Abstract: A cavity creation device is introduced into a cancellous bone volume of a vertebral body through a percutaneous access path. The cavity creating device is manipulated to form a cavity in the cancellous bone volume. A volume of filling material is placed in the cavity by introducing a tube through the percutaneous access path and by conveying the filling material through a side dispensing port of the tube.

Abstract: The present invention relates to a bone cement precursor system that is presented in the form of two shelf-stable pastes which have been terminally sterilized and are held in separate containers during product transport and storage. When the product is used during surgery, these pastes inject to a site of application through a static mixing device by the action of applied injection force. When the two pastes are mixed, they start to react to each other while injecting out. The resulting composition is highly biocompatible, osteoconductive, injectable, rapid setting and bioresorbable, and is useful in connection with bone repair procedures, for example, in the craniomaxillofacial, trauma and orthopedic areas.

Abstract: A method for filling a bone defect in a subject in need thereof is disclosed. The method includes heating a bone cement composition at a first temperature where the bone cement composition is fluidic, and delivering an effective amount of the fluidic bone cement composition at a second temperature to the bone defect thereby filling the bone defect and allowing the fluidic bone cement composition to solidify, the second temperature being sufficiently high for maintaining the bone cement composition fluidic without causing thermal necrosis. Also disclosed are systems for carrying out the method.

Abstract: The embodiments provide provides devices, instruments, and associated methods for treating joint pain. A joint is evaluated using magnetic resonance imaging to detect any defects in the subchondral bone. For example, using T2-weighted MRI images, bone marrow lesions or edemas can be identified, and using T1-weighted MRI images, associated regions of sclerotic bone adjacent to the bone marrow lesion can be identified. The treatment method may involve introducing a bone void filler material at the site to address the bone marrow lesion or edema, and/or drilling and inserting an implant to address the sclerotic bone, bone marrow lesion or edema, and insufficiency or stress fractures. An access path is mapped to a location in the subchondral region where the insufficiency fracture resides. The access path attempts to preserve an articular surface of the joint. A reinforcing member that stabilizes the insufficiency fracture is then implanted via the access path.

Abstract: A tissue prosthesis insertion system includes a first assembly comprising a plurality of nested tubes, one of the tubes being a carrier tube which, in use, receives a component of a tissue prosthesis at a distal end of the carrier tube. A magnetic mount is carried at a proximal end of the first assembly. A second assembly is removably attachable to the first assembly. An attachment device is carried at a distal end of the second assembly, the attachment device being responsive to the magnetic mount of the first assembly, the magnetic mount and the attachment device carrying complementary engaging formations to facilitate hermetic sealing between the magnetic mount and the attachment device.

Abstract: A system for treating a vertebral body comprises a cannula leading into a vertebral body and a cavity creating device. The cavity creating device comprises a shaft having a distal end portion sized to extend through the cannula, an expandable body that undergoes expansion between a collapsed condition and an expanded condition to form a cavity in the vertebral body, and a tubular fluid transport member to convey fluid through the distal region of the expandable body and into the cavity. The system further comprises a device coupled to the shaft to change the expandable body between the collapsed condition to the expanded condition. The system further comprises a source of fluid coupled to the tubular fluid transport member to convey fluid through the distal region of the expandable body and into the cavity. The system further includes a device to convey a filling material into the cavity.

Abstract: Disclosed is a multi-lumen mixing device that includes a first and second lumen constructed and arranged to separately pass a first and second reagent to a mixing chamber in the device, where the mixing chamber includes a mixing feature that mixes the first and second reagents. The disclosed multi-lumen mixing device may also include a port in fluid communication with the reaction mixing to permit the product of the combined reagents to be injected into a patent.

Abstract: The present invention relates to a device for providing spongy bone with bone substitute and/or bone reinforcing material, wherein at least one perforating device (4) is provided for making at least one hole (5) in the spongy bone (1) and wherein at least one flushing or rinsing device (6) is provided for flushing or rinsing the hole (5) with a rinsing agent (7). At least one vacuum source (9) is provided for generating a vacuum in the hole (5) in the spongy bone (1) for sucking and/or facilitating insertion or feeding of the bone substitute and/or bone reinforcing material (3) into said spongy bone (1). The invention also relates to bone substitute and/or bone reinforcing material and methods in connection with the invention.

Abstract: Internal bone fixation devices and methods for using the devices for repairing a weakened or fractured bone are disclosed herein. According to aspects illustrated herein, there is provided a device for repairing a fractured bone that includes a delivery catheter having an elongated shaft with a proximal end, a distal end, and a longitudinal axis therebetween, the delivery catheter having an inner void for passing at least one reinforcing material, and an inner lumen for accepting a light pipe, wherein a distal end of the inner lumen terminates in an optical lens; a conformable member releasably engaging the distal end of the delivery catheter, the conformable member moving from a deflated state to an inflated state when the at least one reinforcing material is delivered to the conformable member; and an adapter releasably engaging the proximal end of the delivery catheter for receiving the light pipe and the at least one reinforcing material.

Abstract: A system and method is provided for maintaining a proper intervertebral disc height during the replacement or augmentation of the spinal disc. In one embodiment, a cannulated distractor is used to distract the adjacent vertebrae and maintain a proper disc space height. The cannulated distractor is fluidly connected to a source of fluent material for injection into the disc space. The distraction includes a distraction tip resident within the disc space that includes a central lumen and a number of openings communicating with the lumen to dispense the fluent material within the disc space.

Abstract: A surgical device, in particular for percutaneous osteoplastic surgery, for example vertebroplastic operations or the like, and/or for biopsy operations, includes at least a guide for injection of a therapeutic fluid into a bony part, for example a cementing fluid, a needle being slidable internally of said guide, which needle having a first end provided with a gripping knob, and a second end opposite the first end, the guide having a first end which defines an obliquely-shaped dispensing opening of the fluid internally of the bony part, and a second end which defines a loading opening of the fluid at the outside of the bony part, the second end including a grip exhibiting two wings having different shapes, such that the position and orientation of the oblique profile of the opening can be recognized.

Abstract: The invention features bone screws having a threaded screw body and a screw head attached to one end of the screw body, the bone screw further including: a) an interior channel extending longitudinally through the screw head and through at least a portion of the screw body, wherein the interior channel has a width of less than 5.0 millimeters; and b) a plurality of radially-disposed delivery channels connecting the interior channel to the exterior of the screw body, each delivery channel having exterior openings. The invention further features devices that include a bone screw and a delivery manifold detachably attached to the screw head of the bone screw. In addition, the invention features methods of treating a patient having a bone defect by using a bone screw described herein.

Abstract: The present invention relates to a screw (1) for stabilization of a bone fracture having a longitudinal body (2), with a lateral surface and a first and a second end (4, 6), said second end being insertable within the bone tissue (10), and a head (5) coupled with said first end (4) of the body (2); said screw being characterized in that it has a main channel (7) passing through said body (2) and said head (5), provided along its longitudinal axis (8); and in that said body (2) has one or more through holes (9) on said lateral surface, communicating with said main channel (7), said main channel (7) and said one or more through holes (9) are suitable to permit passage there through of bone cement and/or biologically active substances that can be introduced through said head (5). Present invention further relates to a kit for stabilization of fractures.

Abstract: The invention provides a method and a kit for administering bone cement to the interior cavity of a bony member to enhance bone strength, stabilizing an existing fracture thus reducing susceptibility of the bone to further fracture and/or collapse. The method and kit may include additional components, such as, bone growth enhancing agents, radiopaque components or the like.

Abstract: An instrument for performing a medical procedure includes a drive shafts a holding clutch, a drive clutch, and an actuator. The holding clutch only allows advancement of the drive shaft, while the drive clutch transfers an advancement force from the actuator to the drive shaft. The dual clutch system allows a lever to be used as the actuator so that a user can generate large actuation forces manually (and optionally remotely) without significant physical effort. This capability can beneficially improve the usability and effectiveness of percutaneous surgical systems, such as those for vertebroplasty or kyphoplasty.

Abstract: Internal bone fixation devices and methods for using the devices for repairing a weakened or fractured bone are disclosed herein. According to aspects illustrated herein, there is provided a device for repairing a fractured bone that includes a delivery catheter having an elongated shaft with a proximal end, a distal end, and a longitudinal axis therebetween, the delivery catheter having an inner void for passing at least one reinforcing material, and an inner lumen for accepting a light pipe, wherein a distal end of the inner lumen terminates in an optical lens; a conformable member releasably engaging the distal end of the delivery catheter, the conformable member moving from a deflated state to an inflated state when the at least one reinforcing material is delivered to the conformable member; and an adapter releasably engaging the proximal end of the delivery catheter for receiving the light pipe and the at least one reinforcing material.

Abstract: A method for delivering material into bone deploys a cannula through soft tissue to establish a subcutaneous path into bone. The method deploys a cavity forming instrument through the cannula to form a cavity in cancellous bone. The method introduces a material into the cavity through the cannula, which includes the advancement of a tamping instrument through the cannula to urge material into the cavity.

Abstract: A stand for use with a syringe is structured to engage a portion of the syringe in order to maintain the syringe in an upright position. The stand may include an aperture structured to engage the nozzle or the plunger of the syringe. Another embodiment of the stand may include a protrusion structured to engage the proximal end of the syringe, or a clip structured to engage a handle of the syringe. The stand may include a package portion having compartments for holding various components, such as components of a bone cement preparation kit. The proximal and distal portions of the barrel of the syringe may be separable to provide an opening into the barrel through which an injectable material may be inserted. The plunger of the syringe may also include a plunger rod removably affixed to the plunger tip.

Abstract: An apparatus and method for distracting, in a given direction, and supporting two tissue surfaces. A plurality of wafers are consecutively inserted between the two tissue surfaces to create a column of wafers. The column of wafers is oriented between the tissue surfaces so as to expand in the given direction as the wafers are consecutively added to the column.

Abstract: Aspects of the invention include methods for producing flowable compositions, e.g. pastes, that set into calcium phosphate containing products, where the products include autologous bone. Aspects of the invention further include compositions produced by the methods, as well as kits for preparing the same. The subject methods and compositions produced thereby find use in a variety of applications, including hard tissue repair applications.

Abstract: An apparatus and method for introducing material into an injection site of a patient is disclosed. The device includes a cannula and a carrier. The cannula is inserted into an injection site of a patient. The carrier is connected to an injector containing a volume of material. Material may be pre-loaded into the carrier so that the material is delivered to a distal end of the carrier from the injector and the carrier is thus pre-loaded with material. A portion of the distal end of the pre-loaded carrier is inserted into the cannula and material is delivered to an injection site. The supply section can be rotatable with respect to the longitudinal axis of the inner section.

Abstract: Erosion of elements of the ossicular chain in the middle ear, resulting in hearing loss, is corrected by creating a bridge between the eroded elements, employing a bone cement formed as a paste of a self-hardening material, which is molded into an elongated bridge, secured at its two ends to the elements to be bridged, and supported in its desired position until the material hardens to fuse the two elements, at which time the support may be removed. The material is preferably hydroxyapatite cement, bone source, or similar material, such as ionomeric bone cement. These materials strongly bond to the contacting bone and may stimulate bone in-growth, resulting in osseointegration. The apparatus for forming the bridge consists of a reservoir of the bridge material in liquid or paste form connected to a bridge supporting tube. The tube is preferably placed in contact with the two elements to be bridged and the bone source material is injected into the tube using a manually actuated plunger until the tube is full.

Abstract: The present invention relates to a device for providing spongy bone with bone substitute and/or bone reinforcing material, wherein at least one perforating device (4) is provided for making at least one hole (5) in the spongy bone (1) and wherein at least one flushing or rinsing device (6) is provided for flushing or rinsing the hole (5) with a rinsing agent (7). At least one vacuum source (9) is provided for generating a vacuum in the hole (5) in the spongy bone (1) for sucking and/or facilitating insertion or feeding of the bone substitute and/or bone reinforcing material (3) into said spongy bone (1). The invention also relates to bone substitute and/or bone reinforcing material and methods in connection with the invention.

Abstract: Systems and methods for repairing a weakened or fractured bone are disclosed herein. A system for repairing a fractured bone includes a delivery catheter having an elongated shaft with a proximal end, a distal end, and a longitudinal axis therebetween, wherein the delivery catheter has an inner void for passage of bone cement components and an inner lumen for passage of a mixing element; an internal bone fixation device releasably engaging the distal end of the delivery catheter, wherein the internal bone fixation device moves from a first compact state to a second expanded state when the bone cement components are delivered to the internal bone fixation device and mixed within the internal bone fixation device; and a spinning mechanism engaged to a rotatable shaft, wherein the spinning mechanism is inserted into the internal bone fixation device.

Abstract: One embodiment is directed to instrumentation for performance of a spinal implantation procedure. In one form, this instrumentation includes: a tube device with an inner surface defining a passage from a proximal end portion to a distal end portion, a conveyor including a threaded conveying rod to be received in the passage of the tube device that can be rotated in the tube or moved in translation along the passage, and a deformable prosthesis structured to move through the passage of the tube by rotating the threaded conveying rod while at least a portion of the deformable prosthesis is positioned between the inner surface and the rod. Optionally, a tool to maintain position of the tube device can be included that has a jaw mechanism, among other things.

Abstract: Embodiments of a method for introducing a substance near a fracture of a bone include installing an osteosynthesis nail into a canal of the bone, the osteosynthesis nail including a fixation aperture, coupling an alignment device with the osteosynthesis nail, the alignment device including an alignment sleeve having a longitudinal axis passing through the fixation aperture, drilling a hole through a wall of the bone and into the canal using the alignment sleeve, inserting an injector through the alignment sleeve, the injector having an injector body with an injection nozzle and a plunger, and moving the plunger to push the substance from within the injector body through the injection nozzle and into the canal.

Abstract: A system for performing a minimally invasive surgical procedure comprises a cannula, a bone filler material delivery nozzle for performing the procedure through the cannula, and a retainer for securing the delivery nozzle relative to the cannula. The retainer eliminates the need to manually stabilize and position the delivery nozzle during the procedure, thereby allowing the physician to perform the procedure outside of the fluoroscopic radiation field used to visualize the procedure location. The retainer can be attached to the cannula, and can provide either selective or constant clamping force onto the delivery nozzle.

Abstract: A system for performing a minimally invasive surgical procedure includes a cannula, a surgical instrument for use through the cannula, and a remote positioning system to adjust the relative position between the surgical instrument and the cannula. By allowing a physician to perform the minimally invasive surgical procedure at a distance from the patient, the remote positioning system minimizes the radiation exposure of the physician while still providing accurate control over the procedure.

Abstract: The invention provides a particulate composition adapted for forming a bone graft substitute cement upon mixing with an aqueous solution, including i) a calcium sulfate hemihydrate powder having a bimodal particle distribution and a median particle size of about 5 to about 20 microns, wherein the calcium sulfate hemihydrate is present at a concentration of at least about 70 weight percent based on the total weight of the particulate composition; ii) a monocalcium phosphate monohydrate powder; and iii) a ?-tricalcium phosphate powder having a median particle size of less than about 20 microns. Bone graft substitute cements made therefrom, a bone graft substitute kit comprising the particulate composition, methods of making and using the particulate composition, and articles made from the bone graft substitute cement are also provided.

Abstract: A curable material delivery cannula device is disclosed. The device includes a cannula and a hub. The cannula includes an open proximal end, a deflectable segment forming a pre-set curve, a lumen, and side orifice(s) adjacent, and proximally spaced from, the distal end and fluidly connected to the lumen. When inserted within a guide cannula, the deflectable segment straightens. When distally extended from the guide cannula, the deflectable segment reverts to the curved shape. The distal end has a blunt tip for non-traumatic interface with bodily material. During use, curable material, such as bone cement, is delivered from the side orifice(s) in a radial direction relative to the lumen.

Abstract: Erosion of elements of the ossicular chain in the middle ear, resulting in hearing loss, is corrected by creating a bridge between the eroded elements, employing a bone cement formed as a paste of a self-hardening material, which is molded into an elongated bridge, secured at its two ends to the elements to be bridged, and supported in its desired position until the material hardens to fuse the two elements, at which time the support may be removed. The material is preferably hydroxyapatite cement, bone source, or similar material, such as ionomeric bone cement. These materials strongly bond to the contacting bone and may stimulate bone in-growth, resulting in osseointegration. The apparatus for forming the bridge consists of a reservoir of the bridge material in liquid or paste form connected to a bridge supporting tube. The tube is preferably placed in contact with the two elements to be bridged and the bone source material is injected into the tube using a manually actuated plunger until the tube is full.

Abstract: A method for delivering material into bone deploys a cannula through soft tissue to establish a subcutaneous path into bone. The method deploys a cavity forming instrument through the cannula to form a cavity in cancellous bone. The method introduces a material into the cavity through the cannula, which includes the advancement of a tamping instrument through the cannula to urge material into the cavity.

Abstract: This invention provides devices and methods for mixing and extruding compositions which are medically and non-medically useful. The devices are particularly useful for mixing substances which are relatively inert when alone but become reactive when mixed. A common feature of all of the devices is that they allow the user to mix and ultimately extrude a composition from a single device which includes a single container or multiple interconnected containers.

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: Systems and methods treat fractured or diseased bone by deploying more than a single therapeutic tool into the bone. In one arrangement, the systems and methods deploy an expandable body in association with a bone cement nozzle into the bone, such that both occupy the bone interior at the same time. In another arrangement, the systems and methods deploy multiple expandable bodies, which occupy the bone interior volume simultaneously. Expansion of the bodies form cavity or cavities in cancellous bone in the interior bone volume.

Abstract: An interbody implant system for use with a first vertebra having a first endplate and a second vertebra having a second endplate. The system includes an expandable implant that includes a plurality of supports and means for linking the plurality of supports. The plurality of supports are capable of moving apart from one another so that the expandable implant is in an expanded condition. A channel extends through the first vertebra from a pedicle or the body wall to the first endplate. An unexpanded diameter for the expandable implant is configured to permit passage of the expandable implant through the channel. An expanded diameter for the expandable implant is greater than the channel diameter at the first endplate. The support height is configured to permit the plurality of supports to be positioned between the first endplate and the second endplate. Methods for the use of the system are described.

Abstract: A bone displacement assembly for use during a medical procedure including preparing soft bone includes a cannula and a probe that is removably inserted into the cannula. The probe includes a curved tip designed to mechanically displace soft bone and to prepare the bone tissue for subsequent treatment such as cement injection. The probe also includes a handle assembly that connects with the cannula and also includes one control device for independently rotating the distal tip and a second control device to independently translate the distal tip.

Abstract: A cavity creation device is introduced into a cancellous bone volume of a vertebral body through a percutaneous access path. The cavity creating device is manipulated to form a cavity in the cancellous bone volume. A volume of filling material is placed in the cavity by introducing a tube through the percutaneous access path and by conveying the filling material through a side dispensing port of the tube.

Abstract: An apparatus and a method configured for the efficient delivery of a viscous material, such as bone cement, to a surgical site are described. A housing removably receives a large gauge syringe which is filled with the viscous material. The apparatus is a syringe-type assembly that uses at least one vibrating motor together with a plunger rod assembly. The method employs the continuous application of vibrational forces to the central barrel portion of the apparatus during the time that the viscous material is being delivered and/or applied in vivo. The vibration to the central barrel portion increases the tendency of the viscous material to flow thereby making delivery of such materials easier and more efficient.

Abstract: A bone filler delivery device includes a syringe assembly. The syringe assembly has a barrel with a first opening for dispensing bone filler and a second opening adapted to receive a plunger. A plunger is adapted to mate with the barrel to define a bone filler dispensing chamber therein. The plunger can move through the barrel in an axial direction. A seal is coupled to the plunger and is adapted to seal against the barrel. The seal includes an annular body and an annular first lip that extends from the body in a first direction and is adapted to flex toward the barrel when the plunger is moved through the barrel toward the first opening.

Abstract: Systems and methods provide greater control over the placement of cement and other flowable liquids into bone.

Abstract: The present invention relates in certain embodiments to medical devices for treating vertebral compression fractures. More particularly, embodiments of the invention relate to instruments and methods for controllably restoring vertebral body height by controlling the flow of bone cement into the interior of a vertebra and the application of forces causes by the cement flow. An exemplary system utilizes Rf energy in combination a conductive bone cement for selectively polymerizing the inflow plume to increase the viscosity of the cement. In one aspect of the invention, the system utilizes a controller to control bone cement flow parameters to either allow or disallow cement interdigitation into cancellous bone. A method of the invention includes pulsing the flows of bone cement wherein high acceleration of the flow pulses can apply expansion forces across the surface of the cement plume to reduce a vertebral fracture.

Abstract: An expandable structure carried at the end of a catheter tube assembly can be contracted and/or wrapped to present a reduced profile during deployment and/or removal from a targeted tissue site.

Abstract: A curable material delivery cannula device is disclosed. The device includes a cannula and a hub. The cannula includes an open proximal end, a deflectable segment forming a pre-set curve, a lumen, and side orifice(s) adjacent, and proximally spaced from, the distal end and fluidly connected to the lumen. When inserted within a guide cannula, the deflectable segment straightens. When distally extended from the guide cannula, the deflectable segment reverts to the curved shape. The distal end has a blunt tip for non-traumatic interface with bodily material. During use, curable material, such as bone cement, is delivered from the side orifice(s) in a radial direction relative to the lumen.

Abstract: A system for delivering bone cement to a bone anchor includes an anchor connection instrument for releasably connecting to a proximal end of the bone anchor. The anchor connection instrument includes a first member coupled to an opposed second member. The first member and the second member have a distal end configured to releasably connect to the proximal end of the bone anchor. The first member is movable between a release position to facilitate release of the anchor connection instrument from the proximal end of the bone anchor and a connect position in which the first member and the second member connect to the proximal end of the bone anchor. A cement delivery tube is positionable in the passage between the first member and the second member of the anchor connection instrument. A bone cement delivery system is coupled to the tube.

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: An apparatus and method for transferring curable material to an injector to convenient deliver the curable material to a patient. The apparatus contains a mixing chamber for mixing a liquid component and a powder component to form a curable material. The curable material is transferred to an injector to when the mixing chamber and injector are moved toward each other.

Abstract: The present invention is directed to a system and method for percutaneous delivery of bone cement during a surgical procedure. The system of the present invention has a plunger assembly 100, comprising: a shaft having a first end, a middle section, and a second end, wherein the middle section is threaded; and a handle attached to the first end of the shaft. The system further comprises a dispenser hub assembly 200 around the shaft having a collar and a hand-grip attached to the collar, and a threaded portion formed on an interior surface of the collar. The system may further comprise a hollow tube 300 for containing the bone cement during the surgical procedure having a first end and a second end, the first end of the hollow tube adapted to be removably engaged with the threaded portion of the dispenser hub assembly. The shaft is axially displaceable through the hollow tube for controlled displacement of the bone cement through the second end of the hollow tube.

Abstract: A method and device for the insertion of a vertebral cage that may be done through a posterior approach that is minimally traumatic and does not require retraction of the spinal cord, dural sac or spinal nerves. The insertion of the cage may therefore be parallel to the spinal cord and the cage will be rotated ninety degrees (or as desired or required) in the vertebral body defect or as applicable to achieve its proper positioning before expansion.

Abstract: A curable material delivery cannula device and method are disclosed. The device includes a cannula and a hub. The cannula includes an open proximal end, a deflectable segment forming a pre-set curve, a lumen, and side orifice(s) adjacent, and proximally spaced from, the distal end and fluidly connected to the lumen. When inserted within a guide cannula, the deflectable segment straightens. When distally extended from the guide cannula, the deflectable segment reverts to the curved shape, which may be used to create a void in the bone for receiving curable material. The distal end has a blunt tip for non-traumatic interface with bodily material. During use, curable material, such as bone cement, is delivered from the side orifice(s) in a radial direction relative to the lumen.