Tissue removal device and method

Abstract

A tissue removal device for removing hard and/or soft tissue is disclosed. The device can have an elongated rigid shaft attached to an articulating broach. The device can be inserted through a transosseous delivery channel formed in a bone. The broach can articulate after passing through the transosseous delivery channel.

Description

BACKGROUND

Existing surgery to treat spinal ailments includes the removal of intervertebral discs, known as a discectomy. The removed discs can be replaced by other devices including rigid metal implants.

Discectomies performed between the L5 and S1 vertebrae are difficult because the path to access the L5-S1 intervertebral space often passes through tissue in front of the sacrum which contains a large quantity of sensitive nerves and arteries. There is a substantial risk of serious damage caused as a side effect of the discectomy and the delivery of the implant to the L5-S1 intervertebral space.

There exists a method for creating a delivery channel through the hone of the iliac and/or sacrum to deliver the implant. However, manipulating, positioning and orienting the implant on the medial side of the channel is not easy. Also, unintended soft tissue damage is still possible when a device is exiting the hone channel and traverses soft tissue before entering the intervertebral space. Furthermore, performing the discectomy is difficult if not impossible through the channel because access to the disc space is constrained through the channel.

Accordingly, a method and device for performing a discectomy through and on the far side of a transosseous or other constrained channel is desired.

SUMMARY OF THE INVENTION

Devices for removing tissue are disclosed. The device can have a rigid shaft attached to an articulating broach. The broach can have a tapered distal terminal tip. The broach can have teeth extending laterally or radially from the broach.

The broach can have a first segment longitudinally distal to a second segment. The first segment can be rotatably attached to the second segment. The broach can have a third segment longitudinally proximal to the second segment. The third segment can be rotatably attached to the second segment. The third segment can be attached to the rigid shaft.

A method for removing tissue from a biological target site is also disclosed. The method includes inserting the multi-segmented articulating broach into the target site. The method can include forming a channel through an obstructing bone, such as the iliac and/or sacral ala. The channel can have an exit port in the S1 endplate. The broach can be translated into and out of the channel. The broach can be articulated while the broach is located at the target site.

The broach can capture tissue debris at the target site and can be removed from the target site. When the broach is removed from the target site, the broach can remove tissue debris from the target site. The method can be performed, for example, in the L5-S1 intervertebral disc space.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a variation of the tissue removal device,

FIG. 2 is a side view of a variation of the broach in an unarticulated configuration.

FIG. 3 is a side view of the broach of FIG. 2 in an articulated configuration.

FIG. 4 is a perspective view of a variation of the broach in an articulated configuration.

FIG. 5 illustrates the lower spine and pelvis.

FIGS. 6 through 9 illustrate a variation of a method of using the tissue removal device.

FIGS. 10 through 12 illustrate views through the transverse plane from a superior location, the sagittal plane from a lateral location, and the coronal plane from an anterior location, respectively, of a variation of the location of the transosseous delivery channel.

FIGS. 13 a through 13d illustrate a superior view of a variation ( ) a method of using the tissue removal device anatomically showing the iliac and sacrum, but not the L5-S1 disc or remainder of the spine for illustrative purposes.

FIGS. 14 a through 14d illustrate a posterior perspective view of a variation eta method of using the tissue removal device anatomically showing the iliac and sacrum, but not the L5-S1 disc or remainder of the spine for illustrative purposes.

FIGS. 15 a through 15c are radiographic visualization of a variation of a method of using the tissue removal device at a target site in the L5-S1 intervertebral space.

DETAILED DESCRIPTION

FIG. 1 illustrates that a tissue removal tool 10 or device can have a broach 12, auger, or borer attached to the distal end of a shaft. The tool 10 can be configured to remove hard tissue and or soil tissue, such as bone, cartilage, ligaments, collagenous tissue such as intervertebral discs, infected tissue, or combinations thereof from a target site inside of a patient's body. The tool 10 can be configured to remove the tissue through a tunnel or channel formed in the patient's body.

The broach 12 can be rigid, flexible, fixed (i.e., unarticulatable), articulatable within the broach 12 and/or at the broach's connection with the shaft 14, or combinations thereof. The distal terminal end of the broach 12 can be traumatically or atraumatically sharpened and/or pointed, for example to dissect tissue when pushed through the tissue. Part or all of the broach surface can be smooth and/or textured. The shaft 14 can taper at a shaft taper 16 to the broach 12.

The shaft 14 can be rigid or flexible along the entire length, or have alternating flexible and rigid lengths. The shaft 14 can be unitary and unarticulatable or jointed and articulatable. The shaft 14 can have control rods (not shown) disposed within or outside of the shaft 14 to control articulation (e.g., lock and unlock articulation, and to control the angles of articulation for each joint) of the broach 12.

The distal terminal end of the shaft 14 can taper at a shaft taper 16 to a connection with the broach 12. The distal end of the shaft 14 can be fixably or removably attached to the broach 12.

The proximal end of the shaft 14 can taper to a shaft neck 18. The proximal end of the shaft 14 can attach to or be integral with a handle 20. The handle 20 can have one, two, three, tour or five finger (and thumb) seats 24, for example to ergonomically confirm to the user's hand along with the shaft neck 18. The handle 20 can have articulating control surfaces, such as buttons, switches or triggers in one or more of the finger seats 24. The articulating control surfaces can control the articulation, attachment, detachment, or combinations thereof of the broach 12 with respect to the distal end of the shaft 14.

The proximal terminal end of the shaft 14 can have a shaft head 22. The shaft head can be fixed to or removable from the remainder of the shaft 14. The shaft head 22 can be removed from the remainder of the shaft 14, for example, allowing removal and replacement of the handle 20 (e.g., to replace the handle 20 with a larger or smaller handle 20 to fit the user's hand). The shaft 14 can be attached, for example at the shaft head 22, to auxiliary devices not shown. The auxiliary devices can be or have an electronic, hydraulic or pneumatic supersonic, hypersonic or subsonic oscillator; a power and/or control unit configured to articulate the broach 12; visualization and lighting devices for delivering and receiving visualization and lighting power and signals to and from the distal end of the shaft 14 and/or the broach 12; aspiration and/or irrigation tools for delivering and receiving solids and fluids (e.g., saline, analgesics, anesthetic, antibiotics, debris) to and from the distal end of the shaft 14 and/or the broach 12 or combinations thereof.

FIG. 2 illustrates that the broach 12 can have a connecting segment 26a fixedly 6 or rotatably attached to the shaft 14. The connecting segment 26a can have a connecting segment longitudinal axis 28a. The connecting segment 26a can be fixed to or rotate with respect to the shaft 14 around the connecting segment longitudinal axis 28a and/or around one or more axes perpendicular to the connecting segment longitudinal axis 26a.

The broach 12 can have a second trailing segment 26b. The second trailing segment 26b can have a second trailing hinge 30a at the proximal end of the second trailing segment 26b. The second trailing, segment 26b can be rotatably attached to the connecting segment 26a at the second trailing hinge 30a.

The broach 12 can have a first trailing segment 26c. The first trailing segment 26c can have a first trailing hinge 30b at the proximal end of first trailing, segment 26c. The first trailing segment 26c can be rotatably attached to the second trailing segment 26b at the first trailing hinge 30b.

The broach 12 can have a distal segment 26d at the distal terminal end of the broach 12. The distal segment 26d can have a lead hinge 26c at the proximal end of the distal segment 26d. The distal segment 26d can be rotatably attached to the first trailing segment 26c at the lead hinge 26c.

The broach 12 can have zero, one, three, four or more trailing segments 26 rotatably connected in series, similar to the configuration shown in FIG. 2, between the distal or lead segment 26d and the connecting segment 26a or shaft 14.

The first trailing hinge 30b, second trailing hinge 30a and lead hinge 30c can be in the same (as shown) or different planes when the broach 12 is in a linear configuration, as shown in FIG. 2.

The broach 12 can have an inferior side 32a and a superior side 32b. During use, the inferior side 32a can face the inferior end of the patient and the superior side 32b can face the superior end of the patient.

Any or all segments 26 of the broach 12 can have one or more teeth 34 on the inferior and/or superior sides 32a and/or 32b of the broach 12. Any or all segments 26 of the broach 12 can have one or more teeth 34 on the lateral sides of the broach, for example on perpendicular planes to the inferior and superior sides 32a and 32b. The segments 26 can have face teeth 34a and hinge teeth 34b. The face teeth 34a can be equivalent or differently shaped than the hinge teeth 34b. The face teeth 34a can be shaped and located symmetrically compared with teeth 34 on the opposite side of the broach 12 or asymmetrically shaped or located compared with teeth 34 on the opposite side of the broach 12. The hinge teeth 34b can be on one side of the broach 12, for example on the superior side 32b of the broach 12, but no hinge tooth 34b can be positioned on the inferior side 32a of the broach 12 at the same length along the broach 12 as the corresponding hinge tooth 34b, as shown. The hinge teeth 34b can correspond in length to the position of the hinge 30. Each segment 26 can have one, two, three, four (as shown), five or more face teeth 34a on one or each (as shown) side of the segment 26.

Each face tooth 34a can have a hinge tooth leading face 36a and a face tooth trailing face 36b. Each hinge tooth can have a hinge tooth leading face and a hinge tooth trailing face that can be analogous to the face tooth leading face 36a and the face tooth trailing lace 36b, respectively. The teeth 34 can have a face or hinge tooth angle 38 formed between the tooth leading face and the tooth trailing face. The tooth angles 38 can be from about 3° to about 90°, more narrowly from about 10° to about 45°, for example about 25°.

The teeth 34 can have flat trailing faces or concave trailing faces. The teeth 34 can have flat leading faces or convex leading faces.

The trailing faces can be perpendicular to the longitudinal axis of the respective segment or pointed in a proximal direction. The teeth 34 can be unidirectional, providing less resistance when the broach 12 is pushed distally against tissue and more resistance when the broach 12 is pulled proximally against tissue.

The distal segment 26d can have lead teeth 34c. The lead teeth 34c can be configured identically to the face or hinge teeth 34a or 34b or can be smaller. For example, the lead teeth 34x can have a flatted radially distal tip. The lead teeth 34c can be on the superior and/or inferior sides of the distal segment 26d.

Any or all of the teeth 34 can be configured to produce less three resistance when the broach 12 is pushed distally through tissue and more forced resistance when the broach 12 is pulled proximally through tissue. For example, the lace tooth leading face 36a can be perpendicular to the longitudinal axis of the respective segment 26, and the face tooth trailing face 36b can extend proximally as the face tooth trailing face 36b extends away from the segment 26. The teeth 34 can be configured to separate and remove tissue when the broach 12 is pushed distally through tissue and to not or minimally separate and remove tissue when the broach 12 is pulled proximally through tissue.

The distal terminal end of the distal segment 26d can have a distal tip 40. The distal segment 26d can taper to the distal tip 40. The inferior and/or superior faces of the distal segment 26d can be flat and/or convex and/or concave. The distal tip 40 can be flat, a bullet tip, or a chisel tip (as shown).

The distal tip 40 can form a distal tip angle 42. The distal tip angle 42 can be measured as the intersecting angle between the plane of the face of the interior side of the distal segment 26d and the plane of the face of the superior side of the distal segment 26d. The distal tip angle 42 can be from about 1° to about 90°, more narrowly from about 3° to about 45°, yet more narrowly from about 5° to about 35°, yet more narrowly from about 15° to about 30°.

FIG. 3 illustrates that the broach 12 can be articulated, as shown by arrow 44. The connecting segment longitudinal axis 28a can be collinear with the shaft longitudinal axis.

The broach 12 can articulate at a broach articulation angle 46. The broach articulation angle 46 can be measured between the connecting segment longitudinal axis 28a and the distal segment longitudinal axis 28d. The broach articulation angle 46 can be about 180° as shown in FIG. 2. The broach articulation angle 46 can be controlled to be a minimum of about 155°, yet more narrowly about 135°, yet more narrowly about 90°, yet more narrowly about 60°, yet more narrowly about 45°.

The distal segment 26d can have a distal segment longitudinal axis 28d. The first trailing segment 26c can have a first trailing segment longitudinal axis 28c. The second trailing segment 26b can have a second trailing segment longitudinal axis 28b.

The second trailing segment 26b can articulate about the second trailing hinge 30a with respect to the connecting segment 26a, as shown by arrow 44a. The second trailing segment longitudinal axis 28b can form a second trailing segment articulation angle 46a with respect to the connecting segment longitudinal axis 28a. The second trailing segment articulation angle 46a can be about 180° as shown in FIG. 1. The second trailing segment articulation angle 46a can be controlled to be a minimum of about 155°, yet more narrowly about 135°, yet more narrowly about 90°, yet more narrowly about 60°, yet more narrowly about 45°.

The first nailing segment 26e can articulate about the first trailing, hinge 30b with respect to the second trailing segment 26d, as shown by arrow. The first trailing segment longitudinal axis 28c can form a first trailing segment articulation angle 46b with respect to the second trailing segment longitudinal axis 28a. The first trailing segment articulation angle 46b can be about 180° as shown in FIG. 1. The second trailing segment articulation angle 46b can be controlled to be a minimum of about 155°, yet more narrowly about 135°, yet more narrowly about 90°, yet more narrowly about 60°, yet more narrowly about 45°.

The distal segment 26d can articulate about the lead hinge 30c with respect to the first trailing segment 26c, as shown by arrow. The distal segment longitudinal axis 28d can form a distal segment articulation angle 46c with respect to the first trailing segment longitudinal axis 28c. The distal segment articulation angle 46c can be about 180° as shown in FIG. 1. The distal segment articulation angle 46c can be controlled to be a minimum of about 155°, yet more narrowly about 135°, yet more narrowly about 90°, yet more narrowly about 60°, yet more narrowly about 45°.

The hinges 30 can be perpendicular to the longitudinal axes 28 of the respective segments 26.

FIG. 4 illustrates that the connecting segment 26a can have one or more connecting segment through ports 48a. The second trailing segment 26b can have one or more second trailing segment through ports 48b. The first trailing segment 26c can have one or more first trailing, segment through ports 48c. The distal segment 26d can have one or more distal segment through ports.

Any or all of the through ports 48 can extend through the entire device or broach 12. Instead of one or more (e.g., all) of through ports 48, the broach 12 can have recesses or cavities. During use, the through ports, recesses, cavities or combinations thereof can fill with debris 82, such as hard or soft tissue debrided by the teeth 34.

Any or all of the hinges 30 can have a hinge tooth 34h extending radially away from the hinge 30 in the direction of the superior side 32b and/or inferior side 34a of the broach 12. The hinge teeth 34b can be rotatably fixed to the hinge 30 or one of the segments 26 adjacent to the respective hinge 30.

FIG. 5 illustrates that a straight or curved transosseous delivery channel 50 can be drilled, chiseled, punched, or a combination thereof, through the iliac hone 52 and/or the sacral ala 54. The transosseous delivery channel 50 can have a laterally-located channel entry port 56 outside of the sacral ala 54 and/or iliac bone 52. The transosseous delivery channel 50 can have a channel exit port 58 adjacent to the L5-S1 intervertebral disc 62 space. For example, the channel exit port 58 can be in the S1 vertebral endplate 60. The channel exit port 58 can be positioned so the circumference of the channel exit port 58 tangentially coincides with or is closely adjacent to (e.g., within about 2 cm, more narrowly within about 1 cm, more narrowly within about 5 mm, yet more narrowly within about 2 mm) with the edge of the S1 vertebral endplate 60. Also shown for clarity are the L5 vertebra 64, sacroiliac joint 66, sacrum 68, and symphysis pubis 70.

FIG. 6 illustrates that the broach 12 of the tissue removal device 10 can be inserted, as shown by arrow 72, medially through the channel entry port 56 of the transosseous delivery channel 50.

FIG. 7 illustrates that the shaft 14 can be further translated, as shown by arrow 76, into the transosseous delivery channel 50. The broach 12 can translate toward and into the L5-S1 intervertebral disc 62 space. The distal tip of the broach 12 can pierce the L5-S1 intervertebral disc 62, and/or the distal tip can wedge between the L5-S1 intervertebral disc 62 and the L5 or S1 vertebra. The broach 12 can enter the target site of the L5-S1 intervertebral disc 62 directly from the transosseous delivery channel 50 without passing through any soft tissue between the L5-S1 intervertebral disc 62 and the iliac bone 52.

FIG. 8 illustrates that the shalt 14 can be further translated, as shown by arrow 76, medially through the transosseous delivery channel 50. The broach 12 can translate, as shown by arrow 78, through the L5-S1 intervertebral disc and/or between the L5-S1 intervertebral disc 62 and the L5 and/or the S1 vertebra. The broach 12 can articulate, as shown by arrow 102. One or more of the hinges 30 can rotate. The hinges 30 can be controllably rotatably locked and unlocked, for example, by controls on the handle 20.

The broach 12 can then be translated, such as being vibrated (e.g., manually, ultrasonically), for example, medially and laterally, and/or superior and inferiorly, and/or anteriorly and posteriorly. The through ports 48 and/or cavities and/or recesses in the broach 12 can partially and/or completely fill with soft (e.g., part or all of the L5-S1 vertebral disc) and/or hard tissue (e.g., a portion of either or both of the L5 or S1 vertebra) debris 82. The broach 12 can deliver a cauterizing electrical energy. The broach 12 and shaft 14 can have one or more longitudinal lumens that can be used to irrigate (e.g., with analgesic agents, saline, anesthetic agents, bone morphogenic proteins, visualization agents, other agents described herein, or combinations thereof) and/or aspirate (e.g., to remove irrigated material and/or debris 82) the target site (e.g., the L5-S1 intervertebral disc space).

FIG. 9 illustrates that the shaft 14 can be translated laterally, for example removing the broach 12 from the L5-S1 intervertebral disc 62 space and the transosseous delivery channel 50. The debris 82 removed from the L5-S1 intervertebral disc 62 space and held by the broach 12 upon exiting the transosseous delivery channel 50 can be passively or actively removed from the through ports 48, cavities, recessesor combinations thereof, before or after the broach 12 is removed from the transosseous delivery channel 50. The removed portion of tissue can leave a partial or complete discectomy 84. The method shown in FIGS. 6 though 9 can be repeated to remove additional tissue.

FIGS. 10 through 12 illustrate that the transosseous delivery channel 50 can have a coronal delivery angle 86 measured to the coronal plane 88, a sagittal delivery angle 90 measured to the sagittal plane 92, and a transverse delivery angle 94 measured to the transverse plane 96. The coronal delivery angle 86 can be from about 0° to about 25°, for example about 12°. The sagittal delivery angle 90 can be from about 65° to about 90°, for example about 75°. The transverse delivery angle 94 can be from about 0° to about 20°, for example about 10°. The broach 12 and shaft 14 are configured so the broach 12 can exit the channel exit port 58 (e.g., directly into the L5-S1 intervertebral disc 62) and articulate sufficiently to enter and pass through all or a significant portion (e.g., more than about 40%, yet more narrowly more than about 50%, yet more narrowly more than about 75%) of the width of the L5-S1 intervertebral space. The femurs 98 are shown for illustrative purposes.

FIGS. 13 a through 13d, and separately FIGS. 14a through 14e illustrate the deployment of the broach into the L5-S1 intervertebral disc space target site 104, as described for FIGS. 5-8.

FIG. 14 d illustrates the shaft can be rotated about the longitudinal axis of the shaft 14 before during or after the broach 12 is positioned in the L5-S1 intervertebral disc 62 space target site. The broach 12 can rotate in the L5-S1 intervertebral disc 62 space. The shaft 14 can rotate, as shown by arrow 106, about the longitudinal axis of the shaft to further dig the teeth 34 into the tissue.

FIGS. 15 a through 15c illustrate the delivery of the broach 12 through the transosseous delivery channel 50 and into the L5-S1 intervertebral disc 62. The broach 12 can have one or more radiopaque markers 100, for example one marker 100 in each segment 26.

Any or all elements of the device 10 and/or other devices or apparatuses described herein can be made from, for example, a single or multiple stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), nickel-cobalt alloys (e.g., MP35N® from Magellan Industrial Trading Company, Inc., Westport, Conn.), molybdenum alloys (e.g., molybdenum TZM alloy, for example as disclosed in International Pub. No. WO 03/082363 A2, published 9 Oct. 2003, which is herein incorporated by reference in its entirety), tungsten-rhenium alloys, for example, as disclosed in International Pub. No. WO 03/082363, polymers such as polyethylene teraphathalate (PET), polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), poly ester amide (PEA), polypropylene, aromatic polyesters, such as liquid crystal polymers (e.g., Vectran, from Kuraray Co., Ltd., Tokyo, Japan), ultra high molecular weight polyethylene (i.e., extended chain, high-modulus or high-performance polyethylene) fiber and/or yarn (e.g., SPECTRA® Fiber and SPECTRA® Guard, from Honeywell International, Inc., Morris Township, N.J., or DYNEEMA® from Royal DSM N.V., Heerlen, the Netherlands), polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ketone (PEK), polyether ether ketone (PEEK), poly ether ketone ketone (PEKK) (also poly aryl ether ketone ketone), nylon, polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., TECOFLEX® from Thermedics Polymer Products, Wilmington, Mass.), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), absorbable or resorbable polymers such as polyglycolic acid (PGA), poly-L-glycolic acid (PLGA) polylactic acid (PLA), poly-L-lactic acid (PLLA), polycaprolactone (PCL), polyethyl acrylate (PEA), polydioxanone (PDS), and pseudo-polyamino tyrosine-based acids, extruded collagen, silicone, zinc, echogenic, radioactive, radiopaque materials, a biomaterial (e.g., cadaver tissue, collagen, allograft, autograft, xenograft, bone cement, morselized bone, osteogenic powder, beads of bone) any of the other materials listed herein or combinations thereof. Examples of radiopaque materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium alloys, tantalum and gold.

The device 10 can be made from substantially 100% PEEK, substantially 100% titanium or titanium alloy, or combinations thereof.

Any or all elements of the device and/or other devices or apparatuses described herein, can be, have, and/or be completely or partially coated with agents for cell ingrowth.

The device 10 and/or elements of the device and/or other devices or apparatuses described herein can be filled, coated, layered and/or otherwise made with and/or from cements, tillers, and/or glues known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent. Any of these cements and/or fillers and/or glues can be osteogenic and osteoinductive growth factors.

Examples of such cements and/or fillers includes bone chips, demineralized hone matrix (DBM), calcium sulfate, coralline hydroxyapatite, biocoral, tricalcium phosphate, calcium phosphate, polymethyl methacrylate (PMMA), biodegradable ceramics, bioactive glasses, hyaluronic acid, lactoferrin, bone morphogenic proteins (BMPs) such as recombinant human hone morphogenetic proteins (rhBMPs), other materials described herein, or combinations thereof.

The agents within these matrices can include any agent disclosed herein or combinations thereof, including radioactive materials; radiopaque materials; cytogenic agents; cytotoxic agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non-steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (e.g., VIOXX® from Merck & Co., Inc., Whitehouse Station, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE®, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Examples of other agents are provided in Walton et al, Inhibition of Prostoglandin E₂ Synthesis in Abdominal Aortic Aneurysms, Circulation, Jul. 6, 1999, 48-54; Tambiah et al, Provocation of Experimental Aortic Inflammation Mediators and Chlamydia Pneumoniae, Brit. J. Surgery 88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and Its Effect on Inflammation and Proteolysis, Brit. J. Surgery 86 (6), 771-775; Xu et al, Sp1 Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular Endothelium, J. Biological Chemistry 275 (32) 24583-24589; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms, J. Clinical Investigation 105 (11), 1641-1649 which are all incorporated by reference in their entireties.

Any elements described herein as singular can be pluralized (i.e., anything described as “one” can be more than one). Any species element of a genus element can have the characteristics or elements of any other species element of that genus. The above-described configurations, elements or complete assemblies and methods and their elements for carrying out the invention, and variations of aspects of the invention can be combined and modified with each other in any combination.

Claims

1. A method for removing tissue from a biological target site in a patient comprising: inserting a multi-segmented articulating broach into the target site, wherein the broach comprises a first segment longitudinally distal to a second segment, and wherein the first segment is rotatably attached to the second segment, and wherein inserting comprises rotating the first segment with respect to the second segment, and wherein the rotation has a component of rotation around an axis parallel with a sagittal axis of the patient.

2. The method of claim 1, further comprising forming a channel through an obstructing bone.

3. The method of claim 2, wherein inserting comprises translating the broach through the channel.

4. The method of claim 3, wherein inserting further comprises articulating the broach while the broach is located at the target site.

5. The method of claim 4, wherein the broach comprises teeth extending across the width of the broach.

6. The method of claim 1, further comprising removing the broach from the target site.

7. The method of claim 1, further comprising capturing tissue debris in the broach.

8. The method of claim 1, further comprising removing the broach from the target site, wherein removing the broach from the target site comprises removing tissue debris from the target site.

9. The method of claim 1, wherein the target site comprises an L5-S1 intervertebral disc space.

10. The method of claim 1, wherein the broach comprises teeth extending across the width of the broach.

11. A method for removing tissue from a biological target site in a patient comprising: inserting a multi-segmented articulating broach into the target site, wherein the broach comprises teeth, and wherein inserting comprises articulating between at least two segments of the broach, and wherein the articulation comprises rotating around an axis parallel with a sagittal axis of the patient; anddebriding the tissue comprising oscillating the broach at the target site, further comprising scraping the tissue with at least some of the teeth.

12. The method of claim 11, further comprising forming a channel through an obstructing bone.

13. The method of claim 12, wherein inserting comprises translating the broach through the channel.

14. The method of claim 13, wherein inserting further comprises articulating the broach while the broach is located at the target site.

15. The method of claim 14, wherein the broach comprises teeth extending across the width of the broach.

16. The method of claim 11, further comprising removing the broach from the target site.

17. The method of claim 11, further comprising capturing tissue debris in the broach.

18. The method of claim 11, further comprising removing the broach from the target site, wherein removing the broach from the target site comprises removing tissue debris from the target site.

19. The method of claim 11, wherein the target site comprises an L5-S1 intervertebral disc space.

20. The method of claim 11, wherein the broach comprises teeth extending across the width of the broach.