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WO1995022285A1 - Appareil de traitement de disques hernies - Google Patents

Appareil de traitement de disques hernies Download PDF

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Publication number
WO1995022285A1
WO1995022285A1 PCT/US1995/002105 US9502105W WO9522285A1 WO 1995022285 A1 WO1995022285 A1 WO 1995022285A1 US 9502105 W US9502105 W US 9502105W WO 9522285 A1 WO9522285 A1 WO 9522285A1
Authority
WO
WIPO (PCT)
Prior art keywords
jig
cannula
bore
disc
access
Prior art date
Application number
PCT/US1995/002105
Other languages
English (en)
Inventor
Parviz Kambin
Original Assignee
Smith & Nephew Richards, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Smith & Nephew Richards, Inc. filed Critical Smith & Nephew Richards, Inc.
Priority to AU18471/95A priority Critical patent/AU1847195A/en
Publication of WO1995022285A1 publication Critical patent/WO1995022285A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00261—Discectomy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments

Definitions

  • This invention relates to surgery and specifically to a novel method and apparatus for accessing herniated intervertebral discs in a human patient.
  • An intervertebral disc is a structure which occupies the space between the vertebrae and acts, among other things, as a shock absorbing cushion.
  • a normal disc consists of two parts; a central part known as the "nucleus” and a surrounding part known as the "annulus” or “annulus fibrosis”. The annulus degenerates with age, as does the nucleus. Degeneration of the disc is characterized by coUagenation, in which some of the fluid content of the nucleus is lost and fragments of coUagenized fibrous tissue are formed which float in the tissue fluid.
  • laminectomy involves the surgical excision of the symptomatic portion of the herniated disc. This method of treatment has been used for many years, however, typical hospitalization time in nine days. Microsurgery has also been used in the treatment of herniated discs, in a procedure known as “microlumbar discectomy.” This microsurgical procedure, although less invasive, nevertheless carries with it many of the complications associated with the older procedure, including injury to the nerve root and dural sac, perineural scar formation, reherniation of the site of the surgery, and instability due to excess bone removal. Another method of treatment is known as chemonucleolysis, which is carried out by injection of the enzyme chymopapain into the disc structure.
  • 4,573,448 limits the design of an operating discoscope and limits the type and size of instruments that would allow for the visualization and simultaneous suction, irrigation and resection of the nuclear material.
  • the introduction of a second portal to the annulus from the opposite side of a first portal has been reported by Schreiber and his co- workers in Clinical Orthopaedics and Related Research. Number 238, page 36, January 1989.
  • this bilateral, biportal procedure increases the operating room time, exposure to radiation by physician, patient and operating room personnel and also increases post-operative morbidity by involving both sides of the back and may cause excessive removal of nuclear material which increases the possibility for stenosis of the foramen and nerve root compression.
  • a unilateral, biportal approach will allow for continuous visualization, identification and extraction of nuclear fragments from the disc under discoscopic control. Large central herniations and partially extruded fragments may be visualized and evacuated.
  • Such a unilateral approach to place more than one percutaneous portal in, for example, the L5-S1 vertebral joint is also highly desirable because this procedure requires deflection of the patient's spine to enable access on the one side, causing a corresponding restriction of access on the opposite side.
  • the present invention provides a percutaneous surgical disc procedure, comprising the steps of percutaneously entering the back of the patient in a posterolateral direction with an access cannula, advancing said access cannula through a first percutaneously created fenestration of the annulus of the disc, percutaneously entering the back of the patient in a posterolateral direction with an accessory cannula, and advancing said accessory cannula through a second percutaneously created fenestration of the annulus adjacent to and on the same side of the disc as the first fenestration.
  • the present invention also provides a method for the percutaneous decompression of a herniated intervertebral disc in a human patient, which comprises percutaneously entering the back of the patient in a posterolateral direction with an access cannula, advancing the access cannula into the disc through a first percutaneously created fenestration of the annulus of the disc, percutaneously entering the back of the patient in a posterolateral direction with an accessory cannula, advancing the accessory cannula into the disc through a second percutaneously created fenestration of the annulus adjacent to and on the same side of the disc as the first fenestration, removing nuclear material through one of the cannulae and observing the removal with an endoscope through the other.
  • the present invention also provides a guide means or jig for guiding the accessory cannula into the disc in an aligned relationship with the access cannula.
  • a single oval cannula replaces the two cannulae through which both the procedure and the viewing can be performed.
  • the present invention provides a method of percutaneously emplacing at least two cannulae in a patient, comprising percutaneously entering the back of the patient in a posterolateral direction with a first cannula and advancing the first cannula into the body of the patient to a position where the distal end of the first cannula is at a first predetermined location inside the body and the proximal end thereof projects beyond the outer surface of the back, securing a guide means to the proximal end of the first cannula and using the guide means to guide a second cannula as it percutaneously enters the back of the patient in a posterolateral direction and is advanced to a second predetermined location relative to said first predetermined location.
  • the method of the present invention requires only a small incision to place the cannulae, since this biportal approach utilizes unilateral placement.
  • the unilateral biportal approach allows for continuous discoscopic control and visualization and provides adequate channels for fluid management, which significantly enhances the visual identification of the posterior annulus.
  • the method in accordance with the invention may be carried out under local anesthesia, thus avoiding the risk of general anesthetics.
  • FIGURE 1 is a plan view of a guide wire useful in the present invention
  • FIGURE 2 is a plan view, partly in section, of a cannulated obturator useful in the present invention
  • FIGURE 3 is a plan view, partly in section, of an access cannula useful in the present invention
  • FIGURE 4 is a plan view of a trephine useful in the present invention
  • FIGURE 5 is an elevational view of a first jig useful in the present invention
  • FIGURE 6 is a view in section, taken along the lines 6-6 in Fig. 5;
  • FIGURE 7 is an elevational view in section of a sealing adaptor useful in the present invention
  • FIGURE 8 is an elevational view of a second jig useful in the present invention
  • FIGURE 9 is a view in section, taken along the lines 9-9 in Fig. 8;
  • FIGURE 10 is a schematic view of a first access cannula inserted into the herniated disc;
  • FIGURE 11 is a view similar to Fig. 10 showing the use of the second jig to index a second accessory cannulae relative to the first access cannula;
  • FIGURE 12 is a schematic view showing two cannulae placed in the body of the patient with the sealing adaptor of Fig. 7;
  • FIGURE 13 is an elevational view of an alternate embodiment of a first jig of the present invention.
  • FIGURE 14 is a view in section, taken along the lines 14-14 in Fig. 13;
  • FIGURE 15 is an elevation view of an alternate embodiment of a second jig of the present invention
  • FIGURE 16 is a view in section, taken along the line 16-16;
  • FIGURE 17 is a schematic view of an access cannula and a converging accessory cannula inserted into the disc.
  • FIGURE 18 is a schematic view of two cannulae inserted into the herniated disc
  • FIGURE 19 is a schematic view of an oval cannula inserted over the two cannulae shown in Fig. 18;
  • FIGURE 20 is a view in section, taken along the lines of 20-20 in Fig. 19;
  • FIGURE 21 is a schematic view of a procedure being performed through an oval cannula inserted into the herniated disc;
  • FIGURE 22 is an elevational view of a second alternate embodiment of a jig of the present invention.
  • instruments are generally made out of suitable austenitic stainless steel, unless otherwise specified. While the surgical procedure described herein refers to decompression of intervertebral lumbar discs, it is to be understood that the procedure is not limited to lumbar discectomy and may be used in any procedure for percutaneously emplacing at least two cannulae in a patient, such as an intervertebral disc procedure or operation.
  • the patient is positioned on a radiolucent table in the appropriate prone or lateral position and a guidewire 10 (Fig. 1), suitably of about 0.050 in. diameter, is advanced through the skin of the back posterolaterally under fluoroscopic observation until the guidewire 10 contacts the exterior symptomatic side of the annulus fibrosis of the herniated disc.
  • a guidewire 10 (Fig. 1), suitably of about 0.050 in. diameter, is advanced through the skin of the back posterolaterally under fluoroscopic observation until the guidewire 10 contacts the exterior symptomatic side of the annulus fibrosis of the herniated disc.
  • the cannulated obturator 20 (Fig. 2), having a lumen with a diameter slightly larger than that of the guidewire 10
  • the removal of the guidewire 10 at this point is optional.
  • An access cannula 30a (Fig. 3), suitably of about 0.25 in. outer diameter and having external gradations 31 of 10 mm, is then passed over the cannulated obturator 20 and advanced to the external surface of the annulus fibrosis. At this point, the guidewire 10 is removed if not previously removed.
  • the inner diameter of the access cannula 30a is sized to closely fit over the cannulated obturator 20.
  • the cannulated obturator 20 is then removed, and a 3 mm or 5 mm trephine 40 (Fig. 4) is introduced through the access cannula 30a.
  • the trephine 40 has a plurality of saw teeth 40a or other cutting members.
  • the trephine 40 is advanced into the annulus of the disc, with rotation, creating an annular fenestration (that is, a bore) through the annulus fibrosis into the nucleus.
  • the trephine 40 is then removed.
  • the cannulated obturator 20 is reintroduced into the access cannula 30a and passed into the fenestration of the annulus. Fluoroscopic guidance may be utilized. The access cannula 30a is then advanced into the fenestration of the annulus, with rotary movement. After the access cannula 30a is in the proper position, the cannulated obturator 20 is removed. The proximal end of cannula 30a projects beyond the surface of the patient's back (not shown) while the distal end is in the position shown in Fig. 10. The procedure described for placement of cannula 30a into the annulus of the disc follows the procedure described in U.S. Patent 4,573,448. As is known, suitable local anesthetic is used as appropriate.
  • First jig 50 (Figs. 5, 6 and 10) is slid downwardly over the proximal end of the access cannula 30a by passing the access cannula 30a through the central bore 51 in the first jig 50.
  • Jig 50 is secured in place near the proximal end of cannula 30a by tightening the screw 53 thereby clamping the legs 52a and 52b to the access cannula
  • First jig 50 preferably has a plurality of smaller bores 55 each having a diameter substantially the same as the diameter of the guidewire 10.
  • the axes of the bores 55 are spaced from and are preferably parallel to the axis of the large bore 51.
  • jig 50 may have only one smaller bore 55.
  • the bores 55 may be oblique to the axis of the large bore 51.
  • the guidewire 10 is slid through a selected one of the small bores 55 so that the guidewire 10 will ideally be centered on the annulus fibrosis. If necessary, a second guidewire 10 is passed through another of bores 55 and advanced toward the annulus fibrosis of the disc, while under fluoroscopic observation. Proper positioning of the guidewire on the annulus is determined by palpation and, if necessary, by fluoroscopy. The surgeon can then evaluate the placement of the guidewires and select the guidewire best positioned to provide the second fenestration of the annulus of the disc.
  • the other guidewire, if any, is removed, and the guidewire 10 is then introduced through the fibers of the annulus fibrosis for a distance of about three to about four millimeters.
  • Jig 50 is removed, leaving the guidewire 10 and access cannula 30a in place.
  • Second jig 70 (Figs. 8, 9 and 11) is secured to access cannula 30a near the proximal end by passing access cannula 30a through bore 70a, passing the guidewire 10 through bore 70b, and clamping legs 70c together by means of screw 70d.
  • Cannulated obturator 20 is then advanced over the guidewire 10 by rotary movement through the bore 70b of the second jig 70 until the cannulated obturator 20 contacts the annulus fibrosis, as shown in Fig. 11.
  • the guidewire 10 and jig 70 are removed leaving the cannulated obturator 20 in place.
  • An accessory cannula 30b is passed over the cannulated obturator 20 and advanced toward the annulus fibrosis. Accessory cannula 30b is sized to slide in the annulus between bore 70b and the outer surface of cannulated obturator 20. The cannulated obturator 20 is then removed, leaving the accessory cannula 30b in place. While it is presently preferred that cannulae 30a, 30b have the same inner and outer diameters, one may have a smaller inner and/or outer diameter than the other. Although it is presently preferred to use the second jig 70, it is not necessary to do so.
  • a jig which has one or more of the bores positioned oblique to the center bore rather than parallel to it.
  • a jig 80 (Figs. 13 and 14) is provided which is identical in structure to jig 50 except for the axis of the smaller bores 55.
  • a plurality of smaller bores 85 have an axis that is at an angle relative to the longitudinal axis of a large bore 81.
  • the angle of the axis of the smaller bores 85 can be between about 10 to 50° and is preferably 30° relative to the longitudinal axis of the large bore 81 as shown in Fig. 14.
  • the converging cannulas can be most useful in extra discal surgery and for foraminal surgery or surgery inside of the spinal canal for direct visualization and retrieval of sequestrated fragments.
  • a jig 90 (Figs. 15 and 16) is also provided which is identical in structure to jig 70 except for the axis of the bore 70b.
  • a bore 90b has an axis that is at an angle relative to the longitudinal axis of a central bore 90a.
  • the angle of the axis of the bore 90b can be between about 10 to 50° and is preferably 30° relative to the longitudinal axis of the central bore 91 as shown in Fig. 16.
  • Both of the jigs 80 and 90 are used in the method of the present invention in the same manner as jigs 50 and 70 are used.
  • the annulus fibrosis is inspected endoscopically through the accessory cannula 30b, and if satisfactory, a trephine 40 is passed through the accessory cannula 30b and a second fenestration is cut through the annulus fibrosis into the nucleus. The trephine 40 is then removed. The accessory cannula 30b is advanced into the annulus.
  • Fragments of the herniated disc can be removed through the desired cannula 30a and 30b by inserting a trephine 40 in the desired cannula and moving it back and forth within the nucleus of the herniated disc as suction is applied.
  • the trephine can be removed and suction may be applied through the cannula itself.
  • forceps, trimmer blades, suction punch forceps laser lights, etc. are used to remove such fragments via one of the cannula.
  • a sealing adaptor 60 (Fig. 7), which is suitably comprised of silicon rubber, is attached to the proximal extremity of the access cannula 30a and accessory cannula 30b, as shown in Fig. 12 with access cannula 30a and accessory cannula 30b received in bores 61a and 6 lb of sealing adaptor 60. Insertion of access cannula 30a and accessory cannula 30b into the sealing adaptor will stop when the cannulae contact shoulders 63 and 64, respectively of bores 61a and 61b.
  • Nuclear evacuation through one of the cannulae 30a or 30b and simultaneous arthroscopic observation via the other of cannulae 30a or 30b is possible by sealingly passing an arthroscope (not shown) into one of bores 62a and 62b and thence into one of cannula 30a or 30b, while a tool (not shown) is inserted into the other bore and thence into the other cannula.
  • Nuclear material may then be evacuated by a conventional powered surgical instrument (not shown) through the access cannula 30a or accessory cannula 30b while under arthroscopic observation through the other cannula.
  • a saline solution may be passed via the arthroscope through one cannula and excess fluid may be evacuated through the other cannula. Direct visualization of the resection of the desired disc material is thus made possible.
  • the surgical procedure and viewing can be done through a single oval cannula rather than the cannulae 30a and 30b. If this alternate method is used two cannulated obturators 20 or cannulas 30a, 30b are inserted into the disc 101 in the manner described above using the jig 70 to align the obturators 20 or cannulae 30a, 30b in parallel alignment as shown in Fig. 18.
  • the jig 70 is removed and an oval cannula 110, slightly larger in diameter than the two obturators 20a, 20b or cannulae 30a, 30b, is slid downwardly over the obturators 20a, 20b or cannulae 30a, 30b and inserted into the annulus fibrosis (Figs. 19 and 20).
  • the oval cannula 110 has a uniform inner and outer diameter and a transverse cross section that is defined by an X axis Dl and a Y axis D2 (Fig. 20).
  • the Y axis D2 has a dimension generally between about 3 to 11 millimeters and the X axis Dl has a dimension of generally between about 5 to 22 millimeters and a longitudinal length of generally between about 50 to 250 millimeters.
  • a half circle cannula of a type known in the industry can be used with an alternate jig 120 having a central bore 121 and a second bore 122 in the shape of a half circle as shown in Fig. 22.
  • An oval cannula 110 with a smaller diameter can then be slid over the cannulae to provide a working channel which will fit into the smaller disc space.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Pathology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un procédé et un appareil permettant de procédé à une intervention chirurgicale percutanée sur un disque qui consiste à pénétrer par voie percutanée dans le dos du patient, dans un sens postéro-latéral, au moyen d'une canule d'accès (30a), à faire avancer ladite canule à travers une première fenestration créée par voie percutanée dans l'anneau du disque (101), et à fixer un moyen de guidage (50) par rapport à la canule d'accès. On pénètre à nouveau dans le dos du patient par voie percutanée dans un sens postéro-latéral au moyen d'une canule accessoire (30b) qui est avancée par rapport au moyen de guidage, de sorte qu'elle soit guidée dans une seconde fenestration créée de manière percutanée dans l'anneau, à proximité et du même côté du disque que la première fenestration, et que ladite canule d'accès et ainsi que ladite canule accessoire soient orientées l'une par rapport à l'autre du même côté du disque.
PCT/US1995/002105 1994-02-18 1995-02-17 Appareil de traitement de disques hernies WO1995022285A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU18471/95A AU1847195A (en) 1994-02-18 1995-02-17 Apparatus for treating herniated discs

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US19855194A 1994-02-18 1994-02-18
US08/198,551 1994-02-18

Publications (1)

Publication Number Publication Date
WO1995022285A1 true WO1995022285A1 (fr) 1995-08-24

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AU (1) AU1847195A (fr)
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Cited By (39)

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WO1997034536A2 (fr) * 1996-03-22 1997-09-25 Sdgi Holdings, Inc. Dispositifs et procedes de chirurgie percutanee
EP0807415A2 (fr) * 1996-05-09 1997-11-19 Olympus Optical Co., Ltd. Outillage pour retenir une cavité en chirurgie osseuse, outillage pour retenir une cavité en chirurgie generale, système d'endoscopie chirurgical utilisant un outillage pour retenir une cavité, et une procédure de chirurgie
US5792044A (en) * 1996-03-22 1998-08-11 Danek Medical, Inc. Devices and methods for percutaneous surgery
US6152871A (en) * 1996-03-22 2000-11-28 Sdgi Holdings, Inc. Apparatus for percutaneous surgery
US6575979B1 (en) 2000-02-16 2003-06-10 Axiamed, Inc. Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae
US6592625B2 (en) 1999-10-20 2003-07-15 Anulex Technologies, Inc. Spinal disc annulus reconstruction method and spinal disc annulus stent
US6679833B2 (en) 1996-03-22 2004-01-20 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US6837891B2 (en) 1998-08-20 2005-01-04 Endius Incorporated Cannula for receiving surgical instruments
US6899716B2 (en) 2000-02-16 2005-05-31 Trans1, Inc. Method and apparatus for spinal augmentation
US7004970B2 (en) 1999-10-20 2006-02-28 Anulex Technologies, Inc. Methods and devices for spinal disc annulus reconstruction and repair
US7052516B2 (en) 1999-10-20 2006-05-30 Anulex Technologies, Inc. Spinal disc annulus reconstruction method and deformable spinal disc annulus stent
US7056321B2 (en) 2000-08-01 2006-06-06 Endius, Incorporated Method of securing vertebrae
US7144393B2 (en) 2001-05-15 2006-12-05 Dipoto Gene P Structure for receiving surgical instruments
US7198598B2 (en) 1996-03-22 2007-04-03 Warsaw Orthopedic, Inc. Devices and methods for percutaneous surgery
US7226451B2 (en) 2003-08-26 2007-06-05 Shluzas Alan E Minimally invasive access device and method
US7309338B2 (en) 2000-02-16 2007-12-18 Trans1 Inc. Methods and apparatus for performing therapeutic procedures in the spine
US7427264B2 (en) 2005-04-22 2008-09-23 Warsaw Orthopedic, Inc. Instruments and methods for selective tissue retraction through a retractor sleeve
US7473256B2 (en) 2003-10-23 2009-01-06 Trans1 Inc. Method and apparatus for spinal distraction
WO2009045225A1 (fr) * 2007-10-01 2009-04-09 Disc Motion Technologies, Inc. Système d'instrument chirurgical
US7547317B2 (en) 2000-02-16 2009-06-16 Trans1 Inc. Methods of performing procedures in the spine
US7569056B2 (en) 2000-02-16 2009-08-04 Trans1 Inc. Methods and apparatus for forming shaped axial bores through spinal vertebrae
US7608077B2 (en) 2000-02-16 2009-10-27 Trans1 Inc. Method and apparatus for spinal distraction and fusion
US7641657B2 (en) 2003-06-10 2010-01-05 Trans1, Inc. Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae
US7641670B2 (en) 1998-08-20 2010-01-05 Zimmer Spine, Inc. Cannula for receiving surgical instruments
US7799036B2 (en) 1998-08-20 2010-09-21 Zimmer Spine, Inc. Method and apparatus for securing vertebrae
US7846208B2 (en) 1999-10-20 2010-12-07 Anulex Technologies, Inc. Spinal disc annulus reconstruction method and deformable spinal disc annulus stent
US7985247B2 (en) 2000-08-01 2011-07-26 Zimmer Spine, Inc. Methods and apparatuses for treating the spine through an access device
USRE44268E1 (en) 1997-07-15 2013-06-04 Zimmer Spine, Inc. Method and instruments for percutaneous arthroscopic disc removal, bone biopsy and fixation of the vertebral
EP2842591A3 (fr) * 2013-08-27 2015-04-08 Covidien LP Ensemble de canule d'administration de médicament
US9095442B2 (en) 1999-10-20 2015-08-04 Krt Investors, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
US9192372B2 (en) 2008-10-14 2015-11-24 Krt Investors, Inc. Method for the treatment of tissue
US9204906B2 (en) 2009-10-22 2015-12-08 Nuvasive, Inc. Posterior cervical fusion system and techniques
US9526568B2 (en) 2012-05-31 2016-12-27 Covidien Lp Drug-delivery device for use with ablation device
US9675347B2 (en) 1999-10-20 2017-06-13 Krt Investors, Inc. Apparatus for the treatment of tissue
US9737294B2 (en) 2013-01-28 2017-08-22 Cartiva, Inc. Method and system for orthopedic repair
US9795372B2 (en) 2010-01-11 2017-10-24 Krt Investors, Inc. Intervertebral disc annulus repair system and bone anchor delivery tool
US9814598B2 (en) 2013-03-14 2017-11-14 Quandary Medical, Llc Spinal implants and implantation system
US10098674B2 (en) 2009-10-22 2018-10-16 Nuvasive, Inc. System and method for posterior cervical fusion
US10179012B2 (en) 2013-01-28 2019-01-15 Cartiva, Inc. Systems and methods for orthopedic repair

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US4545374A (en) * 1982-09-03 1985-10-08 Jacobson Robert E Method and instruments for performing a percutaneous lumbar diskectomy
US4573448A (en) * 1983-10-05 1986-03-04 Pilling Co. Method for decompressing herniated intervertebral discs
US4539976A (en) * 1984-02-08 1985-09-10 Sharpe Jewett M Endoscopic surgical instrument
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Cited By (84)

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US6176823B1 (en) 1996-03-22 2001-01-23 Sdgi Holdings, Inc. Fixture for supporting a viewing element within a cannula
US6206822B1 (en) 1996-03-22 2001-03-27 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
EP1466564A1 (fr) * 1996-03-22 2004-10-13 SDGI Holdings, Inc. Dispositifs pour la chirurgie percutanée
US5792044A (en) * 1996-03-22 1998-08-11 Danek Medical, Inc. Devices and methods for percutaneous surgery
US6679833B2 (en) 1996-03-22 2004-01-20 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US5902231A (en) * 1996-03-22 1999-05-11 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
US5954635A (en) * 1996-03-22 1999-09-21 Sdgi Holdings Inc. Devices and methods for percutaneous surgery
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