A percutaneous system in which tubular retractors are utilized as a means of access, visualization, and a controlled orientation for preparation of posterior spinal elements and delivery of graft material for posterior spinal fusion. The tubular retractors are affixed to screw extensions to rotate and articulate relative to multi-axial screws percutaneously inserted into respective pedicles of vertebral bodies. The procedure is done bilaterally, although it could be performed unilaterally in cases where the anatomy or surgeon preference dictates. A number of different deployable graft concepts are disclosed, the primary features being to allow for creation of a graft space volume and a means for delivery of the graft material preferred by the surgeon.

A bone graft delivery system can include an elongate tube, a handle having a trigger, and a tip. The trigger is actuated to deliver bone graft material through the tube. The tip has one or more openings to deliver the bone graft material to a desired location and includes a surface suitable to act as a rasp for decorticating bone. A method for delivering bone graft material to a desired surgical location includes providing a bone graft delivery device, positioning the device adjacent the surgical location, decorticating bone, and delivering bone graft material to the surgical location.

A catheter device that includes a double-threaded guidance wire that allows multiple use of a compliant cavity creation device (i.e., treatment of more than one level). The double-threaded guidance wire may be connected with the luer part of the device and a distal part of the balloon using a threaded engagement to avoid lengthening of the inner tube, avoid lengthening of the balloon, and to limit the plastic deformation of the system in axial direction. In other implementations, the double-threaded guidance wire may be reconnected to the distal part of the balloon with a distal thread of the double-threaded guidance wire in order to restore the nominal length.

A method for augmenting a tissue including introducing into the tissue a first thermoplastic material at a first condition; treating the first thermoplastic material to achieve a second condition that includes an at least partially crystalline skin; and introducing a second material into the tissue whereby the first thermoplastic material and the second material are contained by the at least partially crystalline skin. Also a method of fracture reduction in a tissue including exposing to gamma radiation a mass of polycaprolactone characterized by a first shape; heating the mass of irradiated polycaprolactone above its melting temperature; introducing the heated mass of polycaprolactone into the tissue annulus to deform it from the first shape; allowing the material to return to the first shape.

Methods and devices are shown for forming polymer fasteners into bone by expelling the polymer from a cannula. Devices and methods shown allow a user to form multiple fasteners of various sizes without re-loading a device. Devices and methods shown further provide temperature profiles during fastener formation that reduce or eliminate thermal necrosis. Devices and methods shown further provide fasteners with increased strength.

An improved handheld instrument assembly for penetrating into a patient's spine, the instrument assembly has a needle, an outer sleeve, and a removable handle. The needle has a shaft with a bone penetrating tip at a distal end and an enlarged head rotationally fixed to the needle shaft at a proximal end. The outer sleeve is for receiving the needle. The removable handle is configured to removably attach to and engage the handle attachment from the distal side or the proximal side at the discretion of a surgeon. The removable handle has a T shaped body. The removable handle has a slotted opening on a frontal side, the slotted opening being sized to pass over the outer sleeve between the distal end and the handle attachment when the needle is inserted into the patient.

A surgical system including an expandable device is provided, including an inflatable body, an inner shaft and an outer shaft. The inflatable body has at least one folded segment, which are housed in a distal portion of the outer shaft. The inflatable body is tethered to a portion of the outer shaft. The inner shaft is affixed to a portion of the inflatable body, and is configured to control an axial and/or a radial inflation pattern of the folded inflatable body.

Systems and methods for treating conditions and diseases of the spine are disclosed herein. A device includes a balloon catheter comprising at least one inner lumen incorporated within an elongated shaft; a distal end having an inner balloon positioned inside and completely surrounded by an outer balloon; and a proximal end having an adapter for passage of at least one of an inflation fluid or a medical instrument; and an optical fiber comprising an outer diameter sized to pass through the inner lumen of the elongated shaft; a nonlinear light-emitting portion of a given length, wherein a portion of a cladding material from the nonlinear light-emitting portion has been removed so that light energy may be emitted along the length of the nonlinear light-emitting portion; and a linear elongated portion for guiding light towards the nonlinear light-emitting portion.

Methods and apparatus for treating bones, including, in one or more embodiments, methods and apparatus for treatment of vertebral fractures that include an inflation device for cavity creation and an inflation and containment device for maintaining vertebral height and cement containment. Methods for treating a bone comprising: creating a cavity in the bone; inflating a containment jacket in the cavity; inflating a balloon within the containment jacket so that the balloon occupies a first portion of the containment jacket; introducing a first filler material into a second portion of the containment jacket, wherein the second portion of the containment jacket is not occupied by the balloon; removing the balloon from the containment jacket; and introducing a second filler material into the first portion of the containment jacket.

A method for augmenting a tissue including introducing into the tissue a first thermoplastic material at a first condition; treating the first thermoplastic material to achieve a second condition that includes an at least partially crystalline skin; and introducing a second material into the tissue whereby the first thermoplastic material and the second material are contained by the at least partially crystalline skin. Also a method of fracture reduction in a tissue including exposing to gamma radiation a mass of polycaprolactone characterized by a first shape; heating the mass of irradiated polycaprolactone above its melting temperature; introducing the heated mass of polycaprolactone into the tissue annulus to deform it from the first shape; allowing the material to return to the first shape.