Abstract: An apparatus and method is provided for interbody fusion including distracting, in a given direction, and supporting opposing vertebral bodies. A plurality of wafers are consecutively inserted between the vertebral bodies to create a column of wafers. The column of wafers is oriented between the vertebral bodies so as to expand in the given direction as the wafers are consecutively added to the column.

Abstract: A kit for injecting a biomaterial into an intradiscal space accessed through an opening in the disc annulus comprises a plurality of needles, each sized for introduction through the annulus opening with a passageway for injecting the biomaterial therethrough, and each including a distal end to be disposed within the intradiscal space when the needle extends through the annulus opening. Each needle includes a stop affixed thereto at different pre-determined distances from the distal end to define the location of the distal end within the intradiscal space when the needle extends through the opening in the annulus. The kit further includes a plurality of seals defining a bore for sliding engagement with a needle, each of the plurality of seals including a sealing face for engaging the annulus around the needle. Each sealing face defines a differently configured area of contact, such as circular, elliptical, tapered and threaded.

Abstract: Apparatus and devices for percutaneously extending an existing spinal construct ipsilaterally with an additional spinal construct in a patient are disclosed. The additional spinal construct comprises a rod connector that includes an elongate additional rod integrally attached thereto. The additional rod is placed through an access port in a first orientation generally parallel to the longitudinal axis of the access port and rotated to a different second orientation generally transverse to the longitudinal axis of the access port. During such rotation the additional rod is moved subcutaneously beneath the skin of the patient from the existing spinal rod to an additional bone engaging implant. In another arrangement, the extension of an existing spinal construct in a minimally invasive procedure comprises a rod connector having an offset support for receiving an additional spinal rod that may be placed laterally interiorly or exteriorly of the existing spinal construct.

Abstract: A method of attaching an extension to a bone anchor for use in percutaneous spinal surgery is provided that comprises the steps of: providing a bone anchor including a first portion for attachment to a vertebra and a second portion for attachment to a connecting element, the bone anchor including an extension coupling surface; providing an elongate hollow extension having a distal end and a proximal end, the extension having a rotationally movable anchor engaging member projecting radially from the distal end thereof; placing the distal end of the extension adjacent the bone anchor; and rotating the anchor engaging member to engage the extension coupling surface on the anchor and couple the extension and the bone anchor.

Abstract: A spinal fixation system includes a rod and anchor devices that include a bone engaging fastener having a head defining a spherical socket. A ball insert is placed within the socket and rotated so that the ball insert is juxtaposed with the socket. The anchor device further includes a yoke defining a yoke channel for receiving the rod and a stem engaged to the ball insert captured within the socket. A sleeve disposed between the yoke channel and the fastener head supports the rod. A set screw is operable to clamp the rod against the sleeve and draw the insert into engagement within the socket. A friction element in the form of a wave spring is disposed between the yoke and the fastener head is configured to releasably retain the yoke in at least one discrete position relative to the fastener.

Abstract: A spinal fixation system includes a rod and anchor devices that include a bone engaging fastener having a head defining a spherical socket. A ball insert is placed within the socket and rotated so that the ball insert is juxtaposed with the socket. The anchor device further includes a yoke defining a yoke channel for receiving the rod and a stem engaged to the ball insert captured within the socket. A sleeve disposed between the yoke channel and the fastener head supports the rod. A set screw is operable to clamp the rod against the sleeve and draw the insert into engagement within the socket. A releasable detent defined between the yoke and the fastener head is configured to releasably retain the yoke in at least one discrete position relative to the fastener. Portions of the releasable detent may also exert a frictional retention force against the fastener head.

Abstract: A cross connector for attachment between two spinal implants comprises a first element having one end and an opposite end configured for engaging one of the two spinal implants, a second element having one end and an opposite end configured for engaging the other of the two spinal implants, an engagement mechanism between the one end of each of the first and second elements, and a locking element for locking the two elements together at the respective one end. The engagement mechanism includes an interface configured to permit relative pivoting between the first element and the second element about at least two non-parallel axes.

Abstract: Apparatus and devices for adding an additional spinal construct in a patient are disclosed. In one arrangement the additional spinal construct extends an existing spinal construct ipsilaterally with an inline rod connector in a minimally invasive or preferably, percutaneous procedure. In another arrangement, the ipsilateral extension of an existing spinal construct uses an offset rod connector for receiving an additional spinal rod that may be placed interiorly or exteriorly of the existing spinal construct.

Abstract: Apparatus and instruments for percutaneously extending an existing spinal construct ipsilaterally with an additional spinal construct in a patient are disclosed. The additional spinal construct comprises a rod connector that includes an elongate additional rod integrally attached thereto. The additional rod is placed through an access port in a first orientation generally parallel to the longitudinal axis of the access port and rotated to a different second orientation generally transverse to the longitudinal axis of the access port. During such rotation the additional rod is moved subcutaneously beneath the skin of the patient from the existing spinal rod to an additional bone engaging implant. In another arrangement, the extension of an existing spinal construct in a minimally invasive procedure comprises a rod connector having an offset support for receiving an additional spinal rod that may be placed laterally interiorly or exteriorly of the existing spinal construct.

Abstract: Methods and techniques for attaching a cross connector to a pair of contraterally implanted spinal rods in a patient are disclosed. In one arrangement, the cross connector is subcutaneously placed to interconnect contralaterally to a pair of rod connectors that are percutaneously attached respectively to a pair of rods in existing spinal constructs implanted on opposite sides of spine.

Abstract: Apparatus and devices for percutaneously extending an existing spinal construct ipsilaterally with an additional spinal construct in a patient are disclosed. The additional spinal construct comprises a rod connector that includes an elongate additional rod integrally attached thereto. The additional rod is placed through an access port in a first orientation generally parallel to the longitudinal axis of the access port and rotated to a different second orientation generally transverse to the longitudinal axis of the access port. During such rotation the additional rod is moved subcutaneously beneath the skin of the patient from the existing spinal rod to an additional bone engaging implant. In another arrangement, the extension of an existing spinal construct in a minimally invasive procedure comprises a rod connector having an offset support for receiving an additional spinal rod that may be placed laterally interiorly or exteriorly of the existing spinal construct.

Abstract: Methods and techniques for percutaneously extending an existing spinal construct ipsilaterally with an additional spinal construct in a patient are disclosed. An inline rod connector is utilized which includes an elongate additional rod integrally attached thereto. The additional rod is placed through an access port in a first orientation generally parallel to the longitudinal axis of the access port and rotated to a different second orientation generally transverse to the longitudinal axis of the access port. During such rotation the additional rod is moved subcutaneously beneath the skin of the patient from the existing spinal rod to an additional bone engaging implant. In another arrangement, the extension of an existing spinal construct in a minimally invasive procedure uses a rod connector having an offset support for receiving an additional spinal rod that may be placed laterally interiorly or exteriorly of the existing spinal construct.

Abstract: A kit for injecting a biomaterial into an intradiscal space accessed through an opening in the disc annulus comprises a plurality of needles, each sized for introduction through the annulus opening with a passageway for injecting the biomaterial therethrough, and each including a distal end to be disposed within the intradiscal space when the needle extends through the annulus opening. Each needle includes a stop affixed thereto at different pre-determined distances from the distal end to define the location of the distal end within the intradiscal space when the needle extends through the opening in the annulus. The kit further includes a plurality of seals defining a bore for sliding engagement with a needle, each of the plurality of seals including a sealing face for engaging the annulus around the needle. Each sealing face defines a differently configured area of contact, such as circular, elliptical, tapered and threaded.

Abstract: A method of attaching a curved rod to a plurality of pedicle screws in the thoracic region of the spine is disclosed. Preferably, the method is practiced in a procedure for percutaneously fixing the rod to the pedicle screws through slots formed through a plurality of screw extensions releasably attached respectively to the pedicle screws. The method includes the steps of releasably and pivotally attaching the curved rod to a rod introducer having a handle and holding the rod initially in a fixed position. The rod is introduced in the fixed position through the slots in the extensions with the rod curvature defining a lordotic angle relative to the spine. The rod is released from the fixed position without separating the rod from the introducer. While the rod is in the released position the handle is rotated 180° thereby rotating the rod to a kyphotic angle relative to the thoracic region of the spine.

Abstract: A method for the pre-treatment of an intervertebral disc prior to the introduction of a disc prosthesis or implant includes removing at least a portion of the nucleus pulposus of the intervertebral disc to expose at least a portion of the endplate of an adjacent vertebra to the disc. A fluent treatment material is then injected into the disc space to come into contact with the portion of the endplate. The fluent treatment material is operable to prepare the portion of the endplate to accommodate a disc prosthesis, implant or graft subsequently introduced into the disc space. Different fluent treatment materials are provided that depend upon the condition of the vertebral endplates.

Abstract: An expandable interbody fusion device includes superior and inferior endplates that are configured to receive a sequentially inserted stack of interlocking expansion members or wafers. The like-configured wafers include features on their top and bottom surfaces that interlock the wafers in multiple degrees of freedom so that the wafer stack is not disrupted when the fusion device is fully expanded. One of the interlocking features includes a plurality of prongs projecting from an upper surface of the wafers and into a recess defined in the lower surface of an adjacent previously inserted like-configured wafer. The prongs and recesses are configured to prevent retrograde movement of each new wafer in a direction opposite the direction of insertion. Other interlocking features prevent movement in the direction of insertion, transverse to the insertion direction and vertically within the stack.

Abstract: A method for treating a diseased or damaged spinal disc comprises the steps of: (a) providing access to the nucleus pulposus through the annulus; (b) removing at least a portion of the nucleus pulposus to create an intradiscal space; (c) determining the size of the intradiscal space; and (d) sealably introducing under pressure a curable biomaterial through the annulus directly into the intradiscal space. The step of determining the size of the intradiscal space may be accomplished by expanding a compliant balloon within the intradiscal space using a contrast medium capable of visualization under fluoroscopy. The curable material is sealably introduced through a vented needle inserted through the opening. The curable biomaterial is introduced until a quantity of the material flows into the vent.

Abstract: Described here are deformable, monolithic, stabilization devices, or implants, suitable for use within bone and between bones, for instance, to fuse vertebral bodies, to repair herniated discs, or to repair spinal compression fractures. The implants are introduced into a chosen site at a first, smaller height and then plastically deformed to achieve a second, but unique, pre-selected, larger height. Variations of the device provide one or more specific larger heights. The devices are particularly suitable as intervertebral spinal fusion implants for the immobilization of adjacent vertebral bodies. Methods of deploying the implants are also described as are instruments for such deployment. Also described are variations of the device particularly suitable as sizing instruments. These versions are elastic, i.e., not plastically deformable, and may be restored to their original size. Many of the described variations include deformable regions serving as hinges.

Abstract: ?n apparatus and method for distracting, in a given direction, and supporting two tissue surfaces is provided. A plurality of wafers are consecutively inserted using a wafer insertion apparatus between the two tissue surfaces to create a column of wafers. A detachable wafer assembly is provided that includes a base wafer initially associated with a track assembly of a wafer insertion apparatus. The base wafer is dislodged from the track assembly so that the base wafer is left within the distraction site as the track assembly is removed. A top cap wafer is provided that is situated at the top of the wafer stack, in which the top cap wafer is larger than the remaining wafers to form a gap surrounding the stack to receive biologic material.

Abstract: A method and assembly is provided for linking an additional vertebral construct to an existing spinal construct having at least two bone screws engaged to corresponding vertebrae and connected by a connecting member. The assembly includes a fastener configured to engage a bone screw of the existing construct and to engage a connecting member connected to the bone screw. The assembly further includes a linking member having an elongated portion configured to connect to a bone screw of the additional construct and a mounting structure configured for mounting on the bone screw of the existing construct. A locking member fixes the orientation of the linking member relative to the bone screw and a clamping member locks the linking member and existing connecting member to the bone screw of the existing construct.