Annulus repair systems and techniques

BACKGROUND OF THE INVENTION

P-0001[0001] The present invention relates generally to the field of spinal surgery, and more particularly to systems and techniques for repairing the annulus fibrosis of a spinal disc.

P-0002[0002] There are various surgical procedures and conditions that create a defect in the annulus fibrosis, such as, for example, an annulotomy, a discectomy, nucleotomy, implantation of artificial disc nucleus or artificial disc prosthesis, or repair of a disc herniation. Repair of annulus defects is normally perceived as time consuming and ineffective. Thus, annulus defects are commonly left unrepaired. This may lead to a higher incidence of disc reherniation or expulsion of the implant from the disc space.

P-0003[0003] In those procedures where the annulus is repaired via sutures that attempt to close the defect by pulling the surrounding tissue together, there are difficult challenges encountered. Often, the annulus defect is a relatively large hole that is difficult to close with conventional suturing techniques. It can also be difficult to actively engage the sutures in the surrounding annulus tissues, and the sutures could cut or tear through the annulus tissues after the repair has been made.

P-0004[0004] What is therefore needed are systems and methods for spinal surgery which provide an effective repair for defects in the annulus fibrosis. The present invention is directed toward meeting this need, among others.

SUMMARY OF THE INVENTION

P-0005[0005] The present invention is directed to systems, techniques and methods for repairing annulus defects. Embodiments of the systems include at least one blocking member positionable in or adjacent to the annulus defect, one or more attachment portions coupled to the at least one blocking member for securing the blocking member to the adjacent vertebrae, and instruments for placing the blocking member in and/or adjacent to the annulus defect. The blocking member extends at least partially across the annulus defect for repair of the defect and/or retention of nucleus material, one or more implants, bio-compatible materials or devices, and/or other objects positioned in the disc space.

BRIEF DESCRIPTION OF THE DRAWINGS

P-0006[0006]FIG. 1 is an exploded perspective view directed to one embodiment of an annulus repair system.

P-0007[0007] FIGS. <b>2</b>A-<b>2</b>C are side elevation views of various embodiments of anchors that can be employed with the annulus repair system of FIG. 1.

P-0008[0008]FIG. 2D is a perspective view of a portion of another embodiment anchor.

P-0009[0009] FIGS. <b>3</b>A-<b>3</b>G are elevation views of various embodiments of anchors that can be employed with the annulus repair system of FIG. 1.

P-0010[0010] FIGS. <b>4</b>A-<b>4</b>C illustrate a pre-insertion configuration and post-insertion configuration in section, and a post-insertion configuration in elevation, respectively, of the annulus repair system of FIG. 1 relative to a pair of adjacent vertebrae.

P-0011[0011]FIG. 5 illustrates a material stock from which a blocking member comprising part of an annulus repair system can be fabricated.

P-0012[0012]FIG. 6 illustrates a portion of an annulus repair system with another embodiment attachment portion.

P-0013[0013]FIG. 7 is a perspective view of a distal end portion of one embodiment instrument for inserting and engaging the annulus repair systems of the present invention in an annulus defect.

P-0014[0014]FIG. 8 is an elevation view of the portion of the instrument of FIG. 7 with the annulus repair system of FIG. 6 mounted thereon and extending through a retractor sleeve.

P-0015[0015]FIG. 9 is an elevation view of the instrument and annulus repair system of FIG. 7 illustrating the insertion of the annulus repair system into the annulus defect and engagement of the annulus repair system to vertebrae adjacent the defect.

P-0016[0016] FIGS. <b>10</b>A-B illustrate an elevation view and end view, respectively, of one embodiment proximal portion for the instrument of FIG. 7.

P-0017[0017]FIG. 11 is a perspective view of another embodiment anchor.

P-0018[0018] FIGS. <b>12</b>A-<b>12</b>C are a perspective view, elevation view, and end view, respectively, of the anchor of FIG. 11 mounted to an insertion instrument.

P-0019[0019]FIG. 13 illustrates the anchors of FIG. 11 engaged in an annulus defect to the adjacent vertebrae with a blocking member extending therebetween.

P-0020[0020]FIG. 14 is a perspective view of another embodiment annulus repair system.

P-0021[0021] FIGS. <b>15</b>A-<b>15</b>C illustrate various means for attaching a blocking member to an anchor.

P-0022[0022] FIGS. <b>16</b>A-<b>16</b>C are partial elevation views of a portion of an insertion instrument and annulus repair system of FIG. 14 illustrating the insertion and engagement of the annulus repair system at the annulus defect.

P-0023[0023] FIGS. <b>17</b>A-<b>17</b>C illustrate another embodiment annulus repair system in an annulus defect in a pre-engagement configuration, in an engaged configuration, and in a plan view, respectively.

P-0024[0024] FIGS. <b>18</b>A-<b>18</b>B illustrate schematically another embodiment instrument for inserting and engaging the annulus repair system of FIGS. <b>17</b>A-<b>17</b>C to the vertebrae adjacent the annulus defect.

P-0025[0025] FIGS. <b>19</b>A-<b>19</b>C are elevation views of another embodiment blocking member members and an anchor of an annulus repair system.

P-0026[0026] FIGS. <b>20</b>A-<b>20</b>B are a side view and elevation view, respectively, in partial section of the blocking member and anchor of FIGS. <b>19</b>A-<b>19</b>B engaged in an annulus defect.

P-0027[0027] FIGS. <b>21</b>A-<b>21</b>B are a side view and elevation view, respectively, in partial section of another embodiment annulus repair system engaged in an annulus defect.

P-0028[0028] FIGS. <b>22</b>A-<b>22</b>B are a side view and elevation view, respectively, in partial section of another embodiment annulus repair system engaged in an annulus defect.

P-0029[0029] FIGS. <b>23</b>A-<b>23</b>B are a side view and elevation view, respectively, in partial section of another embodiment annulus repair system engaged in an annulus defect.

P-0030[0030] FIGS. <b>24</b>A-<b>24</b>B are a side view and elevation view, respectively, in partial section of another embodiment annulus repair system engaged in an annulus defect.

P-0031[0031] FIGS. <b>25</b>A-<b>25</b>B are a side view and elevation view, respectively, in partial section of another embodiment annulus repair system engaged in an annulus defect.

P-0032[0032] FIGS. <b>26</b>A-<b>26</b>B are a side view and elevation view, respectively, in partial section of another embodiment annulus repair system engaged in an annulus defect.

P-0033[0033] FIGS. <b>27</b>A-<b>27</b>B are a side view and elevation view, respectively, in partial section of another embodiment annulus repair system engaged in an annulus defect.

P-0034[0034]FIG. 28 is a side section view of another embodiment annulus repair system engaged adjacent to an annulus defect.

P-0035[0035]FIG. 29 is a side section view of another embodiment annulus repair system engaged adjacent to an annulus defect.

P-0036[0036]FIG. 30 is a side section view of another embodiment annulus repair system engaged adjacent to an annulus defect.

P-0037[0037]FIG. 31 is a side section view of another embodiment annulus repair system engaged adjacent to an annulus defect.

P-0038[0038] FIGS. <b>32</b>A-<b>32</b>D illustrate various embodiments of a blocking member comprising part of an annulus repair system attachable to hard, bony tissues.

P-0039[0039] FIGS. <b>33</b>A-<b>33</b>D illustrate various embodiments of a blocking member comprising part of an annulus repair system attachable to soft tissues.

P-0040[0040] FIGS. <b>34</b>A-<b>34</b>D illustrate various embodiments of a blocking member comprising part of an annulus repair system attachable to both hard and soft tissues.

DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

P-0041[0041] For the purposes of promoting an understanding of the principles of the invention, reference will now be made to embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended. Any such alterations and further modifications in the illustrated embodiments, and any such further applications of the principles of the invention as illustrated herein are contemplated as would normally occur to one skilled in the art to which the invention relates.

P-0042[0042] The annulus repair system and methods include a blocking member retained by one or more attachment portions within or adjacent a defect in the annulus fibrosis of a spinal disc. The blocking member can block all or a portion of the defect or void within the annulus fibrosis, such as may be caused by surgery or disc herniation. The one or more attachment portions can be connectable to or integrally formed with the blocking member. The attachment portions may be engaged to soft tissue and/or hard tissue or bone adjacent to the defect or void. Thus, the attachment portions retain the blocking member in a substantially fixed position within the defect or void relative to adjacent soft or hard tissue.

P-0043[0043] With respect to the various embodiments described herein, the attachment portion can be joined or fixed to the blocking member using various devices and/or techniques, or can be integrally formed with or an extension of the blocking member. The blocking member can be joined or attached to the attachment portion by, for example, sewing the attachment portion to the blocking member, thermal welding or bonding, adhesive bonding, three dimensional weaving or braiding, screws, staples, pins, tacks or rivet fixation. Furthermore, the attachment portion can be secured to the blocking member either before or after the blocking member is placed into or adjacent to the annulus defect.

P-0044[0044] The blocking member can be fabricated from components that are flexible or exhibit at least some flexibility. Examples of such components include woven fabric tubing, woven and non-woven mesh, or braided or woven structures, sutures, tethers, cords, planar members, bands, wires, cables, or any other component capable of extending across an annulus defect. Additionally, the blocking member may be resilient and/or elastic so it can assume various shapes during and after insertion and attachment. Growth factors or cells can be incorporated into the blocking member to accelerate the annulus repair process. Growth factors can be transforming growth factor β1, insulin-like growth factor 1, platelet-derived growth factor, fibroblast growth factor, bone morphogenetic protein (BMP), LIM mineralization protein (LMP) and combinations thereof.

P-0045[0045] The blocking member can be made from any biocompatible material, material of synthetic or natural origin, and material of a resorbable or non-resorbable nature. Suitable examples of blocking member material include autograft, allograft or xenograft; tissue materials including soft tissues, connective tissues, demineralized bone matrix and combinations thereof; resorbable materials including polylactide, polyglycolide, tyrosinederived polycarbonate, polyanhydride, polyorthoester, polyphosphazene, calcium phosphate, hydroxyapatite, bioactive glass, collagen, albumin, fibrinogen and combinations thereof; and non-resorbable materials including polyethylene, polyester, polyvinyl alcohol, polyacrylonitrile, polyamide, polytetrafluorethylene, polyparaphenylene terephthalamide, cellulose, and combinations thereof.

P-0046[0046] The attachment portion described herein can include anchors made from any biocompatible material, including synthetic or natural autograft, allograft or xenograft tissues, and can be resorbable or non-resorbable nature. Examples of tissue materials include hard tissues, connective tissues, demineralized bone matrix and combinations thereof. Further examples of resorbable materials are polylactide, polyglycolide, tyrosine-derived polycarbonate, polyanhydride, polyorthoester, polyphosphazene, calcium phosphate, hydroxyapatite, bioactive glass, and combinations thereof. Further examples of non-resorbable materials are carbon-reinforced polymer composites, shape memory alloys, titanium, titanium alloys, cobalt chrome alloys, stainless steel, and combinations thereof.

P-0047[0047] Referring now to FIG. 1 there is illustrated annulus repair system <b>50</b> according to one embodiment of the present invention. The annulus repair system <b>50</b> includes a blocking member and an attachment portion for engaging the blocking member to one or more vertebrae adjacent the annulus defect. In the illustrated embodiment, repair system <b>50</b> includes a pair of anchors <b>70</b><i>a</i>, <b>70</b><i>b </i>and a blocking member <b>52</b> extending between anchors <b>70</b><i>a</i>, <b>70</b><i>b</i>. Blocking member <b>52</b> has a first end <b>54</b><i>a </i>and a second end <b>54</b><i>b</i>. First end <b>54</b><i>a </i>has a passage therethrough receiving coupling pin <b>56</b><i>a</i>, and second end <b>54</b><i>b </i>has a passage therethrough receiving coupling pin <b>56</b><i>b. </i>

P-0048[0048] Referring now further to FIG. 2A, anchors <b>70</b><i>a </i>and <b>70</b><i>b</i>, designated generally as anchor <b>70</b>, each include a body <b>71</b> with a concave-convex curvature or spoon shape. First surface <b>76</b> has a convexly curved portion extending from tip <b>74</b> and a linear portion extending therefrom to end <b>73</b>. Second surface <b>78</b> has a concave portion extending from tip <b>74</b> and a linear portion extending therefrom to end <b>73</b>. End <b>73</b> includes a hook member <b>86</b> defining a receptacle <b>72</b> extending therealong between the sides of body <b>71</b>. Receptacle <b>72</b> is sized to receive one of the ends <b>54</b><i>a</i>, <b>54</b><i>b </i>of blocking member <b>52</b> through opening <b>84</b> between hook member <b>86</b> and body <b>71</b>. Receptacle <b>72</b> is also sized to receive a respective one of the coupling pins <b>56</b><i>a</i>, <b>56</b><i>b </i>laterally through the sidewall opening of receptacle <b>72</b>; however, coupling pin <b>56</b><i>a </i>cannot pass through opening <b>84</b>. Anchor <b>70</b> is coupled to blocking member <b>52</b> with a respective one of the coupling pins <b>56</b><i>a</i>, <b>56</b><i>b </i>in the passage of a respective end <b>54</b><i>a</i>, <b>54</b><i>b </i>of blocking member <b>52</b> with the end <b>54</b><i>a</i>, <b>54</b><i>b </i>positioned in receptacle <b>72</b>.

P-0049[0049] In FIG. 2B there is shown another embodiment anchor <b>70</b>′ that is similar to anchor <b>70</b> discussed above. Anchor <b>70</b>′ includes a roughened portion <b>75</b> along convexly curved first surface <b>76</b> to resist anchor pullout from the vertebral body when inserted therein. Roughened portion <b>75</b> can include one or more teeth, spikes, serrations, knurlings, or barbs, for example, to engage the bony tissue. In FIG. 2C anchor <b>70</b>″ includes a roughened portion along concavely curved second surface <b>78</b>. Other embodiments contemplated an anchor that includes a roughened portion along first surface <b>76</b> and second surface <b>78</b>.

P-0050[0050] Referring now to FIG. 2D, there is shown another embodiment anchor <b>170</b> that is generally the same as anchor <b>70</b>, but having an alternate end arrangement for connection with blocking member <b>52</b>. Anchor <b>170</b> includes a body <b>171</b> having an end <b>173</b> defining a receptacle <b>172</b> for receiving pin <b>56</b> and an end <b>54</b><i>a</i>, <b>54</b><i>b </i>of the blocking member as discussed above with respect to anchor <b>70</b>. An opening <b>184</b> is defined between hook member <b>186</b> and end surface <b>180</b> of body <b>171</b>. Opening <b>184</b> has a width A sized to allow passage of blocking member <b>52</b> therethrough but preventing coupling pin <b>56</b> from being passed therethrough. End surface <b>180</b> is offset toward end <b>173</b> so that the end of hook member <b>186</b> and opening <b>184</b> is positioned more proximate end <b>173</b>. This results in less length of blocking member <b>52</b> wrapped around hook member <b>186</b>. Other embodiments contemplate that opening <b>184</b> can be positioned further toward end <b>173</b>, including positioning of opening <b>184</b> between surfaces <b>176</b> and <b>178</b>. Anchors <b>70</b>, <b>170</b> can each be provided with a width W<b>2</b> that is about the same as or greater than width W<b>1</b> of the blocking member to which it is coupled.

P-0051[0051] FIGS. <b>3</b>A-<b>3</b>G provide further embodiment anchors having a shape similar to that of anchor <b>70</b> and connectable to a blocking member. In FIG. 3A anchor <b>1000</b> includes a body <b>1002</b> having an end <b>1006</b> for engagement with a blocking member and a hole <b>1004</b> formed through body <b>1002</b>. In FIG. 3B anchor <b>1010</b> includes a body <b>1012</b> having an end <b>1016</b> for engagement with a blocking member. Body <b>1012</b> includes a first hole <b>1014</b><i>a </i>and a second hole <b>1014</b><i>b </i>formed therethrough. Hole <b>1004</b> in anchor <b>1000</b> and holes <b>1014</b><i>a</i>, <b>1014</b><i>b </i>of anchor <b>1010</b> provide avenues for bone ingrowth through the anchor for long term fixation in the vertebral bodies. The holes can also receive fasteners to engage the anchor to the vertebral body.

P-0052[0052] In FIG. 3C there is an anchor <b>1020</b> including a body <b>1022</b> having an end <b>1026</b> for engagement with a blocking member. Body <b>1022</b> also includes a first cutout <b>1024</b><i>a </i>in one side thereof and a second cutout <b>1024</b><i>b </i>in the opposite side thereof. In FIG. 3D anchor <b>1030</b> includes a body <b>1032</b> having an end <b>1036</b> for engagement with a blocking member. Body <b>1032</b> includes a number of first cutouts <b>1034</b><i>a </i>in one side thereof and a number of second cutouts <b>1034</b><i>b </i>in the opposite thereof. In the illustrated embodiment, three cutouts <b>1034</b><i>a</i>, <b>1034</b><i>b </i>are provided. Cutouts <b>1034</b> are relatively smaller than cutouts <b>1024</b> so that an increased number of cutouts can be provided while maintaining the structural integrity of anchor <b>1030</b>. The cutouts of anchors <b>1020</b>, <b>1030</b> provide initial fixation by providing barbs or pointed surfaces facing away from the insertion direction along the edges of the anchor that resist anchor pullout from the vertebral body. Long term fixation of anchors <b>1020</b>, <b>1030</b> is enhanced by bone growth through the cutouts.

P-0053[0053] In FIG. 3E there is an anchor <b>1040</b> that includes a body <b>1042</b> having an end <b>1046</b> for engagement with a blocking member. Body <b>1042</b> includes an ogival tip <b>1044</b> extending between the edges of body <b>1042</b> opposite end <b>1046</b> to facilitate penetration through the vertebral endplate and into the vertebral body. In FIG. 3F there is shown an anchor <b>1050</b> that includes a body <b>1052</b> having an end <b>1056</b> for engagement with a blocking member. Body <b>1052</b> includes a pointed end <b>1054</b> opposite end <b>1056</b> to facilitate penetration through the vertebral endplate and into the vertebral body.

P-0054[0054] In FIG. 3G there is an anchor <b>1060</b> having a body <b>1062</b> with an end <b>1066</b> for engagement with a blocking member. Body <b>1062</b> includes a number of flexible first member <b>1064</b><i>a </i>along one side thereof and a number of flexible second members <b>1064</b><i>b </i>along the opposite side thereof. Members <b>1064</b><i>a</i>, <b>1064</b><i>b </i>are normally flexed away from body <b>1062</b> and extend away from the insertion direction, as shown by anchor <b>1060</b>. During insertion into the vertebral body, members <b>1064</b><i>a</i>, <b>1064</b><i>b </i>flex inwardly along body <b>1062</b> to provide a substantially smooth edge profile along body <b>1062</b>, as shown by anchor <b>1060</b>′, to facilitate insertion. After insertion, a pullout force exerted on body <b>1062</b> causes members <b>1064</b><i>a</i>, <b>1064</b><i>b </i>to flex away from body <b>1062</b> and engage the bony tissue, as shown by anchor <b>1060</b>″.

P-0055[0055] The annulus repair systems are positionable in or adjacent an annulus defect X between vertebrae V<b>1</b> and V<b>2</b>, such as shown in FIGS. <b>4</b>A-<b>4</b>C, for repair or reconstruction of annulus A. It is contemplated that defect X in annulus A may have been created in order to perform an annulotomy, discectomy, nucleotomy or some other procedure in the disc space, and/or defect X has resulted due to aging, trauma, degenerative condition, or the like. It is further contemplated that the nucleus N of the spinal disc can be the natural spinal disc nucleus pulposus, or can be an artificial disc nucleus or disc prosthesis, fusion device or some other device that has been inserted into the disc space through defect X. The remaining portion of annulus A extending around the nucleus is substantially intact, or has been repaired using the system and method of the present invention or some other known annulus repair technique.

P-0056[0056] Annulus repair system <b>50</b> is shown in FIG. 4A with blocking member <b>52</b> positioned in or adjacent to annulus defect X, anchor <b>70</b><i>a </i>extending along the endplate of vertebra V<b>1</b>, and anchor <b>70</b><i>b </i>extending along the endplate of vertebra V<b>2</b>. Blocking member <b>52</b> can be made from flexible material and collapsed, folded or otherwise positioned in a reduced size configuration for insertion into or adjacent to defect X. In FIG. 4B anchors <b>70</b><i>a</i>, <b>70</b><i>b </i>have been moved from their FIG. 4A position and are embedded in a respective one of the vertebral bodies V<b>1</b>, V<b>2</b> through the cortical rim or vertebral endplate. It is contemplated that blocking member <b>52</b> has a length between anchors <b>70</b><i>a</i>, <b>70</b><i>b </i>sufficient to extend along height H of defect X between anchors <b>70</b><i>a</i>, <b>70</b><i>b</i>. It should be understood that it is contemplated that the other embodiment anchors can also be employed with repair system <b>50</b> and embedded in vertebrae V<b>1</b> and V<b>2</b>

P-0057[0057] As shown in FIG. 4C, width W<b>1</b> of blocking member <b>52</b> along annulus A can be about the same as or less than width W of defect X so that blocking member <b>52</b> extends across all or a portion of defect X, thereby effectively blocking defect X and implants or disc material in the disc space from protruding or expelling through defect X, as indicated by arrow F in FIG. 4B. In one embodiment, width W<b>1</b> of blocking member <b>52</b> is about 90% or less than width W of defect X. In another embodiment, width W<b>1</b> of blocking member <b>52</b> is about 50% or less than width W of defect X. In a further embodiment, width W<b>1</b> of blocking member <b>52</b> is about 10% or less than width W of defect X. In addition, blocking member <b>52</b> can have a depth D<b>1</b> that is less than the depth D of annulus A at defect X, providing additional unobstructed or unoccupied area in defect X for growth and regeneration of annulus tissue.

P-0058[0058] It is also contemplated that blocking member <b>52</b> can be provided with width W<b>1</b> that is greater than width W of defect X. In such an embodiment, width W of the annulus defect X can be dilated to accommodate width W<b>1</b> of blocking member <b>52</b> for insertion into the defect. As the annulus tissue returns to its pre-dilated state, the surrounding annulus tissue will press against the width of blocking member <b>52</b>. Alternatively, blocking member <b>52</b> is positioned along the exterior surface of the disc space and overlaps the exterior of the annulus tissue for attachment thereto and/or the adjacent vertebral bodies. It is contemplated in such embodiments that width W<b>1</b> can be up to 50% greater than width W of defect X.

P-0059[0059] It is contemplated that anchors <b>70</b><i>a</i>, <b>70</b><i>b </i>engage vertebrae V<b>1</b> and V<b>2</b> with sufficient pullout resistance that supplemental fixation is not required. However, supplemental fixation can also be provided to further increase pullout resistance of anchors <b>70</b><i>a</i>, <b>70</b><i>b</i>. Fasteners <b>80</b><i>a</i>, <b>80</b><i>b </i>can be engaged to anchors <b>70</b><i>a</i>, <b>70</b><i>b </i>in the respective vertebrae V<b>1</b> and V<b>2</b> to provide increased pullout resistance, as shown in FIGS. 4B and 4C. A hole is drilled and/or tapped in each vertebra and through the respective anchor <b>70</b><i>a</i>, <b>70</b><i>b</i>. Fastener <b>80</b><i>a </i>is placed in the hole in vertebra V<b>1</b> through anchor <b>70</b><i>a</i>, and fastener <b>80</b><i>b </i>is placed in the hole in vertebra V<b>2</b> through anchor <b>70</b><i>b</i>. Anchors <b>70</b><i>a</i>, <b>70</b><i>b </i>can also be provided with holes preformed therethrough for receipt of fasteners <b>80</b><i>a</i>, <b>80</b><i>b</i>. Fasteners <b>80</b><i>a</i>, <b>80</b><i>b </i>can have a threaded distal end portion as shown, or can have a threaded proximal portion with a pin extending distally from the threaded proximal portion for positioning through holes in anchors <b>70</b><i>a</i>, <b>70</b><i>b. </i>

P-0060[0060] In FIG. 5 there is shown one embodiment of a material stock from which blocking member <b>52</b> can be fabricated. Stock material <b>90</b> has a tubular form and sized to provide a number of blocking members <b>52</b><i>a</i>, <b>52</b><i>b</i>, <b>52</b><i>c</i>, and <b>52</b><i>d</i>. Trim areas <b>96</b> are provided between adjacent blocking members to allow width WI of the blocking member to be sized as desired. Stack material <b>90</b> can be provided with a basic underlying webbing structure <b>94</b> around which reinforcement webbing <b>92</b> is provided. Underlying webbing structure <b>94</b> can be adhered to or interwoven with a backing <b>98</b> that extends along the length of stock material <b>90</b>. In the illustrated embodiment, the underlying webbing structure <b>94</b> includes vertical fibers and horizontal fibers, while the reinforcement webbing <b>92</b> includes diagonal fibers. The different fiber orientations provide resistance to extension, lateral bending and rotational loading applied to blocking member <b>52</b> by movement of the spinal column at defect X.

P-0061[0061] In FIG. 6 there is shown another embodiment anchor <b>70</b>′″ attached to blocking member <b>52</b>. Anchor <b>70</b>′″ is similar to anchor <b>70</b>, but includes a notch <b>88</b> extending from tip <b>74</b> and into body <b>71</b>. As discussed further below, notch <b>88</b> is sized to receive a retaining member to couple anchor <b>70</b>′″ to an insertion instrument.

P-0062[0062] Referring now to FIG. 7 there is shown one embodiment of an insertion instrument <b>100</b> for inserting and engaging repair system <b>50</b> in an annulus defect. Instrument <b>100</b> includes a mounting member <b>102</b> movably positioned in an actuating member <b>104</b>. Mounting member <b>102</b> includes a distal mounting portion <b>106</b> having a driving member <b>108</b> at a distal end thereof. Driving member <b>108</b> includes an upper driving portion <b>108</b><i>a </i>and a lower driving portion <b>108</b><i>b</i>. Each of the driving portions <b>108</b><i>a</i>, <b>108</b><i>b </i>include a proximally oriented driving surface <b>118</b><i>a</i>, <b>118</b><i>b</i>, respectively. Mounting portion <b>106</b> further includes an upper mounting surface <b>116</b><i>a </i>extending from upper driving portion <b>108</b><i>a</i>, and a lower mounting surface <b>116</b><i>b </i>extending from lower driving portion <b>108</b><i>b</i>. Upper mounting surface <b>116</b><i>a </i>and lower mounting surface <b>116</b><i>b </i>extend generally parallel to one another and into actuating member <b>104</b>. The side surfaces between upper mounting surface <b>116</b><i>a </i>and lower mounting surface <b>116</b><i>b </i>can be convexly curved between surfaces <b>116</b><i>a</i>, <b>116</b><i>b </i>or otherwise shaped to provide a camming action to drive the anchors into the adjacent vertebral bodies upon rotation of mounting portion <b>106</b>, as discussed further below.

P-0063[0063] Actuating member <b>104</b> includes an upper actuating surface <b>120</b><i>a </i>and a lower actuating surface <b>120</b><i>b </i>at a distal end thereof. Actuating surfaces <b>120</b><i>a</i>, <b>120</b><i>b </i>are concavely shaped to engage the attachment portion, such as convexly curved first surface <b>76</b> of anchor <b>70</b>′″ or the other anchors described herein. Actuating member <b>104</b> further includes an upper retainer <b>114</b><i>a </i>and a lower retainer <b>114</b><i>b </i>extending distally therefrom in slots <b>112</b> (only one shown in FIG. 7.) Upper and lower retainers <b>114</b><i>a</i>, <b>114</b><i>b </i>are moveable relative to actuating member <b>104</b> to selectively engage and disengage an anchor on mounting portion <b>106</b>, such as notch <b>88</b> in anchor <b>70</b>′″.

P-0064[0064] As shown in FIGS. 8 and 9, annulus repair system <b>50</b> having attachment portions with anchors <b>70</b><i>a</i>′, <b>70</b><i>b</i>′ is mounted on mounting portion <b>106</b>. Driving surface <b>118</b><i>a </i>of upper driving portion <b>108</b><i>a </i>is in contact with end <b>73</b><i>a </i>of upper anchor <b>70</b><i>a</i>′, and driving surface <b>118</b><i>b </i>of lower driving portion <b>108</b><i>b </i>is in contact with the end <b>73</b><i>b </i>of anchor <b>70</b><i>b</i>′. The body of anchor <b>70</b><i>a</i>′ is position on upper mounting surface <b>116</b><i>a </i>with the concave side of the anchor oriented toward the endplate of the upper vertebra V<b>1</b>. The body of anchor <b>70</b><i>b</i>′ is positioned on lower mounting surface <b>116</b><i>b </i>with the concave side of the anchor oriented toward the endplate of the lower vertebra V<b>2</b>. Blocking member <b>52</b> extends around the distal end of driving member <b>108</b> between anchor <b>70</b><i>a</i>′ and anchor <b>70</b><i>b</i>′. The distal end <b>110</b> of driving member <b>108</b> can have a convex profile extending between upper driving portion <b>108</b><i>a </i>and lower driving portion <b>108</b><i>b </i>to maintain blocking member <b>52</b> in a taut or relatively taut condition as it is inserted.

P-0065[0065] Upper and lower retainers <b>114</b><i>a</i>, <b>114</b><i>b </i>are positionable in respective ones of the notches <b>88</b> of anchor <b>70</b><i>a</i>′, <b>70</b><i>b</i>′ to maintain repair system <b>50</b> on mounting portion <b>106</b> before and during insertion to defect X. When repair system <b>50</b> is in a desired insertion position relative to defect X, the upper and lower retainers <b>114</b><i>a</i>, <b>114</b><i>b </i>can be withdrawn from notches <b>88</b> by a tool or another actuating portion (not shown) associated with insertion instrument <b>100</b>. It is contemplated that mounting portion <b>106</b> can be detachable from a proximal shaft <b>103</b> of mounting member <b>102</b>. Shaft <b>103</b> and actuating member <b>104</b> can be provided as a re-useable instrument, with repair system <b>50</b> and mounting portion <b>106</b> provided as a disposable cartridge attachable to proximal shaft portion <b>103</b>. In this form, a number of mounting portions <b>106</b> can be provided with variously sized repair systems <b>50</b> pre-mounted thereon, and the surgeon can select the repair system providing a blocking member of desired height and width.

P-0066[0066] Insertion of repair system <b>50</b> to defect X with insertion instrument <b>100</b> can be performed through an open incision with tissue retracted to expose annulus defect X, through a micro-incision, or through a retractor sleeve such as sleeve <b>125</b> shown partially in FIG. 8. In FIG. 9, repair system <b>50</b> is positioned in defect X with insertion instrument <b>100</b>. Mounting member <b>102</b> is moved proximally in the direction of arrow P to bring anchors <b>70</b><i>a</i>′, <b>70</b><i>b</i>′ into contact with respective ones of the actuating surfaces <b>120</b><i>a</i>, <b>120</b><i>b</i>. As mounting member <b>102</b> is moved further in the direction P, actuating surfaces <b>120</b><i>a</i>, <b>120</b><i>b </i>drive respective ones of the anchors <b>70</b><i>a</i>′, <b>70</b><i>b</i>′ to a first actuated position into the endplate of the adjacent vertebra V<b>1</b>, V<b>2</b>. When driving member <b>108</b> is adjacent actuating surfaces <b>120</b><i>a</i>, <b>120</b><i>b </i>then anchors <b>70</b><i>a</i>′, <b>70</b><i>b</i>′ cannot be further driven into the endplates by proximal movement P. Anchors <b>70</b><i>a</i>′, <b>70</b><i>b</i>′ can be further driven into the endplates to a second actuated position by rotating insertion instrument <b>100</b> in either rotational direction, such as that indicated by arrow R. Rotation of insertion instrument <b>100</b> causes mounting portion <b>106</b> to act as a camming member that further drives anchors <b>70</b><i>a</i>, <b>70</b><i>b </i>into the respective endplates of vertebrae V<b>1</b> and V<b>2</b>. Referring now to FIGS. 10A and 10B, there is shown one embodiment of a handle system that can comprise a proximal portion of insertion instrument <b>100</b>. The handle system includes a fixed arm <b>122</b> and a movable arm <b>124</b> pivotally coupled thereto. Actuating member <b>104</b> is secured to fixed handle <b>122</b>. The handle system further includes an end member <b>126</b> and a cylinder <b>127</b> extending around a distal portion of mounting member <b>102</b> and threadingly engaged thereto. A torque arm <b>128</b> extends outwardly from end member <b>126</b>. Movable arm <b>124</b>′, end member <b>126</b>′ and torque arm <b>128</b>′ are shown in dashed lines in the unactuated state of annulus repair system <b>50</b>. Torque arm <b>128</b> can be provided in the form of a pin, rod or other member that can be grasped by the surgeon to rotate end member <b>126</b> and cylinder <b>127</b> as indicated by arrow R (or in the direction opposite arrow R). This in turn moves mounting member <b>102</b> linearly and proximally with respect to actuating member <b>104</b>, and the anchors are driven or cammed along actuating surfaces <b>120</b><i>a</i>, <b>120</b><i>b </i>to penetrate the vertebral endplates.

P-0067[0067] Mounting member <b>102</b> is driven proximally in the direction of arrow P to actuate the anchors of repair system <b>50</b> mounted thereon with actuating surface <b>120</b><i>a</i>, <b>120</b><i>b</i>, as indicated by the movement of proximal end <b>102</b><i>a </i>of mounting member <b>102</b> to the location indicated by proximal end <b>102</b><i>a</i>′. In this actuated position, the upper end of movable arm <b>124</b> is positionable against or adjacent fixed arm <b>122</b> by pivoting the moveable arm <b>124</b> about pivot pin <b>130</b> to the position indicated in solid lines. This indicates to the surgeon that initial actuation is complete. Movable handle <b>124</b> can also block torque arm <b>128</b> from further rotation by contact of torque arm <b>128</b> with handle <b>124</b> and/or by contact between fixed handle <b>122</b> and movable handle <b>124</b> at the upper ends thereof. The entire handle assembly can then be rotated in the direction of arrow R (or in the direction opposite arrow R) to rotate mounting member <b>102</b>, causing the camming surfaces along and/between mounting surfaces <b>116</b><i>a</i>, <b>116</b><i>b </i>of mounting portion <b>106</b> to further drive the anchors of repair system <b>50</b> into the adjacent vertebrae.

P-0068[0068] In one specific embodiment, it is contemplated that the proximal portion of actuating member <b>104</b> is a 10 millimeter diameter tube mounted to fixed arm <b>122</b>, and the proximal portion <b>103</b> of mounting member <b>102</b> is an 8 millimeter diameter rod mounted to moveable arm <b>124</b>. Insertion instrument <b>100</b> can have a length extending between the distal end of mounting member <b>102</b> and the inside of fixed arm <b>122</b> of about 7 inches. The pullback of mounting member <b>102</b> relative to actuating member <b>104</b> for actuating repair system <b>50</b> from its insertion configuration to a first actuated position can be about 3 millimeters, and thereafter torque applied to cam the anchors of repair system <b>50</b> to a second actuated position where the anchors are further embedded in the adjacent vertebrae.

P-0069[0069] Referring now to FIG. 11, there is shown another embodiment anchor <b>270</b> to which a blocking member can be engaged before insertion or after insertion of the anchor <b>270</b> into the vertebral endplate. Anchor <b>270</b> includes a body <b>271</b> having an edge <b>274</b> at one end thereof for insertion into the vertebral endplate. Body <b>271</b> further includes a first surface <b>276</b> having a convex portion and an opposite second surface <b>278</b> having a concave portion. A number of holes <b>272</b> are formed through body <b>271</b> between first surface <b>276</b> and second surface <b>278</b> adjacent end <b>273</b>. An end of a blocking member can be attached to anchor <b>270</b> with sutures, rivets, screws or other fasteners that extending through the blocking member and into or through holes <b>272</b>.

P-0070[0070] As shown in FIGS. 12A to <b>12</b>C, anchor <b>270</b> can be mounted on mounting member <b>206</b> of insertion instrument <b>200</b>. Mounting member <b>206</b> includes a mounting portion <b>208</b> having a mounting surface <b>205</b> upon which anchor <b>270</b> is positioned. Anchor <b>270</b> includes a hole <b>275</b> through which a fastener can extend to provisionally engage anchor <b>279</b> to mounting portion <b>208</b>. Insertion instrument <b>200</b> includes an actuating member <b>204</b> in which mounting member <b>200</b> is movably positioned. Mounting member <b>204</b> includes an actuating surface <b>202</b> at a distal end thereof. As mounting member <b>206</b> is moved in the direction of arrow P relative to actuating member <b>204</b>, actuating surface <b>202</b> contacts first side <b>276</b> of anchor <b>270</b>, moving tip <b>274</b> away from mounting portion <b>206</b> and into the adjacent vertebral endplate.

P-0071[0071] As shown in FIG. 13, blocking member <b>52</b> can be secured to the inserted anchors <b>270</b><i>a</i>, <b>270</b><i>b </i>to provide repair system <b>250</b>. It is contemplated that blocking member <b>52</b> can be attached to respective ones of the anchors <b>270</b><i>a</i>, <b>270</b><i>b </i>after one or both of the anchors are engaged to the adjacent vertebral endplates. It is further contemplated that blocking member <b>52</b> can be pre-attached to anchors <b>270</b><i>a</i>, <b>270</b><i>b </i>and inserted as discussed above with respect to insertion instrument <b>100</b>. Once in position in defect X, blocking member <b>52</b> can resist expulsion or protrusion forces, indicated by arrows F, created by an implant or disc material.

P-0072[0072] Referring now to FIG. 14 there is shown another embodiment annulus repair system <b>350</b>. Repair system <b>350</b> includes a blocking member <b>352</b> having an attachment portion including a first anchor <b>370</b><i>a </i>attached at one end thereof and a second anchor <b>370</b><i>b </i>attached to another end thereof. Blocking member <b>352</b> is similar to blocking member <b>52</b> discussed above. Blocking member <b>352</b> includes a width W<b>1</b> that extends across all or a portion of width W of defect X. Anchor <b>370</b> includes a number of teeth, barbs, serrations or other engagement means <b>372</b> formed along one side thereof

P-0073[0073] Referring now to FIGS. 15A to <b>15</b>C, there is shown various means for connecting the blocking member to an attachment portion. In FIG. 15A anchor <b>370</b> includes a receptacle <b>374</b> extending along one end thereof. Blocking member <b>352</b> is in looped form and has one end in receptacle <b>374</b>. In a manner similar to that discussed above with respect to anchor <b>70</b>, a coupling pin <b>356</b> is positioned within a looped portion of blocking member <b>352</b> in receptacle <b>374</b> to retain the end of blocking member <b>352</b> therein.

P-0074[0074] In FIG. 15B anchor <b>370</b>′ includes teeth <b>372</b>′ extending along one side thereof. Anchor <b>370</b> includes a passage <b>374</b>′ formed in one end thereof through which a looped portion of blocking member extends to couple anchor <b>370</b>′ thereto. In this embodiment, the width of blocking member <b>352</b> could be less than the width of the anchor <b>370</b>′ so that passage <b>374</b>′ is formed along a portion of the width of anchor <b>370</b>′. In FIG. 15C, anchor <b>370</b>″ includes teeth <b>372</b>″ and a receptacle <b>374</b>″ along one end thereof. Anchor <b>370</b>″ further includes one or more holes <b>376</b>″ extending therethrough in communication with receptacle <b>374</b>″. Blocking member <b>352</b> can be attached to anchor <b>370</b>″ in receptacle <b>374</b>″ with sutures <b>378</b>″ extending through holes <b>376</b>″ and also through blocking member <b>352</b>. In the illustrated embodiment, the end of blocking member <b>352</b> is folded upon itself in order to provide a reinforced area of material for sutures <b>378</b>″ to engage.

P-0075[0075] Referring now to FIGS. <b>16</b>A-<b>16</b>C, there is shown another embodiment insertion instrument <b>300</b> for inserting the repair system of the present invention. Instrument <b>300</b> is described with reference to repair system <b>350</b>, although application with other repair systems described herein is also contemplated. In FIGS. 16A to <b>16</b>C, only the upper half of insertion instrument <b>300</b> is shown, it being understood that the lower half of insertion instrument <b>300</b> can be symmetrical thereto. Instrument <b>300</b> includes a mounting member <b>304</b> movably positioned along an actuating member <b>306</b>. Anchor <b>370</b> is mounted to mounting member <b>304</b>, such as described above with respect to insertion instruments <b>100</b> and <b>200</b>. As mounting member <b>304</b> is pulled proximally in the direction of arrow P relative to actuating member <b>302</b> as shown in FIG. 16B, anchor <b>370</b> is pushed to a first actuated position into the endplate of vertebra V<b>1</b> by actuating surface <b>308</b> of actuating member <b>302</b>. When mounting member <b>304</b> has been actuated to the first actuated position relative to actuating member <b>302</b>, mounting member <b>304</b> is rotated in the direction of arrow R. Camming surface <b>310</b> of mounting member <b>304</b> pushes against the end of anchor <b>370</b> to push anchor <b>370</b> to a second actuated position further embedded into the endplate of vertebra VI. Blocking member <b>352</b> can be engaged to anchor <b>370</b> before or after engagement of anchor <b>370</b> with the adjacent vertebra.

P-0076[0076] Referring now to FIGS. 17A to <b>17</b>C, there is shown another embodiment annulus repair system <b>450</b>. Repair system <b>450</b> includes a blocking member <b>452</b> and an attachment portion coupled to blocking member <b>452</b>. The attachment portion includes a first anchor <b>470</b><i>a </i>coupled to one end of blocking member <b>452</b> and a second anchor <b>470</b><i>b </i>coupled to the other end of blocking member <b>452</b>. In the illustrated embodiment, blocking member <b>452</b> is attached to anchor <b>470</b><i>a </i>with pin <b>454</b>, and the other end of blocking member <b>452</b> is attached to anchor <b>470</b><i>b </i>with pin <b>456</b>. This allows the end of blocking member <b>452</b> to rotate relative to the anchor as repair system <b>450</b> is moved from its insertion position to its actuated or engaged position. Other means for attaching blocking member <b>452</b> to anchors <b>470</b><i>a</i>, <b>470</b><i>b </i>are also contemplated.

P-0077[0077] In FIG. 17A repair system <b>450</b> is shown in its insertion position adjacent to or in defect X in annulus A between vertebrae V<b>1</b> and V<b>2</b>. In FIG. 17B repair system <b>450</b> has been actuated or moved to an actuated position in which anchors <b>470</b><i>a</i>, <b>470</b><i>b </i>have been moved away from one another for engagement to vertebrae V<b>1</b> and V<b>2</b>, respectively. Anchors <b>470</b><i>a</i>, <b>470</b><i>b </i>can be provided with teeth, barbs, serrations, spikes <b>472</b><i>a</i>, <b>472</b><i>b </i>or other means therealong to resist pullout from the vertebral body when inserted therein.

P-0078[0078] In FIG. 17C it is shown with repair system <b>450</b> and blocking member <b>452</b> that the blocking members described herein need not occupy the entire depth D of defect X, but rather only a portion thereof. However, it is also contemplated that the blocking members described herein could occupy all or a substantial portion of depth D. Furthermore, the blocking member can be centered laterally along width W and also along depth D to minimize the size of any unblocked area in defect X. However, repair system <b>450</b> could also be offset laterally to one side of defect X in order to, for example, provide room for a second repair system. Repair system <b>450</b> could also be positioned at various locations along depth D depending on operative and/or anatomical conditions encountered by the surgeon.

P-0079[0079] In FIGS. 18A and 18B, there is shown a schematic of an insertion instrument for actuating or moving repair system <b>450</b> from its insertion position in defect X to its engaged position with vertebrae V<b>1</b> and V<b>2</b>. Insertion instrument <b>400</b> includes a first arm <b>402</b> coupled to a second arm <b>404</b>. Anchor <b>470</b><i>a </i>is mounted on or in contact with a distal mounting portion <b>406</b> of first arm <b>402</b>, and second anchor <b>470</b><i>b </i>is mounted on or in contact with distal mounting portion <b>408</b> of second arm <b>404</b>. First arm <b>402</b> and second arm <b>404</b> can be moved relative to one another from an insertion configuration of FIG. 18A where anchors <b>470</b><i>a</i>, <b>470</b><i>b </i>are positioned in or adjacent to defect X to an actuated configuration in FIG. 18B where anchors <b>470</b><i>a</i>, <b>470</b><i>b </i>are engaged to vertebrae V<b>1</b>, V<b>2</b>, respectively. Blocking member <b>452</b> can be engaged to anchors <b>470</b><i>a</i>, <b>470</b><i>b </i>before or after engagement of anchors <b>470</b><i>a</i>, <b>470</b><i>b </i>with vertebra V<b>1</b>, V<b>2</b>.

P-0080[0080] Referring now to FIG. 19A, there is shown another embodiment blocking member <b>502</b>. Blocking member <b>502</b> has a body formed of a suture, braid, cord, rope, or strand like material. First end <b>504</b><i>a </i>of blocking member <b>502</b> includes an attachment portion with an eyelet and second end <b>504</b><i>b </i>also includes an attachment portion with an eyelet. Another embodiment blocking member <b>502</b>′ is shown in FIG. 19B. Blocking member <b>502</b>′ has a body formed of a sheet of material that can be woven or non-woven material. First end <b>504</b><i>a</i>′ of blocking member <b>502</b>′ includes an attachment portion with an eyelet and second end <b>504</b><i>b</i>′ also includes an attachment portion with an eyelet. The ends of blocking members <b>502</b>, <b>502</b>′ can be crimped, sewn, riveted, screwed, clamped, glued or otherwise fastened to the attachment portions. The attachment portion further includes an anchor <b>510</b> in the form of a pin fastener as shown in FIG. 19C. Anchor <b>510</b> has a threaded portion <b>512</b> and a pin <b>516</b> extending distally therefrom. A tool engaging recess <b>516</b> is provided at the proximal end of the pin fastener.

P-0081[0081]FIGS. 20A and 20B show a repair system <b>500</b> including blocking member <b>502</b> and an attachment portion including anchors <b>510</b><i>a</i>, <b>510</b><i>b</i>. Blocking member <b>502</b> is positioned in defect X with its first end <b>504</b><i>a </i>positioned in a tunnel or hole formed from the endplate of vertebra V<b>1</b> into the body of vertebra V<b>1</b>. The second end <b>504</b><i>b </i>of blocking member <b>502</b> is positioned in a tunnel or hole formed from the endplate of vertebra V<b>2</b> into the body of vertebra V<b>2</b>. Anchor <b>510</b><i>a </i>is positioned in a bore or hole extending from a face of vertebra V<b>1</b> so that pin <b>516</b> extends through the eyelet at first end <b>504</b><i>a</i>. Anchor <b>510</b><i>b </i>is positioned in a bore or hole extending from a face of the vertebra V<b>2</b> so that pin <b>516</b><i>b </i>extends through the eyelet at second end <b>504</b><i>b. </i>

P-0082[0082] It is contemplated that the face of vertebrae V<b>1</b> and V<b>2</b> from which anchors of the repair systems described herein could extend include the anterior, antero-lateral, lateral, posterior-lateral or posterior portion of vertebrae V<b>1</b>, V<b>2</b>. It should also be understood that blocking member <b>502</b>′ could similarly be secured in defect X, and that blocking member <b>502</b>′ can be provided with a width as discussed above with respect to blocking member <b>52</b>.

P-0083[0083]FIGS. 21A and 21B show a repair system <b>520</b> including blocking member <b>522</b> and an attachment portion including anchors <b>530</b><i>a</i>, <b>530</b><i>b</i>. In order to attach blocking member <b>522</b> to vertebrae V<b>1</b> and V<b>2</b>, blocking member <b>522</b> is positioned in defect X with its upper end positioned in a tunnel or hole formed from the endplate of vertebra V<b>1</b> into the body of vertebra V<b>1</b>. The lower end of blocking member <b>522</b> is positioned in a tunnel or hole formed from the endplate of vertebra V<b>2</b> into the body of vertebra V<b>2</b>. Anchor <b>530</b><i>a </i>is attached to the upper end of blocking member <b>522</b> with a suture or the like and extends in the same tunnel or hole as the upper end of blocking member <b>522</b>. Anchor <b>530</b><i>b </i>is attached to the lower end of blocking member <b>522</b> with a suture or the like and extends in the same tunnel or hole as the lower end of blocking member <b>522</b>. In the illustrated embodiment, anchors <b>530</b><i>a</i>, <b>530</b><i>b </i>include pivotal gulls extending therefrom to resist pullout from the vertebral body in which the anchor is engaged.

P-0084[0084]FIGS. 22A and 22B show a repair system <b>540</b> including blocking member <b>542</b> and an attachment portion including anchors <b>550</b><i>a</i>, <b>550</b><i>b</i>. In order to attach blocking member <b>542</b> to vertebrae V<b>1</b> and V<b>2</b>, blocking member <b>542</b> is positioned in defect X with its upper end positioned in a tunnel or hole formed from the endplate of vertebra V<b>1</b> into the body of vertebra V<b>1</b>. The lower end of blocking member <b>542</b> is positioned in a tunnel or hole formed from the endplate of vertebra V<b>2</b> into the body of vertebra V<b>2</b>. Anchor <b>550</b><i>a </i>is attached to the upper end of blocking member <b>542</b> with a suture or the like and extends in the same tunnel or hole as the upper end of blocking member <b>542</b>. Anchor <b>550</b><i>b </i>is attached to the lower end of blocking member <b>542</b> with a suture or the like and extends in the same tunnel or hole as the lower end of blocking member <b>542</b>. In the illustrated embodiment, anchors <b>550</b><i>a</i>, <b>550</b><i>b </i>include wings or barbs extending laterally therefrom to resist pullout from the vertebral body in which the anchor is engaged.

P-0085[0085]FIGS. 23A and 23B show a repair system <b>560</b> including blocking member <b>562</b> and an attachment portion including anchors <b>570</b><i>a</i>, <b>570</b><i>b</i>. In order to attach blocking member <b>562</b> to vertebrae V<b>1</b> and V<b>2</b>, blocking member <b>562</b> is positioned in defect X with its first end <b>564</b><i>a </i>positioned in a tunnel or hole formed from the endplate of vertebra V<b>1</b> through the body and opening at a face of vertebra V<b>1</b>. The second end <b>564</b><i>b </i>of blocking member <b>562</b> is positioned in a tunnel or hole formed from the endplate of vertebra V<b>2</b> through the body and opening at a face of vertebra V<b>2</b>. Anchor <b>570</b><i>a </i>is coupled to first end <b>564</b><i>a </i>and abuts against the face of vertebra VI adjacent the tunnel opening. Anchor <b>570</b><i>b </i>is coupled to second end <b>564</b><i>b </i>and abuts against the face of vertebra V<b>2</b> adjacent the tunnel opening. In one form, it is contemplated that anchors <b>570</b><i>a</i>, <b>570</b><i>b </i>are buttons having a thread or attachment loop extending therefrom engaged to the attachment portion of blocking member <b>562</b> in the tunnels formed in vertebrae V<b>1</b> and V<b>2</b>. In another form, the implant is placed through a hole in the anchor and secured thereto by knotting the ends of the implant or tying the ends of the implant to the anchor with sutures or the like.

P-0086[0086]FIGS. 24A and 24B show a repair system <b>560</b>′ similar to repair system <b>560</b>. However, blocking member <b>562</b> is includes an upper portion <b>562</b><i>a </i>and separate a lower portion <b>562</b><i>b</i>. Upper portion is attached to lower portion <b>562</b><i>b </i>at mid portion <b>564</b> after engagement of the upper portion <b>562</b><i>a </i>and lower portion <b>562</b><i>b </i>with respective ones of the vertebrae V<b>1</b>, V<b>2</b>. It is contemplated that attachment can be made with sutures, tying or knotting the end portions together, thermal welding or fusing the ends together, or attaching the end with fasteners or the like.

P-0087[0087]FIGS. 25A and 25B show a repair system <b>600</b> including blocking member <b>602</b> in defect X. In order to attach blocking member <b>602</b> to vertebrae V<b>1</b> and V<b>2</b>, blocking member <b>602</b> is positioned in defect X with its first end <b>604</b> positioned in a tunnel or hole formed from the endplate of vertebra V<b>1</b> through the vertebral body and opening at a face of vertebra V<b>1</b>. The second end <b>606</b> of blocking member <b>602</b> is positioned in a tunnel or hole formed from the endplate of vertebra V<b>2</b> through the vertebral body and opening at a face of vertebra V<b>2</b>. Blocking member <b>602</b> is looped along the faces of vertebrae V<b>1</b> and V<b>2</b> so that ends <b>604</b>, <b>606</b> are adjacent to and tied to one another. It is contemplated that tying can be made with sutures or knotting the end portions together.

P-0088[0088] In FIGS. 26A and 26B, repair system <b>600</b> is provided with the end portions <b>604</b>, <b>606</b> of blocking member <b>602</b> attached to one another in order to attach blocking member <b>602</b> to vertebrae V<b>1</b> and V<b>2</b>. Contemplated attachment means include thermal welding or fusing the ends together, sewing the ends together, or fastening the ends together with staples, tacks, screws or the like. In FIGS. 27A and 27B repair system <b>600</b> includes two blocking members <b>602</b><i>a </i>and <b>602</b><i>b </i>in defect X and attached to vertebrae V<b>1</b> and V<b>2</b> as discussed above.

P-0089[0089] In FIGS. <b>28</b>-<b>31</b> there are shown various means for attaching blocking members adjacent annulus defect X and along the face of vertebrae V<b>1</b> and V<b>2</b>. In FIG. 28, repair system <b>610</b> includes blocking member <b>612</b> adjacent defect X and extending along vertebrae V<b>1</b> and V<b>2</b>. In order to attach blocking member <b>612</b> to vertebrae V<b>1</b> and V<b>2</b>, the ends of blocking member <b>612</b> extend into tunnels or bores formed in vertebrae V<b>1</b> and V<b>2</b>, and are attached to respective ones of vertebrae V<b>1</b> and V<b>2</b> with anchors <b>620</b><i>a </i>and <b>620</b><i>b</i>. Anchors <b>620</b><i>a</i>, <b>620</b><i>b </i>are positioned in tunnels or bores formed in the vertebral bodies V<b>1</b> and V<b>2</b> along with the portion of blocking member <b>612</b> attached thereto.

P-0090[0090] In FIG. 29, repair system <b>630</b> includes blocking member <b>632</b> extending adjacent defect X along vertebrae V<b>1</b> and V<b>2</b>. In order to attach blocking member <b>632</b> to vertebrae V<b>1</b> and V<b>2</b>, the ends of blocking member <b>632</b> are embedded in tunnels or bores formed in vertebrae V<b>1</b> and V<b>2</b> and engaged therein with interference screws <b>640</b><i>a </i>and <b>640</b><i>b. </i>

P-0091[0091] In FIG. 30, repair system <b>650</b> includes blocking member <b>652</b> extending adjacent defect X along vertebrae V<b>1</b> and V<b>2</b>. In order to attach blocking member <b>652</b> to vertebrae V<b>1</b> and V<b>2</b>, the ends of blocking member <b>652</b> are attached to the faces of vertebrae V<b>1</b> and V<b>2</b> with tacks or staples <b>660</b><i>a </i>and <b>660</b><i>b</i>. In FIG. 31, repair system <b>670</b> includes blocking member <b>672</b> extending adjacent defect X along vertebrae V<b>1</b> and V<b>2</b>. In order to attach blocking member <b>672</b> to vertebrae V<b>1</b> and V<b>2</b>, the ends of blocking member <b>672</b> are attached to the faces of vertebrae V<b>1</b> and V<b>2</b> with bone screws <b>680</b><i>a </i>and <b>680</b><i>b. </i>

P-0092[0092] Referring now to FIGS. 32A through 32D, various embodiments of blocking members are designated generally at <b>690</b>. Blocking member <b>690</b> has a configuration for connection to hard tissue, such as the bony vertebral bodies V<b>1</b> and V<b>2</b>. Blocking member <b>690</b> can be secured to the vertebral bodies adjacent annulus defect X via anchors to maintain the positioning of blocking member <b>690</b> in or adjacent the defect.

P-0093[0093] In FIG. 32A blocking member <b>690</b><i>a </i>includes a body portion <b>692</b><i>a </i>extending between an upper end <b>694</b><i>a </i>and a lower end <b>695</b><i>a</i>. Blocking member <b>690</b><i>a </i>includes a rectangular or square shape. Upper end <b>694</b><i>a </i>can be provided with a pair of upper holes <b>696</b><i>a</i>, and lower end <b>695</b><i>a </i>can be provided with a pair of lower holes <b>697</b><i>a</i>. Anchors, screws, staples, pins, fasteners or other attachment means can be positioned through holes <b>696</b><i>a</i>, <b>697</b><i>a </i>or coupled to the ends of blocking member <b>690</b><i>a </i>to engage blocking member <b>690</b><i>a </i>to vertebrae V<b>1</b> and V<b>2</b> adjacent to or in defect X.

P-0094[0094] In FIG. 32B blocking member <b>690</b><i>b </i>includes a body portion <b>692</b><i>b </i>extending between an upper end <b>694</b><i>b </i>and a lower end <b>695</b><i>b</i>. Blocking member <b>690</b><i>b </i>includes an oval shape, although other shapes are also contemplated. Upper end <b>694</b><i>b </i>can be provided with an upper hole <b>696</b><i>b</i>, and lower end <b>695</b><i>b </i>can be provided with a lower hole <b>697</b><i>b</i>. Anchors, screws, staples, pins, fasteners or other attachment means can be positioned through holes <b>696</b><i>b</i>, <b>697</b><i>b </i>or coupled to the ends of blocking member <b>690</b><i>b </i>to engage blocking member <b>690</b><i>b </i>to vertebrae V<b>1</b> and V<b>2</b>.

P-0095[0095] In FIG. 32C blocking member <b>690</b><i>c </i>includes includes a body portion <b>692</b><i>c </i>extending between an upper end <b>694</b><i>c </i>and a lower end <b>695</b><i>c</i>. Blocking member <b>690</b><i>c </i>includes an oval shape, although other shapes are also contemplated. Anchors, screws, staples, pins, fasteners or other attachment means can be positioned directly through respective ones of the upper end <b>694</b><i>c </i>and lower end <b>695</b><i>c</i>, or the upper and lower ends can be coupled to anchors that engage blocking member <b>690</b><i>c </i>to vertebrae V<b>1</b> and V<b>2</b>.

P-0096[0096] In FIG. 32D blocking member <b>690</b><i>d </i>includes a body portion <b>692</b><i>d </i>having an upper tab <b>694</b><i>d </i>with an elongated, reduced width shape extending upwardly from body portion <b>692</b><i>d</i>. Body portion <b>692</b><i>d </i>also includes a lower tab <b>695</b><i>d </i>having an elongated, reduced width shape extending downwardly from body portion <b>692</b><i>d</i>. These elongated, reduced width tabs can be attached to or engaged by an interference screw or other embedded anchor with tabs at least partially embedded into vertebrae V<b>1</b>, V<b>2</b> along with the anchor, such as shown in FIGS. 20A and 20B, FIGS. 21A and 21B, and FIGS. 22A and 22B. The tabs can also be coupled to the anchors described herein for engagement with vertebrae V<b>1</b> and V<b>2</b>.

P-0097[0097] In FIGS. 33A through 33D, there are shown various embodiments of a blocking member <b>700</b> connectable with the adjacent annulus tissue surrounding annulus defect X. In FIG. 33A blocking member <b>700</b><i>a </i>includes a body portion <b>702</b><i>a </i>having a first lateral tab <b>704</b><i>a </i>with a rectangular shape and an opposite second lateral tab <b>705</b><i>a </i>with a rectangular shape, each extending laterally outwardly from body portion <b>702</b><i>a</i>. Lateral tabs <b>704</b><i>a</i>, <b>705</b><i>a </i>can be engaged to the annulus tissue adjacent annulus defect X with sutures, staples, or other suitable attachment means. It is contemplated that height H<b>1</b> of body portion <b>702</b><i>a </i>need not extend along the entire height H (FIG. 4A) of defect X between vertebra V<b>1</b> and V<b>2</b>. In one embodiment, height H<b>1</b> is less than 90 percent of the height of defect X. In another embodiment, height H<b>1</b> is less than 50 percent of the height of defect X.

P-0098[0098] In FIG. 33B blocking member <b>700</b><i>b </i>includes a body portion <b>702</b><i>b </i>having a first lateral tab <b>704</b><i>b </i>with a semi-circular or rounded end shape and an opposite second lateral tab <b>705</b><i>b </i>with a semi-circular or rounded end shape. Lateral tabs <b>704</b><i>b</i>, <b>705</b><i>b </i>can be engaged to the annulus tissue adjacent annulus defect X with sutures, staples, or other suitable attachment means. It is contemplated that height HI of body portion <b>702</b><i>b </i>can be provided as discussed above with respect to blocking member <b>700</b><i>a. </i>

P-0099[0099] In FIG. 33C blocking member <b>700</b><i>c </i>includes a body portion <b>702</b><i>c </i>having a first lateral tab <b>704</b><i>c </i>with a semi-circular or rounded end shape and an opposite second lateral tab <b>705</b><i>c </i>with a semi-circular or rounded end shape. Lateral tabs <b>704</b><i>c</i>, <b>705</b><i>c </i>taper to a reduced height configuration at the middle of body portion <b>702</b><i>c </i>forming a figure-eight shape. Lateral tabs <b>704</b><i>c</i>, <b>705</b><i>c </i>can be engaged to the annulus tissue adjacent annulus defect X with sutures, staples, or other suitable attachment means. It is contemplated that height H<b>1</b> of body portion <b>702</b><i>c </i>can be provided as discussed above with respect to blocking member <b>700</b><i>a. </i>

P-0100[0100] In FIG. 33D blocking member <b>700</b><i>d </i>includes a body portion <b>702</b><i>d </i>having a first lateral tab <b>704</b><i>d </i>with a pair of laterally extending flanges <b>706</b><i>d </i>at the end of the tab. Body portion <b>702</b><i>d </i>includes an opposite second lateral tab <b>705</b><i>d </i>having a pair of laterally extending flanges <b>707</b><i>d </i>at the end of the tab. The lateral flanges on lateral tabs <b>704</b><i>d</i>, <b>705</b><i>d </i>provide extensions that add perimeter length for suture attachment. Lateral tabs <b>704</b><i>d</i>, <b>705</b><i>d </i>taper to a reduced height configuration at the middle of body portion <b>702</b><i>d </i>forming a figure-eight shape. Lateral tabs <b>704</b><i>d</i>, <b>705</b><i>d </i>can be engaged to the annulus tissue adjacent annulus defect X with sutures, staples, or other suitable attachment means. It is contemplated that height HI of body portion <b>702</b><i>d </i>can be provided as discussed above with respect to blocking member <b>700</b><i>a. </i>

P-0101[0101] Referring now to FIGS. 34A through 34D various embodiments of a blocking member <b>800</b> connectable to both hard tissue and soft tissue using the attachment techniques discussed above. In FIG. 34A blocking member <b>800</b><i>a </i>has a body portion <b>802</b><i>a </i>with an upper tab <b>804</b><i>a </i>and an opposite lower tab <b>805</b><i>a </i>for engagement with hard tissue. Upper tab <b>804</b><i>a </i>has a hole <b>808</b><i>a </i>to receive or to facilitate attachment to an anchor, and lower tab <b>805</b><i>a </i>has a hole <b>809</b><i>a </i>to receive or facilitate attachment to an anchor. Body portion <b>802</b><i>a </i>includes opposite laterally extending tabs <b>806</b><i>a</i>, <b>807</b><i>a </i>for attachment to the soft tissue surrounding the defect. The upper and lower tabs and lateral tabs together form an octagonal shape in the FIG. 34A embodiment.

P-0102[0102] In FIG. 34B blocking member <b>800</b><i>b </i>has a body portion <b>802</b><i>b </i>with an upper tab <b>804</b><i>b </i>and an opposite lower tab <b>805</b><i>b </i>for engagement with hard tissue. Upper tab <b>804</b><i>b </i>has a hole <b>808</b><i>b </i>to receive or to facilitate attachment to an anchor, and lower tab <b>805</b><i>b </i>has a hole <b>809</b><i>b </i>to receive or facilitate attachment to an anchor. Body portion <b>802</b><i>b </i>includes opposite laterally extending tabs <b>806</b><i>b</i>, <b>807</b><i>b </i>for attachment to the soft tissue surrounding the defect. The upper and lower tabs and lateral tabs together form a cross shape in the FIG. 34B embodiment.

P-0103[0103] In FIG. 34C blocking member <b>800</b><i>c </i>has a body portion <b>802</b><i>c </i>with an upper tab <b>804</b><i>c </i>and an opposite lower tab <b>805</b><i>c </i>for engagement with hard tissue. Upper tab <b>804</b><i>c </i>has a hole <b>808</b><i>c </i>to receive or to facilitate attachment to an anchor, and lower tab <b>805</b><i>c </i>has a hole <b>809</b><i>c </i>to receive or facilitate attachment to an anchor. Body portion <b>802</b><i>c </i>includes opposite laterally extending tabs <b>806</b><i>c</i>, <b>807</b><i>c </i>for attachment to the soft tissue surrounding the defect. The upper and lower tabs and lateral tabs together form an arcuate or curvilinear cross shape in the FIG. 34C embodiment.

P-0104[0104] In FIG. 34D blocking member <b>800</b><i>d </i>has a body portion <b>802</b><i>d </i>with an upper tab <b>804</b><i>d </i>and lower tab <b>805</b><i>d</i>. Tabs <b>804</b><i>d</i>, <b>805</b><i>d </i>have an elongated, reduced width configuration for embedding into the vertebrae V<b>1</b>, V<b>2</b> as discussed above with respect to the embodiment of FIG. 32D. Body <b>802</b><i>d </i>also includes first lateral portion <b>806</b><i>d </i>and opposite second lateral portion <b>807</b><i>d </i>for attachment to the soft tissue surrounding the annulus defect.

P-0105[0105] The blocking member embodiments of FIGS. <b>32</b>A-D and <b>34</b>A-D can be provided with a body portion having a width as discussed above with respect to blocking member <b>50</b>. Furthermore, the blocking member embodiments of FIGS. <b>34</b>A-D can be provided with a height as discussed with respect to blocking member <b>700</b><i>a. </i>

P-0106[0106] While embodiments of the invention have been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that all changes and modifications that come within the spirit of the invention are desired to be protected.