Devices and methods for annular repair of intervertebral discs
Devices and methods for treating a damaged intervertebral disc to reduce or eliminate associated back pain. The present invention provides disc reinforcement therapy (DRT) which involves implanting one or more reinforcement members in and preferably around the annulus of the disc. The reinforcement members may be used to stabilize the annulus and/or compresses a portion of the annulus so as to reduce a bulge and/or close a fissure. The implantable devices and associated delivery tools may incorporate heating capabilities to thermally treat the annular tissue. Alternatively or in combination, other devices may be specifically employed for such thermal treatment.
1. A method of treating an intervertebral disc having an annulus and a nucleus, comprising:
providing a first elongate member having a proximal end and a sharp tissue penetrating distal end;
inserting the distal end of the first member into the annulus tissue, including piercing the annulus tissue with the sharp tissue penetrating distal end;
providing a second elongate member having a proximal end and a distal portion configured to receive the first elongate member;
positioning the distal receiving portion of the second member proximate the disc;
passing the distal end of the first member through disc tissue; and
receiving the first member in the distal receiving portion of the second member.
2. A method as in claim 1 , wherein the distal receiving portion of the second member is inserted into the disc prior to receiving the first member.
3. A method as in claim 1 , wherein the distal receiving portion receives a distal portion of the first member.
4. A method as in claim 1 , wherein the distal receiving portion receives the distal end of the first member.
5. A method as in claim 1 , wherein the receiving portion includes an opening sized to accommodate the first member.
6. A method as in claim 5 , wherein the receiving portion includes a lumen sized to accommodate the first member.
7. A method as in claim 6 , wherein the first member is advanced through the lumen of the second member.
8. A method as in claim 1 , further comprising a flexible elongate line connected to a proximal portion of the first member.
9. A method as in claim 8 , wherein the flexible elongate line comprises a suture.
10. A method as in claim 8 , wherein the line passes through disc tissue.
11. A method as in claim 10 , wherein the line passes through disc tissue along a path defined by the first member and the second member.
12. A method as in claim 11 , wherein the line is looped through and around disc tissue.
13. A method as in claim 12 , wherein the line has end portions residing outside the disc and a mid portion residing in the disc.
14. A method as in claim 13 , wherein the end portions of the line are secured.
15. A method as in claim 14 , wherein the end portions are tied.
16. A method as in claim 14 , wherein the end portions are secured to a pledget.
17. A method as in claim 1 , wherein the first member has a curved distal end.
18. A method as in claim 17 , wherein the curved distal end has a curvature, and wherein the distal end of the first member passes through disc tissue along a path with a similar curvature.
19. A method as in claim 18 , wherein the curved path is aligned with the receiving portion of the second member.
20. A method as in claim 1 , wherein the first member enters the disc along a first path defined by the first member and exits the disc along a second path defined by the second member.
21. A method as in claim 1 , wherein the first member enters and exits the disc along a path defined by the second member.
22. A method as in claim 1 , wherein the first member comprises a stylet.
23. A method as in claim 1 , wherein the first member comprises a hollow stylet.
24. A method as in claim 1 , wherein the second member includes two lumens.
25. A method as in claim 1 , wherein the first member is delivered via a hollow guide tube.
26. A method of treating an intervertebral disc having an annulus and a nucleus, comprising:
providing a first elongate member having a proximal end, a curved distal portion defining a curvature, and a sharp tissue penetrating distal end;
inserting the distal end of the first member into the annulus tissue, including piercing the annulus with the sharp tissue penetrating distal end;
providing a second elongate member having a proximal end and a distal portion configured to receive the first elongate member;
positioning the distal receiving portion of the second member proximate the disc in alignment with the curvature of the first member;
passing the distal end of the first member through disc tissue along a curved path; and
receiving the distal end of first member in the distal receiving portion of the second member.
27. A method as in claim 26 , wherein the distal receiving portion of the second member is inserted into the disc prior to receiving the first member.
28. A method as in claim 26 , wherein the receiving portion includes an opening sized to accommodate the first member.
29. A method as in claim 28 , wherein the receiving portion includes a lumen sized to accommodate the first member.
30. A method as in claim 26 , wherein the first member is advanced through the lumen of the second member.
31. A method as in claim 26 , further comprising a flexible elongate line connected to a proximal portion of the first member.
32. A method as in claim 31 , wherein the flexible elongate line comprises a suture.
33. A method as in claim 31 , wherein the line passes through disc tissue.
34. A method as in claim 33 , wherein the line passes through disc tissue along a path defined by the first member and the second member.
35. A method as in claim 34 , wherein the line is looped through and around disc tissue.
36. A method as in claim 35 , wherein the line has end portions residing outside the disc and a mid portion residing in the disc.
37. A method as in claim 36 , wherein the end portions of the line are secured.
38. A method as in claim 37 , wherein the end portions are tied.
39. A method as in claim 37 , wherein the end portions are secured to a pledget.
40. A method as in claim 26 , wherein the first member enters the disc along a first path defined by the first member and exits the disc along a second path defined by the second member.
41. A method as in claim 26 , wherein the first member enters and exits the disc along a path defined by the second member.
42. A method as in claim 26 , wherein the first member comprises a stylet.
43. A method as in claim 26 , wherein the first member comprises a hollow stylet.
44. A method as in claim 26 , wherein the second member includes two lumens.
45. A method as in claim 26 , wherein the first member is delivered via a hollow guide tube.
46. A method of treating an intervertebral disc having an annulus and a nucleus, comprising:
providing a first elongate member having a proximal end and a sharp tissue penetrating distal end;
providing a flexible elongate line connected to the first member;
inserting the distal end of the first member into the annulus tissue, including piercing the annulus tissue with the sharp distal end;
providing a second elongate member having a proximal end and a distal portion configured to receive the first elongate member;
positioning the distal receiving portion of the second member proximate the disc;
passing the distal end of the first member through disc tissue;
receiving the first member in the distal receiving portion of the second member; and
passing the line through disc tissue.
47. A method as in claim 46 , wherein the line is looped through and around disc tissue.
48. A method as in claim 46 , wherein the distal receiving portion of the second member is inserted into the disc prior to receiving the first member.
49. A method as in claim 46 , wherein the distal receiving portion receives a distal portion of the first member.
50. A method as in claim 46 , wherein the distal receiving portion receives the distal end of the first member.
51. A method as in claim 46 , wherein the receiving portion includes an opening sized to accommodate the first member.
52. A method as in claim 51 , wherein the receiving portion includes a lumen sized to accommodate the first member.
53. A method as in claim 52 , wherein the first member is advanced through the lumen of the second member.
54. A method as in claim 46 , wherein the flexible elongate line comprises a suture.
55. A method as in claim 46 , wherein the line passes through disc tissue along a path defined by the first member and the second member.
56. A method as in claim 46 , wherein the line is looped through and around disc tissue.
57. A method as in claim 46 , wherein the line has end portions residing outside the disc and a mid portion residing in the disc.
58. A method as in claim 57 , wherein the end portions of the line are secured.
59. A method as in claim 58 , wherein the end portions are tied.
60. A method as in claim 58 , wherein the end portions are secured to a pledget.
61. A method as in claim 46 , wherein the first member has a curved distal end.
62. A method as in claim 61 , wherein the curved distal end has a curvature, and wherein the distal end of the first member passes through disc tissue along a path with a similar curvature.
63. A method as in claim 62 , wherein the curved path is aligned with the receiving portion of the second member.
64. A method as in claim 46 , wherein the first member enters the disc along a first path defined by the first member and exits the disc along a second path defined by the second member.
65. A method as in claim 46 , wherein the first member enters and exits the disc along a path defined by the second member.
66. A method as in claim 46 , wherein the first member comprises a stylet.
67. A method as in claim 46 , wherein the first member comprises a hollow stylet.
68. A method as in claim 46 , wherein the second member includes two lumens.
69. A method as in claim 46 , wherein the first member is delivered via a hollow guide tube.