Devices, systems, and methods for spinal disc removal and vertebral endplate preparation for spinal fusion

Abstract

Embodiments disclosed herein include devices, systems, and methods for spinal disc removal and vertebral endplate preparation for spinal fusion. In an embodiment, a surgical device includes a sleeve including a proximal end and a distal end, a cutting head, and a handpiece secured to the sleeve. The cutting head is selectively movable between a retracted position in which the cutting head is disposed within the sleeve and a deployed position in which the cutting head is disposed outside the sleeve. The cutting head includes a drill member and multiple cutting blades that automatically adjust between a collapsed configuration in the retracted position within the sleeve and an expanded configuration in the deployed position outside the sleeve. A distance between the multiple cutting blades in the expanded configuration is greater than a diameter of the sleeve. The multiple blades are configured to cut spinal discs when rotated.

Description

DEVICES, SYSTEMS, AND METHODS FOR SPINAL DISC REMOVAL AND VERTEBRAL ENDPLATE PREPARATION FOR SPINAL FUSIONCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Provisional Patent Application No. 63 / 662,363 filed on June 20, 2024, the disclosure of which is incorporated herein, in its entirety, by this reference.BACKGROUND

[0002] Lower back issues are the number one cause of disability worldwide, affecting both developed and developing societies. Generally, operations aim to decompress nerve roots and / or the spinal cord and stabilize the spinal column. Within the growing trend of spinal operations, sub-trends point towards increasing use of minimally invasive techniques (MIS) to minimize morbidity and improve outcomes. Lumbar surgery for decompression and fusion are consistently growing operations to help with ameliorating the ails of those with degenerative spinal conditions, lumbar radiculopathy, and for correction of spinal deformities. Disc removal and disc space preparation are steps for nerve root decompression as well to create an environment for spinal fusion between the two vertebral bodies to occur.SUMMARY

[0003] Embodiments disclosed herein are surgical devices, systems, and methods for spinal disc removal and vertebral endplate preparation for spinal fusion. In an embodiment, a surgical device includes a sleeve including a proximal end and a distal end, a cutting head, and a handpiece. The cutting head is selectively movable between a retracted position in which the cutting head is disposed within the sleeve and a deployed position in which the cutting head is disposed outside the sleeve. The cutting head includes a drill member and multiple cutting blades that automatically adjust between a collapsed configuration in the retracted position within the sleeve and an expanded configuration in the deployed position outside the sleeve. A distance between the multiple cutting blades in the expanded configuration is greater than a diameter of the sleeve. The handpiece is secured to the sleeve and includes one or more control members configured to selectively move the cutting head between the retracted position andthe deployed position in which the cutting head is rotatable. The multiple blades are configured to cut spinal discs when rotated.

[0004] In an embodiment, a surgical device includes a sleeve including a proximal end and a distal end, a cutting head, and a handpiece secured to the sleeve. The cutting head is selectively movable between a retracted position in which the cutting head is disposed within the sleeve and a deployed position in which the cutting head is disposed outside the sleeve. The cutting head includes multiple cutting blades that automatically adjust between a collapsed configuration in the retracted position within the sleeve and an expanded configuration in the deployed position outside the sleeve. A distance between the multiple cutting blades in the expanded configuration is greater than a diameter of the sleeve. The handpiece includes one or more control members configured to selectively move the cutting head between the retracted position and the deployed position in which the cutting head is rotatable. The multiple blades are configured to cut spinal discs when rotated. The handpiece also includes a vacuum port configured to fluidly connect to a vacuum source. When the cutting head is in the deployed position and the vacuum source is activated, the distal end of the sleeve is in fluid communication with the vacuum source effective to draw material cut by the multiple blades into and through the sleeve for removal.

[0005] In an embodiment, a method of cutting tissue material between vertebrae is disclosed. The method includes inserting a distal end of a sleeve of a surgical device between the vertebrae. The surgical device includes a handpiece secured to the sleeve and a cutting head in a retracted position at least partially within the sleeve. The method also includes deploying the cutting head from the distal end of the sleeve to a deployed position with the cutting head disposed outside the sleeve and between the vertebrae. The cutting head includes a drill member and multiple cutting blades that automatically expand from a collapsed configuration in the retracted position within the sleeve to an expanded configuration in the deployed position outside the sleeve. A distance between the multiple cutting blades in the expanded configuration is greater than a diameter of the sleeve. The method also includes rotating the cutting head to cut material between the vertebrae, retracting the cutting head within the sleeve to the retracted position, and withdrawing the sleeve from between the vertebrae.

[0006] Features from any of the disclosed embodiments may be used in combination with one another, without limitation. In addition, other features and advantages of the presentdisclosure will become apparent to those of ordinary skill in the art through consideration of the following detailed description and the accompanying drawings.BRIEF DESCRIPTION OF THE DRAWINGS

[0007] The drawings illustrate several embodiments of the present disclosure, wherein identical reference numerals refer to identical or similar elements or features in different views or embodiments shown in the drawings.

[0008] FIG. 1A is an isometric view of a surgical device in a first configuration, according to an embodiment.

[0009] FIG. IB is an isometric view of the surgical device of FIG. 1A in a second configuration.

[0010] FIG. 1C is a side view of a cutting head of the surgical device of FIG. 1A in the second configuration of FIG. IB.

[0011] FIG. 2 is a side view of a cutting head of a surgical device, according to an embodiment.

[0012] FIG. 3 is a side view of a cutting head of a surgical device, according to an embodiment.

[0013] FIG. 4 is a side view of a cutting head of a surgical device, according to an embodiment.

[0014] FIGS. 5A-5B are isometric views of a portion of the surgical device of FIG. 1A during use, according to an embodiment.

[0015] FIG. 6 is a flow diagram of a method of cutting tissue material between vertebrae, according to an embodiment.DETAILED DESCRIPTION

[0016] Lumbar surgery for decompression and fusion are consistently growing operations to help with ameliorating the ails of those with degenerative spinal conditions, lumbar radiculopathy, and for correction of spinal deformities. Disc removal and disc space preparation are steps for nerve root decompression as well to create an environment for spinal fusion between the two vertebral bodies to occur. The steps involving disc removal and endplate preparation are broadly applicable in open, minimally invasive, as well as endoscopictechniques, and are relevant for clinical outcomes. The nuanced nature of the technique, presence of vital neural structures, as well as duration of time necessary for adequate work are fraught with complications.

[0017] The steps involved in achieving the goals of lumbar fusion can be complex. First, after meticulous exposure, whether via open, percutaneous-intramuscular or endoscopic techniques, the surgeon places posterior fixation by way of pedicle screws. This allows the disc spaces to be distracted to give the surgeon exposure to the disc space that is to be removed. The disc is subsequently removed using paddle shavers, blades resembling propellers that disrupt the disc space in sequentially enlarging sizes. Next, the surgeon scrapes away cartilaginous endplates (the interface between the disc and the endplates of the vertebral bodies) to expose the bony endplate. Finally, an interbody device along with bone graft are placed to distract open the disc space and to scaffold the bony union between the cranial and caudal vertebral bodies.

[0018] The operation, however, includes one or more failure points. The operation is often done through unilateral access into the disc, via a corridor known as Kambin’s triangle. This corridor is composed of the exiting nerve root as the hypotenuse of the triangle, the traversing nerve root exiting at the level below as the vertical of the triangle, and the disc space as the horizontal of the triangle. Through this small area, multiple instruments must pass repeatedly, often as many as 50 times or more, in order to remove an adequate amount of disc material. Patients are at risk of injury to the dorsal root ganglion of the exiting nerve root, injury to the preganglionic root of the nerve root of the level below (traversing nerve root), tearing of the dura with resultant spinal fluid fistula, and potentially to vascular injury. Every pass increases the risk of these complications. Moreover, all studied clinical outcomes in the literature are diminished by nerve root injury or spinal fluid leakage. However, multiple passes are required with the existing instrumentation to remove adequate disc material.

[0019] Inadequate disc preparation increases the rate of failed fusion, known as pseudoarthrosis, a radiographic diagnosis whereby fusion fails to occur. Pseudoarthrosis results in increasing pain due to micromotion within the spine, creating a clinical presentation of mechanical back pain. Multiple studies show inadequate disc removal as the primary driver of non-union. As a result, graft area is studied to determine what threshold of disc removal helps determine rate of fusion. The higher the bone graft area ratio (bone graft area / removeddisc to endplate surface comparison), the higher the rate of arthrodesis. Evidence indicates that this area must be significantly greater than 30%, without specifying below how much is inadequate. In experienced, well-versed hands, this can be as high as 71% but generally not much higher. This result is presumed to be related to the challenge of removing disc in the contralateral dorsal aspect of disc.

[0020] Most surgeons approach the disc space unilaterally, typically on the patient’s symptomatic side. Unfortunately, unilateral access provides inadequate exposure of the disc space to allow for enough disc removal. Contrast medium may be inserted and anteroposterior / lateral fluoroscopy may be used to visualize how much disc is removed and whether cartilaginous endplates are adequately removed. Even with the best attempts, however, complications related to access are prevalent. Moreover, the greater the surgeon’s ability to remove disc out laterally, the better the chances of preventing interbody cage subsidence, a phenomenon where the cage pistons into the vertebral bodies and loses the intended height that the surgeon built into the construct. Getting the disc prepared to the anterior hypophyseal ring is important in that the bone is 2x stronger and can handle stiffer loads and reduce rate of subsidence.

[0021] Minimally invasive lumbar fusions are beneficial due to reduced paraspinal muscle dissection, blood loss, length of stay and enhanced recovery. The recovery from an MIS operation also requires significantly less narcotics. Despite the perceived challenge of disc removal appearing higher with MIS techniques, fusion rates with the MIS interbody fusion is better than in open fusion, presumably related to maintenance of paraspinal muscles. This may also explain why Oswestry Disability Index (ODI) scores are lower in MIS compared to open fusions. One should note, however, that MIS fusions are lengthier and require a significant degree of radiation exposure by the patient and operating room staff, which the literature reports at an average of 1.69 minutes of radiation per case. This results in a lifetime occupational exposure limit at 194 cases, readily reached within only a short number of years of practice.

[0022] This leads to the assumption and extrapolation that higher fusion rates and lower morbidity as well as increased clinical outcomes scores would be expected for patients undergoing endoscopic discectomy and fusions. In this technique, the disc space is entered via a far lateral approach through Kambin’s triangle through a 5-10 mm endoscope. This musclesplitting approach leaves the patient’s normal paraspinal muscles intact with the least degree of violation. Posterior lumbar endoscopic discectomies are promising with regard to clinical outcomes and can reduce blood loss and need for hospitalization. However, the main reason for failure of endoscopic fusions thus far is inadequate disc removal. As a result, pioneering surgeons pushing this field are often using high doses of nerve-irritating biological enhancers, increasing the postoperative rate of radiculitis and significantly taking back any cost reductions associated with the less invasive operation. In short, endoscopic spinal fusion as a procedure has not been reproducible and thus not well-enough studied to determine efficacy, primarily because no adequate discectomy or disc preparation technology exists.

[0023] Spinal disc removal for spinal fusion is heavily dependent on the degree of disc removal for clinical outcomes. Due to the nature of how the operation is currently performed, however, the removal process falls short in terms of patient safety and ergonomics. Embodiments disclosed herein are medical devices, systems, and methods that adequately clear the disc space and prepare the vertebral endplates to allow nerve root decompression and fusion with a single pass of instrumentation. This single pass of the instrumentation reduces the likelihood of nerve root injury, spinal fluid leakage and potential endplate violation. In many embodiments, the device may be selectively steerable and may be provided with the ability to suction aspirate as the device clears the disc space. In at least one, some, or all embodiments, the devices and systems disclosed herein may be integrated with off-the-shelf endoscopic instrumentation.

[0024] Embodiments of devices, systems, and methods disclosed herein achieve high disc removal rates and preparation of the endplates without bony violation to help improve fusion, increase decompression, and to release the spine for realignment. Moreover, embodiments of the devices, systems, and methods disclosed herein can perform this process through a single passage of instrumentation, thereby reducing the risk of nerve / dural injury. Further, embodiments of devices, systems, and methods disclosed herein can perform the removal and endplate preparation in a timesaving manner, reducing costs, increasing efficiency and ergonomics. Finally, embodiments of devices, systems, and methods disclosed herein can reduce the need for fluoroscopy via built-in optics, reducing the amount and duration of radiation exposure to the patient and operating room staff.

[0025] In current practice, lumbar disc removal is achieved by multiple passes ofinstrumentation through a narrow anatomical window known as Karnin’s triangle, bordered by nerves and sensitive tissues. Each pass of instrumentation carries the risk of nerve damage and other complications. Disc removal is achieved by using incrementally sized “shavers” to scrape disc tissue and cartilaginous endplate tissue from the bone. The prepared space is “distracted,” separating the vertebrae, and devices intended to facilitate spinal fusion are placed. “Violation,” or damage to the vertebral bone, is also a risk during shaving, and sufficient disc removal is difficult to achieve or confirm using the currently available instrumentation. In addition to the greater risk of multiple pass procedures, a single pass procedure would be faster, reducing surgical complications. Further, current instrumentation relies on radiological imaging, exposing patients and staff to radiation and reducing the ability of practitioners to accumulate procedural experience before reaching their lifetime radiation exposure limit. Embodiments of the devices, systems, and methods disclosed herein address these procedural concerns.

[0026] As used herein, distraction may include separation of vertebrae, a shaver may include a tool used to remove vertebral disc material from the disc body, and violation may include damage to the vertebral bone. In one or more embodiments, a device is disclosed having bone removal features, an expandable tissue removal feature (e.g, shaver or cutting head) that also allows for vertebral distraction, suction for material removal, and / or optics for visualizing the procedure and the degree of completion. The device may be sized such that, when collapsed, a portion of the device may pass through standard endoscope channels and easy passage to the disc space. The shaver or cutting head may be configured to remove the disc and cartilaginous endplates while preserving the bone.

[0027] In one or more embodiments, embodiments of the devices and systems disclosed herein may be used for endoscopic lumbar interbody fusion (ELIF). Such a procedure may include: a Wiltse approach to put in bilateral pedicle screws, distraction, a far lateral subcentimeter incision (much smaller than an incision for a transforaminal lumbar interbody fusion (TLIF)), insertion of dilators / endoscope down to inferior transverse process (e.g., if doing L4-5 fusion, the transverse process of L5); shaving the superior articulating process of the level below to allow access to the disc, just cranial to the pedicle of the level below (e.g., foraminoplasty) using an embodiment of the disclosed device; cutting into the disc with an embodiment of the disclosed device (additional or initial distraction may be performed at thistime with the embodiment of the disclosed device); performing discectomy with the embodiment of the disclosed device invention in a single pass; insertion of an interbody spacer; release distraction; insertion of a rod; taking an x-ray of the procedure area; final tightening of the rod; and closing of the incision.

[0028] One or more of the embodiments disclosed herein may include one or more of the following aspects. In some embodiments, the device is configured to allow multiple lumbar fusion access methods. For example, embodiments of the device may be used without modification for vertebral disc removal for either laparoscopic transforaminal lumbar inner body fusion (TLIF) or endoscopic lumbar inner body fusion (ELIF). In some embodiments, the device may be configured for use in TLIF and / or ELIF, and may be steerable. The device may be sized and dimensioned to be compatible with endoscopic tool channels.

[0029] In some embodiments, the device is configured as a single pass instrumentation. For example, the device may be configured for vertebral disc removal and include multiple functionalities or multiple exchangeable components to allow a single pass procedure, thereby reducing the risk of nerve injury and complications.

[0030] In some embodiments, the device is configured with interchangeable layers. For example, the device may be configured for vertebral disc removal with an inner layer (e.g., axial member or drill bit), a meso layer (e.g., cutting blades), and outer layers (e.g., sleeve or tube). The inner layer may be interchanged within the meso layer, the meso layer may be interchanged within the outer layer, and / or the inner and meso layers can be interchanged within the outer layer.

[0031] In some embodiments, the device is configured for relative movement between layers of the device. For example, the device may be configured for vertebral disc removal with inner, meso, and outer layers. The inner layer may be moved relative to the meso layer, the meso layer may be moved relative to the outer layer, and / or the inner and meso layers may be moved relative to the outer layer.

[0032] In some embodiments, the device is selectively guidable by a user. For example, the device may include a cutting head that can be guided by pivoting, steering, or a combination of pivoting and steering.

[0033] In some embodiments, the device includes a selectively actuated guide. For example, the device may be configured such that a sleeve and / or cutting head of the device arepivotable and / or steerable with one or more tension elements (e.g., cords, wires, chains, and / or wire braids), compression elements (e.g., wires, rods, tubing, braided wire, stacks of individual segments, and / or interlocking segments), and / or by rotation of a feature such as a threaded rod.

[0034] In some embodiments, the device includes a biased layer structure. For example, the device may be configured such that actuation may be accomplished using one of the instrument layers with material removed or with material added to create movement bias under force.

[0035] In some embodiments, the device may be configured to deflect, thereby providing increased reach of the cutting head. For example, the device may include one or more selectively actuatable steering and / or pivoting mechanism configured to provided increased reach to or within the disc body.

[0036] In some embodiments, the device may include a rigid section. For example, for example, torque transfer in one or more embodiments of the device is improved by incorporating stiff sections of tubing, braided wire, or other material that is relatively rigid compared to steerable or pivotable sections of the instrument. Mechanisms of the device allowing for rigid portions or mechanisms employed to improve torque transfer also allow the user to sense tissue resistance or to sense tissue compliance or to improve tactile feel of the instrument path for the user.

[0037] In some embodiments, the device may include a shaving tool having an adjustable size. For example, the device may include a cutting head having a shaving tool which can be selectively varied in width, height, or diameter to remove varying amounts of disc material. In some embodiments, variation in the size and / or reach of the shaving tool may be accomplished using a shaving feature that is spread when actuated by tension elements (e.g., cords, wires, chains, or wire braids), compression elements (e.g., wires, rods, tubing, braided wire, stacks of individual segments, and / or interlocking segments), and / or by rotation of a feature such as a threaded rod or such as a driveshaft. In some embodiments, the device may include a pull cord, push rod, and / or threaded rod and nut that may be pulled, pushed, or rotated to shorten the cutting head length in order to expand its width. In some embodiments, the cutting head can be expanded using pneumatic or hydraulic pistons by foreshortening the cutting tool length. In some embodiments, the cutting head can be directly expanded using pistons or similar pressure vessels which change length or position when pressure or vacuum is applied. In someembodiments, a cutting head can be inflated using gas or fluid to increase the diameter of the cutting head. In some embodiments, device includes a jack assembly comprising a rotational element and a threaded rod configured to expand the cutting head. In some embodiments, the cutting head may be flexible such that when the cutting head is foreshortened or biased, the cutting portion extends from the tool midline. In some embodiments, the cutting head may include one or more hinges or living hinges configured to extend from the tool midline when the cutting head is foreshortened or biased. In some embodiments, the cutting head includes multiple blades biased or otherwise configured to automatically adjust between a collapsed configuration in the retracted position within a sleeve and an expanded configuration in the deployed position outside the sleeve.

[0038] In some embodiments, the device may include an incremental shaving tool and / or a two-diameter shaving tool. For example, the device may include a cutting head with two or more configurations having different widths or diameters. The cutting head may be guided or directed to the disc in a smaller or retracted configuration and may be increased in size to an expanded configuration for cutting or other actions.

[0039] In some embodiments, the device may include a cutting head having various shaver shapes. For example, the device may include a cutting head having adjustable dimensions and a shaving surface. The shaving surface may be one-sided (e.g., one blade) or which may include two or more sides (e.g., two or three blades) to approach opposing vertebral endplates. The multiple sides or blades on the shaving surface may provide additional stability, provide additional distraction force, or allow for multiple instrument orientations.

[0040] In some embodiments, the device may include a cammed shaver. For example, the device may include a cutting head having cam shaped lobes which allow for improved vertebral distraction and / or which allow for graded removal of disc material.

[0041] In some embodiments, the device may include a cutting head having a variable taper. For example, the cutting head may include a variable taper or a cammed taper which allows for variable application of force or reach when biased or deflected.

[0042] In some embodiments, the device may include a cutting head have a selected motion. For example, the cutting head may be configured to separate disc material and / or displace or move disc material by rotation of the cutting head, reciprocation of the cutting head, by relative motion of one or multiple blades and a still feature on the cutting head, and / or byrelative motion of multiple blades or shaving features.

[0043] In some embodiments, the device may include a cutting head having a scoop or otherwise configured to scoop material. For example, the cutting head may be configured to separate and / or move disc material by rotation or by translation of a scooping feature. The scooping feature may include a scoop or other recess(es) in the cutting head. The scooping feature may selectively allow for a consistent or varying amount of disc material removal during motion of the cutting head. In some embodiments, the scooping feature may be configured for removal of a specific shape from the disc, such as a groove, multiple grooves, a scoop, or other shapes.

[0044] In some embodiments, the device may be configured for progressive shaving of the vertebral disc material. For example, the device may include a cutting head where the removal of vertebral disc material facilitates the progression of the cutting head through the disc, or where displacement of the disc material for removal facilitates progression of the cutting head through the disc.

[0045] In some embodiments, the device may be configured to allow for an indication of shaving progress of the cutting head. For example, the device may include a cutting head which removes vertebral disc material in a shape or in a fashion which facilitates visualization of the disc removal progress. In some embodiments, a clear visual indication of where disc material has been removed may be provided by the device, such as a characteristic shape to the material removed or by other continuous or intermittent removal of material to create a visually distinct border. The clear visual indication also may include an alteration of a removal shape or pattern as an indication of progress, or by progress indications at specific intervals.

[0046] In some embodiments, the cutting head device may include one or more cutting blades or elements. For example, the cutting head may be configured to remove vertebral disc material using a sharpened edge or a blade made of polymer, metal, ceramic, or a composite material. In some embodiment cutting head may include bristles or a multiplicity of features to remove small amounts of disc material. In some embodiments, the cutting head may include one or more teeth, serrations, or variations in the edge of a cutting element to create removal patterns. Blades, bristles, or teeth on the cutting head may have a squared edge, or a triangular edge, or a variable taper. The shape of the edge may have straight sections, curved sections, or a combination of straight and curved sections.

[0047] In some embodiments, the device may include a suction inlet to remove disc material from the procedure site. For example, the device may be configured to transfer abraded or separated disc material from the procedure site using suction through a suction inlet. The suction inlet may include a dedicated or shared channel on the cutting head and / or sleeve of the device. The suction inlet may be formed through removal of the inner layer, the meso layer, or the inner and meso layers of the instrument, with or without irrigation. The suction inlet may allow for continuous suction, variable suction, or accumulation of suction that focuses suction at a specific time or location.

[0048] In some embodiments, the device may include a selectively adjustable housing on the cutting head. For example, the device may include an external housing on the cutting head that can be adjusted in size, and which may include a blade or material removal feature inside the housing. The housing and removal feature can move relative to one another or can be fixed together.

[0049] In some embodiments, the device also may include a cutting head actuator. For example, the cutting head may be driven manually by direct motion, through the use of a crank handle or gear mechanism, a motor, an engine, and / or a pneumatic or hydraulic mechanism.

[0050] In some embodiments, the device also may include a torque indicator. For example, the device may include one or more visual indicators of torque on the cutting feature or on one or more of the instrument layers. The one or more visual indicators may include a gauge or dial. In some embodiments, the one or more visual indicators may include visual representation of force, such as changing light intensity or light color. In some embodiments, the one or more visual indicators may include auditory cues such as clicks, beeps, changing sound, and / or changing pitch of sound.

[0051] In some embodiments, the device also may include a torque tactile feedback element. For example, the device may be configured to provide the user with tactile feedback of torque by providing direct physical feedback of torque through a substantially rigid element or a series of rigid elements. The tactile feedback of torque may include amplifying torque through gears, mechanical advantage, an electronic method (such as vibration or pulses or change to the handle configuration, or a change to a dimension of the handle.

[0052] In some embodiments, the device may be configured to automatically limit torque of the device. For example, the device may be configured to limit the amount of torque or forcethat can be applied using a clutch or similar mechanisms, using a slip differential, using material with limited torque transfer ability due to the strength or configuration of the material (such as a looser braid or a thinner wall), a feature with a reduced mechanical advantage, by using a motor / engine with limited power, and / or by limiting the pressure of pneumatic or hydraulic inputs. In these and other embodiments, the device may be used to selectively remove materials with different strengths or consistencies.

[0053] In some embodiments, the device may be configured to force limitation of the cutting head for selective material. For example, the device may be configured limits the amount of torque or force that can be applied to tissue. The device may be configured to allow the cutting head to reduce diameter or to change shape at higher forces, and retreating or staying at the surface of bone or harder materials that are not intended for removal. The cutting head may be force limited by spring loading the foreshortening mechanisms or by building in a desired or predetermined amount of give in the feature, such as elasticity, flexibility, incorporation of pistons, and / or incorporation of inflated components which may shorten or compress under force. In some embodiments of the device, the cutting may be configured to vibrate to limit the force of material removal. For example, when the cutting strikes harder material, the cutting head may rebound from the material, reducing the amount of contact. In some embodiments, feedback from the cutting head may limit the force of material removal. For example, deflection of a component may use mechanical or electronic elements to communicate to the cutting to move away from the harder surface, retract, or reduce its size to move away from harder surface on either side of the feature.

[0054] In some embodiments, the device may be configured for localized material removal. For example, the device may be configured to apply greater force to material nearer the center and which apply less force to material further from the center, thereby allowing for greater material removal with reduced risk of removing undesired material.

[0055] In some embodiments, the device may be configured for selective material removal. For example, the device may include a blade designed to remove disc material and cartilaginous endplate material preferentially over removal of bone material. The device may accomplish this selective removal using a specific blade material (such as a softer polymer or composite). The device may accomplish this selective removal by using a blade motion or a blade angle that is designed to penetrate soft tissue more effectively than hard tissue, such asvery shallow or very steep angles of approach or by approaching the material gradually. In some embodiments, selective material removal may utilize force limitation, such as the mechanisms described above.

[0056] In some embodiments, the device may be configured for depth limitation and indication. For example, the device may be configured to allow only a fixed or adjustable depth of material removal relative to the bone or relative to an external reference. In some embodiments, the device may be configured to provide indication of depth (such as a visual dial, gauge, or slide), a visible indication (such as light, changing light intensity, changing colors), or an audible indication (such as clicks, a tone, a change in tone volume, a change in tone intensity, and / or a change in tone frequency. In some embodiments, the device may be configured to allow visualization of depth to allow the user to adjust the depth setting or to guide the instrument.

[0057] In some embodiments, the device is configured to vertebral distraction. For example, the device may be configured to distract adjacent vertebra to assist disc material removal and preparation of the space for introduction of fusion materials or tools. In some embodiments, the device may be configured to distract the vertebra using the same expansion or adjustability mechanisms as the cutting head, or by separate or additional mechanisms. In some embodiments, the device may include a pull cord, push rod, or threaded rod and nut that can be pulled, pushed, and / or rotated to foreshorten an element of the instrument, increasing its width or diameter for vertebral distraction. In some embodiments, the device may include a distraction feature that can be expanded using pneumatic or hydraulic pistons by foreshortening an element of the instrument, or by directly expanding the feature using pistons or similar pressure vessels which change length or position when pressure or vacuum is applied. In some embodiments, the device may include a balloon or pressure vessel which can be expanded using gas or fluid for vertebral distraction. In some embodiments, the device may include a jack element comprising a rotation element and a threaded rod to directly expand the distraction tool for vertebral distraction. In some embodiments, the device may include a distraction tool that is flexible such that when the distraction tool is foreshortened and / or biased, the distraction tool extends from the tool midline. In some embodiments, the device may include a distraction feature comprising hinges and / or living hinges, such that when the distraction feature is foreshortened and / or biased, the feature extends from the tool midline.

[0058] In some embodiments, the device is configured to remove one or more portions of bone for an access path. For example, the device may be configured to remove a portion of the superior articulating process of the facet joint in order to improve access to the disc. In some embodiments, the device may include a rotary or reciprocating shaving tool on the outer layer, the meso layer, or the inner layer of the cutting head. In some embodiments, the device may be configured such that the inner layer and / or the meso layer may be selectively exchanged for a rotary or reciprocating shaving tool. In some embodiments, the cutting comprises a burr or abrasive component moveable by mechanical or motorized or by pressurized elements.

[0059] In some embodiments, the device is configured for neural monitoring. For example, the device may be configured to receive feedback from a neural monitor, indicating proximity to one or more nerves, allowing for steering or guidance or allowing the instrument to reduce or increase material removal near the nerve.

[0060] In some embodiments, the device may include an atraumatic tip. For example, the device may include an atraumatic tip shape configured to assist in passing nerve or other sensitive tissue features without catching or damaging the nerves or other sensitive tissue features.

[0061] In some embodiments, the device is configured for visualization of the procedure using the device. For example, the device may include optical elements or sensors configured to allow visualization of the procedures or portions of the procedures, thereby reducing requirements for radiological imaging and reducing patient and practitioner exposure to radiation. The optical elements or sensors may be built into the device (e.g., the cutting head), may be selectively exchanged for one or more layers of the instrument, and / or may be passed through a dedicated or shared channel.

[0062] Turning now to the drawings, FIG. 1A is an isometric view of a surgical device 100 in a first configuration and FIG. IB is an isometric view of the surgical device 100 in a second configuration, according to an embodiment. In an embodiment, the surgical device 100 includes a handpiece 120, one or more shafts 110, 112 secured to the handpiece 120, and a cutting head 140. The cutting head 140 is selectively movable between a retracted position (shown in FIG. 1A) in which the cutting head 140 is disposed within the sleeve 110 and a deployed position (shown in FIG. IB) in which the cutting head 140 is disposed outside the sleeve 110.

[0063] Turning ahead in the drawings, FIG. 1C is a side view of the cutting head 140 of the surgical device 100 in the deployed position of the second configuration of FIG. IB. The cutting head 140 includes multiple cutting blades 142 that selectively adjust between a collapsed configuration in the retracted position (shown in FIG. 1A) within the sleeve 110 and an expanded configuration (shown in FIGS. 1B-1C) in the deployed position outside the sleeve 110. In the expanded configuration, the multiple blades 142 increase a diameter or width Wi of the cutting head 140. As the multiple cutting blades 142 adjust from the collapsed configuration in the sleeve 110 to the expanded configuration outside the sleeve 110, a distance between each of the multiple cutting blades 142 and an axis of the cutting head 140 when the cutting head 140 is in the expanded configuration is greater than a diameter of the sleeve 110 and / or a distance between each of the multiple cutting blades 142 and the axis of the cutting head 140 when the cutting head 140 is in the collapsed configuration. In embodiments having two cutting blades 142, the diameter or width Wi of the cutting head 140 is substantially equal to a distance between the two cutting blades 142.

[0064] In some embodiments, the diameter or width Wi of the cutting head 140 in the expanded configuration is about 1.5 times to about 4 times greater than the diameter or width of the cutting head 140 in the sleeve 110 or the diameter of the sleeve 110 itself, such as about 1.5 times to about 2.5 times greater, 2 times to about 3 times greater, about 2.5 times to about 3 times greater, about 3 times to about 4 times greater, about 1.5 times greater, about 2 times greater, about 2.5 times greater, about 3 times greater, about 3.5 times greater, or about 4 times greater. In some embodiments, the sleeve 110 may be sized to fit within a corridor or passage to the disc that is about 5 mm to about 7 mm in width or diameter. Accordingly, the sleeve 110 may have a diameter that is less than about 7 mm, less than about 6 mm, or less than about 5 mm. In these and other embodiments, the cutting head 140 may be configured to expand to the diameter or width Wi of about 10 mm to about 20 mm, such as about 10 mm to about 15 mm, about 12.5 mm to about 17.5 mm, about 15 mm to about 20 mm, about 10 mm to about 12 mm, about 11 mm to about 13 mm, about 12 mm to about 14 mm, about 13 mm to about 15 mm, about 14 mm to about 16 mm, about 15 mm to about 17 mm, about 16 mm to about 18 mm, about 17 mm to about 19 mm, or about 18 mm to about 20 mm.

[0065] In some embodiments, the multiple blades 142 may allow the cutting head 140 to be adjustable to multiple widths. For example, the width Wi described above may be amaximum width of the cutting head 140 when the cutting head 140 is fully extended from the sleeve 110. However, when the cutting head 140 is only partially extended from the sleeve 110, the multiple blades 142 may be in a partially expanded configuration providing the cutting head 140 with a width that is greater than a width of the sleeve 110 but less than the maximum width Wi.

[0066] In some embodiments, the multiple cutting blades 142 automatically adjust between a collapsed configuration in the retracted position (shown in FIG. 1A) within the sleeve 110 and an expanded configuration in the deployed position outside the sleeve 110 (shown in FIGS. 1B-1C). For example, the multiple cutting blades 142 may be configured to be substantially straight when positioned within the sleeve 110, and then automatically adjust to an outwardly curved or bent position when the cutting head 140 is moved to the deployed position outside the sleeve 110. Accordingly, the multiple cutting blades 142 may include a self-expanding material such as nickel -titanium superelastic alloy (e.g., NITINOL) or other super elastic alloys. In some embodiments, the multiple blades may include stainless steel, titanium, or other materials having a shape or configuration that allows the multiple blades to self-expand when positioned outside the sleeve. In some embodiments, the multiple blades 142 may be laser cut effective to form sharp edges on the cutting edge of the multiple cutting blades. The multiple blades 142 are configured to cut material between vertebrae. For example, the multiple blades 142 may be configured to cut vertebral disc material.

[0067] In the surgical device 100, the cutting head 140 includes two opposing blades 142. In other embodiments, the cutting head 140 may include three or more (e.g., three or four) blades 142 positioned at substantially equal radial distances from one another. In many embodiments, the cutting head 140 also includes an axial member generally aligned with an axis of the cutting head 140. In the surgical device 100, the axial member includes a drill bit 144 (e.g., auger) generally aligned with an axis of the cutting head 140 and including one or more flutes 146. The drill bit 144 also may include a pointed distal tip. In some embodiments, the drill bit 144 may be bendable or flexible. In some embodiments, the drill bit 144 may be selectively removable.

[0068] In some embodiments, the cutting head 140 includes a cylindrical member 148 securing the blades 142 to the drill bit 144. For example, the cylindrical member 148 may be secured to the distal ends of the multiple blades 142. In some embodiments, the cylindricalmember 148 may be integral with and / or formed of the same material as the multiple blades 142. The cylindrical member 148 may be shaped and positioned such that a distal portion of the drill bit 144 extends through the cylindrical member 148 as the cutting head 140 is adjusted to the deployed position in expanded configuration. In some embodiments, the cylindrical member 148 includes a cap positioned on a distal end of the drill bit 144.

[0069] The cutting head 140 is configured to selectively rotate, effective to cut material between the vertebrae, such as vertebral disc material, with the multiple blades 142. In many embodiments, when the cutting head 140 is rotated, the drill bit 144 rotates a first direction and the multiple blades 142 rotate a second direction counter to the first direction. Accordingly, the drill bit 144 and the multiple blades may counter rotate as the cutting head 140 is rotated.

[0070] In many embodiments, the handpiece is configured to fluidly couple to a vacuum source, effective to create a negative pressure at an inlet 152 of the distal end of sleeve 110. When the cutting head 140 is in the deployed position and the vacuum source is activated, the inlet 152 at the distal end of the sleeve 110 is in fluid communication with the vacuum source effective to pull material cut by the multiple blades 142 into and through the sleeve 110 for removal. More particularly, the one or more flutes 146 in the drill bit 144 may allow fluid communication through the inlet 152 when the cutting head 140 is in the deployed configuration. When rotated and / or retracted back into the sleeve, the multiple blades 142 may be configured to compress the material cut into the one or more flutes 146 of the drill member 144 and / or the inlet 152 of distal end of the sleeve 110 for removal. In some embodiments, the surgical device 100 may include a cutting head 140 where the removal of vertebral disc material facilitates the progression of the cutting head 140 through the disc, or where displacement of the disc material for removal facilitates progression of the cutting head 140 through the disc.

[0071] Returning to FIGS. 1A-1B, the handpiece 120 is secured to the one or more sleeves 110, 112 and may include one or more control members configured to selectively move the cutting head 140 between the retracted position (shown in FIG. 1A) and the deployed position (shown in FIG. IB) in which the cutting head is rotatable. The one or more control members include at least a movable member configured to pull the sleeve 110 proximally to deploy the cutting head 140 to the deployed position. For example, the handpiece 120 may include a pivotable arm 116 configured to selectively move the configured to selectively move thecutting head 140 between the retracted position and the deployed position. The pivotable arm 116 may be hingedly secured to a body 125 of the handpiece 120. The pivotable arm 116 may include a slot 118 having at least one sleeve of the one or more sleeves 110, 112 extending therethrough. The pivotable arm 116 may be secured to at least one of the one or more sleeves 110, 112 such that when the pivotable arm 116 is pivoted, pulled, or otherwise moved towards the body 125, the sleeve 110 is pulled back from the cutting head 140 to move the cutting head 140 from the retracted position in the sleeve 110 to the deployed position at least partially outside the sleeve 110. In some embodiments, the pivotable arm 116 is biased such that release of the pivotable arm 116 automatically retracts the cutting head 140 into the sleeve 110 to the retracted position. For example, the handpiece 120 may include a spring 114 or other biasing element positioned between the body 125 and the pivotable arm 116. The handpiece 120 also may include a handle 128 extending from the body 125. An operator may be able to hold the handle 128 and a portion of the pivotable member 116 when the pivotable member is pulled fully towards the body 125 and the handle 128.

[0072] The handpiece 120 also may include a rotatable member 130 (e.g., cutting head actuator) operably connected to the cutting head 140 such that manual rotation of the rotatable member 130 rotates the cutting head 140. In some embodiments, the cutting head 140 may be driven manually by direct motion, through the use of a crank handle and / or gear mechanism, a motor, an engine, and / or a pneumatic or hydraulic mechanism. In the surgical device 100, one or more gears 122 may be housed within the control body 125. The rotatable member 130 and the cutting head 140 may be operably coupled to the one or more gears 122 such that rotation of the rotatable member 130 rotates the cutting head 140. As noted previously, in some embodiments of the multiple blades 142 and the drill bit 144 may counter rotate when the cutting head 140 is rotated. Accordingly, rotation of the rotatable member 130 may be rotate the drill bit 144 a first direction and rotate the multiple blades 142 a second direction opposite or counter to the first direction of rotation of the drill bit 144.

[0073] In some embodiments, the surgical device 100 may include a suction inlet 152 to remove disc material from the procedure site. For example, the surgical device 100 may be configured to transfer abraded or separated disc material from the procedure site using suction through a suction inlet 152. Accordingly, the handpiece 120 may include a vacuum port 126 configured to fluidly connect to a vacuum source, such as a conduit or tube 132 in fluidcommunication with the vacuum source. In some embodiments, the handpiece 120 includes a collection chamber 128 in fluid communication with the suction inlet 152 at the distal end of the sleeve 110 and also the vacuum source through the tube 132. For example, one or more tubes 124 or conduits may extend through the body 124 and provide fluid communication between the sleeve 110 and the collection chamber 128. The collection chamber 128 sized and positioned to collect the material cut by the multiple blades 142 and pulled through the sleeve 110 and the one or more tubes 124. In some embodiments, the collection chamber 128 is removable for emptying.

[0074] Accordingly, during use, rotation of the multiple blades 142 may cut material at the procedure site and compress the cut material towards the drill bit 144 and / or the suction inlet 152 of the sleeve 110. Actuation of a vacuum source may pull the cut material through the sleeve 110, the one or more tubes 124, and into the collection chamber 128.

[0075] In some embodiments, the surgical device 100 is selectively guidable by an operator. For example, the cutting head 140 may be guided by pivoting, steering, or a combination of pivoting and steering. In some embodiments, the surgical device 100 includes a selectively actuated guide. For example, the surgical device 100 may be configured such that the sleeve 110 and / or the cutting head 140 are pivotable and / or steerable with one or more tension elements (e.g., cords, wires, chains, and / or wire braids), compression elements (e.g., wires, rods, tubing, braided wire, stacks of individual segments, and / or interlocking segments), and / or by rotation of a feature such as a threaded rod.

[0076] In some embodiments, the surgical device 100 may include the sleeve 110 (e.g. shaft) and the sleeve 112 (e.g. shaft). The sleeve 110 may be flexible or bendable, while the sleeve 112 may be rigid. Turning ahead in the drawings, FIGS. 5A-5B are isometric views of a portion of the surgical device of FIG. 1A during use, according to an embodiment. The sleeve may be inserted through a sleeve 500 into, for example, a disc 502 between vertebrae 504, where the cutting head 140 may be adjusted from the retracted position to the expanded configuration in the deployed position shown in FIGS. 5A-5B. For example, the pivotable member 116 may be pulled at least partially towards the body 125 to deploy the cutting head 140 in the disc 502. In some embodiments, the sleeve 112 of the surgical device 100 may replace the sleeve 500 shown in FIGS. 5A-5B.

[0077] In some embodiments, the sleeve 110 may include a deflection sleeve 110 that isselectively bendable. The deflection sleeve 110 may include a plastic encapsulated braided shaft with pull wires running therethrough to a tip of the deflection sleeve 110. The pull wires may be configured and attached to cause deflection when the pivotable member 116 is pulled past a predetermined point (e.g., perpendicular) and / or possibly when collection chamber 128 is rotated. Said another way, pulling the pivotable member 116 a first portion of distance to the body 125 may move the cutting head 140 from the retracted position to the deployed position. Once the pivotable member 116 is pulled the first portion of distance to the body 125, continuing to pull the pivotable member 116 towards the body 125 may deflect or bend the deflection sleeve 110.

[0078] In some embodiments, one or more gears 122 may be connected to a tube shaft that runs inside the sleeve 110. Rotation of the rotatable member 130 may counter rotate the one or more gears 122 connected to the tube shaft. The tube shaft running inside the sleeve 110 may be integrally formed and / or include the same material as the multiple blades 142. For example, the tube shaft running inside the sleeve 110 may be one single pieces with the multiple blades 142. This configuration allows the tube shaft to bend and rotate at the same time through a laser cut pattern on the tube shaft that allows the tube shaft to be flexible. The tube shaft may extend at least partially over the flutes 146 of the drill bit 144 to provide fluid communication between the vacuum source and the cutting head 140 through the flutes 146 and the tube shaft.

[0079] In some embodiments, the surgical device 100 may operably connected or coupled to a device for automated control of the surgical device 100. Accordingly, the surgical device 100 may include automated interface controls configured to allow for automated control of automatic adjustment of the cutting head 140 and / or the sleeve 110.

[0080] Turning now to FIGS. 2-4, embodiments of the surgical device 100 may include various configurations of the cutting head. Although not shown, the cutting heads of FIGS. 2- 4 may be used with any embodiments and any aspect of the surgical device 100 described above unless otherwise noted. In particular, FIG. 2 is a side view of a cutting head 240 of a surgical device in the deployed position, according to an embodiment. In some embodiments, the cutting head 240 includes an axial member 244 or drill member including one or more perforations 246 in fluid communication with the vacuum source. Accordingly, the tube shaft 254 described above in relation to the surgical device 100 may extend outward from the sleeve 110 in the deployed position, and the perforations 246 may form an inlet 252 for the tube shaft254 in fluid communication with the vacuum source. The cutting head 240 may include the multiple blades 142 as described above.

[0081] FIG. 3 is a side view of a cutting head 340 of a surgical device in the deployed position, according to an embodiment. In some embodiments, the cutting head 340 may include three or more blades 342 each having a helical configuration. The blades 342 may include any aspect of the blades 142, and thus may be adjustable between the collapsed configuration in the retracted position and the expanded configuration in the deployed position.

[0082] FIG. 4 is a side view of a cutting head 440 of a surgical device in the deployed position, according to an embodiment. In some embodiments, the cutting head 440 includes multiple blades 442 having one or more teeth 445. For example, each of the multiple blades 442 may include a zig-zag shape forming a plurality of a teeth 445. The multiple blades 442 may include any aspect of the blades 142, and thus may be adjustable between the collapsed configuration in the retracted position and the expanded configuration in the deployed position.

[0083] FIG. 6 is a flow diagram of a method 600 for collecting fluids. The method 600 may include use of any embodiments of the surgical devices 600 and / or cutting heads 140, 240, 340, 440 disclosed herein. The method 600 includes inserting 605 a distal end of a sleeve of a surgical device between the vertebrae, the surgical device including a handpiece secured to the sleeve and a cutting head in a retracted position at least partially within the sleeve. The method 600 also may include deploying 610 the cutting head from the distal end of the sleeve to a deployed position with the cutting head disposed outside the sleeve and between the vertebrae. The cutting head may include a drill member and multiple cutting blades that automatically expand from a collapsed configuration in the retracted position within the sleeve to an expanded configuration in the deployed position outside the sleeve. A distance between the multiple cutting blades in the expanded configuration may be greater than a diameter of the sleeve. The method 600 also may include rotating 615 the cutting head to cut material between the vertebrae, retracting 620 the cutting head within the sleeve to the retracted position, and withdrawing 625 the sleeve from between the vertebrae.

[0084] In many embodiments, the method 600 also includes cutting an incision into a patient at least proximate to the vertebrae and inserting at least the sleeve through the incision. In some embodiments, the method also may include inserting at least a portion of an endoscope into the incision in the patient and then inserting at least a portion of the device into theendoscope. For example, the device may be sized such that, when collapsed, a portion of the device (e.g., the sleeve) may pass through standard endoscope channels for easy passage to the disc space.

[0085] In some embodiments of the method 600, rotating 615 the cutting head to cut material between the vertebrae includes rotating the drill member a first direction and rotating the multiple blades rotate a second direction counter to the first direction. The method 600 also may include vacuuming the material through the sleeve for removal from between the vertebrae. In these and other embodiments, the multiple blades, when rotating, compress the material cut into the drill member and / or the distal end of the sleeve. In some embodiments, the drill member includes one or more flutes through which the material cut is vacuumed into the sleeve. In some embodiments, the drill member includes one or more perforations through which the material cut is vacuumed into the sleeve. Vacuuming the material through the sleeve for removal from between the vertebrae may vacuuming the material through the sleeve and into a collection chamber of the handpiece.

[0086] In some embodiments of the method 600, deploying 610 the cutting head from the distal end of the sleeve to the deployed position includes pulling a movable member operably connected to the sleeve to deploy the cutting head. In these and other embodiments, retracting 620 the cutting head within the sleeve to the retracted position includes releasing the movable member. The movable member may be biased such that release of the movable member automatically retracts the cutting into the sleeve to the retracted position. In some embodiments of the method 600, rotating the cutting head to cut material between the vertebrae includes manually rotating a rotatable member secured to the handpiece and operably connected to the cutting head to rotate the cutting head.

[0087] Acts of the method 600 are for illustrative purposes. For example, the act of the method 600 may be performed in different orders, split into multiple acts, modified, supplemented, or combined. Any of the acts may include using any of the devices or systems disclosed herein.

[0088] As used herein, the term “about” or “substantially” refers to an allowable variance of the term modified by “about” by ±10% or ±5%. Further, the terms “less than,” “or less,” “greater than”, “more than,” or “or more” include as an endpoint, the value that is modified by the terms “less than,” “or less,” “greater than,” “more than,” or “or more.”

[0089] While various aspects and embodiments have been disclosed herein, other aspects and embodiments are contemplated. The various aspects and embodiment disclosed herein are for purposes of illustration and are not intended to be limiting.

Claims

CLAIMS1. A surgical device, comprising: a sleeve including a proximal end and a distal end; a cutting head selectively movable between a retracted position in which the cutting head is disposed within the sleeve and a deployed position in which the cutting head is disposed outside the sleeve, the cutting head including a drill member and multiple cutting blades that automatically adjust between a collapsed configuration in the retracted position within the sleeve and an expanded configuration in the deployed position outside the sleeve, wherein a distance between the multiple cutting blades in the expanded configuration is greater than a diameter of the sleeve; and a handpiece secured to the sleeve and including one or more control members configured to selectively move the cutting head between the retracted position and the deployed position in which the cutting head is rotatable, wherein the multiple blades are configured to cut spinal discs when rotated.

2. The surgical device of claim 1, wherein when the cutting head is rotated, the drill member rotates a first direction and the multiple blades rotate a second direction counter to the first direction.

3. The surgical device of claim 1, wherein the handpiece includes a vacuum port configured to fluidly connect to a vacuum source, wherein when the cutting head is in the deployed position and the vacuum source is activated, the distal end of the sleeve is in fluid communication with the vacuum source effective to pull material cut by the multiple blades into and through the sleeve for removal.

4. The surgical device of claim 3, wherein, when rotated, the multiple blades are configured to compress the material cut into the drill member and / or the distal end of the sleeve.

5. The surgical device of claim 3, wherein the drill member includes one or more flutes in fluid communication with the vacuum source.

6. The surgical device of claim 3, wherein the drill member includes one or more perforations in fluid communication with the vacuum source.

7. The surgical device of claim 3, wherein the handpiece includes a collection chamber in fluid communication with the distal end of the sleeve and the vacuum source, the collection chamber sized and positioned to collect the material cut by the multiple blades and pulled through the sleeve.

8. The surgical device of claim 1, wherein the one or more control members include at least a movable member configured pull the sleeve proximally to deploy the cutting head to the deployed position, wherein the movable member is biased such that release of the movable member automatically retracts the cutting head into the sleeve to the retracted position.

9. The surgical device of claim 1, wherein the one or more control members include at least a rotatable member operably connected to the cutting head such that manual rotation of the rotatable member rotates the cutting head.

10. A surgical device, comprising: a sleeve including a proximal end and a distal end; a cutting head selectively movable between a retracted position in which the cutting head is disposed within the sleeve and a deployed position in which the cutting head is disposed outside the sleeve, the cutting head including multiple cutting blades that automatically adjust between a collapsed configuration in the retracted position within the sleeve and an expanded configuration in the deployed position outside the sleeve, wherein a distance between the multiple cutting blades in the expanded configuration is greater than a diameter of the sleeve; and a handpiece secured to the sleeve, the handpiece including: one or more control members configured to selectively move the cutting head between the retracted position and the deployed position in which the cutting head is rotatable, the multiple blades being configured to cut spinal discs when rotated; and a vacuum port configured to fluidly connect to a vacuum source, wherein when the cutting head is in the deployed position and the vacuum source is activated, the distal end of the sleeve is in fluid communication with the vacuum source effective to draw material cut by the multiple blades into and through the sleeve for removal.

11. The surgical device of claim 10, wherein, when rotated, the multiple blades are configured to compress the material cut towards the distal end of the sleeve.

12. The surgical device of claim 10, wherein the cutting head include an elongate member between the multiple blades, the elongated member including one or more perforations or one or more flutes in fluid communication with the vacuum source.

13. The surgical device of claim 12, wherein the elongate member includes the one or more perforations.

14. The surgical device of claim 12, wherein the elongate member includes a drill member having the one or more flutes.

15. The surgical device of claim 14, wherein when the cutting head is rotated, the drill member rotates a first direction and the multiple blades rotate a second direction counter to the first direction.

16. The surgical device of claim 10, wherein the handpiece includes a collection chamber in fluid communication with the distal end of the sleeve and the vacuum source, the collection chamber sized and positioned to collect the material cut by the multiple blades and pulled through the sleeve.

17. The surgical device of claim 10, wherein the one or more control members include at least a movable member configured pull the sleeve proximally to deploy the cutting head to the deployed position, wherein the movable member is biased such that release of the movable member automatically retracts the cutting head into the sleeve to the retracted position.

18. The surgical device of claim 10, wherein the one or more control members include at least a rotatable member operably connected to the cutting head such that manual rotation of the rotatable member rotates the cutting head.

19. A method of cutting tissue material between vertebrae, the method comprising: inserting a distal end of a sleeve of a surgical device between the vertebrae, the surgical device including a handpiece secured to the sleeve and a cutting head in a retracted position at least partially within the sleeve;deploying the cutting head from the distal end of the sleeve to a deployed position with the cutting head disposed outside the sleeve and between the vertebrae, the cutting head including a drill member and multiple cutting blades that automatically expand from a collapsed configuration in the retracted position within the sleeve to an expanded configuration in the deployed position outside the sleeve, wherein a distance between the multiple cutting blades in the expanded configuration is greater than a diameter of the sleeve; rotating the cutting head to cut material between the vertebrae; retracting the cutting head within the sleeve to the retracted position; and withdrawing the sleeve from between the vertebrae.

20. The method of claim 19, wherein rotating the cutting head to cut material between the vertebrae includes rotating the drill member a first direction and rotating the multiple blades rotate a second direction counter to the first direction.

21. The method of claim 19, further comprising vacuuming the material through the sleeve for removal from between the vertebrae.

22. The method of claim 21, wherein, when rotating, the multiple blades compress the material cut into the drill member and / or the distal end of the sleeve.

23. The method of claim 21, wherein the drill member includes one or more flutes through which the material cut is vacuumed into the sleeve.

24. The method of claim 21, wherein the drill member includes one or more perforations through which the material cut is vacuumed into the sleeve.

25. The method of claim 21, wherein vacuuming the material through the sleeve for removal from between the vertebrae includes vacuuming the material through the sleeve and into a collection chamber of the handpiece.

26. The method of claim 19, wherein: deploying the cutting head from the distal end of the sleeve to the deployed position includes pulling a movable member operably connected to the sleeve to deploy the cutting head; and retracting the cutting head within the sleeve to the retracted position includes releasing the movable member, wherein the movable member is biased such that release of the movable member automatically retracts the cutting head into the sleeve to the retracted position.

27. The method of claim 19, wherein rotating the cutting head to cut material between the vertebrae includes manually rotating a rotatable member secured to the handpiece and operably connected to the cutting head to rotate the cutting head.

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