US20070198013A1 - Surgical instrumentation and method for treatment of the spine - Google Patents

Abstract

Instrumentation for treatment of the spine, including an elongate member having a deformable distal end portion at least partially formed of a flexible and preferably elastic material. The distal end portion has an initial configuration for placement adjacent a vertebral body and a deformed configuration defining at least one outwardly extending projection for displacement of at least a portion of the vertebral body. The elongate member preferably comprises a rod member, a sleeve member and an actuator mechanism for imparting relative linear displacement between the rod and sleeve members to effect outward deformation of the distal end portion of the sleeve member. In one embodiment, the instrumentation is used to compact cancellous bone to form a cavity within a vertebral body. In another embodiment, the instrumentation is used to reduce a compression fracture. In yet another embodiment, the instrumentation is used to distract a disc space between adjacent vertebral bodies.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• The present application claims the benefit of Provisional Application Ser. No. 60/224,491, filed Aug.11, 2000 and entitled Vertebral Plasty Reduction Device, the contents of which are hereby incorporated by reference in their entirety.
FIELD OF THE INVENTION
• The present invention relates generally to the field of surgical instrumentation and methods for treatment of the spine, and more particularly relates to instrumentation and methods for transversely displacing structures associated with the spine.
BACKGROUND OF THE INVENTION
• Various instruments and methods for the treatment of compression-type bone fractures and other osteoporotic and/or non-osteoporotic conditions have been developed. Such methods generally include a series of steps performed by a surgeon to correct and stabilize the compression fracture. A cavity is typically formed in the bone to be treated, followed by the insertion of an inflatable balloon-like device into the bone cavity. Inflation of the balloon-like device causes a compaction of the cancellous bone and/or bone marrow against the inner cortical wall of the bone, thereby resulting in enlargement of the bone cavity and/or reduction of the compression fracture. The balloon-like device is then deflated and removed from the bone cavity. A biocompatible filling material, such as methylmethacrylate cement or a synthetic bone substitute, is sometimes delivered into the bone cavity and allowed to set to a hardened condition to provide internal structural support to the bone.
• While the above-described instruments and methods provide an adequate protocol for the treatment and fixation of compression-type bone fractures, it has been found that expansion of the balloon-like device is not controllable. Instead, when such balloon-like device is inflated, expansion occurs along a path of least resistance. As a result, the direction of compaction of the cancellous bone and/or reduction of the compression fracture is not controllable, and expansion occurs in multiple directions and along multiple axes.
• Thus, there is a general need in the industry to provide surgical instrumentation and methods for use in treatment of the spine that provide a greater degree of control over transverse displacement of structures associated with the spine than is currently available within the industry. The present invention meets this need and provides other benefits and advantages in a novel and unobvious manner.
SUMMARY OF THE INVENTION
• The present invention relates generally surgical instrumentation and methods for displacement of at least a portion of a vertebral body. While the actual nature of the invention covered herein can only be determined with reference to the claims appended hereto, certain forms of the invention that are characteristic of the preferred embodiments disclosed herein are described briefly as follows.
• In one form of the present invention, instrumentation is provided for treatment of the spine, comprising an elongate member extending along a longitudinal axis and including a deformable distal end portion having an initial configuration for placement adjacent a spinal structure and a deformed configuration defining at least one transverse projection for transverse displacement of at least a portion of the spinal structure.
• In another form of the present invention, instrumentation is provided for treatment of the spine, comprising a first member, a second member having a distal end portion engaged with the first member, with the distal end portion having an initial configuration for placement adjacent a spinal structure and an expanded configuration for displacement of at least a portion of the spinal structure, and wherein relative displacement between the first and second members causes the distal end portion to reform from the initial configuration toward the expanded configuration.
• In yet another form of the present invention, instrumentation is provided for treatment of the spine, comprising a member including a deformable distal end portion having an initial configuration for positioning adjacent a spinal structure and a deformed configuration for displacing at least a portion of the spinal structure, and means for mechanically deforming the distal end portion from the initial configuration toward the deformed configuration to displace the spinal structure in at least one predetermined direction.
• In still another form of the present invention, a method is provided for treatment of the spine, comprising providing an instrument including a distal end portion having an insertion configuration and a deformed configuration. The method further comprises positioning the distal end portion adjacent a spinal structure while in the insertion configuration and deforming the distal end portion toward the deformed configuration to displace at least a portion of the spinal structure.
• It is one object of the present invention to provide improved surgical instrumentation and methods for treatment of the spine.
• Further objects, features, advantages, benefits, and aspects of the present invention will become apparent from the drawings and description contained herein.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective view of a surgical instrument according to one form of the present invention.
• FIG. 2 is an exploded side view of a distal end portion of the surgical instrument depicted inFIG. 1.
• FIG. 3 is an exploded side view of a proximal end portion of the surgical instrument depicted inFIG. 1.
• FIG. 4 is a broken cross-sectional side view of the surgical instrument depicted inFIG. 1.
• FIG. 5 is a perspective view of the distal end portion of the surgical instrument depicted inFIG. 1, as shown in an initial configuration.
• FIG. 6 is a perspective view of the distal end portion depicted inFIG. 5, as shown in a deformed configuration.
• FIG. 7 is a perspective view of the distal end portion of a surgical instrument according to another form of the present invention, as shown in an initial configuration.
• FIG. 8 is a perspective view of the distal end portion depicted inFIG. 7, as shown in a deformed configuration.
• FIG. 9 is a perspective view of the distal end portion of a surgical instrument according to another form of the present invention, as shown in an initial collapsed configuration.
• FIG. 10 is a perspective view of the distal end portion depicted inFIG. 9, as shown in a partially expanded configuration.
• FIG. 11 is a perspective view of the distal end portion depicted inFIG. 9, as shown in a fully expanded configuration.
• FIG. 12 is a partial cross-sectional side view of a spinal column illustrating treatment of a vertebral body using the surgical instrument illustrated inFIG. 1.
DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS
• For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is hereby intended, such alterations and further modifications in the illustrated devices, and such further applications of the principles of the invention as illustrated herein being contemplated as would normally occur to one skilled in the art to which the invention relates.
• Referring toFIG. 1, shown therein is aninstrument20 for treatment of the spine according to one form of the present invention.Instrument20 is particularly useful for placement adjacent a spinal structure and selective displacement of at least a portion of the spinal structure. In one embodiment of the invention, the spinal structure is a vertebral body. It should be understood thatinstrument20 may be used in intrabody applications such as, for example, a vertebral plasty procedure to compact cancellous bone within the vertebral body and/or to reduce a compression fracture of the vertebral body. Additionally, it should be understood thatinstrument20 may be used in interbody applications such as, for example, to distract a space between adjacent vertebral bodies, such as the vertebral disc space. It should further be understood that in other embodiments of the invention, the spinal structure may be comprised of a spinal implant such as, for example, a cage device, or any other structure used in association with treatment of the spine. Additionally, althoughinstrument20 is illustrated and described in the context of treatment of a human spine, it should be understood thatinstrument20 may be used to treat other animals. It should further be understood thatinstrument20 may be used in association with applications outside of the spinal field such as, for example, to treat other types of bony structures.
• Instrument20 is generally comprised of anelongate member22 extending generally along a longitudinal axis L and having adistal end portion22aand aproximal end portion22b. Although the illustrated embodiment depictselongate member22 as having a generally linear, unitary configuration, it should be understood thatelongate member22 may take on other configurations as well, such as, for example, a curvilinear configuration or a hinged configuration.Instrument20 also includes anactuator mechanism24 coupled to theproximal end portion22bofelongate member22. As will be discussed in greater detail below, thedistal end portion22ais deformable and is configured to outwardly expand in response to a mechanically induced force. Such force may be effected, for example, by the selective actuation ofactuator mechanism24.
• As shown inFIGS. 5 and 6, thedistal end portion22ais reformable between an initial configuration (FIG. 5) and a deformed configuration (FIG. 6). As used herein, the term “initial configuration” is broadly defined to encompass a structural configuration ofelongate member22 that is suitable for placement adjacent a spinal structure, and the term “deformed configuration” is broadly defined to encompass a structural configuration ofelongate member22 that is suitable for displacement of at least a portion of the spinal structure. As discussed above, in one embodiment of the invention, the spinal structure is a vertebral body, and displacement of the vertebral body could be associated with either intrabody or interbody applications.
• Referring toFIG. 2, shown therein are further details regarding theelongate member22, and more specifically the deformabledistal end portion22aofelongate member22. In one embodiment of the invention, theelongate member22 is comprised of aninner rod member30 and anouter sleeve member32. Theinner rod30 is preferably formed of a substantially rigid medical grade material such as, for example, titanium or stainless steel. Thedistal end portion30aofrod30 includes atapered portion34, a reduced cross-sectionintermediate portion36, and a roundeddistal end portion38. In one embodiment, theintermediate portion36 has a diameter somewhat smaller than the diameter of thetapered portion34 and the roundeddistal end portion38 so as to define a pair ofopposing shoulders40,42. Althoughrod30 has been illustrated and described as having a substantially circular cross section, it should be understood that other shapes and configurations are also contemplated as being within the scope of the invention including, for example, elliptical, square, rectangular or other polygonal configurations.
• Theouter sleeve32 preferably has a tubular configuration defining an inner passage extending therethrough generally along longitudinal axis L and sized to slidably receiverod30.Sleeve32 is preferably formed of a flexible material that is capable of facilitating deformation from an initial configuration toward a deformed configuration. Additionally,sleeve32 is preferably formed of an elastic material that is capable of facilitating elastic deformation from the initial configuration toward the deformed configuration and reformation back toward the initial configuration.Sleeve32 may be formed of materials including, but not limited to, titanium, stainless steel, an elastomer, a polymer, a rubber, a composite material or a shape-memory material. Although the entire length ofsleeve32 may be formed of a flexible, elastic material, it should be understood that only thedistal end portion32aofsleeve32 need be formed of such material, with the remainder ofsleeve32 being formed of any suitable medical grade material. Moreover, althoughouter sleeve32 is illustrated as having a substantially tubular configuration, it should be understood that other shapes and configurations ofsleeve32 are also contemplated as being within the scope of the present invention. Additionally, althoughsleeve32 has been illustrated and described as being formed as a single-piece, unitary structure, it should be understood that thedistal end portion32acould be formed separately from the remainder ofsleeve32, and coupled together by any known method, such as, for example, by fastening, welding or adhesion.
• Thedistal end portion32aofsleeve32 includes at least oneslot50 extending generally along longitudinal axis L, and preferably includes at least a pair ofslots50 and52 (not shown) disposed generally opposite one another so as to define a pair of longitudinally extending flexible strips ofmaterial54,56. It should be understood, however, that thedistal end portion32aofsleeve32 could be configured to define any number of longitudinally extending slots, including three or more slots, which would in turn define a corresponding number of longitudinally extending flexible strips of material. It should further be understood thatdistal end portion32amay include a number of slots disposed at various axial locations along longitudinal axis L. As will be described below, theslots50,52 are provided to facilitate outward buckling of thedistal end portion32aofsleeve32 in at least one predetermined direction upon the selective actuation of theactuator mechanism24.
• In the illustrated embodiment, theslots50,52 are substantially identical in shape and configuration, and thus only slot50 will be described in detail. However, it should be understood thatslots50,52 may take on different shapes and configurations.Slots50,52 and strips ofmaterial54,56 are illustrated as having a predetermined shape to provide a degree of control over the outward buckling of the strips ofmaterial54,56. In one embodiment of the invention, theslots50,52 and strips ofmaterial54,56 have an irregular shape.Slot50 includes a relatively narrow andstraight slot portion60, a first hourglass-shapedslot portion62 formed by a first series of arcuate portions, and a second hourglass-shapedslot portion64 formed by a second series of arcuate portions. As will become apparent below, the widened areas of the hourglass-shapedportions62 and64 serve as bending or flexion points to control the outward deformation of the flexible strips ofmaterial54,56.
• Thestraight slot portion60 extends longitudinally from the distal end ofsleeve32. The first hourglass-shapedportion62 extends longitudinally fromslot portion60 and includes a first widenedarea62a, a narrowedarea62b, and a second widened area62c. The second hourglass-shapedportion64 extends longitudinally from the first hourglass-shapedportion62 and includes a first widened area64a, anarrow area64b, and a second widenedarea64c. Although a specific configuration ofslots50,52 have been illustrated and described, it should be understood that other shapes and configuration ofslots50,52 are also contemplated as falling within the scope of the invention.
• In one embodiment of the invention, thedistal end portion32aofsleeve32 is secured to theinner rod30 by way of acompression ring70. Specifically, the distal-most portion ofsleeve32 is disposed aboutportion36 ofrod30, with the distal end ofsleeve32 abutting theshoulder42 formed by the roundeddistal end portion38. Thecompression ring70 is positioned about the distal-most portion ofsleeve32 and is compressed thereabout, such as, for example, by mechanical crimping to securesleeve32 toinner rod30. As should be appreciated,slot portion60 aids in tightly compressingsleeve32 aboutinner rod30 to provide secure engagement therebetween. It should be understood thatcompression ring70 could alternatively be compressed about distal-most portion ofsleeve32 by other means, such as, for example, by formingcompression ring70 out of a shape-memory material that is reformable to a memorized configuration having an internal diameter that is less than the outer diameter ofsleeve32. It should further be understood that the distal-most end portion ofsleeve32 could be secured torod30 by other means, such as, for example, by fastening, welding, adhesion or other methods of attachment known to those of skill in the art.
• Referring toFIGS. 3 and 4, shown therein are further details regarding theactuator mechanism24.Actuator mechanism24 is generally comprised of arotary handle100, astationary handle102, aconnector assembly104, and anactuator member106. As will be discussed in further detail below, theconnector assembly104 is configured to secure theelongate member22, and more specifically theouter sleeve32, to the remainder of theactuator mechanism24. As will also be discussed below, the threadedactuator member106 is coupled to theinner.rod30 and is engaged with therotary handle100 such that rotational displacement ofhandle100 about longitudinal axis L linearly displaces theactuator member106 along longitudinal axis L. As described above, the linear displacement ofrod30 relative tosleeve32 causes thedistal end portion32aofsleeve32 to reform from its initial configuration toward its deformed configuration.
• Therotary handle100 includes a pair oflateral extensions110,112 extending outwardly from amain body portion114 to define a T-handle arrangement which aids the surgeon in rotating thehandle100 relative to thestationary handle102. Themain body portion114 includes an opening extending along longitudinal axis L and having a threadedportion116 and an unthreadedportion118. Ahub portion120 extends from themain body portion114 and defines anannular groove122.
• Thestationary handle102 includes a pairlateral extensions130,132 extending outwardly from amain body portion134 to define a second T-handle arrangement which aids the surgeon in securely grippinginstrument20 and in maintaining thehandle102 in a stationary rotational position during rotation ofhandle100. Themain body portion134 includes an opening extending therethrough along longitudinal axis L and defining afirst cavity136 and asecond cavity138. A pair ofopenings140,142 extend through themain body portion134 and are disposed in communication with thefirst cavity136. Thehub portion120 ofhandle100 is inserted within thefirst cavity136 and a pin orfastener148 is inserted throughopening140 and positioned within theannular groove122 to axially couplerotary handle100 tostationary handle102 while permitting relative rotational displacement therebetween.
• Theactuator member106 includes a threadedshank portion150 and an unthreadedshank portion152. The threadedshank portion150 is configured to threadingly engage the threadedopening116 inrotary handle100. In one embodiment of the invention, the threadedshank portion150 and the threadedopening116 each define right hand threads. The unthreadedshank portion152 includes a slottedopening154 extending therethrough that is aligned with theopening142 in thestationary handle102. A pin orfastener155 is inserted through theopening142 and the slottedopening154 to couple theactuator member106 to thestationary handle102. As should be apparent, pin155 substantially prevents relative rotational displacement betweenactuator member106 and handle102 while allowing a limited amount of relative linear displacement along longitudinal axis L. The distal end portion of theactuator member106 includes asocket156 configured to accept acorresponding ball portion158 extending from theproximal end portion30bofrod30. Thesocket opening156 includes aspherical portion160 sized to receive theball portion158 therein, and acylindrical portion162 sized to receive thedistal end portion30bofrod30 therethrough to connectrod30 toactuator member106. It should be understood, however, that other methods ofinterconnecting rod30 andactuator member106 are also contemplated as would occur to one of skill in the art.
• As discussed above, theconnector assembly104 is configured to connect theelongate member22, and more specifically theouter sleeve32, to the remainder of theactuator mechanism24. Theconnector assembly104 is generally comprised of agripper member170, alock collar member172 and a biasingmember174. Thegripper member170 includes a connectingsegment176, a grippingsegment178 and a longitudinal passage having afirst portion180 extending through connectingsegment176 and asecond portion181 extending through the grippingsegment178. Thefirst portion180 of the passage is sized to receive theshank portion152 ofactuator member150 therein, and thesecond portion181 of the passage is sized to receive theproximal end portion32bofsleeve32 therein.
• The grippingsegment178 ofgripper member170 has a generally conical shape and includes a taperedouter surface182. The grippingsegment178 also includes alongitudinally extending slit183 and a pair oftransverse slots184 that intersect slit183, with both theslit183 and theslots184 intersecting thelongitudinal passage181. One purpose of theslit183 and theslots184 is to facilitate compression of the grippingsegment178 about theproximal end portion32bofsleeve32. Theproximal end portion32bofsleeve32 defines an opening orwindow185 extending therethrough to further facilitate gripping ofsleeve32 by grippingsegment178. Another purpose ofslit183 is to provide a passageway for the lateral insertion of theproximal end portion30bofrod30 therethrough to permit assembly with theactuator member106. The grippingsegment178 also includes an outertapered surface186, the purpose of which will become evident below.
• The connectingsegment176 ofgripper member170 defines anelongate opening187 extending transversely therethrough and being positioned in communication with thelongitudinal slit183. One purpose of theelongate opening187 is to facilitate compression of the grippingsegment178 about theproximal end portion32bofsleeve32. Another purpose of thetransverse slot187 is to provide a passageway for the lateral insertion of theball portion158 ofrod30 therethrough and into engagement with thesocket156 defined inactuator member106. The connectingsegment176 also includes anopening188 extending transversely therethrough and aligned with theopening142 in thestationary handle102.Pin155 is inserted through theopening188 to axially couple thegripper member170, and in turn theelongate member22, to thestationary handle102 in a manner that substantially prevents relative linear and rotational displacement therebetween.
• Thelock collar member172 includes a cylindrically-shapedbody portion190, atapered end portion192, and alongitudinal passage194 extending therethrough and being sized to receive the connectingsegment176 ofgripper member170 therein. Thecylindrical body portion190 is sized to be received withincavity138 ofstationary handle102. Thelongitudinal passage194 includes an innertapered surface196 that corresponds to the outer taperedsurface186 of grippingsegment178. In one embodiment of the invention, the biasingmember174 is a coil spring. However, it should be understood that other types of biasing devices may alternatively be used as would occur to one of skill in the art.
• Referring toFIG. 4,spring174 is disposed within thecavity138 ofstationary handle102 and is engaged against the proximal end of thelock collar172 to bias thelock collar172 toward the grippingsegment178. The biasing oflock collar172 engages the taperedinner surface196 tightly against the taperedouter surface186 of grippingsegment178. Such engagement creates an inward compression force onto the grippingsegment178 which causes the grippingsegment178 to collapse tightly about theproximal end portion32bofsleeve32 to securely gripsleeve32 within thelongitudinal passage181. The taperedouter surface192 oflock collar172 is oriented at about the same angle as the taperedouter surface182 of grippingsegment178 to provide a relatively smooth transition betweenlock collar172 andgripping segment178.
• Based on the above description and corresponding illustrations, it should be apparent that rotation ofhandle100 relative tostationary handle102 in a clockwise direction (assuming right hand threading) will cause theactuator member106 to be linearly displaced in the direction of arrow A, which will correspondingly causerod30 to be linearly displaced in the direction of arrow A. Furthermore, since the distal end portion ofsleeve32 is engaged with the distal end portion ofrod30, linear displacement ofrod30 in the direction of arrow A will cause the deformabledistal end portion32aofsleeve32 to buckle outwardly toward the deformed configuration illustrated inFIG. 6. It should also be apparent that rotation ofhandle100 relative tostationary handle102 in a counter-clockwise direction will cause theactuator member106 to be linearly displaced in the direction of arrow B, which will correspondingly causerod30 to be linearly displaced in the direction of arrow B. Linear displacement ofrod30 in the direction of arrow B will cause the deformabledistal end portion32aofsleeve32 to reform back toward the insertion configuration illustrated inFIG. 5. As should be apparent, instead ofrotating handle100 relative to handle102 to impart relative linear displacement betweenrod30 andsleeve32, it is also possible to holdhandle100 in a stationary position and to rotate handle102 relative to handle100 to impart relative linear displacement betweenrod30 andsleeve32.
• Although one specific embodiment of theactuator mechanism24 has been illustrated and described herein, it should be understood that the use of other types and configurations of actuator mechanisms are also contemplated as would occur to one of skill in the art. As should be apparent, any type of actuator mechanism that is capable of imparting relative displacement betweenrod30 andsleeve32 to reform thedistal end portion32aofsleeve32 between the initial and deformed configurations may be used. It should further be understood that in an alternative form of the invention,rod30 may be manually displaced by the surgeon relative tosleeve32, thereby eliminating the need for aseparate actuator mechanism24.
• Referring now toFIGS. 5 and 6, shown therein is thedistal end portion22aofelongate member22, as shown in an initial insertion configuration and a mechanically deformed expanded configuration, respectively. When in the initial configuration (FIG. 5), thedistal end portion32aofsleeve32 has a relatively low profile to facilitate positioning adjacent a vertebral body. As should be appreciated, the roundeddistal end portion38 reduces the likelihood of damage to adjacent tissue during such positioning. As used herein, positioning of thedistal end portion32aadjacent a vertebral body is meant to include positioning of thedistal end portion32ain proximity to a vertebral body, within a vertebral body or within a space between adjacent vertebral bodies. As discussed above,instrument20 may also be used in association with spinal structures other than a vertebral body, such as, for example, a spinal implant, with thedistal end portion32aofsleeve32 being positioned adjacent or within the spinal implant when in the insertion configuration.
• Once properly positioned adjacent the vertebral body, thedistal end portion32aofsleeve32 is mechanically deformed by displacing therod30 relative to thesleeve32. In the illustrated embodiment of the invention, such relative displacement is accomplished by linearly displacingrod30 relative tosleeve32 in the direction of arrow A, and is initiated by the selective actuation ofactuator mechanism24. In an alternative embodiment of the invention, thedistal end portion32aofsleeve32 may be mechanically deformed toward the expanded configuration by way of relative rotational displacement betweenrod30 andsleeve32.
• When reformed toward the expanded configuration (FIG. 6), thedistal end portion32aofsleeve32 is outwardly deformed relative to longitudinal axis L so as to form a number of laterally extending projections orprotrusions198a,198b. As discussed above, the deformed configuration ofinstrument20 may define any number of laterally extending projections, including a single projection or three or more projections, and may define a number of laterally extending projections at various axial locations along longitudinal axis L. It should be apparent that the number, position, and direction of the laterally extending projections is at least partially controlled by the configuration and placement of theslots50 insleeve32. In this manner, formation of the laterally extending projections and the resulting displacement of the vertebral body is said to be directionally controlled. Moreover, if the deformed configuration ofinstrument20 defines asingle projection198a, or a single pair of opposingprojections198a,198baligned along a common transverse axis T, then formation of the laterally extending projection and the resulting displacement of the vertebral body is said to be uniaxial. Further, if the deformed configuration ofinstrument20 defines asingle projection198aextending in a single direction, then formation of the laterally extending projection and the resulting displacement of the vertebral body is said to be unidirectional.
• Following displacement of the vertebral body, thedistal end portion32aofsleeve32 may be reformed from its deformed/expanded configuration back toward its initial insertion configuration by linearly displacingrod30 relative tosleeve32 in the direction of arrow B. As discussed above, thedistal end portion32aofsleeve32 may be formed of a shape-memory material, such as, for example, a shape-memory alloy (“SMA”) to aid in reforming thedistal end portion32afrom the deformed configuration back toward its initial configuration. More specifically, SMAs are known to exhibit a characteristic or behavior in which a particular component formed of an SMA is capable of being deformed from an initial “memorized” shape or configuration to a different shape or configuration, and then reformed back toward its initial shape or configuration.
• The ability to possess a shape-memory characteristic or behavior is a result of the fact that the SMA undergoes a reversible transformation from an austenitic state to a martensitic state. If the martensitic transformation occurs due to the imposition of stress, the shape-memory phenomena is referred to as stress-induced martensitic transformation. As a result, SMAs are known to display a superelastic or rubber-like behavior in which a strain attained beyond the elastic limit of the SMA material during loading is recovered during unloading. This superelastic phenomena occurs when stress is applied to an SMA article at a temperature slightly higher than the temperature at which the SMA begins to transform into austenite (sometimes referred to as the transformation temperature or A_s). When stressed, the article first deforms elastically up to the yield point of the SMA material (sometimes referred to as the critical stress). However, upon the further imposition of stress, the SMA material begins to transform into stress-induced martensite. This transformation takes place at an essentially constant stress, up to the point where the SMA material is completely transformed into martensite. When the stress is removed, the SMA material will revert back into austenite and the article will automatically return toward its original, pre-programmed or memorized shape without a corresponding change in temperature.
• Further details regarding the superelastic phenomena of a SMA and additional characteristics of stress-induced martensite are more fully described by Yuichi Suzuki in an article entitledShape Memory Effect and Super-Elasticity in Ni—Ti Alloys, Titanium and Zirconium, Vol. 30, No. 4, Oct. 1982, the contents of which are hereby incorporated by reference. Additionally, while there are many alloys that exhibit shape-memory or superelastic characteristics, one of the more common SMAs is an alloy of nickel and titanium. One such well-known SMA is Nitinol®, which has proven to be highly effective for devices to be placed within the human body because its transformation temperature range generally falls between room temperature and normal human body temperature (i.e., at about 35-40 degrees Celsius). Moreover, Nitinol® has a very low corrosion rate and excellent wear resistance, thereby providing an advantage when used as a support structure within the human body. Additionally, implant studies in animals have shown minimal elevations of nickel in the tissues in contact with the Nitinol® material. It should be understood, however, that other SMA materials that exhibit superelastic characteristics are contemplated as being within the scope of the invention.
• If thedistal end portion32bofouter sleeve32 is formed of an SMA material and is reshaped or deformed while at a temperature above the transformation temperature A_sof the SMA, thedistal end portion32bwill automatically recover or reform toward its initial shape or configuration when the stress is removed fromdistal end portion32b. As illustrated inFIG. 5, whendistal end portion32bis in its unstressed initial configuration, virtually all of the SMA material will be in an austenitic state. However, upon the imposition of stress ontodistal end portion32b(e.g., by turningactuator handle100 in a clockwise direction relative to stationary handle102), at least a portion of the SMA material will transform into reversible stress-induced martensite as thedistal end portion32bis deformed toward the expanded configuration. Upon the reduction or removal of the stress (e.g., by turningactuator handle100 in a counter clockwise direction), at least a portion of the SMA material will be transformed back into austenite and thedistal end portion32bwill automatically reform back toward the initial configuration.
• Referring now toFIGS. 7 and 8, shown therein is the distal end portion of aninstrument200 according to another form of the present invention, as shown in an initial insertion configuration and a mechanically deformed configuration, respectively. It should be understood thatinstrument200 may be used in association with applications similar to those discussed above with regard toinstrument20, including both intrabody and interbody applications involving displacement of at least a portion of a vertebral body.
• Instrument200 is generally comprised of anelongate member222 extending along a longitudinal axis L and having a distal end portion (as shown) and a proximal end portion (not shown) coupled to an actuator mechanism which may be configured similar toactuator mechanism24. The distal end portion ofelongate member222 is deformable and is configured to outwardly expand in response to a mechanically induced force. Specifically, the distal end portion is reformable between an initial configuration (FIG. 7) for positioning adjacent a vertebral body, and a deformed configuration (FIG. 8) for displacement of at least a portion of the vertebral body. Although the illustrated embodiment depictselongate member222 as having a generally linear, unitary configuration, it should be understood thatelongate member222 may take on other configurations as well, such as, for example, a curvilinear configuration or a hinged configuration.
• In the illustrated embodiment ofinstrument200, theelongate member222 is generally comprised of aninner rod member230 and anouter sleeve member232. Theinner rod230 is preferably formed of a substantially rigid medical grade material such as, for example, titanium or stainless steel. Therod230 includes adistal end portion230athat is disposed within and coupled to adistal end portion232aofsleeve232. Althoughrod230 has been illustrated and described as having a substantially circular cross, it should be understood that other shapes and configurations are also contemplated as being within the scope of the present invention, such as, for example, elliptical, square, rectangular or other polygonal configurations.
• Theouter sleeve232 preferably has a tubular configuration defining an inner passage extending therethrough generally along longitudinal axis L and sized to slidably receiverod230 therein.Sleeve232 is formed of a relatively flexible material that is capable of being reformed from an initial configuration to an expanded configuration. Preferably,sleeve232 is formed of a relatively elastic material that is capable of being elastically deformed to the expanded configuration and reformed back toward the initial configuration.Sleeve232 may be formed of materials including, but not limited to, titanium, stainless steel, an elastomer, a polymer, a rubber, a composite material or a shape-memory material. Although the entire length ofsleeve232 may be formed of a flexible, elastic material, it should be understood that only thedistal end portion232aneed be formed of such material, with the remainder ofsleeve232 being formed of any suitable medical grade material. Additionally, althoughsleeve232 is illustrated as having a substantially cylindrical or tubular configuration, it should be understood that other shapes and configurations ofsleeve232 are also contemplated as being within the scope of the present invention. Furthermore, althoughsleeve232 has been illustrated and described as being formed as a single-piece, unitary structure, it should be understood that thedistal end portion232acould be formed separately from the remainder ofsleeve232, and coupled together by any known method, such as, for example, by fastening, welding or adhesion.
• In one embodiment ofinstrument200, thedistal-most end portion270 ofsleeve232 is secured to thedistal end portion230aofrod230 by way of crimping. In other embodiments,sleeve portion270 may be connected torod portion230aby a compression ring similar tocompression ring70, or by other connection techniques such as, for example, fastening, welding, adhesion, or other methods of attachment known to those of skill in the art.
• Thedistal end portion232aofsleeve232 includes at least one rectangular-shaped window or slot250 extending generally along longitudinal axis L, and preferably includes at least a pair ofslots250 and252 (not shown) disposed generally opposite one another so as to define a pair of longitudinally extending flexible strips ofmaterial254,256. However, it should be understood that thedistal end portion232aofsleeve232 could define any number of longitudinally extending slots, including three or more slots, which would in turn define a corresponding number of flexible strips of material disposed between the slots. Theslots250,252 are provided to facilitate outward buckling of thedistal end portion232aofsleeve232 upon the imposition of relative linear displacement betweenrod230 andsleeve232. As illustrated inFIG. 8, when reformed toward the expanded configuration, the flexible strips ofmaterial254,256 will outwardly buckle along transverse axis T at a location adjacent the midpoint ofslots250,252. In the illustrated embodiment ofinstrument200, theslots250,252 are substantially identical in shape and configuration. However, it should be understood thatslots250,252 may take on different predetermined shapes and configurations. Additionally, althoughslots250,252 and strips ofmaterial254,256 are illustrated as having a generally rectangular shape, other predetermined shapes and configurations are also contemplated.
• When in the initial configuration (FIG. 7), thedistal end portion232aofsleeve232 has a relatively low profile to facilitate positioning adjacent a vertebral body. However, once properly positioned adjacent the vertebral body, thedistal end portion232ais mechanically deformed by displacingrod230 relative tosleeve232. In the illustrated embodiment, such relative displacement is accomplished by linearly displacingrod230 relative tosleeve232 in the direction of arrow A. In an alternative form of the present invention, thedistal end portion232aofsleeve232 may be mechanically deformed toward the expanded configuration by way of relative rotational displacement betweenrod230 andsleeve232.
• When reformed toward the expanded configuration (FIG. 8), thedistal end portion232aofsleeve232 is outwardly deformed relative to longitudinal axis L so as to form a number of laterally extending projections orprotrusions298a,298b. As discussed above, the deformed/expanded configuration ofinstrument200 may alternatively define any number of laterally extending projections, including a single projection or three or more projections. Similar toinstrument20, formation of the laterally extending projections and the resulting displacement of the vertebral body byinstrument200 is directionally-controlled, and can be uniaxial, unidirectional or both uniaxial and unidirectional. Following displacement of the vertebral body, thedistal end portion232aofsleeve232 may be reformed back toward its initial insertion configuration by linearly displacingrod230 relative tosleeve232 in the direction of arrow B. As discussed above with regard toinstrument20, thedistal end portion232aofsleeve232 may be formed of a shape-memory material, such as, for example, a shape-memory alloy to aid in reformingdistal end portion232aback toward its initial configuration.
• In one embodiment of the invention, at least the distal end portion of theelongate member222 is covered by aflexible membrane280. Theflexible membrane280 is preferably formed of a resilient material that is capable of conforming to the shape of thedistal end portion232aofsleeve232 during reformation between the initial and deformed configurations. Such flexible materials include, but are not limited to, silicone, latex, rubber, a polymer or other suitable elastomeric materials. One purpose of theflexible membrane280 is to prevent tissue or other foreign material from passing through theslots250,252 and being deposited within the space between the strips ofmaterial254,256 and therod230 and/or between therod230 and the remainder of thesleeve232. As should be appreciated, such a build-up of tissue or foreign material may block or otherwise inhibit reformation of thedistal end portion232aofsleeve232 from the deformed configuration (FIG. 8) back toward the initial configuration (FIG. 7). Although theflexible membrane280 is illustrated as covering the distal end portion ofelongate member222, it should be understood that theflexible membrane280 could be sized to cover the entire length of theelongate member222. It should also be understood that a flexible membrane similar toflexible membrane280 may be used in association with thesurgical instrument20 discussed above and/or thesurgical instrument300 discussed below.
• Referring now toFIGS. 9-11, shown therein is the distal end portion of aninstrument300 according to another form of the present invention, as shown in an initial insertion configuration, a partially deformed intermediate configuration, and a fully deformed configuration, respectively. It should be understood thatinstrument300 may be used in association with applications similar to those discussed above with regard toinstrument20, including both intrabody and interbody applications involving displacement of at least a portion of a vertebral body.
• Instrument300 is comprised of anelongate member322 extending generally along a longitudinal axis L and having a distal end portion (as shown) and a proximal end portion (not shown) which may be coupled to an actuator mechanism similar to actuator mechanism. The distal end portion is deformable and is configured to outwardly expand upon the imposition of a mechanically induced force. Specifically, the distal end portion is reformable between an initial configuration (FIG. 9) for positioning adjacent a vertebral body, and a deformed configuration (FIG. 11) for displacement of at least a portion of the vertebral body. Although the illustrated embodiment depictselongate member322 as having a generally linear, unitary configuration, it should be understood thatelongate member322 may take on other configurations as well, such as, for example, a curvilinear configuration or a hinged configuration.
• In the illustrated embodiment ofinstrument300, theelongate member322 is generally comprised of aninner rod member330 and anouter sleeve member332. Theinner rod330 is preferably formed of a substantially rigid medical grade material such as, for example, titanium or stainless steel.Rod330 includes adistal end portion330aextending from amain body portion330b. In the illustrated embodiment, thedistal end portion330ahas a rectangular shape and themain body portion330bhas a square shape. However, it should be understood that other shapes and configurations ofrod330 are also contemplated as being within the scope of the present invention such as, for example, circular, elliptical or polygonal configurations.
• Theouter sleeve332 has a deformabledistal end portion332acoupled to amain body portion332b. Themain body portion332bhas a square configuration defining an inner passage extending therethrough generally along longitudinal axis L and sized to slidably receiveportion330bofrod330 therein. How-ever, it should be understood that other shapes and configurations ofsleeve portion332bare also contemplated as being within the scope of the present invention. Preferably, themain body portion332bis formed of a substantially rigid material, such as, for example, titanium, stainless steel or other substantially rigid medical grade materials.
• The deformabledistal end portion332aofsleeve332 is at least partially formed of a relatively flexible material that is capable of being reformed from the initial configuration illustrated inFIG. 9 toward the deformed configuration illustrated inFIG. 1. Preferably,distal end portion332bis formed of a relatively elastic material that is capable of being elastically deformed toward the deformed configuration and reformed back toward the initial configuration. The deformabledistal end portion332bmay be formed of materials including, but not limited to, titanium, stainless steel, an elastomer, a polymer, a rubber, a composite material or a shape-memory material.Distal end portion332bis preferably formed separately frommain body portion332aand connected thereto by any method know to one of skill in the art, such as, for example, by fastening, welding or adhesion. However, is should be understood thatdistal end portion332bcould alternatively be formed integral withmain body portion332ato define a single-piece, unitary structure.
• The deformabledistal end portion332aofsleeve332 includes a plurality of wall elements354-357 that are flexibly interconnected by a number orinterconnection portions360. In one embodiment of the invention, theinterconnection portions360 are defined by forming an opening orchannel362 at locations where adjacent wall elements adjoin to one another. In one embodiment of the invention the wall elements354-357 are integrally formed to define a unitary, single-piece reformable structure that is collapsible to define a relatively low-profile insertion configuration and expandable to define an outwardly deformed configuration.
• To aid in reformation of thedistal end portion332abetween the insertion and deformed configurations, thedistal end portion332aofsleeve332 is preferably flexibly coupled to themain body portion332b. In one embodiment. theouter wall elements354,355 each include aflexible interconnection portion366 defined by forming an opening orchannel367 adjacent their respectivedistal end portions354a,355a. Thedistal end portions354a,355aof theouter wall elements354,355 are in turn coupled to inner surfaces of themain body portion332bofsleeve332, such as, for example, by fastening, welding or adhesion. Theouter wall elements354,355 are separated by a distance sufficient to receive thedistal end portion330aofrod330 therebetween.
• As shown inFIG. 9, the insertion configuration has a substantially rectangular-shaped profile, with each of the wall elements354-357 being disposed in a substantially uniform orientation (i.e., parallel to one another), and with the twoinner wall elements356,357 being disposed between the twoouter wall elements354,355. As shown inFIG. 11, the deformed/expanded configuration has a substantially triangular-shaped profile, with the twoinner wall elements356,357 being disposed in a substantially parallel and co-linear orientation, and the twoouter wall elements354,355 being disposed at an angle θ relative toinner wall elements356,357. In one embodiment, the angle θ is about 30°-45°. It should be understood that other insertion and expanded configurations are also contemplated as falling within the scope of the present invention. Additionally, although the reformabledistal end portion332bofsleeve332 has been illustrated and described as including four wall elements354-357, it should be understood that any number of wall elements may be flexibly interconnected to form the reformabledistal end portion332b.
• When in the initial folded configuration illustrated inFIG. 9, the deformabledistal end portion332aofsleeve332 has a relatively low profile to facilitate positioning adjacent a vertebral body. However, once properly positioned adjacent the vertebral body, thedistal end portion332ais mechanically deformed by displacingrod330 relative tosleeve332. In the illustrated embodiment, such relative displacement is accomplished by linearly displacingrod330 relative tosleeve332 in the direction of arrow B, and is initiated by the selective actuation of an actuator mechanism (not shown).
• As shown inFIG. 10, relative displacement ofrod330 in the direction of arrow B causes thedistal end portion330aofrod330 to engage theinterconnection portion360 extending between theinner wall elements356,357, thereby initiating the outward expansion or unfolding of the wall elements354-357. In one embodiment of the invention, thedistal end portion330aofrod330 is secured to theinterconnection portion360, such as, for example, by fastening, welding or adhesion. However, it should be understood that thedistal end portion330aofrod330 need not necessarily be rigidly secured tointerconnection portion360, but could alternatively form an abutting relationship therewith to initiate the outward expansion of wall elements354-357.
• As shown inFIG. 11, when reformed to the deformed configuration, the wall elements354-357 are unfolded and expanded outwardly relative to longitudinal axis L so as to form laterally extending projections orprotrusions398a,398bdisposed along a transverse axis T. Althoughinstrument300 has been illustrated and described as including a pair of oppositely disposedprojections398a,398bwhen in the expanded configuration, it should be understood that thedistal end portion332aofsleeve332 may be configured to define any number of projections, including a single projection or three or more projections. Further, similar toinstrument20, the expansion of thedistal end portion332aofsleeve332 and the resulting displacement of the spinal structure accomplished byinstrument300 is directionally-controlled, and can be uniaxial, unidirectional or both uniaxial and unidirectional.
• Following displacement of the vertebral body, thedistal end portion332aofsleeve332 may be reformed toward its initial insertion configuration by linearly displacingrod330 relative tosleeve332 in the direction of arrow A (FIG. 11). As discussed above with regard toinstrument20, thedistal end portion332aofsleeve332 may be formed of a shape-memory material, such as, for example, a shape-memory alloy (“SMA”) to aid in reformingdistal end portion332aback toward its initial configuration.
• Referring toFIG. 12, shown therein is a lateral view of a spinal column, illustrating the introduction and expansion ofinstrument20 within a vertebral body V₁to perform intrabody distraction. Thedistal end portion32aofsleeve30 is initially passed through an access opening (not shown) extending through an outer wall of the vertebral body V₁while in the undeformed initial configuration illustrated inFIG. 5. Subsequent to insertion within the vertebral body V₁, thedistal end portion32aofsleeve32 is reformed by a mechanically-induced force created by linearly displacingrod30 relative tosleeve32 in the direction of arrow A. As a result, thedistal end portion32ais outwardly deformed to form opposingprojections198a,198bextending along transverse axis T. Such outward deformation is particularly useful, for example, to compact or compress cancellous bone against the inner cortical wall of the vertebral body V₁to form a cavity C therein. Compaction of the cancellous bone may have the effect of exerting an outward force on the inner surface of the cortical wall, making it possible to elevate or push broken and/or compressed bone back to or near its original pre-fracture condition or another desired condition. Alternatively, the opposingprojections198a,198bmay bear directly against the inner surface of the cortical bone to reduce a compression fracture in the vertebral body V₁.
• In one form of the present invention, access into the inner cancellous region of the vertebral body V₁is be accomplished by drilling a relatively small access opening through an outer wall of the vertebral body, such as, for example, through the pedicular region of the vertebral body V₁. The undeformed initial configuration of thedistal end portion32aofsleeve30 is sized to pass through the small access opening to gain access to the inner cancellous region of the vertebral body V₁. In this manner, insertion of thedistal end portion32aofsleeve32 is accomplished in a minimally invasive manner. Additionally, unlike certain prior art devices that require a relatively larger access opening to accommodate spreading of the proximal end portions of opposing members attached to one another in a scissors-like manner, only thedistal end portion32aofsleeve32 is outwardly expanded when reformed toward the deformed configuration.
• In one embodiment of the invention, the initial configuration of thedistal end portion32aofsleeve32 is sized to pass through an access opening having a diameter between about 1 millimeter and about 5 millimeters. In a specific embodiment, the initial configuration of thedistal end portion32ais sized to pass through an access opening having a diameter of about 3 millimeters. In another embodiment of the invention, the deformed configuration of thedistal end portion32aofsleeve30 is sized to displace the vertebral body V₁within a range of about 3 millimeters to about 15 millimeters. In a specific embodiment, the deformed configuration of thedistal end portion32ais sized to displace the vertebral body V₁about 10 millimeters. In another specific embodiment of the invention, theinstrument20 is capable of assuming a deformed configuration that is over three times greater than its initial configuration. Although ranges and specific sizes of the initial and deformed configurations ofdistal end potion32bofsleeve32 have been set forth above, it should be understood that such ranges and specific sizes are exemplary and are not intended to limit the scope of the present invention in any manner whatsoever.
• Following displacement of the vertebral body V₁, thedistal end portion32aofsleeve32 is reformed toward its initial insertion configuration by displacingrod30 relative tosleeve32 in the direction of arrow B. As a result, the opposingprojections198a,198bare inwardly deformed to the extent necessary to provide uninhibited removal of thedistal end portion32aofsleeve32 from the vertebral body V₁. As discussed above, reformation of theinstrument20 back toward its initial insertion configuration may be facilitated by forming thedistal end portion32aofsleeve32 from a shape-memory material. Following the removal ofinstrument20 from the vertebral body V₁, the cavity C may be filled with a biocompatible filling material, such as, for example, methylmethacrylate cement (e.g., bone cement), a structural implant, and/or a therapeutic substance to promote healing. Once set to a hardened condition, the filling material provides internal structural support to the vertebral body V₁, and more particularly provides structural support to the cortical bone of the vertebral body V₁.
• In another form of the present invention, acannula assembly400 may be used to provide minimally invasive access to the vertebral bodies V₁, V₂and/or the disc space D. As shown inFIG. 12, use of thecannula assembly400 permits displacement of the vertebral body V₁via insertion and manipulation ofinstrument20 through a single working channel. Further details regarding a cannula assembly suitable for use in association with the present invention are disclosed in U.S. patent application Ser. No. 09/692,932 to Foley et al., filed on Oct. 20, 2000, the contents of which are incorporated herein by reference.
• Thecannula assembly400 includes acannula402 having adistal end402aand defining aninner working channel404 extending between thedistal end402aand a proximal end (not shown). The length of thecannula402 is sized such that the proximal end (not shown) of thecannula402 is positioned beyond the skin of the patient when thedistal end402ais positioned adjacent the vertebral body V₁. One advantageous feature of thecannula assembly400 is the relatively large cross section of the workingchannel404 extending throughcannula402. Such a large cross section permits the surgeon to introduce a wide variety of instruments or tools into the workingchannel404, as well as the simultaneous introduction of two or more instruments or tools. Furthermore, the relatively large cross section of workingchannel404 permits a wide range of motion of the instruments and tools.
• Thecannula assembly400 may also include an endoscope assembly (not shown) mounted to the proximal end portion of thecannula402 to provide remote visualization of the surgical site. The endoscope assembly may include, for example, aviewing element406 disposed within the workingchannel404 ofcannula402 and having adistal end406apositioned adjacent the surgical site. Theviewing element406 is preferably linearly and rotatably displaceable within the workingchannel404 to provide a wide degree of visualization of the surgical site. The endoscope assembly may also include an illumination element (not shown), a remote viewing apparatus such as an eyepiece (not shown), and/or irrigation and aspiration components (not shown) extending alongviewing element406. One embodiment of an endoscope assembly suitable for use in association with the present invention is described in U.S. Pat. No. 6,152,871 to Foley et al., issued on Nov. 28, 2000, the contents of which are incorporated herein by reference. Thecannula assembly400 may also include a microscopic viewing system (not shown) mounted to the proximal end portion of thecannula402 to provide microscopic visualization of the surgical site. One embodiment of a microscopic viewing system suitable for use in association with the present invention is described in U.S. patent application Ser. No. 09/815,693 to Foley et al., filed on Mar. 23, 2001, the contents of which are incorporated herein by reference.
• AlthoughFIG. 12 illustrates the use ofinstrument20 to at least partially displace the vertebral body V₁, it should be understood thatinstruments200 and300 could alternatively be used to perform the technique. It should also be understood that in addition to performing intrabody distraction,instruments20,200 and300 may be used to perform interbody distraction of one or both of the adjacent vertebral bodies V₁, V₂, such as, for example, to increase the height of the disc space D. Interbody distraction of adjacent vertebral bodies V₁, V₂may also be effective to increase the distance between corresponding portions of the vertebral bodies V₁, V₂. In cases involving brittle portions of the vertebral bodies V₁, V₂, shims may be positioned between the deformabledistal end portion32aofsleeve32 and the vertebral bodies V₁, V₂to distribute the compressive force over a larger area to avoid puncturing or crushing of the brittle portions. It should additionally be understood that although the distraction technique illustrated inFIG. 12 uses a posterior surgical approach, other surgical approaches are also contemplated, such as, for example, anterior, lateral, and postero-lateral approaches.
• While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiments have been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.

Claims (24)

1.-79. (canceled)

80. A method for treatment of the spine, comprising:

providing an instrument including a deformable distal portion having an insertion configuration and a deformed configuration, the deformed configuration defining at least one transverse projection arranged along a single transverse axis;

positioning the deformable distal portion adjacent a spinal structure while in the insertion configuration; and

deforming the distal portion toward the deformed configuration to uniaxially displace at least a portion of the spinal structure along the transverse axis.

81. The method ofclaim 80, wherein the deforming is directionally controlled.

82. The method ofclaim 80, further comprising:

deforming the distal end portion back toward the insertion configuration; and

removing the distal end portion from the spinal structure.

83. The method ofclaim 80, wherein the positioning comprises inserting the deformable distal portion through an outer wall of a vertebral body; and

wherein displacement of the at least a portion of the spinal structure comprises compacting cancellous bone to form a cavity within the vertebral body.

84. The method ofclaim 80, wherein the positioning comprises inserting the deformable distal portion through an outer wall of a vertebral body; and

wherein displacement of the at least a portion of the spinal structure comprises at least partially reducing a compression fracture in the vertebral body.

85. The method ofclaim 80, wherein the positioning comprises inserting the deformable distal portion into an intervertebral disc space between adjacent vertebral bodies; and

wherein displacement of the at least a portion of the spinal structure comprises exerting a force onto the adjacent vertebral bodies and distracting the intervertebral disc space.

86. The method ofclaim 80, wherein the deforming of the distal portion toward the deformed configuration comprises selectively controlling the deforming to generate a controlled magnitude of force against the at least a portion of the spinal structure.

87. The method ofclaim 80, wherein the instrument includes a first member and a second member engaged with the first member, the second member comprising the deformable distal portion, the deforming of the distal portion occurring in response to relative displacement between the first and second members, the relative displacement between the first and second members being regulated to generate a controlled magnitude of force against the at least a portion of the spinal structure.

88. A method for treatment of the spine, comprising:

providing an instrument including a first member and a second member engaged with the first member, the second member including a deformable distal portion having an insertion configuration and a deformed configuration;

positioning the deformable distal portion adjacent a spinal structure while in the insertion configuration; and

deforming the distal portion toward the deformed configuration in response to relative displacement between the first and second members, the deformed configuration displacing at least a portion of the spinal structure.

89. The method ofclaim 88, wherein the relative displacement between the first and second members is regulated to control the deforming and to generate a controlled magnitude of force against the at least a portion of the spinal structure.

90. The method ofclaim 88, wherein the deforming is directionally controlled.

91. The method ofclaim 88, wherein the deformed configuration of the distal portion defines at least one transverse projection arranged along a single transverse axis; and

wherein the deforming of the distal portion toward the deformed configuration uniaxially displaces at least a portion of the spinal structure along the transverse axis.

92. The method ofclaim 88, further comprising:

inserting a cannula having a working channel through the skin and tissue of a patient;

positioning a distal end of the cannula adjacent a vertebral body; and

inserting the distal end portion of the instrument through the working channel to access the vertebral body.

93. The method ofclaim 92, further comprising inserting a viewing element into a working channel of the cannula to provide visualization of the vertebral body.

94. A method for treatment of the spine, comprising:

providing an instrument including a deformable distal end portion having an insertion configuration and a deformed configuration;

inserting a cannula having a working channel through the skin and tissue of a patient;

positioning a distal end of the cannula adjacent a spinal structure;

inserting the deformable distal end portion of the instrument through the working channel of the cannula;

positioning the deformable distal end portion proximately adjacent the spinal structure while in the insertion configuration; and

deforming the deformable distal end portion toward the deformed configuration to displace at least a portion of the spinal structure.

95. The method ofclaim 94, wherein the deformed configuration of the deformable distal end portion defines at least one transverse projection arranged along a single transverse axis; and

wherein the deforming results in uniaxially displacing the at least a portion of the spinal structure along the single transverse axis.

96. The method ofclaim 94, wherein the deforming is directionally controlled.

97. The method ofclaim 94, wherein the positioning comprises inserting the deformable distal end portion through an outer wall of a vertebral body; and

wherein displacement of the at least a portion of the spinal structure comprises compacting cancellous bone to form a cavity within the vertebral body.

98. The method ofclaim 97, wherein the compacting results in at least partially reducing a compression fracture in the vertebral body.

99. The method ofclaim 94, wherein the deforming of the deformable distal end portion toward the deformed configuration comprises selectively controlling the deforming to generate a controlled magnitude of force against the at least a portion of the spinal structure.

100. The method ofclaim 94, wherein the instrument includes a first member and a second member engaged with the first member, the second member comprising the deformable distal end portion, the deforming of the distal end portion occurring in response to relative displacement between the first and second members.

101. The method ofclaim 100, wherein the relative displacement comprises linearly displacing the first member relative to the second member.

102. The method ofclaim 100, further comprising mechanically regulating the relative displacement between the first and second members to generate a controlled magnitude of force against the at least a portion of the spinal structure.

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