“ bone fill , fill material , or infill material or composition ” includes its ordinary meaning and is defined as any material for infilling a bone that includes an in - situ hardenable material or that can be infused with a hardenable material . the fill material also can include other “ fillers ” such as filaments , microspheres , powders , granular elements , flakes , chips , tubules and the like , autograft or allograft materials , as well as other chemicals , pharmacological agents or other bioactive agents . “ flowable material ” includes its ordinary meaning and is defined as a material continuum that is unable to withstand a static shear stress and responds with an irrecoverable flow ( a fluid )— unlike an elastic material or elastomer that responds to shear stress with a recoverable deformation . flowable material includes fill material or composites that include a fluid ( first ) component and an elastic or inelastic material ( second ) component that responds to stress with a flow , no matter the proportions of the first and second component , and wherein the above shear test does not apply to the second component alone . “ substantially ” or “ substantial ” mean largely but not entirely . for example , substantially may mean about 10 % to about 99 . 999 %, about 25 % to about 99 . 999 % or about 50 % to about 99 . 999 %. “ osteoplasty ” includes its ordinary meaning and means any procedure wherein fill material is delivered into the interior of a bone . “ vertebroplasty ” includes its ordinary meaning and means any procedure wherein fill material is delivered into the interior of a vertebra . as background , a vertebroplasty procedure , according to one embodiment , would include inserting the introducer of fig1 through a pedicle of a vertebra for accessing the osteoporotic cancellous bone . the initial aspects of the procedure are similar to a conventional percutaneous vertebroplasty wherein the patient is placed in a prone position on an operating table . the patient is typically under conscious sedation , although general anesthesia is an alternative . the physician injects a local anesthetic ( e . g ., 1 % lidocaine ) into the region overlying the targeted pedicle or pedicles as well as the periosteum of the pedicle ( s ). thereafter , the physician uses a scalpel to make a 1 to 5 mm skin incision over each targeted pedicle . thereafter , the introducer is advanced through the pedicle into the anterior region of the vertebral body , which typically is the region of greatest compression and fracture . prior to said advancement of the introducer , an elongated member 102 ( see fig1 ), such as rod or trocar , can be inserted into the channel in the introducer so as to block the channel and inhibit the introduction of debris into the channel of the introducer during advancement of the introducer into the vertebral body . the elongated member 102 can be withdrawn from the introducer when the treatment region has been reached . the physician can confirm the introducer path posterior to the pedicle , through the pedicle and within the vertebral body by anteroposterior and lateral x - ray projection fluoroscopic views . the introduction of infill material as described below can be imaged several times , or continuously , during the treatment depending on the imaging method . referring to fig1 - 2 , one embodiment of bone fill introducer or injector system 100 a is shown that is configured for treatment of the spine in a vertebroplasty procedure . introducer system 100 a can be used for injecting a fill material from a source 110 , wherein injection of the fill material can be carried out by a pressure mechanism or source 112 . the pressure mechanism 112 can be a manually operated syringe loaded with bone fill material , a hydraulically actuated syringe or any other pressurized source of fill material . in one embodiment , the fill material source includes a sleeve with a piston therein that is drivable by a fluid pushed by the hydraulic source as pressure mechanism 112 . the source 110 of fill material can include a coupling or fitting 114 for sealably locking to a cooperating fitting 115 at a proximal end or handle 116 of an elongated bone fill injector 118 . the injector 118 can have a introducer sleeve 120 with a proximal portion 135 a and a distal portion 135 b . in one embodiment , a syringe - type source 110 can be removably coupled directly to the fitting 115 in the handle 116 via a threaded coupling , a luer lock or the like , the fitting 115 communicating with the introducer sleeve 120 . in another embodiment , shown in fig1 , a flexible tube 117 , can be used to couple the source 110 to the introducer 120 . however , in other embodiments , the tube 117 can be a rigid tube or a bendable ( deformable ) tube . in fig1 - 4 , it can be seen that the bone fill injector 118 includes an elongated sleeve 120 with an interior channel 122 extending about an axis 124 , wherein the channel 122 terminates in a distal outlet opening 125 . in the illustrated embodiment , the outlet opening 125 is a single opening . however , in other embodiments , the outlet opening can be a plurality of openings disposed about the radially outward surface 128 or an opening at the distal tip 130 of the introducer sleeve 120 . the distal tip 130 can be blunt or sharp . as can be seen in fig1 - 2 , the exterior surface of introducer sleeve 120 carries at least one sensor system 144 that is adapted to sense the flow or movement of a fill material 145 ( see fig3 a - 3c ) proximate to the sensor system 144 . in the illustrated embodiment , the sensor system 144 has a plurality of spaced apart electrodes 144 a - 144 e , which can be ring - type electrodes . though the sensor system 144 in the illustrated embodiment shows five ring - type electrodes , any number of electrodes , and other types of electrodes can also be used . the introducer sleeve 120 and sensor system 144 can be used to monitor and prevent extravasation of fill material 145 in a vertebroplasty procedure . in one embodiment and method of use , referring to fig3 a - 3c , the introducer sleeve 120 can be used in a conventional vertebroplasty with a single pedicular access or a bi - pedicular access . the fill material 145 can be a bone cement , such as pmma , that is injected into cancellous bone 146 which is within the interior of the cortical bone surface 148 of vertebra 150 . fig3 a - 3b illustrate a progressive flow of cement 145 provided through the outlet opening 125 of the introducer sleeve 120 into the interior of the vertebra 150 . fig3 c depicts a situation that is known to occur where bone is fractured along the entry path of the introducer 120 or the pressurized cement 145 finds the path of least resistance to be a retrograde path along the surface of introducer 120 . the retrograde flow of cement 145 , as in fig2 c , if allowed to continue , could lead to cement extravasation into the spinal canal 152 which can lead to serious complications . as can be understood from fig3 c , the sensor system 144 is configured to be actuated when bone cement 145 comes proximate to , or into contact with , the sensor system 144 . in one embodiment , as shown in fig1 - 3c , the sensor system 144 can have a plurality of spaced apart electrodes ( e . g ., electrodes 144 a , 144 b , 144 c ) that are coupled to an electrical source 140 via , for example an electrical cable 156 , to an electrical connector 158 in the proximal end of the introducer 118 . as shown in fig2 , the electrical connector 158 can connect with a corresponding connector 160 coupled to the electrical source via the electrical cable 156 . the electrical source 140 can provide a low voltage direct current or rf current between the opposing potentials of spaced apart electrodes ( e . g ., electrodes 144 a , 144 b , 144 c ). the voltage can be from about 0 . 1 volt to 500 volts , or from about 1 volt to 5 volts and can create a current path through the tissue between a pair of electrodes . the current can be continuous , intermittent and / or multiplexed between different electrode pairs or groups of electrodes . in the illustrated embodiment , the arrangement of electrodes can be spaced apart ring - type electrodes and axially spaced apart as shown in fig1 and 2 . however , in other embodiments the electrodes can be discrete elements , helically spaced electrodes , or the electrodes can be miniaturized electrodes as in thermocouples , mems devices or any combination thereof . the number of sensors or electrodes can range from about 1 to 100 and can be adapted to cooperate with a ground pad or other surface portion of the introducer sleeve 120 . in one embodiment , the electrodes can include a ptc or ntc material ( positive temperature coefficient of resistance or negative temperature coefficient of resistance ) to thereby function as a thermistor to allow for measurement of temperature , as well as functioning as a sensor . as shown in fig2 , a controller 155 can be electrically connected to the sensor system 144 , which can measure at least one selected parameter of the current flow to determine a change in a parameter , such as impedance . when non - conductive bone cement 145 contacts one or more electrodes 144 a - 144 e of the sensor system 144 , the controller 155 can identify a change in the selected electrical parameter and generate a signal to the operator of the introducer system 100 a . the scope of the invention includes sensor systems capable of sensing a change in electrical properties , reflectance , fluorescence , magnetic properties , chemical properties , mechanical properties or a combination thereof . now referring to fig4 , another view of an injector 118 ′ is shown , which includes an introducer 120 ′ having a proximal portion 160 a that is larger in cross - section than a distal portion 160 b thereof , with corresponding larger and smaller bore portions therein . this configuration allows for lesser injection pressures since the cement flow needs to travel less distance through the smallest diameter distal portion 160 b of the introducer sleeve 120 ′. the distal portion 160 b of the introducer can have a cross section ranging between about 2 mm and 4 mm with a length ranging between about 40 mm and 60 mm . the proximal portion 160 a of the introducer can have a cross section ranging between about 5 mm and 15 mm ., or between about 6 mm and 12 mm . however , other suitable cross - sectional dimensions and lengths can be used . in the system of fig1 - 4 , the bone fill injection system 100 a can also include a thermal energy emitter 210 within the interior channel 122 of the introducer 120 ′ for heating a flow of bone cement prior to ejection of the same from the outlet opening 125 in the introducer sleeve 120 ′. in the illustrated embodiment , the thermal energy emitter 210 is disposed in the distal portion of the introducer 120 ′. however , in other embodiments , the thermal energy emitter 210 can be disposed in other locations within the introducer 120 ′. in one embodiment , the thermal energy emitter 210 is configured to raise the temperature of bone cement , for example chilled bone cement , to body temperature or within about 5 ° c . above or below body temperature . in another embodiment , thermal energy emitter 210 is configured to raise the temperature of chilled bone cement 145 to the range of 50 ° c . to 55 ° c . to accelerate polymerization and increase the viscosity of the bone cement , which can be a pmma or similar bone cement . the thermal energy emitter 210 can be an rf emitter adapted for heating a conductive bone cement as disclosed in the following co - pending u . s . patent applications : ser . no . 11 / 165 , 652 filed jun . 24 , 2005 ; ser . no . 11 / 165 , 651 filed jun . 24 , 2005 ; ser . no . 11 / 208 , 448 filed aug . 20 , 2005 ; and ser . no . 11 / 209 , 035 filed aug . 22 , 2005 . in another embodiment , as shown in fig6 , the thermal energy emitter 210 can deliver thermal energy by conduction to bone cement flowing through the introducer , as further discussed below . the thermal energy emitter 210 can be selected from the group consisting of a resistively heated emitter , a light energy emitter , an inductive heating emitter , an ultrasound source , a microwave emitter and any other electromagnetic energy emitter to cooperate with the bone cement . in the embodiment illustrated in fig4 and 5 , the controller 155 is adapted to control all parameters of ( i ) heating the bone cement , ( ii ) the cement injection pressure and / or flow rate , ( iii ) energy delivery to cement flows in or proximate the distal end of the introducer and ( iv ) energy delivery to sense retrograde flows about the exterior surface of the introducer . in one embodiment depicted in fig5 , the thermal energy emitter 210 is a resistively heated element 210 in any suitable from ( e . g ., a helical configuration ) that is provided within the interior channel 122 of the introducer 120 ′. the heating element 210 can further be formed from ( or coated with ) a positive temperature coefficient material and coupled to a suitable voltage source , such as the electrical source 140 , to provide a constant temperature heater as is known in the art . in the illustrated embodiment , the heating element 210 is carried within an insulative coating 226 on an inner surface of the introducer 120 ′, where the introducer 120 ′ can be metal . as discussed above in connection with fig2 , the electrical source 140 can be coupled to the handle 116 via electrical connectors 158 , 160 . with continued reference to the embodiment in fig5 , the exterior surface of the probe has a coating 225 that can include a thin layer of an insulative amorphous diamond - like carbon ( dlc ) or a diamond - like nanocomposite ( dcn ). it has been found that such coatings have high scratch resistance , lubricious and non - stick characteristics that are useful in the bone cement injectors disclosed herein that are configured for carrying electrical current for ( i ) impedance sensing purposes ; ( ii ) for energy delivery to bone fill material ; and / or ( iii ) ohmic heating of tissue . for example , when inserting a bone cement injector , such as the injector 118 , through the cortical bone surface of a pedicle and then into the interior of a vertebra , it is important that the exterior insulative coating portions do not fracture , chip or scratch to thereby ensure that the electrical current carrying functions of the injector are not compromised . the amorphous diamond - like carbon coatings and the diamond - like nanocomposites are available , for example , from bekaert progressive composites corporations , 2455 ash street , vista , calif . 92081 or its parent company or affiliates . further information on said coatings can be found at : http :// www . bekaert . com / bac / products / diamond - like % 20coatings . htm , the contents of which are incorporated herein by reference . the diamond - like coatings comprise amorphous carbon - based coatings with high hardness and a low coefficient of friction . the amorphous carbon coatings exhibit non - stick characteristics and excellent wear resistance . the coatings are thin , chemically inert and have a very low surface roughness . in one embodiment , the coatings have a thickness ranging between 0 . 001 mm and 0 . 010 mm ; or between 0 . 002 mm and 0 . 005 mm . the diamond - like carbon coatings are a composite of sp2 and sp3 bonded carbon atoms with a hydrogen concentration between 0 and 80 %. another suitable diamond - like nanocomposite coating ( a - c : h / a - si : o ; dln ) is made by bekaert and is suitable for use in the bone cement injector described in the embodiments above . the materials and coatings are known by the names dylyn ® plus , dylyn ®/ dlc and cavidur ®. fig6 illustrates another embodiment of a bone fill introducer system 100 b . the introducer system 100 b is similar to the introducer system 100 a discussed above in connection with fig5 . thus , the reference numerals used to designate corresponding components in the introducer system 100 a and the introducer system 100 b are identical , except that a “″” is added where there are differences . the introducer system 100 b has a bone cement injector 118 ″ that again includes a thermal energy emitter 210 within the interior passageway 122 of an introducer 120 ″ for heating a flow of bone cement before the same is ejected from the outlet opening 125 of the introducer 120 ″. in this embodiment , the thermal energy emitter 210 is a helical coil that is resistively heated . a lubricious surface 280 is provided in the interior passageway 122 of the introducer 120 ″. in one embodiment , the lubricious surface 280 can be provided via a coating applied to the inner surface of the interior channel 122 . in another embodiment , the introducer sleeve 120 ″ can be made of the lubricious material . in still another embodiment , the lubricious surface 280 can be provided via a sleeve fitted into the introducer sleeve 120 ″. the lubricious surface 280 advantageously facilitates the flow of bone fill material 145 through the interior passageway 122 of the introducer 120 ″. in one embodiment , the lubricious surface 280 can be a fluorinated polymer surface , such as teflon ® or polytetrafluroethylene ( ptfe ). other suitable fluoropolymer resins are fluorinated ethylenepropylene ( fep ) and perfluoroalkoxy ( pfa ). other materials also can be used such as fep ( fluorinated ethylenepropylene ), ectfe ( ethylenechlorotrifluoroethylene ), ethylene tetrafluoroethylene ( etfe ), polyethylene , polyamide , polyvinylidene difluoride ( pvdf ), polyvinyl chloride and silicone . in one embodiment , the surface 280 of the flow channel 122 has a static coefficient of friction of less than 0 . 5 , less than 0 . 2 , or less than 0 . 1 . in another embodiment , at least a portion of the surface 280 of the flow channel 122 is ultrahydrophobic or hydrophobic which may better prevent a hydrophilic cement from sticking to the surface 280 as it flows through the channel 122 . in still another embodiment , at least a portion of the surface 280 of the flow channel 122 is hydrophilic , which may prevent a hydrophobic cement from sticking . in yet another embodiment , the surface 280 of the flow channel 122 has high dielectric strength , a low dissipation factor , or a high surface resistivity . in another embodiment , the surface 280 of the flow channel 122 is oleophobic . in another embodiment , the surface 280 of the flow channel 122 has a wetting contact angle greater than 70 °, greater than 85 °, and greater than 100 °. in another embodiment , the surface 280 of the flow channel 122 has an adhesive energy of less than 100 dynes / cm , less than 75 dynes / cm , and less than 50 dynes / cm . in another embodiment , the surface 280 of the flow channel 122 includes a low coefficient of friction polymer or ceramic . the system 100 a , 100 b can use any suitable energy source , other that radiofrequency energy , to accomplish the purpose of altering the viscosity of the fill material 145 . the energy source for altering fill material can be , for example , at least one of a radiofrequency source , a laser source , a microwave source , a magnetic source and an ultrasound source . in one embodiment , each of these energy sources can preferably deliver energy to a cooperating , energy sensitive filler component carried by the fill material . for example , such filler can be suitable chromophores for cooperating with a light source , ferromagnetic materials for cooperating with magnetic inductive heating means , or fluids that thermally respond to microwave energy . in one embodiment , the apparatus disclosed above can also be configured with a thermal energy emitter that comprises at least in part an electrically conductive polymeric layer . in such an apparatus , the electrically conductive polymeric layer has a positive temperature coefficient of resistance . the scope of the invention includes using additional filler materials such as porous scaffold elements and materials for allowing or accelerating bone ingrowth . in one embodiment , the filler material can comprise reticulated or porous elements of the types disclosed in co - pending u . s . patent application ser . no . 11 / 146 , 891 , filed jun . 7 , 2005 , titled “ implants and methods for treating bone ,” which is incorporated herein by reference in its entirety and should be considered a part of this specification . such fillers also can carry bioactive agents . additional fillers , or the conductive filler , also can include thermally insulative solid or hollow microspheres of a glass or other material for reducing heat transfer to bone from the exothermic reaction in a typical bone cement component . the above description of the invention is intended to be illustrative and not exhaustive . particular characteristics , features , dimensions and the like that are presented in dependent claims can be combined and fall within the scope of the invention . the invention also encompasses embodiments as if dependent claims were alternatively written in a multiple dependent claim format with reference to other independent claims . specific characteristics and features of the invention and its method are described in relation to some figures and not in others , and this is for convenience only . while the principles of the invention have been made clear in the above descriptions and combinations , it will be obvious to those skilled in the art that modifications may be utilized in the practice of the invention , and otherwise , which are particularly adapted to specific environments and operative requirements without departing from the principles of the invention . the appended claims are intended to cover and embrace any and all such modifications , with the limits only of the true purview , spirit and scope of the invention . of course , the foregoing description is that of certain features , aspects and advantages of the present invention , to which various changes and modifications can be made without departing from the spirit and scope of the present invention . moreover , the bone treatment systems and methods need not feature all of the objects , advantages , features and aspects discussed above . thus , for example , those skill in the art will recognize that the invention can be embodied or carried out in a manner that achieves or optimizes one advantage or a group of advantages as taught herein without necessarily achieving other objects or advantages as may be taught or suggested herein . in addition , while a number of variations of the invention have been shown and described in detail , other modifications and methods of use , which are within the scope of this invention , will be readily apparent to those of skill in the art based upon this disclosure . it is contemplated that various combinations or subcombinations of these specific features and aspects of embodiments may be made and still fall within the scope of the invention . accordingly , it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the discussed bone treatment systems and methods .
a bone cement injector used for treating vertebral compression fractures has diamond - like coatings or amorphous carbon based coatings with a high hardness and a low coefficient of friction on an interior flow channel thereof . such a bone cement injector includes a sensor system for sensing retrograde bone cement flows that can migrate along a fractured path toward a pedicle and risk leakage into the spinal canal . an energy delivery system can be coupled to the injector for applying energy to tissue and / or to bone cement that migrates in a retrograde direction , wherein the energy polymerizes the cement and / or coagulates tissue to inhibit further retrograde cement migration .