Methods and apparatuses for facilitating percutaneous fusion

Abstract

A delivery mechanism comprising a dilator, catheter, lumen or the like is provided to allow a filler material to be injected to a gap in a partially fused intervertebral disc space to allow correction of the incomplete, partial, or deteriorated fusion.

1 . A method of correct incomplete or partial bone fusions in patients, the method comprising the steps of:
 placing a guide having a distal end and a proximate end such that the distal end resides proximate the incomplete or partial bone fusion and the distal end resides external to a skin of the patient;   guiding a distal end of a delivery tool to a surgical site using the guide;   providing a reservoir of filler material at a proximate end of the delivery tool, the filler material adapted to promote bone fusion;   injecting the filler material to the surgical site;   removing the delivery tool from the guide; and   removing the guide from the patient.   
     
     
         2 . The method of  claim 1 , further comprising the steps of:
 accessing the incomplete or partial bone fusion site with a surgical tool adapted to prepare the site for treatment;   treating the site to promote bone fusion; and   removing the surgical tool prior to guiding the distal end of the delivery tool to the surgical site.   
     
     
         3 . The method of  claim 2 , wherein the step of treating the site to promote bone fusion comprises causing bleeding in the surgical site. 
     
     
         4 . The method of  claim 3 , wherein the step of treating the site to promote bone fusion comprises scarring the surgical site. 
     
     
         5 . The method of  claim 1 , further comprising the step of packing the surgical site with bone growth promoting agents. 
     
     
         6 . The method of  claim 1 , wherein the packing the surgical site with bone growth promoting agents comprises inserting hone chips in the surgical site. 
     
     
         7 . The method of  claim 1 , further comprising the steps of:
 inserting a cutting tool through, the guide to make an incision in a disc annulus; and   incising the disc annulus,   
     
     
         8 . The method of  claim 7 , further comprising the step of:
 closing the incision after the delivery tool is removed from the guide.   
     
     
         9 . The method of  claim 8 , wherein the step of closing the incision comprises suturing the disc annulus. 
     
     
         10 . An apparatus for delivering filler material to a bone fusion site to facilitate correcting an incomplete or partial bone fusion, the apparatus comprising;
 a reservoir adapted to contain filler material that promotes bone fusion, the reservoir having an outlet and a plunger opposite the outlet; and   a delivery mechanism having a proximal end and a distal end, the proximal end coupled to the outlet and in fluid communication with the reservoir, the distal end in fluid communication with the proximal end.   
     
     
         11 . The apparatus of  claim 10 , wherein the filler material comprises at least one an agent to promote bone fusion selected from the group of agents consists of: an adhesive, a cement, a polymer, a resin, a putty, biologic agents, or an osteo-conductive material. 
     
     
         12 . The apparatus of  claim 10 , wherein the filler material comprises at least a bone morphogentic protein. 
     
     
         13 . The apparatus of  claim 12 , wherein the bone morphogentic protein comprises a bone morphogentic protein consisting of: BMP2, BMP7, or BMP 14. 
     
     
         14 . The apparatus of  claim 12 , wherein the filler material comprises at least an osteo-inductive material. 
     
     
         15 . The apparatus of  claim 14 , wherein the osteoinductive material comprises bone chips. 
     
     
         16 . A system for correcting incomplete or partial bone fusions, comprising:
 a guide having a proximate end and a distal end, the proximate end adapted to be located external to a patient and the distal end adapted to be located at a surgical site;   a delivery mechanism slidably coupled to the guide, the delivery mechanism having a distal end adapted to access the surgical site and a proximal end;   a reservoir comprising an outlet coupled to the proximal end and a plunger opposite the proximal end, the reservoir in fluid communication with the surgical site through the delivery mechanism; and   a filler, the filler contained in the reservoir and adapted to be injected to the surgical site, such that as the plunger is moved towards the outlet, the filler is injected to the surgical site.   
     
     
         17 . The system of  claim 16 , further comprising:
 a marring instrument, slidably coupled to the guide, the instrument having a distal end adapted to access the surgical site and mar the surgical site to induce bleeding.   
     
     
         18 . The system of  claim 16 , wherein the filler comprises a bone fusion promoting agent selected from a group of hone fusion promoting agents consisting of: an adhesive, a cement, a polymer, a resin, a putty, biologic agents, or an osteo-conductive material. 
     
     
         19 . The system of  claim 16 , wherein further comprising osteo-inductive material adapted to be injected to the surgical site. 
     
     
         20 . The system of  claim 17 , wherein the marring instrument comprises a rotating marring surface. 
     
     
         21 . The system of  claim 17 , wherein the marring instrument is flexible. 
     
     
         22 . The system of  claim 17 , wherein the marring instrument comprises at least one pivot. 
     
     
         23 . The system of  claim 16 , wherein the guide is a guide wire. 
     
     
         24 . The system of  claim 16 , wherein the guide is a trochar.