CN101437457A - Cutter for preparing intervertebral disc space - Google Patents

Abstract

Cutter assemblies for use with cutter blades made of shape memory materials. The cutter blades may be deployed in the interior of an intervertebral disc space and rotated relative to a central axis of the cutter assembly to cut the material present for removal from the intervertebral disc space. Cutter blades with different attributes (such as throw length, cutter blade angle, type and location of blade edges) are adapted to achieve different objectives within the intervertebral disc space. Some cutter blades are adapted to promote bleeding of cartilage and vertebral body endplates and some cutter blades are adopted to avoid causing such bleeding. Closed loop cutter blades are described which have certain desirable attributes including the ability to remove the entire cutter blade from the intervertebral disc space after a break in the blade. Serration patterns are disclosed including a serration pattern that makes use of trapezoidal serrations.

Description

Be used for the spatial cutter of preparing intervertebral disc

Technical field

The present invention relates generally to be used to treatment procedure subsequently and in spine for example the interbody space place between two contiguous vertebral bodys prepare the modified model cutter and the method for therapentic part, described treatment procedure subsequently comprises the therapy that does not need to merge described two contiguous vertebral bodys, for example the motion holding device is implanted to the therapy in the described spine.

Background technology

This application case is based upon on a series of applications of representing the assignee.In particular, this application case is the extension to the invention work in the field of material in the manipulation spine described in the following application case: be used for handling the spine material method and apparatus the 10/972nd, No. 077 common U.S. patent application case co-pending and commonly assigned, described application case applies on October 22nd, 2004 and subsequently as the US2005/0149034 A1 U.S. patent application case and the 60/778th of the method and apparatus that is used for tissue manipulation and extraction of on February 28th, 2006 application, No. 035 the U.S. Provisional Patent Application case is disclosed, and this application case advocates that preferentially the incorporating into by reference for the time being of ' 035 application case ' 077 application case and ' 035 application case are among both.

This application case is the extension that the motion of the vertebra described in the following application case is kept the invention work in molectron field: the motion of the vertebra that is used for of application on October 24th, 2006 keeps the common co-pending and commonly assigned the 11/586th of molectron, being used to of No. 338 U.S. patent application case and on October 24th, 2006 application sends motion of the vertebra and keeps the 11/586th of the method for molectron and instrument, No. 486 U.S. patent application case, this application case advocate that ' 338 reach both priority of ' 486 application cases and incorporate described two application cases by reference into.

Although incorporated some application cases by reference into so that additional detail to be provided, should note these other application cases (comprising those application cases of having issued as patent subsequently) be early the time, write out and have a focus different with the application's case.Therefore, incorporate into regard to these and to exist the teaching or the term that are different from the application's case to use in many application cases of application case, the present invention has control force.

General introduction

The present invention is the extension to the work of a series of patent application cases with commonly-assigned us (some patent application cases have wherein been issued now and have been patent).The major part of described work is above mentioned and be incorporated into way of reference in many application cases in this application case and described in detail.Therefore, background technology of the present invention provided herein is not all details that provided in the repetition earlier application case but emphasizes how to add the present invention to this operative body.

Spinal column is complicated joint (vertebral body and other joint) system, and described joint is as a rule by the dish in the interbody space (the sacrum vertebra is an exception) separated from one another.Fig. 1 shows the various joints of the human spinal column when inspecting from the side.In the context of the present invention, " motion segment " comprises contiguous vertebra, promptly inner vertebral body and outside vertebral body, and intervertebral disc space separates described two vertebral bodys, and no matter be the space of nuclear excision or under the situation of damage not or the spinal disc that damaged.Unless previous through merging (or having damaged), each motion segment all help spine overall flexibility, help to make the spine bending to think the mobile whole capability that provides support of trunk and head.

Routinely, the vertebra of spinal cord is subdivided into several sections.When moving to coccyx from the head, described section is cervical vertebra 104, thoracic vertebra 108, lumbar vertebra 112, sacral 116 and coccyx 120.Indivedual vertebral bodys in described section are by near the numbering identification of the vertebral body place beginning of head.Be more suitable for vertebral body in turnover lumbar segment and sacral section through the sacral approach.Because the various vertebral bodys in the adult sacral section can merge usually, therefore only with reference to rumpbone but not indivedual sacral assembly just have sufficient illustrative and may have more illustrative.

Before background technology of the present invention was carried out more detailed argumentation, it was useful illustrating some standard medical vocabulary.In the context of this argumentation: the place ahead is meant the front (abdominal part) of spinal column; And the rear is meant the back (back) of post; Mean head (being sometimes referred to as " top ") to head towards the patient; Caudad (being sometimes referred to as " below ") is meant the direction or the position of more approaching foot.Because therefore the present invention expection is that definition is near and far away in the context of this approach passage via entering from rumpbone and headward mobile optimization approach passes in and out various vertebral bodys and interbody space.Therefore, therefore closely be more to approach the beginning of described passage and towards foot or surgeon, far be apart from the farther place of the beginning of described passage and therefore headward or with the surgeon at a distance of farther.When mentioning the instrument that comprises cutter, far will be intended to be used for being inserted into the end of passage channel and closely be meant the other end, it normally more approaches the end of handle for tool.

Intravertebral indivedual motion segment allows to move in the limit of constraint and provides protection for spinal cord.Described dish is to buffering and distribute to pass through the most important energetically of spinal column when the people walks, bends over, stands up or does other and moves.Unfortunately, for following mentioned some reasons, for some, one or more dishes in the spinal column will be can be by such operation of planning.The scope of cross-examining the reason of topic comprises from birth defect, disease, damage or can be because of the old and feeble degeneration that causes.Usually when dish can not correctly be operated, the gap between the contiguous vertebral body reduces and this causes comprising pain in interior additional problem.

Developed in order to alleviate and the various therapies of cross-examining the pain that topic is associated.The solution of a classification is to remove the inefficacy dish and then with permanent but inflexible interval with contiguous vertebral fusion together, this is also referred to as steady stability.A kind of estimation is that the fusion of implementing in the whole world in 2004 is estimated as 300,000 examples.A section and some ends that can bend in the motion segment are merged.May suffer pain better than continuing although the fusion by motion segment makes motion segment lose normal physiology dish function, the whole or most normal performances of the motion segment that eases the pain and still keep fit will be better.

Another kind of other therapy is to attempt the repairing dish so that it is with set intervertebral space and mechanical performance recovery operation.One type repairing is to change the primary dish of damage with prosthetic disc.The therapy of this type has different titles, and for example dynamic stability or motion of the vertebra keep.

The operation of spine

The body of successive lumbar vertebra, thoracic vertebra and cervical vertebra vertebra joint each other is connected and separates by the intervertebral spinal disc.Each spinal disc comprises and is encapsulated with the centroplasm piece fibrous cartilage shell of (be called " vertebral pulp " or be referred to herein as " nuclear "), and it provides the buffering and the inhibition of compression stress for spinal column.Sealing nuclear shell comprises to be attached to comprise around vertebral pulp to the cartilaginous end plates of the relative cortical bone end plate of head and caudad vertebral body and " fibrous ring " (or be called herein " ring ") and trails in peripheral mode and connect a plurality of layers relative collagen fiber of cartilaginous end plates.Natural physiology nuclear comprises hydrophilic (attraction water) mucopolysaccharide and fiber band (protein polymer).Described nuclear phase is to nonelastic, but described ring can a little outwards be given prominence to the load that is applied to the motion of the vertebra joint in the axial direction to adapt to.

Intervertebral disc is in the place ahead of spinal canal and between the opposing end surface or end plate of head and caudad vertebral body.Inferior articular process and caudad (that is, towards foot or below) the superior articular process joint of next continuous vertebra on the direction is connected.Several ligaments (above the spinous process, below spinous process, the place ahead and rear vertically reach ligamenta flava) remain on vertebra in the appropriate location and still permit moving of limited extent.The molectron of the intervertebral spinal disc of two vertebral bodys, plant and attached ligament, muscle and facet joint is called " motion of the vertebra joint ".

The big relatively vertebral body that is arranged in the place ahead part of spine and intervertebral disc is born the support to the most of weight of vertebra post.Each vertebral body has strong relatively cortical bone layer, described cortical bone layer form described body exposure outer surface and with end plate and fragile spongy bone be included in vertebral body in the heart.

The vertebral pulp that forms the core of intervertebral disc comprises 80% water, and described water is absorbed by the Dan Baijutang in adult's spine of health.Along with aging, the described nuclear flowability that becomes is littler and more viscous, even dewaters sometimes and shrink (being sometimes referred to as " the isolatism dish absorbs ") again, thereby causes serious pain in many cases.Spinal disc serves as " suppressor " between each vertebral body, and it makes to move reduces to minimumly to the influence of spinal column, and make dish effectively load to be sent to circular layer with the disk degeneration that water content in the described nuclear is reduced to sign.In addition, described ring trends towards thickening, becomes dry and becomes and has more rigidity, thereby the ability of its strain under load is reduced and makes it be subject to the influence of breaking or chapping, and therefore a kind of disk degeneration of form takes place when ring be full of cracks or its are torn.Described be full of cracks can or can not be extruded in the ring and exceed ring and take place with nuclear matter.Described be full of cracks itself may be to be higher than and to exceed the independent morphological change that the vague generalization degenerative in the conjunctive tissue of dish changes, and the dish be full of cracks still can cause pain and weak.The biochemical substances that is contained in the described nuclear can be via near the structure that be full of cracks is overflowed and stimulation is.

Attempt to keep intervertebral spinal disc and only lenitive various other surgical intervention to comprise " diskectomy " or " dish decompression ", reduce pressure whereby or reduce outward pressure on the described ring to remove some or most inner core.In being called Wicresoft's microsurgery program that " micro-intervertebral disc of lumbar vertebra excision " reach " automatic puncturing intervertebral disc of lumbar vertebra excision ", described nuclear is to aspirate by the pin that extension is horizontally through described ring to remove.Though these programs are Wicresofts than open surgery, described iatrotechnics still can stand may the injured nerve root and dural sac, form cicatrix around nerve, form hernia again and because of the unstability of excessive bone due to removing at surgical site.In addition, the described iatrotechnics perforation that is usually directed to encircle.

Though can use complicated diagnosing image to discern dish and the vertebral body that has damaged, existing surgical operation is got involved and clinical achievement is not consistent satisfied.In addition, suffer the patient experience severe complications and the convalescence uncomfortable and that prolong of this fusion surgery.For example, the surgical operation complication comprises the disk space infection; Nerve root injury; Form hematoma; The unstability of adjacent vertebrae and destruction muscle, tendon and ligament.

Number companies are just making great efforts to develop plans to be used for changing fully the human spine prosthese of physiology dish, that is, and and artificial disc.Degree of degeneration does not proceed in the individuality of breaking-up ring as yet therein, substitutes the replacing of whole artificial disc, and the preferred therapeutic option can be to change or the expansion vertebral pulp, and this relates to deployment prosthetic disc nuclear.As discussed previously, normal nuclear be contained in by more than described nuclear and below the bone vertebra and the space of being delimited around the fibrous ring of described nuclear in peripheral mode in.In this way, described nuclear is by complete capsule envelope and sealing and only be communicated to described body, and this is the fluid communication that takes place via the bone interface (being called end plate) with vertebra.

The hygroscopic matter of finding in physiology nuclear has the affinity (and swelling) to water on volume, this affinity is enough to make intervertebral disc space to disperse (that is, raising or " rising "), although carried sizable physiology load in normal activity mid-game.These power (it is in the scope from about 0.4x to about 1.8x body weight) produce the local pressure more than normal arterial pressure just, and in fact, described nuclear and internal ring tissue are actually avascular.

The details of certain benefits and special exercise holding device (comprising the method that is used for implanting the motion holding device) is described in various application cases co-pending, comprises mentioned above 11/586,338 and 11/586,486.The reader can select to read these details, but there is no need to repeat described material with its full content herein.

Although the cutter of the following stated can be used for other surgical procedure, comprise not via axial approach near interbody space but arrive described spatial spinal surgery by the place ahead or rear approach.Described cutter can be used for following surgical procedure: after partially or completely examining excision (nucleectomy) and may entering into disk space with the enucleation of surgery modus operandi by the sleeve pipe of docking on rumpbone from the described access point of crossing over treatment region, the motion holding device is inserted in the spine in the axial direction.In this program, introducing motion of the vertebra maintenance molectron of the present invention is to realize under the existing foraminous situation that need not form or not enlarge nocuously with the surgery modus operandi in the described dish fibrous ring.

The design of cutter blade has comprised the content that makes the cutter blade prepare described nuclear effectively in many cases for the consideration that is removed by cutting (cut into slices, tear or both a certain combination).Usually, (this has benefit aspect minimizing use expensive resource to reduce the surgical operation time to need to allow the surgeon to work fast and effectively, for example, surgical team and surgical operation clothing) and also reduce the patient and be in time span under the narcotism.

Therefore compare with a kind of cutter blade that must frequently change, may more need a kind ofly have similar characteristics but more durable and can use the longer time and the cutter blade that need not to change.

A kind ofly can easily remove the similar cutter blade that the cutter blade that lost efficacy the pattern of all inefficacy cutter blade members may be better than not having this characteristic therein from intervertebral disc space and patient body.

Summary of the invention

What disclose herein is to be used for the cutter molectron used with the cutter blade of being made by shape-memory material.Described cutter blade can be deployed in the inside of intervertebral disc space and with respect to the central axis rotation of the cutter molectron and centrage rough alignment axial passage.The cutter blade is rendered as the material that removes from described intervertebral disc space as the rotary cutting of a part in intervertebral disc space of cutter molectron.Cutter blade with different attribute (for example, the type and the position of throw length, cutter blade angle, blade edge) is suitable for realizing various objectives in described intervertebral disc space.Some cutter blades are suitable for facilitating bleeding of cartilage and vertebral body end plate and some cutter blades are suitable for avoiding causing this to bleed, and bleed or seek to avoid this to bleed because different treatment procedures is sought this.

Description has the closed circuit cutter blade of some required attribute, is included in to occur fracture removes described whole cutter blade afterwards from described intervertebral disc space ability announcement saw tooth pattern in the described blade, and it comprises the saw tooth pattern of using trapezoidal sawtooth.

The those skilled in the art will understand other system of the present invention, method, feature and advantage in check with figure below and after describing in detail.Planning all these additional system, method, feature and advantage all is included in this explanation, and is contained in the scope of the present invention, and is protected by attached claims of following.

Description of drawings

With reference to understanding the present invention better with figure below.Assembly among the figure may not be pro rata, but emphasizes graphic extension principle of the present invention.Yet in described figure, identical Ref. No. is represented the corresponding component in all different views.

Fig. 1 discerns the section of human spine.

Fig. 2 (A)-(C) be illustrated in the spine form axial passage through the place ahead sacral axial passageway method, it is used in prepares axial passage for using with the present invention in the spine.

Fig. 3 shows the cutter molectron that is inserted in the axial passage, and wherein the cutter blade is in extended position.

Fig. 4 A-4B is the view of cutter molectron.

Fig. 5 A-5B shows a kind of method that is used for the cutter blade is connected to the cutter axle.

Fig. 6 A-6D provides the additional views of cutter molectron, comprises the block of the stroke range of restriction cutter sheath.

Fig. 7 explains orally the notion of the cutter blade of a series of different throw length in the intervertebral disc space.

Fig. 8 introduction is caused problem when axial passage is not substantially perpendicular to the end plate of intervertebral disc space.

Fig. 9 shows the cutter blade arm that has the cutter blade of 45 degree, 90 degree and 135 degree angles with respect to the longitudinal component of cutter blade.

Figure 10 A-10C shows three views of cutter blade.

Figure 12 is presented at the cutter blade in the first cutter axle with cutter axle extension.

Figure 13 is presented at the cutter blade in the cutter axle with cutter axle extension.

Figure 14-16 shows the view of the cutter axle that does not have cutter axle extension.

Figure 17-19 shows the view of the cutter axle with cutter axle extension.

Figure 20 A-20C is the view that has the cutter blade of circular sawtooth on a side of cutter blade.

Figure 21 A-21C is the view that has circular sawtooth and have the cutter blade of different saw tooth pattern at cutter blade top end on a side of cutter blade.

The counterclockwise side that Figure 22 A-22C is presented at the clockwise side of cutter blade and cutter blade has several views of cutting the device blade of zigzag cutting edge on both.

Figure 23 and Figure 24 show the details of sawtooth being added to the flat blank of the suitable size that is used to form the cutter blade.

Figure 25 points out to treat to remove to use trapezoidal saw tooth pattern to form the material of cutter blade from flat blank.

Figure 26 shows the cutter blade with trapezoidal saw tooth pattern, and wherein said cutter blade is in the cutter molectron.

Figure 27 A-27D shows the view of the bit blank with trapezoidal saw tooth pattern.

Figure 28 A-D shows the round tooth saw tooth pattern that is cut in the bit blank.

Figure 29 A-G shows the various views of the cutter blade of being made by bit blank, and its saw tooth pattern is similar to the saw tooth pattern shown in Figure 28 A-D.

Figure 30 and 31 is presented at two examples that have the cutter blade of 135 degree angles between the only part of cutter blade arm and the longitudinal component of cutter blade.

Figure 32 A-32C cutter blade is to the connection based on rivet of cutter axle.

The specific embodiment

Although the invention cutter of the following stated can be used for other surgical procedure, be used for describing how to make these cutters can be suitable for using in the present context through the sacral approach.As mentioned above, there are the many advantages that are associated through the axial approach of sacral with the low damage of minimally invasive.Describedly (describe and be disclosed in commonly assigned U.S. patent application case the 6th, 558,386,6 through the axial approach of sacral, 558,390,6,575,979,6,921,403,7,014,633 and 7, in 087,058) have the some advantages that are better than therapy equipment is delivered to other route of motion segment, but exist via the spatial logistics challenge of axial passageway passage preparing intervertebral disc.Solve some aspect of the cutter that the process influence of these challenges is intended for use to use in this way.

Through the sacral axial passageway

The muscle that is associated with traditional spinal surgery cuts and the needs of other traumatic step in illustrated having eliminated through sacral axial passageway method among Fig. 2, allow design simultaneously and dispose new and get involved through improved instrument and treatment, stable, the motion that comprise the treatment process of crossing in getting involved keep and fixture/emerging system.

Fig. 2 provides the introductory general introduction of described process, wherein Fig. 2 (a) and 2 (b) show blunt taper probe 204 the place ahead of rumpbone 116 towards on " advancing " monitor the process of one or more cryptoscope (not shown)s simultaneously to the desired location on the rumpbone 116.This process shifts out rectum 208, so that set up straight path for later step.Fig. 2 (c) graphic extension is passed that set up and the representativeness that enter into L5 vertebra 216 of rumpbone 116, L5/ rumpbone interbody space through sacral axial passage 212.If the therapy that provides is used for the L4/L5 motion segment, passage will continue across L5 vertebra 216, pass the L4/L5 interbody space and enter into L4 vertebra 220 so.

Provide the argumentation of Fig. 2 to be intended to for the invention provides context.Previous application case (some application cases have wherein been issued now and have been United States Patent (USP)) with commonly-assigned us has comprised the explanation to the alternative path method, described alternative path method be the rear through the axial vertebra approach of sacral but not the place ahead through the axial vertebra approach of sacral.(for example, be implanted into the 6th of the axial spinal implant of axial spinal implant and method and apparatus referring to being used for vertebra at spine, 558, No. 386 United States Patent (USP)s, as patent herewith is described in graphic extension among Fig. 2 and the mode quoted in full is incorporated herein the place ahead through the axial approach of sacral).

With reference to Fig. 3, cutter 400 is to pass axially aligned the place ahead bundle 372 (its tube chamber by dilator sheath 380 defines) and axial passage 212 (because of dilator sheath 380 by rumpbone 116 time roughly fill axial passage 212 be difficult to see) to insert and (be understood by those skilled in the art that and can axial passage 212 extended axially by a sequence of steps, so that the length of the axial passage among figure can be different from another figure, thereby makes axial bundle can comprise extra vertebral body or intervertebral disc space).Be understood by those skilled in the art that because anatomic differences another part that the axial passage of some therapies can miss rumpbone and can pass spine enters.

As shown in Figure 3, motion segment 316 comprises nearly vertebra 308 (rumpbone 116), interbody space 312 (in the case, for having dish 330, fibrous ring 334 and examining 338 L5-S1 space), vertebra 304 (in the case, being L5216) far away.But cutter 400 comprises the cutting tip (for example, being referred to as the cutter blade 453 of arbitrary blade configuration) of remote control.The manipulation of cutter blade 453 can comprise cutter blade 453 is withdrawn in the cutter molectron 400, so that the maximum radius of cutter molectron 400 reduces and have can pass axial passage 212 through the cutter molectron of withdrawal blade 453 and advance.After arriving cutter blade 453 exercisable positions, cutter blade 453 is extended.

As shown in Figure 3, the centrage 262 of cutter 400 is in close proximity to the centrage of axial passage 212, and this is because dilator sheath 380 is assemblied in the axial passage 212 and cutter 400 is assemblied in the dilator sheath 380.When cutter blade 453 extended as shown in Figure 3, the cutter blade roughly was transverse to the centrage 262 of cutter 400, and the cutter blade 453 through extending extends transverse in the nuclear 338 of spinal disc 330.

Preferably, cutter axle 410, cutter sheath 430 (being shown among Fig. 4) and Handleset through be configured to jointly can " push-and-pull " cutter blade 453 and be attached to it cut device axle 410, thereby optionally make cutter blade 453 retract in the cutter sheath and then make the remote extension of cutter blade 453 from the cutter sheath; More particularly, make the cutter blade edge of cutter blade 453 be withdrawn in the cutter sheath 430 (Fig. 4) so that be delivered in the intervertebral disc space 312.In case cutter 400 is in the appropriate location, just use handle to make cutter blade 453, with the tissue in the cutting intervertebral disc space 312 to remote extension and rotation.After finishing the cutting task or till the cutter blade need be changed, make cutter blade 453 be withdrawn in the cutter sheath 430 (Fig. 4) once more so that remove cutter molectron unit 400 from axial passage 212.

Cutter molectron 400, cutter blade 453 and cutter molectron axle 410 be illustrated schematically among Fig. 4 A-4B and each other or with axial passage 212 may not be proportional.

Cutter can be used for via being inserted in the disk space with from end plate, from the dish intracavity and from the below and top epiphysis plate skin cut, fragmentation and become flexible vertebral pulp and cartilage in addition and carry out the nuclear excision.As described in the present invention, damage or remove cartilage and tend to cause bleed in the intervertebral disc space 312.Bleeding tends to facilitate osteogenesis, and this in a kind of therapy of fused type may be need and may be unwanted in other therapies, described other therapies comprises requirement the motion holding device is implanted to therapy in the motion segment 316.

With reference to the exemplary embodiment of Fig. 4 A-B, cutter molectron 400 (also being called cutter simply) comprises: cutter axle 410, and it has far-end 412 and near-end 414; Cutter blade 453, it is connected to the far-end 412 of cutter axle 410; Handle 416, it is connected to the near-end 414 of cutter axle by attach procedure (for example, fixed screw or pin); Cutter sheath 430, it places on the axle 410 with concentric manner; And axle sleeve 418 (its be shown in graphic subsequently in).

A kind of method that cutter blade 453 is connected to cutter axle 410 of Fig. 5 A-5B graphic extension.Before inserting pin 409, the longitudinal component 406 of cutter blade 453 is placed near the groove 413 the far-end 412 of cutter axle 410.Cutter insert groove 427 can be aimed at the cutter axis hole 411 in the axial trough 413.Pin 409 can pass the axle sleeve hole 419 in the axle sleeve 418 through storing and pass cutter blade aperture 407 (as the best finding in Figure 10 A) on the opposite side of longitudinal component 406 of cutter insert groove 427 (can see), cutter blade 453 in Fig. 5 A.Pin is by cutter blade aperture 407 and enter into the cutter axis hole 411 of cutter axial trough 413.

The size of axial trough 413 is through determining to adapt to cutter blade 453.The width of groove 413 is identical approximately with the width of the longitudinal component 406 of cutter blade 453.The sweep 428 of the far-end of groove 413 adapts to the sweep through extension 402 between of cutter blade 453 at longitudinal component 406 and cutter blade, and described extension 402 also is called cutter cutter blade arm 402 and defines the accessibility distance or the throw of cutter blade 453.Groove 413 provides axial support to strengthen cutter blade 453 in conjunction with the work of cutter blade edge geometry for cutter cutter blade arm 402 provides the sweep 428 of the far-end that reverses support and groove 413 for cutter cutter blade arm 402.Cutter axle extension 480 (following will the argumentation in more detail) is for cutter blade 453 provides extra support, to reduce its warp tendency when the cutter blade rotates in the tissue.

When through pin joint, axle sleeve 418 is used to aim at and the longitudinal component 406 of fixed axis 410 and cutter blade 453 effectively.For the purpose of graphic extension, cutter blade 453 is fixed to the diameter that axle 410 pin 409 is about 0.06 inch (1.5 millimeters).

When cutter blade aperture 407 was pinned to cutter blade shaft 410, cutter blade 453 just was affixed to cutter blade shaft 410.What cutter insert groove 427 allowed longitudinal components 406 has a certain relative motion of slot part with respect to the pin joint part of longitudinal component 406, to adapt to the change when cutter blade 453 its shape from the sheath internal state to extension state and when getting back to the sheath internal state.

Can use any known fixed mechanism that remaining cutter 400 assembly is firmly fixed together each other.

Fig. 6 A-6D provides a series of views of cutter molectron 400.Fig. 6 A is the vertical view of cutter molectron 400.Fig. 6 B is the rearview of cutter molectron 400.Fig. 6 C is the cross section of Fig. 6 B.Fig. 6 D be Fig. 6 C through amplifier section.

As shown in Fig. 6 A and 6D, the groove in the cutter axle 410 can be through orientation so that handle 416 aim at cutter blade arm 402 (when extending).Although do not need, this relation between handle and the blade is to allow the surgeon to follow the trail of the useful mode of the position through extending cutter blade arm 402 by the position of rotation of understanding handle 416.

As best finding in Fig. 6 D, the stroke range 440 of cutter sheath 430 is limited in the proximal end by the proximal stop 444 that is attached to cutter axle 410.The stroke range 440 of cutter sheath 430 is limited in far-end by the shoulder on the cutter axle 410 448.

Be understood by those skilled in the art that although cutter blade 453 can be used for single patient and then apply some assembly, for example handle 416, cutter axle 410 and cutter sheath 430 can re-use.Handle and cutter axle can be made into a black box.

Cover or inner sheath lining (not shown) can be inserted into the inboard of cutter sheath to reduce friction.Cutter blade 453 can be formed by marmem, comprises for example Nitinol ^TMNiti-shaped memorial alloy.Cutter sheath 430 can be made by the rustless steel that is fit to grade.For the friction between the inner surface that reduces cutter blade 453 and cutter sheath 430, can use dry lubricant, for example polytetrafluoroethylene (PTFE).Another selection is that described cover or inner sheath lining can be made by the coefficient of friction material lower than cutter blade.If re-use this assembly, can select described assembly at its ability that stands a plurality of decontamination cycle so.A kind of this type of material is ultra-high molecular weight polyethylene (UHMWPE).

After having introduced cutter and cutter assembly, argumentation can be used the reason of a cutter sequence when the inside in preparing intervertebral disc space 312.Fig. 7 shows first example.In Fig. 7, show that motion segment 316 comprises vertebral body 304 far away, intervertebral disc space 312 (its intervertebral disc 330 comprises fibrous ring 334 and vertebral pulp 338 and delimited by end plate) and nearly vertebral body 308.For the purpose of this example, related vertebral body has exceeded makes its needs as contiguous vertebral body unimportant.

Fig. 7 comprises the end plate 342 of vertebral body 304 far away and is positioned at the expression of the cartilage layers 346 of a part that defines intervertebral disc space 312 on the end plate 342.Suppose that the path route is through the sacral axial passageway, from the reference point of intervertebral disc space 312, end plate 342 will be the top end plate so.Similarly, Fig. 7 comprises the end plate 352 of nearly vertebral body 308 and is positioned at the expression of the cartilage layers 356 of a part that defines intervertebral disc space 312 on the end plate 352.Suppose that the path route is through the sacral axial passageway, from the reference point of intervertebral disc space 312, end plate 352 will be the below end plate so.

Those skilled in the art will realize that comprising cartilage layers 346 and 356 is to plan to make it become correct anatomically for the purpose of discussing cutter and cartilage that size is suitable is represented.

The position surgeon of cutter in intervertebral disc space can see under real-time fluorescence mirror imaging (may be forward/rear and horizontal imaging both).

Be a kind of viewpoint of graphic extension, Fig. 7 comprises three different cutter blades 504,508 of different throw length and 512 expression.Be understood by those skilled in the art that a kind of method that is used to cut nuclear 338 will use a series of cutter blades (504,508,512 and have other longer blade) to examine 338 with cutting little by little.Those skilled in the art will appreciate that, show that simultaneously three different blade lengths only are the viewpoints for graphic extension these three blades that will be from short to the long different throw length (being sometimes referred to as accessibility distance) that use in order and Fig. 7.For context is provided, arrived in the distance of a series of cutter blades that in specific program, use can between from 0.40 inch (for little cutter blade) in the scope of 0.70 inch (for big cutter blade).Those skilled in the art will realize that these scopes are illustrative and can are different.The optimum throw of understanding the cutter blade is depended on several factors, comprise the patient who enters into disk space and dissect (axially) inlet point and the problem symmetrical relevant of reaching with the sagittal of spinal disc.In addition, for security reasons, the length that may need to limit the cutter blade approaches very much plate edge with the prevention throw, in other words avoids contacting with prevention between cutter blade and fibrous ring and jeopardizes fibrous ring.

Should notice that when extending cutter blade 504,508 and 512 is transverse to the centrage of cutter 262 and is parallel to axis 266 perpendicular to cutter blade centerline 262.The cutter blade also approaches to be parallel to end plate 342 and 352 and cartilage layers 346 and 356.

In this example, successive longer cutter blade 504,508 and 512 can revolve three-sixth turn or more around centrage 262.Some surgeon may preferences then make the cutter handle rotate in the opposite direction to turn back to the cutter position occupied by the mark (perhaps being about 90 degree) that makes the cutter handle and revolve three-sixth turn once to work on a joint.Therefore, described process is proceeded when tending to work on quadrant radially.Sometimes, with this short move with automobile on the mobile phase ratio of windscreen wiper.

Except that use has a series of cutter blades of the throw that order increases, the surgeon also will need by with respect to motion segment to front slide cutter (towards on the direction in a distant place) so that the cutter blade sequentially moves to such an extent that more approach the axial location that cartilage 346 on the end plate 342 on the vertebral body 304 far away is adjusted the cutter blade.The surgeon can select by the cutter sequence of using the throw that increases and then repeat first space that described process (and blade sequence of the throw that repeats to increase) forms approaching relatively nearly vertebral body with the cutter that further extends in the nuclear.

Another selection is, the surgeon can select to use one or more cutters with first throw to form approximate cylindrical space, and its spatial height and its radius that highly is roughly between two cartilage layers approximates the first blade throw.This process can relate to using and has the throw of appointment length radial cutting device blade and follow into different blade angle (for example, 45 degree) closely but one or more identical cutter blades of throw length.In case finish the cutting of specifying throw length, the surgeon begins to move the cutter blade of longer throw length equally with radial cutting device blade.The cutter blade of the blade throw that this process can increase repeats till the space that forms aequum.

The character that treatment procedure and patient dissect will be determined required maximum cutter blade throw length.Some program can be tended to a large amount of cutter blade throw length to be increased with the throw length of carrying out less increment.Other program can only be used little throw length and then move to the required maximum throw length in preparing intervertebral disc space.

When the cutting nuclear matter, the surgeon can periodically remove cutter and use any suitable tissue extractor instrument from axial passage.The 10/972nd, No. 077 U.S. patent application case (above mentioned) described several regracting tissue extractor that can be used for this purpose.

The 10/972nd, No. 077 U.S. patent application case (above mentioned) is pointed out when for fusion program preparing intervertebral disc space, use cutter to come the scraping cartilaginous end plates and the vertebral body roughening of vascularization is bled so that cause, for promoting bone growth and facilitate the fusion of the vertebral body of relevant motion segment that described bleeding needs.

Yet, be not that all treatment procedures are all sought to obtain this and bled and facilitate fusion.This is passing a part that hinders the end plate 352 of nearly vertebral body when end plate 352 forms axial passage inevitably, and this hinders the part of the cartilage 356 that is close to axial passage (same inevitably, if axial passage 212 (Fig. 2 C) extends in the vertebral body 304 far away, will hinder end plate 342 and the cartilage 346 of vertebral body 304 far away so).Yet, can not remove advantage in some program that the other parts that can avoid cartilage and end plate cause damage to a fraction of inevitable obstruction of end plate and cartilage.

Fig. 8 describes the different alignings between the end plates of axial passage 212 and two vertebral bodys.In Fig. 8, the cutter molectron 400 that enters into and partly pass the dilator sheath 380 of axial passage 212 through transmission has the cutter centrage 262 that becomes to keep off in perpendicular to the angle of the end plate 342 (below of intervertebral disc space 312 and top end plate) of the end plate 352 of nearly vertebral body 308 or vertebral body far away.

The cutter blade 353 that has about an angle of 90 degrees degree between cutter axle 310 and cutter blade 353 will be used to cut the part of nuclear but the other parts that can not be used to remove nuclear.Cutter blade with an angle of 90 degrees degree is sometimes referred to as the radial cutting device.

Fig. 8 is intended for use to emphasize to having the needs of the cutter blade of blade angle except that 90 degree.Fig. 8 also is not intended as indication at the optimal alignment of the axial passage of arbitrary particular treatment program.In the actual medical program, although axial passage is put in plan, the surgeon will assess and select to provide and the aiming at of the suitable space of anatomical structure, and securely and effectively implant in the vertebral body of being correlated with permission, comprise and carry out anchoring effectively.

The UNC that Fig. 9 uses when being illustrated in other attribute of discussing the cutter blade.In the case, cutter blade 460 is 90 degree cutter blades, because have an angle of 90 degrees degree (nominal) between the longitudinal component 406 of the portions of proximal of cutter blade arm and cutter blade 460.Show the part of 45 degree cutter blades 464, wherein one of the described part of cutter blade 464 nearlyer part is spent into about 45 with respect to the back side of longitudinal component 406.Although do not show that herein mid portion is connected to longitudinal component 406 with the described part of cutter blade 464.

Equally, show the part of 135 degree cutter blades 468, wherein a nearlyer part of the described part of 135 degree cutter blades 468 is spent into about 135 with respect to the back side of longitudinal component 406.

It should be noted that as can be based on the observation of Fig. 5 and 6, the longitudinal component 406 of cutter blade be roughly parallel to the length of cutter axle 410 and cutter sheath 430 and the cener line of cutter 262, so that these lines can be used to measure the cutter blade angle.

Show 45 complete degree cutter blades among Figure 21 A.Show 135 complete degree cutter blades among Figure 30 and 31.

In some cutter blades, the nearly part of cutter blade does not stretch abreast with any angle reference line.In the case, this can be used for only based on measuring the cutter blade angle through the forefield of extending cutter blade arm.

Just those skilled in the art will realize that and make the cutter blade with a limited number of nominal ablation device blade angle, the actual measurement of accurate angle can depart from the several years (perhaps being 5) with the Nominal angle value.Actual angle can move to through a plurality of circulations of extended position through the sheath internal state of associating and depart from.

Under many situations, the cutter blade of one group of various throw length and angle (for example, 45 degree, 90 degree and 135 degree) combination can be enough.Some surgeon may feel that the result of its acquisition can not be satisfactory when only using 90 degree and 45 degree cutter blades for some therapies.Can use other angle, comprise and 90 depart from less angle, 60 and 120 degree for example, or depart from more angle, for example 25 and 155 degree with 90 degree.Can use the angle that more approaches 90 degree in some applications, for example near 105 angles of spending.Tool kit can comprise the cutter blade more than three angle values.For instance, tool kit may comprise the blade with 25,45,60,90,105,120,135 and 155 degree angles.Under the situation of this blade angle scope, to be transverse to the degree excursion of long axis of cutter molectron wide through extending blade, but under all these situations, the cutter blade all is transverse to the long axis of cutter molectron and the longitudinal component of cutter blade significantly.

Some surgeon can use short 90 degree cutter blades by initial, then use 90 longer gradually degree cutter blades (one or more longer cutter blades) to cut the material of as much and work under the situation that presented in Fig. 8 in intervertebral disc space 312 as what can use that 90 degree cutter blades dispose safely.Then, the surgeon may want to use short 45 degree cutter blades to follow one or more long 45 degree cutter blades to come work to use 90 degree cutter blades with inaccessible material to remove.At last, in some cases, the surgeon can select to use short 135 degree cutter blades to follow one or more long 135 degree cutter blades closely and use 90 degree or the inaccessible nuclear matter of 45 degree cutter blades with cutting.

Figure 10 shows three views of cutter blade 500.Appreciable is cutter blade aperture 407 and cutter insert groove 427.Cutter cutter blade arm 402 joins longitudinal component 406 to by a pair of transformation segment 470.Although precision positions is not proper especially, intersect in the zone of two longitudinal components 406 at two transformation segments 470, two ends of cutter blade intersect.This contact point can be considered to be closed into the place of loop.Yet, this can be called more simply loop in 550 place's closures, described loop places the current adjacent portion office of cutter blade aperture 407 and cutter insert groove 427, because when the cutter blade is attached to the cutter molectron at the blade shaft place these both be bonded together (referring to Fig. 5).Closed circuit adds a redundant layer, because if cutter blade 500 ruptures in the time of in being inserted into intervertebral disc space, all parts of cutter blade 500 will have the part of groove 427 or part that the cutter blade has hole 407 remains connected to the cutter axle via the cutter blade.Because therefore all parts of cutter blade even still be connected to the cutter axle after the cutter blade breakages can remove described parts from intervertebral disc space by facilitating removing of cutter molectron.

The surgeon can be by the sensation change of operation cutter or by find the fracture of cutter blade according to the visible change of the indicated cutter blade of real-time fluorescence mirror imaging.

It is generally acknowledged that cutter blade 500 can have six different cutting edges 504,508,512,516,520,524.Three cutting edges 504,508,512 on a side and three cutting edges 516,520,524 on opposite side.Edge 504 and 516 is on the nearly part 536 of cutter blade 500, and nearly part 536 is that another part (it is the distal part 542 of cutter blade 500) than closed circuit is more near the part of the cutter blade 500 of handle 416 (Fig. 4 A).In the time of in being inserted into intervertebral disc space, the outside of nearly part 536 usually will be in the face of nearly epicentral end plate (no matter whether described nearly part is parallel to end plate). Edge 508 and 520 is on the distal part 542 of cutter blade 500.In the time of in being inserted into intervertebral disc space, the outside of distal part 542 usually will be in the face of epicentral end plate far away (no matter whether distal part 542 is parallel to end plate). Edge 512 and 524 is on the top 548 of the cutter blade 500 between distal part 542 and the nearly part 536.

The side that should note the cutter blade may not be flat.It is visible feature (just as when the face of watching dice or the side, being visible the same from the impression on one in six faces of the single dice of pair of dice) that described side (being sometimes referred to as face) has when side of watching described object or face.

Under each situation, cutting edge all is on the inner rim 552 of closed circuit but not on neighboring 556, because neighboring 556 more may contact the cartilage on the end plate.By making cutting edge recessed with respect to the neighboring 556 of closed circuit, cutter blade 500 is suitable for making the wound to the cartilage 346 (Fig. 8) on cartilage 356 (Fig. 8) on the proximal plate 352 (end plate below when inspecting in the context of intervertebral disc space 312 may being) or the distal plate 342 (end plate above when inspecting in intervertebral disc space 312 contexts may being) to drop to minimum.As illustrated among Fig. 8, although cutter blade 500 has the nominal blade angle of 90 degree, this cutter blade 500 can not contact with the cartilage on the end plate of top.

Owing to all have cutting edge on two sides of cutter blade 500, so surgeon's cutting nuclear matter during the rotating sharpener blade in the counterclockwise direction during the rotating sharpener blade and also in the clockwise direction.(reach clockwise and all depend on orientation counterclockwise).A kind of define clockwise mode will be when when cutter is inspected from the near-end of cutter molectron towards far-end.This will mate the mode that the surgeon will inspect the rotation of cutter handle.)

Although two-way is a kind of useful feature, be not that all cutter blades all must have cutting edge on two sides.Similarly, as discussed below, some cutter blades can have one type cutting edge and the cutter blade that has second type on second side on a side.Although for some cutter blades, on the top of cutter blade, (for example has blade edge, blade edge 512 and 524 among Figure 10) may be favourable, but some cutter blades may not have blade edge or may have the blade edge type that is different from distal part 542 and the nearly part 536 in tops 548 in described top.

Cutting tip 500 has gap 528 in closed circuit, this can allow cutter blade 500 to make material pass through described gap in intervertebral disc space 312 internal rotation.What this can add stock removal action reduces resistance to the cutter blade 500 that moves through intervertebral disc space 312 on the other hand simultaneously.Other cutter blade can have less gap or very close to each other at all between distal part and nearly part.As mentioned above, there is not enough big gap to obtain benefit by the cutter blade in the gap in the inner peripheral of closed circuit from closed circuit to allow material, if rupture for the cutter blade provides two junction points and cutter blade, provide at least one junction point from each part of cutter blade to cutter axle 410 because have the closed circuit that is connected to the cutter axle.

Cutter blade 500 can be described as has back slope so that cutting edge is placed away from outer circumference.Should note, although the blade edge on the cutter blade 500 504,508,512,516,520 and 524 is recessed to the inner rim 552 of closed circuit all the time, other cutter blade of seeking to avoid to damage cartilage or end plate can make blade edge be recessed to away from 556 places, neighboring of closed circuit but be not the inner rim 552 that is recessed to closed circuit all the time.For instance, blade edge can and can be recessed into to avoid damaging cartilage fully at the midway place between neighboring 556 and the inner rim 552.

Figure 11 shows the cross section of the cutter blade 500 with blade edge 508 and 520.Oblique angle 532 can be in the scopes of 15 to 80 degree, usually in the scopes of 15 to 40 degree, usually in the scopes of 20 to 35 degree and be 30 degree sometimes.

Two notions that Figure 12 and Figure 13 graphic extension are paid close attention to.Watch among Figure 12 cutter blade 600 and with its with before in Figure 10, discussed and in Figure 13 once more the cutter blade 500 of demonstration compare, a difference is that nearly blade edge 604 is roughly not parallel with the blade edge far away 608 in the cutter blade 600.The extension of two blade edges will engage and form the angle that is about 12 degree.This is opposite with the cutter blade 500 with the nearly blade edge 504 that is roughly parallel to blade edge 508 far away.

Figure 12 and 13 allows the feature of the cutter axle 410 that can see in Fig. 5 A and 5B is discussed.Cutter axle 610 is received into the longitudinal component of cutter blade 600 in the groove and can cutter blade 600 be pinned to cutter axle 610 about the mode that Fig. 5 A and 5B are discussed.Yet cutter axle 610 is different from cutter axle 410, because it does not have cutter axle extension 480.These cutter axle extensions 480 (being sometimes referred to as the target pillar) provide extra support for cutter blade 500.Particularly, may need this extra support for cutter blade with longer throw.

For some cutter blades, the cutter blade that particularly has shorter throw, may need along the cutter axle of the line of cutter axle 610, contact (referring to Fig. 8) with the cartilage 342 on the end plate 342 of avoiding making cutter axle extension 480 and vertebral body 304 far away.When using together, this risk may be properer with having cutter blade (the cutter blade of angles that for example, has 45 degree) less than the angles of 90 degree.

Second reason of using the cutter axle 610 do not have cutter axle extension 480 is to have to allow the needs that blade more can bending when using short throw cutter blade.In some instances, the extra bending of shorter throw cutter blade is believed to be helpful in the cutter blade and more effectively cuts.

Figure 14 is the far-end of cutter axle (for example, the cutter axle 610).Figure 15 be Figure 14 through enlarged detail.Figure 16 is the cross section of the far-end of cutter axle 610.Show the similar graphic of cutter axle 410 with cutter axle extension 480 among Figure 17-19.

Serrated blade

Although the cutter blade with the blade edge as shown in Figure 10 A-10C is effectively for the cutting nucleus material, in some cases, another blade type may be aspect the nucleus material of preparing Gong to remove more effective or effective percentage more.

Figure 20 A-20C shows three views of the cutter blade 704 of flat (blunt) side 712 that has a zigzag side 708 and be not intended for use to cut.Figure 20 A is a cutter blade birds-eye perspective of inspecting zigzag side 708.Figure 20 B is a front view of watching the cutter blade arm of longitudinal component 406 with cutter blade 704 and cutter blade aperture 407.Figure 20 C is the birds-eye perspective of flat sides 712.Saw tooth pattern is used circular sawtooth 716.

Figure 21 A-21C shows three views (this graphic cutter blade aperture or cutter insert groove that does not comprise as the focus on the crenellation pattern) of cutter blade 720.Equally, there are zigzag truncated sides 724 and non-truncated sides 728.The degrees of offset of the saw tooth pattern (sawtooth otch 742,744,746) on the inner peripheral of saw tooth pattern on the outer periphery of Figure 21 graphic extension closed circuit (sawtooth otch 732,734 and 736) and closed circuit.Figure 21 A-21C emphasizes that the saw tooth pattern at 750 places, cutter blade top is different from the saw tooth pattern in other places usually.

The counterclockwise side 768 that Figure 22 A-22C is presented at the clockwise side 764 of cutter blade 760 and cutter blade 760 has several views of the cutter blade 760 of zigzag cutting edge on both.Figure 22 B is the front view of cutter blade 760 that shows the cutter blade aperture 407 of longitudinal component 406.Saw tooth pattern is the continuous pattern (near be embodied in far respectively when cutter blade 760 (far) is cutter molectron a part of, in the context of cutter handle 416 (closely)) of the other end 780 on from the end 772 on the distal part of the cutter blade 760 on blade top 776 to the nearly part of cutter blade 760.Employed saw tooth pattern has double inclined plane on the cutter blade 760, so that the point of sawtooth tooth is near the center line of the material thickness that is used to make cutter blade 760.As shown in Figure 21, sawtooth is not circular sawtooth but has the triangle sawtooth of the pronunciation of forming for the sawtooth trench of " V " shape between described crown.In some instances, when the cutter blade with V-arrangement sawtooth trench moved with respect to nuclear matter, V-arrangement sawtooth trench can cause the localization of nuclear matter is compressed with respect to moving of nuclear matter, thereby pushes nuclear matter effectively.This effect can continue to help when mobile the sawtooth trench to clamp nuclear matter and facilitate the avulsion of nuclear matter from the cutter blade at the cutter blade, is preparing nuclear matter for the work when intervertebral disc space removes to strengthen the cutter blade.

The tooth pattern and bibeveled the formation on effect is each cutting tip at two faces of described both sides cutter blade that are shown in the various views that provided among Figure 22 A-22-C have the pyramidal a pair of cutting surface of a series of tetragons in fact, and wherein said pyramidal summit midway locating between the inner rim of the neighboring of closed circuit and closed circuit aimed at.

It is treated to be cut to the blade edge in the described blank before taking the closed circuit configuration to be understood by those skilled in the art that the cutter blade can have in flat blank.The blade that is understood by those skilled in the art that bit blank or has been shaped can need post-processing step to remove material by polishing or similar procedure.

Figure 23 and Figure 24 show the details of sawtooth being added to the flat blank that is fit to size.Figure 23 is the view of relevant portion of blank of having fined away before bending to the cutter blade shapes.

Figure 24 graphic extension is used for removing metal to form for example pattern of the saw tooth pattern shown in Figure 23 on each side of bit blank.Indicated as removable pattern right side, be removed and along with the described amount of the degree of depth that is cut in the bit blank reduces at the material of the top end 100% of bit blank.Angle at the reduction of this quantity of material that removes can be about about 20 degree.For helping to present visually the interaction between the described figure, will be used for indication that first material on (802,804,806 and 808) remove and show with being used for the indication that second material on (812,814,186,181,820,822) remove.In Figure 23, in bit blank, only show one group of sawtooth.This blade cut (rather than can cut on both clockwise and counterclockwise) when therefore, will only can rotate in one direction.

Figure 25 is similar to Figure 24, and it points out to wait to remove the material with the saw tooth pattern that forms the cutter blade.Figure 25 shows the example of trapezoidal saw tooth pattern 830.Each trapezoidal 834 has pair of parallel line (top is the end) and a pair of non-flat line.The trapezoid turning 838 that is cut in the bit blank can be circular, as shown here.As for the saw tooth pattern shown in Figure 24, the left back is offset in order to the material of the point that forms sawtooth tooth 842, so that crown on face and the trapezoid midpoint alignment on the opposite face.

In Figure 25 and in other saw tooth pattern in the present invention,, X the repetition of a pattern on a face repeated to combine with on opposite face X+1 time as a part that makes the staggered effort of crown.Be understood by those skilled in the art that for five trapezoid patterns are all aimed on same mid point with six trapezoid second patterns by removing trapezoidal 840 or add trapezoidal each side that realizes of vicinity to 844 and can have the trapezoid required interlaced pattern of similar number, changing into.

Figure 26 shows the example of the trapezoidal saw tooth pattern on the cutter blade 850.The saw tooth pattern of this type produces has aggressive serrated blade, wherein the sawtooth tooth between the outer periphery (for example, crown 862) of the inner peripheral (for example, crown 854) of closed circuit and closed circuit alternately.

Figure 27 A-27D shows the view of the bit blank 866 with trapezoidal saw tooth pattern 868.In this pattern 868, five trapezoidal is cut in the face of bit blank 866 and six trapezoidal being cut in the opposite face, wherein makes described pattern shift so that the trapezoid center line scheduling delegation on tooth on face and the opposite face.Be understood by those skilled in the art that to exist and exceed 5 trapezoidal and 6 trapezoid other configurations and increase that the trapezoid number that cuts will produce thinner tooth pattern on each side in order to the regular length of admitting saw tooth pattern.On the contrary, the trapezoidal number that reduces every side in order to the regular length of admitting saw tooth pattern will obtain thicker tooth pattern.In some cases, can be preferable over than the bastard pattern than the serration pattern.

As apparent when inspecting Figure 26, can cross over described cutting saw tooth pattern so that the trapezoid degree of depth changes and drops to zero from the full degree of depth of bit blank.The angle on this inclined-plane is about 20 degree, but can use other angle.

When the degree of depth be cut in the bit blank when forming the aggressivity crenellation pattern, can need not have the zigzag cutting edge (for example shown in Figure 10 A-10C) forms robust and durable cutter blade by not going up by cutting surface or provide at opposite side (cutter blade clockwise to counterclockwise side).This mix cutter blade (on the side be zigzag and on the opposite side right and wrong zigzag) need because it uses a cutter blade that two kinds of dissimilar stock removal actions (zigzag/tear action and section) are provided.

Figure 28 A-D shows that being cut in the bit blank 874 is 0.140 inch (3.5 millimeters) horizontal wide, 3 inches (76 millimeters) long and dark round tooth saw tooth pattern 870 of .025 inch (0.64 millimeter).Saw tooth pattern 870 is little more many than above some saw tooth pattern of discussing.

Figure 29 A-G shows the various views of cutter blade 880, and cutter blade 880 is to make by having the bit blank that is similar to the saw tooth pattern of saw tooth pattern 870 shown in Figure 28 A-D.Bit blank is crooked so that cutting edge is positioned on the neighboring 884.This layout will trend towards making cutter blade 880 to be more suitable in for fusion program preparing intervertebral disc space rather than the treatment procedure that does not need cartilage and end plate are bled (for example, provide the dynamic stability therapy, for example, motion holding device).Those skilled in the art will realize that direction by the dog-leg(bend) bit blank (and carry out necessary correction to the process that is used to add cutter blade aperture 407 and cutter insert groove 427), can use this bit blank to be produced on the cutter blade (not shown) that has the cutter edge on the inner peripheral 888 of cutter blade.This cutter blade can be suitable for using from the program that cartilage and end plate are bled not wanting.

Figure 30 shows the side view of the cutter blade 492 with 135 degree blade angle.Figure 31 shows the side view of the cutter blade 496 with 134 degree blade angle, and wherein the nearly part of cutter blade arm 402 is not parallel with the distal part of cutter blade arm 402.

Material is selected and other details

In the context of the present invention, term " biocompatible " if be meant when or physiological tissue contact or be exposed to (for example, the remains of wearing and tearing) material of the present invention and device and have chronic infection reaction or cytotoxicity.Except that biocompatibility, in another aspect of this invention, the material that preferably constitutes instrument is sterilizable; Visible and/or imageable, for example in the cryptoscope mode.

That cutter axle and cutter sheath are normally made by metal or metal alloy (for example, rustless steel) and can machined or injection moulding.

Because the dish among some patient is highly limited, for example, since herniae or the dish that subsided indicate fusion place, so preferably the cutter blade is built into extension, use and withdraw during have than low profile.

In one aspect of the invention, the separating distance between first and second cutting edge is that the variable that can control in the mill (that is, can be by to the preferred niti-shaped memorial alloy of pin joint (Nitinol for example ^TM) heat-treat and during the cutter blade forms, pre-determine).Separating distance between the cutting edge can change to about 8 millimeters from about 2 millimeters, and usually at about 3 millimeters to about 4 millimeters.Some cutter blades have streamline-shaped.Maximum separation distance between the cutting edge can be positioned at 1/3rd of the total blade lengths upwards the most outside about the footpath.Another selection is, maximum separation can be positioned the most inside diametrically blade lengths 1/3rd in or be positioned in the center of blade lengths, this depends on required deployment and cutting characteristic.

An aspect according to embodiment as herein described, cutter blade arm and cutter blade can be formed by the stripping that is marmem usually, preferably, described stripping has super-elasticity or Ovshinsky bulk phase and is having width and the thickness from about 0.015 inch (0.38 millimeter) to about 0.050 inch (1.3 millimeters) in from about 0.10 inch (2.5 millimeters) to about 0.20 inch (5 millimeters) scope under room temperature and the body temperature.The cutter blade arm that forms according to present embodiment can surpass the bending of 100 cycle-indexes does not usually have tangible shape loss, and can twist up to one and 1/2nd circles (about 540 spend) and can not rupture.This is with another part distortion with respect to the cutter blade of an end of cutter blade.

Shape memory characteristics is useful aspect following two: allow the cutter blade to recover extended position in shape memory, and described shape memory helps the cutter blade at the intervertebral disc space internal rotation and receive the uneven resistance of motion and recover its set shape after being out of shape.

In one embodiment, cutting tip and cutter blade edge are formed by the super-elastic shape memory metal alloy, and preferably, described super-elastic shape memory metal alloy represents biocompatibility and recover general shape when being tightened to 12%.A kind of approximate known suitable material that is used for the preferred biochemical specification of cutter blade and cutter blade edge and cutter blade arm is alloy (for example, the Ni of nickel and titanium _56-Ti ₄₅And other alloying element, by weight), for example, for instance, can be from Nitinol device and assembly company (Nitinol Devices andComponents, Inc.in Fremont, the Nitinol stripping #SE508 that CA) buys of the Freemont that is positioned at the California.This material represents roughly shape recovery fully (that is, when recover elongation when about 6%-10% is tightened up, this roughly is better than the recovery elongation of rustless steel under these strain levels).

The shape of formed cutter blade and length change at different cutting modes usually.Shape-memory material can follow thermal coagulation closely by alloy material being pinned to specific forming jig, the time-temperature process is formed in the required cutter blade configuration, and is as described below: titanium alloy band (with the cutting edge of the blade that has ground) is placed forming jig and uses bolted; And place baking oven (for example to reach between the time in the scope whole anchor clamps from about 15 to about 40 minutes, the optimal time of one of them anchor clamps is about 20 minutes), described temperature of oven between from about 500 ℃ in about 550 ℃ scope (for example, the Optimal Temperature of one of them anchor clamps is about 525 ℃).Be particularly suitable for being withdrawn in the axle sleeve by the formed in this way flexible cutter blade of Nitinol, and can extend into the right angle and enter into disk space.In addition, described flexible cutter blade can stand a large amount of machine cut " circulation " before breaking down.

The cutting tip edge is preferably ground in accurate and reproducible mode.The inclined surface of blade is spent between spending about 70 from about 5 usually with respect to the angle on the flat sides surface of blade, and about 20 spend in the scopes of about 50 degree usually.In one embodiment, blade angle is about 30 degree with respect to the side surface of blade.

In one aspect of the invention, disposing serrate cutter blade is to form with the optimal design profile by lead EDM (Electrical Discharge Machine processing) process.For higher manufacturing volume, the cutter blade is to grind via profile; The progressive die punching press; Machined or conventional EDM form.

In one embodiment, the axle of molectron is formed by solid rustless steel or other known suitable material.In one embodiment, described axle has the diameter of about 0.25 inch (6.3 millimeters).Cutter axle sheath can be formed by stainless steel bar or bar or other known suitable material pipe, and has the length of about 0.7 inch (17.8 millimeters).

As being understood by those skilled in the art that another selection is, some assembly of molectron of the present invention or adnexa can be by be fit to (for example, can be biocompatible; Sterilizable) polymeric material makes, and for instance, can be fit to or the situation of needs under be applied (for example, using PTFE) to reduce friction.

For instance, the cutter sheath can be made by the combination (for example, the polymer of UHMWPE, HDPE, PVDF, PTFE loading) of polymeric material, rustless steel or stainless steel pipe and low friction polymer cover.Described sheath has the external diameter (O.D.) of about 0.31 inch (7 millimeters) to about 0.35 inch (9 millimeters) usually.

Alternative method

Blade is appended to the alternative method of blade shaft.

In Figure 32 A-32B, cutter blade 453 is placed the axial trough 413 of the far-end 412 of cutter axle 410 by the rivet 429 that passes cutter insert groove 427 and cutter blade aperture (407, but invisible) herein and enter into cutter axis hole 411.When using rivet, do not need axle sleeve (comparing) with the element 418 among Fig. 5 A and the 5B.Figure 32 C shows that this fixing means can combine with above-mentioned target pillar feature.

Although above-mentioned closed circuit cutter blade has used the cutter blade aperture 407 on the longitudinal component of the nearly part that is directly connected to cutter blade arm most and has been directly connected to cutter insert groove 427 on the longitudinal component of distal part of cutter blade arm most, but be understood by those skilled in the art that and revise cutter blade and cutter axle with the cutter blade aperture on the longitudinal component that allows to use the distal part that is directly connected to cutter blade arm most and be directly connected to cutter insert groove on the longitudinal component of nearly part of cutter blade arm most, and this does not deviate from the spirit of teaching of the present invention.

Similarly, can revise above shown cutter blade and on two longitudinal components, have the hole, so that in case just can not do relative motion with respect to another axial component through longitudinal component of pin joint with the cutter blade that allows at least some types.Can use and not allow the attached selection of other non-pin that relatively moves.This alternative method will more depend on the ability that shape-memory material recovers designated shape, because can not move relative to each other so that described transformation is given a hand through the axial component of pin joint.

The cutter axle can be specifically designed to the specific cutter blade with particular blade angle and work.For instance, it may be favourable that the cutter axle is used for 45 degree blades, touches because this allows 45 degree blades to begin still to be coupling with cutter simultaneously with its downward angle.Another selection is, standard cutter axle can be used for a certain scope the cutter blade angle and will be after cutter blade and cutter axle disengage in the variation of cutter blade disposed blade angle.The combination of two kinds of strategies may need a kind of a little different cutter axle, and for example the attribute of 45 degree cutter axles and 90 degree cutter axles and use cutter blade provides the cutter blade angle through spreading range.

Described herein cutter molectron also can be used in combination with other method, and for example fluid power excision or laser (this only is two examples enumerating) is with operating part or perfect kernel excision, or promotes other tissue manipulation (for example, broken and/or extract).

Substitute handle

According to the aspect of embodiment as herein described, provide a kind of and be configured to (for instance) bar or grips for handguns and append to the handle of the near-end of cutter axle.With reference to Fig. 4 B, illustrated handle 416 appends to the near-end 414 of cutter axle 410 by cross pin or fixed screw, and this reduces the danger (because of getting loose that the slewing maneuver during the cutting causes) that handle and cutter axle 410 break away from.As described, preferably, handle 416 warps are additional so that it aims at and be used as the directed in situ reference marker of cutter blade arm to rotate localized mode with cutter blade arm.

Another selection is, the knob (not shown) of the handle configurations of cutter molectron for making by polymeric material, and append to the cutter axle by screw-threaded engagement or other engagement with cutter axle near-end, for instance, described polymer for example can be injection moldable and machinable abs polymer or similar polymer.

Rotary block

An aspect according to embodiment as herein described, provide through cutter blade arm and the cutter of design, promptly to go up rotation and to use in a direction (that is, clockwise or counterclockwise), cutter blade arm is rotatablely moving initial cut-out to nuclear matter on a direction (for example, clockwise) only.Use the set motion class during these blades to be similar to seesawing of windscreen wiper, wherein take place in the skimming in the clockwise direction with respect to the excision of these cutters.

In an embodiment (not shown), in the cutter axle, put one or more blocks with control blade radian or range of movement.In another embodiment (not shown), one or more blocks are assembled on the cutter sheath with control blade radian or range of movement.

Various tooth height

Produce the evenly pattern of the crown of height although the above example that provides uses, the those skilled in the art can revise pattern as example to form the pattern of some tooth depths in other teeth.

Tool kit

Form that can tool kit provides the various combinations of above-mentioned instrument and device, so that can obtain to carry out all required instruments of specific program in individual packaging.Can comprise the preparation tool bag that is used for required treatment region according to tool kit of the present invention, that is, have the preparation of coiling tools necessary.Pan Zhunbeigongjubao is different, and this depends on that it still is that the therapy of motion segment is prepared that described program is intended at one or more vertebral level.Pan Zhunbeigongjubao can comprise a plurality of cutters.In the single layer tools bag, the cutter and in one embodiment from 3 to 7 is provided probably, 5 cutters are provided.In two-layer tool kit, the cutter and in one embodiment from 5 to 14 can be provided probably, 10 cutters are provided.The cutter molectron will comprise the cutter blade of a kind.Described kind will be different, and this depends on pending specific program and may be based on patient's dissection (this can influence the scope of required cutter blade throw length).

Usually, tool kit will comprise and have the cutter molectron of path to cutter blade, medium radial cutter blade and big radial cutting device blade.Usually, tool kit also will comprise three above cutter molectrons, and its medium and small, medium and big cutter blade all has the blade angle of 45 degree.The tool kit that is used for specific program can comprise the cutter molectron that has at the specific cutter blade of special-purpose, for instance, comprise at having and be cut in below or the top end plate and cause the ability of bleeding in below or the top end plate and the cutter blade selected.All cutter blades all are disposable uses, that is, be droppable.Some included other assembly can droppablely maybe can re-use in the cutter molectron.

In addition, Pan Zhunbeigongjubao can comprise (according to circumstances) one or more tissue extractor that are used to remove fragment.In one deck tool kit, 3 to 8 tissue extraction instrument and in one embodiment is provided, 6 tissue extraction instruments are provided.In two-layer dish preparation tool bag, general tissue extraction instrument from about 8 to about 14 is provided, and in one embodiment, provides 12 tissue extraction instruments.Described tissue extraction instrument can be droppable.

Above-mentioned cutter has been described in the context that has used in intervertebral disc space.The attribute described that those skilled in the art will realize that the cutter that is disclosed can be used in other medical procedure, described other medical procedure by take at the cutter blade cutter blade wherein have shape memory through send before the extended position be in the sheath internal state the cutter blade to pass tube chamber near material to be cut (probably for removing before the treatment procedure subsequently).Those skilled in the art will realize that the size that may need to adjust cutter blade and associated component is to meet the relevant anatomy size and to be used to provide the size of the tube chamber of path.Although maintenance or scraping are coated with the vertebral body end plate (depending on required result) of cartilage possibly; but other anatomical structure that also may need protection is avoided damage or another selection of cutting edge; a part of preparing as the position needs described other anatomical structure of scraping, and therefore many specific teachings of the present invention are proper.

Those skilled in the art will realize that above some illustrated alternate embodiment be not repel fully mutually and in some cases, can form the extra embodiment of both or both the above aspect that adopts above-mentioned version.Similarly, the present invention is not limited to through providing in order to facilitate particular instance or the specific embodiment to the understanding of various teachings of the present invention.In addition, the scope of above claims covers the scope of version, modification and the alternative form of the assembly described herein that is understood by those skilled in the art that.

Claims (45)

1, a kind of cutter, it is used for destroying the material of two interbody spaces between the vertebral body end plate, described cutter is suitable for extending through the axial passage with cener line, and described axial passage comprises at least one vertebral body end plate and extends in the described interbody space

Described cutter comprises:

The cutter blade of making by shape-memory material;

First side surface on the described cutter blade, its described cutter blade be oriented when roughly being transverse to described cener line roughly in the described vertebral body end plate one;

Second side surface on the described cutter blade, itself and described first side surface are separated blade thickness;

Clockwise side on the described cutter blade, it is leading side when described cutter turns clockwise in described axial passage;

Counterclockwise side on the described cutter blade, it is the hangover side when described cutter turns clockwise in described axial passage; And

At least one cutting edge on described clockwise and in the counterclockwise side at least one.

2, a kind of for the cutter blade that uses in intervertebral disc space, described cutter blade is formed by shape-memory material and comprises:

First longitudinal component of described cutter blade, it has the cutter blade aperture that is used for described closed circuit cutter blade is attached to the cutter molectron;

Second longitudinal component, it has and is used for by there being groove to connect the cutter insert groove that will described second longitudinal component be connected to described cutter molectron, and described have groove to connect described second longitudinal component of permission to do narrow motion; And

Described closed circuit cutter blade can withdraw from the cutter sheath that constitutes a described cutter molectron part and extend.

3, closed circuit cutter blade as claimed in claim 2, the closed circuit cutter blade of wherein said extension defines closed circuit, described closed circuit is delimited when the closed circuit cutter blade of described extension is connected to described cutter molectron by the junction point that passes described first longitudinal component and described second longitudinal component, and described closed circuit has inner rim and neighboring.

4, closed circuit cutter blade as claimed in claim 3, wherein all cutting edges are all recessed from described neighboring.

5, closed circuit cutter blade as claimed in claim 3, wherein all cutting edges are all along the described inner peripheral of described closed circuit.

6, closed circuit cutter blade as claimed in claim 2, wherein said closed circuit cutter blade has two faces, first and second, so that when described closed circuit cutter blade is attached to the cutter molectron that rotates up in first party, described first face is that preceding guide face and described second face are trailing faces, and described closed circuit cutter blade has in cutting edge on described first at least a portion and the blunt side on described second.

7, closed circuit cutter blade as claimed in claim 2, wherein said closed circuit cutter blade has two faces, first and second, so that when described closed circuit cutter blade is attached to the cutter molectron that rotates up in first party, described first face is that preceding guide face and described second face are trailing faces, and described closed circuit cutter blade has at the cutting edge on described first at least a portion and has cutting edge on described second at least a portion.

8, closed circuit cutter blade as claimed in claim 7, the described cutting edge on wherein said first use the described cutting edge on zigzag cutting edge with first pattern and described second to be different from described cutting edge on described first.

9, closed circuit cutter blade as claimed in claim 7, the described cutting edge on wherein said first use the described cutting edge on zigzag cutting edge with first pattern and described second to use the zigzag cutting edge with the pattern that is different from described first pattern.

10, closed circuit cutter blade as claimed in claim 7, the described cutting edge on wherein said first use the described cutting edge on zigzag cutting edge and described second not use the zigzag cutting edge.

11, closed circuit cutter blade as claimed in claim 21, wherein said closed circuit cutter blade has two faces, first and second, so that when described closed circuit cutter blade is attached to the cutter molectron that rotates up in first party, described first face is that preceding guide face and described second face are trailing faces, and described closed circuit cutter blade has the cutting edge on described first at least a portion, and the described cutting edge on described first is formed by pattern on the counterpart of the described inner peripheral that is applied to described first a described part and described closed circuit and the repetition that is applied to the described pattern on the counterpart of described outer periphery of described first part and described closed circuit.

12, closed circuit cutter blade as claimed in claim 2, wherein said closed circuit cutter blade has two faces, first and second, so that when described closed circuit cutter blade is attached to the cutter molectron that rotates up in first party, described first face is that preceding guide face and described second face are trailing faces, and cutting edge and described first mask that described closed circuit cutter blade has on described first at least a portion have a series of tetragon pyramids, and wherein said pyramidal summit is located in alignment with the pact between the described inner rim of the described neighboring of described closed circuit and described closed circuit midway.

13, closed circuit cutter blade as claimed in claim 2, wherein said closed circuit be included on the nearly part of described cutter blade cutting edge and in being in described extended position the time the described near part of described cutting tip and the angle between described first longitudinal component between about 25 degree are spent with about 90.

14, closed circuit cutter blade as claimed in claim 2, wherein said closed circuit be included on the nearly part of described cutter blade cutting edge and in being in described extended position the time the described near part of described cutting tip and the angle between described first longitudinal component between about 90 degree are spent with about 155.

15, closed circuit cutter blade as claimed in claim 2, wherein said closed circuit be included on the nearly part of described cutter blade cutting edge and in being in described extended position the time the described near part of described cutting tip and the angle between described first longitudinal component between about 80 degree are spent with about 100.

16, a kind of described closed circuit cutter blade has the shape memory of extended position for the closed circuit cutter blade that uses in intervertebral disc space, and described closed circuit cutter blade has:

Inner surface, it forms at least a portion of the inner rim of described closed circuit;

Outer surface, it forms at least a portion of the neighboring of described closed circuit;

First, it is on the outside of described closed circuit cutter blade and between described inner surface and described outer surface, when described closed circuit cutter blade be attached to the cutter molectron and around the long axis of described cutter molectron when first party rotates up, described first is preceding guide face;

Second, it is on the described outside of described closed circuit cutter blade and between described inner surface and described outer surface, when described closed circuit cutter blade be attached to the cutter molectron and around the described long axis of described cutter molectron when described first party rotates up, described second is trailing face; And

Described first at least a portion has the cutting edge that has one group of sawtooth.

17, closed circuit cutter blade as claimed in claim 16, wherein said first mask have the first group of sawtooth that extends in the described outer surface and extend to second group of sawtooth in the described inner surface.

18, closed circuit cutter blade as claimed in claim 17, wherein first group of sawtooth has sawtooth crown and described second group of sawtooth and has not and the described first group aligned sawtooth crown of described sawtooth crown.

19, closed circuit cutter blade as claimed in claim 18, wherein said first group of sawtooth have saw tooth pattern that saw tooth pattern and described second group of sawtooth have identical but skew so that described crown misalignment.

20, closed circuit cutter blade as claimed in claim 18, wherein said first group of sawtooth have first saw tooth pattern and described second group of sawtooth have be different from described first saw tooth pattern and skew second saw tooth pattern so that described crown misalignment.

21, closed circuit cutter blade as claimed in claim 18, wherein said first mask has at the trench between the sawtooth tooth on sawtooth tooth on the described outer surface and the described inner surface.

22, closed circuit cutter blade as claimed in claim 21, wherein said trench comprises the V that is formed by acute angle.

23, closed circuit cutter blade as claimed in claim 16, wherein said group of sawtooth comprises circular sawtooth.

24, closed circuit cutter blade as claimed in claim 16, wherein said group of sawtooth comprises the circular sawtooth of cutting sth. askew.

25, closed circuit cutter blade as claimed in claim 16, wherein said group of sawtooth comprises one group of polygon.

26, closed circuit cutter blade as claimed in claim 16, wherein said group of sawtooth comprise one group trapezoidal.

27, closed circuit cutter blade as claimed in claim 16, wherein said group of sawtooth are to form to cross over described first angle cutting so that the degree of depth of described sawtooth between from described first thickness in zero scope.

28, a kind of cutter, it is used for destroying the material of the interbody space between epicentral end plate far away and the nearly epicentral end plate, the bore hole extension that described cutter is suitable for passing along axis navigates in the described interbody space with the end with described cutter, wherein this axis extends through described at least nearly vertebral body, and described cutter comprises:

The cutter axle;

The cutter sheath, it is around at least a portion of described cutter axle;

The cutter blade; The described cutter of described cutter is configured to be withdrawn in the described cutter sheath and from described cutter sheath and extends, described cutter blade has the shape memory of described extended position, and the cutter blade of described extension is transverse to the long axis of described cutter axle significantly;

Distal surface on the described cutter blade, it is suitable for when described cutter blade extends in the described interbody space than more approaching described epicentral described end plate far away to described nearly epicentral described end plate on the side of the cutter blade of described extension;

Proximal face on the described cutter blade, it is suitable for when described cutter blade extends in the described interbody space than more approaching described nearly epicentral described end plate to described epicentral described end plate far away on the side of the cutter blade of described extension;

First edge on the described cutter blade, the described long axis that its cutter blade in described extension centers on described cutter axle will be the preceding limb of described cutter blade when first party rotates up;

Second edge on the described cutter blade, the described long axis that its cutter blade in described extension centers on described cutter axle will be the described preceding limb of described cutter blade when second party rotates up, and described second direction is opposite with described first direction; And

At least one cutting edge in described first or second edge at least one, described cutting edge are with respect to the described distal surface of described cutter blade and be recessed into.

29, cutter as claimed in claim 28, wherein said cutting edge are with respect to the described proximal face of described cutter blade and be recessed into.

30, cutter as claimed in claim 28, wherein said cutter blade comprises the extended loop of a part from the described cutter blade that is connected to described cutter axle, so that comprising the second portion of described distal surface and described loop, the first of described loop comprises described proximal face, described loop also comprises the loop top that connects described first and described second portion, and described loop defines open region so that the described long axis that centers on described cutter axle when described cutter blade is when rotating.

31, cutter as claimed in claim 28, wherein said cutter blade comprises the extended loop of a part from the described cutter blade that is connected to described cutter axle, so that comprising the second portion of described distal surface and described loop, the first of described loop comprises described proximal face, described loop also comprises the loop top that connects described first and described second portion, described loop defines open region so that when described cutter blade during around the described long axis rotation of described cutter axle, material can be by described open region.

32, cutter as claimed in claim 28, the cutter blade of described extension that wherein is transverse to the described long axis of described cutter axle significantly are oriented to leave the described long axis about 25 of described cutter axle and spend between about 155 degree.

33, cutter as claimed in claim 28, the distal part of wherein said cutter blade are roughly parallel to the nearly part of described cutter blade.

34, cutter as claimed in claim 28, the extension of the described nearly part of the extension of the described distal part of wherein said cutter blade and described cutter blade intersect to form acute angle.

35, cutter as claimed in claim 28, the cutting edge on described first edge of wherein said cutter blade is zigzag.

36, cutter as claimed in claim 35, it is roughly the same that wherein the cutter blade has the height of a series of teeth and described tooth.

37, cutter as claimed in claim 35, wherein the cutter blade has a series of teeth, and wherein one group of tooth has first tooth height and one group of tooth has second tooth height, and described second tooth height is greater than described first tooth height.

38, cutter as claimed in claim 35, wherein the cutter blade has saw tooth pattern, and the trench of wherein said saw tooth pattern has acute angle.

39, cutter as claimed in claim 35, wherein said distal surface engages by the loop top with described proximal face, so that described cutter has along the vertical saw tooth pattern of described loop with the cutting edge that is on first edge that cutter blade in the extended position forms closed circuit and described cutter blade, described saw tooth pattern is different from the described saw tooth pattern that exists on the another part at described first edge.

40, cutter as claimed in claim 35, the cutting edge on described second edge of wherein said cutter blade is not zigzag.

41, a kind of cutter, it is used for destroying the material of the interbody space between epicentral end plate far away and the nearly epicentral end plate, described cutter is suitable for extending through axial bore along the axis that extends through described at least nearly vertebral body end plate and navigates in the described interbody space with the end with described cutter, and described cutter comprises:

The cutter axle, it has long axis;

The cutter sheath, it is around at least a portion of described cutter axle;

The cutter blade; The described cutter of described cutter is configured to be withdrawn in the described cutter sheath and from described cutter sheath and extends, and described cutter blade generally is transverse to the described long axis of described cutter axle and extends;

Distal surface on the described cutter blade on the side of the cutter blade of its described extension, is being suitable for when described cutter blade extends in the described interbody space than more approaching described epicentral described end plate far away to described nearly epicentral described end plate;

Proximal face on the described cutter blade, on the side of the extension cutter blade of its described insertion, when extending in the described interbody space, described cutter blade is being suitable for than more approaching described nearly epicentral described end plate to described epicentral described end plate far away;

Described distal surface engages by the loop top with described proximal face, so that described cutter and cutter blade form closed circuit in extended position; And

Described cutter axle has the extension, is arranged in described cutter axle extension so that generally be transverse to the part of extension cutter blade of the described long axis of described cutter axle.

42, a kind of spatial tool kit of treatment procedure preparing intervertebral disc that is used to, described tool kit comprises:

The cutter molectron, it has the radial cutting device blade of the first throw length;

The cutter molectron, it has less than the blade angle of 90 degree and the cutter blade of the described first throw length;

The cutter molectron, it has the radial cutting device blade of the second throw length of being longer than the described first throw length; And

The cutter molectron, it has less than the blade angle of 90 degree and the cutter blade of the described second throw length.

43, tool kit as claimed in claim 42, it comprises:

The cutter molectron, it has the radial cutting device blade of the 3rd throw length of being longer than the described second throw length; And

The cutter molectron, it has less than the blade angle of 90 degree and the cutter blade of described the 3rd throw length.

44, tool kit as claimed in claim 42, the described blade angle of wherein said cutter molectron are about 45 degree, and described cutter molectron has less than the blade angle of 90 degree and the cutter blade of the described first throw length.

45, a kind of described in description and reference diagram and illustrated invention.

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