Intervertebral devices and associated systems and methods

Abstract

Spinal surgical procedures for implanting intervertebral devices and associated devices and systems are described herein. Representative spinal surgical procedures may include steps to gain access to the affected intervertebral disc of the patient's spine via minimally invasive lateral, transpedicle, transfacet joint, or transforaminal access routes. Various instruments may be inserted through a trocar to (i) remove part or all of the affected intervertebral disc, (ii) expand the intervertebral space around the affected intervertebral disc, (iii) insert an intervertebral device into the intervertebral space, and / or (iv) fill the intervertebral device with filling material. Each of the aforementioned steps can be performed through a minimally invasive access route provided by a trocar. This can minimize damage to the patient's soft tissues and minimize patient pain and recovery time.

Description

[Technical Field]

[0001] (Cross-reference of related applications) This application claims the benefits of (i) U.S. Provisional Patent Application No. 63 / 492,731, filed on 28 March 2023 and titled "INTERVERTEBRAL DEVICES, AND ASSOCIATED SYSTEMS AND METHODS", (ii) U.S. Provisional Patent Application No. 63 / 617,743, filed on 4 January 2024 and titled "INTERVERTEBRAL DEVICES, AND ASSOCIATED SYSTEMS AND METHODS", and (iii) U.S. Provisional Patent Application No. 63 / 562,033, filed on 6 March 2024 and titled "INTERVERTEBRAL DEVICES, AND ASSOCIATED SYSTEMS AND METHODS".

[0002] This technology applies to intervertebral devices, such as intervertebral fixation devices, and associated systems and methods that can be deployed with minimal invasiveness. [Background technology]

[0003] Degenerative joint diseases of the spine typically involve the continuous degeneration of the intervertebral discs and the two posterior facet joints, which act as a tripod to provide stability between the vertebrae of the spine. The degeneration of these joints is referred to as degenerative disc disease (DDD) or intervertebral disc arthropathy and degenerative facet joint disease or facet joint arthropathy, respectively. As a result of DDD, the intervertebral discs often thin, and disc height collapse occurs. Nerve foramina are openings through which spinal nerve roots pass when they are coming from the vertebral column, and the height of these nerve foramina directly corresponds to the height of the intervertebral disc. When disc height collapses, the original height of the nerve foramina also collapses, and therefore the exiting nerve roots are also compressed, which can induce neuralgia or radiculopathy extending down the leg. Disc height collapse can further cause ligament laxity and bulging in the spine. These ligaments, namely the posterior longitudinal ligament (PLL) and the ligamentum flavum, surround the spinal cord and can bulge into the spinal canal as the intervertebral disc height is compressed. As a result, compression of the entire spinal cord and / or meningeal sac occurs, located in the center of the spinal canal, which can cause weakness and fatigue in the legs (e.g., neurogenic claudication), in addition to nerve root pain that extends to the legs.

[0004] Surgical treatment for lower back pain and sciatica all involve pain etiologies stemming from degenerative joint disease of the intervertebral discs in the spine. Surgical treatment includes, among other things, treating mechanical instability of the spine, treating nerve root compression, and restoring the spine's original alignment.

[0005] Mechanical instability is a result of degeneration of both the intervertebral discs and / or posterior facet joints. Mechanical instability causes painful arthritis or arthropathy. Treating mechanical instability of the spine may include spinal fusion. Many spinal fusions aim to reduce mechanical instability and thereby reduce the movement of arthritis-affected joints that become inflamed with movement. Numerous methods of spinal fusion exist, including, for example, the surgical implantation of anterior and / or posterior fusion devices. The most widely used method of spinal fusion today is posterior screw fusion, used in combination with an intervertebral cage for anterior support.

[0006] As described above, nerve root compression can occur around the spinal cord or the meninges, or laterally around the exiting nerve root at the neural foramen. Pain from nerve root compression often progresses along the nerve root dermatome, causing radiculopathy or sciatica. Spinal surgical decompression is one way to treat nerve root compression, aiming to remove the neuralgia by removing the compression from the nerve root. This can be accomplished directly through the removal of bone / ligament / intervertebral disc compressing the nerve. It can also be accomplished indirectly using an intervertebral body spacer or an interlaminar spacer to mechanically increase the intervertebral height, thereby restoring the neural foramen height and reducing the bulge of the ligament / intervertebral disc that bulges centrally into the spinal canal.

[0007] One of the newer paradigms in spinal fixation and stabilization is to restore the natural alignment of the spine. For example, sagittal balance can be restored using an intervertebral spacer that restores the natural lordotic curvature of the spine. Restoring neutral spinal alignment enables the patient to walk or stand with a good posture rather than slouching forward. This reduces the strain on the paravertebral muscle groups in the spine. When performing spinal fixation, if the natural spinal alignment is not restored, often a "flatback syndrome" is brought about, and the patient is troubled by chronic low back pain due to muscle fatigue. In addition, inducing the natural sagittal balance using the use of an anterior lordotic spacer has become a major means in preventing degeneration in the adjacent intervertebral spaces above and below the spinal fixation.

[0008] Intervertebral spacers are an important part of spinal fixation due to reasons related to the basic principles of treating low back pain and neuralgia, such as treating mechanical instability, treating nerve root compression, and restoring the original alignment of the spine. Intervertebral spacers can improve the treatment of mechanical instability. For example, the insertion of an intervertebral spacer provides more anterior support in spinal fixation. This helps to stabilize mechanical instability. Some intervertebral spacers with a large footprint can be used as independent fixation devices. They can also be used in combination with posterior spinal fixation because they add anterior strut support and enable more rigid stabilization, which helps to prevent fixator loosening and fixation failure.

[0009] Intervertebral spacers can also improve the treatment of nerve root compression. For example, intervertebral spacers can be used to increase the height of the collapsed and degenerated intervertebral disc space. This enables an indirect restoration of the height of the associated neural foramen, which can relieve the compression of the spinal nerve root exiting at that vertebral level. In addition, increasing the height of the intervertebral disc space can restore the tension on the crushed and bulging ligaments within the spinal canal, namely, the PLL and the ligamenta flava. Restoring the tension on these ligaments through distraction, known as ligamentoplasty, can reduce the bulging of these ligaments into the spinal canal. The combination of neural foramen and spinal canal decompression methods can reduce radiculogenic sciatica and improve neurogenic claudication.

[0010] Intervertebral spacers can also help restore the spine's natural alignment. For example, when the spine deviates from its neutral global alignment (which primarily refers to a forward-leaning posture or deviation from sagittal alignment), the patient will suffer muscle pain as a back strain throughout the day in attempts to force the patient into a more neutral posture. The lumbar spine is constructed in its natural lordosis, which allows for standing in an upright, neutral position. As intervertebral discs degenerate, thin, and lose height, the lumbar spine often loses its lordosis, which is why older patients with degenerated spines are often forward-leaning. The popularity of intervertebral spacers is driven by the fact that restoring disc height or anterior column height can help bring a patient's spine into a more neutral or lordotic position. Thus, the harmony of spinal balance can be achieved using fixation. In fact, the use of lordosis and hyperlordosis intervertebral spacers is increasing, as they help to further induce lordosis in the lumbar spine and compensate for kyphosis at other degenerated levels. Until now, when the spine was fixed without the use of intervertebral spacers, spinal fixation often resulted in a flat or kyphotic position, which can leave patients with chronic pain, a condition known as "flatback" syndrome. Fixation without intervertebral spacers is gradually becoming obsolete. Currently, there are no existing percutaneous interbody systems that allow for prescribed lordosis correction in the spine.

[0011] Interbody fusion implants can be placed in the intervertebral space through any of the following approaches: posterior, lateral, or anterior. There are two posterior approaches: one is posterior lumbar interbody fusion (PLIF), in which the interbody fusion implant is placed through laminectomy, and the other is transforaminal lumbar interbody fusion (TLIF), in which the facet joint is resected and the interbody fusion implant is placed through a posterolateral approach. Lateral approaches to the spine for the placement of interbody fusion implants are called lateral lumbar or extreme lateral lumbar interbody fusion (LLIF / XLIF). There are two anterior approaches to the lumbar spine: one is a direct anterior open approach called anterior lumbar interbody fusion (ALIF), and the other is an anterolateral approach called oblique lumbar interbody fusion (OLIF). Each of these approaches, except ALIF, can be performed through either an open or traction-based minimally invasive approach. Current minimally invasive interbody fusion implants utilize an oblique posterolateral approach with a trajectory similar to TLIF, but necessitate a slightly more lateral trajectory to reach beneath the facet joints and target the Cambin's triangle. Typically, the facet joints are not removed using these approaches; rather, the intervertebral space is opened within the Cambin's triangle.

[0012] One drawback of intervertebral cage insertion is that, in order to gain access to the intervertebral space, there is still a significant amount of dissection and tissue trauma associated with open or minimally invasive open approaches, which directly leads to more severe postoperative pain and a longer recovery period. The use of less invasive traction devices allows for less tissue trauma, but still potentially involves tissue and nerve root traction, which can result in non-minor postoperative pain. Furthermore, current approaches using less invasive traction devices utilize smaller intervertebral implants that can pass through the access port. However, a drawback of using smaller implants is that they have a smaller contact surface area with the superior and inferior vertebrae, leading to poor support, which increases the risk of the implant itself collapsing into the adjacent vertebrae. Percutaneous approaches to the spine using tubular retractors are used to further limit tissue dissection and traction, but their adoption is limited due to poor visualization of the emanating nerves in the Cambin's triangle and the risk of nerve damage when attempting to retract within a collapsed foramen where the safety margin of the Cambin's triangle is even narrower. In addition, current percutaneous techniques are unfamiliar to many surgeons, require additional training, and low familiarity can often increase procedure time and risk.

[0013] Current developments in intervertebral fusion devices and techniques focus not only on minimizing the approach but also on restoring disc height and lordosis to restore spinal alignment. Existing open and minimally invasive techniques employ instruments such as raspers, curettes, bone cutters, and retractors to remove the intervertebral space, release the vertebral ligament attachments, and allow for intervertebral space separation. Many of these instruments are hampered when used in endoscopic or minimally invasive approaches because the system instruments are unable to allow the surgeon to properly prepare the intervertebral space due to the geometry to which the implant is deployed, as access is restricted during the procedure.

[0014] Several existing options for interbody fusion devices exist. The original interbody fusion devices were static polyether ether ketone (PEEK) or metal cages. To allow for improved lordosis correction, these static cages were either constructed and formed to create a lordosis angle, or inserted and filled on the anterior portion of the vertebral body, with screws that compressed posteriorly to induce lordosis. However, the disadvantages of both static and expandable posteriorly inserted cages remain, and they often collapse due to the fact that they do not conform well to the vertebral body, along with their small occupancy area and / or contact surface area on the vertebral endplate, which leads to point loading and endplate fractures. Expandable cages are more prone to endplate fractures, in particular, because expansion causes higher forces at the endplate / implant interface. Focused on inducing lordosis, expandable cages not only expand along the anterior wall but also cause point loading along the implant. These expandable cages can also reduce the overall contact surface area by lifting the vertebrae away from the more posterior portion of the rigid implant structure.

[0015] While cages positioned laterally and anteriorly certainly have a larger surface area and thereby improved endplate coverage, they still result in separate incisions and dissections for the approach. Currently, interbody fixation devices inserted endoscopically can only be expanded in height.

[0016] Lumbar intervertebral fusion devices are adapted for use in bone-mature patients with DDD at one, two, or more continuous levels of L2-S1. DDD is defined as discogenic low back pain with intervertebral disc degeneration, confirmed through medical history and radiographic examination. Patients with DDD may also have spondylolisthesis at the level involved. Intervertebral devices are adapted for use in conjunction with stabilization systems and autologous bone grafting. Intervertebral fusion devices aim to restore disc height and lumbar lordosis. Several methods of insertion for these devices exist, and their limitations vary across different approaches for insertion. Many insertion methods employ either anterior or posterior approaches, with anterior insertion carrying a greater risk of complications but achieving superior restoration of height and lumbar lordosis.

[0017] Due to the nature of the incisions and complications associated with anterior methods of inserting intervertebral devices, surgeons are gravitating towards posterior methods for insertion. Specifically, the transforaminal lumbar interbody fusion (TLIF) approach has become dominant in the field of interbody fusion. However, insertion at a posterolateral angle is accompanied by limitations on the occupied area size, which, given that a small insertion window limits the intervertebral space, can lead to a higher incidence of endplate fractures and collapses. [Brief explanation of the drawing]

[0018] Many aspects of this technology can be better understood by referring to the following drawings. The components in the drawings are not necessarily to scale. Instead, the focus is on clearly illustrating the principles of this technology.

[0019] [Figure 1A] Figures 1A and 1B are a side view and a top view of a portion of the spine according to an embodiment of the present technology, respectively, illustrating the access steps of a spinal surgical procedure. [Figure 1B]Figures 1A and 1B are a side view and a top view of a portion of the spine according to an embodiment of the present technology, respectively, illustrating the access steps of a spinal surgical procedure.

[0020] [Figure 1C] Figures 1C and 1D are a side view and a top view of a portion of the spine according to an embodiment of the present technology, illustrating the discectomy step of a spinal surgical procedure. [Figure 1D] Figures 1C and 1D are a side view and a top view of a portion of the spine according to an embodiment of the present technology, illustrating the discectomy step of a spinal surgical procedure.

[0021] [Figure 1E] Figures 1E and 1F are side views of a portion of the spine according to an embodiment of the present technology, illustrating the first and second stages of the balloon deployment step in a spinal surgical procedure. [Figure 1F] Figures 1E and 1F are side views of a portion of the spine according to an embodiment of the present technology, illustrating the first and second stages of the balloon deployment step in a spinal surgical procedure.

[0022] [Figure 1G] Figures 1G and 1H are corresponding top views of the spine portion shown in Figures 1E and 1F, respectively, according to an embodiment of the present technology, illustrating the first and second stages of the balloon deployment step. [Figure 1H] Figures 1G and 1H are corresponding top views of the spine portion shown in Figures 1E and 1F, respectively, according to an embodiment of the present technology, illustrating the first and second stages of the balloon deployment step.

[0023] [Figure 1I] Figures 1I-1K show a lateral view, another lateral view, and a top view of a portion of the spine according to an embodiment of the present technology, illustrating the intervertebral device deployment step in a spinal surgical procedure. [Figure 1J]Figures 1I-1K show a lateral view, another lateral view, and a top view of a portion of the spine according to an embodiment of the present technology, illustrating the intervertebral device deployment step in a spinal surgical procedure. [Figure 1K] Figures 1I-1K show a lateral view, another lateral view, and a top view of a portion of the spine according to an embodiment of the present technology, illustrating the intervertebral device deployment step in a spinal surgical procedure.

[0024] [Figure 1L] Figures 1L-1N show a lateral view of a portion of the spine, another lateral view, and a top view, respectively, illustrating the first step of the intervertebral device implantation procedure in a spinal surgical technique. [Figure 1M] Figures 1L-1N show a lateral view of a portion of the spine, another lateral view, and a top view, respectively, illustrating the first step of the intervertebral device implantation procedure in a spinal surgical technique. [Figure 1N] Figures 1L-1N show a lateral view of a portion of the spine, another lateral view, and a top view, respectively, illustrating the first step of the intervertebral device implantation procedure in a spinal surgical technique.

[0025] [Figure 10] Figures 1O-1Q illustrate a second step of the intervertebral device filling step, showing a corresponding side view, another side view, and a top view of the vertebral portion shown in Figure 1L-1N, respectively, according to an embodiment of the present technology. [Figure 1P] Figures 1O-1Q illustrate a second step of the intervertebral device filling step, showing a corresponding side view, another side view, and a top view of the vertebral portion shown in Figure 1L-1N, respectively, according to an embodiment of the present technology. [Figure 1Q] Figures 1O-1Q illustrate a second step of the intervertebral device filling step, showing a corresponding side view, another side view, and a top view of the vertebral portion shown in Figure 1L-1N, respectively, according to an embodiment of the present technology.

[0026] [Figure 1R] Figure 1R is an enlarged lateral view of a portion of the spine according to an embodiment of the present technology, illustrating the intervertebral device closure step of a spinal surgical procedure.

[0027] [Figure 1S] Figure 1S is a lateral view of a portion of a patient's spine according to an embodiment of the present technology, illustrating the posterior fixation step of a spinal surgical procedure.

[0028] [Figure 2] Figure 2 is a flowchart illustrating a process or method for performing a spinal surgical procedure according to an embodiment of this technology.

[0029] [Figure 3A] Figure 3A is a side view of a portion of the spine according to an embodiment of the present technology, illustrating the first posterior fixation step of a spinal surgical procedure.

[0030] [Figure 3B] Figure 3B is a lateral view of a portion of the spine according to an embodiment of the present technology, illustrating the second posterior fixation step of a spinal surgical procedure.

[0031] [Figure 3C] Figure 3C is a lateral view of a portion of the spine according to an embodiment of the present technology, illustrating the third posterior fixation step of a spinal surgical procedure.

[0032] [Figure 3D] Figure 3D is a side view, including an enlarged portion of the spine, illustrating the access steps of a spinal surgical procedure according to an embodiment of the present technology.

[0033] [Figure 3E] Figures 3E and 3F are side views, including an enlarged portion of the spine, illustrating the separation step of a spinal surgical procedure according to an embodiment of the present technology. [Figure 3F]Figures 3E and 3F are side views, including an enlarged portion of the spine, illustrating the separation step of a spinal surgical procedure according to an embodiment of the present technology.

[0034] [Figure 3G] Figure 3G-3I is a side view including an enlarged portion of a part of the spine according to an additional embodiment of the present technology, illustrating the separation step of a spinal surgical procedure. [Figure 3H] Figure 3G-3I is a side view including an enlarged portion of a part of the spine according to an additional embodiment of the present technology, illustrating the separation step of a spinal surgical procedure. [Figure 3I] Figure 3G-3I is a side view including an enlarged portion of a part of the spine according to an additional embodiment of the present technology, illustrating the separation step of a spinal surgical procedure.

[0035] [Figure 3J] Figures 3J and 3K are side views of a portion of the spine according to an embodiment of the present technology, illustrating the posterior fixation and locking step of a spinal surgical procedure. [Figure 3K] Figures 3J and 3K are side views of a portion of the spine according to an embodiment of the present technology, illustrating the posterior fixation and locking step of a spinal surgical procedure.

[0036] [Figure 3L] Figure 3L is a side view, including an enlarged portion of the spine, illustrating the intervertebral device deployment step in a spinal surgical procedure according to an embodiment of the present technology.

[0037] [Figure 3M] Figure 3M is a lateral view of a portion of the spine according to an embodiment of the present technology, illustrating the first and second intervertebral devices and posterior fixation assembly that will ultimately be implanted.

[0038] [Figure 4A] Figures 4A and 4B are side views of a portion of the spine before and after balloon inflation according to an embodiment of this technology. [Figure 4B]Figures 4A and 4B are side views of a portion of the spine before and after balloon inflation according to an embodiment of this technology.

[0039] [Figure 5] Figure 5 is a flowchart of the process or method for performing a spinal surgical procedure according to an embodiment of this technology.

[0040] [Figure 6A] Figure 6A is a perspective view of an access-matching assembly positioned on a patient, according to an embodiment of the present technology.

[0041] [Figure 6B] Figure 6B is a schematic perspective view of the marker grid of the access alignment assembly shown in Figure 6A, according to an embodiment of the present technology.

[0042] [Figure 7A] Figures 7A and 7B are a top view and a side view, respectively, of a trocar for providing access to the vertebrae or intervertebral discs of the spine according to an embodiment of the present technology. [Figure 7B] Figures 7A and 7B are a top view and a side view, respectively, of a trocar for providing access to the vertebrae or intervertebral discs of the spine according to an embodiment of the present technology.

[0043] [Figure 8A] Figure 8A is a perspective view of a trocar and a pair of styletes for use with the trocar, according to an embodiment of the present technology.

[0044] [Figure 8B] Figure 8B is a lateral view of the spine according to an embodiment of the present technology, illustrating the access via the trocar and stylet shown in Figure 8A.

[0045] [Figure 8C] Figure 8C is a side view of the stylet shown in Figures 8A and 8B, according to an additional embodiment of the present technology.

[0046] [Figure 9] Figure 9 is a side view of a trocar according to an embodiment of this technology.

[0047] [Figure 10] Figure 10 is a side view of a trocar according to an embodiment of this technology.

[0048] [Figure 11A] Figures 11A and 11B are side views of the trocar in a first and second position according to an embodiment of the present technology, respectively. [Figure 11B] Figures 11A and 11B are side views of the trocar in a first and second position according to an embodiment of the present technology, respectively.

[0049] [Figure 11C] Figures 11C and 11D are side views of the expandable mooring section of the trocar in Figures 11A and 11B at a second position according to an embodiment of the present technology. [Figure 11D] Figures 11C and 11D are side views of the expandable mooring section of the trocar in Figures 11A and 11B at a second position according to an embodiment of the present technology.

[0050] [Figure 12A] Figure 12A is a perspective view of a trocar according to an embodiment of this technology.

[0051] [Figure 12B] Figures 12B and 12C are side views of the trocar of Figure 12A in a first and second position, respectively, as inserted through the introducer according to an embodiment of the present technology. [Figure 12C] Figures 12B and 12C are side views of the trocar of Figure 12A in a first and second position, respectively, as inserted through the introducer according to an embodiment of the present technology.

[0052] [Figure 13A]Figures 13A-13C are coronal, top, and another top view of the intervertebral device deployment step in a spinal surgical procedure, utilizing the trocar of Figures 12A-12C and the introducer of Figures 12B and 12C, respectively, according to an embodiment of the present technology. [Figure 13B] Figures 13A-13C are coronal, top, and another top view of the intervertebral device deployment step in a spinal surgical procedure, utilizing the trocar of Figures 12A-12C and the introducer of Figures 12B and 12C, respectively, according to an embodiment of the present technology. [Figure 13C] Figures 13A-13C are coronal, top, and another top view of the intervertebral device deployment step in a spinal surgical procedure, utilizing the trocar of Figures 12A-12C and the introducer of Figures 12B and 12C, respectively, according to an embodiment of the present technology.

[0053] [Figure 14] Figure 14 is a side view of a rear-fixed assembly according to an embodiment of this technology.

[0054] [Figure 15A] Figure 15A is an exploded side view of the fixing member of the rear fixing assembly according to an embodiment of this technology.

[0055] [Figure 15B] Figure 15B is a side cross-sectional view of the screw of the fixing member shown in Figure 15A, according to an embodiment of this technology.

[0056] [Figure 15C] Figure 15C is a side view of a rear fixing assembly, including the multiple fixing members shown in Figure 15A, according to an embodiment of the present technology.

[0057] [Figure 15D] Figures 15D and 15E are side views of the fixing member and tower member shown in Figure 15C, which are fixed to the vertebrae of the spine according to an embodiment of this technology. [Figure 15E]Figures 15D and 15E are side views of the fixing member and tower member shown in Figure 15C, which are fixed to the vertebrae of the spine according to an embodiment of this technology.

[0058] [Figure 16] Figure 16 is a side view of a fixed and access assembly according to an embodiment of the present technology.

[0059] [Figure 17A] Figures 17A and 17B are side views of a trocar access system, including an access trocar and a steerable trocar, according to an embodiment of the present technology. [Figure 17B] Figures 17A and 17B are side views of a trocar access system, including an access trocar and a steerable trocar, according to an embodiment of the present technology.

[0060] [Figure 18A] Figure 18A is a side view of a discectomy device according to an embodiment of this technology.

[0061] [Figure 18B] Figure 18B is a side view of the discectomy device shown in Figure 18A, according to an additional embodiment of the present technology.

[0062] [Figure 18C] Figure 18C is a side view of the discectomy device shown in Figure 18A, according to an additional embodiment of the present technology.

[0063] [Figure 19] Figure 19 is a side view of an intervertebral disc resection device according to an embodiment of this technology.

[0064] [Figure 20] Figure 20 is a perspective view of an elongated member of a discectomy device according to an embodiment of this technology.

[0065] [Figure 21]Figure 21 is a perspective view of an elongated member of a discectomy device according to an embodiment of this technology.

[0066] [Figure 22A] Figure 22A is a side view of a discectomy device according to an embodiment of this technology.

[0067] [Figure 22B] Figure 22B is an enlarged perspective view of a portion of the elongated member of the intervertebral discectomy device shown in Figure 22A, according to an embodiment of this technology.

[0068] [Figure 23] Figure 23 is a perspective side view of a discectomy device according to an embodiment of this technology.

[0069] [Figure 24A] Figures 24A-24D are side views of various parts of a discectomy device according to an embodiment of this technology. [Figure 24B] Figures 24A-24D are side views of various parts of a discectomy device according to an embodiment of this technology. [Figure 24C] Figures 24A-24D are side views of various parts of a discectomy device according to an embodiment of this technology. [Figure 24D] Figures 24A-24D are side views of various parts of a discectomy device according to an embodiment of this technology.

[0070] [Figure 25] Figure 25 is a side view of a discectomy device, inserted through an introducer to access a patient's spine, according to an embodiment of the present technology.

[0071] [Figure 26] Figure 26 is a side view of a discectomy device according to an embodiment of this technology.

[0072] [Figure 27A]Figures 27A and 27B are enlarged side views of the distal portion of a discectomy device according to an embodiment of this technology. [Figure 27B] Figures 27A and 27B are enlarged side views of the distal portion of a discectomy device according to an embodiment of this technology.

[0073] [Figure 28] Figure 28 includes multiple side views of the distal portion of a curette-like or raspo-like intervertebral discectomy device according to an embodiment of the present technology.

[0074] [Figure 29A] Figures 29A-29D are perspective side views of the distal portion of a discectomy device according to an embodiment of this technology. [Figure 29B] Figures 29A-29D are perspective side views of the distal portion of a discectomy device according to an embodiment of this technology. [Figure 29C] Figures 29A-29D are perspective side views of the distal portion of a discectomy device according to an embodiment of this technology. [Figure 29D] Figures 29A-29D are perspective side views of the distal portion of a discectomy device according to an embodiment of this technology.

[0075] [Figure 30] Figure 30 is a side view of the distal portion of a balloon device positioned through a trocar according to an embodiment of the present technology.

[0076] [Figure 31] Figure 31 is a side view of the balloon of a balloon device deployed and expanded into the intervertebral space of a patient's spine, according to an embodiment of the present technology.

[0077] [Figure 32A] Figure 32A is a side view of the balloon of a balloon device according to an embodiment of this technology.

[0078] [Figure 32B]Figure 32B is a side view of the balloon shown in Figure 32A, which is deployed and expanded into the intervertebral space of a patient's spine according to an embodiment of the present technology.

[0079] [Figure 33A] Figure 33A is a side view of the balloon of a balloon device according to an embodiment of this technology.

[0080] [Figure 33B] Figure 33B is a side view of the balloon shown in Figure 33A, which is deployed and expanded into the intervertebral space of a patient's spine according to an embodiment of the present technology.

[0081] [Figure 34] Figure 34 is a side view of a balloon device deployed and expanded into the intervertebral space of a patient's spine according to an embodiment of the present technology.

[0082] [Figure 35] Figure 35 is a graph illustrating a typical pressure-volume curve sensed by the pressure-sensing assembly during balloon expansion according to an embodiment of the present technology.

[0083] [Figure 36] Figure 36 is a side view of the balloon of a balloon device according to an embodiment of this technology.

[0084] [Figure 37] Figure 37 is a side view of the balloon of a balloon device according to an embodiment of this technology.

[0085] [Figure 38] Figure 38 is a side view of the balloon of a balloon device according to an embodiment of this technology.

[0086] [Figure 39] Figure 39 is a side view of the balloon of a balloon device deployed and expanded into the intervertebral space of a patient's spine according to an embodiment of the present technology.

[0087] [Figure 40A] Figure 40A is an oblique side view of an intervertebral device according to an embodiment of this technology.

[0088] [Figure 40B] Figure 40B illustrates various patterns in which the filaments of the intervertebral device shown in Figure 40A can be braided together, according to an embodiment of this technology.

[0089] [Figure 40C] Figure 40C illustrates various patterns in which the filaments of the intervertebral device shown in Figure 40A may be woven together and / or may include axial reinforcing filaments, according to embodiments of the present technology.

[0090] [Figure 41] Figure 41 is a side view of an intervertebral device deployed and expanded into the intervertebral space of a patient's spine according to an embodiment of the present technology.

[0091] [Figure 42] Figure 42 is a perspective view of an intervertebral device according to an embodiment of this technology.

[0092] [Figure 43] Figure 43 is a perspective view of an intervertebral device according to an embodiment of this technology.

[0093] [Figure 44] Figure 44 is a perspective view of the filament of an intervertebral device according to an embodiment of this technology.

[0094] [Figure 45A] Figures 45A-45D are side views of different steps in a method for fixing multiple filaments of an intervertebral device to a hub according to an embodiment of this technology. [Figure 45B] Figures 45A-45D are side views of different steps in a method for fixing multiple filaments of an intervertebral device to a hub according to an embodiment of this technology. [Figure 45C] Figures 45A-45D are side views of different steps in a method for fixing multiple filaments of an intervertebral device to a hub according to an embodiment of this technology. [Figure 45D] Figures 45A-45D are side views of different steps in a method for fixing multiple filaments of an intervertebral device to a hub according to an embodiment of this technology.

[0095] [Figure 45E] Figure 45E is an enlarged view of the portion shown in Figure 45D, according to an embodiment of this technology.

[0096] [Figure 46A] Figures 46A-46D are side views of different steps in a method for fixing multiple filaments of an intervertebral device together to a hub, according to an additional embodiment of the present technology. [Figure 46B] Figures 46A-46D are side views of different steps in a method for fixing multiple filaments of an intervertebral device together to a hub, according to an additional embodiment of the present technology. [Figure 46C] Figures 46A-46D are side views of different steps in a method for fixing multiple filaments of an intervertebral device together to a hub, according to an additional embodiment of the present technology. [Figure 46D] Figures 46A-46D are side views of different steps in a method for fixing multiple filaments of an intervertebral device together to a hub, according to an additional embodiment of the present technology.

[0097] [Figure 47A] Figures 47A and 47B are side views of different steps in a method for fixing multiple filaments of an intervertebral device together to a hub, according to an embodiment of the present technology. [Figure 47B] Figures 47A and 47B are side views of different steps in a method for fixing multiple filaments of an intervertebral device together to a hub, according to an embodiment of the present technology.

[0098] [Figure 48A] Figures 48A and 48B are oblique top and side views, respectively, of an intervertebral device according to an embodiment of this technology. [Figure 48B] Figures 48A and 48B are oblique top and side views, respectively, of an intervertebral device according to an embodiment of this technology.

[0099] [Figure 49] Figure 49 is an enlarged perspective view of the filler material according to an embodiment of this technology.

[0100] [Figure 50] Figure 50 is an enlarged side view of the filling material according to an embodiment of this technology.

[0101] [Figure 51] Figure 51 is an enlarged perspective view of the filling material extending from the inlet according to an embodiment of this technology.

[0102] [Figure 52] Figure 52 is a graph showing the filling density (y-axis) versus the percentage of large filling particles relative to small filling particles (x-axis) according to an embodiment of this technology.

[0103] [Figure 53] Figure 53 is a table of different elastic moduli of various materials that can be used for filler particles according to embodiments of this technology.

[0104] [Figure 54] Figure 54 is an enlarged side view of the filler material according to an embodiment of this technology.

[0105] [Figure 55] Figure 55 is an enlarged side view of the filling material according to an embodiment of this technology.

[0106] [Figure 56] Figure 56 is a perspective view of a filler material comprising multiple particles according to an embodiment of the present technology.

[0107] [Figure 57A] Figure 57A is a perspective view of a filler material comprising multiple particles that receive axial force via a loading machine, according to an embodiment of the present technology.

[0108] [Figure 57B] Figure 57B is a perspective view of one of the particles of the filler material shown in Figure 57A, according to an embodiment of the present technology.

[0109] [Figure 58A] Figure 58A is a perspective view of a filler material comprising multiple particles that receive axial force via a loading machine, according to an embodiment of the present technology.

[0110] [Figure 58B] Figure 58B is a perspective view of one of the particles of the filler material shown in Figure 58A, according to an embodiment of the present technology.

[0111] [Figure 59A] Figure 59A is a perspective view of a filler material comprising multiple particles that receive axial force via a loading machine, according to an embodiment of the present technology.

[0112] [Figure 59B] Figure 59B is a perspective view of one of the particles of the filler material shown in Figure 59A, according to an embodiment of the present technology.

[0113] [Figure 60A] Figure 60A is a perspective view of a filler material comprising multiple particles that receive axial force via a loading machine, according to an embodiment of the present technology.

[0114] [Figure 60B] Figure 60B is a perspective view of one of the particles of the filler material shown in Figure 60A, according to an embodiment of the present technology.

[0115] [Figure 61]Figure 61 is a perspective side view of the proximal portion of the filling device, which is inserted through the introducer according to an embodiment of this technology.

[0116] [Figure 62] Figure 62 is a perspective side view of the distal portion of the filling device according to an embodiment of this technology.

[0117] [Figure 63] Figure 63 is a side view of the distal portion of the filling device and the intervertebral device, which is deployed and expanded into the intervertebral space of the patient's spine, according to an embodiment of the present technology.

[0118] [Figure 64] Figure 64 is a side view of the distal portion of the filling device and the intervertebral device, which is deployed and expanded into the intervertebral space of the patient's spine, according to an embodiment of the present technology.

[0119] [Figure 65] Figure 65 is a side view of the closing mechanism according to an embodiment of this technology.

[0120] [Figure 66A] Figure 66A is a front view of a tensioning and / or closing mechanism according to an embodiment of the present technology.

[0121] [Figure 66B] Figure 66B is a side view of the tensioning and / or closing mechanism shown in Figure 66A, which is disposed on an intervertebral device according to an embodiment of the present technology.

[0122] [Figure 67] Figure 67 is a side view of a tensioning and / or closing mechanism according to an embodiment of the present technology.

[0123] [Figure 68] Figure 68 is a top view of an intervertebral device, including a tension-applying mechanism, deployed within the intervertebral space of the spine, according to an embodiment of the present technology.

[0124] [Figure 69A] Figure 69A is a side view of an intervertebral device coupled to an unfolding shaft according to an embodiment of this technology.

[0125] [Figure 69B] Figures 69B and 69C are enlarged views of the connection between the intervertebral device in Figure 69A and the deployment shaft in Figure 69B, and a side view of the deployment shaft in Figure 69A, respectively, according to an embodiment of the present technology. [Figure 69C] Figures 69B and 69C are enlarged views of the connection between the intervertebral device in Figure 69A and the deployment shaft in Figure 69B, and a side view of the deployment shaft in Figure 69A, respectively, according to an embodiment of the present technology.

[0126] [Figure 70A] Figure 70A is a perspective view of an intervertebral device and deployment shaft according to an embodiment of this technology.

[0127] [Figure 70B] Figure 70B is a perspective view of a filled cartridge according to an embodiment of this technology.

[0128] [Figure 70C] Figure 70C is an enlarged view of a portion of the filling cartridge shown in Figure 70B, according to an embodiment of this technology.

[0129] [Figure 70D] Figure 70D is a perspective view of the filling member shown in Figures 70B and 70C according to an embodiment of this technology.

[0130] [Figure 71A] Figure 71A is a lateral view of the spine during a vertebral resection procedure according to an embodiment of this technology.

[0131] [Figure 71B] Figure 71B is a side view of the spine in Figure 71A during another stage of the vertebral resection procedure according to an embodiment of the present technology.

[0132] [Figure 72A] Figure 72A is a side view of a portion of a spinal fixation system, which is attached to a patient's spine, according to an embodiment of the present technology.

[0133] [Figure 72B] Figure 72B is a side view of the same portion of the spinal fixation system attached to the spine of Figure 72A according to an embodiment of the present technology, illustrating various distances, angles, and / or rotation points that can be manipulated to drive other target distances, angles, and / or rotation points.

[0134] [Figure 73A] Figure 73A is a partial schematic side view of a portion of the spinal fixation system shown in Figures 72A and 72B, according to an embodiment of the present technology.

[0135] [Figure 73B] Figure 73B is a lateral view of a portion of the spine shown in Figures 72A-73A according to an embodiment of the present technology, further illustrating an additional inferior vertebra.

[0136] [Figure 74] Figure 74 is a side view of the same portion of the spinal fixation system attached to the spine of Figure 72A according to an embodiment of the present technology, illustrating an additional driver inserted through a first tower member and engaging with the first fixation member.

[0137] [Figure 75] Figure 75 is a side view of a posterior spinal fixation device / system according to an embodiment of this technology.

[0138] [Figure 76] Figure 76 is a side view of a posterior spinal fixation device / system according to an embodiment of this technology.

[0139] [Figure 77]Figure 77 is a partial side view of a spinal position sensing system configured to be attached to a patient's spine, according to an embodiment of the present technology.

[0140] [Figure 78A] Figure 78A is an isometric view of a connector guide member according to an embodiment of this technology.

[0141] [Figure 78B] Figure 78B is an isometric view of the connector guide member of Figure 78A, which, according to an embodiment of the present technology, connects the trocar to a spinal fixation system that is attached to a portion of the patient's spine.

[0142] [Figure 79A] Figure 79A is a top view of a connector guide member according to an embodiment of this technology.

[0143] [Figure 79B] Figures 79B and 79C are side views of the clamp member of the connector guide member shown in Figure 79A in the fully engaged position and the partially engaged position, respectively, according to an embodiment of the present technology. [Figure 79C] Figures 79B and 79C are side views of the clamp member of the connector guide member shown in Figure 79A in the fully engaged position and the partially engaged position, respectively, according to an embodiment of the present technology.

[0144] [Figure 79D] Figure 79D is an isometric view of the connector guide member shown in Figures 79A-79C, which connects the trocar to a spinal fixation system attached to a portion of the patient's spine, according to an embodiment of the present technology.

[0145] [Figure 80] Figure 80 is an isometric view of a connector guide member that connects a trocar to a spinal fixation system attached to a portion of a patient's spine, according to an embodiment of this technology.

[0146] [Figure 81A]Figures 81A and 81B are isometric views of a connector guide member that connects a trocar to a spinal fixation system attached to a portion of a patient's spine, according to an embodiment of the present technology. [Figure 81B] Figures 81A and 81B are isometric views of a connector guide member that connects a trocar to a spinal fixation system attached to a portion of a patient's spine, according to an embodiment of the present technology.

[0147] [Figure 82] Figure 82 is an isometric view of a connector guide member that connects a trocar to a spinal fixation system attached to a portion of a patient's spine, according to an embodiment of the present technology.

[0148] [Figure 83A] Figure 83A is an isometric view of a connector guide member that connects a trocar to a spinal fixation system attached to a portion of a patient's spine, according to an embodiment of the present technology.

[0149] [Figure 83B] Figure 83B is a cross-sectional side view of the connector guide member shown in Figure 83A, according to an embodiment of this technology.

[0150] [Figure 84A] Figures 84A-84C are isometric cross-sectional views of the connector guide member shown in Figures 83A and 83B, according to an additional embodiment of this technology. [Figure 84B] Figures 84A-84C are isometric cross-sectional views of the connector guide member shown in Figures 83A and 83B, according to an additional embodiment of this technology. [Figure 84C] Figures 84A-84C are isometric cross-sectional views of the connector guide member shown in Figures 83A and 83B, according to an additional embodiment of this technology.

[0151] [Figure 85-1]Figure 85 is a flowchart of a process or method for performing a spinal surgical procedure on a patient's spine, according to an embodiment of the present technology, in which a connector guide member is used to fix a trocar to a span member of a posterior fixation system. [Figure 85-2] Figure 85 is a flowchart of a process or method for performing a spinal surgical procedure on a patient's spine, according to an embodiment of the present technology, in which a connector guide member is used to fix a trocar to a span member of a posterior fixation system.

[0152] [Figure 86] Figure 86 is an isometric view of a connector guide member that connects a trocar to a spinal fixation system attached to a portion of a patient's spine, according to an embodiment of this technology.

[0153] [Figure 87-1] Figures 87-89 are flowcharts of a process or method for performing a spinal surgical procedure on a patient's spine, according to an embodiment of the present technology, in which the connector guide member of Figure 86 is used to secure the trocar to the fixing member of the posterior fixation system. [Figure 87-2] Figures 87-89 are flowcharts of a process or method for performing a spinal surgical procedure on a patient's spine, according to an embodiment of the present technology, in which the connector guide member of Figure 86 is used to secure the trocar to the fixing member of the posterior fixation system. [Figure 88-1] Figures 87-89 are flowcharts of a process or method for performing a spinal surgical procedure on a patient's spine, according to an embodiment of the present technology, in which the connector guide member of Figure 86 is used to secure the trocar to the fixing member of the posterior fixation system. [Figure 88-2] Figures 87-89 are flowcharts of a process or method for performing a spinal surgical procedure on a patient's spine, according to an embodiment of the present technology, in which the connector guide member of Figure 86 is used to secure the trocar to the fixing member of the posterior fixation system. [Figure 89-1]Figures 87 - 89 are flow diagrams of a process or method for performing a spinal surgical procedure on a patient's spine, according to an embodiment of the present technology, in which the connector guide member of FIG. 86 is used to fix a trocar to a fixing member of a posterior fixation system. [Figure 89-2] Figures 87 - 89 are flow diagrams of a process or method for performing a spinal surgical procedure on a patient's spine, according to an embodiment of the present technology, in which the connector guide member of FIG. 86 is used to fix a trocar to a fixing member of a posterior fixation system.

[0154] [Figure 90A] FIG. 90A is a side view of a part of a patient's spine, according to an embodiment of the present technology, illustrating the navigation and trajectory planning steps of a spinal surgical procedure.

[0155] [Figure 90B] FIG. 90B is a side view of a part of the spine, according to an embodiment of the present technology, illustrating the access step of a spinal surgical procedure.

[0156] [Figure 90C] FIG. 90C is a side view and an enlarged front view of a part of the spine, according to an embodiment of the present technology, illustrating the first intervertebral device deployment step of a spinal surgical procedure.

[0157] [Figure 90D] FIG. 90D is a side view and an enlarged front view of a part of the spine, according to an embodiment of the present technology, illustrating the second intervertebral device deployment step of a spinal surgical procedure.

MODE FOR CARRYING OUT THE INVENTION

[0158] Detailed Description Aspects of this technology generally relate to intervertebral devices, such as intervertebral fixation devices, and associated systems and methods that can be deployed minimally invasively or percutaneously. In some of the embodiments described below, a method for performing a spinal surgical procedure to implant an intervertebral device may include the step of inserting a trocar into the patient via a lateral, transpedicle, transfacet joint, transforaminal, and / or other approach so as to be close to the affected intervertebral disc. The trocar can provide an access route for subsequent instruments to be inserted therein to treat the affected intervertebral disc. The method may further include the step of inserting a discectomy device through the trocar, and the step of using the discectomy device to remove part or all of the affected intervertebral disc and form an intervertebral space. Next, the balloon can be inserted into the intervertebral space through a trocar and expanded to further destroy and / or remove any remaining portion of the affected intervertebral disc and lift the superior vertebra adjacent to the affected intervertebral disc relative to the inferior vertebra adjacent to the affected intervertebral disc (e.g., to create lordosis). Then, the intervertebral device can be inserted into the intervertebral space through a trocar and expanded within the intervertebral space. The intervertebral device may comprise a braid of filaments, a fabric, a mesh, and / or equivalent. Next, the intervertebral device may be filled with a filling material such as a plurality of particles, which, when loaded, form a gabion-like structure. In some embodiments, the intervertebral device is tensioned to better fill the filling material therein and / or induce the gabion-like structure. The intervertebral device can then be closed to prevent or further prevent the filling material from leaving and released into the intervertebral space (e.g., from the delivery shaft). Finally, the posterior fixation assembly can be attached to the upper and lower vertebrae adjacent to the intervertebral space to stabilize the vertebrae and provide intraosseous growth into the intervertebral device and the filling material within it.

[0159] Notably, each step of the spinal surgical procedure can be performed through a percutaneous port / access route, provided by open surgery, minimally invasive surgery, or a trocar. In some aspects of this technique, this can minimize damage to the patient's tissues and reduce patient pain and recovery time. Furthermore, the spinal surgical procedure can traverse safer routes that require smaller sizes compared to conventional techniques. For example, trocars and various instruments can be sized to traverse transpedicle (or other) approaches that encompass routes (e.g., corridors) smaller than 4.5 millimeters.

[0160] Certain details are described below and in Figures 1A-90D to provide a complete understanding of the various embodiments of the Art. In other cases, well-known structures, materials, actions, and / or systems, often associated with spinal surgical procedures, intervertebral devices, spinal fusion procedures, posterior fusion assemblies, and equivalents, are not illustrated or described in detail in the following disclosure to avoid unnecessarily obscuring the description of the various embodiments of the Art. However, those skilled in the art will recognize that the Art can be practiced without one or more of the details described herein, and / or with other structures, methods, components, etc. The technical terms used below should be interpreted in their broadest and most reasonable form, even when used in conjunction with a detailed description of an embodiment of the Art.

[0161] With regard to the terms “distal” and “proximal” in this description, unless otherwise specified, the terms may refer to the relative position of a part of the spinal access system relative to the operator and / or its location within the spinal biomolecular structure. Furthermore, as used herein, the expressions “posterior,” “anterior,” “upward,” “downward,” and equivalents do not mean to limit the components referred to to a specific orientation. Such expressions refer to the orientation of the components referred to as illustrated in the figures, i.e., the system of this technology can be used in any orientation that is convenient for the user. In addition, the terms “distal” and “proximal” may also be referred to as “anterior edge” and “posterior edge” and / or equivalents, respectively.

[0162] The accompanying drawings illustrate embodiments of the Art and are not intended to limit its scope unless expressly indicated. The sizes of the various elements depicted are not necessarily drawn to exact scale, and these elements may be enlarged to improve visibility. Details of components are abstracted in the drawings where such details are unnecessary for a complete understanding of how the Art is made and used, and details such as the location of components and certain precise connections between such components may be omitted. Many of the details, dimensions, angles, and other features shown in the drawings are merely illustrative of a particular embodiment of the present disclosure. Therefore, other embodiments may have other details, dimensions, angles, and features without departing from the Art. In addition, those skilled in the art will understand that further embodiments of the Art may be practiced without some of the details described below.

[0163] To the extent to which any material incorporated herein by reference conflicts with this disclosure, this disclosure shall prevail. The headings provided herein are for convenience only and should not be construed as limiting the subject matter disclosed. I. Selected Embodiments of Intervertebral Devices, Systems, and Methods

[0164] Figures 1A-1S illustrate different aspects of a spinal surgical procedure (e.g., a spinal surgical method) on a patient's spine 100 according to an embodiment of the present technology. The spinal surgical procedure can be a spinal fixation procedure (e.g., single-level fixation) in which an existing affected intervertebral disc of the spine is completely or partially removed, and an intervertebral device is inserted into the intervertebral space to support the adjacent vertebra and provide endoosseous growth into it. Figures 1A-1S provide an overview of some common aspects / steps of a spinal surgical procedure, and Figures 2-90D illustrate additional embodiments and / or aspects of various steps, devices, and / or systems that may be used therein. In some embodiments, the devices and systems used in some of the steps of a spinal surgical procedure, as illustrated in Figures 1A-1S, may include some features that are at least generally similar in structure and function to, or identical in structure and function to, the corresponding features of the devices, systems, and / or methods described in International Patent Application No. PCT / US2021 / 051829, filed September 23, 2021, titled "INTERVERTEBRAL FUSION DEVICE WITH BONE GRAFT LUMBAR" (which is incorporated herein by reference as a whole).

[0165] Figures 1A and 1B are a lateral view (e.g., a lateral view) and a top view (e.g., an axial view) of a portion of the spine 100 according to an embodiment of the present technology, illustrating the access steps of a spinal surgical procedure. Referring to Figures 1A and 1B, the spine includes a plurality of vertebrae 102 (including individually identified first or superior vertebrae 102a and second or inferior vertebrae 102b) separated by intervertebral discs 104 (e.g., intervertebral discs including individually identified affected discs 104a). The affected disc 104a may result from degenerative joint disease and / or disc arthropathy. As a result of the affected disc 104a, in many cases the affected disc 104a becomes thin and collapses of the disc height H (Figure 1A) of the affected disc 104a. Such a collapse of the intervertebral disc height H can lead to collapse of the nerve foramen, and therefore to compression of the exiting nerve root, which can induce neuralgia and / or radiculopathy radiating down the patient's leg. Similarly, a collapse of the intervertebral disc height H can further cause ligament laxity and bulging in the spine. As a result, compression of the entire spinal cord and / or meningeal sac, located in the center of the spinal canal, can occur, which can cause weakness and fatigue in the leg (e.g., neurogenic claudication), in addition to radiculopathy radiating down the leg.

[0166] In the illustrated embodiments, a trocar 110 is used to access the affected intervertebral disc 104a via either a transpedicle or transforaminal (e.g., transfacet joint) approach. Referring to Figure 1A, the trocar 110 may include a handle 112 that is coupled to a hollow cannula 114 defining its lumen. The trocar 110 and / or cannula 114 may be referred to as a sheath, shaft, stylet, access port, introducer, tube, and / or equivalent. In some embodiments, the handle 112 includes a seal that selectively provides access to the lumen of the cannula 114. In some embodiments, during the illustrated access step of a spinal surgical procedure, the introducer 111 is positioned within the cannula 114. For example, the insertion device 111 may include a handle 113 (e.g., a proximal portion) which can be selectively locked onto the handle 112 of the trocar 110, and an elongated member (hidden by the cannula 114 in Figures 1A and 1B; e.g., a needle, a skewer) having a tip 115 (Figure 1B) configured to extend distally outward from the cannula 114, beyond the distal end portion 116 of the cannula 114, when the handles 112 and 113 are locked together. The tip 115 may be sharp, pointed, angled, and / or equivalent to facilitate the insertion of the trocar 110 through the patient's soft tissue and bone (e.g., the upper vertebra 102a or the lower vertebra 102b) until it approaches the affected intervertebral disc 104a (e.g., near the affected intervertebral disc 104a, within the affected intervertebral disc 104a). The trocar 110 and the introducer 111 can be pushed, rotated, and / or otherwise advanced through the soft tissue and bone to approach the affected intervertebral disc 104a.

[0167] Referring to Figures 1A and 1B, in the illustrated embodiments, the transpedicle approach may include the step of advancing the trocar 110 and introducer 111 through the pedicle 105b and superior endplate 106b of the inferior vertebra 102b. In some embodiments, such an approach may traverse the same insertion trajectory as a subsequent pedicle screw used for posterior fixation (for example, as described in detail below with reference to Figure 1S). The transforaminal approach may include the step of advancing the trocar 110 and introducer 111 through the facet joint 107 between the superior and inferior vertebrae 102a-b. Referring to Figure 1A, in other embodiments, the transpedicle approach may include the step of advancing the trocar 110 and introducer 111 through the pedicle 105a and inferior endplate 106a of the superior vertebra 102a. Transpedicle, transfacet joint, and transforaminal approaches all access the affected intervertebral disc 104a through the bones of the superior and / or inferior vertebrae 102a-b along a trajectory, avoiding the spinal nerve roots and thus avoiding traction of the spinal nerve roots during spinal surgical procedures, which could pose a risk to the patient. Thus, in some aspects of this technique, since any of the trajectories can avoid conventional access corridors that pass through bone and space, where nerves can also be found, the trocar 110 can be prevented or further prevented from contacting the nerve roots and potentially damaging them. In contrast, many conventional access techniques access the intervertebral space by pushing aside the bone elements of the vertebrae through openings where the spinal nerve roots exit the vertebral column, for example, increasing the possibility of nerve damage during access.

[0168] Referring to Figures 1A and 1B, the transpedicle approach can have a variety of different access angles, shown as shaded area 117, and similarly, the transforaminal and transfacetal approaches can have a variety of different access angles, shown as shaded area 118. The specific access angles and trajectories for the trocar 110 can be determined by radiographic (e.g., X-ray) imaging and / or other medical imaging procedures performed before (e.g., preoperatively) and / or during (e.g., intraoperatively) spinal surgical procedures, as described in detail below with reference to Figures 6A-17B, for example.

[0169] Figures 1C and 1D are a side view (e.g., lateral view) and a top view (e.g., axial view) of a portion of the spine 100 according to an embodiment of the present art, illustrating the discectomy step of a spinal surgical procedure. Referring to Figures 1C and 1D, after accessing the affected disc 104a, the introducer 111 (Figures 1A and 1B) can be removed from the cannula 114 of the trocar 110, and the discectomy device 120 can be inserted into the affected disc 104a through the cannula 114, beyond its distal end portion 116. In some embodiments, the discectomy device 120 is configured to be self-expanding, bladed, sharp, rotatable, translatable, and / or otherwise engage with the affected disc 104a, break it, and / or dislodge it. Further embodiments of the discectomy device are described in detail below with reference to Figures 18A–29D.

[0170] The affected intervertebral disc 104a may include a ligamentous ring 108 (e.g., comprising the annulus fibrosus, posterior longitudinal ligament, and / or anterior longitudinal ligament) surrounding a nucleus 109 (e.g., nucleus pulposus). In Figures 1C and 1D, the ligamentous ring 108 is shown partially as transparent for clarity, and the nucleus 109 is shown as transparent. The ligamentous ring 108 connects to the superior and inferior vertebrae 102a-b and can keep the nucleus 109 intact when force is applied to the vertebra 100, while the nucleus 109 can provide cushioning between the superior and inferior vertebrae 102a-b. Therefore, the nucleus 109 may be softer than the ligamentous ring 108 and easier to destroy and remove. A discectomy device 120 can engage with one or both of the ligamentous ring 108 and the nucleus 109 and be operated to remove and dislodge such material.

[0171] In some embodiments, the discectomy device 120 may be inserted through a separate medial trocar (not shown), which is inserted through a trocar 110, which functions as a lateral trocar. The medial trocar may be curved or otherwise shaped to facilitate the deployment of the discectomy device 120 to different portions of the affected intervertebral disc 104a.

[0172] After a sufficient amount of diseased intervertebral disc 104a has been removed and / or destroyed, the spinal surgical technique can include the step of deploying a balloon into the intervertebral cavity. For example, FIGS. 1E and 1F are, respectively, side views (e.g., lateral views) of a portion of spine 100 according to an embodiment of the present technique, illustrating the first and second stages of the balloon deployment step of the spinal surgical technique. Similarly, FIGS. 1G and 1H are, respectively, corresponding top views (e.g., axial views) of the portion of spine 100 shown in FIGS. 1E and 1F according to an embodiment of the present technique, illustrating the first and second stages of the balloon deployment step. Referring to FIGS. 1E-1H together, after a sufficient amount of diseased intervertebral disc 104a (FIGS. 1A-1D) has been removed by intervertebral disc excision device 120 (FIGS. 1C and 1D), intervertebral disc excision device 120 can be removed from cannula 114 of trocar 110, and first balloon 130 can be inserted through cannula 114 and beyond distal end portion 116 into intervertebral cavity 101 (e.g., within any remaining portion of annulus fibrosus 108), and diseased intervertebral disc 104a (FIGS. 1A-1D) has been removed, either completely or partially, in the intervertebral disc excision step. First balloon 130 can have a distal portion coupled to inner balloon shaft 132 and a proximal portion (hidden in FIGS. 1E and 1G) coupled to outer balloon shaft 134 that is advanceable through cannula 114. First balloon 130, inner balloon shaft 132, and outer balloon shaft 134 can collectively be referred to as a balloon device or a balloon expansion device.

[0173] In the first stage shown in FIGS. 1E and 1G, first balloon 130 is partially inserted into intervertebral cavity 101 and partially inflated within intervertebral cavity 101. First balloon 130 can be inflated via an external pressure source coupled to the lumen of outer balloon shaft 134. In the second stage shown in FIGS. 1F and 1H, first balloon 130 is fully inserted into intervertebral cavity 101 and fully inflated within intervertebral cavity 101.

[0174] The expansion of the first balloon 130 within the intervertebral space 101 can act to rupture, distract, and / or otherwise destroy any remaining portion of the affected intervertebral disc 104a, such as part or all of the ligamentous ring 108. More specifically, the first balloon 130 can expand horizontally (e.g., along a plane extending between the lower and upper endplates 106a-b) to directly destroy and rupture the ligamentous ring 108, and / or expand vertically by moving the upper and lower vertebrae 102a-b away from each other to indirectly destroy and rupture the ligamentous ring 108. Similarly, as best seen in Figures 1E and 1F, inflating the first balloon 130 can enlarge the intervertebral space 101 by increasing its height (for example, from a first value H1 shown in Figure 1E to a second value H2 shown in Figure 1F, which is above the first value). That is, the first balloon 130 can lift the upper vertebra 102a away from the lower vertebra 102b. As will be described in more detail below with reference to Figures 30-39, the first balloon 130 can be expanded into a selected shape and configured (molded, sized, constructed) to provide differential lift of the upper and lower vertebrae 102a-b, for example. In some embodiments, the first balloon 130 expands until it contacts a substantial portion of the upper endplate 106b of the lower vertebra 102b and / or a substantial portion of the lower endplate 106a of the upper vertebra 102a. In some aspects of this technique, it can avoid point loading on the inferior and superior endplates 106a-b, thereby preventing or further preventing fractures of the inferior and superior endplates 106a-b. In contrast, many conventional techniques expand the intervertebral space via interbody devices, which carries a significant risk of endplate fracture.

[0175] In some embodiments, the first balloon 130 may be inserted through a separate internal trocar (not shown), which is inserted through the trocar 110, and which functions as an external trocar. The internal trocar may be curved or otherwise shaped to facilitate the deployment of the first balloon 130 into a defined portion of the intervertebral space 101. In addition, the pressure and / or volume within the first balloon 130 may be monitored, and feedback may be provided to the user (e.g., a surgeon) regarding the rupture state of the ligamentous ring 108 and / or the lifting state of the superior and inferior vertebrae 102a-b.

[0176] After expanding the first balloon 130 within the intervertebral space 101, destroying any remaining portion of the affected intervertebral disc 104a, and lifting the upper vertebra 102a relative to the lower vertebra 102b, the spinal surgical procedure may include the step of deploying the intervertebral device into the intervertebral space 101. For example, Figures 1I-1K illustrate the intervertebral device deployment step of a spinal surgical procedure, showing a lateral view (e.g., a lateral view), another lateral view (e.g., anterior view), and a top view (e.g., an axial view) of a portion of the spine 100 according to an embodiment of the present technique. Referring together to Figures 1I-1K, after the first balloon 130 (Figures 1G and 1H) has been expanded within the intervertebral space 101, the first balloon 130 can be removed from the cannula 114 of the trocar 110, and the intervertebral device 140 can be inserted into the intervertebral space 101 through the cannula 114, beyond the distal end portion 116, and expanded within the intervertebral space 101.

[0177] The intervertebral device 140 may be referred to as an intervertebral instrument, implant, intervertebral disc replacement device, cage, and / or equivalent. The intervertebral device 140 may be a braid, mesh, or knit of filaments 142, terminating at a proximal portion 141 (e.g., proximal hub; concealed in Figures 1I and 1L) and a distal portion 143 (e.g., distal hub), and / or joined together therein. The intervertebral device 140 may be coupled to a deployment shaft 144 (concealed in Figures 1I and 1J) to advance the intervertebral device 140 into the intervertebral space 101 through a cannula 114. For example, the proximal portion 141 of the intervertebral device 140 may be releasably coupled to the distal portion of the deployment shaft 144 so that the intervertebral device 140 can be removed from the deployment shaft 144 after it has been suitably positioned within the intervertebral space 101.

[0178] In the illustrated embodiment, the intervertebral device 140 is deployed into the intervertebral space 101 and subsequently expanded within the intervertebral space 101 by a second balloon 150 positioned within the intervertebral device 140. The second balloon 150 can be analogous to the first balloon, as described in detail with reference to Figure 1E-1H. For example, the second balloon 150 can be inserted through a cannula 114 (e.g., through a lumen in a deployment shaft 144 coupled to the intervertebral device 140) and coupled to one or more balloon shafts 152 having one or more expansion lumens for inflating the second balloon 150 via an external pressure source. Inflating the second balloon 150 can expand the intervertebral device 140, bringing it into contact with the lower and upper endplates 106a-b of the upper and lower vertebrae 102a-b, respectively, and can also act to re-expand (e.g., lift) the intervertebral space 101 by increasing the height of the intervertebral space 101 (for example, from a first value H1 shown in Figure 1E to a second value H2 shown in Figure 1F, which is above the first value). In some aspects of this technique, re-expanding the intervertebral space 101 may be easier than initially expanding the intervertebral space 101 using the first balloon 130, i.e., it may require less force.

[0179] In some embodiments, the second balloon 150 is configured to (i) expand within the intervertebral device 140 without contacting the lower or upper endplate 106a-b, and / or (ii) to lift the upper vertebra 102a relative to the lower vertebra 102b, since it is not necessary to apply the same force as the first balloon 130 to lift the upper vertebra 102a relative to the lower vertebra 102b, after first using the first balloon 130 to lift the upper vertebra 102a and rupture the ligamentous ring 108 (Figures 1G and 1H). Furthermore, the second balloon 150 can be thinner and / or smaller than the first balloon 130, while the intervertebral device 140, when expanded, applies more force to the upper and lower vertebrae 102a-b, as it acts as a reinforcement for the second balloon 150, giving the second balloon 150 greater burst resistance. In some embodiments, the first balloon 130 and the second balloon 150 may be the same balloon. For example, the first balloon 130 may first be inserted through the trocar 110, inflated as shown in the balloon deployment step illustrated in Figure 1E-1H, then deflated and removed from the trocar 110, and subsequently inserted through the deployment shaft 144 of the intervertebral device 140 to expand the intervertebral device 140.

[0180] In some embodiments, the intervertebral device 140 may be configured to maximize the contact surface area between the upper and / or lower endplates 106a-b and the intervertebral device 140, thereby promoting conformation between them (e.g., molding, sizing). That is, the intervertebral device 140 may conform to the upper and / or lower endplates 106a-b. Similarly, the intervertebral device 140 may be configured to expand selectively or differentially, for example, as described in detail below with reference to Figures 40A-48B, to lift one portion of the upper vertebra 102a above another, thereby restoring the original alignment of the spine 100.

[0181] After deploying the intervertebral device 140 in the intervertebral space 101, the spinal surgical procedure may include a step of filling the intervertebral device 140 with a filling material. For example, Figures 1L-1N illustrate a first stage of the intervertebral device filling step of a spinal surgical procedure, showing a side view (e.g., a lateral view), another side view (e.g., anterior view), and a top view (e.g., an axial view) of a portion of the spine 100 according to an embodiment of the present art. Similarly, Figures 1O-1Q illustrate a second stage of the intervertebral device filling step, showing a corresponding side view, another side view, and a top view of the portion of the spine 100 shown in Figure 1L-1N, according to an embodiment of the present art. Referring to Figure 1L-1Q, after deploying the intervertebral device 140 and expanding the second balloon 150, the intervertebral device 140 can be filled with a filling material 160. The filling material 160 may comprise a load-bearing material configured to support the upper and lower vertebrae 102a-b in a desired (e.g., lifted) position, restoring the height of the intervertebral space 101, and may be configured to promote intrinsic bone growth within it. As described in more detail below with reference to Figure 49-60B, the filling material 160 may comprise one or more liquids, gases, and solids, such as cement, demineralized bone putty, epoxy, rigid particles, small metal particles, demineralized bone, biomaterials, sandy particles, silica particles, ceramic particles, metal particles, bone particles, beads, gabion structures, bone fragments, and / or equivalents.

[0182] Referring to Figure 1L-1N, the filling material 160 can be injected into the interior of the intervertebral device 140 through the balloon shaft 152. Thus, the second balloon 150 can be partially deflated simultaneously with the injection of the filling material 160, providing space for the filling material 160. In some aspects of this technology, the second balloon 150 can at least partially keep the intervertebral device 140 open while it is being filled with the filling material 160, reducing the resistance of the intervertebral device 140 to filling and / or guiding the filling material 160 to take on a specific geometric shape (e.g., a geometric shape selected to induce lordosis, kyphosis, and / or equivalents of the spine 100) within the intervertebral device 140. In the illustrated embodiment, the distal portion 143 of the intervertebral device 140 is filled with the filling material 160 in front of the proximal portion 141 (for example, the intervertebral device 140 is filled in the direction from the distal portion 143 toward the proximal portion 141). In other embodiments, the filling material 160 may be filled in the direction from the proximal portion 141 toward the distal portion and / or in other directions.

[0183] In other embodiments, the second balloon 150 and balloon shaft 152 can be removed from the trocar 110 prior to filling the intervertebral device 140 with the filling material 160, and the filling material 160 can be injected directly through the deployment shaft 144 (Figure 1K) and / or another shaft inserted through it. In yet another embodiment, the filling material 160 can be injected into the second balloon 150 so that the filling material 160 fills the second balloon 150. In such embodiments, the second balloon 150 can remain in the intervertebral device 140 after implantation, can be removed (e.g., ruptured) after filling, or can be made from a soluble or bioreabsorbable material.

[0184] Referring to Figure 1O-1Q, the filling material 160 can completely or substantially fill the intervertebral device 140 in the second stage of the intervertebral device filling step. Filling the intervertebral device 140 with the filling material 160 can expand the intervertebral device 140 (e.g., re-expand or partially expand) and bring it into contact with the lower and upper endplates 106a-b of the upper and lower vertebrae 102a-b, respectively, and can also act to re-expand (e.g., lift again) the intervertebral space 101 by increasing the height of the intervertebral space 101 (e.g., from a first value H1 shown in Figure 1E to a second value H2 shown in Figure 1F, which is above the first value). In some embodiments, the intervertebral device 140 may be configured to maximize the contact surface area between the upper and / or lower endplates 106a-b and the intervertebral device 140 when the intervertebral device 140 is filled with the filling material 160, thereby promoting conformation between them (e.g., molding, sizing). Similarly, the intervertebral device 140 may be configured to expand selectively or differentially when filled with the filling material 160, selectively increasing the distance between parts of the upper and lower vertebrae 102a-b compared to other parts (e.g., to lift a part of the upper vertebra 102a), thereby restoring the original alignment of the spine 100. After the intervertebral device 140 is filled with the filling material 160, the second balloon 150 may be removed from the cannula 114 of the trocar 110.

[0185] In some embodiments, after the intervertebral device 140 is filled with the filling material 160, the intervertebral device 140 can be tensioned to, for example, reduce the volume and / or surface area of ​​the intervertebral device 140, fill the filling material 160 together, and / or increase the stiffness of the filling material 160 or the overall device. As described in more detail below with reference to Figures 65-70D, tensioning the intervertebral device 140 may include the step of applying force to the filaments 142 to pull the filaments closer together and / or tighter together. In some embodiments, tensioning the intervertebral device 140 may occur before or in parallel with filling the intervertebral device 140 with the filling material 160 and / or closing the proximal portion 141 of the intervertebral device 140, as described in more detail below with reference to Figure 1R.

[0186] In some embodiments, the intervertebral device 140 is tensioned by filling it with a filler material 160. For example, filling the intervertebral device 140 with the filler material 160 expands the volume of the intervertebral device 140 relative to the constraints of the upper and lower vertebrae 102a-b (e.g., the constrained surface area in contact with the intervertebral device 140), thereby applying tension to the intervertebral device 140. In some embodiments, the intervertebral device 140 is filled to have a substantially spherical shape. Such a spherical shape can have the best efficiency of surface area versus volume. After the source of pressure used to inject the filler material 160 is removed, or after any balloons (e.g., a second balloon 150) that hold the space are removed, the biostructure may apply a compacting / deformation force to the filled intervertebral device 140, flattening it to a near-ideal shape. This, assuming a consistent volume, generates a larger surface area and therefore allows tension to be applied to the filament 142.

[0187] After tension is applied to the intervertebral device 140 and it is filled, the spinal surgical procedure may include the step of removing the intervertebral device 140 from the deployment shaft 144 (Figure 1K) and closing the proximal portion 141 of the intervertebral device 140. For example, Figure 1R is an enlarged lateral view (e.g., posterior view) of a portion of the spine 100 according to an embodiment of the present art, illustrating the intervertebral device closure step of the spinal surgical procedure. In the illustrated embodiment, the deployment shaft 144 has been removed from the proximal portion 141 of the intervertebral device 140, and a closure mechanism 146 is fixed to the proximal portion 141 of the intervertebral device 140, with the filament 142 and the closure mechanism 146 fixed to the proximal portion 141 of the intervertebral device 140 to retain the filling material 160 inside the intervertebral device 140 and to prevent or further prevent the filling material 160 from flowing out of the intervertebral device 140. In the illustrated embodiments, the closure mechanism 146 is a nut or screw fixed within a corresponding opening 145 in the proximal portion 141 of the intervertebral device 140. The closure mechanism 146 can be advanced and actuated (e.g., rotated) by a separate shaft or instrument inserted through the cannula 114 of the trocar 110. In some embodiments, anti-torque and / or anti-rotation features are used to allow the closure mechanism 146 to be screwed in and unscrewed. In other embodiments, the closure mechanism 146 can be a clip, slider, self-closing valve, and / or other mechanism, as described in detail below with reference to Figures 65-70D.

[0188] After filling and closing the intervertebral device 140, the trocar 110 can be removed from the patient. Referring together to Figures 1A-1R, in some aspects of this technique, steps of the spinal surgical procedure can be performed through minimally invasive port / access routes provided by the cannula 114 of the trocar 110. That is, for example, (i) the affected intervertebral disc 104a can be accessed and at least partially removed through the cannula 114 of the trocar 110, (ii) the superior vertebra 102a can be lifted through the cannula 114 of the trocar 110 via the first balloon 130 and the ligamentous ring 108 can be further destroyed, and (iii) the intervertebral device 140 can be advanced through the cannula 114 of the trocar 110 and from there into the intervertebral space 1 (iv) The intervertebral device 140 can be deployed within 01, and can be expanded within the intervertebral space 101 via the second balloon 150 through the cannula 114 of the trocar 110, (v) the intervertebral device 140 can be filled with filling material 160 through the cannula 114 of the trocar 110, and (vi) the intervertebral device 140 can be closed and the filling material 160 fixed through the cannula 114 of the trocar 110. Thus, embodiments of the present technology can minimize damage to the soft tissues of patients undergoing surgical procedures, and minimize patient pain and recovery time.

[0189] In some embodiments, after removing the trocar 110 from the patient, the spinal surgical procedure further includes the step of attaching a posterior fixation assembly to the patient's spine 100. For example, Figure 1S is a side view (e.g., anterior view) of a portion of the patient's spine 100 according to an embodiment of the art, illustrating the posterior fixation step of the spinal surgical procedure. In the illustrated embodiment, the posterior fixation assembly 170 is fixedly attached to the upper and lower vertebrae 102a-b to substantially stabilize the upper and lower vertebrae 102a-b relative to each other, for example. The posterior fixation assembly 170 may include one or more first fixation members 172a fixed within the upper vertebra 102a and one or more second fixation members 172b fixed within the lower vertebra 102b. The upper and lower fixation members 172a-b may be pedicle screws, cortical screws, wires, bands, interspinous clamps, interarchic clamps, plates, dowels, and / or equivalents. The pair of upper and lower fixing members 172a-b can be fixed together via a span member 174 such as a rod, wire, band, plate, clamp, and / or equivalent. The stabilization provided by the posterior fixing assembly 170 can promote intraosseous growth into the intervertebral device 140 (Figure 1I-1R).

[0190] Referring together to Figures 1A-1R, some steps in spinal surgery procedures can be omitted, and / or various steps can be performed in a different order. For example, the posterior fixation step can be omitted, the balloon dilation step can occur before the mechanical discectomy step, and the mechanical discectomy step can be omitted if sufficient disc material is removed via the balloon dilation step, and so on.

[0191] Figure 2 is a flowchart of a process or method 280 for performing a spinal surgical procedure, such as a spinal surgical procedure (e.g., a spinal fusion procedure), according to an embodiment of the present technology, illustrated with reference to Figures 1A-1S. In block 281, method 280 may include the step of inserting a trocar into the patient via a transpedicle-to-intervertebral or transforaminal approach so as to be close to the affected intervertebral disc, as described in more detail above with reference to Figures 1A and 1B. In blocks 282 and 283, method 280 may include the step of inserting a discectomy device through a trocar, as described in more detail above with reference to Figures 1C and 1D, and the step of destroying and / or removing part or all of the affected intervertebral disc using a mechanical discectomy device to form an intervertebral space. In blocks 284 and 285, method 280 may include, respectively, the steps of inserting a balloon into the intervertebral space through a trocar, as described in detail with reference to Figure 1E-1H, and inflating the balloon to further destroy and / or remove any remaining portion of the affected intervertebral disc and lifting the superior vertebra adjacent to the affected intervertebral disc relative to the inferior vertebra adjacent to the affected intervertebral disc. In some embodiments, blocks 285 and 286 may be performed before blocks 283 and 284.

[0192] In blocks 286 and 287, method 280 may include the steps of inserting an intervertebral device into the intervertebral space through a trocar and expanding the intervertebral device within the intervertebral space, respectively, as will be described in detail with reference to Figure 1I-1K. In block 288, method 280 may include the step of filling the intervertebral device with a filling material, as will be described in more detail above with reference to Figure 1L-1Q. In some embodiments, the same or different balloons may be used to expand the intervertebral device within the intervertebral space in block 287, while in other embodiments, the step of filling the intervertebral device with a filling material in block 288 may expand the intervertebral device.

[0193] In block 289, method 280 may include the step of applying tension to the intervertebral device and, for example, filling the intervertebral device with a filling material. In block 290, method 280 may include the step of closing the intervertebral device so that the filling material remains therein, as described in more detail above with reference to Figure 1R. In block 291, method 280 may include the step of releasing the intervertebral device into the intervertebral cavity, for example, by removing the intervertebral device from the delivery shaft. Finally, in block 291, method 280 may include the step of fixing the upper and lower vertebrae from the posterior and stabilizing the upper and lower vertebrae.

[0194] Figures 3A-3M illustrate different spinal surgical procedures (e.g., spinal surgical methods) on the spine 300 of patient 301 according to additional embodiments of the present technology (shown partially as transparent for clarity). The spinal surgical procedure can be a two-level spinal fusion procedure, in which two existing affected intervertebral discs of the spine are completely or partially removed, and two intervertebral devices are inserted into the intervertebral space to support adjacent vertebrae and provide endoosseous growth into them. In other embodiments, the spinal surgical procedure can be a single-level spinal fusion procedure or a multi-level (e.g., more than two levels) spinal fusion procedure. Figures 3A-3M provide an overview of some common aspects / steps of the spinal surgical procedure, and Figures 1A-2 and 4A-90D illustrate additional embodiments and / or aspects of various steps, devices, and / or systems that may be used therein. In some embodiments, some of the steps of a spinal surgical procedure illustrated in Figures 3A-3M, and / or the devices and systems used therein, may include some features that are at least generally similar, or identical in structure and function to, the corresponding features and structures of the devices, systems, and / or methods described above in more detail with reference to Figure 1A-2.

[0195] Figure 3A is a partial side view (e.g., lateral view) of the spine 300 according to an embodiment of the present technology, illustrating a first posterior fixation step (e.g., screw insertion step) of a spinal surgical procedure. The spine 300 includes a plurality of vertebrae 302 (including individually identified first or superior vertebrae 302a, second or central vertebrae 302b, and third or inferior vertebrae 302c) separated by intervertebral discs 304 (e.g., intervertebral discs including individually identified first affected intervertebral disc 304a and second affected intervertebral disc 304b). The superior, central, and inferior vertebrae 302a-c are shown as partially transparent in Figures 3A-3M for clarity. The affected intervertebral discs 304a-b may result from degenerative joint disease and / or disc arthropathy. In the illustrated embodiment, the upper vertebra 302a is the L4 lumbar vertebra, the central vertebra is the L5 lumbar vertebra, and the lower vertebra 302c is the S1 sacral vertebra.

[0196] In the first posterior fixation step, one or more (e.g., two) first fixation members 372a are fixed within the upper vertebra 302a, one or more (e.g., two) second fixation members 372b are fixed within the middle vertebra 302b, and one or more (e.g., two) third fixation members 372c are fixed within the lower vertebra 302c. The first, second, and third fixation members 372a-c (collectively, “fixation members 372”) can be pedicle screws, cortical screws, wires, bands, interspinous clamps, interarchal clamps, plates, dowels, and / or equivalents. For example, in the illustrated embodiment, the fixation member 372 is a pedicle screw, each comprising a threaded screw body 373, configured to be screwed into and fixed within the corresponding vertebra 302, and a multi-axis head or tulip portion 375 rotatably coupled to the screw body 373. In some embodiments, the fixing member 372 may include several features that are similar in structure and / or function to the fixing member 1572, which will be described in detail with reference to Figures 15A and 15B.

[0197] Figure 3B is a side view (e.g., lateral view) of a portion of the spine 300 according to an embodiment of the present technology, illustrating a second posterior fixation step (e.g., rod insertion step) of a spinal surgical procedure. In the second posterior fixation step, one or more span members 374 can be coupled to a fixation member 372, thereby fixing the fixation member 372 together. The span members 374 can be rods, wires, bands, plates, clamps, and / or equivalents. In the illustrated embodiment, two of the span members 374 each comprise a rod, and each of the span members 374 is coupled to the corresponding tulip portion 375 of one of the first fixation members 372a, one of the second fixation members 372b, and one of the third fixation members 372c. The fixation members 372 and the span members 374 together can define / constitute a posterior fixation assembly 370.

[0198] Figure 3C is a side view (e.g., lateral view) of a portion of the spine 300 according to an embodiment of the present technology, illustrating a third posterior fixation step (e.g., tower insertion step) of a spinal surgical procedure. In the third posterior fixation step, tower members 384 (e.g., tower, positioning tube, access channel) can be releasably (e.g., rigidly) fixed to the corresponding tulip portion 375 of the fixation member 372. Each tower member 384 can provide an access channel to access the corresponding portion of the fixation member 372 during subsequent steps of the spinal surgical procedure, which are described in detail below.

[0199] Figure 3D is a side view (e.g., lateral view) including a magnified portion of a part of the spine 300 according to an embodiment of the present technology, illustrating the access step of a spinal surgical procedure. In the access step, a first trocar 310a can be used to access a first affected intervertebral disc 304a, and a second trocar 310b can be used to access a second affected intervertebral disc 304b. In some embodiments, the first and second trocars 310a-b (collectively, “trocar 310”) can be inserted via a minimally invasive lateral approach. In other embodiments, one or both of the trocars 310 can be inserted via a transpedicle or transforaminal (e.g., transfacet joint) approach, as described above with reference to, for example, Figures 1A and 1B. In yet another embodiment, one or both of the trocars 310 can be inserted via an anterior approach. The trocar 310 may include several features that are generally similar or identical in structure and / or function to the trocar 110, as described above in more detail with reference to Figures 1A-1S and / or elsewhere herein. For example, in the illustrated embodiments, each trocar 310 includes a handle 312, which is coupled to a hollow cannula 314 that defines a lumen. In some embodiments, an introducer is positioned within each lumen of the trocar 310 during access steps such that the trocar 310 is pushed, rotated, and / or otherwise advanced through the soft tissue of the patient 301 so that it is close to the affected intervertebral disc 304a-b.

[0200] Figures 3E and 3F are side views (e.g., lateral views) including an enlarged portion of a part of the spine 300 according to an embodiment of the present technology, illustrating a separation step (e.g., parallel separation step) of a spinal surgical procedure. Referring to Figure 3E, a first balloon 330a is inserted through the cannula 314 of a first trocar 310a and inflated in a first intervertebral space 307a between the upper vertebra 302a and the middle vertebra 302b, thereby separating the first intervertebral space 307a and creating a separation (e.g., height) between the upper and middle vertebrae 302a-b. For example, inflation of the first balloon 330a can push the upper and middle vertebrae 302a-b forward, causing them to move apart from each other by a first distance D1, such as approximately 1-15 mm, approximately 1-10 mm, approximately 1-8 mm, approximately 8 mm, etc. The first fixing member 372a and the second fixing member 372b (e.g., its screw body 373; Figure 3A) are fixed therein, respectively, so that they move with the upper and lower vertebrae 302a-b during the expansion of the first balloon 330a. Thus, in some embodiments, the tulip portion 375 of the first fixing member 372a (and the coupled tower member 384) and / or the tulip portion 375 of the second fixing member 372b can slide along the span member 374 during the expansion of the first balloon 330a.

[0201] Referring to Figure 3F, the second balloon 330b is similarly inserted through the cannula 314 of the second trocar 310b and inflated in the second intervertebral space 307b between the central vertebra 302b and the lower vertebra 302c, thereby separating the second intervertebral space 307b and creating a separation (e.g., height) between the central and lower vertebrae 302b-c. For example, inflation of the second balloon 330b can push the central and lower vertebrae 302b-c forward, moving them apart by a first distance D2, such as approximately 1-15 mm, approximately 1-10 mm, approximately 1-8 mm, approximately 8 mm, etc. The second and third fixing members 372b and 372c (e.g., their screw bodies 373; Figure 3A) are fixed therein, respectively, so that they move together with the central and lower vertebrae 302b-c during the inflation of the second balloon 330b. Therefore, in some embodiments, the tulip portion 375 of the second fixing member 372b (and the connected tower member 384) and / or the tulip portion 375 of the third fixing member 372c can slide along the span member 374 during the expansion of the second balloon 330b.

[0202] Referring to Figures 3E and 3F, the first and second balloons 330a-b may include several features that are generally similar in structure and / or function to those of the first balloon 130, as described above in more detail with reference to Figures 1E-1H and / or elsewhere herein. In some embodiments, for example, as described above in more detail with reference to Figures 1C and 1D and / or elsewhere herein, a discectomy device is first inserted through the first trocar 310a before the separation of the first intervertebral space 307a using the first balloon 330a to remove part or all of the first affected intervertebral disc 304a, and / or the same or a different discectomy device is first inserted through the second trocar 310b before the separation of the second intervertebral space 307b using the second balloon 330b to remove part or all of the second affected intervertebral disc 304b. Balloons 330a and 330b can be inflated sequentially (for example, the second balloon 330b after the first balloon 330a, and the first balloon 330a after the second balloon 330b) or simultaneously.

[0203] Figure 3G-3I is a side view (e.g., a lateral view) including a magnified portion of a part of the spine 300 according to an additional embodiment of the present technology, illustrating a separation step (e.g., lordosis and separation step) of a spinal surgical procedure. The separation step illustrated in Figure 3G-3I can be performed as an alternative to the separation step illustrated in Figures 3E and 3F, or can be performed after the separation step illustrated in Figures 3E and 3F.

[0204] Referring to Figure 3G, the locking device 378 (e.g., a positioning tie) can be releasably fixed to part or all of the tower member 385. The locking device 378 may be a clamp or similar structure configured to fix and secure (e.g., lock) the position and orientation of the tower member 385 relative to one another. The tower member 385 is fixedly coupled to the corresponding tulip portion 375 of the fixing member 372 such that the locking device 378 further acts to fix and secure (e.g., lock) the position and orientation of the tulip portion 375 relative to one another. That is, for example, the locking device 378 can prevent or further prevent the tulip portion 375 from sliding (e.g., axially) and / or rotating along the span member 374. In some embodiments, the locking device 378 may comprise one or more clips, clamps, and / or equivalents fixed to the span member 374 adjacent to the tulip portion 375 to prevent or further prevent the tulip portion 375 from sliding (e.g., axially) along the span member 374. More generally, the locking device 378 is configured to prevent or further prevent (e.g., lock) the axial movement of the tulip portion 375 along the span member 374 such that the fixing member 372 is constrained to pivot rather than move laterally relative to one another.

[0205] Referring to Figure 3H, the first balloon 330a is inserted through the cannula 314 of the first trocar 310a and inflated in the first intervertebral space 307a between the upper vertebra 302a and the central vertebra 302b, thereby separating the first intervertebral space 307a and creating separation (e.g., height) and lordosis between the upper and central vertebrae 302a-b. For example, inflation of the first balloon 330a can push the upper and central vertebrae 302a-b forward, causing them to pivot so that they are separated from each other by an angle A1, such as approximately 1-15 degrees, approximately 1-10 degrees, approximately 2-8 degrees, approximately 7 degrees, etc. More specifically, the locking device 378 can fix and secure the position and orientation of the tulip portion 375 relative to each other such that the threaded screw bodies 373 (marked in the enlarged portion of the figure) of the first and second fixing members 372a-b are constrained to pivot about / inside the tulip portion 375. Such mechanical constraints on the first and second fixing members 372a-b constrain the upper and central vertebrae 302a-b to pivot and generate angle A1 as the first balloon 330a expands, as opposed to simply moving laterally away from each other, as shown in Figure 3E, for example. In some embodiments, the tower member 384 and / or other components of the system may include one or more devices configured to measure the angle A1 in real time or near real time (as described in detail below with reference to, for example, Figures 72A-77) and to provide, for example, a surgeon or other operator with intelligent feedback on the effect of the expansion of the first balloon 330a on the curvature of the spine 300. Such devices for measuring the angle A1 may be optical, electrical, mechanical, and / or equivalent.

[0206] Referring to Figure 3I, the second balloon 330b is similarly inserted through the cannula 314 of the second trocar 310b and inflated in the second intervertebral space 307b between the central vertebra 302b and the inferior vertebra 302c, thereby separating the second intervertebral space 307b and creating separation (e.g., height) and lordosis between the central and inferior vertebrae 302b-c. For example, inflation of the second balloon 330b can push the central and inferior vertebrae 302b-c forward, causing them to pivot so that they are separated from each other by an angle A2 such as approximately 1-15 degrees, approximately 1-10 degrees, approximately 2-8 degrees, or approximately 7 degrees. More specifically, the locking device 378 can fix and secure the position and orientation of the tulip portion 375 relative to each other such that the threaded screw bodies 373 (marked in the enlarged portion of the figure) of the second and third fixing members 372b-c are constrained to pivot around / within the tulip portion 375. Such mechanical constraints on the second and third fixing members 372b-c restrict the central and inferior vertebrae 302b-c to pivot and generate angle A2 as the second balloon 330b expands, as opposed to simply moving laterally away from each other, as shown, for example, in Figure 3F. In some embodiments, the tower member 384 and / or other components of the system may include one or more devices configured to measure angle A2 in real time or near real time (as described in detail below with reference to, for example, Figures 72A-77) and to provide, for example, a surgeon or other operator with intelligent feedback on the effect of the expansion of the first balloon 330a on the curvature of the spine 300. Such a device for measuring angle A2 can be optical, electrical, mechanical, and / or equivalent. In some embodiments, angle A2 can be identical or similar to angle A1 (Figure 3H).

[0207] Referring to Figures 3H and 3I, the first and second balloons 330a-b can include several features that are generally similar in structure and / or function to those of the first balloon 130, as described above in more detail with reference to Figures 1E-1H and / or anywhere else herein. In some embodiments, for example, as described above in more detail with reference to Figures 1C and 1D and / or anywhere else herein, a discectomy device is first inserted through the first trocar 310a before the separation of the first intervertebral space 307a using the first balloon 330a to remove part or all of the first affected intervertebral disc 304a, and / or the same or a different discectomy device is first inserted through the second trocar 310b before the separation of the second intervertebral space 307b using the second balloon 330b to remove part or all of the second affected intervertebral disc 304b. Balloons 330a and 330b can be inflated sequentially (for example, the second balloon 330b after the first balloon 330a, and the first balloon 330a after the second balloon 330b) or simultaneously.

[0208] In some aspects of this technology, the inflation of the first and second balloons 330a-b can generate lordosis of the vertebra 300 without compressing the vertebral foramina around the nerve roots, and in some embodiments, can decompress the vertebral foramina around the nerve roots. For example, the pivot point of the vertebra 302 in the posterior fixation assembly 370 (e.g., in the tulip portion 375) is located behind (e.g., posteriorly) the vertebral foramina and nerve roots so that the inflation of the first and second balloons 330a-b increases the intervertebral foramen height. More specifically, Figures 4A and 4B are lateral views (e.g., lateral views) of a portion of the vertebra 300 before and after inflation of the second balloon 330b according to embodiments of this technology. Referring to Figure 4A, before inflation of the second balloon 330b, the central and inferior vertebrae 302b-c can have / define the first intervertebral foramen height H1. Referring to Figure 4B, inflation of the second balloon 330b can generate lordosis of the vertebra 300, increasing its height to the second foramen height H2, exceeding the first foramen height H1. This can reduce compression around the nerve roots extending from the vertebral foramen, and is achieved because the pivot point for lordosis generation is located in the tulip portion 375, posterior to the vertebral foramen. In contrast, many conventional surgical techniques using intervertebral instruments generate lordosis by compressing a screw that pivots on the anterior edge. If the facet joints are not left intact, and therefore the compartment is partially free and floating during the placement of the intervertebral instrument, and the posterior side is reduced, the foramen height is reduced, potentially generating nerve root compression.

[0209] Figures 3J and 3K are partial side views (e.g., lateral views) of a portion of the spine 300 according to an embodiment of the present technology, illustrating the posterior fixation and locking step of a spinal surgical procedure. The posterior fixation step, illustrated in Figures 3J and 3K, can be performed after the separation and lordosis step, illustrated in Figures 3G-3I. Referring to Figure 3J, with the first balloon 330a and the second balloon 330b expanded and maintaining lordosis angles A1 and A2, the set screws 380 can be inserted through each of the tower members 384 into the corresponding tulip portions 375 of the fixation member 372. Referring to Figure 3J, with the first balloon 330a and the second balloon 330b expanded and maintaining their forward curve angles A1 and A2, the rear fixing assembly 370 can be locked in place by inserting one or more drivers 379 through the tower member 384, rotating the drivers 379, and tightening the set screws 380 (Figure 3J), for example, by locking the orientation / position of the tulip portion 375 to (i) the respective screw bodies 373 of the fixing member 372 and (ii) the span member 374 (e.g., via friction). In some embodiments, the fixing member 372 can be locked in place / orientation as described in detail below with reference to Figures 15A and 15B and / or anywhere else in this specification.

[0210] Figure 3L is a side view (e.g., lateral view) including a magnified portion of a part of the spine 300 according to an embodiment of the present technology, illustrating the intervertebral device deployment step of a spinal surgical procedure. In the illustrated embodiment, after the posterior fixation assembly 370 (Figure 3K) is locked, the first and second balloons 330a-b can be deflated and removed through the cannulas 314 of the first and second trocars 310a-b, respectively, (i) the first intervertebral device 340a can be inserted through the cannula 314 of the first trocar 310a and deployed in the first intervertebral space 307a between the superior and central vertebrae 302a-b, and (ii) the second intervertebral device 340b can be inserted through the cannula 314 of the second trocar 310b and deployed in the second intervertebral space 307b between the central and inferior vertebrae 302b-c. In some embodiments, the first and second intervertebral devices 340a-b may include several features that are generally similar or identical in structure and / or function to the intervertebral device 140, as described more in detail above with reference to Figures 1I-1R and / or elsewhere herein, and may be deployed in generally similar or identical manner (including, for example, expansion, filling, tensioning, and closure). In some embodiments, for example, as described more in detail above with reference to Figures 1C and 1D and / or elsewhere herein, a discectomy device is first inserted through the first trocar 310a before the deployment of the first intervertebral device 340a to remove part or all of the first affected intervertebral disc 304a (Figure 3A), and / or the same or a different discectomy device is first inserted through the second trocar 310b before the deployment of the second intervertebral device 340b to remove part or all of the second affected intervertebral disc 304b (Figure 3A). Alternatively, the first and second intervertebral devices 340a-b can be deployed after the separation step illustrated in Figures 3E and 3F, without locking the posterior fixation assembly 370. The posterior fixation assembly 370 can then be locked after the deployment of the first and second intervertebral devices 340a-b.

[0211] Finally, the tower member 384 and the first and second trocars 310a-b can be removed from the patient. Figure 3M is a side view of a portion of the spine 300 according to an embodiment of the present technology, for example, illustrating the first and second intervertebral devices 340a-b and the posterior fixation assembly 370 that are ultimately implanted.

[0212] Referring to Figures 3A-3M, in some aspects of this technology, spinal surgical procedures can be performed without the use of a traction device, as the first and second trocars 310a-b provide minimally invasive traction-free access ports for deployment of the first and second intervertebral devices 340a-b, separation of the first and second intervertebral spaces 307a-b, and lordosis, etc. Not requiring the use of a traction device can minimize trauma to the patient's muscles, viscera, nerves, and / or equivalents, which are significant contributors to postoperative pain that is not minor in conventional spinal surgical procedures. Similarly, in an additional aspect of this technology, the patient 301 can be positioned in a single position (e.g., prone position) throughout the entire spinal surgical procedure. In particular, the trocar 310a-b can provide access ports to the first and second intervertebral spaces 307a-b, which do not require direct visualization, so that the patient 301 can be positioned in a single location during the placement and manipulation of the posterior fixation assembly 370. Furthermore, although a two-level spinal fixation procedure is illustrated in Figures 3A-3M, spinal surgical procedures can also be performed to treat only a single affected intervertebral disc 304 and fix only two adjacent levels of the vertebra 302, and / or to treat more than two affected intervertebral discs 304 and fix more than three adjacent levels of the vertebra 302.

[0213] Figure 5 is a flowchart of a process or method 580 for performing a spinal surgical procedure, such as a spinal surgical procedure (e.g., a spinal fusion procedure), according to an embodiment of the present technology, illustrated with reference to Figures 3A-3M. In block 581, method 580 may include the step of attaching a posterior fixation assembly, including at least one span member and a fixation member, to two or more vertebrae of a patient, as described in more detail above with reference to Figures 3A and 3B. In block 581, method 580 may include the step of attaching a tower member to the fixation member, as described in more detail above with reference to Figure 3C. In block 583, method 580 may include the step of inserting at least one trocar into a patient, for example via a lateral approach, so as to be close to the affected intervertebral disc between two or more vertebrae, as described in more detail above with reference to Figure 3D. In some embodiments, for a two-level fixation procedure, a first trocar is inserted adjacent to a first affected intervertebral disc, and a second trocar is inserted adjacent to a second affected intervertebral disc. Block 584 may include the step of inserting balloons into two or more intervertebral spaces through trocars. In some embodiments, for a two-level fixation procedure, a first balloon is inserted into a first intervertebral space through a first trocar, and a second balloon is inserted into a second intervertebral space through a second trocar.

[0214] After block 584, method 580 may proceed to block 585, which includes the step of inflating the balloon and separating the intervertebral space, as described more in detail above with reference to Figures 3E and 3F, or to block 586, which is for locking the position and orientation of at least a portion of the posterior fixation assembly (e.g., the tulip portion of the fixation member) by locking the tower member together, as described more in detail above with reference to Figure 3G. In some embodiments, method 580 may proceed from block 585 to block 586. In block 587, method 580 may include the step of inflating the balloon and separating the intervertebral space to generate lordosis of two or more vertebral lordosis. In some embodiments, method 580 includes the step of determining / measuring the generated lordosis (e.g., lordosis angle) in real time or near real time.

[0215] In block 588, method 580 may include a step of locking the orientation and position of the posterior fixation assembly, as described more in detail above with reference to Figures 3J and 3K. In block 589, method 580 may include a step of deploying the intervertebral device in the intervertebral space through a trocar, as described more in detail above with reference to Figure 3L. In some embodiments, for a two-level fixation procedure, etc., a first intervertebral device is deployed in a first intervertebral space through a first trocar, and a second intervertebral device is deployed in a second intervertebral space through a second trocar.

[0216] If the method proceeds to block 585 and not to block 586, method 580 may include the step of deploying the intervertebral device in the intervertebral space through a trocar in block 590, and then locking the position and orientation of the posterior fixation assembly in block 591. II. Selected embodiments of devices and associated systems and methods for providing spinal access

[0217] Figures 6A-17B illustrate embodiments of certain instruments and / or instruments that may be used to facilitate and / or assist access to the affected intervertebral disc, as described in more detail above with reference to Figures 1A and 1B, block 281 of Method 280 in Figure 2, Figure 3D, and block 583 of Method 5. Thus, embodiments described with reference to Figure 6A-17B may be utilized in the workflow of spinal surgical procedures, as described in more detail with reference to Figure 1A-5 and / or elsewhere in this specification.

[0218] Figure 6A is a perspective view of an access matching assembly 610 positioned on a patient 600 according to an embodiment of the present art. In the illustrated embodiment, the access matching assembly 610 includes a marker grid 612 bonded to a sterile adhesive or other layer 614. Figure 6B is a schematic perspective view of the marker grid 612 according to an embodiment of the present art. Referring to Figure 6B, the marker grid 612 may comprise a plurality of radiopaque markers 611 positioned within a grid pattern along one of a plurality of grid layers 613 (e.g., individually identified first grid layer 613a, second grid layer 613b, and third grid layer 613c). Referring to Figures 6A and 6B, when the access alignment assembly 610 is positioned on the patient 600, the first grid layer 613a can be positioned in close proximity to the patient's skin (e.g., adjacent to the patient's skin), and the third grid layer 613c can be positioned as far away from the patient's skin.

[0219] During spinal surgery, patient 600 may be imaged using radiography, computed tomography (CT), magnetic resonance imaging (MRI), and / or equivalents while the access matching assembly 610 is positioned on patient 600. By acquiring images from at least two different viewpoints (e.g., along two different orthogonal axes), an image processor can construct a three-dimensional (3D) model of a portion of patient 600, including the acquired marker grid 612. The 3D model can be used to define the optimal entry point and trajectory for inserting the trocar into the affected intervertebral disc of patient 600 through a transpedicle or transforaminal approach. For example, the image processor can (i) determine the optimal entry point and output this information as a first coordinate (x,y) on a first grid layer 613a adjacent to the patient's skin, and (ii) determine the optimal trajectory and output this information as a second coordinate in a second grid layer 613b and / or a third coordinate in a third grid layer 613c. Thus, the surgeon only needs to traverse the identified coordinates and ensure that they follow the correct entry point and trajectory. In contrast, some conventional systems use imaging during surgery to locate the entry point and trajectory as the needle is advanced into the patient. However, the surgeon may be required to start and stop while taking radiographs during the process, relying on experience and anatomical reference.

[0220] Figures 7A and 7B are a top (e.g., axial) and side (e.g., lateral) view of a trocar 710 for providing access to the vertebrae or intervertebral discs of the spine 700 (e.g., lateral, transpedicle, transfacet joint, transforaminal, and / or other access), respectively, according to embodiments of the present technology. Referring to Figures 7A and 7B, the trocar 710 includes a handle 712 which is coupled to a hollow cannula 114. In the illustrated embodiments, the trocar 710 is constructed within the trocar 710 (e.g., within the handle 712) along different axes, at an axial angle A A (Figure 7A), sagittal angle A SThe system may include an angle determination unit 716 configured to detect the angle of the cannula 114 relative to the spine 700, such as (Figure 7B), and / or other angles. The angle determination unit 716 may comprise a gyroscope, a protractor, and / or other devices configured to determine the angle. During a spinal surgical procedure, the surgeon can position the cannula 714 at a predetermined entry point into the patient, and then adjust the angle of the cannula 714 based on readings from the angle determination unit 716 to align the cannula 714 along a predetermined trajectory, providing transpedicle- or transforaminal access to the spine 700.

[0221] Figure 8A is a perspective view of a trocar 810 and a pair of internal stylets 816 for use with the trocar 810 according to an embodiment of the present technology. In the illustrated embodiment, the trocar 810 includes a handle 812 coupled to a hollow cannula 814, and each stylet 816 includes a grip 817 (e.g., handle, hub) coupled to an elongated member 818 (e.g., needle). The grip 817 of the stylet 816 may be detachable from the elongated member 818. During a spinal surgery procedure, the surgeon can first insert one of the stylets 816 into the patient through a determined entry point along a determined trajectory. Then, if the stylet 816 is properly positioned, the surgeon can remove the grip 817 from the elongated member 818 and then advance the cannula 814 of the trocar 810 across the elongated member 818, aligning the trocar along the determined trajectory. In some aspects of this technology, positioning the stylet 816 along the correct trajectory first, i.e., before introducing the trocar 810, can reduce trauma to the patient because, if the stylet 816 needs to be repositioned, the elongated member 818 of the stylet 816 has a smaller external shape than the cannula 814 of the trocar 810, thus minimizing tissue trauma. Figure 8B is a side view (e.g., lateral view) of an embodiment of this technology, illustrating two steps: (i) first, inserting the stylet 816 into the patient's spine 800; and (ii) advancing the trocar 810 across the stylet 816 to access the spine 800. After advancing the trocar 810 across the stylet 816, the stylet 816 can be removed from the cannula 814 so that additional devices (e.g., balloons, intervertebral devices) can be advanced through the cannula 814.

[0222] Figure 8C is a side view of a stylet 816 according to an additional embodiment of the present technology. In the illustrated embodiment, the grip 817 of the stylet 816 has a pen-like shape to facilitate surgical manipulation. The grip 817 can be combined with additional features that are attachable to the stylet 816 so that the stylet 816 can be driven into position.

[0223] Figure 9 is a side view of a trocar 910 according to an embodiment of the present technology. In the illustrated embodiment, the trocar 910 includes a handle 912 coupled to a hollow cannula 914, the cannula 914 having a radiolucent notch 916 thereon to facilitate visualization of the depth of the cannula 914 within the patient via radiographic imaging. The cannula 914 may have any number of notches 916 positioned at any longitudinal position along the cannula 914.

[0224] Figure 10 is a side view of a trocar 1010 according to an embodiment of the present technology. In the illustrated embodiment, the trocar 1010 includes a handle (not shown) coupled to a hollow cannula 1014, which is positioned to access the patient's spine 1000. The cannula 1014 is inserted through a portion of the lower vertebra 1002b of the spine 1000, for example, via a transpedicle approach. In the illustrated embodiment, the cannula 1014 includes a distal end portion 1016 having a sloped tip 1017 such that the distal end portion 1016 of the cannula 1014 may be substantially coplanar with the endplate 1006a (e.g., the upper endplate) of the lower vertebra 1002b when the trocar 1010 is inserted through it. In some aspects of this technology, positioning the sloped tip 1017 coplanar with the endplate 1006a can facilitate the introduction of the instrument into the intervertebral space 1001 above the inferior vertebra 1002b without interference from the trocar 1010. For example, a balloon (not shown) or intervertebral device 1040 can be inserted into the intervertebral space 1001 through the trocar 1010 and expanded within the intervertebral space 1001 without expanding to the point of contact with the distal end portion 1016 of the cannula 1014, which could potentially damage the balloon or intervertebral device 1040.

[0225] Figures 11A and 11B are side views of the trocar 1110 in a first and second position according to an embodiment of the present technology, respectively. Referring to Figures 11A and 11B, in the illustrated embodiment, the trocar 1110 includes a handle (not shown) coupled to a hollow cannula 1114, which is positioned to access the patient's spine 1100. The cannula 1114 is inserted through a portion of the lower vertebra 1102b of the spine 1100, for example, via a transpedicle approach. The cannula 1114 may further include an expandable anchoring section 1116 positioned along its length. The expandable anchoring section 1116 is compressed in the first position shown in Figure 11A and expanded in the second position shown in Figure 11B. In some embodiments, the expandable mooring section 1116 is similar to an expandable screw and can be actuated to flex outward from a first position to a second position via the operation (e.g., rotation) of a trocar 1110. For example, the expandable mooring section 1116 may include a plurality of movable arms configured to extend radially outward in the expanded second position. Figures 11C and 11D are side views of the expandable mooring section 1116 in the expanded second position, for example, according to an embodiment of the present art.

[0226] Referring to Figures 11A and 11B, the trocar 1110 is inserted through the patient's spine 1100 in a compressed first position to gain access to its intervertebral space 1101, and then the expandable anchoring section 1116 can be expanded to an expanded second position to anchor the trocar 1110 to the intervertebral space 1101. In the illustrated embodiment, the expandable anchoring section 1116 expands within the pedicle 1105b of the lower vertebra 1102b and is positioned to anchor the trocar 1110 therein. In some aspects of this technique, the expandable anchoring section 1116 is used with the trocar 1110 during spinal surgical procedures to prevent or further prevent axial and / or rotational displacement of the trocar 1110 (for example, as an additional device is inserted through a cannula 1114).

[0227] Figure 12A is a perspective view of a trocar 1210 according to an embodiment of the present technology. In the illustrated embodiment, the trocar 1210 includes a handle 1212 coupled to a hollow cannula 1214 having a curved distal portion 1216. The distal portion 1216 can have a curved shape when unconstrained, and can have a straight shape (e.g., as shown by the dashed line) when the distal portion 1216 is constrained within a straight lumen. The distal portion 1216 can be thermally solidified or otherwise configured to have a curved shape. In some embodiments, the cannula 1214 of the trocar 1210 is configured to be inserted through an introducer (e.g., a cannula of another trocar) with a straight distal portion 1216, and the distal portion 1216 is configured to have a curved shape when extending outward from the introducer. In other embodiments, a straight stylet or other elongated member can be inserted through the cannula 1214 to maintain a straight distal portion 1216. The stylet or other elongated member can then be removed from the distal portion 1216 (for example, by being pulled proximally through it), allowing the distal portion 1216 to take on a curved shape.

[0228] The cannula 1214 can receive one or more instruments (e.g., balloons, intervertebral devices) during spinal surgical procedures and guide the instruments into the intervertebral space of the patient's spine. In some aspects of this technique, once the distal portion 1216 is positioned within the intervertebral space, the trocar 1210 can be rotated and / or translated to provide access to different portions of the intervertebral space. For example, Figures 12B and 12C are side views of the trocar 1210 inserted through an introducer 1220 (e.g., another trocar) in a first and second position, respectively, according to embodiments of this technique. Referring to Figures 12B and 12C, the introducer 1220 includes a handle (not shown) coupled to a hollow cannula 1224, which is positioned to access the patient's spine 1200. The cannula 1224 is inserted through a portion of the lower vertebra 1202b of the spine 1200, for example, via a transpedicle approach.

[0229] In the illustrated embodiment, the distal portion 1216 of the trocar 1210 extends from the introducer 1220 into the intervertebral space 1201 of the vertebra 1200. In Figure 12A, the distal portion 1216 is curved toward the anterior portion of the intervertebral space 1201 to facilitate the introduction of an instrument (e.g., a discectomy device) toward the anterior portion. In Figure 12B, the trocar 1210 is rotated so that the distal portion 1216 is curved toward the posterior portion of the intervertebral space 1201. Furthermore, advancing / retracting the distal portion relative to the cannula 1224 can further shift the position of the curved distal portion 1216 within the intervertebral space 1201, providing further maneuverability and control. That is, rotation and translation of the curved distal portion 1216 relative to the cannula 1224 can sweep / maneuver the curved distal portion 1216 through the intervertebral space 1201. Thus, the curved distal portion 1216 facilitates access to different areas of the intervertebral space 1201. Specifically, the curved distal portion 1216 can help guide the instrument received through the cannula 1214 to a desired position within the intervertebral space 1201.

[0230] Referring to Figures 12A-12C, during spinal surgical procedures, the trocar 1210 can be used to guide multiple instruments, or different trocars having different curved distal portions can be used at different times to give different trajectories to instruments inserted through them. Similarly, multiple trocars having curved distal portions can be nested together to traverse multiple bends. In yet another embodiment, the cannula 1214 of the trocar 1210 can be molded to curve in multiple directions / planes.

[0231] Figures 13A–13C are coronal, top, and another top view of the intervertebral device deployment step of a spinal surgical procedure utilizing the trocar 1210 of Figure 12A and the introducer 1220 of Figures 12B and 12C, respectively, according to embodiments of the present technology. Referring to Figures 13A and 13B, the curved trocar 1210 can be inserted through the straight introducer 1220 to provide access to the intervertebral cavity 1301. Then, referring to Figure 13C, the intervertebral device 1340 can be inserted into the intervertebral cavity 1301 across / through the curved trocar 1210 for deployment therein. In some aspects of the present technology, the curved trocar 1210 may help guide the intervertebral device to a desired location within the intervertebral cavity 1301, such as a central location therein. In other embodiments, the intervertebral device 1340 can be inserted into the intervertebral cavity 1301 through the straight introducer 1220.

[0232] Figure 14 is a side view of a posterior fixation assembly 1470 according to an embodiment of the present technology. In the illustrated embodiment, the posterior fixation assembly 1470 is fixedly attached to the upper vertebra 1402a and lower vertebra 1402b of the patient's spine 1400, for example, substantially stabilizing the upper and lower vertebrae 1402a-b relative to each other. The posterior fixation assembly may include one or more first fixation members 1472a fixed within the upper vertebra 1402a and one or more second fixation members 1472b fixed within the lower vertebra 1402b. The upper and lower fixation members 1472a-b may be pedicle screws and / or equivalents. The pair of upper and lower fixation members 1472a-b may be fixed together via a span member 1474 such as a rod.

[0233] In the illustrated embodiments, the second fixation member 1472b includes a channel or cannulation 1476 that partially extends through it. The cannulation 1476 may be a straight channel that partially extends through the second fixation member 1472b from a posterior opening 1475 to an anterior opening 1477. The anterior opening 1477 may extend through the side wall of the second fixation member 1472b and may therefore be referred to as a lateral port or lateral fenestration. The cannulation 1476 may serve as a working channel for receiving a trocar through it to access the affected intervertebral disc 1404, which is located between the superior and inferior vertebrae 1402a-b. In some embodiments, for example, a curved trocar (e.g., a trocar 1210, described in detail with reference to Figures 12A-13C) can be inserted through the cannulation to access the affected intervertebral disc 1404 via a transpedicle approach. In other embodiments, the cannulation 1476 can be curved.

[0234] Figure 15A is an exploded side view of a fixing member 1572 of a posterior fixation assembly according to an embodiment of the present technology. The fixing member 1572 may be a pedicle screw. In the illustrated embodiment, the fixing member 1572 includes a screw 1523 (e.g., screw body), a tulip portion 1578, a grooved insert 1579 (e.g., saddle), and a set screw 1580. The screw 1573 may include a head portion 1581 configured to be coupled to / inside the tulip portion 1578, and is inserted (e.g., screwed) into the vertebra to provide a screw-bone interface. The head portion 1581 may be spherical, and the tulip portion 1578 may be rotatably coupled to the head portion 1581 such that the tulip portion 1578 can rotate relative to the screw 1573 along its spherical shape. The tulip portion 1578 may include an opening 1582 for receiving a span member (e.g., a rod) through it, as will be described in more detail below with reference to Figures 15C-15E, and may be configured (e.g., molded and sized) to be releasably coupled to a tower member. Thus, the fixing member 1572 may be a multi-screw such that the tulip portion 1578 is spherically rotatable about the head portion 1581 of the screw 1573. The set screw 1580 may rotate and compress a grooved insert 1579 against the tulip portion 1578 and / or the span member inserted through it, thereby locking the orientation / position of the tulip portion 1578 against the screw 1573 (e.g., via friction).

[0235] Figure 15B is a side cross-sectional view of a screw 1573 according to an embodiment of the present art. Referring to Figures 15A and 15B, in the illustrated embodiment, the screw 1573 includes a channel or cannulation 1576 that extends partially through it. The cannulation 1576 may be a straight channel that extends from a rear opening 1575 to an anterior portion 1577, partially through the screw 1573 and / or head portion 1581. The anterior portion 1577 may extend through the side wall of the screw 1573 and may therefore be referred to as a lateral port or lateral fenestration. The cannulation 1576 may serve as a working channel for receiving a trocar through it to access the affected intervertebral disc.

[0236] Figure 15C is a side view of a posterior fixation assembly 1570, including a plurality of fixation members 1572 as shown in Figure 15A, according to an embodiment of the present technology. Each screw 1573 of the fixation member 1572 can be fixed to the corresponding vertebra of the patient's spine. In the illustrated embodiment, a span member 1574 is coupled / fixed to the tulip portion 1578 of the fixation member 1572 by being inserted, for example, through its opening 1582 (Figure 15A). Each tulip portion 1578 is further releasably fixed to a corresponding to a plurality of tower members 1584 (e.g., towers). The tower members 1584 can provide access channels 1585 for accessing the fixation member 1572, and can be rotated / pivoted to vary the orientation / position of the tulip portion 1528 relative to the screw 1573. For example, a driver can be inserted through the access channel 1585 and used to drive the screw into the vertebra (e.g., rotate the screw). Next, referring to Figures 15A-15C, after the driver is removed, the tower member 1584 can be rotated to change the orientation of the tulip portion 1578 and the corresponding opening 1582, allowing the span member 1574 to slide through it and secure the fixing member 1572 together. Finally, the same or a different driver can be inserted through the access channel 1585 to tighten the set screw 1580, securing the fixing member 1572 to the span member 1574 and locking the orientation of the tulip portion 1578 to the screw 1573. The tower member 1584 can be disengaged from the tulip portion 1578 at the end of the procedure.

[0237] Figures 15D and 15E are side views of a single fixing member 1572 and a single tower member 1584 of Figure 15C, which are fixed to a vertebra 1502 of a spine 1501 according to an embodiment of the present technology. Referring to Figure 15D, the tower member 1584 is positioned in a first position in which the tulip portion 1578 and access channel 1585 are substantially aligned with the screw 1583 of the fixing member 1572 (Figures 15A-15C). In the first position, the screw 1583 can be driven into the vertebra 1502 (for example, rotated via a screwdriver inserted through the access channel 1585). Referring to Figure 15E, the tower member 1584 can be rotated to rotate the tulip portion 1578 to a second position relative to the screw 1583, thereby generally aligning the tower member 1584 and the access channel 1585 with the cannulation 1576 (Figures 15A and 15B). Referring to Figures 15A-15E, in the second position (Figure 15E), the trocar is inserted through the access channel 1585 and cannulation 1576 to access the affected intervertebral disc 1504 of the vertebra 1501. In some embodiments, a set screw 1580 is rotated to lock the tulip portion 1578 in the second position, resisting movement of the tower member 1584 during spinal surgical procedures and allowing the intervertebral device to be embedded in the space of the intervertebral disc 1504 (for example, as described in more detail above with reference to Figure 1A-2). For example, once locked, the tower member 1584 can resist movement from forces applied by the patient's tissues and / or skin. Thus, the tower member 1584 can be rotated to a position aligned with the off-axial cannulation 1576 and locked in that aligned position. After the intervertebral device is implanted, the tulip portion 1578 can be released from the screw 1573 (for example, by rotating the set screw 1580), and the tulip portion 1578 can be rotated again to facilitate the insertion of the span member 1574 (Figure 15C). Finally, the tower member 1584 can be released from the fixing member 1572.

[0238] Figure 16 is a side view of a fixing and access assembly 1670 according to an embodiment of the present technology. In the illustrated embodiment, the fixing and access assembly 1670 includes a fixing member 1672 coupled to a trocar 1610. The fixing member 1672 may include several features that are at least generally similar in structure and function to, or identical in structure and function to, the corresponding features and features of the fixing member 1572, which are described in more detail above with reference to Figures 15A-15E. For example, in the illustrated embodiment, the fixing member 1672 includes a tulip portion 1678 rotatably coupled to a screw 1673. The tulip portion 1678 can be locked to a fixed orientation / position relative to the screw 1673 via rotation of a set screw (not shown) or other locking mechanism. The tulip portion 1678 can further be releasably coupled to a tower member 1684 to manipulate the orientation of the tulip portion 1678 relative to the screw 1673. The fixing member 1672 can be fixed (for example, screwed into) a vertebra 1602 adjacent to the affected intervertebral disc 1604 and used to provide posterior fixation.

[0239] In the illustrated embodiment, the trocar 1610 is coupled to the tulip portion 1678 (e.g., the lateral portion of the tulip portion 1678). The trocar 1610 can be integrated with the tulip portion 1678 (e.g., built into it) or can be releasably coupled to the tulip portion 1678. In other embodiments, the trocar 1610 can be inserted through a channel or cannulation within the tulip portion 1678. The tulip portion 1678 can be operated by the tower member 1684 to position the trocar 1610 relative to the vertebra 1602, and / or the trocar 1610 can be operated to change the orientation of the tulip portion 1678. The trocar 1610 can be used to access the intervertebral disc 1604 once the fixing member 1672 is fixed to the vertebra 1602. For example, one or more devices 1620 (e.g., discectomy devices, balloon devices, intervertebral devices, closure devices, tensioning devices, and / or equivalents described herein) can be inserted through the trocar 1610 to facilitate the deployment of the intervertebral device in place of or in conjunction with the intervertebral disc 1604.

[0240] Figures 17A and 17B are side views of a trocar access system according to an embodiment of the present art, including an access trocar 1720 (e.g., a first trocar, an external catheter, an access sheath, and / or equivalent) and a steerable trocar 1710. The trocar access system is in a first (e.g., engaged) position in Figure 17A and in a second (e.g., disengaged) position in Figure 17B. Referring to Figures 17A and 17B, in the illustrated embodiments, the access trocar 1720 includes a first handle 1722 coupled to a hollow first cannula 1724, and the steerable trocar 1710 includes a second handle 1712 coupled to a hollow second cannula 1714. Referring to Figure 17A, the second cannula 1714 is inserted through the first cannula 1724 and configured to exit, at least partially, from the first cannula 1724. The distal portion of the second cannula 1714 can be configured to deflect within the intervertebral space or to be actively maneuvered (e.g., via the second handle 1712), as described in more detail above with reference to Figures 12B and 12C. In some embodiments, the second handle 1712 can occlude / couple with the first handle 1722 in the first position shown in Figure 17A. Referring to Figures 17A and 17B, the second cannula 1714 can receive one or more instruments, such as an intervertebral device 1752, which are inserted during spinal surgical procedures and guide the instruments into the intervertebral space of the patient's spine. III. Selected Embodiments of Discectomy Devices and Associated Systems and Methods

[0241] Figures 18A-29D illustrate embodiments of a discectomy device that can be inserted through a trocar and used to remove part or all of an affected intervertebral disc, as described in more detail above with reference to blocks 282 and 283 of method 280 in Figures 1C and 1D and Figure 2. Thus, embodiments described with reference to Figures 18A-29D can be utilized within the workflow of spinal surgical procedures, as described in more detail with reference to Figures 1A-2, 3A-5 and / or anywhere else herein.

[0242] Figure 18A is a side view of a discectomy device 1820 according to an embodiment of the present technology. In the illustrated embodiment, the discectomy device 1820 includes a handle 1822 coupled to an elongated shaft 1824. The elongated shaft 1824 includes a disc cutting element 1826 (e.g., a disc osteoscision element) at its distal end. The disc cutting element 1826 may include a plurality (e.g., two) expandable members 1825 configured (e.g., molded, sized) to expand radially outward relative to the elongated shaft 1824 in order to mechanically engage with and break the disc material. The expandable members 1825 may be formed from spring steel, nitinol, and / or other materials such that when deployed from an introducer (e.g., either a trocar and / or introducer as described in detail above), the expandable members 1825 expand radially outward. During spinal surgery, the disc cutting element 1826 can be translated proximal and distal to the introducer and / or rotated relative to the intervertebral cavity and / or the introducer to mechanically engage with and break the disc material. In some embodiments, an expandable member 1825 is sharp and provides a cutting mechanism for cutting the disc material. After engaging with the disc material, the expandable member 1825 can be compressed as it is retracted back into the introducer.

[0243] Figure 18B is a side view of the discectomy device 1800 of Figure 18A according to an additional embodiment of the present technology. In the illustrated embodiment, the expandable member 1825 is molded to have a more radially expanded (e.g., semicircular) outer shape when expanded.

[0244] Figure 18C is a side view of the discectomy device 1800 of Figure 18A according to an additional embodiment of the present technology. In the illustrated embodiment, the expandable member 1825 extends distally and, when expanded, is molded to curve and widen radially and / or proximal.

[0245] Figure 19 is a side view of a discectomy device 1920 according to an embodiment of the present technology. In the illustrated embodiment, the discectomy device 1920 includes an elongated shaft 1824 (Figure 18B) and a disc cutting element 1826. The elongated shaft 1824 may further include a proximal threaded portion 1921 coupled to a handle 1922. The discectomy device 1920 may further include an outer shaft 1923 positioned at least partially along the elongated shaft 1824 and an actuator 1927 positioned along the threaded portion 1921. The actuator 1927 may include a threaded inner channel that engages with the threaded portion 1921 of the elongated shaft 1824. The actuator 1927 can be actuated (e.g., rotated) to retract the elongated shaft 1824 and the discecting element 1826 into the outer shaft 1923, crushing / compressing the expandable member 1825 into it, and / or advance the outer shaft 1923 across the discecting element 1826, crushing the expandable member 1825 into it. Alternatively, or in addition, the actuator 1927 can be actuated to retract the discecting element 1826 against an introducer (e.g., a curved trocar) through which the discectomy device 1920 is inserted, crushing the discecting element 1826 into the introducer. In some aspects of this technology, the actuator 1927 offers a mechanical advantage, for example, making it easier to crush the discecting element 1826 when the expandable member 1825 is relatively rigid in the expanded configuration and therefore requires a significant force to crush.

[0246] Figure 20 is a perspective view of an elongated member 2024 of a discectomy device according to an embodiment of the present technology. In the illustrated embodiment, the elongated member 2024 is a helical hollow chain tube comprising a first (e.g., outer) layer 2021 comprising one or more helically wound filaments or chains 2023, and a second (e.g., inner) layer 2025 comprising one or more helically wound filaments or chains 2027. The second layer 2025 may define an inner channel 2029. The chains 2023 and 2027 may comprise stainless steel, cobalt-chromium, titanium, nitinol, tungsten, composite materials, other metallic materials, and / or equivalents. In some aspects of this technology, the structure of the elongated member 2024 allows the elongated member 2024 to transmit torque and compressive force to the intervertebral disc cutting element coupled thereto, even when traversing a curved path, such as when the elongated member 2024 is introduced through a curved trocar. More specifically, the elongated member 2024 can have very low flex properties and high resistance to torsion, enabling the transmission of torque and compressive force along a curved trajectory. In some embodiments, the elongated member 2024 includes only one of the first layer 2021 or the second layer 2025, or includes an additional layer of helically wound filaments or chains.

[0247] Figure 21 is a perspective view of an elongated member 2124 of a discectomy device according to an embodiment of the present technology. In the illustrated embodiment, the elongated member 2124 is a cable comprising several groups 2121 of individual filaments of a chain 2123, which are braided / wound together. The groups 2121 are further braided / wound together to form the elongated member 2124. In the illustrated embodiment, each group 2121 comprises seven chains 2123, and the elongated member 2124 comprises seven groups 2121. In other embodiments, the groups 2121 may comprise more or fewer chains 2123, and / or the elongated member 2124 may comprise more or fewer groups 2121. The chains 2123 may comprise stainless steel, cobalt-chromium, titanium, nitinol, tungsten, composite materials, other metallic materials, and / or equivalents. In some aspects of this technology, the structure of the elongated member 2124 allows the elongated member 2124 to transmit torque and compressive force to the intervertebral disc cutting element to which it is coupled, even when the elongated member 2124 traverses a curved path, such as when it is introduced through a curved trocar.

[0248] Figure 22A is a side view of a discectomy device 2220 according to an embodiment of the present technology. In the illustrated embodiment, the discectomy device 2220 includes an elongated member 2224 coupled to a disc cutting element 2226. In Figure 22A, the elongated member 2224 is shown in a curved position, such as a position where the elongated member 2224 can navigate a curved guide. Figure 22B is an enlarged perspective view of a portion of the elongated member 2224 according to an embodiment of the present technology. In the illustrated embodiment, the elongated member 2224 comprises a flexible tube 2221 having an opening or groove 2223 formed therein. The groove 2223 can be laser-cut into the flexible tube 2221. In some embodiments, the elongated member is a flexible laser-cut hypotube.

[0249] Figure 23 is a perspective side view of a discectomy device 2320 according to an embodiment of the present technology. In the illustrated embodiment, the discectomy device 2320 includes (i) a handle 2322, (ii) an actuator 2321 (e.g., a trigger) operably coupled to the handle 2322, (iii) an outer elongated member 2324 fixedly coupled to the handle 2322, (iv) an inner elongated member 2328 extending through the outer elongated member 2324 and coupled to the actuator 2321, and (v) a discectomy element 2326 having a distal end portion coupled to the inner elongated member 2328 and a proximal end portion coupled to the outer elongated member 2324. The discectomy device 2320 can be inserted into the intervertebral space of the patient's spine through an introducer.

[0250] The disc cutting element 2326 may include a plurality (e.g., two) expandable members 2325 configured to expand radially outward in order to mechanically engage with and break the material of the intervertebral disc within the intervertebral space. More specifically, a user (e.g., a surgeon) can grasp the handle 2322 and actuate the actuator 2321 (e.g., by squeezing) to retract the inner elongated member 2328 relative to the outer elongated member 2324, compressing the disc cutting element 2326 longitudinally and expanding the expandable members 2325 radially outward. In the illustrated embodiment, acting the actuator 2321 expands both expandable members 2325 radially ("bilateral expansion"). In other embodiments, acting the actuator 2321 expands only one of the expandable members 2325 radially ("unidirectional expansion"). Similarly, the intervertebral disc cutting element 2326 may include one or more than two of the expandable members 2325.

[0251] In some aspects of this technology, forcibly expanding the disc cutting element 2326 within the intervertebral space can allow for a larger area for removing disc material within the intervertebral space. For example, the inlet may have an internal lumen with a diameter of approximately 1.5 to 4.5 millimeters, while the intervertebral space may have dimensions of up to approximately 14 millimeters. Therefore, expanding the disc cutting element 2326 to a dimension exceeding that of the inlet can allow the disc cutting element 2326 to better match the dimensions of the intervertebral space in order to facilitate robust removal of disc material. In some embodiments, the disc cutting element 2326 can be expanded to a dimension exceeding that of the intervertebral space (e.g., height). This allows the disc cutting element 2326 to flex relative to the adjacent vertebra and scrape the disc material from there.

[0252] Figures 24A-24D are side views of various parts of a discectomy device 2420 according to an embodiment of the present technology. Referring to Figures 24A and 24B, the discectomy device 2420 may include a discectomy element 2426 comprising a hypotube 2427 having a plurality (e.g., three) laser cutting gaps 2429 that extend longitudinally along the hypotube 2427 and are spaced circumferentially around the hypotube 2427. In Figure 24A, the discectomy element 2426 is in a compressed position, and in Figure 24B, it is in an expanded position. Referring to Figures 24C and 24D, the discectomy device 2420 may further include an inner elongated member 2428 coupled to the distal end portion 2423a of the hypotube 2427, and an outer elongated member 2424 coupled to the proximal end portion 2423b of the hypotube 2427. Therefore, the inner elongated member 2428 can be pulled proximal to the outer elongated member 2424, for example, via a handle (not shown; for example, handle 2322 in Figure 23), thereby compressing the hypotube 2427 longitudinally. Referring to Figures 24A-24D, longitudinal compression of the hypotube 2427 causes it to rupture along the gap 2429, expanding radially outward and forming a cut member 2425 (Figure 24D). In its expanded position, the cut member 2425 can engage with and break the intervertebral disc material.

[0253] Figure 25 is a side view of a discectomy device 2520, inserted through an introducer 2510 to access a patient's spine 2500, according to an embodiment of the present technology. In the illustrated embodiment, the discectomy device 2520 includes an elongated member 2524 having one or more energy delivery elements 2526 positioned thereon. The energy delivery elements 2526 may be configured to deliver ablation energy, heat, and / or equivalent into the intervertebral space 2501 to remove disc material therein. In some embodiments, the energy delivery elements 2526 are electrodes.

[0254] Figure 26 is a side view of a discectomy device 2620 according to an embodiment of the present technology. In the illustrated embodiment, the discectomy device 2620 includes a grip or handle 2622 coupled to an elongated shaft 2624, and a disc cutting element 2626 at the distal end of the elongated shaft 2624. The disc cutting element 2626 may be a rigid ring for curettage of the disc material. Thus, the discectomy device 2620 may be analogous to a curette device.

[0255] Figures 27A and 27B are enlarged side views of the distal portion of a discectomy device 2720 according to an embodiment of the present technology. Referring to Figures 27A and 27B, in the illustrated embodiment, the discectomy device 2720 includes an elongated shaft 2724 having a disc cutting element 2726 at its distal end. The disc cutting element 2726 may have a textured curettage surface 2727 (Figure 27A) that is angled relative to the elongated shaft 2724. Thus, the discectomy device 2720 can be analogous to a rasporotherapy device.

[0256] Figure 28 includes multiple side views of the distal portion of a curette-like or raspo-like intervertebral discectomy device 2800 according to an embodiment of the present technology.

[0257] Referring to Figures 26-28, in some embodiments, the raspo-like or curette-like discecting element can be pivotably and / or otherwise movably coupled to the elongated shaft of the discecting device by a hinge, so that the discecting element can pivot within the intervertebral space and access different portions of the intervertebral space. In some embodiments, the movement (e.g., pivoting) of the discecting element can be controlled via a handle or other user control.

[0258] Figures 29A-29D are perspective side views of the distal portions of discectomy devices 2920a-2920d according to embodiments of the present technology, respectively. Referring together to Figures 29A-29D, each discectomy device 2920a-d includes a cutting portion 2926 coupled to an elongated member 2924, and the cutting portion 2926 is configured to be rotated (e.g., at a high revolutions per minute (RPM)) to engage with and break the disc material, similar to an end mill or bore mill. More specifically, the cutting portion 2926 may comprise an end mill having grooves, teeth, longitudinal grooves, channels, and / or equivalents that, when rotated, can cut through the disc material and capture / take in the disc material for removal from the patient.

[0259] The discectomy devices 2920a-2920d can be inserted through a curved trocar, as described in detail above, and the curved trocar can be rotated and / or translated to sweep and steer the discectomy devices 2920a-d through the intervertebral cavity. Thus, in some embodiments, a portion of the elongated member 2934 is flexible, allowing the discectomy devices 2920a-2920d to traverse through the curved introducer trocar. In other embodiments, the cutting portion 2926 is so rigid that it is impossible to traverse the curved trocar. In such embodiments, the curved trocar can be retracted into a straight trocar, and the discectomy devices 2920a-d can be inserted into the intervertebral cavity through the curved and straight trocars. The curved trocar can then be advanced, bending / steering the cutting portion 2926. Such embodiments may utilize a torque cable, a laser-cut hypotube, and / or equivalents described herein (see, for example, Figure 20-22B) so that the discectomy devices 2920a-d have a flexible portion suitable for steering.

[0260] In some embodiments, the cut portion 2926 may be configured to expand when unfolded from the inlet trocar and to collapse when re-captured within the inlet trocar. IV. Selected Embodiments of Balloon Devices and Associated Systems and Methods

[0261] Figures 30-39 illustrate embodiments of a balloon device that is inserted through a trocar, expands within the intervertebral space, can disrupt the intervertebral disc material within the intervertebral space, and / or enlarge the intervertebral space (e.g., by lifting a vertebra adjacent to the intervertebral space), as described in more detail above with reference to Figures 1E-1H, blocks 284 and 285 of Method 280 in Figure 2, Figure 3E-3K, and blocks 584, 585, and 587 of Method 580 in Figure 5. Thus, embodiments described with reference to Figures 30-39 can be utilized within the workflow of spinal surgical procedures, as described in more detail with reference to Figures 1A-2, 3A-5, and / or anywhere else herein.

[0262] Figure 30 is a side view of the distal portion of a balloon device 3031 positioned through an introducer or trocar 3010 according to an embodiment of the present technology. The balloon device 3031 includes an outer elongated member 3034, an inner elongated member 3032 extending at least partially through the outer elongated member 3034, and a balloon 3030 having a proximal portion coupled to the outer elongated member 3034 and a distal portion coupled to the inner elongated member 3032. In the illustrated embodiment, the distal portion of the inner elongated member 3032 extending from the outer elongated member 3034 is curved. The inner elongated member 3032 can be thermally solidified or otherwise configured to take on a curved shape. In some embodiments, the inner elongated member 3032 can take on a substantially straight shape when advanced through the trocar 3010, and the inner elongated member 3032 can be configured to take on a curved shape when extending outward from the trocar 3010. In other embodiments, the inner elongated member 3032 can be omitted, and the balloon 3030 can be freely coupled to the distal end portion of the outer elongated member 3034.

[0263] In some aspects of this technology, the curved shape of the inner elongated member 3032 can facilitate the placement of the balloon 3030 at a desired position within the intervertebral space. For example, as described above with reference to Figures 12B and 12C, the curved shape of the inner elongated member 3032 can allow the balloon 3030 to be swept and directed through the intervertebral space via rotation and / or translation of the balloon device 3031. In some embodiments, the balloon 3030 can be directed for placement along the midline and / or anterior edge of the intervertebral space before the balloon 3030 is expanded.

[0264] Figure 31 is a side view (e.g., lateral view) of a balloon 3130 of a balloon device deployed and expanded within an intervertebral space 3101 of a patient's spine 3100, according to an embodiment of the present technology. In the illustrated embodiment, the balloon 3130 includes a wall 3135 having a first (e.g., posterior) portion 3136 and a second (e.g., anterior) portion 3137. The first portion 3136 of the wall 3135 may be thicker than the second portion 3137 of the wall 3135 so that the balloon 3130 expands differentially when inflated. For example, the first portion 3136 may expand less than the second portion 3137 such that the balloon 3130 has a height H1 along the first portion 3136, which is less than a height H2 along the second portion 3137. In some aspects of this technology, such differential shape of balloon 3130 can allow the balloon to lift the anterior portion of the upper vertebra 3102a adjacent to the intervertebral space 3101 from the posterior portion of the upper vertebra 3102a relative to the lower vertebra 3102b adjacent to the intervertebral space 3101, thereby helping to restore the original lordosis of the spine 3100.

[0265] In other embodiments, different portions of the wall 3135 of the balloon 3130 may have different compliance / resistance and provide different differential lifts of the upper vertebra 3102a. For example, different portions of the balloon 3130 may have different thicknesses, be made of different materials, and / or be made of fibers and / or other materials that affect the compliance of different portions of the balloon 3130. For example, fibers embedded in the balloon 3130 may limit the expansion of the balloon 3130 beyond a certain dimension. Similarly, a larger wall thickness for a portion of the balloon 3130 may provide greater resistance to expansion, and vice versa.

[0266] Figure 32A is a side view of balloon 3230 of the balloon device according to an embodiment of the present technology. Figure 32B is a side (e.g., lateral) view of balloon 3230 deployed and expanded within the intervertebral space 3201 of a patient's spine 3200, according to an embodiment of the present technology. Referring to Figures 32A and 32B, in the illustrated embodiments, balloon 3230 is compliant such that, in response to expansion within the intervertebral space 3201, balloon 3230 expands substantially horizontally within the intervertebral space 3201 and directly engages with the intervertebral disc material within it, such as the ligamentous ring 3208 of the intervertebral disc, destroying and / or rupturing it.

[0267] Figure 33A is a side view of balloon 3330 of the balloon device according to an embodiment of the present technology. Figure 33B is a side (e.g., lateral) view of balloon 3330 deployed and expanded within the intervertebral space 3301 of a patient's spine 3300, according to an embodiment of the present technology. Referring to Figures 33A and 33B, in the illustrated embodiments, balloon 3330 is non-compliant such that, in response to expansion within the intervertebral space 3301, balloon 3330 expands substantially vertically within the intervertebral space 3301, pushing the upper vertebra 3302a of spine 3300 adjacent to the intervertebral space 3301 away from the lower vertebra 3302b of spine 3300 adjacent to the intervertebral space 3302, indirectly engaging with the intervertebral disc material (e.g., the ligamentous ring of the intervertebral disc) therein, destroying and / or rupturing it. More specifically, a non-compliant balloon 3330 can expand vertically beyond intervertebral compliance. The balloon 3330 can be manufactured in a non-compliant manner by incorporating the braided material 3336 into the wall of the balloon 3330.

[0268] More generally, the selected compliance and non-compliance of the balloon in this technology can determine whether the balloon will expand in the direction of less resistance or expand into a predetermined shape. By causing the balloon to expand into a predetermined shape, the balloon ensures that at least a minimum height will be achieved when the balloon is fully inflated. A non-compliant balloon will expand like a compliant balloon until the balloon wall no longer sags.

[0269] Figure 34 is a side view (e.g., lateral view) of a balloon device 3431 deployed and expanded within an intervertebral space 3401 of a patient's spine 3400, according to an embodiment of the present technology. In the illustrated embodiment, the balloon device 3431 includes a balloon 3430 operably coupled to a pressure-sensing assembly 3436. In some embodiments, an inflation shaft 3434 (e.g., the outer balloon shaft 134 in Figures 1F and 1H) fluidly connects the balloon 3430 to the pressure-sensing assembly 3436. The inflation shaft 3434 and balloon 3430 can be inserted through an introducer / trocar (not shown). The pressure-sensing assembly 3436 can sense the pressure and / or volume within the balloon 3430 and provide feedback to an operator (e.g., a surgeon) based on the sensed pressure and / or volume. For example, the pressure-sensing assembly 3436 can use pressure measurements to determine the extent of disc failure within the intervertebral space 3401, such as the degree of destruction of the ligamentous rings 3408 of the intervertebral disc (e.g., including the anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL), and / or annular ligament of the intervertebral disc). For example, the pressure inside the balloon 3430 may suddenly decrease when the ligamentous rings 3408 rupture, and the volume of the balloon 3430 may suddenly increase when it is no longer constrained by the ligamentous rings 3408. The pressure inside the balloon 3430 can further provide an indication of the sufficiency / quality of the previous discectomy step performed on the intervertebral disc. Similarly, the pressure-sensing assembly 3436 can detect a sudden decrease in pressure inside the balloon 3403 and determine whether the balloon 3430 has failed (e.g., ruptured). In some embodiments, pressure and / or volume can be measured by rotating the injector handle of the pressure sensing assembly 3436, including a zero button when balloon 3430 is slightly above zero atmosphere and / or zero volume when dead space in the system is occupied.

[0270] In addition, the pressure-sensing assembly 3436 can continuously monitor the pressure of the balloon 3430 during its expansion to determine the degree of disc degeneration, the degree of disc calcification, and / or equivalent. The pressure-sensing assembly 3436 can further use the measured final expansion pressure once the balloon 3430 is fully expanded to predict the amount of force that the intervertebral device and / or posterior fixation assembly to be subsequently implanted are likely to experience. This can be used to select the optimal filling material for the intervertebral device, the optimal volume of filling material to be injected into the intervertebral device, the optimal posterior fixation assembly, and / or equivalent. For example, the pressure-sensing assembly 3436 can determine the volume of the balloon 3430 and the optimal filling volume for the intervertebral device. The measured expansion force can also be used to predict or model whether the endplates 3406a-b of vertebrae 3402a-b, adjacent to the intervertebral space 3401, are likely to be fractured or whether a depression would be present. In addition, the measured expansion force can help determine the volume and pressure of the filling, which allows the intervertebral device to be optimally tensioned or to achieve the desired shape for postural restoration.

[0271] In a further aspect of this technology, the pressure-sensing assembly 3436 can sense the pressure and / or volume within the balloon 3430 and provide feedback to prevent or further prevent excessive separation of the intervertebral space 3401. Figure 35 is a graph illustrating a typical pressure-volume curve sensed by the pressure-sensing assembly 3436 during the expansion of the balloon 3430, for example, according to an embodiment of this technology. Referring to Figures 34 and 35, in some embodiments, the volume of the balloon 3430 sensed by the pressure-sensing assembly 3436 can directly correspond to the intervertebral height between vertebrae 3402a-b, for example, when the balloon 3430 is constrained to expand to a pre-selected shape. As the volume of the balloon 3430 increases, the pressure of the balloon 3430 may increase at a greater rate as the vertebrae become further separated. In some embodiments, the pressure-sensing assembly 3436 can measure / calculate the differential value of the pressure-volume curve. For example, there may be a first region R1 of the pressure-volume curve where the intervertebral space 3401 is not over-separated, as indicated by the differential value D1 of the pressure-volume curve, indicating that the pressure is increasing at a rate below a predetermined threshold rate. Similarly, there may be a second region R2 of the pressure-volume curve where the intervertebral space 3401 is beginning to become over-separated or is already over-separated, as indicated by the differential value D2 of the pressure-volume curve, indicating that the pressure is increasing at a rate above a predetermined threshold rate. Therefore, the pressure sensing assembly 3436 can stop the inflation of the balloon 3430, issue a warning (e.g., an audible or visual alarm, warning, etc.), and / or similar action when the differential value of the pressure-volume curve exceeds a predetermined threshold rate, thereby preventing over-separation of the intervertebral space 3401.

[0272] In some embodiments, pressure, volume, and / or height data measured using the pressure-sensing assembly 3436 can be used to guide the filling of an intervertebral device, which is subsequently embedded in the intervertebral space 3401. Specifically, pressure, volume, and / or height data can be used to configure the desired (e.g., corresponding) pressure, volume, and / or height of the intervertebral device. For example, measuring the amount of resistance and / or force required to fill the intervertebral device may help correlate the filling of the intervertebral device with a target pressure measured / determined via the pressure-sensing assembly 3436. Similarly, modeling the filling composition and / or filling density of the filling material used to fill the intervertebral device may help determine the amount of filling material to inject into the intervertebral device to achieve the target volume and / or height measured / determined via the pressure-sensing assembly 3436.

[0273] Figure 36 is a side view of a balloon 3630 of a balloon device according to an embodiment of the present technology. In the illustrated embodiment, the balloon 3630 includes a wall 3635 and a plurality of cutting (e.g., cutting) blades 3636 coupled to the wall 3635 and extending outward therefrom. The cutting blades 3636 can engage with the intervertebral disc material and cut and / or break it when the balloon 3630 is expanded in the intervertebral space. The cutting blades 3636 can be uniformly positioned around the wall 3635 or differentially distributed along some portion away from the wall 3635.

[0274] Figure 37 is a side view of a balloon 3730 of a balloon device according to an embodiment of the present technology. In the illustrated embodiment, the balloon 3730 includes a wall 3735 and a plurality of cutting (e.g., cutting) teeth 3736 coupled to the wall 3735 and extending outward therefrom. The cutting teeth 3736 can engage with the intervertebral disc material and cut and / or break it when the balloon 3730 is expanded in the intervertebral space. The cutting teeth 3736 can be uniformly positioned around the wall 3735 or differentially distributed along some portion away from the wall 3735.

[0275] Figure 38 is a side view of a balloon 3830 of a balloon device according to an embodiment of the present technology. In the illustrated embodiment, the balloon 3830 includes a wall 3835 and a helical cutting element 3836 coupled to the wall 3835 and extending outward therefrom. The helical cutting element 3836 can engage with the intervertebral disc material, cutting and / or breaking it when the balloon 3830 is expanded within the intervertebral space. In some embodiments, the helical cutting element 3836 can be formed from nitinol, steel, and / or another preferred material. Although one helical cutting element 3836 is shown in Figure 38, the balloon 3830 may include multiple helical cutting elements 3836 extending from it.

[0276] Referring to Figures 36-38, the balloon according to an embodiment of the present technology may include a combination of cutting elements, including one or more of the cutting blade 3636, cutting teeth 3736, helical cutting elements 3836, and / or other cutting elements.

[0277] Figure 39 is a side view (e.g., lateral view) of a balloon 3930 of a balloon device deployed and expanded within an intervertebral space 3901 of a patient's spine 3900, according to an embodiment of the present technology. In the illustrated embodiment, the balloon 3930 includes a cover 3936 that extends at least partially around it. The cover 3936 may be formed from a stent-like (e.g., metal, mesh) material and can provide a protective layer between the balloon 3930 and the endplates 3906a-b of the vertebrae 3902a-b, respectively, adjacent to the intervertebral space 3901. Thus, when the balloon 3930 is expanded within the intervertebral space 3901, the cover 3936 can prevent or further prevent the balloon 3930 from rupturing by the endplates 3906a-b, the introducer trocar, and / or other components within the intervertebral space 3901. In some embodiments, the cover 3936 comprises the body of an intervertebral device, which is embedded within the intervertebral space 3901. V. Selected Embodiments of Intervertebral Devices and Associated Systems and Methods

[0278] Figures 40A–48B illustrate embodiments of intervertebral devices that can be inserted through a trocar and deployed within the intervertebral space, as described in more detail above with reference to Figures 1I–1K, blocks 286 and 287 of method 280 in Figure 2, Figures 3L and 3M, and blocks 589 and 590 of method 580 in Figure 5. Thus, embodiments described with reference to Figures 40A–48B can be utilized within the workflow of spinal surgical procedures, as described in more detail with reference to Figures 1A–2, 3A–5, and / or anywhere else herein.

[0279] Figure 40A is a perspective side view of an intervertebral device 4040 according to an embodiment of the present technology. The intervertebral device 4040 may be a braid, mesh, and / or knit of chains or filaments 4042, terminated at a proximal hub 4041 and a distal hub 4043, and / or joined together. The filaments 4042 may define a plurality of openings or pores 4047 between them. The filaments 4042 may be stainless steel, cobalt-chromium, titanium, nitinol, tungsten, composite materials, other metallic materials, and / or equivalents. In the illustrated embodiment, the filaments 4042 are generally identical to each other and are woven / braided together in an upper and lower pattern. In other embodiments, some or all of the filaments 4042 may have different cross-sectional dimensions, cross-sectional thickness, cross-sectional shape, etc., and / or the filaments 4042 may be woven together in different patterns. Figure 40B illustrates various patterns in which the filaments 4042 of the intervertebral device 4040 in Figure 40A may be braided together, for example, according to embodiments of the present technology. Referring to Figures 40A and 40B, in some aspects of the present technology, different braiding patterns shown may result in intervertebral devices 4040 having different overall compliances, and / or different classifications of intervertebral devices 4040 having different compliances. Varying the compliance of the intervertebral device 4040, when extended, may result in variations in the shape of the intervertebral device 4040. In some embodiments, one or more of the filaments 4042 of the intervertebral device 4040 may be axial reinforcement filaments. For example, Figure 40C illustrates various patterns in which the filaments 4042 of the intervertebral device 4040 in Figure 40A may be braided together, and / or include axial reinforcement filaments, according to embodiments of the present technology. In some aspects of the present technology, axial reinforcement filaments may reduce the compliance of the intervertebral device 4040.

[0280] Figure 41 is a side view (e.g., lateral view) of an intervertebral device 4140 deployed and expanded within the intervertebral space 4101 of a patient's spine 4100, according to an embodiment of the present technology. In the illustrated embodiment, the intervertebral device 4140 comprises a braid of filaments 4142. The filaments 4142 can be interlocked differently or braided together differently in the proximal portion 4141 so that the intervertebral device 4140 expands differentially when expanded, for example, by a balloon or a filling material inserted therein. For example, the proximal portion 4141 of the intervertebral device 4140 can expand less than the rest of the intervertebral device 4140 so that the intervertebral device 4140 conforms to the endplates 4106a-b of the vertebrae 4102a-b adjacent to the intervertebral space 4101. That is, the proximal portion 4141 can be braided in such a manner that the expansion of the proximal portion 4141 is constrained to the rest of the intervertebral device 4140. In some aspects of this technology, differential expansion of such intervertebral device 4140 can restore the original lordosis angle A (e.g., about 20°) between vertebrae 4102a-b.

[0281] Figure 42 is a perspective view of an intervertebral device 4240 according to an embodiment of the present technology. In the illustrated embodiment, the intervertebral device 4240 comprises a braid of filaments 4242 having overlapping, different braiding densities, and / or different diameters, such that the intervertebral device 4240 expands differentially. In some embodiments, when expanded, the intervertebral device 4240 may have a proximal portion 4241 and a distal portion 4243 that expand more than the central portion 4245 (for example, so that the intervertebral device 4240 has a dambell shape). In other embodiments, the overlapping and / or different diameter filaments 4242 may give the intervertebral device 4240 different shapes when expanded. For example, the central portion 4245 and the distal portion 4243 may expand radially more than the proximal portion 4241 (for example, to induce the natural lordosis angle of the spine).

[0282] Figure 43 is a perspective side view of an intervertebral device 4340 according to an embodiment of the present technology. The intervertebral device 4340 may include several features that are at least generally similar in structure and function to, or identical in structure and function to, the corresponding features and features of the intervertebral device 4040, which are described in more detail above with reference to Figure 40A. For example, the intervertebral device 4340 includes a braid of filaments 4042. In the illustrated embodiment, the intervertebral device 4340 further includes a barrier layer 4346 across the filaments 4042. The barrier layer 4346 may be a layer of coating or other material located radially inward and / or radially outward of the filaments 4042. The barrier layer 4346 can substantially cover and close the pores 4047 between the filaments 4042 (Figure 40A). Thus, in some aspects of the present technology, the barrier layer 4346 may help to include the filler material within the intervertebral device 4340 after the intervertebral device 4340 has been filled with the filler material. In other words, the barrier layer 4346 can prevent or further prevent the filling material from passing through the pores 4047. In some embodiments, the barrier layer 4346 is dissolvable so that it can dissolve after the intervertebral device 4340 has been implanted in the patient.

[0283] Figure 44 is a perspective view of a filament 4442 of an intervertebral device according to an embodiment of the present technology. In the illustrated embodiment, the filament 4442 is a cable comprising a plurality of wires / strands 4443 wound together. For example, the filament 4442 may include a first group 4444 of strands 4443 extending substantially linearly / longitudinally, and a second group 4445 of strands 4443 extending substantially spirally around the first group 4444. The strands 4443 may comprise stainless steel, cobalt-chromium, titanium, nitinol, tungsten, composite materials, other metallic materials, and / or equivalents. In some embodiments, the strands 4443 are identical, and the filament 4442 comprises 19 strands 4443 (e.g., 7 in the first group 4444 and 12 in the second group 4445). In other embodiments, the filament 4442 may have a different number of strands 4443, and / or the strands 4443 may be arranged differently. In addition, referring to Figure 40A, for example, the intervertebral device 4040 may have many filaments 4442 (for example, instead of filament 4042), woven together, such as about 200-400 filaments 4442, about 250-300 filaments 4442, about 280-290 filaments 4442, about 288 filaments 4442, etc. In some aspects of this technology, forming each filament 4442 from multiple strands 4443 can reduce the stiffness of the filament 4442 and / or provide higher strength compared to a filament consisting of, for example, a single wire of comparable dimensions. This can, for example, allow the intervertebral device to be inserted through a smaller trocar. An additional aspect of this technology is that forming each filament 4442 from multiple strands 4443 can increase the surface area of ​​the intervertebral device, provide osseointegration, and / or improve the conformation of the intervertebral device.

[0284] Figures 45A–45D are side views of different steps in a method for fixing multiple filaments 4542 of an intervertebral device 4540 together to a hub 4541 according to an embodiment of the present technology. Figure 45E is an enlarged view of a portion of Figure 45D according to an embodiment of the present technology. Referring to Figures 45A–45D, the hub 4541 can be a proximal hub fixed to the proximal end portion of the filaments 4542 (e.g., a proximal hub 4041 shown in Figure 40A), or a distal hub fixed to the distal end portion of the filaments 4542 (e.g., a distal hub 4043 shown in Figure 40A). In the illustrated embodiment, the hub 4541 comprises an outer member 4545 and an inner member 4546. The inner and outer members 4545, 4546 may have a ring-like and / or annular shape.

[0285] Referring to Figure 45A, in the first step, the outer member 4545 can be positioned (e.g., screwed over) the filament 4542 at a desired position along the intervertebral device 4540. For example, the filament 4542 can be screwed over through a lumen defined by the inner surface 4547 of the outer member 4545. Referring to Figure 45B, in the second step, the inner member 4546 can be positioned inside the filament 4542 and moved toward the outer member 4545. For example, the filament 4542 can be screwed over the outer surface 4548 of the inner member 4546. In some embodiments, the inner surface 4549 of the inner member 4546 can be screwed over to facilitate, for example, tensioning of the filament 4542, closure of the intervertebral device 4540 after the filling material has been deposited therein, as described in detail herein. In the illustrated embodiment, the soldering paste 4550 is applied to the outer surface 4548 of the inner member 4546, the filament 4542, and / or the inner surface 4547 of the outer member 4545.

[0286] Referring to Figure 45C, in the third step, the inner member 4546 can be positioned at least partially (e.g., completely) within the outer member 4545 such that (i) the outer surface 4548 of the inner member 4546 faces the inner surface 4547 of the outer member 4545, and (ii) the inner member 4546 and the outer member 4545 sandwich the filament 4542 between them. Heat is then applied to fluidize the soldering paste 4550, allowing the inner member 4546 to adhere to the outer member 4545. In some embodiments, the soldering paste 4550 can substantially fill any gaps between the filaments 4542, creating a strong connection of the filaments 4542 between the inner member 4546 and the outer member 4545. In some aspects of the art, the soldering process uses heat that is selected not to melt the inner member 4546 or the outer member 4545. In other embodiments, the inner member 4546 may be fixed to the outer member 4545 by welding (e.g., melting a portion of the outer member 4545 onto the inner member 4546 and subsequent cooling), soldering, adhesive (e.g., epoxy), crimping, riveting, and / or equivalent.

[0287] Referring to Figure 45D, in the fourth step, the filament 4542 may be cut so as to terminate at the hub 4541 (e.g., distally or proximal). Referring to Figures 45D and 45E, in some embodiments, the inner surface 4547 of the outer member 4545 may be beveled / tapered / angled at a first angle A1 with respect to the horizontal, and the outer surface 4548 of the inner member 4546 may be angled at a second angle A2 with respect to the horizontal. The first angle A1 may substantially coincide with the second angle A2 so that the inner surface 4547 and the outer surface 4548 cooperate to form a wedge shape in order to fix the filament 4542 between them. For example, the first angle A1 may be equal to and opposite to the second angle A2 so that the outer surface 4548 and the inner surface 4547 extend parallel to each other. In some embodiments, angles A1 and / or A2 are less than 25 degrees, less than 20 degrees, less than 15 degrees, less than 10 degrees, about 1 to 5 degrees, about 1 to 3 degrees, about 1 to 2 degrees, etc.

[0288] In some aspects of this technology, the tapered inner surface 4547 and tapered outer surface 4548 provide a mechanical advantage in preventing the filament 4542 from being pulled out of the hub 4541. For example, during expansion, filling, tensioning, loading, etc., of the intervertebral device 4540, the tension on the filament 4542 can act to pull the inner member 4546 in the direction of arrow S, which provides a friction, compression, tightening, interference, and / or similar force that pulls the wedge shape of the inner member 4546 toward / against the wedge shape of the outer member 4545, and acts to prevent the filament 4542 from moving out from between the inner member 4546 and the outer member 4545. Such a force may be added to the resistive force provided by the brazing, welding, and / or soldered connection between the inner member 4546 and the outer member 4545. In addition, the brazing paste 4550 (and / or epoxy, a material melted and re-solidified from welding, etc.) can provide bulk that also acts to prevent the filament 4542 from moving out from between the inner member 4546 and the outer member 4545. Specifically, the bulk of such a material needs to be significantly compressible and pulled out from between the inner member 4546 and the outer member 4545, thereby providing a significant termination force that acts to prevent the filament 4542 from moving out from between the inner member 4546 and the outer member 4545. In some aspects of this technology, the termination force provided by the hub 4541 (e.g., the force required to pull the filament 4542 out from between the inner member 4546 and the outer member 4545) can be comparable to the force of the filament 4542 itself. In other words, for example, the filament 4542 may break if an excessive force is applied before it moves out from between the inner member 4546 and the outer member 4545.

[0289] Figures 46A–46D are side views of different steps in a method for fixing multiple filaments 4642 of the intervertebral device 4640 together to a hub 4641 according to an additional embodiment of the present technology. Referring to Figures 46A–46D, the hub 4641 can be a proximal hub (e.g., a proximal hub 4041 shown in Figure 40A) fixed to the proximal end portions of the filaments 4642, or a distal hub (e.g., a distal hub 4043 shown in Figure 40A) fixed to the distal end portions of the filaments 4642. The intervertebral device 4640 may include several features that are at least generally similar in structure and function to, or identical in structure and function to, the corresponding features and structure of, the intervertebral device 4540, which is described in more detail above with reference to Figures 45A–45D. In the illustrated embodiment, for example, the hub 4641 comprises an outer member 4645 and an inner member 4646. The inner and outer members 4645, 4646 may have a ring-like and / or annular shape.

[0290] Referring to Figure 46A, in the first step, the outer member 4645 can be positioned (e.g., screwed over) the filament 4642 at a desired position along the intervertebral device 4640. For example, the filament 4642 can be screwed over through a lumen defined by the inner surface 4647 of the outer member 4645. Referring to Figure 46B, in the second step, the inner member 4646 can be positioned inside the filament 4642 and moved toward the outer member 4645. For example, the filament 4642 can be screwed over the outer surface 4648 of the inner member 4646 (including individually identified first surface portion 4648a, stepped surface portion 4648b, and second surface portion 4648c). In some embodiments, the inner surface 4649 of the inner member 4646 can be screwed to facilitate, for example, tensioning of the filament 4642, closure of the intervertebral device 4640 after the filling material has been deposited therein, as described in detail herein. The second surface portion 4650c may have a larger maximum diameter than the first surface portion 4650a.

[0291] Referring to Figure 46C, in the third step, the inner member 4646 can be positioned at least partially (e.g., completely) within the outer member 4645 such that (i) the outer surface 4648 of the inner member 4646 faces the inner surface 4647 of the outer member 4645, and (ii) the inner member 4646 and the outer member 4645 sandwich the filament 4642 between them. Referring to Figure 46D, in the fourth step, the outer member 4645 can be crimped by applying a radially inward force in the direction of arrow C such that, for example, the inner surface 4647 of the outer member 4645 conforms at least partially to the stepped shape of the outer surface 4648 of the inner member 4646. More specifically, after crimping, the inner surface 4647 of the outer member 4645 may comprise a first surface portion 4647a, a stepped surface portion 4647b, and a second surface portion 4647c, respectively, which are similar in shape (for example, match) to the first surface portion 4648a, the stepped surface portion 4648b, and the second surface portion 4648c of the inner member 4646.

[0292] In some aspects of this technology, the stepped surface portion 4647b of the outer member 4645 and the stepped surface portion 4648b of the inner member 4646 cooperate to provide a mechanical advantage in preventing the filament 4642 from being pulled out of the hub 4641. For example, during expansion, filling, tensioning, loading, etc. of the intervertebral device 4640, the tension on the filament 4642 can act to pull the inner member 4646 in the direction of arrow S, which provides friction, compression, tightening, interference, and / or similar forces that pull the stepped surface portion 4648b of the inner member 4646 toward the stepped surface portion 4647b of the outer member 4645, preventing the filament 4642 from moving out from between the inner member 4646 and the outer member 4645. In some embodiments, the first and second surface portions 4647a, c of the outer member 4645 and the first and second surface portions 4648a, c of the inner member 4646 are tapered / angled, as described in more detail above with reference to Figure 45D, to further provide the mechanical advantage of preventing the filament 4642 from being pulled out of the hub 4641. In some embodiments, the inner member 4646 can further be connected to the outer member 4645 via brazing, welding, soldering, and / or equivalent. As further shown in Figure 46D, the filament 4642 can be cut to terminate at the hub 4641 (e.g., distally or proximal).

[0293] Figures 47A and 47B are side views of different steps in a method for fixing multiple filaments 4742 of an intervertebral device 4740 together to a hub 4741 according to embodiments of the present technology. Referring to Figures 47A and 47B, the hub 4741 can be a proximal hub (e.g., a proximal hub 4041 shown in Figure 40A) fixed to the proximal end portions of the filaments 4742, or a distal hub (e.g., a distal hub 4043 shown in Figure 40A) fixed to the distal end portions of the filaments 4742. The intervertebral device 4740 may include several features that are at least generally similar in structure and function to, or identical in structure and function to, the corresponding features and structures of, the intervertebral devices 4540 and / or intervertebral devices 4640, which are described in more detail above with reference to Figures 45A-46D. In the illustrated embodiments, for example, the hub 4741 comprises an outer member 4745 and an inner member 4746. The inner and outer members 4745 and 4746 may have a ring-like and / or annular shape.

[0294] Referring to Figure 47A, in one or more first steps, (i) an outer member 4745 can be positioned (e.g., screwed over) the filament 4742 at a desired position along the intervertebral device 4740, and (ii) an inner member 4746 can be positioned inside the filament 4742 and at least partially (e.g., completely) within the outer member 4745 such that the outer surface 4748 of the inner member 4746 faces the inner surface 4747 of the outer member 4745, and the inner member 4746 and the outer member 4745 sandwich the filament 4742 between them. For example, the filament 4742 can be screwed (i) through a lumen defined by the inner surface 4747 of the outer member 4745, and (ii) across the outer surface 4748 of the inner member 4746 (including individually identified first surface portion 4748a and second surface portion 4748b). In some embodiments, the inner surface 4749 of the inner member 4746 can be screwed to facilitate, for example, tensioning of the filament 4742, closure of the intervertebral device 4740 after the filling material has been deposited therein, as described in detail herein. In the illustrated embodiments, the first surface portion 4748a is inclined / tapered such that the diameter of the inner member 4746 increases along it in the direction of arrow S, and the second surface portion 4748b is inclined / tapered such that the diameter of the inner member 4746 decreases along it in the direction of arrow S. Thus, the tapered first and second surface portions 4748a-b can merge at peak 4748c, where the inner member 4746 has its maximum diameter.

[0295] Referring to Figure 47B, in the second step, the outer member 4745 can be crimped by applying a radially inward force in the direction of arrow C (Figure 47A) such that, for example, the inner surface 4747 of the outer member 4745 conforms at least partially to the tapered shape of the outer surface 4748 of the inner member 4746. More specifically, after crimping, the inner surface 4747 of the outer member 4745 may comprise a first surface portion 4747a and a second surface portion 4747b, respectively, which are similar in shape (e.g., match) to the first surface portion 4748a and the second surface portion 4748b of the inner member 4746.

[0296] In some aspects of this technology, the tapered first and second surface portions 4747a-b of the outer member 4745 cooperate with the tapered first and second surface portions 4748a-b of the inner member 4746, respectively, to prevent the filament 4742 from being pulled out of the hub 4741, providing a mechanical advantage. For example, during expansion, filling, tensioning, loading, etc., of the intervertebral device 4740, the tension on the filament 4742 can act to pull the inner member 4746 in the direction of arrow S, which provides friction, compression, tightening, interference, and / or similar forces that pull the second surface portion 4748b of the inner member 4746 toward the second surface portion 4747b of the outer member 4745, preventing the filament 4742 from moving out from between the inner member 4746 and the outer member 4745. Similarly, a force acting on the filament 4742 can act to pull the inner member 4746 in the direction of arrow R opposite to the direction of arrow S, which provides a friction, compression, tightening, interference, and / or similar force that pulls the first surface portion 4748a of the inner member 4746 toward the second surface portion 4747a of the outer member 4745, preventing the filament 4742 from moving out from between the inner member 4746 and the outer member 4745. In some embodiments, the inner member 4746 can further be connected to the outer member 4745 via brazing, welding, soldering, and / or equivalent. As further shown in Figure 47B, the filament 4742 can be cut to terminate at the hub 4741 (e.g., distally or proximal).

[0297] In other embodiments, the intervertebral device hub may include different combinations of crimping, welding, brazing, soldering, tapering, wedge joining, and / or equivalents, and may offer mechanical advantages that work to resist forces pulling the intervertebral device filaments. For example, in some embodiments, the hub may comprise a sperta socket or sperta lock, where the intervertebral device filaments terminate in a wedge-shaped (e.g., conical) opening of the socket. A resin or other filler material may flow around the filaments within the wedge-shaped opening. Thus, when a load is applied to the filaments in an outward direction from the socket, friction between the resin, the filaments, and the socket walls surrounding the opening may act to prevent or further prevent the filaments from being pulled out of the socket.

[0298] Figures 48A and 48B are perspective top and side views, respectively, of an intervertebral device 4840 according to an embodiment of the present technology. Referring to Figures 48A and 48B, in the illustrated embodiment, the intervertebral device 4840 extends between a pair of clear plates 4802 (Figure 48B; e.g., planar) that simulate adjacent vertebrae (e.g., vertebral endplates) in the intervertebral space 4801. The intervertebral device 4840 can be a braid, mesh, and / or knit of chains or filaments 4842 (e.g., wires) terminated at a proximal hub 4841 (Figure 48A) and a distal hub 4843 (Figure 48A), and / or spliced ​​together. The filaments 4842 can define a plurality of openings or pores 4847 between them.

[0299] In some embodiments, when the intervertebral device 4840 is expanded within the confined intervertebral space 4801, the intervertebral device 4840 takes on a flattened or pancake-like shape, having an upper portion 4850 adjacent to and / or in contact with the upper portion of the plate 4802, a lower portion 4851 (Figure 48B) opposite the upper portion 4850 and adjacent to and / or in contact with the lower portion of the plate 4802, a first lateral portion 4852 extending between the upper portion 4850 and the lower portion 4851, and a second lateral portion 4853 (Figure 48A) opposite the first lateral portion 4852 and extending between the upper portion 4850 and the lower portion 4851. The first and second lateral portions 4852 and 4853 together can form the equatorial zone of the intervertebral device 4840. In the illustrated embodiment, the filament 4842 expands in the upper portion 4850 and the lower portion 4851 compared to the first side portion 4852 and the second side portion 4853, such that the pores 4847 are generally larger in the upper portion 4850 and the lower portion 4851 compared to the first side portion 4852 and the second side portion 4853. That is, filaments 4842 extending across / through / around the upper portion 4850 and the lower portion 4851 expand over longer distances, while filaments 4842 extending across the first side portion 4852 and the second side portion 4853 (e.g., in the equatorial direction) tend to collapse and, in some cases, form solid walls (e.g., pores 4847 are not formed, and / or very small pores 4847 are formed in the first and second side portions 4852, 4853).

[0300] In some aspects of this technology, a configuration of the vertebral device 4840 having (or not having) smaller pores 4847 located along the first lateral portion 4852 and the second lateral portion 4853 can offer several advantages. For example, this can prevent the filling material and / or graft material inserted into the intervertebral device 4840 from escaping through the first and second lateral portions 4852, 4853. In the upper and lower portions 4850, 4851, where the pores 4847 are larger, the intervertebral device 4840 is bounded by a plate 4802 (e.g., a vertebral endplate), which prevents the filling material and / or graft material from escaping from the intervertebral device 4840. In addition, the larger pores 4847 in the first and second lateral portions 4850, 4851 can allow for greater bone growth from the vertebral endplate into the intervertebral device 4840 for fixation.

[0301] In some aspects of this technology, the filaments 4842 in the first and second lateral portions 4852, 4853 can be compressed together, increasing the hoop strength of the intervertebral device 4840. More specifically, in the illustrated pancake shape of the intervertebral device 4840, the filaments 4842 along the first and second lateral portions 4852, 4853 are more extended and therefore more load-bearing, and the compressed configuration of the filaments 4842 in the first and second lateral portions 4852, 4853 (e.g., in the equatorial region) increases the strength to withstand the load. In some embodiments, the number of filaments 4842 can be maximized, each extending through the first lateral portion 4852 and / or the second lateral portion 4853 (e.g., crossing through it), and compressing in the first lateral portion 4852 and / or the second lateral portion 4853, increasing the strength of the intervertebral device 4840. For example, each filament 4842 can traverse along the intervertebral device 4840 between the proximal hub 4841 and the distal hub 4843 in a spiral or helical shape, such that each filament 4842 extends through a first lateral portion 4852 and / or a second lateral portion 4853, respectively. The number of filaments 4842 (e.g., the number of wires), the braiding angle of the filaments 4842, the size of the filaments 4842, the configuration of the filaments 4842, and / or equivalents can be selected / controlled so that each filament 4842 extends through a first lateral portion 4852 and / or a second lateral portion 4853, respectively. In contrast, if, for example, one of the filaments 4842 does not extend through the first lateral portion 4852 and / or the second lateral portion 4853, such filaments are less likely to be subjected to load and / or may sag, and therefore do not significantly contribute to the overall strength of the intervertebral device 4840 when it is expanded within the intervertebral space 4801. VI. Selected Embodiments of Filling Materials and Associated Systems and Methods for Intervertebral Devices

[0302] Figures 49-60B illustrate embodiments of filling materials that may be used to fill intervertebral devices, as described in more detail above with reference to Figures 1L-1Q, block 288 of method 280 in Figure 2, Figure 3L, and blocks 589 and 590 of method 580 in Figure 5. Thus, embodiments described with reference to Figures 49-60B may be utilized in the workflow of spinal surgical procedures, as described in more detail with reference to Figures 1A-2, 3A-5, and / or anywhere else herein.

[0303] Figure 49 is an enlarged perspective view of a filler material 4960 according to an embodiment of the present technology. In the illustrated embodiment, the filler material 4960 comprises a plurality of particles 4962 that, when filled into an intervertebral device, can form a gabion structure. The particles 4962 can be formed from cancellous bone tissue, titanium, metal, silica, metal, biomaterial, sand, demineralized bone, and / or equivalents. The particles 4962 may have a three-dimensional lattice structure with an irregular (e.g., roughened) outer surface 4963. The irregular outer surface 4963, when filled into an intervertebral device, can provide high-friction interfaces and / or interlocking interfaces between the particles 4962, for example, providing "Velcro-like" bonding between the particles 4962 and improving the gabion effect.

[0304] Figure 50 is an enlarged side view of the filler material 5060 according to an embodiment of the present technology. In the illustrated embodiment, the filler material 5060 comprises a plurality of beads 5062 bonded to / along a string 5064. The beads 5062 can be formed from cancellous bone tissue, titanium, metal, silica, metal, biomaterial, sand, demineralized bone, and / or equivalents. In some aspects of the present technology, the filler material 5060 can be deployed into the intervertebral device through an introducer shaft (e.g., balloon shaft 152 in Figure 1L-1M) and removed from the intervertebral device by pulling the string 5064 proximal through the introducer shaft as needed. That is, the filler material 5060 can be deployed reversibly / removably into the intervertebral device.

[0305] Figure 51 is an enlarged perspective view of a filler material 5160 extending from an introducer 5110 according to an embodiment of the present technology. In the illustrated embodiment, the filler material 5160 comprises a material body 5162 having a plurality of grooves or channels 5164 extending through it. The channels 5164 can be laser-cut into the material body 5162, allowing the material body 5162 to take on a coiled shape when deployed within the intervertebral device. The material body 5162 may comprise polyetheretherketone (PEEK), hydroxyapatite (HA), and / or other materials described herein. In some aspects of the present technology, the filler material 5160 can be deployed into the intervertebral device through the introducer 5110 and, if necessary, removed from the intervertebral device by pulling the material body 5162 proximal through the introducer 5110. That is, the filler material 5160 can be deployed reversibly / removably within the intervertebral device.

[0306] In some embodiments, the filling material according to this technology may include multiple particles having different sizes. The variable size of the particles, when filled into the intervertebral device, helps in particle interlocking, increasing the strength of the filling material and preventing or further preventing collapse of the intervertebral device. In some embodiments, such a filling material may include large and small particles. Figure 52 is a graph illustrating, for example, the filling density (y-axis) versus the percentage of large filling particles to small filling particles (x-axis) according to an embodiment of this technology. As shown, there exists a percentage of large filling particles to small filling particles (approximately 80%) where the filling density is maximized. In some embodiments, the filling material according to this technology may include a ratio of large and small filling particles selected to maximize the filling density and, for example, prevent or further prevent collapse of the intervertebral device.

[0307] In some embodiments, the filler material according to this technology may include particles having different moduli. By varying the moduli of the particles, the filler material can be configured to have a desired overall moduli, for example, selected to be similar to that of a vertebra. Figure 53 is a table of different moduli of various materials that may be used for particles in the filler material according to embodiments of this technology.

[0308] In some embodiments, the filler material according to this technology may comprise (i) a plurality of particles configured to interlock together, and (ii) an internal filler material configured to surround and fill the particles. For example, the particles may be configured to interlock together in a gabion structure, and the internal filler material may fill the gabion structure. Thus, the filler material may comprise different types of filler materials used together such that the overall filler material is not homogeneous. The particles may have different sizes and / or moduli, and may comprise different types of particles (e.g., heterogeneous mixtures of particles). The internal filler material may be cement, bone grafts, polymers, or similar materials, and may be amorphous or liquid when injected between the particles. In some aspects of this technology, different properties are imparted by different types and combinations of filler materials. For example, smaller filler particles may fill together more densely and provide greater load-bearing capacity. Larger particles may provide greater porosity and negative space for the internal filler material to be injected. Filling materials containing particles of different sizes can allow for control over such different properties. In some embodiments, the internal filling material is an adhesive that allows for stronger and / or faster interlocking between particles, which can help maintain the intended shape / volume / height of the intervertebral device. In some embodiments, the internal filling material may help resist tensile forces, while the particles (e.g., arranged within a gabion structure) primarily withstand compressive forces. In some embodiments, the internal filling material includes a material that promotes bone growth and fixation.

[0309] The gabion properties and behavior of the infill material can be influenced by the geometry of the individual particles of the infill material. In particular, the macro-features of the infill material (e.g., shape, size, geometry) may be more important to the gabion structure than the micro-features of the infill material (e.g., surface texture, friction), considering the relatively large forces the infill material experiences when deployed within the intervertebral device. For example, micro-features, due to their smaller interface surface, may not withstand outward / radial forces as well, and therefore even small forces may cause fracture of the micro-features, leading to gabion reconstruction. Overall, this may lead to more consistent outward radial forces until the final settling of the infill material. In contrast, macro-features can be configured to require larger feature-breaking forces, which may lead to a higher threshold for the applied force to cause gabion reconstruction. Overall, this may lead to higher resistance to initial settling or faster locking of the infill material as the applied load increases. Macro-features can reduce the radial component vectors and maintain a higher ratio of axial component vectors to axially applied forces. In some aspects of this technology, it is advantageous that it reduces the forces on the braiding of intervertebral devices, enabling intervertebral devices with smaller external dimensions (e.g., thinner wires, smaller diameters).

[0310] More specifically, for example, Figure 54 is an enlarged side view of a filler material 5460 according to an embodiment of the present technology. In the illustrated embodiment, the filler material 5460 comprises a plurality of particles 5462 having a substantially circular cross-sectional shape. When an axial force F is applied to the filler material 5460 (for example, when an intervertebral device filled with the filler material 5460 is loaded), the interface between the particles 5462 is subjected to a relatively large radial vector force component F through the filler material 5460 due to the circular shape of the particles 5462. radial Correspondingly, there is a small axial vector force component F axialA force F can be transmitted through the 4460. In contrast, Figure 55 is an enlarged side view of the filler material 5560 according to an embodiment of the present technology. In the illustrated embodiment, the filler material 5560 comprises a plurality of particles 5562 having a substantially cross-shaped or +-shaped cross-section. When an axial force F is applied to the filler material 5560 (for example, when an intervertebral device filled with the filler material 5560 is loaded), the interfaces between the particles 5562 transmit a relatively large axial vector force component F through the filler material 5460 due to the substantially cross-shaped shape of the particles 5562. axial Correspondingly, there is a small radial vector force component F radial This allows for the transmission of force F. In some aspects of this technology, this can reduce the radial force acting on the braid of the intervertebral device and reduce the collapse of the filling material 5560. As a result, more of the overall axial force F is transmitted / carried through the gabion structure of the filling material 5560 rather than through the intervertebral device.

[0311] Figures 56-60B illustrate different filler materials configured according to embodiments of the present technology to form a gabion structure with high-axial force transmission for radial force transmission. Figure 56 is a perspective view of a filler material 5660 comprising a plurality of particles 5662 according to embodiments of the present technology, for example. In the illustrated embodiments, each particle 5662 has a substantially ellipsoidal shape comprising a plurality of (e.g., four) fins 5664. That is, each particle 5662 may comprise an integrated body comprising a pair of elliptical cylinders extending orthogonally and intersectingly to each other.

[0312] Figure 57A is a perspective view of a filler material 5760 comprising a plurality of particles 5762 that receive an axial force F via a loading machine 5780, according to an embodiment of the art. Figure 57B is a perspective view of one of the particles 5762 of the filler material 5760, according to an embodiment of the art. Referring to Figure 57B, each particle 5762 may have a pyramidal shape comprising triangular faces 5764 (e.g., four triangular faces). Some or all (e.g., all) of the triangular faces 5764 may have pyramidal cutouts 5766 formed therein. Referring to Figure 57A, the shape of the particles 5762 may cause the filler material 5760 to form a strong gabion structure in which a substantial portion (e.g., 90% or more) of the axial force F is transmitted axially rather than radially. For example, in the illustrated embodiment, when the axial force F is high (e.g., above 100 pounds per inch), the filler material 5760 is held radially in place only by the plastic sheet 5782, which is secured by the rubber band 5784, and the majority of the axial force F is transmitted axially rather than radially by the filler material 5760.

[0313] Figure 58A is a perspective view of a filler material 5860 comprising a plurality of particles 5862 that receive an axial force F via a loading machine 5780, according to an embodiment of the present art. Figure 58B is a perspective view of one of the particles 5862 of the filler material 5860, according to an embodiment of the present art. Referring to Figure 58B, each particle 5862 may have a substantially spherical shape including a plurality (e.g., eight) wedge-shaped cutouts 5864. That is, each particle 5862 may include a single body comprising a substantially cylindrical central portion 5866 defining opposing sides and a pair of partially cylindrical fins 5868 extending from each side and intersecting each other orthogonally. Referring to Figure 58A, the shape of the particles 5862 may cause the filler material 5860 to form a strong gabion structure in which a substantial portion (e.g., 90% or more) of the axial force F is transmitted axially rather than radially. For example, in the illustrated embodiment, when the axial force F is high (e.g., above 100 pounds per inch), the filler material 5860 is held radially in place only by the plastic sheet 5782, which is secured by the rubber band 5784, and the majority of the axial force F is transmitted axially rather than radially by the filler material 5860.

[0314] Figure 59A is a perspective view of a filler material 5960 comprising a plurality of particles 5962 that receive an axial force F via a loading machine 5780, according to an embodiment of the present art. Figure 59B is a perspective view of one of the particles 5962 of the filler material 5960, according to an embodiment of the present art. Referring to Figure 59B, each particle 5962 may have a substantially spherical shape, formed by an integrated body comprising a pair of circular rings 5964 extending orthogonally and intersectingly to each other. Referring to Figure 59A, the shape of the particles 5962 may cause the filler material 5960 to form a strong gabion structure, in which a substantial portion (e.g., 90% or more) of the axial force F is transmitted axially rather than radially. For example, in the illustrated embodiment, when the axial force F is high (e.g., above 100 pounds per inch), the filler material 5960 is held radially in place only by the plastic sheet 5782, which is secured by the rubber band 5784, and the majority of the axial force F is transmitted axially rather than radially by the filler material 5960.

[0315] Figure 60A is a perspective view of a filler material 6060 comprising a plurality of particles 6062 that receive an axial force F via a loading machine 5780, according to an embodiment of the present technology. Figure 60B is a perspective view of one of the particles 6062 of the filler material 6060, according to an embodiment of the present technology. Referring to Figure 60B, each particle 6062 may comprise an integral body comprising a pair of rectangular columns 6064 extending orthogonally and intersectingly to each other. Referring to Figure 60A, the shape of the particles 6062 may cause the filler material 6060 to form a strong gabion structure, in which a substantial portion (e.g., 90% or more) of the axial force F is transmitted axially rather than radially. For example, in the illustrated embodiment, when the axial force F is high (e.g., above 100 pounds per inch), the filler material 6060 is held radially in place only by the plastic sheet 5782, which is secured by the rubber band 5784, and the majority of the axial force F is transmitted axially rather than radially by the filler material 6060. VII. Selected embodiments of filling devices and associated systems and methods for filling intervertebral devices with filling material

[0316] Figures 61-64 illustrate filling devices for filling intervertebral devices with filling material or for assisting filling, as described in detail above with reference to Figures 1L-1Q, block 288 of method 280 in Figure 2, Figure 3L, and blocks 589 and 590 of method 580 in Figure 5. Thus, embodiments described with reference to Figures 61-64 can be utilized within the workflow of spinal surgical procedures, as described in detail with reference to Figures 1A-2, Figure 3A-5, and / or anywhere else herein.

[0317] Figure 61 is a perspective side view of the proximal portion of a filling device 6161 inserted through an introducer 6110 according to an embodiment of the present technology. In the illustrated embodiment, the filling device 6161 includes an elongated member 6163 coupled to a handle 6165. The handle 6165 further includes an actuator 6167 operably coupled to a plunger 6169 configured to move through the lumen of the elongated member 6163. In the illustrated embodiment, the actuator 6167 is a trigger. The elongated member 6163 can be inserted through a cannula 6114 of the introducer 6110, which is positioned to access an intervertebral cavity containing an intervertebral device into which filling material can be contained and deployed. The actuator 6167 can be actuated (e.g., compressed) to drive the plunger 6169 distally through the lumen of the elongated member 6163, thereby ejecting the filling material out of the elongated member 6163 into the intervertebral device. In some aspects of this technology, the actuator 6167 provides a mechanical advantage in facilitating the injection of filling material from the elongated member 6163 into the intervertebral device. In other embodiments, the actuator 6167 may be a rotatable member or other member configured to provide a mechanical advantage in moving the plunger 6169 through the elongated member 6163.

[0318] Figure 62 is a perspective side view of the distal portion of a filling device 6261 according to an embodiment of the present technology. In the illustrated embodiment, the filling device 6261 comprises an elongated member 6264 having a balloon 6266 coupled thereto. The balloon 6266 may have a donut or toroidal shape with respect to the elongated member 6264. The elongated member 6264 defines a filling lumen (e.g., a primary lumen) and includes one or more injection ports 6263 at its distal end. The elongated member 6264 may further define one or more expansion lumens (e.g., secondary lumens) that are fluidly coupled to the balloon 6266 for inflating the balloon 6266. The filling device 6261 can be inserted through an introducer so that the balloon 6266 and the injection ports 6263 are positioned within the intervertebral device. The filling material can be injected through the filling lumen and exit into the intervertebral device through the injection ports 6263. The balloon 6266 is inflated before and / or during the filling of the intervertebral device, and can at least partially expand the intervertebral device, thereby reducing the filling resistance of the intervertebral device and / or affecting the shape of the intervertebral device.

[0319] Figure 63 is a side view (e.g., lateral view) of the distal portion of the filling device 6361 and the intervertebral device 6340, which is deployed and expanded within the intervertebral space 6301 of the patient's spine 6300, according to an embodiment of the present technology. In the illustrated embodiment, the filling device 6361 comprises a balloon 6366 positioned outside the intervertebral device 6340. The intervertebral device 6340 can be filled with filling material through a first introducer 6310. The balloon 6346 can be deployed through the first introducer 6310 (e.g., parallel to the intervertebral device 6340) or through a second introducer 6320 (e.g., a trocar) positioned to access the intervertebral space 6301 independently of the first introducer 6310 (e.g., via a transforaminal approach). The balloon 6366 is inflated before and / or during the filling of the intervertebral device 6340, keeping the intervertebral space 6301 open (for example, by pushing the vertebrae 6302a-b adjacent to the intervertebral space 6301 away from each other), thereby reducing the filling resistance of the intervertebral device 6340. In some embodiments, the balloon 6346 comes into contact with the intervertebral device 6340, causing it to expand.

[0320] Similarly, in some embodiments, the balloon 6346 is positioned over a first side of the intervertebral space 6301 and can lift the first side, while the intervertebral device 6340 is deployed over a second side of the intervertebral space 6301. The balloon 6346 can therefore work in conjunction with the intervertebral device 6340 as the intervertebral device 6340 is expanded and filled with filling material.

[0321] Figure 64 is a side view (e.g., lateral view) of a filling device 6461 and an intervertebral device 6440, which is deployed and expanded within the intervertebral space 6401 of a patient's spine 6400, according to an embodiment of the present technology. In the illustrated embodiment, the filling device 6451 includes a pressure-sensing assembly 6466 coupled to an injector 6410. Filling material can be injected through the injector 6410, while the pressure-sensing assembly 6466 measures / detects the pressure within the intervertebral device 6440 and / or the volume of filling material injected into the intervertebral device 6440, and provides feedback to the operator (e.g., surgeon) based on the sensed pressure and / or volume. For example, the pressure-sensing assembly 6466 can determine when (i) a desired / optimal volume of filling material has been injected into the intervertebral device 6440, (ii) the intervertebral device 6440 has reached an optimal internal pressure, and / or (iii) the intervertebral device 6440 has reached an optimal braiding tension. In some embodiments, the desired volume can be determined from a pressure / volume that is predetermined by a balloon used to expand the intervertebral device 6440 (for example, via a balloon device 3431, as described in detail with reference to Figure 34).

[0322] In a further aspect of this technology, the pressure-sensing assembly 6466 can sense the pressure and / or volume within the intervertebral device 6440 and provide feedback to prevent or further prevent overfilling of the intervertebral device 6440 and / or overtensioning of the braid of the intervertebral device 6440. For example, in a manner similar to or the same as that described above with reference to Figure 35, the pressure-sensing assembly 6466 can determine a pressure-volume (and / or similar) curve during the filling of the intervertebral device 6440 with filling material. As the volume of filling material increases, the pressure within the intervertebral device 6440 may also increase. In some embodiments, the pressure-sensing assembly 6466 can measure / calculate the differential value of the pressure-volume curve. For example, there may be a first region of the pressure-volume curve where the intervertebral device 6440 is not overfilled and / or the braid is not overtensioned, as indicated by the differential value of the pressure-volume curve, indicating that the pressure is increasing at a rate below a predetermined threshold rate. Similarly, there may be a second region in the pressure-volume curve where the intervertebral device 6440 is beginning to become overfilled, or is overfilled, and / or the braid is beginning to become overtensioned, or is overtensioned, as indicated by the derivative of the pressure-volume curve, indicating that the pressure is increasing at a rate exceeding a predetermined threshold rate. Therefore, the pressure-sensing assembly 6466 may stop filling the intervertebral device 6440, issue a warning (e.g., an audible or visual alarm, warning, etc.), and / or do the same, when the derivative of the pressure-volume curve exceeds a predetermined threshold rate, in order to avoid overfilling the intervertebral device 6440 and / or overtensioning the braid of the intervertebral device 6440.

[0323] In some embodiments, a pressure-sensing assembly 6466 can be coupled to a balloon that expands within the intervertebral device 6440. A filling material can be injected into the balloon. Such a balloon can be fully or partially dissolvable so that it remains after the filling material has been injected into it, before subsequent dissolution. In such embodiments, the balloon can be inflated to establish a desired tension on the braid of the intervertebral device 6440. The pressure-sensing assembly 6466 can sense the pressure of the balloon to indicate that the desired braid tension has been achieved. VIII. Selected embodiments of devices for closing, applying tension to, and / or removing intervertebral devices, and associated systems and methods.

[0324] Figures 65-70D illustrate embodiments of methods for closing, tensing, and / or removing intervertebral devices, as described in more detail above with reference to Figure 1R, blocks 289-291 of Method 280 in Figure 2, Figure 3L, and blocks 589 and 590 of Method 580 in Figure 5. Thus, embodiments described with reference to Figures 65-70D can be utilized in the workflow of spinal surgical procedures, as described in more detail with reference to Figures 1A-2, 3A-5, and / or anywhere else herein.

[0325] Figure 65 is a side view of a closure mechanism 6546 according to an embodiment of the present technology. In the illustrated embodiment, the closure mechanism 6546 is a screw comprising a threaded head portion 6542 and a body portion 6544. Referring to Figures 1R and 65, the closure mechanism 6546 is inserted into an opening 145 in the proximal portion 141 of the intervertebral device 140, and the threaded head portion 6542 can be rotated along the proximal portion 141 surrounding the opening 145 so as to engage with the corresponding threads. The body portion 6544 extends into the intervertebral device 140 and can displace a portion of the filling material 160 within it, thereby increasing the total volume of material within the intervertebral device 140. In some aspects of this technology, increasing the volume within the intervertebral device 140 in this way increases the tension of the filament 142, allowing for better filling of the intervertebral device 140 with, for example, the filling material 160, and preventing or further preventing collapse of the intervertebral device 140 after implantation in the intervertebral space 101. In some embodiments, the closing mechanism 6546 can be rotated (e.g., torqued) to a specified torque using a torque limiter to set the filament 142 to a specified tension.

[0326] Figure 66A is a front view of a tensioning and / or closing mechanism 6646 ("mechanism 6646") according to an embodiment of the present art. In the illustrated embodiment, mechanism 6646 includes a body 6647 defining an opening 6648. Figure 66B is a side view of mechanism 6646 deployed on and / extended over an intervertebral device 6640 according to an embodiment of the present art. The intervertebral device 6640 comprises a braid of filaments including a proximal portion 6641 and a distal portion 6643. Referring to Figures 66A and 66B, mechanism 6646 can be positioned over a portion of the intervertebral device 6640, for example, such that a portion of the proximal portion 6641 extends through the opening 6648 and mechanism 6646 fastens the intervertebral device 6640. Mechanism 6646 can be slid distally (e.g., by a clamping / tensioning shaft inserted through an introducer) as indicated by arrow D, to further clamp the intervertebral device 6640 (e.g., similar to a clamping collar). Alternatively, or in addition, the proximal portion 6641 of the intervertebral device 6640 can be pulled proximal (e.g., by an unfolding shaft coupled thereto) as indicated by arrow P, to further clamp the intervertebral device 6640. Clamping the intervertebral device 6640 can increase the tension of the braided filaments. In some embodiments, mechanism 6646 is configured to close the intervertebral device 6640 (e.g., to prevent or further prevent the filling material from coming out there), while in other embodiments, mechanism 6646 can be applied across the intervertebral device 6640 after a separate closing mechanism has been attached thereto.

[0327] In some embodiments, instead of having a constant opening 6648, the mechanism 6646 can be analogous to a code lock. Figure 67 is a side view of a tensioning and / or closing mechanism 6746 ("mechanism 6746") according to an additional embodiment of the present technology, for example. In the illustrated embodiment, mechanism 6746 includes a barrel portion 6742 defining a first opening 6744, a plunger portion 6747 movably positioned within the barrel portion 6742 defining a second opening 6748, and a spring 6749 operably coupling the barrel portion 6742 to the plunger portion 6747. The spring 6749 biases the second opening 6748 away from the first opening 6744, and the plunger portion 6747 is pressed down, allowing the first opening 6744 and the second opening 6748 to be substantially aligned. Referring to Figures 66A and 67, the mechanism 6746 can be positioned over the proximal portion 6641 of the intervertebral device 6640 such that the proximal portion 6641 extends through the first and second openings 6744, 6748. The mechanism 6746 can then be slid distally, as indicated by arrow D, to fasten the intervertebral device 6640, and / or the proximal portion 6641 of the intervertebral device 6640 can be pulled proximal, as indicated by arrow P, to fasten the intervertebral device 6640. The spring 6749 can bias the plunger portion 6747 away from the barrel portion 6742 so that the mechanism 6746 is locked in place relative to the intervertebral device 6640.

[0328] Figure 68 is a top (e.g., axial) view of an intervertebral device 6840 deployed within the intervertebral space 6801 of a vertebra 6800, and including a tension-applying mechanism 6846, according to an embodiment of the present technology. In the illustrated embodiment, the intervertebral device 6840 comprises a braid of filaments 6842, including a proximal portion 6841 and a distal portion 6843. The tension-applying mechanism 6846 includes an internal shaft 6847 coupled to the distal portion 6843 and an external shaft 6848 coupled to the proximal portion 6841. The internal shaft 6847 can be moved relative to the external shaft 6848 (e.g., proximal or distal), and / or the external shaft 6848 can be moved relative to the internal shaft 6847 (e.g., proximal or distal), thereby longitudinally extending / shortening the intervertebral device 6840 and affecting the tension of the braid of filaments 6842. The medial shaft 6847 and the lateral shaft 6848 remain embedded within the intervertebral device 6840 after deployment, allowing the tension of the filament 6842 to be maintained.

[0329] In some embodiments, the tensioning mechanism according to embodiments of the present technology may include one or more circumferential bands that are tightly pulled together and locked under a locking set screw (e.g., a closing mechanism 6546, described in detail with reference to Figure 65) or a clamping mechanism (e.g., mechanisms 6646 and / or 6746, described in detail with reference to Figures 66A-67) to apply tension to (e.g., tighten) an intervertebral device. Furthermore, such a tensioning mechanism may include an internal gear that can be operated to tighten the bands and apply tension to the intervertebral device.

[0330] Figure 69A is a side view of an intervertebral device 6940 coupled to a deployment shaft 6944 according to an embodiment of the present art. Figures 69B and 69C are enlarged views of the coupling between the intervertebral device 6940 and the deployment shaft 6944, and a side view of the deployment shaft 6944, respectively, according to an embodiment of the present art. Referring to Figures 69A and 69B, the intervertebral device 6940 includes a proximal hub 6941 having a plurality of grooves 6942 configured to receive corresponding tabs 6945 of the deployment shaft 6944. The engagement between the locking grooves 6942 and tabs 6954 maintains a movable connection between the deployment shafts 6944 so that the intervertebral device 6940 can be translated (e.g., proximal and / or distal) and / or rotated via the corresponding translation / rotation of the deployment shafts 6944.

[0331] In the illustrated embodiment, the locking shaft 6948 is inserted through the deployment shaft 6944 and extends at least partially beyond the tab 6945. Referring to Figure 69C, the tabs 6945 are biased radially inward so that they flex radially inward in the absence of external force. In some embodiments, the tabs 6945 are formed from Nitinol, spring steel, and / or equivalent. Referring to Figures 69A–69C, the locking shaft 6948 contacts the tab 6945 and flexes the tab 6945 into the corresponding groove 6942, beyond which it is inserted. Thus, pulling the locking shaft 6948 proximal beyond the tab 6945 allows the tab 6945 to flex radially inward out of the groove 6942, disengaging the deployment shaft 6944 from the intervertebral device 6940. Thus, the intervertebral device 6940 can be removed from the deployment shaft 6944 after delivery to the intervertebral cavity.

[0332] In some embodiments, a filling material can be inserted through a locking shaft 6948 for injection into the intervertebral device 6940. The intervertebral device 6940 may include a valve 6949 (shown schematicly) in the proximal hub 6941. In some embodiments, the locking shaft 6948 extends through the valve 6949, opening the valve 6949 so that the filling material can be injected into the intervertebral device 6940. Pulling the locking shaft 6948 proximal through the valve 6949 (for example, during removal of the intervertebral device 6940 from the deployment shaft 6944) can close the valve 6949 or allow the valve 6949 to close so that the valve 6949 prevents or further prevents the filling material from flowing out of the intervertebral device 6940 beyond the valve 6949. In other embodiments, the locking shaft 6948 does not need to extend through the valve 6949, and the pressure of the filling material can be used to open the valve 6949 and allow the filling material to be injected into the intervertebral device 6940. In such embodiments, the valve 6949 can be passively closed after the filling material has been injected.

[0333] Figure 70A is a perspective view of an intervertebral device 7040 and a deployment shaft 7044 according to an embodiment of the present technology. In Figure 70A, the intervertebral device 7040 is shown detached from the deployment shaft 7044 for clarity. In the illustrated embodiment, the intervertebral device 7040 includes a proximal hub 7041, which is fixed to a mesh or braid of woven filaments 7042 and has at least partially a threaded inner surface 7043. The proximal hub 7041 may include several features that are generally similar or identical in structure and / or function to any of the hubs 4541, 4641, and / or 4741, which are described in more detail above with reference to Figures 45A-47B. The deployment shaft 7044 may include a distal portion with at least partially a threaded outer surface 7045. The deployment shaft 7044 can be fixed to the proximal hub 7041 by screwing its threaded outer surface 7045 into the threaded inner surface 7043 of the proximal hub 7041 of the intervertebral device 7040. Once connected in this manner, the intervertebral device 7040 can be translated (e.g., proximal and / or distal) and / or rotated via the corresponding translation / rotation of the deployment shaft 7044. For example, the deployment shaft 7044 can be used to advance the intervertebral device 7040 through the access trocar 7010.

[0334] Figure 70B is a perspective view of a filling cartridge 7070, used for filling the intervertebral device 7040 of Figure 70A with filling material, according to an embodiment of the present technology. Figure 70C is an enlarged view of a portion of the filling cartridge 7070 of Figure 70B, according to an embodiment of the present technology. Referring to Figures 70B and 70C, the filling cartridge 7070 may include a proximal hub 7071 coupled to an elongated shaft 7072, and a plurality of filling members 7073 slidably positioned along the elongated shaft 7072. Figure 70D is a perspective view of one of the filling members 7073, according to an embodiment of the present technology. Referring to Figures 70C and 70D, each filling member 7073 can define a lumen 7074 configured to slide longitudinally along the elongated shaft 7072. In some embodiments, the lumen 7074 of the filler member 7073 and the elongated shaft 7072 can be shaped to prevent or further prevent rotation of the filler member 7073 around the elongated shaft 7072. In the illustrated embodiment, for example, each lumen 7074 of the filler member 7073 is defined by an inner surface 7075 having a polygonal (e.g., hexagonal) shape, and the elongated shaft 7072 has a corresponding polygonal shape so that the filler member 7073 is fed along the elongated shaft 7072 and rotates together with the elongated shaft 7072, but not independently of the elongated shaft 7072. In other embodiments, the lumen 7074 of the filler member 7073 and the elongated shaft 7072 can have other shapes (e.g., irregular) selected to prevent rotation of the filler member 7073 relative to the elongated shaft 7072.

[0335] Referring to Figure 70D, the filler member 7073 may comprise polyetheretherketone (PEEK), hydroxyapatite (HA), titanium, and / or other rigid materials described herein. In some embodiments, the filler member 7073 may have an outer surface comprising threaded features 7076, separated by a flat portion or cutout 7077.

[0336] Referring to Figures 70A-70D, the proximal hub 7071 of the filling cartridge 7070 is configured to be coupled to a filling device (e.g., a filling gun) and / or other actuation source, and the elongated shaft 7072 and the filling member 7073 on it are configured to be inserted into the proximal hub 7041 of the intervertebral device 7040 (Figure 70A) through the deployment shaft 7044 (Figure 70A) and / or another access path. The filling device can be actuated to (i) rotate the elongated shaft 7072 and (ii) drive the filling member 7073 distally along the elongated shaft 7072. Such movement can drive the filling member 7073 into the intervertebral device 7040 through the proximal hub 7041. More specifically, the filling member 7073 can be rotated (e.g., screwed) through the proximal hub 7041 with the threaded feature 7076 of the filling member 7073 engaged with the threaded inner surface 7043 of the proximal hub 7041. In some aspects of this technology, rotation of the filling member 7073 through the proximal hub 7041 can rotate the proximal hub 7041 and apply tension to the filament 7042. As the filling member 7073 fills the intervertebral device 7040 and tension is applied to the filament 7042, the filling member 7073 can form a gabion-like structure within the intervertebral device 7040. In some aspects of this technology, the filling member 7073 can be molded so that it interlocks substantially vertically (e.g., in the direction between adjacent vertebrae) and provides rigid vertical support and strength. In contrast, spherical filling members, for example, can redirect substantial forces radially through their non-vertical engagements. Similarly, cutouts 7077 in the filling member 7073 can help maximize the surface area of ​​the resulting (e.g., gabion-like) structure and provide osseointegration. In some embodiments, the last-inserted filling member 7073 remains within the proximal hub 7041 and coronaries or closes the intervertebral device 7040. IX. Selected Embodiments of Intervertebral Devices, Systems, and Methods for Vertebral Resection and / or Other Spinal Surgical Procedures

[0337] While many of the embodiments described above are described in the context of spinal fusion procedures, the devices, systems, and methods described herein can be used in a variety of other spinal surgical procedures, such as vertebrobectomy procedures and / or equivalents. A vertebrobectomy procedure involves removing part (e.g., the vertebral body) or all of a vertebra and an adjacent intervertebral disc. A vertebrobectomy procedure according to an embodiment may also include the steps of accessing the vertebra through a minimally invasive access port (e.g., a trocar), removing the vertebra and adjacent intervertebral disc via an instrument inserted through the minimally invasive access port, inserting an intervertebral device through a minimally invasive access port into the spinal cavity where the vertebra and adjacent intervertebral disc were previously located, expanding the intervertebral device within the spinal cavity via an instrument inserted through the minimally invasive access port, and filling the intervertebral device via an instrument inserted through the minimally invasive access port.

[0338] More specifically, for example, Figure 71A is a side view (e.g., lateral view) of the spine 7100 during a vertebral resection procedure according to an embodiment of the present technology. The spine 7100 includes a vertebra 7102a and an intervertebral disc 7104 adjacent to the vertebra 7102a, which will be removed during the vertebral resection procedure. In the illustrated embodiment, an introducer 7110 is positioned to access the vertebra 7102a, and a balloon device 7131, including a balloon 7130, is inserted through the introducer 7110. The balloon 7130 expands within the vertebra 7102a, which can mechanically break (e.g., rupture to separate) the vertebra 7102a and / or the adjacent intervertebral disc 7104. In some embodiments, other mechanical components (e.g., disc scrapers, bone scrapers, cutting instruments) can be inserted through the introducer 7110 to facilitate the removal of the vertebra 7102a and the adjacent intervertebral disc 7104.

[0339] Figure 71B is a side view (e.g., an anterior view) of the spine 7100 after removal of the vertebrae 7102a and intervertebral disc 7104 to form the spinal cavity 7101, according to an embodiment of the present art. In the illustrated embodiment, the intervertebral device 7140 is deployed within the spinal cavity 7101. The intervertebral device 7140 may comprise a mesh or braid of filaments, filled with a filling material, as described in detail above. The intervertebral device 7140 may contact, conform to, and provide support between a pair of remaining vertebrae 7102b and / or other vertebral structures. In some aspects of the present art, the intervertebral device 7140 may be deployed through the same introducer 7110 (Figure 71A) so that the entire vertebral resection procedure is performed through open surgery, minimally invasive, or percutaneous access ports. X. Selected embodiments of devices, systems, and methods for measuring spinal angle

[0340] Figures 72A–77 illustrate embodiments of systems and methods for correcting and / or measuring lordosis, kyphosis, scoliosis, and / or other curvatures of a patient's spine, as described in more detail above with reference to Figures 3G–3L and blocks 586–589 of Method 580 in Figure 5. Thus, embodiments described with reference to Figures 72A–77 can be utilized in the workflow of spinal surgical procedures, as described in more detail with reference to Figures 1A–2, 3A–5, and / or anywhere else herein.

[0341] Figure 72A is a partial side view (e.g., lateral view) of a spinal fixation system 7210, which is attached to a patient's spine 7200, including an upper (e.g., first) vertebra 7202a and a lower (e.g., second) vertebra 7202b, according to an embodiment of the present technology. Generally, the spinal fixation system 7210 is configured to allow (i) relative movement of the vertebrae 7202 to establish a desired angle of the spine 7200, (ii) measurement / determination of the angle, and (iii) subsequent fixation of the vertebrae 7202 at the desired angle with intervertebral devices 7240 between them. In the illustrated embodiment, the first fixation member 7272a is fixed to / inside the upper vertebra 7202a, and the second fixation member 7272b is fixed to / inside the lower vertebra 7202b. The first and second fixing members 7272a-b (collectively, “fixing members 7272”) may be pedicle screws, cortical screws, anchors, rivets, wires, bands, interspinous clamps, interarchal clamps, plates, dowels, cement, friction devices, adhesives, epoxy, and / or equivalents. For example, in the illustrated embodiment, the fixing member 7272 is a pedicle screw, each comprising (i) a threaded screw body 7273 (including an individually identified first screw body 7273a and a second screw body 7273b) having a head 7274 (including an individually identified first head 7274a and a second head 7274b) and configured to be screwed into and fixed therein in a corresponding vertebra 7202; and (ii) a multi-axis head or tulip portion 7275 (including an individually identified first tulip portion 7275a and a second tulip portion 7275b) coupled to the head 7274. The tulip portion 7275 can rotate relative to the head 7274 or can be fixed in a fixed orientation relative to the head 7274. In some embodiments, the fixing member 7272 may include several features that are generally similar or identical in structure and / or function to the fixing member 1572, which will be described in detail with reference to Figures 15A and 15B.

[0342] In the illustrated embodiments, a first tower member 7284a (e.g., a tower, tube, rigid member, positioning tube, and / or equivalent) is releasably fixed to a first head 7274a of a first fixed member 7272a, and a second tower member 7284b is releasably fixed to a second head 7274b of a second fixed member 7272b. The tower member 7284 can provide an access channel for accessing the head 7274 of the fixed member 7272. In some embodiments, one or more positioning ties 7278 (e.g., a locking device including individually identified first positioning ties 7278a and second positioning ties 7278b) can be fixed between the tower members 7284. In some embodiments, the positioning tie 7278 includes one or more joints 7279 (each including a first joint 7279a and a second joint 7279b, respectively, which may be fixed or movable). The positioning tie 7278 may be integrated with and / or separate from a tower member 7284 and / or may be releasably coupled thereto. The positioning tie 7278 and the tower member 7284 together may define a positioning system or assembly 7220. In the illustrated embodiments, an intervertebral device 7240, which is one of the intervertebral devices described in detail herein, such as expandable, fillable, tensionable, etc., is embedded in the intervertebral space 7207 between the vertebrae 7202. The intervertebral device 7240 may replace the affected intervertebral disc, which has been at least partially removed. In other embodiments, the intervertebral device 7240 may include a balloon that is inflatable to separate the intervertebral space 7207, as described in detail herein.

[0343] Figure 72B is a side view (e.g., lateral view) of the same portion of the spinal fixation system 7210 of Figure 72A, which is attached to the patient's spine 7200 according to an embodiment of the present technology, illustrating various distances, angles, and / or rotation points that can be operated to drive other target distances, angles, and / or rotation points. For clarity, reference numerals for the various components of the spinal fixation system 7210 are omitted in Figure 72A.

[0344] Referring to both FIGS. 72A and 72B, (i) the first distance d1 can be defined as the intervertebral distance along the anterior side of the intervertebral cavity 7207, (ii) the second distance d2 can be defined as the distance between the heads 7274 of the fixation members 7272 or the distance between the tulip portions 7275 of the fixation members 7272, i.e., the distance between two anatomical landmarks along the posterior side of the intervertebral cavity 7207, (iii) the third distance d3 can be defined as the distance between the tower members 7284 along the first positioning tie 7278a, and (iv) the fourth distance d4 can be defined as the distance between the tower members 7284 along the second positioning tie 7278b. Similarly, the system 7210 can define (i) a first rotation point R1 of the first tulip portion 7275a about the first head 7274a, (ii) a second rotation point R2 of the second tulip portion 7275b about the second head 7274b, (iii) a third rotation point R3 at the first joint 7279a of the first positioning tie 7278a, (iv) a fourth rotation point R4 at the second joint 7279b of the first positioning tie 7278a, (v) a fifth rotation point R5 at the first joint 7279a of the second positioning tie 7278b, and (vi) a sixth rotation point R6 at the second joint 7279b of the second positioning tie 7278b, etc., one or more rotation points. The rotation point R 1-6 can be restricted to move partially around one axis, two axes, and / or three axes, or can be completely movable around one axis, two axes, and / or three axes. In some embodiments, the spinal fixation system 7210 has more or fewer distances d 1-4 and / or rotation points R 1-6 For example, one or both of the tulip portions 7275 can be fixed to the head 7274 such that the spinal fixation system 7210 does not include the first and second rotation points R 1-2 The spinal fixation system 7210 can be such that the spinal fixation system 7210 does not include the fourth distance d4 and the fifth and sixth rotation points R 5-6To avoid including the first positioning tie 7278, it may contain only one of the positioning ties 7278 (for example, the first positioning tie 7278a).

[0345] In some embodiments, lordosis, kyphosis, and / or other spinal angles are desired between two adjacent vertebrae 7202, across two discontinuous vertebrae, or along a segment of one or more vertebrae. Figure 73A is a partial schematic side view (e.g., lateral view) of a portion of a spinal fixation system 7210 attached to a spine 7200 according to an embodiment of the present art. In the illustrated embodiment, the lordosis angle θ1 is defined between the upper vertebra 7202a and the lower vertebra 7202b. More specifically, the lordosis angle θ1 can be defined between the lower (e.g., inferior) surface or endplate 7306a of the upper (e.g., superior) vertebra 7202a and the upper (e.g., superior) surface or endplate 7306b of the lower (e.g., inferior) vertebra 7202b. Figure 73B is a lateral view (e.g., a lateral view) of a portion of the vertebra 7200 according to an embodiment of the present art, further illustrating an additional inferior vertebra 7202c below the inferior vertebra 7202b. In the illustrated embodiment, the lordosis angle θ2 may be defined, alternatively or in addition, between the sagittal-plane-oriented / superior projection of the superior (e.g., superior) surface or endplate 7306b of the superior vertebra 7202a and the sagittal-plane-oriented projection of the inferior (e.g., inferior) surface or endplate 7306a of the adjacent inferior vertebra 7202b. The lordosis angle θ3 may be defined, alternatively or in addition, between the sagittal-plane-oriented projection of the superior surface 7306b of the superior vertebra 7202a and the sagittal-plane-oriented projection of the superior (e.g., superior) surface or endplate 7306b of the inferior vertebra 7202c. In other embodiments, the lordosis angle may be defined in other ways. In some embodiments, the lordosis angle is determined preoperatively before the spinal surgery procedure, through preoperative scanning of the spine (e.g., computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, and / or equivalent).

[0346] Referring to both Figures 72A and 73B, various distances d of the spinal fixation system 7210 are shown. 1-4 and / or rotation point R1-6 Some of them are at a distance d 1-4 and / or rotation point R 1-6 It affects other things, for example, the lordosis angle of the spine at 7200 (for example, any lordosis angle θ) 1-3 ) and / or other spinal angles (e.g., kyphosis, scoliosis) can be manipulated to change various distances d 1-4 and / or rotation point R 1-6 Some or all of these can be actively manipulated to achieve spinal angle correction, at various distances d 1-4 and / or rotation point R 1-6 Some or all of the spine can be fixed during the operation of the spinal fixation system 7210 (for example, no changes in distance and / or orientation are possible), and / or various distances d 1-4 and / or rotation point R 1-6 Some or all of these can be freely moved and driven by the active operation of the spinal fixation system 7210. For example, the lordosis angle θ 1-3 This can be adjusted by adjusting the first distance d1 relative to the second distance d2, adjusting the second distance d2 relative to the first distance d1, and / or adjusting both the first distance d1 and the second distance d2 in relation to each other. Therefore, the general goal of the spinal fixation system 7210 is the first and / or second distance d 1-2 This can be defined as changing the relative size of the vertebrae and altering the lordosis angle of the vertebrae 7200. While this specification focuses on adjusting the lordosis angle of the vertebrae 7200, those skilled in the art will understand that the spinal fixation system 7210 may also be operated in different planes (e.g., coronal, sagittal, etc.) to achieve correction of other spinal angles of the vertebrae 7200 (e.g., kyphosis, scoliosis). For example, with respect to coronal adjustment of the vertebrae 7200, one side of the spinal fixation system 7210 may be locked, while the other side may be adjusted for separation and / or angle changes of the vertebrae 7200.

[0347] As a first embodiment, the spinal fixation system 7210 can be configured according to an embodiment described in detail with reference to Figures 3G-3K. In such an embodiment, the spinal fixation system 7210 is configured such that the spinal fixation system 7210 is configured such that the fourth distance d4 and the fifth and sixth rotation points R 5-6 Only one of the positioning ties 7278 (e.g., the first positioning tie 7278a) may be included so as not to include the third and fourth rotation points R 3-4 However, it can be a rigid clamp or locking device (e.g., locking device 378 in Figure 3G-3K) so as to be fixed (e.g., omitted). Furthermore, the second and third distances d 2-3 It can be fixed. Therefore, during spinal surgical procedures, the intervertebral device 7240 can be extended to affect / manipulate a first distance d1. Manipulation of the first distance d1 via the intervertebral device 7240 is achieved through the rotation of the head 7274 of the fixing member 7272 in the tulip portion 7275 as the screw body 7273 moves with the vertebra 7202, thereby affecting first and second rotation points R 1-2 This causes a corresponding change. The change in lordosis angle can be determined by measuring the change in rotation of the head 7274 within the tulip section 7275, mechanically, optically, electronically, and / or equivalently. The actual lordosis angle can be determined by mapping the change in angle to the original lordosis angle (e.g., before operation of the spinal fixation system 7210), which is determined preoperatively, for example, through measurements of a preoperative scan of the spine 7200. The spinal fixation system 7210 also includes, but in addition, a second positioning tie 7288b, for example, fifth and sixth rotation points R 5-6 With the fourth distance d4 fixed, it can be operated.

[0348] As a second embodiment, the third and / or fourth distance d 3-4 However, the first and / or second distance d 1-2The angle can be changed and manipulated to alter the lordosis angle. For example, the third distance d3 and / or the fourth distance d4 are reduced, and correspondingly the first and / or second distance d 1-2 It can be increased.

[0349] As a third embodiment, the first, third, and fifth rotation points R 1、3、5 However, it is along a first rigid structure comprising a first tulip section 7275a and a first tower member 7284a, and the second, fourth, and sixth rotation points R 2、4、6 However, it lies along a second rigid structure comprising a second tulip section 7275b and a second tower member 7284b. The two rigid structures may be constrained to the same plane or may be in different spatial planes. One or both of the positioning ties 7278 may be actuated to adjust a third distance d3 and / or a fourth distance d4 between the first and second rigid structures. A third positioning tie (not shown) may extend between the first and second rigid structures (e.g., the tulip section 7275) at first and second rotation points R1 and R2 and may be actuated (e.g., by the user) to control distance d2. The first positioning tie 7278a, the second positioning tie 7278b, and / or the third positioning tie may be used to adjust the second-fourth distance d, such as a rack and pinion gear, worm drive, toggle arm, threaded rod, clamped rod, and / or equivalent. 2-4 A linear motion mechanism can be provided to change the rotation point R. 1-6 While keeping each of them free to rotate, the user can set distances d3 and d4 via the first and second positioning ties 7278a-b, respectively, and vary (e.g., establish) the second distance d2. When establishing the second distance d2 relative to the first distance d1, the user can adjust the lordosis and / or configure a different spinal angle, such as any lordosis angle θ 1-3 ) can be constructed.

[0350] In a fourth embodiment, the first distance d1 can be fixed initially, and the second distance d2, the third distance d3, and / or the fourth distance d4 can be made movable, and the lordosis angle (e.g., any lordosis angle θ) can be adjusted. 1-3 ) can be changed. In a fifth embodiment, the second distance d2 can be fixed first, and the first distance d1, the third distance d3, and / or the fourth distance d4 can be made movable, and the lordosis angle (e.g., any lordosis angle θ) can be changed. 1-3 ) can be changed. In a sixth embodiment, the third distance d3 can be fixed first, and the first distance d1, the second distance d2, and / or the fourth distance d4 can be made movable, and the lordosis angle (e.g., any lordosis angle θ) can be changed. 1-3 ) can be changed. In a seventh embodiment, the fourth distance d4 can be fixed first, and the first distance d1, the second distance d2, and / or the third distance d3 can be made movable, and the lordosis angle (e.g., any lordosis angle θ) can be changed. 1-3 ) can be changed.

[0351] In some embodiments, the various structures / components of the spinal fixation system 7210 allow the user to maintain a range of distances d 1-4 and / or rotation point R 1-6 It can be coupled to, attached to, and / or integrated with a towing, compression, and / or release device as a means for controlling some or all of it.

[0352] In some embodiments, various structures / components of the spinal fixation system 7210 can be coupled, attached, and / or integrated with spinal implants and their associated devices. For example, in the illustrated embodiment, the first and second rotation points R 1-2 It comprises a multi-axis head of the pedicle screw (for example, a head 7274 rotatable within the tulip portion 7275). In some embodiments, the first, third, and fifth rotation points R 1、3、5The rigid structure including the pedicle screw (e.g., first fixing member 7272a) forms part of the tulip section (e.g., first tulip section 7275a) which is attached to the pedicle screw (e.g., first fixing member 7272a). In some embodiments, the second, fourth, and sixth rotation points R 2、4、6 The rigid structure including the pedicle screw (e.g., second fixing member 7272b) forms part of the tulip section (e.g., second tulip section 7275b). In some embodiments, the first, third, and fifth rotation points R 1、3、5 The rigid structure, including the first tower member 7284a, is used for the implantation of a minimally invasive pedicle screw (e.g., the first fixing member 7272a). In some embodiments, the second, fourth, and sixth rotation points R 2、4、6 The rigid structure, including the above, constitutes part of a percutaneous tower (e.g., a second tower member 7284a) used for the implantation of a minimally invasive pedicle screw (e.g., a second fixing member 7272b).

[0353] In some embodiments, the desired distance d 1-4 and / or rotation point R 1-6 However, while this is achieved, distance d 1-4 and / or rotation point R 1-6 Some or all of it moves freely. When the desired configuration is reached, distance d 1-4 and / or rotation point R 1-6 Some or all of the components can be locked in place and the configuration maintained. In some embodiments, once the desired configuration is achieved and optionally locked in place, some or all of the various structures / components of the spinal fixation system 7210, for example, the tower member 7284, are removed from the patient. In some embodiments, once the desired configuration is achieved and optionally locked in place, none of the various structures / components of the spinal fixation system 7210 are removed from the patient and remain as an implanted device.

[0354] In some embodiments, the second distance d2 remains fixed, while the first and second rotation points R 1-2The rotation of the tulip section 7275 is made possible around the first point (for example, still allowing for multi-axis movement of the tulip section 7275 around the head 7274), allowing for the operation of the tower member 7284 and the positioning tie 7278, and defining the lordosis angle. For example, a notched spine rod is inserted between the fixing members 7272, fixing a second distance d2 between the fixing members 7272, while still allowing the first and second rotation points R 1-2 The tulip portion 7275 can be made to rotate around this point. In other embodiments, the second distance d2 can be fixed by inserting a wedge component between two fixing members 7272, which adopts a geometric shape of a gap for fixing the second distance d2.

[0355] In other embodiments, the first and second rotation points R 1-2 It may be desirable to allow manipulation of a second distance d2 while fixing the rotation of the tulip portion 7275 around a first rotation point. Figure 74 is a side view (e.g., lateral view) of the same portion of the spinal fixation system 7210 of Figure 72A, which is attached to the patient's spine 7200 according to an embodiment of the present art, and illustrates an additional driver 7490 inserted through the first tower member 7284a and engaging with the first fixation member 7272a. The driver 7490 may have a keyed distal tip portion 7492 that engages with the first head 7274a (e.g., the threads of its screw) and the first tulip portion 7275a (e.g., its threads) and is configured to block or further prevent rotation between them (e.g., around the first rotation point R1; Figure 72B). In some embodiments, the driver 7490 may also be used to manipulate third and fourth distances d3 and d4 (Figure 72B). In some embodiments, a separate driver can similarly be inserted through the second tower member 7284b and engage with the second screw head 7274b and the second tulip portion 7275b.

[0356] Figure 75 is a side view of a posterior spinal fixation device / system 7510 according to an additional embodiment of the present technology. The spinal fixation system 7510 includes several features that are generally similar in structure and / or function to the spinal fixation system 7210, which is described above in more detail with reference to Figures 72A-74 and / or elsewhere in this specification. In the illustrated embodiments, the spinal fixation system 7510 comprises a first rigid structure 7584a, a second rigid structure 7584b, a rotatable / pivotable joint 7587 which connects the proximal portion of the first rigid structure 7584a to the proximal portion of the second rigid structure 7584b, and a positioning tie 7578 which extends between the first and second rigid structures 7584a-b distal to the joint 7587 and connects them. In some embodiments, the positioning tie 7578 comprises a threaded rod 7593 which is coupled to an actuator 7594 (e.g., a screw wheel).

[0357] The spinal fixation system 7510 is the same distance d as described above with reference to Figures 72A and 74. 2-4 and / or rotation point R 1-6 This can be defined / configured. In the illustrated embodiment, the fourth distance d4 is fixed within the joint 7587, and the fifth and sixth rotation points R 5-6 However, they constitute the same point of rotation. The second distance d2 can be controlled / changed by operating the actuator 7594, moving the threaded rod 7593, and changing (e.g., increasing, decreasing) the third distance d3.

[0358] Figure 76 is a side view of a posterior spinal fixation device / system 7610 according to an additional embodiment of the present technology. The spinal fixation system 7610 includes several features that are generally similar or identical in structure and / or function to the spinal fixation system 7210, which is described more in detail above with reference to Figures 72A-74, and the spinal fixation system 7510, which is described more in detail above with reference to Figure 75 and / or anywhere else in this specification. In the illustrated embodiment, the spinal fixation system 7610 comprises a first rigid structure 7684a, a second rigid structure 7684b, and a positioning tie 7678 coupled to the first and second rigid structures 7684a-b and comprising a rack 7695 and pinion 7696 mechanism. More specifically, the proximal portion of the first rigid structure 7684a can be rotatably or fixedly coupled to the pinion 7696, and the proximal portion of the second rigid structure 7684b can be rotatably or fixedly coupled to the rack 7695.

[0359] The spinal fixation system 7610 has the same second and third distances d as described above with reference to Figures 72A and 75. 2-3 and / or rotation point R 1-4 The following can be defined / configured. In some embodiments, the second distance d2 is controlled / changed by acting on the rack 7695 and pinion 7696 mechanism, while the third and fourth rotation points R 3-4 The second distance d2 locks the third distance d3 using the rack 7695 and pinion 7696 mechanism, and then the third and / or fourth rotation point R 3-4 It is controlled / changed by changing it.

[0360] In some embodiments, the spinal fixation system according to embodiments of the present technology may include one or more mechanisms to measure / capture / determine changes in lordosis and / or spinal angles (e.g., kyphosis angle, scoliosis angle). Such mechanisms can verify and validate the effectiveness of the spinal fixation system and provide real-time or near-real-time quantifiable data of the spinal fixation system to a user (e.g., a surgeon). Such mechanisms may include, for example, mechanical, electrical encoding, and / or optical encoding mechanisms. Referring to Figures 72A and 72B, such mechanisms may be mounted in / on any of the fixation members 7272, tower members 7284, and / or positioning ties 7278, and / or such mechanisms may be embedded in the intervertebral device 7240.

[0361] In some embodiments, a mechanical mechanism for measuring changes in lordosis and / or other spinal angles can measure the change in angle via a ratchet mechanism that captures incremental changes in the lordosis angle as d1 and d2 are defined via the operation of the spinal fixation system 7210. In other embodiments, the mechanical mechanism can measure any distance d 1-4 A dial indicator can be used to capture changes in the forward curvature angle via the use of a plunger, which then captures the change and converts it into an angle measurement.

[0362] In some embodiments, an electrical encoding mechanism for measuring changes in lordosis and / or other spinal angles can utilize a small circuit with strain gauges that can be used to capture changes in lordosis and / or other spinal angles as the tower member 7284, positioning tie 7278, fixing member 7272, and / or intervertebral device 7240 are operated. In other embodiments, electrical encoding feedback can be collected by implementing software code that plots pressure-volume and / or pressure-height curves during operation (e.g., expansion) of the intervertebral device 7240, generates a first distance d1 to a calibration curve, and correlates the anterior edge distance (e.g., first distance d1) and / or posterior edge distance (e.g., second distance d2) with the lordosis angle (e.g., lordosis angle θ1). The data captured to generate such curves can be achieved by using pressure sensors and / or electrical sensors that alert the user to real-time or near-real-time pressure during operation of the intervertebral device 7240 to define d1. In other embodiments, electrical encoding feedback can be collected by tracking the inflation volume of a balloon within an intervertebral device 7240, which can be used to correlate anterior expansion with changes in lordosis angle, and which implements a balloon with known pressure-volume and / or pressure-height curves.

[0363] In some embodiments, an optical encoding mechanism for measuring changes in lordosis and / or other spinal angles can calculate changes in lordosis and / or other spinal angles via image and processing techniques, utilizing a base point marker mounted on the tower member 7284. In other embodiments, optical encoding feedback can be collected by implementing an optical sensor mounted on the fixed member 7272, which projects a shadow onto a dial to capture changes in lordosis and / or other spinal angles.

[0364] As described above, the actual lordosis angle can be determined by mapping the change in angle, which is determined by mechanical, electrical encoding, optical encoding, and / or other measurement mechanisms, to the original lordosis angle, which is determined preoperatively, for example, through measurements via a preoperative scan of the spine 7200.

[0365] In some embodiments, one or more sensors may be attached to the vertebral body (not necessarily via pedicle screws) to measure changes in lordosis angle and / or intervertebral height. Each sensor may comprise (i) a pin (e.g., a Casper pin) positioned on the spinous process of the vertebra or any location on the bony biostructure, and (ii) a sensing system attached to the pin, embedded in it, integrated in it, and / or otherwise coupled to it. The sensing system may comprise inertial motion sensors, gyroscopes, inclinometers, electromagnetic markers / basepoints, infrared markers / basepoints, and / or equivalents. For example, a sensor (e.g., its pin) may be coupled to each of a pair of vertebrae adjacent to the intervertebral space. Each sensor may comprise an inertial measurement sensor configured to measure motion, and the relative motion of two sensors may be used to derive changes in height and lordosis angle. In another embodiment, the sensor may comprise an infrared and / or electromagnetic basepoint that can be read / tracked by a navigation system to detect changes in height and lordosis angle.

[0366] In yet another embodiment, one or more of the sensors may comprise an emission array, and one or more of the sensors may comprise a receiving array. The emission array may be configured to emit sound, light, electromagnetic waves, and / or other signals, and the receiving array may receive / detect the emitted sound, light, electromagnetic waves, and / or other signals. One of the sensors with an emission array may be coupled to one of a pair of vertebrae adjacent to the intervertebral space, and one of the sensors with a receiving array may be coupled to the other of a pair of vertebrae adjacent to the intervertebral space. The sensors may be coupled to a processor configured to determine the relative positions of the emission and receiving arrays and to determine changes in intervertebral height and angle using time of flight, relative distance, capacitance change, triangulation, and / or other processing techniques. Multiple emission arrays or a single emission array may also be used. Similarly, multiple receiving arrays or a single receiving array may also be used.

[0367] Figure 77 is a partial side view (e.g., lateral view) of a spinal position sensing system 7710 configured to be attached to a patient's spine, for example, according to an embodiment of the present technology. In the illustrated embodiment, the spinal position sensing system 7710 includes a first sensor 7720 and a second sensor 7730. The first sensor 7720 may include (i) a pin 7722 configured to be attached to a patient's vertebra or other rigid structure, and (ii) a transmission array 7724 coupled to the pin 7722 and having one or more transmission elements 7726. The second sensor 7730 may include (i) a pin 7732 configured to be attached to a patient's vertebra or other rigid structure, and (ii) a receiving array 7734 coupled to the pin 7732 and having one or more receiving elements 7736. The transmission elements 7726 of the transmission array 7724 may generate signals 7712 (e.g., light, sound, electromagnetic, and / or other waves). Therefore, the transmission element 7726 may comprise a light-emitting diode (LED), a speaker, an electromagnetic wave generator, and / or equivalent. The receiving element 7736 of the receiving array 7734 may be positioned to receive the signal 7712 and, for example, convert the signal into an electrical signal. Therefore, the receiving element 7736 may comprise a photovoltaic cell, a microphone, and / or equivalent. The spinal position sensing system 7710 may further include a processor coupled to the first and second sensors 7720, 7730 and configured to process data from the transmission and receiving elements 7726, 7736 using time-of-flight, relative distance, capacitance change, triangulation, and / or other processing techniques to determine the relative positions of the first and second sensors 7720, 7730 and to determine changes in intervertebral height and angle. The transmission element 7726 may be configured to transmit signals of the same type (e.g., with a common frequency, amplitude, mode, etc.) or to transmit different types of signals. The receiving element 7736 can be configured to receive signals from one or more of the transmitting elements 7726. XIII. Selected Embodiments of Robot Integration

[0368] The systems and devices described in detail herein are suitable for integration into robotic systems. That is, some or all of the various components can be coupled to a robot configured to move, translate, rotate, torque, deploy, etc., the components. More specifically, such a robot can provide planned trajectories for the various components. As an example, referring to Figure 1A-1R, the trocar 110 can be coupled to a robot configured to insert the trocar 110 into the intervertebral space 101 along a planned trajectory; the discectomy device 120 can be coupled to the same or a different robot configured to insert the discectomy device 120 through the trocar 110, operate the discectomy device 120 within the intervertebral space 101, and remove / destroy the affected intervertebral disc 104a; the medial balloon shaft 132 can be coupled to the same or a different robot configured to insert the medial balloon shaft 132 and the first balloon 130 through the trocar 110 and / or inflate the first balloon 130; and one or more balloon shafts 152 can be coupled to the same or a different robot configured to insert one or more balloon shafts 152 and the second balloon 150 through the trocar 110 and / or inflate the second balloon 150, and so on. XIV. Selected embodiments of intervertebral devices, systems, and methods for use during open and / or partially open surgical procedures

[0369] While many of the embodiments described above are described in the context of minimally invasive spinal surgery, many of the devices, systems, and methods described herein can be used in a variety of other spinal surgery procedures, such as open or at least partially open spinal surgery. For example, during open spinal surgery, the muscles and soft tissues surrounding a portion of the patient's spine are moved so that the portion of the patient's spine can be exposed, at least partially. The surgeon can then access the spine and, for example, remove the affected intervertebral disc and fix a posterior fixation assembly to the spine. In some embodiments, according to embodiments of the art, a trocar can be used to deploy balloons (e.g., for lordosis and / or separation) and / or intervertebral devices into the intervertebral space of the removed intervertebral disc, as described in detail above. The trocar can be coupled to the posterior fixation assembly via a connector guide member during the procedure. In some embodiments, the connector guide member is configured to be fixed to a tower member of the posterior fixing assembly, and the tower member provides multi-axial or at least one degree of freedom to move the trocar relative to a portion of the spine and align the trocar with the intervertebral space. In some embodiments, the connector guide member is configured to be fixed to a span member (e.g., a rod) of the posterior fixing assembly, and the connector guide member provides multi-axial or at least one degree of freedom to move the trocar relative to a portion of the spine and align the trocar with the intervertebral space.

[0370] Figures 78A-81B illustrate various connector guide members configured according to this technology to secure the trocar of a posterior fixation assembly to a tower member. In some aspects of this technology, the tower member can have several general-purpose sizes (e.g., diameters), and the connector guide members can be adjustably fixed to tower members of different sizes. In contrast, there are many fixing members with different shapes and arrangements that are commonly used during spinal surgical procedures (e.g., produced by different manufacturers), and to which tower members can be fixed. Therefore, by fixing the connector guide member to the tower member rather than to the fixing member of the posterior fixation assembly, the connector guide member can be more easily used with a wide variety of posterior fixation assemblies.

[0371] Figure 78A is an isometric view of a connector guide member 7830 according to an embodiment of the present technology. Figure 78B is an isometric view of the connector guide member 7830 of Figure 78A, which connects a trocar 7810 to a spinal fixation system 7820 (e.g., a posterior fixation assembly) that is attached to a portion of a patient's spine 7800. Referring to Figure 78A, the connector guide member 7830 may be a spring clip having a first arm 7832 that is pivotably coupled to a second arm 7834 in a pivot joint 7836. The first arm 7832 may include a first end portion 7831 and a second end portion 7833, and the second arm 7834 may include a first end portion 7835 and a second end portion 7837. The second end portion 7833 of the first arm 7832 and the second end portion 7837 of the second arm 7834 can together define an opening or lumen 7838. In some embodiments, a biasing member (e.g., a torsion spring) is positioned between the first and second arms 7832, 7834 to (i) bias the first end portion 7831 of the first arm 7832 away from the first end portion 7835 of the second arm 7834, and (ii) bias the second end portion 7833 of the first arm 7832 toward the second end portion 7837 of the second arm 7834 (e.g., thereby reducing the cross-sectional dimensions of the lumen 7838). In some embodiments, the second arm 7834 includes a connecting portion 7840 that defines a through hole 7842 (e.g., an opening, lumen).

[0372] Referring to Figure 78B, the spinal fixation system 7820 may include a fixation member 7822, such as a pedicle screw, having a screw body 7823 fixed to the spine 7800 (e.g., its vertebrae) and a multi-axis head or tulip portion 7824 rotatably coupled to the screw body 7823. In the illustrated embodiment, the spinal fixation system 7820 further includes a tower member 7826 detachably coupled to the tulip portion 7824. Referring to Figures 78A and 78B, the connector guide member 7830 can be removably coupled to the tower member 7826 by, for example, (i) moving the first end portion 7831 of the first arm 7832 toward the first end portion 7835 of the second arm 7834 (e.g., by squeezing it with the user), moving the second end portion 7833 of the first arm 7832 toward the second end portion 7837 of the second arm 7834 with respect to the biasing force of the biasing member, (ii) positioning the tower member 7826 within the lumen 7838, and (iii) releasing the first and second arms 7832 and 7834 so that the biasing member biases the first and second arms 7832 and 7834 and clamps the tower member 7826 within the lumen 7838.

[0373] The trocar 7810 can be inserted through the through-hole 7842 so as to be fixed in place to move together with the tower member 7826. That is, the connector guide member 7830 provides a firm connection between the trocar 7810 and the tower member 7826. The tower member 7826 can be moved (e.g., pivoted relative to the tulip section 7824) to adjust the position of the trocar 7810 relative to the spine 7800. Thus, the tower member 7826 provides multiaxial or at least one degree of freedom to move the trocar 7810 relative to the spine 7800 and to align the trocar 7810 with the intervertebral space to deliver one or more balloons, intervertebral devices, and / or equivalents through the trocar 7810 and treat the intervertebral space. The connector guide member 7830 can be released from the tower member 7826 by (i) moving the first end portion 7831 of the first arm 7832 toward the first end portion 7835 of the second arm 7834 (for example, by squeezing it) and moving the second end portion 7833 of the first arm 7832 toward the second end portion 7837 of the second arm 7834, and (ii) removing the tower member 7826 from inside the lumen 7838.

[0374] Figure 79A is a top view of a connector guide member 7930 according to an embodiment of the present technology. The connector guide member 7930 may be a hose clamp having a first clamp member 7932 fixed to a second clamp member 7934. In some embodiments, the first and second clamp members 7932, 7934 may be identical (e.g., identical components and / or size). For example, in the illustrated embodiment, the first and second clamp members 7932, 7934 each include a first arm 7931 and a second arm 7933, together defining a lumen 7935 (e.g., a substantially circular lumen). The first and second arms 7931, 7933 may be flexible and formed from, for example, plastic. The first arm 7931 may include a first clamp portion 7936 adjacent to the lumen 7935 and a first locking portion 7937 positioned radially outward from the first clamp portion 7936. The first locking portion 7937 may include / define a plurality of teeth 7938 along its length. The first clamp portion 7936 and the first locking portion 7937 may define a first channel 7939 between them. The second arm 7931 may similarly include a second clamp portion 7940 adjacent to the lumen 7935 and a second locking portion 7941 positioned radially outward from the second clamp portion 7940. The second clamp portion 7940 and the second locking portion 7941 may define a second channel 7942 between them. The second clamp portion 7940 and the second locking portion 7941 may include / define a plurality of teeth 7943 adjacent to the second channel 7942 along their length.

[0375] The first arm 7931 of each of the first and second clamp members 7932 and 7934 can be secured to the second arm 7933 by inserting the first locking portion 7937 into the second channel 7942. The teeth 7938 of the first locking portion 7937 engage with the teeth 7943 along the second channel 7942, preventing the first arm 7931 from moving away from the second arm 7933. More specifically, Figures 79B and 79C are side views of one of the first and second clamp members 7932 and 7934 in the fully engaged and partially engaged positions, respectively, according to embodiments of the present art. Referring to Figures 79A and 79B, the first locking portion 7937 of the first arm 7931 is fully inserted into the second channel 7942 of the second arm 7933 with teeth 7938 and 7943 engaged with each other. In this position, (i) the engagement of teeth 7938 and 7943 prevents the first locking portion 7937 from being dislodged from the second channel 7942 (for example, fixing the first arm 7931 to the second arm 7933), and (ii) the lumen 7935 may have a first (e.g., minimum) cross-sectional dimension A1 (e.g., diameter, area, etc.). Referring to Figures 79A and 79C, the first locking portion 7937 of the first arm 7931 is partially inserted into the second channel 7942 of the second arm 7933 with teeth 7938 and 7943 engaged with each other (for example, three teeth 7938 and 7943 engaged with each other). In this position, (i) the engagement of teeth 7938 and 7943 prevents the first locking portion 7937 from being dislodged from the second channel 7942 (for example, fixing the first arm 7931 to the second arm 7933), and (ii) the lumen 7935 may have a second cross-sectional dimension A2 (e.g., diameter, area, etc.) that exceeds the first cross-sectional dimension A1. By adjusting the extent to which the locking portion 7937 is inserted into the second channel 7942, the connector guide member 7930 can be sized to engage and connect with tower members of different dimensions (e.g., diameter).Referring to Figures 79A-79C, the first arm 7931 can be disengaged from the second arm 7933 by bending the first arm 7931 and / or the second arm 7933 laterally (for example, in a direction toward and / or toward the page) so that the first locking portion 7937 slides out of the second channel 7942.

[0376] Figure 79D is an isometric view of the connector guide member 7930 of Figures 79A-79C, which connects the trocar 7910 to a spinal fixation system 7920 (e.g., a posterior fixation assembly) attached to a portion of the patient's spine 7900, according to an embodiment of the present technology. In the illustrated embodiment, the spinal fixation system 7920 includes a fixation member 7922 such as a pedicle screw, and has a screw body 7923 fixed to the spine 7900 (e.g., its vertebrae), and a multi-axis head or tulip portion 7924 rotatably coupled to the screw body 7923. In the illustrated embodiment, the spinal fixation system 7920 further includes a tower member 7926 detachably coupled to the tulip portion 7924. Referring to Figures 79A-79D, the connector guide member 7930 can be releasably coupled to the tower member 7926 by, for example, (i) bending the first arm 7931 and the second arm 7933 of the first clamp member 7932 so that they are separated from each other, thereby positioning the tower member 7926 within the lumen 7935 (and / or sliding the first clamp member 7932 across the tower member 7926), and then (ii) pressing the first locking portion 7937 into the second channel 7942 until the first clamp member 7932 is clamped to the tower member 7926. The lumen 7935 can be sized by inserting the first locking portion 7937 more or less into the second channel 7942 to match the size of the tower member 7926, and the first clamp member 7932 can be fixed and clamped to the tower member 7926. Similarly, the connector guide member 7930 can be releasably coupled to the trocar 7910 by, for example, (i) bending the first arm 7931 and the second arm 7933 of the second clamp member 7934 so that they are separated from each other, thereby positioning the trocar 7910 within the lumen 7935, and then (ii) pressing the first locking portion 7937 into the second channel 7942 until the second clamp member 7934 is clamped to the trocar 7910.The lumen 7935 is sized by inserting the first locking portion 7937 more or less into the second channel 7942 to match the size of the trocar 7910, and the second clamping member 7932 can be fixed to the trocar 7910 and clamped.

[0377] In some aspects of this technology, the connector guide member 7930 provides a robust connection between the trocar 7910 and the tower member 7926. The tower member 7926 is movable (e.g., pivoted relative to the tulip portion 7924) to adjust the position of the trocar 7910 relative to the spine 7900. That is, the tower member 7926 provides multiaxial or at least one degree of freedom to move the trocar 7910 relative to the spine 7900, allowing one or more balloons, intervertebral devices, and / or equivalents to be delivered through the trocar 7910 and aligned with the intervertebral space of the spine 7900 to treat the intervertebral space. The connector guide member 7930 can be released from the tower member 7926 and the trocar 7910 by bending the first arm 7931 and / or the second arm 7933 of the first and second clamp members 7932 and 7934 laterally (for example, in the direction toward and / or toward the page in Figures 79A-79C) so that the first locking portion 7937 slides out of the second channel 7942.

[0378] Figure 80 is an isometric view of a connector guide member 8030 that connects a trocar 8010 to a spinal fixation system 8020 (e.g., a posterior fixation assembly) which is attached to a portion of the patient's spine 8000, according to an embodiment of the present technology. In the illustrated embodiment, the spinal fixation system 8020 includes a fixation member 8022 such as a pedicle screw and has a screw body 8023 fixed to the spine 8000 (e.g., its vertebrae), and a multi-axis head or tulip portion 8024 rotatably coupled to the screw body 8023. In the illustrated embodiment, the spinal fixation system 8020 further includes a tower member 8026 which is detachably coupled to the tulip porti...

Claims

1. A method for treating a patient's spine, wherein the method is Inserting a trocar along a lateral, transpedicle, transface joint, or transforaminal access route so as to be close to the affected intervertebral disc within the intervertebral space of the vertebra, Inserting the discectomy device through the aforementioned trocar, Using the aforementioned discectomy device, destroy at least a portion of the affected intervertebral disc, Inserting the intervertebral device into the intervertebral space through the trocar, To expand the intervertebral device within the intervertebral space, The intervertebral device is filled with a filling material. Methods that include...

2. The method according to claim 1, wherein the intervertebral device comprises a braided filament.

3. The method according to claim 2, further comprising expanding the intervertebral device within the intervertebral space and then applying tension to the braided filaments.

4. The above method further, Inserting a balloon into the intervertebral space through the trocar, The balloon in the intervertebral space expands and the intervertebral space separates. The method according to claim 1, including the method described in claim 1.

5. The method according to claim 1, wherein the trocar is a first trocar, and the method further comprises inserting a second trocar through the first trocar, the second trocar having a curved distal portion configured to extend from the first trocar.

6. The method according to claim 5, wherein inserting the discectomy device includes inserting the discectomy device through the second trocar.

7. The above method further, Inserting a balloon into the intervertebral space through the second trocar, The balloon in the intervertebral space expands and the intervertebral space separates. The method according to claim 5, including the method described in claim 5.

8. The method according to claim 5, wherein the insertion of the intervertebral device includes inserting the intervertebral device through the second trocar.

9. The method according to claim 1, further comprising destroying at least a portion of the ligamentous structure located around the affected intervertebral disc.

10. The method according to claim 1, wherein the intervertebral space is the L4 / L5 intervertebral space of the vertebra, and inserting the trocar so as to be close to the affected intervertebral disc within the L4 / L5 intervertebral space includes inserting the trocar along a lateral approach extending through the iliac crest of the patient.

11. The method according to claim 1, wherein the intervertebral space is the L5 / S1 intervertebral space of the vertebra, and inserting the trocar so as to be close to the affected intervertebral disc within the L5 / S1 intervertebral space includes inserting the trocar along a lateral approach extending through the iliac crest of the patient and the sacrum of the patient's vertebra.

12. A system for treating the patient's spine, A trocar, wherein the trocar is configured to be inserted laterally, transpedicle, transface joint, or transforaminal access pathway so as to be close to the affected intervertebral disc within the intervertebral space of the vertebra, A discectomy device, wherein the discectomy device is inserted through the trocar and is configured to operate to destroy at least a portion of the affected disc, An intervertebral device, wherein the intervertebral device is inserted through the trocar and configured to expand within the intervertebral space, A filling material, wherein the filling material is configured to be inserted into the expanded intervertebral device through the trocar, and A system equipped with these features.

13. The intervertebral device comprises a braided filament, according to claim 12.

14. The system according to claim 13, further comprising a tension-applying device inserted through the trocal and configured to act to apply tension to the braided filaments within the intervertebral space.

15. The system according to claim 12, further comprising a balloon inserted through the trocar and configured to expand within the intervertebral space to separate the intervertebral space.

16. The system according to claim 12, wherein the trocar is a first trocar, further comprising a second trocar configured to be inserted through the first trocar, the second trocar having a curved distal portion configured to extend from the first trocar.

17. The system according to claim 16, wherein the discectomy device is configured to be inserted through the second trocar.

18. The system according to claim 16, wherein the intervertebral device is configured to be inserted through the second trocar.

19. A method for treating a patient's spine, wherein the method is The first posterior fixing member is attached to the first vertebra of the spine, The second posterior fixing member is attached to the second vertebra of the spine adjacent to the first vertebra, and the intervertebral space is positioned between the first vertebra and the second vertebra. Inserting the trocar into the intervertebral space, Inserting a balloon into the intervertebral space through the trocar, The position and orientation of the first portion of the first rear fixing member are locked to the first portion of the second rear fixing member, The balloon in the intervertebral space is expanded, the intervertebral space is separated, and a lordosis is created between the first vertebra and the second vertebra. The position and orientation of the second portion of the first rear fixing member are locked to the position and orientation of the second portion of the second rear fixing member, thereby maintaining the generated lordosis. To deploy the intervertebral device within the intervertebral space and Methods that include...

20. The method according to claim 19, wherein locking the position and orientation of the second portion of the first rear fixing member with respect to the position and orientation of the second portion of the second rear fixing member includes tightening a first set screw of the first rear fixing member and tightening a second set screw of the second rear fixing member.

21. The method according to claim 19, further comprising filling the intervertebral device with a filling material.

22. The method according to claim 19, wherein inserting the trocar into the intervertebral space includes inserting the trocar via a lateral approach.

23. The above method further, Attaching the first tower member to the first rear fixing member, The second tower member is attached to the second rear fixing member, The method according to claim 19, including the method described in claim 19.

24. The method according to claim 23, wherein locking the position and orientation of the first portion of the first rear fixing member with respect to the first portion of the second rear fixing member includes clamping the first tower member to the second tower member.

25. The method according to claim 19, wherein locking the position and orientation of the first portion of the first rear fixing member with respect to the first portion of the second rear fixing member includes attaching the limiter to a span member that connects the first portion of the first rear fixing member to the first portion of the second rear fixing member.

26. The method according to claim 19, wherein the first portion of the first rear fixing member comprises a first tulip portion, the first portion of the second rear fixing member comprises a second tulip portion, the second portion of the first rear fixing member comprises a first screw body, and the second portion of the second rear fixing member comprises a second screw body.

27. The method according to claim 19, wherein the first vertebra is the L4 vertebra of the vertebra, the second vertebra is the L5 vertebra of the vertebra, the intervertebral space is the L4 / L5 intervertebral space of the vertebra, and insertion of the trocar into the intervertebral space comprises inserting the trocar along a lateral approach extending through the iliac crest of the patient.

28. The method according to claim 19, wherein the first vertebra is the L5 vertebra of the spine, the second vertebra is the S1 vertebra of the spine, the intervertebral space is the L5 / S1 intervertebral space of the spine, and inserting the trocar into the intervertebral space comprises inserting the trocar along a lateral approach extending through the iliac crest of the patient and the sacrum of the patient's spine.

29. The method according to claim 19, further comprising inflating the balloon in the intervertebral space while measuring the lordosis angle of the spine in real time or near real time to generate the lordosis between the first vertebra and the second vertebra.

30. A system for treating the patient's spine, A trocar, wherein the trocar is configured to be inserted laterally, transpedicle, transface joint, or transforaminal access pathway so as to be close to the affected intervertebral disc within the intervertebral space of the vertebra, A balloon, wherein the balloon is inserted through the trocar, expands within the intervertebral space, and is configured to separate the intervertebral space, A locking device, wherein the locking device is coupled to a posterior fixation assembly fixed to the spine and is configured to (a) lock the position and orientation of a portion of a first posterior fixation member fixed to a first vertebra adjacent to the intervertebral space with respect to (b) a portion of a second posterior fixation member fixed to a second vertebra adjacent to the intervertebral space, thereby causing the balloon to expand and generating lordosis between the first and second vertebrae. An intervertebral device, wherein the intervertebral device is inserted through the trocar and configured to expand within the intervertebral space, and A system equipped with these features.

31. The system according to claim 30, further comprising a filling material configured to be inserted into the expanded intervertebral device through the trocar.

32. The system according to claim 30, further comprising a spinal angle measuring device configured to measure the generated lordosis in real time or near real time.

33. The system according to claim 30, wherein the locking device comprises a clamp configured to fix and connect a first tower member, which is attached to the first rear fixing member, to a second tower member, which is attached to the second rear fixing member.

34. The system according to claim 30, wherein the locking device comprises a limiter configured to fix a portion of the first rear fixing member to a span member that connects a portion of the second rear fixing member.

35. The system according to claim 30, wherein a portion of the first rear fixing member is provided with a tulip portion of the first rear fixing member that is coupled to the screw body of the first rear fixing member, and a portion of the second rear fixing member is provided with a tulip portion of the second rear fixing member that is coupled to the screw body of the second rear fixing member.

36. A method for treating the spine of a human patient, wherein the method is Inserting a trocar along a lateral access path extending through the patient's iliac crest so as to be close to the affected intervertebral disc in the L4 / L5 intervertebral space between the L4 and L5 vertebrae of the spine, Inserting the intervertebral device into the intervertebral space through the trocar, To expand the intervertebral device within the intervertebral space and Methods that include...

37. The method according to claim 36, further comprising filling the intervertebral device with a filling material.

38. The above method further, Inserting a balloon into the intervertebral space through the trocar, The balloon in the intervertebral space is expanded, the intervertebral space is separated, and a lordosis is created between the L4 vertebra and the L5 vertebra. The method according to claim 36, including the method described in claim 36.

39. A method for treating the spine of a human patient, wherein the method is Inserting a trocar along the lateral access path extending through the patient's iliac crest and the sacrum of the patient's spine, so as to be close to the affected intervertebral disc in the L5 / S1 intervertebral space between the L5 and S1 vertebrae of the spine, Inserting the intervertebral device into the intervertebral space through the trocar, To expand the intervertebral device within the intervertebral space and Methods that include...

40. The method according to claim 39, further comprising filling the intervertebral device with a filling material.

41. The above method further, Inserting a balloon into the intervertebral space through the trocar, The balloon in the intervertebral space is expanded, the intervertebral space is separated, and a lordosis is created between the L5 vertebra and the S1 vertebra. The method according to claim 39, including the method described in claim 39.

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