초록 ▼

A system for repairing an intervertebral disc by delivering and curing a biomaterial in situ within the disc. The system includes both a device, having an insertable balloon and related lumen, controls and adapters, as well as an in situ curable biomaterial (and related biomaterial delivery means).

A system for repairing an intervertebral disc by delivering and curing a biomaterial in situ within the disc. The system includes both a device, having an insertable balloon and related lumen, controls and adapters, as well as an in situ curable biomaterial (and related biomaterial delivery means). The system can allow the doctor to determine a suitable endpoint for biomaterial delivery, by controlling distraction and/or biomaterial delivery pressure, and in turn, to deliver a desired quantity of biomaterial to the balloon in order to achieve improved polymer cure and implant characteristics. Also provided is a related method for repairing an intervertebral disc by using such a system to deliver and cure the biomaterial in situ. The system can be used to implant a prosthetic total disc, or a prosthetic disc nucleus in a manner that leaves the surrounding disc tissue substantially intact.

대표청구항 ▼

What is claimed is: 1. A method for repairing or resurfacing the site of an injured or diseased articulating joint, the method comprising the steps of: providing a curable biomaterial; and performing the surgical steps of; (a) accessing and preparing the joint site for receipt of the biomaterial; (

What is claimed is: 1. A method for repairing or resurfacing the site of an injured or diseased articulating joint, the method comprising the steps of: providing a curable biomaterial; and performing the surgical steps of; (a) accessing and preparing the joint site for receipt of the biomaterial; (b) delivering a quantity of the curable biomaterial to the prepared joint site; (c) curing the delivered biomaterial in such a manner that the cured biomaterial is permanently retained in apposition to the prepared site; and contouring the cured, retained biomaterial to achieve a desired conformation approximating that of the natural joint, wherein steps (a) through (c) comprise an intervertebral disc replacement using minimally invasive surgical means. 2. The method according to claim 1 wherein the minimally invasive surgical means are arthroscopic means. 3. The method according to claim 1 wherein the delivery step is performed under arthroscopic visualization using a cannula suitably dimensioned to deliver the curable biomaterial. 4. The method according to claim 1 comprising the further step of coating or modifying the surface of the contoured material with a permanent interface material in order to improve the biocompatability or coefficient of friction of the cured biomaterial, wherein the coating or modifying step is also performed using minimally invasive surgical means. 5. The method according to claim 1 wherein the biomaterial comprises a curable polyurethane polymer. 6. The method according to claim 1 wherein the delivery step is performed using an arthroscopic cannula. 7. The method according to claim 1 wherein the intervertebral disc comprises a mold for retaining the curable biomaterial. 8. A method for repairing a damaged or diseased intervertebral disc, the method comprising the steps of: using minimally invasive techniques to remove damaged or diseased nucleus from the disc; providing a mold apparatus comprising a balloon adapted to contain a biomaterial and a delivery cannula adapted to flowably connect a biomaterial source to the balloon; positioning the balloon in the intervertebral disc space using minimally invasive techniques; providing a biomaterial source comprising a flowable biomaterial; mixing the flowable biomaterial; purging a portion of the flowable biomaterial prior to delivery to the intervertebral disc space; delivering the flowable biomaterial into the balloon using minimally invasive techniques to provide a distraction pressure to the intervertebral disc space; allowing the delivered biomaterial to cure a sufficient amount to permit the cannula to be removed and to provide a permanent replacement for the nucleus. 9. The method of claim 8 wherein the biomaterial comprises a polyurethane system. 10. The method of claim 8 wherein the balloon when inflated fills less than the entire volume of the intervertebral disc space. 11. The method of claim 8 comprising locating biomaterial in the intervertebral disc space outside of the balloon. 12. The method of claim 11 wherein the biomaterial located in the intervertebral disc space outside of the balloon is different from the biomaterial located in the balloon. 13. The method of claim 11 wherein the biomaterial located in the balloon is more flexible than the biomaterial located in the intervertebral disc space outside of the balloon. 14. The method of claim 11 wherein the biomaterial located outside of the balloon is in-situ curable. 15. The method of claim 8 comprising purging a portion of the biomaterial prior to delivery to the balloon. 16. The method of claim 8 comprising purging a volume of biomaterial equal to about 1 to about 4 times a volume of a mixing element prior to delivery of the biomaterial to the balloon. 17. The method of claim 8 wherein the delivery of biomaterial is done at a substantially constant flow rate. 18. The method of claim 8 wherein the delivery of biomaterial is done at a substantially continuous flow rate. 19. A method for repairing a damaged or diseased intervertebral disc, the method comprising the steps of: using minimally invasive techniques to remove damaged or diseased nucleus from the disc; providing a mold apparatus comprising a balloon adapted to contain a biomaterial and a delivery cannula adapted to flowably connect a biomaterial source to the balloon; positioning the balloon in the intervertebral disc space using minimally invasive techniques; providing a biomaterial source comprising a flowable biomaterial; mixing the flowable biomaterial; withdrawing air from the balloon located in the intervertebral disc space; delivering the flowable biomaterial into the balloon using minimally invasive techniques to provide a distraction pressure to the intervertebral disc space; and allowing the delivered biomaterial to cure a sufficient amount to permit the cannula to be removed and to provide a permanent replacement for the nucleus. 20. The method of claim 19 wherein the biomaterial comprises a polyurethane system. 21. The method of claim 19 wherein the balloon when inflated fills less than the entire volume of the intervertebral disc space. 22. The method of claim 19 comprising locating biomaterial in the intervertebral disc space outside of the balloon. 23. The method of claim 22 wherein the biomaterial located in the intervertebral disc space outside of the balloon is different from the biomaterial located in the balloon. 24. The method of claim 22 wherein the biomaterial located in the balloon is more flexible than the biomaterial located in the intervertebral disc space outside of the balloon. 25. The method of claim 22 wherein the biomaterial located in the annular shell is in-situ curable. 26. The method of claim 19 comprising applying herein mechanical distraction in combination with the pressurized injection of flowable biomaterial to apply a distraction force to the intervertebral disc space. 27. The method of claim 19 comprising purging a portion of the biomaterial prior to delivery to the balloon. 28. The method of claim 19 comprising purging a volume of biomaterial equal to about 1 to about 4 times a volume of a mixing element prior to delivery of the biomaterial to the balloon. 29. The method of claim 19 wherein the delivery of biomaterial is done at a substantially constant flow rate. 30. The method of claim 19 wherein the delivery of biomaterial is done at a substantially continuous flow rate. 31. A method for repairing a damaged or diseased intervertebral disc, the method comprising the steps of: using minimally invasive techniques to remove damaged or diseased nucleus from the disc; providing a mold apparatus comprising a balloon adapted to contain a biomaterial and a delivery cannula adapted to flowably connect a biomaterial source to the balloon; positioning the balloon in the intervertebral disc space using minimally invasive techniques; providing a biomaterial source comprising a flowable biomaterial; mixing the flowable biomaterial; delivering the flowable biomaterial into the balloon using minimally invasive techniques to provide a distraction pressure to the intervertebral disc space; and allowing the delivered biomaterial to cure a sufficient amount to permit the cannula to be removed and to provide a permanent replacement for the nucleus, wherein the cured biomaterial provides a heterogeneous implant having a plurality of regions with a more rigid outer region and a more flexible inner region. 32. The method of claim 31 wherein the injection of pressurized biomaterial is sufficient to distract the intervertebral disc space from constricted dimensions of on the order of 3 mm to 4 mm to dimensions of on the order of 8 mm to 12 mm. 33. The method of claim 31 wherein the biomaterial comprises a polyurethane system. 34. The method of claim 31 wherein the balloon when inflated fills less than the entire volume of the intervertebral disc space. 35. The method of claim 31 comprising locating biomaterial in the intervertebral disc space outside of the balloon. 36. The method of claim 35 wherein the biomaterial located in the intervertebral disc space outside of the balloon is different from the biomaterial located in the balloon. 37. The method of claim 35 wherein the biomaterial located in the balloon is more flexible than the biomaterial located in the intervertebral disc space outside of the balloon. 38. The method of claim 31 wherein the biomaterial located in the annular shell is in-situ curable. 39. The method of claim 31 comprising applying mechanical distraction in combination with the pressurized injection of flowable biomaterial to apply a distraction force to the intervertebral disc space. 40. The method of claim 31 comprising purging a portion of the biomaterial prior to delivery to the balloon. 41. The method of claim 31 comprising purging a volume of biomaterial equal to about 1 to about 4 times a volume of a mixing element prior to delivery of the biomaterial to the balloon. 42. The method of claim 31 wherein the delivery of biomaterial is done at a substantially constant flow rate. 43. The method of claim 31 wherein the delivery of biomaterial is done at a substantially continuous flow rate. 44. A method for repairing a damaged or diseased intervertebral disc, the method comprising the steps of: using minimally invasive techniques to remove damaged or diseased nucleus from the disc; providing a mold apparatus comprising a balloon adapted to contain a biomaterial and a delivery cannula adapted to flowably connect a biomaterial source to the balloon; positioning the balloon in the intervertebral disc space using minimally invasive techniques; providing a biomaterial source comprising a flowable biomaterial; mixing the flowable biomaterial; purging a portion of the biomaterial prior to delivery to the balloon; delivering the flowable biomaterial into the balloon using minimally invasive techniques; and allowing the delivered biomaterial to cure a sufficient amount to permit the cannula to be removed and to provide a permanent replacement for the nucleus. 45. The method of claim 44 wherein the step of purging comprises purging a volume of biomaterial equal to about 1 to about 4 times a volume of a mixing element prior to delivery of the biomaterial to the balloon. 46. The method of claim 44 wherein the delivery of biomaterial is done at a substantially constant flow rate. 47. The method of claim 44 wherein the delivery of biomaterial is done at a substantially continuous flow rate. 48. A method for repairing a damaged or diseased intervertebral disc, the method comprising the steps of: using minimally invasive techniques to remove damaged or diseased nucleus from the disc; providing a mold apparatus comprising a balloon adapted to contain a biomaterial and a delivery cannula adapted to flowably connect a biomaterial source to the balloon; positioning the balloon in the intervertebral disc space using minimally invasive techniques; providing a biomaterial source comprising a flowable biomaterial; mixing the flowable biomaterial; delivering the flowable biomaterial into the balloon located in the intervertebral disc space while applying a vacuum to the balloon using minimally invasive techniques; terminating the flow of biomaterial in response to an endpoint monitor adapted to provide an indication of an endpoint for biomaterial delivery; and allowing the delivered biomaterial to cure a sufficient amount to permit the cannula to be removed and to provide a permanent replacement for the nucleus. 49. The method of claim 48 wherein the endpoint for delivery of biomaterial is determined by delivery pressure of the biomaterial. 50. The method of claim 48 wherein the endpoint for delivery of biomaterial is determined by volume of biomaterial delivered. 51. The method of claim 48 wherein the endpoint for delivery of biomaterial is determined by the amount of distraction of the intervertebral disc. 52. A method for repairing or resurfacing the site of an injured or diseased articulating joint, the method comprising the steps of: providing a curable biomaterial; and performing the surgical steps of; (a) accessing and preparing the joint site for receipt of the biomaterial; (b) purging a portion of the biomaterial prior to delivery into the prepared joint site; (c) delivering a quantity of the curable biomaterial to the prepared joint site; (d) curing the delivered biomaterial in such a manner that the cured biomaterial is permanently retained in apposition to the prepared site; and contouring the retained biomaterial to achieve a desired conformation approximating that of the natural joint, wherein steps (a) through (d) comprise an intervertebral disc replacement using minimally invasive surgical means. 53. The method according to claim 52 wherein the biomaterial comprises a curable polyurethane polymer. 54. The method according to claim 52 wherein the delivery step is performed using an arthroscopic cannula. 55. The method according to claim 52 wherein the intervertebral disc site comprises a mold for retaining the curable biomaterial. 56. The method according to claim 19 wherein air is withdrawn from the balloon at the same time the flowable biomaterial is delivered into the balloon. 57. The method according to claim 7 comprising providing a mold with elastic properties and non-elastic properties at different regions. 58. The method according to claim 7 wherein at least one lateral wall of the mold comprises a compliance value higher than a delivery pressure of the biomaterial. 59. The method according to claim 7 wherein the mold provides a distraction force in essentially a vertical direction without exerting a high expansion force on a surrounding annulus. 60. The method according to claim 7 comprising incorporating a reinforcing material in at least a portion of the mold. 61. The method according to claim 8 comprising providing a mold with elastic properties and non-elastic properties at different regions. 62. The method according to claim 8 wherein at least one lateral wall of the balloon comprises a compliance value higher than a delivery pressure of the biomaterial. 63. The method according to claim 8 wherein the balloon provides a distraction force in essentially a vertical direction without exerting a high expansion force on a surrounding annulus. 64. The method according to claim 8 comprising incorporating a reinforcing material in at least a portion of the balloon. 65. The method according to claim 19 comprising providing a mold with elastic properties and non-elastic properties at different regions. 66. The method according to claim 19 wherein at least one lateral wall of the balloon comprises a compliance value higher than a delivery pressure of the biomaterial. 67. The method according to claim 19 wherein the balloon provides a distraction force in essentially a vertical direction without exerting a high expansion force on a surrounding annulus. 68. The method according to claim 19 comprising incorporating a reinforcing material in at least a portion of the balloon. 69. The method according to claim 44 comprising providing a mold with elastic properties and non-elastic properties at different regions. 70. The method according to claim 44 wherein at least one lateral wall of the balloon comprises a compliance value higher than a delivery pressure of the biomaterial. 71. The method according to claim 44 wherein the balloon provides a distraction force in essentially a vertical direction without exerting a high expansion force on a surrounding annulus. 72. The method according to claim 44 comprising incorporating a reinforcing material in at least a portion of the balloon.