Devices, apparatus, and methods for bilateral approach to disc augmentation
A method of augmenting a nucleus pulposus of an intervertebral disc comprises forming a first opening in an annulus of the intervertebral disc and forming a second opening in the annulus of the intervertebral disc. The method further comprises providing a space creation instrument including an expandable spacing device and introducing the spacing device through the first opening and into the nucleus pulposus. The method further comprises introducing a material delivery instrument through the second opening and into the nucleus pulposus and expanding the spacing device to create a space within the nucleus pulposus. The method also comprises injecting a biocompatible material from the material delivery instrument and into the space within the nucleus pulposus.
1 . A method of augmenting a nucleus pulposus of an intervertebral disc, the method comprising:
forming a first opening in an annulus of the intervertebral disc;
forming a second opening in the annulus of the intervertebral disc;
providing a space creation instrument including an expandable spacing device;
introducing the spacing device through the first opening and into the nucleus pulposus;
introducing a material delivery instrument through the second opening and into the nucleus pulposus;
expanding the spacing device to create a space within the nucleus pulposus; and
injecting a biocompatible material from the material delivery instrument and into the space within the nucleus pulposus.
2 . The method of claim 1 wherein none of the nucleus pulposus is removed prior to expanding the spacing device.
3 . The method of claim 1 further comprising expanding the spacing device to dilate the annulus.
4 . The method of claim 1 wherein the spacing device comprises an inflatable balloon.
5 . The method of claim 4 wherein the balloon comprises multiple chambers.
6 . The method of claim 1 wherein the spacing device is mechanically actuated.
7 . The method of claim 1 wherein the step of introducing the spacing device further comprises introducing a guide member adjacent to the spacing device.
8 . The method of claim 1 wherein the step of introducing a material delivery instrument further comprises guiding the introduction of the material delivery instrument with an imaging system to direct the material delivery instrument to the spacing device.
9 . The method of claim 8 wherein the imaging system is fluoroscopic.
10 . The method of claim 1 wherein the step of expanding the spacing device to create a space within the nucleus pulposus comprises pressurizing an inflation medium.
11 . The method of claim 1 wherein the step of expanding the space creation device to create a space within the nucleus pulposus comprises compressing the nucleus pulposus.
12 . The method of claim 1 wherein the first and second openings are bilateral posterior openings.
13 . The method of claim 1 wherein the step of injecting a biocompatible material from the material delivery instrument further comprises monitoring the injection of the biocompatible material with an imaging system to avoid overfilling the space.
14 . The method of claim 1 wherein the step of expanding the spacing device further comprises distracting a pair of vertebral endplates adjacent to the intervertebral disc.
15 . The method of claim 1 further comprising detaching the spacing device from the space creation instrument within the space in the nucleus pulposus.
16 . The method of claim 15 wherein the step of injecting a biocompatible material from the material delivery instrument includes filling the spacing device within the space in the nucleus pulposus.
17 . The method of claim 1 further comprising collapsing the spacing device as the biomaterial is injected into the space within the nucleus pulposus.
18 . The method of claim 1 further comprising withdrawing the spacing device from the nucleus pulposus.
19 . A system for augmenting a nucleus pulposus of an intervertebral disc, the system comprising:
a first cannula adapted for accessing a nucleus pulposus of the intervertebral disc;
a second cannula adapted for accessing the nucleus pulposus of the intervertebral disc;
a space creation instrument adapted for passage through the first cannula and including a spacing portion adapted to create a space in the nucleus pulposus of the intervertebral disc; and
a material delivery instrument adapted for passage through the second cannula and to carry a biocompatible material,
wherein the space created in the nucleus pulposus of the intervertebral disc with the spacing portion receives the biocompatible material delivered by the material delivery instrument through the second cannula.
20 . The system of claim 19 wherein at least one of the cannulae is directed through an annulus of the intervertebral disc to the nucleus pulposus.
21 . The system of claim 19 wherein at least one of the cannulae is directed through an endplate of a vertebral body adjacent to the intervertebral disc.
22 . The system of claim 19 wherein none of the nucleus pulposus is removed through the first or second cannulae.
23 . The system of claim 19 further comprising an accessing instrument adapted to pass through the first cannula to puncture an annulus of the intervertebral disc.
24 . The system of claim 19 further comprising a gauge for monitoring pressure in the spacing portion.
25 . A method for treating a nucleus pulposus of an intervertebral disc, the method comprising:
creating a first opening to access the intervertebral disc;
creating a second opening to access the intervertebral disc;
inserting a first space creation instrument having a first spacing device through the first opening and into the nucleus pulposus of the intervertebral disc;
inserting a second space creation instrument having a second spacing device through the second opening to access the intervertebral disc;
injecting a first biomaterial into the first spacing device to expand the first spacing device; and
injecting a second biomaterial into the second spacing device to expand the second spacing device,
wherein the expansion of the first and second spacing devices occur without removing a portion of the nucleus pulposus.
26 . The method of claim 25 wherein the first opening is in an annulus of the intervertebral disc.
27 . The method of claim 25 further comprising detaching the first spacing device from the first space creation instrument.
28 . The method of claim 25 wherein the first biomaterial is the same as the second biomaterial.
29 . The method of claim 25 wherein the first spacing device conforms to an annulus of the intervertebral disc.
30 . The method of claim 29 further comprising inserting a third spacing device into the nucleus pulposus of the intervertebral disc and expanding the third spacing device with a third biomaterial
31 . The method of claim 30 wherein the third spacing device is inserted through the first spacing device.
32 . The method of claim 25 wherein at least one of the first or second biomaterials is curable in situ.
33 . The method of claim 25 further comprising inserting a material delivery instrument through the first spacing device and injecting a third biomaterial into the nucleus pulposus.