Methods and apparatus for performing therapeutic procedures in the spine

• US 20030195518A1
• Filed: 05/06/2003
• Published: 10/16/2003
• 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 7,309,338 B2
• Time in Patent Office: Days
• US Class Current: 606/80
• 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 for prostheses A61F2210/0014
• 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. 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.

2. The apparatus of claim 1, 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 a disc augmentation catheter into said axial bore.

3. The apparatus of claim 1, 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

a 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.

4. The apparatus of claim 1, 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.

5. 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:

a 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.

6. The apparatus of claim 5, wherein the bore forming means comprises means for boring a curved anterior axial bore aligned with an 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.

7. The apparatus of claim 6, 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.

8. The apparatus of claim 5, 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.

9. The apparatus of claim 5, wherein the means for performing a therapeutic procedure comprises means for implanting a bone growth material into the axial bore.

10. The apparatus of claim 5, 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.

11. The apparatus of claim 5, 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.

12. The apparatus of claim 5, 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.

13. The apparatus of claim 12, 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.

14. The apparatus of claim 5, 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.

15. 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 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.

16. The apparatus of claim 15, 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.

17. The apparatus of claim 15, 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.

18. The apparatus of claim 17, wherein the means for performing a therapeutic procedure further comprises means for implanting a bone growth material into the axial bore.

19. The apparatus of claim 15, 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.

20. The apparatus of claim 15, 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.

21. The apparatus of claim 15, 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.

22. The apparatus of claim 15, 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.

23. The apparatus of claim 22, 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.

24. 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;

a spinal disc 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.

25. The apparatus of claim 24, 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.

26. 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.

27. The apparatus of claim 26, 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.

28. 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.

29. The apparatus of claim 28, 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.

30. 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 for desiccating at least a portion of the nucleus to form a disc cavity; and

means for aspirating byproducts of the desiccation.

31. A method for performing a therapeutic procedure on one or more of a series of vertebral bodies 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 posterior sacral position of a sacral vertebral body;

from the accessed posterior sacral position, forming a trans-sacral axial bore cephalad and axially through at least the caudal sacral vertebra and through or into at least one cephalad vertebral body of said series of adjacent vertebral bodies and through or into at least one 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.

32. The method of claim 31, wherein the bore forming step comprises boring a curved posterior axial bore cephalad through the vertebral bodies of said series of adjacent vertebrae and any intervertebral, spinal discs, the posterior axial bore having a bore curvature in the posterior-anterior plane of the spine.

33. The method of claim 31, wherein the step of performing a therapeutic procedure comprises performing disc augmentation of any of the spinal discs through the axial bore and the axial disc opening exposed or traversed by the axial bore.

34. The method of claim 31, 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.

35. The method of claim 31, 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.

36. The method of claim 35, 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.

37. The method of claim 31, 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.

38. The method of claim 31, 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.

39. The method of claim 31, 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.

40. The method of claim 31, 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.

41. The method of claim 31, 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.

42. The method of claim 31, 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.

43. The method of claim 42, wherein the vertebroplasty performing step comprises the steps of:

extending a vertebroplasty catheter having a vertebroplasty catheter lumen through said axial bore and into 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.

44. The method of claim 31, 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.

45. The method of claim 44, 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.

46. The method of claim 31, 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.

47. The method of claim 31, 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.

48. The method of claim 31, 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.

49. The method of claim 31, 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.

50. The method of claim 31, 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.

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. The method of claim 31, 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 and annulus of the spinal disc leaving a disc space.

54. The method of claim 53, 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 and annulus of the spinal disc;

operating the fragmentation head to fragment the nucleus and annulus of the spinal disc to form the disc space; and

aspirating the nucleus and annulus fragments through the discectomy instrument aspiration lumen.

55. The method of claim 53, 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 and annulus;

operating the energy emitting head to desiccate the nucleus and annulus of the spinal disc to form the disc space; and

aspirating byproducts of desiccation through the discectomy instrument aspiration lumen.

56. The method of claim 31, wherein the step of performing a therapeutic procedure comprises the step of introducing at least one radiation emitting implant to a selected site in relation to a sarcoma through the axial bore.

57. The method of claim 31, 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.

58. The method of claim 57, 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.

59. The method of claim 57, 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 to form an open disc space or disc cavity between the caudal and cephalad vertebral body endplates.

60. The method of claim 57, 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.

61. The method of claim 57, 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.

62. The method of claim 57, 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.

63. 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 therapeutic procedure in one or both of a vertebral body or spinal disc located within a human spine accessed through the axial bore and disc opening.

64. The method of claim 63, wherein the step of performing a therapeutic procedure comprises performing disc augmentation of any of the spinal discs through the axial bore and the axial disc opening exposed or traversed by the axial bore.

65. The method of claim 63, 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.

66. The method of claim 63, 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

67. The method of claim 63, wherein 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.

68. The method of claim 63, wherein 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.

69. The method of claim 63, 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.

70. The method of claim 63, 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 balloon-assisted vertebroplasty of the fractured vertebral body through the axial bore to repair damage and strengthen the fractured vertebral body.

71. The method of claim 63, 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.

72. The method of claim 63, 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.

73. The method of claim 63, 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.

74. The method of claim 63, 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.

75. The method of claim 63, wherein the step of performing a therapeutic procedure comprises the step of introducing at least one radiation emitting implant to a selected site in relation to a sarcoma through the axial bore.

76. Apparatus for obtaining access to a series of adjacent vertebral bodies located within a human spine, the vertebral bodies separated by 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 anterior 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.

77. The apparatus of claim 76, wherein the bore forming means comprises means for boring a curved anterior axial bore aligned with an anterior axial instrumentation/fusion line cephalad through the vertebral bodies of said series of adjacent vertebrae and any intervertebral spinal discs, the axial bore having a bore curvature in the posterior-anterior plane of the spine.

78. The apparatus of claim 77, wherein 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.

79. The apparatus of claim 76, wherein 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.

80. The apparatus of claim 76, wherein the means for performing a therapeutic procedure comprises means for implanting a bone growth material into the axial bore.

81. The apparatus of claim 76, 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 introducing into the axial bore along with the axial spinal implant.

82. The apparatus of claim 76, wherein the means for performing a therapeutic procedure comprises means for performing disc augmentation of at least one intervertebral spinal disc.

83. The apparatus of claim 82, wherein the means for performing disc augmentation comprises:

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

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

84. The apparatus of claim 76, 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

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

85. The apparatus of claim 76, 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.

86. The apparatus of claim 85, wherein the means for performing a therapeutic procedure further comprises a spinal disc implant replacement device or material adapted to be inserted through the axial bore and the disc opening into the disc space.

87. The apparatus of claim 76, 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 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 the axial bore and into the disc cavity and having a through-hole adapted to be aligned with the axial bore; and

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.

88. The apparatus of claim 76, 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 at least a portion of the nucleus and annulus of the spinal disc leaving a disc space;

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

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.

89. The apparatus of claim 76, wherein:

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

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

90. The apparatus of claim 76, wherein the means for performing a therapeutic procedure comprises means for applying electrical stimulation to a spinal structure of interest.

91. The apparatus of claim 76, wherein the means for performing a therapeutic procedure comprises means for delivering a drug to a spinal structure of interest through the trans-sacral axial bore.

92. The apparatus of claim 76, wherein the means for performing a therapeutic procedure comprises means for absorbing shock between at least one caudal vertebral body and at least one cephalad vertebral body from within the trans-sacral axial bore.

93. The apparatus of claim 76, wherein the means for performing a therapeutic procedure comprises means for distracting at least one caudal vertebral body and at least one cephalad vertebral body from within the trans-sacral axial bore.

94. The apparatus of claim 76, wherein the means for performing a therapeutic procedure comprises means for emitting radiation from within the trans-sacral axial bore.

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

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

bore forming means operable from the exposed posterior 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.

96. The apparatus of claim 95, wherein the bore forming means comprises means for boring a curved posterior axial bore aligned with a posterior axial instrumentation/fusion line cephalad through the vertebral bodies of said series of adjacent vertebrae and any intervertebral spinal discs, the axial bore having a bore curvature in the posterior-anterior plane of the spine.

97. The apparatus of claim 95, wherein 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.

98. The apparatus of claim 95, wherein 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.

99. The apparatus of claim 95, wherein the means for performing a therapeutic procedure comprises means for implanting a bone growth material into the axial bore.

100. The apparatus of claim 95, 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 introducing into the axial bore along with the axial spinal implant.

101. The apparatus of claim 95, wherein the means for performing a therapeutic procedure comprises means for performing disc augmentation of at least one intervertebral spinal disc.

102. The apparatus of claim 101, wherein the means for performing disc augmentation comprises:

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

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

103. The apparatus of claim 95, 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

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

104. The apparatus of claim 95, 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.

105. The apparatus of claim 104, wherein the means for performing a therapeutic procedure further comprises a spinal disc implant replacement device or material adapted to be inserted through the axial bore and the disc opening into the disc space.

106. The apparatus of claim 95, 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 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 the axial bore and into the disc cavity and having a through-hole adapted to be aligned with the axial bore; and

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.

107. The apparatus of claim 95, 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 at least a portion of the nucleus and annulus of the spinal disc leaving a disc space;

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

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.

108. The apparatus of claim 95, wherein:

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

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

109. The apparatus of claim 95, wherein the means for performing a therapeutic procedure comprises means for applying electrical stimulation to a spinal structure of interest.

110. The apparatus of claim 95, wherein the means for performing a therapeutic procedure comprises means for delivering a drug to a spinal structure of interest through the trans-sacral axial bore.

111. The apparatus of claim 95, wherein the means for performing a therapeutic procedure comprises means for absorbing shock between at least one caudal vertebral body and at least one cephalad vertebral body from within the trans-sacral axial bore.

112. The apparatus of claim 95, wherein the means for performing a therapeutic procedure comprises means for distracting at least one caudal vertebral body and at least one cephalad vertebral body from within the trans-sacral axial bore.

113. The apparatus of claim 95, wherein the means for performing a therapeutic procedure comprises means for emitting radiation from within the trans-sacral axial bore.