Abstract: Devices and surgical methods treat various types of adult spinal pathologies, such as degenerative spondylolisthesis, spinal stenosis, degenerative lumbar scoliosis, and kypho-scoliosis. Various types of spinal joint replacement prostheses, surgical procedures for performing spinal joint replacements, and surgical instruments are used to perform the surgical procedures.

Abstract: A filler instrument comprises a first chamber section having a first cross sectional area and a second chamber section having a second cross sectional area less than the first cross sectional area. The second chamber section communicates with the first chamber section. The first chamber section includes an inlet for receiving a material into the filler instrument, and the second chamber section includes an outlet for discharging the material from the filler instrument. A first plunger is sized to pass through the first chamber section and not the second chamber section. A second plunger is sized to pass through an interior bore of the first plunger and into the second chamber section. In use, the first plunger displaces material residing in the first chamber section through the second chamber section toward the outlet, and the second plunger displaces material residing in the second chamber section through the outlet.

Abstract: The invention provides a method of revising an implanted spinal device, such as an implanted arthroplasty device having a cephalad component fixed to a first vertebra and a caudal component fixed to a second vertebra inferior to the first vertebra. The method includes the following steps: removing a portion of a previously implanted spinal arthroplasty device; and attaching a revision component to a remaining portion of the previously implanted spinal arthroplasty device to alter a biomechanical characteristic of the implanted arthroplasty device.

Abstract: Devices and surgical methods treat various types of adult spinal pathologies, such as degenerative spondylolisthesis, spinal stenosis, degenerative lumbar scoliosis, and kypho-scoliosis. Various types of spinal joint replacement prostheses, surgical procedures for performing spinal joint replacements, and surgical instruments are used to perform the surgical procedures.

Abstract: A device is introduced into the vertebral body through a percutaneous access path. The device is manipulated to modify the cancellous bone volume for introduction of bone filling material. Bone filling material is introduced into the cancellous bone volume modified by the device along the percutaneous path. Discharge of the bone filling material is directed into the cancellous bone volume through an opening that is oriented at an angle relative to the axis of the access path.

Abstract: A first instrument having a distal end is sized and configured to penetrate tissue and a proximal end comprising a first handle assembly. A second instrument including an interior lumen is sized and configured to accept passage of the first instrument. The second instrument has a proximal end comprising a second handle assembly sized and configured to releasably interlock with the first handle assembly to form a composite instrument sized and configured to provide percutaneous access to a cancellous bone region. The second handle assembly is also sized and configured to permit controllably release by a user of the first handle assembly from the second handle assembly to allow removal of the first instrument from the interior lumen. At least one additional instrument is sized and configured for passage through the interior lumen of the second instrument upon removal of the first instrument.

Abstract: A shaft member is sized and configured for introduction through a percutaneous access path into a cancellous bone volume. The shaft has an elongated axis. A cutting blade is sized and configured to be carried by the shaft member and project radially outward of the elongated axis into contact with cancellous bone. The cutting blade is capable of cutting cancellous bone in a path about the elongated axis in response to rotation of the shaft member within cancellous bone.

Abstract: A tubular member is sized and configured to establish an access path to bone having an interior volume occupied, at least in part, by cancellous bone. The tubular member includes a distal end portion having at least one opening. A structure is sized and configured to be carried by the tubular member and controllably advanced through the at least one opening to define a cutting surface that projects outside the distal end portion. The cutting surface has a dimension capable of cutting cancellous bone in response to rotation of the tubular member within the cancellous bone.

Abstract: Cephalad and caudal vertebral facet joint prostheses and methods of use are provided. The cephalad prostheses are adapted and configured to be attached to a lamina portion of a vertebra without blocking a pedicle portion of the cephalad vertebra.

Abstract: Various bone fixation/fusion devices are sized and configured to be placed across fracture fragments or between bones that are to be fused.

Abstract: Systems and methods provide for the fixation of osteoporotic and non-osteoporotic long bones, especially Colles' fractures. A cannula having a circumferential opening is inserted into cancellous bone and directed such that the circumferential opening faces the fracture. The cannula is further adapted to receive an expandable structure, the expandable structure being inserted through the cannula until it is in registration with the circumferential opening. The expandable structure is expanded through the circumferential opening into cancellous bone and toward the fracture. The expansion of the expandable structure through the circumferential opening toward the fracture causes compression of cancellous bone and moves fractured cortical bone, thus creating a cavity proximal to the fracture. The cavity is then filled with a flowable bone filling material and the material allowed to harden.

Abstract: Systems and methods insert an expandable body in a collapsed configuration into a space defined between adjacent vertebral bodies. The systems and methods cause expansion of the expandable body within the space, thereby pushing apart adjacent vertebral bodies as part of a therapeutic procedure.

Abstract: An ankle implant for use in ankle arthroplasty in total ankle replacement is provided. The implant includes an upper prosthesis anchored to the tibia and a lower prosthesis anchored to the talus. The lower prosthesis is operable associated with the upper prosthesis. The implant also includes a stem which is rigidly removably connected to the second member. The stem includes a portion for attachment to the calcaneous. The stem is be adapted to be in a first position in the calcaneous when the stem is in a first relative position with respect to the lower prosthesis, and to provide for a second position in the calcaneous when the stem is in a second relative position with respect to the lower prosthesis.

Abstract: An adaptable spinal facet joint prosthesis, including a pedicle fixation element; a laminar fixation element; and a facet joint bearing surface having a location adaptable with respect at least one of the pedicle fixation element and the laminar fixation element. The invention also includes a method of implanting an adaptable spinal facet joint prosthesis including the steps of determining a desired position for a facet joint bearing surface; and attaching a prosthesis comprising a facet joint bearing surface to a pedicle portion of a vertebra and a lamina portion of a vertebra to place the facet joint bearing surface in the desired position. The invention also provides a facet joint prosthesis implant tool including a tool guide adapted to guide a vertebra cutting tool; and first and second fixation hole alignment elements extending from the saw guide.

Abstract: A cannula is positioned to establish a subcutaneous access path into a cancellous bone. A bone filling material is conveyed into the cancellous bone with a tamping instrument configured to be manipulated independent of the cannula. The bone filling material is compacted with the tamping instrument.

Abstract: The invention discloses methods and devices for repairing, replacing and/or augmenting natural facet joint surfaces and/or facet capsules. A facet joint restoration device of the invention for use in a restoring a facet joint surface comprises: a cephalad facet joint element comprising a flexible member adapted to engage a first vertebrae and an artificial cephalad joint; and a caudad facet joint element comprising a connector adapted for fixation to a second vertebrae and an artificial caudad joint adapted to engage the cephalad facet joint.

Abstract: Cancellous bone is accessed through a subcutaneous access path in soft tissue. A cavity is formed in cancellous bone by a cavity forming tool that is advanced through the subcutaneous access path into cancellous bone and manipulated to form the cavity. A measured volume of bone filling material is delivered into the cavity through the subcutaneous access path by a nozzle having an interior bore defining an interior volume sized for containing bone filling material, which is advanced through the subcutaneous access path. A nested instrument is formed while clearing residual bone filling material from the interior bore by an auxiliary tool that can be manipulated independently of the nozzle, which is advanced through the interior bore of the nozzle.

Abstract: A cavity forming structure is introduced through a percutaneous access path into a selected bone having an interior volume occupied, at least in part, by cancellous bone, e.g., a vertebral body. A cavity is formed in the cancellous bone volume by manipulation of the cavity forming structure. Tissue is removed from within the cavity through the percutaneous access path.

Abstract: A percutaneous path is created into a bone having an interior volume occupied, at least in part, by a cancellous bone, e.g., a vertebral body. An expandable balloon structure is introduced into the cancellous bone by deployment of a tool through the percutaneous path into the cancellous bone. The expandable balloon structure is expanded and the tool withdrawn, leaving the expandable balloon structure expanded inside the cancellous bone. Expansion of the expandable balloon structure within cancellous bone can, e.g., compact cancellous bone, and/or create a cavity in cancellous bone, and/or move fractured cortical bone.

Abstract: An energy transmitter is introduced into a bone, e.g., a vertebral body, through a percutaneous path. Energy is propagated into the bone by the energy transmitter to create a cavity in the bone. A material is conveyed into the cavity. The material can be, e.g., a bone cement, allograft material, synthetic bone substitute, a medication, or a flowable material that sets into a hardened condition.