2010-10-29 Assigned to WARSAW ORTHOPEDIC, INC. reassignment WARSAW ORTHOPEDIC, INC. MERGER (SEE DOCUMENT FOR DETAILS). Assignors: SDGI HOLDINGS, INC.
A device and method for use in a vertebral spine to prepare a space between adjacent vertebral bodies to receive an implant. The device includes a shaft, and a mounting member at one end of the shaft. A working end is mounted on the mounting member and is coupled to a drive mechanism adjacent to the working end. The drive mechanism is operable to move the upper and lower cutters of the working end to create surfaces having predetermined contours in the end plate region of the adjacent vertebral bodies. A guard provides protected access to the disc space and the adjacent vertebral bodies for the working end of the bone removal device through a passageway.
This application is a continuation of application Ser. No. 10/779,099, filed Feb. 14, 2004, now U.S. Pat. No. 7,611,514; which is a continuation of application Ser. No. 09/972,560, filed Oct. 6, 2001, now U.S. Pat. No. 6,692,501; which claims benefit of Provisional Application No. 60/255,463, filed Dec. 14, 2000; all of which are incorporated by reference herein.
Present methods of forming an implantation space between adjacent vertebral bodies in the human spine generally include the use of one or more of the following: hand held biting and grasping instruments known as rongeurs; curettes; drills and drill guides; rotating burrs driven by a motor; and osteotomes and chisels. Sometimes the vertebral end plate must be sacrificed as occurs when a drill is used to drill across the disc space and deeper into the vertebral bodies than the thickness of the bony end plate region. Such a surgical procedure necessarily results in the loss of the hardest and strongest bone tissue of the vertebral bodies located in the bony end plate region and thereby removes from the vertebral bodies that portion of its structure best suited to absorbing and supporting the loads placed on those vertebral bodies by an interbody spinal implant. Nevertheless, the surgeon must work upon the adjacent end plates of the adjacent vertebral bodies to access the underlying vascular bone that is capable of participating in the fusion by allowing active bone growth, and also to attempt to obtain an appropriately shaped surface in the vertebral bodies to receive the implant. Because the end plates of the adjacent vertebral bodies are not flat, but rather have a compound curved shape, and because the implants, whether made of bone or any other suitable implant material, when fabricated or manufactured, tend to have a geometric rather than a biologic shape, it is generally necessary to conform at least a portion of the vertebral bodies to the shape of the implant to be received therebetween.
It is important in forming the space between the adjacent bone structures to provide a surface contour that closely matches the contour of the implants so as to provide an adequate support surface across which the load transfer between the adjacent bone structures can be evenly applied. In instances where the surgeon has not been able to form the appropriately shaped space for receiving the implants, those implants may slip or be forcefully ejected from the space between the adjacent vertebral bodies, or lacking broad contact between the implant and the vertebral bodies, a failure to obtain fusion may occur.
Prior devices having a plurality of rotating cutting elements for removing bone with a drive mechanism between the cutting elements had limitations in certain applications. For example, if the bone to be cut was thicker than the individual thickness of each of the cutting elements, then the portion of the device between the cutting elements could hit the uncut bone and stop the bone removal device from advancing deeper into the bone being cut. Further, the presence of the drive member between the cutting elements kept the cutting elements spaced apart and thus could prevent the placement of the bone removal device into very narrow spaces such as, but not limited to, disc spaces as might be found in some instances in the cervical spine.
There remains therefore a need for an improved spinal interspace shaper that does not have such limitations so as to achieve the desired purposes as described herein.
The present invention relates to a bone removal device for insertion into and at least in part across the height of a disc space between adjacent vertebral bodies in the human spine, and a guard for providing protected access to the disc space and for maintaining a desired positioning of the adjacent vertebral bodies relative to each other, and to a method of working on those portions of the vertebral bodies adjacent that disc space to remove bone material sufficient to form a desired contoured end plate and to thereby access the underlying vascular bone. For purposes of this application, the bony "end plate region" of the vertebral bodies is defined as the outer shell of compact bone (the bony end plate) adjacent to the spinal disc and the underlying subchondral zone.
The apparatus and associated method of the present invention is adapted to form a surface on or into each of the vertebral body surfaces that are adjacent the intervertebral disc space. The prepared spaces are formed through the inert outer bone of the vertebral bodies to get to the vascularized underlying bone, preferably, without generally removing all of the thickness of the end plate region. The formed surface(s) have a defined shape and a contour corresponding to a preferred interbody spinal implant to be implanted in the disc space.
The bone removal device of the present invention is useful in the cervical, thoracic, and lumbar spine from anterior to the transverse processes of the vertebrae, lateral or anterolateral in the thoracic and lumbar spines, or from posterior in the lumbar spine. The bone removal device, in a preferred embodiment, generally includes a cutting element movably and preferably replaceably mounted on the distal end of a shaft. A depth limiting mechanism preferably controls the depth of insertion of the cutting element into the intervertebral space (i.e., the disc space). The device also includes a handle that may be detachable from the shaft. As used herein, the term "handle" refers to a portion of the device that a surgeon may grip or otherwise manipulate to guide the working end of the device. That "handle" may in fact have multiple purposes. For example, the handle may be a portion of the shaft on which the working end is mounted at one end. Alternatively, the handle may be part of a segment that connects the device to a power source. For example, the handle may be part of a power source that supplies pressurized gas to the power source if turbine driven, or the handle may be a drill, but the term "handle" is used herein in its broadest context to refer to that which the surgeon grasps to use the present invention.
Additionally, the shaft may be detachable from the working end. The device also includes a drive mechanism that transmits power to activate, i.e., move, the cutters. The drive mechanism connects to an energy source, e.g., a rechargeable battery that further may be but need not be housed within the handle of the device. By way of example only, the drive mechanism may include an electric motor or an electromagnetic oscillating mechanism. Or, again by way of example only, the drive mechanism and handle in which it may be disposed may include the head unit of a gas powered turbine of a type commonly used in other surgical instruments.
In a preferred embodiment, the working end is generally as wide as the spinal implant to be implanted or the width of a combined plurality of implants adapted for side-by-side use between the adjacent vertebral bodies adjacent the disc space. The receiving bed, i.e., the prepared surface of the vertebral bodies, when formed by the device, will correspond in shape, size, and contour to the corresponding surfaces of a preferred spinal implant or combined width of implants to be implanted. The surface produced by the bone removal device is generally flat or concave to correspond to the upper or lower vertebral body contacting surfaces of the implant that will be implanted between the vertebral bodies. In an embodiment of the present invention having domed or convex upper and lower cutters or cutting members the device may be inserted into the spine and then turned on to form to desired shape into the adjacent vertebral bodies. The cutters have a leading end that is capable of cutting through bone and/or disc material to form a pocket or socket having a contour corresponding to the forward aspect of the leading end, as well as at least a portion of the side surfaces of the preferred implant to be implanted. These sidewalls assist in restraining the implant from lateral movement.
The working end of the present invention includes a pair of opposed, outwardly facing cutters which lie in planes that may be either parallel to each other or, alternatively, convergent to each other. The present invention saves time by simultaneously preparing both of the vertebral end plates adjacent a disc space. The bone removal device shapes the three-dimensional space created between the adjacent vertebral bodies, which space can be made to conform to the desired lordosis of that portion of the spine that will receive the implant. The end plate space may be, but need not be, identical to the height of the implant, as the implant may be there to optimize the distance of the disc space.
The drive mechanism of the bone removal device is preferably located adjacent the working end of the instrument permitting a reduction in the overall height of the cutting elements. This configuration permits the overall height of the cutting mechanism to be thicker or given the same height, it can be less than what was previously possible with the cutting elements having a drive member therebetween because the cutting elements can be placed closer together. A reduced overall height of the cutting mechanism permits the placement of the bone removal device into narrower spaces, such as but not limited to disc spaces as might be found in some instances in the cervical spine, than previously possible. Moreover, because the space between the cutting elements is minimized, the thickness of the cutting elements may be increased.
The cutting element of the present invention is not limited to being a unitary, one-piece construction, regardless of the number of cutting surfaces of the cutting element. The cutting element may include multiple pieces that, by way of example and not limitation, are mountable on the end of the device to, in combination, define the overall shape of the cutting element and its surfaces. Thus, the term "cutting element" is used herein to refer to both a unitary, one-piece construction or a multi-piece construction.
The cutting element is preferably mounted on the mounting member and may be removable and interchangeable. In such an embodiment, the mounting member may be, but does not have to be, attachable to a shaft that is attachable to the handle cutting element and the mounting member may be separable from each other. Alternatively, the working end and the mounting member may, together, be removable from the handle.
While a preferred embodiment of the present invention is discussed and disclosed herein for creating a space between adjacent vertebral bodies in the spine, the present invention is not limited to a device for creating a space between adjacent vertebral bodies, but can also be used in other portions of the body where it is desirable to place an implant between adjacent bone structures. Furthermore, an embodiment of the present invention may have upper and lower cutting surfaces that are in angular relationship to each other so as to, for example, match the natural lordotic curvature of the human spine at the location of the vertebral bodies to be operated upon. Additionally, sequentially larger, that is wider and/or thicker, ones of the cutting elements, or mounting member, may be used to form the desired sized space in a step-wise fashion, or the working end may be sized to substantially match the final desired width of the surface to be formed in the vertebral end plate. Furthermore, the working end is preferably configured with a sharpened leading edge to allow the working end to "forward cut" as it is inserted between the adjacent vertebral bodies. In this manner, progressive insertion of the cutting element between the vertebral bodies is facilitated.
In a preferred embodiment, a guard for use with the bone removal device has a body with a passageway passing therethrough. In a preferred embodiment, a first disc penetrating extension and a second disc penetrating extension extend from the leading end of the guard and are adapted to be inserted into the disc space between adjacent vertebral bodies. The disc penetrating extensions are preferably adapted to distract and align the disc space, and restore lordosis. The disc penetrating extensions also further limit lateral excursion of the bone removal device and protect vital structures lateral to the disc space. In the alternative, the guard could be attached with screws or pins to each of the vertebral bodies like portions to bear upon the end plates.
The guard provides protected access to the disc space and the adjacent vertebral bodies for the working end of the bone removal device through a passageway, which may be sufficiently taller than the height of the space to be formed by the working end so as to allow for the sequential use of working ends of increasing height or the insertion of a spinal implant taller than the height of the working end thereby allowing the surgeon the option of keeping the guard in place after the cutting procedure. For example, the guard can be left in place distracting and aligning the adjacent vertebral bodies after the cutting step so that spacers (i.e. trial implants) can be trialed and then the implant of the optimal height, and perhaps of a greater height than the cutter, can be inserted.
The bone removal device preferably remains appropriately positioned relative to the height of the passageway during the cut. By way of example and not limitation, this may be achieved by having the bone removal device and guard aligned by a cooperative track, or a longitudinal groove and cooperating protrusion. In an alternative embodiment, a mounting element may be located between the cutting portion at the leading end of the bone removal device and the trailing end of the bone removal device. In a preferred embodiment, the mounting element can be taller than the cutting portion. When the taller mounting element passes through the passageway of the guard, it contacts the interior of the passageway to maintain the cutting portion in a preferred orientation to the guard so that the cutting portion can form an implantation space of a height less than the height of the passageway that is still properly positioned relative to removing the dense thickness of bone from each of the vertebral bodies adjacent the disc space being prepared. This height differential permits an implant having a height greater than the height of the implantation space to be inserted through the guard. Somewhere along the shaft an enlarged portion may cooperate with the inner height and even the rearward portion of a guard.
The leading end of the guard may have a foot plate adapted to contact the vertebral bodies when for use generally anteriorly or anteriorlaterally and may be contoured to generally conform to at least a portion of the exterior aspect of the vertebral bodies where contacted. The foot plate may have holes for receiving, for example, fasteners including spikes, bone screws, pins, prongs, nails, or the equivalent therethrough to secure the foot plate to the vertebral bodies or such spikes, bone screws, pins, prongs, or nails maybe part of the foot plate. The attachment of the guard with fasteners to the adjacent vertebral bodies may further secure the vertebral bodies in the desired relationship and hold the vertebral bodies steady for the cutting operation to be performed.
For use posteriorly, it is generally preferred that the guard have at least one and more preferably two disc penetrating extensions, such that a foot plate may be minimized or absent.
Thus, the present invention provides a device and method for preparing a disc space between adjacent vertebral bodies to receive a spinal implant, and prepares that disc space by removing a portion of the bony end plate region of those vertebrae adjacent that disc space to form predetermined surfaces in that vertebral bodies adjacent the disc space. The prepared spaces are formed through the inert outer bone of the vertebral bodies to get to the vascularized underlying bone, preferably, generally without removing the full thickness of bone in the end plate region. The prepared surfaces are sized and contoured to have broad intimate contact with the preferred spinal implant to be implanted between the adjacent vertebral bodies and along side walls of a socket, which broad contact provides for increased implant stability. This broad area of intimate contact between the vertebral bodies and the implant promotes bone ingrowth from the vertebral bodies into the implant, and also provides a broad area over which to support the incumbent loads so as to minimize the risk of vertebral collapse or subsidence of the implant into the vertebra.
While the present invention has been generally described above, and the preferred embodiments of that invention will be described in detail below, neither that general description nor the detailed description limits the scope of the present invention. That scope is defined by the claims appearing at the end of this patent specification.
It is an object of certain embodiments of the present invention to provide a device and method for quickly, safely, effectively, and accurately working upon the region of the bony vertebral body end plate regions adjacent a disc space so as to, while preferably preserving bone of that region, to at least in part, remove bone such that to access the active bone growth end plate at least in part, remove bone to produce a socket to accept and implant corresponding in size, shape, and contour to an implant to be implanted between the adjacent vertebral bodies.
It is a further object of certain embodiments of the present invention, to provide a device capable of simultaneously working upon both of the vertebral body end plate regions adjacent a disc space to produce opposed receiving surfaces in the adjacent end plate regions corresponding in size, shape and contour to a preferred implant to be implanted, and in so doing to define the shape of the implant space.
It is a further object of certain embodiments of the present invention to provide a vertebral interspace preparation device that, in a preferred embodiment, is capable of working with linear insertion, i.e., insertion along a single axis, and without the need to substantially move the device from side to side within the disc space along a second axis. In such a preferred embodiment, the device has at a working end having a width generally corresponding to the width of the implant to be implanted, and a leading edge corresponding to a generally arcuate leading end of the implant to be implanted, for creating a space of a fixed geometry corresponding to an implant of corresponding dimensions.
It is a further object of certain embodiments of the present invention to have a safety mechanism built into the device that limits the depth of insertion of the device into the spine.
It is a further object of certain embodiments of the present invention to provide a vertebral interspace preparation device that can have interchangeable working ends so as to be capable of producing a variety of differently sized and contoured surfaces and shapes within the intervertebral space.
It is a further object of certain embodiments of the present invention to have cutters extending to the leading end of the device such that the device may remove bone along its leading end as it is advanced within the disc space.
FIG. 18 is a top plan view of an end plate of a lumbar vertebral body with implantation spaces formed therein from a posterior approach with the instrumentation and method in accordance with the present invention.
The following description is intended to be representative only and not limiting. Many variations can be anticipated according to these teachings, which are included within the scope of the present invention. Reference will now be made in detail to a preferred embodiment of this invention, an example of which is illustrated in the accompanying drawings.
Human vertebral bodies have a hard outer shell of compacted dense cancellous bone (sometimes referred to as the cortex) and a relatively softer, inner mass of cancellous bone. Just below the cortex adjacent the disc is a region of bone referred to herein as the "subchondral zone". As best shown in FIG. 1A, the outer shell of compact bone (the bony end plate) adjacent to the spinal disc and cartilaginous end plate and the underlying subchondral zone are together herein referred to as the bony "end plate region" and, for the purposes of this application, is hereby so defined. In the lumbar spine the thickness of the cortex end plate adjacent the disc space is generally not greater than several millimeters deep. By way of example, prior art threaded implants requiring approximately a 3 mm drill depth into the vertebral body and having threads of approximately 1 mm or more in height result in a total depth of penetration into the vertebral body of at least 4 mm sacrificing the best structural bone adjacent the disc space. The present instrumentation and method permits the preparation of the inter space to receive an implant with less depth of penetration into the vertebral bodies.
FIGS. 1B, 2, 3, and 4 show various views of bone removal device 100 in accordance with a preferred embodiment of the present invention. FIG. 1B is a top view of bone removal device 100 and FIG. 2 is a side view thereof. Bone removal device 100 has a leading end 102 including a cutting mechanism 104, and an opposite trailing end 106 configured to cooperatively engage a driving mechanism, such as a power drill, turbine, and the like, or an electrical driving mechanism suitable for the intended purpose. The particular power source that powers bone removal device 100 does not form a part of the present invention except to the extent it is adapted to achieve the appropriate and desirable amount of movement of the working end, or serves as part of the "handle" when in use.
As shown in FIGS. 1B and 4, cutting mechanism 104 includes a drive element 108 and a working end 110. Working end 110 preferably includes two opposed cutters, upper cutter 112 and lower cutter 114 that are configured with a sharpened leading edge. In this embodiment, working end 110 preferably includes two disc-shaped cutting members 116, 118 that are removably mounted on the distal end of the device by a recessed connector 120 and connector shaft 122. Upper cutter 112 is formed on the edge of cutting member 116, and lower cutter 114 is formed on the edge of cutting member 118. Mounting member 152 facilitates removing cutting members 116, 118 and replacement with other disc-shaped members of similar or alternative cutting or abrading designs. Brace 124 prevents rotation of shaft 126 during use of the device such as by chucking shaft 126 into a drill and fitting brace 124 into a non-rotating portion of the drill.
In an alternative embodiment, cutters 112, 114 may be manufactured separately from cutting members 116, 118. For example, in FIG. 4, disposable or interchangable ring 128 includes upper cutter 112 and disposable or interchangable ring 130 includes lower cutter 114. Cutting ring 128 is mounted on cutting member 116, and cutting ring 130 is mounted on cutting member 118. Such a mounting may be accomplished by threadably connecting a cutting ring to its associated cutting member. The threads of such a threadable connection preferably oppose the direction of rotation of the cutting member when the device is in use. Other equivalent mountings to the threadable connection may be employed, such as where the ends of the wheel are configured such that one end secures into the other.
Drive element 108 is positioned to rotationally engage working end 110. Drive element 108 is preferably located adjacent to cutting members 116, 118. Drive element 108 preferably includes two disc-shaped drive members 132, 134 (shown in phantom in FIG. 4). Drive members 132, 134 may be removably mounted on bone removal device 100 by a connector 136 and connector shaft 138. Although two disc-shaped elements are preferred, it should be understood that a number of equivalent structures may be used to impart rotation to working end 110. For example, instead of two drive members 132, 134 as shown in FIG. 4, a hollow or solid cogwheel could be used to interface between working end 110 and a driving mechanism. Another alternative could employ the use of a threaded spindle acting as a drive element. Alternatively, a pulley, spindle, or other rotating device may be coupled to a power source to drive a cord, cable, or belt, or similar power-transferring element to thereby drive cutters 112, 114. Such an alternative embodiment removes the bulk of the drive mechanism from between cutters 112, 114 and is within the scope of the present invention. It is also possible and within the scope of the present invention to angle the cutting elements such that they converge towards leading end 102 to form an angled cut into the adjacent vertebral bodies. For example, as shown in FIG. 3A, working end 110 can include cutters 112′, 114′ and corresponding cutting members 116′, 118′. Cutters 112′, 114′ are tapered relative to one another and converge toward leading end 102. Furthermore, as shown in FIG. 3B, working end 110 can include cutters 112″, 114″ and corresponding cutting members 116″, 118″. Cutters 112″, 114″ face outwardly, and are inclined relative to one another.
Upper and lower cutting members 116, 118 and their associated cutters may rotate in opposite directions so as to mitigate any undesired torque and to avoid any tendency of the cutting end of the device to move laterally. This counter-rotating motion may be achieved by using a rotating drive rod 140 that extends through shaft 126 and is configured with a gear 142 at its distal end that engages with mating gear teeth 144, 146 formed on respective sides of drive members 132, 134. The resulting counter-rotation of drive members 132, 134 (shown by arrows A in FIG. 4) acts to counter rotate cutting members 116, 118 by way of cutting member engagement surfaces 148, 150, shown in FIG. 4 as radial teeth. This counter-rotating motion of members 116, 118 is illustrated by the arrows B in FIG. 4. Mating gear teeth 144, 146 may be inwardly sloping, ramped surfaces that engage cone-shaped gear 142 disposed on the distal end of a rotating drive rod 140 to turn drive members 132, 134 in opposite directions as drive rod 140 spins about its axis. Alternatively, cutting member engagement surfaces 148, 150, and driver 140 can be radially splined to engage one another or may comprise of any other known cord, cable, belt or similar power transferring element that operatively drives cutters 112, 114.
In the embodiment described, mounting element 152 may interchangeably receive various sizes of working end 110 and/or driving element 108. Thus, element 108 and/or working end 110 may be quickly and easily attached to and detached from mounting member 152 during surgery. In order to accommodate the various sizes of working ends and driving elements, mounting member 152 may be adapted to permit slidable adjustment between shafts 122 and 138. While in a preferred embodiment, upper and lower cutters 112, 114 are selected to have a width that is substantially the same as the width of the surface to be formed in the vertebral end plate, a surgeon might also elect to use a working end of lesser height than the ultimate desired depth of the surfaces to be formed. Thereafter, the surgeon may use a successively wider and/or taller work ends of the bone removal device until he arrives at the desired dimensions of the space formed between the adjacent bone structures.
The positioning of drive members 132, 134 adjacent to cutting members 116, 118, instead of between cutting members 116, 118, permits the overall thickness of cutting mechanism 104 to be less than was previously possible with cutting members 116, 118 having the bulk of a drive member therebetween because cutting members 116, 118 can be placed closer together. A reduced overall thickness of cutting mechanism 104 permits the placement of bone removal device 100 into narrower spaces, such as in narrow disc spaces for example, such as but not limited to disc spaces as might be found in some instances in the cervical spine, than was previously possible. Moreover, because the space between cutting members 116, 118 is reduced, the thickness of the cutting area may be increased to permit cutting thicker pieces of bone. For example, in prior devices where a relatively thick portion of the drive mechanism is located between the cutting members, if the bone to be cut is thicker than the individual thickness of each of the cutting members, then the portion of the device between the cutting members could hit the uncut bone and stop the bone removal device from advancing deeper into the bone being cut.
As shown in FIG. 3, in a preferred embodiment a thin portion 154 of mounting element 152 extends between cutting members 116, 118 to provide support and permit attachment of cutting members 116, 118 to mounting element 152. As shown in FIG. 2, a depth stop 156 having an end 159 for abutting a substrate to be cut, such as for example the exterior of a vertebral body, is in slideable engagement to mounting element 152 so as to adjust the depth of penetration of cutting mechanism 104 of bone removal device 100. An adjusting mechanism 158, such as a spring-biased lever for example, locks depth stop 156 at the depth selected by the surgeon. Depth stop 156 also may include an abutment surface or any number or shape of projection capable of carrying out the intended function and any known means for securing it. Adjustment mechanism 158 may also comprise a number of equivalent structures, such as, for example, one or more push button spring locks, adjustable turn screws, a collar with spring loaded detents or ball bearings and the like. Brace 124 extends from trailing end 106 for holding bone removal device 100 in a desired position relative to the drive means to which it attaches.
In another embodiment, mounting element 152 can be taller than cutting members 116, 118. When the taller mounting element 152 passes through the passageway of guard 160, it contacts the interior of the passageway to maintain the cutting mechanism 104 in a preferred orientation to guard 160 so that cutting mechanism 104 can form an implantation space of a height less than the height of the passageway. This height differential permits an implant having a height greater than the height of the implantation space to be inserted through guard 160.
As a further enhancement to the device it may have evacuation flutes for moving debris proximal. Additionally, an irrigation tube and/or a suction tube may be formed within, or outside of shaft 126. For example, as shown in FIG. 4, a tube 161 for irrigation and/or suction can extend along shaft 126. These irrigation and suction tubes may be connected to appropriate sources of irrigation fluid and a source of vacuum, respectively, to efficiently irrigate and clear the surgical site during use of the device.
Numerous other configurations of working end 110 are possible within the scope of the present invention. For example, upper and lower cutters 112′″, 114′″ and corresponding cutting members 116′″, 118′″ may be provided with, as shown in FIG. 3C, convex portions C1, C2, respectively, to form concave receiving surfaces in the vertebral end plates. The geometry and configuration of the shapes of the upper and lower cutters and cutting members can be matched to the desired shape and configuration of the space which the surgeon intends to create between adjacent bone structures and to the desired contour of the surfaces created in the bone structures as is disclosed in applicant's International Patent Application No. PCT/US99/12890, filed Jun. 9, 1999, and applicant's U.S. Pat. No. 6,083,228, issued Jul. 4, 2000, both of which are incorporated herein by reference.
Additionally, working end 110 may be configured to have roughenings, knurls, ridges, small pyramid shaped projections, or any other surface configuration that is capable of cutting or abrading the bone structures.
FIGS. 5-7A show a guard 160 for use with device 100. In the preferred embodiment, guard 160 has a body 166 with a leading end 162, a trailing end 164 opposite leading end 162, and a passageway 168 passing therethrough. In a preferred embodiment, a first disc penetrating extension 170 and a second disc penetrating extension 172 extend from leading end 162. First disc penetrating extension 170 and second disc penetrating extension 172 are adapted to be inserted into the disc space between adjacent vertebral bodies. Guard 160 provides protected access to the disc space and the adjacent vertebral bodies for working end 110 through opening 168. Opening 168 is preferably taller than the height of working end 110. Such a taller opening 168 allows the sequential use of working ends 110 of increasing thickness or the insertion of a spinal implant taller than the thickness of working end 110 thereby allowing the surgeon the option of keeping guard 160 in place after the cutting operation. Additionally, body 166 may have a cross section transverse to its longitudinal axis with a complete or incomplete perimeter, (i.e. the cross section may be generally square, rectangular, oval, circular or any other shape with either an open or closed perimeter suitable for the intended purpose). The spinal implant is preferably sized and shaped to match the space formed in the spine by the working end.
Leading end 162 of guard 160 preferably has a foot plate 174 (for use anteriorly) adapted to contact the vertebral bodies and may be contoured to generally conform to at least a portion of the exterior aspect of the vertebral bodies in any or all planes. Foot plate 174 preferably is adapted to cover at least a portion of each of the two vertebral bodies adjacent the disc space into which guard 160 is to be inserted. Foot plate 174 may have receiving holes 176, 178 for receiving, for example, fasteners including spikes, bone screws 196, 198, pins, prongs, nails, or the equivalent therethrough to secure foot plate 174 to the vertebral bodies. The attachment of foot plate 174 with screws 196, 198 or the equivalent to the adjacent vertebral bodies may rigidly secure the vertebral bodies in the desired relationship and hold the vertebral bodies steady for the cutting operation to be performed, when the guard does not have disc penetrating extensions, or further secure it when it does. The disc penetrating extensions may be entirely sufficient by themselves such that no other means for securing the guard is needed. The example of the foot plate shown in FIGS. 5-8 is suitable for use in the anterior cervical spine. For use in the lumbar spine, preferably little or no foot plate would extend outward from the body of the guard, as the body of the guard itself functions as a depth limiting stop.
Guard 160 also may include one or more guide surfaces along the interior surface of passageway 168 to direct cutting mechanism 104 while accessing the disc space and adjacent vertebral bodies through passageway 168. Such guide surfaces may include any structure designed to direct the cutting mechanism. For example only, such structures can include a cooperative track, longitudinal groove, cooperating protrusion, and the like. However, it is emphasized that the guide surface may include any surface designed to direct cutting mechanism 104.
As shown in FIG. 8, first disc penetrating extension 170 and second disc penetrating extension 172 have an upper surface 180 and a lower surface 182 adapted to contact and support the end plates of the adjacent vertebral bodies. Upper and lower surfaces 180, 182 can be generally parallel to each other or can be in angular relationship to each other. One or both of upper and lower surfaces 180, 182 may be tapered proximate their insertion end to facilitate insertion of extensions 170, 172 into the disc space. An example of a configuration of extensions 170, 172 for use in the cervical spine that generally conforms to the bony architecture within the disc space is best shown in FIGS. 7A and 11. In the lumbar spine, for use from the posterior approach, extensions 170, 172 may have any configuration useful for the intended purpose including but not limited to those disclosed in applicant's U.S. Pat. No. 6,080,155 filed Feb. 27, 1995, incorporated herein by reference. For example, as shown in FIG. 7B, a guard 160′ is provided including a first disc penetrating extension 170′ and an oppositely positioned second disc penetrating extension (not shown).
Guard 160′ (except for first extension 170′ and the second extension) includes the features of guard 160. Furthermore, the second extension would be similar in placement to second extension 172, as shown in FIG. 6. Both first extension 170′ and the second extension extend from leading end 162, and include upper and lower surfaces 180′, 182′. Upper and lower surfaces 180′, 182′ have an angular relationship with respect to one another defining a height for first extension 170′ and the second extension that is lesser at a point proximate leading end 162 that initially increases in the direction away from body 166, and then tapers towards their insertion end to facilitate insertion thereof into the disc space.
While not requisite, extensions 170, 172 (as well as alternative embodiments thereof) are preferably adapted to distract and align the disc space, and to restore lordosis. Extensions 170, 172 further limit lateral excursion of bone removal device 100 and protect vital structures lateral to the disc space. Trailing end 164 of guard 160 cooperates with depth stop 156 of bone removal device 100 to limit the depth of penetration of cutting mechanism 104 into the disc space. Guard 160 assures balanced resection depth of each of the adjacent vertebral bodies and restrains migration of debris generated by the bone removal device. As best shown in FIG. 12, after guard 160 is properly positioned relative to the adjacent vertebral bodies, guard 160 provides the surgeon a line of sight through passageway 168 to evaluate the bone resection prior to actually performing it. As the length of the extensions 170, 172 are known to the surgeon and are appropriate for their intended purpose, the surgeon can, by direct observation, measurement, and/or x-ray, assess the appropriate depth for resection and implantation. Other shapes of disc penetrating extensions may be desired and are within the scope of the present invention.
Having described the apparatus, methods for its use will now be described. It should be understood that the order disclosed is only preferred and that the steps may be performed in other orders while still being within the scope of the present invention. Additionally, some steps may be repeated or omitted as necessary.
Referring to FIGS. 9-15, a method for use in the cervical spine from the anterior approach is described by way of example. As shown in FIG. 9, the correct disc space to be operated upon is identified by the surgeon by direct vision and counting, or preferably, by the use radiographical imaging with a marker. After the correct disc is identified, guard 160 is inserted into the disc space between the adjacent vertebral bodies as shown in FIG. 10.
The disc may have a portion excised and then guard member 160 is inserted such that extensions 170, 172 penetrate the disc space and contact the adjacent vertebral end plates adjacent that disc space. Guard insertion may be performed over a long distractor such as disclosed in applicant's U.S. Pat. No. 6,159,214, incorporated herein by reference. It is appreciated that guard 160 may be inserted into the disc space where the spinal disc is still in place; where at least a portion of the disc has been removed and a distractor is inserted into the disc space and guard 160 is placed over the distractor; or the guard may be inserted into the disc space without first using a distractor.
As shown in FIG. 10, extensions 170, 172 of guard 160 are shaped to penetrate the disc space to help secure guard 160 in position to the spine. Extensions 170, 172 may also be beneficial in spacing apart the vertebral bodies, restoring lordosis, or for correcting a relative translation of the vertebral bodies. After insertion, guard 160 may be, but need not be, further fixated to the spine by the use of one or more fasteners including screws 196, 198, pins, or other suitable elements, preferably into each of the adjacent vertebral bodies. Again, it should be noted that the presence of foot plate 174 is preferred when the guard is used anteriorly but is not essential.
With reference to FIGS. 11 and 12, the correct depth of the disc space to be prepared is determined. The correct disc space depth may be determined in a number of ways. For example, the depth may be determined by pre-operative imaging studies such as plain radiographs, CAT scans, MRIs, and the like. Alternatively, the depth may be determined by direct visualization and/or measurement at the time of surgery, or by intraoperative radiographic monitoring, or any combination of the above. In using radiographic monitoring, for example, a lateral x-ray, the surgeon can assess the depth of the disc space from the length of either or both of extensions 170, 172, and the remaining depth of the disc space. For example, alternatively the surgeon may radiographically monitor the progress of cutter mechanism 104 towards the posterior aspect of the vertebral bodies. Additionally, the surgeon by looking toward the spine through the passage of the guard can assess the bone to be resected prior to resecting any bone. Intraoperative radiographic monitoring will confirm to the surgeon whether the guard is generally parallel to the disc space, the thickness of the bone to be cut, the depth of resection for each of the adjacent vertebral bodies, if the guard is centered from side to side, and the depth of extensions into the space so as to assess the depth of the disc space.
Disc penetrating extensions 170,172 are inserted into the disc space to contact the adjacent end plates of the vertebral bodies and, if not already in the desired position, to position the adjacent vertebral bodies in the appropriate distraction and angular orientation to each other for bone resection. After the adjacent vertebral bodies are in the desired position, guard 160 may be secured to the spine such that foot plate 174 is placed against the anterior aspect of the vertebral bodies and screws 196, 198 are inserted through holes 176, 178 and into the adjacent vertebral bodies. The adjacent vertebral bodies are held in the desired position relative to one another during the bone removal procedure, and if desired, also during the spinal implant insertion procedure.
Referring to FIG. 13, cutter mechanism 104 is advanced through guard 160 into the disc space, removing bone from each of the adjacent vertebral bodies to the desired depth. It should be noted that the progress of distal end 102 of the cutter instrument towards the posterior aspects of the vertebral bodies may be monitored radiographically for greater accuracy. The desired depth also may be determined-with adjustable depth stop 156 that may be set to limit the depth of the cutter insertion. Cutter mechanism 104 is then removed. Debris can be removed by suction and/or irrigation, and optionally with grasping instruments such as rongeurs.
FIG. 14 shows a cutaway side view of adjacent vertebral bodies V1 and V2 that have had surfaces 184 and 186 formed in their respective adjacent end plates. The remaining portion of the more dense, bony rim 188 assists in retaining the spinal implant in the desired position between the adjacent vertebral bodies by acting as an abutment preventing lateral or posterior movement of the spinal implant. The prepared faces of these abutment portions of the vertebral end plate also increase the surface area of contact between the spinal implant and the vertebral body. FIG. 14 also shows the cut portion of the disc space being taller than extension 172.
After removal of cutting mechanism 104, the surgeon has two options depending upon whether the cutter thickness and the spinal implant height are similar or not. If the cutter thickness and spinal implant height are not similar, then the surgeon may elect to remove guard 160 as shown in FIG. 15. Next, the correct spinal implant height is determined. This determination may be made by knowing the extent of distraction prior to cutting, or by trialing the space with spacers to determine the correct height, or by distracting the space and measuring the height. Once the implant height has been determined, the correct spinal implant is selected which preferably has a width equal to the space prepared and a length selected to correspond to the depth of the space preparation or less, and a height sufficient to restore appropriate spacing to the inter space. Additionally, the spinal implant is preferably selected to impart a desired amount of lordosis to the vertebral bodies adjacent the interspace.
The spinal implant is then inserted into the prepared space. During insertion, the prepared space may be held at least in part distracted as the spinal implant is introduced into the prepared space. Preferably, the implant is introduced with an implant driver into the spine and advanced along the mid-longitudinal axis of the prepared space to the desired depth by urging it forward as by impaction, and/or pushing it forward, or the equivalent.
If, after removal of cutter mechanism 104, passageway 168 of guard 160 has a height as great as the height of the implant to be inserted, then the surgeon may insert the spinal implant through guard 160. It should be noted that if the guard was selected to have a passageway height greater than the cutter thickness, then the ideal height of the spinal implant may be determined by introducing into the disc space progressively taller spacers to determine the optimal disc space distraction and implant height. After insertion of the implant, the implant driver, if one was used, is removed.
If the implant is to be inserted without the guard, then guard 160 is removed from the adjacent vertebral bodies prior to the insertion of the implant.
Device 100 also may be used in a posterior approach, for example, between the adjacent vertebrae in the lower back, such as L1 through S1, from a posterior approach, or from posterior to the transverse processes of the vertebrae, including both straight posterior and posterolateral. If a posterior approach is used, many of the above steps apply. In order to position guard 160, the dural sac is retracted towards the side opposite of the insertion and protected along with the traversing nerve root. For easier visualization of the area to be resected, guard 160 may include inspection slots placed away from tissues such as the dural sac and nerves that need to be protected. Guard 160 is preferably placed to one side of the midline, that is, the line separating right and left halves of the vertebral bodies, especially when the surgeon intends to place an implant on each side of the midline. During the posterior approach, the surgeon will normally prefer to place two implants, each having a maximum width less than half of the width of the disc space and generally oriented from the back to the front of the disc space, or slightly toed in. Alternatively, the surgeon may elect to place but a single implant. In such instance, the single implant may be placed more diagonally across the disc space allowing for the use of a longer implant, or to place two implants from the same side.
In a posterior lateral approach, no laminar bone need be removed as the disc space is entered lateral to the spinal canal. In that case, two toed-in implants can be used or a single implant placed diagonally which may be longer than when the two are used. As the disc penetrating extensions themselves (the part in the disc) can be of various cross sectional shapes it may be preferred to utilize a distractor having a height greater than its width so that it can be introduced on its side and then rotated 90° to its height. In that case, it is preferred that at least one of the diagonals, if not both, be reduced in length by reduction of the junctions or corners where the top and bottom meet the sides. Alternatively, the trial spacers may resemble the implant in shape, though it may be preferred to leave the bone engaging surfaces smooth to facilitate removing the trial implants or distractors. As used herein, the term trials refers to spacers that are similar to an implant in shape but without a bone engaging surface such that it is smooth and lesser in height than an implant and used to determine the appropriate tension for the disc space in which a spinal implant is to be inserted.
FIGS. 16-18 illustrate various views of vertebral bodies with implantation spaces that have been prepared by a device incorporating the present invention. The cross-hatching in these figures represents the machined areas of vascular bone. FIG. 16 shows a top view of a first vertebral body V1 such as in the lumbar spine where the depth of resection is sufficient to allow for the full diameter of the cutter to pass into the disc space, leaving parallel straight sides and anatomic contour at the trailing (anterior) aspect of the vertebral body. The created space includes a leading portion adapted to correspond to the leading end of an implant and sides adapted to correspond to at least a portion of the sides of the implant. First vertebral body V1 has a surface 190 formed by working end 110 as shown in FIG. 4. The width of surface 190 formed on first vertebral body V1 closely matches the width of working end 110 that was advanced into the disc space along a single front to back axis.
FIG. 17 shows the top view of a second vertebral body V2 such as in the cervical spine where the depth of resection may be limited such that the full diameter of the cutter never passes into the bone. The created space is adapted to correspond to at least a portion of the leading end of the implant and possibly a portion of the sides.
FIG. 18 shows the top view of a lumbar vertebral body V3 showing side-by-side passes of the hemi-width cutter from a posterior to anterior approach. In such an instance, the cutter preferably has a maximum width of less than half the width of the disc space. The prepared areas may or may not touch each other.
a guard for providing protected access to the adjacent vertebral bodies, said guard comprising a body having a leading end, a trailing end opposite said leading end, a mid-longitudinal axis therebetween, and an opening passing through said leading and trailing ends, said opening having a height and a width transverse to and greater than said height, said height of said opening being greater than the maximum height of the forward facing cutting area of said bone removal device, said opening being sized and shaped to permit said first and second cutters to pass through said body and access the vertebral body endplates.
2. The system of claim 1, wherein said first and second cutters include teeth formed thereon to cooperatively engage said drive element, said drive element and said teeth being configured such that said first and second cutters are rotated by said drive element.
3. The system of claim 1, wherein said first and second cutters are adapted to be rotated in opposite directions by said drive element.
4. The system of claim 1, wherein at least one of said first and second cutters has a width, said width substantially matching the width of the nucleus pulposus of a disc space in which it is inserted.
5. The system of claim 1, wherein said first and second cutters are inclined relative to one another.
6. The system of claim 1, wherein said first and second cutters are driven in a reciprocating, arcuate motion by said drive element.
7. The system of claim 1, wherein said drive element is adapted to produce a rotary movement of said first and second cutters about an axis generally perpendicular to the mid-longitudinal axis of said shaft.
8. The system of claim 1, wherein said drive element is adapted to produce one of an oscillating rotation and a vibratory motion of said first and second cutters.
9. The system of claim 1, wherein said guard further includes a foot plate sized and shaped to contact at least a portion of each of the adjacent vertebral bodies, said foot plate having at least one opening configured to receive a fastener adapted to secure said foot plate to the vertebral bodies.
10. The system of claim 1, wherein said guard further comprises first and second disc penetrating extensions extending from said guard for insertion into the disc space between the adjacent vertebral bodies, each of said disc penetrating extensions having a portion for bearing against each of the adjacent end plates of the adjacent vertebral bodies, each of said portions of said disc penetrating extensions having an upper surface adapted to contact one of the adjacent end plates of the adjacent vertebral bodies and a lower surface adapted to contact the other of the adjacent end plates of the adjacent vertebral bodies, said portions of said disc penetrating extensions having a height between said upper and lower surfaces and a length sufficient to properly align and distance apart the adjacent vertebral bodies.
11. The system of claim 10, wherein said upper and lower surfaces are parallel to each other along a substantial portion of the length of said portions.
12. The system of claim 10, wherein said disc penetrating extensions are diametrically opposed to each other and spaced apart from one another to provide access to the adjacent vertebral bodies from within the disc space.
13. The system of claim 10, wherein the height of said disc penetrating extensions have at least a portion that approximates the height of a normal disc space between the adjacent vertebral bodies.
14. The system of claim 10, wherein said disc penetrating extensions have a tapered leading end to facilitate placement of said disc penetrating extensions into the disc space, said portion of said disc penetrating extensions having opposite surfaces for bearing against the end plates of the adjacent vertebral bodies, said opposite surfaces diverging away from said guard along at least a portion of their length.
15. The system of claim 10, wherein said upper and lower surfaces converge away from said guard along at least a portion of their length.
16. The system of claim 10, wherein said opening of said guard has an interior having a cooperating surface for guiding a corresponding cooperating surface of said first and second cutters.
17. The system of claim 1, in combination with an implant sized and shaped to match the implantation space formed in the spine by said first and second cutters.
18. The system of claim 17, wherein said implant is one of a spinal implant and a spacer.
19. The system of claim 1, wherein at least a portion of said first and second cutters are separated by a space and substantially overlie one another, said drive element being configured to engage said first and second cutters outside the space separating said cutters.
20. The system of claim 1, wherein at least a portion of said first and second cutters is operatively connected to said drive element in a plane parallel to the mid-longitudinal axis of said shaft.


In 1979, Rosalind Krauss wrote the essay "Sculpture in the Expanded Field," that defined sculpture in terms of a structural diagram of differing fields. Outside of the dualities between landscape and architecture, not-landscape and not-architecture, and the differing combinations of these quadrants, there were zones of creation that defined what it was that human beings did when they went out across the earth to intentionally build a construction. In her essay, Krauss said that this structural definition was necessary to understand not the historical meaning of sculpture, but the current definition for that place and time. In an era when artists like Nancy Holt, Sol LeWitt, Michael Heizer, Mary Miss, and many others were exploring the boundaries and overlaps between architecture, landscapes, sites, and sculpture, it was not so much material definition that was necessary, but a field in which artists could experiment.
But clearly, since this is a matter of history, it is also important to explore a deeper set of questions which pertain to something more than mapping and involve instead the problem of explanation. These address the root cause-the conditions of possibility-that brought about the shift into postmodernism, as they also address the cultural determinants of the opposition through which a given field is structured.
And indeed, this is the subject of most of the essays in the publication. The word "production" is used more often than "sculpture." Production is a loaded concept, with echoes of Marxist and materialist theory. But a conceptual "seizing" of production by the artistic process is exactly what is on the minds of contemporary artists. Who is making the art, how, and where? The materials, the process, the networks of distribution, and the labor involved are all new fields that are being drawn into the current sculptural diagram. Production defines an action, rather than the object being made. It is a function involving multiple equations, leading to a cascading chain of actions that often crosses larger borders than those of the gallery. If in 1979, the history leading up to the current structure was Krauss' question, today artists are preoccupied by how the current structures of artistic production will lead into the future. Where is Production? asks not just about the substance of current sculpture, but about its status. In a time of networks, to produce sculpture becomes a algorithmic, contingent activity. From these essays, one can see that today's artists are not shying away from the question or simply posing it, but trying to answer it for themselves in as many ways as possible.
This book grew out of of a closed discussion hosted at Sculpture Center in 2013. Artists, curators, historians and others were convened for four hours to identify a central question to ask about sculpture today, with the understanding that the question would then become the basis of a book. Very little of that actual private conversation is reported in the book but almost half of the participants contribute texts or images that elaborate on the topic "Where is production?".
The book is slim, handsomely produced and varies in the rigor which with that topic is both addressed and adhered to. Three texts in the book stood out in my reading of it. Curator Ruba Katrib's essay "Location, location, location" is centrally positioned (literally) in the book and offers a robustly argued perspective as she advances her case for "Where?" as a geopolitical and cultural question. Michell Kuo surveys the space of fabrication to ask if "Where?" is ultimately useful or relevant to the reception of work and Clair Staebler makes a brief but intriguing case for the production of sculpture as a form of territorialism (possibly endorsing a kind of productive colonial art?).
Where is Production? is described as being the first in a 3-part series called "Inquiries into Contemporary Sculpture". Thinking about the overall goals of an initiative like this it seems like there there is an as-yet unrealized opportunity to expand the conversation and audience. Rather than limiting dialogue to an initial closed door meeting and a specialized publication it would be interesting to see Sculpture Center open these conversations to the public, if not as actual live-audience scenarios at least as a series incorporated into their online presence. SC already hosts a couple of online series that excel at exposing new work and artist's insights (Sculpture Notebook, Framing Sculpture) perhaps a similar approach could be applied to their new project of interrogating sculpture.


A US Coast Guard MH-60 Jayhawk helicopter assigned to Air Station Kodiak flies over an active volcano near Cold Bay. Aircrews are forward-deployed to Cold Bay during the harsh Alaskan winter months to reduce search and rescue response times.
KODIAK—Coast Guard Air Station Kodiak aircrews demobilized forward operating locations in St. Paul and Cold Bay, concluding the supplemental coverage of the Bering Sea and Aleutian Chain.
Air Station Kodiak MH-60 Jayhawk helicopter aircrews deployed to Cold Bay from October 20 to November 20, 2018, and then again from January 15 to February 19, 2019. Aircrews later deployed to St. Paul from February 17 to March 15, 2019, in support of Coast Guard operations in the Bering Sea to provide search and rescue and maritime law enforcement coverage.
A Coast Guard Air Station Kodiak HC-130 Hercules aircrew offloads equipment needed to open the St. Paul forward operating location.


I was delighted to discover some heirloom tomatoes at the Noosa Farmers Market when I recently visited. I purposely put them in the back of my car for the trip home to avoid eating them all. They were sweet and full of flavour. Once home, they were turned into a quick easy tart. Super easy and great for a late breakfast or light lunch. For a non gluten free version you could use 1-½ cups of plain wholemeal flour in place of the gluten free flours and omit the xantham gum.
Transfer to a bowl and cover. Refrigerate for 1 to 2 hours.
Place in oven and cook for approximately 30 minutes or until the base of tart is cooked through.
Looks really fabulous and I am loving that crust!
Looks quick, easy, delicious...and healthy. Thanks!
I can't wait to try the pastry and tomatoes sound like the perfect filling! Delicious!
I love the pastry recipe. Your photos are luminous. this tart looks irresistible.
I adore the look of this tart! Just my kind of food. Perfect weekend food. Another stunning post!
I am just dying to find bright, juicy heirloom tomatoes so I can make gorgeous recipes like this one. I'm off to the farmers' market!
Love ya and hope you are well.


I got an application to our BSN program today from Test McTesterton. I knew it was actually Sean in IT working on a problem in our online admissions program, but how awesome would it be to have a real student named Testy T. McTesterton? I would LOVE to type that name in an admissions letter. I wrote Sean back and told him how much I wished it were a real application, and he wrote back maybe someday.
I like our IT department.
One of the girls in IT took over doing the campus IT Newsletter. She and I were talking about it one day, and she confessed she almost used "Have you tried turning it off and on?" as the tag line but didn't know if anyone would get it.


Women tend to live longer than men, making it even more essential that they accumulate enough superannuation to last through retirement.
But women face unique challenges when it comes to retirement savings. Lower pay, time out of the workforce to raise children, or running a single-parent household, can make it challenging to build a reasonable amount of super. However, some simple strategies make it possible for women to overcome these hurdles.
Superannuation is a very tax-effective way to save for retirement. Your super fund pays a low rate of tax on contributions and investment earnings while you grow your nest egg. From age 60, you can withdraw your super tax-free.
Without super, many women must rely on the Age pension in their senior years. But the age pension is designed as a safety net and won't provide you with a comfortable life.
Taking time off paid work (e.g. to have a baby or care for someone) or working part time can impact your super.
If you haven't given your employer instructions about the super fund of your choice, it's likely the contributions are paid into a MySuper fund your employer has chosen. This may not be the sort of fund you would prefer.
By law, you can normally choose your own fund and have your employer's contributions paid into that fund. If you have several super funds, it's a good idea to roll over or consolidate your super into your preferred fund. This will save you extra administration fees and make it easier to keep track of your super.
To choose a super fund, look at all the fees charged and the long-term average returns of the investment option you are comfortable with. Don't base your choice solely on past investment returns, as past performance may not be a reliable indicator of future performance.
When choosing a fund also consider the insurance it provides and the level of cover you require. For more information see insurance through super.
There are a number of ways to build your super. You cannot normally access your super before you retire, so only contribute money you can afford to set aside.
Ask your employer to pay part of your pre-tax salary or wages into your super fund. Making concessional, or salary sacrificed super contributions can be a tax-effective way to grow your super.
Make super contributions out of your own pocket. Non-concessional contributions, also known as after-tax super contributions, are not subject to the 15% contributions tax that can apply to other types of contributions. Depending on your annual income, you may also be eligible for government super contributions. It's an easy way to give your super a valuable boost.
Ask your partner or spouse to make contributions on your behalf. He or she may be able to claim a tax offset on the contributions made to your fund.


text:
Graeme Paton, Transport Correspondent
Grant Shapps has asked the CAA to focus on non-commercial aviation
The transport secretary has been accused of abusing his position to promote a hobby after telling the aviation watchdog to focus on recreational pilots.
Grant Shapps, a keen flyer, became embroiled in a spat with the Civil Aviation Authority (CAA) after ordering it to support private pilots and enthusiasts. He wrote to the CAA to indicate that it should devote more energy to so-called general aviation, including private aircraft, gliders and parachuting.
His letter — sent in October but only now released — said that the authority should be "at the forefront of promoting the UK aviation industry".
The intervention has been described as extraordinary as the CAA faces pressures involving Brexit, the Heathrow expansion and consequences of the collapse of Thomas Cook.
Mr Shapps,…

redpajama_set_name: RedPajamaCommonCrawl


#05948e hex color is (5, 148, 142) in RGB color palette. Closest web safe color is #009999.
#05948e hex code consists of 5 red value, 148 green and 142 blue. In HSL notation it has 177.5 hue, 93.5 saturation and 30 lightness. The process color (CMYK) is combination of 97 cyan, 0 magenta, 4 yellow and 42 key (black).
Shades are created by adding a black color. The lightest one in this statement is #058a85, whereas #023030 is the darkest.
Tints are formed by combining with white color. The brightest one of the following tints is #ffffff, and the darkest is #06bbb4.
Some of pre-made examples using #05948e hex color in HTML.


To cut down on comment spam, I have Bad Behavior enabled on this blog, and there was a minor issue with the version I had, though in general it has been wonderful. My apologies if it blocked you. I didn't get any email from folks saying they were blocked, but it blocked me! Apparently a fairly common complaint. I've upgraded now and I'm not seeing any more issues.
There's a lot of hate mail towards Bad Behavior's author because of this, so I want to try to cancel some of that out: this plugin has saved me many gray hairs. Thanks.


TWO spots just opened up for next Sunday's (April 7) studio sessions with @blushartistrymua! DM me for special pricing on the two available session times. Great for boudoir, family, maternity, mommy & me, couples, headshots etc.


text:
Q: Trouble creating folder in SharePoint Online (PnP module) I am trying to use PowerShell to create a new folder in a Teams document library, using the PnP Sharepoint Online module.
I can authenticate to the site in both PowerShell and in a browser. Then I run this code:
$cred = Get-Credential
$result = Add-PnPFolder -Folder "/sites/SalesDemo/Shared Documents/General/Acme Corp" -Name "testfolder" -Connection (Connect-PnPOnline -Url 'https://tenant.sharepoint.com' -Credentials $cred)

The result looks fine, showing the name, type, items/size, and last modified time, but when I view the site in SharePoint or in Teams, I do not see "testfolder". However, "testfolder" is returned when I run:
Get-PnPFolderItem -FolderSiteRelativeUrl "/sites/SalesDemo/Shared Documents/General/Acme Corp" -ItemType Folder -Connection (Connect-PnPOnline -Url 'https://tenant.sharepoint.com' -Credentials $cred)

Unfortunately, there are other folders in "Acme Corp" that are not returned.
Where is my "testfolder" being created?

A: Update:
As discussed, when using Connect-PnPOnline, the url parameter should be the same as the site url where the library hosted, if it's hosting in specific site collection, the url should be:
https://Tenant.sharepoint.com/sites/SalesDemo
The testfolder should be located at the relative url:
/sites/SalesDemo/Shared Documents/General/Acme Corp
"Acnm Corp" should be a subfolder within /Shared Documents/General folder, the test folder should be there:

redpajama_set_name: RedPajamaStackExchange


Radio Gets Our Vote for Political Advertising!
A host of state and local elections will be taking place this year in New York, and voters are more engaged than ever. For example, more than four-fifths (81%) of New York metro Adults 18+ are registered to vote in their district of residence – a whopping 12.1 million voters!
These voters span a wide range of the political spectrum. Here's how New York metro's Adults 18+ break out by political party. Nearly half (49%) are Democrat or Independent, but feel closer to Democrat. Nearly one-quarter (23%) are Republican or Independent, but feel closer to Republican. Nearly one in ten (9%) are Independent. And one-fifth (20%) are registered with other political parties.
And for all those political campaigns that need to get their message out, Radio is a great place to reach voters! Of those who always vote in local elections, 90% listen to Radio on a weekly basis. And of those who always vote in statewide elections, 91% listen to Radio on a weekly basis. That's a lot of voters who can be reached by Radio!
In fact, Radio reaches more registered voters than these other media. Over 10.7 million registered voters tune to Radio in an average week!
In addition, Radio allows for great targetability with its various formats. For example, Republicans are 172% more likely than the market average to listen to Adult Standards-formatted stations, 50% more likely to listen to Mainstream Rock, and 42% more likely to listen to Country.
When it comes to Democrats, they are 73% more likely to listen to Gospel-formatted stations, 57% more likely to listen to Spanish Sports, and 37% more likely to listen to Urban AC.
And that's just scratching the top-ten surface. Obviously, there are many more formats that would help campaigns even further fine tune their candidate's message to the voters who count.
The bottom line is this. Radio has multiple advantages when it comes to contacting voters. It has mass reach, it's targeted, and it's affordable. It's got my vote!


text:
Category: Heteroflexible
Straight Guys And BRO-Jobs; Ricky Martin's Bedroom Shenanigans; Psychic Denies Housing to Queer Couple
Straight Guys And BRO-Jobs
There's an app called BRO that I think helps "heteroflexible" guys when they are looking for something same sex oriented. They word it a little differently in the article to which I'm linking, but this is what it sounds like to me.
First, here's the definition of heteroflexible. I'm doing this because it's all news to me. I always thought of this sort of thing as "in the closet."
A primarily straight individual who, in certain situations can find persons of the same sex appealing.
Now here's more about BRO…
"BRO goes beyond using labels, and is for men that are interested in meeting other men," the description reads. "It's as simple as that. Just sign up, and start looking for new bros!"
Jane Ward, whose bestselling book Not Gay: Sex Between Straight White Men caused a media frenzy last summer, says BRO further supports her theory that straight-identifying men engage in homosexual behaviors a lot more often than people might think.
"This kind of product serves as more evidence that the labels 'gay' and 'bisexual' do not capture all of the ways that men want to make intimate contact with other men, whether emotionally or sexually," Ward tells Queerty.
Interesting. I'm sticking with my resolution for 2016 and trying to remain objective this year.
You can read the rest here.
Check out the comments. They aren't objective at all.
Ricky Martin's Bedroom Shenanigans
Even though I despise the word shenanigans, I'm posting this about Ricky Martin because it talks more about "labels."
"I know that I like both men and women," Martin confessed. "I'm against sexual labels, we are simply human beings with emotional and sexual needs."
Though he identifies as gay, Martin said he's not totally opposed to the idea of having sexual intercourse with a member of the opposite sex.
"I am gay," he said, "Men fascinate me. But I like to enjoy sex in total freedom, so I'm open to having sex with a woman if I feel desire."
You can read more here. I love Ricky Martin, but as Judge Judy says, "don't pee on my leg and tell me it's raining."
Psychic Allegedly Denies Housing To Queer Couple
Here's a story about a self-proclaimed psychic who allegedly refused housing to a queer couple.
When Tonya Smith and her wife Rachel, a trans woman, applied to rent a home from psychic Deepika Avanti in the town of Gold Hill (pop. 230), they were allegedly told in an email that their "unique relationship" would become a "town focus," triggering gossip and blowing Avanti's "low profile."
"In small towns everyone talks and gossips," the email read. "All of us would be the most popular subject in town. … There is no way to avoid this."
The queer couple has filed a lawsuit against the psychic, and the psychic didn't even know it until the media contacted her. The psychic claims the queer couple have children and she didn't want the noisy kids living there.
It's hard to speculate on this one.
The Rainbow Detective Agency
Amazon in Print or E-book
Phychic Denies House to Queer Couple
Ricky Martin's Bedroom Shenanigans
Ryan Field Gay Romance Author
Straight Guys Getting Head
Wil Wheaton and HuffPost; "Heteroflexible" Boy George Sleeping With Prince?
Wil Wheaton and HuffPost
To be honest I'm not totally sure who Wil Wheaton is but he has a lot of followers on Twitter and he wrote an eloquent blog post about writers not getting paid for content contributed to HuffPost…and publications like them. HuffPost isn't the only one. These publications claim you'll get "exposure" in exchange for your written works.
I absolutely agree with everything in Wheaton's post, and I think I've even posted about this topic a while back.
I'm not talking about sharing a blog post or something you've written for smaller web sites or personal bloggers. If your good author friend has a small blog and you decide to write a blog post for them without getting paid I think that's excellent. That's called support. My blog is not for profit and I've had guest posts here (but not often) and I didn't pay the authors either. I've also contributed to small blogs for free and I have no regrets.
But I think there's a huge difference between contributing your written content for free to a small not for profit blogger as opposed to any huge multi-million dollar publication that can afford to pay you.
I'm not copying and pasting Wheaton's content, but you can read the entire post here. The main point for me is that writers deserve to get paid for their hard work and their contributions. If you choose to do otherwise, that's up to you.
It seems as if there's a new PC term almost daily for yet another group that's a little different. This time it's "heteroflexible." In my own lame attempt to define it, I think it's about a straight guy with a girlfriend who wants to bring other men into their bedroom for sex…once in a while and only when he's in the mood. But please don't quote me on that. I know and understand as much about this as I do asexuals. Which is nothing at all.
This happened after he explained himself to the girlfriend…
She said that she was sorry that her reaction was a little harsh. She explained that she has zero problem with gays/bisexuals but that when it's with her own partner it feels different. She agreed maybe it is close-minded but she said it's an instinctive reaction. She said she is honestly not 100% comfortable with the idea, but that realistically it isn't that big of a deal. She said she doesn't truly understand the whole "it's more about dick than being attracted to men" thing, but that she understands human sexuality is complex and believes me.
I don't even know how to comment on this one. You can read the rest here. I do know for certain that as a gay man I wouldn't be going near their bedroom any time soon. And I have zero problems with women/straights but it's just not something that turns me on.
You'll want to read the comments, trust me.
Boy George Sleeping With Prince?
This one is just too easy. The jokes could write themselves.
During the taping of some TV reality show, Boy George claimed he slept with Prince.
George boasted, "I have duetted with some of the greatest soul singers in history including Luther Vandross and Smokey Robinson," prompting Paloma Faith to come back with, "Well OK, if we're throwing big soul names out there I've performed with Prince."
"Forget that, darling," George quickly retorted. "I've slept with Prince."
As it turns out, this is all clickbait. Boy George was joking around and talking about a poster of Prince in his bedroom. He didn't actually sleep with Prince in a literal sense. So you can all take that proverbial sigh of relief now…especially Prince.
I could ask why do people do these things, but then I could also ask why do people watch reality TV shows.
The rest is here.
Gang Bang Fangsters
Here's a link for Allromanceebooks…
Straight Guys Sleeping With Guys


Maths Beyond Limits 2017 was an international mathematics camp for high school students from Czech Republic, Hungary, Poland and Slovakia. It took place on 6-17.09.17 in Milówka, Poland and was free of charge, thanks to the generous financial support from the International Visegrad Fund and the Adamed Group Foundation.
The project was run under the patronage of the Polish Children's Fund - an established Polish NGO operating in the field of talented youth education with undisputable experience of organising science and interdisciplinary camps - in cooperation with partner organisations from other countries, which were Joy of Thinking Foundation (Hungary), Trojsten (Slovakia) and Faculty of Mathematics and Physic at Charles University in Prague (Czech Republic). All of them are involved in organising mathematical camps, national and international competitions, summer schools and seminars for youth interested in mathematics.
MBL 2017 was an 11-day-long programme, filled with numerous events. Every regular day there were three 80-minute-long blocks of Mathematical Classes. Classes were followed by 45-minute-long TAU and then Camper Talks. The hard work was followed by fun, challenging, educational or thought-provoking Evening Activities and Sports such as running as well as playing volleyball, football and frisbee.
On MBL we do not to let anyone get bored, therefore also quite a few special events were organised. We went for a Hike in Beskidy mountains and solved a mystery during the Night Criminal Game, as well as had fun playing guitars and singing by the Campfire. Participants also got a chance to talk about careers, universities and olympiads with tutors and organisers during the Questions Evening Café. Moreover, they were able to improve their problem solving skills thanks to Relays (team competition similar to Náboj), Mathematical Matches and Olympic Challenge. There were 3 divisions of Mathematical Matches differing in difficulty, each of them was a team contest where teams got problem sets in the evening and presented their solutions by the board the next day. If students wanted to train a specific branch of mathematics, they were able to do so in the Olympic Challenge. If they solved a given problem, they were rewarded with a next one and if they got stuck, they could ask staff members for hints.
Jump to... Jump to... Site announcements Our Purpose Organising Committee Overview Our Supporters Testimonials MBL 2016 MBL 2018 Apply!


Selling a home, investment property or any form of real estate can be a daunting and emotional experience for some. In most cases, a piece of real estate could be your greatest asset, so it's only fitting that you want to extract maximum value from your property when it hits the market.
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To stay, it's $420 per person per week (for parties of two, another $420 is added to supplement cost). Kids under 4 years stay for free. Located in town, just off the tourist path, Dar Beida is a 10-minute walk to the beach. They can arrange someone to either prepare traditional Moroccan meals at the house, or bring them to your door. Rent it at castlesinthesand.com.
this place is so gorgeous is breaks my heart.
i am going to go start shopping for skulls now to build that wall installation! thanks for the inspiration.
Property prices have shot up in the last 5/10 years in the area, as so many places have been sold only to become holiday rentals.
More chain hotels moving in the area too. Not what it used to be, but then, nothing ever stays the same.
Locals have moved to a new build area out of town. I sometimes wonder if heart of the town will just be a tourist ghetto once the older generations die out once the younger generations have settled in the new builds…..
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Not all small insurance businesses are built alike. From startups and small businesses to grow and established companies, small insurance broker companies, and insurance agencies have diverse business management needs. Insurance software is important to manage your business effectively. Hundreds of different software are available for brokers and agents – which one to choose?
There are a few software comparison sites on the Internet that you can use when need to find the best IT solution for your business. Our team analyzed three most popular and independent software comparison sites for the listing – capterra.com, getapp.com, topbestalternatives.com and found out what are the best insurance software products for insurance brokers and agencies in 2018.
We were looking for a software that is web-based and allows agents and brokers to manage their policies and customers. Insly is really proud to be the top one insurance software product in all comparison sites and we are happy to present you the list to show all alternatives for brokers and agencies.
Capterra offers the most comprehensive list of business software solutions on the web so that you're guaranteed to find your best match. Capterra's service is free for anybody looking for business software. Every year, millions of people start their software research in one of the 300+ software categories listed on their website.
Insly is the best insurance intermediary software solution on the market created by the collection of the best and brightest insurance software developers. Our goal at Insly is to support insurance intermediaries – agents and brokers all over the world. Saving time and making more money on insurance, that's what Insly solutions are all about. We have over a decade of experience making insurance easy to use and understand, from providers to end-users.
Real-Time personal lines rater supports over 500 carriers nationally, 100% accurate, saves agents up to 85% of their quoting time.
New generation project software designed to meet unique business needs, bring value to your business, & streamline project management.
Insurance Agency Management System for agencies across the US with lots of awesome integrations to make agency life easier!
Advanced software framework providing contact management, policy administration, servicing, billing, claims tracking and premium acct.
User-friendly software for insurance brokers, insurance agents, and insurance broking company.
Web-based innovative CRM-based agency management system with built-in marketing, text messaging, mobile application and more.
Insurance agency management software that allows you to manage your book of business, your staff and your office from anywhere.
Business management software for insurance agencies with CRM, lead management, and commission tracking capabilities.
TopBestAlternatives is UK based web service with contributors around the world. Their sole inclination is to provide alternatives to software you already know and need to replace. Based on the users' indulgence, they file useful alternatives to the applications you are looking for a replacement for your current ones.
Here is the list of TOP best insurance policy software products according to topbestalternatives.com.
Insly is an ideal insurance intermediary software solution on the market developed by a range of the best and striking insurance software developers. The company focuses on to support insurance intermediaries – agents and brokers across the world. Saving time and making more money on insurance, that's what Insly solutions are all about.
InsuranceFaces caters a service to combine all your systems into one pliant, adjustable and strong application to organize all your general insurance administration needs. Customizable to your business processes and data, InsuranceFaces gives a friendly and intuitive browser-based interface, allowing you, your call centers, brokers, clients and third parties to share and manage information proficiently.
Authority Suite by Camilion Solutions is a fully functional modern P&C policy administration system for all lines of business that gives a sound set of policy transactions and allows the true pace to market. It includes policy issuance, policy processing, underwriting management, commercial lines, for casualty insurance, and much more.
Instanda is an insurance software for easily underwriting and managing insurance product online. As you explain about your products, your sales website is automatically created. It provides you full control over every side of insurance policy creation, billing and selling. You can use it for the full life cycle of any insurance product and get to market quickly.
InsureAccess is one of the ideal and most effective online platforms in the market that consolidates insurance experience and technical proficiency to serve the requirements of insurance brokers and their customers for fast access to all of their insurance files.
Insurance Policy Administration by Radix comes with features including life insurance, policy issuance, policy processing, renewal management, underwriting management, claims tracking, casualty insurance, and much more.
Insurance Systems Inc. (ISI) is a fully devoted to giving software suites to the P&C insurance industry. It is a complete solution, combining top-edge browser-based technology with functionality not seen in any other solution. The company takes an integrated concept to policy administration. Billing, claims, reinsurance, loss control, and financials are key components of the business, which this suite brings together on one modern platform.
Mantacore caters an end-to-end enterprise solution for the insurance department and has developed and deployed solutions for the Property & Casualty insurance market. Mantacore is aimed at developing, marketing and implementing FlexSure, its modern standard policy & claim management system. It comes with policy issuance, renewal management, underwriting management, accounting integration, and much more.
OneShield caters the insurance industry the most developed and customizable end-to-end policy management solution for every stage of the policy lifecycle and for all lines of commercial, personal and specialty insurance. It offers a rich abundance of pre-configured features and functions. OneShield Policy helps you drive your success as well.
GetApp® is a registered trademark of Nubera eBusiness S.L. Nubera launched in January 2010, with the aim of becoming "The Premier App Store for Business Software". Their mission is to provide research programs and detailed user-generated and editorial reviews on tens of thousands of software and mobile apps that are relevant to businesses. Today, millions of professionals are using Nubera's websites to discover, compare and select business apps.
Cloud-based software for insurance agents and insurance brokers with the monthly fee that simplifies sales process and helps with administration and reporting. Free trial.
Agency Matrix's solution provides easy to use automation and a user-friendly interface to eliminate much of the burdensome processes associated with your business. Every client, every policy, every form, every endorsement, payment, image, and report you could ever need or want is just a click away.
Guidewire provides powerful software, but that is only part of the solution. We also provide you with the delivery expertise to successfully implement the system and commit to supporting you in the long run.
AgentMethods is the fastest way for insurance agents to launch and manage a high-quality insurance website.
AgencyBloc was created to fill a gap between web-based CRM offerings, and expensive, client-based agency management systems. Many agencies attempt to use generic web-based CRM systems such as Salesforce, only to realize that it does not fit the model of health insurance and can be very difficult and expensive to customise.
Hope this article is helpful for your insurance business to select the best insurance software according to your business needs.


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Sunrise and sunset times in Glenedagh
Check out today's and tomorrow's sunrise and sunset times in Glenedagh, Connaught, Ireland, as well as the whole calendar for January 2023.
January 26, 2023. Current time: 10:08 pm (Europe/Dublin timezone)
Day length: 8 hours, 33 minutes
Sunset in Glenedagh, Connaught was 5 hours, 2 minutes ago
Tomorrow will be 3 minutes longer than today in Glenedagh
Glenedagh,
Longitude: -9.383610
Time zone: Europe/Dublin
January 2023 - Glenedagh, Connaught - Sunrise and sunset calendar
Sunrise and sunset times, civil twilight start and end times as well as solar noon, and day length for every day of January in Glenedagh.
In Glenedagh, Connaught, the first day of January is 7 hours, 31 minutes long. The last day of the month is 8 hours, 51 minutes, so the length of the days gets 1 hour, 20 minutes longer in January 2023.
8:13:58 am 8:55:18 am 4:26:41 pm 5:08:01 pm 07:31:23 12:40:59 pm 7:27 am 5:54 pm 6:44 am 6:37 pm
Year distribution of sunrise and sunset times in Glenedagh, Connaught - 2023
The following graph shows sunrise and sunset times in Glenedagh for every day of the year. There are two jumps in the graph that represent the hour change for Daylight Saving Time (DST) in Glenedagh, Connaught.
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Coolinarrig
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