the adhesive or spinal flowable polymerizable fill material according to a feature of the invention is pibma , polyisobutylmethacrylate . it is generally made up of two constituents that are mixed together by the surgeon outside of the surgical site to form a flowable paste or cream - like consistency that can be injected into the spinal tissue . the resultant cream is then injected into the spinal tissue at the surgical site . the material self - cures in situ in about 6 - 8 min . the first constituent is liquid monomer isobutylmethacrylate available commercially in liquid form . to it is added finely powered polyisobutylmethacrylate , a solid polymer . typically , the liquid monomer is added to a suitable container , and sufficient powdered polymer added while mixing with , say , a spatula , until a creamy consistency is formed ; the creamy mixture is then poured into the instrument for delivering the mixture , and then injected by the instrument into the spinal area at the surgical site . it begins to harden when exposed to air or liquid and generally sets hard , i . e . polymerizes , after about 6 - 8 minutes . when hardened it has similar or better properties than pmma , including strength , retentive ability , and lack of distortion or low curing shrinkage , and importantly lower curing heat . light - cured plastic materials are also commercially available and include materials such as polyesters and acrylic materials , such as urethane dimethacrylate . other well - known examples include the camphoroquinone / amine chemistry . camphoroquinone features an absorption maximum in the visible spectrum at 470 nm ( approximately blue light ). in conjunction with a suitable amine , as is known , free radical species are generated to cause polymerisation and , therefore , hardening of the material . polymerisation may be carried out using a suitable uv - generating lamp , such a quartz - halogen , plasma arc , or an argon laser . with both kinds of adhesive or spinal polymerizable fill material a small amount of up to 20 % of inert tissue - compatible non - toxic materials can be added to the mix . the inert material may be finely - divided glass , quartz , or ceramics . in addition , to make the hardened fill x - ray visible , a small amount of a known ba or sr x - ray opaque compound or material , such as baso 4 can be added to the mix . the basic procedure is the same as used for other spinal procedures except for the spinal fill material used or the use of the light - activated fill . essentially , a tubular member is inserted into the patient as in a conventional percutaneous or endoscopic procedure so that the distal end of the tubular member is at the spinal surgical site where the surgery is to be performed . conventional instruments can be used to remove any degenerative material or portions of the disc nucleus or the disc itself as required by the selected procedure to forma cavity . then , through the tube ( or cannula as it is sometimes called ) can be inserted again a conventional instrument for injecting a suitable spinal fill of adhesive material to fill up a crack in the vertebrae or to fill a cavity created in the nucleus , pulpous , or disc itself all of this can be done as is usual either by percutaneous or radiologic guidance under the view of an endoscopic camera to ensure that the injected fill material is positioned in the proper place . following the teachings of the invention , the injected adhesive and fill material is the paste mixture of ingredients that will form the polyisobutylmethacrylate when cured , or a paste mixture of ingredients that can be light - activated to harden . if the latter , then after the injection instrument has completed its task , it can be removed from the tubular member and a tubular member having the ability to transmit light inserted in its place . the light transmitting member may be a bundle of optical fibers , known in itself , the distal end of which is placed near the injected material and to the proximal end , outside the patient &# 39 ; s body , is placed a source of uv radiation which travels through the fiber bundle and exits at the surgical site to illuminate the injected fill . if the fill is thick , it may be desirable to carry out this sequence in several small steps , meaning , that first a thin layer of the fill is injected , next the light - transmitting member is inserted to illuminate and cure the initial layer , then the sequence is repeated to form a second cured layer on top of the first cured layer , and so on until the cured fill has the desired size and volume . if the known mesh bag procedure is used , then in an earlier step the mesh bag would be inserted in the cavity and the injection of fill material occur into the open end of the bag using again standard commercially - available instruments for this purpose . this would apply where the fill is the self - curing polyisobutylmethacrylate - forming mixture . where the light - activated material is used , then as a further alternative the bag mesh can be composed of optical fiber strands so that the incident light is spread around the fill inside the bag by the optical fiber strands . the bag remains in place with the hardened fill . as further alternative , instead of using an optical fiber bundle to transmit the light down the cannula , an additional tubular member with an internal mirrored surface can be inserted and the uv source coupled to the proximal end , such that the uv radiation is tranmitted down the tube by multiple reflections from the internal mirrored surface . the latter can be achieved in a conventional way by plating the inside of the tubular member with a thin layer of nickel as an example , or any other shiny material . fig1 schematically illustrates part of a spinal column 10 with a cavity 12 formed by any suitable instruments such as that described in the referenced patent application , and next to the cavity opening a tubular instrument 14 or cannula , again commercially - available , for injecting a previously - formed polymerizable fill into the cavity using the procedure described above . with the self - curing polymerizable pibma , nothing more is required until the fill sets . fig1 also schematically illustrates the part of a spinal column 10 into the cavity 12 of which a mesh bag 16 is shown being introduced in a known way and with the injecting tube 14 in place to inject a light - activated fill into the bag . in this use , it is preferred to employ a cannula 14 containing on its interior two side - by - side internal tubes 18 , 20 . the latter is illustrated in fig4 , in which the cannula 14 contains an inner tube 15 containing the two side - by - side internal tubes 18 , 20 . between the inner 15 and outer tube 14 is an empty space 22 , the purpose of which will be explained below . fig1 illustrates that the lower tube 18 can be used to successively inject or administer the tubular mesh 16 and polymerizable fill . the adjacent upper tube 18 can be used for manipulating a guide bar or rod ( not shown ) to direct the bag to the position desired . or alternatively , the adjacent upper tube 18 can be used with a viewer for viewing the site during the procedure . in the case illustrated , a spinal tissue has a fracture 24 around which a cavity has been formed and the mesh bag 16 injected from a suitable source 8 is positioned in the cavity alongside the fracture 24 . either of the tubes can be used for endoscopic viewing of the procedure when the other tube is in use . fig2 illustrates the spinal fill ( not shown ) being injected from a suitable supply 9 via one of the tubes 18 , 20 into the bag 16 to fill same and such that it fills the space alongside the fracture such that when hardened the fractured region is reinforced by the hardened self - polymerized fill . when a light - activated fill is employed , then after the fill has been introduced directly to the surgical site or administered into the mesh bag , it must be illuminated with activating light to polymerize . preferably , a mesh bag 30 composed of optical fibers is used to help distribute the light around the fill . this embodiment is illustrated in fig3 , which shows activating light being introduced via one of the inner tubes 18 , 20 of the cannula 14 . a suitable source is schematically illustrated at 32 , the irradiating light by 34 . in the alternative illustrated in fig4 , the activating light 36 is shown being introduced directly to a filled cavity or into the mesh bag ( not shown ) via the space 22 between the inner 15 and outer 14 tubes . in this embodiment , the activating light is provided at the proximal end of the tube outside of the body from , for example , an uv source 32 supplying radiation capable of polymerizing and curing the fill inside the bag . the radiation can be transmitted down the tube 18 by , for example , mirroring the inside surface of the tube , or by extending a bundle of optical fibers that are transparent to the activating radiation down the tube 18 to the vicinity of the mesh opening . to further spread the radiation as completely as possible around the fill inside the mesh bag , the mesh fibers are constructed of thin flexible optical fibers , which are capable of conveying the radiation throughout the bag meshes so that the fill is illuminated from all sides . it will also be apparent to those skilled in this art that the invention should not be limited to the fill injecting or light injecting devices shown as other devices can readily be devised to perform the same function as will be appreciated by the person of ordinary skill in this art . while the invention has been described in connection with preferred embodiments , it will be understood that modifications thereof within the principles outlined above will be evident to those skilled in the art and thus the invention is not limited to the preferred embodiments but is intended to encompass such modifications .
the invention is based on the use of polyisobutylmethacrylate instead of pmma as an adhesive or spinal fill material for treating diseases of the spine . polyisobutylmethacrylate has several advantages over pmma , mainly less heat is developed during the in situ polymerization process . when using any spinal adhesive of fill material that is light activated , a tube can be used to transmit activating light to the light - activated adhesive or spinal polymerizable fill material at the surgical site . in addition , a mesh bag comprising optical fibers or similar light transmitting material can be employed to receive the injected light - activated fill , with the mesh bag , irradiated externally , for directing the light via the bag to the polymerizable fill .