Abstract: In endoscopic surgery, a retractor having independently spreadable retractor blades mounted at the distal end of a tube is introduced percutaneously. A balloon dissector is passed through the tube and expanded. Following dissection by expansion of the balloon, the balloon is contracted, the tube is advanced, and the dissected tissue is spread by moving the blades apart from each other. The balloon dissector is withdrawn and another instrument is then introduced to carry out surgery on the anatomical structure exposed by the dissection and spreading steps.

Abstract: In endoscopic surgery, a retractor having independently spreadable retractor blades mounted at the distal end of a tube is introduced percutaneously. A balloon dissector is passed through the tube and expanded. Following dissection by expansion of the balloon, the balloon is contracted, the tube is advanced, and the dissected tissue is spread by moving the blades apart from each other. The balloon dissector is withdrawn and another instrument is then introduced to carry out surgery on the anatomical structure exposed by the dissection and spreading steps.

Abstract: An instrument for endoscopic surgery comprises a retractor having independently spreadable retractor blades pivotally mounted at the distal end of a tube, through which a balloon dissector can be passed. The blades are pivoted on axes transverse to the elongation of the tube. The blades are externally convex and internally concave in cross-sectional planes to which the elongation of the tube is perpendicular. The balloon is transparent, and the balloon dissector is provided with an image transmitter for visualization of tissue dissection.

Abstract: An instrument for endoscopic surgery comprises a retractor having independently spreadable retractor blades mounted at the distal end of a tube, through which a balloon dissector can be passed. The balloon is transparent, and the balloon dissector is provided with an image transmitter for visualization of tissue dissection.

Abstract: The insertion points for guide pins used in percutaneous vertebral fixation by pedicle screw are determined by establishing an approach path on a CT image, measuring on the CT image the distance from the intersection of the approach path and the skin of the patient's back to the patient's midline, and marking off the corresponding distance while visualizing the patient by anteroposterior fluoroscopy. An longitudinally expansible pedicle screw comprises a shaft with bone-engaging threads on a distal portion, machine screw threads on a proximal portion, and a tubular extension having wrench-engageable holes on a proximal face, and internal threads engaging the machine screw threads on the proximal portion of the shaft. An oval cannula accommodates an arthroscope and forceps simultaneously for intervertebral disc surgery.

Abstract: The insertion points for guide pins used in percutaneous vertebral fixation by pedicle screw are determined by establishing an approach path on a CT image, measuring on the CT image the distance from the intersection of the approach path and the skin of the patient's back to the patient's midline, and marking off the corresponding distance while visualizing the patient by anteroposterior fluoroscopy. An longitudinally expansible pedicle screw comprises a shaft with bone-engaging threads on a distal portion, machine screw threads on a proximal portion, and a tubular extension having wrench-engageable holes on a proximal face, and internal threads engaging the machine screw threads on the proximal portion of the shaft. An oval cannula accommodates an arthroscope and forceps simultaneously for intervertebral disc surgery.

Abstract: The insertion points for guide pins used in percutaneous vertebral fixation by pedicle screw are determined by establishing an approach path on a CT image, measuring on the CT image the distance from the intersection of the approach path and the skin of the patient's back to the patient's midline, and marking off the corresponding distance while visualizing the patient by anteroposterior fluoroscopy. A longitudinally expansible pedicle screw comprises a shaft with bone-engaging threads on a distal portion, machine screw threads on a proximal portion, and a tubular extension having wrench-engageable holes on a proximal face, and internal threads engaging the machine screw threads on the proximal portion of the shaft. An oval cannula accommodates an arthroscope and forceps simultaneously for intervertebral disc surgery.

Abstract: The present invention os a method and apparatus for performing percutaneous surgical disc procedures. The method includes percutaneously entering the back of a patient in a posterolateral position with an obturator and advancing the obturator through a percutaneously created fenestration of the annulus of the disc. A guide containing an oval shaped bore is placed over the obturator. An elongated member, having a cross-sectional shape such that when placed adjacent to the obturator forms an assembly having an oval cross-section, is inserted through the bore of guide and into the back of the patient and the fenestration of the annulus of the disc, The guide is removed and an oval cannula having a bore with an oval transverse cross-section and a proximal and distal end, is slid downwardly over the obturator and elongated member assembly. The distal end of the oval cannula is inserted into the disc.

Abstract: An expandable intervertebral cage apparatus includes a pair of cage components, each generally in the shape of a half cylinder. Each of the cage components provides a corresponding, abutting conically shaped recess that cooperates with a conical end portion of an expansion screw. One of the cage components carries a fitting with an internally threaded bore that receives external threads of the expansion screw. As the expansion screw advances into the cage, the conically shaped end portion of the expansion screw engages the conically shaped recesses on the cage components to expand the two cage components apart until they are in contact with the vertebral plates of adjacent vertebrae. The cage components have passageways for packing with bone-inducing-growth material allowing the cage to become part of a spinal fusion. A surgical method for installing the expandable intervertebral cage is also disclosed.

Abstract: A double barrel adjustable clamping system adaptable for use with laminar hooks and pedicular bolts for use by a surgeon for reduction and fixation of a spinal column is disclosed which provides a rigid construct and is independent from the rod system thereby simplifying the surgical installation thereof. Also disclosed are multi-piece round and quadrilateral rod systems which are separated by novel adjustable cross bar assemblies.

Abstract: A method for percutaneous fixation of a pair of vertebrae of a patient, which comprises posterolaterally entering the back of a patient percutaneously with a plurality of offset bone bolts, screwing each bone bolt into the medullary canal of the pedicles of adjacent thoracic and/or lumbar vertebrae or the pedicles of the L5 and S1 vertebrae, to a position where the proximal end thereof lies adjacent the fascia of the patient; inserting bone bolt linkages under the skin of the back of the patient and detachably securing the linkage means to the proximal ends of the bolts on the same side of the spinous processes of the vertebrae to restrict relative movement between the vertebrae. A kit is provided for percutaneous fixation of vertebrae of a patient, comprising a plurality of offset bone bolts of different sizes, yet of a size to enable the distal end of each bolt to be screwed into the medullary canal of a pedicle of a vertebra with the proximal end thereof lying adjacent the fascia of a patient.

Abstract: A method for vertebral fixation of a pair of vertebrae of a patient, which includes in steps of posterolaterally entering the back of a patient by means of an open surgical technique, introducing a plurality of pedicle screws into the medullary canal of the pedicles of adjacent thoracic and/or lumbar vertebrae or the pedicles of the L5 and S1 vertebrae, to a position where the proximal end lies adjacent the fascia of the patient; inserting pedicle screw linkages between the skin of the patient and the lumbar fascia of the patient and detachably securing the linkage means to the proximal ends of the screws on the same side of the spinous processes of the vertebrae to restrict relative movement between the vertebrae.

Abstract: A method of percutaneously emplacing at least two cannulae in a patient, such as for percutaneous decompression of a herniated disc, using a guide secured to one cannula to index a second cannula as it is percutaneously advanced into the body. The guide may take the form of jigs adapted to be secured to one cannula with bores arranged to slidingly receive a guidewire or a cannula.

Abstract: A forceps having forceps jaws operated by manually operable handle also has a cable connected between the forceps jaws and a manually operable actuator such that the forceps jaws are swung to a desired position when the actuator is operated.

Abstract: A method for percutaneous fixation of a pair of vertebrae of a patient, which comprises posterolaterally entering the back of a patient percutaneously with a plurality of pedicle screws, screwing each pedicle screw into the medullary canal of the pedicles of adjacent thoracic and/or lumbar vertebrae or the pedicles of the L5 and S1 vertebrae, to a position where the proximal end thereof lies adjacent the fascia of the patient; inserting pedicle screw linkages under the skin of the back of the patient and detachably securing the linkage means to the proximal ends of the screws on the same side of the spinous processes of the vertebrae to restrict relative movement between the vertebrae. A kit is provided for percutaneous fixation of vertebrae of a patient, comprising a plurality of pedicle screws of different sizes, yet of a size to enable the distal end of each screw to be screwed into the medullary canal of a pedicle of a vertebra with the proximal end thereof lying adjacent the fascia of a patient.

Abstract: A surgical cutting device, particularly suited for back surgery where a ruptured disk is involved. The device includes an elongated, narrow tube which has a smooth end for insertion into the area adjacent the required surgery. The tube further includes at least a single opening on the lateral surface of the tube adjacent the smooth end. The opening extends into the bore of the tube, with the bore extending substantially the length of the tube. The device further includes a cutting member having a periphery which is embraced and is slidable within the bore of the tube. The cutting member is reciprocally slidable within the tube so that the forwardmost surface of the cutting member traverses the opening to enable cutting of any material that is located in the opening and suction means connected to the bore of the tube for drawing loose materials to the side of the opening for cutting.

Abstract: Decompression of herniated discs in the lumbar spine is carried percutaneously by the insertion of a specially designed cannulated trocar over a guide wire extending through the patient's back toward the herniated disc at an angle of approximately 35 degrees with respect to the patient's perpendicular line. A thin-walled cannula is passed over the trocar, and a hollow cutting instrument is inserted through the cannula to form a window in the disc. Disc fragments are removed through the cannula by means of a special punch forceps, after the application of suction to the disc nucleus through the cutting instrument.

Abstract: The insertion points for guide pins used in percutaneous vertebral fixation by pedicle screw are determined by establishing an approach path on a CT image, measuring on the CT image the distance from the intersection of the approach path and the skin of the patient's back to the patient's midline, and marking off the corresponding distance while visualizing the patient by anteroposterior fluoroscopy. An longitudinally expansible pedicle screw comprises a shaft with bone-engaging threads on a distal portion, machine screw threads on a proximal portion, and a tubular extension having wrench-engageable holes on a proximal face, and internal threads engaging the machine screw threads on the proximal portion of the shaft. An oval cannula accommodates an arthroscope and forceps simultaneously for intervertebral disc surgery.