Patent Publication Number: US-2012029412-A1

Title: Internal and external disc shunt alleviate back pain

Description:
FIELD OF INVENTION 
     Diffusion of nutrients, oxygen and pH buffer into avascular intervertebral disc is limited to the depths of diffusion zones near superior and inferior endplates. Lactic acid produced anaerobically in the mid layers of the nucleus can leak out of the disc and cause persistent back pain. This invention relates to devices drawing nutrients, oxygen and pH buffer from diffusion zones supplied by capillaries in the endplates to neutralize the lactic acid to relieve back pain. The device also serves as a bulking agent within the degenerated disc to reduce strain and pain of the facet joints. Furthermore, strands of the device can extend from the disc into muscle to draw additional nutrients, oxygen and pH buffer to neutralize the acid and regenerate the disc. 
     BACKGROUND 
     Chronic back pain is an epidemic. Nerve impingement is not seen by CT or MRI in about 85% of back pain patients [Deyo R A, Weinstein J N: Low back pain, N Eng J Med, 344(5) February, 363-370, 2001. Boswell M V, et. al.: Interventional Techniques: Evidence-based practice guidelines in the management of chronic spinal pain, Pain Physician, 10:7-111, ISSN 1533-3159, 2007]. In fact, lumbar disc prolapse, protrusion, or extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions (Manchikanti L, Derby R, Benyamin R M, Helm S, Hirsch J A: A systematic review of mechanical lumbar disc decompression with nucleoplasty, Pain Physician; 12:561-572 ISSN 1533-3159, 2009). The cause of chronic back pain in most patients has been puzzling to both physicians and patients. 
     Studies indicate back pain is correlated with high lactic acid in the disc. Leakage of the acid causes acid burn and persistent back pain. In addition, as the disc degenerates and flattens, the compressive load is shifted from the flattened disc to facet joints, causing strain and pain. Both lactic acid burn and strain of the facet joints are not visible under CT or MRI. 
     SUMMARY OF INVENTION 
     A disc shunt delivery device contains a needle, a sleeve with a snagging point and a shunt strand extending from a lumen of the needle and draping outside the sleeve and needle with a beveled tip. As the needle is twisted or rotated, the beveled tip catches and winds the outside shunt strand to spiral around the needle. The sleeve slides over the needle, using the snagging point to snag and dislodge the spiraled shunt strand from the needle into the disc. Spiraling and dislodgement of coiled shunt strands can be repeated to build an internal disc shunt near one or both endplates to draw nutrients, oxygen and buffering solute supplied through the endplates to neutralize lactic acid and relieve back pain. The internal disc shunt also serves as a cushion or bulking agent within the disc to reduce load, strain and pain in facet joints. 
     One or more strands of the internal disc shunt can be extended outside the disc into muscle or bodily circulation to draw additional nutrients, oxygen and/or pH buffer solute into the disc, forming an internal and external disc shunt. 
     REFERENCE NUMBERS 
     
         
           100  Intervertebral disc 
           100 A L5-S1 disc 
           100 B L4-5 disc 
           100 C L3-4 disc 
           101  Needle 
           102  Dull external edge of the distal end of the needle 
           103  Guide wire or tube 
           104  Filament of disc shunt 
           105  Endplate 
           106 A Superior diffusion zone 
           106 B Inferior diffusion zone 
           107  Capillaries 
           108  Calcified layers 
           109  Dip stick 
           110  Beveled or indented distal end of the sleeve 
           111  Lumen of the cannula needle 
           114  Annular delamination 
           115  Epiphysis 
           116  Lumen for guide wire 
           118  Nerve 
           119  Epidural space 
           121  Fissure 
           122  Gel or foam internal disc shunt 
           123  Spinal cord 
           124  Pores of sponge shunt 
           126  Main shunt 
           126 A U-section, bent section, distal portion, or distal section of the main shunt 
           126 B Second end-strand or portion of the main shunt 
           126 C First end-strand or portion of the main shunt 
           127  Shunt sheath, wrapper or cover layer 
           128  Nucleus pulposus 
           129  Facet joint 
           130  Handle of needle 
           131  Nutrients, oxygen and pH buffering solute 
           132  Handle of sleeve 
           133  Transverse process 
           134  Spinous process 
           135  Lamina 
           140  Ilium 
           142  Superior articular process 
           143  Inferior articular process 
           152  Puncture site 
           153 A Marker showing orientation of the sharp needle Quincke tip 
           153 B Marker showing orientation of the snagging point of sleeve 
           153 C Marker showing orientation of cannula Quincke tip 
           159  Vertebral body 
           160  Biosynthetic product or molecule 
           161  Fluid flow 
           162  Lactic acid 
           163  Contrast agent 
           184  Nucleus hole 
           193  Muscle 
           194  Spinal nerve root 
           195  Posterior longitudinal ligament 
           220  Sleeve 
           221  Snagging point, tip or edge of the sleeve 
           230  Cannula needle 
           231  Quincke tip of the cannula needle 
           232  Dull external edge of the cannula needle 
           233  Dull or rounded inner wall of the cannula needle 
           268  Lumen of the sleeve 
           269  Lumen of the needle 
           270  Handle of the cannula needle 
           271  Proximal protrusion of cannula handle 
           272  Distal protrusion of cannula handle 
           276 A Syringe 
           276 B Contrast injecting needle 
           277  Cell 
           278  Pedicle 
           279  Sleeve pusher 
           310  Quincke sharp tip of the needle 
           360  Sleeve pushing slot or opening 
           362  Sleeve pushing stop 
           363  Sleeve pushing hinge 
           368  Blade-like inner wall of the needle 
           369  Damaged portion of the shunt 
           370  Dull or rounded inner wall of the needle 
           373  Linked or attached shunt 
           373 A Linked U-section, linked bent section or linked distal section of the linked shunt 
           373 B First linked end strand or portion 
           373 C Second linked end strand or portion 
           378  Annulus or annular layer 
           460  Pull line 
           461  Retainer or holder of the shunt stands 
           462  Fold or crease on the pull line 
           463  Knot on the pull line 
           492  Proximal opening of bi-handle holder 
           493  Bi-handle holder 
           494  Cavity of bi-handle holder 
           495  Distal wall of bi-handle holder 
           496  Distal opening of bi-handle holder 
           497  Proximal wall of bi-handle holder 
           498  Distal protrusion of sleeve handle 
           499  Proximal protrusion of sleeve handle 
           500  Distal protrusion of needle handle 
           501  Proximal protrusion of needle handle 
           502  Gripping or friction ridges of needle handle 
           503  Needle-sleeve spacer 
           504  Kambin&#39;s triangle 
           505  Skin 
           506  Sleeve-cannula spacer 
           507 A Distal wall of sleeve-cannula spacer 
           507 B Distal opening of sleeve-cannula spacer 
           508 A Proximal wall of sleeve-cannula spacer 
           508 B Proximal opening of sleeve-cannula spacer 
           509  Cavity of sleeve-cannula spacer 
           510  Tri-handle holder 
           511 A Distal wall of tri-handle holder 
           511 B Distal opening of tri-handle holder 
           512 A Proximal wall of tri-handle holder 
           512 B Proximal opening of tri-handle holder 
           513  Cavity of tri-handle holder 
           514  Esophagus 
           515  Larynx or trachea 
       
    
    
    
     
       DESCRIPTION OF THE DRAWINGS 
         FIG. 1  shows a longitudinal view of a healthy spinal segment with nutrients  131  supplied by capillaries  107  at the endplates  105  to feed the cells within the disc  100 . 
         FIG. 2  shows a graph of distance from endplate of a disc versus oxygen concentration. 
         FIG. 3  shows calcified layers  108  accumulated at the endplates  105 , blocking diffusion of nutrient/oxygen  131  from capillaries  107 , forming and leaking lactic acid  162  to nerve  118 . 
         FIG. 4  shows leakage of lactic acid  162 , burning or irritating the spinal nerve  194 . 
         FIG. 5  depicts diagnostic discography by flushing lactic acid from disc  100  with contrast agent  163  to sensory nerve  118  to confirm pain. 
         FIG. 6  shows a hole or vacuole  184  in the disc  100 . 
         FIG. 7  shows load transfer from the flattened and degenerated disc  100  to facet joint  129 . 
         FIG. 8  depicts swaying of a vertebral body  159  above a disc  100  with low-swelling pressure. 
         FIG. 9  depicts spinal instability from the low-pressure disc  100 , straining and wearing the facet joints  129 . 
         FIG. 10  shows portions of main shunt  126 , linked shunt  373 , needle  101  and sleeve  220  for treating discogenic and facet pain. 
         FIG. 11  shows a fluoroscopic anterior-posterior view of the needle  101 , about half way past pedicles  278 , entering into the disc  100  space. 
         FIG. 12  shows a fluoroscopic lateral view of the needle  101  entering into the disc  100  space, but not into the epidural space  119 . 
         FIG. 13  shows entry of the needle  101  and shunt strands  126 ,  373  through skin  505 , muscle  193  and Kambin&#39;s triangle  504  of the degenerated disc  100 . 
         FIG. 14  shows a needle handle  130 , sleeve handle  132  and a bi-handle holder  493  to facilitate disc  100  puncturing. 
         FIG. 15  shows twisting or rotation of the beveled needle  101  to wind or spiral the shunt strands  126 B,  373 B,  373 C on the distal shaft of the needle  101 . 
         FIG. 16  shows a sleeve pusher  279  for inserting between the sleeve handle  132  and needle handle  130  to advance the sleeve  220 . 
         FIG. 17  shows a snagging point  221  on the distal end of the advancing sleeve  220  to snag, catch, hook, connect, push or engage the spiraled shunt strands  126 B,  373 B,  373 C. 
         FIG. 18  shows progressive advancement of the sleeve  220  to dislodge, push or strip the spiraled shunt strands  126 B,  373 B,  373 C off the needle  101 . 
         FIG. 19  shows that the snagging point  221  slides parallel to the needle  101  to deploy or dislodge the spiraled shunt strands  126 B,  373 B,  373 C within the disc. 
         FIG. 20  shows slight withdrawal of the needle  101  to expose a new strand  126 C from the lumen of the needle  101 . The needle  101  will then advance, so distal tips of the needle  101  and sleeve  220  are generally aligned as shown in  FIG. 19 . 
         FIG. 21  shows withdrawal of the sleeve  220  and coiling of shunt strands  126 B,  373 B,  373 C over strand  126 C extending from the lumen  269  of the needle  101 . 
         FIG. 22  shows subsequent twisting of the needle  101  to spiral another length of shunt strands  126 B,  373 B,  373 C on the distal shaft of the needle  101 . 
         FIG. 23  shows substantial repetitive spiraling of disc shunts  126 ,  373  within the degenerated disc  100 , before cutting shunt strands  126 B,  126 C,  373 B and  373 C. 
         FIG. 24  shows the shunt strands  126 B,  373 B,  373 C being reeled under the skin  505  by adding more spiraled shunt strands  126 ,  373  into the disc  100 . A dip stick  109  is used to check the depth of the shunt strand  126 C within the needle  101 . 
         FIG. 25  shows the internal shunts  126 ,  373  within the disc  100 , and external shunt strands  126 B,  126 C,  373 B,  373 C drawing plasma from the muscle  193  into the disc  100 . 
         FIG. 26  shows the internal shunt  126 ,  373  drawing nutrients/oxygen/buffer  131  from superior  106 A and inferior  106 B diffusion zones, and the external shunt  126 ,  373  drawing nutrients/oxygen/buffer  131  from muscle  193  into the disc  100 . 
         FIG. 27  shows thickening of the repaired disc  100  by the spiraled internal disc shunts  126 ,  373  to reduce load, strain and pain of the facet joints  129 . 
         FIG. 28  shows an internal disc shunts  126 ,  373  entirely spiraled, coiled, knotted or deployed within the disc  100 , reaching one or more diffusion zones  106 A,  106 B. 
         FIG. 29  shows that the internal shunts  126 ,  373  reach, absorb and/or draw nutrients  131  from the superior  106 A and/or inferior  106 B diffusion zones into the mid layers of the disc  100 . 
         FIG. 30  depicts compression on the internal shunts  126 ,  373 , squeezing nutrients  131  absorbed in the shunts  126 ,  373  to mid layers and other portion of the disc  100 . 
         FIG. 31  depicts relaxation or expansion of the internal shunt  126 ,  373 , drawing or absorbing nutrients  131  from the superior  106 A and inferior  106 B diffusion zones. 
         FIG. 32  shows injection of a gel or foam shunt  122 , capable of drawing nutrients  131  from the superior  106 A and/or inferior  106 B diffusion zones into the mid layers of the disc  100 . 
         FIG. 33  shows shielding of L5-S1 disc  100 A, L4-5 disc  100 B by the ilium  140 , blocking entry of the straight needle  101 . 
         FIG. 34  shows ilium shielding of the lower lumbar disc  100 , preventing needle  101  entry into the nucleus of the disc  100 . 
         FIG. 35  shows curvatures of the needle  101  and sleeve  220  deployed from a straight and rigid cannula needle  230  into the nucleus  128  of the intervertebral disc  100 . 
         FIG. 36  shows the curved needle  101  and sleeve  220  with shunt strands  126 B,  373 B and  373 C draped outside the needle  101 , sleeve  220  and cannula needle  230 . 
         FIG. 37  shows the handle of the needle  130 , handle of the sleeve  132 , handle of the cannula needle  270 , sleeve-cannula spacer  506  and a tri-handle holder  510 . 
         FIG. 38  shows the resiliently straightened curved needle  101  and sleeve  220  within the cannula needle  230  with a guide wire  103  leading into the disc  100 . 
         FIG. 39  shows a mid-longitudinal view of a naturally occurring blade-like inner wall  368  of the needle  101 , cutting the U-section  126 A of the main shunt  126  during tissue puncturing. 
         FIG. 40  shows a rounded, blunt or dull inner wall  370  of the needle  101 , supporting without cutting the U-section  126 A of the main shunt  126 . 
         FIG. 41  shows a rounded, blunt or dull inner wall  233  of the cannula needle  230  to prevent cutting the U-section  126 A of the main shunt  126 . 
         FIG. 42  shows two snagging points or tips  221  of the sleeve  220  for engaging and dislodging the spiraled strands  126 B,  373 B,  373 C from the distal shaft of the needle  101 . 
         FIG. 43  shows multiple snagging points or tips  221  of the sleeve  220 . 
         FIG. 44  shows a single snagging point or tip  221  of the sleeve  220 . 
         FIG. 45  shows a longitudinal view of the spiraled strands  126 B,  373 B,  373 C, the needle  101  and the sleeve  220  with snagging points  221  made by beveling the inner wall of the sleeve  220 . 
         FIG. 46  shows braided filaments  104  to form the disc shunt strands  126 ,  373 . 
         FIG. 47  shows woven filaments  104  to form the disc shunt strands  126 ,  373 . 
         FIG. 48  shows knitted filaments  104  to form the disc shunt strands  126 ,  373 . 
         FIG. 49  depicts a slanted cut of the disc shunt strands  126 ,  373 , showing the slanted orientations of filaments  104  relative to the length-wise shunt strands  126 ,  373 . 
         FIG. 50  shows cross-sections of filaments  104  oriented parallel to shunt strands  126 ,  373 , wrapped, encircled or enveloped by a sheath or cover  127 . 
         FIG. 51  shows cross-sections of tubular filaments  104  oriented parallel to the shunt strands  126 ,  373 , wrapped, encircled or enveloped by a sheath or cover  127 . 
         FIG. 52  shows a disc shunt strand  126  or  373  made with sponge or foam with pores  124 . 
         FIG. 53  shows a section of the disc shunt strand  126 ,  373  transporting and supplying nutrients  131  to cells  277  to produce biosynthetic products  160 . 
         FIG. 54  shows fluid flowing  161  into the disc  100  due to increased osmolarity from newly made biosynthetic products  160  using the continual supply of nutrients  131 . 
         FIG. 55  shows injection of nutrients  131  and/or cells  277  into the internal and external shunted disc  100  to expedite production of biosynthetic products  160 . 
         FIG. 56  shows a misguided needle  101  and sleeve  220  delivering shunt strands  126 B,  373 B,  373 C under the skin  505  of a neck. 
         FIG. 57  shows needle  101  withdrawal for redirecting the needle  100 , but pre-maturely deploying the shunt strands  126 B,  126 C,  373 B,  373 C under skin  505 . 
         FIG. 58  shows pull lines  460  threaded through the proximal ends of the shunt strands  126 B,  373 B,  373 C, and the shunt strand  126 C within the needle  101 . 
         FIG. 59  shows a retainer  461  holding the shunt strands  126 B,  373 B,  373 C for attachment to the pull line  460 . 
         FIG. 60  depicts a crease  462  formed on the pull line  460  during tension pulling on the shunt strands. 
         FIG. 61  depicts release of tension from the crease-resistant pull line  460  to facilitate pull line  460  withdrawal from the shunt strands. 
         FIG. 62  shows the pull line  460  attached to the shunt strands  126 B,  373 B,  373 C and extending above the skin  505  to assist needle  101  withdrawal and redirecting. 
     
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
     Intervertebral discs are avascular (no blood vessels). Nutrients, oxygen and pH buffer  131  essential for disc cells are supplied by the capillaries  107  in the vertebral bodies  159  and diffused from the superior and inferior endplates  105  into the disc  100 , as shown in  FIG. 1 . Normal blood pH is tightly regulated between 7.35 and 7.45, mainly by the pH buffering bicarbonate dissolved in blood plasma diffused through the superior and inferior endplates  105  into the disc  100 . 
     However, depth of diffusion is shallow into thick human discs  100 . The calculated depth of oxygen diffusion from the endplates  105  is summarized in  FIG. 2  (Stairmand J W, Holm S, Urban J P G: Factor influencing oxygen concentration gradients in disc, Spine, Vol. 16, 4, 444-449, 1991). 
     Similarly, calculated depths of glucose diffusion are less than 3 mm from superior and inferior endplates (Maroudas A, Stockwell R A, Nachemson A, Urban J: Factors involved in the nutrition of the human lumbar intervertebral disc: Cellularity and diffusion of glucose in vitro, J. Anat., 120, 113-130, 1975). Nearly all animals have thin discs; depths of diffusion of nutrients and oxygen seem to be sufficient. Lumbar discs of a large sheep weighing 91 kg (200 pounds) are less than 4 mm thick. However, human lumbar discs are about 7-12 mm thick. Mid layers of our thick discs are highly vulnerable to severe nutritional and oxygen deficiency. 
     As we age, calcified layers  108  form and accumulate at the endplates  105 , blocking capillaries  107  and further limiting the depth of diffusion of nutrients/oxygen/pH buffer  131  into the disc  100 , as shown in  FIG. 3 . Cell death, matrix degradation and lactic acid  162  accumulation due to starvation and anaerobic conditions are common in the mid layer of the avascular discs  100 . Degradation of glycosaminoglycans may provide sugars to fuel the production of lactic acid  162 . [Urban J P, Smith S, Fairbank J C T: Nutrition of the Intervertebral Disc, Spine, 29 (23), 2700-2709, 2004. Benneker L M, Heini P F, Alini M, Anderson S E, Ito K: Vertebral endplate marrow contact channel occlusions &amp; intervertebral disc degeneration, Spine V30, 167-173, 2005. Holm S, Maroudas A, Urban J P, Selstam G, Nachemson A: Nutrition of the intervertebral disc: solute transport and metabolism, Connect Tissue Res., 8(2): 101-119, 1981]. 
     When glycosaminoglycans diminish, water content and swelling pressure of the nucleus pulposus  128  decrease. The nucleus  128  with reduced swelling pressure can no longer distribute forces evenly against the circumference of the inner annulus  378  to keep the annulus bulging outward. As a result, the inner annulus  378  sags inward while the outer annulus  378  bulges outward, creating annular delamination  114  and weakened annular layers  378 , possibly initiating fissure  121  formation depicted in  FIGS. 3 and 4 . 
     High lactic acid content in discs correlates with back pain. In fact, dense fibrous scars and adhesions, presumably from lactic acid  162  burn, can be found around nerve roots  194  during spinal surgery [Diamant B, Karlsson J, Nachemson A: Correlation between lactate levels and pH of patients with lumbar rizopathies, Experientia, 24, 1195-6, 1968. Nachemson A: Intradiscal measurements of pH in patients with lumbar rhizopathies. Acta Orthop Scand, 40, 23-43, 1969. Keshari K R, Lotz J C, Link T M, Hu S, Majumdar S, Kurhanewicz J: Lactic acid and proteoglycans as metabolic markers for discogenic back pain, Spine, Vol. 33(3):312-317, 2008]. 
     Under anaerobic condition within the mid layer, lactic acid  162  is produced and leaked from the nucleus  128  through fissure  121  to burn surrounding nerves  118  causing persistent back pain, as depicted in  FIG. 3 . Colored drawings in the U.S. Provisional Application 61/399,088, Alleviate back pain by expanding the diffusion zones, filed on Jul. 6, 2010 by Jeffrey Yeung and Teresa Yeung show superior and inferior diffusion zones near the calcified endplates and lactic acid zone in the mid layer of the degenerated disc. Similar black and white drawing is depicted in  FIG. 3 . 
     Some patients experience leg pain without visible spinal nerve impingement under MRI or CT. Lactic acid  162  can leak from the nucleus  128  through fissures  121  to spinal nerves  194 , causing leg pain as depicted in  FIG. 4 . Leg pain without visible impingement is commonly called chemical radiculitis. 
     Discography is a common diagnostic technique for identifying or confirming a painful disc  100  before surgical intervention. Intradiscal injection of an X-ray contrast  163  flushes the lactic acid  162  from the nucleus  128  through fissure  121  to adjacent nerve  118 , causing instant and excruciating pain, as shown in  FIG. 5 . For normal or non-painful discs, discography with mild injection pressure is nearly painless. 
     Composition Change of the Intervertebral Discs (Approximation) 
                                                     % Change from            Normal Discs   Painful Discs   Normal Discs                  Glycosamino-   27.4 ± 2.4%   14.1 ± 1.1%   −48.5%        glycans                   Collagen   22.6 ± 1.9%   34.8 ± 1.4%    +54%       Water content   81.1 ± 0.9%   74.5 ± 1%     −8.1%       Acidity   pH 7.14   pH 6.65-5.70   [H + ]: +208%            [H + ]: 7.20 × 10 −8     [H + ]: 2.23 × 10 −7     to +2,661%               to 2.00 × 10 −6                      
(Reference: Kitano T, Zerwekh J, Usui Y, Edwards M, Flicker P, Mooney V: Biochemical changes associated with the symptomatic human intervertebral disk, Clinical Orthopaedics and Related Research, 293, 372-377, 1993. Scott J E, Bosworth T R, Cribb A M, Taylor J R: The chemical morphology of age-related changes in human intervertebral disc glycosaminoglycans from cervical, thoracic and lumbar nucleus pulposus and annulus fibrosus. J. Anat., 184, 73-82, 1994. Diamant B, Karlsson J, Nachemson A: Correlation between lactate levels and pH of patients with lumbar rizopathies, Experientia, 24, 1195-1196, 1968. Nachemson A: Intradiscal measurements of pH in patients with lumbar rhizopathies, Acta Orthop Scand, 40, 23-43, 1969.)
 
     Disc cells can survive without oxygen, but will die without glucose. The central area in the mid layer of the disc  100  is most vulnerable to glucose deficiency and cell death. Holes or vacuoles  184  can be found during dissection of cadaveric discs  100 , as shown in  FIG. 6 . Nuclei pulposi  128  of degenerated discs  100  are usually desiccated, with reduced swelling pressure and decreased capability to sustain compressive loads. The compressive load is thus transferred to the facet joints  129 , pressing the inferior articular process  143  against the superior articular process  142  of the facet joint  129 , causing strain, wear and/or pain as shown in  FIG. 7  (Dunlop R B, Adams M A, Hutton W C: Disc space narrowing and the lumbar facet joints, Journal of Bone and Joint Surgery—British Volume, Vol 66-B, Issue 5, 706-710, 1984). 
     A disc  100  with reduced swelling pressure is similar to a flat tire with flexible or flabby side walls. The vertebral body  159  above the soft or flabby disc  100  easily shifts or sways, as shown in  FIG. 8 . This is commonly called segmental or spinal instability. As shown in  FIG. 9 , the frequent or excessive movement of the vertebral body  159  strains the facet joints  129 , which are responsible for limiting the range of segmental mobility. Patients with spinal instability often use their muscles to guard or support their spines to ease facet pain. As a result, muscle tension and aches arise, but are successfully treated with muscle relaxants. Spinal motions, including compression, torsion, extension, flexion and lateral bending, were measured before and after saline injection into cadaveric discs. Intradiscal saline injections reduced all spinal motions in the cadaveric study (Andersson G B J, Schultz A B: Effects of fluid on mechanical properties of intervertebral discs, J. Biomechanics, Vol. 12, 453-458, 1979). 
     The shunt  126 ,  373  delivery needle  101  in  FIG. 10  is made for tissue puncturing, not tissue cutting to prevent nerve injury. Unlike common needles with blade-like distal cutting edges, the shunt  126 ,  373  delivery needle  101  has a Quincke sharp tip  310  and dull external beveled edges  102 . Similar to an awl, the shunt  126 ,  373  delivery needle  101  penetrates skin  505 , muscle  193  and disc  100 , gently pushing or deflecting the embedded blood vessels or spinal nerves  194  aside during penetration. The Quincke tip  310  can be called the beveled tip of the needle  101 . 
     A main shunt strand  126  in  FIG. 10  has two end-strands or portions  126 C,  126 B, and a main U-section, U-strand, bent section or distal section  126 A. The first end-strand  126 C is inserted into or through a lumen  269  of the needle  101 . The U-section  126 A extends from the lumen  269 , draping the second end-strand  126 B over the outer wall of the needle  101 . A linked shunt strand  373  also has two linked end-strands or portions  373 B,  373 C, and a linked U-section, linked U-strand, or linked distal section  373 A. The linked shunt  373  is attached to or threaded through the second end-strand  126 B to form the linked U-strand  373 A, the first linked end-strand  373 B and second linked end-strand  373 C. The main shunt strand  126  can be called the first shunt strand  126 . The linked shunt strand  373  can be called the second shunt strand  373 . The end-strand can be called shunt strand, end portion,  126 C,  126 B,  373 B or  373 C. The main U-section  126 A can be called the U-shaped distal portion. The linked U-strand  373 A can be called the linked U-shaped distal portion. 
     The delivery device of the shunt strands  126 ,  373  contains a sleeve  220 , sized and configured to retain or house the needle  101 . The length of the sleeve  220  is shorter than the length of the needle  101 . The shunt strands  126 B,  373 B,  373 C drape outside the sleeve  220  and needle  101 . The sleeve  220  has two snagging points  221  at the distal end and a solid side-wall, capable of sliding length-wise over the needle  101  shaft. The snagging points  221  maintain a fixed distance from the outer wall of the needle  101 . The fixed distance is less than the outer-diameter or thickness of the shunt strands  126 A,  126 B,  126 C,  373 A,  373 B or  373 C. In addition, the gap between the needle  101  and sleeve  220  is less than the outer-diameter or thickness of the shunt strands  126 A,  126 B,  126 C,  373 A,  373 B or  373 C. The gap is an inner diameter of the sleeve  220  minus an outer diameter of the needle  101 , which should be less than the thickness of the shunt strands  126 A,  126 B,  126 C,  373 A,  373 B or  373 C. Therefore, the shunt strands  126 A,  126 B,  126 C,  373 A,  373 B or  373 C cannot be trapped between the snagging point  221  and needle  101  shaft. Furthermore, the sleeve  220  wall thickness is preferred to be at least a seventh of the thickness of the shunt strands  126 A,  126 B,  126 C,  373 A,  373 B or  373 C. Thus, the height of the snagging points  221  is sufficient to catch and dislodge the spiraled shunts  126 ,  373  from the distal shaft of the needle  101 . 
     Kambin&#39;s Triangle  504  shown in  FIG. 7  is a posterior-lateral area through which a needle can access a lumbar disc  100  safely. Similar to needle entry for discography, the shunt  126 ,  373  delivery needle  101  is guided by a fluoroscope (X-ray), entering into a patient in prone position.  FIG. 11  shows an anterior-posterior fluoroscopic view of the needle  101  entering into disc  100  space, between superior and inferior endplates  105 . However, the anterior-posterior view does not show the ventral-dorsal position. Before passing the pedicle  278  midway, a lateral fluoroscopic view depicted in  FIG. 12  must be taken to ensure the needle  101  is not too dorsal, entering into the epidural space  119 .  FIG. 12  depicts the lateral fluoroscopic view, showing the needle  101  tip is ventral to the epidural space  119 , safely entering into the mid layer of the disc  100 . 
     In literature, sizable disc puncturing or laceration causes disc degeneration. The shunts  126 ,  373  delivery device is self-sealing, as shown in  FIG. 13 . The shunt strands  126 B,  373 B,  373 C outside the needle  101  and sleeve  220  are pressed against the wall of the needle  101  and sleeve  220 , and squeezed into the annulus  378  through a very small punctured hole. After withdrawal of the needle  101  and sleeve  220 , the shunt strands  126 B,  126 C  373 B,  373 C seal the needle tract within the annulus  378  to prevent or minimize the loss of hydrostatic pressure of the disc  100 , as a press-fitted implant. 
     In sheep and human clinical study, the outer diameters of the needle  101  and sleeve  220  are only 1.00 and 1.27 mm respectively. The outer diameter of each shunt strand  126 B,  126 C,  373 B or  373 C is about 0.55 mm. Diameter of combined shunt strands  126 B  126 C,  373 B,  373 C is about 2.10 mm to seal the needle tract in the disc  100 . 
       FIG. 13  shows initial entry of the needle  101  and shunt strands  126 ,  373  through skin  505 , muscle  193  and Kambin&#39;s triangle  504  of the degenerated disc  100 . Skin  505  of the puncture site  152  can be superficially cut with a scalpel to ease needle  101  puncture. During disc  100  puncturing, the Quincke sharp tip  310  of the needle  101  is preferred facing or near the mid line of the body to minimize the possibility of nicking the spinal nerve  194  or scraping the superior or inferior endplate  105 . A marker  153 A on a needle handle  130  indicates orientation of the Quincke tip  310 , about 45 degrees from the endplates  105 . The needle handle  130  also contains gripping or friction ridges  502  to facilitate twisting or rotating of the needle  101 . The needle handle  130  is spool shaped with proximal protrusion  501  and distal protrusion  500  to facilitate needle  101  withdrawal and advancement. 
     To avoid scrapping the superior or inferior endplate  105 , the snagging point  221  is preferred staying away or about 45 degrees from the superior and inferior endplates  105 . A marker  153 B on a sleeve handle  132  shows orientations of the snagging points  221 , as shown in  FIG. 13 . The sleeve handle  132  also contains a proximal protrusion  499  to facilitate sleeve  220  withdrawal, and a distal protrusion  498  to facilitate sleeve  220  advancement, as shown in  FIG. 13 . The U- or distal sections  126 A,  373 A are in the disc  100 . The shunt strands  126 C,  126 B,  373 B, and  373 C are usually extending from the disc  100  into the muscle  193 . For lumbar disc  100  repair, the shunt strands  126 C,  126 B,  373 B, and  373 C are preferred to be long, extending outside the skin  505 . 
     Both handles  130 ,  132  should be bound or linked together until the needle  101  is properly positioned within the degenerated disc  100 .  FIG. 14  shows a removable bi-handle holder  493  contains a bi-handle cavity  494  to house the needle handle  130  and the sleeve handle  132 . The proximal wall  497  of the bi-handle holder  493  retains the needle handle  130 ; the proximal opening  492  of the proximal wall  497  arches over the shunt strand  126 C. The distal wall  495  of the bi-handle holder  493  retains the sleeve handle  132 ; the distal opening  496  of the distal wall  495  arches over the sleeve  220 . Binding the handles  130 ,  132  with the bi-handle holder  403  can further be fastened by a removable tie or band. The needle handle  130  and the sleeve handle  132  are separated by a needle-sleeve spacer  503  for insertion of a sleeve pusher  279 . 
     After the needle  101  is positioned as shown in  FIG. 13 , the bi-handle holder  493  is removed.  FIG. 15  shows twisting or rotation of the beveled needle  101  to wind, spiral, spool or coil the outside shunt strands  126 B,  373 B,  373 C into a coiled or spiraled shunt strand, section or configuration on the distal shaft of the needle  101 . Tension of the spiraled strands  126 B,  373 B,  373 C can be felt on the needle handle  130  after about 3- to 7-needle  101  rotations. The U-section  126 A contacting the inner wall at the lumen  269  of the needle  101  in  FIG. 15  is vulnerable to damage or cutting. The inner wall of the needle  101  lumen  269  can be rounded or dulled by machining to prevent damage to the U-section  126 A. 
     The main shunt  126  alone is sufficient to build the internal and/or external disc shunt  126 . The linked shunt strand  373  adds bulk, size, cushion, filling or mass to the internal and/or external disc shunts  126 ,  373 . 
     A sleeve pusher  279  contains a hinge  363 , an adjustable stop  362 , slots  360  and handles of the sleeve pusher  279 , in  FIG. 16 . The adjustable stop  362  prevents excessive advancement of the sleeve  220  beyond the Quincke sharp tip  310  of the needle  101 . For sleeve advancement, the needle handle  130  is held stationary. The slots  360  of the sleeve pusher  279  are inserted over the needle-sleeve spacer  503  between the sleeve handle  132  and needle handle  130 . The needle handle  130  is held stationary, while using leverage of the sleeve pusher  279  to advance the sleeve  220  and dislodge the spiraled shunt strands  126 B,  373 B,  373 C from the distal shaft of the needle  101  into the disc  100 . During dislodgement, the strands  126 B,  373 B,  373 C outside the skin  505  can be seen advancing into the body of the patient. 
     The snagging point  221  is preferred to be a sharp tip, edge or rim, protruding and maintaining a fixed distance, sliding parallel over the outer wall of the needle  101  shaft. The snagging point  221  on the distal portion of the advancing sleeve  220  snags, catches, hooks, pushes or engages the spiraled shunt strands  126 B,  373 B,  373 C as shown in  FIGS. 17-18 . 
     Longitudinal advancement of the snagging points  221  of the sleeve  220  over the needle  101  creates minimal damage, disruption or opening to the annulus  378 , for preserving hydrostatic pressure of the disc  100 . The spiraled shunt strands  126 B,  373 B,  373 C may have several layers coiled over the distal shaft of the needle  101 . The sleeve  220  and the snagging points  221  slide over the needle  101  shaft to catch and push mainly the bottom layer of the shunt strands  126 B,  373 B,  373 C. The needle  101  can be coated with a lubricant to ease dislodgement or deployment of shunt strands  126 B,  373 B,  373 C. Furthermore, tension of the spiraled shunt strands  126 B,  373 B,  373 C over the needle  101  shaft can be loosened by slightly counter turning the needle handle  130  before advancing the sleeve  220  to dislodge the spiraled shunt strands  126 B,  373 B,  373 C. The sleeve  220  in  FIGS. 17-20  has two snagging points  221 , showing sequential dislodging, stripping or deploying of the spiraled shunt strands or section  126 B,  373 B,  373 C from the distal shaft of the needle  101  into the degenerated disc  100 . 
     During sleeve  220  advancement and strands  126 B,  373 B,  373 C dislodging, the strand  126 C is also pulled through the needle lumen  269  into the disc  100 , as depicted in  FIGS. 18-19 . Furthermore, the spiraled strands  126 B,  373 B,  373 C are wound, spiraled, coiled or spooled over the strand  126 C. Therefore, the spiraled strands  126 B,  126 C,  373 B,  373 C are intertwined forming an inter-connected coil. Each shunt strand  126 B,  126 C,  373 B or  373 C is not easily expelled, extruded or migrated from the repaired disc  100 . The coil or spiral of shunt strands  126 B,  126 C,  373 B,  373 C also serve as an anchor or large knot within the disc  100 , too large to pass through the press-fitted needle tract. 
     For lumbar discs  100 , initial spiraling of shunt strands or section  126 B,  373 B,  373 C in  FIG. 19  may not be sufficient to reach one or both superior  106 A and inferior  106 B diffusion zones. Additional spiraling and deployment of shunt strands are required to build the internal disc shunt  126 ,  373  and a bulking mass within the nucleus  128  to relieve pain from lactic burn and facet joint  129  loading. It is prudent to check positions of the needle  101  and sleeve  220  through fluoroscopic views after each deployment of spiraled strands  126 B,  373 B,  373 C. 
     The portion of the shunt strand  126 C at the lumen  269  opening can be excessively frail, weakened or partially torn from tension of spiraling in  FIG. 15 . A new portion of the shunt strand  126 C is exposed by slightly withdrawing the needle  101  while holding the sleeve  220  stationary as shown in  FIG. 20 , then re-advancing the needle  101 , so the Quincke tip  310  is even with the snagging points  221 , similar to  FIG. 19 . The sleeve  220  is withdrawn while holding the needle  101  stationary, as shown in  FIG. 21 . The needle  101  is twisted or rotated again to spiral additional shunt strands or section  126 B,  373 B,  373 C over the distal shaft of the needle  101 , as shown in  FIG. 22 . In the event that tension of winding shunt strands  126 B,  373 B,  373 C is not felt during needle  101  twisting, the shunt strand  126 C extending from proximal end of the needle handle  130 , as shown in  FIG. 14 , is pulled to re-establish contact between the U-section  126 A and the beveled tip of the needle  101  for catching and spiraling the U-section  126 A over the beveled tip of the needle  101 . If location of the Quincke tip  310  is still in the nucleus  128 , a slight advancement of the needle  101  also helps to re-engage the U-section  126 A with the beveled tip of the needle  101  for additional spiraling of shunt strands or section  126 B,  373 B,  373 C. Positions of the shunt strand  126 C in the needle  101 , the U-section  126 A at the lumen opening  269  and strand  126 B outside allow for re-adjustments and repetitive spiraling and deployment of strands  126 B,  126 C,  373 B,  373 C into the disc  100 . The linked shunt strand  373  can be optional, but it adds bulk, size, mass and fluid transport, especially as external disc shunts  126 ,  373 . 
     Additional spiraled or coiled shunt strands or sections  126 B,  373 B,  373 C are delivered or dislodged individually, packing into the disc  100  by advancement of the sleeve  220  to fill the weak, malleable, flabby or sponge-like area or vacuole  184 , within the degenerated disc  100 . When the disc  100  is nearly full, packing of coiled or spiraled shunt strands  126 B,  126 C,  373 B,  373 C becomes more difficult, requiring more force to push the sleeve  220 . The outside shunt strands  126 B,  373 B,  373 C are cut above the skin  505 , and the shunt strand  126 C extending from the proximal opening of the needle handle  130  is also cut, as shown in  FIG. 23 . Additional shunt spiraling by the needle  101  and dislodgement by the sleeve  220  draw, reel or pull the shunt strands  126 B,  373 B,  373 C under the skin  505  and within the muscle  193 , as shown in  FIG. 24 . 
     The follow steps advance the shunt strand  126 C within the lumen  269  of the needle  101  under the skin  505 . Starting from the position of the shunt delivering device depicted in  FIG. 21 : (1) Rotate the needle  101  about twice, which winds only the shunt strand  126 C over the needle  101  shaft. (2) Advance the sleeve  220  to dislodge the spiraled shunt strand  126 C into the coils of spiraled shunt strands  126 ,  373 , as shown in  FIG. 24 . (3) Withdraw the needle  101  about 1 cm, then re-insert the needle  101  for about 1 cm to position additional shunt strand  126 C in the disc  100 . (4) Withdraw the sleeve  220  to the needle handle  130 . (5) Detect depth of the strand  126 C within the needle  101  by inserting a dip stick  109  into the lumen  269  of the needle  101  through a proximal opening of the needle handle  130  as shown in  FIG. 24 . If the end of strand  126 C is not beneath the skin  505 , repeat the steps (1) to (5), until strands  126 C,  126 B,  373 B,  373 C are beneath the skin  505  and in the muscle  193 . (6) Withdraw the needle  101  and sleeve  220  from the skin  505  after forming the internal and external disc shunts  126 ,  373 , as shown in  FIG. 25   
     In essence, the needle  101  has two positions. First position of the needle  101  is with the shunt strands  126 B,  373 B,  373 C draping or residing outside the needle  101 . Second position of the needle  101  has the shunt strands  126 B,  373 B,  373 C spiraling, coiling, wrapping or winding over the beveled needle  101  shaft; the spiraling, coiling or wrapping is preferred to be on the distal portion of the needle  101 . The conversion between the first and second position of the needle  101  is achieved by twisting or rotating the needle  101  to spiral, coil, reel or wind the shunt strands  126 B,  373 B,  373 C over the beveled tip  310  at the distal end of the needle  101 . 
     The sleeve  220  and the snagging point  221  also have two positions when sliding longitudinally over the beveled needle  101 . In position one, the distal snagging point  221  is located proximal to the Quincke tip  310  of the needle  101 . In position two, the snagging point  220  is located at, near, substantially level or substantially even with the Quincke tip  310  of the needle  101 . During sliding from the position one to the position two, the snagging point  221  of the sleeve  220  maintains a fixed distance to the needle  101  shaft or the needle  101  outer wall. In position two, the snagging point  221  catches and dislodges the spiraled shunt strands  126 B,  373 B,  373 C from the needle  101 . 
     In the second position of the needle  101  and position one of the sleeve  220 , the spiraled shunt strands or sections of  126 B,  373 B,  373 C are mostly distal to the snagging point  221 . During traveling or sliding from the position one to the position two of the sleeve  220 , the snagging point  221  dislodges the spiraled shunt strands or sections  126 B,  373 B,  373 C from the distal portion of the needle  101  into the disc  100 , to convert from the second to the first position of the needle  101 . 
       FIG. 26  shows a longitudinal view of a shunted disc  100  with calcified layers  108  accumulated over the endplate  105 . The spiraled, coiled or knotted disc shunts  126 ,  373  reach, locate, reside or contact at least one of the superior  106 A and inferior  106 B diffusion zones, drawing and transporting nutrients/oxygen/pH buffer  131  to neutralize lactic acid  162  and nourish cells in the mid layer of the disc  100 . The spiraled, coiled or knotted shunt strands are the internal disc shunts  126 ,  373  which relieve discogenic pain from lactic acid  162  burn. Bicarbonate and other pH buffering solutes  131  in the superior  106 A and inferior  106 B diffusion zones are absorbed, drawn and stored by the spiraled shunts  126 ,  373 . Due to compression and relaxation of the disc  100  from daily activities of the patient, bicarbonate and other pH buffering solutes  131  are released or squeezed from the spiraled internal disc shunts  126 ,  373  in the lactic acid zone or mid layer of the disc  100  to neutralize the lactic acid  162 . In essence, the internal disc shunts  126 ,  373  expand the superior  106 A and inferior  106 B diffusion zones, covering, erasing, inundating or obliterating the lactic acid zone in the central-mid layer of the disc  100 . Hence, fluid leaking from the fissure  121  is pH neutral or near pH neutral to alleviate or reduce pain, as shown in  FIG. 26 . 
     The shunt strands  126 B,  126 C,  373 B,  373 C can also extend from the spiraled or coiled internal disc shunts  126 ,  373  within the disc  100  to muscle  193  or bodily circulation to draw nutrient/oxygen/pH buffer  131  into the disc  100 , as external disc shunts  126 ,  373 , shown in  FIGS. 25-27 . 
     Fluid flows from low to high osmolarity. External disc shunts  126 ,  373  were implanted into sheep (430 mOsm/liter) and human cadaver discs (300-400 mOsm/liter) of various degenerative levels, Thompson Grade 0-4. The shunted specimens were submerged in saline with blue dye (350 mOsm/liter). Dissection of the specimens showed blue saline permeation into the nuclei of all externally shunted discs. 
     Another external disc shunt  126 ,  373  was implanted through a muscle into a sheep disc. The sheep muscle was saturated with iopamidol (contrast agent with blue dye, 545 mOsm/l). The blue iopamidol did not permeate through the external shunt  126 ,  373  into the sheep disc (430 mOsm/liter). In fact the dissected disc looked desiccated; fluid within the sheep disc was probably drawn into the muscle infused with 545 mOsm/liter blue iopamidol through the external disc shunt  126 ,  373 . The experiment was repeated with diluted blue iopamidol solution (150 mOsm/liter). The diluted iopamidol solution saturated the muscle and permeated through the external disc shunt  126 ,  373  into the sheep disc visible and traceable from muscle to nucleus under CT. Dissection confirmed permeation of the diluted blue iopamidol into the nucleus of the sheep disc. 
     More external disc shunts  126 ,  373  were implanted into sheep discs, then submerged in pork blood (about 300 mOsm/liter). Dissection of the specimens showed pork blood permeation through the external disc shunts into the gelatinous nuclei of the sheep discs (430 mOsm/liter). 
     In-vivo sheep study, implanted internal and external disc shunts  126 ,  373  showed no tissue reaction within the discs  100  or tissues adjacent to the discs  100  after 1, 3, 6 and 12 months study with histology staining. Color photo of the histology is shown in the U.S. Provisional Application 61/399,088, Alleviate back pain by expanding the diffusion zones, filed on Jul. 6, 2010. In addition, no adverse reaction occurred to the external disc shunts  126 ,  373  in human during a pilot study. 
     Osmolarity of human blood is about 300 mOsm/liter. Evidence indicates that nutrients/oxygen/pH buffer  131  in blood plasma of the muscle  193  and/or capillaries  107  at the endplate  105  flow through the hydrophilic or fluid absorbing internal and/or external disc shunt  126 ,  373  into the desiccated disc  100  with high osmolarity. 
     Furthermore, oxygen  131  from the superior  106 A, and inferior  106 B diffusion zones and muscle  193  converts anaerobic into aerobic conditions within the central-mid layer of the disc  100 . Hence, in the presence of oxygen  131 , production of lactic acid  162  may decrease significantly to further reduce lactic acid burn. 
     Compression and relaxation of the disc  100  from patient&#39;s daily activities behave similar to a diaphragm pump, drawing fluid from the diffusion zones  106 A,  106 B, and/or muscle  193  through the shunts  126 ,  373  into the mid layer of the disc  100 , then expelling the fluid through the fissure  121 . Fluid flow in the internal and/or external shunted disc  100  becomes dynamic, nutrients/oxygen/pH buffer  131  are re-supplied or replenished through the superior  106 A and/or inferior  106 B diffusion zones and/or muscle  193 . 
     The multiple coiled or spiraled disc shunts  126 ,  373  provide bulk, shimming, filling, cushion, mass, wedging or fortification within the disc  100  to elevate, raise, lift, increase or sustain disc  100  height as indicated by arrows in  FIG. 26 . The spiraled disc shunts  126 ,  373  also serve as a filler or stabilizer to support and repair the flabby disc  100  from within. The repaired disc  100  in  FIG. 27  becomes firm, stiff and/or thickened to reduce spinal instability. Disc height increases or elevates; difference can be compared or measured before and after implantation of spiraled disc shunts  126 ,  373  using standing X-rays. During compressive loading on the spine, the load is shifted from the inferior articular process  143  to the shunted disc  100 , as shown in  FIG. 27 . Hence, the compressive load, strain and pain of the facet joints  129  are reduced. 
     Nutrients  131  are diffused from the capillaries  107  at the endplates  105  into the nutrient-poor avascular disc  100 , as shown in  FIG. 26 . Diffusion is concentration related; solutes moves from high to low concentration, from capillaries  107  into diffusion zones  106 A,  106 B. Due to drawing of nutrients  131  into the internal disc shunts  126 ,  373 , concentration of nutrients  131  at the superior  106 A and/or inferior  106 B diffusion zones is reduced. Additional diffusion of nutrients  131  will be re-supplied through the capillaries  107  vascular buds. The net supply of nutrients/oxygen/pH buffer solutes  131  into the disc  100  will increase with implantation of the internal shunt  126 ,  373 , as shown in  FIGS. 28 and 29 . The concentration gradient of nutrients/oxygen/pH buffer solutes  131  is extended or expanded by the internal shunts  126 ,  373 , covering, diffusing or permeating the full-thickness of the intervertebral disc  100  to neutralize lactic acid  162 , nourish starving disc cells  277  and rebuild disc matrix to sustain compressive loading of the spine. 
       FIG. 28  shows the internal disc shunts  126 ,  373  entirely spiraled, coiled, knotted or deployed within the disc  100 , to increase supply of nutrients/oxygen/pH buffer  131  especially into the mid layer of the disc  100 .  FIG. 29  shows that the internal shunts  126 ,  373  reach, locate, absorb and/or draw nutrients  131  from at least one of the superior  106 A and inferior  106 B diffusion zones into the mid layers of the disc  100 , expanding the diffusion zones and extending concentration gradient of the nutrient  131  into the central mid layer of human disc  100 . 
     Depending on severity of the calcified layers  108  covering the capillaries  107  and vascular buds at the endplates  105 , the superior  106 A and inferior  106 B diffusion zone containing nutrients/oxygen/pH buffer  131  are between 1 and 5 mm from the cartilaginous endplates  105 . For degenerated and/or painful discs  100 , the superior  106 A and inferior  106 B diffusion zones are likely between 0 and 3 mm from the superior and inferior endplates  105 . Hence, the internal disc shunts  126 ,  373  should reach at least one, but preferably both superior  106 A and inferior  106 B diffusion zones, between 0 and 3 mm from both endplates. Repetitive formations and deployments of the coiled or spiraled shunt strands  126 A,  126 B,  126 C,  373 A,  373 B,  373 C are used to position, reside, locate, reach or contact at least one diffusion zones  106 A,  106 B, between 0 and 3 mm from at least one endplates  105  to form the internal disc shunt  126 ,  373 . Distance of the internal disc shunt  126 ,  373  from the endplate  105  determines availability or quantity of nutrients/oxygen/pH buffer  131  for supplying the mid layer of the disc  100  to alleviate discogenic pain from lactic acid  162  burn. 
     In summary, insertion of the internal disc shunt  126 ,  373  increases the depth of diffusion of nutrients/oxygen/pH buffer  131  to neutralize lactic acid  162  and nourish disc cells in the mid layer of the disc  100 . Furthermore, the internal disc shunts  126 ,  373  also add bulk, cushion, filling, thickness or fortification, as depicted by arrows in  FIG. 29 , to reduce or alleviate pain from the facet joints  129  and spinal instability, in  FIG. 27 . 
     The disc shunt strands  126 ,  373  are hydrophilic with measurable characteristics under ambient temperature and pressure for transporting and retaining fluid to relieve pain and/or regenerate the degenerated disc  100 . After saturation in water, the disc shunts  126 ,  373  gain weight between 10% and 500% by absorbing water within the matrix of the disc shunt strands  126 ,  373 . A healthy human disc  100  contains 80% water. The preferred water absorbency after water saturation is between 30% and 120%. The shunt strands  126 ,  373  can have pore sizes between 1 nano-meter and 200 micro-meters, serving as water retaining pockets or water transporting channels. Pores  124  of the disc shunt strands  126 ,  373  also function as scaffolding or housing for cell  277  attachment and cellular proliferation. Water contact angle on the disc shunt strands  126 ,  373  is between 0 and 60 degrees. The preferred water contact angle of the shunt strands  126 ,  373  is between 0 and 30 degrees. Height of capillary action for drawing saline up the disc shunt strands  126 ,  373  is between 0.5 and 120 cm. The preferred height of capillary action of drawing saline is between 1 and 60 cm. Height of capillary action for drawing pork blood up the disc shunt strands  126 ,  373  is between 0.5 and 50 cm. The preferred height of capillary action for drawing pork blood up the disc shunt strands  126 ,  373  is between 1 cm and 25 cm. Saline siphoning transport rate through the disc shunt strands  126 ,  373  is between 0.1 and 10 cc per 8 hours in a humidity chamber. Human lumbar disc  100  loses between about 0.5 and 1.5 cc fluid per day due to compression. The saline siphoning transport rate through the disc shunt strands  126 ,  373  is preferred between 0.5 and 5 cc per 8 hours in a humidity chamber. Pork blood siphoning transport rate through the disc shunt strands  126 ,  373  is between 0.1 and 10 cc per 8 hours in a humidity chamber. The pork blood siphoning transport rate through the disc shunt strands  126 ,  373  is preferred between 0.5 and 3 cc per 8 hours in a humidity chamber. 
     The shunt strands  126 ,  373  used in the sheep and human clinical studies have the following physical properties under ambient temperature and pressure: (1) weight gain 80% after water saturation, (2) water contact angle zero degree, (3) height of capillary action 11 cm with pork blood, 40 cm with saline with blue dye, and (4) rate of siphoning pork blood 1.656+/−0.013 cc per 8 hours in a humidity chamber. 
     Average lactic acid concentration in painful lumbar disc  100  is about 14.5 mM, 15 cc or less in volume (Diamant B, Karlsson J, Nachemson A: Correlation between lactate levels and pH of patients with lumbar rizopathies. Experientia, 24, 1195-1196, 1968). An in-vitro study was conducted to show instant lactic acid neutralization by blood plasma. The spiraled shunt strands  126 ,  373  were formed within, and then extracted from a fresh portion of beef. Blood plasma absorbed in the spiraled shunt strands  126 ,  373  instantly neutralized 42% of the 14.5 mM, 15 cc of lactic acid solution, measurable by a pH meter. 
     Approximately 85% back pain patients show no nerve impingement under MRI or CT. A patient without nerve impingement suffered chronic back pain with visual analog score 9 out of 10 (most severe), and leg pain with visual analog score 8. Five days after implantation of the disc shunts  126 ,  373 , the visual analog score dropped to 2.5 for her back pain, but the visual analog score persisted at 8 for leg pain. During 5.5-month follow-up, the visual analog score dropped to 2.0 for her back pain, and visual analog score dropped from 8 to zero for leg pain. Quick back pain relief may be contributed to instant lactic acid  162  neutralization by blood plasma of the patient to relieve acid burning of the adjacent sensory nerves  118 . Leg pain may be caused by acid scaring of the spinal nerve  194  and chemical radiculitis, which takes time to relieve the pain. 
     The internal disc shunt  126 ,  373  is a fluid-transferring or delivery device, inserted into the nucleus  128  of a degenerated disc  100 . The multiple coiled or spiraled internal disc shunts  126 ,  373  are shape-conforming, malleable, resilient or squeezable between endplates  105 , as shown in  FIG. 30 . During compressive loading of the disc  100 , nutrients/oxygen/pH buffer  131  absorbed in the shunts  126 ,  373  are squeezed out, and distributed throughout the disc  100 . During relaxation of the disc  100 , the spiraled internal disc shunts  126 ,  373  expand, absorb and draw nutrients/oxygen/pH buffer  131  from superior  106 A and/or inferior  106 B diffusion zones into the matrix of the shunts  126 ,  373 , as shown in  FIG. 31 . Repetitive compression and relaxation cycles help to distribute and circulate nutrients/oxygen/pH buffer  131  within the disc  100 . Distribution of nutrients  131  is made possible by the sponge-like internal disc shunt  126 ,  373  with hydrophilic and malleable properties, absorbing and delivering nutrients/oxygen/pH buffer  131  within the avascular disc  100 . 
       FIG. 32  shows injection of a hydrophilic gel, foam, viscous liquid or flowable liquid  122  into a disc  100 . The injected gel, foam, viscous liquid or flowable liquid  122  is located in at least one of the superior  106 A and inferior  106 B diffusion zones. The superior  106 A and inferior  106 B diffusion zones are defined as depth into the disc  100 , between 0 and 3 mm from the superior and inferior endplates  105  respectively. The injected gel, foam, viscous liquid or flowable liquid  122  is capable of drawing nutrients  131  from the superior  106 A and inferior  106 B diffusion zones into the mid layers of the disc  100 . The hydrophilic gel, foam, viscous liquid or flowable liquid  122  is preferred having a shape changing or volume changing capability or characteristic, such as contraction and expansion for expelling and absorbing fluid, similar to a sponge.  FIGS. 30 and 31  depict the shape or volume changing capability of an internal disc shunt  126 ,  373  during compression and relaxation of the spinal segment from daily activities of the patient, to help distributing nutrients/oxygen/pH buffer through out the degenerated disc  100 . The hydrophilic gel, foam, viscous liquid or flowable liquid  122  has water contact angle between 0 and 60 degree in ambient temperature and pressure. The preferred water contact angle of the internal foam shunt  122  is between 0 and 30 degrees. After saturation in water, the hydrophilic gel, foam, viscous liquid  122  has water content between 10% and 700% under ambient temperature and pressure. The injectable gel, foam, viscous liquid or flowable liquid  122  becomes an internal foam shunt  122  to transport nutrients/oxygen/pH buffer from at least one of the superior  106 A and inferior  106 B diffusion zones into the mid layers of the disc  100  to neutralize the lactic acid  162  and nourish the disc cells. 
     Lower lumbar L5-S1 disc  100 A and L4-5 disc  100 B are shielded by a pair of ilia  140 , as shown in  FIG. 33 . The straight shunt delivery needle  101  enters superiorly over the ilium  140  at an angle, as shown in  FIG. 34 , difficult or even impossible to deliver the disc shunt strands  126 ,  373  into the nucleus  128  of the disc  100 . 
       FIG. 35  shows a straight and rigid cannula needle  230 , guided by fluoroscopy to the Kambin&#39;s Triangle  504  of a degenerated disc  100 . Quincke sharp tip  231  of the cannula needle  230  is preferred facing and/or close to the facet joint  129  to avoid nicking the spinal nerve  194 . An elastically curved needle  101  and sleeve  220  are resiliently straightened within the rigid cannula needle  230 , as shown in  FIG. 38 . During fluoroscopic-guided deployment of the elastically curved needle  101  from the straight and rigid cannula needle  230 , a sharp tip  310  located at the concave side of the curved needle  101  helps to steer the needle  101  into the nucleus  128  of the intervertebral disc  100 . As steering spearhead, the sharp tip  310  at the concave side may reduce curvature of the shunt delivery needle  101  and sleeve  220 , resulting in less strain in resiliently straightened positions within the rigid cannula needle  230 . 
     Similar to the shunt delivery needle  101 , the cannula needle  230  has the sharp Quincke tip  231  with a dull distal external edge  232 , shown in  FIG. 36 , for puncturing tissue and pushing nerves or blood vessels aside during body puncturing with the cannula needle  230 . The shunt strands  126 B,  373 B and  373 C drape along the outside wall of the cannula needle  230  to minimize size of the cannula needle  230 , risk of injuring spinal nerve  194  and patient discomfort. The shunt strands  126 B,  373 B and  373 C are press-fitted into the body of the patient, outside the outer wall of the cannula needle  230 . 
     A handle  270  of the cannula needle  230  in  FIG. 37  has a marker  153 C showing orientation of the Quincke sharp tip  231 , a distal protrusion  272  to facilitate cannula  230  advancement, and a proximal protrusion  271  to facilitate cannula  230  withdrawal. 
     Stacking of the needle  101 , sleeve  220  and cannula  230  needs spacers to keep them apart and a holder  510  to keep the stack together, especially during tissue puncturing. A sleeve-cannula spacer  506  is required to keep the needle  101  and sleeve  220  from deploying past the distal lumen  111  of the cannula needle  230 . The removable sleeve-cannula spacer  506  contains a trough-like cavity  509 , with a distal opening  507 B and a proximal opening  508 B to house the sleeve  220 . The sleeve-cannula spacer  506  also contains a distal wall  507 A abutting the proximal protrusion  271  and a proximal wall  508 A abutting the distal protrusion  498  of the sleeve handle  132 . A removable tri-handle holder  510  contains a trough-like cavity  513  to house the cannula handle  270 , sleeve-cannula spacer  506 , sleeve handle  132 , sleeve-needle spacer  503  and needle handle  130 . The tri-handle holder  510  also contains a distal wall  511 A to support the distal protrusion  272  of the cannula handle  270 , and a proximal wall  512 A to support the proximal protrusion  501  of the needle handle  130 . The distal wall  511 A contains an opening  511 B, sized and configured to arch over the cannula  230 . The proximal wall  512 A contains another opening  512 B, sized and configured to arch over the shunt strand  126 C, as shown in  FIG. 37 . The tri-handle holder  510  unifies and fastens the cannula handle  270 , sleeve-cannula spacer  506 , sleeve handle  132 , sleeve-needle spacer  503  and needle handle  130 . A removable tie or band can be used to fasten, secure or bundle the tri-handle holder  510  with the handles  270 ,  132 ,  130  and sleeve-cannula spacer  506 . 
     To improve accuracy and decrease procedural time, the cannula needle  230  can be guided by a guide wire  103  into the disc  100 . Discography is often used to confirm discogenic pain using contrast  163  injection, as shown in  FIG. 5 . Aiming and positioning the needle  276 B for discography takes time and skill. After confirming the discogenic pain, the syringe  276 A for discography is removed, while the discography needle  276 B remains. The guide wire  103  with blunted distal and proximal ends is inserted through the discography needle  276 B into the disc  100 . The proximal end of the guide wire  103  is held stationary during withdrawal of the discography needle  276 B from the patient. The guide-wire lumen  116  of the cannula needle  230  is inserted over the proximal end of the long guide wire  103 , as shown in  FIG. 38 . The proximal end of the guide wire  103  is held stationary during advancement of the cannula needle  230  toward the Kambin&#39;s Triangle  504 . The main lumen  111  of the cannula  230  houses the resiliently straightened needle  101 , sleeve  220  and shunt strand  126 C. The U-section  126 A is positioned near the distal lumen  111  opening of the cannula  230 . The main and linked shunt strands  126 B,  373 A,  373 B,  373 C drape, dangle, reside, position or lay along the outside wall of the cannula needle  230 , as shown in  FIG. 38 . 
     The guide wire  103  can also be inserted into the lumen  269  of the needle  101  with the shunt strand  126 C, or into a separate longitudinal chamber or opening parallel with the lumen  269 , for housing the guide wire  103  to facilitate needle  101  entry into the disc  100 . 
     The tri-handle holder  510  and sleeve-cannula spacer  506  are removed when the proximal end of the guide wire  103  extends beyond the proximal protrusion  271  of the cannula handle  270 . To avoid kinking the guide wire  103  during advancement of the cannula  230 , the proximal portion of the guide wire  103  is held firmly while the cannula needle  230  is advanced into the body of the patient, toward the Kambin&#39;s Triangle  504  under fluoroscopic guidance. Needle positioning takes multiple X-rays, skill and time. Placement of the guide wire  103  allows the physician to diagnose then treat the pain by aiming or positioning the needle only once, as shown in  FIGS. 5 and 38 . 
     As mentioned, discography is a diagnostic technique for detecting or confirming discogenic pain by flushing lactic acid  162  to sensory nerves  118 . Saline or other non-buffering solution can also be injected into, then aspirated from the disc  100 , which may contain lactic acid  162 . Acidity of the aspirated solution is checked with a pH electrode. If the aspirated solution is highly acidic, shunt strands  126 .  373  with buffering or alkaline coating may be needed for instant pain relief. 
     Needle  101  sharpening inevitably creates a semi-circular blade-like inner wall  368  at lumen opening  269 , as shown in a mid-longitudinal view in  FIG. 39 . During in-vitro and in-vivo disc  100  puncturing to press-fit the U-section  126 A of the shunt  126  into sheep discs  100 , the blade-like inner wall  368  often sheared and damaged the U-section  126 A. The damaged portion  369  of the U-section  126 A forms small fibers or shedding debris  369  which can cause tissue reaction to the otherwise inert material. In fact, shearing was so serious that many U-sections  126 A were severed during press-fit disc  100  puncturing. 
       FIG. 40  shows a rounded or blunt inner wall or inner lip  370  at the lumen  269  opening of a needle  101 . The rounded or blunt inner wall  370  can be formed by machining or filing to prevent damage to the U-section  126 A during press-fit puncturing into the disc  100  or needle  101  rotation for spiraling shunt strands  126 B,  373 B,  373 C. It is also possible to pad, cover, coat or fortify the U-section  126 A to minimize damage by the sharp inner wall  368  of the needle  101 . Similarly, a rounded or dull semi-circular inner wall  233  or inner lip is made at the lumen  111  of the cannula needle  230 , as shown in  FIG. 41 , to prevent cutting or damaging the U-section  126 A during tissue puncturing. 
       FIG. 42  shows the distal end of the sleeve  220  with a lumen  268  for housing and sliding over the needle  101 . Two snagging points or tips  221  of the sleeve  220  are made with bi-beveling  110  of the distal end of the sleeve  220 . The snagging points or tips  221  are preferred to be sharp, for snagging, catching, hooking, engaging, pinning, nailing pushing or dislodging the spiraled shunt strands  126 B,  373 B,  373 C from the distal shaft of the needle  101 .  FIG. 43  shows four snagging points  221 ; and  FIG. 44  shows a single snagging point  221  by beveling or indenting  110  the distal end of the sleeve  220 . 
     The snagging point  221  can also be a distal wall, rim or end of the sleeve  220 .  FIG. 45  shows a mid-longitudinal view of spiraled shunt strands  126 B,  373 A,  373 B,  373 C over the distal shaft of the needle  101 . The snagging points  221  are made by beveling or shaving the inner wall at the distal lumen opening  268  of the sleeve  220  to snag, catch, engage or dislodge the spiraled shunt strands  126 B,  373 A,  373 B,  373 C from the distal shaft of the needle  101 . 
     The snagging point  221  can also be a rim or edge of an outer wall of the sleeve  220 . The edge or rim is formed by a simple 90 degree cut on the sleeve  220 . 
     Flexible disc shunt strands  126 ,  373  can be made or formed by fabric making techniques, such as braiding or twisting filaments  104  as shown in  FIG. 46 . For twisting, minimum number of filaments  104  is two. For braiding, minimum number of filaments  104  is three, as shown in  FIG. 46 . Braiding is intertwining three or more filaments  104  for excellent flexibility, strength and porosity. The snagging point  221  can catch, snag or engage the spiraled braided shunt strands  126 B,  373 B,  373 C well. The flexible disc shunt strands  126 ,  373  can also be woven, as shown in  FIG. 47 . Weaving is interlacing the filaments  104  over and under each other, generally oriented at 90 degree angles. Half of the filaments  104  from weaving can be oriented length-wise along the linear shunt strands  126 ,  373 , to expedite fluid flow from the muscle  193  or diffusion zones  106 A,  106 B into the degenerated disc  100 . The flexible disc shunt strands  126 ,  373  can be knitted, as shown in  FIG. 48 . Knitting is a construction made by interlocking loops of one or more filaments  104 . A knitted shunt strands  126 ,  373  may have the greatest elasticity, capable of stretching and elongating during the press-fitted delivery into the disc  100 . After the disc shunts  126 ,  373  are coiled, spiraled or reeled within the disc  100 , diameters of the shunt strands  126 B,  126 C,  373 B,  373 C extending from the disc  100  expand, further sealing the needle tract to prevent the loss of hydrostatic pressure within the disc  100 . In addition, the knitted shunts  126 ,  373  in coils, spirals or reels may have the highest porosity to enhance fluid absorbency, creating a reservoir of nutrients/oxygen/pH buffer  131  for dispersing into various parts of the avascular disc  100 , as shown in  FIGS. 30 and 31 . Furthermore, the coiled or spiraled shunt strands  126 ,  373  with knitted filaments  104  provide an elastic cushion within the disc  100  to reduce loading and pain in the facet joints  129 . The knitted shunt  126 ,  373  may be an excellent matrix or scaffolding for cell  277  attachment and proliferation. The disc shunt strand  126 ,  373  can be made with non-woven filaments  104 . The term non-woven is used in fabric industry to include all other techniques, such as carded/needle-punched, spun bonded, melt blown or other. Non-woven disc shunts  126 ,  373  can provide large surface area as scaffolding for cell  277  growth and proliferation. Combinations of fabric making techniques can be used to form the internal and/or external disc shunts  126 ,  373 . The main shunt  126  and the linked shunt  373  can be made with different material or different fabric making techniques. For example, the main shunt  126  can be made primarily for fluid transport, while the linked shunt  373  can be made primarily for cell  277  attachment and proliferation. The main shunt  126  and the linked shunt  373  can be coated with different substances to alleviate back pain and/or promote disc  100  regeneration. 
     Material and/or orientation of the filaments  104  of the disc shunts  126 ,  373  can affect (1) flow rate, (2) tensile strength, (3) annular sealing, (4) porosity, (5) fluid absorbency, (6) snagging ability, (7) elasticity, (8) selectivity of solute transport, (9) scaffold attachment of cells, (10) flexibility, (11) durability, (12) sterilization technique, (13) fibrotic formation, and/or (14) biocompatibility. A disc shunt  126 ,  373  is cut at a slanted angle, showing a cross-section of a shunt strand  126  or  373 ; the filaments  104  are slanted or diagonally oriented to the length-wise shunt strands  126 ,  373 , as shown in  FIG. 49 .  FIG. 50  shows cross-sections of filaments  104  parallel to the disc shunt strands  126 ,  373 , covered by a wrapper, sheath or cover  127 . The parallel-oriented filaments  104  and wrapper  127  can be manufactured by extrusion. The filaments  104  can also be micro tubes, as shown in  FIG. 51 , parallel to the disc shunt strands  126 ,  373 . A wrapper  127  is used to cover, retain, enclose or house the micro tubular filaments  104  to form a strand of the disc shunts  126 ,  373 . Individual micro tubular filament  104  is capable of having capillary action, drawing nutrients/oxygen/pH buffer  131  through the shunt strands  126 ,  373  into the disc  100 . 
     The filaments  104  are preferred to be made with biocompatible and hydrophilic material, absorbing, retaining or drawing fluid with nutrients/oxygen/pH buffer solutes  131  from a tissue with low osmolarity to mid layer of the desiccated disc  100  with high osmolarity. The internal and/or external disc shunt strands  126 ,  373  can be a suture, approved for human implant. Instead of fastening tissue, the suture is used as disc shunts  126 ,  373 , transporting fluid from low to high osmolarity to alleviate back pain. 
     The internal and/or external shunt strands  126 ,  373  can be made with a hydrophilic sponge or foam with pores  124 , as shown in  FIG. 52 , to transport and retain fluid in the disc  100 . The pores  124  can be open, connecting to other pores  124 . The pores  124  can also be closed, not connecting to other pores  124  to retain fluid and cells  277 . 
     Disc cells  277  isolated from advanced degenerated human discs  100  are still capable of producing collagen and glycosaminoglycans in tissue culture with abundant supply of nutrients in proper pH. (Gruber H. E., Leslie K., Ingram J., Hoelscher G., Norton H. J., Hanley E. N. Jr.: Colony formation and matrix production by human anulus cells: modulation in three-dimensional culture, Spine, July 1, 29(13), E267-274, 2004. Johnstone B, Bayliss M T: The large proteoglycans of the human intervertebral disc, Changes in their biosynthesis and structure with age, topography, and pathology, Spine, March 15; 20(6):674-84, 1995.) Furthermore, stem cells have recently been found in degenerated discs. (Risbud M V, Gattapalli A, Tsai T T, Lee J Y, Danielson K G, Vaccaro A G, Albert T J, Garzit Z, Garzit D, Shapiro Evidence for skeletal progenitor cells in the degenerate human intervertebral disc, Spine, November 1; 32(23), 2537-2544, 2007.) Nutrient  131  deficiency and acidic pH may hinder disc  100  repair in-vivo. 
     The internal and/or external disc shunts  126 ,  373  can be scaffolds and spigots for supplying nutrients/oxygen/pH buffering solute  131  for cells  277  to attach, as shown in  FIG. 53 . With a continual or renewable supply of nutrients/oxygen/pH buffer solutes  131 , disc cells  277  resume making biosynthetic products  160 , such as the water-retaining glycosaminoglycans and collagen, the major components of the nucleus  128  and annulus  378 , as depicted in  FIGS. 53-54 . In sheep study, newly formed glycosaminoglycans can be seen on filaments  104  of the disc shunt  126 ,  373  after 3 months using Safranin histological staining. 
     The rate of sulfate incorporation for biosynthesizing glycosaminoglycans is pH sensitive. The maximum rate of sulfate incorporation is with pH 7.2-6.9. The rate of sulfate incorporation drops about 32-40% in acidic pH within the disc [Ohshima H, Urban J P: The effect of lactate and pH on proteoglycan and protein synthesis rates in the intervertebral disc. Spine, September: 17(9), 1079-82, 1992]. Hence, pH normalization with pH buffer solute  131  through the disc shunts  126 ,  373  will likely increase production of the water-retaining glycosaminoglycans and swelling pressure of the shunted disc  100 . 
     With continual supply of nutrients  131 , newly formed biosynthetic products  160  increase osmolarity within the disc  100  and enhance inward fluid flow  161 , as shown in  FIG. 54 . The increased fluid flow  161  comes through (1) the internal and/or external disc shunts  126 ,  373 , (2) blood capillaries  107  through the endplates  105 , and/or (3) annulus  378 . The fluid is also retained by the newly formed water-retaining glycosaminoglycans  160 . As a result, swelling pressure of the shunted disc  100  increases. Segmental or spinal instability is reduced. Muscle tension and ache from guarding the spinal instability decrease. Load and pain of the facet joints  129  decrease. Lactic acid is further neutralized by inflow  161  of nutrients/oxygen/pH buffering solute  131  to reduce or alleviate acid burn. Disc  100  height is elevated, raised or increased as depicted by arrows in  FIG. 54 . In essence, implantation of the internal and/or external disc shunts  126 ,  373  enables the degenerated disc  100  to be repaired. 
     Furthermore, adenosine triphosphate, ATP, is the high-energy compound essential for driving or energizing biochemical reactions, including the biosynthesis of the water retaining glycosaminoglycans for sustaining compressive loads on the disc  100 . Under anaerobic conditions, metabolism of each glucose molecule produces only two ATP and two lactic acids  162 , which irritate adjacent nerves  118 . When oxygen  131  permeates through the internal and/or external disc shunts  126 ,  373 , thirty-six ATP can be produced from each glucose molecule through glycolysis, citric acid cycle and electron transport chain under aerobic conditions to energize disc regeneration and alleviate back pain. 
     High concentration of nutrients  131  can also be injected into the internal and/or external shunted disc  100  to instantly create high osmolarity, as shown in  FIG. 55 . High osmolarity promotes fluid inflow  161  into the shunted disc  100 . However, glucose or sugars injection can produce additional lactic acid  162 , causing more pain. Sulfate and amino acids can be injected in high concentration to boost osmolarity and production of glycosaminoglycans and collagen, as the biosynthetic product  160  in  FIG. 55 . Magnesium, potassium, or sodium sulfate has high water solubility. Proline and glycine also have reasonably high water solubility and are essential nutrients  131  for biosynthesis of collagen in the annulus  378 . 
     Analgesics, anti-depressant, steroid, NSAID, antibiotics, anti-inflammatory drugs, alkaline agent or other drugs can also be injected into the internal and/or external shunted disc  100  to further reduce pain. 
     Autograft disc cells  277  from a healthy disc  100  of the patient can be transplanted into the degenerated and shunted disc  100  to promote disc regeneration and production of biosynthetic product  160 , as shown in  FIG. 55 . 
     The avascular disc  100  is well sealed. Even small ions, such as sulfate, and small molecules, such as proline, are greatly limited from diffusing into the nucleus pulposus  128 . The well sealed disc  100  may be able to encapsulate donor cells  277  from a disc  100  of another person, cadaver or even animal without triggering an immune response. For disc  100  regeneration, the donor cells  277  can also be stem cells  277 , notochord  277  or chondrocytes  277 . The internal and/or external disc shunts  126 ,  373  are permeable to nutrients/oxygen/pH buffering solute  131  but impermeable to cells and/or cytokines responsible for triggering an immune reaction. The cells of the immune system include giant cells, macrophages, mononuclear phagocytes, T-cells, B-cells, lymphocytes, Null cells, K cells, NK cells and/or mask cells. The cytokines may also include immunoglobulins, IgM, IgD, IgG, IgE, other antibodies, interleukins, lymphokines, monokines or interferons. 
     The molecular weights of nutrients  131  and lactic acid  162  are much smaller than the immuno-responsive cells and cytokines. The transport selectivity can be regulated or limited by the size of the pores or channels within the semi-permeable internal and/or external shunts  126 ,  373 . The upper molecular weight cut-off of the disc shunts  126 ,  373  can be 3000 or lower to allow the passage of nutrients and waste but exclude the immuno-responsive cells and cytokines. The semi-permeable disc shunts  126 ,  373  may also contain ionic or affinity surfaces to attract nutrients  131  and waste, including lactic acid  162 . The surfaces of the semi-permeable disc shunts  126 ,  373  can be made, coated or modified to repel, exclude or reject immuno-responsive components. 
     In recent years, cell transplants from cadavers or live donors have been successful in providing therapeutic benefits. For example, islet cells from a donor pancreas are injected into a type I diabetic patient&#39;s portal vein, leading into the liver. The islets begin to function as they normally do in the pancreas by producing insulin to regulate blood sugar. However, to keep the donor cells alive, the diabetic patient requires a lifetime supply of anti-rejection medication, such as cyclosporin A. In addition to the cost of anti-rejection medication, the side effects of these immuno-suppressive drugs may include cancer. The benefit of cell transplant may not out weigh the potential side effects. 
     The intervertebral disc  100  with semi-permeable internal and external disc shunts  126 ,  373  can be used as a semi-permeable capsule to encapsulate the injected therapeutic donor cells  277  or agent, as shown in  FIG. 55 , to evade the immune response; hence no life-long immuno-suppressive drug would be required. A variety of donor cells  277  or agent can be harvested and/or cultured from the pituitary gland (anterior, intermediate lobe or posterior), hypothalamus, adrenal gland, adrenal medulla, fat cells, thyroid, parathyroid, pancreas, testes, ovary, pineal gland, adrenal cortex, liver, renal cortex, kidney, thalamus, parathyroid gland, ovary, corpus luteum, placenta, small intestine, skin cells, stem cells, gene therapy, tissue engineering, cell culture, other gland or tissue. The donor cells  277  are immunoisolated within the shunted discs  100 , the largest avascular organs in the body, maintained by nutrients  131  and waste transport through the semi-permeable shunts  126 ,  373 . The donor cells  277  can be from human, animal or cell culture. When disc pressure is low during sleep or supine position, nutrients/oxygen/pH buffering solutes  131  are supplied through the internal and external shunts  126 ,  373  to the donor cells  277 . During waking hours while the pressure within the disc  100  is high, biosynthesized products  160  by these donor cells  277  are expelled through the shunts  126 ,  373  into the muscle  193 , as shown in  FIG. 55 , or through fissures  121  into bodily circulation and target sites. 
     The biosynthesized product  160  made by the donor cells  277  nourished by the internal and external shunted disc  100  can be adrenaline, adrenocorticotropic hormone, aldosterone, androgens, angiotensinogen (angiotensin I and II), antidiuretic hormone, atrial-natriuretic peptide, calcitonin, calciferol, cholecalciferol, calcitriol, cholecystokinin, corticotropin-releasing hormone, cortisol, dehydroepiandrosterone, dopamine, endorphin, enkephalin, ergocalciferol, erythropoietin, follicle stimulating hormone, γ-aminobutyrate, gastrin, ghrelin, glucagon, glucocorticoids, gonadotropin-releasing hormone, growth hormone-releasing hormone, human chorionic gonadotrophin, human growth hormone, insulin, insulin-like growth factor, leptin, lipotropin, luteinizing hormone, melanocyte-stimulating hormone, melatonin, mineralocorticoids, neuropeptide Y, neurotransmitter, noradrenaline, oestrogens, oxytocin, parathyroid hormone, peptide, pregnenolone, progesterone, prolactin, pro-opiomelanocortin, PYY-336, renin, secretin, somatostatin, testosterone, thrombopoietin, thyroid-stimulating hormone, thyrotropin-releasing hormone, thyroxine, triiodothyronine, trophic hormone, serotonin, vasopressin, or other therapeutic products. These biosynthetic products  160  have low molecular weights and are able to be transported through disc shunts  126 ,  373  and/or fissures  121 , while the donor cells  277  are trapped within the disc  100 . 
     The biosynthesized products  160  (hormones, peptides, neurotransmitter, enzymes, catalysis or substrates) generated within the internal and/or external shunted disc  100  may be able to regulate bodily functions including blood pressure, energy, neuro-activity, metabolism, and activation and suppression of gland activities. Some hormones and enzymes govern, influence or control eating habits and utilization of fat or carbohydrates. These hormones or enzymes may provide weight loss or gain benefits. Producing neurotransmitters, such as dopamine, adrenaline, noradrenaline, serotonin or γ-aminobutyrate, from the donor cells  277  within the shunted disc  100  can treat depression, Parkinson&#39;s disease, learning disability, memory loss, attention deficit, behavioral problems, mental or neuro-related diseases. 
     Release of the biosynthesized products  160  by the donor cells  277  within the internal and/or external shunted disc  100  is synchronized with body activity. During activities of daily living, the pressure within the shunted disc  100  is mostly high to expel the biosynthesized products  160  by the donor cells  277  into circulation to meet the demands of the body. In the supine position, pressure within the shunted disc  100  is low; fluid inflow  161  through the internal and/or external shunts  126 ,  373  is favorable, bringing nutrients/oxygen/pH buffer  131  into the disc  100  to nourish the cells  277 . As an example, islets of Langerhans from a donor&#39;s pancreas are implanted or injected into the shunted disc  100 . In supine position during sleeping, glucose enters into the shunted disc  100  to induce production of insulin from the implanted islets of Langerhans. During waking hours when disc pressure is high, insulin is expelled through the shunts  126 ,  373  or fissure  121  into circulation to regulate concentration of glucose in the body. At night, the insulin released from the shunted disc  100  is minimal to prevent the hypoglycemia. In essence, biosynthesized products  160  by the donor cells  277  are released concurrent with physical activity to meet the demands of the body. 
     Donor cells  277  can also be seeded on the shunt strands  126 ,  373 , or injected days, weeks, months or even years after implanting the internal and/or external disc shunts  126 ,  373 , to ensure favorable biological conditions, including pH, electrolytic balance and nutrients and oxygen  131 , for cell  277  survival and proliferation in the shunted disc  100 . 
     The internal and/or external disc shunt  126 ,  373  can treat the cervical disc  100  as well. The Quincke tip  310  of the needle  101  is preferred to point away from the esophagus  514  and larynx/trachea  515 , as shown in  FIG. 56 . Cervical discs  100  are thin; the superior  106 A and/or inferior  106 B diffusion zone can be reached by a single or few spirals of short shunt strands  126 B,  126 C,  373 B,  373 C. However, during needle  101  insertion toward the intervertebral disc  100 , the proximal ends of the short shunt strands  126 B,  126 C,  373 B,  373 C can be under the skin  505  as shown in  FIG. 56 . If the needle  101  is misguided as shown in  FIG. 56 , the physician would have to slightly withdraw the needle  101 , then bend the proximal portion of the needle  101  above the skin  505  to change penetrating direction of the needle  101  beneath the skin  505 . However, the slight withdrawal of the needle  101  would deploy the shunt strands  126 B,  126 C,  373 B,  373 C prematurely under the skin  505 , as shown in  FIG. 57 , by pulling or exposing the shunt strand  126 C from the lumen  269  of the needle  101 . 
     A pull line  460  is threaded through the proximal ends or portions of the shunt strands  126 B,  373 B,  373 C, as shown in  FIG. 58 . Another pull line  460  can also thread through the proximal portion of the shunt strand  126 C within the needle  101 . A retainer  461  can be used to hold the shunt strands  126 B,  373 B,  373 C together for attachment to the pull line  460 , as shown in  FIG. 59 . The retainer  461  is made with biocompatible and/or biodegradable material. The pull line  460  is made with a kink-, fold- or crease-resistant material, such as nylon monofilament suture, poly-propylene monofilament suture or other. During tension pulling on the shunt strands  126 B,  373 B,  373 C, a fold or crease  462  would inevitably form on the pull line  460 , as depicted in  FIG. 60 . When tension is released, the fold or crease  462  disappears from the fold-resistant pull line  460 , as shown in  FIG. 61 , to facilitate withdrawal of the pull line  460  from the shunt strands  126 B,  373 B,  373 C under the skin  505 . 
       FIG. 62  shows the pull line  460  attached to the shunt strands  126 B,  373 B,  373 C and extending outside the skin  505 . The pull line  460  can be a loop, joined by a knot  463  outside the skin  505 . If the needle  101  is misguided under fluoroscopic view, as depicted in  FIG. 56 , tension is applied to the pull line  460  during partial withdrawal of the needle  101 . Tension on the pull line  460  keeps the U-section  126 A positioned at the distal lumen  269  opening of the withdrawing needle  101 . From cadaveric studies and human clinical, the pull line  460  attached to the shunt strands  126 B,  373 B,  373 C is sufficient for partial withdrawal of the needle  101  before re-directing; another pull line  460  attached to the shunt strand  126 C within the needle  101  is optional. After sufficient spiraling and delivery of shunt strands  126 B,  126 C,  373 B,  373 C within the cervical disc  100  to form internal and/or external disc shunt  126 ,  373  by the needle  101  and sleeve  220  as shown in  FIGS. 15-22 , a strand of the fold-resistant pull line  460  is cut next to the knot  463 . By holding the knot  463 , the pull line  460  is pulled and retrieved from shunt strands  126 B,  373 B,  373 C beneath the skin  505  of the patient. The needle  101  and sleeve  220  are then withdrawn from the patient. 
     In the United States, average age of patients undergoing back surgery is about 40-45 years old. The internal and/or external disc shunts  126 ,  373  are preferred to be made with permanent material to provide long-lasting pain relief. A wide range of non-degradable materials can be used to fabricate the shunt strands  126 ,  373 . Polymers, such as Nylon, polytetrafluoroethylene, polypropylene, polyethylene, polyamide, polyester, polyurethane, silicon, poly-ether-ether-ketone, acetal resin, polysulfone, polycarbonate, silk, cotton, or linen are possible candidates. Fiberglass can also be a part of the shunt strands  126 ,  373  to provide capillarity for transporting nutrients  131  and waste. 
     Especially for investigative purposes, biodegradable shunts  126 ,  373  may provide evidence within weeks or months. Since the internal and external disc shunts  126 ,  373  degrade within months, any unforeseen adverse outcome would be dissipated. If the investigative-degradable disc shunts  126 ,  373  shows promise, permanent internal and external shunts  126 ,  373  can then be implanted to provide continuous benefits. The biodegradable shunt strands  126 ,  373  can be made with polylactate, polyglycolic, poly-lactide-co-glycolide, polycaprolactone, trimethylene carbonate, silk, catgut, collagen, poly-p-dioxanone or combinations of these materials. Other degradable polymers, such as polydioxanone, polyanhydride, trimethylene carbonate, poly-beta-hydroxybutyrate, polyhydroxyvalerate, poly-gama-ethyl-glutamate, poly-DTH-iminocarbonate, poly-bisphenol-A-iminocarbonate, poly-ortho-ester, polycyanoacrylate or polyphosphazene can also be used. 
     The needle  101 , sleeve  220 , dip stick  109  and cannula needle  230  can be made with stainless steel, nickel-titanium alloy or other metal or alloy. The needle  101 , sleeve  220  and/or cannula needle  230  can be coated with lubricant, tissue sealant, analgesic, antibiotic, radiopaque, magnetic and/or echogenic agents. 
     The internal and/or external disc shunts  126 ,  373 , can be used as a drug delivery device, delivering oral, intravenous or injectable drugs into the avascular or nearly impenetrable disc  100  to treat infection, inflammation, pain, tumor or other disease. Drugs can be injected into the muscle  193  to be drawn into the external shunted disc  100 . Discitis is a painful infection or inflammatory lesion in the intervertebral disc  100  of adults and children (Wenger D R, Bobechko W P, Gilday D L: The spectrum of intervertebral disc-space infection in children, J. Bone Joint Surg. Am., 60:100-108, 1978. Shibayama M, Nagahara M, Kawase G, Fujiwara K, Kawaguchi Y, Mizutani J: New Needle Biopsy Technique for Lumbar Pyogenic Spondylodiscitis, Spine, 1 November, Vol. 35-Issue 23, E1347-E1349, 2010). Due to the avascular nature of the disc  100 , oral or intravenous drugs cannot easily reach the bacteria or inflammation within the disc  100 . Therefore, discitis is generally difficult to treat. However, the internal and/or external disc shunts  126 ,  373  can be used as a drug-delivery device. The internal disc shunts  126 ,  373  draw the systemic drugs through the endplates  105 ; and the external disc shunts  126 ,  373  draw the systemic drugs from muscles  193  into the sealed, avascular disc  100 . In addition, antibiotics, anti-inflammatory drugs, anesthetics or other drugs can be injected into the muscle  193  near the strands of the external disc shunts  126 ,  373  to increase drug concentration within the disc  100  to treat discitis or pain. Injection near the external shunt strands  126 ,  373  is called peri-shunt injection. 
       Staphylococcus aureus  is the most common bacteria found in discitis. The shunt strands  126 ,  373  can be loaded or coated with an antibiotic, such as nafcillin, cefazolin, dicloxacillin, clindamycin, bactrim, penicillin, mupirocin (bactroban), vancomycin, linezolid, rifampin, sulfamethoxazole-trimethoprim or other, to treat  staphylococcus aureus  infection.  Corynebacterium  is also found in discitis. The shunt strands  126 ,  373  can be loaded or coated with an antibiotic, such as erythromycin, vancomycin, eifampin, penicillin or tetracycline, to treat  corynebacterium  infection. Other antibiotics, such as cefdinir, metronidazole, tinidazole, cephamandole, latamoxef, cefoperazone, cefmenoxime, furazolidone or other, can also be used to coat the shunt strands  126 ,  373 . 
     Inflammation in the disc  100  can cause excruciating pain. MRI can show inflammation at the endplates  105 , and distinguish inflammatory classification as Modic I, II or III. The disc shunt strands  126 ,  373  can be coated or loaded with nonsteroidal anti-inflammatory drugs/analgesics. (NSAID), such as aspirin, diflunisal, salsalate, ibuprofen, naproxen, fenoprofen, ketoprofen, flurbiprofen, oxaprozin, indomethacin, sulindac, etodolac, ketorolac, diclofenac, nabumetone, piroxicam, meloxicam, tenoxicam, droxicam, lornoxicam, isoxicam, mefenamic acid, meclofenamic acid, flufenamic acid, tolfenamic acid, celecoxib, rofecoxib, valdecoxib, parecoxib, lumiracoxib, etoricoxib, firocoxib, nimesulide, licofelone or other NSAID, to treat inflammation in the disc  100  for pain relief. 
     The disc shunt strands  126 ,  373  can also be coated or loaded with steroidal anti-inflammatory drugs/analgesics, such as betamethasone, budesonide, cortisone, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone, triamcinolone or other steroid, to treat inflammation in the disc  100  for pain relief. 
     The shunt strands  126 ,  373  can be loaded or coated with anesthetics, such as procaine, amethocaine, cocaine, lidocaine, prilocaine, bupivacaine, levobupivacaine, ropivacaine, mepivacaine, dibucaine, methohexital, thiopental, diazepam, lorazepam, midazolam, etomidate, ketamine, propofol, alfentanil, fentanyl, remifentanil, sufentanil, buprenorphine, butorphanol, diamorphine, hydromorphone, levophanol, meperidine, methadone, morphine, nalbuphine, oxycodone, oxymorphone, pentazocine or other anesthetic, to provide instant pain relief. 
     The shunt strands  126 ,  373  can be loaded or coated with a muscle relaxant, such as succinylcholine, decamethonium, mivacurium, rapacuronium, atracurium, cisatracurium, rocuronium, vecuronium, alcuronium, doxacurium, gallamine, metocurine, pancuronium, pipecuronium, tubocurarine or other relaxant, to relief muscle tension and ache. 
     The shunt strands  126 ,  373  can be loaded or coated with buffering agents, such as sodium carbonate, sodium bicarbonate, potassium carbonate, potassium bicarbonate, magnesium carbonate, calcium carbonate, barium carbonate, potassium phosphate, sodium phosphate or other buffering agent, to neutralize lactic acid  162  and spontaneously alleviate pain caused by acid irritation or burn. 
     The shunt strands  126 ,  373  can be loaded or coated with alkaline agents, such as magnesium oxide, magnesium hydroxide, sodium hydroxide, potassium hydroxide, barium hydroxide, cesium hydroxide, strontium hydroxide, calcium hydroxide, lithium hydroxide, rubidium hydroxide, neutral amines or other alkaline agent, to neutralize lactic acid  162  and spontaneously alleviate pain caused by acid irritation. 
     The shunt strands  126 ,  373  can be loaded or coated with initial supplies of nutrients  131 , such as sulfate, glucose, glucuronic acid, galactose, galactosamine, glucosamine, hydroxylysine, hydroxylproline, serine, threonine, chondroitin sulfate, keratan sulfate, hyaluronate, magnesium trisilicate, magnesium mesotrisilicate, magnesium oxide, magnosil, orthosilicic acid, magnesium trisilicate pentahydrate, sodium metasilicate, silanolates, silanol group, sialic acid, silicic acid, boron, boric acid, other mineral, other amino acid or nutrients  131 , to enhance or initiate production of sulfated glycosaminoglycans and collagen within the degenerative disc  100 . 
     Oral intake of antidepressants has shown temporary pain reduction or pain tolerance in back pain patients. Anti-depressants can be coated on the shunt strands  126 ,  373  to treat chronic back pain. The anti-depressant coating may include tricyclic antidepressant, serotonin-reuptake inhibitor, norepinephrine reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, noradrenergic/serotonergic antidepressants, norepinephrine-dopamine reuptake inhibitor, serotonin reuptake enhancers, norepinephrine-dopamine disinhibitors or monoamine oxidase inhibitor. The antidepressant can be amitriptyline, amitriptylinoxide, butriptyline, clomipramine, demexiptiline, desipramine, dibenzepin, dimethacrine, dosulepin/dothiepin, doxepin, duloxetine, imipramine, imipraminoxide, lofepramine, melitracen, metapramine, nitroxazepine, nortriptyline, noxiptiline, pipofezine, propizepine, protriptyline, quinupramine, amineptine, iprindole, opipramol, tianeptine, trimipramine, or other antidepressant. 
     Fibrous formation over the internal and/or external shunts  126 ,  373  may affect the exchange of nutrients  131  and waste between the disc  100  and bodily circulation or muscle  193 . Immuno inhibitor can be coated or incorporated into the shunt strands  126 ,  373  to minimize fibrous formation or tissue response. Examples of immuno inhibitors include but are not limited to: actinomycin-D, aminopterin, azathioprine, chlorambucil, corticosteroids, crosslinked polyethylene glycol, cyclophosphamide, cyclosporin A, 6-mercaptopurine, methylprednisolone, methotrexate, niridazole, oxisuran, paclitaxel, polyethylene glycol, prednisolone, prednisone, procarbazine, prostaglandin, prostaglandin E 1 , sirolimus, steroids or other immune suppressant drugs. 
     The shunt strands  126 ,  373  can be loaded or coated with a calcium channel blocker for inhibiting activation of neuro-receptor to alleviate pain. The calcium channel blocker can be dihydropyridines, phenylalkylamines, benzothiazepines, magnesium ion, Amlodipine, Felodipine, Isradipine, Lacidipine, Lercanidipine, Nicardipine, Nifedipine, Nimodipine, Nisoldipine, Verapamil, Diltiazem or other calcium channel blocker. 
     Healthy intervertebral discs  100  are avascular. To ensure avascular conditions, the shunt strands  126 ,  373  can be incorporated, coated or partially coated with an anti-angiogenic compound. Examples of anti-angiogenic compounds include, but are not limited to, Marimastat from British Biotech [a synthetic inhibitor of matrix metalloproteinases (MMPs)], Bay 12-9566 from Bayer (a synthetic inhibitor of tumor growth), AG3340 from Agouron (a synthetic MMP inhibitor), CGS 27023A from Novartis (a synthetic MMP inhibitor), COL-3 from Collagenex (a synthetic MMP inhibitor, Tetracycline® derivative), Neovastat from Aeterna, Sainte-Foy (a naturally occurring MMP inhibitor), BMS-275291 from Bristol-Myers Squib (a synthetic MMP inhibitor), TNP-470 from TAP Pharmaceuticals, (a synthetic analogue of fumagillin; inhibits endothelial cell growth), Thalidomide from Celgene (targets VEGF, bFGF), Squalamine from Magainin Pharmaceuticals (Extract from dogfish shark liver; inhibits sodium-hydrogen exchanger, NHE3), Combretastatin A-4 (CA4P) from Oxigene, (induction of apoptosis in proliferating endothelial cells), Endostatin collagen XVIII fragment from EntreMed (an inhibition of endothelial cells), Anti-VEGF Antibody from Genentech, [Monoclonal antibody to vascular endothelial growth factor (VEGF)], SU5416 from Sugen (blocks VEGF receptor signaling), SU6668 from Sugen (blocks VEGF, FGF, and EGF receptor signaling), PTK787/ZK 22584 from Novartis (blocks VEGF receptor signaling), Interferon-alpha (inhibition of bFGF and VEGF production), Interferon-alpha (inhibition of bFGF and VEGF production), EMD121974 from Merck, KcgaA (small molecule blocker of integrin present on endothelial cell surface), CAI from NCI (inhibitor of calcium influx), Interleukin-12 from Genetics Institute (Up-regulation of interferon gamma and IP-10), IM862 from Cytran, Avastin, Celebrex, Erbitux, Herceptin, Iressa, Taxol, Velcade, TNP-470, CM101, Carboxyamido-triazole, Anti-neoplastic urinary protein, Isotretionin, Interferon-alpha, Tamoxifen, Tecogalan combrestatin, Squalamine, Cyclophosphamide, Angiostatin, Platelet factor-4, Anginex, Eponemycin, Epoxomicin, Epoxy-β-aminoketone, Antiangiogenic antithrombin III, Canstatin, Cartilage-derived inhibitor, CD59 complement fragment, Fibronectin fragment, Gro-beta, Heparinases, heparin hexasaccharide fragment, Human chorinonic gonadotropin, Interferon (alpha, beta or gamma), Interferon inducible protein (IP-10), Interleukin-12 (IL-12), Kringle 5 (plasminogen fragment), Tissue inhibitors of metalloproteinases, 2-Methoxyestradiol (Panzem), Placental ribonuclease inhibitor, Plasminogen activator inhibitor, Prolactin 16 kD fragment, Retinoids, Tetrahydrocortisol-S, Thrombospondin-1, Transforming growth factor beta, Vasculostatin, and Vasostatin (calreticulin fragment). 
     In summary, the internal and/or external disc shunt  126 ,  373  alleviates back pain by (1) drawing nutrients/oxygen/pH buffer  131  into the disc  100 , (2) neutralizing lactic acid  162  to alleviate acid burn, (3) converting anaerobic to aerobic conditions to reduce lactic acid  162  production, (4) increasing sulfate incorporation in neutral pH for biosynthesis of glycosaminoglycans. (5) increasing ATP production from aerobic metabolism of sugars to drive biosynthetic reactions in disc  100 , (6) bulking up the disc  100  to take load off painful facet joints  129 , (7) fortifying the disc  100  to reduce spinal instability and muscle tension, (8) rebuilding disc matrix to increase osmolarity, fluid intake and absorption, (9) re-establishing the swelling pressure to sustain disc  100  compression, (10) regenerating the disc  100  for long term pain relief, and/or (11) delivering systemic drugs in disc  100  to treat discitis. 
     Unlike many surgical interventions of the spine, benefits of the internal and/or external disc shunts  126 ,  373  include (1) spinal motion preservation, (2) no tissue removal, (3) reversible by extraction, (4) micro-invasive, (5) out-patient procedure, (6) approved implant material, (7) 15-minutes per disc, (8) long-lasting and no-harm-done, (9) no incision, (10) compatible with drugs, conservative treatment or surgical intervention, if needed, and (11) drug coated shunt if needed to expedite pain relief. 
     The internal disc shunt device can be used to spiral and pack coiled or spiraled strands  126 ,  373  into a mucosal wall of a urethra to treat urinary stress incontinence. The strands  126 ,  373  can be a nylon or polypropylene mono-filament suture, to provide an elastic backboard support within the posterior mucosal wall of the urethra. The coils of spiraled strands  126 ,  373  in the mucosal wall also serve as a bulking agent, narrowing the urethral lumen opening to enhance or restore sphincteric control of the urethra. 
     The spiraling device can also be used to spiral and pack strands  126 ,  373  under skin, especially into an indentation from acne scar or cosmetic defect. 
     The present invention is broadly claimed that the shunt strands  126 ,  373  is delivered by a needle and packed into a disc  100 , reaching one or both diffusion zones  106 A,  106 B between 0 and 3 mm from the endplates  105 , to draw nutrients/oxygen/pH buffer  131  diffused from capillaries  107  at the endplate  105  into the mid layer of the disc  100 . The needle may also contain a sleeve. 
     Deployment of the spiraled shunt strands  126 ,  373  from the distal portion of the needle  101  into the disc  100  can be done without the sleeve  220 . Annulus  378  of the disc  100  holds or traps the spiraled or knotted shunt strands  126 ,  373 , while the needle  100  is withdrawn to fully deploy the internal and/or external disc shunts  126 ,  373 . Especially for thin cervical discs  100 , the spiraled shunt strands  126 ,  373  from the second position of the needle  101  may be sufficient, reaching one or both diffusion zones  106 A,  106 B between 0 and 3 mm from the endplates  105 , to draw nutrients/oxygen/pH buffer  131  diffused from capillaries  107  at the endplate  105  into the mid layer of the disc  100 . This technique for implanting the internal and/or external disc shunts  126 ,  373  was used in the in-vivo sheep studies, without failed deployment in nearly 100 sheep discs. 
     It is to be understood that the present invention is by no means limited to the particular constructions disclosed herein and/or shown in the drawings, but also includes any other modification, changes or equivalents within the scope of the claims. Many features have been listed with particular configurations, curvatures, options, and embodiments. Any one or more of the features described may be added to or combined with any of the other embodiments or other standard devices to create alternate combinations and embodiments. The shunt strands  126 B,  126 C,  373 B,  373 C can also have a gate to regulate rate and/or direction of flow. It is also possible to connect a pump to the shunt strands  126 B,  126 C,  373 B,  373 C to assist the exchange between the disc  100  and the bodily fluid. A pH electrode may be exposed near the tip of the needle  101  to detect the acidity within the disc  100 . 
     It should be clear to one skilled in the art that the current embodiments, materials, constructions, methods, tissues or incision sites are not the only uses for which the invention may be used. Different materials, constructions, methods or designs for various sections  126 A,  373 A and end strands  126 B,  126 C,  373 B,  373 C can be substituted and used. The internal and/or external disc shunt  126 ,  373  can be called a conduit, wick, sponge or absorbent. Nothing in the preceding description should be taken to limit the scope of the present invention. The full scope of the invention is to be determined by the appended claims. For clarification in claims, sheath is a tubular member. Spiraled shunt strand can be called a spool of strand or spool shunt.