Methods and devices for applying localized thermal therapy

Abstract

Methods and devices are disclosed herein that generally involve applying thermal therapy to tissue (e.g., localized cooling or heating of tissue), and in particular applying thermal therapy to the spinal canal, tissue disposed within the spinal canal, and/or nerve roots extending from the spinal canal. In some embodiments, tissue can be cooled or heated by implanting or positioning a thermal device in proximity to the targeted tissue. A number of exemplary thermal devices are disclosed, including bone anchors, inserts for use with bone anchors, K-wires, bone anchor extensions or towers, cross-connectors, spinous process plates, spinal rods, pedicle markers, bone taps, drill bits, bone plugs, bone plates, clamps, interbody or disc implants, thermal pads, and tubing loops. The thermal device can be left in place following surgery to facilitate application of post-surgical thermal therapy. In some embodiments, the thermal device can be removed post-surgery in a minimally- or non-invasive manner.

1 . A thermal device, comprising:
 a connector configured to couple a first spinal fixation rod to a second spinal fixation rod, the connector having a first recess formed therein configured to receive a first spinal fixation rod and a second recess formed therein configured to receive a second spinal fixation rod;   a delivery conduit extending from the connector and being configured to supply a thermal medium to a chamber formed in the connector; and   an exhaust conduit extending from the connector and being configured to withdraw the thermal medium from the chamber.   
     
     
         2 . The thermal device of  claim 1 , wherein the chamber comprises an inflatable member configured to expand outward from the connector when inflated with the thermal medium. 
     
     
         3 . The thermal device of  claim 2 , wherein the inflatable member is configured to protrude through a window formed in a sidewall of the connector when inflated with the thermal medium. 
     
     
         4 . The thermal device of  claim 2 , wherein at least one of the delivery and exhaust conduits are attached to the inflatable member such that removing said at least one of the delivery and exhaust conduits from the thermal device is effective to remove the inflatable member from the thermal device. 
     
     
         5 . The thermal device of  claim 1 , wherein a lower surface of the connector is concave and configured to receive at least a portion of a patient's dura therein. 
     
     
         6 . The thermal device of  claim 1 , wherein the delivery and exhaust conduits are selectively detachable from the connector. 
     
     
         7 . The thermal device of  claim 1 , wherein the delivery and exhaust conduits are formed by inner lumens of a multi-lumen conduit. 
     
     
         8 . A method of applying localized thermal therapy, comprising:
 coupling a connector to a first spinal fixation rod and to a second spinal fixation rod secured to a spine of a patient such that a cavity formed in the connector is disposed adjacent to a spinal canal of the patient; and   delivering a thermal medium to the cavity to apply a thermal effect to the spinal canal of the patient.   
     
     
         9 . The method of  claim 8 , wherein delivering the thermal medium comprises supplying a heated or cooled fluid to the cavity to expand an inflatable member of the connector into contact with or into close proximity to the spinal canal. 
     
     
         10 . The method of  claim 8 , wherein the first rod is disposed on a first side of a midline of the patient's spine and the second rod is disposed on a second, opposite side of the midline of the patient's spine. 
     
     
         11 . The method of  claim 8 , further comprising positioning the connector such that at least a portion of the patient's spinal cord is received within a concave recess formed in a lower surface of the connector. 
     
     
         12 . The method of  claim 8 , wherein delivering the thermal medium comprises supplying a heated or cooled fluid to the cavity through a delivery conduit coupled to the connector and in fluid communication with the cavity. 
     
     
         13 . The method of  claim 12 , further comprising closing an incision around the delivery conduit such that the delivery conduit extends out of the patient while the connector remains implanted in the patient. 
     
     
         14 . The method of  claim 13 , wherein the thermal medium is delivered after closing the incision. 
     
     
         15 . The method of  claim 13 , further comprising decoupling the delivery conduit from the connector after closing the incision and pulling the delivery conduit through the closed incision to remove the delivery conduit from the patient. 
     
     
         16 . The method of  claim 15 , wherein removing the delivery conduit comprises removing an inflatable member attached to the delivery conduit. 
     
     
         17 . A thermal device, comprising:
 an elongate shield configured to be positioned over a midline of a patient's spinal canal, the shield including a superior flange having an opening formed therein through which a bone anchor can be received to couple the shield to a superior vertebra and an inferior flange having an opening formed therein through which a bone anchor can be received to couple the shield to an inferior vertebra;   a delivery conduit extending from the shield, the delivery conduit being configured to supply a thermal medium to a chamber formed in the shield; and   an exhaust conduit extending from the shield, the exhaust conduit being configured to withdraw the thermal medium from the chamber.   
     
     
         18 . The thermal device of  claim 17 , wherein the shield has a width of at least about 15 mm. 
     
     
         19 . A method of protecting a spinal canal and applying localized thermal therapy, comprising:
 positioning a plate over a spinal canal such that a longitudinal axis of the plate is substantially parallel to a longitudinal axis of the spinal canal;   attaching a superior flange of the plate to a superior vertebra using at least one bone anchor;   attaching an inferior flange of the plate to an inferior vertebra using at least one bone anchor; and   applying a thermal effect to the plate to apply localized thermal therapy to the spinal canal.   
     
     
         20 . The method of  claim 19 , wherein positioning the plate comprises positioning the plate over a midline of the spinal canal. 
     
     
         21 . The method of  claim 19 , wherein positioning the plate comprises positioning the plate laterally offset from a midline of the spinal canal on a first side of the spinal canal and positioning a second plate laterally offset from the midline of the spinal canal on a second, opposite side of the spinal canal. 
     
     
         22 . A thermal device, comprising:
 a bone anchor having a proximal head and a distal shank, the proximal head having first and second opposed arms that define a rod-receiving recess therebetween;   a fluid inlet pathway that extends through at least one of the first and second arms;   a fluid outlet pathway in fluid communication with the fluid inlet pathway and that extends through at least one of the first and second arms;   a delivery conduit configured to be selectively coupled to the proximal head and to supply a thermal medium to the fluid inlet pathway; and   an exhaust conduit configured to be selectively coupled to the proximal head and to withdraw the thermal medium from the fluid outlet pathway.   
     
     
         23 . The thermal device of  claim 22 , wherein the fluid inlet pathway extends through the first arm, through a base of the proximal head, through a plug disposed in a cannulation of bone anchor, and through a tube that extends distally from the plug within the cannulation of the bone anchor. 
     
     
         24 . The thermal device of  claim 22 , wherein the fluid outlet pathway extends through a cannulation of the bone anchor, through a plug disposed in the cannulation, through a base of the proximal head, and through the first arm. 
     
     
         25 . The thermal device of  claim 22 , wherein the fluid inlet pathway and the fluid outlet pathway extend only through one of the first and second arms. 
     
     
         26 . The thermal device of  claim 25 , wherein the distal shank is polyaxially movable with respect to the proximal head. 
     
     
         27 . The thermal device of  claim 22 , wherein
 the fluid inlet pathway extends through the first arm, through a base of the proximal head, through a plug disposed in a cannulation of bone anchor, and through a tube that extends distally from the plug within the cannulation of the bone anchor; and   the fluid outlet pathway extends through the cannulation of the bone anchor, through the plug disposed in the cannulation, through the base of the proximal head, and through the second arm.   
     
     
         28 . The thermal device of  claim 22 , further comprising a connector from which the delivery and exhaust conduits extend, the connector being configured to be selectively coupled to at least one of the first and second arms to place the delivery and exhaust conduits in fluid communication with the fluid inlet and outlet pathways, respectively. 
     
     
         29 . The thermal device of  claim 28 , wherein the connector includes one or more mating features configured to align the connector with at least one of the first and second arms and to couple the connector to said at least one arm. 
     
     
         30 . The thermal device of  claim 28 , wherein the connector is configured to mate with a proximal-facing surface of at least one of the first and second arms. 
     
     
         31 . The thermal device of  claim 28 , wherein the connector comprises an elongate sleeve through which the fluid delivery and exhaust conduits extend. 
     
     
         32 . The thermal device of  claim 22 , further comprising a plug disposed in the bone anchor through which the fluid inlet and fluid outlet pathways extend, the plug being disposed distal to a driving interface of the bone anchor. 
     
     
         33 . A thermal device, comprising:
 a bone anchor having a proximal head and a distal shank, the proximal head having first and second opposed arms that define a rod-receiving recess therebetween;   at least one cut-out formed in the proximal head beneath the rod-receiving recess;   a plug disposed within the bone anchor beneath the rod-receiving recess;   a fluid inlet pathway that extends through the plug;   a fluid outlet pathway in fluid communication with the fluid inlet pathway and that extends through the plug;   a delivery conduit extending laterally-outward from the plug through the at least one cut-out, the delivery conduit being configured to supply a thermal medium to the fluid inlet pathway; and   an exhaust conduit extending laterally-outward from the plug through the at least one cut-out, the exhaust conduit being configured to withdraw the thermal medium from the fluid outlet pathway.   
     
     
         34 . The thermal device of  claim 33 , wherein the at least one cut-out comprises only a single cut-out through which the delivery and exhaust conduits extend. 
     
     
         35 . The thermal device of  claim 33 , wherein the at least one cut-out comprises first and second opposed cut-outs, the delivery conduit extending through the first cut-out and the exhaust conduit extending through the second cut-out. 
     
     
         36 . A thermal device, comprising:
 a plug having a distal projection and first and second lateral extensions, the plug being configured to be received within a head portion of a bone anchor such that a fluid-tight seal is formed between the distal projection and a cannulation of the bone anchor and such that the first and second lateral extensions are seated within a rod-receiving recess of the bone anchor;   a delivery conduit extending from the plug, the delivery conduit being configured to supply a thermal medium to a fluid inlet pathway formed in the plug; and   an exhaust conduit extending from the plug, the exhaust conduit being configured to withdraw the thermal medium from a fluid outlet pathway formed in the plug.   
     
     
         37 . A method of applying localized thermal therapy, comprising:
 implanting a bone anchor a bone structure of a patient;   attaching a connector having fluid delivery and exhaust conduits coupled thereto to the bone anchor to place the fluid delivery and exhaust conduits in fluid communication with fluid inlet and outlet pathways formed in the bone anchor, respectively; and   circulating a cooled or heated fluid through the bone anchor via the delivery and exhaust conduits to applying a thermal effect to the bone anchor, the bone structure of the patient, and tissue adjacent to said bone structure.   
     
     
         38 . The method of  claim 37 , wherein attaching the connector comprises attaching the connector to a head portion of the bone anchor such that a distal-facing surface of the connector abuts a proximal facing surface of the head portion of the bone anchor. 
     
     
         39 . The method of  claim 37 , further comprising seating a spinal fixation element in a rod-receiving recess defined in a head portion of the bone anchor prior to attaching the connector. 
     
     
         40 . The method of  claim 37 , wherein said circulating comprises circulating the fluid only through a proximal head portion of the bone anchor. 
     
     
         41 . The method of  claim 37 , wherein attaching the connector comprises seating the connector in a recess formed in the bone anchor such that the delivery and exhaust conduits extend through at least one cut-out formed in the bone anchor beneath a rod-receiving recess defined in the bone anchor. 
     
     
         42 . The method of  claim 41 , further comprising seating a spinal fixation element in the rod-receiving recess after attaching the connector. 
     
     
         43 . The method of  claim 37 , wherein attaching the connector comprises seating the connector such that a distal projection of the connector forms a seal with a cannulation of the bone anchor and such that first and second lateral extensions of the connector are seated within a rod-receiving recess of the bone anchor. 
     
     
         44 . The method of  claim 37 , further comprising closing a skin incision through which the bone anchor is implanted in the patient such that the delivery and exhaust conduits extend through the incision and circulating the fluid after closing the skin incision. 
     
     
         45 . The method of  claim 44 , further comprising detaching the connector from the bone anchor and removing the connector from the patient after closing the incision without re-opening the incision. 
     
     
         46 . The method of  claim 37 , further comprising using the connector to manipulate the position of the bone structure prior to, during, or after circulating the fluid. 
     
     
         47 . The method of  claim 37 , further comprising delivering an implant through the connector prior to, during, or after circulating the fluid. 
     
     
         48 . The method of  claim 47 , wherein the implant comprises a fixation rod and wherein the method further comprises coupling the fixation rod to the bone anchor to which the connector is attached. 
     
     
         49 . A thermal device, comprising:
 a cylindrical insert sized and configured for placement into a cannulation of a bone anchor, the insert including first and second concentric tubes, an interior of the first tube defining an inner chamber and a space between the first and second tubes defining an outer chamber, the inner and outer chambers being in fluid communication with one another at a distal end of the first tube;   a delivery conduit coupled to the insert and in fluid communication with the inner chamber, the delivery conduit being configured to supply a thermal medium to the inner chamber; and   an exhaust conduit coupled to the insert and in fluid communication with the outer chamber, the exhaust conduit being configured to withdraw the thermal medium from the outer chamber.   
     
     
         50 . A thermal device, comprising:
 a bone anchor having a cannulation formed therein;   a cylindrical insert sized and configured for placement into the cannulation of the bone screw, the insert including a first tube having an open distal end, an interior of the first tube defining an inner chamber and a space between the first tube and the cannulation of the bone anchor defining an outer chamber, the inner and outer chambers being in fluid communication with one another at a distal end of the first tube;   a delivery conduit coupled to the insert and in fluid communication with the inner chamber, the delivery conduit being configured to supply a thermal medium to the inner chamber; and   an exhaust conduit coupled to the insert and in fluid communication with the cannulation of the bone anchor, the exhaust conduit being configured to withdraw the thermal medium from the outer chamber.   
     
     
         51 . The thermal device of  claim 50 , further comprising a cap disposed in the cannulation of the bone anchor to seal a distal end of the cannulation. 
     
     
         52 . The thermal device of  claim 50 , wherein the cannulation extends only partially through the bone anchor such that a distal end of the bone anchor is closed. 
     
     
         53 . A thermal device, comprising:
 a bone anchor having a proximal head, a distal shank, and a thread formed on at least a portion of the distal shank;   a fluid chamber defined within the thread;   a delivery conduit coupled to the device and in fluid communication with the chamber, the delivery conduit being configured to supply a thermal medium to the chamber; and   an exhaust conduit coupled to the device and in fluid communication with the chamber, the exhaust conduit being configured to withdraw the thermal medium from the chamber.   
     
     
         54 . The thermal device of  claim 53 , wherein the chamber is defined only within the thread and does not extend into the distal shank. 
     
     
         55 . A method of applying localized thermal therapy, comprising:
 positioning a distal end of a guide wire in a bone structure of a patient;   advancing a cannulated bone anchor over the guide wire such that the guide wire extends through the cannulation of the bone anchor;   implanting the bone anchor in the bone structure; and   applying a thermal effect to a proximal end of the guide wire to heat or cool the guide wire, the bone anchor, the bone structure of the patient, and tissue adjacent to said bone structure.   
     
     
         56 . A method of applying localized thermal therapy, comprising:
 implanting a bone anchor in a bone structure of a patient;   inserting a solid thermally-conductive member into a cannulation of the bone anchor; and   applying a thermal effect to a proximal end of the thermally-conductive member to heat or cool the thermally-conductive member, the bone anchor, the bone structure of the patient, and tissue adjacent to said bone structure.   
     
     
         57 . A thermal device, comprising:
 a first plate having a superior wing portion and an inferior wing portion, the first plate being configured for placement against lateral sides of superior and inferior spinous processes;   a bridge extending laterally from the first plate and defining a chamber therein;   a delivery conduit extending from the bridge, the delivery conduit being configured to supply a thermal medium to the chamber; and   an exhaust conduit extending from the bridge, the exhaust conduit being configured to withdraw the thermal medium from the chamber.   
     
     
         58 . The thermal device of  claim 57 , further comprising a second plate from which the bridge extends laterally, the second plate having a superior wing portion and an inferior wing portion, the second plate being configured for placement against lateral sides of superior and inferior spinous processes such that said spinous processes are disposed between the first and second plates and such that the bridge is disposed between said spinous processes. 
     
     
         59 . The thermal device of  claim 58 , wherein the chamber extends into at least one of the first and second plates. 
     
     
         60 . The thermal device of  claim 58 , wherein the chamber extends into the superior and inferior wing portions of at least one of the first and second plates. 
     
     
         61 . A device, comprising:
 a first plate having a superior wing portion and an inferior wing portion, the first plate being configured for placement against lateral sides of superior and inferior spinous processes;   a bridge extending laterally from the first plate; and   a second plate having a superior wing portion and an inferior wing portion, the second plate being configured for placement against lateral sides of superior and inferior spinous processes such that said spinous processes are disposed between the first and second plates and such that the bridge is disposed between said spinous processes;   wherein the bridge is slidably received within an opening formed in the second plate such that a distance between the first and second plates can be adjusted by sliding the second plate along the bridge.   
     
     
         62 . The device of  claim 61 , further comprising at least one locking screw threadably mounted in the second plate such that the at least one locking screw can be advanced into engagement with the bridge to lock a position of the second plate relative to the bridge. 
     
     
         63 . The device of  claim 62 , wherein the at least one locking screw comprises first and second locking screws and wherein a longitudinal axis of the first locking screw extends at an oblique angle to a longitudinal axis of the second locking screw. 
     
     
         64 . The device of  claim 61 , further comprising a temperature sensor embedded in at least one of the first plate, the second plate, and the bridge. 
     
     
         65 . The device of  claim 64 , wherein the temperature sensor extends anteriorly from the bridge towards a spinal canal when the first plate is positioned against lateral sides of superior and inferior spinous processes. 
     
     
         66 . The device of  claim 64 , wherein the temperature sensor comprises a flexible contact. 
     
     
         67 . A method of applying localized thermal therapy, comprising:
 removing at least a portion of the cortical bone of a spinous process to form a decorticated portion of the spinous process;   positioning a plate in contact with the decorticated portion of the spinous process; and   applying a thermal effect to the plate to heat or cool the spinous process and a spinal canal adjacent thereto.   
     
     
         68 . The method of  claim 67 , further comprising measuring a temperature using a temperature sensor embedded in the plate. 
     
     
         69 . A method of applying localized thermal therapy, comprising:
 forming an incision in a patient to access a spinous process of the patient;   positioning a plate in contact with the decorticated portion of the spinous process, the plate having at least one conduit extending therefrom through which a thermal effect can be applied to the plate;   closing the incision around the at least one conduit such that the at least one conduit extends out of the patient; and   after closing the incision, applying a thermal effect to the plate to heat or cool the spinous process and a spinal canal adjacent thereto.   
     
     
         70 . The method of  claim 69 , further comprising decoupling the at least one conduit from the plate after closing the incision and removing the at least one conduit through the closed incision. 
     
     
         71 . A method of applying localized thermal therapy, comprising:
 implanting a first bone anchor in a first vertebra;   implanting a second bone anchor in a second vertebra;   seating a first spinal rod within rod-receiving recess formed in proximal heads of the first and second bone anchors;   seating a second spinal rod within outriggers extending laterally outward from the proximal heads of the first and second bone anchors; and   at least one of:
 delivering a thermal medium through a delivery conduit to a chamber formed in the first spinal rod to apply a thermal effect to the first spinal rod; and 
 delivering a thermal medium through a delivery conduit to a chamber formed in the second spinal rod to apply a thermal effect to the second spinal rod. 
   
     
     
         72 . A thermal device, comprising:
 an elongate shaft having a chamber defined therein and a distal end configured for insertion into bone;   a thermal source configured to deliver a thermal medium to the chamber of the elongate shaft to apply a thermal effect to the elongate shaft.   
     
     
         73 . The thermal device of  claim 72 , wherein the elongate shaft comprises at least one of a pedicle marker, a bone tap, and a drill bit. 
     
     
         74 . The thermal device of  claim 72 , wherein the elongate shaft is rigid along its entire length. 
     
     
         75 . The thermal device of  claim 72 , wherein the elongate shaft has a length sufficient to extend from a bone opening in which the distal end of the elongate shaft is disposed to a location proximal to a skin surface overlying said bone opening. 
     
     
         76 . A method of applying localized thermal therapy, comprising:
 advancing an elongate shaft into a bone structure of a patient such that a distal end of the shaft is positioned in a bone opening formed in the bone structure and a proximal end of the shaft is disposed outside of the patient; and   applying a thermal effect to the elongate shaft to apply localized thermal therapy to the bone structure and tissue adjacent thereto.   
     
     
         77 . The method of  claim 76 , wherein applying the thermal effect comprises circulating a heated or cooled fluid through a chamber formed in the elongate shaft. 
     
     
         78 . A thermal device, comprising:
 a bone plug having a non-threaded cylindrical distal projection configured to be received in a bone hole and a proximal body portion, the bone plug defining a chamber therein;   a delivery conduit extending from the proximal body portion, the delivery conduit being configured to supply a thermal medium to the chamber; and   an exhaust conduit extending from the proximal body portion, the exhaust conduit being configured to withdraw the thermal medium from the chamber.   
     
     
         79 . The thermal device of  claim 78 , wherein the proximal body portion comprises a plate configured such that, when the distal projection is seated in a bone hole, the plate lies over a surface of the bone structure in which the bone hole is formed. 
     
     
         80 . The thermal device of  claim 79 , wherein the chamber extends into the plate. 
     
     
         81 . The thermal device of  claim 79 , wherein the plate includes at least one opening through which a bone anchor can be received to anchor the plate to bone disposed adjacent thereto. 
     
     
         82 . A thermal device, comprising:
 a bone plate having a chamber defined therein;   a delivery conduit extending from the bone plate, the delivery conduit being configured to supply a thermal medium to the chamber; and   an exhaust conduit extending from the bone plate, the exhaust conduit being configured to withdraw the thermal medium from the chamber.   
     
     
         83 . A thermal device, comprising:
 a bone plate having a bone-contacting surface and at least one opening formed therein configured to receive a bone anchor for anchoring the bone plate to bone; and   at least one bone anchor having delivery and exhaust conduits extending therefrom configured to circulate a cooled or heated fluid through the first bone anchor.   
     
     
         84 . The thermal device of  claim 83 , wherein the plate includes a chamber formed therein and delivery and exhaust conduits extending from the plate configured to circulate a cooled or heated fluid through the chamber. 
     
     
         85 . The thermal device of  claim 83 , wherein the plate is rigid. 
     
     
         86 . A method of applying localized thermal therapy, comprising:
 forming a bone hole in a bone structure of a patient;   seating a non-threaded cylindrical distal projection of a bone plug in the bone hole; and   delivering a thermal medium through a delivery conduit to a chamber formed in the bone plug to apply a thermal effect to the bone plug and apply localized thermal therapy to the bone structure and tissue adjacent thereto.   
     
     
         87 . The method of  claim 86 , wherein the adjacent tissue comprises neural tissue. 
     
     
         88 . The method of  claim 86 , wherein the adjacent tissue comprises a spinal canal of the patient. 
     
     
         89 . The method of  claim 86 , further comprising closing an incision through which the bone plug is inserted around the delivery conduit and applying the thermal effect after closing the incision. 
     
     
         90 . The method of  claim 89 , further comprising removing the bone plug from the bone hole by pulling the delivery conduit proximally through the closed incision and pulling the delivery conduit and the bone plug out of the patient through the closed incision. 
     
     
         91 . The method of  claim 89 , further comprising decoupling the delivery conduit from the bone plug by pulling the delivery conduit proximally through the closed incision and pulling the delivery conduit out of the patient through the closed incision. 
     
     
         92 . A method of applying localized thermal therapy, comprising:
 positioning a bone plate adjacent to at least one bone structure of a patient;   securing the bone plate to the at least one bone structure using one or more bone anchors;   delivering a thermal medium through a delivery conduit to a chamber formed in at least one of the bone plate and the one or more bone anchors, thereby applying a thermal effect to the bone plate and applying localized thermal therapy to the at least one bone structure and tissue adjacent thereto.   
     
     
         93 . The method of  claim 92 , further comprising closing an incision around the delivery conduit. 
     
     
         94 . The method of  claim 93 , further comprising selectively decoupling the delivery conduit from the bone plate or the bone anchors and removing the delivery conduit through the closed incision. 
     
     
         95 . A thermal device, comprising:
 a first clamping arm having a first cavity, a first delivery conduit configured to supply a thermal medium to the first cavity, and a first exhaust conduit configured to withdraw the thermal medium from the first cavity;   a second clamping arm pivotally coupled to the first clamping arm, the second clamping arm having a second cavity, a second delivery conduit configured to supply a thermal medium to the second cavity, and a second exhaust conduit configured to withdraw the thermal medium from the second cavity;   the first and second clamping arms each having an engagement portion configured to grasp an implant or an anatomical structure, the engagement portions forming a substantial negative of the implant or the anatomical structure.   
     
     
         96 . The thermal device of  claim 95 , wherein:
 the first cavity is formed entirely in a distal portion of the first clamping arm adjacent the engagement portion of the first clamping arm, the first cavity being in fluid communication with the first delivery conduit and the first exhaust conduit via fluid pathways having a reduced cross-section that extend through the first clamping arm; and   the second cavity is formed entirely in a distal portion of the second clamping arm adjacent the engagement portion of the second clamping arm, the second cavity being in fluid communication with the second delivery conduit and the second exhaust conduit via fluid pathways having a reduced cross-section that extend through the second clamping arm.   
     
     
         97 . A method of applying localized thermal therapy, comprising:
 forming an incision in a patient;   inserting at least a portion of a clamp through the incision;   grasping an implant implanted in a patient or an anatomical structure of the patient with first and second opposed arms of the clamp; and   delivering a thermal medium through a first delivery conduit to a first chamber formed in the first arm of the clamp and delivering a thermal medium through a second delivery conduit to a second chamber formed in the second arm of the clamp to apply a thermal effect to the clamp and thereby apply localized thermal therapy to the implant or anatomical structure.   
     
     
         98 . The method of  claim 97 , further comprising closing the incision around the first and second delivery conduits such that the delivery conduits extend through the closed incision while the clamp remains implanted in the patient. 
     
     
         99 . The method of  claim 98 , further comprising decoupling the first and second delivery conduits from the clamp after closing the incision and removing the delivery conduit through the closed incision. 
     
     
         100 . A thermal therapy system, comprising:
 a disc implant sized and configured for placement between superior and inferior vertebrae, the implant having a superior bone contacting surface, an inferior bone contacting surface, a first side surface configured to face a spinal canal when the implant is disposed between superior and inferior vertebrae, a second side surface opposite to the first side surface, and third and fourth side surfaces extending between the first and second side surfaces;   a thermally-conductive member coupled to the implant and configured to extend across at least one surface of the implant; and   a thermal probe having a chamber formed therein to which a thermal medium can be delivered to apply a thermal effect to the thermal probe;   wherein the thermal probe can be coupled to or placed in contact with the thermally-conductive member to apply the thermal effect to the thermally-conductive member and tissue proximate thereto.   
     
     
         101 . The system of  claim 100 , wherein the thermally-conductive member comprises a plate coupled to the first side surface of the implant. 
     
     
         102 . The system of  claim 100 , wherein the thermally-conductive member is a load bearing component of the implant configured to bear physiological loads. 
     
     
         103 . The system of  claim 100 , wherein the implant is sized and configured for delivery to a disc space via a lateral approach. 
     
     
         104 . The system of  claim 100 , wherein the implant is sized and configured for delivery to a disc space via an anterior approach. 
     
     
         105 . The system of  claim 100 , wherein the implant is sized and configured for delivery to a disc space via a posterior approach. 
     
     
         106 . The system of  claim 100 , wherein the thermally-conductive member comprises a first plate coupled to the first side surface of the implant and a second plate coupled to the second side surface of the implant. 
     
     
         107 . The system of  claim 100 , wherein the thermally-conductive member comprises a first thin layer of thermally-conductive material applied to the first side surface of the implant and a second thin layer of thermally-conductive material applied to the second side surface of the implant. 
     
     
         108 . The system of  claim 100 , wherein the thermally-conductive member comprises a C-shaped plate configured to extend across the first side surface and the third and fourth side surfaces of the implant. 
     
     
         109 . The system of  claim 108 , wherein first and second terminal ends of the plate sit flush with the second side surface of the implant. 
     
     
         110 . The system of  claim 100 , wherein the thermally-conductive member comprises an O-shaped plate configured to extend across the first side surface, the second side surface, and the third and fourth side surfaces of the implant. 
     
     
         111 . A method of applying localized thermal therapy, comprising:
 forming an incision in a patient;   inserting at least a portion of a thermal probe through the incision;   at least one of coupling the thermal probe to a disc implant disposed within a disc space of a patient and placing the thermal probe in contact with the disc implant;   applying a thermal effect to the thermal probe, thereby applying a thermal effect to the disc implant and applying localized thermal therapy to tissue proximate to the disc implant.   
     
     
         112 . The method of  claim 111 , wherein applying a thermal effect to the thermal probe comprises delivering a thermal medium to a chamber formed in the thermal probe. 
     
     
         113 . The method of  claim 111 , further comprising closing the incision around the thermal probe such that the thermal probe extends through the closed incision while remaining in contact with or coupled to the implant. 
     
     
         114 . The method of  claim 113 , further comprising decoupling the thermal probe from the implant after closing the incision and removing the thermal probe through the closed incision. 
     
     
         115 . A thermal therapy device, comprising:
 a pad having an upper surface, a lower surface, and a sidewall extending therebetween, the pad defining a chamber therein;   a fluid inlet conduit extending from the pad and in fluid communication with the chamber;   a fluid outlet conduit extending from the pad and in fluid communication with the chamber;   a thermal source coupled to the fluid inlet conduit and the fluid outlet conduit and configured to circulate heated or chilled fluid through a fluid path defined by the fluid inlet conduit, the chamber, and the fluid outlet conduit to apply thermal therapy to anatomy disposed in proximity to the pad.   
     
     
         116 . The device of  claim 115 , wherein the upper surface of the pad includes one or more grooves or enclosed loops for retaining sutures. 
     
     
         117 . The device of  claim 115 , wherein the pad includes at least one opening through which fluid can drip from the chamber into surrounding tissue. 
     
     
         118 . The device of  claim 117 , wherein the at least one opening comprises a plurality of openings formed in a grid pattern in the lower surface of the pad. 
     
     
         119 . The device of  claim 117 , wherein the at least one opening is formed in a distal-facing portion of the sidewall of the pad. 
     
     
         120 . The device of  claim 115 , wherein the pad includes at least one suction port through which fluid can be evacuated from the vicinity of the pad through an aspiration conduit. 
     
     
         121 . The device of  claim 120 , wherein the at least one suction port is formed in a proximal end of the pad, adjacent to a location at which the inlet and outlet conduits meet the pad. 
     
     
         122 . The device of  claim 120 , wherein the at least one suction port is formed in a distal-facing potion of the sidewall of the pad. 
     
     
         123 . The device of  claim 115 , wherein the pad includes at least one wing extending outward therefrom configured to increase contact area with anatomy of a patient when the pad is placed in contact with said anatomy for at least one of stabilization and adhesion. 
     
     
         124 . The device of  claim 115 , wherein the pad comprises upper and lower rigid shells that define the chamber therebetween. 
     
     
         125 . The device of  claim 124 , wherein the lower shell is formed from a thermally-conductive material and the upper shell is formed from a thermally-insulative material. 
     
     
         126 . A surgical method, comprising:
 forming an incision in a patient;   inserting a pad through the incision and positioning the pad at a target site within the patient;   closing the incision around an aspiration conduit extending proximally from the pad with the pad at the target site; and   after closing the incision, aspirating fluid through the aspiration conduit.   
     
     
         127 . A method of applying localized thermal therapy, comprising:
 forming an incision in a patient;   inserting a pad through the incision and positioning the pad at a target site within the patient;   closing the incision around at least one fluid outlet conduit extending proximally from the pad with the pad at the target site; and   after closing the incision, delivering a heated or cooled fluid through the at least one fluid conduit to a chamber formed in the pad and releasing at least a portion of the fluid into the target site through one or more openings formed in the pad.   
     
     
         128 . The method of  claim 127 , wherein the at least one fluid conduit includes an aspiration conduit and wherein the method further comprises aspirating fluid from the target site through the aspiration conduit. 
     
     
         129 . The method of  claim 128 , further comprising aspirating fluid from the target site while simultaneously delivering heated or cooled fluid to the pad. 
     
     
         130 . The method of  claim 127 , wherein positioning the pad comprises positioning the pad under a lamina of the patient. 
     
     
         131 . The method of  claim 127 , further comprising at least temporarily adhering at least a portion of the pad to a spinal canal of the patient. 
     
     
         132 . A thermal therapy device, comprising:
 a length of flexible tubing having first and second free ends, the length of tubing being bent into a predetermined non-linear shape;   a biodegradable or bioabsorbable substrate coupled to the tubing and configured to maintain the tubing in the non-linear shape until the substrate is at least partially dissolved;   a thermal source coupled to at least one of the free ends of the tubing and configured to circulate heated or chilled fluid through a fluid path defined by the tubing to apply thermal therapy to anatomy disposed in proximity to the tubing.   
     
     
         133 . The device of  claim 132 , wherein the length of tubing has an outside diameter that is less than about 5 mm. 
     
     
         134 . The device of  claim 132 , wherein the substrate comprises a planar sheet to which the tubing is adhered. 
     
     
         135 . The device of  claim 132 , wherein the tubing is encapsulated in the substrate. 
     
     
         136 . The device of  claim 132 , wherein the first and second free ends are coupled to the thermal source. 
     
     
         137 . The device of  claim 132 , wherein the length of tubing includes a first interior lumen and a second interior lumen. 
     
     
         138 . The device of  claim 137 , wherein the first free end is coupled to the thermal source and wherein the second free end of the tubing is closed, a fluid communication path between the first and second lumens being defined adjacent the second free end. 
     
     
         139 . A method of applying localized thermal therapy, comprising:
 forming an incision in a patient;   inserting a length of flexible tubing through the incision and positioning a bent portion of the tubing at a target site within the patient, the bent portion of the tubing being formed into a predetermined non-linear shape and maintained in said shape by a biodegradable substrate coupled to the tubing;   closing the incision around an unbent portion of the tubing that extends proximally from the bent portion with the bent portion being positioned at the target site; and   after closing the incision, delivering a heated or cooled fluid through the length of tubing to apply localized thermal therapy to tissue in proximity to the bent portion of the tubing.   
     
     
         140 . The method of  claim 139 , further comprising pulling the length of tubing out of the patient through the closed incision by transitioning the bent portion of the tubing to an unbent configuration after the substrate dissolves in the patient. 
     
     
         141 . The method of  claim 139 , wherein the unbent portion comprises first and second free ends of the length of tubing. 
     
     
         142 . The method of  claim 139 , wherein the unbent portion comprises a first free end of the tubing and wherein the bent portion of the tubing includes a second free end of the tubing. 
     
     
         143 . The method of  claim 142 , wherein delivering the fluid comprises delivering the fluid into a first inner lumen of the tubing such that the fluid flows through the first inner lumen and then enters a second inner lumen in fluid communication with the first inner lumen adjacent the second free end of the tubing.