now referring to fig1 a , there is provided an injection needle 1 for use in percutaneous vertebroplasty , comprising : a ) a substantially longitudinal first tube 2 having a throughbore 4 , a proximal end portion 3 defining a proximal end opening 5 and a distal end portion 7 defining a distal end opening 9 , b ) a handle 11 surrounding the proximal end portion of the first tube and having an outer surface 13 , wherein the proximal end opening of the first tube opens onto the outer surface of the handle , and c ) a second tube 21 located at least partially within the handle and having a throughbore 23 , a distal end 25 in fluid connection with the first tube at a junction 27 , and a proximal end 29 defining a proximal end opening 31 that opens onto the outer surface of the handle . in some embodiments , the tube component of the present invention can be formed of a material that is distinct from the surrounding handle . in other embodiments , the tube is formed by simply making a throughbore in the surrounding handle . when assembled , the needle comprises a bone access port at its distal end , and two ports on its proximal end . the proximal end of the needle includes a first pathway to the bone access port to accommodate a stylet and a second pathway to the bone access port for attachment of a cement injection system . the second pathway is more horizontally disposed than the first pathway , allowing for improved positioning and ergonomics during delivery of the viscous implant material . the first and second tubes meet at a junction and form an angle α . fig1 a shows a substantially horizontal attachment of the delivery system to the handle ( α = 90 °); however , a more ergonomic approach may have the second pathway directed at an angle ( i . e ., angled up ( α & gt ; 90 °) or down ( α & lt ; 90 °)) from the horizontal . now referring to fig1 b , there is provided an embodiment of the present invention wherein the second tube 30 is directed upwards from the first tube 32 whereby angle α is greater than 90 degrees . in other embodiments , the second pathway is directed at a lateral angle ( i . e ., to the left or right of the handle ). in other embodiments , the angle is rotatably adjustable . this invention provides multiple pathways to the bone access port of an access needle for pv procedures , one of which is an access pathway for a straight stylet . it advantageously provides the surgeon with better positioning in relation to the proximal injection port during delivery of the implant material , while at the same time including the required stylet access for pv procedures . the proper orientation of the proximal access port and delivery system may also eliminate the need for the extension tubing . since the angled design of the present invention displaces the surgeon &# 39 ; s hands laterally ( in relation to the longitudinal axis of the second tube ), it may also allow the surgeon &# 39 ; s hands to be moved out of the fluoroscopy field during implant delivery without the use of an extension tube . because extension tubes often impose additional pressure requirements upon the injection device , the elimination of the extension tube may reduce the pressure requirements to deliver the viscous implant material . in some embodiments , a one - way valve or silicone plug is provided to prohibit backflow of implant material through the second proximal pathway . typically , the one - way valve is located in the first tube at a location proximal of the junction . alternatives to a one - way valve or silicone plug include a thumb - trigger that opens the second pathway when depressed , or a ball - plunger that retracts when the stylet is placed within the second pathway . in order to prevent injection of material while the stylet is in place , the handle includes a feature to fully or partially cover the luer connection 33 ( shown open in fig1 a ) associated with the injection port . an ergonomic handle component is provided that is able to separate into a delivery section and a stylet to partially or fully cover the luer connector to the delivery device so that implant material may not be injected while the stylet is in place . thereafter , when the stylet is removed , there is full exposure of the luer connection . in order to improve ergonomics , the luer connector to the delivery system may be placed at an angle to the handle or adapted to allow rotation to a preferred position . the use of allowable rotation provides a single beveled needle to be optimally oriented ( typically anteriorly ) while allowing the proximal inlet port to be oriented towards the surgeon . this not only provides improved ergonomics , it also may allow for elimination of extension tubing from the system . therefore , in accordance with the present invention , there is provided ( claim 12 ) an injection needle for use in percutaneous vertebroplasty , comprising : a . a substantially longitudinal first tube having a throughbore , a proximal end portion defining a proximal end opening and a distal end portion defining a distal end opening , b . a handle surrounding the proximal end portion of the first tube and having an outer surface , wherein the proximal end opening of the first tube opens onto the outer surface of the handle , and c . a rotatable luer connection disposed at the distal end opening of the first tube in order to increase surgeon visibility to the bone access site , the stylet may be removed from the handle . in so doing , most of the bulk of the handle is likewise removed . also , the handle may include two or more components that contain the stylet and the delivery access tube to the vertebral body . the handle may have a luer connection in the injection system that is partially or full contained within the removal stylet component . therefore , and now referring to fig1 c , in accordance with the present invention , there is provided an injection needle for use in percutaneous vertebroplasty , comprising : a ) a substantially longitudinal outer tube 2 having a throughbore 4 , a proximal end portion 3 defining a proximal end opening 5 and a distal end portion 7 defining a distal end opening 9 , b ) an outer handle 11 surrounding the proximal end portion of the outer tube and having a proximal surface 15 having a recess 17 , wherein the proximal end opening of the outer tube opens onto the proximal surface of the handle within the recess , c ) a substantially longitudinal inner stylet 41 having a proximal end portion 43 and a distal end portion 45 , and d ) an inner handle 51 surrounding the proximal end portion of the inner stylet , wherein the inner stylet is received within the throughbore of the outer tube , and wherein the inner handle fits substantially within the recess of the outer handle . preferably , the inner handle has a proximal surface 53 , the proximal surface of the the outer handle forms a first plane , and the proximal surface of the inner handle lies substantially the first plane when the inner stylet is received within the throughbore of the outer tube during the delivery of the cement and subsequent fluoroscopic assessment thereof , it appears that the large dimensions of the handle may sometimes obstruct the clinician &# 39 ; s view of the injection site . this obstruction may be particularly problematic when the surgeon seeks to use the stylet as a tamp for tamping the bone cement that remains in the delivery tube . therefore , in some embodiments of the present invention , the handle is manufactured as a modular component of the injection needle . the handle can be modularized by providing a first luer attachment at the distal end of the substantially longitudinal first tube , and a second luer attachment adapted to mate with the first luer attachment upon the delivery tube . now referring to fig2 , in accordance with the present invention , there is provided ( claim 28 ) an injection needle for use in percutaneous vertebroplasty , comprising : a ) a substantially longitudinal first tube 71 having a throughbore , a proximal end portion 73 defining a proximal end opening and a distal end portion 75 defining a distal end opening having a first luer connection thereon 77 , and b ) a handle 81 surrounding the proximal end portion of the first tube and having an outer surface 83 , wherein the proximal end opening of the first tube opens onto the outer surface of the handle , and c ) a delivery tube 85 having a throughbore and a proximal end portion 87 defining a proximal end opening having a second luer connection 89 thereon that mates with the first luer connection . in use , the surgeon can inject cement through the needle , and then remove the handle in order to have better visualization of the operative site when using the stylet . alternatively , the surgeon can inject the cement through the delivery tube 85 and second luer 89 without the handle attached . during the manufacturing of long tubes or needles used in pv , there may be manufacturing remnant materials inherently remaining within the tube or on the stylet . this is typically seen as grey material within the cement during injection . while cleaning with brushes or high pressure fluids assists in removing some of the remnant material , there is typically some remnant material left behind . the present invention seeks to reduce the delivery to the patient of debris remaining from the manufacturing process . this is accomplished by providing a coating on the inside surface of the needle to encapsulate or cover the inside of the tube ( or outside surface of the stylet ). the inner surface of the needle may be coated with a variety of materials ( i . e . ptfe ( teflon ), or its surface may be conditioned by a variety of manufacturing methods ( such as electropolishing or plating ) that may cover up undesirable manufacturing debris present upon the inside of the needle , thereby precluding their delivery to the patient . in addition , such a coating may reduce the friction on the inner surface of the cannula , thereby easing the flow of the cement passing through the needle and requiring less pressure to deliver the implant material . therefore , in accordance with the present invention , there is provided ( claim 13 ) injection needle for use in percutaneous vertebroplasty , comprising : a ) a substantially longitudinal first tube having an inner surface defining a throughbore , a proximal end portion defining a proximal end opening and a distal end portion defining a distal end opening , b ) a handle surrounding the proximal end portion of the first tube and having an outer surface , wherein the proximal end opening of the first tube opens onto the outer surface of the handle , and wherein the inner surface of the first tube is coated , electropolished or electroplated . now referring to fig3 a - 3b , in use , the device of the present invention is connected to a syringe contain a bone paste , and the paste is injected into the bone via the needle . the bone paste used in the vertebroplasty procedure may be any material typically used to augment vertebral bodies . therefore , in accordance with the present invention , there is provided ( claim 20 ) a device for use in percutaneous vertebroplasty , comprising : i ) a substantially longitudinal first tube 2 having a throughbore , a proximal end portion defining a proximal end opening 5 and a distal end portion 7 defining a distal end opening 9 , ii ) a handle 11 surrounding the proximal end portion of the first tube and having an outer surface 13 , wherein the proximal end opening of the first tube opens onto the outer surface of the handle , and ii ) a second tube 21 located at least partially within the handle and having a throughbore , a distal end in fluid connection with the first tube at a junction , and a proximal end defining a proximal end opening 31 , and b ) a syringe 61 fluidly connected to the proximal end opening of the second tube . in some embodiments , the syringe can be replaced with a delivery device having a material reservoir and tubing adapted to deliver the cement from the reservoir to the proximal end opening of the second tube . preferred bone pastes include bone cements ( such as acrylic - based bone cements , such as pmma - based bone cements ), pastes comprising bone particles ( either mineralized or demineralized or both ; and either autologous , allogenic or both ), and ceramic - based bone cements ( such as ha and tcp - based pastes ).
the vertebroplasty needle has two cannulae sharing a common distal end , wherein the cement injection cannula merges into a straight stylet cannula .