Patent Publication Number: US-8535380-B2

Title: Fixation device and method

Description:
BACKGROUND OF THE INVENTION 
     1. Technical Field 
     Devices and methods for fixation of tissue are disclosed. More specifically, the devices and methods can be for inter body vertebral fusion of vertebrae or fusion of other bones to one another. 
     2. Background of the Art 
     A vertebroplasty device and method that eliminates or reduces the risks and complexity of the existing art is desired. A vertebroplasty device and method that may reduce or eliminate the need to inject a liquid directly into the compression fracture zone is also desired. 
     Other ailments of the spine result in degeneration of the spinal disc in the intervertebral space between the vertebral bodies. These include degenerative disc disease and traumatic injuries. In either case, disc degeneration can cause pain and other complications. Conservative treatment can include non-operative treatment requiring patients to adjust their lifestyles and submit to pain relievers and a level of underlying pain. Operative treatment options include disc removal. This can relieve pain in the short term, but also often increases the risk of long-term problems and can result in motor and sensory deficiencies resulting from the surgery. Disc removal and more generally disc degeneration disease are likely to lead to a need for surgical treatment in subsequent years. The fusion or fixation will minimize or substantially eliminate relative motion between the fixed or fused vertebrae. In surgical treatments, adjacent vertebra can be fixated or fused to each other using devices or bone grafts. These may include, for example, screw and rod systems, interbody spacers (e.g., PEEK spacers or allograft bone grafts) threaded fusion cages and the like. 
     Some fixation or fusion devices are attached to the vertebra from the posterior side. The device will protrude and result in additional length (i.e., needed to overlap the vertebrae) and additional hardware to separately attach to each vertebrae. Fusion cages and allografts are contained within the intervertebral space, but must be inserted into the intervertebral space in the same dimensions as desired to occupy the intervertebral space. This requires that an opening sufficient to allow the cage or graft must be created through surrounding tissue to permit the cage or graft to be inserted into the intervertebral space. 
     A spinal fixation or fusion device that can be implanted with or without the need for additional hardware is desired. Also desired is a fixation or fusion device that can be deployed in a configuration where overlapping the fixated or fused vertebrae is not required. 
     Also desired is an intervertebral device the may be inserted in to the intervertebral space at a first smaller dimension and deployed to a second, larger dimension to occupy the intervertebral space. The ability to insert an intervertebral spacer at a dimension smaller than the deployed dimension would permit less disruption of soft and boney tissue in order to access the intervertebral space. 
     SUMMARY OF THE INVENTION 
     A device that can replace or supplement the screw or rod elements of a typical fusion system is disclosed. The device can be placed in the inter-vertebral space to fuse adjacent vertebrae and/or create a bone mass within the inter-vertebral space in a patient&#39;s spine. 
     The device can be less invasive than typical existing devices. For example, the device can be in a compacted (i.e., small) configuration when inserted into a patient and transformed into an expanded (i.e., large) configuration when positioned at the target site. For example, the device can be expanded when the device is between the inferior and superior vertebral body surfaces. The device can create less soft tissue (e.g., bone) disruption than a typical fusion system. The device in an expanded configuration can improve anchoring within the joint, structural stability, and create an environment for bone healing and growth leading to fusion between adjacent vertebrae. 
     During deployment into tissue (e.g., bone), one, two or more holes can be drilled into the target site to create a deployment hole in which to insert the device. The deployment hole can be round or non-round (e.g., by drilling more than one overlapping or adjacent hole, or crafting a square or rectangular hole), for example to substantially match the transverse cross-section of the device in a contracted configuration. 
     The device can be cannulated, for example having a lateral (i.e., transverse or latitudinal) and/or lengthwise (i.e., longitudinal) channel through the device. The device can be deployed over a wire or leader, such as a guidewire. The device can be slid over the guidewire, with the guidewire passing through the longitudinal channel of the device. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is an exploded view of a variation of the expandable support device. 
         FIGS. 2 through 4  illustrate variations of cross-section A-A of  FIG. 1 . 
         FIGS. 5 and 6  illustrate variations of cross-section B-B of  FIG. 1 . 
         FIG. 7  illustrates the variation of the expandable support device of  Figure 1  with the ramps slidably attached to the base. 
         FIGS. 8 and 9  are perspective and side views, respectively, of the variation of the expandable support device of  FIG. 7  with the top and ramps in pre-assembly positions. 
         FIGS. 10 ,  11  and  12  are perspective, side and end views, respectively of the variation of the device of  FIG. 1  in an assembled configuration. 
         FIG. 13  is a variation of close-up section E-E of  FIG. 12  in a first configuration. 
         FIG. 14  is a variation of close-up section E-E of  FIG. 12  in a second configuration. 
         FIGS. 15 and 16  are a variation close-up section D-D of  FIG. 11  in first and second configurations, respectively. 
         FIGS. 17 ,  18 ,  20  and  21  are perspective, side, end and top views, respectively, of the variation of the device of  FIG. 1  in a pre-deployment configuration. 
         FIGS. 19 and 22  are side and top views, respectively, of a variation of the device of  FIG. 1  in a pre-deployment configuration. 
         FIG. 23  illustrates a method of longitudinally compression and radially expanding the variation of the device of  FIG. 17 , for example after deployment at a target site. 
         FIGS. 24 and 25  are perspective and top views, respectively, of the variation of the device of  FIG. 1  in a deployed configuration.  FIG. 22  is illustrated with the top and the base in see-through views for illustrative purposes. 
         FIGS. 26 and 27  illustrate variations of the locking pin. 
         FIGS. 28 and 29  illustrate a variation of a method for using the variation of the locking pin of  FIG. 26 . 
         FIGS. 30 and 31  illustrate a variation of a method for using the variation of the locking pin of  FIG. 27 . 
         FIGS. 32 ,  33  and  34  are top, side and end views, respectively, of a variation of the device with the locking pin. 
         FIGS. 35 and 36  are side and end views, respectively, of a variation of the device with the locking pin. 
         FIGS. 37 and 38  are side and end views, respectively, of a variation of the device with the locking pin. 
         FIGS. 39   a ,  39   b  and  39   c  are bottom perspective, end and side views, respectively, of a variation of the device in a longitudinally expanded configuration. 
         FIGS. 40   a ,  40   b , and  40   c  are bottom perspective, end and side views, respectively, of the device of  FIGS. 39   a  through  39   c  in a longitudinally compressed and radially expanded configuration. 
         FIGS. 41   a  through  41   d  are top, top perspective, side, and bottom perspective views, respectively, of a variation of the device in a longitudinally expanded and radially contracted configuration. 
         FIGS. 42   a  through  42   c  are top, side and top perspective views, respectively, of the variation of the device of  FIGS. 41   a  through  41   d  with the side ramps not shown for illustrative purposes. 
         FIGS. 43   a  through  43   d  are top, top perspective, side, and bottom perspective views, respectively, of the device of  FIGS. 41   a  through  41   d  in a longitudinally contracted and radially (e.g., height) expanded configuration. 
         FIGS. 44   a  through  44   c  are top, side and top perspective views, respectively, of the variation of the device of  FIGS. 43   a  through  43   d  with the side ramps not shown for illustrative purposes. 
         FIGS. 45   a  and  45   b  are top and top perspective views, respectively, of a variation of the bottom plate. 
         FIGS. 46   a  and  46   b  are bottom and bottom perspective views, respectively, of a variation of the top plate. 
         FIGS. 47   a  and  47   b  are top perspective and bottom perspective exploded views, respectively, of the variation of the device of  FIGS. 41   a  through  41   d.    
         FIGS. 48   a  through  48   d  are top, top perspective, side, and bottom perspective views, respectively, of a variation of the device in a longitudinally expanded and radially contracted configuration. 
         FIGS. 49   a  through  49   d  are top, top perspective, side, and bottom perspective views, respectively, of the device of  FIGS. 48   a  through  48   d  in a longitudinally contracted and radially (e.g., height) expanded configuration. 
         FIGS. 50   a  and  50   b  are side and top perspective views of the device of  FIGS. 49   a  through  49   d  in a longitudinally contracted configuration, with the top plate exploded away from the rest of the device. 
         FIGS. 51   a  and  51   b  are top and top perspective views, respectively, of a variation of the bottom plate. 
         FIGS. 52   a  through  52   c  are bottom, bottom perspective, and end perspective views, respectively, of a variation of the top plate. 
         FIGS. 53   a  through  53   d  are top, top perspective, side, and bottom perspective exploded views, respectively, of the variation of the device of  FIGS. 48   a  through  48   d.    
         FIGS. 53   c  and  53   d  illustrate the device upside down compared to the orientation shown in  FIGS. 53   a  and  53   b.    
         FIG. 54  illustrates a visualization of a variation of a method for deploying the device into the spine between adjacent vertebrae. 
         FIGS. 55   a  and  55   b  illustrate visualizations of variations of the device deployed into the spine between adjacent vertebrae. 
         FIGS. 56   a  and  56   b  illustrate variations of methods for inserting one or more devices into one or more target sites. 
     
    
    
     DETAILED DESCRIPTION 
     A device  2  is disclosed that can be inserted into a target site  264  with the device  2  in a compressed or contracted (i.e., small) configuration. Once positioned in the deployment site, the device  2  can be transformed into an expanded (i.e., larger, bigger) configuration. The device  2  can be inserted and expanded in orthopedic target sites  264  for fixation and/or support. For example, the device  2  can be inserted and expanded over a guidewire between adjacent vertebral bodies. 
       FIG. 1  illustrates that the device  2  can have a first longitudinal end and a second longitudinal end along a longitudinal axis  4 . The longitudinal axis  4  can be straight or substantially straight. The device  2  can have a bottom or plate  286  (bottom and base plate are used interchangeably) and a top plate  6 . The base  138  or bottom plate  10  and top plate  6  can be or have plates  286 , panels, struts  216  (e.g., legs), ports, cells  88 , and combinations thereof. The base plate  10  and top plate  6  can be configured to be slidably attachable to the other. For example, the base (or top) plate can have one or more stability bars  102 . The top (or base) plate can have one or more stability grooves  128 . The stability bars  102  can be configured to be slidably attachable to the stability grooves  128 . 
     The slidable attachment of the top and base plates can permit the base  138  to move radially (with respect to the longitudinal axis  4 ) relative to the top and vice versa. 
     The top plate  6  can have a high-friction and/or low-friction texture extending radially away from the base  138 . For example, the top plate  6  can have one or numerous rows of top teeth  118 . The bottom plate  10  can have a high-friction and/or low-friction texture extending radially away from the base plate. For example, the bottom plate  10  can have one or numerous rows of bottom teeth  104 . The top teeth  118  and the bottom teeth  104   
     The top plate  6  can have one or more side ports  114  and/or top ports. The base plate can have one or more base ports  120  and/or side ports  114 . The base ports  120 , side ports  114 , and/or top ports can be ingrowth channels  28 . The ports can be circular, square, triangular, oval, elongated in the longitudinal direction, elongated in the radial direction, or combinations thereof. 
     The top plate  6  can have a top chamfer  156 . The base plate can have a base chamfer. The chamfers can be atraumatic edges. The chamfers can extend along the perimeter of the base  138  and/or top. 
     The device  2  can have one, two or more wedges, for example a first or distal side ramp  96  on a first longitudinal side (e.g., the distal side) of the base plate and a second or proximal side ramp  108  on a second longitudinal side (e.g., the proximal side) of the base plate. The side ramps  96  and  108  can be configured to be slidably attachable to the base plate  10  and/or the top plate  6 . The wedges or ramps  96  and  108  can be separate from each other. The ramps  96  and  108  can move independent of each other. The ramps  96  and  108  can be constrained by the top and bottom plates  6  and  10  to move concurrently and at the same rate in opposite directions. The angled faces of the ramps  96  and  108  can face each other. The “pointed” ends of the ramps  96  and  108  can point toward each other. 
     The ramps  96  and  108  and top plate  6  can be brought within proximity of the base plate  10 . The ramps  96  and  108  can be slidably attached to the base plate  10 . The ramps  96  and  108  can have ramp second tongues and grooves  98 . The base plate  10  can have one or more base tongues and grooves  106 . The ramp second tongues and grooves  98  can be configured to slidably attach to the base tongues and grooves  106 . 
     The ramps  96  and  108  can be configured to be slidably attachable to the top plate  6 . For example, the ramps  96  and  108  can have ramp first tongues and grooves  100 . The top plate  6  can have top tongues and grooves  284 . The ramp first tongues and grooves  100  can slidably engage the top tongues and grooves  284 . 
     The first tongues and grooves can be at a ramp angle  136  with respect to the second tongues and grooves. The ramp angle  136  can be from about 15° to about 75°, more narrowly from about 30° to about 60°, for example about 45°. 
     One or more of the ramps  96  and  108  can have a ramp locking plate port  110 . The ramp locking plate ports  110  can each be configured to receive a ramp locking plate. The ramps  96  and  108  can each have ramp ports, such as the threaded ramp ports. The threaded ramp ports can pass through the ramps  96  and  108 , for example opening into the ramp locking plate port  110 . 
       FIG. 2  illustrates that each of the top, or base  138  or bottom plates can have a plate thickness  122 . The plates  286  can be thinned adjacent to some or all ports. The plate thickness  122  can be substantially constant along the length of the top or base  138 . The plate thickness  122  can be non-constant, for example along the length and/or width of the top port or base port  120  and the top teeth  118  or base teeth. Each plate  286  of the first side ramp  96  and the second side ramp  108  can have a substantially constant plate thickness  122  along the height of the plate  286  save for the respective ramp ports. 
       FIG. 3  illustrates that the top and/or bottom plates can thin as the plate  286  nears the port. For example, the plate  286  can have a maximum plate thickness  126  and a minimum plate thickness  124 . The maximum plate thickness  126  and minimum plate thickness  124  can be measured with or without accounting for the change in thickness due to the teeth. The minimum plate thickness  124  can be substantially less than the maximum thickness  126 . The minimum plate thickness  124  can be substantially 0. The plate  286  can slope outward (as shown), inward, or a combination of both (e.g., sloping inward and outward concurrently to form the rim of the port at a radius from the longitudinal axis between the radii of the outer and inner surfaces of the plate  286 ). 
     When the device  2  is in a deployed configuration in vivo, the device  2  can be partially or substantially filled with a liquid, gel, or solid (e.g., in small parts or granules) filler  262  material, or combinations thereof, such as bone morphogenic powder or any other material disclosed herein or combinations thereof. The filler  262  material can contact or be in near contact with the surrounding tissue near the edge of the ports, for example where the plate  286  is thinned. The filler  262  can be inserted into the device  2  before, and/or during (i.e., prepacked), and/or after the device  2  is inserted and/or expanded in the target site. 
     As the device  2  is expanded and contracted, the volume of the interior channel of the device (i.e., defined between the top and base plates and the opposing ramps) can remain constant. For example, filler can be inserted into the device  2  before the device is radially expanded. The device  2  can be longitudinally contracted and radially expanded (e.g., expanded in height). The ratio of the volume of filler to the volume of the interior channel of the device can then remain substantially constant as the device is radially expanded. For example, the decrease in volume of the interior channel of the device caused by the contracting ramps can be substantially equivalent to the increase in volume of the interior channel of the device  2  caused by the radially expanding top and base plates. 
       FIG. 4  illustrates that the plates  286  of the first side ramp  96  and/or the second side ramp  108  can thin as the plate  286  nears the threaded ramp port(s). The minimum plate thickness  124  can be substantially less than the maximum plate thickness  126 . The minimum plate thickness  124  can be substantially 0. The plate  286  can slope outward (as shown), inward, or a combination of both (e.g., sloping inward and outward concurrently to form the rim of the port at a radius from the longitudinal axis between the radii of the outer and inner surfaces of the plate  286 ). 
       FIG. 5  illustrates that the stability bars  102  can be configured to slide into the stability groove  128  when the top and base plates intersect. The radially inner surface of the stability bar  102  can be substantially the same or a greater radius from the longitudinal axis of the expandable support device  188  as the radius of the radially outer surface of the top plate  6  adjacent to the side port  114  (i.e., within the stability groove  128 ). The stability bar  102  can be configured to not directly attach to the top plate  6  when the top is translated into the base plate, or the stability bars  102  can be configured to bias inward against and frictionally hold the top when the top plate  6  is translated into the base plate. 
       FIG. 6  illustrates that the stability bars  102  can have one or more latches  130  along the length of the stability bar  102 , for example at the terminal end of the stability bars  102 , as shown. The latch  130  can be configured to attach to the top plate  6 . The latch  130  can protrude radially inward. The latch  130  can have a latch top  288  and a latch bottom  134 . 
     The latch top  288  can be configured to allow the top to pass over the latch  130 . For example, the latch top  288  can be rounded and configured to push radially outward and clear of the top plate  6  when the top is pressed down into the latch top  288 . The latch bottom  134  can be configured to grasp or otherwise attach to the top when the top is translated to a particular location into the base plate. 
     The stability bars  102  can be configured to resiliently bend radially outward and/or inward. 
       FIG. 7  illustrates that the ramps  96  and  108  can be slidably attached, as shown by arrows, to the base plate  10  before the ramps  96  and  108  are slidably attached to the top plate  6 . The ramp second tongues and grooves  98  can be slidably engaged with the base tongues and grooves  106 , as shown in  FIGS. 12 ,  13  and  14 . 
       FIGS. 8 and 9  illustrate that the ramps  96  and  108  can be positioned, as shown by arrows, so that one or both ramp first tongues and grooves  100  can be aligned to slidably engage the top tongues and grooves  284  as the top plate  6  is translated toward the base plate, as shown by arrows. The stability bar  102  can be slid into the stability groove  128 . 
       FIGS. 10 through 12  illustrate that as the top plate  6  is translated toward the base plate, as shown by arrows, the top plate  6  can slidably engage one or more of the ramps  96  and  108 . The first tongues and grooves can slidably engage the top tongues and grooves  284 . 
       FIG. 13  illustrates that there can be a substantial ramp gap  140  between the side ramp and the base plate, for example before the expandable support device  188  is completely deployed. The ramp gap  140  can have a ramp gap height  150 . The ramp gap height  150  can vary, for example, from about 0 mm (0 in.) to about 4 mm (0.2 in.). The side ramps can substantially slide along the base plate. For example, the ramp second tongue and groove  98  can slide along the base tongue and groove  106 , separated by the ramp gap  140 . Most or all of the friction in this configuration can be created by the ramp second tongue in contact with the base tongue  148  and/or side of the base groove  146 . 
     The wall of the base groove  146  can have an outwardly slanted configuration relative to the height of the wall of the base groove  146  from the bottom of the base plate. 
       FIG. 14  illustrates that the first side ramp  96  and the base  138  can be pressed into or otherwise translated toward each other. For example, after implantation of the device  2 , the surrounding tissue in the in vivo environment can naturally compress the device  2 . 
     The ramp gap  140  can be substantially closed. The ramp gap height  150  can be substantially about 0. The side ramps can be substantially friction fit along the base plate. For example, the friction in this configuration can be created along the top surface of substantially the entire base plate including the top of the base tongue  148 , and the bottom surface of substantially the entire side ramps. 
     As the side ramp is pushed, as shown by arrows, toward the base plate, the ramp second tongues  144  can be pressed between the base grooves  146 , for example, frictionally fitting the side ramps into the base plate. The base grooves  146  can be tapered, as shown, to force the ramp second tongues  144  to wedge fit or press fit into the base grooves  146  when the side ramp is pushed towards the base plate. 
     The side ramps can have less friction with the base plate in the configuration of the expandable support device  188  of  FIG. 13  than in the configuration of the expandable support device  188  of  FIG. 14 . 
       FIG. 15  illustrates that the second side ramp  108  (and/or the first side ramp  96 , not shown) can have ramp bottom teeth  152  on the side of the second side ramp  108  (and/or first side ramp  96 ) facing the base plate. The ramp bottom teeth  152  can extend into the ramp gap  140 . Either or both side ramps can have teeth on any and/or all sides of the side ramp, for example the surfaces that contact the base plate and the top plate  6 . The top plate  6  can have additional teeth, not shown, along surfaces that contact the side ramps. 
     The ramp bottom teeth  152  and/or base interior teeth  154  can be unidirectionally or bidirectionally oriented (i.e., providing additional resistance against movement in one direction, or substantially the same resistance against movement in either direction). 
     As the side ramp translates, as shown by arrows, with respect to the base plate, the ramp gap height  150  is substantially non-zero, as shown in  FIGS. 13 and 15 . When the ramp gap height  150  is substantially non-zero, the ramp bottom teeth  152  can slide over the base interior teeth  154 . 
       FIG. 16  illustrates that when the side ramp and base plate are pressed together, as shown by arrows, for example when deployed in vivo, the ramp gap height  150  can be minimized, for example approaching about 0 mm (0 in.). The ramp bottom teeth  152  can interlock with the base interior teeth  154 . The interlocked ramp bottom teeth  152  and base interior teeth  154  can provide an interference fit or otherwise prevent or minimize the side ramp translating relative to the base plate. 
     In place of, or in addition to, the ramp bottom teeth  152  and/or the base top teeth, the respective surfaces can have high friction surfaces, for example a textured (e.g., knurled) surface and/or coated with a high friction material. The respective surfaces can also be smooth, having no teeth or texturing. 
     The side ramp can be pulled away from the base plate by reducing the compressive force between the side ramp and the base plate and pulling or pushing the side ramp. 
     The side ramp can have a belt and suspenders lock with the base plate. 
       FIGS. 17 ,  18 , and  20  illustrate that the ramps can be pushed outward, as shown by arrows, toward each ramp&#39;s respective longitudinal side of the base plate. The ramps  96  and  108  can be pushed outward, for example, by a deployment or other tool. When the ramps  96  and  108  are slid outward, as shown, the top plate  6  and base plate can translate toward each other, as shown by arrow. The top plate  6  and base plate can then have a radially compressed (e.g., only in the “y”-axis or from the top of the page to the bottom of the page of  FIGS. 17 ,  18 , and  20 ) configuration. The top plate  6  can interference fit against the bottom plate  10  when the expandable support device  188  is fully radially compressed, as shown. The interference fit of the top against the bottom plate, and the slidable attachment of the ramps  96  and  108  to the top and the bottom plate  10  can lock the top plate  6 , base plate and ramps  96  and  108  together (e.g., not allowing any to separate). The device  2  can be attached to a deployment tool  80  (e.g., by removably attaching to one or more ramp ports) and/or delivered to a target site  264  in the radially compressed configuration. 
       FIGS. 19 and 22  illustrate that one or more locking pin channels  164  can be defined transversely through the device  2 . A locking pin  162  can be inserted through each locking pin channel  164 . The locking pin  162  can be inserted through the locking pin channel  164  after the device  2  has been inserted at the target site  264  and expanded. The locking pin channel  164  can be defined by locking pin ports  166  on the stability bars  102  and the side port  114 . The locking pin ports  166  can be circular, as shown, oval, or combinations thereof. 
     The locking pin  162  can be configured to limit the vertical expansion of the device  2 . For example, the locking pin  162  can be configured to substantially prevent the device  2  from disassembling. 
       FIG. 23  illustrates that the device  2  can be longitudinally compressed, as shown by arrows, resulting in radial and/or vertical expansion, as shown by arrow, for example performed after the device  2  is positioned within a vertebra or between vertebrae. The ramps  96  and  108  can be slidably translated along the longitudinal axis and inward and/or toward the center of the device  2 . The expansion of the device  2  can increase the height and provide structure support for a compressed or otherwise damaged vertebra (e.g., when the device  2  is deployed within a vertebra) and/or return adjacent vertebrae to a more natural/physiological configuration (e.g., when the device  2  is deployed between adjacent vertebrae). 
       FIGS. 24 and 25  illustrate the device  2  in a deployed configuration, for example after completion of the longitudinal compression  160  and radial and/or vertical expansion as shown in  FIG. 23 . 
       FIG. 26  illustrates a variation of the locking pin  162  that can have a pin shaft  170  with a driver slot  172 , for example, configured to receive a screw driver or drill bit. The pin shaft  170  can have pin thread  168  configured to releasably or fixedly attach to one or both of the ramp ports. The pin thread  168  can extend along all or part of the length of the pin shaft  170 . The pin shaft  170  can be rotatably or fixedly attached to or integral with a locking plate  290 . The locking plate  290  can be at the end of the pin shaft  170  with the driver slot  172 . The locking plate  290  can be at the same or opposite end of the pin shaft  170  from the thread. 
       FIG. 27  illustrates that the pin shaft  170  can have no locking plate  290 . The pin thread  168  can be at the end of the pin shaft  170  with the driver slot  172 . One end of the pin shaft  170 , for example opposite the driver slot  172 , can be an abutment end  174 . 
       FIG. 28  illustrates that the locking pin  162  can be inserted, as shown by arrow, through the second side ramp  108 .  FIG. 29  illustrates that the pin shaft  170  can be translated and rotated, as shown by arrows, to screw the pin thread  168  into the threaded distal ramp port  94  in the first side ramp  96 . The ramp locking plate can fit into the ramp locking plate port  110 . The locking pin  162  can be screwed tightly enough to substantially fix the locking pin  162 . 
       FIG. 30  illustrates that the locking pin  162  can be inserted, as shown by arrow, through the threaded ramp port. The second side ramp  108  and/or the top and/or the bottom plates can have a ramp abutment section  180 . The ramp abutment section  180  can be configured to interference fit with and/or fixedly attach to the abutment end  174 . 
       FIG. 31  illustrates that the pin shaft  170  can be translated and rotated, as shown by arrows. The abutment end  174  can interference fit and/or fixedly attach to the ramp abutment section  180 . 
     A biocompatible adhesive or epoxy can be applied to the pin thread  168 , threaded ramp port, abutment end  174 , ramp abutment section  180 , or combinations thereof. 
       FIGS. 32 ,  33  and  34  illustrate that one, two or more locking pin channels  164  can be defined longitudinally through the device  2 . One, two or more locking pins  162  can be inserted in each locking pin channel  164 , for example during or after deployment of the remainder of the device  2 . The locking pins  162  can prevent overexpansion and/or overcompression and/or disassembly of the device  2 . 
     The locking pin channel  164  can have locking pin ports  166  through the top, and/or bottom plates, and/or either or both side ramps. 
     Two locking pin channel  164  can be located on opposite sides of the threaded ramp port. The locking pin channels  164  and ports can have a circular cross-section (i.e., be cylindrical), as shown in  FIG. 34 . 
       FIGS. 35 and 36  illustrates that the locking pin  162  can be cylindrical. The locking pin channel  164  and locking pin port  166  can have elongated cross-sections, such as an oval or rectangular or oblong cross-sections. The locking pin  162  can be free to move vertically within a range of motion within the locking pin port  166 . 
       FIGS. 37 and 38  illustrate that the locking pin  162  can be a substantially similar shape and size as the locking pin channel  164 . The locking pin  162  can be substantially unmovable within the locking pin port  166 . The locking pin  162 , locking pin channel  164  and locking pin port  166  can all have elongated cross-sections, such as an oval or rectangular or oblong cross-sections. 
     One or both of the ramps  96  and  108  can have first fixing teeth  192 . The first fixing teeth  192  can be in contact with the top and/or the bottom. The top and/or the bottom (shown as bottom only) plates  286  can have second fixing teeth  190 . 
     The first fixing teeth  192  can mechanically interact with the second fixing teeth  190  to allow relative translation in a first direction. The first fixing teeth  192  and the second fixing teeth  190  can interact to obstruct (e.g., by interference fitting the first fixing teeth  192  against the second fixing teeth  190 ) relative translation in a second direction. For example, the fixing teeth can obstruct the side ramps from moving longitudinally away from each other (i.e., and obstruct the top from moving closer to the bottom). Also for example, the fixing teeth can allow relative translation of the side ramps toward each other (i.e., and allow the top to move away from the bottom). 
     The second side ramp  108  can have a first end  186 . The first end  186  can be configured to dissect tissue. The first end  186  can have a blunt or sharp point. 
     The second side ramp  108  can have a tool connector  184 , such as an externally and/or internally threaded cylinder extending longitudinally from the second side ramp  108  away from the first side ramp  96 . The tool connector  184  can be configured to removably attach to a deployment tool  80 . 
     The first side ramp  96  and second side ramp  108  can be longitudinally compressed toward each other. For example, an external deployment tool  80  can be attached to the first side ramp  96  and second side ramp  108  and apply a compressive force. The base  138  and top plates  6  can expand away from each other. 
     The first fixing teeth  192  can unidirectionally interference fit the second fixing teeth  190 . The unidirectional interference fit of the first fixing teeth  192  and the second fixing teeth  190  can substantially impede or prevent the opposite ramps  96  and  108  from moving longitudinally away from each other, for example, therefore impede or preventing compression  196  of the top toward the bottom and vice versa. 
     The unidirectional interference fit of the first fixing teeth  192  and the second fixing teeth  190  can allow the opposite ramps  96  and  108  to move longitudinally toward each other, for example, therefore allowing the top to expand away from the bottom and vice versa. 
     The expandable support devices  188  can have textured and/or porous surfaces for example, to increase friction against bone surfaces, and/or promote tissue ingrowth. The expandable support devices  188  can be coated with a bone growth factor, such as a calcium base  138 . 
       FIGS. 39   a  through  39   c  illustrate that the bottom ports can be one or more circular ports, for example six ports. The bottom ports can be aligned in a single row parallel with the longitudinal axis of the device  2 . 
     The side ports  114  can open against the edge of the top plate  6  on one or more sides (e.g., the bottom sides, as shown) of the side ports  114 . 
     The top plate  6  can have top plate side teeth  198  on the external lateral sides of the top plate  6 . The bottom plate  10  can have bottom plate side teeth  202  on the external lateral sides of the bottom plate. The top plate side teeth  198  and/or the bottom plate side teeth  202  can be oriented from the top to the bottom of the device  2  (i.e., perpendicular to the longitudinal axis of the device  2 ). The top plate side teeth  198  can be aligned with the bottom plate side teeth  202 . 
     The external lateral sides of the first side ramp  96  and/or second side ramp  108  can have ramp side teeth  200 . The ramp side teeth  200  can be oriented parallel with the longitudinal axis of the device  2 . The top plate side teeth  198  and/or the bottom plate side teeth  202  can be oriented perpendicular to the orientation of the ramp side teeth  200 . 
       FIGS. 40   a  through  40   c  illustrate that the top plate  6  and/or bottom plate  10  can be expanded away from each other in the directions of the orientation of the longitudinal axes of the top plate side teeth  198  and the bottom plate side teeth  202 . The first and/or second side ramps  108  can be contracted toward one another in the direction of the orientation of the longitudinal axis of the ramp side teeth  200  of the first and second side ramps  108 . The top plate side teeth  198 , bottom plate side teeth  202 , and ramp side teeth  200  can act as low-friction rails  42  against surrounding tissue when the device  2  is radially expanded at the target site  264 . 
     The side ports  114  that open to the bottom edge of the top plate  6  can create a single side port  114  that can extend to the bottom plate. 
     The plates  286  and wedges can be rigid or exhibit ductile or deformable expansion during deployment. The transverse cross-section of the device  2  can be non-round. For example, the device  2  can have a square or rectangular transverse cross-section. The device  2  can have a substantially triangular or quadrilateral (e.g., trapezoidal) cross-section. The device  2  can have a round, hexagonal, octagonal, or other transverse cross-sectional configuration. 
       FIGS. 41   a  through  41   d  illustrate that the device  2  can be curved, rounded (e.g., a continuous curvature along the entire length) or bent (e.g., at one or more angles at specific, discrete positions along the length). Any or all of the components of the device  2  can be curved, for example the top plate  6 , bottom plate  10 , a distal ramp  96 , the proximal ramp  108 , and combinations thereof. During use, the device  2  can be inserted into a target site, for example intervertebrally, rotating and translating the device  2 , so the concave aspect of the curvature can be positioned to miss nearby sensitive tissue (e.g., the spinal cord) during placement. 
     The longitudinal axis of the device  2  can have a device radius of curvature  300 . The device radius of curvature  300  can be from about 0.5 cm (0.2 in.) to about 40 cm (16 in.), more narrowly from about 1 cm (0.4 in.) to about 20 cm (8 in.), yet more narrowly from about 1.9 cm (0.75 in.) to about 7.0 cm (2.75 in.), for example about 3.2 cm (1.25 in.). 
     The proximal ramp  108  can have one or more proximal protrusions  304 . For example, a single protrusion can extend proximally from the proximal ramp  108  centered with or asymmetric or off-center (as shown) to the longitudinal axis  4 . The protrusion  304  can have a proximal ramp hole  302   a , for example extending from the top of the protrusion  304  part or all of the way through the protrusion  304 . 
     A deployment tool can releasably or fixedly attach to the proximal ramp hole  302   a  and/or protrusion  304 . For example, the deployment tool can be rotatably attached to the proximal ramp hole  302   a . For example, the deployment tool can have a removable pin that can be inserted into the hole proximal ramp hole  302   a . The pin, still fixed to the deployment tool, can then be press fit (e.g., friction fit or interference fit) or rotated inside of the hole  302   a , acting as a rotatable hinge. The pin can rotationally stabilize the device  2 . 
     The pin can act as a stabilization device. The deployment tool can press on one or both sides of the protrusion  304  to rotate the device  2  about the proximal ramp hole  302   a.    
     The distal ramp  96  can have a distal ramp keyhole  302   b . The distal ramp keyhole  302   b  can extend from the top of the distal ramp  96  part or all the way through the distal ramp  96 . The distal ramp keyhole  302   b  can be cylindrical (as shown), square, triangular, oval, rectangular, or star-shaped in cross section. An attachment key  308  can be inserted into the distal ramp key hole  302   b , as shown by arrow in  FIG. 41   b . The inserted attachment key  308  can abut against the larger cylinder  170   b  and the distal 
     The attachment key  308  can have the same cross-section as the distal ramp key hole  302   b.    
     The locking pin  162  can be straight (as shown) or curved, such as having a substantially equal radius of curvature to the longitudinal axis. The locking pin  162  can have a proximal locking head plate or tool interface proximal section  290   a  that can extend proximally of the proximal ramp  108  when the device  2  is in a radially contracted and longitudinally expanded configuration. The locking pin  162  can be fixedly or detachably attached to the distal ramp  96 . 
       FIGS. 42   a  through  42   c  illustrate that the locking pin  162  can have an adjustable length. The locking pin  162  can have a smaller cylinder or proximal locking pin shaft  170   a  with radially outer threads and a larger outer cylinder or distal locking pin shaft  170   b  with radially inner threads. The smaller cylinder  170   a  can helically (e.g., threadably, as a screw or bolt) engage the larger cylinder  170   b  (e.g., as a nut). 
     The outside of the smaller cylinder  170   a  and the inside of the larger cylinder  170   b  can have a set of slidably engaging longitudinal ribs, slides, rails, guides, or combinations thereof. 
     The smaller cylinder  170   a  can be spring loaded with respect to the larger cylinder  170   b . The inside of the locking pin  162  can have hydraulic fluid and an internal seal and/or piston so the locking pin  162  can act as a hydraulic damper or shock absorber. 
     The locking pin  162  can have a distal locking head or plate  290   b . The distal locking head  290   b  can have a larger diameter than the diameter of the distal locking pin shaft  170   b  and distal ramp port  94   a . The distal locking head  290   b  can be releasably attached to or fixed in or distal to the distal ramp port  94   a.    
     The locking pin  162  can have a proximal locking head or plate  290   a . The proximal locking head  290   a  can have a larger diameter than the diameter of the proximal locking pin shaft  170   a  and the proximal ramp port  94   b . When the locking pin  162  is shortened, the proximal locking pin head  170   a  can abut or interference fit with the proximal ramp  108 , pushing the proximal ramp  108  toward the distal ramp  96 , longitudinally contracting and radially expanding the device  2 . 
     The distal locking head  290   b  can have a key interface  306 . The key interface  306  can be a notch, divot, threads, other engagement feature, or combinations thereof. The key interface  306  can slidably receive the attachment key  308 , for example after the attachment key  308  is delivered into the distal keyhole  302   b . The attachment key  308  can fix the locking pin  162  to the distal ramp  96 , for example transferring force from the distal locking plate  290   a  to the distal ramp, capable of translating the distal ramp  96  proximally and distally with respect to the proximal ramp  108  when the length of the locking pin  162  is expanded and contracted. 
       FIGS. 43   a  through  43   d  and  44   a  through  44   c  illustrate that the locking pin  162  can be attached to the distal ramp  96 . The locking pin  162  can be longitudinally shortened. The distal ramp  96  can be contracted toward the proximal ramp  108 , resulting in a longitudinal contraction of the device and a radial (e.g., height) expansion between the top plate  6  and the bottom plate  10 . The ramps  96  and  108  can longitudinally contract along a straight or curved path (e.g., correlating with the shape of the grooves in the top plate, ramps and base plate) toward the center of the device  2 . 
     The top plate  6  can extend in a parallel or non-parallel plane away from the bottom plate  10 . A compressive force can be exerted between the proximal and distal ramps  108  and  96  along the longitudinal axis  4 . 
     The attachment key  308  is not shown in  FIG. 44   b  and shown in phantom lines in  FIG. 44   c  for illustrative purposes. 
       FIGS. 45   a  and  45   b  illustrate that the base plate  10  can have proximal base grooves  106   a  and distal base grooves  106   b . The proximal base grooves  106   a  can be a separate groove than the distal base grooves  106   b . The proximal and distal base grooves  106   a  and  106   b  can be substantially straight (as shown) or curved. 
     The longitudinal axis of the proximal base grooves  106   a  and the longitudinal axis of the distal base grooves  106   b  can form a base groove angle  310 . The base groove angle  310  can be from about 125° to about 175°, more narrowly from about 140° to about 160°, for example about 154°. 
       FIGS. 46   a  and  46   b  illustrate that the top plate  6  can have proximal top grooves  284   a  and distal top grooves  284   b . The proximal top grooves  284   a  can be separate from the distal top grooves  284   b . The top grooves  284   a  and  284   b  can be substantially straight (as shown) or curved. 
     The longitudinal axis of the proximal top grooves  284   a  and the longitudinal axis of the distal top grooves  294   b  can form a top groove angle  312 . The top groove angle  312  can be equal to the bottom groove angle  310 . 
       FIGS. 47   a  and  47   b  illustrate that the components of the device  2  can be slidably and rotatably assembled. 
     The outer locking pin shaft  170   b  can have an outer locking pin shaft channel  314 . The inner locking pin shaft  170   a  can screw, slide, clip or otherwise engage into the outer locking pin shaft channel  314 . The inner locking pin shaft  170   a  can be longitudinally translated within the locking pin shaft channel  314 , for example by rotating the inner locking pin shaft  170   a  with respect to the outer locking pin shaft  170   b . The total length of the locking pin  162  can be adjusted. 
       FIGS. 48   a  through  48   d  and  49   a  through  50   a  illustrate that the device can have a radius of curvature  300 . A compressive force can be exerted onto the ramps  96  and  108  along the longitudinal axis  4 . For example, the locking pin and/or deployment tool can be flexible and/or have a rigid shape with a radius of curvature that matches the radius of curvature  300  of the device  2 . 
     The ramps  96  and  108  can longitudinally contract along a curved path, such as along the longitudinal axis  4 , toward the center of the device  2 . During radial expansion, the top plate  6  can extend in a parallel plane away from the bottom plate  10 . 
     The distal ramp  96  can have threading on inside of a distal ramp port  94   a . The distal ramp port  94   a  can be aligned with the longitudinal axis  4 . 
     The proximal ramp  108  can have threading on the radial exterior and/or interior of the tool connector  184 . The proximal ramp  108  can have the tool connector  184 , for example extending proximally from the remainder of the device  2 . The tool connector  184  can be a cylindral proximal extension from the proximal ramp  108 . The threading on the radial outside of the tool connector  184  can, for example, removably attach to a deployment tool. 
       FIGS. 50   a  and  50   b  illustrate that the device can be assembled by sliding the iramps  96  and  108  onto the base plate. The ramps  96  and  108  can then be contracted to close to or at their respective inner-most positions on the base plate  10 . The top plate  6  can then be delivered, as shown by arrow, onto the ramps  96  and  108 . The ramps  96  and  108  can then be slid outward, extending away from the opposite ramp, as shown by arrows, engaging the top plate and pulling the top plate and the bottom plate together. 
       FIGS. 51   a  and  51   b  illustrate that the inner base groove  106 ′ and/or outer base groove  106 ″ can be curved along a part or the entire length of the respective base grooves  106 . The inner base groove  106 ′ can have an inner base groove radius of curvature  316 ″ from about 1.3 cm (0.5 in.) to about 6.4 cm (2.5 in.) for example about 2.5 cm (1.0 in.). The outer base groove  106 ″ can have an outer base groove radius of curvature  316 ″ from about 2.5 cm (1.0 in.) to about 7.6 cm (3.0 in.), for example about 3.8 cm (1.5 in.). 
       FIGS. 52   a  through  52   c  illustrate that the inner proximal and distal top grooves  284   a ′ and  284   b ′ and outer proximal and distal top grooves  284   a ″ and  284   b ″ can be curved along a part or the entire length of the respective grooves. 
     The inner top grooves  284   a ′ and  284   b ′ can have inner top groove radii of curvature  318 ′ from about 1.3 cm (0.5 in.) to about 6.4 cm (2.5 in.) for example about 2.5 cm (1.0 in.). The inner top groove radii of curvature  318 ′ can be the same or different for the inner proximal and distal top grooves  284   a ′ and  284   b′.    
     The outer top grooves  284   a ″ and  284   b ″ can have outer top groove radii of curvature  318 ″ from about 2.5 cm (1.0 in.) to about 7.6 cm (3.0 in.), for example about 3.8 cm (1.5 in.). The outer top groove radii of curvature  318 ″ can be the same or different for the outer proximal and distal top grooves  284   a ″ and  284   b″.    
       FIGS. 53   a  through  53   d  illustrate that that the components of the device  2  can be slidably assembled. A deployment tool and/or fixation rod can be inserted into the device after the component are assembled. 
     The device  2  can have one or more radiopaque and/or echogenic markers. For example, the device  2  can have aligned markers on the top plate  6 , middle plate of ramps  108  and  96  and bottom plate. When the device  2  is in a contracted pre-deployment configuration, the markers can be located immediately adjacent to one another, for example appearing as a single marker. When the device  2  is in an expanded configuration, the markers can move apart from each other, indicating to a doctor performing the implantation and deployment procedure using visualization (e.g., x-ray or ultrasound-based) that the device  2  has expanded. Under visualization the markers can also indicate the location and orientation of the device  2 . 
     Method of Using 
     The devices can be made from PEEK, any medical grade polymer or metal, or any other material disclosed herein. For example, the side ramps can be made from titanium and/or a titanium alloy and the bottom and/or top plates can be made from PEEK. The device can be coated, for example with bone morphogenic protein (BMP), ceramic, and/or any other material disclosed herein, before, during or after deployment into the target site. The device can be deployed less (e.g., minimally) invasively, over the wire, percutaneously, used with a vertebral body replacement or fusion cage, or combinations thereof. The device can be expandable and un-expandable for removal or repositioning. 
       FIG. 54  illustrates that the device can be removably attached to a delivery system or deployment tool. The deployment tool can insert the device into the target site. For example the deployment tool can be pushed over a guidewire. 
     When the device is positioned as desired (e.g., between adjacent vertebral plates) and expanded and/or locked, the deployment tool can then be releases from the device. The device can be configured to lock itself into place with outward expansion, wedging, or interference force when receiving a release force from the deployment tool or otherwise. For example, the device can have unidirectionally sliding teeth oppositely located on the adjacent surfaces of the wedges and plates. 
     A leader or wire, such as a guidewire, can be inserted or otherwise deployed into the target site, for example, the wire can be percutaneously inserted in a minimally invasive procedure. The wire can be inserted into the intervertebral space, for example between a first vertebral plate and an adjacent, second, vertebral plate. The wire can be anteriorly and/or posteriorly inserted. The wire can be laterally inserted. 
     Whether or not the device is inserted over or along the wire, the device can be inserted into the target site (e.g., between adjacent vertebral bodies) from an anterior, lateral, posterior, transforaminal approach, or combinations thereof. 
       FIG. 54  illustrates the deployment tool inserted to a target site in vivo between a first vertebra and a second vertebra. For example, the device can be placed at the target site after a partial or complete discectomy. When the device is in a contracted configuration, the tool can position the device between a first vertebral body of the first vertebra and a second vertebral body of the second vertebra. The device can be inserted into the target site a direction substantially parallel to the surfaces of the vertebral body end plates. The device can be placed between a first vertebral end plate of the first vertebral body and the adjacent second vertebral end plate of the second vertebral body. In this inter-vertebral location, the top plate of the device can be in contact with or directly adjacent to the first vertebral end plate. The bottom plate of the device can be in contact with or directly adjacent to the second vertebral end plate. 
       FIGS. 55   a  and  55   b  illustrate that the deployment tool can radially expand the device between the first vertebral end plate and the second vertebral end plate. The top plate  6  can press against and/or embed into the first vertebral end plate  234 . The bottom plate  10  can press against and/or embed into the second vertebral end plate  238 . The device  2  can fuse or fix the first vertebra  234  to the second vertebra  238 . 
       FIG. 56   a  illustrates that one, two or more devices  2 , such as a first device  2   a  and a second device  2   b , can be inserted, deployed and/or implanted the target site, such as in a vertebral body  324  or on a vertebral body  324  (e.g., between adjacent vertebral bodies). The devices  2  can be oriented so the longitudinal axes  4  of the devices  2  are substantially parallel with an anterior-posterior axis  320  of the patient. 
     The first device  2   a  can be oriented so the first device longitudinal axis  4   a  can be substantially parallel with the anterior-posterior axis  320 . 
     The second device  2   b  can be oriented so the second device longitudinal axis  4   b  can be substantially parallel with the anterior-posterior axis  320 . The second device  2   b  can be positioned in a substantially symmetric location and angular orientation to the first device  2   a  with respect to the anterior-posterior axis  320 . 
     The concavity of the radius of curvature  300  of the device can face toward (as shown) or away from the medial direction (i.e., the central anterior-posterior axis  320 ). 
     After placed into position at the target site, the device  2  can be longitudinally contracted and radially expanded. For example, as shown, the second device  2   b  has been radially expanded, and the first device  4   a  has been delivered to the target site and not yet radially expanded. Multiple devices  4  can be delivered concurrently or sequentially. Multiple devices  4  can be radially expanded sequentially or concurrently. 
     The devices  4  can be inserted with a surgical technique such as an Anterior Lumbar Interbody Fusion (ALIF), shown by arrow  322   a , Posterior Lumbar Interbody Fusion (PLIF), shown by arrow  322   b , Transforaminal Lumbar Interbody Fusion (TLIF), shown by arrow  322   c , a direct linear lateral delivery, as shown by arrow  322   d , a curvilinear lateral delivery initially inserted posteriorly, as shown by arrow  322   e , or other methods or combinations thereof. 
     Operative planning and templating can be performed using MRI and CAT imaging scans to determine what size device fits the patient&#39;s anatomy and pathology. 
     The disc (i.e., intervertebral) space or other target site can then be prepared. For PLIF procedures, the vertebrae can be accessed through an incision in the patient&#39;s back (i.e., posterior to the vertebrae). Depending on the number of vertebral levels to be fused, about a 3-6 inch incision can be made in the patient&#39;s back. The spinal muscles can then be retracted (or separated), for example, to allow access to the target vertebral discs. The lamina can then be removed (i.e., a laminectomy), for example, to be able to see and access the nerve roots. The facet joints, which can lie directly over the nerve roots, can be trimmed, for example, to allow more room for the nerve roots. The target disc and surrounding tissue can then be removed and the bone surfaces of adjacent vertebrae can be prepared (e.g., cleaned, abraded, debrided, textured, scored, coated with osteogenic powders or other agents, or combinations thereof). 
     The devices  2  can then be inserted into the target site. One or more devices  2  and/or bone graft (e.g., autograft, allograft, xenograft), BMP, or combinations thereof, can be inserted into the target site or disc space, for example, to promote fusion between the vertebrae. Additional instrumentation (e.g., rods or screws) can also be used at this time to further stabilize the spine. 
     TLIF can include delivering the device  2  to the spine in a path more from the side of the spinal canal than a PLIF approach and through a midline incision in the patient&#39;s back. TLIF can reduce the amount of surgical muscle dissection and can minimizes nerve manipulation required to access the vertebrae, discs and nerves. 
     TLIF can include removing disc material from the spine and inserting the device(s)  2  and bone graft, BMP, screws, rods, or combinations thereof. 
     ALIF is performed inserting the from the front (anterior) of the body, usually through a 3-5 inch incision in the lower abdominal area or on the side. This incision may involve cutting through, and later repairing, the muscles in the lower abdomen. 
     A mini open ALIF approach can be performed. A mini open ALIF can preserves the muscles and allow access to the front of the spine through an incision. This approach maintains abdominal muscle strength and function and can be used to fuse the L5-S1 disc space, for example 
     Once the incision is made and the vertebrae are accessed, and after the abdominal muscles and blood vessels have been retracted, the disc material can be removed. The surgeon can then insert the devices  2  and/or bone graft, rods, screws, BMP, or combinations thereof, for example to stabilize the spine and facilitate fusion. 
     The target site for the device(s)  2  can be between sacral, lumbar, thoracic, cervical vertebrae, or combinations thereof. The target site can be between other bones, such as intercostal (between ribs), in the knee, elbow, wrist, ankle, or combinations thereof. 
       FIG. 56   b  illustrates that one (as shown) or more devices  2  can be inserted into the target site, such as in a vertebral body or on a vertebral body (e.g., between adjacent vertebral bodies). The longitudinal axis  4  of the device  2  can be oriented substantially perpendicular to the anterior-posterior axis  320  (i.e., parallel to a lateral axis). The concavity of the radius of curvature  300  can face anteriorly or posteriorly. 
     The device  2  can be filled with a filled before or after radial expansion. Tissue ingrowth can occur into the top plate through the top ports, bottom plate through the bottom ports, and elsewhere through the device. 
     The device  2  can provide fusion between the adjacent vertebrae. The devices  2  can have radiopaque and/or echogenic visualization markers, for example the markers can be along the top plate, bottom plate, and one or more panels of the plates. The deployment tool can also have one or more markers. The devices  2  can be inserted into multiple interbody target sites of the spine to provide fusion between adjacent vertebral bodies. A first device can be inserted into a first interbody site and a second device can be inserted into a second interbody site. The first and second devices can be inserted bilaterally, for example both devices can be inserted between the same first vertebra and second vertebra from opposite lateral sides. 
     Any or all elements of the device  2  and/or other devices or apparatuses described herein can be made from, for example, a single or multiple stainless steel alloys, nickel titanium alloys (e.g., Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin Specialty Metals, Elgin, Ill.; CON ICHROME® from Carpenter Metals Corp., Wyomissing, Pa.), nickel-cobalt alloys (e.g., MP35N® from Magellan Industrial Trading Company, Inc., Westport, Conn.), molybdenum alloys (e.g., molybdenum TZM alloy, for example as disclosed in International Pub. No. WO 03/082363 A2, published 9 Oct. 2003, which is herein incorporated by reference in its entirety), tungsten-rhenium alloys, for example, as disclosed in International Pub. No. WO 03/082363, polymers such as polyethylene teraphathalate (PET), polyester (e.g., DACRON® from E. I. Du Pont de Nemours and Company, Wilmington, Del.), poly ester amide (PEA), polypropylene, aromatic polyesters, such as liquid crystal polymers (e.g., Vectran, from Kuraray Co., Ltd., Tokyo, Japan), ultra high molecular weight polyethylene (i.e., extended chain, high-modulus or high-performance polyethylene) fiber and/or yarn (e.g., SPECTRA® Fiber and SPECTRA® Guard, from Honeywell International, Inc., Morris Township, N.J., or DYNEEMA® from Royal DSM N.V., Heerlen, the Netherlands), polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polyether ketone (PEK), polyether ether ketone (PEEK), poly ether ketone ketone (PEKK) (also poly aryl ether ketone ketone), nylon, polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris, France), aliphatic polyether polyurethanes (e.g., TECOFLEX® from Thermedics Polymer Products, Wilmington, Mass.), polyvinyl chloride (PVC), polyurethane, thermoplastic, fluorinated ethylene propylene (FEP), absorbable or resorbable polymers such as polyglycolic acid (PGA), poly-L-glycolic acid (PLGA), polylactic acid (PLA), poly-L-lactic acid (PLLA), polycaprolactone (PCL), polyethyl acrylate (PEA), polydioxanone (PDS), and pseudo-polyamino tyrosine-based acids, extruded collagen, silicone, zinc, echogenic, radioactive, radiopaque materials, a biomaterial (e.g., cadaver tissue, collagen, allograft, autograft, xenograft, bone cement, morselized bone, osteogenic powder, beads of bone) any of the other materials listed herein or combinations thereof. Examples of radiopaque materials are barium sulfate, zinc oxide, titanium, stainless steel, nickel-titanium alloys, tantalum and gold. 
     The device  2  can be made from substantially 100% PEEK, substantially 100% titanium or titanium alloy, or combinations thereof. 
     Any or all elements of the device  2  and/or other devices or apparatuses described herein, can be, have, and/or be completely or partially coated with agents for cell ingrowth. 
     The device  2  and/or elements of the device and/or other devices or apparatuses described herein can be filled, coated, layered and/or otherwise made with and/or from cements, fillers, and/or glues known to one having ordinary skill in the art and/or a therapeutic and/or diagnostic agent. Any of these cements and/or fillers and/or glues can be osteogenic and osteoinductive growth factors. 
     Examples of such cements and/or fillers includes bone chips, demineralized bone matrix (DBM), calcium sulfate, coralline hydroxyapatite, biocoral, tricalcium phosphate, calcium phosphate, polymethyl methacrylate (PMMA), biodegradable ceramics, bioactive glasses, hyaluronic acid, lactoferrin, bone morphogenic proteins (BMPs) such as recombinant human bone morphogenetic proteins (rhBMPs), other materials described herein, or combinations thereof. 
     The agents within these matrices can include any agent disclosed herein or combinations thereof, including radioactive materials; radiopaque materials; cytogenic agents; cytotoxic agents; cytostatic agents; thrombogenic agents, for example polyurethane, cellulose acetate polymer mixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious, hydrophilic materials; phosphor cholene; anti-inflammatory agents, for example non-steroidal anti-inflammatories (NSAIDs) such as cyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, for example ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, for example ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamic acid), COX-2 inhibitors (e.g., VIOXX® from Merck &amp; Co., Inc., Whitehouse Station, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1 inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE®, from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP) inhibitors (e.g., tetracycline and tetracycline derivatives) that act early within the pathways of an inflammatory response. Examples of other agents are provided in Walton et al, Inhibition of Prostoglandin E 2  Synthesis in Abdominal Aortic Aneurysms, Circulation, Jul. 6, 1999, 48-54; Tambiah et al, Provocation of Experimental Aortic Inflammation Mediators and Chlamydia Pneumoniae, Brit. J. Surgery 88 (7), 935-940; Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and Its Effect on Inflammation and Proteolysis, Brit. J. Surgery 86 (6), 771-775; Xu et al, SpI Increases Expression of Cyclooxygenase-2 in Hypoxic Vascular Endothelium, J. Biological Chemistry 275 (32) 24583-24589; and Pyo et al, Targeted Gene Disruption of Matrix Metalloproteinase-9 (Gelatinase B) Suppresses Development of Experimental Abdominal Aortic Aneurysms, J. Clinical Investigation 105 (11), 1641-1649 which are all incorporated by reference in their entireties. 
     Any elements described herein as singular can be pluralized (i.e., anything described as “one” can be more than one). Any species element of a genus element can have the characteristics or elements of any other species element of that genus. The above-described configurations, elements or complete assemblies and methods and their elements for carrying out the invention, and variations of aspects of the invention can be combined and modified with each other in any combination.