and delivery device for injection and method thereof |
US6780191B2 (en) * | 2001-12-28 | 2004-08-24 | Yacmur Llc | Cannula system |
US7901407B2 (en) * | 2002-08-02 | 2011-03-08 | Boston Scientific Scimed, Inc. | Media delivery device for bone structures |
US7320686B2 (en) * | 2002-10-09 | 2008-01-22 | Depuy Acromed, Inc. | Device for distracting vertebrae and delivering a flowable material into a disc space |
US6875219B2 (en) * | 2003-02-14 | 2005-04-05 | Yves P. Arramon | Bone access system |
US20050021084A1 (en) * | 2003-05-19 | 2005-01-27 | Lu William Weijia | Bone treatment device and method |
US20050015148A1 (en) * | 2003-07-18 | 2005-01-20 | Jansen Lex P. | Biocompatible wires and methods of using same to fill bone void |
US7252686B2 (en) * | 2003-08-13 | 2007-08-07 | Boston Scientific Scimed | Methods for reducing bone compression fractures using wedges |
US7824412B2 (en) * | 2003-09-05 | 2010-11-02 | Medical Design Instruments LLC | Cement/biologics inserter and method for bone-fastener fixation augmentation |
US6997713B2 (en) * | 2003-09-24 | 2006-02-14 | Levatino Samuel R | Microtubes for surgery and dentistry |
US7513900B2 (en) * | 2003-09-29 | 2009-04-07 | Boston Scientific Scimed, Inc. | Apparatus and methods for reducing compression bone fractures using high strength ribbed members |
US7909833B2 (en) * | 2003-09-29 | 2011-03-22 | Depuy Acromed, Inc. | Vertebroplasty device having a flexible plunger |
-
1998
- 1998-08-14 US US09/134,323 patent/US6241734B1/en not_active Expired - Lifetime
-
1999
- 1999-07-26 DE DE69940791T patent/DE69940791D1/en not_active Expired - Lifetime
- 1999-07-26 KR KR1020017001940A patent/KR100818384B1/en not_active IP Right Cessation
- 1999-07-26 CA CA002657235A patent/CA2657235A1/en not_active Abandoned
- 1999-07-26 WO PCT/US1999/016289 patent/WO2000009024A1/en active IP Right Grant
- 1999-07-26 IL IL14126999A patent/IL141269A0/en active IP Right Grant
- 1999-07-26 KR KR1020087018325A patent/KR100922026B1/en not_active IP Right Cessation
- 1999-07-26 KR KR1020077021466A patent/KR100793005B1/en not_active IP Right Cessation
- 1999-07-26 DE DE69933037T patent/DE69933037T3/en not_active Expired - Lifetime
- 1999-07-26 KR KR1020077004545A patent/KR20070044470A/en not_active Application Discontinuation
- 1999-07-26 AT AT99937310T patent/ATE337734T1/en active
- 1999-07-26 ES ES99937310T patent/ES2275347T3/en not_active Expired - Lifetime
- 1999-07-26 EP EP99937310.3A patent/EP1104260B2/en not_active Expired - Lifetime
- 1999-07-26 JP JP2000564531A patent/JP4138248B2/en not_active Expired - Fee Related
- 1999-07-26 AU AU52172/99A patent/AU759710B2/en not_active Ceased
- 1999-07-26 ES ES04076440T patent/ES2332219T3/en not_active Expired - Lifetime
- 1999-07-26 EP EP04076440A patent/EP1459689B3/en not_active Revoked
- 1999-07-26 AT AT04076440T patent/ATE429182T1/en active
- 1999-07-26 NZ NZ509696A patent/NZ509696A/en not_active IP Right Cessation
- 1999-07-26 CA CA002339157A patent/CA2339157C/en not_active Expired - Fee Related
-
2001
- 2001-02-04 IL IL141269A patent/IL141269A/en not_active IP Right Cessation
- 2001-02-12 NO NO20010723A patent/NO20010723L/en not_active Application Discontinuation
- 2001-03-12 US US09/804,107 patent/US6613054B2/en not_active Expired - Lifetime
-
2003
- 2003-07-11 US US10/617,976 patent/US7153307B2/en not_active Expired - Fee Related
-
2005
- 2005-03-22 HK HK05102445.2A patent/HK1069757A1/en unknown
-
2006
- 2006-11-06 US US11/593,284 patent/US7771431B2/en not_active Expired - Fee Related
- 2006-11-15 US US11/599,943 patent/US7708742B2/en not_active Expired - Fee Related
- 2006-11-15 US US11/599,904 patent/US20070093847A1/en not_active Abandoned
-
2007
- 2007-10-29 US US11/978,372 patent/US20080058825A1/en not_active Abandoned
- 2007-10-29 US US11/978,371 patent/US20080065090A1/en not_active Abandoned
- 2007-10-29 US US11/978,386 patent/US20080058826A1/en not_active Abandoned
- 2007-10-29 US US11/978,358 patent/US20080058725A1/en not_active Abandoned
- 2007-10-29 US US11/978,274 patent/US20080065091A1/en not_active Abandoned
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2008
- 2008-01-09 JP JP2008002534A patent/JP4764432B2/en not_active Expired - Fee Related
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2010
- 2010-03-25 US US12/731,571 patent/US20100179556A1/en not_active Abandoned
- 2010-07-02 US US12/829,757 patent/US20110022051A1/en not_active Abandoned
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