Systems and methods are described for correcting sagittal imbalance in a spine including instruments for performing the controlled release of the anterior longitudinal ligament through a lateral access corridor and hyper-lordotic lateral implants.

Systems, methods, and kits for performing endoscopic fusion with neuromonitoring. The endoscopic fusion may be performed, for example, through a cannula providing a portal to the disc space. Throughout various steps in the procedure, neuromonitoring may occur to minimize the possibility of injuring or contacting a nerve.

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 surgical device controllable by a surgical robotic system is provided. The surgical device includes a housing capable of being coupled to the surgical robotic system, a drive system at least partially mounted in the housing; and a shaft rotatably coupled to the drive system at a first end of the shaft. The surgical device further includes a tissue-removal assembly coupled to the second end of the shaft. The tissue-removal assembly includes a first cutting member having a plurality of rotatable blades. The first cutting member is coupled to a second end of the shaft. The tissue-removal assembly further includes a second cutting member, one or more support elements slidably or fixedly coupled to the second cutting member, and one or more extendable elements slidably or fixedly coupled to the second cutting member.

An approach is provided for delivering therapeutic materials to an intervertebral disc via a sub-ligamentous space. The approach includes positioning a tool at an interface of a longitudinal ligament and an outer surface of the intervertebral disc, in which the interface is the sub-ligamentous space. The tool may include a first needle and a second needle housed within the first needle. An insertion end of the first needle may include a shallow beveled end. The approach includes inserting the insertion end of the first needle into the sub-ligamentous space. The approach includes deploying the second needle from within the first needle into at least one of an annulus and a nucleus of the intervertebral disc. The approach includes delivering the therapeutic materials to the at least one of the annulus and the nucleus.

Systems and methods for augmenting a vertebral body. An introducer device includes a shaft having a flexible distal portion with a pre-set curve in an unconstrained state. An input provided to an actuator to tension a pulling element to move the pre-set curve to a constrained state in which the distal portion and a flexible sheath conforming to the shaft at least partially straighten. The introducer device is removable from the sheath remaining off-set from a longitudinal axis. A spacer hub facilitates proximal movement of the sheath relative to an access cannula expose a balloon through a syringe-style input. A hub of the access cannula may be adjustable to selectively adjust an interference surface relative to a datum. At least two radiopaque markers may be disposed on the sheath with relative positions between the markers viewable on lateral and A-P radiography to determine the location and/or curvature of the sheath.

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.

An access device for accessing an intervertebral disc having an outer shield comprising an access shield with a larger diameter (˜16-30 mm) that reaches from the skin down to the facet line, with an inner shield having a second smaller diameter (˜5-12 mm) extending past the access shield and reaches down to the disc level. This combines the benefits of the direct visual microsurgical/mini open approaches and the percutaneous, “ultra-MIS” techniques.

A disc implant device can be provided in a generally planar rectangular sheet having a first elongated side, a second elongated side opposing the first elongated side, a first end, and a second end opposing the first end. The generally planar rectangular sheet is structured with alternating segments of joint ridges, each segment of joint ridges being configured to form a spacing joint segment and alternating segments of arm ridges, each arm segment being configured to form a plurality of radially extending arms, the joint segments providing flexibility to the device. When the disc implant is folded or rolled from its planar configuration to a generally cylindrical configuration, the arm segments are axially collapsible and radially expandable such that in such a configuration, the implant includes segments of radially expanded arms separated by spacing joint segments.

Methods and surgical tools for treating back pain use a spinal facet debridement tool with cautery and denuding action and minimally invasive protocol that can denude and cauterize soft tissue associated with a synovial capsule of the spinal facet joint.