Abstract: Methods and apparatus for treating defects in the annulus fibrosis are described. The methods include providing first and second elongate fastening members, each having a first end and an anchor on the first end that is substantially transverse when deployed. The first end of the first and second elongate fastening members are positioned distal of the outer layer and at least one inner layer of the annulus fibrosis. The defect is then closed by interlocking the first and second elongate fastening members. Alternatively, second ends of the elongate fastening members may be linked, resulting in reducing the size of the opening of the defect. Devices having first and second elongate fastening members, each having a first end, a second end, and an anchor on the first end that is substantially transverse when deployed; and a connector that links the first and second elongate fastening members are also described.

Abstract: Methods and devices for fixing a defect in a vertebral disc of a patient. One method includes providing first, second, third, and fourth sutures. The first and second sutures are fastened to a vertebra cranial to the vertebral disc at first and second locations, respectively. The third and fourth sutures are fastened to a vertebra caudal to the vertebral disc at third and fourth locations, respectively. A device, such as a mesh device, is positioned adjacent the defect. The first, second, third, and fourth sutures are then positioned against the device, on the side of the device opposite of the defect. Tension is then applied to the first, second, third, and fourth sutures. Each of the first, second, third, and fourth sutures are then attached to at least one of the first, second, third, and fourth sutures, thereby holding the device adjacent the defect.

Abstract: Check reins in the form of elongated members are used to limit the extreme range of motion which would otherwise be permitted by some ADR designs. The check reins serve two main purposes. First, they retain disc spacers, if present. Additionally, the wedge shape of ADRs and the removal of the Anterior Longitudinal Ligament (ALL) and a portion of the Annulus Fibrosus (AF) to insert the ADR from an anterior approach, favor anterior extrusion of disc spacers. In preferred embodiments the check reins are therefore limited to the anterior portion of the periphery of the ADR. Second, check reins serve to prevent excessive spinal motion. Again, although they may be helpful in other locations, anterior check reins help restore the motion limiting functions of the ALL and AF that were removed in anterior approaches to the spine.

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

Abstract: An Artificial Disc Replacement (ADR) includes a body and/or outer wall that is fortified, reinforced, stiffened or otherwise strengthened with a higher durometer, for example, where it rests against a weakened or deficient area of the annulus fibrosis (AF). The “less stiff” portions facilitate the transfer of load to the healthier portion of the AF. A hydrogel or other compressible and/or resilient material may be used within the center of the ADR to selectively transfer the forces to the outer wall. The outer wall may constructed of an elastomer, and may include a radial ply, bias ply, and/or belted construction. Methods of determining a properly sized ADR are also disclosed.

Abstract: An artificial disc replacement (ADR) includes a pair of opposing endplate components, each attached to one of the upper and lower vertebrae, a cushioning component disposed between the endplate components; and a filler material contained within the cushioning component. The filler material may be a gas, liquid, foam, or gel, including a hydrogel. In a preferred embodiment, the ADR may further include one or more opposing, spaced-apart projections configured to impinge if the endplate components are subjected to an excessive force. Such projections may allow for unrestricted motion between the endplates until impingement, or may restrict translation between the endplates until a greater excessive force is reached. One or both of the endplate components may include a modified surface to increase adherence to the respective vertebral endplates.

Abstract: Methods and devices for fixing a defect in the anulus fibrosus of a patient. The devices include first and second vertical components extending from the middle region of the horizontal component, each of the first and second vertical components having a width and an end. The middle region of the horizontal component of the device blocks the defect in the anulus fibrosus. The first vertical component is attached to the upper vertebra and the second vertical component is attached to the lower vertebra. The horizontal component can be positioned beneath a layer of the posterior longitudinal ligament.

Abstract: Arthroplasty devices having improved bone in growth to provide a more secure connection within the body. Different embodiments disclosed include devices having threaded intramedullary components, devices configured to receive bone growth promoting substances, devices with resorbable components, and devices configured to reduce shear stress.

Abstract: Methods and devices for fixing a defect in the annulus fibrosis of a patient. The devices include first and second vertical components extending from the middle region of the horizontal component, each of the first and second vertical components having a width and an end. The middle region of the horizontal component of the device to block the defect in the annulus fibrosis. The first vertical component is attached to the upper vertebra and the second vertical component is attached to the lower vertebra. The horizontal component can be positioned beyond at least an outer layer of the annulus fibrosis, alternatively positioned beyond the innermost layer of annulus fibrosis, alternatively positioned between adjacent layers of annulus fibrosis, or alternatively positioned on the exterior of the annulus fibrosis.

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: Methods for treating an annulus fibrosis having a defect include inserting a flexible device into the defect. The flexible device is advanced distally beyond an outer layer of the annulus fibrosus. The flexible device is then expanded such that a width of the flexible device is larger than the defect, where the flexible device prevents escape of nucleus pulposus through the defect. The flexible device may have at least two appendages made from a shape-memory metal. Alternatively, the flexible device may have a U-shaped structure that includes a central portion and two legs. The flexible device may also be anchored to the annulus fibrosis and/or the vertebrae.

Abstract: Arthroplasty devices having improved bone in growth to provide a more secure connection within the body. Different embodiments disclosed include devices having threaded intramedullary components, devices configured to receive bone growth promoting substances, devices with resorbable components, and devices configured to reduce shear stress.

Abstract: Check reins in the form of elongated members are used to limit the extreme range of motion which would otherwise be permitted by some ADR designs. The check reins serve two main purposes. First, they retain disc spacers, if present. Additionally, the wedge shape of ADRs and the removal of the Anterior Longitudinal Ligament (ALL) and a portion of the Annulus Fibrosus (AF) to insert the ADR from an anterior approach, favor anterior extrusion of disc spacers. In preferred embodiments the check reins are therefore limited to the anterior portion of the periphery of the ADR. Second, check reins serve to prevent excessive spinal motion. Again, although they may be helpful in other locations, anterior check reins help restore the motion limiting functions of the ALL and AF that were removed in anterior approaches to the spine.

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: Apparatus and methods are used to expand and/or connect disc replacement devices in situ, allowing such devices to be inserted through smaller openings including posterior as well as an anterior approaches to the spine. Other embodiments reside in nucleus replacements that do not expand within the disc space, providing improved longevity compared to existing NRs. Embodiments of the invention may be used in the cervical, thoracic, or lumbar spine. The invention may also be used in other joints such as, the knee, prosthetic knees, prosthetic hips, or other joints in the body.

Abstract: An artificial joint or disc replacement (ADR) broadly includes a pair of opposing endplate components, each attached to one of the upper and lower vertebrae, a cushioning component disposed between the endplate components, and a mechanism for coupling the cushioning component to one or both of the endplates. In the preferred embodiment, the cushioning component takes the form of a tire-like outer structure attached to an inner hub. A filler material is also preferably contained within the cushioning component. The filler material may be a gas, liquid, foam, or gel, including a hydrogel. One or both of the endplate components may include a modified surface to increase adherence to respective opposing bone surfaces.

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 replacement (ADR) systems with intradiscal components feature non anterior-posterior (A-P) or oblique-oriented keels such that the great vessels do not require as much retraction during insertion. The system may further include guides for aligning the ADR prior to insertion, and for cutting an oblique slot into a vertebral endplate to receive the keel. A screw adapted to penetrate a vertebral body may be used in conjunction with the keel. The screw and keel may converge, diverge or intersect. The screw may further include a mechanism providing a locking relationship with the keel. The system may further including a guide to direct drill bits and screws through holes in the keel. ADRs according to the invention may additionally, independently include a non-symmetrical endplate shaped so as to decrease the risk of injuring the great vessels.

Abstract: A method for performing kyphoplasty is disclosed. A catheter having a balloon-like component is located at its distal end, is inserted into a fractured vertebra. A substance such as PMMA to fill the balloon and stabilize the fracture is injected through the catheter. The balloon is held in place until the material begins to set.

Abstract: One or more rigid components associated with an articulating bone are used to encase, encapsulate, contain, or otherwise protect a compressible/resilient member. The embodiments are applicable not only to artificial disc replacement (ADR) devices, but also to joint situations including total knee and hip arthroplasty. The cushion elements in the preferred embodiments include synthetic rubbers, hydrogels, elastomers, and other polymeric materials such as viscoelastic polymers and foam polyurethanes. The invention effectively combines the advantages of such materials (cushioning, shape memory, and expansion after insertion in the case of hydrogels), while providing increased protection, particularly the elimination of shear stresses. When applied to an ADR, the invention also minimizes the risk of extrusion.