A surgical instrument includes a first member defining an axis and including an end surface and a passageway. A second member is movably disposed within the passageway and includes a tip and a plurality of spaced apart markings. The second member is movable between a first configuration in which the tip extends parallel to the axis and a second configuration in which the tip extends transverse to the axis. The end surface is aligned with a first one of the markings when the second member is in the first configuration and the end surface is aligned with a second one of the markings when the second member is in the second configuration. Methods are disclosed.

A system for penetrating the lateral cortex of a long bone includes a tubular cortex penetrator having an inner surface and an outer surface, a proximal end, and a distal end comprising a beveled cutting edge configured to penetrate the lateral cortex. A guide wire is configured to pass over the tubular cortex penetrator, and a guide sleeve is configured to surround the outer surface of the tubular cortex penetrator. A hollow extraction screw with an axial bore, a proximal end, a distal end, and a threaded cutting edge is configured to pass through the axial bore of the hollow extraction screw; and the hollow extraction screw is configured to retract into a distal end of a bore through the tubular cortex penetrator.

Described herein are various implementations of systems and methods for accessing and modulating tissue (for example, systems and methods for accessing and ablating nerves or other tissue within or surrounding a vertebral body to treat chronic lower back pain). Assessment of vertebral endplate degeneration or defects (e.g., pre-Modic changes) to facilitate identification of treatment sites and protocols are also provided in several embodiments. Several embodiments comprise the use of biomarkers to confirm or otherwise assess ablation, pain relief, efficacy of treatment, etc. Some embodiments include robotic elements for, as an example, facilitating robotically controlled access, navigation, imaging, and/or treatment.

A coiled shaft for tissue disruption is described herein where a flexible aspiration cannula has a first portion and a second portion formed of the coiled shaft. The cannula is configured in a particular embodiment to rotate over the length of the cannula to disrupt the matrix of bone marrow without the cannula buckling or collapsing. The cannula also includes a disruption tip coupled to the coiled shaft. The disruption tip has a radiused portion along a distal tip face of the disruption tip.

For fixedly implanting a device for material or signal delivery or acquisition or a part of such a device in a human or animal body, an opening is provided in hard tissue of the body, the opening reaching through a hard tissue layer, e.g. through a cortical bone layer into cancellous bone underneath. The device includes a plug portion and/or a cover portion which includes a ring of a material having thermoplastic properties extending around the plug portion or on a tissue facing surface of the cover portion. The opening provided in the hard tissue has a cross section at least in the area of its mouth that is adapted to the plug or cover portion such that the plug portion can be introduced through the mouth of the opening or the cover portion can be positioned over the mouth of the opening such that the ring extends around the opening, along its wall and/or on the hard tissue surface around its mouth.

This invention relates to local administration of a bone-forming agent and at least one anti-resorptive agent to treat osteoporosis and related disorders.

System and methods for channeling a path into bone include a trocar having a proximal end, distal end and a central channel disposed along a central axis of the trocar. The trocar includes a distal opening at the distal end of the trocar. The system includes a curved cannula sized to be received in the central channel, the curved cannula comprising a curved distal end configured to be extended outward from the distal opening to generate a curved path extending away from the trocar. The curved cannula has a central passageway having a diameter configured to allow a treatment device to be delivered through the central passageway to a location beyond the curved path.

The risk of bone cement extravasation can be reduced by delivering a calcium-dependent polymerizing sealant into a bone structure prior to delivery of bone cement into that structure. The polymerization of the sealant in response to the calcium within the bone structure can fill cracks and any other potential cement leakage paths, thereby minimizing the potential for subsequent extravasation. The benefits of the use of a calcium-dependent polymerizing sealant can be provided in any procedure involving the use of bone cement, such as spinal fixation, vertebroplasty, and kyphoplasty, among others.

System and methods for channeling a path into bone include a trocar having a proximal end, distal end and a central channel disposed along a central axis of the trocar. The trocar includes a distal opening at or near the distal end of the trocar. The system includes a curved cannula sized to be received in the central channel, and having a curved distal end configured to be extended laterally outward from the distal opening in a curved path extending away from the trocar. The curved cannula has a central passageway having a diameter configured allow a probe to be delivered through the central passageway to a location beyond the curved path.

A cannula for use in a terminable intraosseous device comprises a cannula body, and a penetrator-independent proximal bone penetration indicator (PBPI) associated with the body for positively indicating initial penetration into the proximal bone. In various embodiments, the PBPI comprises a roughened surface provided at a distal end of the cannula body to assist in increasing an amplitude of vibrations that are generated immediately upon contact with a proximal bone cortex during performance of an intraosseous injection, a resilient element fixed at one end which becomes plastically deformed, a visually indicative element which is exposed when the distance between the cannula body and penetrator is changed, or a frictionally engageable element. In some embodiments, a stopper prevents additional penetration into the proximal bone, and a reinforcing member inserted within a cannula body lumen reinforces a thin-walled portion of the cannula body.