Apparatus and methods for bone cavity preparation. Formed broaching members may be supported inside a bone by a rotator. The broaching members may be bowed out inside the bone to create a cavity having a shape determined by the broaching members and bone anatomy.

Methods and apparatus for treating bones, including, in one or more embodiments, a device for delivering a bone filler material comprising: a housing having a throughbore; a plunger comprising a shaft having external threads, wherein the plunger is configured for advancement through the throughbore of the housing; and a threaded receiving member configured to releasably engage the plunger. Methods for removing an instrument from a vertebral body comprising applying ultrasonic energy to the instrument, wherein a distal end of the instrument is disposed in a cavity in the vertebral body, wherein the cavity contains a filler material; and removing the instrument from the vertebral body.

Methods for altering the natural history of degenerative disc disease and osteoarthritis of the spine are proposed. The methods focus on the prevention, or delayed onset or progression of, subchondral defects such as bone marrow edema or bone marrow lesion, and subchondral treatment to prevent the progression of osteoarthritis or degenerative disc disease in the spine and thereby treat pain.

A device for safely approaching vertebral disc space utilizing stereotactic guidance, clearing material from the disc space, a device for expanding the disc space, stereotactic methods for implant planning and monitoring articulating instrument end effectors and a device for implantation into the disc space for the purpose of fusion or disc replacement.

Apparatus and methods for bone cavity preparation. Formed broaching members may be supported inside a bone by a rotator. The broaching members may be bowed out inside the bone to create a cavity having a shape determined by the broaching members and bone anatomy.

Intervertebral discs are avascular. Oxygen, nutrients and bicarbonate diffuse from capillaries in cartilaginous endplates into discs to feed and maintain disc cells. As we age, calcified layers form at the endplates, blocking and occluding capillaries. Diffusion zones of oxygen and nutrients in disc become shallow. Cells in mid-layer of the disc suffer chronic anaerobic and starving conditions. Lactic acid is produced. Disc cells die from starvation, causing disc degeneration and forming fissures in annulus. Lactic acid leaks from fissures to the outer annulus of the disc to cause irritation, inflammation and persistent pain. Spirals of filament are implanted into the painful and degenerating disc to draw oxygen, nutrients and bicarbonate from the shallow diffusion zones of the cartilaginous endplates into the mid-layer of the degenerating disc. Oxygen inhibits anaerobic production of lactic acid; nutrients feed disc cells to halt disc degeneration; bicarbonate neutralizes lactic acid in the mid-layer to relieve pain.

A flexible chain implant for insertion into an interior volume of a vertebral body. The implant may be implanted in an insertion position for sliding through a cannula and is flexible for packing into the interior volume in an implanted configuration. The implant randomly separates in the implanted configuration. The implant includes a top member and a bottom member, wherein the top and bottom members are coupled to one another at a coupled portion. The top and bottom members preferably each include an inner surface such that the inner surfaces include a plurality of alternating projections and recesses so that the projections are received within the recesses in an insertion position. Alternatively, the implant may include a plurality of substantially non-flexible bodies and a plurality of substantially flexible links interconnecting the bodies. The non-flexible bodies include a plurality of facets and/or abutment surfaces.

Methods for altering the natural history of degenerative disc disease and osteoarthritis of the spine are proposed. The methods focus on the prevention, or delayed onset or progression of, subchondral defects such as bone marrow edema or bone marrow lesion, and subchondral treatment to prevent the progression of osteoarthritis or degenerative disc disease in the spine and thereby treat pain.

Implants and methods for augmentation, preferably by minimally invasive procedures and means, of body tissue, including in some embodiments repositioning of body tissue, for example, bone and, preferably vertebrae are described. The implant may comprise one or more chain linked bodies inserted into the interior of body tissue. As linked bodies are inserted into body tissue, they may fill a central portion thereof and for example in bone can push against the inner sides of the cortical exterior surface layer, for example the end plates of a vertebral body, thereby providing structural support and tending to restore the body tissue to its original or desired treatment height. A bone cement or other filler can be added to further augment and stabilize the body tissue. The preferred implant comprises a single flexible monolithic chain formed of allograft cortical bone having a plurality of substantially non-flexible bodies connected by substantially flexible links.

An implant for filling and/or distracting a body region, particularly a non-soft tissue cavity, has a plurality of segments wherein at least two of the segments are flexibly connected. The segments have a crush-strength sufficient to create and/or maintain the distraction of two or more non-soft tissue body surfaces, and to maintain the stability of the body region. The implant may be inserted into a cavity by an applicator having a cannula with a distal opening, and a rotary driver for applying force to move the implant within the cannula.