Methods and apparatus for performing therapeutic procedures in the spine

• US 20010049527A1
• Filed: 02/13/2001
• Published: 12/06/2001
• Est. Priority Date: 02/16/2000
• Status: Active Grant

• Current Assignee: Mis Ip Holdings LLC
• Original Assignee: TranS1 Incorporated (Baxano Surgical, Inc.)
• Inventors: Cragg, Andrew H.
• Granted Patent: US 6,558,390 B2
• Time in Patent Office: Days
• US Class Current: 606/61
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 takes precedence
• CPC Class Codes: A61B 17/70 Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
• CPC Class Codes: A61B 17/7055 connected to sacrum, pelvis or skull
• CPC Class Codes: A61B 17/7061 for stabilising vertebrae or discs by improving the condition of their tissues, e.g. using implanted medication or fluid exchange intraosseous injection devices A61B17/3472
• CPC Class Codes: A61B 17/7097 Stabilisers comprising fluid filler in an implant, e.g. balloon; devices for inserting or filling such implants disc prostheses made of inflatable chambers or pockets filled with fluid A61F2/441; replacing the nucleus pulposus A61F2002/444
• CPC Class Codes: A61B 17/7098 wherein the implant is permeable or has openings, e.g. fenestrated screw hollow surgical screws A61B17/864
• CPC Class Codes: A61B 17/8811 characterised by the introducer tip, i.e. the part inserted into or onto the bone
• CPC Class Codes: A61B 17/8819 characterised by the introducer proximal part, e.g. cannula handle, or by parts which are inserted inside each other, e.g. stylet and cannula A61B17/8825 takes precedence
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00734 battery operated
• CPC Class Codes: A61B 2017/00867 shape memory effect
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/320733 with a flexible cutting or scraping element, e.g. with a whip-like distal filament member
• CPC Class Codes: A61F 2/30723 Plugs or restrictors for sealing a cement-receiving space tools for inserting plugs A61F2/4614; sealing collars for use during cementing A61B17/8808
• CPC Class Codes: A61F 2/441 made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
• CPC Class Codes: A61F 2/442 Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2/4455 : for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages intervertebral discs A61F2/442
• CPC Class Codes: A61F 2/4465 : having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine
• CPC Class Codes: A61F 2/4601 : for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• CPC Class Codes: A61F 2/4611 : of spinal prostheses
• CPC Class Codes: A61F 2002/2821 : Bone stimulation by electromagnetic fields or electric current for enhancing ossification
• CPC Class Codes: A61F 2002/2835 : Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30092 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2002/30291 : spirally-coiled, i.e. having a 2D spiral cross-section
• CPC Class Codes: A61F 2002/3055 : for adjusting length
• CPC Class Codes: A61F 2002/30563 : having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
• CPC Class Codes: A61F 2002/30566 : Helical springs
• CPC Class Codes: A61F 2002/30593 : hollow
• CPC Class Codes: A61F 2002/30677 : Means for introducing or releasing pharmaceutical products, e.g. antibiotics, into the body
• CPC Class Codes: A61F 2002/30774 : internally-threaded
• CPC Class Codes: A61F 2002/30841 : Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
• CPC Class Codes: A61F 2002/3085 : with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
• CPC Class Codes: A61F 2002/30879 : Ribs
• CPC Class Codes: A61F 2002/30884 : Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
• CPC Class Codes: A61F 2002/30892 : parallel
• CPC Class Codes: A61F 2002/30925 : etched
• CPC Class Codes: A61F 2002/3097 : using laser
• CPC Class Codes: A61F 2002/448 : comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants
• CPC Class Codes: A61F 2002/4627 : with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: A61F 2210/0014 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2230/0091 : helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
• CPC Class Codes: A61F 2310/00353 : Bone cement, e.g. polymethylmethacrylate or PMMA
• CPC Class Codes: A61N 5/1027 : Interstitial radiation therapy
• CPC Class Codes: Y10S 606/907 : Composed of particular material or coated
• CPC Class Codes: Y10S 606/908 : Bioabsorbable material
• CPC Class Codes: Y10S 606/909 : Bone
• CPC Class Codes: Y10S 606/91 : Polymer
• CPC Class Codes: Y10S 606/912 : Radiolucent material

Abstract

Methods and apparatus for forming one or more trans-sacral axial instrumentation/fusion (TASIF) axial bore through vertebral bodies in general alignment with a visualized, anterior or posterior axial instrumentation/fusion line (AAIFL or PAIFL) in a minimally invasive, low trauma, manner and providing a therapy to the spine employing the axial bore. Anterior or posterior starting positions aligned with the AAIFL or PAIFL are accessed through respective anterior and posterior tracts. Curved or relatively straight anterior and curved posterior TASIF axial bores are formed from the anterior and posterior starting positions. The therapies performed through the TASIF axial bores include discoscopy, full and partial discectomy, vertebroplasty, balloon-assisted vertebroplasty, drug delivery, electrical stimulation and various forms of spinal disc cavity augmentation, spinal disc replacement, fusion of spinal motion segments and implantation of radioactive seeds. Axial spinal implants and bone growth materials can be placed into single or multiple parallel or diverging TASIF axial bores to fuse two or more vertebrae, or distract or shock absorb two or more vertebrae.

Claims

1. A method for performing a therapeutic procedure of a one or more vertebral body or any intervertebral spinal disc normally formed of a nucleus and annulus and separating adjacent vertebral bodies of a human spine, the method comprising:

accessing an anterior sacral position of a sacral vertebral body;

from the accessed anterior sacral position, forming a trans-sacral axial bore cephalad and axially through at least the caudal sacral vertebra and through or into one or more cephalad vertebral bodies of said series of adjacent vertebral bodies and through or into an intervertebral, spinal disc; and

performing a therapeutic procedure in one or both of a vertebral body or spinal disc located within a human spine accessed through the trans-sacral axial bore.

2. The method of

claim 1

, wherein

the bore forming step comprises boring a curved anterior axial bore aligned with said anterior axial instrumentation/fusion line cephalad through the vertebral bodies of said series of adjacent vertebrae and any intervertebral, spinal discs, the anterior axial bore having a bore curvature in the posterior-anterior plane of the spine.

3. The method of

claim 2

, wherein the step of performing a therapeutic procedure comprises implanting an axial spinal implant into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body.

4. The method of

claim 1

, wherein the step of performing a therapeutic procedure comprises implanting an axial spinal implant into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body.

5. The method of

claim 1

, wherein:

the bore forming step comprises boring the axial bore through a caudal vertebral body, an intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc; and

the step of performing a therapeutic procedure comprises;

implanting a spinal disc implant having a through-hole within the intervertebral disc space traversed by the axial bore with the through-hole aligned with the axial bore; and

implanting an axial spinal implant into said axial bore to extend cephalad through the caudal vertebral body, through the through-hole and into or through the cephalad vertebral body.

6. The method of

claim 5

, wherein at least one of the spinal disc implant and the axial spinal implant are formed of bone growth materials that promote the fusion of the cephalad and caudal vertebral bodies

7. The method of

claim 1

, wherein the step of performing a therapeutic procedure comprises implanting a bone growth material into the axial bore and into cancellous bone of a vertebral body penetrated by the axial bore.

8. The method of

claim 1

, wherein the step of performing a therapeutic procedure comprises:

implanting an axial spinal implant into the axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body and through any intervertebral, spinal discs; and

implanting a bone growth material into the axial bore along with the axial spinal implant.

9. The method of

claim 1

, wherein:

the bore forming step comprises boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the step of performing a therapeutic procedure comprises performing a discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus leaving a disc cavity enclosed by the annulus.

10. The method of

claim 1

, wherein:

the bore forming step comprises boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the step of performing a therapeutic procedure comprises;

performing a partial discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus leaving a disc cavity enclosed by the annulus; and

inserting an augmentation device or material through said disc opening into the disc cavity.

11. The method of

claim 1

, wherein:

the bore forming step comprises boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the step of performing a therapeutic procedure comprises performing a discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus and annulus of the spinal disc leaving a disc space.

12. The method of

claim 1

, wherein:

the bore forming step comprises boring a trans-sacral axial bore exposing cancellous bone of a fractured vertebral body; and

the step of performing a therapeutic procedure comprises performing a vertebroplasty of the fractured vertebral body through the axial bore to repair damage and strengthen the fractured vertebral body.

13. The method of

claim 12

, wherein the vertebroplasty performing step comprises the steps of:

extending a vertebroplasty catheter having a vertebroplasty catheter lumen through said axial bore and laterally into cancellous bone of the damaged vertebral body exposed by said axial bore; and

injecting a vertebral body reinforcing material for reinforcing the vertebral body into cancellous bone within the vertebral body and filling the axial bore extending into the fractured vertebral body.

14. The method of

claim 1

, wherein:

the bore forming step comprises the step of boring a trans-sacral axial bore exposing cancellous bone of a fractured vertebral body; and

the step of performing a therapeutic procedure comprises the step of performing a balloon-assisted vertebroplasty of the fractured vertebral body through the axial bore to repair damage and strengthen the fractured vertebral body.

15. The method of

claim 14

, wherein the balloon-assisted vertebroplasty performing step comprises the steps of:

extending a balloon catheter having a balloon catheter lumen and bearing a deflated balloon through said axial bore to locate the deflated balloon in relation to cancellous bone of the damaged vertebral body exposed by said axial bore;

inflating the balloon of the balloon catheter through the balloon catheter lumen to apply force to cancellous bone and compress cancellous bone to form a vertebral body cavity;

deflating the balloon; and

injecting a vertebral body reinforcing material for reinforcing the vertebral body into one of the vertebral body cavity and cancellous bone within the vertebral body or into the deflated balloon.

16. The method of

claim 1

, wherein the step of performing a therapeutic procedure comprises the steps of:

introducing a medical electrical stimulation lead into the trans-sacral axial bore and locating electrical stimulation electrodes of the electrical stimulation lead in relation to a spinal structure of interest for electrical stimulation; and

applying electrical stimulation to the spinal structure of interest through the electrical stimulation lead and from the stimulation electrodes.

17. The method of

claim 1

, wherein the step of performing a therapeutic procedure comprises the steps of:

introducing a drug delivery catheter having a drug delivery lumen and at least one drug delivery port into the trans-sacral axial bore and locating each drug delivery port in relation to a spinal structure of interest to be treated; and

delivering a drug to the structure of interest through the drug delivery lumen and the drug delivery port.

18. The method of

claim 1

, wherein the step of performing a therapeutic procedure comprises implanting a shock absorbing axial spinal implant into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body.

19. The method of

claim 1

, wherein the step of performing a therapeutic procedure comprises implanting a distracting axial spinal implant into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body.

20. The method of

claim 1

, wherein:

the bore forming step comprises boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the step of performing a therapeutic procedure comprises introducing a discectomy instrument through the axial bore and disc opening and performing a discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus leaving a disc cavity enclosed by the annulus.

21. The method of

claim 20

, wherein the discectomy instrument has a discectomy instrument fragmentation head and an aspiration lumen with an aspiration lumen opening, and the discectomy performing step comprises the steps of:

positioning the fragmentation head and aspiration lumen opening in operative relation to the nucleus;

operating the fragmentation head to fragment the nucleus to form the disc cavity; and

aspirating the nucleus fragments through the discectomy instrument aspiration lumen.

22. The method of

claim 20

, wherein the discectomy instrument has a discectomy instrument energy emitting head and an aspiration lumen with an aspiration lumen opening, and the discectomy performing step comprises the steps of:

positioning the energy emitting head and aspiration lumen opening in operative relation to the nucleus;

operating the energy emitting head to desiccate the nucleus to form the disc cavity; and

aspirating byproducts of desiccation through the discectomy instrument aspiration lumen.

23. The method of

claim 1

, wherein the step of performing a therapeutic procedure comprises the step of implanting at least one radiation emitting implant to a selected site in relation to a sarcoma through the TASIF axial bore.

24. The method of

claim 1

, wherein:

the bore forming step comprises boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the step of performing a therapeutic procedure comprises performing a discectomy of the intervertebral spinal disc accessed by the axial bore through the axial bore and disc opening to remove all or substantially all of the disc body and leaving a disc space between the vertebral bodies or at least a portion of the nucleus and leaving a disc cavity within the annulus.

25. The method of

claim 24

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument to the accessed sacral position and through said axial bore and disc opening to the interior of the spinal disc; and

operating the discectomy instrument to remove at least a portion of the nucleus to form a disc cavity within the annulus and between the caudal and cephalad vertebral body endplates.

26. The method of

claim 24

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument to the accessed sacral position and through said axial bore and disc opening to the interior of the spinal disc; and

operating the discectomy instrument to remove at least a portion of the the caudal and cephalad cartilaginous endplates to form an open disc space or disc cavity between the caudal and cephalad vertebral body endplates.

27. The method of

claim 24

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument to the accessed sacral position and through said axial bore and disc opening to the interior of the spinal disc; and

operating the discectomy instrument to remove at least a portion of the caudal and cephalad cartilaginous endplates and a portion of the caudal and cephalad vertebral body end plates to form an open disc space or disc cavity extending axially into cancellous bone of the caudal and cephalad vertebral bodies.

28. The method of

claim 24

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument having a discectomy instrument fragmentation head and an aspiration lumen with an aspiration lumen opening through said axial bore locating the fragmentation head and aspiration lumen opening within the spinal disc opening;

operating the fragmentation head to fragment portions or substantially all of the disc body to form the disc space or disc cavity; and

aspirating disc body fragments through the discectomy instrument aspiration lumen.

29. The method of

claim 24

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument having a discectomy instrument energy emitting head and an aspiration lumen with an aspiration lumen opening through said axial bore locating the energy emitting head and aspiration lumen opening within the spinal disc opening;

operating the energy emitting head to desiccate portions of or substantially all of the disc body to form the disc space or disc cavity; and

aspirating byproducts of desiccation through the discectomy instrument aspiration lumen.

30. A method for performing a therapeutic procedure of an intervertebral spinal disc of a human spine, the spinal disc having a disc body comprising caudal and cephalad cartilaginous endplates adhered to the respective opposed endplates of adjacent caudal and cephalad vertebral bodies and joined together by a disc annulus and enclosing a disc nucleus, the method comprising the steps of:

accessing one of an anterior or posterior sacral position of a sacral vertebral body;

from the accessed sacral position, boring a curved trans-sacral axial bore cephalad and axially through at least the caudal sacral vertebra and through or into one or more cephalad vertebral bodies of said series of adjacent vertebral bodies and through or into at least one intervertebral spinal disc, thereby forming an axial disc opening; and

performing a discectomy of the intervertebral spinal disc accessed by the axial bore through the axial bore and disc opening to remove all or substantially all of the disc body and leaving a disc space between the vertebral bodies or at least a portion of the nucleus and leaving a disc cavity within the annulus.

31. The method of

claim 30

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument to the accessed sacral position and through said axial bore and disc opening to the interior of the spinal disc; and

operating the discectomy instrument to remove at least a portion of the nucleus to form a disc cavity within the annulus and between the caudal and cephalad vertebral body endplates.

32. The method of

claim 30

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument to the accessed sacral position and through said axial bore and disc opening to the interior of the spinal disc; and

operating the discectomy instrument to remove at least a portion of the the caudal and cephalad cartilaginous endplates to form an open disc space or disc cavity between the caudal and cephalad vertebral body endplates.

33. The method of

claim 30

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument to the accessed sacral position and through said axial bore and disc opening to the interior of the spinal disc; and

operating the discectomy instrument to remove at least a portion of the caudal and cephalad cartilaginous endplates and a portion of the caudal and cephalad vertebral body end plates to form an open disc space or disc cavity extending axially into cancellous bone of the caudal and cephalad vertebral bodies.

34. The method of

claim 30

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument having a discectomy instrument fragmentation head and an aspiration lumen with an aspiration lumen opening through said axial bore locating the fragmentation head and aspiration lumen opening within the spinal disc opening;

operating the fragmentation head to fragment portions or substantially all of the disc body to form the disc space or disc cavity; and

aspirating disc body fragments through the discectomy instrument aspiration lumen.

35. The method of

claim 30

, wherein the step of performing a discectomy comprises the steps of:

extending a discectomy instrument having a discectomy instrument energy emitting head and an aspiration lumen with an aspiration lumen opening through said axial bore locating the energy emitting head and aspiration lumen opening within the spinal disc opening;

operating the energy emitting head to desiccate portions of or substantially all of the disc body to form the disc space or disc cavity; and

aspirating byproducts of desiccation through the discectomy instrument aspiration lumen.

36. A method for providing access to and performing a discectomy and disc augmentation of at least one intervertebral spinal disc separating caudal and distal vertebral bodies located within a human spine, the method comprising the steps of:

accessing a sacral position of a sacral vertebral body;

from the accessed sacral position, boring a trans-sacral axial bore extending cephalad and axially through a vertebral body caudal to a spinal disc and making an axial disc opening into the nucleus of the spinal disc;

excising at least a portion of the nucleus of a spinal disc from the interior of the spinal disc accessed by the axial bore and disc opening to form a disc cavity; and

positioning an augmentation device or material through said disc opening into the disc cavity.

37. The method of

claim 36

, further comprising the step of closing one or more of the disc opening and the trans-sacral axial bore to maintain the disc augmentation device or material within the disc cavity.

38. The method of

claim 36

, wherein the positioning step comprises delivering disc augmentation material or device selected from the group consisting of bone growth materials, biomaterials, and spinal disc replacement devices into the disc cavity.

39. The method of

claim 38

, further comprising the step of closing one or more of the disc opening and the trans-sacral axial bore to maintain the disc augmentation device or material within the disc cavity.

40. The method of

claim 36

, wherein the positioning step comprises delivering disc augmentation materials selected from a biomaterial that cures in situ in the disc cavity.

41. The method of

claim 40

, further comprising the step of closing one or more of the disc opening and the trans-sacral axial bore to maintain the disc augmentation device or material within the disc cavity.

42. The method of

claim 36

, wherein the positioning step comprises delivering a planar spiral disc augmentation device into the disc cavity.

43. The method of

claim 36

, wherein the positioning step comprises extending a deflated envelope through said axial bore and disc opening into the disc cavity with an envelope opening accessible through the disc opening;

and

filling and inflating the deflated envelope with an augmentation material.

44. The method of

claim 43

, wherein the filling and inflating step comprises delivering a planar spiral disc augmentation device formed of a strip of resilient material having a planar spiral shape when unrestrained into the disc space by:

straightening and advancing the strip of resilient material through the axial bore and the disc opening; and

releasing the strip of resilient material in the disc cavity to assume a planar spiral shape between the vertebral endplates.

45. The method of

claim 43

, wherein the filling and inflating step comprises delivering disc augmentation materials and devices selected from the group consisting of bone growth materials, biomaterials and spinal disc replacement devices introduced into the deflated envelope.

46. The method of

claim 43

, wherein the filling and inflating step comprises delivering disc augmentation materials selected from biomaterials that cure in situ in the envelope.

47. The method of

claim 43

, further comprising the step of closing one or more of the balloon opening, the disc opening, and the trans-sacral axial bore to maintain the disc augmentation device or material within the disc cavity.

48. The method of

claim 36

, further comprising the step of implanting an axial spinal implant into said axial bore to extend cephalad through at least one caudal vertebral body and into the disc opening.

49. The method of

claim 36

, wherein:

the bore forming step comprises boring the axial bore through the caudal vertebral body, the intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc;

the positioning step comprises implanting a spinal disc implant having a through-hole within the intervertebral disc space traversed by the axial bore with the through-hole aligned with the axial bore; and

further comprising;

implanting an axial spinal implant into said axial bore to extend cephalad through the caudal vertebral body, through the through-hole and into or through the cephalad vertebral body.

50. The method of

claim 36

, wherein the excising step comprises introducing a discectomy instrument through the axial bore and disc opening and performing a discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus leaving a disc cavity enclosed by the annulus.

51. The method of

claim 50

, wherein the discectomy instrument has a discectomy instrument fragmentation head and an aspiration lumen with an aspiration lumen opening, and the discectomy performing step comprises the steps of:

positioning the fragmentation head and aspiration lumen opening in operative relation to the nucleus;

operating the fragmentation head to fragment the nucleus to form the disc cavity; and

aspirating the nucleus fragments through the discectomy instrument aspiration lumen.

52. The method of

claim 50

, wherein the discectomy instrument has a discectomy instrument energy emitting head and an aspiration lumen with an aspiration lumen opening, and the discectomy performing step comprises the steps of:

positioning the energy emitting head and aspiration lumen opening in operative relation to the nucleus;

operating the energy emitting head to desiccate the nucleus to form the disc cavity; and

aspirating byproducts of desiccation through the discectomy instrument aspiration lumen.

53. A method for providing access to and performing a complete discectomy of at least one spinal disc separating vertebral bodies located within a human spine, the method comprising the steps of:

accessing a sacral position of a sacral vertebral body;

from the accessed sacral position, boring a trans-sacral axial bore extending cephalad and axially through the vertebral bodies of said series of adjacent vertebral bodies and through or into at least one intervertebral spinal disc, thereby forming an axial disc opening;

performing a discectomy through said axial bore and disc opening to remove at least a portion of both the annulus and nucleus of the disc accessed by the axial bore and leaving a disc space; and

delivering a disc replacement material or device through the axial bore and into the disc space.

54. The method of

claim 53

, wherein the delivering step further comprises delivering a disc replacement material or device selected from the group consisting of bone growth materials, biomaterials, and functional spinal disc replacement devices.

55. The method of

claim 53

, wherein the delivering step further comprises the step of inserting an axial spinal implant into the axial bore extending into the disc space to retain the disc replacement material or device in place.

56. The method of

claim 53

, wherein the delivering step further comprises delivering a planar spiral disc augmentation device formed of a strip of resilient material having a planar spiral shape around a through-hole into the disc space by:

straightening and advancing the strip of resilient material through the axial bore into the disc space; and

releasing the strip of resilient material in the disc space to assume the planar spiral shape between the vertebral endplates.

57. The method of

claim 56

, further comprising the step of inserting an axial spinal implant into the axial bore extending through the through-hole of the planar spiral disc augmentation device and into the caudal and cephalad vertebral bores bridging the disc space to retain the planar spiral disc augmentation device in the disc space.

58. The method of

claim 53

, wherein the delivering step further comprises the steps of:

extending a deflated envelope through said axial bore and disc opening to the interior of the spinal disc with an envelope opening accessible through the disc opening; and

filling and inflating the deflated envelope with an augmentation material or device.

59. The method of

claim 58

, further comprising the step of closing one or more of the inflated envelope opening, the disc opening and the axial bore.

60. The method of

claim 58

, wherein the filling and inflating step comprises delivering disc augmentation materials and devices selected from the group consisting of bone growth materials, biomaterials and spinal disc replacement devices introduced into the deflated envelope.

61. The method of

claim 60

, further comprising the step of inserting an axial spinal implant into the axial bore extending through the envelope opening to retain the envelope filled with the disc augmentation device or material in the disc space.

62. The method of

claim 60

, further comprising the step of closing one or more of the inflated envelope opening, the disc opening and the axial bore.

63. The method of

claim 58

, wherein the filling and inflating step comprises delivering a planar spiral disc augmentation device formed of a strip of resilient material having a planar spiral shape around a through-hole through the deflated envelope opening by:

straightening and advancing the strip of resilient material through the axial bore and the envelope opening; and

releasing the strip of resilient material within the envelope to assume the planar spiral shape between the vertebral endplates.

64. The method of

claim 63

, further comprising the step of inserting an axial spinal implant into the axial bore extending through the through-hole of the planar spiral disc augmentation device within the envelope to retain the planar spiral disc augmentation device and envelope in the disc space.

65. The method of

claim 58

, wherein the filling and inflating step comprises delivering disc augmentation materials selected from biomaterials that cure in situ through the axial bore and into the envelope.

66. The method of

claim 65

, further comprising the step of closing one or more of the inflated envelope opening, the disc opening and the axial bore.

67. The method of

claim 53

, wherein the delivering step further comprises the steps of:

extending an elongated deflated envelope having a planar spiral shape around a through-hole through said axial bore and disc opening to the interior of the spinal disc with an envelope opening accessible through the disc opening; and

filling and inflating the deflated envelope with an augmentation material or device to assume the planar spiral shape and through-hole between the vertebral endplates.

68. The method of

claim 67

, wherein the filling and inflating step comprises delivering disc augmentation materials and devices selected from the group consisting of bone growth materials, biomaterials and spinal disc replacement devices introduced into the deflated envelope.

69. The method of

claim 67

, further comprising the step of closing one or more of the inflated envelope opening, the disc opening and the axial bore.

70. The method of

claim 67

, further comprising the step of inserting an axial spinal implant into the axial bore extending through the through-hole to retain the planar spiral envelope filled with the disc augmentation device or material in the disc space.

71. The method of

claim 53

, further comprising inserting an axial spinal implant into said axial bore to extend cephalad through at least one caudal vertebral body, through the spinal disc space, and into or through at least one cephalad vertebral body.

72. The method of

claim 53

, further comprising the step of implanting a bone growth material into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body bridging at least one spinal disc.

73. The method of

claim 53

, further comprising the steps of:

inserting an axial spinal implant having a toroidal shape surrounding a throughhole through said axial bore and disc opening to the interior of the disc space; and

inserting an axial spinal implant into the axial bore extending through the through-hole.

74. A method for providing access to and performing a vertebroplasty of at least one fractured vertebral body in a series of vertebral bodies located within a human spine, the method comprising the steps of:

accessing a sacral position of a sacral vertebral body;

from the accessed sacral position, boring a trans-sacral axial bore extending cephalad and axially through the vertebral bodies of said series of adjacent vertebral bodies and any intervertebral, spinal discs, the trans-sacral axial bore exposing cancellous bone of the fractured vertebral body; and

performing a vertebroplasty of the fractured vertebral body through the axial bore to repair damage and strengthen the fractured vertebral body.

75. The method of

claim 74

, wherein the vertebroplasty performing step comprises the steps of:

extending a vertebroplasty catheter having a vertebroplasty catheter lumen through said axial bore and laterally into cancellous bone of the damaged vertebral body exposed by said axial bore; and

injecting a vertebral body reinforcing material for reinforcing the vertebral body into cancellous bone within the vertebral body; and

closing at least a portion of the axial bore extending into the fractured vertebral body.

76. The method of

claim 74

, wherein the vertebral body reinforcing material comprises a bone growth material or bone cement.

77. The method of

claim 74

, wherein:

the accessing step comprises accessing a posterior target point of a posterior surface of a sacral vertebral body; and

the bore forming step comprises boring a curved trans-sacral axial bore in alignment with a visualized, curved, posterior, axial instrumentation/fusion line extending in said axial aspect through the series of vertebral bodies.

78. The method of

claim 74

, wherein:

the accessing step comprises accessing an anterior target point of an anterior surface of a sacral vertebral body; and

the bore forming step comprises boring a trans-sacral axial bore in alignment with a visualized, anterior, axial instrumentation/fusion line extending in said axial aspect through the series of vertebral bodies.

79. A method for providing access to and performing a balloon-assisted vertebroplasty of at least one fractured vertebral body in a series of vertebral bodies located within a human spine, the method comprising the steps of:

accessing a sacral position of a sacral vertebral body;

from the accessed sacral position, boring a trans-sacral axial bore extending cephalad and axially through the vertebral bodies of said series of adjacent vertebral bodies and any intervertebral, spinal discs, the trans-sacral axial bore exposing cancellous bone of the fractured vertebral body; and

performing a balloon-assisted vertebroplasty of the fractured vertebral body through the axial bore to repair damage and strengthen the fractured vertebral body.

80. The method of

claim 79

, wherein the balloon-assisted vertebroplasty performing step comprises the steps of:

extending a balloon catheter having a balloon catheter lumen and bearing a deflated balloon through the axial bore to locate the deflated balloon in relation to cancellous bone of the damaged vertebral body exposed by said axial bore;

inflating the balloon of the balloon catheter through the balloon catheter lumen to apply force to cancellous bone and compress cancellous bone to form a vertebral body cavity;

deflating the balloon and withdrawing the balloon catheter through the axial bore; and

injecting a vertebral body reinforcing material for reinforcing the vertebral body through the axial bore and into the vertebral body cavity and cancellous bone within the vertebral body.

81. The method of

claim 80

, wherein the vertebral body reinforcing material comprises a bone growth material.

82. The method of

claim 80

, wherein the balloon-assisted vertebroplasty performing step comprises the step of closing the axial bore after the vertebral body reinforcing material is injected into the vertebral body cavity.

83. The method of

claim 80

, wherein:

the accessing step comprises accessing a posterior target point of a posterior surface of a sacral vertebral body; and

the bore forming step comprises boring a curved trans-sacral axial bore in alignment with a visualized, curved, posterior, axial instrumentation/fusion line extending in said axial aspect through the series of vertebral bodies.

84. The method of

claim 80

, wherein:

the accessing step comprises accessing an anterior target point of an anterior surface of a sacral vertebral body; and

the bore forming step comprises boring a trans-sacral axial bore in alignment with a visualized, anterior, axial instrumentation/fusion line extending in said axial aspect through the series of vertebral bodies.

85. The method of

claim 80

, wherein the balloon-assisted vertebroplasty performing step comprises the steps of:

extending a balloon catheter having a balloon catheter lumen and bearing a deflated balloon through the axial bore to locate the deflated balloon in relation to cancellous bone of the damaged vertebral body exposed by said axial bore;

inflating the balloon of the balloon catheter through the balloon catheter lumen to apply force to cancellous bone and compress cancellous bone to form a vertebral body cavity;

deflating the balloon; and

injecting a vertebral body reinforcing material for reinforcing the vertebral body into the balloon.

86. The method of

claim 85

, wherein the balloon-assisted vertebroplasty performing step comprises the step of closing one or both of the inflated balloon opening or the axial bore after the vertebral body reinforcing material is injected into the balloon.

87. A method for providing access to and providing electrical stimulation therapy to a spinal structure of interest including vertebral bone, spinal discs, spinal nerves or the spinal cord, the method comprising the steps of:

accessing a sacral position of a sacral vertebral body;

from the accessed sacral position, boring a trans-sacral axial bore extending cephalad and axially through the vertebral bodies of said series of adjacent vertebral bodies and any intervertebral, spinal discs;

introducing an electrical stimulation axial spinal implant having at least one simulation electrode into the trans-sacral axial bore from the accessed sacral position;

locating the electrical stimulation electrode of the axial spinal implant in relation to a spinal structure to be stimulated; and

applying electrical stimulation to the spinal structure of interest through the stimulation electrode.

88. The method of

claim 87

, wherein:

the accessing step comprises accessing a posterior target point of a posterior surface of a sacral vertebral body; and

the bore forming step comprises boring a curved trans-sacral axial bore in alignment with a visualized, curved, posterior, axial instrumentation/fusion line extending in said axial aspect through the series of vertebral bodies to an axial bore cephalad end located in relation to a spinal structure of interest.

89. The method of

claim 87

, wherein:

the accessing step comprises accessing an anterior target point of an anterior surface of a sacral vertebral body; and

the bore forming step comprises boring a trans-sacral axial bore in alignment with a visualized, anterior, axial instrumentation/fusion line extending in said axial aspect through the series of vertebral bodies an axial bore cephalad end located in relation to a spinal structure of interest.

90. The method of

claim 87

, wherein the applying step comprises applying bone growth stimulation through the electrode to the vertebral bone to promote bone growth.

91. The method of

claim 87

, wherein the axial spinal implant comprises a tubular axial spinal implant that extends through one or more vertebral body and intervertebral disc space to reinforce or stabilize a spinal motion segment.

92. The method of

claim 87

, wherein the applying step comprises applying pain relief stimulation through the electrode to a selected nerve or the spinal cord to effect pain relief.

93. The method of

claim 87

, wherein the axial spinal implant comprises an electrical medical lead that extends into or through one or more vertebral body or intervertebral disc space to locate the electrode in operative relation to the spinal structure of interest.

99. The method of

claim 87

, wherein the delivering step comprises delivering pain relief drugs through the axial spinal implant to a selected nerve or the spinal cord to effect pain relief.

100. The method of

claim 87

, wherein the axial spinal implant comprises a catheter that extends into or through one or more vertebral body or intervertebral disc space having at least one drug delivery port along the length thereof.

94. A method for providing access to and providing drug therapy to a spinal structure of interest including vertebral bone, spinal discs, spinal nerves or the spinal cord, the method comprising the steps of:

accessing a sacral position of a sacral vertebral body;

from the accessed sacral position, boring a trans-sacral axial bore extending cephalad and axially through the vertebral bodies of said series of adjacent vertebral bodies and any intervertebral, spinal discs;

introducing a drug delivery axial spinal implant having a drug delivery lumen and at least one drug delivery port into the trans-sacral axial bore and locating each drug delivery port in relation to a spinal structure to be treated; and

delivering a drug to the structure of interest through the drug delivery lumen and the drug delivery port.

95. The method of

claim 94

, wherein:

the accessing step comprises accessing a posterior target point of a posterior surface of a sacral vertebral body; and

the bore forming step comprises boring a curved trans-sacral axial bore in alignment with a visualized, curved, posterior, axial instrumentation/fusion line extending in said axial aspect through the series of vertebral bodies.

96. The method of

claim 94

, wherein:

the accessing step comprises accessing an anterior target point of an anterior surface of a sacral vertebral body; and

the bore forming step comprises boring a trans-sacral axial bore in alignment with a visualized, anterior, axial instrumentation/fusion line extending in said axial aspect through the series of vertebral bodies.

97. The method of

claim 94

, wherein the delivering step comprises delivering a bone growth encouraging drug through the axial spinal implant to the vertebral bone to promote bone growth.

98. The method of

claim 94

, wherein the axial spinal implant comprises a tubular axial spinal implant that extends through one or more vertebral body and intervertebral disc space to reinforce or stabilize a spinal motion segment having at least one delivery port along the axial spinal implant.

101. A method of treating adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs, the method comprising the steps of:

accessing a sacral position of a sacral vertebral body;

boring a trans-sacral axial bore extending axially through the series of adjacent vertebral bodies, the trans-sacral axial bore having a caudal axial bore opening through the anterior surface of the sacrum and extending cephalad through at least one caudal vertebral body and into or through a cephalad vertebral body to a cephalad bore end, the axial bore traversing any intervertebral spinal disc or disc space;

providing an axial spinal implant comprising an axial spinal implant formed of a bio-compatible material having a cephalad axial bore engaging body that is dimensioned and configured to be inserted through said caudal axial bore opening and advanced in the cephalad direction to be seated in the cephalad bore, a caudal axial bore engaging body that is dimensioned and configured to fit within the axial bore traversing the caudal vertebral body, and a plunger rod extending between the caudal and cephalad bore engaging bodies and adapted to enable relative movement between the caudal bore engaging body and the cephalad axial bore engaging body when axial force is applied to the axial spinal implant between the caudal bore engaging body and the cephalad axial bore engaging body; and

implanting said axial spinal implant into said axial bore to extend cephalad and axially between the cephalad and caudal vertebral bodies and across the intervertebral spinal disc or disc space.

102. An axial spinal implant adapted to be inserted in alignment with a trans-sacral axial fusion line extending from the sacrum of the spinal column cephalad within an axial bore having a caudal axial bore opening through the sacrum and extending cephalad through at least two vertebral bodies and any intervertebral spinal discs to a cephalad bore end within a cephalad vertebral body, the axial spinal implant comprising:

a caudal bore engaging body;

a cephalad axial bore engaging body; and

a plunger rod extending between the caudal bore engaging body and the cephalad axial bore engaging body and adapted to enable relative movement between the caudal bore engaging body and the cephalad axial bore engaging body when axial force is applied to the axial spinal implant between the caudal bore engaging body and the cephalad axial bore engaging body.

103. The axial spinal implant of

claim 102

, further comprising

means for engaging the caudal bore engaging body with the caudal vertebral body surrounding the portion of the axial bore traversing the caudal vertebrae when the axial spinal implant is inserted into said axial bore to locate the cephalad axial bore engaging body within a cephalad end portion of the axial bore traversing a cephalad vertebrae, whereby force applied between the spinal vertebrae is absorbed by the axial spinal implant.

104. A method of treating adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs, the method comprising the steps of:

accessing a sacral position of a sacral vertebra;

boring a trans-sacral axial bore axially through a series of adjacent vertebral bodies, the trans-sacral axial bore having a caudal axial bore opening through the anterior surface of the sacrum and extending cephalad through at least one caudal vertebral body and into or through a cephalad vertebral body to a cephalad bore end, the axial bore traversing any interposed intervertebral spinal disc or disc space;

providing an axial spinal implant comprising an axial spinal implant formed of a bio-compatible material having a cephalad axial bore engaging body that is dimensioned and configured to be inserted through said caudal axial bore opening and advanced in the cephalad direction to be seated in the cephalad bore, a caudal axial bore engaging body that is dimensioned and configured to fit within the axial bore traversing the caudal vertebral body, and means extending between the caudal bore engaging body and the cephalad bore engaging body for distracting the cephalad vertebrae and caudal vertebrae by adjusting the length of the axial spinal implant;

inserting said axial spinal implant into said axial bore to extend cephalad and axially between the cephalad and caudal vertebral bodies and across the intervertebral spinal disc or disc space; and

adjusting the length of the axial spinal implant while axial load applied between the cephalad vertebrae and caudal vertebrae is minimized.

105. An axial spinal implant adapted to be inserted aligned with a trans-sacral axial fusion line extending from the sacrum of the spinal column cephalad within an axial bore having a caudal axial bore opening through the sacrum and extending cephalad through at least two vertebral bodies and any intervertebral spinal discs to a cephalad bore end within a cephalad vertebral body, the axial spinal implant comprising:

a caudal bore engaging body;

a cephalad axial bore engaging body; and

means extending between the caudal bore engaging body and the cephalad bore engaging body for distracting the cephalad vertebrae and caudal vertebrae by adjusting the length of the axial spinal implant while axial load applied between the cephalad vertebrae and caudal vertebrae is minimized.

106. The axial spinal implant of

claim 105

, further comprising

means for engaging the caudal bore engaging body with the caudal vertebral body surrounding the portion of the axial bore traversing the caudal vertebrae when the axial spinal implant is inserted into said axial bore to locate the cephalad axial bore engaging body within a cephalad end portion of the axial bore traversing a cephalad vertebrae, whereby the cephalad vertebrae and caudal vertebrae remain separated under load applied between the cephalad vertebrae and caudal vertebrae.

107. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human lumbar and sacral spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs, and performing disc augmentation of a selected spinal disc, the apparatus comprising:

means for exposing a sacral position of a sacral vertebra in alignment with a visualized, axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore axially through the vertebral bodies of said series of adjacent vertebral bodies and forming an axial disc opening into or through any intervertebral, spinal discs; and

means for performing a disc augmentation of any of the spinal discs through the axial bore and axial disc opening exposed or traversed by said axial bore.

108. The apparatus of

claim 107

, further comprising means for performing a discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus leaving a disc cavity enclosed by the annulus prior to insertion of said disc augmentation catheter into said axial bore.

109. The apparatus of

claim 107

, wherein said means for performing a disc augmentation comprises:

a disc augmentation catheter having a disc augmentation catheter body and disc augmentation catheter lumen extending between a disc augmentation catheter proximal end and a disc augmentation catheter distal end, the disc augmentation catheter distal end adapted to be advanced through said axial bore and laterally into or adjacent to the interior of a spinal disc body traversed and exposed by the axial bore; and

disc augmentation material delivery means coupled to the disc augmentation catheter proximal end for delivery of disc augmentation materials through said disc augmentation catheter lumen and from said disc augmentation catheter distal end and into the interior of the disc body.

110. The apparatus of

claim 107

, further comprising means for performing a discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus and the annulus leaving a disc space prior to insertion of said disc augmentation catheter into said axial bore.

111. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs normally formed of a nucleus and annulus, and performing a therapy, the apparatus comprising:

means for exposing an anterior sacral position of an anterior sacral vertebral body;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore cephalad and axially through or into at least one cephalad vertebral body and intervertebral disc; and

means for performing a therapeutic procedure in one of a vertebral body or spinal disc located within a human lumbar and sacral spine accessed through the trans-sacral axial bore.

112. The apparatus of

claim 111

, wherein the bore forming means comprises means for boring a curved anterior axial bore aligned with said anterior axial instrumentation/fusion line cephalad through the vertebral bodies of said series of adjacent vertebrae and any intervertebral, spinal discs, the anterior axial bore having a bore curvature in the posterior-anterior plane of the spine.

113. The apparatus of

claim 112

, wherein the means for performing a therapeutic procedure comprises an axial spinal implant adapted to be implanted into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body.

114. The apparatus of

claim 111

, wherein the means for performing a therapeutic procedure comprises an axial spinal implant adapted to be implanted into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body.

115. The apparatus of

claim 111

, wherein the means for performing a therapeutic procedure comprises implanting a bone growth material into the axial bore.

116. The apparatus of

claim 111

, wherein

the bore forming means comprises means for boring the axial bore through a caudal vertebral body, an intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc;

and

the means for performing a therapeutic procedure comprises;

an axial spinal implant adapted to be implanted into the axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body and through any intervertebral, spinal discs; and

a bone growth material adapted to be implanted into the axial bore along with the axial spinal implant.

117. The apparatus of

claim 111

, wherein:

the bore forming means comprises means for boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the means for performing a therapeutic procedure comprises;

means for performing a partial discectomy through the axial bore and the disc opening to remove at least a substantial portion of the nucleus leaving a disc cavity enclosed by the annulus; and

an augmentation device or material adapted to be inserted through said disc opening into the disc cavity.

118. The apparatus of

claim 111

wherein:

the bore forming means comprises means for boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the means for performing a therapeutic procedure comprises means for performing a complete discectomy through the axial bore and the disc opening to remove substantially all of the nucleus and annulus of the spinal disc leaving a disc space.

119. The apparatus of

claim 118

, wherein the means for performing a therapeutic procedure further comprises a spinal disc implant replacement device or material adapted to be inserted through said axial bore and said disc opening into the disc space.

120. The apparatus of

claim 111

, wherein

the bore forming means comprises means for boring the axial bore through a caudal vertebral body, an intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc;

and

the means for performing a therapeutic procedure comprises;

means for performing a discectomy through the axial bore and the disc opening to remove all of the nucleus and annulus of the spinal disc leaving a disc space or at least a portion of the nucleus leaving a disc cavity within the annulus;

a spinal disc implant device or material adapted to be inserted through said axial bore and into said disc space or disc cavity and having a through-hole adapted to be aligned with said axial bore;

an axial spinal implant adapted to be implanted into the axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body and through the through-hole of the spinal disc implant device or material.

121. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs normally formed of a nucleus and annulus, and performing is therapy, the apparatus comprising:

means for exposing one of an anterior or posterior sacral position of a sacral vertebra in alignment with a visualized, anterior or posterior axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies;

bore forming means operable from the exposed anterior or posterior sacral position for boring a curved anterior or posterior trans-sacral axial bore in alignment with said anterior or posterior axial instrumentation/fusion line extending cephalad and axially through or into at least one cephalad vertebral body and intervertebral disc, the anterior or posterior axial bore having a bore curvature in the posterior-anterior plane of the spine; and

means for performing a therapeutic procedure in one of a vertebral body or spinal disc located within a human lumbar and sacral spine accessed through the trans-sacral axial bore.

122. The apparatus of

claim 121

, wherein the means for performing a therapeutic procedure comprises an axial spinal implant adapted to be implanted into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body.

123. The apparatus of

claim 121

, wherein

the bore forming means comprises means for boring the axial bore through a caudal vertebral body, an intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc;

and

the means for performing a therapeutic procedure comprises;

means for performing a discectomy through the axial bore and the disc opening to remove a portion of the nucleus and annulus of the spinal disc leaving a disc space or at least a portion of the nucleus leaving a disc cavity within the annulus;

a spinal disc implant device or material adapted to be inserted through said axial bore and into said disc space or disc cavity and having a through-hole adapted to be aligned with said axial bore;

an axial spinal implant adapted to be implanted into the axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body and through the through-hole of the spinal disc implant device or material.

124. The apparatus of

claim 123

, wherein the means for performing a therapeutic procedure comprises implanting a bone growth material into the axial bore.

125. The apparatus of

claim 121

, wherein

the bore forming means comprises means for boring the axial bore through a caudal vertebral body, an intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc;

and

the means for performing a therapeutic procedure comprises;

an axial spinal implant adapted to be implanted into the axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body and through any intervertebral, spinal discs; and

a bone growth material adapted to be implanted into the axial bore along with the axial spinal implant.

126. The apparatus of

claim 121

, wherein:

the bore forming means comprises means for boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the means for performing a therapeutic procedure comprises means for performing a discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus leaving a disc cavity enclosed by the annulus.

127. The apparatus of

claim 121

, wherein:

the bore forming means comprises means for boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the means for performing a therapeutic procedure comprises;

means for performing a partial discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus leaving a disc cavity enclosed by the annulus; and

an augmentation device or material adapted to be inserted through said disc opening into the disc cavity.

128. The apparatus of

claim 121

, wherein:

the bore forming means comprises means for boring the axial bore through a caudal vertebral body and making an axial disc opening into an intervertebral spinal disc; and

the means for performing a therapeutic procedure comprises means for performing a discectomy through the axial bore and the disc opening to remove at least a portion of the nucleus and annulus of the spinal disc leaving a disc space.

129. The apparatus of

claim 128

, wherein the means for performing a therapeutic procedure further comprises a spinal disc implant replacement device or material adapted to be inserted through said disc opening into the disc space.

130. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs normally formed of a nucleus and annulus, and performing a therapy, the apparatus comprising:

means for exposing a sacral position of a sacral vertebral body;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore extending cephalad and axially through a caudal vertebral body, an intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc;

an axial spinal implant having a through-hole;

means for implanting the spinal disc implant within the intervertebral disc space traversed by the axial bore with the through-hole aligned with the axial bore; and

an axial spinal implant adapted to be implanted into said axial bore to extend cephalad through the caudal vertebral body, through the through-hole and into or through the cephalad vertebral body.

131. The apparatus of

claim 130

, wherein at least one of the spinal disc implant and the axial spinal implant are formed of bone growth materials that promote the fusion of the cephalad and caudal vertebral bodies

132. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs and repairing a damaged vertebral body, the apparatus comprising:

means for exposing a sacral position of a sacral vertebral body;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore extending cephalad and axially through a caudal vertebral body, any intervertebral spinal disc, and into a fractured cephalad vertebral body; and

means for performing a vertebroplasty of the fractured vertebral body through the axial bore to repair damage and strengthen the fractured vertebral body.

133. The apparatus of

claim 132

, wherein the vertebroplasty performing means comprises:

a vertebroplasty catheter having a vertebroplasty catheter lumen adapted to be extended through said axial bore and laterally into cancellous bone of the damaged vertebral body exposed by said axial bore; and

a vertebral body reinforcing material for reinforcing the vertebral body; and

means for injecting the vertebral body reinforcing material through the vertebroplasty catheter lumen into cancellous bone within the vertebral body and filling the axial bore extending into the fractured vertebral body.

134. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs, and repairing a damaged vertebral body, the apparatus comprising:

means for exposing a sacral position of a sacral vertebral body;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore extending cephalad and axially through a caudal vertebral body, any intervertebral spinal disc, and into a fractured cephalad vertebral body; and

means for performing a balloon-assisted vertebroplasty of the fractured vertebral body through the axial bore to repair damage and strengthen the fractured vertebral body.

135. The apparatus of

claim 134

, wherein the balloon-assisted vertebroplasty performing means comprises:

a balloon catheter having a balloon catheter lumen and bearing a deflated balloon adapted to be extended through said axial bore to locate the deflated balloon in relation to cancellous bone of the damaged vertebral body exposed by said axial bore;

means for inflating the balloon of the balloon catheter through the balloon catheter lumen to apply force to cancellous bone and compress cancellous bone to form a vertebral body cavity;

means for deflating the balloon; and

means for injecting a vertebral body reinforcing material for reinforcing the vertebral body into one of the vertebral body cavity and cancellous bone within the vertebral body or into the deflated balloon.

136. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs, and providing electrical stimulation, the apparatus comprising:

means for exposing a sacral position of a sacral vertebral body;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore extending cephalad and axially through a caudal vertebral body, and any intervertebral spinal disc; and

stimulation means extending into or through said trans-sacral axial bore for providing electrical stimulation to a spinal structure of interest.

137. The apparatus of

claim 136

, wherein the stimulation means further comprises:

a medical electrical stimulation lead having a proximal end and a distal section having at least one stimulation electrode adapted to be extended into the trans-sacral axial bore to locate the electrical stimulation electrode in relation to a spinal structure of interest for electrical stimulation; and

an electrical stimulator coupled to said electrical stimulation lead proximal end that provides electrical stimulation through the electrical stimulation lead and from the stimulation electrode to the spinal structure of interest.

138. The apparatus of

claim 136

, wherein the stimulation means further comprises:

an axial spinal implant comprising a stimulation electrode adapted to be extended into the trans-sacral axial bore to locate the electrical stimulation electrode in relation to a spinal structure of interest for electrical stimulation; and

an electrical stimulator coupled to said axial spinal implant that provides electrical stimulation from the stimulation electrode to the spinal structure of interest.

139. The apparatus of

claim 136

, wherein the stimulation means further comprises:

an axial spinal implant comprising a stimulation electrode adapted to be extended into the trans-sacral axial bore to locate the electrical stimulation electrode in relation to a spinal structure of interest for electrical stimulation;

a medical electrical stimulation lead having a proximal end and a distal end coupled to said stimulation electrode; and

an electrical stimulator coupled to said electrical stimulation lead proximal end that provides electrical stimulation through the electrical stimulation lead and from the stimulation electrode to the spinal structure of interest.

140. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs, and providing a drug therapy, the apparatus comprising:

means for exposing an a sacral position of a sacral vertebral body;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore extending cephalad and axially through a caudal vertebral body, and any intervertebral spinal disc; and

drug delivery means extending into or through said trans-sacral axial bore for delivering a drug to a spinal structure of interest.

141. The apparatus of

claim 140

, wherein the drug delivery means comprises:

a drug delivery catheter having a drug delivery lumen extending between a drug deliver catheter proximal end and a drug delivery catheter distal end;

an axial spinal implant adapted to be extended into the trans-sacral axial bore and coupled with said drug delivery catheter distal end, the axial spinal implant further comprising at least one drug delivery port adapted to be located in relation to a spinal structure of interest for drug delivery; and

means coupled to the drug delivery catheter proximal end for delivering a drug through the drug delivery lumen and the drug delivery port to the spinal structure of interest.

142. The apparatus of

claim 140

, wherein the drug delivery means comprises:

a drug delivery catheter having a drug delivery lumen and at least one drug delivery port adapted to be advanced into the trans-sacral axial bore to locate the drug delivery port in relation to a spinal structure of interest to be treated; and

means for delivering a drug through the drug delivery lumen and the drug delivery port to the structure of interest.

143. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs normally formed of a nucleus and annulus, and performing a therapy, the apparatus comprising:

means for exposing a sacral position of a sacral vertebral body;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore extending cephalad and axially through a caudal vertebral body, an intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc; and

a shock absorbing axial spinal implant adapted to be extended into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body.

144. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by intact or damaged intervertebral spinal discs normally formed of a nucleus and annulus, and performing a therapy, the apparatus comprising:

means for exposing a sacral position of a sacral vertebral body;

bore forming means operable from the exposed sacral position for boring a trans-sacral axial bore extending cephalad and axially through a caudal vertebral body, an intervertebral spinal disc, and into a cephalad vertebral body, whereby the axial bore traverses the spinal disc; and

a distracting axial spinal implant adapted to be extended into said axial bore to extend cephalad through at least one caudal vertebral body and into or through at least one cephalad vertebral body

means coupled to the energizing means for energizing the energy emitting head to desiccate the nucleus to form the disc cavity; and

means for aspirating byproducts of the desiccation through the discectomy instrument aspiration lumen.

145. A method for performing a therapeutic procedure of a one or more vertebral body or any intervertebral spinal disc normally formed of a nucleus and annulus and separating adjacent vertebral bodies of a human spine, the method comprising:

accessing a sacral position of a sacral vertebral body;

from the accessed anterior sacral position, boring a trans-sacral axial bore extending cephalad and axially through at least the caudal sacral vertebra and through or into one or more cephalad vertebral bodies of said series of adjacent vertebral bodies and through or into an intervertebral, spinal disc; and

implanting at least one radiation emitting implant through the axial bore at a selected site.

146. The method of

claim 145

, wherein:

the bore forming step comprises boring a plurality of trans-sacral axial bores diverging apart within a cephalad vertebral body; and

the implanting step comprises inserting at least one radiation emitting implant at a selected site through each such axial bore.

147. Apparatus for performing a therapeutic procedure of a one or more vertebral body or any intervertebral spinal disc normally formed of a nucleus and annulus and separating adjacent vertebral bodies of a human spine, the apparatus comprising:

means for accessing a sacral position of a sacral vertebral body;

means for boring a trans-sacral axial bore from the accessed anterior sacral position cephalad and axially through at least the caudal sacral vertebra and through or into one or more cephalad vertebral bodies of said series of adjacent vertebral bodies and through or into an intervertebral, spinal disc;

a radiation emitting implant dimensioned to fit within said axial bore; and

means for implanting said radiation emitting implant at a selected site through the axial bore.

148. The method of

claim 147

, wherein:

the bore forming means further comprises means for boring a plurality of transsacral axial bores diverging apart within a cephalad vertebral body; and

the implanting means further comprises means for inserting at least one radiation emitting implant at a selected site through each such axial bore.