Abstract:
Suture locking devices and methods. In one embodiment, the device includes a suture lock, a rotatable actuator adjacent to the lock, and a release mechanism. The lock defines a pair of suture holes which receive sutures attached to tissue (e.g. a spinal disc) of the surgical site. When the actuator rotates the sutures are wound together (preferably around a hub on the lock) thereby securing the plate to the tissue. Furthermore, the release mechanism is coupled to the lock in such a manner that when the release mechanism is actuated the device releases the lock. The release mechanism may include a push button that is biased away from the lock. Also, the actuator may include a thumbwheel and a gear. Further, the gear may also define suture holes. Additionally, a pull ring connected to a pair of loops for drawing the sutures through the instrument may be included.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS  
       [0001]     This application relates to co-pending U.S. patent application entitled SYSTEM AND METHOD TO DELIVER ANCHORS INTO ANNULUS TISSUE No. 60/720,848 filed On Sep. 27, 2005, to co-pending U.S. Patent Application entitled ANNULAR ACCESS DEVICE USING T-ANCHORS” No. 60/780,897 filed on Mar. 9, 2006, and to U.S. patent application entitled “ANNULAR ACCESS DEVICES” Ser. No. 11/462,319 filed on Aug. 3, 2006 all of which are incorporated herein as if set forth in full. 
     
    
     TECHNICAL FIELD  
       [0002]     The invention relates generally to medical devices for treatment of spinal injuries and, more particularly, to devices for closing a breach in annulus tissue and/or nucleus tissue of an intervertebral disc.  
       BACKGROUND  
       [0003]     The spinal column comprises a number of bony vertebrae. Each vertebral body is composed of hard cortical bone on the outside, and less dense cancellous bone on the inside. The top and bottom of the vertebral body are called the endplates. In a healthy state the vertebrae are separated from each other by intervertebral discs, which lie between the respective endplates.  
         [0004]     The intervertebral discs are complex structures that support the weight of the body and, with the facet joints, permit a significant range of motion. Each disc is made up of fibrocartilage and has two parts: the nucleus pulposus (the “nucleus”) and the annulus fibrosis (the “annulus”). The nucleus is a gel-like material located in the center of the disc. It has a high water content, which allows it to act as a cushion and distribute loads onto the vertebral body endplates and to the annulus. The annulus is the outer portion of the disc. The annulus consists of 15 to 25 layers of collagen, much like the layers of a truck tire. The structural design allows the annulus to contain the nucleus under pressure, and to help hold the vertebral bodies in place. The annulus also binds the adjacent vertebrae together using collagen fibers that are attached to the vertebrae and cross each other so that half of the individual fibers will tighten as the vertebrae are rotated in either direction, thus resisting twisting or torsional motion.  
         [0005]     As the aging process continues, the center of the disc may start to lose water content, making the disc less effective as a cushion. This may cause a displacement of the disc&#39;s center (called a herniated or ruptured disc) through a crack in the outer layer. The result is that the disc height is reduced leading to compression of the nerve bundles, causing pain and in some cases damage to the nerves.  
         [0006]     Currently, there are many systems and methods at the disposal of a physician for reducing, or eliminating, the pain by minimizing the stress on the nerve bundles. In some instances, the existing disc is removed and an artificial disc is substituted therefore. In other instances, two or more vertebrae are fused together to prevent relative movement between the fused discs.  
         [0007]     The ruptured disc should be surgically repaired as quickly as possible and without doing more damage to the surrounding tissue and muscle of the patient unless absolutely necessary. With traditional surgical techniques, relatively large amounts of muscle and tissue must be removed to access the annulus. Such procedures expose the patients to more pain, additional recovery time, and a greater likelihood of infection.  
         [0008]     What is needed, therefore, are devices and methods which allow for rapid and secure closure of the disc in a minimally invasive or percutaneous manner.  
       SUMMARY  
       [0009]     In response to these and other problems, in one embodiment, there is disclosed a suture locking device which includes a suture lock, a rotatable actuator adjacent to the lock, and a release mechanism. The lock defines a pair of suture holes which receive sutures attached to tissue of the surgical site. When the actuator rotates the sutures are wound together thereby securing the plate to the tissue. Furthermore, the release mechanism is coupled to the lock in such a manner that when the release mechanism is actuated the device releases the lock.  
         [0010]     These and other features, and advantages, will be more clearly understood from the following detailed description taken in conjunction with the accompanying drawings. It is important to note the drawings are not intended to represent the only aspect of the invention.  
         [0011]     Although the present invention and its advantages have been described in detail, it should be understood that various changes, substitutions and alterations can be made herein without departing from the invention as defined by the appended claims. Moreover, the scope of the present application is not intended to be limited to the particular embodiments of the process, machine, manufacture, composition of matter, means, methods, and steps described in the specification. As one will readily appreciate from the disclosure, processes, machines, manufacture, compositions of matter, means, methods, or steps, presently existing or later to be developed that perform substantially the same function or achieve substantially the same result as the corresponding embodiments described herein may be utilized. Accordingly, the invention is intended to encompass within its scope such processes, machines, manufacture, compositions of matter, means, methods, or steps. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0012]     For a more complete understanding of the present invention, and the advantages thereof, reference is now made to the following descriptions taken in conjunction with the accompanying drawings, in which:  
         [0013]      FIG. 1  is a top view of an embodiment of an anchor delivery device;  
         [0014]     FIGS.  2 A-B are longitudinal section views of one embodiment of a deployment end of the anchor delivery device;  
         [0015]      FIG. 2C  is a needle and a T-anchor which has been deployed from an exit port as a result of the actuating device;  
         [0016]     FIGS.  3 A-C are detail sectional views of one embodiment of an actuating mechanism of the anchor delivery device;  
         [0017]      FIG. 4  is one embodiment of a suture locking device;  
         [0018]      FIG. 5A  is a detailed section view of an actuating mechanism of the suture locking device of  FIG. 4 ;  
         [0019]      FIG. 5B  is a section view illustrating one embodiment of a distal end of a shaft mechanism coupled to a suture cap of the suture locking device;  
         [0020]      FIG. 5C  is a transverse cross-section view of the actuating mechanism of the suture locking device;  
         [0021]      FIG. 5D  is another detailed section view of an actuating mechanism of the suture locking device of  FIG. 4 ;  
         [0022]      FIG. 5E  is a section view illustrating one embodiment of a distal end of a shaft mechanism releasing the suture cap of the suture locking device;  
         [0023]      FIG. 6A  is an isometric detail view of one embodiment of a suture cap;  
         [0024]      FIG. 6B  is section view of the suture cap;  
         [0025]      FIG. 6C  is a perspective view of the distal end of the distal end of the shaft mechanism with a suture cap lid transparent;  
         [0026]     FIGS.  7 A-C are exploded views of the suture cap;  
         [0027]      FIG. 8  illustrates a method for using certain aspects of the present invention;  
         [0028]     FIGS.  9 A-E illustrate one method of preparing a surgical site and placement of one embodiment of the present invention;  
         [0029]      FIG. 10A  is a detailed view showing a distal end of the anchor delivery device placed next to an exposed exterior surface of the annulus;  
         [0030]      FIG. 10B  is a detailed view showing where a T-anchor has been deployed into the nucleus and is protruding beyond an outer tube;  
         [0031]      FIG. 10C  is a detailed view showing where both T-anchors have been deployed into the nucleus;  
         [0032]      FIG. 10D  is a detailed view showing where both T-anchors have been deployed and the anchor delivery device is being removed;  
         [0033]      FIG. 10E  is a detailed view showing where a suture lock device is about to be deployed;  
         [0034]      FIG. 10F  is a detailed view showing where the sutures are pulled up through the suture lock device;  
         [0035]      FIG. 10G  is a detailed view showing a suture cap being released from the suture lock device and the sutures cut;  
         [0036]      FIG. 11A  is a detailed view showing a distal end of the anchor delivery device placed next to an exposed exterior surface of the annulus;  
         [0037]      FIG. 11B  is a detailed view showing where a T-anchor has been deployed into the annulus and is protruding beyond an outer tube;  
         [0038]      FIG. 11C  is a detailed view showing where both T-anchors have been deployed into the annulus;  
         [0039]      FIG. 11D  is a detailed view showing where both T-anchors have been deployed and the anchor delivery device is being removed;  
         [0040]      FIG. 11E  is a detailed view showing where a suture lock device is about to be deployed;  
         [0041]      FIG. 11F  is a detailed view showing where the sutures are pulled up through the suture lock device;  
         [0042]      FIG. 11G  is a detailed view showing a suture cap being released from the suture lock device and the sutures cut;  
         [0043]     FIGS.  12 A-D are detailed views of one embodiment of a T-anchor;  
         [0044]     FIGS.  13 A-D are detailed views of an alternative embodiment of a T-anchor;  
         [0045]     FIGS.  14 A-D are detailed views of an alternative embodiment of a T-anchor; and  
         [0046]     FIGS.  15 A-D are detailed views of an alternative embodiment of a T-anchor. 
     
    
     DETAILED DESCRIPTION  
       [0047]      FIG. 1  depicts a top view of one embodiment of an anchor delivery device  200 . The anchor delivery device  200  can comprise an outer tube or cannula  202 , having a proximal end  14  and a distal end or deployment end  16 . In some embodiments, an actuating mechanism  18  may be coupled to the proximal end of the cannula. In certain embodiments, the outer cannula  202  may also contain one or more needle delivery lumens (not shown in  FIG. 1 ) running longitudinally from the actuating mechanism  18  to the deployment end  16 .  
         [0048]     Turning now to  FIGS. 2A and 2B , there are longitudinal section views of one embodiment of the deployment end  16 .  FIG. 2A  illustrates a section cut in one direction and  FIG. 2B  illustrates a section cut in another direction. In some embodiments, the outer tube  202  of the anchor delivery device  200  can comprise a central channel  204  running lengthwise therethrough, and an inner assembly disposed within the central channel  204 . In certain embodiments, the inner assembly can comprise an inner tube  208  having at least two internal lumens  210 ,  212  running lengthwise therethrough. In some embodiments, the inner tube  208  may extend beyond the distal end of outer tube  202 . A tip  214  may be formed at a distal end of inner tube  208 . In some embodiments, the tip  214  may be generally conical having a rounded point so that inner tube  208  may function as a blunt obturator. In other words, the pointed tip allows the obturator to puncture tissue, such as the annulus. In other embodiments, there may be only an outer tube  202  without using the inner tube  208 . In yet other embodiments, the tip  214  may not be rounded and would not be used as an obturator.  
         [0049]     In certain embodiments, the internal lumens  210 ,  212  can run longitudinally, but then curve to connect to exit ports  216 ,  218 , respectively formed in sides the inner tube  208  behind the tip  214 . In certain embodiments, there may be anchors  232   a  and  232   b  positioned within the internal lumens  212  and  210 , respectively. In certain embodiments, these anchors  232   a - 232   b  may be T-anchors. T-anchors are further described with reference to  FIGS. 12-15 . In some embodiments, the anchors  232   a - 232   b  may be hollow and/or flexible. In certain embodiments, the anchors  232   a - 232   b  may be fabricated from a flexible polymer or other bio-resorbable plastic material. In certain embodiments, flexible drive rods  234  may be slidably disposed within the internal lumens  212 ,  210  between the anchors  232   a - 232   b  and pusher tubes  230   a  and  230   b . In certain embodiments, the drive rods  234  may be fabricated from a flexible metal alloy such as Nitinol, a nickel-titanium alloy.  
         [0050]     In some embodiments, sutures (not shown) may be attached to each anchor  232   a ,  232   b  and may run through the drive rods  234  and pusher tubes  230   a - 230   b . In some embodiments, there may be needles  238   a  and  238   b  which pass through the anchors  232   a - 232   b . In certain embodiments, the needles  238   a  and  238   b  may extend from the forward tip of the anchors to assist in penetration of the annulus and insertion of the anchors in the annulus. In some embodiments, there may be filler plates  240   a  and  240   b  which separate the channels  210 ,  212  as the channels cross over each other to connect to exit ports  216  and  218 .  
         [0051]     In certain embodiments, there may be an actuating device  18  ( FIG. 1 ) which longitudinally moves the pusher tubes  230   a - 230   b  within the internal lumens  210  and  212 , respectively. As the pusher tubes  230   a - 230   b  move, they move the drive rods  234 , which, in turn, drive the anchors  232   a - 232   b  out of the respective ports  218  and  216 , respectively. Accordingly, when the anchors are driven out of their respective ports, they may be deployed into the nucleus or the annulus.  
         [0052]     Referring now to  FIG. 2C , there is illustrated a needle  238   a  and a T-anchor  232   a  which has been deployed or pushed out of the exit port  218  as a result of the actuating mechanism actuating or pushing on the pusher tube  230   b  (not shown). Note that the drive rod  234  is flexible so that it bends as the curved portion of the internal lumen  212 .  
         [0053]     Turning now to  FIG. 3A , there is one embodiment of an actuating device  18 . In this illustrative figure, one half of a handle body  260  is removed for clarity. In certain embodiments, an actuation handle or lever  256  may be pivotally coupled to the handle body  260  at a pivot pin  264 . In some embodiments, link members  266   a  and  266   b  may operatively couple actuation lever  256  to a shuttle  268 . The shuttle  268  may be slidably mounted within the handle body  260 . In certain embodiments, the shuttle  268  may engage a pusher tube  230   a  that extends into the outer cannula  202  to drive one of the anchors as discussed above.  
         [0054]     In a similar fashion, an actuation lever  258  may be pivotally mounted on the handle body  260 , and link members  270   a - 270   b  may operatively couple the actuation lever  258  to a shuttle  274  which may be slidably mounted within the handle body  260  as illustrated. In certain embodiments, the shuttle  274  may engage a pusher tube  230   b  that extends into the outer cannula  202  to drive another one of the anchors, as discussed above.  
         [0055]     In certain embodiments, there may be a selector switch  262 , which may be operated from either side of handle assembly  254 . The selector switch allows a surgeon to selectively engage one or both shuttles  268 ,  274 . Consequently, allowing the anchor delivery device  200  to drive one or both of the anchors depending on the position of the selector switch.  
         [0056]     For instance,  FIG. 3B  illustrates a situation where only the actuation lever  258  is pressed into the handle assembly  254 . Thus, the linkage comprising links  270   a  and  270   b  (not shown) can be extended and drive the shuttle  274  forward. This action can move the pusher tube  230   b , which in turn, deploys an anchor (not shown) at the deployment end of the device. Handle  256  remains extended from the handle body  260 , link members  266   a - 266   b  remain un-extended, and shuttle  268  remains in its original, rearward position.  FIG. 3C  illustrates in detail one embodiment of the action of the selector switch  262  engaging the shuttle  274 , but leaving behind shuttle  268 .  
         [0057]     Referring now to  FIG. 4 , there is illustrated one embodiment of a suture locking device  500 . In this exemplary embodiment, the suture locking device  500  may comprise a shaft mechanism  502 , a suture actuating mechanism  504 , a release mechanism  506 , and a pull ring  508 . The shaft mechanism  502  may comprise an outer tube  510  and an inner tube (not shown) having a distal end  512  and a proximal end  514 . In this embodiment, the shaft mechanism  502  can deliver a suture lock or suture cap  516  which may be releasably coupled to the distal end  512 . In some embodiments, the suture cap could be fabricated from a flexible polymer or other bio-resorbable plastic material.  
         [0058]      FIG. 5A  is a detailed section view of the actuating mechanism  504 . In this embodiment, there is a housing  520  which may also serve as a handle. The housing  520  can have a central bore  522 , which widens at its proximal end to form a shoulder  524 . An inner or center tube  526  can run longitudinally from the distal end of the shaft mechanism  502  to a cap release button  528 . The cap release button  528  may slidingly engage the center tube  526 . In certain embodiments, the cap release button comprises a circular top portion and a lower plate portion. The cap release button may have a central bore for coupling with the suture pull ring  508  ( FIG. 4 ). In certain embodiments, the cap release button may also be coupled to a release tube  530 , which is disposed concentrically between the center tube  526  and the outer tube  510 .  
         [0059]     In certain embodiments, a helical spring  527  disposed within the central bore  522  biases the cap release button  528  towards the proximal direction. Rotatably mounted within the suture actuating mechanism  504  can be a thumb wheel  532  which may be coupled to release tube  530  via the cap release button  528 . Rotation of the thumb wheel  532  causes concomitant rotation of the center tube  526  and a portion of the suture cap  516  which may be coupled to the distal end of the center tube  526 .  
         [0060]      FIG. 5B  is a section view illustrating one embodiment of a distal end of the shaft mechanism coupled to the suture cap  516 . In this embodiment, there may be a center or inner tube  526 , the release tube  530 , and the outer tube  510 . In one embodiment, the inner tube  526  may be coupled to a plurality of bent coupling arms (arms  536   a  and  536   b  are shown). The coupling arms may be bent so that they extend into the path of the release tube  530 . At their distal ends, the coupling arms may also be bent to form a hook  537  which couples to the suture cap  516 . In yet another embodiment, the inner tube may have longitudinal slits extend up from the distal end to provide additional flexibility to the coupling arms  536 . The inner tube may then be bent in a manner similar to the coupling arms. Thus, as illustrated, the coupling arms (or, alternatively, the inner tube) may engage the suture cap  516 .  
         [0061]     Turning now to  FIG. 5C , there is a transverse cross-section view of the suture actuating mechanism  504 . In  FIG. 5C , the thumb wheel  532  is illustrated in a plan view. Also illustrated is a bottom plate  534  of the cap release button  528 . In this illustrated embodiment, the bottom plate  534  has four keys evenly spaced around the periphery of the plate. The four keys mate with corresponding slots of the thumb wheel  532 . Thus, as can be seen from  FIGS. 5A and 5C , when the cap release button  528  is biased in a first or proximal position, the keys of the bottom plate may engage the slots of the thumb wheel  532 . When the keys and slots are engaged, turning the thumb wheel turns the cap release button, which subsequently turns the center tube  526 . In contrast, when the cap release button  528  is in a second or distal position (in which the biasing force of the spring  527  has been overcome), the keys of the bottom plate are disengaged from the slots of the thumb wheel  532 . Accordingly, with the cap release button depressed, turning the thumb wheel  532  results in no rotation of the cap release button  528  or the center tube  526 .  
         [0062]     Pressing on the release button  528  may move the release tube  530  in a distal direction. When the release tube moves  530  down towards the distal end of the shaft mechanism, the release tube moves the coupling arms  536  in an inward direction. The hooks  537  may also be moved in an inward direction, which then releases the suture cap  516  from the shaft mechanism as illustrated in FIGS.  5 D-E.  
         [0063]      FIG. 6A  is an isometric detail view of one embodiment of a suture cap  516 . On the other hand,  FIG. 6B  is a section view of the suture cap  516 . Turning now to both  FIGS. 6A and 6B , it can be seen that in this embodiment, the suture cap  516  can comprise a cap housing  538 , a cap lid  540  and a gear  542 . In some embodiments, the cap housing  538  can have four holding slots  544   a - 544   d  ( 554   a  and  554   b  are illustrated) evenly spaced around the periphery thereof. The holding slots  544   a - 544   b  may mate with tabs formed on the distal end of the outer tube  510  for rotationally stabilizing the suture cap with the outer tube  510 .  
         [0064]      FIG. 6C  illustrates the distal end of the instrument  500  with the suture cap  516  transparent and the gear  542  visible. More particularly,  FIG. 6C  shows the hooks  537  engaging a land  539  on the inside of the cap housing  538  which allows the hooks  537  to retain the cap until the hooks  537  are moved in by release tube  530 . Moreover,  FIG. 6C  shows that the gear  542  includes an alignment slot  541  for the hooks  537  so that during assembly of the instrument  500 , the gear  542  can be aligned with the hooks  537  and assembled into the instrument. Furthermore, the gear  542  includes slots  543  which partially define the teeth of the gear and which allow drive pins  545  of center tube  526  to engage and drive the gear  542 . More specifically, the elongate slots  543  may provide some flexibility to the gear teeth to aid in their engagement of the cap teeth  546  to allow rotation in one direction but not the other. Thus, when the center tube  526  turns via thumbwheel  532  ( FIG. 5D ), the drive pins  545  cause the gear  542  to turn.  FIG. 6C  also shows that the gear  542  may rotate from one position where the suture holes  554 A and  554 B may initially be aligned with the suture holes  550 A and  550 B of the suture cap  540  to a second position where the gear suture holes  554 A and  554 B are represented as references  554 A′ and  554 B′.  
         [0065]     Turning now to  FIG. 7A , there is an exploded view of the suture cap  516 . As illustrated in this view, there can be a plurality of teeth  546  on the inside surface of the cap housing  538 . The teeth  546  engage the gear  542  in such a manner as to allow rotation in one direction, but not the other. As illustrated, the gear  542  may be rotatably coupled to the cap lid  540  via a center hub  548  protruding from the cap lid. In this embodiment, the cap lid  540  may have two suture holes  550   a  and  550   b  for passing two ends of sutures  552   a  and  552   b  therethrough. In certain embodiments, the suture cap  516  can include a gusset around the end of the hub  548  which can assist in retaining the sutures on the hub  548  during, and after, the sutures are wound around the hub  548 . Further, in some embodiments, the gear  542  can also have a set of suture holes  554   a  and  554   b  for passing the two ends of the sutures  552   a  and  552   b.    
         [0066]     As will be explained below in greater detail, the distal end of device  500  may be positioned adjacent the site of a surgical procedure, such as an annulotomy. At the completion of a surgical procedure, the surgeon can rotate the thumbwheel knob  532  ( FIG. 5A ), thereby rotating the inner tube  526  ( FIG. 5A ) which may be coupled to the gear  542 . Thus, the sutures  552   a  and  552   b  passing through suture holes  550   a  and  550   b  of the cap lid  540  and suture holes  554   a  and  554   b  of the gear  542  may be wound together over or around the hub  548  as illustrated in  FIG. 7B .  
         [0067]      FIG. 7B  is an exploded view of the suture cap  516 , where the gear  542  is rotated 45 degrees with respect to the cap lid  540 . Similarly,  FIG. 7C  is an exploded view of the suture cap  516 , where the gear  542  is rotated 90 degrees with respect to the cap lid  540  which illustrates more suture winding around the center hub  548 . Once the winding is complete, the surgeon can the press the release button  528  ( FIG. 5A ) to extend the release tube  530  in a distal direction and release the suture cap  516  from the shaft mechanism. The device  500  may then be removed from the surgical site and the sutures cut.  
         [0068]     Referring now to  FIGS. 8-9 , one manner of using the anchor delivery device  200  will now be described.  FIG. 8  illustrates a general method which could employ one or more aspects of the present invention.  FIGS. 9A through 9E  illustrate one method of preparing a surgical site and placement of one embodiment of the present invention.  
         [0069]     Turning now to  FIG. 8 , there is illustrated a method for using certain aspects of the present invention. Details regarding the method will be explained below. The procedure begins at step  901  and flows to step  902 . In step  902 , an annulotomy may be performed. In step  904 , the anchor delivery device may then deploy the anchors into the annulus in step  906 . After deployment of the anchors, in step  908 , the anchor delivery device may be removed. In step  910 , a suture locking device may be inserted adjacent to the annulus, where the suture cap is deployed (step  912 ). The suture locking device may then be removed and the sutures may be cut (step  914 ). The procedure stops at step  916  and closure may be accomplished in a conventional manner.  
         [0070]     One aspect of performing an annulotomy may be illustrated in  FIGS. 9A-9E . As illustrated in  FIG. 9A , a k-wire  80  may be advanced percutaneously in a lateral or posterolateral approach. The surgeon may use fluoroscopic techniques to guide him through the muscles and tissues  82  to the annulus  84 . The surgeon may drive the k-wire through the annulus  84  and into the nucleus disc space  85 . An obturator  86  may then be advanced over the guide wire to the outer surface of the annulus as illustrated in  FIG. 9B . A first dilator  88  having a larger radius than the obturator  86  may then be advanced over the obturator as illustrated in  FIG. 9C . The first dilator  88  may be either straight or beveled as illustrated. In certain embodiments, a plurality of dilators may be used to provide a progressive larger access to the surgical site. As illustrated in  FIG. 9D , a second dilator  90 , having a larger radius than the first dilator may be advanced over the first dilator  88 . The second dilator may also be straight or beveled. The k-wire  80 , the obturator  86 , and the first dilator  88  may then be removed leaving the second dilator  90  in place and exposing the surface of the annulus  84 .  
         [0071]      FIG. 9E  illustrates a situation where the k-wire  80 , the obturator  86 , and the first dilator  88  have been removed and an anchor delivery device  200  has been inserted into the second dilator  90  such that the distal end of the annular access device is adjacent to the surface of the annulus.  
         [0072]     In certain embodiments, an incision into the annulus  84  may be performed with a trephine (not shown). In some alternative embodiments, an obturator may be used to perform the annulotomy. Such an incision may be made through the outer surface of the annulus of the disc. In other embodiments, a cannula or dilator may include an extendable or fixed sheath or guard (not shown) to protect the annulus during the surgical procedure. In such embodiments, the cannula may be advanced into the disc space at a depth beyond the surface of the annulus.  
         [0073]      FIG. 10A  is a detailed view showing the distal end  16  of the anchor delivery device  200  placed next to an exposed exterior surface  92  of the annulus  84 . For illustrative purposes, line  94  represents a demarcation between the annulus  84  and a nucleus  85 . However, an actual disc would not have a clear demarcation line between the annulus  84  and the nucleus  85 . As previously discussed, in certain embodiments, the anchor delivery device  200  may be placed within the second dilator  90 . In this situation, the needles and the anchors (T-anchors) may be within the respective needle lumens in a first or retracted position.  
         [0074]     In  FIG. 10B , the distal end of the anchor delivery device  200  is shown where a T-anchor  232   a  has been deployed into the nucleus  85  and is protruding beyond the outer tube. In this figure, one of the actuation levers may have been pressed which has caused one of the T-anchors to deploy in the nucleus  85 . The T-anchor can penetrate the annulus  84  to get into the nucleus  85 . As previously explained in reference to  FIGS. 2A and 2B , when an actuating lever or handle of an actuating device  18  is depressed, a corresponding linkage can move a shuttle longitudinally towards the distal end  16 . The shuttle can move a pusher tube within one of the internal lumens. As the pusher tube moves, it also can move a drive rod, which, in turn, drives the T-anchor  232   a  out of the side port.  
         [0075]      FIG. 10C , therefore, illustrates a situation where both actuation levers may have been pressed. Consequently, both T-anchors  232   a  have been deployed into the nucleus  85 .  
         [0076]      FIG. 10D  illustrates a situation where the T-anchors have been deployed and the anchor delivery device is being removed. Note that the sutures may be attached to the T-anchors as the device is being removed.  
         [0077]     In  FIG. 10E , the suture lock device is about to be deployed. In this embodiment, one end of a first suture which is coupled to the first T-anchor can be coupled to a loop  560  hanging out of the suture lock device. The second end of the first suture can then be coupled to a second loop  560  hanging out of the suture lock device. Similarly, one end of a second suture which is coupled to the second anchor may be coupled to the first loop  560  hanging out of the suture lock device. The second end of the first suture is then coupled to the second loop  560  hanging out of the suture lock device as illustrated.  
         [0078]     After the loops have been coupled to the sutures, the suture lock device  500  may be inserted into the dilator as is illustrated in  FIG. 10F . Once the suture lock device  500  has been fully inserted into the dilator, the pull ring  508  (which may be coupled to threads which are attached to the loops), may then be pulled. When the pull ring  508  is pulled the sutures may be pulled up through the suture lock device  500  as illustrated in  FIG. 10F . Each suture can be attached to the middle of a T-anchor. This feature enables the t-anchors to securely attach to the inside of the annulus  84  within the nucleus  85 .  
         [0079]     As previously described, the thumb wheel may then be turned which will wrap the sutures around the suture cap  516 . The suture cap  516  may then be released from the suture lock device  500  and the sutures cut as illustrated in  FIG. 10G . The T-anchors  232   a  can be secured to the annulus  84 , but can be located in the nucleus  85 . Thus, a surgical closure of the annular breach may be provided.  
         [0080]     Similarly, FIGS.  11 A-G illustrate certain embodiments, wherein the T-anchors  232   a  are deployed in the annulus  84 .  FIG. 11A  is a detailed view showing a distal end  16  of the anchor delivery device  200  placed next to an exposed exterior surface of the annulus  84 .  FIG. 11B  is a detailed view showing where a T-anchor  232   a  has been deployed into the annulus  84  and is protruding beyond an outer tube.  FIG. 11C  is a detailed view showing where both T-anchors  232   a  have been deployed into the annulus  84 .  FIG. 11D  is a detailed view showing where both T-anchors have been deployed and the anchor delivery device  200  is being removed.  FIG. 11E  is a detailed view showing where a suture lock device is about to be deployed.  FIG. 11F  is a detailed view showing where the sutures are pulled up through the suture lock device  500 .  FIG. 11G  is a detailed view showing a suture cap  516  being released from the suture lock device  500  and the sutures cut. Each suture may be attached to the middle of a T-anchor. This feature enables the T-anchors to securely attach to the annulus  15   84 . In  FIG. 11G , the T-anchors are secured in the annulus  84 , and a surgical closure of the annular breach may be provided.  
         [0081]     FIGS.  12 A-D are detailed views of one embodiment of a T-anchor  1200 .  FIG. 12A  is a side view of the T-anchor  1200 .  FIG. 12B  is a top view of the T-anchor  1200 . Two holes  802  on the top of the T-anchor  1200  indicate where the sutures may be secured.  FIG. 12C  is an isometric view of the T-anchor  1200 .  FIG. 12D  is a front view of the T-anchor  1200 . A hole  804  in the front of the T-anchor  1200  indicates where a needle may be inserted into the T-anchor. As previously described, a needle can be used to penetrate the annulus.  
         [0082]     FIGS.  13 A-D are detailed views of an alternative embodiment of a T-anchor  1300 .  FIG. 13A  is a top view of the T-anchor  1300 .  FIG. 13B  is a bottom view of the T-anchor  1300 . Two holes  810  on the top of the T-anchor  1300  indicate where the sutures may be secured.  FIG. 13C  is an isometric view of the T-anchor  1300 . Fingers  812  on the bottom of the T-anchor  1300  may be used to anchor the T-anchor into the annulus.  FIG. 13D  is a front view of the T-anchor  1300 .  
         [0083]     FIGS.  14 A-D are detailed views of an alternative embodiment of a T-anchor  1400 .  FIG. 14A  is a side view of the T-anchor  1400 . Fingers  824  on the bottom of the T-anchor  1400  may be used to anchor the T-anchor into the annulus.  FIG. 14B  is a bottom view of the T-anchor  1400 .  FIG. 14C  is an isometric view of the T-anchor  1400 . Two holes  820  on the top of the T-anchor  1400  indicate where the sutures may be secured.  FIG. 14D  is a front view of the T-anchor  1400 . A hole  822  in the front of the T-anchor  1400  indicates where a needle can be inserted into the T-anchor.  
         [0084]     FIGS.  15 A-D are detailed views of an alternative embodiment of a T-anchor  1500 .  FIG. 15A  is a side view of the T-anchor  1500 . Fingers  834  on the bottom of the T-anchor  1500  may be used to anchor the T-anchor into the annulus.  FIG. 15B  is a bottom view of the T-anchor  1500 .  FIG. 15C  is an isometric view of the T-anchor  1500 . Two holes  830  on the top of the T-anchor  1500  indicate where the sutures may be secured.  FIG. 15D  is a front view of the T-anchor  1500 . A hole  832  in the front of the T-anchor  1500  indicates where a needle can be inserted into the T-anchor.  
         [0085]     Other embodiments may include:  
         [0086]     1. An apparatus for performing a surgical operation on an intervertebral disc wherein the disc has an annulus on which an annulotomy may be performed, the apparatus comprising a cannula having a proximal end and a distal end, an obturator coupled to the distal end of the cannula and being adapted for insertion into the annulotomy, an annulus engaging member operatively coupled to the obturator and adapted to engage the annulus, and an actuator operatively coupled to the member in such a manner that when the actuator is actuated the member engages the annulus thereby securing the apparatus to the annulus.  
         [0087]     2. The apparatus of Embodiment 1 wherein the annulus engaging member comprises an anchor.  
         [0088]     3. The apparatus of Embodiment 2 wherein the anchor comprises a barb.  
         [0089]     4. The apparatus of Embodiment 1 wherein the cannula has a longitudinal axis extending between the proximal and distal ends, and wherein the annulus engaging member is configured to extend from the cannula at an acute angle with respect to the longitudinal axis of the cannula.  
         [0090]     5. The apparatus of Embodiment 1 wherein the actuator further comprises a handle having a first position and a second position and being operatively coupled to the annulus engaging member in such a manner that when the handle is moved from the first position to the second position the annulus engaging member engages the annulus.  
         [0091]     6. The apparatus of Embodiment 1 wherein the cannula has an inner diameter of approximately 5 mm or less.  
         [0092]     7. The apparatus of Embodiment 1 wherein the annulus engaging member is configured to detach from the obturator.  
         [0093]     8. The apparatus of Embodiment 1 wherein the annulus engaging member is further adapted to engage at least one suture in such a manner that the suture is drawn through at least a portion of the annulus when the actuator is actuated.  
         [0094]     9. An apparatus for performing a surgical operation on an intervertebral disc wherein the disc has an annulus on which an annulotomy may be performed, the apparatus comprising a cannula having a proximal end and a distal end, an obturator coupled to the distal end of the cannula and being adapted for insertion into the annulotomy, means for engaging the annulus operatively coupled to the obturator, and means for actuating operatively coupled to the means for engaging in such a manner that when the means for actuating is actuated the means for engaging engages the annulus thereby securing the apparatus to the annulus.  
         [0095]     10. A method of performing a surgical operation on an intervertebral disc wherein the disc has an annulus, the method comprising inserting an obturator into an annulotomy in the annulus, the obturator including a member adapted to engage the annulus and being coupled to a cannula and engaging the annulus with the member by actuating an actuator operatively coupled to the member thereby securing the obturator to the annulus.  
         [0096]     11. The method of Embodiment 10 wherein the engaging the annulus with the member further comprises drawing at least one suture through at least a portion of the annulus.  
         [0097]     12. The method of Embodiment 10 further comprising leaving the member in the annulus.  
         [0098]     It is understood that the present invention can take many forms and embodiments. Accordingly, several variations may be made in the foregoing without departing from the spirit or the scope of the invention.  
         [0099]     Having thus described the present invention by reference to certain of its preferred embodiments, it is noted that the embodiments disclosed are illustrative rather than limiting in nature and that a wide range of variations, modifications, changes, and substitutions are contemplated in the foregoing disclosure and, in some instances, some features of the present invention may be employed without a corresponding use of the other features. Many such variations and modifications may be considered obvious and desirable by those skilled in the art based upon a review of the foregoing description of preferred embodiments. Accordingly, it is appropriate that the appended claims be construed broadly and in a manner consistent with the scope of the invention.