text:
|Publication number
|Publication type
|Application number
|Publication date
|May 26, 2011
|Priority date
|Aug 18, 1999
|Also published as
|Publication number
|Gregory H. Lambrecht, Robert Kevin Moore, Jacob Einhorn
|Original Assignee
|Intrinsic Therapeutics, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (5), Referenced by (3), Classifications (75)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of co-pending U.S. application Ser. No. 11/417,793, filed May 3, 2006, which is a continuation of U.S. application Ser. No. 10/359,516, filed Feb. 5, 2003, now issued as U.S. Pat. No. 7,717,961, which is a continuation-in-part of U.S. application Ser. No. 10/020,507, filed Dec. 11, 2001, now issued as U.S. Pat. No. 6,821,276, which claims benefit to U.S. Provisional Application No. 60/298,605, filed Jun. 14, 2001, and wherein 10/359,516 is a continuation-in-part of U.S. application Ser. No. 10/055,504, filed Oct. 25, 2001, now issued as U.S. Pat. No. 7,258,700, which claims benefit to U.S. Provisional Application No. 60/311,586, filed Aug. 10, 2001, and wherein 10/359,516 is a continuation-in-part of U.S. application Ser. No. 10/325,320, filed Dec. 19, 2002, now issued as U.S. Pat. No. 7,124,761, which is a continuation of U.S. application Ser. No. 09/696,636, filed 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 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 Jun. 30, 2000, now issued as U.S. Pat. No. 6,425,919, which claims benefit to 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, all of which are incorporated by reference herein.
1. Field
The present invention relates generally to devices and instrumentation for intervertebral disc diagnosis and treatment, and methods thereof.
2. Description of the Related Art
An intervertebral 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 surrounded by a tough, woven anulus fibrosus. Herniation is a result of a weakening in the anulus. Symptomatic herniations occur when weakness in the anulus allows the nucleus to bulge or leak posteriorly toward the spinal cord and major nerve roots. The most common symptoms of herniation include pain radiating along a compressed nerve and lower back pain, both of which can be crippling for the patient. Herniation, and the resulting dehabilitating symptoms, are of significant medical concern in the United States because of the low average age of diagnosis. Indeed, over 80% of patients in the United States diagnosed with herniation are under the age of 59.
Information regarding anular thickness, internal dimensions of the disc space normally occupied by the nucleus, and the location of anular apertures and lesions in relation to the vertebral endplates and lateral walls of the anulus facilitates accurate diagnosis and treatment of intervertebral disc conditions. For example, medical procedures involving the implantation of an artificial nucleus or anular augmentation depend on this information for accurate sizing of such implants. Also important are safe, dependable, and minimally invasive methods and devices for the manipulation of anular and nuclear tissue, especially along the inner wall of the posterior anulus. For example, tissues in the anulus and nucleus are commonly removed or manipulated during the implantation of artificial discs either to clear a path for the insertion of other types of prosthetic devices or as part of a discectomy procedure.
Specialized tools have evolved for the surgical treatment of intervertebral discs in the lumbar, cervical, and thoracic spine, which have suffered from tears in the anulus fibrosis or herniation of the nucleus pulposus. These tools are well-known in the prior art. The devices of the prior art, however, are designed for specific procedures, including complete discectomies (as opposed to partial discectomy or minute removal of tissue) and the installation of vertebral fusion implants. Accordingly, these devices cannot be used to manipulate anular and nuclear tissue in a precise and minimally invasive manner. Moreover, such devices are typically designed to access the disc using an anterior approach, i.e., through the abdomen. Although an anterior surgical approach provides direct access to intervertebral discs, it is highly invasive to the abdominal organs. Thus, surgery is typically more complicated and time consuming. A direct posterior approach is not anatomically practicable because the spinal cord and its surrounding bony protective sheath lies directly in front of each vertebral disc. An posterior-lateral aspect approach is the least invasive of these methods but provides limited and oblique access to the disc and its interior. Depending upon the surgical necessities involved, several methods of percutaneous disc tissue manipulation are available, including chemonucleolysis (e.g., U.S. Pat. No. 4,439,423), laser (e.g., U.S. Pat. No. 5,437,661), manual, focused energy, ultrasonic disruption (e.g., U.S. Pat. No. 5,772,661), arthroscopy and endoscopy.
Endoscopic instrumentation has evolved over the past 25 years and permits viewing, irrigation, suction, and cutting. Probes that permit automated percutaneous suction such as nucleotomes or cylindrically housed rotating cutting means, such as debriders, provide gross but efficient removal of disc tissue. Varying tip profiles control the amount and direction of tissue resection as well as the likelihood of damage to surrounding tissue. These devices tend to be limited by the size of the cannula which houses the instrumentation and its ability to maneuver around vertebral bodies and delicate tissues of the spine.
Hand tools for use in the spine are also well known and can be inserted through cannulae or freely guided by hand. These tips may be blades, burs, rongeurs, curettes or forcep-like "graspers" that are capable of pinching of small amounts of material. To the extent that these instruments can access the various tissues, these devices provide good tactical feedback and control. However, if used in an antero-lateral spinal approach, these tools are generally limited by the indirect approach necessitated by the laminae and spinous processes of the adjacent vertebrae, and thus, access to tissues is substantially hampered.
Some intervertebral disc devices have been designed with flexible tips that are designed not to perforate or deflect off of the interior surface of the disc. Unfortunately, such tips deflect off of healthy disc tissue only, not the pathological tissue that caused the need for the surgery in the first place. Thus, such instrumentation can exit the anulus and cause considerable damage to the surrounding tissues and spinal cord. Also, the flexible probe tips on some instruments which permit access to remote locations within the disc can only do so by sacrificing direct control because the devices are passively guided or blindly "snaked" within the disc. Accordingly, delicate and precise work within a disc is not possible with such instruments.
Among other disadvantages, the devices and methods of the prior art are typically invasive and destructive to surrounding tissue, frequently causing disc infection and nerve root injury. Moreover, such devices are unable to precisely manipulate disc material along the posterior anulus in a minimally invasive manner. Accordingly, there is a need for an intervertebral disc diagnostic and manipulation device which is capable of performing delicate and precise work within a disc, especially along the posterior anulus and between anular lamella.
Embodiments of current invention relate generally to devices and instrumentation for intervertebral disc diagnosis and treatment, and methods thereof. In several embodiments, the present invention provides for minimally invasive and actively guided intervertebral diagnostic and implant delivery devices.
Various embodiments of the disclosed devices may be guided by tactile feedback or through active viewing. Also, various embodiments may be used in conjunction with medical imaging technologies, including MRI, ultrasound, or fluoroscopy. Further, several embodiments of the invention having radiopacity or selective radiopacity may be used in conjunction with imaging methods for guidance and/or to facilitate measurement of organs or tissues.
Various embodiments of the disclosed devices may be guided by using one or more indicators. These indicators include, but are not limited to, biochemical marker, pH value, tissue density, tissue reflectance and light absorption. In one embodiment, the indicator is coupled to a transducer. The transducer contacts the disc and any signal changes are interpreted to facilitate guiding.
Various embodiments of the current invention are particularly advantageous because they provide active controlled direction of the working end of the instrument within the anulus or nucleus. Further, several embodiments provide access to the posterior portion of the anulus using a posterior surgical approach. In various embodiments, access to the posterior anulus, via circumferential navigation of the instrument as it is deflected from the lateral, anterior, opposite lateral, and finally to the posterior anulus, is avoided. This is advantageous because circumferential deflection of the working end of the instrument within the anulus can result in the tip of the instrument passing through a fissure in the posterior anular surface and outward to the spinal cord. This can occur because the circumferential navigation from a typical posterior surgical approach eventually directs the tip perpendicular to the posterior anular surface, which may contain lesions large enough to allow protrusion of the tip directly through to the spinal cord.
There is provided in accordance with one aspect of the present invention, a device for treating the spine. The device comprises an elongate guide having a longitudinal axis. An axially moveable actuator is carried by the guide. A probe is movable with the actuator, and a deflection surface is carried by the guide. Axial movement of the actuator causes the probe to advance along the deflection surface and extend away from the guide at an angle to the longitudinal access of the guide.
In one implementation of the invention, the guide comprises an elongate tubular body having at least one lumen extending therethrough. The actuator extends through at least a portion of the guide. The probe may comprise an elongate flexible body, attached to the actuator. The probe may be biased in a nonlinear configuration. In one embodiment, the probe comprises a nickel titanium alloy.
In accordance with another aspect of the present invention, there is provided a method of treating a disc in the spine. The method comprises the steps of advancing a device at least part way through an anulus. A probe is advanced laterally from the device in a first direction along a portion of the anulus.
In one application of the invention, the advancing a probe step comprises advancing the probe in between adjacent (anular lamella) layers of the anulus. In another application of the invention, the advancing a probe step comprises advancing the probe along an interior surface of the anulus, between the anulus and the nucleus. The method may further comprise the step of repositioning the probe and advancing the probe in a second direction along a second portion of the anulus.
In accordance with a further aspect of the present invention, the method additionally comprises the step of introducing media through the delivery device and into the disc. In one application, the media comprises contrast media, to permit fluoroscopic visualization. The media may alternatively or additionally comprise a medication, and/or a nucleus augmentation material. The method may additionally comprise the step of introducing a prosthesis into the disc. The prosthesis may be introduced by proximately retracting a push rod from a lumen in the delivery device, and introducing the prosthesis into the disc through the lumen.
As will be appreciated by those of skill in the art, the present invention, therefore, provides a minimally invasive access pathway into the anulus and/or nucleus of a vertebral disc. The pathway may be utilized to perform any of a wide variety of procedures, including diagnostic and therapeutic procedures, some of which will be identified below.
Several embodiments of this invention provide a new intervertebral disc manipulation and diagnostic device.
One or more embodiments disclosed herein provide a convenient, reliable, and accurate way to measure the anular thickness and the internal dimensions of the disc space normally occupied by the nucleus pulposus.
Several embodiments of this invention provide a device useful in determining various disc dimensions in order to enable a surgeon to size various implants and tools and facilitate their guidance within the disc.
Various embodiments provide for the manipulation through an opening in the anulus. Manipulation includes, but is not limited to, dissection, resection or ablation of disc tissue. The opening may be a single iatrogenic hole, such as an anulotomy, a naturally occurring hole, or a lesion in the anulus.
One or more aspects of the current invention prepare or manipulate disc tissue in preparation for the insertion of an implant or other instruments.
Several embodiments of the present invention diagnose and manipulate disc tissue with minimal invasiveness and risk of unintended passage of the device outside of the posterior anulus in the direction of the spinal cord or other sensitive areas proximal thereto.
Various aspects of this invention permit direct access to the interior aspect of anulus via an anulotomy.
Several embodiments of invention provide an intervertebral disc manipulation and diagnostic device wherein the travel of the working end of the device is parallel to the lamellae of the anulus.
Several embodiments of invention provide a method of delivering an intervertebral disc implant. In one embodiment, the method includes the steps of identifying an interface of a lamella of an anulus fibrosus and a nucleus pulposus, providing an implant delivery tool having a depth stop, a proximal end and a distal end, inserting at least a portion of the delivery tool within the anulus such that the depth stop is placed against an external aspect of a functional spinal unit and the distal end of the delivery tool is inserted to a selected depth relative to the interface, and delivering the implant.
Several embodiments of the present invention provide a method of performing a procedure within an intervertebral disc. In one embodiment, the method includes the following steps: identifying a first depth corresponding to an inner surface of an anulus lamella of a selected intervertebral disc, providing a surgical device comprising a depth stop, a proximal end and a distal end, inserting at least a portion of the device within the anulus along a first axis such that said depth stop is placed against an outer surface of a functional spinal unit and the distal end of the device is inserted to a second depth relative to said first, and performing the procedure.
Several embodiments of the invention include a method of performing a procedure on an intervertebral disc that includes the following steps: providing a therapeutic device comprising a distal intradiscal component located at a distal end of said device, advancing at least a portion of the distal end of the therapeutic device into the disc, retracting at least a portion of the device such that at least a portion of the intradiscal component is placed against an inner surface of an anular lamella, and performing a procedure with the device on the disc.
This disclosure utilizes particular orthopedic references, nomenclature, and conventions. Accordingly, several background figures and descriptions are included to aid in the understanding of the environment under which specific embodiments of the invention may be used. In this description and the following claims, the terms "anterior" and "posterior", "superior" and "inferior" are defined by their standard usage in anatomy, i.e., anterior is a direction toward the front (ventral) side of the body or organ, posterior is a direction toward the back (dorsal) side of the body or organ; superior is upward (toward the head) and inferior is lower (toward the feet).
In one aspect of the invention, there is provided a guide such as a hollow delivery cannula having a distal end and a proximal end. The guide is dimensioned to fit within a small anulotomy as might be created by a surgeon or through a naturally occurring hole or lesion in the anulus. An advancer, push rod, or actuator is axially moveably carried by the guide, and coupled to a flexible probe member. The flexible probe member has a proximal end connected to the advancer and distal end connected to or formed into a probe tip.
The probe is advanceable outwardly from the distal end of the cannula via axial movement of the advancer within the cannula. In the illustrated embodiment, the probe member exits through a slot having a curved pathway or deflection surface located at the distal end of the cannula and can be advanced outwardly therefrom generally at an angle of between about 30 to about 150 degrees relative to the cannula's longitudinal axis. Accordingly, when the distal end of the cannula is properly inserted within the anulotomy at sufficient depth, the probe travels along a path that is parallel to and along the surface of or in between the anular lamellae. The probe may be retracted via reversing the action (e.g. proximal retraction) of the advancer.
A means for measuring the distance advanced by the probe is associated with the probe and cannula. Any of a variety of measurement indicia may be used, such as calibrated markings on the advancer visible through or proximal to the cannula. An indicator for measuring the distance advanced by the cannula within the anulotomy or lesion may also be included. For example, a calibrated depth stop may be affixed in a slideably adjustable manner to the delivery cannula.
The probe tip at the distal end of the probe member may be an integral piece of the probe wherein the tip and the probe are of a unitary construction. Alternatively, the tip may be secured, either releasably or permanently to the probe. The tip can be blunt enabling it to forcibly part the tissue without cutting it (blunt dissection) or be sharpened to present a sharp dissecting blade surface (sharp dissection).
The tip may also be constructed in a backwardly curved manner facing back towards the longitudinal axis of the cannula and with its reverse facing edge sharpened to facilitate resection or sharp dissection as it is retracted. This curved shape also serves to present a blunt profile that is less likely to perforate the anulus as it is advanced, even in the presence of uneven or degenerated anular tissue. Alternatively, the curved resection tip or blade may be formed as a multi-sided scoop with a concave trailing surface and convex leading surface such that it presents a blunt frontal profile even when advanced off-angle into the anulus or toward a vertebral endplate.
In another embodiment, the tip may be configured to house an ablation element. This element may be preferentially insulated on particular surfaces of the probe and/or tip to minimize unwanted damage to adjacent tissues. For example, the surface of the probe or tip facing an inner aspect of the anulus may be insulated to prevent unwanted travel through or harm other portions of the anulus, nucleus and vertebral endplates. Ablation energy is instead directed to the targeted tissue adjacent to the probe tip and not the endplates or tissue facing the insulted side of the probe tip.
Intervertebral disc 315 is comprised of the outer AF 310 which normally surrounds and constrains the NP 320 to be wholly within the borders of the intervertebral disc space. Axis M extends between the anterior (A) and posterior (P) of the functional spine unit. The vertebrae also include facet joints 360 and the superior 390 and inferior 390′ pedicle that form the neural foramen 395.
The delivery cannula 30 may be manufactured in accordance with any of a variety of techniques well known in the medical device arts. In one embodiment, the cannula 30 comprises a metal tube such as stainless steel or other medical grade metal. Alternatively, the cannula 30 may comprise a polymeric extrusion such as high density polyethylene, PTFE, PEEK, PEBAX, or others well known in the medical device arts.
In general, the axial length of the delivery cannula 30 will be sufficient to reach the desired treatment site from a percutaneous or small incision access through the skin. Lengths within the range from about 10 centimeters to about 30 centimeters are contemplated, with a length from a proximal end 32 to distal end 34 within the range of from about 14 to about 20 centimeters contemplated for most posterior lateral access pathways. The length may be varied depending upon the intended access pathway and patient size.
Preferably, the outside diameter of the delivery cannula 30 is no greater than necessary to accomplish the intended functions disclosed herein. In general, outside diameters of less than one centimeter are preferred. In typical embodiments of the present invention, the delivery cannula 30 has an outside diameter of no greater than approximately 5 millimeters.
Referring to
Push rod 40 is preferably dimensioned to extend throughout the length of the delivery cannula 30, so that the probe 20 is fully extended from the intradiscal tip 50 when the ring handle 45 is brought into contact with the cannula handle 35 or other stop surface.
The device 10 may optionally be provided with one or more axially extending lumens, for placing the proximal end of the device 10 in fluid communication with the distal end, for any of a variety of purposes. For example, one or more lumens may extend through the push rod 40. Alternatively or in addition, the outside diameter of push rod 40 may be dimensioned smaller than the inside diameter of the delivery cannula 30 to create an annular space as is well understood in the catheter arts. A first lumen may be utilized for introduction of radiopaque dye to facilitate visualization of the progress of the probe 20 and or distal end of the device 10 during the procedure. The first lumen or second lumen may be utilized to introduce any of a variety of media such as saline solution, or carriers including any of a variety of medications such as anti-inflammatory agents e.g., steroids, growth factors e.g., TNfα antagonists, antibiotics, and functional proteins and enzymes e.g., chymopapain. A lumen may also be utilized to aspirate material such as nucleus pulposus, and/or to introduce nucleus augmentation material during or at the end of the procedure.
Referring to
The distal end 34 of the cannula 30 may be provided with any of a variety of constructions, depending upon the mode of deflection of the probe 20. In the illustrated embodiment, the distal end 34 is provided with a cap 52 which contains the deflection surface 62 therein. Cap 52 may be molded from any of the polymeric materials identified elsewhere herein, and secured to the distal end 34 by adhesive bonding, interference fit, or other conventional securing technique. Cap 52 has an atraumatic distal surface 50, which may comprise the distal end of cap 52, or may include a coating or layer of an atraumatic material such as silicone, carried by the cap 52.
Any of a variety of alternative deflection surfaces may be used, depending upon the desired distal tip design. For example, the distal molded cap 52 may be eliminated, and the deflection surface formed instead by an inside surface of the tubular cannula 30. This may be accomplished by providing two opposing axial slots extending proximally from the distal end 34 of the cannula 30 to isolate two opposing axial ribbons on the distal end 34. A first one of the ribbons is severed and removed, while the second one is curved across the central axis of the cannula 30 to provide a curved deflection surface.
Alternatively, the deflection surface may be eliminated in certain circumstances. For example, in the procedure illustrated in
The foregoing axial launch embodiment of the invention may be utilized through the naturally occurring defect. However, the axial launch device is more likely to find application through an iatrogenic access pathway, created through the annulus spaced apart from the natural defect such that the longitudinal axis of the iatrogenic access is substantially parallel (e.g., no more than about +/−20 degrees) from the plane in which the natural defect resides.
As a further alternative, the probe 20 may be laterally deflectable in response to manipulation of a deflection control at the proximal end of the device 10. For example, the probe 20 in one construction comprises a flexible metal or polymeric ribbon, extending from the distal end of the advancer 40 or other axial support. An axially extending steering element is attached to the probe 20. Generally the steering element will be attached near the distal end of the probe 20. Axial proximal or distal movement of the steering element relative to the advancer 40 will cause a lateral deflection of the probe 20.
The radius of curvature of the deflection can be controlled in a variety of ways as will be apparent to those of skill in the art in view of the disclosure herein, such as by varying the lateral flexibility of the probe 20, and the attachment point of the steering element to the probe 20. Due to the differing physical requirements of devices under tension compared to compression, the cross section of the device may be minimized if the steering element is a pull wire or ribbon such that axial proximal retraction of the pull wire relative to the probe 20 causes a lateral deflection of the probe 20. The lateral deflection can be coordinated with the extent of distal advance to cause the probe to follow the desired curved path either by mechanics in the proximal handpiece, or by the clinician. For this purpose, the proximal handpiece can be provided with any of a variety of controls, such as slider switches or rotatable levers or knobs to allow the clinician to control deflection as well as distal (and lateral) advance.
In an alternate construction, the probe launches axially from the distal end 34 of the cannula or other guide 30, but curves under its own bias to travel in a lateral arc and slide along the posterior annulus or other desired surface. This may be accomplished by constructing the probe from a nickel-titanium alloy such as Nitinol and providing it with a lateral pre bent orientation. The probe is restrained into an axial orientation within the cannula 30, but extends laterally under its own bias as it is advanced distally from an opening in the distal end of the cannula 30.
The probe member 20 in the illustrated embodiment may be formed from a superelastic nickel titanium alloy, or any other material with suitable rigidity and strain characteristics to allow sufficient deflection by deflection surface 62 without significant plastic deformation. The probe member 20 can be formed from an elongated sheet, tube, rod, wire or the like. Probe 20 may also be constructed in various cross-sectional geometry's, including, but not limited to hemicircular, semicircular, hollow, and rectangular shapes.
A probe tip 80 at the distal end of the probe member 20 can be used to dissect between the anulus 310 and nucleus 320, to dissect between layers of the anulus 310, or to dissect through the nucleus. The probe tip 80 can be constructed of the same material as the probe member 20 or another suitable material for the purposes of cutting or presenting a blunt rounded surface. A sharpened surface on the distal edge of the probe member 20 forming the probe tip 80 can be used to dissect a path to enable the insertion of an implant in the created space. Similarly, a blunted tip profile may be used to separate or disrupt anular lamella and create an open space between the anulus 310 and nucleus 320 or within the nucleus 320 itself.
The probe tip 80 may also be provided with a backward curve as shown in
The distal end of device 10 is shown in
As demonstrated in
The probe tip 80 may also be coupled to an ablation unit for ablating tissue, as shown in
An embodiment of a bipolar radio-frequency unit is depicted in
Tube 92 is shown attached to probe 20 to provide an escape path for vapor and material ablated or for the infusion of fluids or gasses. These fluids or gasses may be added to alter the conductive characteristics of the tissue or may include various drugs, medications, genes or gene vectors or other materials to produce a desirable therapeutic effect. Tube 92 is shown with a single distal orifice. It may alternatively comprise any number of side holes or channels to increase the spread of fluids or gasses within the tissue or similarly to remove such materials as required by the procedure. Axial lumen are provided as needed to place the side holes or other apertures in communication with the proximal end of the device 10. The ablation unit could be activated as the probe member 20 is advanced through the tissues to create a cavity or activated as the probe member 20 is retracted after it has been advanced to a desired distance. Moreover, the power supplied to the ablation unit 90 could be varied according to the instantaneous velocity of the probe member 20 in order to ablate a more uniform cavity within the disc.
Whether used to dissect, resect or ablate tissue within the disc, device 10 may be used as part of an implantation procedure by creating a cavity or dissected region into which any of a variety of intradiscal implants or medications may be inserted. This region may be between or within anular layers 310, within the nucleus 320, or between the anulus 310 and nucleus 320 or within a defect. It may include a portion or the entirety of the nucleus. Increasing amounts of disc tissue may be removed by advancing and retracting the probe tip repeatedly at different depths within the disc. Intradiscal implants may be inserted independently using separate instrumentation or along, through, or around probe 20. Suitable implants include, among others, those disclosed in U.S. patent application Ser. No. 09/642,450 filed Aug. 18, 200, now issued as U.S. Pat. No. 6,482,235, entitled Devices and Methods of Vertebral Disc Augmentation, the disclosure of which is incorporated in its entirety herein by reference. As disclosed in U.S. Pat. No. 6,482,235, suitable implants include one or more anchors and/or support members, such as sutures, bone anchors, soft tissue anchors, tissue adhesives, and materials that support tissue ingrowth. These may be permanent devices or resorbable. Any attachment to a portion of the functional spine unit and a herniated segment must be strong enough to resist the tensional forces that result from repair of a hernia and the loads generated during daily activities. The implant may also comprise a barrier. In one embodiment, the barrier is inserted into the interior of the disc and positioned proximate to the interior aspect of an anulus defect. The barrier material is preferably considerably larger in area than the size of the defect, such that at least some portion of the barrier means abuts healthier anulus fibrosis. The device acts to seal the anulus defect, recreating the closed isobaric environment of a healthy disc nucleus. This closure can be achieved simply by an over-sizing of the implant relative to the defect. It can also be achieved by affixing the barrier means to tissues within the functional spinal unit. In a preferred aspect of the present invention, the barrier is affixed to the anulus surrounding the anulus defect. This can be achieved with sutures, staples, glues or other suitable fixation means or fixation device. The barrier means can also be larger in area than the defect and be affixed to a tissue or structure opposite the defect, i.e. anterior tissue in the case of a posterior defect. The barrier means is preferably flexible in nature. It can be constructed of a woven material such as Dacron or Nylon, a synthetic polyamide or polyester, a polyethplene, and can further be an expanded material, such as expanded polytetrafluroethelene (e-PTFE), for example. The barrier means can also be a biologic material such as cross-linked collagen or cellulous. The barrier means 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. 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 can be mounted within an anulus and covering an anulus defect. The barrier can be secured to the anulus with a fixation mechanism or fixation means. The fixation means can include a plurality of suture loops placed through the barrier and the anulus. Such fixation can prevent motion or slipping of the barrier away from the anulus defect. The barrier means can also be anchored to the disc in multiple locations. In one preferred embodiment, the barrier means can be affixed to the anulus tissue in or surrounding the defect and further affixed to a secondary fixation site opposite the defect, e.g. the anterior anulus in a posterior herniation, or the inferior or superior vertebral body. For example, fixation means can be used to attach the barrier to the anulus near the defect, while an anchoring mechanism can secure the barrier to a secondary fixation site. A connector can attach the barrier to the anchor. Tension can be applied between the primary and secondary fixation sites through a connector so as to move the anulus defect toward the secondary fixation site. This may be particularly beneficial in closing defects that result in posterior herniations. By using this technique, the herniation can be moved and supported away from any posterior neural structures while further closing any defect in the anulus. The barrier means can further be integral to a fixation means such that the barrier means affixes itself to tissues within the functional spinal unit.
Another method of securing the barrier means 12 is to insert the barrier means 12 through the defect or another opening into the disc 315, position it proximate to the interior aspect of the defect, and pass at least one fixation means 25 through the anulus 310 and into the barrier 12. In a preferred embodiment of this method, the fixation means 25 can be darts and are first passed partially into anulus 310 within a fixation device 120, such as a hollow needle. As depicted in
By rotating the device 10, while the probe member 20 is fully retracted, 180 degrees and performing the same action in the lateral direction, as shown in
The measurement techniques described above may also be used to achieve the complete resection of the nucleus from the disc space. For example, a resection or ablation tip as described above may be passed repeatedly into the disc to the lateral borders of the nucleus. This process may be repeated at varying depths within the disc from the inner aspect of the posterior anulus to the inner aspect of the anterior anulus as determined by the depth stop.
Through adjustments to the depth stop 70 setting, the device 10 may be used in various procedures at different locations within the disc such as dissection or resection of a space within the disc and also placement of another intradiscal instrument or implant. More generally, the depth stop may be used as part of a method of performing a procedure within the disc at a certain location. For example, as shown in
As discussed above, it may be desirable for medical professionals to determine the location of the interface between the nucleus and anulus for selecting an implant site or for delivering therapeutic or diagnostic agents. This can be achieved through tactile feedback from the various embodiments of the devices described herein, imaging equipment, or via transducers coupled to the devices. Biophysical or biochemical transducers could be designed to differentiate or indicate the disparate properties between anulus tissue and nucleus pulposus tissue. Such transducers could, for example, be used to indicate the difference in pH, tissue density, hydration, reflectance, light absorption, thermal transmission or any of a number of tissue surveillance techniques known to those skilled in the art.
Probe 20 may be used as part of the placement of an intradiscal implant in any of a variety of ways. One advantageous use of the probe 20 can be achieved by detaching it from advancer 40 once probe 20 is in a desired position within the disc space. Implants including those depicted in
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.
|Cited Patent
|Filing date
|Publication date
|May 4, 1936
|Mar 28, 1939
|American Box Board Co
|Title not available
|Title not available
|Title not available
|Title not available
|Citing Patent
|Filing date
|Publication date
|Jun 27, 2011
|Dec 25, 2012
|The Boeing Company
|Method and apparatus for measuring spaces with limited access
|Mar 7, 2013
|May 26, 2015
|Intrinsic Therapeutics, Inc.
|Bone anchor systems
|Jun 12, 2012
|Jan 2, 2013
|The Boeing Company
|Method and apparatus for measuring spaces with limited access
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification


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Comments On Jan 21, 2015:Saves time during trail side flats
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Comments On Jun 12, 2014:In the shop I have all kinds of tools at my disposal to easily get the axle out but on the trail this will be very handy. Installation was easy and it looks nice!
Additional Comments On Nov 23, 2014:I was riding the Hatfield Mccoy trails so maybe it crashed off in some crazy singletrack but it fell out! Too bad because I've been so happy with everything Enduro Engineering.
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Comments On Dec 20, 2013:I have not found an Enduro Engineering part that I was unhappy with. So glad RM started carrying these parts.
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Comments On Aug 12, 2013:not great as it doesnt clamp on tight enought to get the axel out if axel binds slightly. Ok for installing axel.
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Comments On Jun 17, 2013:Easy to install, looks good, works well. Makes taking the wheels off of a KTM much easier.
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Comments On Jun 17, 2013:Easy to install, looks good, works well. Makes taking the wheels off of a KTM much easier.
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Comments On Mar 08, 2013:Easy to install and now I can easily pull the axle without having to knock it out with a mallet and a punch.
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Comments On Feb 18, 2013:Instillation was a snap, part is sturdy and appears like it will put up with some abuse. Would purchase again and would recommend to a friend.
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Comments On Feb 05, 2013:AI put these on all our bikes. Makes changing the tires so much easier. Easy to install and work and look great. Enduro Engineering is the best and so is Rocky Mountain.
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subset: commoncrawl


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Canadian music television station MuchMoreMusic will air a 90-minute pre-recorded "live" special from April 18, 2000 in Paris, France this weekend. Check it out Sunday at 6pm & 9pm PST and again on Monday at 11am PST.
Ben Harper and The Innocent Criminals will make another appearance on NBC's "Tonight Show with Jay Leno" on June 6th. Click here for details from the band's last performance on the late night talk show.
At last night's show in New Orleans, the Blind Boys of Alabama sat in on four songs during the first encore. Click here to read more about it.


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Robertson Backpackers의 약도
지도 및 약도
The best way to get to our place in Robertson is by car which is about one and a half hour drive from Capetown.
Alternatively there is the Translux bus which arrives daily from Capetown.
With prior arrangements, we do a free pick-up from the town centre.
It is best to phone or e-mail us for directions.


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The Community of Disc Golfers and About All Things Disc Golf
I´ve been thhrowing my Latitude GL Flow 172g for a while. Had some really nice lines and length with it, but it seemed a little inconsistent to me. Perhaps it was me, over torquing it. I´m playing for about a year now.
Then I threw a ESP Surge 172g from a friend and liked it. Now i have two in my bag but didn´t throw it too much yet.
On my last round i gave the Flow another try and was very suprised how long anf straight it flew, with a turnover in a Headwind that really was to neglect.
So, i don´t know it i should keep both molds in my bag.
What do you think, are these quite similar discs? Is there much overlapping?
What is your experience with those two discs?
Thank you!
Views: 185
I keep both the surge and the flow in my bag. I agree they are very similar in flight, but mine have subtle differences most likely due to the degree of "break-in". The flow does give me slightly more distance, but not always. I love them both and can't imagine playing without either of them.
I also have both and really LOVE the dependability of both discs, I'm partial to the Flow, but that's mainly because it's my absolute favorite disc.
As I always say, just go with the Flow.
So, do you use the Flow also in a moderate headwind, perhaps a heavier Opto?
What about the Westside Sword with some wind?
The Flow will not handle headwinds very well and the Sword is OK for a mild headwind, but if it's to windy it will flip for sure. Two solid headwind drivers would be the Halo or Riot. I've tried them both and they work very well witha stiff headwind, but for me. The Good old Teerex is my favorite. I just seem to get more "D" with my Teerex. If you can, I'd see if you could try a buddies Halo or Riot first. Because the Riot has a odd rim to it. It's one of those disc that you either love or hate and there's no in between.
I think the Surge is better into a headwind than the Flow, the Flow is more understable but has more glide than the Surge. I like both molds, I moved from a Surge to a Flow as my go-to driver when the Flow came out.
the flow is slow compared to a surge but goes much further. On a scale from 1-20 id say the surge is a 17 in speed where the flow is a 15. But in glide a flow is an 18 wherein the surge is a 14.
But doesn´t the Surge´s higher speed offset the glide of the Flow?
By the way, I don´t think the Surge has remarkable less glide than the Flow.
© 2015 Created by Terry "the Pirate" Calhoun.


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Elegant, yet totally cool, this deep aqua velvet maxi dress features black sheer crochet detailing at back and low slits at side. Stretch fabric, unlined. By Motel.
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US officials finalize changes to annual soot standard
2:15 PM MST | December 17, 2012 | Kara Sissell
US EPA has finalized changes to annual requirements for reducing fine particles (PM 2.5), or soot, from the prior 15 micrograms/cubic meter (mg/cu meter), to 12 mg/cu meter. EPA's science advisory panel had recommended a standard of 11–13 mg/cu meter. The standard for daily PM 2.5 concentrations and for the coarser PM 10 standard will remain unchanged, EPA says. The revised annual standard is part of a court order to settle a lawsuit by the American Lung Association (Washington), which had filed suit to compel EPA to comply with a Clean Air Act...
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Riot police officers detain opposition activists in central St.... News PhotoActivist,Competition,Conflict,Constitution,Crisis,Detainee,Freedom,Horizontal,Opposition Party,Political Party,Political Rally,Politics,Protest,Riot Police,Russia,St. Petersburg - RussiaPhotographer AFPCollection: AFP 2013 AFPRiot police officers detain opposition activists in central St. Petersburg on March 31, 2013, during an unauthorized protest rally of opposition activists to defend the article 31 of the Russian constitution which guarantees freedom of assembly. Russian opposition activists call on authorities to respect the right to organize rallies every 31st of a month, which often leads to arrests by the police. AFP PHOTO / OLGA MALTSEVA (Photo credit should read OLGA MALTSEVA/AFP/Getty Images)


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|Official site
|Singer Songwriter
About Jackson Browne
A musician with an insightful lyrical sense, Jackson Browne is a Grammy Award nominee and an inductee in to the Rock and Roll Hall of Fame. Delivering compelling albums like "Solo Acoustic, Vol. 1" and "Time the Conqueror," he has sold over 17 million copies in the US alone. Jackson Browne Tickets present you with the chance to see a great performer.
Indeed, Browne is known as one of the most iconic singer/songwriters of the 1970s, and later tackled socio-political themes that went hand-in-hand with his social activism. From his time spent with the early version of the Nitty Gritty Dirt Band to writing for the likes of Bonnie Raitt and Linda Ronstadt, all the way to the debut album hit "Doctor My Eyes," Browne's career highlights are many. He even co-wrote the Eagles' first smash, "Take It Easy," and even today continues to work side-by-side with some of the biggest names in music.
To know the essence of Jackson Browne, one must see the work he has put in to organizations like MUSE (Musicians United for Safe Energy), Amnesty International and the Christic Institute. He is an activist as much as he is an artist, and dedicated himself to those efforts for quite some time. It wasn't until 2008 that he would release "Time the Conqueror," his first true studio album in a six year period, that many would realize how much his advocacy and involvement with other issues had left his solo career a bit in the shadows.
On April 1, 2013, a 23-song, two disc set called "Looking Into You: A Tribute to Jackson Browne," was released. It featured covers of Browne's songs by superstars like Raitt, Lyle Lovett, Don Henley and Bruce Springsteen.
Jackson Browne to Release New Music, Tour the U.S. this Fall
Legendary singer-songwriter Jackson Browne has just announced that not only will he be releasing a new studio album (his first in six years), but he'll also be going on a unique road tour through the United States. Broken into two parts, the first half will be all solo acoustic shows, and the second half will…Read more
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date city state venue 2/17/2015 Fort Myers FL Barbara B Mann Performing Arts Hall 2/18/2015 Melbourne FL King Center for the Performing Arts 2/20/2015 Miami Beach FL The Fillmore Miami Beach 2/21/2015 Clearwater FL Ruth Eckerd Hall 2/23/2015 Jacksonville FL Florida Theatre 2/24/2015 Orlando FL Bob Carr Performing Arts Centre 3/9/2015 Nagoya-shi Aichi Prefectural Art Theater 3/11/2015 Tokyo Bunkamura Orchard Hall 3/12/2015 Tokyo Bunkamura Orchard Hall 3/13/2015 Tokyo Bunkamura Orchard Hall 3/16/2015 Osaka Festival Hall 3/17/2015 Hiroshima Bunka Koryu Kaikan 3/19/2015 Osaka Festival Hall 4/9/2015 Escondido CA California Center for the Arts Escondido 5/24/2015 Rome ?? Auditorium Parco della Musica 5/25/2015 Bologna BO Teatro Manzoni 5/27/2015 Como CO Teatro Sociale 5/28/2015 Torino TO Teatro Colosseo 5/31/2015 Aviles Centro Niemeyer 6/1/2015 Bilbao Sala de Exposiciones BBK 6/6/2015 Zurich ZH Volkshaus 6/8/2015 Berlin BE Admiralspalast 6/10/2015 Oslo 03 Frognerbadet 6/13/2015 Oslo 03 Frognerbadet 6/15/2015 Stockholm AB Waterfront 6/16/2015 Gothenburg O Liseberg 6/18/2015 Copenhagen Danish Capital Regio Amager Bio 6/19/2015 Aarhus 070 Train 6/21/2015 Hamburg HH Stadtpark Freilichtbuhne 6/22/2015 Amsterdam Nhl Heineken Music Hall 6/24/2015 Brussels Cirque Royal 6/25/2015 Paris ?? La Cigale 6/27/2015 Stuttgart BW Liederhalle Hegelsaal 6/28/2015 Frankfurt am Main Hesse Jahrhunderthalle 6/30/2015 Munich Tollwood 7/30/2015 Airway Heights WA Northern Quest Resort & Casino 7/31/2015 Stateline NV Lake Tahoe Outdoor Arena at Harveys 8/1/2015 Woodinville WA Chateau Ste Michelle Winery 8/2/2015 Woodinville WA Chateau Ste Michelle Winery 8/4/2015 Portland OR Arlene Schnitzer Concert Hall 8/5/2015 Eugene OR Cuthbert Amphitheater 8/7/2015 Stateline NV Lake Tahoe Outdoor Arena at Harveys 8/8/2015 Paso Robles CA Vina Robles Amphitheatre 8/11/2015 Santa Barbara CA Santa Barbara Bowl 8/12/2015 San Diego CA San Diego Civic Theatre 8/14/2015 Los Angeles CA Greek Theatre 8/15/2015 Berkeley CA Greek Theatre - Berkeley 8/18/2015 Morrison CO Red Rocks Amphitheatre 8/20/2015 Mesa AZ Mesa Arts Center 8/21/2015 Las Vegas NV Pearl Concert Theater at Palms Casino Resort
date city state venue 1/10/2014 Atlanta GA Fox Theatre 4/30/2014 Los Angeles CA Largo at the Coronet 7/2/2014 Omaha NE Orpheum Theatre Omaha 7/3/2014 Kansas City MO Uptown Theater 7/5/2014 Springfield MO Gillioz Theatre 7/7/2014 St. Louis MO Peabody Opera House 7/8/2014 Peoria IL Peoria Civic Center 7/10/2014 Ann Arbor MI Michigan Theater 7/12/2014 Interlochen MI Kresge Auditorium 7/13/2014 Grand Rapids MI Frederik Meijer Gardens 7/15/2014 Milwaukee WI Riverside Theatre 7/16/2014 Madison WI Overture Center 7/18/2014 Minneapolis MN State Theatre 7/19/2014 Cedar Rapids IA Paramount Theatre 7/21/2014 Wichita KS Orpheum Theatre 8/4/2014 Holmdel NJ PNC Bank Arts Center 8/5/2014 Wantagh NY Nikon at Jones Beach Theater 8/8/2014 New York NY City Winery 8/9/2014 Easton PA State Theatre 8/11/2014 Lewiston NY Artpark 8/13/2014 Syracuse NY Landmark Theatre 8/14/2014 Albany NY Palace Theatre 8/16/2014 Boston MA Boston Opera House 8/17/2014 Portland ME Merrill Auditorium 8/19/2014 Concord NH Capitol Center for the Arts 8/20/2014 Providence RI Providence Performing Arts Center 8/22/2014 Wallingford CT The Dome at Oakdale Theatre 8/23/2014 Baltimore MD Hippodrome at France-Merrick PAC 9/14/2014 Washington DC Kennedy Center Concert Hall 9/27/2014 Santa Monica CA Santa Monica Pier 10/4/2014 York PA Strand-Capitol Performing Arts Center 10/7/2014 New York NY Beacon Theatre 10/8/2014 New York NY Beacon Theatre 10/10/2014 Philadelphia PA Academy of Music 10/12/2014 Pittsburgh PA Benedum Center 10/14/2014 Chicago IL Chicago Theatre 10/15/2014 Akron OH EJ Thomas Hall 10/17/2014 Columbus OH Palace Theatre Columbus 10/18/2014 Indianapolis IN Murat Theatre 10/25/2014 Santa Barbara CA Arlington Theatre 11/17/2014 Birmingham War Symphony Hall 11/18/2014 Manchester Gtm Bridgewater Hall 11/20/2014 Gateshead Edh Sage Gateshead 11/21/2014 Glasgow Sct Theatre Royal Glasgow 11/24/2014 London Kec Royal Albert Hall
date city state venue 1/19/2013 Portland OR Keller Auditorium 1/20/2013 Seattle WA Benaroya Hall 1/22/2013 San Jose CA City National Civic 1/26/2013 San Diego CA Copley Symphony Hall 1/28/2013 Thousand Oaks CA Fred Kavli Theatre-Thousand Oaks Civic Arts 1/29/2013 Long Beach CA Long Beach Terrace Theater 1/31/2013 Bakersfield CA Bakersfield Fox Theater 2/1/2013 Temecula CA Pechanga Entertainment Center 2/2/2013 Santa Cruz CA Santa Cruz Civic Auditorium 2/4/2013 San Luis Obispo CA Christopher Cohan Center 2/6/2013 San Francisco CA Nob Hill Masonic Auditorium 2/12/2013 Albuquerque NM Popejoy Hall 2/13/2013 Phoenix AZ Orpheum Theatre 2/15/2013 Las Vegas NV Pearl Concert Theater at Palms Casino Resort 2/16/2013 Reno NV Silver Legacy Casino 5/4/2013 Frisco TX Toyota Stadium 5/9/2013 Napa CA Napa Valley Expo 5/10/2013 Napa CA Napa Valley Expo 5/11/2013 Napa CA Napa Valley Expo 6/14/2013 Sturgeon Bay WI Holiday Music Motel 6/15/2013 Sturgeon Bay WI Holiday Music Motel 6/19/2013 Salt Lake City UT Red Butte Garden 6/20/2013 Telluride CO Telluride Town Park 6/20/2013 Telluride CO Telluride Town Park 6/21/2013 Aspen CO Jazz Aspen Snowmass 6/23/2013 Telluride CO Telluride Town Park 6/25/2013 Des Moines IA Des Moines Civic Center 6/26/2013 Highland Park IL Ravinia Pavilion 6/28/2013 Columbus OH Palace Theatre Columbus 6/29/2013 Niagara Falls NY Seneca Events Center 7/1/2013 Lancaster PA American Music Theatre 7/2/2013 New Brunswick NJ State Theatre 7/4/2013 Lenox MA Tanglewood 7/5/2013 Atlantic City NJ Borgata Event Center 7/6/2013 Atlantic City NJ Borgata Event Center 7/9/2013 Wallingford CT The Dome at Oakdale Theatre 7/13/2013 Woodstock NY Levon Helm Studios 7/20/2013 Detroit MI Comerica Park 7/23/2013 Oklahoma City OK Chesapeake Energy Arena 8/24/2013 East Troy WI Alpine Valley Music Theatre 9/29/2013 Richmond CA Craneway Pavilion 11/5/2013 Los Angeles CA Walt Disney Concert Hall 11/24/2013 West Hollywood CA The Troubadour
date city state venue 6/9/2012 Los Angeles CA Orpheum Theatre 7/14/2012 Charlotte NC Belk Theatre 7/17/2012 Greenville SC Peace Center 7/18/2012 Nashville TN Ryman Auditorium 7/20/2012 Richmond VA Carpenter Theatre 7/22/2012 Durham NC Durham Performing Arts Center 7/23/2012 Vienna VA Wolf Trap 7/25/2012 Philadelphia PA Academy of Music 7/26/2012 Floyd VA Floydfest Grounds 7/28/2012 Newport RI Fort Adams State Park 7/28/2012 Newport RI Fort Adams State Park 7/29/2012 Newport RI Fort Adams State Park 7/30/2012 Gilford NH Bank of New Hampshire Pavilion 8/3/2012 New York NY Beacon Theatre 8/4/2012 New York NY Beacon Theatre 8/5/2012 West Long Branch NJ The MAC at Monmouth University 8/7/2012 Shippensburg PA Luhrs Center 8/9/2012 Williamsport PA Williamsport Community Arts Center 8/11/2012 Cincinnati OH PNC Pavilion 8/12/2012 Louisville KY Whitney Hall 8/14/2012 Indianapolis IN Murat Theatre 8/15/2012 Cleveland Heights OH Cain Park 10/12/2012 Atlantic City NJ Caesars Atlantic City 10/15/2012 Morgantown WV Lyell B Clay Concert Theatre 10/17/2012 Newport News VA Ferguson Center for the Arts 10/18/2012 Wilkes-Barre PA Kirby Center 10/20/2012 Detroit MI Music Hall Center 10/21/2012 Milwaukee WI Riverside Theatre 10/23/2012 Springfield IL Sangamon Auditorium 10/25/2012 South Bend IN Morris Performing Arts Center 10/26/2012 Chicago IL Chicago Theatre 10/28/2012 Minneapolis MN State Theatre 10/29/2012 Duluth MN DECC Auditorium 11/1/2012 Davenport IA Adler Theatre 11/2/2012 St. Louis MO Fabulous Fox Theatre 11/4/2012 Grand Prairie TX Verizon Theatre at Grand Prairie 11/5/2012 Linden TX Music City Texas Theater 11/7/2012 Houston TX Revention Music Center 11/8/2012 Austin TX Bass Concert Hall 11/10/2012 Catoosa OK The Joint - Hard Rock Hotel & Casino Tulsa 11/12/2012 Omaha NE Orpheum Theatre Omaha 11/14/2012 Denver CO Paramount Theatre 11/15/2012 Colorado Springs CO Pikes Peak Center 11/18/2012 Northridge CA Valley Performing Arts Center 12/14/2012 New York NY Beacon Theatre
date city state venue 2/23/2011 Santa Cruz CA Santa Cruz Civic Auditorium 2/25/2011 Santa Barbara CA Arlington Theatre 2/26/2011 Bakersfield CA Bakersfield Fox Theater 3/1/2011 Santa Rosa CA Ruth Finley Person Theater 3/2/2011 Sacramento CA Community Center Theater 3/4/2011 Phoenix AZ Comerica Theatre 3/5/2011 Temecula CA Pechanga Entertainment Center 3/8/2011 Long Beach CA Long Beach Terrace Theater 3/9/2011 Thousand Oaks CA Fred Kavli Theatre-Thousand Oaks Civic Arts 3/10/2011 Tucson AZ Tucson Arena 3/25/2011 Victoria BC Save On Foods Memorial Centre 3/26/2011 Vancouver BC Queen Elizabeth Theatre 3/28/2011 Edmonton AB Northern Alberta Jubilee Auditorium 3/28/2011 San Francisco CA The Warfield 3/29/2011 Calgary AB Jack Singer Concert Hall 3/31/2011 Saskatoon SK TCU Place 4/2/2011 Winnipeg MB Centennial Concert Hall 4/3/2011 Thunder Bay ON Thunder Bay Community Auditorium 4/5/2011 Toronto ON Massey Hall 4/6/2011 Hamilton ON Hamilton Place Theatre 4/8/2011 Kingston ON K-Rock Centre 4/12/2011 Halifax NS Scotiabank Centre 4/14/2011 St. John's NL Mile One Centre 4/17/2011 Ottawa ON National Arts Centre 4/18/2011 London ON Budweiser Gardens 4/20/2011 Ann Arbor MI Michigan Theater 4/21/2011 Grand Rapids MI DeVos Performance Hall 4/23/2011 Hammond IN The Venue at Horseshoe Casino 5/3/2011 Madison WI Overture Center 5/4/2011 Minneapolis MN State Theatre 5/6/2011 Peoria IL Peoria Civic Center 5/8/2011 Charleston WV Clay Center 5/9/2011 Knoxville TN Tennessee Theatre 5/11/2011 Memphis TN Orpheum Theatre Memphis 5/13/2011 Austin TX Moody Theater 5/16/2011 New Orleans LA Mahalia Jackson Theater for the Performing Arts 5/17/2011 Jackson MS Thalia Mara Hall 5/19/2011 Pensacola FL Saenger Theatre 5/21/2011 Fort Lauderdale FL Amaturo Theater at Broward Center 5/22/2011 Melbourne FL King Center for the Performing Arts 5/24/2011 Jacksonville FL Florida Theatre 5/25/2011 Clearwater FL Ruth Eckerd Hall 5/29/2011 Minneapolis MN State Theatre 8/7/2011 Mountain View CA Shoreline Amphitheatre 8/21/2011 Lyons CO Planet Bluegrass 9/23/2011 Interlochen MI Interlochen Center for the Arts 9/24/2011 East Lansing MI Wharton Center 9/26/2011 Akron OH EJ Thomas Hall 9/27/2011 Columbus OH Palace Theatre Columbus 9/29/2011 Pittsburgh PA Heinz Hall 9/30/2011 Rochester NY Rochester Auditorium Theatre 10/2/2011 Utica NY Stanley Theatre 10/3/2011 Albany NY Palace Theatre 10/5/2011 Portland ME Merrill Auditorium 10/6/2011 Worcester MA Hanover Theatre for the Performing Arts 10/8/2011 Waterbury CT Palace Theater - Waterbury 10/9/2011 York PA Strand-Capitol Performing Arts Center 10/11/2011 Reading PA Santander Performing Arts Center 10/12/2011 Westbury NY NYCB Theatre at Westbury 10/14/2011 Westhampton Beach NY Westhampton Beach Performing Arts Center 10/15/2011 Montclair NJ Wellmont Theatre 10/17/2011 Morristown NJ Mayo Performing Arts Center 10/18/2011 Red Bank NJ Count Basie Theatre 10/20/2011 Wilmington DE Grand Opera House 10/21/2011 Baltimore MD Lyric Opera House 10/23/2011 Washington DC Warner Theatre 10/26/2011 Coral Gables FL University of Miami 11/3/2011 Chico CA Laxson Auditorium 11/4/2011 Redding CA Cascade Theatre 11/6/2011 Arcata CA Van Duzer Theatre 11/8/2011 Cupertino CA Flint Center 11/8/2011 Yountville CA Lincoln Theater 11/9/2011 San Rafael CA Marin Veterans Memorial Auditorium at Marin Center 11/11/2011 Turlock CA Turlock Community Theatre 11/12/2011 Hanford CA Hanford Fox Theatre
date city state venue 6/29/2010 London ON Royal Albert Hall 7/18/2010 Rancho Mirage CA Agua Caliente Casino 7/20/2010 Las Vegas NV The Joint at Hard Rock Hotel & Casino 7/21/2010 San Diego CA Humphreys Concerts by the Bay 7/23/2010 Los Angeles CA Greek Theatre 7/24/2010 Berkeley CA Greek Theatre - Berkeley 7/26/2010 Jacksonville OR Britt Pavilion 7/27/2010 Eugene OR Cuthbert Amphitheater 7/30/2010 Woodinville WA Chateau Ste Michelle Winery 7/31/2010 Goldendale WA Maryhill Winery 8/2/2010 Boise ID Idaho Botanical Garden 8/3/2010 Bozeman MT Brick Breeden Fieldhouse 8/5/2010 Morrison CO Red Rocks Amphitheatre 8/7/2010 Sioux City IA Orpheum Theatre Sioux City 8/8/2010 Kansas City MO Starlight Theatre 8/10/2010 St. Louis MO Fabulous Fox Theatre 8/11/2010 Tulsa OK Brady Theater 8/13/2010 Grand Prairie TX Verizon Theatre at Grand Prairie 8/15/2010 Atlanta GA Chastain Park Amphitheatre 8/24/2010 Baltimore MD Pier Six Concert Pavilion 8/25/2010 Portsmouth VA nTelos Wireless Pavilion 8/27/2010 Wallingford CT The Dome at Oakdale Theatre 8/28/2010 Boston MA Blue Hills Bank Pavilion 8/30/2010 Buffalo NY Sheas Performing Arts Center 9/1/2010 Scranton PA The Pavilion at Montage Mountain 9/2/2010 West Long Branch NJ MAC at Monmouth 9/4/2010 Atlantic City NJ The Borgata Outdoor Entertainment Complex 9/5/2010 Atlantic City NJ The Borgata Outdoor Entertainment Complex 9/7/2010 Albany NY Palace Theatre 9/9/2010 Hershey PA Hersheypark Stadium 9/9/2010 Hershey PA Hersheypark Stadium 9/9/2010 Hershey PA Hershey Theatre 9/11/2010 Upper Darby PA Tower Theatre 9/12/2010 Vienna VA Wolf Trap 9/14/2010 New York NY Beacon Theatre 9/15/2010 New York NY Beacon Theatre 9/18/2010 Detroit MI Fox Theatre Detroit 9/19/2010 Cleveland OH Time Warner Cable Amphitheater at Tower City 9/21/2010 Indianapolis IN The Lawn at White River 9/23/2010 Chicago IL Chicago Theatre 9/24/2010 Milwaukee WI Riverside Theatre 9/30/2010 San Diego CA Humphreys Concerts by the Bay 10/23/2010 Mountain View CA Shoreline Amphitheatre
date city state venue 8/25/2009 Park City UT Deer Valley Resort 8/26/2009 Morrison CO Red Rocks Amphitheatre 8/28/2009 Oklahoma City OK Oklahoma City Zoo Amphitheatre 8/29/2009 Omaha NE Orpheum Theatre Omaha 8/31/2009 Saint Paul MN Minnesota State Fair Grandstand 11/1/2009 Harrisburg PA Whitaker Center 11/3/2009 Morristown NJ Community Theatre (NJ) 11/4/2009 Scranton PA Scranton Cultural Center 11/6/2009 Kingston NY The Broadway Theater - Kingston 11/7/2009 Greenvale NY Tilles Center for the Performing Arts 11/9/2009 Chicago IL Lyric Opera House (Chicago) 11/11/2009 Durham NC Durham Performing Arts Center 11/12/2009 Asheville NC Thomas Wolfe Auditorium 11/14/2009 Savannah GA Johnny Mercer Theatre 11/15/2009 Greenvale NY Tilles Center for the Performing Arts 11/17/2009 Orlando FL Bob Carr Performing Arts Centre 11/18/2009 Sarasota FL Van Wezel Performing Arts Hall 11/20/2009 Clearwater FL Ruth Eckerd Hall 11/21/2009 Miami Beach FL The Fillmore Miami Beach 11/30/2009 Austin TX Bass Concert Hall 12/1/2009 Houston TX Revention Music Center 12/4/2009 Memphis TN Orpheum Theatre Memphis 12/6/2009 Salina KS Stiefel Theatre 12/7/2009 Des Moines IA Des Moines Civic Center


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Why did you choose this product?
ITEM#: 12506840Celebrate your union with a band that shines as bright as your love. This band comes in your choice of white or yellow 10-karat gold, and features 13 round bead-set diamonds that sparkle in the light. A decorative border on each side of the strip of diamonds makes this ring even more visually exciting.
- This classic wedding band sparkles with the everlasting brilliance of fiery diamonds
- Diamond wedding band will be cherished always
- Jewelry shimmers in 10-karat white or yellow gold
- 13 round bead-set diamonds
- Diamond color is H-I, clarity is I2-I3
- Total diamond weight is 1/4* carat
- Ring setting measures 20 mm wide x 3.5 mm long x 2.5 mm high
- Band measures 2 mm wide
All weights and measurements are approximate and may vary slightly from the listed information. *T.W. (total weight) is approximate. 1/4 carat T.W. may be 0.22 to 0.28 carats. Treatment code N. See Treatment Guide for further information.
Click here for Ring Sizing Chart.
See Treatment Guide for further information.
This item is part of the Miadora Wedding Collection
|Diamond Color
|H-I White
|Total Diamond Weight
|Up to .5 Carats
|Ring Style
|Diamond Cut
|Gold Karat
|Gemstone Color
|Band Width
|2-3 mm
|Jewelry Setting
|Metal Color
|White Yellow
|20 mm L x 3.5 mm W x 2.5 mm H x 2 mm W Band
|10K gold and Diamonds
|Model Number
Customer Reviews
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The diamonds are not good quality at allRead More
it get discolored very easily. it became yellowish and no solution can make it silver looking.Read More
Simple yet elegant. Stones twinkle in the sunlight.Read More
Great Quality
I love my ring. It's very accurate to the picture and description.Read More
My rating is excellent
I was pleasantly surprised by the good quality of the diamonds when I opened packages. I bought them to use as guard bands with my Mother's engagement ring which is set in bezel set diamonds and is flat. It looks very nice together and I would recommend this ring to anyone who is thinking of buying. The diamonds are small but brilliant and good quality.Read More
This ring is perfect. I did the math (1/4 / 13 diamonds) and was expecting much smaller diamonds. The diamonds are of excelent quality and very well set on the band. Craftsmanship is excellent, and the band is sturdy yet delicate. It goes perfectly with my engagement ring also from overstock. Perfect ring, perfect price, great experience overall, thank you.Read More
Beautiful ring fit for a princess
I bought this ring as an engagement ring for my girlfriend. She absolutely loved it! It's quite wide which is good since she didn't want a ring that was to thin. It's a great lloking ring with kind of a vintage look to it. The small details are really well done for a ring in this price range. Recommended!Read More
Beautiful Ring
I received this ring yesterday and it's absolutely beautiful! Overstock did a great job of delivering the ring before Valentine's Day and they have a great customer service department. Thank you Overstock and will be back soon! Very happy with my ring! :)Read More
This was purchased for my daughter who is renewing her vows this year and she wanted a new wedding band. This ring is absolutely beautiful and such sparkle! She absolutely loved it as soon as she saw it! Great value!Read More
My girlfriend loved the wedding band. It looked great on her hand; however, we ended up having to return it because the color didn't match her engagement ring. Her engagement ring is 14k and this wedding band is 10k which made a great difference. Other than that, she wouldn've loved to keep it, but we didnt think about it before we purchased it.Read More
Questions & Answers
I am getting married and this is the ring she wanted
It's pretty
Can this ring be made in black gold?
No, we do not currently offer this ring in black gold.
is this a pave setting?
No, this would not be considered a pave setting. A pave setting has many small stones set very close together so that the piece literally looks "paved" with stones.
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Chances are, you know how to handle basic first aid at home. You have ice packs for head bonks, bandages in various sizes for minor scrapes and cuts and over-the-counter medicine for fevers and headaches. You also know that you should call 9-1-1 if you or a loved one shows signs of a heart attack or stroke. But what about all the concerns that fall in between, like deep gashes, high fevers and broken bones?
"When you or a loved one is injured or sick, it is most important to see a doctor sooner rather than later," says Bridgeport Hospital Chairman of Emergency Medicine Michael Werdmann, MD. "If the injury or illness can't wait for an appointment, an Urgent Care Center or Walk-in Medical Center is an immediate way to get medical attention. If the physicians there determine that the situation should be handled at the hospital, they will call an ambulance to bring the patient to the Emergency Department." Two exceptions, he says, are the elderly and small children. "Parents know their children best," says Dr. Werdmann. "If a parent is very concerned, it may be better to go directly to the hospital."
Here are some guidelines to help determine where to go for certain injuries and illnesses.