A system for dynamically controlling a weld profile includes a generator, and end effector, a sensor, and a computer. The generator is configured to supply energy based on the weld profile. The end effector operatively connected to the generator and configured to apply vibratory energy and pressure to an object. The sensor configured to provide an output with respect to the object. The computer configured to monitor the output and change the weld profile of the generator based on the output.

An intervertebral implantation system for restoring disc height and vertebral alignment, while allowing dynamic mobility and stabilization of the vertebral segment, and minimally invasive methods of implanting the same. The implantation system includes an annular reinforcement implant, including an elastomeric balloon inserted into the hollow or interior of a tubular sleeve, and secured only at a first and second neck portions to a securement element coupled to an attachment fixture, forming an annular structure attached to the outer margin of the annulus fibrosus. When the prosthetic implant is in a contracted state the tubular sleeve is redundant and undulated, forming folds, gathered loosely around the circumference of the inner balloon. Upon pressurized inflation with in-situ curable polymer, the elastomeric balloon elongates and expands circumferentially, and the tubular sleeve stretches and unfolds, constraining further expansion and elongation of the elastomeric balloon. The attachment fixture is configured to provide secure attachment to the outer margin of the annulus fibrosus. A temporary, high pressure vertebral distraction balloon is utilized to aid in vertebral distraction during a surgical procedure to implant the annular reinforcement implant.

A percutaneous minimally-invasive procedure to prevent a potential fracture in an osteoporotic vertebra of an osteoporotic patient who has no history of vertebral fracture is provided by minimally-invasively injecting a non-dispersive, biocompatible and resorbable calcium-based cement paste into the osteoporotic vertebral body.

A central inflatable distractor and a perimeter balloon are inserted into the disc space in uninflated configurations. The central inflatable distractor is then expanded, thereby distracting the vertebral endplates to the controlled height of the central inflatable distractor. The perimeter balloon is then inflated with a curable substance. The perimeter balloon expands as it is filled with the curable substance and conforms to the void remaining in the disc space around the central inflatable distractor, thereby creating a horseshoe shape. Once the flowable material in the perimeter balloon has cured, the central inflated distractor can be deflated and removed. The remaining void (or inner space) is then packed with graft for fusion.

Methods and apparatus are disclosed for distracting tissue. The devices and methods may include insertion of first and second elongated members into the space between two tissue layers, with an augmenting elongated member at least partially inserted therebetween to form a distraction device between the tissues to be distracted. At least one of the first and second elongated members may be formed of a flexible core member with a plurality of rigid veneer members spaced along the length of the core member. At least one of the elongated members may include a shaping member that automatically moves from a generally linear configuration to a generally less linear configuration. A deployment catheter may include a deformable distal end to allow augmentation of the tissue distraction device during implantation. An injection aid may be provided for introducing a filler material into an interior defined by a deployed tissue distraction device.

An expandable introducer with embodiments that may include a fastener, tubular member, sleeve and combinations thereof. The sleeve may have a wall with an inner surface and an outer surface. The sleeve may include a slit through the wall, which may allow the sleeve to be decreased in diameter for implantation and/or increased in diameter after implantation for alignment. The sleeve may include two slits in the tubular wall thereby forming two semi-tubular members. The semi-tubular members may be placed separately at the implantation site then aligned to form a tubular member. The tubular member may include threads, pebbles, bumps, ridges, hills, openings and combinations thereof.

Methods and compositions for the biological repair of cartilage using a hybrid construct combining both an inert structure and living core are described. The inert structure is intended to act not only as a delivery system to feed and grow a living core component, but also as an inducer of cell differentiation. The inert structure comprises concentric internal and external and inflatable/expandable balloon-like bio-polymers. The living core comprises the cell-matrix construct comprised of HDFs, for example, seeded in a scaffold. The method comprises surgically removing a damaged cartilage from a patient and inserting the hybrid construct into the cavity generated after the foregoing surgical intervention. The balloons of the inert structure are successively inflated within the target area, such as a joint, for example. Also disclosed herein are methods for growing and differentiating human fibroblasts into chondrocyte-like cells via mechanical strain.

A central inflatable distractor and a perimeter balloon are inserted into the disc space in uninflated configurations. The central inflatable distractor is then expanded, thereby distracting the vertebral endplates to the controlled height of the central inflatable distractor. The perimeter balloon is then inflated with a curable substance. The perimeter balloon expands as it is filled with the curable substance and conforms to the void remaining in the disc space around the central inflatable distractor, thereby creating a horseshoe shape. Once the flowable material in the perimeter balloon has cured, the central inflated distractor can be deflated and removed. The remaining void (or inner space) is then packed with graft for fusion.

A surgical instrument and method are provided for removal of a spinal implant from the intervertebral disc space. The instrument includes a carriage body for interfacing with the implant, a housing for interfacing with the vertebrae, and a handle portion having a first portion rotatably coupled with a proximal end of the housing and a second portion rotatably engageable with a proximal attachment portion of the carriage body. A central passage of the housing extends between the proximal end and a distal engagement surface of the housing. The central passage is dimensioned to mate with the carriage body. Rotation of the handle portion about an axis causes translational movement of the carriage body along the axis. A modular inserter/distractor apparatus and method and an anchor remover and method are also provided.

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.