Method and apparatus for closing fissures in the annulus fibrosus
A method for closing a fissure in a region of tissue having an inner surface and an outer surface, the method comprising: providing at least a pair of transverse anchor components, each transverse anchor component being coupled to at least one flexible longitudinal fixation component having a longitudinal axis; placing the transverse anchor components relative to the inner surface of the tissue on both sides of the fissure such that an exposed end of a flexible longitudinal fixation component extends through the tissue and past the outer surface of the tissue on both sides of the fissure; applying axial tension to the exposed ends; and anchoring the exposed ends.
1. A method for closing a fissure in a region of tissue having an inner surface and an outer surface, the method comprising:
providing a first transverse anchor having a first flexible longitudinal fixation component extending therefrom, and providing a second transverse anchor having a second flexible longitudinal fixation component extending therefrom;
advancing the first transverse anchor component through the outer surface of the tissue and then through the inner surface of the tissue on one side of the fissure such that an exposed end of the first flexible longitudinal fixation component extends through the tissue and past the outer surface of the tissue on one side of the fissure, and advancing the second transverse anchor component through the outer surface of the tissue and then through the inner surface of the tissue on another side of the fissure such that an exposed end of the second flexible longitudinal fixation component extends through the tissue and past the outer surface of the tissue on the other side of the fissure;
applying axial tension to the exposed ends of the first and second flexible longitudinal fixation components, without applying lateral tension to the exposed ends of the first and second flexible longitudinal fixation components, so as to pull the exposed ends of the first and second flexible longitudinal fixation components in a direction perpendicular to the inner surface of the tissue and position the first and second transverse anchor components against the inner surface of the tissue;
after the first and second transverse anchor components have been positioned against the inner surface of the tissue, applying lateral tension to the exposed ends of the first and second flexible longitudinal fixation components so as to pull the exposed ends of the first and second flexible longitudinal fixation components in a direction parallel to the outer surface of the tissue and close the fissure; and
anchoring the exposed ends of the first and second flexible longitudinal fixation components.
2. A method according to claim 1 wherein the tissue comprises an intervertebral disc, and further wherein the inner surface comprises an inner surface of the annulus and the outer surface comprises an outer surface of the annulus.
3. The method of claim 1 , including applying a predetermined amount of axial tension to the exposed ends of the first and second flexible longitudinal fixation components.
4. The method of claim 3 wherein the predetermined amount of axial tension is about 15 N to 25 N.
5. The method of claim 1 , including applying a predetermined amount of lateral tension to the exposed ends of the first and second flexible longitudinal fixation components.
6. The method of claim 5 , wherein the predetermined amount of lateral tension is about 15 N to 25 N.
7. The method of claim 1 , wherein the exposed ends of the first and second flexible longitudinal fixation components are anchored by joining the exposed ends of the first and second flexible longitudinal fixation components to one another.
8. The method of claim 7 , wherein the exposed ends of the first and second flexible longitudinal fixation components are joined by welding.
9. The method of claim 1 , wherein a single flexible longitudinal fixation component is coupled to each anchor component.
10. The method of claim 1 , wherein each anchor component is coupled to a separate flexible longitudinal fixation component.
11. The method of claim 1 , wherein the at least one flexible longitudinal fixation component is coupled to at least two transverse anchor components.
12. The method of claim 1 , wherein at least one flexible longitudinal fixation component is threaded through each transverse anchor component.
13. The method of claim 1 , wherein the transverse anchor components are cylindrical.
14. The method of claim 1 , wherein the transverse anchor components are formed out of a material selected from the group consisting of titanium, tantalum, stainless steel, polypropylene, Delrin, and poyetheretherketone (PEEK).
15. The method of claim 1 , wherein each flexible longitudinal fixation component is a length of suture material.
16. The method of claim 1 , wherein the exposed ends are associated with a flexible longitudinal fixation component having a breaking strength; and
the step of tensioning is related to the breaking strength.
17. The method of claim 1 , wherein the tissue forms part of an annulus fibrosus having a posterior surface, wherein the axial tension is applied in a direction perpendicular to the posterior surface of the annulus, and further wherein the lateral tension is applied in a direction parallel to the posterior surface of the annulus.
18. The method of claim 1 , wherein the exposed ends are anchored to an upper or lower vertebral body.
19. A method for closing a fissure in the annulus of an intervertebral disc, the annulus having an inner surface and an outer surface, the method comprising:
providing a first transverse anchor having a first filament extending therefrom, and providing a second transverse anchor having a second filament extending therefrom;
advancing said first transverse anchor through the outer surface of the annulus of the intervertebral disc on one side of the fissure so that the first transverse anchor is disposed within the interior of the intervertebral disc and an exposed end of the first filament extends through the wall of the annulus on one side of the fissure, and advancing said second transverse anchor through the outer surface of the annulus of the intervertebral disc on a second side of the fissure so that the second transverse anchor is disposed within the interior of the intervertebral disc and an exposed end of the second filament extends through the wall of the annulus on the second side of the fissure;
applying axial tension to the exposed ends of the first and second filaments, without applying lateral tension to the exposed ends of the first and second filaments, so as to pull the exposed ends of the first and second filaments in a direction perpendicular to the inner surface of the annulus and position the first transverse anchor and the second transverse anchor against the inner surface of the annulus;
after the first transverse anchor and the second transverse anchor have been positioned against the inner surface of the annulus, applying lateral tension to the exposed ends of the first and second filaments so as to pull the exposed ends of the first and second filaments in a direction parallel to the outer surface of the annulus and close the fissure; and
welding the first filament to the second filament.