Abstract: Spacerless artificial disc replacements (ADR) are disclosed. One preferred embodiment includes two saddle-shaped components to facilitate more normal spinal flexion, extension, and lateral bending while limit axial rotation, thereby protecting the facet joints and the annulus fibrosus (AF). Either or both of the superior and inferior components are made of a hard material such as chrome cobalt, titanium, or a ceramic including alumina, zirconia, or calcium phosphate. The articulating surfaces of the ADR are also preferably highly polished to reduce friction between the components. Metals, alloys or other materials with shape-memory characteristics may also prove beneficial.

Abstract: This invention relates generally to spine surgery and, in particular, to methods and apparatus for treating spinal stenosis.

Abstract: Apparatus for repairing a defect in an anulus fibrosis surrounding an intradiscal space, the apparatus comprising a first surgical instrument having a distal end adapted for penetration through an annulus fibrosis on one side of a defect in the annulus fibrosis such that the distal end of the first surgical instrument enters into an intradiscal space; a flexible longitudinal fixation component temporarily coupled to the distal end of the first surgical instrument; and a second surgical instrument having a distal end adapted for penetration through an annulus fibrosis on the other side of a defect in the annulus fibrosis or through a defect in the annulus fibrosis, the distal end of the second surgical instrument including a device for capturing the flexible longitudinal fixation component within an intradiscal space and pulling the flexible longitudinal fixation component so as to repair the defect.

Abstract: Spacerless artificial disc replacements (ADR) are disclosed. One preferred embodiment includes two saddle-shaped components to facilitate more normal spinal flexion, extension, and lateral bending while limit axial rotation, thereby protecting the facet joints and the annulus fibrosus (AF). Either or both of the superior and inferior components are made of a hard material such as chrome cobalt, titanium, or a ceramic including alumina, zirconia, or calcium phosphate. The articulating surfaces of the ADR are also preferably highly polished to reduce friction between the components. Metals, alloys or other materials with shape-memory characteristics may also prove beneficial.

Abstract: Spinal stabilization mechanisms act to prevent lateral bending, extension, and rotation across adjacent vertebrae. Methods for spinal stabilization includes placing one or more anchors at each vertebral level, positioning one or more sutures around each anchor at each level such that the each suture forms a loop or band around two adjacent anchors, applying tension to the ends of each suture to tighten the suture loop around the anchors and welding overlapping ends of each suture together to form suture bands connecting the anchors and thereby preventing lateral bending, extension, and rotation of the spinal segment. A suture banding tool may be used to place the sutures around the anchors in a looped configuration, apply tension to the suture ends to tighten the suture loop around the anchors and weld the ends of the suture to form a suture band connecting the anchors.

Abstract: Methods and devices facilitate welding sutures during laparoscopic and robotic surgical procedures. A first end of a weldable suture is reversibly fastened to the distal end of a novel welding instrument then inserted into a patient, preferably through a laparoscopic portal or trocar. A needle on the second or distal end of the suture is passed through tissue then the distal end of the suture is reversibly fastened to the distal end of the novel welding instrument. An alignment feature in the distal end of the instrument aligns portions of the suture for placement in the jaws of a welding tool. The surgeon may tighten the suture by pulling on the ends of the suture, which reduces the diameter of the suture loop and pulls the tissues together. The instrument maintains tension on the suture and immobilizes the suture during suture welding. Sutures with low melting temperatures may be melted into and around portions of rapid absorption multifilament suture.

Abstract: Artificial disc replacements (ADRs) and total disc replacements (TDRs) are based upon two, directly articulating components, resulting in a restricted-motion system that better approximates more normal spinal flexion, extension, and lateral bending. One component may have a concave articulating surface, and the other a convex articulating surface. The radius of curvature of the articulating surface may be smaller in the anterior-to-posterior direction of the ADR than the radius of curvature of the articulating surface in the left-to-right direction of the ADR. Both components are preferably made of a hard material and are highly polished to reduce friction.

Abstract: Surgical implants are configured for placement posteriorly to a spinal canal between vertebral bodies to distract the spine and enlarge the spinal canal. The device permits spinal flexion while limiting spinal extension thereby providing an effective treatment for treating spinal stenosis without the need for laminectomy. The device may be used in the cervical, thoracic, or lumbar spine. Numerous embodiments are disclosed, including elongated, length-adjustable components coupled to adjacent vertebral bodies using pedicle screws. The device is configured for placement between adjacent vertebral bodies and adapted to fuse the lamina, facet, spinous process or other posterior elements of a single vertebra. Preferably, the device forms a pseudo-joint in conjunction with the non-fused vertebra. Alternatively, the device could be fused to the caudal vertebra or both the cranial and caudal vertebrae.

Abstract: Methods for providing a flexible spinal stabilization system operative to prevent lateral bending, extension, and rotation across two or more adjacent vertebrae are described. Broadly, the invention utilizes a pair of connectors on each vertebrae, and flexible elongated elements, such as sutures or cables, in an axial and crisscrossed pattern to provide an arrangement that resists extension, lateral bending, and torsional/rotational motion. In some embodiments, the flexible stabilization system includes a pair of locking anchors and a pair of hook-like anchors. The locking anchors are pre-threaded with a suture in a loose looped configuration before insertion into the vertebra. Once the locking anchors have been inserted, the suture loops can be looped over hook-like anchors inserted into an adjacent vertebrae to join the vertebrae and apply tension across the disc space. In some embodiments, the hook-like anchors can have multiple hooks for use in joining multiple vertebral levels.

Abstract: This invention relates generally to spine surgery and, in particular, to methods and apparatus for treating spinal stenosis. The methods comprising gaining access to an interspinous space, abrading a portion of the superior spinous process, inserting an implant into the interspinous process space, verifying the position of the implant by observing the position of three radio-opaque markers embedded in the implant, and coupling the implant to the superior spinous process.

Abstract: Methods for spinal stabilization operative to prevent lateral bending, extension, and rotation across two or more adjacent vertebrae are described. Broadly, the method includes placing two or more anchors at each vertebral level, passing one or more sutures through each anchor at each level, applying tension to the sutures and joining the sutures in a cross-braced arrangement over the disc space between two or more vertebrae to prevent lateral bending, extension, and rotation of the spinal segment. The sutures can be welded in any combination of diagonal and vertical patterns across the adjacent vertebrae. In some embodiments, two or more sutures can be threaded through some of the suture anchors such that multiple vertebral levels can be joined in a cross-braced arrangement. Two or more sutures can also be used in multiple anchors in two adjacent vertebrae to provide additional reinforcement or stabilization across different portions of the two vertebrae.

Abstract: Devices and methods for fixing defects in the anulus fibrosus (vertebral disc) of a patient are described. The devices a mesh patch; first, second, third, and fourth sutures; and first, second, third, and fourth anchors. Each anchor has a first portion adapted for insertion into a bone and a second portion having an opening. The sutures are disposed through the openings of the anchors. The first portions of the first and second anchors are inserted into a cranial vertebra. The first portions of the third and fourth anchors are inserted into a caudal vertebra. The mesh patch is positioned adjacent the defect. An end of first suture can be attached to an end of the third suture. An end of the second suture can be attached to an end of the fourth suture. The other ends of each of the first, second, third, and fourth sutures can then be anchored.

Abstract: Instruments and methods facilitate reconstruction, repair, and the closure of apertures in soft tissues, including the anulus fibrosus (AF), heart, lung, abdomen, thorax, vascular structures and other organs. Flexible longitudinal fixation components (i.e., sutures) are positioned across apertures in soft tissues, preferably to closes the inlets and/or outlets of such apertures. Tension on the flexible longitudinal fixation components may be used to narrow or close the apertures. Knotless fixation technologies such as suture welding are preferably used to fasten the ends of the flexible longitudinal fixation components. Certain embodiments include an intra-aperture component dimensioned for positioning within a defect in the AF, with one or more components being used to maintain the intra-aperture component in position. For example, the flexible longitudinal fixation component(s) may be anchored to one of the upper and lower vertebral bodies.

Abstract: Methods for spinal stabilization operative to prevent lateral bending, extension, and rotation across two or more adjacent vertebrae are described with particular emphasis on preventing excessive forces on the facet joins. Broadly, the method includes placing one or more anchors, each having one or more sutures at each vertebral level on a posterior portion of the vertebrae, applying tension to the sutures and joining the sutures over the disc space between two or more vertebra. The sutures can be wrapped around the spinous process of the adjacent vertebrae. Alternatively, the sutures can be welded in a cross-braced pattern extending between the spinous process of the adjacent vertebrae.

Abstract: Devices and methods for fixing defects in the anulus fibrosus (vertebral disc) of a patient are described. The devices a mesh patch; first, second, third, and fourth sutures; and first, second, third, and fourth anchors. Each anchor has a first portion adapted for insertion into a bone and a second portion having an opening. The sutures are disposed through the openings of the anchors. The first portions of the first and second anchors are inserted into a cranial vertebra. The first portions of the third and fourth anchors are inserted into a caudal vertebra. The mesh patch is positioned adjacent the defect. An end of first suture can be attached to an end of the third suture. An end of the second suture can be attached to an end of the fourth suture. The other ends of each of the first, second, third, and fourth sutures can then be anchored.

Abstract: Methods for treating a defect in an annulus fibrous are described. The annulus fibrosis has an outer layer, at least one inner layer, and a defect extending through the outer and inner layers. An implant is inserted into the defect in the annulus fibrosis, the implant having at least one aperture. The implant is advanced distally beyond the outer layer in the annulus fibrosis and positioned to occlude the defect. An elongate fixation element is inserted through the at least one aperture, the elongate fixation element having a first end region and a second end region. The elongate fixation element is positioned such that the first end region is within the at least one aperture. The second end region of the elongate fixation element is anchored to the annulus fibrosis. The implant prevents escape of nucleus pulposus through the defect.

Abstract: Methods and apparatus for treating disc herniation provide a conformable device which assumes a first shape associated with insertion and a second shape or expanded shape to occlude the defect which typically follows partial discectomy. The device may take different forms according to the invention, including patches size to cover the defect or plugs adapted to fill the defect. In a preferred embodiment, however, the device is a gel or other liquid or semi-liquid which solidifies to occlude the defect from within the body of the disc itself. In another preferred embodiment, a mesh screen is collapsed into an elongated form for the purposes of insertion, thereby minimizing the size of the requisite incision while avoiding delicate surrounding nerves.

Abstract: Artificial disc replacements (ADRs) and total disc replacements (TDRs) are based upon two, directly articulating components, resulting in a restricted-motion system that better approximates more normal spinal flexion, extension, and lateral bending. One component has a concave articulating surface, and the other with a convex articulating surface. The radius of curvature of the articulating surface is smaller in the anterior to posterior direction of the ADR than radius of curvature of the articulating surface in the left to right direction of the ADR. The use of an articulating surface with two or more radius of curvature also limits axial rotation, thereby protecting the facet joints and the Annulus Fibrosus (AF). The two different radii used to create the articulating surfaces also naturally leads to an oval shape as seen from the top, which better fits the oval shape of the vertebral endplate better than circularly shaped ADRs.

Abstract: Apparatus, systems and methods are used to repair, reconstruct and/or replace spinal features. A flexible longitudinal fixation component such a suture is passed around or through a portion of a spine, with the end sections of the component either being attached to one another or coupled to at least one bone implant. The bone implant may be a bone anchor or may form part of a pedicle screw assembly. The flexible longitudinal fixation component may pass through an anulus fibrosis (AF) and at least one intra-aperture component situated within a void or defect in an AF. The intra-aperture component may be composed of a porous mesh, allograft tissue or xenograft tissue. The intra-aperture component preferably includes one or more proximal-to-distal channels facilitating the intentional initial passage of nucleus pulposis (NP) tissue while preventing the extrusion of the NP long term.

Abstract: Instrumentation and methods facilitate reconstruction of the anulus fibrosus (AF) and the nucleus pulposus (NP). An intra-aperture component is dimensioned for positioning within a defect in the AF, with one or more components being used to maintain the intra-aperture component in position. The intra-aperture component may be porous and flexible while being intentionally non-expandable in cross section following its positioning within the defect. A component used to maintain the intra-aperture component within the defect includes a flexible longitudinal fixation component that passes through the intra-aperture component and a region of the AF apart from the defect. If available, this may be a region of the AF having overlapping layers with intact fibers in different directions. The flexible longitudinal fixation component may be anchored to one of the upper and lower vertebral bodies.