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Publication number | US7563282 B2 |
Publication type | Grant |
Application number | US 10/442,659 |
Publication date | 21 Jul 2009 |
Filing date | 21 May 2003 |
Priority date | 18 Aug 1999 |
Fee status | Paid |
Also published as | CA2425951A1, CA2425951C, EP1328221A2, EP1328221A4, EP1328221B1, US7198047, US7258700, US7524333, US7867278, US8021425, US8257437, US8409284, US9333087, US20020151979, US20040030392, US20040034429, US20040260397, US20060217812, US20080215154, US20090281517, US20110106264, US20110118844, US20140005786, US20150374504, US20170056193, WO2002054978A2, WO2002054978A3 |
Publication number | 10442659, 442659, US 7563282 B2, US 7563282B2, US-B2-7563282, US7563282 B2, US7563282B2 |
Inventors | Greg H. Lambrecht, Robert Kevin Moore, Jacob Einhorn |
Original Assignee | Intrinsic Therapeutics, Inc. |
Export Citation | BiBTeX, EndNote, RefMan |
Patent Citations (104), Non-Patent Citations (36), Referenced by (34), Classifications (87), Legal Events (4) | |
External Links: USPTO, USPTO Assignment, Espacenet | |
This application is a continuation of U.S. application Ser. No. 10/055,504, filed on Oct. 25, 2001, now U.S. Pat. No. 7,258,700, which is a continuation-in-part of U.S. application Ser. No. 09/696,636 filed on Oct. 25, 2000, now issued as U.S. Pat. No. 6,508,839, which is a continuation-in-part of U.S. application Ser. No. 09/642,450 filed on Aug. 18, 2000, now issued as U.S. Pat. No. 6,482,235, which is a continuation-in-part of U.S. application Ser. No. 09/608,797 filed on Jun. 30, 2000, now issued as U.S. Pat. No. 6,425,919, and claims benefit to U.S. Provisional Application No. 60/311,586 filed Aug. 10, 2001, U.S. Provisional Application No. 60/304,545 filed on Jul. 10, 2001, U.S. Provisional Application No. 60/172,996 filed Dec. 21, 1999, U.S. Provisional Application No. 60/161,085 filed Oct. 25, 1999, and U.S. Provisional Application No. 60/149,490 filed Aug. 18, 1999, the entire teachings of these applications being incorporated herein by reference; and this application is a continuation in part of U.S. application Ser. No. 10/194,428, filed Jul. 10, 2002, now U.S. Pat. No. 6,936,072 which claims priority to U.S. Provisional Nos. 60/311,586, filed Aug. 10, 2001, and 60/304,545, filed Jul. 10, 2001, and this application is a continuation-in-part of U.S. application Ser. No. 10/020,507, filed Dec. 11, 2001, now U.S. Pat. No. 6,821,276, which claims priority to U.S. Provisional No. 60/298,605, filed Jun. 14, 2001, the entire contents of all of these applications are incorporated by reference herein.
1. Field of the Invention
The present invention relates to the surgical treatment of intervertebral discs in the lumbar, cervical, or thoracic spine that have suffered from tears in the anulus fibrosis, herniation of the nucleus pulposus and/or significant disc height loss.
2. Description of the Related Art
The disc performs the important role of absorbing mechanical loads while allowing for constrained flexibility of the spine. The disc is composed of a soft, central nucleus pulposus (NP) surrounded by a tough, woven anulus fibrosis (AF). Herniation is a result of a weakening in the AF. Symptomatic herniations occur when weakness in the AF allows the NP to bulge or leak posteriorly toward the spinal cord and major nerve roots. The most common resulting symptoms are pain radiating along a compressed nerve and low back pain, both of which can be crippling for the patient. The significance of this problem is increased by the low average age of diagnosis, with over 80% of patients in the U.S. being under 59.
Systems and methods for repairing tears in soft tissues are known in the art. Also, disclosed in the art are methods of augmenting the intervertebral disc. However, the efficacious treatment of intervertebral discs has not been adequately addressed using the systems and methods in the art. Accordingly, there still remains a need for devices and methods to treat intervertebral discs that have been compromised, including, but not limited to, discs that have suffered from tears in the anulus fibrosis, herniation of the nucleus pulposus and/or significant disc height loss.
Various embodiments of the present invention seek to exploit the individual characteristics of various anulus and nuclear augmentation devices to optimize the performance of both within the intervertebral disc. A primary function of anulus augmentation devices is to prevent or minimize the extrusion of materials from within the space normally occupied by the nucleus pulposus and inner anulus fibrosus. A primary function of nuclear augmentation devices is to at least temporarily add material to restore diminished disc height and pressure. Nuclear augmentation devices can also induce the growth or formation of material within the nuclear space. Accordingly, the inventive combination of these devices can create a synergistic effect wherein the anulus and nuclear augmentation devices serve to restore biomechanical function in a more natural biomimetic way. Furthermore, according to the invention both devices may be delivered more easily and less invasively. Also, the pressurized environment made possible through the addition of nuclear augmentation material and closing of the anulus serves both to restrain the nuclear augmentation and anchor the anulus augmentation in place.
One or more of the embodiments of the present invention also provide non-permanent, minimally invasive and removable devices for closing a defect in an anulus and augmenting the nucleus.
One or more of the embodiments of the present invention additionally provide and anulus augmentation device that is adapted for use with flowable nuclear augmentation material such that the flowable material cannot escape from the anulus after the anulus augmentation device has been implanted.
There is provided in accordance with one aspect of the present invention, a disc augmentation system configured to repair or rehabilitate an intervertebral disc. The system comprises at least one anulus augmentation device, and at least one nuclear augmentation material. The anulus augmentation device prevents or minimizes the extrusion of materials from within the space normally occupied by the nucleus pulposus and inner anulus fibrosus. In one application of the invention, the anulus augmentation device is configured for minimally invasive implantation and deployment. The anulus augmentation device may either be a permanent implant, or removable:
The nuclear augmentation material may restore diminished disc height and/or pressure. It may include factors for inducing the growth or formation of material within the nuclear space. It may either be permanent, removable, or absorbable.
The nuclear augmentation material may be in the form of liquids, gels, solids, or gases. It may include any/or combinations of steroids, antibiotics, tissue necrosis factors, tissue necrosis factor antagonists, analgesics, growth factors, genes, gene vectors, hyaluronic acid, noncross-linked collagen, collagen, fibren, liquid fat, oils, synthetic polymers, polyethylene glycol, liquid silicones, synthetic oils, saline and hydrogel. The hydrogel may be selected from the group consisting of acrylonitriles, acrylic acids, polyacrylimides, acrylimides, acrylimidines, polyacrylnitriles, and polyvinyl alcohols.
Solid form nuclear augmentation materials may be in the form of geometric shapes such as cubes, spheroids, disc-like components, ellipsoid, rhombohedral, cylindrical, or amorphous. The solid material may be in powder form, and may be selected from the group consisting of titanium, stainless steel, nitinol, cobalt, chrome, resorbable materials, polyurethane, polyesther, PEEK, PET, FEP, PTFE, ePTFE, PMMA, nylon, carbon fiber, Delrin, polyvinyl alcohol gels, polyglycolic acid, polyethylene glycol, silicone gel, silicone rubber, vulcanized rubber, gas-filled vesicles, bone, hydroxy apetite, collagen such as cross-linked collagen, muscle tissue, fat, cellulose, keratin, cartilage, protein polymers, transplanted nucleus pulposus, bioengineered nucleus pulposus, transplanted anulus fibrosis, and bioengineered anulus fibrosis. Structures may also be utilized, such as inflatable balloons or other inflatable containers, and spring-biased structures.
The nuclear augmentation material may additionally comprise a biologically active compound. The compound may be selected from the group consisting of drug carriers, genetic vectors, genes, therapeutic agents, growth renewal agents, growth inhibitory agents, analgesics, anti-infectious agents, and anti-inflammatory drugs.
In accordance with another aspect of the present invention, there is provided a method of repairing or rehabilitating an intervertebral disk. The method comprises the steps of inserting at least one anulus augmentation device into the disc, and inserting at least one nuclear augmentation material, to be held within the disc by the anulus augmentation device. The nuclear augmentation material may conform to a first, healthy region of the anulus, while the anulus augmentation device conforms to a second, weaker region of the anulus.
In one embodiment, a method of supporting and augmenting a nucleus pulposus of an intervertebral disc in a spine is provided. In one embodiment, a flexible biocompatible material is inserted into the disc space, the material being at least partially attached to an anchor. The biocompatible material is then anchored to a site within the functional spine unit. In one aspect, at least one plug of biocompatible material is inserted into the disc space. In several embodiments, the biocompatible material is disc-shaped, cube-like, spheroid, ellipsoid, rhombohedral, cylindrical and/or amorphous. In one embodiment, the material is collagen and/or cellulose. In some aspects, at least a portion of the collagen and/or cellulose is a hydrogel.
In one aspect of the invention, at least one portion of an anulus fibrosus of the disc is supported. In one embodiment, at least one portion of the anulus fibrosus is attached to the biocompatible material for support. In another embodiment, at least one portion of the anulus fibrosus is attached to the anchor for support. Regions to be supported include, but are not limited to, anterior, anterior medial, anterior lateral, posterior, and lateral portion of the anulus fibrosus.
In one embodiment, a method of supporting and augmenting a nucleus pulposus of an intervertebral disc in a spine is provided in which a first anchor is installed in a site in a spine, at least one connector leading from said anchor is provided, and at least one plug of biocompatible material is inserted into the disc space, wherein the plug is coupled with the connector. In one aspect, the connector is terminated so as to secure the plug. In several embodiments, the connector includes, but is not limited to, one or more sutures, wires, rigid rods, broad bands, pins, woven tubes and webs.
Further features and advantages of the present invention will become apparent to those of skill in the art in view of the detailed description of preferred embodiments which follows, when taken together with the attached drawings and claims.
The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.
The present invention provides for an in vivo augmented functional spine unit. A functional spine unit includes the bony structures of two adjacent vertebrae (or vertebral bodies), the soft tissue (anulus fibrosis (AF), and optionally nucleus pulposus (NP)) of the intervertebral disc, and the ligaments, musculature and connective tissue connected to the vertebrae. The intervertebral disc is substantially situated in the intervertebral space formed between the adjacent vertebrae. Augmentation of the functional spine unit can include repair of a herniated disc segment, support of a weakened, torn or damaged anulus fibrosis, or the addition of material to or replacement of all or part of the nucleus pulposus. Augmentation of the functional spine unit is provided by herniation constraining devices and disc augmentation devices situated in the intervertebral disc space.
Intervertebral disc 15 is comprised of the outer AF 10 which normally surrounds and constrains the NP 20 to be wholly within the borders of the intervertebral disc space. In
Partial disruption 121 of the inner layers of the anulus 10 without a true perforation has also been linked to chronic low back pain. Such a disruption 4 is illustrated in
In one embodiment of the present invention, the disc herniation constraining devices 13 provide support for returning all or part of the herniated segment 30 to a position substantially within its pre-herniated borders 40. The disc herniation constraining device includes an anchor which is positioned at a site within the functional spine unit, such as the superior or inferior vertebral body, or the anterior medial, or anterior lateral anulus fibrosis. The anchor is used as a point against which all or part of the herniated segment is tensioned so as to return the herniated segment to its pre-herniated borders, and thereby relieve pressure on otherwise compressed neural tissue and structures. A support member is positioned in or posterior to the herniated segment, and is connected to the anchor by a connecting member. Sufficient tension is applied to the connecting member so that the support member returns the herniated segment to a pre-herniated position. In various embodiments, augmentation material is secured within the intervertebral disc space, which assists the NP in cushioning and supporting the inferior and superior vertebral bodies. An anchor secured in a portion of the functional spine unit and attached to the connection member and augmentation material limits movement of the augmentation material within the intervertebral disc space. A supporting member, located opposite the anchor, may optionally provide a second point of attachment for the connection member and further hinder the movement of the augmentation material within the intervertebral disc space.
Anchor 1 is depicted in a representative form, as it can take one of many suitable shapes, be made from one of a variety of biocompatible materials, and be constructed so as to fall within a range of stiffness. It can be a permanent device constructed of durable plastic or metal or can be made from a resorbable material such as polylactic acid (PLA) or polyglycolic acid (PGA). Specific embodiments are not shown, but many possible designs would be obvious to anyone skilled in the art. Embodiments include, but are not limited to, a barbed anchor made of PLA or a metal coil that can be screwed into the anterior AF. Anchor 1 can be securely established within a portion of the functional spine unit in the usual and customary manner for such devices and locations, such as being screwed into bone, sutured into tissue or bone, or affixed to tissue or bone using an adhesive method, such as cement, or other suitable surgical adhesives. Once established within the bone or tissue, anchor 1 should remain relatively stationary within the bone or tissue.
Support member 2 is also depicted in a representative format and shares the same flexibility in material and design as anchor 1. Both device elements can be of the same design, or they can be of different designs, each better suited to being established in healthy and diseased tissue respectively. Alternatively, in other forms, support member 2 can be a cap or a bead shape, which also serves to secure a tear or puncture in the AF, or it can be bar or plate shaped, with or without barbs to maintain secure contact with the herniated segment. Support member 2 can be established securely to, within, or posterior to the herniated segment.
The anchor and support member can include suture, bone anchors, soft tissue anchors, tissue adhesives, and materials that support tissue ingrowth although other forms and materials are possible. They may be permanent devices or resorbable. Their attachment to a portion of FSU and herniated segment must be strong enough to resist the tensional forces that result from repair of the hernia and the loads generated during daily activities.
Connection member 3 is also depicted in representative fashion. Member 3 may be in the format of a flexible filament, such as a single or multi-strand suture, wire, or perhaps a rigid rod or broad band of material, for example. The connection member can further include suture, wire, pins, and woven tubes or webs of material. It can be constructed from a variety of materials, either permanent or resorbable, and can be of any shape suitable to fit within the confines of the intervertebral disc space. The material chosen is preferably adapted to be relatively stiff while in tension, and relatively flexible against all other loads. This allows for maximal mobility of the herniated segment relative to the anchor without the risk of the supported segment moving outside of the pre-herniated borders of the disc. The connection member may be an integral component of either the anchor or support member or a separate component. For example, the connection member and support member could be a length of non-resorbing suture that is coupled to an anchor, tensioned against the anchor, and sewn to the herniated segment.
Generally, a suitable position for affixing one or more anchors is a location anterior to the herniated segment such that, when tension is applied along connection member 3, herniated segment 30 is returned to a site within the pre-herniated borders 40. The site chosen for the anchor should be able to withstand the tensile forces applied to the anchor when the connection member is brought under tension. Because most symptomatic herniations occur in the posterior or posterior lateral directions, the preferable site for anchor placement is anterior to the site of the herniation. Any portion of the involved FSU is generally acceptable, however the anterior, anterior medial, or anterior lateral AF is preferable. These portions of the AF have been shown to have considerably greater strength and stiffness than the posterior or posterior lateral portions of the AF. As shown in
In various forms of the invention, the anchor(s) and connection member(s) may be introduced and implanted in the patient, with the connection member under tension. Alternatively, those elements may be installed, without introducing tension to the connection member, but where the connection member is adapted to be under tension when the patient is in a non-horizontal position, i.e., resulting from loading in the intervertebral disc.
A further embodiment of the present invention involves augmentation of the soft tissues of the intervertebral disc to avoid or reverse disc height loss.
Augmentation material 7 may have a passageway 9, such as a channel, slit or the like, which allows it to slide along the connection member 3, or augmentation material 7 may be solid, and connection member 3 can be threaded through augmentation material by means such as needle or other puncturing device. Connection member 3 is affixed at one end to anchor 1 and terminated at its other end by a support member 2′, one embodiment of which is shown in the figure in a cap-like configuration. Support member 2′ can be affixed to connection member 3 in a variety of ways, including, but not limited to, swaging support member 2′ to connection member 3. In a preferred embodiment, support member 2′ is in a cap configuration and has a dimension (diameter or length and width) larger than the optional passageway 9, which serves to prevent augmentation material 7 from displacing posteriorly with respect to anchor 1. The right half of the intervertebral disc of
Augmentation or spacer material can be made of any biocompatible, preferably flexible, material. Such a flexible material is preferably fibrous, like cellulose or bovine or autologous collagen. The augmentation material can be plug or disc shaped. It can further be cube-like, ellipsoid, spheroid or any other suitable shape. The augmentation material can be secured within the intervertebral space by a variety of methods, such as but not limited to, a suture loop attached to, around, or through the material, which is then passed to the anchor and support member.
Any of the devices described herein can be used for closing defects in the AF whether created surgically or during the herniation event. Such methods may also involve the addition of biocompatible material to either the AF or NP. This material could include sequestered or extruded segments of the NP found outside the pre-herniated borders of the disc.
The method consists of inserting the barrier 12 into the interior of the disc 15 and positioning it proximate to the interior aspect of the anulus defect 16. The barrier material is preferably considerably larger in area than the size of the defect 16, such that at least some portion of the barrier means 12 abuts healthier anulus fibrosis 10. The device acts to seal the anulus defect 16, recreating the closed isobaric environment of a healthy disc nucleus 20. This closure can be achieved simply by an over-sizing of the implant relative to the defect 16. It can also be achieved by affixing the barrier means 12 to tissues within the functional spinal unit. In a preferred aspect of the present invention, the barrier 12 is affixed to the anulus surrounding the anulus defect 16. This can be achieved with sutures, staples, glues or other suitable fixation means or fixation device 14. The barrier means 12 can also be larger in area than the defect 16 and be affixed to a tissue or structure opposite the defect 16, i.e. anterior tissue in the case of a posterior defect.
The barrier means 12 is preferably flexible in nature. It can be constructed of a woven material such as Dacron™ or Nylon™, a synthetic polyamide or polyester, a polyethylene, and can further be an expanded material, such as expanded polytetrafluroethylene (e-PTFE), for example. The barrier means 12 can also be a biologic material such as cross-linked collagen or cellulous.
The barrier means 12 can be a single piece of material. It can have an expandable means or component that allows it to be expanded from a compressed state after insertion into the interior of the disc 15. This expandable means can be active, such as a balloon, or passive, such as a hydrophilic material. The expandable means can also be a self-expanding elastically deforming material, for example.
The barrier means 12 can also be anchored to the disc 15 in multiple locations. In one preferred embodiment, shown in
The barrier means 12 can further be integral to a fixation means such that the barrier means affixes itself to tissues within the functional spinal unit.
Any of the methods described above can be augmented by the use of a second barrier or a second barrier means 24 placed proximate to the outer aspect of the defect 16 as shown in
To prevent further herniation of the nucleus 20 and to repair any present herniation, in a preferred embodiment, a barrier or barrier means 12 can be placed into a space between the anulus 10 and the nucleus 20 proximate to the inner aspect 32 of defect 16, as depicted in
In position, the barrier means 12 preferably spans the defect 16 and extends along the interior aspect 36 of the anulus 10 until it contacts healthy tissues on all sides of the defect 16, or on a sufficient extent of adjacent healthy tissue to provide adequate support under load. Healthy tissue may be non-diseased tissue and/or load bearing tissue, which may be micro-perforated or non-perforated. Depending on the extent of the defect 16, the contacted tissues can include the anulus 10, cartilage overlying the vertebral endplates, and/or the endplates themselves.
In the preferred embodiment, the barrier means 12 comprises two components—a sealing means or sealing component 51 and an enlarging means or enlarging component 53, shown in
The sealing means 51 forms the periphery of the barrier 12 and has an interior cavity 17. There is at least one opening 8 leading into cavity 17 from the exterior of the sealing means 51. Sealing means 51 is preferably compressible or collapsible to a dimension that can readily be inserted into the disc 15 through a relatively small hole. This hole can be the defect 16 itself or a site remote from the defect 16. The sealing means 51 is constructed from a material and is formed in such a manner as to resist the passage of fluids and other materials around sealing means 51 and through the defect 16. The sealing means 51 can be constructed from one or any number of a variety of materials including, but not limited to PTFE, e-PTFE, Nylon™, Marlex™, high-density polyethylene, and/or collagen. The thickness of the sealing component has been found to be optimal between about 0.001 inches (0.127 mm) and 0.063 inches (1.6 mm).
The enlarging means 53 can be sized to fit within cavity 17 of sealing means 51. It is preferably a single object of a dimension that can be inserted through the same defect 16 through which the sealing means 51 was passed. The enlarging means 53 can expand the sealing means 51 to an expanded state as it is passed into cavity 17. One purpose of enlarging means 53 is to expand sealing means 51 to a size greater than that of the defect 16 such that the assembled barrier 12 prevents passage of material through the defect 16. The enlarger 53 can further impart stiffness to the barrier 12 such that the barrier 12 resists the pressures within nucleus pulposus 20 and expulsion through the defect 16. The enlarging means 53 can be constructed from one or any number of materials including, but not limited to, silicon rubber, various plastics, stainless steel, nickel titanium alloys, or other metals. These materials may form a solid object, a hollow object, coiled springs or other suitable forms capable of filling cavity 17 within sealing means 51.
The sealing means 51, enlarging means 53, or the barrier means 12 constructs can further be affixed to tissues either surrounding the defect 16 or remote from the defect 16. In the preferred embodiment, no aspect of a fixation means or fixation device or the barrier means 12 nor its components extend posterior to the disc 15 or into the extradiscal region 500, avoiding the risk of contacting and irritating the sensitive nerve tissues posterior to the disc 15.
In a preferred embodiment, the sealing means 51 is inserted into the disc 15 proximate the interior aspect 36 of the defect. The sealing means 51 is then affixed to the tissues surrounding the defect using a suitable fixation means, such as suture or a soft-tissue anchor. The fixation procedure is preferably performed from the interior of the sealing means cavity 17 as depicted in
Another method of securing the barrier 12 to tissues is to affix the enlarging means 53 to tissues either surrounding or remote from the defect 16. The enlarging means 53 can have an integral fixation region 4 that facilitates securing it to tissues as depicted in
Another method of securing the barrier means 12 is to insert the barrier means 12 through the defect 16 or another opening into the disc 15, position it proximate to the interior aspect 36 of the defect 16, and pass at least one fixation means 14 through the anulus 10 and into the barrier 12. In a preferred embodiment of this method, the fixation means 14 can be darts 15 and are first passed partially into anulus 10 within a fixation device 120, such as a hollow needle. As depicted in
In another aspect of the present invention, the barrier (or "patch") 12 can be placed between two neighboring layers 33, 37 (lamellae) of the anulus 10 on either or both sides of the defect 16 as depicted in
A dissecting tool can be used to form an opening extending circumferentially 31 within the anulus fibrosis such that the barrier can be inserted into the opening. Alternatively, the barrier itself can have a dissecting edge such that it can be driven at least partially into the sidewalls of defect 16, annulotomy 416, access hole 417 or opening in the anulus. This process can make use of the naturally layered structure in the anulus in which adjacent layers 33, 37 are defined by a circumferentially extending boundary 35 between the layers.
Another embodiment of the barrier 12 is a patch having a length, oriented along the circumference of the disc, which is substantially greater than its height, which is oriented along the distance separating the surrounding vertebral bodies. A barrier 12 having a length greater than its height is illustrated in
The barrier 12 can be used in conjunction with an augmentation device 11 inserted within the anulus 10. The augmentation device 11 can include separate augmentation devices 42 as shown in
In another embodiment of the present invention, the barrier or patch 12 may be used as part of a method to augment the intervertebral disc. In one aspect of this method, augmentation material or devices are inserted into the disc through a defect (either naturally occurring or surgically generated). Many suitable augmentation materials and devices are discussed above and in the prior art. As depicted in
Another method of securing the barrier means 12 is to adhere it to surrounding tissues through the application of heat. In this embodiment, the barrier means 12 includes a sealing means 51 comprised of a thermally adherent material that adheres to surrounding tissues upon the application of heat. The thermally adherent material can include thermoplastic, collagen, or a similar material. The sealing means 51 can further comprise a separate structural material that adds strength to the thermally adherent material, such as a woven Nylon™ or Marlex™. This thermally adherent sealing means preferably has an interior cavity 17 and at least one opening 8 leading from the exterior of the barrier means into cavity 17. A thermal device can be attached to the insertion instrument shown in
The barrier means 12 shown in
The cross section of the barrier 12 can be any of a number of shapes. Each embodiment exploits a sealing means 51 and an enlarging means 53 that may further add stiffness to the overall barrier construct.
The expansion means 53 shown in
The patterns shown in
This embodiment employs a multitude of fingers 162 to aid in holding a flexible sealer or membrane against the superior and inferior vertebral endplates. The distance between the superior-most point of the superior finger and the inferior-most point on the inferior finger is the expansion means height 172. This height 172 is preferably greater than the disc height at the inner surface of the posterior anulus. The greater height 172 of the expander 153 allows the fingers 162 to deflect along the superior and inferior vertebral endplates, enhancing the seal of the barrier means 12 against egress of material from within the disc 15.
The spacing between the fingers 162 along the expander length 170 can be tailored to provide a desired stiffness of the expansion means 153. Greater spacing between any two neighboring fingers 162 can further be employed to insure that the fingers 170 do not touch if the expansion means 153 is required to take a bend along its length. The central strut 164 can connect the fingers and dissecting ends and preferably lies along the inner surface of the anulus 10 when seated within the disc 15. Various embodiments may employ struts 164 of greater or lesser heights and thicknesses to vary the stiffness of the overall expansion means 153 along its length 170 and height 172.
The bending stiffness of expander 153 can resist migration of the implant from this preferred position within the disc 15. The principle behind this stiffness-based stability is to place the regions of expander 153 with the greatest flexibility in the regions of the disc 153 with the greatest mobility or curvature. These flexible regions of expander 153 are surrounded by significantly stiffer regions. Hence, in order for the implant to migrate, a relatively stiff region of the expander must move into a relatively curved or mobile region of the disc.
For example, in order for expander 153 of
The expander 153 is preferably covered by a membrane that acts to further restrict the movement of materials through the frame and toward the outer periphery of the anulus fibrosis.
The embodiment of the frame 153 as shown in
The struts 192 can be spaced to provide nuclear gaps 194. These gaps 194 can encourage the flow of nucleus pulposus 20 into the interior of the expander 154. This flow can insure full expansion of the barrier 12 within the disc 15 during deployment.
The embodiments of
Pulling on the control filament 406 causes the implant 400 to move toward the annulotomy 416. The distal end 410 of the delivery cannula 402 can be used to direct the proximal end 420 of the implant 400 (that portion of the implant 400 that is last to be expelled from the delivery cannula 402) away from the annulotomy 416 and toward an inner aspect of the anulus 10 nearest the desired implant location. Alternately, the advancer 404 can be used to position the proximal end of the implant toward an inner aspect of the anulus 20 near the implant location, as shown in
The implant 400 can be any of the following: nucleus replacement device, nucleus augmentation device, anulus augmentation device, anulus replacement device, the barrier of the present invention or any of its components, drug carrier device, carrier device seeded with living cells, or a device that stimulates or supports fusion of the surrounding vertebra. The implant 400 can be a membrane which prevents the flow of a material from within the anulus fibrosis of an intervertebral disc through a defect in the disc. The material within the anulus fibrosis can be, for example, a nucleus pulposus or a prosthetic augmentation device, such as hydrogel. The membrane can be a sealer. The implant 400 can be wholly or partially rigid or wholly or partially flexible. It can have a solid portion or portions that contain a fluid material. It can comprise a single or multitude of materials. These materials can include metals, polymers, gels and can be in solid or woven form. The implant 400 can either resist or promote tissue ingrowth, whether fibrous or bony.
The cannula 402 can be any tubular device capable of advancing the implant 400 at least partially through the anulus 10. It can be made of any suitable biocompatible material including various known metals and polymers. It can be wholly or partially rigid or flexible. It can be circular, oval, polygonal, or irregular in cross section. It must have an opening at least at its distal end 410, but can have other openings in various locations along its length.
The advancer 404 can be rigid or flexible, and have one of a variety of cross sectional shapes either like or unlike the delivery cannula 402. It may be a solid or even a column of incompressible fluid, so long as it is stiff enough to advance the implant 400 into the disc 15. The advancer 404 can be contained entirely within the cannula 402 or can extend through a wall or end of the cannula to facilitate manipulation.
Advancement of the implant 400 can be assisted by various levers, gears, screws and other secondary assist devices to minimize the force required by the surgeon to advance the implant 400. These secondary devices can further give the user greater control over the rate and extent of advancement into the disc 15.
The guide filament 406 may be a string, rod, plate, or other elongate object that can be secured to and move with the implant 400 as it is advanced into the disc 15. It can be constructed from any of a variety of metals or polymers or combination thereof and can be flexible or rigid along all or part of its length. It can be secured to a secondary object 418 or device at its end opposite that which is secured to the implant 400. This secondary device 418 can include the advancer 404 or other object or device that assists the user in manipulating the filament. The filament 406 can be releasably secured to the implant 400, as shown in
Multiple guide filaments can be secured to the implant 400 at various locations. In one preferred embodiment, a first or distal 422 and a second or proximal 424 guide filament are secured to an elongate implant 400 at or near its distal 412 and proximal 420 ends at attachment sites 426 and 428, respectively. These ends 412 and 420 correspond to the first and last portions of the implant 400, respectively, to be expelled from the delivery cannula 402 when advanced into the disc 15. This double guide filament system allows the implant 400 to be positioned in the same manner described above in the single filament technique, and illustrated in
Both the first 422 and second 424 guide filaments can be simultaneously tensioned, as shown in
In another embodiment of the present invention, as illustrated in
The implant guide 430 is releasable from the implant 400 following or during implantation. This release may be coordinated with the release of the guide filaments 422 and 424. The implant guide 430 may further be able to slide along the guide filaments 422 and 424 while these filaments are secured to the implant 400.
Various embodiments of the barrier 12 or implant 400 can be secured to tissues within the intervertebral disc 15 or surrounding vertebrae. It can be advantageous to secure the barrier means 12 in a limited number of sites while still insuring that larger surfaces of the barrier 12 or implant juxtapose the tissue to which the barrier 12 is secured. This is particularly advantageous in forming a sealing engagement with surrounding tissues.
Each stiffening element can aid in securing segments of the barrier 12 to surrounding tissues. The stiffening elements can have parts 307, including through-holes, notches, or other indentations for example, to facilitate fixation of the stiffening element 300 to surrounding tissues by any of a variety of fixation devices 306. These fixation devices 306 can include screws, darts, dowels, or other suitable means capable of holding the barrier 12 to surrounding tissue. The fixation devices 306 can be connected either directly to the stiffening element 300 or indirectly using an intervening length of suture, cable, or other filament for example. The fixation device 306 can further be secured to the barrier 12 near the stiffening element 300 without direct contact with the stiffening element 300.
The fixation device 306 can be secured to or near the stiffening element 300 at opposing ends of the length of the barrier 12 required to be in sealing engagement with surrounding tissues. Alternatively, one or a multitude of fixation devices 306 can be secured to or near the stiffening element 300 at a readily accessible location that may not be at these ends. In any barrier 12 embodiment with an interior cavity 17 and an opening 8 leading thereto, the fixation sites may be proximal to the opening 8 to allow passage of the fixation device 306 and various instruments that may be required for their implantation.
Various methods may be employed to decrease the forces necessary to maneuver the barrier 12 into a position along or within the lamellae of the anulus fibrosis 10.
In the undeployed state depicted in
Certain embodiments, as shown in
Fluid nuclear augmentation 554 is particularly well-suited for use in various aspects of the current invention because it can be delivered with minimal invasiveness and because it is able to flow into and fill minute voids of the intervertebral disc space. Fluid nuclear augmentation 554 is also uniquely suited for maintaining a pressurized environment that evenly transfers the force exerted by the endplates to the anulus augmentation device and/or the anulus. However, fluid nuclear augmentation materials 554 used alone may perform poorly in discs 15 with a degenerated anulus because the material can flow back out through anulus defects 8 and pose a risk to surrounding structures. This limitation is overcome by several embodiments of the current invention because the barrier 12 shunts the pressure caused by the fluid augmentation 554 away from the damaged anulus region 8 and toward healthier regions, thus restoring function to the disc 15 and reducing risk of the extrusion of nuclear augmentation materials 7 and fluid augmentation material 554.
Exemplary fluid nuclear augmentation materials 554 include, but are not limited to, various pharmaceuticals (steroids, antibiotics, tissue necrosis factor alpha or its antagonists, analgesics); growth factors, genes or gene vectors in solution; biologic materials (hyaluronic acid, non-crosslinked collagen, fibrin, liquid fat or oils); synthetic polymers (polyethylene glycol, liquid silicones, synthetic oils); and saline. One skilled in the art will understand that any one of these materials may be used alone or that a combination of two or more of these materials may be used together to form the nuclear augmentation material.
Any of a variety of additional additives such as thickening agents, carriers, polymerization initiators or inhibitors may also be included, depending upon the desired infusion and long-term performance characteristics. In general, "fluid" is used herein to include any material which is sufficiently flowable at least during the infusion process, to be infused through an infusion lumen in the delivery device into the disc space. The augmentation material 554 may remain "fluid" after the infusion step, or may polymerize, cure, or otherwise harden to a less flowable or nonflowable state.
Additional additives and components of the nucleus augmentation material are recited below. In general, the nature of the material 554 may remain constant during the deployment and post-deployment stages or may change, from a first infusion state to a second, subsequent implanted state. For example, any of a variety of materials may desirably be infused using a carrier such as a solvent or fluid medium with a dispersion therein. The solvent or liquid carrier may be absorbed by the body or otherwise dissipate from the disc space post-implantation, leaving the nucleus augmentation material 554 behind. For example, any of a variety of the powders identified below may be carried using a fluid carrier. In addition, hydrogels or other materials may be implanted or deployed while in solution, with the solvent dissipating post-deployment to leave the hydrogel or other media behind. In this type of application, the disc space may be filled under higher than ultimately desired pressure, taking into account the absorption of a carrier volume. Additional specific materials and considerations are disclosed in greater detail below.
Solid or gel nuclear augmentation materials 7 used in various embodiments of the current invention include single piece or multiple pieces. The solid materials 7 may be cube-like, spheroid, disc-like, ellipsoid, rhombohedral, cylindrical, or amorphous in shape. These materials 7 may be in woven or non-woven form. Other forms of solids including minute particles or even powder can be considered when used in combination with the barrier device. Candidate materials 7 include, but are not limited to: metals, such as titanium, stainless steels, nitinol, cobalt chrome; resorbable or non-resorbing synthetic polymers, such as polyurethane, polyester, PEEK, PET, FEP, PTFE, ePTFE, Teflon, PMMA, nylon, carbon fiber, Delrin, polyvinyl alcohol gels, polyglycolic acid, polyethylene glycol; silicon gel or rubber, vulcanized rubber or other elastomer; gas filled vesicles, biologic materials such as morselized or block bone, hydroxy apetite, cross-linked collagen, muscle tissue, fat, cellulose, keratin, cartilage, protein polymers, transplanted or bioengineered nucleus pulposus or anulus fibrosus; or various pharmacologically active agents in solid form. The solid or gel augmentation materials 7 may be rigid, wholly or partially flexible, elastic or viscoelastic in nature. The augmentation device or material 7 may be hydrophilic or hydrophobic. Hydrophilic materials, mimicking the physiology of the nucleus, may be delivered into the disc in a hydrated or dehydrated state. Biologic materials may be autologous, allograft, zenograft, or bioengineered.
In various embodiments of the present invention, the solid or gel nuclear augmentation material 7, as depicted in
In one aspect of the invention, the nuclear augmentation material or device 7, 554 constructed therefrom is phase changing, i.e. from liquid to solid, solid to liquid, or liquid to gel. In situ polymerizing nuclear augmentation materials are well-known in the art and are described in U.S. Pat. No. 6,187,048, herein incorporated by reference. Phase changing augmentation preferably changes from a liquid to a solid or gel. Such materials may change phases in response to contact with air, increases or decreases in temperature, contact with biologic liquids or by the mixture of separate reactive constituents. These materials are advantageous because they can be delivered through a small hole in the anulus or down a tube or cannula placed percutaneously into the disc. Once the materials have solidified or gelled, they can exhibit the previously described advantages of a solid augmentation material. In a preferred embodiment, the barrier device is used to seal and pressurize a phase changing material to aid in its delivery by forcing it into the voids of the disc space while minimizing the risk of extrusion of the material while it is a fluid. In this situation, the barrier or anulus augmentation device 12 may be permanently implanted or used only temporarily until the desired phase change has occurred.
Another aspect of the present invention includes an anulus augmentation device 12 that exploits the characteristics of nucleus augmentation devices or materials to improve its own performance. Augmenting the nucleus 20 pressurizes the intervertebral disc environment which can serve to fix or stabilize an anulus repair device in place. The nucleus 20 can be pressurized by inserting into the disc 15 an adequate amount of augmentation material 7, 554. In use, the pressurized disc tissue and augmentation material 7, 554 applies force on the inwardly facing surface of the anulus augmentation device 12. This pressure may be exploited by the design of the anulus prosthesis or barrier 12 to prevent it from dislodging or moving from its intended position. One exemplary method is to design the inwardly facing surface of the anulus prosthesis 12 to expand upon the application of pressure. As the anulus prosthesis 12 expands, it becomes less likely to be expelled from the disc. The prosthesis 12 may be formed with a concavity facing inward to promote such expansion.
In several embodiments, the anulus augmentation device 12 itself functions as nuclear augmentation 7. In a preferred embodiment, the barrier 12 frame is encapsulated in ePTFE. This construct typically displaces a volume of 0.6 cubic centimeters, although thicker coatings of ePTFE or like materials may be used to increase this volume to 3 cubic centimeters. Also, the anulus augmentation device may be designed with differentially thickened regions along its area.
Alternatively, the anulus augmentation device 12 and nuclear augmentation material 7 may be fabricated as a single device with a barrier 12 region and a nuclear augmentation region 7. As an example, the barrier 12 may form at least a portion of the surface of an augmentation sack 455 or balloon. The sack 455 may be filled with suitable augmentation materials 7 once the barrier has been positioned along a weakened inner surface of the anulus 10.
The sequence of inserting the barrier 12 and nuclear augmentation 7 in the disc can be varied according to the nuclear augmentation 7 used or requirements of the surgical procedure. For example, the nuclear augmentation 7 can be inserted first and then sealed in place by the barrier device 12. Alternatively, the disc 15 can be partially filled, then sealed with the barrier device 12, and then supplied with additional material 7. In a preferred embodiment, the barrier device 12 is inserted into the disc 15 followed by the addition of nuclear augmentation material 7 through or around the barrier 12. This allows for active pressurization. A disc 15 with a severely degenerated anulus can also be effectively treated in this manner.
In an alternative embodiment, the nuclear augmentation material 7 is delivered through a cannula inserted through an access hole 417 in the disc 15 formed pathologically, e.g. an anular defect 8, or iatrogenically, e.g. an anuulotomy 416 that is distinct from the access hole 417 that was used to implant the barrier 12. Also, the same or different surgical approach including transpsoas, presacral, transsacral, tranpedicular, translaminar, or anteriorly through the abdomen, may be used. Access hole 417 can be located anywhere along the anulus surface or even through the vertebral endplates.
In alternative embodiments, the anulus augmentation device 12 includes features that facilitate the introduction of augmentation materials 554 following placement. The augmentation delivery cannula may simply be forcibly driven into an access hole 417 proximal to the barrier 12 at a slight angle so that the edge of the barrier 12 deforms and allows passage into the disc space. Alternatively, a small, flexible or rigid curved delivery needle or tube may be inserted through an access hole 417 over (in the direction of the superior endplate) or under (in the direction of the inferior endplate) the barrier 12 or around an edge of the barrier 12 contiguous with the anulus 15.
In several embodiments, ports or valves are installed in the barrier 12 device that permit the flow of augmentation material into, but not out of, the disc space. One-way valves 450 or even flaps of material held shut by the intervertebral pressure may be used. A collapsible tubular valve may be fashioned along a length of the barrier. In one embodiment, multiple valves or ports 450 are present along the device 12 to facilitate alignment with the access hole 417 and delivery of augmentation material. Flow channels within or on the barrier 12 to direct the delivery of the material 554 (e.g. to the ends of the barrier) can be machined, formed into or attached to the barrier 12 along its length. Alternatively, small delivery apertures (e.g. caused by a needle) can be sealed with a small amount of adhesive or sutured shut.
One skilled in the art will appreciate that any of the above procedures involving nuclear augmentation and/or anulus augmentation may be performed with or without the removal of any or all of the autologous nucleus. Further, the nuclear augmentation materials and/or the anulus augmentation device may be designed to be safely and efficiently removed from the intervertebral disc in the event they no longer be required.
While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims.
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US7727241 | 21 Jun 2004 | 1 Jun 2010 | Intrinsic Therapeutics, Inc. | Device for delivering an implant through an annular defect in an intervertebral disc |
US7749275 | 20 Sep 2004 | 6 Jul 2010 | Intrinsic Therapeutics, Inc. | Method of reducing spinal implant migration |
US7857857 * | 10 Nov 2005 | 28 Dec 2010 | The Board Of Trustees Of The Leland Stanford Junior University | Devices, systems and methods for augmenting intervertebral discs |
US7867278 * | 14 Mar 2008 | 11 Jan 2011 | Intrinsic Therapeutics, Inc. | Intervertebral disc anulus implant |
US7879097 | 3 May 2006 | 1 Feb 2011 | Intrinsic Therapeutics, Inc. | Method of performing a procedure within a disc |
US7931689 | 19 Mar 2004 | 26 Apr 2011 | Spineology Inc. | Method and apparatus for treating a vertebral body |
US7959679 | 16 Jan 2007 | 14 Jun 2011 | Intrinsic Therapeutics, Inc. | Intervertebral anulus and nucleus augmentation |
US7972337 | 19 Dec 2006 | 5 Jul 2011 | Intrinsic Therapeutics, Inc. | Devices and methods for bone anchoring |
US7998213 | 17 Nov 2006 | 16 Aug 2011 | Intrinsic Therapeutics, Inc. | Intervertebral disc herniation repair |
US8002836 | 20 Sep 2004 | 23 Aug 2011 | Intrinsic Therapeutics, Inc. | Method for the treatment of the intervertebral disc anulus |
US8021425 * | 21 Jul 2009 | 20 Sep 2011 | Intrinsic Therapeutics, Inc. | Versatile method of repairing an intervertebral disc |
US8025698 | 27 Apr 2009 | 27 Sep 2011 | Intrinsic Therapeutics, Inc. | Method of rehabilitating an anulus fibrosus |
US8105384 | 29 Jun 2009 | 31 Jan 2012 | Intrinsic Therapeutics, Inc. | Weakened anulus repair |
US8114082 | 20 Aug 2009 | 14 Feb 2012 | Intrinsic Therapeutics, Inc. | Anchoring system for disc repair |
US8163018 * | 14 Feb 2006 | 24 Apr 2012 | Warsaw Orthopedic, Inc. | Treatment of the vertebral column |
US8231678 | 3 May 2006 | 31 Jul 2012 | Intrinsic Therapeutics, Inc. | Method of treating a herniated disc |
US8257437 | 10 Jan 2011 | 4 Sep 2012 | Intrinsic Therapeutics, Inc. | Methods of intervertebral disc augmentation |
US8323341 | 12 Nov 2009 | 4 Dec 2012 | Intrinsic Therapeutics, Inc. | Impaction grafting for vertebral fusion |
US8361155 | 19 Jan 2010 | 29 Jan 2013 | Intrinsic Therapeutics, Inc. | Soft tissue impaction methods |
US8394146 | 1 Jul 2011 | 12 Mar 2013 | Intrinsic Therapeutics, Inc. | Vertebral anchoring methods |
US8409284 | 10 Jan 2011 | 2 Apr 2013 | Intrinsic Therapeutics, Inc. | Methods of repairing herniated segments in the disc |
US8454612 | 20 Aug 2009 | 4 Jun 2013 | Intrinsic Therapeutics, Inc. | Method for vertebral endplate reconstruction |
US8632591 | 17 Oct 2007 | 21 Jan 2014 | Ldr Medical | Nucleus prostheses |
US9039741 | 7 Mar 2013 | 26 May 2015 | Intrinsic Therapeutics, Inc. | Bone anchor systems |
US9226832 | 28 Jan 2013 | 5 Jan 2016 | Intrinsic Therapeutics, Inc. | Interbody fusion material retention methods |
US9333087 | 22 Dec 2014 | 10 May 2016 | Intrinsic Therapeutics, Inc. | Herniated disc repair |
US9358122 | 9 Jan 2012 | 7 Jun 2016 | K2M, Inc. | Interbody spacer |
US20050004578 * | 5 Feb 2003 | 6 Jan 2005 | Lambrecht Gregory H. | Apparatus delivery in an intervertebral disc |
US20060247776 * | 2 May 2005 | 2 Nov 2006 | The Board Of Trustees Of The Leland Stanford Junior University | Systems and methods for augmenting intervertebral discs |
US20060247784 * | 10 Nov 2005 | 2 Nov 2006 | Kim Daniel H | Devices, systems and methods for augmenting intervertebral discs |
US20070260249 * | 19 Dec 2006 | 8 Nov 2007 | Thomas Boyajian | Devices and methods for bone anchoring |
US20080312743 * | 17 Oct 2007 | 18 Dec 2008 | Thierry Vila | Nucleus Prostheses |
US20120116514 * | 6 Sep 2011 | 10 May 2012 | Kuslich Stephen D | Semi-biological intervertebral disc replacement system |
Date | Code | Event | Description |
28 Sep 2010 | CC | Certificate of correction | |
18 Jan 2013 | FPAY | Fee payment | Year of fee payment: 4 |
7 Dec 2016 | AS | Assignment | Owner name: CRG SERVICING LLC, TEXAS Free format text: SECURITY AGREEMENT;ASSIGNOR:INTRINSIC THERAPEUTICS, INC.;REEL/FRAME:040841/0541 Effective date: 20161202 |
18 Jan 2017 | FPAY | Fee payment | Year of fee payment: 8 |


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Chic and versatile, this stylish shirt from White Stuff is a great piece to introduce pattern to your working wardrobe. Crafted from cotton, this shirt boasts a subtle, all-over spot print in multi-colours. It features an on-trend boxy fit, flattering for all shapes, and pearly button fastenings. Wear yours with tailored trousers, a cardigan and heels for a smart office-friendly ensemble with a feminine flourish or, team with jeans and flats for chic off-duty wear.
Check stock and price

subset: commoncrawl


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One of my favorite things about owning a house is having a back yard with room to garden! Getting the garden planted was the first thing I did as soon as the snow melted; there are still boxes left to unpack from the move, but our garden is planted and thriving!
The second thing I did was build a DIY compost bin! I love the idea of reusing food waste; it keeps it out of the landfill, and my plants will absolutely love the rich soil! I know there are tons of pre-made compost bins that you can buy from a hardware store, but I had specific ideas about how I wanted mine to work, so I built my own!
I had a lot of fun designing this DIY compost bin! My mom is also an avid gardener and I spent a lot of time talking to her, my dad (the woodworker), and my aunt and uncle who just finished building their own compost bin about what makes a good compost bin. We decided the following things were important:
- Easy to add things to the top of the pile, preferably being able to open the lid with just one hand since you'll be holding the compost bucket from your kitchen with the other
- Lid has to latch to keep the critters out (my parents have crazy stories of their years long battle with the raccoons and rats in their area that kept getting into the bin!)
- Easy access to the bottom of the compost pile to get out the soil that has finished composting (this piece also has to latch because of critters)
- Bottom of the bin also has to be critter proof so nobody tunnels up from the bottom
- Open and airy enough to allow for good airflow, and to let bugs and worms in to speed the decomposition
- Sturdy enough to hold up to the crazy Chicago weather
So I finally came up with a design that met all the criteria above!
How To Build A DIY Compost Bin
Here's everything you need to build your own DIY compost bin! (affiliate links below to the products I used and recommend)
You can download the scale drawing I created for this compost bin by clicking here. I used SketchUp to create this drawing, so you'll need the SketchUp program in order to open the file. Luckily, SketchUp is free and you can download it here!
This drawing file is copyright by Practically Functional LLC and is for personal use only. Please do not redistribute this file or use it for any commercial purposes. (But feel free to link to this post so others can come download the file for themselves!)
Lumber/Cut List:
We used untreated cedar for our compost bin; it's slightly more expensive than treated lumber, but since I plan on using this compost in our edible garden, I want to make sure the compost doesn't leach any chemicals out of the lumber as it sits in the bin.
You can make the following cuts yourself, or if you buy your lumber from a major hardware store, they'll usually make the cuts for you if you ask! We went to Home Depot, picked out a few boards, and a super nice employee made all of the cuts for us while we continued shopping for the other supplies we needed! Just take this cut list into the store with you and they can do the rest!
- 2×6 boards, cut into the following pieces: (two 12′ boards and three 10′ boards)
- 15 – 2×6 at 3′
- 2 – 2×6 at 3′ 3″
- 2×4 boards, cut into the following pieces: (one 12′ board and one 10′ board)
- 7 – 2×4 at 3′
- 2×2 boards, cut into the following pieces: (two 12′ boards)
- 2 – 2×2 at 3′
- 2 – 2×2 at 1′ 3-3/4″
- 2 – 2×2 at 3′ 1/2″
- 3 – 2×2 at 2′ 9″
- 15′ of 3′ tall chicken wire (1″ holes)
- box of #8 2-1/2″ deck screws
- box of #8 1″ wood screws
- 3′ x 3′ corrugated polycarbonate panel (I used a large SunTuf grey tinted panel that I found at Home Depot and cut it down to size; the large panel is only available in stores, but you can find smaller versions online and attach them together)
- 2 gate handles
- 4 3-1/2″ door hinges
- 4 3-1/2″ rotating post safety hasp latches
- 8
- 2 3″ t-shaped flat corner braces
- 4 4′ fence stakes
- electric drill (I used my Ryobi 18v One+ drill and it worked great! I bought this starter kit that came with the drill and a circular saw!)
- circular saw (if you need to cut down your polycarbonate panel)
- 3/8″ drill bit
- screwdriver bit (flat, phillips, or square drive, depending on the deck screws you have)
- staple gun + staples
- carpenter's square
- wire cutters
- pencil
- tape measure
- fence post driver (or a hammer and a spare block of wood)
Want to share this tutorial with your friends? Just click any of the share buttons off to the left to share with Facebook, Pinterest, Twitter, etc.!
If you liked this project, check out these other great outdoor projects!
More posts you might like!
Jessi Wohlwend
Latest posts by Jessi Wohlwend (see all)
- 2 Surefire Ways To Disinfect & Clean Bath Toys - March 24, 2017
- Creativity Unleashed No. 165 – And An Oriental Trading Giveaway! - March 23, 2017
- My Toddler Puts Everything In Her Mouth! - March 20, 2017
- How To Make Sensory Bags For Babies & Toddlers - March 17, 2017
- Creativity Unleashed No. 164 – And An Oriental Trading Giveaway! - March 16, 2017


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Preparation of 2-oxazolidinones by enzymatic desymmetrisation
Neri, C. and Williams, J. M. J., 2002. Preparation of 2-oxazolidinones by enzymatic desymmetrisation. Tetrahedron: Asymmetry, 13 (20), pp. 2197-2199.
Related documents:
This repository does not currently have the full-text of this item.You may be able to access a copy if URLs are provided below.
Desymmetrisation of achiral N-Boc-serinol was achieved through enzymatic acetylation. Further transformation provided oxazolidinones with >98% enantiomeric excess. (C) 2002 Elsevier Science Ltd. All rights reserved.
Item Type | Articles |
Creators | Neri, C.and Williams, J. M. J. |
Departments | Faculty of Science > Chemistry |
Refereed | Yes |
Status | Published |
ID Code | 5111 |
Additional Information | ID number: ISI:000179311300004 |
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Watch Jose And Wally Show at Smart Araneta Coliseum, A Party For Juan And All on Apil 15 at SNBO
"Jose & Wally at Smart Araneta: A Party for Every Juan" got a huge turnout. The sold-out tickets speak that it has indeed become a party for every "Juan". This showed two important things: the bankability of the comedic tandem of "Jose & Wally" and also the marketing power of Eat Bulaga in building stars who become like family to the masses.
Jose & Wally became a Trending Topic Worldwide on April 15, head to head with Bb. Pilipinas.
Video Replay embed only from YouTube:


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There was a time when fake eyelashes were reserved for the podium and mere mortal women only dreamed about them. Today is different. The day has come when every female can enjoy thick, long lashes.
This new jewel for beautiful eyes is a great weapon for seduction. And you don't even have to go far or pay much to attain it. There are kits of fake lashes on the market which can be affixed at home using special glue. They have an adhesive strip, but most women feel safer when it is reinforced with glue.
Also disposable, but with a longer "life-span" are the tufts of eyelashes placed in beauty salons. With the help of tweezers and silicone glue, they are implanted among the natural eyelashes, giving them more volume and thickness. These lashes can endure for two weeks or more, but you need to be careful not to harm them at night while sleeping. They also require regular maintenance.
If you cannot afford expertly placed fake eyelashes, you can always use folk remedies for improving your own natural ones. Before going to bed at night, carefully treat your lashes with castor oil to make them thicker, longer and shinier.
Fake eyelashes to replace mascara


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Creating a thoughtful and compelling name for your employee newsletter can be the first step to its success.
Do you want your employee newsletter to be strictly information-driven?
If the content is going to be business or industry-driven, a more serious newsletter name may be most appropriate in order to convey its seriousness:
• Just the Facts
• The Advisor
• The Dispatch
• The Bulletin
• The Communique
• The Final Word
Will the content be more informal and employee-driven?
Perhaps you want employees to contribute articles or want to recognize their professional, as well as personal achievements. Consider names like:
• Our Voices
• Hands Up
• All Hands
• In Touch, In Tune
• The Information X Change
• The ___ Company Family Album
A newsletter can be focused on its objective
Are you trying to reinforce certain behaviors and attitudes in the workplace or get everyone working toward the same business goals?
You might consider employee newsletter names such as:• On Target
• The People's Press
• The Right Direction
• The Beacon
• The Forum
• The Lineup
• The Steering Wheel
• Roadmap to Success
An internal newsletter name can provide clarity on its purpose
Deploy screensavers as interactive digital signage for effective internal communication
User generated newsletter, delivered onto employee screens
Visual tools to get employee attention ensuring message cut-through for important internal messages
Deliver message to mobile devices with multiple visual display formats
Scrolling headlines with click through to message windows, intranet or elsewhere
Measure attitudes, track trends and measure the impact of internal communications
Reinforce internal communications and assess capability with themed quizzes
Publish messages on desktop backgrounds and change and sequence messages with ease
The frequency of your publication may help you determine an appropriate employee newsletter name, such as:
From serious to fun, formal to informal, there are virtually thousands of options to consider when creating an employee newsletter name. Take the time to be creative – develop your angle, your content, and define your audience and your overall intent. Draft ideas on the sections you want to include and how you envision the newsletter, as this may help you come up with the most appropriate name.
Employee newsletters can be named to reflect the frequency of publication
Sometimes, it makes the most sense to create an employee newsletter name that plays on the business or industry you're in. The ideas are virtually endless, for example:
• Rebels with a Clause
• The Monthly Rider
• The Banker's Note
• The General Ledger
• In the Black
• The Bottom Line
• Highlights
• Short Cuts
• The Daily Diva
• The Glam-o-Gram
• Under the Microscope
• The Lifeline
• The Heartbeat
• Doctor's Orders
• Bits and Bytes
• Connections
• Tech Talk
• The Daily Download
• The Grapevine
• Fresh Ideas
• The Front Burner
• The Juice
• The Daily Bread
• Just Desserts
• In Tune
• The Key Note
• The Beat
• The Rap Up
• The Right Note
• In Concert
• News Flash
• The Beat
• The Broadcast
• The Lead
• Between the Lines
• The Cable
• This Just In…
• The 5 W's (Who, What, When, Where, Why)


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Oct. 20, 2015
Automotive Testing Expo North America
Praxair representatives will be on hand to introduce customers to Praxair products and services for the emissions and environmental market. From pure gases, calibration standards and custom mixtures to gas generation, control and delivery, Praxair's specialty gas products ensure accuracy and repeatability in your process. Ask how Praxair can help you be more productive in your testing program.
Praxair Booth
The Suburban Collection Showplace 46100 Grand River Avenue Novi, Michigan


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Hi all - quick post today to tell you that today is Digi-Scrapbooking Day and to celebrate MyGrafico is having a 25% off sale! All your favorites... Dilek... Mujka... ReviDevi and Lindsay's Stamp Stuff - just to name a few. Go on over and stock up! I saw some really cute Christmas sets I want in my collection!
OK - might be back later with another post if I can get into my craft room today.
Hugs, Mel
Saturday, November 7, 2009
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text:
City Guides >
Dubai is planning to build a 1 million dirhams Ferris wheel which will stand 210 metres tall. The wheel will be art of a 6 billion-dirham project, which will include top of the line restaurants and a hotel. The wheel will be called the Dubai Eye.
Dubai, the Persian Gulf sheikhdom with the tallest building and biggest shopping mall, plans to build a Ferris wheel that would beat New York's attempt to set the world hight record with a Staten Island attraction.
The Dubai Eye will cost 1 billion dirhams (NZ$400 million) to build and will stand at 210 metres, according to a statement on the website of the emirate's ruler. It will be the centerpiece of a 6 billion-dirham (NZ$2.3 billion) project known as Bluewaters that includes a hotel, restaurants and a family entertainment center on a man-made island off Dubai's coast. The first phase is set to start in April.
Read More on stuff.co.nz
* Lowest nightly rate based on select dates. Please click on hotel for details.


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Jaka Tarub is a handsome young man who has supernatural power. He often went out into the woods to hunt or of knowledge. When one day at a full moon night he entered the forest, from the distance he heard the faint sound of women who were joking. Impelled by curiosity, Jaka Tarub running for directions to the voices. Until finally he found a very beautiful lake in the middle of the woods, along with 7 people a very beautiful woman taking a bath and joking ria.
With sediment-ngendap, Jaka Tarub walked over. Then she found the clothes these women are lying scattered. After choosing, he stole one of them and hide them.
Some time went by and the angel was about to return to Khayangan. 6 of them wearing their clothing and fabrics, then flew into the night sky. Then Jaka Tarub understand if the women are angels Khayangan. But an angel left in the lake. Since losing her clothes she could not return to the sky and then burst into tears.
"If there is to find clothes and kainku, when a man I'll make my husband and when the woman I'll make you," vowed the angel. Jaka Tarub then reveal itself and entertain the angels. He gave a piece of cloth to wear the angel, but still hide his clothes so he could fly to Khayangan left. The angel then fulfill his vow and married to Jaka Tarub.
(There is another version where Nawang Wulan not need to swear like that. When Nawang Wulan crying on the lake, Jaka Tarub appeared immediately and comfort, and it offers a place to stay for Nawang Wulan until they finally get married)
Nawang Wulan angel's name, since married to Jaka Tarub living. The harvest is plentiful and the barn was always full of rice without ever needy. Clothing Nawang Wulan Jaka Tarubhidden in the barn that was always full. They were blessed with a child (could be boys or girls, depending on the version of the story) and live happily.
But after a long marriage life, curiosity terusiklah Tarub Jaka. Every day he and his family always eat rice, but the barn is always not as though nothing less rice they used to eat.
Nawang Wulan One day to go to a river. He told the husband to keep the fire in the kitchen, but forbade him to open the lid the pot (in other versions, Nawang Wulan prohibit even Jaka Tarub to enter the kitchen). Jaka Tarub doing her message, but curiosity had buried long ago finally make it violates the ban already booked. She opened the lid on the pot and it turned out there was only one grain of rice. Apparently during this Nawang Wulan requires only a grain of rice to meet the needs of the family of rice a day.
When Nawang Wulan home and opened the lid the pot, there is only a grain of rice in it. Nawang Wulan angry because her husband had violated the ban, and he became upset because since then he had to cook the rice as normal human beings. He was working too hard to pound rice into a lot of rice before the rice menanaknya.
The result for continuous use, over time the rice supply in the barn Jaka Tarub dwindling. Slowly but surely, the rice they grew up, while the harvest is still not arrived.
When Nawang Wulan someday return to take grain to be ground, he saw a protruding piece of cloth behind a pile of rice. When pulled and reviewed, Nawang Wulan remembered if it is bidadarinya clothes. "Apparently Jaka Tarub been hiding my clothes. And because the content of the barn continued to decrease in the end I could find it again. This would have been the will of the Above, "he thought.
Nawang Wulan bidadarinya then dressed and took the cloth. He then met Jaka Tarub to say goodbye and ask for their child care carefully. Jaka Tarub implored her not to leave, but was meant to Nawang Wulan to return to Khayangan and leave him. "Dahilan me when I saw the moon. I will entertain you from up there, "said Nawang Wulan. He was then flown to the sky to Khayangan, leaving Jaka Tarub who wept in remorse.
source :
Mix and Macth you sneaker gals..
5 years ago


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Eminem's claim of shady iTunes deal
By Tom Cheney | September 23, 2009 at 10:21 AMEminem's music publisher wants a bigger slice from Apple.
Eight Mile Style and a co-plaintiff, Martin Affiliated, are suing Apple, claiming they never authorised the use of 93 songs in a downloadable format on Apple's popular iTunes service.
The non-jury trial is expected to start Thursday in the rapper's hometown of Detroit, unless a settlement is reached Wednesday with the help of US Magistrate Judge Virginia Morgan.
Eight Mile also is suing Aftermath Records, which controls the recordings in question, saying it didn't have the right to make deals on digital downloads.
It's unclear from court documents just how much money is at stake, but the plaintiffs claim Apple wrongfully gained $US2.5 million through iTunes downloads, including $466,915 from Lose Yourself, Eminem's biggest hit from the hip-hop film 8 Mile. The publisher also believes it should get a share of Apple's profit from the sale of iPods.
Eight Mile also claims Aftermath wrongfully collected $4 million off Eminem's songs on iTunes.
Apple denies the allegations and says it has a valid agreement with Aftermath Records. Eight Mile has received royalties but says that doesn't mean it can't press ahead with a lawsuit.
The "acceptance of a single check containing mostly royalties for authorised uses, but also containing small and hidden royalties for unauthorised uses, cannot operate as a satisfaction of a claim," Eight Mile's lawyers said in a recent filing in federal court.
Eight Mile says it still retains ownership, including copyright, of the compositions inside Eminem's recordings. If the case isn't settled, the trial before US District Judge Anna Diggs Taylor will centre on how to interpret contracts.
Eight Mile agreed in 1998 and 2003 that "Eminem would create master sound recordings embodying compositions, and that Aftermath would own those masters," Apple's attorneys said in a court filing.
"The parties also agreed that Aftermath and its distributors and licensees would 'have the exclusive right' to exploit the masters embodying the Eminem compositions 'in any and all forms of media now known or hereinafter developed,'" the lawyers said.
Howard Hertz, a lawyer for Eight Mile, declined to comment on the case Tuesday. A message seeking comment was left with Daniel Quick of the Apple/Aftermath legal team.
It's unknown if the rapper would attend a trial if there is one. Eminem, whose real name is Marshall Mathers, is not on the witness list.


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Archive for the 'Gothic Fairy Tales' Category
I stumbled upon The Robber Bridegroom in a second hand bookstore, and was intrigued immediately, by the quote on the cover: A Gothic fairy tale set in the eighteenth century Mississippi. I like Gothic fairy tales, most of the time, and this was no exception. It had all the key ingredients, worthy of a Grimm […]
Filed under: Books 2009, Eudora Welty, General Fiction, Gothic Fairy Tales, Review, Virago Modern Classics | 6 Comments
Tags: Eudora Welty, Mississippi
I'll say it, right at the very outset. Straight. This is one of the best books I've ever read, and, believe it or not, the cover is equally fantastic. I did judge the book by its cover, and I am still astounded by how incredible this book is, and I can continue staring at its cover […]
Filed under: Angela Carter, Books 2009, Fiction (Coming of Age), Gothic Fairy Tales, Magical Realism, Review, Virago Modern Classics | 12 Comments
Tags: Angela Carter


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Children up to age 8 or under 4 feet, 9 inches tall should ride in a booster seat, according to the National Highway Traffic Safety Administration. Booster seats provide added height to keep the seat belt snug against the child's thighs and chest at the right height. Purchase a booster seat that is comfortable and safe for your child during car travel. The Graco TurboBooster seat is available with a high back so your child can rest comfortably against a back seat that is low or without a headrest.
- Skill level:
- Moderately Easy
Other People Are Reading
- 1
Attach the back pad to the booster seat if it is not already attached. The pad will wrap around the back and hook onto the metal loops on either side of the seat pad.
- 2
Lay the head support section and the back support section on a flat surface with the "wrong side" facing upward.
- 3
Locate the red height adjustment button at the top of the head section and squeeze. Press the head section downward and into the lower back section until you hear a "click" sound. Release the button and verify the two sections are secure by trying to pull them apart. If they remain in place, then they are secure.
- 4
Locate the elastic strap on the back of the booster pad. It will be near the right side of the booster in the centre. Stretch it across the back of the booster to the other side where it will hook.
- 5
Turn the back over so it is "right side" up. Insert the flap of the padding from the head section behind the padding on the middle section. Push the back section to the edge of a table so the "U"-shaped hooks at the bottom of the back are over the edge.
- 6
Hold the seat of the booster at a vertical angle to locate the bars on the back of the seat. Interlock the "U" shaped hooks on the booster back with the bars on the booster seat.
- 7
Turn the seat at a 180 degree angle upward until you hear a "snap" sound. Place the seat in the upright position and gently push the back backward to ensure it is snapped into place properly.
Tips and warnings
- Take the booster to a police or fire station to ensure it is installed properly.
- Failure to install the booster properly could result in severe injuries for the child.


text:
50 Year Paint Made from Organic Flax Seeds. 100% Chemical Free. The Way Paint Used to Be! An "acrylic-free" website.
Other Products You Can Feel Good About:
Customer Service
Secure Online Ordering. We accept all major credit cards using PayPal. PayPal is a global leader in online payments. Membership is free and easy. Your information is kept secure.
Ordering by Phone. Call: 1-585-924-8070. Office hours are Monday - Wednesday 10am - 5 pm EST.
Customer Service. Viking Sales is the exclusive importer of:
Viking Sales, Inc. 7710 Victor-Mendon Road Victor, NY 14564 PH: 1-585-924-8070 Monday - Wednesday 10am - 5 pm EST/ E-mail:
Custom Color Mixing. All shades can be blended to create an infinite array of colors. Special color mixing can only be arranged for pallet orders. Please contact us for more information.
Wholesale Discounts Available for Select Product. Wholesale discounts are available for select product when orders meet the qualifying minimum amount of at least $3500/pallet. Order online and learn more.
Shipping and Order Tracking. UPS is the standard method for continental U.S. shipments. We do not ship to P.O. box postal addresses. To track your UPS shipping status, enter one or more UPS tracking numbers below.
Friendly Return Policy:
NOTE: Linseed Oil Paint is not returnable.