Abstract: Methods for determining structural integrity of a bone within the spine of a patient, the bone having a first aspect and a second aspect, wherein the second aspect separated from the first aspect by a width and located adjacent to a spinal nerve. The methods involve (a) applying an electrical stimulus to the first aspect of the bone; (b) electrically monitoring a muscle myotome associated with the spinal nerve to detect if an onset neuro-muscular response occurs in response to the application of the electrical stimulus to the first aspect of the bone; (c) automatically increasing the magnitude of the electrical stimulus to until the onset neuro-muscular response is detected; and (d) communicating to a user via at least one of visual and audible means information representing the magnitude of the electrical stimulus which caused the onset neuro-muscular response.

Abstract: An expandable tip cannula system, comprising: a hollow cannula shaft having a proximal end and a distal end; and an expandable tip mounted at the distal end of the hollow cannula shaft, the expandable tip comprising a plurality of generally-triangular shaped petals held together in a radially-inwardly tapered arrangement between adjacent petals, each petal comprising a nerve sensing electrode disposed therein.

Abstract: Systems for determining structural integrity of a bone within the spine of a patient, the bone having a first aspect and a second aspect, wherein the second aspect separated from the first aspect by a width and located adjacent to a spinal nerve. A stimulator is configured to generate an electrical stimulus to be applied to the first aspect of the bone. A monitor is configured to electrically monitor a muscle myotome associated with the spinal nerve to detect if an onset neuro-muscular response occurs in response to the application of the electrical stimulus to the first aspect of the bone. An adjuster is configured to automatically increase the magnitude of the electrical stimulus to until the onset neuro-muscular response is detected. Lastly, a communicator is configured to communicate to a user via at least one of visual and audible means information representing the magnitude of the electrical stimulus which caused the onset neuro-muscular response.

Abstract: An expandable tip cannula system, comprising: a hollow cannula shaft having a proximal end and a distal end; and an expandable tip mounted at the distal end of the hollow cannula shaft, the expandable tip comprising a plurality of generally-triangular shaped petals held together in a radially-inwardly tapered arrangement between adjacent petals, each petal comprising a nerve sensing electrode disposed therein.

Abstract: An injection apparatus that includes components that facilitate injection of relatively viscous materials into a subject is provided as well as methods of use. An injection apparatus may include a transition-bore needle apparatus, which has a proximal end, a distal end, and a lumen extending from the proximal end to the distal end, in which the diameter of the proximal end is greater than the diameter of the distal end. An injection apparatus may include a hand-held injection facilitation apparatus, which may be coupled to a syringe. The hand-held injection facilitation apparatus can include a pivot arm and a body with a rod disposed within the body and coupled to the pivot arm. Movement of the pivot arm results in a proximal or distal movement of the rod within the body to effectively cause material to be expelled from the syringe. An injection apparatus may include a transition-bore needle apparatus and a hand-held injection facilitation apparatus in combination.

Abstract: Suture locking devices and methods. In one embodiment, the device includes a suture lock, a rotatable actuator adjacent to the lock, and a release mechanism. The lock defines a pair of suture holes which receive sutures attached to tissue (e.g. a spinal disc) of the surgical site. When the actuator rotates the sutures are wound together (preferably around a hub on the lock) thereby securing the plate to the tissue. Furthermore, the release mechanism is coupled to the lock in such a manner that when the release mechanism is actuated the device releases the lock. The release mechanism may include a push button that is biased away from the lock. Also, the actuator may include a thumbwheel and a gear. Further, the gear may also define suture holes. Additionally, a pull ring connected to a pair of loops for drawing the sutures through the instrument may be included.

Abstract: An annular access device provides minimally invasive access to the interior of an intervertebral disc, a stable working platform for treatment, and closure of an annulotomy. A method of performing a surgical operation on an intervertebral disc provides for inserting an obturator into an annulotomy, and actuating an operable member to secure the obturator to an annulus of an intervertebral disc.

Abstract: A catheter and catheter system can use energy tailored for remodeling and/or removal of target material along a body lumen, often of atherosclerotic material of a blood vessel of a patient. An elongate flexible catheter body with a radially expandable structure may have a plurality of electrodes or other electrosurgical energy delivery surfaces to radially engage atherosclerotic material when the structure expands. An atherosclerotic material detector system may measure and/or characterize the atherosclerotic material and its location, optionally using impedance monitoring.

Abstract: A system and method for discriminating tissue types, controlling the level of therapy to tissue, and determining the health or a known tissue by measuring the characteristics an electrical signal applied to conductive element located within or by the tissue. Additionally, the system and method may be used for determining whether the conductive tip of a pedicle probe or pedicle screw is located in one of cortical bone, cancellous bone, and cortical bone near a boundary with soft tissue, whether the conductive tip of a cannula is located adjacent to one of nerve tissue and annulus tissue, and whether the conductive tip of a cathode is located adjacent to one of nerve tissue and prostate gland tissue.

Abstract: An ultrasonic dissection and coagulation system for surgical use is provided. The system includes an ultrasonic instrument, a control module, and a remote actuator. The ultrasonic instrument has a housing and an elongated body portion extending from the housing. An ultrasonic transducer supported within the housing is operatively connected to a cutting jaw by a vibration coupler. The vibration coupler conducts high frequency vibration from the ultrasonic transducer to the cutting jaw. The cutting jaw has a blade surface which is curved downwardly and outwardly in the distal direction with respect to the longitudinal axis of the elongated body portion along its length such that an angle defined by a line drawn tangent to the blade surface and the longitudinal axis of the elongated body portion varies between 5 degrees and 75 degrees.

Abstract: A system and method for discriminating tissue types, controlling the level of therapy to tissue, and determining the health or a known tissue by measuring the characteristics an electrical signal applied to conductive element located within or by the tissue. Additionally, the system and method may be used for determining whether the conductive tip of a pedicle probe or pedicle screw is located in one of cortical bone, cancellous bone, and cortical bone near a boundary with soft tissue, whether the conductive tip of a cannula is located adjacent to one of nerve tissue and annulus tissue, and whether the conductive tip of a cathode is located adjacent to one of nerve tissue and prostate gland tissue.

Abstract: Devices, systems, and methods for treating atherosclerotic lesions and other disease states, particularly for treatment of vulnerable plaques, can incorporate optical coherence tomography or other imaging techniques which allow a structure and location of an eccentric plaque to be characterized. Remodeling and/or ablative laser energy can then be selectively and automatically directed to the appropriate plaque structures, often without imposing mechanical trauma to the entire circumference of the lumen wall.

Abstract: A tissue penetrating device for endoscopy or endosonography-guided transluminal interventions using an automated spring-loaded mechanism is taught. Various modifications and uses including tissue anchoring, affixing, and creating an anastomosis are explained.

Abstract: A bone block for insertion into a patient's intervertebral space. A method for inserting a bone block into a patient's intervertebral space, comprising: supporting the bone block in an inserter; advancing the inserter into the intervertebral space; rotating the inserter, thereby separating adjacent vertebrae; separating the bone block and the inserter with a push rod; and removing the inserter from the intervertebral space.

Abstract: An elongated syringe for administering a substance to a patient includes an elongated syringe chamber that may be inserted into a duct of a patient without unwantingly injuring the patient, a needle extending from the distal end of the syringe chamber, and a plunger rod extending from the proximal end of the syringe chamber. The syringe chamber may be flexible to accommodate curvatures of the duct of the patient. The syringe chamber includes a plurality of chamber compartments that will contain a fluid. At least one of the chamber compartments contains a fluid that is administered to a patient. The syringe chamber may include a driving piston located between two or more chamber compartments. The needle of the syringe may be a component of a transition-bore needle apparatus to facilitate delivery of a relatively viscous fluid from the syringe. The needle may also be flared at its proximal end so that the diameter of the proximal end of the needle is greater than the diameter of the distal end of the needle.

Abstract: An elongated syringe for administering a substance to a patient includes an elongated syringe chamber that may be inserted into a duct of a patient without unwantingly injuring the patient, a needle extending from the distal end of the syringe chamber, and a plunger rod extending from the proximal end of the syringe chamber. The syringe chamber may be flexible to accommodate curvatures of the duct of the patient. The syringe chamber includes a plurality of chamber compartments that will contain a fluid. At least one of the chamber compartments contains a fluid that is administered to a patient. The syringe chamber may include a driving piston located between two or more chamber compartments. The needle of the syringe may be a component of a transition-bore needle apparatus to facilitate delivery of a relatively viscous fluid from the syringe. The needle may also be flared at its proximal end so that the diameter of the proximal end of the needle is greater than the diameter of the distal end of the needle.

Abstract: A catheter and catheter system for eccentric remodeling and/or removal of atherosclerotic material of a blood vessel of a patient include an elongate flexible catheter body with a radially expandable structure. A plurality of electrodes or other electrosurgical energy delivery surfaces can radially engage atherosclerotic material when the structure expands. An atherosclerotic material detector near the distal end of the catheter body may measure circumferential atherosclerotic material distribution, and a power source selectively energizes the electrodes to eccentrically remodel the measured atherosclerotic material.

Abstract: A method for inserting a bone block into a patient's intervertebral space, comprising: supporting the bone block in an inserter; advancing the inserter into the intervertebral space; rotating the inserter, thereby separating adjacent vertebrae; separating the bone block and the inserter with a push rod; and removing the inserter from the intervertebral space.

Abstract: An elongated syringe for administering a substance to a patient includes an elongated syringe chamber that may be inserted into a duct of a patient without unwantingly injuring the patient, a needle extending from the distal end of the syringe chamber, and a plunger rod extending from the proximal end of the syringe chamber. The syringe chamber may be flexible to accommodate curvatures of the duct of the patient. The syringe chamber includes a plurality of chamber compartments that will contain a fluid. At least one of the chamber compartments contains a fluid that is administered to a patient. The syringe chamber may include a driving piston located between two or more chamber compartments. The needle of the syringe may be a component of a transition-bore needle apparatus to facilitate delivery of a relatively viscous fluid from the syringe. The needle may also be flared at its proximal end so that the diameter of the proximal end of the needle is greater than the diameter of the distal end of the needle.

Abstract: A device and method for selectively engaging or penetrating a layer of a luminal organ wall where the luminal organ wall has a plurality of layers including an outermost layer and an innermost layer adjacent to the lumen of the organ. The device and method select one of the plurality of layers of the organ wall other than the innermost layer and deploy from within the lumen of the organ a tissue device through the innermost layer to a specific depth to engage or penetrate the selected one of the plurality of layers. The device and method may be employed to create luminal pouches or restrictive outlets. In a stomach organ, the device and methods may be employed to treat obesity by forming a gastric pouch with or without a restrictive outlet.