Abstract: A spinal stabilization system, method, and a surgical kit having a surgical extender apparatus for implanting a surgical screw are disclosed. The extender includes a housing having a distal end and a proximal end, a hollow interior passageway disposed between the distal end and the proximal end, a channel disposed along an exterior surface of the housing at least partially between the distal end and the proximal end and configured to at least partially expose the hollow interior passageway, an interior locking mechanism disposed on an interior surface of the housing and substantially adjacent the proximal end, wherein the interior locking mechanism is configured to allow attachment of at least one surgical tool, and at least one flexible member disposed substantially adjacent the distal end. The housing is configured to accommodate placement of a surgical screw implant. The surgical screw implant is secured to the housing using a mating feature in the surgical screw implant.

Abstract: There is provided a system, apparatus and methods for developing laser systems that can create a precise predetermined jigsaw capsulotomy. The systems, apparatus and methods further provide laser systems that can use a single laser as a therapeutic laser and as laser radar and that reduce the patient-to-patient variability and doctor-to-doctor variability associated with hand held apparatus for performing capsulorhexis and capsulotomies. There is further provided a precise predetermined jigsaw shot pattern and shaped capsulotomy that is based at least in part on the shape of an IOL and in particular an accommodating IOL.

Abstract: An apparatus and methods for exerting force on a first bone with respect to a fulcrum, which may be a second bone. A base structure, mechanically coupled to the fulcrum, is coupled to the closure top so that a force may be exerted by the base structure, acting against the fulcrum, in at least one of axial and transverse directions with respect to a pedicle screw inserted into bone. A leg extension, allowing force to be applied through the pedicle screw to a bone, has a first end rotatably coupled to the base structure; and a second end threaded as the closure top. The base structure may also support a retractor in a manner local to the immediate region of surgery.

Abstract: An intramedullary lengthening device includes a housing and a distraction shaft. The intramedullary lengthening device is placed within a cavity of two bone sections (either already separated or purposely separated for insertion of the device). The distraction shaft of the intramedullary lengthening device is attached to the one of the bone sections using, for example, one or more attachment screws. The housing of the intramedullary lengthening device is attached to the second bone section using, for instance, one or more attachment screws. Over the treatment period, the bone is continually distracted, creating a new separation into which osteogenesis can occur. In one embodiment, the intramedullary lengthening device includes an actuator and an extension rod, which can be attached to one other.

Abstract: A system and device for manipulating a spinal construct is provided. For example, the manipulation device can include a drive member to be disposed within a first surgical sleeve extending from a first vertebra, and a coupling member positioned adjacent a second surgical sleeve. In one embodiment, at least one of the drive member and the coupling member can be releasably engaged to an actuation mechanism. In one aspect, the actuation mechanism can include a floating and/or auto-locking pivot point thereby allowing a user to quickly and easily position the manipulation device relative to the adjacent surgical sleeves. Additionally, a method of manipulating spinal constructs is also provided.

Abstract: Systems and methods are disclosed for manipulating an anatomical feature within the body of the patient. An implant such as an internal jackscrew is implanted at the anatomical and has first and second attachment points that secure to spaced-apart locations on the anatomical feature, an internal rotor coupled to the jackscrew, and is configured to drive motion of the jackscrew to manipulate the anatomical feature. The system further includes an external rotor that is magnetically coupled to the internal rotor such that rotation of the external rotor at an exterior location to the patient's body affects a corresponding internal rotation of the internal rotor to manipulate the anatomical feature.

Abstract: Instruments and methods for creating an operative corridor to the spine and performing a spinal fusion. The instruments including, for example, a retractor assembly with a plurality of retractor blades, at least two pedicle screws, and a connecting rod. The retractor blades are coupled to the pedicle screws such that the operative corridor is registered to known anatomical landmarks aiding the surgeon with intraoperative orientation and anatomy identification. The retractor blades may be coupled to the pedicle screws via a polyaxial connection such that the angle of the operative corridor may be adjusted while maintaining the registration to the landmarks. Rod receivers may be attached to the pedicle screws after the disc space is operated on to minimize encumbrances on the working space within the operative corridor. A connecting rod is subsequently locked to the receivers to fix the spinal segment.

Abstract: System, including apparatus and methods, for fixing bone with a bone plate supported temporarily at a slant on bone by a leg member before the bone plate is used as a lever to reposition a region of the bone. In some embodiments, the leg member may be a post member that attaches to the bone plate by threaded engagement with an aperture of the bone plate. In some embodiments, the bone plate and the leg member may be used near the end of a long bone, such as on a distal portion of a radial bone.

Abstract: A surgical instrument, generally in the form of an expandable elongate conduit, for use as a distractor and/or retractor. The conduit generally includes a first elongate trough and a second elongate trough movable between an expanded state and a collapsed state wherein the second trough is nestable with the first trough. The first and second troughs may be fastened to vertebrae to facilitate distraction and/or compression of the vertebrae relative to one another.

Abstract: The present invention provides tools to distract, compress, and measure a vertebral body segment. In one aspect of the invention, a tool includes a handle assembly and a locking mechanism operable between a first condition in which handle portions can translate and pivot relative to one another and a second condition in which the handle portions are fixed translatably. In another aspect of the invention, a tool for distracting and compressing a vertebral body segment includes a measuring device to simultaneously indicate the length of a connecting element for coupling the fasteners. In another aspect of the invention, a measurement device includes indicia defined by a locus of points corresponding to a particular connecting element length. In another aspect of the invention, a method of coupling a first fastener engaged with a first vertebrae to a second fastener engaged with a second vertebrae is provided.

Abstract: A constraining apparatus includes a constraining structure that captures a first and a second anatomical structure. A motion limiting member coupled with the constraining structure is adapted to provide a force resistant to relative movement of the first anatomical structure away from the second anatomical structure. A regulating member is detachably coupled with the motion limiting member or the constraining structure and is adapted to change the resistant force provided by the motion limiting member when the regulating member is in direct engagement with the motion limiting member or constraining structure.

Abstract: A spinal stabilization system, method, and a surgical kit having a surgical extender apparatus for implanting a surgical screw are disclosed. The extender includes a housing having a distal end and a proximal end, a hollow interior passageway disposed between the distal end and the proximal end, a channel disposed along an exterior surface of the housing at least partially between the distal end and the proximal end and configured to at least partially expose the hollow interior passageway, an interior locking mechanism disposed on an interior surface of the housing and substantially adjacent the proximal end, wherein the interior locking mechanism is configured to allow attachment of at least one surgical tool, and at least one flexible member disposed substantially adjacent the distal end. The housing is configured to accommodate placement of a surgical screw implant. The surgical screw implant is secured to the housing using a mating feature in the surgical screw implant.

Abstract: An expandable spinal implant device for supporting vertebral bodies can include first and second body members and first and second expansion mechanisms. The body members can each have a first end positionable toward one of the vertebral bodies and can each define a hollow interior. The expansion mechanisms can be spaced apart from each other and can include a first drive shaft and a second drive shaft, respectively. The first and second drive shafts can each have a gear member fixedly coupled thereto. Each drive shaft can be threadably engaged at a first side to the first body member and at a second side to the second body member. The expansion mechanisms can be operable to effect axial displacement of the first body member relative to the second body member by rotationally driving the gear members of the first and second drive shafts.

Abstract: A device to space vertebral members that may include a deploying device with a first member with an elongated first shaft and a first body at an end of the first shaft, a second member with an elongated second shaft that extends around the first shaft and a second body at an end of the second shaft, and a third member with an elongated third shaft that extends around the second shaft and a third body at an end of the second shaft. The device may include a first plate positioned on a first side of the deploying device, and a second plate positioned on a second side of the deploying device. First, second, and third jointed linkages may be spaced apart along the deploying device and each having a pair of links and each having a first end attached to the first plate, a second end attached to the second plate, and an intermediate joint connecting the pair of links together and being attached to the deploying device.

Abstract: A spinal distraction assembly is provided for distracting the disc space between a pair of vertebrae, the vertebrae each having been implanted with a bone anchor. The spinal distraction assembly includes a first anchor engaging element and a second anchor engaging element. The first anchor engaging element includes a body having a channel extending through the longitudinal axis of the body. The second anchor engaging element includes a guide bar. The guide bar is dimensioned to translate through the body channel. Anchor engaging arms extend laterally from each of the body and guide bar.

Abstract: A bone support and/or barrier device and having an implantable structure including an outer surface, an inner surface, a first bone contact portion, and a second bone contact portion. The structure is collapsible to an undeployed configuration capable of percutaneous insertion to the interior of a bone and expandable to a deployed configuration in the bone. In the deployed configuration, the first bone contact portion contacts a first portion of the bone, and the second bone contact portion contacts a second portion of the bone such that a load placed on the first portion of the bone is transferred through the implantable structure to the second portion of the bone. The implantable structure includes a barrier material adapted to restrict bone filler material inserted into the bone adjacent the inner surface of the structure from flowing to the outer surface of the structure. A method is also disclosed.

Abstract: A method of treating a vertebra, comprising: (a) accessing an interior of a vertebra; and (b) introducing a sufficient amount of artificial biocompatible material which does not set to a hardened condition in storage, into said bone, with sufficient force to move apart fractured portions of said bone.

Abstract: Various methods and devices for minimally invasive treatment and prevention of conditions of the fascia are provided. In one aspect, a method includes providing an acoustic wave source effective to deliver a focused acoustic wave to a target site within a patient's body focusing an acoustic wave through a patient's skin such that at least one location in the patient's fascia is fenestrated in a desired pattern.

Abstract: The invention concerns a clamp, especially a surgical clamp, with a left clamp half to receive a left half of a breastbone during a surgical procedure, a right clamp half to receive a right half of the breastbone, as well as a first toothed rod and a detent mechanism engaging in the first toothed rod to secure the left clamp half at a distance from the right clamp half, wherein the detent mechanism engaging in the first toothed rod has a detent region extending at least from the left clamp half to the right clamp half.

Abstract: An expandable interbody fusion device includes superior and inferior endplates that are configured to receive a sequentially inserted stack of interlocking expansion members or wafers. The like-configured wafers include features on their top and bottom surfaces that interlock the wafers in multiple degrees of freedom so that the wafer stack is not disrupted when the fusion device is fully expanded. One of the interlocking features includes a plurality of prongs projecting from an upper surface of the wafers and into a recess defined in the lower surface of an adjacent previously inserted like-configured wafer. The prongs and recesses are configured to prevent retrograde movement of each new wafer in a direction opposite the direction of insertion. Other interlocking features prevent movement in the direction of insertion, transverse to the insertion direction and vertically within the stack.

Abstract: A clamp assembly for bone fixation elements including first and second clamp structures configured to engage first and second bone fixation elements, respectively. The first clamp structure may have a first spherically contoured bearing surface. The second clamp structure may have a second spherically contoured bearing surface seated in sliding contact with the first bearing surface. A spring-loaded mechanism may apply a spring force urging the bearing surfaces together to resist pivotal movement of the clamp structures relative to each other. The clamp assembly may be used with an assembly of fixation elements to create an external fixation frame.

Abstract: According to one aspect of the present invention, a computer assisted orthopaedic surgery system for performing joint replacement or resurfacing surgeries includes a computer that contains software that is adapted to permit an operator of the system to physically evaluate post-operative laxity and stiffness of a joint based on planned implant placement, prior to all cuts being made for at least one side of the joint to accommodate the implant and before components of the implant are installed in the joint, wherein the planned implant placement is measured in terms of a position of at least one virtual implant.

Abstract: A device is disclosed for reducing a vertebral compression fracture, comprising a superior end plate and an inferior end plate disposed along a vertical axis. The superior end plate and the inferior end plate are slidably separable in a vertical direction along the vertical axis. An interior chamber is provided in fluid communication with a port extending from an exterior to the interior chamber. The device is deployable within a vertebral body and expandable within the vertebral body by injecting a flowable material into the interior chamber thereby displacing the superior and inferior end plates along the vertical axis.

Abstract: An adjustable pin drill guide and method for using an adjustable pin drill guide to prepare a vertebral body space to receive an implant are disclosed. The method includes providing an adjustable pin drill guide, producing a gap by removing tissue between a first vertebral body and a second vertebral body, inserting into the gap first and second extensions of the guide in a first position, moving the first extension and the second extension to a second position, drilling a first hole in the first vertebral body through a first opening in the guide, drilling a second hole in the second vertebral body through a second opening in the guide, placing a first pin into the first hole, and placing a second pin into the second hole. The first and second extensions are preferably in parallel planes when in the first and second positions.

Abstract: Various methods and devices are provided for tensioning a tether. In one embodiment, a tether tensioning device is provided and includes a tensioning mechanism adapted to couple to a tether extending along a path between at least two bone anchors implanted in adjacent vertebrae. The tensioning mechanism can be adapted to apply a tensioning force to the tether along the path of the tether to thereby move the tether along the path. The device further includes an actuation mechanism movably coupled to the tensioning mechanism such that the actuation mechanism is adapted to effect movement of the tensioning mechanism to control the tensioning force applied to the tether.

Abstract: A medical clamp, in particular a spinal clamp, includes two clamp limbs connected to a grip part. The grip part executes a clamping movement of the clamp limbs and the clamp limbs are connected to the grip part in a releasable manner. The clamp permits particularly safe, minimally invasive percutaneous interventions, especially in the area of the spinal column. A device for using a medical clamp for providing a reference position for a positioning system for percutaneous interventions and a method for determining a reference position for a positioning system for percutaneous interventions, are also provided.

Abstract: A device for compressing fractured portions of a bone includes (a) first and second jaws movable relative to one another to compress fractured portions of a bone therebetween, the first and second jaws being connected to one another such that bone gripping portions thereof remain parallel to one another throughout a permitted range of motion of the first and second jaws and (b) a first guide sleeve attached to the distal end of the first jaw and a second guide sleeve attached to the distal end of the second jaw. The first and second guide sleeves have central axes coaxial with one another.

Abstract: A combination of a first assembly for guiding resection of a femur and tibia of a knee joint and a second assembly including femoral and tibial knee components. The combination of the first assembly and the second assembly provides optimal placement and positioning of the femoral and tibial knee components to achieve near-normal knee kinematics and tension. The preparation for and placement of the prosthetic knee components provides medial-pivoting kinematics mimicking that of the natural knee thereby promoting improved outcome for the patient.

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

Abstract: A minimally invasive spacer for positioning between vertebral members. The spacer is adjustable between a first orientation having a reduced size to facilitate insertion between the vertebral members. A second orientation has an enlarged size for contacting the vertebral members. The spacer includes linkages that are attached to a pair of plates. A pull arm is operatively connected to the linkages for adjusting the spacer from the first orientation to the second orientation. A indicator gauge indicates the height of the spacer.

Abstract: A system and method is provided for distracting opposite surfaces from the interior of a bone, such as a vertebral body. A working channel cannula provides a working channel through which an inserter and an injection cannula can simultaneously pass. The inserter transports a plurality of wafers into the interior of the bone to form a load-bearing stack bearing against the opposite surfaces. The injection cannula is used to inject a fluent material into and/or around the stack. In certain embodiments, the fluent material is a load-bearing or hardenable material, such as bone cement. In other embodiments, the fluent material can be a BMP, HAP, or other osteo-inductive, osteo-conductive, or pharmaceutical compositions. A syringe containing the fluent material is engaged to the injection cannula and is operable to inject the fluent material into the vertebral body under controlled pressure.

Abstract: A drill guide assembly having an elongated body is configured with a first and second arm members extending from the elongated body. The second arm member is configured and adapted to be longitudinally movable along the elongated body towards and away from the first arm member for reducing fractured bones for repair. A guide housing provided on the second arm member is fitted with a removable sleeve. The removable sleeve is provided with a longitudinal bore for guiding a guide wire or a drill bit for drilling into the bones.

Abstract: Improved implant devices and methods for interspinous distraction distribute the load of interspinous distraction so that the entire load is not bearing on the interspinous surfaces. The implant device has a narrow midsection and two wider, flange-shaped outer sections. The wider, flange-shaped outer sections can be tightened to bear against the thicker bony portions of the spinous processes to support some of the load. Optionally, the wider, flange-shaped outer sections can be configured with pins that will penetrate and engage the thicker bony portions of the spinous processes, which will increase the load bearing potential of the wider, flange-shaped outer sections. Additionally, the wider, flange-shaped outer sections and the pins will help to stabilize the joint. The joint stabilization may help to prevent further dislocation of the vertebra that occurs with spondylolisthesis.

Abstract: A collapsible bone screw for healing bone fragments across a bone fracture includes an externally threaded inner screw member and an externally threaded outer screw member. The inner screw member is initially screwed into an inner bone portion. An unthreaded portion of the outer screw member is movably joined to the inner screw member. The outer screw member is screwed until it gains purchase in an outer bone portion. As impaction occurs over time, the collapsible bone screw apparatus may shorten in length as the two screw members slide, telescope or otherwise axially move toward each other to shorten the overall length, thereby preventing any portion of the screw apparatus from protruding out of the bone. A bone screw kit of multiple inner and outer screw members are provided as well as a method of surgically fastening bone fragments.

Abstract: A lever device includes first and second levers coupled at a lever pivot. First end of a first bar is pivotally coupled to the first lever at a first lever-bar pivot. First end of a second bar is pivotally coupled to the second lever at a second lever-bar pivot. First tool is pivotally coupled to a distal end of the first lever at a first lever-tool pivot. Second end of the first tool is pivotally coupled to the second end of the second bar. Second tool is pivotally coupled to the second lever at a second lever-tool pivot and a second end of the lever is pivotally coupled to the second end of the second bar. First lever-bar pivot is between the lever pivot and a distal end of the first lever and the second lever-bar pivot is between the lever pivot and a distal end of the second lever.

Abstract: Multiple implants and methods for the minimally invasive treatment of spinal stenosis are disclosed. A spinal implant device includes a spacer region and an attachment region. The spacer region is adapted to be positioned between first and second spinous processes of first and second vertebral bodies to limit movement of the first spinous process and the second spinous process toward one another. The attachment region attaches to the first spinous process via a fastener that extends substantially along a long axis of the spinous process.

Abstract: A surgical instrument and instrumentation are suggested, with which expansion of the vertebral canal of vertebrae is possible with less stress for the patient than with operating procedures customary up to now, this instrument having proximally a gripping part and distally two branches which can be moved relative to one another with tool elements held thereon as well as a lever mechanism arranged between the gripping part and the branches, wherein the tool elements are held with the lever mechanism so as to be movable relative to one another from a closed rest position into an open spread position (distraction position).

Abstract: Embodiments disclosed herein provide a combination compressor/distractor useful for fitting a spinal stabilization system in a patient through minimally invasive surgery. The spinal stabilization system may comprise screws anchored in vertebrae. The vertebrae may need to be compressed or distracted. One embodiment of an instrument disclosed herein may comprise a shaft for engaging one of the screws through an extender sleeve. A driver may engage another screw through an opening of the instrument. Through this engagement, a surgeon may use the rack and pinion of the instrument to compress or distract one or more levels of the vertebrae in a parallel motion, which can be advantageous clinically in certain situations.

Abstract: A mandibular bone transport device includes a carriage block and a set of flanges operable to couple to a transport bone plate. The device also includes a flexible connector configured to flexibly couple the set of flanges to the carriage block such that the flanges can be displaced relative to the carriage block when a force is applied. Further, the device includes a screw housed within the carriage block which is operable to engage a track and operable to advance the carriage block along the track. The device also includes a coupling configured to engage the screw and operable to rotate the screw when rotational force is applied to the coupling.

Abstract: A cervical plate assembly facilitates the fusion of cervical vertebrae by quickly and easily causing the vertebrae to exert a preloading force against a bone graft interposed therebetween. A cervical plate assembly also facilitates the installation of the cervical plate assembly in an orthopedic surgical procedure by providing both a locking mechanism that positively retains one or more fasteners thereto and a viewing window that results in an unobstructed view of the vertebrae and the bone graft.

Abstract: A pair of bone plates adapted for attachment to cranial bone segments, the cranial plates being mounted to a distraction mechanism such that the cranial plates can be separated gradually in very small increments. Each of the cranial plates is mounted to the distraction mechanism with a ball and socket connector assembly, such that each of the plates can move in multiple directions and orientations relative to the distraction mechanism to better accommodate a convex, planar or concave surface topography presented during the distraction procedure.

Abstract: Intra-oral devices for distraction osteogenesis are described. Utilizing a medical model, bone-traced fixation plates with undercut portions are custom-fitted to the skeleton of the patient. To these plates rigid distraction platforms are connected. In the pre-surgical stage, skeletal segments are placed in the post-operative position and occlusal splints are constructed. The occlusal splints are modified to interengage the distraction platforms and to provide docking therefor. One or more distractors are mounted on the rigid platform and, upon operation thereof, guide the segment to the distraction endpoint. Optionally, after distraction and during consolidation, the distractors may be removed.

Abstract: Force-controlled autodistraction for lengthening a bone is disclosed. A distractor is coupled to first and second fixators that are coupled to first and second portions of the bone, respectively, on opposite sides of an osteotomy of the bone. A motor produces a motion of the first fixator relative to the second fixator such that the first portion of the bone is distracted from the second portion of the bone. A force sensor measures a resistant force to the motion, and a distractor displacement sensor measures a distractor displacement. A controller is operably coupled to the force sensor, the distractor displacement sensor, and the motor. The controller is configured to determine a variable limb stiffness using the resistant force, the distractor displacement, and a known distractor stiffness of the distractor, and to adjust a gain of the motor such that the variable limb stiffness matches a desired limb stiffness.

Abstract: The invention is a surgical instrument for measuring an intervertebral space. On the distal end of a handle of the instrument there are at least two measurement plates, whereby an interval between the measurement plates, and an angle enclosed by the measurement plates, are adjustable.

Abstract: In one embodiment, a surgical instrument includes a first and second lever arms coupled by a first pivot. A ratchet bar is coupled to the first lever arm by a second pivot. The ratchet bar has a toothed portion extending from an interior face of the first lever arm and a paddle portion extending from an exterior face of the first lever arm. A catch is disposed at a proximate end of the second lever arm and arranged to engage teeth of the toothed portion of the ratchet bar. Engagement with the teeth couples the proximate ends of the first and second lever arms. The ratchet bar is further arranged to rotate about the second pivot in response to downward pressure upon the paddle. Depression of the paddle causes the teeth of disengage the catch, decoupling the first and second lever arms.

Abstract: A system and method is provided for distracting opposite surfaces from the interior of a bone, such as a vertebral body. A working channel cannula provides a working channel through which an inserter and an injection cannula can simultaneously pass. The inserter transports a plurality of wafers into the interior of the bone to form a load-bearing stack bearing against the opposite surfaces. The injection cannula is used to inject a fluent material into and/or around the stack. In certain embodiments, the fluent material is a load-bearing or hardenable material, such as bone cement. In other embodiments, the fluent material can be a BMP, HAP, or other osteo-inductive, osteo-conductive, or pharmaceutical compositions. A syringe containing the fluent material is engaged to the injection cannula and is operable to inject the fluent material into the vertebral body under controlled pressure.

Abstract: The present application is directed to devices with expandable lengths for treating bony members. The device may include an elongated member with two sections that are movable relative to each other. An expansion chamber may be positioned between the first and second sections. A pump may move fluid from a reservoir and through a conduit into the expansion chamber. The expansion chamber expands upon receiving the fluid to cause the first and second sections to move apart and increase the length of the elongated member. The device may include multiple expansion chambers along the length, and the elongated member may include multiple sections.

Abstract: A joint between two bone segments is fused by passing an elongated, rectilinear bone fusion device over a guide pin across the joint and into tight engagement within bores formed in the bone segments, to thereby restrict movement of the elongated bone fusion device across the joint. The elongated, rectilinear bone fusion device also provides bony in-growth within the bores along the exterior surface of the bone fusion device.

Abstract: A spinal distraction system includes a distraction rod having a first end and a second end, the first end being configured for affixation to a subject's spine at a first location, the distraction rod having a second end containing a recess having a threaded portion disposed therein. The system further includes an adjustable portion configured for affixation relative to the subject's spine at a second location remote from the first location, the adjustable portion comprising a housing containing a magnetic assembly, the magnetic assembly affixed at one end thereof to a lead screw, the lead screw operatively coupled to the threaded portion. A locking pin may secure the lead screw to the magnetic assembly. An o-ring gland disposed on the end of the housing may form a dynamic seal with the distraction rod.

Abstract: A system and method is provided for distracting opposite surfaces from the interior of a bone, such as a vertebral body. A working channel cannula provides a working channel through which an inserter and an injection cannula can simultaneously pass. The inserter transports a plurality of wafers into the interior of the bone to form a load-bearing stack bearing against the opposite surfaces. The injection cannula is used to inject a fluent material into and/or around the stack. In certain embodiments, the fluent material is a load-bearing or hardenable material, such as bone cement. In other embodiments, the fluent material can be a BMP, HAP, or other osteo-inductive, osteo-conductive, or pharmaceutical compositions. A syringe containing the fluent material is engaged to the injection cannula and is operable to inject the fluent material into the vertebral body under controlled pressure.