Abstract: A bone preparation device for shaping endplates forming an intervertebral disc space between two adjacent vertebrae includes a cutter component and a cutter-positioner component. The cutter-positioner is arranged to limit the distal travel of the cutter component and to restrict the range of motion of the distal end of the cutter component. The bone preparation device also includes a rotational interface between the cutter component and the cutter-positioner component. The rotational interface is structurally arranged to permit the cutting blade to be rotated at the same time the cutter component is restricted in its range of motion.

Abstract: A spine shaver designed with increased tissue removing efficiency is described. The shaver comprises a cylindrical shaver blade, an elongated body, and a pulley and belt drive mechanism. The shaver blade further comprises a tissue cutting surface that extends along the longitudinal axis of the shaver. The shaver is further designed with the shaver blade positioned perpendicularly to the elongated body. The increased surface area of the shaver blade and perpendicular blade orientation provide an efficient means of removing spinal tissue and debulking the area between two vertebrae.

Abstract: The invention comprises a method for fixating bones in the foot by aligning the bones in their desired position, inserting a screw in the aligned bones, inserting at least one transverse element near the head or tip of the screw, and tightening the screw to compress the bones. The screw comprises a shaft having first and second ends with spirally wound screw threads beginning near the first end and extending along the shaft. Advantageously, the screw is cannulated and screw threads are formed on an interior surface of the cannulation. Illustratively, the transverse elements may be staples, open-ended washers, or open-ended nuts. Reduction instruments and drill guides used in the invention are also disclosed.

Abstract: Devices and methods for cutting tissue in a patient. In some embodiments, a bimanually controlled device may include a tissue modification region; one or more (e.g., two) flexible elongate length of cable that extend proximally to distally, a tissue modification region along a portion of the length of cable; and a guidewire coupler at the distal end of the device for attaching the distal end of the tissue modification device to the proximal end of a guidewire. Method of using these devices (including devices having two or more parallel length of cutting regions) to cut tissue (e.g., spinal lamina) are also described.

Abstract: A gas operated surgical instrument is provided. The instrument includes a pressurized gas connection for connection to a source of pressurized gas, a working piston adapted to be acted upon by a pressurized gas, an actuating element for actuating the instrument, and a regulating device coupled to the actuating element and to the working piston for regulating a feed force of the working piston. The regulating device is configured such that, for feed forces below a predetermined limit force, it defines a first work area in which the working piston is movable in the distal direction solely owing to a feed force applied with the actuating element, and that above the limit force the regulating device defines a second work area in which the working piston is movable in the distal direction by being acted upon by pressurized gas.

Abstract: A method of accessing target tissue adjacent to a spinal nerve of a patient includes the steps of accessing a spine location of the patient by entering the patient through the skin at an access location, inserting a flexible tissue modification device through the access location to the spine location, advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location, passing through the first exit location and out of the patient, advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location, and passing through the second exit location and out of the patient.

Abstract: Instruments and methods for treating vertebral endplates are disclosed. The instrument includes one or more treatment members movable from a reduced profile position for insertion to the operative site to a deployed position for providing treatment to the vertebral endplates.

Abstract: Methods and devices for performing knee arthroplasty including but not limited to bicruciate retaining knee arthroplasty are provided. Methods and devices for preparing a proximal tibia for a tibial implant are also provided. These methods and devices, in at least some embodiments and uses, facilitate decreasing the complexity of knee arthroplasty procedures such as bicruciate retaining procedures while maintaining, if not improving on, the safety, accuracy and/or effectiveness of such procedures.

Abstract: Single-unit cutting head systems for safe removal of nucleus pulposis tissue are provided. The cutting heads compose a part of the systems that are provided to address several problems, including clogging of state-of-the-art systems during removal of such tissue, for example. The target tissue can include any tissue that is accessible through a small surgical opening, for example, a joint tissue such as a meniscus or an intervertebral tissue, such as a nucleus pulposus. The devices can be referred to as orthopedic tissue removal devices having cutting heads associated with vacuum systems, making the systems useful in several procedures, including X-LIF (lateral approach to an intervertebral fusions) procedures, T-LIF (transforaminal approach to intervertebral fusions) procedures, P-LIF (posterior approach to intervertebral fusions), and a percutaneous, transforaminal approach (Kambin triangle access).

Abstract: A tissue removal device and method of using the device to remove tissue from a patient is provided. The tissue removal device comprises a tissue removal probe and a sheath slideable relative to the probe. The probe has a tissue removal element, and the sheath has a portion that exposes the tissue removal element. The sheath distal end may be pre-shaped to bend when slid distal to the probe. The probe may have a window through which the tissue removal element is exposed.

Abstract: A safe and efficient cutting heads for removing a target tissue from a subject during a surgical procedure are provided, the cutting heads composing a part of systems that address several problems, including clogging of state-of-the-art systems during removal of such tissue, for example. The target tissue can include any tissue that is accessible through a small surgical opening, for example, a joint tissue such as a meniscus or an intervertebral tissue, such as a nucleus pulposus. The devices can be referred to as orthopedic tissue removal devices having cutting heads associated with vacuum systems, making the systems useful in several procedures, including X-LIF (lateral approach to an intervertebral fusions) procedures, T-LIF (transforaminal approach to intervertebral fusions) procedures, P-LIF (posterior approach to intervertebral fusions), and a percutaneous, transforaminal approach (Kambin triangle access).

Abstract: The invention relates to a surgical instrument comprising a handling part and a tool part that encompasses at least one movably mounted tool which is actuated via a force-transmitting and/or actuating mechanism. Said force-transmitting and/or actuating mechanism is operated from the handling part and is provided with a fluid-operated drive unit. In order to improve said surgical instrument such that the same can be operated with as much sensitivity as possible, the movably mounted tool can be impinged upon a first actuation force in a first driven position while being impinged upon by at least one second actuation force in a least one second driven position with the aid of the drive unit.

Abstract: A modular prosthesis rasp is provided, having a rasp body with a rasp main body and at least one modular rasp body part connectable to the main body. The rasp main body has a receptacle for receiving the at least one rasp body part. An outer contour is defined by the rasp main body and the at least one rasp body part. The rasp body part receptacle extends from an indentation, defining a distal end of the receptacle, on a lateral side of the rasp main body to a proximal end thereof. A first tangential plane of the lateral side of the outer contour in the region of the indentation and a second tangential plane at a rasp body part contact surface, in the region of the distal end of the receptacle include an indentation angle of less than 85°.

Abstract: A bone resection system for a prosthetic implant having an anterior and posterior outer surface attached to bone has a cutting guide having slotted guide surfaces thereon mountable on the prosthetic implant. The guide surfaces are alignable with the implant outer anterior and posterior surfaces. A saw comprising a housing having spaced apart first and second sides joined by first and second edge surfaces and having a proximal end and a distal end can be inserted into the slotted guide surfaces. A cutting head drive system on the housing drives a cutting head having teeth extending outwardly of the distal end of the housing. A cam element is mounted on the saw housing intermediate the proximal and the distal ends. The cam element has a distal end with a guide arm extending therefrom engagable, during insertion, with the guide surface on the cutting guide. The cam element having a stop surface for engaging a stop surface on the cutting guide to limit blade travel.

Abstract: An easy-to-assemble modular reamer for medical applications includes a shaft portion, a disposable tapered hollow reamer and a modular pilot. The shaft portion has a proximal end for attachment to a drill, two or more torque transmitting tabs and a distal threaded end. The disposable tapered hollow reamer has an integrally attached cutter sleeve with externally protruding cutters, apertures through the sleeve thickness for discharging bone fragments and cement debris and inwardly protruding anchoring projections. A central molded polymeric portion attaches to the anchoring projection and is fixed to the shaft through central holes and slots in the polymeric portion, which engage torque transmitting shaft tabs. Channels in the polymeric portion collect bone fragments and bone debris. A threaded modular pilot coaxially secures the disposable tapered hollow reamer to the threaded distal end of the shaft, permitting rotation of the tapered hollow reamer without wobbliness.

Abstract: A prosthesis (20) for use in performing joint arthroplasty is provided. The prosthesis (20) is to be fitted to a long bone (3). The prosthesis includes a first body (22) having a first body articulating surface (24) defining a generally circular outer periphery (26) of the first body articulating surface (24). The first body (22) has a support surface (28) opposed to the articulating surface (24). The support surface (28) is adapted to receive the head of the long bone (3). The prosthesis (20) also includes a second body (30) operably associated with the first body (22). The second body (30) has a second body articulating surface (32) extending from a portion of the circular outer periphery (26) of the first body articulating surface (24). A tool kit for preparing a humerus to receive a prosthesis is also disclosed.

Abstract: Method and apparatus for preparing bone and cartilage transplants for the reconstruction of the acetabulum, femoral head, or both with tissue engineered osteochondral constructs or and osteochondral allograft transplant.

Abstract: A keel punch impactor comprises a main body having an interior bore. A locking shaft is positioned in the interior bore of the main body, the locking shaft defining a shaft axis. An actuator is in contact with the locking shaft. The actuator is moveable between a first position and a second position. The position of the locking shaft is moved within the interior bore of the main body upon movement of the actuator. In particular, the locking shaft is moved such that the shaft axis is offset when the actuator is moved from the first position to the second position. When the shaft is moved, a head on the shaft is moved into or out of alignment with a boss extending from the main body of the keel punch impactor.

Abstract: The present invention relates to surgical instruments particularly suitable for preparing vertebral endplates during spinal inter-body surgical procedures. Methods of using such instruments are also disclosed.

Abstract: A disposable acetabular reamer designed to improve tissue removal efficiency is described. The reamer device comprises a reamer cutting shell and a reamer driver interface. The reamer cutting shell has a hemispherical structure with a plurality of spaced apart rib portions that extend from a central region located about an apex of the shell. A tissue cutting surface further extends along a longitudinal leading edge, trailing edge or both leading and trailing rib portions. The tissue cutting surface further comprises a series of alternating cutting teeth and notches which are bent at a rake angle.

Abstract: A device for modifying one or more tissues in a patient's spine may include: an elongate, at least partially flexible body having a proximal portion and a distal portion, wherein at least the distal portion has dimensions that allow it to be passed into an epidural space and between target and non-target tissues of the spine; at least one movable blade disposed along one side of the elongate body; at least one actuator coupled with the at least one blade and disposed at or near the proximal or distal portion of the body for moving the blade(s) to modify one or more target tissues, wherein the at least one actuator is configured to move the blade(s) without significantly translating the elongate body proximally or distally; and means at or near the proximal and distal portions of the elongate body for facilitating application of at least one of anchoring force and tensioning force to the body to urge the at least one blade against the target tissue.

Abstract: A device for trimming an osteochondral implant according to which a body member has a bore for receiving the graft and a cutting slot extending transverse to the bore for receiving a cutting blade. A mechanism adjusts the graft in the bore relative to the slot so that the graft can be cut to a predetermined length with the cutting blade in the slot.

Abstract: A high pressure fluid jet system is provided, which is useful for cutting hard material during a surgical procedure. The cutting of hard material is more efficient as the system delivers abrasive solid particles with the high pressure fluid. A method of effecting cutting during a surgical procedure is also provided. In an exemplary embodiment, a surgical tool that is effective to deliver a pressurized stream of fluid through a nozzle is provided, and the pressurized stream of fluid is delivered through the surgical tool and out of the nozzle to hard material within a patient to effect cutting of the hard material within the patient in a desired pattern. The fluid that cuts the hard material can include a delivery liquid having a plurality of abrasive solid particles that are formed from an organic material. The abrasive solid particles can be entrained in the pressurized fluid stream or the pressurized fluid stream can erode a solid or suspension form of the abrasive particles.

Abstract: Methods and devices for sculpting bones, particularly in preparation for implanting prosthetic devices to replace articulating bone joint surfaces. Improved bone removal devices including burr mills driven by gears and loop drives are provided. Reciprocating cutters and belt cutters are also provided. Some devices have either integral or removable expandable portions to vary the force and bone resection depth. Devices can have irrigation ports and plenums to remove bone fragments. Some cutters are dual cutters, adapted to remove bone in two or more regions, such as the knee joint, simultaneously.

Abstract: The present invention provides a technique for percutaneous intramedullary fixation. A protective outer sheath is provided for internal fixation of the proximal tibia. Additionally, a unique intramedullary plate is provided that is adapted for percutaneous insertion into the intramedullary canal of a long bone. A plate holder is also provided that may be utilized through the outer sheath to drive and position a fixation plate within the intramedullary canal.

Abstract: The invention relates to instruments for reinforcing a human spinal column, in particular in the region of the last vertebral body S1 of the sacrum toward the head and of the lowermost lumbar vertebral body L5 or additionally of the second lowest lumbar vertebral body L4, comprising a tissue protection cover to keep open a position on the sacrum, a tool for removing bone tissue from the vertebral body S1 in the case of single level supply and from the vertebral bodies S1 and L5 in the case of double level supply, at least one tool for removing intervertebral disc tissue between S1 and L5 and a reinforcement screw consisting of a pin with a first, leading, proximal threaded pin portion and a second, driving, distal threaded pin portion.

Abstract: A method for preparing a proximal femoral canal of a patient during total hip replacement surgery uses an instrument having a handle, a shaping member including structure configured to shape bone, wherein the structure configured to shape bone comprises at least two cutting surfaces on opposite sides of the shaping member, and a connecting member connecting the handle and the shaping member, the connecting member having a plurality of transverse cross sections. The connecting member includes a dual offset including a first compound bend between the connecting member and the handle, wherein when following a direction from the connecting member to the handle, the first compound bend includes a bend in a posterior direction and a bend in a lateral direction. The connecting member also includes a second compound bend between the connecting member and the shaping member, the second compound bend in an anterior and a medial direction.

Abstract: A flexible trephine includes a flexible section that is formed of a spring member. The trephine is tubular and includes a central passage so that the trephine can coaxially fit over a longitudinal implant while force is applied to the trephine. The trephine has an annular cutting head for removing bone that surrounds the implant, so that the implant can be removed. The trephine is urged in the longitudinal direction of the implant while fitted coaxially on the implant so that the implant can be separated from the bone. The flexible section of the trephine allows the trephine to conform to and follow a bowed implant. The cutting head can include multiple teeth or a single osteotome.

Abstract: Described herein are devices, systems and methods for cutting tissue in a patient. In some embodiments, a tissue modification region of a device includes a pair of flexible elongate cutting members extending along the length of the tissue modification region. Each elongate cutting member may be configured to cut a discrete trough into tissue to a depth that is greater than the thickness of the cutting member. In some embodiments, the device includes a spacer. The spacer may be sized and configured to operate in one of two modes. A first mode, in which the spacer is coupled to the cutting members such that it holds a portion of each of the two cutting members a distance from one another, and a second mode, in which at least a portion of the spacer is moved away from a cutting member to allow the cutting members to cut further into tissue.

Abstract: A surgical procedure according to which a cutting device is connected in a spaced relationship to an anchor, and the anchor is located over a first area of the bone. The distance between the cutting device and the anchor is adjusted so that the cutting device extends over a second area of the bone, and the anchor is driven into the first area of the bone so that the cutting device cuts into the second area.

Abstract: A dynamic sensing method and apparatus employs microelectromechanical systems (MEMS) and nanoelectromechanical (NEMS) surgical sensors for gathering and reporting surgical parameters pertaining to a drive mechanism of a surgical device, such as speed, rotation, torque and other characteristics of the surgical device. The surgical device employs or affixes the surgical sensor on or about a surgical device for detecting electromechanical characteristics during the surgical procedure. The surgical procedure disposes the medical device in the surgical field responsive to the drive mechanism of a shaver or other endoscopic instrument inserted in a surgical field defined by the surgical procedure.

Abstract: A device for determining the internal structure of a bone along a path directed into the bone (or other tissue) is disclosed. The device comprises a nozzle fluidically connected to a liquid reservoir for providing a liquid jet directed at the bone in the direction of the path; an ultrasonic transducer for generating ultrasonic waves through the liquid jet and for detecting echoes of the ultrasonic waves caused by changes in the acoustical impedance in the bone characterizing changes in the structure of the bone along the path; and an analyzer for interpreting the echoes into meaningful information relating to the location of the structural changes along the path.

Abstract: The present disclosure relates to an arthroscopic resection device. The device includes an outer member including a hub, an inner member including a hub, the inner member housed within the outer member, a tube coupled to the outer member, and means for allowing longitudinal movement of the outer member relative to the inner member, the means coupled to the tube. A method of tissue repair and other arthroscopic resection devices are also disclosed.

Abstract: The invention relates to a bone cutter that is designed for surgical purposes, that can be used with vacuum or impulsive system depending on the preference of the surgeon and that is manufactured in two different, disposable or reusable models, cutter edges with various diameter and size can be installed on the same leg mechanism.

Abstract: A pedicle perforator (1) includes a handle (2) and a shaft (3) which ends opposite the handle (2) with an end (4) that has a perforated shape (hereinafter referred to as “tip”), characterized in that the shaft (3) includes a protruding centering device (7) for a cylindrical surface, provided in a region of the shaft (3) opposite the handle (2), a hollow guide tube (11) having an internal diameter of 4 to 20 mm, an external diameter of 5 to 22 mm and a length of 4 to 25 cm, including an end that has reliefs for attachment (12), for use together with the pedicle perforator, and a set including a pedicle perforator (1) and a hollow guide tube (11), wherein the pedicle perforator (1) can slide loosely in this hollow guide tube.

Abstract: A tissue removal system comprises a rotatable burr element located within a distal housing and a burr opening. The burr opening is located about a distal surface and side surface of the distal housing. The distal housing is configured to bend or pivot with respect to a proximal housing. The proximal housing comprises an auger hole configured to draw fluid and particulate matter for transport proximally along the length of the tissue removal system. A linkage assembly attaches a drive shaft of the tissue removal assembly to the rotatable burr element to permit rotation of the rotatable burr element when the distal housing is bent or pivoted.

Abstract: Described herein are devices and methods for cutting tissue in a patient. In some embodiments, a bimanually controlled device may include a tissue modification region; at least two flexible elongate lengths of cable that extend substantially adjacent to each other proximally to distally; a plurality of rungs extending between the lengths of cable; and a pair of flexible elongate cutting members extending along the length of the tissue modification region of the device. Each elongate cutting member has a thickness cuts a discrete trough into tissue to a depth that is greater than the thickness of the cutting member. The device may further include a substrate sized and configured to releasably hold the cutting members a distance from one another and a pair of couplers positioned toward an outer edge region of the substrate and configured to releasably secure a cutting member to the outer edge region of the substrate.

Abstract: A surgical driver including an open frame and a plurality of drive shafts rotatably routed in said open frame.

Abstract: The invention includes a system and method for the loosening of tissue. In one embodiment, a device for use in an intervertebral tissue removal procedure includes a cannula having a first end portion for insertion into tissue, a feed passage within the cannula, a return passage within the cannula, and a loosening member movable within the feed passage and the return passage and at least partially deployable away from the first end portion of the cannula.

Abstract: A number of orthopedic surgical instruments are also disclosed. A method, apparatus, and system for fabricating such instruments are also disclosed.

Abstract: A surgical tool and monolithic frame therefore are disclosed. The monolithic frame defines a longitudinal axis between opposite first and second ends thereof, and is adapted to receive the flexible drive shaft of a surgical tool, and to support at an end thereof the rotary cutting tool of a surgical tool. The monolithic frame is characterized by greater flexibility in opposite directions along a first axis defined normal to the longitudinal axis than in opposite directions along a second axis defined normal to both the first axis and the longitudinal axis.

Abstract: Described herein are methods and systems for precisely placing and/or manipulating devices within the body by first positioning a guidewire or pullwire. The device to be positioned within the body is coupled to the proximal end of the guidewire, and the device is pulled into the body by pulling on the distal end of the guidewire that extends from the body. The device may be bimanually manipulated by pulling the guidewire distally, and an attachment to a device that extends proximally, allowing control of both the proximal and the distal ends. In this manner devices (and particularly implants such as innerspinous distracters, stimulating leads, and disc slings) may be positioned and/or manipulated within the body. Guidewire exchange systems, devices and methods are also described. A guidewire may be exchanged between different surgical devices and may be releaseably or permanently coupled.

Abstract: A method for use in a vertebral spine to prepare a space between adjacent vertebral bodies to receive an implant. The method is performed using a bone removal device including a shaft and a mounting member at one end of the shaft. A working end is mounted on the mounting member and is coupled to a drive mechanism adjacent to the working end. The drive mechanism is operable to move the upper and lower cutters of the working end to create surfaces having predetermined contours in the end plate region of the adjacent vertebral bodies. A guard provides protected access to the disc space and the adjacent vertebral bodies for the working end of the bone removal device through a passageway.

Abstract: A conical burr template is indexed to the intramedullary canal of a tibia, such that a burr may trace the periphery of the template to define a correspondingly shaped cavity in the bone which is properly sized, shaped, and positioned to receive a cone-shaped tibial augment component. Advantageously, use of the burr template promotes expedient surgery while maintaining optimal fit characteristics and proper spatial placement of the tibial cone augment.

Abstract: A cutting block for use in a bone osteotomy procedure is disclosed, and includes a first cutting guide surface, a second cutting guide surface, and a third cutting guide surface. The first, second, and third cutting guide surfaces are adapted to be temporarily affixed to a bone having a first side and a second side such that the first cutting guide surface is disposed on the first side of the bone, and such that the second cutting guide surface and third cutting guide surface are disposed on the second side of the bone forming an angle therebetween.

Abstract: In one preferred aspect, a method is provided for inserting an instrument set having a tapered configuration into a patient. In another preferred aspect, a method is provided for inserting a cannula having an external threaded portion into bone. In yet another preferred aspect, a method is provided for forming and enlarging an opening in bone.

Abstract: A method for generating an improved tool path for cutting a bone so as to minimize soft tissue trauma, wherein the method comprises: accessing an image of the bone which is to be cut; accessing an image of a pre-determined cutting pattern; superimposing the image of the pre-determined cutting pattern against the image of the bone; calculating the intersection of the pre-determined cutting pattern and the bone using the superimposed images of the pre-determined cutting pattern and the bone; and generating a tool path based upon the intersection of the pre-determined cutting pattern and the bone so as to minimize soft tissue trauma by leaving a thin perimeter of bone at the boundary of the bone cut when the boundary of the bone cut is adjacent to a bone surface.

Abstract: A method of accessing target tissue adjacent to a spinal nerve of a patient includes the steps of accessing a spine location of the patient by entering the patient through the skin at an access location, inserting a flexible tissue modification device through the access location to the spine location, advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location, passing through the first exit location and out of the patient, advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location, and passing through the second exit location and out of the patient.

Abstract: Some introducer tools for bone portals have a handle coupled to a driving member by a force-limiting coupling. A bone portal comprising a bone-penetrating portion and a bone stop may be driven to a desired depth in bone when the force-limiting coupling allows application of force to the bone portal that is sufficient to drive the bone-penetrating portion of the portal into the bone but not sufficient to drive the bone stop significantly into the bone. Bone portals of various types are described herein. Various configurations for stylets suitable for use in introducing bone portals or otherwise penetrating bone and methods for inserting bone portals are also described herein.

Abstract: The present invention is a method for performing a percutaneous laminoplasty that includes entering a first introducer needle introducing a first tool wire into an epidural space above a selected lamina, entering a first catcher exit needle that that is caught with the first introducer needle and pulled through a patient body and entering a second introducer needle introducing a second tool wire into the epidural space below the selected lamina. The method also includes entering a second catcher exit needle that is caught within the epidural space and pulled through the patient body, moving the caught first introducer needle and the first catcher exit needle back and forth to cut the lamina and moving the caught second introducer needle and the second catcher exit needle back and forth to cut the lamina. There is also a method for performing a percutaneous foraminoplasty.