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Spine Technology

I. Pain Management Spine Technologies

 

1. Radiofrequency Generators

What is a Radiofrequency Generator and what procedures is it used for?

These devices use Radiofrequency Energy to generate precise heat temperatures. The heat is then applied to small nerves with the help of needle-like devices (probes). This heat energy is thought to disrupt these nerves ability to transmit pain information.

Radiofrequency generators can also generate electrical impulses at different energy levels (Hertz) which can help the physician find a specific nerve in the spine. Other energy levels can help look for the larger spinal nerves.

Radiofrequency Generators are used to support the following procedures in the spine:

  1. Facet Joint Radiofrequency Rhizotomy
  2. Sacroiliac Joint Radiofrequency Rhizotomy
  3. Intra-Discal Electrothermal Therapy (IDET)
  4. Percutaneous Disc Decompressions

 2. Intra-Discal Electrothermal Therapy (IDET)

What technology is used for the Intra-Discal Electrothermal Therapy (IDET) procedure?

IDET requires the use of a and a specially designed catheter.The IDET catheter has a metal core which delivers the heat energy generated by the Radiofrequency Generator.

 3. Percutanous Discectomy Devices

What technology is used in Percutaneous Discectomy procedures?

  1. Nucleoplasty

A nucleoplasty procedure typically requires the following devices:

  1. Radiofrequency Generator
  2. Specialized needle to give the wand access to the disc
  3. Nucleoplasty wand.

The nucleoplasty wand has a metal core which delivers the energy generated by the Radiofrequency Generator. The wand has markings at the handle which helps to know the depth of the tip inside the disc. Other markings help with the orientation of the tip in the disc.

    2. Nucleotome

The nucleotome procedure typically requires the following devices:

  1. Console

The nucleotome console helps with the sterile fluid flowing through the nucleotome, and helps collect the fluid and pieces of disc material.

     2. Fluid irrigation and suction

This helps to remove the disc material

     3. Specialized needle

A specialized needle is available through which the nucleotome is placed into the disc.

     4. Nucleotome.

The nucleotome has a small cutting tip which cuts disc material after it is pulled into the nucleotome with the help of suction.

3. Endoscopic Laser Discectomy (LASE)

A LASE procedure typically requires the following devices:

  1. Homium Yag Laser

This device provides the actual Laser energy. Homium Yag Lasers provide Laser energy which is controllable and does not penetrate very deep into tissue to avoid injury.

     2. Access Needle

A specialized needle is used to gain access to the disc and provide a channel for the endoscope.

     3. Endoscope

The endoscope has multiple channels. The main channel has a Laser tip at the end which can be seen through the endoscope. This helps remove the disc material with the Laser while looking at it through the endoscope. A small grasper is available which is placed through another channel and can help remove more disc material.

 

4. Spinal Cord Stimulation Devices

What technology is used with Spinal Cord Stimulation Devices?

Spinal Cord Stimulation procedures typically require the following devices:

  1. Spinal Cord Stimulation Generator

This is a device which has the size of a small pacemaker and is implanted under the skin. This device generates the electrical energy which is then transmitted to the spinal cord by the Electrical Lead.

The generator is battery powered and also comes as a version which is rechargeable through the skin.

The generator is highly programmable.

     2. Spinal Cord Stimulation Electrical Lead

This device is implanted into the of the spine and then attached to the generator with an extension. The lead actually delivers the electrical energy to the spinal cord.

     3. Spinal Cord Stimulation Lead Extension

This device is often used to connect the electrical lead to the generator.

     4. Spinal Cord Stimulation Programmer

There are two types of programmers:

  1. Doctor’s Programmer

This device allows the doctor to program the Spinal Cord Stimulation Generator by applying it over the implanted generator. The devices communicate through . There are many programmable aspects to the generator. Examples are how much electrical energy is given, how it is given, at what times, and in which form.

      2. Patient’s Programmer

This device is used by the patient to program some simpler functions than the doctor’s programmer. The patients hold the device over the implanted generator which communicates with telemetry. Examples of programmable aspects are turning the device on and off, increasing and decreasing the energy, when a certain energy is given, and how it is given.

Companies which make Spinal Cord Stimulation Devices:

                                                Medtronic.com

                                                Bostonscientific.com

                                                SJM.com

                           

5. Intrathecal Pumps (Implanted Pain Pump)

What technology is used with Implanted Pain Pumps?

Intrathecal Pumps typically include the following devices:

  1. Intrathecal Pump

The intrathecal pump is a battery driven mechanical device which delivers medication to the patient from its medication reservoir. Compressed gas and a motor are used to push the medication from the reservoir into a catheter which delivers the medication into the spinal fluid.

The device reservoir is refilled through a port which is accessible through the skin by a specialized needle. A syringe delivers the medication through the needle into the reservoir.

The Intrathecal Pump has an alarm for low levels of medication in the reservoir and a low battery status.

      2. Intrathecal Catheter

This is the catheter which is placed into the spinal fluid and is then connected to the Intrathecal Pump to deliver the medication.

      3. Programmer

           a. Doctor's Programmer

The doctor’s programmer is placed over the implanted pump and communicates with it via telemetry. It can turn the pump on and off, and adjust the amount of medication given to the patient.

           b. Patient Programmer

This device also communicates with the pump via telemetry. It allows the patient to program the pump to give a which is a small amount of medication given in excess of what the pump is already programmed to deliver.

 

II. Minimally Invasive Spine Technologies

 

  1. Vertebroplasty (Spine Cement Injection)

What technology is used in the Vertebroplasty procedure?

This procedure typically uses these devices:

  1. Trocar

A trocar is a larger needle which is placed into the collapsed portion of the vertebra.

This provides access to the vertebra.

     2. Delivery Mechanism

This is a device which contains the PMMA and generates pressure to deliver it through the trocar into the collapsed vertebra.

     3. Bone Cement (PMMA)

Polymethyl-Methacrylate is used as the bone cement to fill the vertebra. It usually contains Barium Sulfate which makes it visible on an X-Ray.                      

     2. Kyphoplasty (Balloon Spine Cement Injection)

What technology is used with the Kyphoplasty Procedure?

This procedure typically uses these devices:

  1. Trocar

A trocar is a larger needle which is placed into the collapsed portion of the vertebra.

This provides access to the vertebra.

     2. Inflatable Balloons

An inflatable balloon is placed into the collapsed vertebra. The balloons are filled with to see them on an X-Ray. The balloons are inflated with a syringe to generate high pressures.

     3. Bone Cement (PMMA)

Polymethyl-Methacrylate is used as the bone cement to fill the vertebra. It usually contains Barium Sulfate which makes it visible on an X-Ray.

     4. Bone Cement Mixer

This is a chamber where the PMMA bone cement is mixed.

     5. Bone Cement Delivery Mechanism

These are small metal tubes which are filled with PMMA. They use a plunger to generate pressure to deliver the PMMA into the vertebra.

3. Endoscopic Spine Systems

What technology is used with Endoscopic Spine Surgery?

This procedure typically uses the following devices:

  1. Introducers

These are typically metal tubes which are placed through the skin and advanced into the spine. Sometimes progressively larger tubes are used to gradually widen the tissue until the final largest tube is placed. These introducers provide access for the endoscope to do the work.

     2. Spinal Endoscope

An endoscope is placed through the introducers into the spine next to the anatomy which is diseased such as a spinal disc. The endoscope is attached to a video monitor to show the images. Spinal Endoscopes typically have channels which allow the surgeon to place instruments into the spine. One channel is usually used for and

     3. Instruments

Specialized instruments such as graspers (forceps), and shavers are typically used.

     4. Video Screen

A video screen is used to see the images from the endoscope.

 

5. Minimally Invasive Facet Fusion (Minimally Invasive Fusion of the Spine Joints)

What technology is used in Minimally Invasive Facet Fusion procedures?

This procedure typically involves the following devices:

  1. Introducer

This is a metal tube which is placed through the skin onto the spinal facet joint.

      2. Guide

This is a metal tube-like device which is placed through the introducer secured to the facet joint.

      3. Drill

A small surgical drill which is used to drill a hole into the facet joint

      4. Bone dowel

This is a small piece of bone in the shape of a cylinder which is delivered by a specialized instrument through the guide and into the hole drilled into the facet joint.

      5. Tab

A metal instrument which secures the bone dowel into the facet joint.

6. Minimally Invasive Retractors

What are Minimally Invasive Retractors used for?

These are devices which provide access to the spine to carry out a minimally invasive surgery. They often use the following devices:

  1. Introducers

These are metal or plastic tubes of incremental (increasing) sizes. They are placed sequentially through the skin and muscle to gradually open a channel from the skin to the part of the spine which is the target of the operation.

      2. Retractor

These are metal instruments which are placed over the largest introducer tube and then opened with a mechanical mechanism to widen the channel into the spine. These retractors can have multiple parts, each of which is pushing the tissue in one direction.

Procedures such as and are examples of spine surgeries which use Minimally Invasive Retractors.

 

III. Spine Surgery Technologies

  1. Fusion Systems

What technology is used for Spine fusion Systems?

Fusion systems are used in these areas of the spine:

  1. Occipito-Cervical
  2. Cervical
  3. Thoracic
  4. Lumbar
  5. Trans-S1

The essential components of fusion systems for each area of the spine are similar. However, the configurations and sizes will vary. Here are the essential components of fusion systems:

  1. Pedicle Screws

Pedicle screws are typically made of titanium. This metal does not age or wear over time.

Pedicle screws are in fact screw-like devices which are advanced through bone by turning them with specialized instruments. X-Ray machines are used to help find the pedicle of the vertebra and to monitor the progress of placing them. Specifically, these screws are placed through the of the vertebra into the

      2. Spinal Rods

Spinal rods are also typically made of titanium. They are used to connect the pedicle screws together. This helps secure two or more vertebrae together. They are often bent by the surgeon with rod-benders to give them a curve similar to that of the spine (.

      3. Caps

Titanium caps are typically placed over area where the rod is placed into the head of the pedicle screw. The cap secures the rod and pedicle screw together.

      4. Neuromonitoring

Sometimes Neuromonitoring systems are used to test the spinal nerves and spinal cord when the pedicle screws are inserted into the spine. Since the spinal nerves are next to the pedicle, neuromonitoring helps the surgeon prevent placing a screw accidentally into contact with a spinal nerve or the spinal cord.

Electrodes are placed by the nerves and muscles of the spine which are connected to a machine which gathers and interprets the information about them. When a pedicle screw comes close to a spinal nerve or makes contact with it, neuromonitoring can alert the surgeon, who then redirects it to a better location.

 

           2. Scoliosis Correction Systems

What technology is used to correct a Scoliosis?

These systems typically use the following devices:

  1. Pedicle Screws

Pedicle screws are typically made of titanium. This metal does not age or wear over time.

Pedicle screws are in fact screw-like devices which are advanced through bone by turning them with specialized instruments. X-Ray machines are used to help find the pedicle of the vertebra and to monitor the progress of placing them. Specifically, these screws are placed through the pedicle of the vertebra into the body of the Vertebra.

      2. Spinal Rods

Spinal rods are also typically made of titanium. They are used to connect the pedicle screws together. This helps secure two or more vertebrae together. They are often bent by the surgeon with rod-benders to give them a curve similar to that of the spine (. The particular bent of the rods is very important in scoliosis surgery since the spine’s new curvature after surgery will depend on the bent of the rod.

      3. Reducing Instruments

These instruments are used to align the pedicle screws and rods before they can be connected together. They help the surgeon to straighten the spine.

      4. Neuromonitoring

Usually Neuromonitoring systems are used to test the spinal nerves and spinal cord when the pedicle screws are inserted into the spine. Since the spinal nerves are next to the pedicle, neuromonitoring helps the surgeon prevent placing a screw accidentally into contact with a spinal nerve or the spinal cord.

Electrodes are placed by the nerves and muscles of the spine which are connected to a machine which gathers and interprets the information about them. When a pedicle screw comes close to a spinal nerve or makes contact with it, neuromonitoring can alert the surgeon, who then redirects it to a better location.

 

          3. Artificial Disc Replacements

What technology is involved with Artificial Disc Replacements?

Here are the FDA approved Artificial Disc Replacement devices:

  1. Cervical

a. Prodisc-C Cervical Disc Replacement (made by DePuy-Synthes)

This device has the following components:

  1. Metal endplate components

The metal endplate components are two metal plates which are secured into the vertebrae above and below the space once occupied by the disc. They serve to anchor the artificial disc into bone. These plates are made of titanium and are sprayed with Cobalt Chromium. The cobalt chromium material is designed to help bone grow onto the metal plates.

Each plate has a keel like a boat. These keels secure the plates into the vertebrae above and below the disc.

      2. Core of the disc

The Prodisc-C device has a plastic (polyethylene) core which is rounded like a dome on its top surface. The top surface communicates with the top metal endplate component and allows it to slide over it. This makes for a simple “ball and socket joint” An example of a ball and socket joint is the hip joint where the top of the femur (ball) fits into the hip socket.

b. Prestige Cervical Disc Replacement (made by Medtronic)

This device has the following components:

  1. Top component

The top component is a metal (stainless steel) design which consists of a plate on its top and a ball at the bottom. The plate part is secured to the top vertebra with screws. The ball part faces the bottom component and fits into its socket.

      2. Bottom component

The bottom component is a metal (stainless steel) design which consists of a plate at the bottom and a socket at the top. The plate is secured to the vertebra below with screws, while the socket part at the top receives the ball part from the top component.

Together, the top and bottom components make up a metal ball and socket joint, similar to a hip joint.

                                              

             2. Lumbar

  1. Prodisc-L Lumbar Artificial Disc Replacement

This device has the following components:

  1. Metal endplate components

The metal endplate components are two metal plates which are secured into the vertebrae above and below the space once occupied by the disc. They serve to anchor the artificial disc into bone. These plates are made of titanium and are sprayed with Cobalt Chromium. The cobalt chromium material is designed to help bone grow onto the metal plates.

Each plate has a keel like a boat. These keels secure the plates into the vertebrae above and below the disc.

      2. Core of the Disc

The Prodisc-L device has a plastic (polyethylene) core which is rounded like a dome on its top surface. The top surface communicates with the top metal endplate component and allows it to slide over it. This makes for a simple “ball and socket joint” An example of a ball and socket joint is the hip joint where the top of the femur (ball) fits into the hip socket.

      2. Charite Lumbar Artificial Disc (no longer made by manufacturer DePuy)

This disc is one item, but is made up of the following parts:

  1. Metal Endplate Components

At the top and bottom of the device, titanium plates face towards the vertebrae above and below. These plates have 3 metal spikes on each side which are designed to secure it into the bone of the vertebrae above and below this implant.

      2. Core of the Disc

The core of the disc is made up of a mobile plastic (polyethylene). The core can move in all directions depending on the force on the disc.

 

4. Corpectomy/Vertebrectomy (Removal of part or all of the Vertebra) Cage

What technology is involved with Corpectomy/Vertebrectomy procedures?

These devices are designed to replace a portion or all of a body of a vertebra which has been removed. They can be made of the following materials:

  1. Titanium (metal)
  2. PEEK (Poly-Ether-Ether-Ketone) which is a hard plastic material with a similar density to bone

Corepctomy and Vertebrectomy cages may have “teeth” or other features at the top and bottom where they face the respective vertebrae. These “teeth” are designed to help secure them to these vertebrae. The cages can be hollow to be filled with bone or bone-like material to help grow a solid bone bridge between the vertebrae.

 

5. Spine Fusion Plates

What technology is involved with Spine Fusion Plates

Many different plates are used in spine surgery. They are typically made of titanium metal and are secured to the vertebrae with the help of titanium screws.

Here are some uses of metal plates in the spine:

  1. Fusion Surgery in the Cervical Spine (neck)

A plate is used in the front of the spine to connect two or more vertebrae together after bone, a bone substitute, or metal cage is placed in the disc space.

      2. Fusion Surgery in the Thoracic Spine (mid-back)

A plate is often placed on the side of the spine after a disc is removed and replaced with bone, a bone substitute, or metal cage.

      3. Fusion Surgery in the Lumbar Spine (low-back)

A plate is sometimes placed in the front of the spine following removal of a disc.

6. Bone Fusion Materials

What technology is part of Bone Fusion Materials?

  1. Cadaver Bone (allograft) Cadaver bone is commonly used to help with spine fusions. The bone is harvested and processed by tissue banks. After harvesting the bone, it is irradiated to prevent it from transmitting disease or cause rejection. Cadaver bone does not form a fusion, but allows the patient’s bone to grow onto it, forming essentially a bridge between the patient’s own bone.
  2. Demineralized Bone Matrix (DBM) DBM is cadaver bone which had its minerals removed, leaving behind collagen and bone growth factors. This collagen network may be biologically more active, helping with bone growth.                                              
  3. 3. Autologous Bone (autograft) Autologous bone is the patient’s own bone. It can be harvested from the site of the spine surgery (pieces of the vertebra) other sites of the body and then placed into the spine to help with a fusion. If taken from a site outside the spine, it is commonly harvested from the pelvis (iliac crest). A number of different devices are available to harvest it.

      4. Bone Substitute (xenograft) Bone substitutes are synthetic bone   alternatives. They can consist of plastic-like materials such as Poly-Ether-Ether-Ketone (PEEK), coral, calcium, ceramics, etc.

     5. Bone Morphiologic Protein (BMP) BMP is a natural protein in the human body which accelerates bone growth. BMP can be added to the bone of a fusion to promote more rapid or more complete bone growth.

     6. Stem Cells A patient’s own stem cells can be harvested from other parts of the body and placed into the spine to help grow a fusion. A common place where stem cells are harvested from bone marrow is the pelvis (iliac crest). Large needles can be used to “suck out” the stem cells from the bone marrow and then place them into the fusion area.

7. Spinal Dynamic Stabilization

What technology is used for Spinal Dynamic Stabilization surgery?

Dynamic stabilization systems typically have the following components:

  1. Pedicle Screws

Pedicle screws are typically made of titanium. This metal does not age or wear over time.

Pedicle screws are in fact screw-like devices which are advanced through bone by turning them with specialized instruments. X-Ray machines are used to help find the pedicle of the vertebra and to monitor the progress of placing them. Specifically, these screws are placed through the pedicle of the vertebra into the body of the Vertebra.

       2. Mobile Connector

Between the pedicle screws, a mobile connector is placed to allow for some type of movement between the vertebrae. The mobile connectors can be made of metal springs, or non-metal materials such as plastic.

 

8. Interspinous Process Spacers

What technology is used for Interspinous Process surgery?

Here are some examples of these devices:

A. X-Stop

This device has the following parts:

  1. Spacer

The titanium spacer is the body of the device which is fitted between the spinous processes.

      2. Wings

Two wings, one on each side of the spacer keep it in place, securing it to the inter-spinous ligament.

B. Coflex

This device is one piece with the following features:

  1. Spacer

The body of the device is a titanium spacer which looks like a U, turned on its side. This is the part which is fitted between the spinous processes.

      2. Wings

Two wings at the top and bottom respectively hold the device in place, securing it against the sides of the spinous processes above and below.

C. Wallis Device

This device has the following components:

  1. Spacer

The spacer is the body of the device and consists of plastic-like polymer material. It is fitted between the spinous processes.

      2. Cords

Cords attaché the spacer to the spinous processes above and below the spacer.

D. Diam (Device for Intervertebral Assisted Motion)

This device has the following components:

  1. Spacer

The body of the device consists of a silicone spacer which is fitted between the spinous processes of the vertebrae above and below.

      2. Strings

Strings secure the spacer to the spinous processes of the vertebrae above and below.