AND RELATED METHODS

FIELD

[0001] The present disclosure relates generally to orthopedic implants and, more particularly, to inflatable orthopedic implants and related methods of deploying inflatable implants, e.g., for spinal fusion or other intervertebral surgical procedures.

BACKGROUND

[0002] Degenerative changes in the spine can cause the loss of normal structure and/or function. The intervertebral disc is one structure prone to the degenerative changes associated with wear and tear, aging, and even misuse. Over time the collagen (protein) structure of the intervertebral disc weakens and may become structurally unsound. Additionally, the water and proteoglycan (the molecules that attract water) content decreases, thereby narrowing the space between the adjacent vertebrae, which can result in nerve root compression and pain. These changes can lead to the disc's inability to handle mechanical stress.

[0003] One form of treatment available for degenerative disc disease is spinal fusion surgery, which involves the surgical removal of a portion or all of an intervertebral disc followed by fusion of the adjacent vertebrae. An intervertebral orthopedic implant, e.g. a fusion cage, is often placed between the two adjacent vertebrae to fill the intervertebral space left by the removed disc and to allow bone to grow between the adjacent vertebrae.

[0004] Spinal fusion procedures can present the surgeon with several challenges, especially where the disc is severely degenerative. When the natural disc is removed, the adjacent vertebral bodies collapse upon each other, thereby requiring separation of the vertebral bodies to enable placement of a fusion cage. However, separation or distraction of the vertebral bodies beyond a certain degree can result in further injury or damage to the vertebrae. Conversely, where the disc is severely degenerative, the narrow disc space and lack of elasticity between the vertebrae can hinder the surgeon's ability to separate the vertebrae to a height sufficient to enable placement of the fusion cage. [0005] To overcome some of these problems, specialized mechanical tools have been developed to facilitate the placement of a fusion cage between adjacent vertebral bodies of a patient's spine. Among the known tools for performing such procedures are spinal distracters, e.g. spreaders and insertion devices. In general, the spreader is placed between adjacent vertebrae, and then used to pry the vertebrae apart. Once the space between the vertebral bodies is sufficient to enable placement of a fusion cage, the cage can then be inserted, either manually or with an insertion tool, into the space to hold the adjacent vertebrae apart. Typically, cancellous bone is packed in and/or around the cage to promote fusion of the adjacent vertebrae.

[0006] While most spreader devices are effective to assist surgeons with the placement of fusion cages, the use of such tools can prove cumbersome and not necessarily conducive for minimally invasive surgical (MIS) procedures. For example, insertion of a spreader device into the limited disc space can cause fracture of a vertebra. Moreover, once inserted, the spreaders can cause over-distraction of the vertebral bodies, or can hinder placement of the fusion cage. In the presence of degenerative disease or chronic changes where the disc space has become narrow, it can be difficult to maintain an adequate interbody height and, at the same time, insert and position the cage.

[0007] There remains a continued need for improved orthopedic implants and related methods to facilitate the safe and accurate insertion of an implant between adjacent vertebral bodies while minimizing invasiveness and the risk of further injury to the patient.

SUMMARY

[0008] Inflatable orthopedic implants and related methods are disclosed herein, e.g., for deploying such implants within an intervertebral space for use in spinal fusion surgery, other intervertebral surgical procedures, or other surgical procedures.

[0009] The inflatable intervertebral implant can include a hollow inflatable body that can be configured in a compact state for insertion into a target intervertebral space between a pair of adjacent vertebral bodies. Once the vertebral bodies are separated or distracted, e.g., using one or more inflatable distractors, the hollow body of the inflatable implant can be inflated with bone cement or other curable material. When the curable material hardens, the inflated implant can form a rigid intervertebral support structure (e.g., a fusion cage) capable of maintaining the vertebral distraction and thereby enabling removal of the distractors.

[0010] In some embodiments, an inflatable implant can be deployed for corrective angulation between adjacent vertebral bodies. Such angular correction can be useful to reverse various deformities of the spine, including but not limited to scoliosis or other conditions that produce abnormal lordotic, kyphotic, or other spinal angles. In some embodiments, an inflatable orthopedic implant can be deployed in an intervertebral space in a minimally invasive manner. Although the inflatable orthopedic implants are disclosed for use in spinal fusion surgery, one skilled in the art will recognize that the inflatable implants can be readily modified and deployed for use in other intervertebral surgical procedures, or other surgical procedures in other portions of the body.

[0011] In one aspect, a method of deploying an inflatable implant is provided that can include inserting an inflatable implant into an intervertebral space between anterior portions of adjacent vertebral bodies, inserting an inflatable distractor into the intervertebral space between posterior portions of the adjacent vertebral bodies, and inflating the distractor such that the inflated distractor can exert a force against the posterior portions of the adjacent vertebral bodies and thereby separate the adjacent vertebral bodies. The method can further include inflating the implant after the distractor separates the adjacent vertebral bodies to form an intervertebral support structure having an arcuate shape that can fill the intervertebral space between the anterior portions of the adjacent vertebral bodies.

[0012] The inflatable implant and methods described herein can include any of a variety of additional or alternative features, all of which are considered within the scope of the present disclosure. For example, in some embodiments, the implant can be inflated with a curable material. By way of further example, in certain embodiments, the method can further include deflating the inflated distractor within the intervertebral space after the inflated implant hardens and withdrawing the deflated distractor from the intervertebral space. The inflated implant can remain within the intervertebral space to provide support between the anterior portions of the adjacent vertebral bodies after withdrawal of the distractor. The distractor can be inflated to a size that can separate the adjacent vertebral bodies by a desired height. [0013] In some embodiments, the method can further include inflating multiple distractors. Moreover, in certain embodiments, each of the distractors can be inflated to a respective size to adjust an angle between the adjacent vertebral bodies in a sagittal plane. In certain

embodiments, each of the distractors can be inflated to a respective size to adjust an angle between the adjacent vertebral bodies in a frontal plane.

[0014] In some embodiments, the method can further include filling the intervertebral space with a fusion material that can facilitate bone growth between the adjacent vertebral bodies. In some embodiments, the inflatable implant can be rolled, folded, or collapsed when inserted into the intervertebral space.

[0015] In some embodiments, the intervertebral support structure can include an anterior side wall having a first shape, a posterior side wall having a second shape, a superior bearing surface and an inferior bearing surface, and a lateral end wall and a medial end wall. Each bearing surface can extend transversely between the anterior wall and the posterior wall. In certain embodiments, the anterior side wall can have a convex shape and the posterior side wall can have a concave shape. In certain embodiments, each of the anterior side wall and the posterior side wall can have a substantially flat shape.

[0016] In certain embodiments, a tunnel can be formed through the intervertebral support structure. The tunnel can be formed in some embodiments between the anterior wall and the posterior wall of the intervertebral support structure. The tunnel can have a tensile strength that can resist inflation of the implant such that intervertebral support structure can be inhibited from having a spherical or cylindrical shape between the anterior wall and the posterior wall. In certain embodiments, the tunnel can be formed between the superior bearing surface and the interior bearing surface of the intervertebral support structure. The tunnel can have a tensile strength that can resist inflation of the implant such that the intervertebral support structure can be inhibited from having a spherical or cylindrical shape between the superior bearing surface and the interior bearing surface.

[0017] In some embodiments, the method can include coupling the inflatable implant to an implant holding device. Such a device can be utilized to insert the implant into, e.g., an intervertebral disc space. Further, in some embodiments the inflatable implant can be made of a porous material. In some embodiments, the inflatable implant can have a textured outer surface. In certain embodiments, the intervertebral support structure can be a fusion cage.

[0018] In another aspect, an inflatable implant is provided that can include an inflatable hollow body. The hollow body can be inflated to form an intervertebral support structure configured to fill an intervertebral space between anterior portion of adjacent vertebral bodies.

[0019] As with the aspects and embodiments described above, a number of additional or alternative features can be included that are considered within the scope of the present disclosure. For example, in some embodiments, the intervertebral support structure can include an anterior side wall having a first shape, a posterior side wall having a second shape, a superior bearing surface and an inferior bearing surface, a lateral end wall and a medial end wall. Each bearing surface can extend transversely between the anterior wall and the posterior wall. In certain embodiments, the anterior side wall can have a convex shape and the posterior side wall can have a concave shape. In certain embodiments, each of the anterior side wall and the posterior side wall can have a substantially flat shape.

[0020] In certain embodiments, a tunnel can be formed through the intervertebral support structure. The tunnel can be formed between the anterior wall and the posterior wall of the intervertebral support structure in certain embodiments. The tunnel can have a tensile strength that can resist inflation of the hollow body, such that the intervertebral support structure can be inhibited from having a spherical or cylindrical shape between the anterior wall and the posterior wall. In some embodiments, the tunnel can be formed between the superior bearing surface and the inferior bearing surface of the intervertebral support structure. The tunnel can have a tensile strength that can resist inflation of the hollow body, such that the intervertebral support structure can be inhibited from having a spherical or cylindrical shape between the superior bearing surface and the inferior bearing surface.

[0021] In some embodiments, the hollow body can be inflated with a curable material. Further, the hollow body of the inflatable implant can be configured to be rolled, folded, or collapsed when not inflated. In some embodiments, an implant holding device can be coupled to the implant. The hollow body can be made of a porous material in certain embodiments. In some embodiments, the hollow body can have a textured outer surface. In certain embodiments, the intervertebral support structure can be a fusion cage.

[0022] Any of the features or variations described above can be applied to any particular aspect or embodiment of the present disclosure in a number of different combinations. The absence of explicit recitation of any particular combination is due solely to the avoidance of repetition in this summary.

BRIEF DESCRIPTION OF THE DRAWINGS

[0023] FIG. 1A is a schematic illustration of a perspective view of one embodiment of an inflatable orthopedic implant in an inflated state;

[0024] FIG. IB is a schematic illustration of a top view of the inflatable implant of FIG. 1A in an inflated state;

[0025] FIG. 1C is a schematic illustration of a side view of the inflatable implant of FIG. 1A in an inflated state;

[0026] FIG. ID is a schematic illustration of an end view of the inflatable implant of FIG. 1A in an inflated state;

[0027] FIG. 2A is a schematic illustration of a side view of one embodiment of an inflatable orthopedic implant in a non-inflated state;

[0028] FIG. 2B is a schematic illustration of a side view of another embodiment of an inflatable orthopedic implant in a non-inflated state;

[0029] FIG. 2C is a schematic illustration of a side view of another embodiment of an inflatable intervertebral implant in a non-inflated state;

[0030] FIG. 2D is a schematic illustration of a perspective view of another embodiment of an inflatable intervertebral implant in a non-inflated state;

[0031] FIGS. 3A-3J are schematic illustrations of one exemplary method of deploying an inflatable orthopedic implant; [0032] FIG. 4A is a schematic illustration of a longitudinal cross-sectional view of one exemplary embodiment of an access device, e.g., suitable for use in the method of FIGS. 3A-3J;

[0033] FIGS. 4B-4E are schematic illustrations of transverse cross-sectional views along the access device of FIG. 4A;

[0034] FIG. 5A is a schematic illustration of another embodiment of an inflatable orthopedic implant in an inflated state;

[0035] FIG. 5B is a schematic illustration of another embodiment of an inflatable intervertebral implant in an inflated state; and

[0036] FIG. 5C is a schematic illustration of another embodiment of an inflatable intervertebral implant in an inflated state.

DETAILED DESCRIPTION

[0037] Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments.

[0038] Various embodiments of inflatable orthopedic implants and related methods for deploying such implants within an intervertebral space are described herein, e.g., for use in spinal fusion surgery, other intervertebral surgical procedures, or other surgical procedures. In various embodiments, the inflatable intervertebral implant can include a hollow inflatable body that can be configured in a compact state for insertion into a target intervertebral space between a pair of adjacent vertebral bodies. Once the vertebral bodies are separated or distracted, e.g., using one or more inflatable distractors, the hollow body of the inflatable implant can be inflated with bone cement or other curable material. When the curable material hardens, the inflated implant can form a rigid intervertebral support structure (e.g., a fusion cage) that is capable of maintain the vertebral distraction and thereby enabling removal of the distractors. In some embodiments, an inflatable implant can be deployed for corrective angulation between adjacent vertebral bodies. Such angular correction can be useful to reverse various deformities of the spine, including but not limited to scoliosis or other conditions that produce abnormal lordotic, kyphotic, or other spinal angles. In some embodiments, an inflatable orthopedic implant can be deployed in an intervertebral space in a minimally invasive manner. Although the inflatable orthopedic implants are disclosed for use in spinal fusion surgery, one skilled in the art will recognize that the inflatable implants can be readily modified and deployed for use in other intervertebral surgical procedures, or other surgical procedures in other portions of the body.

[0039] FIGS. 1A-1D are schematic illustrations of one exemplary embodiment of an inflatable orthopedic implant 100 in an inflated state. In the illustrated embodiment, the implant 100 has a hollow body configured to form an intervertebral support structure when inflated. The hollow body of the implant 100 can be inflated with a curable material or substance that hardens so that the inflated implant 100 can form a rigid intervertebral support structure. In some embodiments, the curable material used to inflate the implant can include, but is not limited to, a bone cement, PMMA(polymethyl methacrylate), PLA(polylactic acid) PDLA (poly-d-lactic acid), PLLA (poly-l-lactic acid), PEU (polyester urethane), PCL (polycaprolactone), calcium phosphates including calcium phosphate cements/composites involving fiber reinforcement, PLGA

(polylactic-co-glycolic acid), bio-silks, and composites of the materials, for example. In some embodiments, the implant can be inflated with an elastic filler material or substance, such as but not limited to 2K-Silicon. The elastic filler material or substance can allow the inflated implant 100 to form an intervertebral support structure having a degree of flexibility to provide a dampening feature and therefore functionally substitute a healthy disc.

[0040] As shown, the implant 100 can be inflated to have a generally arcuate shape adapted to fill an intervertebral space between anterior portions of adjacent vertebral bodies. For example, the arcuate shape can be adapted to conform to the arcuate shape of the cortical rim that protrudes into the intervertebral space along the anterior portion of each endplate of the adjacent vertebral bodies. Thus, as discussed in more detail below, the arcuate shape of the inflated implant 100 can allow the implant to be deployed between adjacent vertebral bodies along or in close proximity to the anterior rims of the respective endplates. The bone strength of the endplate of a vertebral body is typically stronger at or surrounding the cortical rim. The intervertebral support structure formed by the inflated implant 100 can be used as a fusion cage for spinal fusion surgery.

[0041] In the illustrated embodiment, the intervertebral support structure formed by the inflated implant 100 includes an anterior side wall 102, a posterior side wall 104, a superior bearing surface 106, an inferior bearing surface 108, lateral end walls 110, 112. The anterior side wall 102 can have a convex shape and the posterior side wall 104 can have a concave shape. Each of the superior and inferior bearing surfaces 106, 108 can have an arcuate shape that extends transversely between the anterior and posterior side walls 102, 104. The lateral end walls 110, 112 can have a generally rectangular shape that defines the lateral ends of the implant.

[0042] Alternatively, in other embodiments, the implant 100 can be configured such that, when inflated, the anterior side wall 102 and the posterior side wall 104 can each have a different shape from the above-mentioned convex and concave shapes. For example, in some

embodiments any of the anterior side wall 102 and the posterior side wall 104 can have a substantially flat or planar shape, e.g., for surgical procedures in which the implant is inserted into the intervertebral space using a lateral approach. In still other embodiments, additional surface shapes can be employed based on a variety of factors, such as desired final implant shape, implantation approach or method, etc.

[0043] The dimensions of the intervertebral support structure formed by the inflated implant 100 can depend on the dimensions of the bony anatomy of the vertebral endplates that bound the target intervertebral space. In some embodiments, the dimensions of the inflated implant 100 may be configured to allow the implant to be deployed between adjacent vertebral bodies along or in close proximity to the anterior rims of the respective vertebral endplates. For example, in some embodiments, the length F of the inflated implant 100 can range between approximately 20 millimeters (mm) and approximately 80 mm; the width W of the inflated implant 100 can range between approximately 8 mm and approximately 25 mm; the height H of the inflated implant 100 can range between approximately 6 mm and approximately 16 mm; and the radius of curvature R of the inflated implant 100 can range between approximately 10 mm and approximately 50 mm. [0044] In some embodiments, the hollow body of the inflatable implant 100 can be configured to form tunnels or passageways that extend through the implant when inflated. One or more of the tunnels can be configured to have a tensile strength that resists inflation of the implant 100 in one or more directions to control the inflated shape of the implant. For example, in the illustrated embodiment, the implant 100 includes a tunnel 114 that extends through the anterior and posterior walls 102, 104. The tunnel 114 can be configured to have a tensile strength that resists inflation of the implant in an anterior-posterior direction A-A to inhibit, if not prevent, the walls from inflating into a spherical or cylindrical shape. Accordingly, the tunnel 114 facilitates inflation of the implant such that the arcuate shape of the implant between the anterior and posterior walls 102, 104 is maintained.

[0045] Alternatively or additionally, and as shown in the illustrated embodiment, the implant 100 can include one or more tunnels 116a, 116b (collectively 116) that extend through the superior and inferior bearing surfaces 106, 108. The tunnels 116 can be configured to have a tensile strength that resists inflation of the implant in a superior-inferior direction A' -A' to inhibit, if not prevent, the bearing surfaces 106, 108 from inflating into a spherical or cylindrical shape. Accordingly, the tunnels 116 facilitate inflation of the implant such that the substantially planar shape of bearing surfaces 106, 108 is maintained. The tunnels 114 and/or 116 can also be useful to facilitate bone growth through the implant.

[0046] In some embodiments, the tunnels 114 and/or 116 can be utilized to form internal tethers that can aid in controlling or biasing the shape of the implant 100, e.g., by limiting expansion of the implant in one or more directions. The tunnels 114 and/or 116 can be integrally formed with the other implant surfaces to provide an uninterrupted shell or envelope that defines the implant. Note that, in some embodiments, a shape of the implant 100 can alternatively or additionally be controlled or biased using one or more internal tethers extending between implant surfaces without forming a tunnel, e.g., a structure that defines a passage through the implant.

[0047] In some embodiments, the hollow body of the inflatable implant 100 can be made of a porous material. Minute spaces or holes in the porous material can allow air to escape during inflation, thereby reducing, if not preventing, the formation of air pockets that may weaken the rigid intervertebral support structure formed by the inflated implant. Alternatively or additionally, in some embodiments, the hollow body of the inflatable implant 100 can have a rough or otherwise textured surface. The textured surface of the inflatable implant 100 can be useful to increase friction between the bearing surfaces 106, 108 and the respective endplates of the adjacent vertebral bodies, thereby reducing migration of the inflated implant once deployed. In some embodiments, the porous material of the implant 100 can include, but need not be limited to, a braided fabric, a woven fabric (e.g., a three-dimensional woven fabric), a perforated foil or sheet, felt, or any combination thereof.

[0048] In some embodiments, the inflatable orthopedic implant 100 can be inserted into a target intervertebral space in a non-inflated, compact state. For example, as shown in the illustrated embodiment of FIG. 2A, the hollow body of the inflatable implant 100 can be folded. As shown in the illustrated embodiment of FIG. 2B, the hollow body of the inflatable implant 100 can be rolled. As shown in the illustrated embodiment of FIG. 2C, the hollow body of the inflatable implant 100 can be collapsed. In each of the foregoing embodiments, the surgeon or other medical staff can deliver the non-inflated implant 100 to the target space through a rigid or flexible cannula, access port, or other access device having a narrow diameter. By configuring the non-inflated implant in a compact state, the implant can be easily positioned to a desired location within the intervertebral space prior to inflation despite narrow space constraints.

[0049] As shown in the illustrated embodiment of FIG. 2D, the inflatable orthopedic implant 100 can be coupled to an implant holding device 120. The implant holding device 120 can serve as a rigid support or backing for inserting the implant 100 into the intervertebral space. In some embodiments, the implant holding device 120 can be an L-shaped bracket. The implant holding device 120 can be coupled to the inflatable implant 100 using one or more sutures 122 looped through one or more suture holes 124 defined in the body of the holding device 120. In other embodiments, an inflatable implant can be coupled to the holding device 120 using other mechanisms, including without limitation, a biocompatible glue, or other adhesive. In the illustrated embodiment, the implant holding device 120 is configured to have a concave shape in order to prevent the device from inhibiting inflation of the implant 100 to have an arcuate shape. The implant holding device 120 can also include a notch 126 or other coupling mechanism for detachably coupling the holding device to an implant insertion instrument. [0050] FIG. 3A-3J are schematic illustrations of one exemplary embodiment of a method of deploying an inflatable orthopedic implant. In the illustrated embodiment, the inflatable orthopedic implant 100 of FIG. 1A is deployed as part of an intervertebral surgical procedure for spinal fusion. Although the inflatable implant 100 of FIG. 1 A is shown in the figures for purposes of example, in some embodiments the inflatable orthopedic implant can be modified to form different geometrical support structures when inflated.

[0051] As shown in FIG. 3A, a target intervertebral space 350 is located between respective endplates 354 of an adjacent pair of superior and inferior vertebral bodies 352. Prior to deploying the implant 100, the target intervertebral space 350 can be cleared of any damaged intervertebral disc. When the natural disc is removed, the adjacent vertebral bodies 352 may collapse upon each other, thereby requiring separation of the vertebral bodies to deploy the inflatable orthopedic implant 100 within the intervertebral space 350. Alternatively, even if there is no collapse associated with removal of the existing disc material, the intervertebral space can be compressed as compared to desired spacing due to the above-described degeneration. Accordingly, for a number of reasons it can be desirable to distract the two vertebral bodies 352 to achieve a desired intervertebral spacing.

[0052] As shown in FIG. 3B, an access device 300 can be percutaneously inserted into the intervertebral space 350. The access device 300 can have a proximal end 300p and a distal end 300d and at least one lumen 302 that extends between the proximal and distal ends. In some embodiments, the access device 300 can include, without limitation, a flexible or rigid cannula, access port, or other tubular working channel, for example. In the illustrated embodiment, the access device 302 can be percutaneously inserted into the intervertebral space 350 using a transforaminal approach. However, in various embodiments the access device 300 can be delivered to the intervertebral space 350 using other surgical approaches, including, without limitation, a lateral approach, a posterior approach, an anterior approach, and a posterolateral approach. The access device 300 can have a narrow width or diameter to minimize invasiveness of the intervertebral surgical procedure. In some embodiments, the outer width or diameter of the access device 300 can range between approximately 3 millimeters (mm) and 9 mm (e.g., 6 mm). [0053] As shown in FIG. 3C, the inflatable implant 100 can be inserted into the intervertebral space 350 in a non-inflated state. In some embodiments, the inflatable implant 100 can be inserted within the intervertebral space 350 between the anterior portions of the adjacent vertebral bodies 352 where bone strength is typically strong and thus the risk of fracture is reduced. For example, the inflatable implant 100 can be inserted between the adjacent vertebral bodies 352 along or in close proximity to the anterior rims 356 of the respective vertebral endplates 354.

[0054] In the illustrated embodiment, the inflatable implant 100 is inserted into the

intervertebral space 350 through the distal end 300d of the access device 300. As discussed above with respect to FIGS. 2A-2D, the inflatable implant 100 can be rolled, folded, collapsed, or otherwise compacted to navigate the implant through the narrow space constraints of the access device 300 and the intervertebral space 350. The inflatable implant 100 can be coupled to the distal end of a fill tube 312 that extends through the access device 300. The fill tube 312 is used as a fluid conduit for flowing a curable material to inflate the hollow body of the implant 100

[0055] In the illustrated embodiment, an elongated insertion instrument 310 can be used to insert the inflatable implant 100 into the intervertebral space 350. For example, as shown in FIG. 3C, the elongated insertion instrument 310 can have a distal end 310d that is detachably coupled to an implant holding device 120. The implant holding device 120 can be attached to the inflatable implant 100 for support as discussed above with respect to FIG. 2D. The distal end 31 Od of the instrument can be detachably coupled to the implant holding device 120 using a clasp, latch, hook, clip or other detachable coupling mechanism. The insertion instrument 310 can be used to push the implant holding device 120 along with the attached implant 100 through the access device 300 and into the intervertebral space 350. However, in some embodiments other insertion instruments can be used to insert the inflatable implant 100 into the target intervertebral space 350. For example, in some embodiments, a removable guide wire or stylet can be used to push the implant through the access device 300 and to a desired location within the intervertebral space 350. [0056] As shown in FIG. 3D, inflatable distractors 320a and 320b (collectively 320) can be inserted into the intervertebral space 350 in a non-inflated state. For example, in some embodiments, the distractors 320 can be balloons. The inflatable distractors 320 can be inserted within the intervertebral space 350 between the posterior portions of the adjacent vertebral bodies 352 where bone strength is typically strong and thus the risk of fracture is less. For example, in some embodiments, the inflatable distractors 320 can be inserted between the adjacent vertebral bodies 352 along or in close proximity to the posterior rim 358 of the respective vertebral endplates 354. The inflatable distractors 320 can be inflated to exert a distraction force against the posterior portions of the adjacent vertebral bodies 352 and thereby create a separation or distraction between the adjacent vertebral bodies.

[0057] In the illustrated embodiment, the inflatable distractors 320 are inserted into the intervertebral space 350 through the distal end 300d of the access device 300. For example, the inflatable distractors 320 can be inserted into the intervertebral space 350 serially. In some embodiments, the inflatable distractors 320 can be inserted into the intervertebral space 350 before insertion of the inflatable implant 100. Each of the inflatable distractors 320a, 320b can be coupled to the distal end of a respective fill tube 322a and 322b (collectively, fill tubes 322). The fill tubes 322 can be used as fluid conduits for flowing a gas or liquid to individually inflate the distractors 320. In some embodiments, the inflatable distractors 320 can be inserted into the intervertebral space 350 using removable guide wires (not shown) inserted through the respective fill tubes 322.

[0058] Although two inflatable distractors 320a and 320b are shown for purposes of example in the figures, in some embodiments fewer or greater than two inflatable distractors can be inserted into the intervertebral space 350 for distracting the adjacent vertebral bodies (e.g., one distractor, three distractors, etc.).

[0059] In some embodiments, a guide (not shown) can be inserted into the intervertebral space 350 to partition the respective anterior and posterior portions of the intervertebral space and thereby facilitate alignment of the inflatable implant 300 and the inflatable distractors 320 into the respective anterior and posterior portions of the target space. The guide can also be useful to avoid migration of the inflatable implant 300 and the inflatable distractors 320 during inflation. In some embodiments, the guide can be a rail disposed at the distal end of a stylet or other elongated instrument.

[0060] As shown in FIG. 3E, the inflatable distractors 320 can be inflated to exert a force against the posterior portions of the adjacent vertebral bodies 352 such that the vertebral bodies can become distracted or separated. For example, in the illustrated embodiment, the distractors 320 are inflated at or in close proximity to the posterior rims 358 of the respective endplates 354. By inflating the distractors 320 in the posterior region of the intervertebral space 350, greater changes in angular distraction can be made between the adjacent vertebral bodies 352 in response to relatively smaller changes in distractor size as compared to embodiments where the distractors are placed elsewhere with regard to the vertebrae. Alternatively or additionally, by inflating the distractors 320 in the posterior region of the intervertebral space 350, the rotational moment of the vertebral bodies 352 can be reduced during inflation and thereby facilitate improved control over the distraction of the vertebral bodies.

[0061] The inflatable distractors 320 are configured to be inflated to internal pressures that are equal to or greater than the external load applied between the adjacent vertebral bodies 352. For example, in some embodiments, the distractors 320 can be inflated to a maximum internal pressure in the range between approximately 2 bars and approximately 30 bars. By inflating the distractors 320 to internal pressures that exceed the external load applied by the adjacent vertebral bodies 352, the distractors can expand to sizes (e.g., diameters) that exert forces which create separation or distraction between the vertebral bodies.

[0062] In some embodiments, the distractors 320 can be inflated to respective sizes which separate or distract the adjacent vertebral bodies 352 by a desired height. In some embodiments, the distractors 320 can be inflated to the same or different sizes to adjust an angle between adjacent vertebral bodies 352 in one or more of a frontal plane (i.e., a plane that divides the body into anterior and posterior parts) and a sagittal plane (i.e., a plane that divides the body into right and left parts). For example, in some embodiments, the distractors 320 can be inflated to have at least a minimum size (e.g., diameter) for adjusting an angle between the adjacent vertebral bodies 352 in the sagittal plane (e.g., a lordotic angle). Alternatively or additionally, the distractors 320 can be inflated to different sizes to adjust an angle between the adjacent vertebral bodies 352 in the frontal plane (e.g., a Cobb angle). Thus, the distractors 320 can be inflated to respective sizes that create angular distractions or separations between adjacent vertebral bodies in order to correct various deformities in the curvature of the spine, e.g., scoliosis or other abnormal lordotic, kyphotic, or other spinal angles.

[0063] In some embodiments, the distractors 320 can be inflated by flowing a non-curable liquid, gas, or other substance through the fill tubes 322 into the distractors 320. For example, the distractors 320 can be balloons inflated by flowing a saline solution through the fill tubes 322 into the distractors 320. In some embodiments, the balloons can be made of a polymer material that can be inflated to a maximum internal pressure greater than the external load applied between the adjacent vertebral bodies 352 (e.g., approximately 20 bars or more).

[0064] As shown in FIG. 3F, while the inflated distractors 320 maintain the desired distraction or separation between the adjacent vertebral bodies 352, the inflatable implant 100 can be inflated. The implant 100 can be inflated by flowing bone cement or other curable material through the fill tube 312 into the hollow body of the implant. As shown in the illustrated embodiment, the inflatable implant 100 can be configured to generally form the intervertebral support structure shown and described with respect to FIGS. 1 A-1D. For example, as shown, the intervertebral support structure formed by the inflated implant 100 can have an arcuate shape that fills the intervertebral space between the anterior portions of the adjacent vertebral bodies.

In some embodiments, the implant 100 can be inflated until the superior and inferior bearing surfaces (e.g., 106, 108) of the implant bear against and preferably conform to the respective vertebral endplates 354 of the adjacent vertebral bodies 352 (e.g., at or in close proximity to the anterior rim 356). After the implant 100 is inflated the fill tube 312 can be cut or otherwise disconnected from the implant.

[0065] As the implant 100 is inflated, the inflated distractors 320 can continue to exert a force on the adjacent vertebral bodies 352 to maintain the desired distraction or separation. Thus, the inflated distractors 320 can shield the implant 100 from the applied load of adjacent vertebral bodies 352 while the implant inflates and cures. Once the bone cement or other curable material hardens, the inflated implant 100 can form a rigid intervertebral support structure capable of withstanding the applied load of the adjacent vertebral bodies 352. Thus, once hardened, the inflated implant 100 can support the distraction or separation of the vertebral bodies without the inflated distractors 320.

[0066] Because the distraction of the vertebral bodies 352 can be supported by the rigid support structure of the inflated implant 100, the implant 100 can be inflated with the curable material to a lower internal pressure than the internal pressure(s) of the inflated distractors 320 used to initially set the distraction. In some embodiments, the implant 100 can be inflated to an internal pressure that does not exert a force capable of distracting or separating the vertebral bodies 352. For example, the inflatable implant 100 can be configured to inflate to a maximum internal pressure that is less than the external load applied between the adjacent vertebral bodies 352. Rather, the implant 100 can be inflated to a lower internal pressure that allows the hollow body of the implant to fill the intervertebral space between the vertebral endplates 352 of the adjacent bodies. For example, in some embodiments, the inflatable implant 100 can be inflated to a maximum internal pressure less than approximately 20 bar, e.g., approximately 1 or 2 bar. With a lower requirement for maximum internal pressure, the inflatable implant 100 can be made of a biocompatible polymer or other suitable material that may rupture at higher pressures needed to distract or separate adjacent vertebral bodies.

[0067] As shown in FIG. 3G, after the inflated implant 100 hardens into a rigid intervertebral support structure, the inflated distractors 320 can be deflated and withdrawn from the

intervertebral space 350. For example, in some embodiments, the inflated distractors 320 can be deflated by suctioning the saline solution or other non-curable material out of the distractors 320. Once deflated, the distractors 320 can be removed from the intervertebral space 350 by withdrawing the fill tubes 322 proximally from the access device 300. The inflated implant 100 can remain within the intervertebral space 350 to provide support between the anterior portion of the adjacent vertebral bodies 352 after withdrawal of the distractors 320.

[0068] As shown in FIG. 3H, the elongated insertion instrument 310 used to insert the inflatable implant 100 can be removed. For example, and as shown in the illustrated embodiment, the distal end 310d of the elongated insertion instrument 310 can be detached from the implant holding device 120 used to support the inflatable implant 100. The distal end 310d of the instrument can be detached by releasing a clasp, latch, hook, clip, or other detachable coupling mechanism used to detachably couple the insertion instrument 310 to the implant holding device 120. Although the insertion instrument 310 is disclosed herein as being removed after the implant 100 is inflated and hardened, the insertion instrument 310 can be removed at any time. For example, where a removable guide wire or stylet is used to insert the implant 100 within the intervertebral space 350, the guide wire or stylet can be removed after the implant 100 is guided to a desired location within the space.

[0069] As shown in FIG. 31, the intervertebral space 350 can be filled with a material 330 that facilitates fusion between the adjacent vertebral bodies 352. For example, in some embodiments, after the inflated implant 100 hardens into a rigid intervertebral support structure and the inflatable distractors 320 are withdrawn from the intervertebral space 350, bone graft, cancellous bone, or other fusion material 330 can be delivered into the space through one or more of the lumens 302 of the access device 300. After the fusion material 330 is delivered, the access device 300 can be withdrawn from the intervertebral space 350 as shown in FIG. 3J. Over time, the fusion material 330 can cause bone to form within the intervertebral space 350, and thereby cause the adjacent vertebral bodies 352 to fuse together between the endplates 354.

[0070] As previously discussed with respect to FIGS. 3A-3J, the inflatable implant 100 and the inflatable distractors 320 can be delivered to the intervertebral space 350 through an access device 300. In an effort to minimize the invasiveness of the intervertebral surgical procedure, the access device 300 can have a narrow width or diameter. For example, in some embodiments, the outer width or diameter of the access device 300 can range between approximately 3 millimeters (mm) and 9 mm (e.g., 6 mm). Delivery of the various components for deploying the inflatable implant 100 through such narrow dimensions can be challenging.

[0071] To facilitate such deployment, the inflatable implant 100 and the inflatable distractors 320 can be serially delivered through the lumen 302 of the access device 300. For example, as shown in the illustrated embodiment of FIGS. 4A-4E, the inflatable implant 100, the first inflatable distractor 320a, and the second inflatable distractor 320b can be inserted serially through the lumen 302 of the access device 300. Although FIGS. 4A-4E show the inflatable implant 100, the first inflatable distractor 320a, and the second inflatable distractor 320b being delivered in a specific order, these inflatable devices can be delivered serially in a different order.

[0072] In some embodiments, the various devices being deployed through the access device 300 can be configured or shaped to provide more efficient use of space within the lumen 302. For example, as shown in FIGS. 4B and 4C, the implant holding device 120 can be used to compress the inflatable implant 100 to occupy less than the entire cross-sectional space in the lumen 302. Alternatively or additionally, as shown in FIGS. 4D and 4E, at least a portion of the elongated insertion instrument 310 used to insert the implant holding device 120 and the attached inflatable implant 100 can be a semi-circular tube having a C-shaped body. The arcuate body of the insertion instrument 310 can thus allow multiple components to occupy the same space. For example, as shown in FIG. 4D, the arcuate shaped insertion instrument 310 can occupy the same space as the first distractor 320a and the implant fill tube 312. As shown in FIG. 4E, the arcuate shaped insertion instrument 310 can occupy the same space as the second distractor 320b and the implant fill tube 312 and the fill tube 322a for the first distractor 320a.

[0073] Although the inflatable intervertebral implant 100 of FIG. 1A is shown in the figures for purposes of example, in some embodiments the inflatable orthopedic implant can be modified to form different geometrical support structures when inflated. For example, as shown in FIG. 5 A, the inflatable orthopedic implant 500 can include an inflatable balloon 510 that forms a substantially cylindrical support structure when inflated. The implant 500 can also include an expandable stent-like structure 512 that wraps around balloon 510. Like the inflatable implant 100, the balloon 510 can be filled with bone cement or other curable material that hardens to form a rigid support structure. The stent-like structure 512 can be useful to grip the bony end plates (e.g., 354) of adjacent vertebral bodies (e.g., 354) bounding the target intervertebral space. In some embodiments, the balloon 510 can have a mesh-like exterior to grip the bony end plates, and thereby avoiding the need for the stent-like structure.

[0074] As shown in FIG. 5B, the inflatable orthopedic implant 600 can include a foil based balloon 610. For example, and as shown in the illustrated embodiment, the foil based balloon 610 can be fabricated using two or more polymer foil sheets 612a, 612b assembled together such that the balloon has a substantially rectangular shape when inflated with bone cement or other curable material. The non-distracting balloon can fill to its designed shape rather than to an unknown morphic shape. The balloon can be chosen as a corrective height and width by the surgeon to ensure a specific finished vertebral alignment. In some embodiments, the foil sheets can be made of a polyetheretherketone (PEEK) material. In some embodiments the balloon can be assembled together with arcuate panels to give an arcuate shape similar to implant 100.

[0075] As shown in FIG. 5C, the inflatable orthopedic implant 700 can include a molded balloon 710 in some embodiments. For example, and as shown in the illustrated embodiment, the molded balloon can be configured to include two or more spherically shaped compartments 712a, 712b that can be filled with bone cement or other curable material.

[0076] It should be noted that any ordering of method steps expressed or implied in the description above or in the accompanying drawings is not to be construed as limiting the disclosed methods to performing the steps in that order. Rather, the various steps of each of the methods disclosed herein can be performed in any of a variety of sequences. In addition, as the described methods are merely exemplary embodiments, various other methods that include additional steps or include fewer steps are also within the scope of the present disclosure.

[0077] The instruments disclosed herein can be constructed from any of a variety of known materials. Exemplary materials include those which are suitable for use in surgical applications, including metals such as stainless steel, titanium, nickel, cobalt-chromium, or alloys and combinations thereof, polymers such as PEEK, ceramics, carbon fiber, and so forth. The various components of the instruments disclosed herein can be rigid or flexible. One or more components or portions of the instrument can be formed from a radiopaque material to facilitate visualization under fluoroscopy and other imaging techniques, or from a radiolucent material so as not to interfere with visualization of other structures. Exemplary radiolucent materials include carbon fiber and high-strength polymers.

[0078] Although specific embodiments are described above, it should be understood that numerous changes may be made within the spirit and scope of the concepts described.

Accordingly, the disclosure is not to be limited by what has been particularly shown and described. All publications and references cited herein are expressly incorporated herein by reference in their entirety.