Abstract:
Percutaneous interbody spine fusion devices are provided. These devices may have a number of different designs and exemplary features. One device consists of a single rotating hollow cam cage with perforations (with or without fixation anchors) and a delivery tool. Another device consists of a counter-rotating cam cage (with or without fixation anchors) and a delivery tool. A third device consists of an expanding cam with anchors and delivery tool; this device may consist of a single expanding cam or a series of expanding cams. A delivery tool is included. A fourth device consists of a spring cage; this device may be a stand-alone device, can be combined with expanding cam device, and may be incorporated into a cage. A delivery tool is included. This spring cage may or may not have fixation anchors. A fifth device consists of a random coil support device that can be used as a nuclear or spine fracture support device; a delivery tool is included. A sixth device consists of a directional ribbon strip coil device and delivery tool. Also provided is a percutaneous off-angle bone stapling/nailing fixation device.

Description:
REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority under 35 U.S.C. 119(e) to U.S. Provisional Patent Application No. 61/266,620, filed Dec. 4, 2009, the contents of which are herein incorporated by reference in its entirety. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present inventions relate to methods and devices for percutaneous spinal stabilization and fusion, and particularly stabilization and fusion of the interbody (intervertebral body) space. These inventions also relate to nuclear and vertebral fracture support devices and methods. 
       BACKGROUND OF THE INVENTION 
       [0003]    The individual vertebrae in the spine are joined to each other at three sites; the fibrocartilaginous intervertebral disc and two facet joints. Each vertebra has an articulating surface (facet) on the left and right sides; when joined with the articulating surfaces (facets) of the adjacent vertebrae, these articulating surfaces form facet joints. The vertebral bodies of the individual vertebrae are separated by intervertebral discs formed of a tough outer fibrous cartilage ring enclosing a central mass “jelly-like” semi-fluid mass, the nucleus pulposus that provides for cushioning and dampening of compressive forces to the spinal column. The adjacent surfaces of the vertebral bodies that abut the discs are covered with thin layers of hyaline cartilage. Several ligaments (supraspinous, interspinous, anterior and posterior longitudinal, and the ligamentum flavum) hold the vertebrae in position yet permit a limited degree of movement. The vertebral bodies are located anteriorly and together with the intervertebral discs provide the majority of the weight bearing support of the vertebral column. Each vertebral body has relatively strong cortical bone comprising the outer surface of the body and weak bone (cancellous) comprising the central portion of the vertebral body. 
         [0004]    Persistent, chronic low back pain is often secondary to degeneration of the lumbar discs. With advancing age and degenerative disease, the water content of the nucleus pulposus diminishes and is replaced by fibrocartilage. The discs often lose height and become less elastic, the loss of disc height often results in bone spur formation, foraminal stenosis, canal stenosis, and resultant pain. In the spine, the pain can be treated by fusing the three sites of articulation: the intervertebral (interbody) space and the two facet joints. 
         [0005]    There are two possible mechanisms that result in pain from diseased discs. The first theory is that the disc itself produces pain through trauma or degeneration and that removal of the disc is necessary to relieve the back pain. Typical surgeries to remove the disc and fuse the adjacent vertebrae together are performed in an open fashion and often involve extensive surgical manipulations with stripping and damaging of the paraspinal musculature. One method involves removing and replacing the disc with bone plugs and/or cages. These surgeries can also involve manipulations in the spinal canal itself. Other procedures include a variety of open lumbar fusion surgeries, with the anterior lumbar fusion often being performed as a “stand-alone” procedure. 
         [0006]    The second theory is that the disc narrowing and degeneration leads to stress on all of the adjacent vertebral structures (including the vertebral bodies, ligaments, and facet joints). A number of devices and techniques involve implantation of spinal implants to reinforce or replace removed discs and to mechanically immobilize areas of the spine assisting in the eventual fusion of the treated adjacent vertebrae. One technique involves the use of pedicle screws and rods to immobilize the posterior aspect of the spine. Another technique involves the placement of anterior plate systems. A number of disc shaped replacements or artificial disc implants are also used. A type of disc reinforcement or augmentation implant is a hollow cylindrical cage that is placed in the interbody space after much of the disc material has been removed. These cages are typically placed in extensive open surgical procedures with considerable perioperative morbidity. 
         [0007]    Another relatively common cause of back pain is spondylolysis. This disorder results from defects in the pars interarticularis which may be congenital or acquired. Spondylolysis can result in spondylolithesis (subluxation) of one vertebra on another. This subluxation can cause back and lower extremity pain from spinal canal stenosis and/or foraminal stenosis. There is a need for a percutaneous treatment device that can reduce the subluxation and prevent it from subluxing after the reduction. 
         [0008]    Also, there are &gt;700,000 vertebral body compression fractures/year in the United States, mainly in patients with osteoporosis. A number of devices and procedures are currently performed for treatment; however, an ideal procedure has not yet been developed. 
         [0009]    It is also evident that there is a need for a percutaneous, off-angle, bone stapling/nailing fixation device to assist in orthopedic/neurosurgical procedures. 
         [0010]    In summary, fusion of the intervertebral space has traditionally required open surgery. Unfortunately, these surgical procedures are extensive, often resulting in considerable peri-operative morbidity and prolonged recovery times. Various methods of fusing the intervertebral disc space have included surgical placement of cage devices, external plating and screws and transacral screw fixation. Most of the commonly used procedures require open surgery with resultant prolonged post-procedure recovery as well as morbidity and mortality associated with major surgery. Transacral screw fixation is only able to treat the lowest two lumbar levels. 
         [0011]    Recently, there has been considerable, increasing interest in percutaneously placing a support device in the nucleus pulposus without removing the annular support fibers in patients with discogenic pain. 
         [0012]    Also, there are a number of procedure and devices for treating vertebral body compression fractures. Some of these involve placing bone cement alone, another creates a cavity with a balloon and then places bone cement, another stacks wafers and surrounds the wafers with bone cement, and another places a containment bag filled with bone chips. 
         [0013]    It is evident that there is a need for percutaneous devices, instrumentation, and techniques that result in safe, effective fusion and stabilization of the intervertebral (interbody) space. Also, there is a need for a percutaneous nuclear support device and delivery system and an improved, percutaneous vertebral body fracture support device and delivery system. Finally, there is a need for a percutaneous, off-angle bone stapling/nailing device to assist in orthopedic and neurosurgical procedures. 
       SUMMARY OF THE INVENTION 
       [0014]    The devices and methods disclosed herein relate to percutaneously placed interbody fusion devices, nuclear and vertebral body support devices; and their accompanying delivery tools and their methods of use. 
         [0015]    1) A single rotating cam cage is described. The cam is oblong/eccentric in shape, allowing it to be placed in a flat dimension and then, once placed in the interbody space, rotated to secure it in place and also to provide lift to the interbody space. The single rotating cam cage has a number of fenestrations along its length. Bone graft material is meant to be placed into the central portion of this rotating fenestrated cam allowing for bony fusion. The length, height, and width of this cam can vary as appropriate for the interbody space. This rotating cam cage may also have fixation anchors integrated into the external body of the cam cage which protrude from the body and have pointed ends to provide additional fixation and immobility of the cam once deployed. The rotating cam cage may be constructed as a tapered or “stepped” device (thicker posteriorly) to aid in posterior elevation and lift; this aids in indirect decompression of spinal canal and neural foraminal stenoses. In addition, this device (especially with fixation anchors) can be used as a reduction device for spondylolithesis (subluxation). By placing this device(s) in a more horizontal fashion, it can result in the fixation anchors being able to move one vertebral body with respect to the adjacent vertebral body, improving alignment and helping to reduce subluxation (spondylolithesis). With either the cam shape itself wedged into the bone, or the rotating cam with anchors wedged into the bone, immediate mechanical interbody fixation can be achieved; the addition of bone graft allows for long-term bony fusion. A unique delivery tool for percutaneously delivering the rotating cam cage to the spine, comprising a delivery sheath and rotating (turning) member, is also described. The delivery tool engages with a delivery tool engagement feature in the cam to rotate the cam cage. If considered necessary, the cam can be further anchored into the endplates using the percutaneous, off-angle bone stapling/nailing device. Both the delivery tool and the cam cage may be cannulated for insertion over a guide pin or wire. 
         [0016]    2) A Counter-rotating cam cage is described. This cam consists of two (or more) oblong/eccentric single rotating cams connected in series with swivel joints between the individual cams. The counter-rotating cam cage may have fixation anchors oriented in opposite directions which are integrated into the external body of the cam cage and protrude from the body having pointed ends. The counter-rotating cam also has multiple fenestrations along its length. Bone graft material is meant to be placed into the central portion of this fenestrated cam allowing for bony fusion. The length, height, and width of this counter-rotating cam cage can vary as appropriate for the interbody space. The counter-rotating cam cage may be constructed as a tapered or “stepped” device (thicker posteriorly) to aid in posterior elevation and lift; this aids in indirect decompression of spinal canal and neural foraminal stenoses. The counter-rotating cam cage has a unique delivery tool used through a delivery sheath for percutaneously delivering the counter-rotating cam cage to the spine. The delivery tool engages with a delivery tool engagement features located in the cam cages. Both the delivery tool and the cam cage may be cannulated for insertion over a guide pin or wire. The delivery tool allows the individual cams to be rotated (turned) in opposite directions, thus allowing for improved fixation with the integrated fixation anchors. The integrated fixation anchors are therefore “swiveled” in opposite directions, this results in opposing anchor fixation and aids in immediate interbody fixation. When bone graft material is added to the device, the device anchors result in immediate mechanical interbody fixation as well as long-term bony fusion. This device may be placed with hand-turning device or a power device such as an impact wrench. If considered necessary, this device can be further anchored into the endplates using the percutaneous off-angle bone stapling/nailing device. 
         [0017]    3) An expanding cam is described. This device consists of side-by-side or two integrated cams meant to open in opposite directions, a pivot pin , an anchor rod comprising a mating hole and a threaded surface opposite the mating hole, and a locking nut comprising an integral washer and an interior threaded surface. Each cam comprising two pin holes, a cam surface and one or more protrusions extending from cam surfaces, the protrusions having pointed ends (i.e., anchoring devices). The pin holes of each cam are coupled to the mating hole of the anchor rod via the pivot pin and anchor rod is coupled to the locking nut via their threaded surfaces, and wherein the cams are rotated 180 degrees relative to each other when assembled. The anchor devices extending from the cams are meant to fix the individual cams into the cortical vertebral body endplates providing for mechanical fixation and lift. The oblong/eccentric cam shapes of the individual cam elements also provide for fixation and lift. This expanding cam can also be constructed in series with two (or more) expanding cams which can all be rotated to provide mechanical fixation and lift. If constructed in series, the posterior device may be constructed with additional height to aid in additional posterior elevation and lift. This expanding cam allows for immediate mechanical interbody fixation and motion prevention; placement of multiple expanding cams (e.g. two on each side of the vertebra) allows for multi-point fixation, the operator is also able to control posterior “lift” by placing slightly larger expanding cams posteriorly. A unique delivery tool configured for percutaneously delivering the expanding cam assembly to the spine is also described. Both the delivery tool and expanding cam assembly may be cannulated for insertion over a guide pin or wire. 
         [0018]    4) A spring cage is described. The spring cage has a helical spring body having an inner and an outer diameter, a cross section diameter, a defined pitch length and a defined number of turns. The cross section may be circular or non-circular in shape. The inner and outer diameters may be uniform or variable along the length of the spring body, such that the external contour of the spring body is non-cylindrical or tapered. This spring-like device is inserted through a small delivery tool which then expands automatically when deployed. This spring cage can be placed as a “stand-alone” device in the nuclear space to provide support, lift, and recoil flexibility. One or more of these devices can be placed in the nuclear space. The ends of the spring cage may or may not have anchor devices for additional fixation. 
         [0019]    A variation of the spring cage is described. The spring cage may also be made of a double or triple interweaved spring design formed by disposing one or more additional spring cages within the interior of the spring cage. The hands of the one or more additional spring cages may be in the same direction or opposite directions. This design meant to provide increased strength and support as well as recoil flexibility and also to provide smaller side openings to better contain bone graft material (meant to be placed into the central portion of this device to allow for bony fusion). The ends of the spring cage may or may not have anchor devices for additional fixation. Exemplary benefits of this spring cage include improved conformation to the adjacent vertebral end plates and the provision of inter-vertebral disc space flexible lift. The inherent flexibility of the spring itself allows for some motion preservation in the disc and/or nuclear space. The stiffness/flexibility of the spring cage can be adjusted depending on its intended use (nuclear support device or interbody fusion device). Also, this spring cage is delivered through an introducer smaller than the fully expanded cage, thus minimizing trauma to the disc space. 
         [0020]    Another variation of the spring cage is described. The spring cage can be combined with one or more expanding cams to provide additional mechanical fixation and lift. A unique delivery tool for percutaneously delivering the spring cage to the spine is also provided. Both the delivery tool and the spring cage may be cannulated for insertion over a guide pin or wire. 
         [0021]    Another fixation method for the spring cage is provided. A fixation staple anchor for the spring cage is described. This employs the percutaneous off-angle bone stapling/nailing device. 
         [0022]    Another variation of the spring cage is described. The spring cage can be incorporated into an expandable, cylindrical shaped containment cage formed from a biocompatible material (e.g., PEEK polymer, stainless steel, titanium). The containment cage has two side walls having a proximal and a distal end and multiple perforations, end plates at the distal end of the side walls, and a plurality of bridging arms connecting the side walls. This spring cage/containment cage design would allow the spring cage to extrude through the openings in between the bridging arms in the containment cage to provide better fixation and also to provide for appropriate sized fenestrations to allow for bone graft containment and resultant bony fusion. An advantage of the spring cage incorporated into a containment cage is that it would better conform to the concave and often irregular surfaces of the adjacent vertebral endplates and provide recoil flexibility in addition to bone graft containment, fixation and lift. A unique delivery tool configured for percutaneously delivering the spring cage/containment cage to the spine is also provided. Both the delivery tool and the spring cage/containment cage assembly may be cannulated for insertion over a guide pin or wire. 
         [0023]    Any of the above spring cages may be constructed as a tapered or “stepped” device (thicker posteriorly) to aid in posterior elevation and lift. The spring cages can also be constructed as thicker in the middle and tapered at the ends when used as a nuclear support device. 
         [0024]    5) A Random Coil Support Device is described. This device consists of strips or coils of pre-formed metal or biocompatible material having a defined length, a cross section diameter, a distal end and a proximal end, the distal end having a blunted shape. The coil body is adapted to buckle along the length of the body when force is applied against the ends of the coil. The device is inserted into the spine through a small, unique delivery tool. Once inserted into the nuclear space, disc space, or vertebral body fracture, the pre-formed coils or strips would randomly open, providing support, lift, and recoil flexibility. A unique delivery tool configured for percutaneously delivering the random coil support device to the nuclear space, disc space, or vertebral body fracture is also provided. Both the delivery tool and the random coil support device may be cannulated for insertion over a guide pin or wire. 
         [0025]    A variation of the Coil Support Device consists of a directional ribbon strip having a rectangular cross section and preformed bends along the length of the strip. The ribbon strip would collapse at the pre-formed bends providing directional force, support, and lift as well as some recoil flexibility. A unique delivery tool for percutaneously delivering the directional ribbon strip to the nuclear space, disc space, or vertebral body fracture is also provided. Both the delivery tool and the directional ribbon strip device may be cannulated for insertion over a guide pin or wire. 
         [0026]    Any of the spinal devices described above can be formed from a biocompatible material, such as stainless steel, titanium, nitinol or PEEK polymer. 
         [0027]    6) A Percutaneous Off-Angle Bone Stapling/Nailing Device is provided. The bone stapling/nailing device is comprised of a guide body assembly, a ram (driver), a cartridge, and the fixation device (e.g., staples, nails or brads). The guide body assembly is comprised of a rigid guide body, a flexible guide, and a cartridge adapter. The flexibility of the guide, which is curved to direct the cartridge radially, allows the distal end of the guide body assembly to deflect during insertion, allowing for off-angle fixation device placement and removal. This device is designed to percutaneously place curved staples, nails, brads, or other types of anchoring/fixation devices, to provide anchor fixation or bone union. Exemplary features of this off-angle, percutaneous staple/nail/brad placement device include a curved staple or nail or brad, various staple, nail or brad shapes (standard wire staple design, barbed points, brad points, metal side fletching anchors, etc), and a flexible staple neck, to allow for fixation devices to be deployed off-axis to the delivery tool. The staples, nails or brads can be in a cartridge (new staple, nail or brad snapped in each time) or the staple/nail/brad can be loaded through the end. The cartridge may have various configurations (e.g., single use, reloadable, multiple staples/nails/brads). There can be multiple staples, nails or brads (like a regular staple or nail gun). The percutaneous off-angle fixation staple/nail/brad anchor delivery tool driver can be driven forward with different driving forces: it can be tapped with a hammer (manual), hit with a single forcible blow (like a standard staple or nail gun), or hit multiple times with smaller blows (impact hammer). Alternatively, the driver can be power driven (pneumatic, electric, etc.) for single hard blow, or a powered impact hammer type device that generates a high repetition of smaller blows. The fixation staple anchor delivery tool may have a notch on its distal tip to locate and center over a device (e.g. wire coil of a spring cage). The off-angle design and small size allow the placement of fixation staples or nails at an angle different from the device placement direction into a bone. Thus, this allows “sideways” placement of staples or nails into a bone. The flexible neck of the delivery tool allows the end of the staple or nail cartridge to deflect radially to contact the spring cage wire; another deployment device can be added to help force the staple out of the delivery tool. If smaller staples are used, two staples can be deployed at the same time, 180 degrees opposed (one in each end plate). The fixation staple anchor and delivery tool can be made in various sizes and can be used for other bony neurologic, orthopedic, and interventional procedures. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0028]    The above-mentioned and other features and objects of this invention, and the manner of attaining them, will become more apparent and the invention itself will be better understood by reference to the following description of embodiments of the invention taken in conjunction with the accompanying drawings, where: 
           [0029]      FIG. 1  is a top, side perspective view of the embodiment of an exemplary rotating cam cage fashioned in accordance with the principles of the present invention. 
           [0030]      FIG. 2  is a top, side perspective view of an alternate embodiment of the rotating cam cage in  FIG. 1  showing incorporated fixation features. 
           [0031]      FIG. 3  is an end view of the rotating cam cage in  FIG. 1  positioned between the top and bottom plates of two adjacent vertebrae. 
           [0032]      FIG. 4  is an end view of the rotating cam cage in  FIG. 1  positioned between the top and bottom plates of two adjacent vertebrae as in  FIG. 3  rotated 90 degrees clockwise. 
           [0033]      FIG. 5  is an end view of the rotating cam cage in  FIG. 2  positioned between the top and bottom plates of two adjacent vertebrae rotated 90 degrees clockwise as in  FIG. 3 . 
           [0034]      FIG. 6  is a top, side perspective view of the rotating cam cage in  FIG. 1  with its delivery tool. 
           [0035]      FIG. 7  is a top, side perspective exploded view of the rotating cam cage in  FIG. 1  with its delivery tool. 
           [0036]      FIG. 8  is a close-up top, side perspective exploded view of the distal end of the delivery tool and the rotating cam cage in  FIG. 1 . 
           [0037]      FIG. 9  is a cross-section top, side perspective view of the distal end of the delivery tool and rotating cam cage in  FIG. 1 . 
           [0038]      FIG. 10  is a top, side perspective view of the embodiment of an exemplary counter-rotating cam cage fashioned in accordance with the principles of the present invention. 
           [0039]      FIG. 11  is a top, side exploded perspective view of the counter-rotating cam cage in  FIG. 10 . 
           [0040]      FIG. 12  is a cross-section top, side perspective view of the counter-rotating cam cage in  FIG. 10 . 
           [0041]      FIG. 13  is a top, side perspective view of the counter-rotating cam cage in  FIG. 10  with its delivery tool. 
           [0042]      FIG. 14  is a top, side exploded perspective view of the counter-rotating cam cage in  FIG. 10  with its delivery tool. 
           [0043]      FIG. 15  is an enlarged top, side exploded perspective view of the distal end of the counter-rotating cam cage in  FIG. 10  with its delivery tool. 
           [0044]      FIG. 16  is an enlarged side cross-sectional view of the distal end of the counter-rotating can cage in  FIG. 10  with its delivery tool. 
           [0045]      FIG. 17  is an enlarged top, side perspective view of the distal end of the counter-rotating cam cage in  FIG. 10  with its delivery tool. 
           [0046]      FIG. 18  is an enlarged top, side perspective view of the distal end of the counter-rotating cam cage in  FIG. 10  with its delivery tool wherein the proximal rotating cam cage has been rotated 90 degrees relative to the distal rotating cam cage. 
           [0047]      FIG. 19  is a top, rear perspective view of the counter-rotating cam cage in  FIG. 10  with its delivery tool as it would be placed into the disk space during the procedure. 
           [0048]      FIG. 20  is a top view of components shown in  FIG. 19 . 
           [0049]      FIG. 21  is an enlarged top view of  FIG. 20  with the top vertebrae and top half of the disk removed revealing the counter-rotating cam cage in place within the disk space. 
           [0050]      FIG. 22  is a side view of an alternate embodiment of the rotating cam cage in  FIG. 1  showing multiple fixation features and a tapered body. 
           [0051]      FIG. 23  is a top, side perspective view of an alternate embodiment of the rotating cam cage in  FIG. 1  showing multiple fixation features and a tapered body. 
           [0052]      FIG. 24  is a top, side perspective view of the embodiment of an exemplary expanding cam fashioned in accordance with the principles of the present invention shown in its delivery position with a section of the sheath removed for clarity. 
           [0053]      FIG. 25  is a top, side perspective view of the expanding cam in  FIG. 24  shown exploded in its delivery position with a section of the sheath removed for clarity. 
           [0054]      FIG. 26  is a top, side perspective cross-section view of the expanding cam in  FIG. 24  shown in its delivery position. 
           [0055]      FIG. 27  is a top, side perspective view of the expanding cam in  FIG. 24  with the expanding cam extended from inside its delivery sheath and the nut driver retracted to reveal the nut. 
           [0056]      FIG. 28  is a front, side perspective view of the expanding cam in  FIG. 24  with the expanding cam extended from inside its delivery sheath and the nut driver retracted to reveal the nut. 
           [0057]      FIG. 29  is a top, side perspective view of the delivery tool for the expanding cam shown in  FIG. 24 . 
           [0058]      FIG. 30  is a top, side exploded perspective view of the delivery tool and the expanding cam shown in  FIG. 24 . 
           [0059]      FIG. 31  is a top, side exploded perspective view of the expanding cam in  FIG. 24 . 
           [0060]      FIG. 32  is a top, side perspective view of the expanding cam in  FIG. 24  shown in a partially expanded position. 
           [0061]      FIG. 33  is a top, side perspective view of the expanding cam in  FIG. 24  shown in a fully expanded position. 
           [0062]      FIG. 34  is a top, side perspective view of the expanding cam in  FIG. 24  shown in a fully expanded position with the delivery tool removed. 
           [0063]      FIG. 35  is a side view of the expanding cam in  FIG. 24  in its fully collapsed position. 
           [0064]      FIG. 36  is a side view of the expanding cam in  FIG. 24  in partially expanded position. 
           [0065]      FIG. 37  is a side view of the expanding cam in  FIG. 24  in fully expanded position. 
           [0066]      FIG. 38  is a top, side perspective view of the embodiment of an exemplary spring cage fashioned in accordance with the principles of the present invention. 
           [0067]      FIG. 39  is a top view of 2 of the spring cages in  FIG. 38  positioned within the disk space atop a vertebral body. 
           [0068]      FIG. 40  is a side view of 2 of the spring cages in  FIG. 38  positioned within the disk space between 2 vertebral bodies where the top half of the disk is removed for clarity. 
           [0069]      FIG. 41  is a front view of 2 of the spring cages in  FIG. 38  positioned within the disk space atop a vertebral body. 
           [0070]      FIG. 42  is a top view of 2 of the spring cages in  FIG. 38 , one of which has been elongated, positioned in a different manner within the disk space atop a vertebral body. 
           [0071]      FIG. 43  is a top, side perspective view of an alternate embodiment of the spring cage in  FIG. 38  wherein a second spring cage has been positioned within the first. 
           [0072]      FIG. 44  is a top, side perspective view of an alternate embodiment of the spring cage in  FIG. 38  depicting a different cross-sectional shape for the wire that forms the spring cage. 
           [0073]      FIG. 45  is a top, side perspective view of an alternate embodiment of the spring cage in  FIG. 38  wherein the exterior profile has a varying contour. 
           [0074]      FIG. 46  is a top, side perspective view of an alternate embodiment of the spring cage in  FIG. 38  wherein the exterior profile has a tapered profile. 
           [0075]      FIG. 47  is a top, side perspective view of the delivery tool for the spring cage shown in  FIG. 38 . 
           [0076]      FIG. 48  is a top, side exploded perspective view of the delivery tool for the spring cage shown in  FIG. 38 . 
           [0077]      FIG. 49  is an enlarged top, side perspective view of the distal end of the delivery tool for the spring cage shown in  FIG. 38  with a section of the introducer tube removed for clarity. 
           [0078]      FIG. 50  is an enlarged top, side perspective view of the distal end of the delivery tool for the spring cage shown in  FIG. 38  with a section of the introducer tube removed for clarity showing partial deployment. 
           [0079]      FIG. 51  is an enlarged top, side perspective view of the distal end of the delivery tool for the spring cage shown in  FIG. 38  with a section of the introducer tube removed for clarity showing three-quarter deployment. 
           [0080]      FIG. 52  is an enlarged top, side perspective view of the distal end of the delivery tool for the spring cage shown in  FIG. 38  with a section of the introducer tube removed for clarity showing full deployment. 
           [0081]      FIG. 53  is a top, side perspective view of the embodiment of an exemplary spring cage containment cage fashioned in accordance with the principles of the present invention. 
           [0082]      FIG. 54  is an enlarged top, side perspective view of the distal end of the delivery tool for the spring cage shown in  FIG. 38  and containment cage shown in  FIG. 53  with a section of the introducer tube removed for clarity. 
           [0083]      FIG. 55  is an enlarged top, side perspective view of the distal end of the delivery tool for the spring cage shown in  FIG. 38  and containment cage shown in  FIG. 53  with a section of the introducer tube removed for clarity showing full deployment. 
           [0084]      FIG. 56  is a top, side perspective view of the embodiment of an exemplary random coil support device fashioned in accordance with the principles of the present invention. 
           [0085]      FIG. 57  is a top, side perspective view of the delivery tool for the random coil support device shown in  FIG. 56 . 
           [0086]      FIG. 58  is a top, side exploded perspective view of the delivery tool for the random coil support device shown in  FIG. 56 . 
           [0087]      FIG. 59  is an enlarged top, side perspective view of the distal end of the deployment rod engaged with the proximal end of the random coil support device shown in  FIG. 56 . 
           [0088]      FIG. 60  is a top, side exploded perspective view of the delivery tool for the random coil support device shown in  FIG. 56  with the distal end of the random coil support device partial deployed. 
           [0089]      FIG. 61  is a top, side perspective view of the delivery tool for the random coil support device shown in  FIG. 56  positioned within the disk space between 2 vertebral bodies. 
           [0090]      FIG. 62  is an enlarged top, side perspective view of the delivery tool for the random coil support device shown in  FIG. 56  positioned within the disk space between 2 vertebral bodies. 
           [0091]      FIG. 63  is an enlarged top, side perspective view of the delivery tool for the random coil support device shown in  FIG. 56  positioned within the disk space between 2 vertebral bodies with the random coil support device partially deployed. 
           [0092]      FIG. 64  is an enlarged top, side perspective view of the delivery tool for the random coil support device shown in  FIG. 56  positioned within the disk space between 2 vertebral bodies with the random coil support device further deployed, coiling within the disk. 
           [0093]      FIG. 65  is an enlarged top, side perspective view of the delivery tool for the random coil support device shown in  FIG. 56  positioned within the disk space between 2 vertebral bodies with the random coil support device fully deployed, coiled within the disk 
           [0094]      FIG. 66  is a top, side perspective view of an alternate embodiment of the random coil support device in  FIG. 56 , referred to as a flexible coil, wherein the cross section of the device is rectangular in shape with alternating bends in a single plane. 
           [0095]      FIG. 67  is a top, side perspective view of the flexible coil support device shown in  FIG. 66  partially collapsed. 
           [0096]      FIG. 68  is a top, side perspective view of the flexible coil support device shown in  FIG. 66  fully collapsed into its final position. 
           [0097]      FIG. 69  is a top, side perspective view of the delivery tool for the flexible coil support device shown in  FIG. 66 . 
           [0098]      FIG. 70  is a top, side perspective view of an alternate embodiment of the spring cage in  FIG. 38  and the expanding cam in  FIG. 24  wherein the two devices have been deployed together within the disk in two different configurations. 
           [0099]      FIG. 71  is a top, side perspective view of the embodiment of an exemplary stapler used to anchor the spring cage shown in  FIG. 38 , fashioned in accordance with the principles of the present invention. 
           [0100]      FIG. 72  is a top, side exploded perspective view of the stapler shown in  FIG. 71 . 
           [0101]      FIG. 73  is an enlarger top, side exploded perspective view of the stapler shown in  FIG. 71  highlighting the distal end. 
           [0102]      FIG. 74  is a top, side perspective cross-section view of the distal end of the stapler shown in  FIG. 71 . 
           [0103]      FIG. 75  is a top, side perspective view of the stapler shown in  FIG. 71  positioned within the disk space relative to the spring cage shown in  FIG. 38 . 
           [0104]      FIG. 76  is an enlarged top, side perspective view of the distal end of the stapler shown in  FIG. 71  positioned within the disk space relative to the spring cage shown in  FIG. 38   
           [0105]      FIG. 77  is a side cross-sectional view of the stapler shown in  FIG. 71  positioned within the disk space relative to the spring cage shown in  FIG. 38  showing the various stages of deploying the staple. 
           [0106]      FIG. 78  is a top, side cross-sectional perspective view of an alternate embodiment of the stapling tool cartridge wherein the staple is formed as a single curved nail. 
       
    
    
     DETAILED DESCRIPTION 
       [0107]    Referring to  FIG. 1 , there is depicted a rotating cam cage generally designated  10 , fashioned in accordance with the present principles. The rotating cam cage consists of a single structure, cam body  12  which may be formed in various manners from an appropriate, biocompatible metal (such as stainless steel, titanium, etc.) or polymer (such as PEEK polymer). The exterior profile is shaped to create cam surfaces  14   a  and  14   b  that connect the base planar sides  24   a  and  24   b  with the expanded planar sides  16   a  and  16   b.  Referring to  FIGS. 3 and 4 , in use, the rotating cam cage is inserted between two adjacent vertebrae  42  and  44  with the base planar surface  24   a  and  24   b  parallel to the top and bottom plates of the vertebral bodies. The cam body  12  is then rotated 90 degrees clockwise to a position shown in  FIG. 4 . Rotation is accomplished using an delivery tool that engages the cam body  12  through features shown here as a typical hex opening  20 . During rotation, the cam surfaces  14   a  and  14   b  engage the top and bottom plates of the adjacent vertebrae  42  and  44  causing them to separate from their initial height (h 1  shown in  FIG. 3 ) to their final height (h 2  shown in  FIG. 4 ). The cam body  12 , in one variation, may for the most part be solid (excluding the delivery tool engagement feature  20 ). An alternative embodiment would create a mostly hollow cam body  12  (as shown in  FIG. 1 ) that can be filled with bone graft material. In this configuration, fenestrations  18  of various sizes and cross section pass from the exterior of the cam body  12  to the interior, hollow volume. The fenestrations  18  would be position on the same sides of the cam body as the expanded planar surfaces  16   a  and  16   b  which are in contact with the bony plates of the vertebra  42  and  44  after rotation into final position. The length of the cam body  20  can vary to accommodate a single long cam or multiple, shorter cam placed with the disk. 
         [0108]      FIG. 2  shows an alternate embodiment of the rotating cam cage  30  that contains fixation anchors  32   a  and  32   b.  The anchors extend from the cam body  12  out over the expanded planar surfaces  16   a  and  16   b .The ends of the anchors have a pointed edge  34   a  and  34   b.  Referring to  FIG. 5 , the pointed ends  34   a  and  34   b  of the fixation anchors  32   a  and  32   b  engage the boney plates of the vertebrae  40  and  42  as the cam  30  is rotated into position piercing through the outer cortical bone  52  and  56 . This provides a structural fixation between the vertebrae  40 / 42  and cam  30 . Note that, though shown here as a single structure on either side, there could exist, multiple fixation anchors of various designs on each end. 
         [0109]      FIGS. 6 ,  7 ,  8 , and  9  depict an delivery tool  100  for the rotating cam cages  10  that consists of a delivery sheath  120 , a rotation handle  140 , and a locking rod  160 . The delivery sheath  120  has a hollow body  126  whose interior cross section  122  is shaped to allow passage of the rotating cam cage  10 . The distal end  128  of the hollow body  126  may be angled such that an approximately equal amount of body will protrude through the disk wall (see  FIG. 21 ). The proximal end of the hollow body  126  has a handle  124  to facilitate insertion and removal. The rotation handle  140  has a hollow shaft  144  that allows the locking rod  160  to pass completely through it. The distal end of the shaft  144  is formed to create an engagement feature  142  the fits into the corresponding structure  20  of the rotating cam cage  10  (shown as a typical hex shaft). The proximal end of the rotation handle  140  has a handle  146  that is used to rotate the rotating cam cage  10  into its final position after locating it within the disk space. The locking rod  160  is used to secure the rotating cam cage  10  to the rotating handle  140 . It consists of a shaft  164  with a locking feature  162  (shown here as a threaded member) at its distal that engages corresponding features  26  in the rotating cam cage  10 . A knurled knob  166  at the proximal end of the shaft  164  is used to release the rotating cam cage  10  from the rotating handle  140  once it has been properly placed in the disk space. 
         [0110]    Depicted in  FIGS. 10 ,  11 , and  12 , and herein defined as a counter-rotating cam cage  200  is an extension to the single rotating cam cages  10  and  30 . Counter-rotating cam cage  200  combines the rotating cam cage  30  with an additional rotating cam cage  210  that is design to be rotated in the opposite direction for installation. The fixation anchors  220   a  and  220   b  face the opposite direction as their counterparts on rotating cam cage  30 . Likewise, cam surfaces  230   a  and  230   b  are arranged to provide the cam/lifting action when the cam cage  210  is rotated in a counter-clockwise direction. The 2 counter rotating cam cages  30  and  210  are linked together through a rotation joint  225  that allows the cams to rotate relative to each other. The joint  225  can take various forms, here it is depicted as an undercut feature  228  on the cam  30  and a overlapping feature  226  on cam  210 . Rotating cam cage  210  has an delivery tool engagement feature  224  that is similar to the one on cam  30  though increased in size. This allows it to engage with its rotational handle while at the same time allowing the rotational handle for the other cam  30  to engage it. 
         [0111]      FIGS. 13 ,  14 ,  15 , and  16  show the counter-rotating cam  200  assembled to its delivery tool  250 . Delivery tool  250  is the same as delivery tool  100  with the addition of a second rotating handle  260  that engages with rotating cam cage  210 . Rotating handle  260  consists of a hollow shaft  262  whose interior  268  is designed to fit over the shaft  144  of rotating handle  140 . The distal end of shaft  264  is shaped to fit into the opening  224  of rotating cam cage  210 . A handle  266  is affixed to the proximal end of shaft  262 . 
         [0112]      FIG. 17  depicts the counter-rotating cam cage  200 , attached to its delivery tool  250 , as it is first inserted into the disk space.  FIG. 18  shows rotating cam cage  210  after it has been rotated 90 degrees counter clockwise while holding rotating cam cage  30  stationary, After rotating cam cage  210  is in position, held be the fixating anchors  220   a  and  220   b,  rotating cam cage  30  is rotated 90 degrees clockwise into its final position. 
         [0113]      FIGS. 19 ,  20 , and  21  illustrate the interaction of the delivery tool assembly  250  with a portion of the spine  300 . The delivery sheath  120  passes through the outer tissue of the patients body and penetrates the side wall of the intended disk  330  which separates the upper disk  320  from the lower disk  310 , Once the delivery sheath  120  is in place and the site preparation performed, the single rotating cam  10 / 30  or the counter-rotating cam cage  200  is passed through the delivery sheath  120  into the interior portion of the disk  334  where it is rotated into its final position. Once properly installed, the locking rod  160  disengages from the cam cage and is withdrawn along with the rotating handle(s). 
         [0114]    The delivery tools  100  and  250  use manual force to rotate the rotating cam cages into position. An alternate embodiment would be to use a powered device to generate the rotational force. In particular a powered device that imparts rapid, measured rotational impacts (i.e. impact wrench), would provided for a controlled installation with less trauma to the boney plates of the vertebrae. 
         [0115]      FIGS. 22 and 23  illustrate an alternate embodiment of the rotating cam cage designated  3000 . This version shows the potential for 2 or more sets of fixation anchors  340   a,    340   b,    340   c , and  340   d.  In addition, the cam body  3100  can have a different sized or shaped profile as it progresses from the distal to the proximal end. The cam body  3100  here tapers along the expanded planar surfaces  3200   a  and  3200   b.  The taper allows for more height increase at the proximal end. 
         [0116]    Referring to  FIGS. 24 through 37 , there is depicted an expanding cam assembly  465  with delivery sheath  410 , installation rod  430 , and nut driver  440  generally designated  400 , fashioned in accordance with the present principles.  FIG. 24  shows the expanding cam assembly  465  positioned inside the delivery sheath  410  as it would be during insertion into the disk space through the side wall of the disk. In  FIG. 25 , the nut  420 , nut driver  440 , and installation rod  430  have been exploded within the sheath  410  to illustrate their interaction.  FIG. 27  depicts the expanding cam assembly  465  positioned outside of the delivery sheath  410  during the initial stage of the installation. 
         [0117]    The expanding cam assembly  465  consists of 2 expanding cams  470  and  480 , an anchor rod  450 , a pivot pin  460 , and a locking nut  420 . The 2 expanding cam  470  and  480  shown in this embodiment are identical (rotated 180 degrees relative to each other as assembled). The expanding cam  470  and  480  has several defining features; a cam surface  478  and  488 , fixation anchors  472  and  482 , a slot  473  and  483 , and a pivot pin hole  471  and  481 . The pivot pin  460  captures each expanding cam  470  and  480  onto the anchor rod  450  as it passes through the expanding cam pivot pin holes  471  and  481  and the mating hole  452  in the anchor rod  450 . The expanding cams  470  and  480  can pivot freely about the pivot pin  460 . Additional features on the anchor rod  450  include external threads  456  that mate with the internal threads  426  of the locking nut  420  and internal threads  454  that mate with the external threads  436  of the installation rod  430 . The final piece of the expanding cam assembly  465  is the locking nut  420  which consists of the aforementioned internal threads  426 , an integral washer  422 , and interfaces surfaces  424  that mate with corresponding surfaces  446  on the nut driver  440 . 
         [0118]    Referring to  FIGS. 29 and 30 , the delivery tool for the expanding cam assembly includes a delivery sheath  410 , an installation rod  430 , and a nut driver  440 . The delivery sheath  410  consists of a hollow tube  412  sized to contain the expanding cam assembly  465  with an over-molded handle  414  for easily handling during insertion and removal. The next piece of the delivery tool assembly is the nut driver  440 . Its hollow cylindrical body  442  fits within the sheath hollow tube  412 . The distal end of the body  442  has internal surfaces  446  formed to mate with the external surfaces  424  of the locking nut  420  whereas, the proximal end contains a handle  444 . The handle  444  is used to apply torque to the nut driver  440  which then transfers that torque to the locking nut  420  through the contact surfaces  424  and  446 . This torque rotates the locking nut  420  which then translates over the threaded portion  456  of the anchor rod  450 . The final piece of the delivery tool is the installation rod  430  which consists of a solid shaft  432  with a handle  434  on the proximal end and a threaded portion  436  on the distal end. The threaded portion  436  mates with the internal threads  454  of the anchor rod  450 . The installation rod  430  holds onto the expanding cam assembly  465  during installation and then releases it by rotating the handle  434  of the installation rod  430  counter clockwise to unthread the distal end from the anchor rod  450 . 
         [0119]    The expanding cam assembly  465  is installed within the disk space between 2 vertebrae by means of the delivery tool as follows: The complete assembly, expanding cam assembly  465  and delivery tool, are assembled as shown in  FIGS. 24 and 29 . Through an appropriate incision, the distal end assembly is inserted into the patient until the distal end of the delivery sheath  410  penetrates through the wall of the disk. The expanding cam assembly  465  is then extended out of the delivery sheath  410  as shown in  FIG. 27  until position at the desired location in the disk space. Torque is applied to the handle  444  of the nut driver  440  while holding the handle  434  of the installation rod  430  stationary. Rotating the handle  444  of the nut driver  440  will cause the locking nut  420  to rotate relative to the anchor rod  450  thus translating the locking nut  420  over the anchor rod  450  due to the mating threads  426  and  456 . As the locking nut  420  translates, the integral washer  422  will contact the curved surface of the fixation anchors  472  and  482  of the cams  470  and  480  forcing the cams  470  and  480  to rotate in opposite directions about the pivot pin  460  (see  FIG. 32 ). The cams  470  and  480  will continue to rotate unimpeded until the sharp tips  474  and  484  of the fixation anchors  472  and  482  or the cam surfaces  478  and  488  contact the upper and lower plates  494  and  498  of the 2 adjacent vertebral bodies  490  and  495  (see  FIGS. 35 through 37 ). As additional torque is applied to the nut driver  440 , the locking nut  420  forces the expanding cams  470  and  480  to continue to rotate. This additional rotation applied a separating on the 2 vertebral bodies  490  and  495  through the interaction of the cam surfaces  478  and  488  on the vertebral plates  494  and  498 . The shape of the cam surfaces  478  and  488  is such that it provides a smooth, gentle force. The initial separation of the vertebral bodies shown as distance “h1” in  FIGS. 35 and 36  is increased to “h2” shown in  FIG. 37  as the expanding cams  470  and  480  reach their final position. In addition to the separation force caused by the cam surfaces  478  and  488 , a piercing force delivered at the sharp ends  474  and  484  of the fixation anchors  472  and  482  causes the fixation anchors  472  and  482  to penetrate the plates  494  and  498  of the vertebral bodies  490  and  495  as the rotation occurs. When the expanding cams  470  and  480  reach their final positions, the fixation anchors  472  and  482  will have been embedded within the plates  494  and  498  creating a mechanical fixation between the 2 vertebral bodies  490  and  495 . Once the locking nut  420  forces the expanding cams  470  and  480  into their final position the installation rod  430  is rotated to unthread itself from the anchor rod  450  allowing the delivery tool (installation rod  430  and nut driver  440 ) to be removed proximally through the delivery sheath  410 . At this point, the delivery sheath  410  can be removed or left in place to allow another expanding cam assembly  465  to be placed through it. 
         [0120]    Referring to  FIG. 38 , there is depicted a spring cage generally designated  600 , fashioned in accordance with the present principles. The spring cage consists of a single structure, spring body  610  which may be formed in various manners from an appropriate bio-compatible material such as stainless steel, nitinol, or a polymeric material. The body of the spring cage  600  is formed from a single wire in a helical form with a defined outside diameter, wire cross section diameter, pitch length  616  (coil to coil spacing), and number of turns. The distal end  614  of the spring cage  600  may be formed in a closed manner to create a tapered end. The proximal end  612  may end abruptly as shown or may have a formed turn-in to eliminate a sharp edge.  FIGS. 39-41  show 2 of the spring cages  600  deployed within the disk  720  between 2 adjacent vertebrae  740  and  760 . They are inserted into the disk space  724  of the disk  720  through the side wall  722 . The outside diameter of the spring body  610  is defined such that it is larger than the separation between the adjacent vertebrae  740  and  760  so that the spring cage  600  applies a separation force to correct any compression of the disk that may have occurred. 
         [0121]      FIG. 42  shows an alternate arrangement wherein one spring cage  600  is installed with an elongated version of the spring cage  650  in a parallel fashion. 
         [0122]      FIG. 43  shows an alternated embodiment of the spring cage  660  where a second spring cage  662  has been deployed within the first spring cage  600 . The second spring cage  662  would have an outside diameter somewhat larger the inside diameter of the first spring cage  600  providing structural support to it. Additional spring cages could be placed within this assembly if desired. The second spring cage  662  could have an opposite hand (counter-clockwise versus clockwise) for the helical shape or the same hand. Having an opposite hand would create a lattice type shell effect helping to contain any biologic material that may be inserted into the interior of the spring cages. It should be noted that the spring cages could have different materials, cross-section shapes, pitches, and number of turns as desired. 
         [0123]      FIG. 44  shows an alternated embodiment of the spring cage  670  wherein the cross-section shape  672  is non-circular. In this example, the cross section  672  is square with an edge of the square position to the outside surface  674  creating screw thread type effect. 
         [0124]      FIG. 45  shows an alternated embodiment of the spring cage  680  that has an external contour  682  that is non-cylindrical. It should be noted that the external envelope or shape can vary in size with each turn symmetrically or non symmetrically, as desired. This could be advantageous in forming to the contours of the non planar vertebral plates. 
         [0125]      FIG. 46  shows an alternated embodiment of the spring cage  690  that has an external contour  692  that is tapered (larger in the proximal section). This could be advantageous in applying variable force to the vertebral plates. 
         [0126]    Referring to  FIGS. 47 and 48 , the delivery tool  800  for the spring cage  600  includes a delivery sheath  880 , an introducer tube  820 , a distal pusher deployment rod  840 , and a proximal pusher deployment rod  860 . The delivery sheath  880  consists of a hollow tube  884  with an over-molded handle  886  for easily handling during insertion and removal. The second piece of the delivery tool assembly is the introducer tube  820 . Its hollow cylindrical body  824  fits within the sheath hollow tube  884 . The diameter of the hollow interior  822  of the introducer tube  820  is smaller than the outside diameter of the spring cage  600 . The spring cage  600  is squeezed radially and elongated axially to fit within this interior cylindrical space. The proximal end of the introducer tube  820  has a formed handle  826  with a cylindrical body  828  that contains internal threads  830 . The internal threads  830  mate with the external threads  872  of the next piece of the delivery tool, the proximal pusher deployment rod  860 . The proximal pusher  860  consists of a hollow shaft  864  with a handle  866  and external threads  872  at its proximal end. The distal end of the proximal pusher  860  contains a cylindrical section  868  that fits within the inner diameter of the compressed spring cage  600  and a drive wall  870  that mates with the proximal end  612  of the spring cage  600 . The final component of the delivery tool  800  is the distal pusher deployment rod  840 . It features a solid shaft  844  with a formed handle  846  at the proximal end and an interface structure  842  at the distal end. The interface structure  842  is formed to mate with the distal end geometry  614  of the spring cage  600 . 
         [0127]    In use, the delivery sheath  880  is passed through the external tissue of the body and through a sized opening in the disk wall where it acts as a conduit for the rest of the delivery tool. The introducer tube  820  with the spring cage  600 , proximal pusher  860 , and distal pusher  840  assembled within it is inserted through the delivery sheath  880  until the distal end of the introducer  820  is positioned at the desired location within the disk space.  FIGS. 49 ,  50 ,  51 , and  52  illustrate the deployment sequence for the spring cage  600  (a section of the introducer wall is removed for clarity).  FIG. 49  shows the spring cage  600  in its pre-deployment state with compressed spring body  610 D. To deploy, the proximal and distal pushers  860  and  840  are rotated relative the introducer tube  820 . The mating threads  872  and  830  of the proximal pusher  860  and the introducer tube  820  drive the pushers  860  and  840  axially within the introducer tube  820 . The axial translation of the pusher  860  and  840  drive the spring cage  600  out the end of the introducer tube body  824  allowing the spring cage body  610  to expand to its original diameter while within the disk space (see  FIG. 50 ,  51 ,  52 ). In addition, the rotation of the pushers  860  and  840  relative to the introducer tube  820  caused the spring cage  600  to rotate relative to the introducer tube  820  as well. This rotation acts to help draw the coils of the spring cage  600  out the end of the introducer tube  820 . 
         [0128]    Referring to  FIG. 53 , there is depicted a containment cage generally designated  900  fashioned in accordance with the present principles. The containment cage consists of a single structure which may be formed in various manners from an appropriate bio-compatible material such as stainless steel, nitinol, or a polymeric material (e.g. PEEK polymer). The body of the containment cage  900  contains 2 side walls  902  and  904  that are connected with a number of bridging arms  906 . Side perforations  912  penetrate both side walls  902  and  904 . The exterior envelope of the side walls  902  and  904  and the bridging arms  906  is cylindrical in shape in its as-constructed shape. The distal ends of the side walls  902  and  904  have formed end plates  908 .  FIGS. 54 and 55  show the containment cage  900  in place over the distal end of the introducer tube  820  which contains the spring cage  600  (a section of the introducer tube is removed for clarity). The interior cylindrical shape of the containment cage matches the exterior shape of the introducer tube  820  such that it fits snuggly in place. As deployment of the spring cage  600  takes place (see  FIGS. 49 through 52 ), the end plates  908  of the containment cage  900  contact the distal end of the spring cage  600  driving the containment cage  900  off of the end of the introducer tube  820  onto the spring cage  600 . As the spring cage  600  expands to its original diameter, the side walls  902  and  904  expand with the spring cage body  610 . the bridging arms  906  are deformed to a near flat shape to allow the side walls  902  and  904  to expand outward. Once fully deployed, the containment cage  900  acts as an integral sidewall containment for the spring cage  600  for biologic material that is placed inside the spring cage  600 . The side walls prevent leakage of the biologic material through the sides of the spring cage into the disk space; however, the material can still make integral contact with the vertebral plates out the top and bottom of the spring cage. Side perforations  912  allow bone growth through and around the side wall  902  and  904 . 
         [0129]    Referring to  FIG. 56 , there is depicted a random coil support device generally designated  1000 , fashioned in accordance with the present principles. The random coil support device consists of a single structure, coil body  1010  which may be formed in various manners from an appropriate bio-compatible material such as stainless steel, nitinol, or a polymeric material (e.g. PEEK polymer). This embodiment of the random coil support device  1000  is formed from a single wire in a helical form with a defined outside diameter, wire cross section diameter, pitch length, and total length. The distal end  1014  of the random coil support device  1000  may be formed, or have a secondary part affixed to it, to create a blunted end. The proximal end  1012  is formed to create shape facilitating the delivery of the device. 
         [0130]    Referring to  FIGS. 57 ,  58 ,  59 , and  60 , the delivery tool  1050  for the random coil support device  1000  includes a delivery sheath  1060 , an introducer tube  1070 , and a deployment rod  1080 . The delivery sheath  1060  consists of a hollow tube  1062  with an over-molded handle  1064  for easily handling during insertion and removal. The second piece of the delivery tool assembly is the introducer tube  1070 . Its hollow cylindrical body  1072  fits within the sheath hollow tube  1062 . The proximal end of the introducer tube  1070  has a formed handle  1074 . The final component of the delivery tool  1050  is the deployment rod  1080 . It features a solid shaft  1082  with a formed handle  1084  at the proximal end and an interface structure  1086  at the distal end. The interface structure  1086  is formed to mate with the proximal end geometry  1012  of the random coil support device  1000  (see  FIG. 59 ).  FIG. 60  shows the random coil support device  1000  as it is deployed from the introducer tube  1070 . 
         [0131]      FIGS. 61 through 65  depict the random coil support device  1000  with its delivery tool  1050  positioned within the disk space  1114  of a vertebral disk  1110  situated between two vertebrae  1120  and  1130 . In use, the delivery sheath  1060  is passed through the external tissue of the body and through a sized opening in the disk wall where it acts as a conduit for the rest of the delivery tool. The introducer tube  1070  with the random coil support device  1000 , and deployment rod  1080  assembled within it is inserted through the delivery sheath  1060  until the distal end of the introducer  1070  is positioned at the desired location within the disk space  1114 .  FIGS. 63 ,  64 , and  65  illustrate the deployment sequence for the random coil support device  1000 . The handle  1084  of the deployment rod  1080  is pushed into the introducer tube  1070  forcing the distal end of the random coil support device  1000  out of the distal end of the introducer tube into the disk space  1114 . The blunted end  1014  of the random coil support device  1000  will contact the inner wall of the disk  1110  and stop. Subsequent force created by the continued pushing on the deployment rod  1070  will cause the coil body  1010  of the random coil support device  1000  to buckle. The buckled section will move in a random direction until some portion of the coil body  1010  again contacts the inner wall of the disk  1110 . This process is continued (i.e., buckling/contact with wall or other portions of the coil body/etc.) forming a randomized mesh of coil body  1010  within the disk space (see  FIGS. 64 and 65 ). Depending on the size of the disk space volume and length of the random coil support device  1000 , multiples of the devices may be used to completely fill the volume as desired. The combined, interwoven, meshed structure of the random coil support device  1000  effectively creates a support structure spanning the two vertebrae  1120  and  1130 . This random coil device and its delivery system may also be used in a similar fashion for deployment within a vertebral body. 
         [0132]    The random coil support device  1000  shown here is but one embodiment of the possible designs for a device of this type. Various wire cross sections can be envisioned along with different body configurations from a straight wire to one with multiple random kinks meant to help create the random buckling of the body during deployment. In addition to fixed lengths of the coil body, a continuous, coiled or wound length of coil body could be used with a delivery system that deploys the desired amount of continuous coil body into the volume, cutting to length (and forming the now proximal end of the wire) at the appropriate point. 
         [0133]      FIGS. 66 ,  67 , and  68  depict a unique embodiment of the random coil support device here designated as a flexible coil  1200  that, by its design, applies a unidirectional force on the containment walls of the volume where it is deployed (i.e. disk space or within a vertebral body). The uniqueness of this design is in the thin rectangular cross section  1220  of the coil body  1210  and the preformed bends  1212  along its length. During deployment, the distal end of the coil body  1210  contacts a section of the containment volume and stops. As the deployment continues, the coil body  1210  buckles at the preformed bends  1212  creating a folded/accordion type structure. As the ends of the coil body  1210  are forced further together the folds come together causing the height of the folds  1230  to increase  1240  until the preformed bends  1212  contact the upper and lower walls of the containment volume. Additional pressure on the proximal end of the coil body forces the preformed bends  1212  into the upper and lower walls of the containment volume creating a separation (or holding) force between them. The wide cross section area  1220  spreads the separation force over a larger area. 
         [0134]      FIG. 69  show an delivery tool set  1300  fashioned for the flexible coil  1200  that is similar in design to the delivery tool set  1050  for the random coil  1000 . The main difference is the shape or cross section of the bodies of the various components; delivery sheath  1360 , introducer tube  1370 , and deployment rod  1380 . The cross section of the sheath  1362  and introducer tube  1372  shown here has a short height and long width to match the thin/wide rectangular cross section  1220  of the flexible coil  1200 . This allows for a smaller dilated opening in the body tissue that the delivery sheath  1360  passes through. 
         [0135]      FIG. 70  illustrates the potential of combining 2 of the previously defined interbody fusion devices, expanding cam  465  and spring cage  600 , in a single fusion procedure. This figure shows 2 different potential combinations. In the left configuration, an expanding cam  465  is first installed within the disk  1420  followed by a spring cage  600  whose distal end mechanically interfaces with a properly formed nut on the expanding cam  465 . In the right configuration, an expanding cam  465  is first installed within the disk  1420  followed by a shortened version of spring  600  (labeled  1440 ). The rod  1450  that was used to guide the nut for expanding cam  465  remains in place guiding a washer  1432  against the proximal end of the spring  1440 . A slightly altered version of expanding cam  465  generally labeled  1430  installs over rod  1450 , it followed by a nut  1434  that is used to expand the cams as it is threaded over rod  1450 . The orientation of the cams is in the opposite direction as those of the first expanding cam  465  thus capturing the spring  1440  between spikes embedded in an opposing fashion. Other combinations of the different devices depicted in this document are possible. 
         [0136]      FIGS. 71 through 77  show an embodiment of a stapling tool, generally designated  1500  used to anchor a spring cage  600  to the two vertebrae on either side of the disk in which it was deployed. Referring to  FIGS. 71 ,  72 ,  73 , and  74 ; the stapling tool consists a guide body assembly  1540 , a ram  1560 , a cartridge  1600  and the anchoring/fixation device, shown here as a staple  1620 . It should be noted that the stapling tool is not limited to the use of staples, and that other types of anchoring/fixation devices, such as brads or nails, can be used with the stapling tool of the invention. The stapler  1500  would be inserted through the delivery sheath  1520  which was installed in the disk and used to deploy the spring cage  600  (see  FIGS. 75 and 76 ). The guide body assembly  1540  is an assembly of the rigid guide body  1542 , the flexible guide  1570 , and the cartridge adapter  1580 . The flexibility of the flexible guide  1570 , which is curved to direct the cartridge  1600  radially make contact with the larger ID spring cage  600 , allows the distal end of the guide body assembly  1540  to deflect during insertion and removal to fit within the delivery sheath  1520 . Installed within the guide body assembly  1540  is the ram  1560 . The ram  1560  has a solid cylindrical body  1562  with a strike point  1564  on the proximal end and a hammer end  1568  connected via a flexible beam  1566 . The ram  1560  slides within the guide body assembly  1540 . The distal end of the cartridge adapter  1580  has locking ears  1586  that locate and contain the tabs  1608  on the cartridge  1600 . Within the body  1602  of the cartridge  1600  is a cavity that contains ribs  1604  that constrain and guide the staple  1620  in addition to guiding the hammer  1568  end of the ram  1560 . A notch  1606  on the distal end of the cartridge  1600  is used to position in over the wire coil of the spring cage  600  so that the staple  1620  captures the wire coil as it embeds in the vertebral bone. The staple  1620  has a curved body  1622  with two legs that end in sharp, angled points  1624 . The cross section of the staple body  1622  can be of various shapes (rectangular, circular, etc.) and may contain barbs or the like to help contain it in the bone after deployment.  FIG. 77  illustrates the deployment of the staple  1620  into the upper plate  1652  of a vertebral body  1662 . When the strike point  1564  of the ram  1560  is struck with either a single hard blow or a high repetition of lighter blows (i.e. impact hammer) it transfers the force through the ram cylindrical body  1562 , the flexible beam  1566 , and through the hammer end  1568  to the head of the staple  1620  driving it down the cartridge guide path over the spring cage  600  wire coil into the bone. Multiple staples  1620  would be used to anchor the spring cage  600  to both the upper and lower vertebral bodies. The energy for the blows that deploy the staples can be delivered by various means; manually with a hammer, using a powered (pneumatic, electric, etc.) ram to single hard blow, or a powered impact hammer type device that generates a high repetition of less energetic blows. Various configurations of the cartridge (single use, reloadable, multiple staples) is possible.  FIG. 78  shows a curved nail version of the stapling tool cartridge generally designated  1700 . The cartridge  1720  contains one or more of the curved nails  1740  which consist of a thin curved body  1742 , a penetrating point  1744 , and a head  1746 . The nails  1740  are deployed using a similar ram device as shown in stapling tool  1500 . This embodiment shows 3 nails in the cartridge which would be deployed sequentially. Additional structural features such as barbs or different head designs are possible while retaining the basic curved shape that allows the nail to be deployed off axis to the delivery tool. 
         [0137]    While the inventions have been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that the embodiments have been shown and described and that all changes and modifications that come within the spirit of these inventions are desired to be protected.