A method and system for guiding at least a portion of a surgical device to a desired position between two tissues in a patient's body involves coupling a guidewire to the device and pulling the distal end of the guidewire to guide at least a portion of the surgical device to a desired position between the two tissues. The surgical device generally includes one or more guidewire coupling members and may comprise a tissue access device. A system may include a guidewire and a surgical device. In some embodiments, a guidewire, a tissue access device, and one or more additional devices to use with the access device may be provided. Methods, devices and systems may be used in open, less-invasive or percutaneous surgical procedures, in various embodiments.

Tissue access guidewire system and method

Guidewire exchange systems, devices and methods, for positioning and actuating surgical devices in a desired position between two tissues in a patient's body are described A guidewire may be coupled to a surgical device for positioning and actuating (eg, urging against a target tissue) The guidewire may be exchanged between different surgical devices during the same procedure, and the guidewire and surgical devices may be releaseably or permanently coupled The surgical device generally includes one or more guidewire coupling members A system may include a guidewire and a surgical device having a guidewire coupling member Methods, devices and systems may be used in open, less-invasive or percutaneous surgical procedures

Guidewire exchange systems to treat spinal stenosis

Described herein are methods and systems for precisely placing and/or manipulating devices within the body by first positioning a guidewire or pullwire. The device to be positioned within the body is coupled to the proximal end of the guidewire, and the device is pulled into the body by pulling on the distal end of the guidewire that extends from the body. The device may be bimanually manipulated by pulling the guidewire distally, and an attachment to a device that extends proximally, allowing control of both the proximal and the distal ends. In this manner devices (and particularly implants such as innerspinous distracters, stimulating leads, and disc slings) may be positioned and/or manipulated within the body. Guidewire exchange systems, devices and methods are also described. A guidewire may be exchanged between different surgical devices and may be releaseably or permanently coupled.

Access and tissue modification systems and methods

https://www.oarsijournal.com/article/S1063-4584(06)00065-3/pdf

Magnetic resonance imaging (MRI) of articular cartilage in knee osteoarthritis (OA): morphological assessment.

Joint tissues are exquisitely sensitive to their mechanical environment, and mechanical loading may be the most important external factor regulating the development and long-term maintenance of joint tissues. Moderate mechanical loading maintains the integrity of articular cartilage; however, both disuse and overuse can result in cartilage degradation. The irreversible destruction of cartilage is the hallmark of osteoarthritis and rheumatoid arthritis. In these instances of cartilage breakdown, inflammatory cytokines such as interleukin-1 beta and tumor necrosis factor-alpha stimulate the production of matrix metalloproteinases (MMPs) and aggrecanases (ADAMTSs), enzymes that can degrade components of the cartilage extracellular matrix. In order to prevent cartilage destruction, tremendous effort has been expended to design inhibitors of MMP/ADAMTS activity and/or synthesis. To date, however, no effective clinical inhibitors exist. Accumulating evidence suggests that physiologic joint loading helps maintain cartilage integrity; however, the mechanisms by which these mechanical stimuli regulate joint homeostasis are still being elucidated. Identifying mechanosensitive chondroprotective pathways may reveal novel targets or therapeutic strategies in preventing cartilage destruction in joint disease.

Mechanical loading, cartilage degradation, and arthritis

This article describes an intramedullary nail that contains a fully implantable motorized programmable sliding mechanism for limb lengthening and bone transport that reduces the risk of infection, discomfort, and scarring usually associated with the external fixators used for the same purpose. Twelve patients were treated surgically with the new system. Eleven patients had unilateral femur shortening between 3 and 7.5 cm, and one patient had a 12-cm defect after tumor resection. In all patients with femur shortening the leg length discrepancy was corrected completely. In the case of bone defect the segment transport worked well without any problems. There was no infection and no axial deformity. Immediately after chemotherapy, delayed bone formation was seen. In two early cases of limb lengthening a technical problem led to replacement of the motor.

A fully implantable motorized intramedullary nail for limb lengthening and bone transport.

Ollier's disease is characterised by severe deformity of the extremities and retarded growth because of multiple enchondromas. For correction of deformity, the Ilizarov method has been used although it has many complications. A 17-year-old boy with Ollier's disease had a limb-length discrepancy of 17.4 cm, with a valgus deformity of the right knee and recurvatum of the femur of 23 degrees . He had undergone three unsuccessful attempts to correct the deformities by using external fixators. We used a fully implantable, motorised, lengthening and correction nail (Fitbone) to achieve full correction of all the deformities without complications. We decided to carry out the procedure in three stages. First, we lengthened the femur by 3.6 cm and the tibia by 4 cm. We then exchanged the femoral nail for a longer implant and achieved a further 6 cm of length. This reduced the shortening to 3.8 cm. When the boy has finished secondary school we will adjust the remaining discrepancy.

The management of leg-length discrepancy in Ollier’s disease with a fully implantable lengthening nail

[First fully implantable intramedullary system for callus distraction--intramedullary nail with programmable drive for leg lengthening and segment displacement. Principles and initial clinical results].

Bone reconstruction after resection of malignant bone tumors of the lower extremity in children and adolescents remains a challenge in limb-sparing surgery. Equal limb length at maturity and good functional outcome are the main goals of these surgeries but often are difficult to achieve. Expandable endoprostheses are available but usually require repeated operative interventions for lengthening. Moreover, as the size of the implant increases, the proportion of the implant relative to the remaining bone increases, generating a biomechanical disadvantage to the limb. The authors describe a new concept combining an endoprosthesis with a fully implantable motorized distraction nail that can be activated in gradual steps to lengthen the remaining bone by callus distraction. New high-quality bone is growing and the proportion of prosthesis length compared with leg length develops in favor of the remaining bone.

The bioexpandable prosthesis: a new perspective after resection of malignant bone tumors in children.

Fur die operative Knochendurchtrennung stehen verschiedene Werkzeuge und Techniken zur Verfugung. Welche Methode vorteilhaft ist, hangt wesentlich von dem ubergeordneten chirurgisch-orthopadischen Behandlungskonzept, der Lokalisation und der nachfolgenden Implantatwahl ab. Je hoher die biologischen Anforderungen an die Schnittflachen sind, desto entscheidender ist ein gewebeschonendes Vorgehen unter Beachtung der Vascularitat und Vermeidung von Hitzeentwicklungen wahrend der Knochendurchtrennung. Die Implantate geben den Zugangsweg vor, dieser sollte auch fur die Knochendurchtrennung genutzt werden. Daraus ergeben sich die fur die oszillierende Sage, die Gigli-Sage, den Meisel, den Bohrer und die Markraumsage spezifischen Einsatzgebiete.

Indikation und Technik der Knochendurchtrennung

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