Method and apparatus for closing a fissure in the annulus of an intervertebral disc, and/or for effecting other anatomical repairs and/or fixations
Apparatus for attaching a first object to a second object, the apparatus comprising a distal anchor comprising a generally cylindrical body and a vertical bore extending through the generally cylindrical body; a proximal anchor comprising a generally cylindrical body, a first vertical bore extending through the generally cylindrical body, a second vertical bore spaced distally from the first vertical bore parallel to the first vertical bore, a third vertical bore spaced distally from the second vertical bore parallel to the first vertical bore, and a fourth vertical bore spaced distally from the third vertical bore parallel to the first vertical bore; and a suture having a proximal end and a distal end, with an enlargement formed at the distal end, wherein the suture extends through the vertical bore, through the fourth vertical bore, through the third vertical bore, through the second vertical bore and through the first vertical bore.
1. Apparatus for attaching a first object to a second object, said apparatus comprising:
a distal anchor comprising a generally cylindrical body, a distal end and a proximal end, wherein said distal end comprises an inclined distal end surface, and a vertical bore extending through said generally cylindrical body, perpendicular to the longitudinal axis of said generally cylindrical body;
a proximal anchor comprising a generally cylindrical body, a distal end and a proximal end, a top surface and a bottom surface, a first vertical bore extending through said generally cylindrical body from said top surface to said bottom surface, perpendicular to the longitudinal axis of the generally cylindrical body, a second vertical bore spaced distally from said first vertical bore and extending from said top surface to said bottom surface parallel to said first vertical bore, a third vertical bore spaced distally from said second vertical bore and extending from said top surface to said bottom surface parallel to said first vertical bore, and a fourth vertical bore spaced distally from said third vertical bore and extending from said top surface to said bottom surface parallel to said first vertical bore; and
a suture having a proximal end and a distal end, with an enlargement formed at said distal end, wherein said suture extends through said vertical bore of said distal anchor, through said fourth vertical bore of said proximal anchor, through said third vertical bore of said proximal anchor, through said second vertical bore of said proximal anchor and through said first vertical bore of said proximal anchor.
2. Apparatus according to claim 1 wherein said distal anchor further comprises a horizontally-extending slot in communication with said vertical bore and said inclined distal surface.
3. Apparatus according to claim 1 wherein said distal anchor further comprises a notch formed adjacent to said proximal end of said distal anchor, whereby to form a pointed heel at said proximal end of said distal anchor.
4. Apparatus according to claim 1 wherein said proximal anchor further comprises a first horizontally-extending slot formed in said bottom surface of said proximal anchor and in communication with said first vertical bore and said second vertical bore, a second horizontally-extending slot formed in said bottom surface and in communication with said third vertical bore and said fourth vertical bore, and a third horizontally-extending slot formed in said top surface and in communication with said second vertical bore and said third vertical bore.
5. Apparatus according to claim 4 wherein said first horizontally-extending slot comprises a wider outer portion and a narrower inner portion, and wherein said second horizontally-extending slot comprises a wider outer portion and a narrower inner portion.
6. Apparatus according to claim 1 wherein said suture comprises a loop between said third vertical bore of said proximal anchor and said second vertical bore of said proximal anchor.
7. A method for connecting a first object to a second object, said method comprising:
providing apparatus comprising:
a distal anchor comprising a generally cylindrical body, a distal end and a proximal end, wherein said distal end comprises an inclined distal end surface, and a vertical bore extending through said generally cylindrical body, perpendicular to the longitudinal axis of said generally cylindrical body;
a proximal anchor comprising a generally cylindrical body, a distal end and a proximal end, a top surface and a bottom surface, a first vertical bore extending through said generally cylindrical body from said top surface to said bottom surface, perpendicular to the longitudinal axis of the generally cylindrical body, a second vertical bore spaced distally from said first vertical bore and extending from said top surface to said bottom surface parallel to said first vertical bore, a third vertical bore spaced distally from said second vertical bore and extending from said top surface to said bottom surface parallel to said first vertical bore, and a fourth vertical bore spaced distally from said third vertical bore and extending from said top surface to said bottom surface parallel to said first vertical bore; and
a suture having a proximal end and a distal end, with an enlargement formed at said distal end, wherein said suture extends through said vertical bore of said distal anchor, through said fourth vertical bore of said proximal anchor, through said third vertical bore of said proximal anchor, through said second vertical bore of said proximal anchor and through said first vertical bore of said proximal anchor;
advancing said distal anchor into the first object, with said suture and said enlargement advancing with said distal anchor;
while holding said suture and said enlargement in place, further advancing said distal anchor so that said inclined distal end surface of said distal anchor engages said enlargement and causes said distal anchor to turn relative to the first object;
advancing said proximal anchor into the second object;
pulling proximally on the portion of said suture extending between said second vertical bore of said proximal anchor and said third vertical bore of said proximal anchor so as to cause said proximal anchor to turn relative to the second object;
passing said proximal end of said suture between (i) the portion of said suture extending between said second vertical bore of said proximal anchor and said third vertical bore of said proximal anchor and (ii) said proximal anchor, so as to form a half hitch in said suture; and
pulling proximally on said proximal end of said suture so as to set said half hitch.
8. A method according to claim 7 wherein said proximal anchor further comprises a first horizontally-extending slot formed in said bottom surface of said proximal anchor and in communication with said first vertical bore and said second vertical bore, a second horizontally-extending slot formed in said bottom surface and in communication with said third vertical bore and said fourth vertical bore, and a third horizontally-extending slot formed in said top surface and in communication with said second vertical bore and said third vertical bore, and wherein said first horizontally-extending slot comprises a wider outer portion and a narrower inner portion, and wherein said second horizontally-extending slot comprises a wider outer portion and a narrower inner portion;
and further wherein pulling proximally on the portion of said suture extending between said second vertical bore of said proximal anchor and said third vertical bore of said proximal anchor causes said suture to enter said narrower inner portion of said second horizontally-extending slot formed in said bottom surface of said proximal anchor.
9. A method according to claim 8 wherein pulling proximally on said proximal end of said suture so as to set said half hitch causes said suture to enter said narrower inner portion of said first horizontally-extending slot formed in said bottom surface of said proximal anchor.
10. A method according to claim 7 wherein said distal anchor is set within the first object.
11. A method according to claim 7 wherein said distal anchor is set against a far side surface of the first object.
12. A method according to claim 7 wherein said proximal anchor is set within the second object.
13. A method according to claim 7 wherein said proximal anchor is set against a far side surface of the second object.
14. A method according to claim 7 wherein the first object comprises one of a vertebral disc, a vertebral body and a mass of soft tissue, and the second object comprises one of a vertebral disc, a vertebral body and a mass of soft tissue.
15. A method according to claim 7 wherein said suture captures a third object relative to the first object and the second object.
16. Apparatus for attaching a suture to an object, said apparatus comprising:
an anchor comprising a generally cylindrical body, a distal end and a proximal end, wherein said distal end comprises an inclined distal end surface, a vertical bore extending through said generally cylindrical body, perpendicular to the longitudinal axis of said generally cylindrical body, a second vertical bore spaced proximally from said vertical bore and extending through said generally cylindrical body parallel to said vertical bore, and a third vertical bore spaced proximally from said second vertical bore and extending through said generally cylindrical body parallel to said vertical bore; and
a suture having a proximal end and a distal end, with an enlargement formed at said distal end, wherein said suture extends through said vertical bore of said anchor, and further wherein said proximal end of said suture extends through said vertical bore of said anchor, through said second vertical bore of said anchor and through said third vertical bore of said anchor.
17. Apparatus according to claim 16 wherein said proximal end of said suture extends between (i) the portion of said suture exiting said vertical bore and entering said second vertical bore and (ii) said generally cylindrical body of said anchor.
18. Apparatus according to claim 16 wherein said anchor further comprises a horizontally-extending slot in communication with said vertical bore and said inclined distal surface.
19. Apparatus according to claim 16 wherein said anchor further comprises a second horizontally-extending slot formed in said anchor and in communication with said second vertical bore and said third vertical bore.
20. Apparatus according to claim 19 wherein said second horizontally-extending slot comprises a wider outer portion and a narrower inner portion.