Method of identifying and treating a pathologic region of an intervertebral disc

• US 20040064023A1
• Filed: 09/30/2002
• Published: 04/01/2004
• Est. Priority Date: 09/30/2002
• Status: Active Grant

• Current Assignee: Depuy Acromed
• Original Assignee: Depuy Acromed
• Inventors: Serhan, Hassan, Reynolds, Martin A., Ryan, Thomas P.
• Granted Patent: US 6,827,716 B2
• Time in Patent Office: Days
• US Class Current: 600/374
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00057 Light
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2018/0044 Spinal cord
• CPC Class Codes: A61N 7/02 Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

This invention relates to a method of treating an intervertebral disc comprising locally identifying a pathologic tissue site and therapeutically treating the identified site.

Claims

1. A method of therapeutically treating an intervertebral disc having a pathologic region, the method comprising the steps of:

a) positioning a probe having a diagnostic element within or adjacent to the disc,

b) activating the diagnostic element to identify the pathologic region, and

c) therapeutically treating the identified pathologic region.

2. The method of claim 1 wherein the treatment comprises coagulating a collagen component of an annulus fibrosus portion of the disc.

3. The method of claim 1 wherein the treatment comprises denervating a nociceptor contained within an annulus fibrosus portion of the disc.

4. The method of claim 1 wherein the treatment comprises removing mass from the nucleus pulposus component within the disc.

5. The method of claim 1 wherein the probe is positioned via a percutaneously placed needle.

6. The method of claim 1 wherein the probe is positioned adjacent the disc.

7. The method of claim 1 wherein the probe further comprises a therapeutic element, and the therapeutic element carries out the treatment step.

8. The method of claim 7 wherein the diagnostic element comprises an optical sensor and the therapeutic element comprises an ultrasound transducer.

9. The method of claim 1 wherein the pathologic region is on an outside surface of the disc, and the treatment treats at least the outside surface of the disc.

10. The method of claim 9 wherein the therapeutic treatment produces disc shrinkage at a point of disc herniation.

11. The method of claim 9 wherein the pathologic region comprises adhesions located on an outside posterior portion of the disc where a spinal cord outer membrane adheres to an annulus fibrosus.

12. The method of claim 9 further comprising the steps of:

d) identifying a location of a structure of an adjacent vertebral body, and

e) therapeutically treating the identified structure.

13. The method of claim 1 wherein the probe is positioned within the disc.

14. The method of claim 13 wherein the probe is positioned within an annulus fibrosus portion of the disc

15. The method of claim 13 wherein the probe is positioned within a nucleus pulposus portion of the disc.

16. The method of claim 15 wherein the probe further comprises a therapeutic element and the therapeutic element treats an inner wall of the annulus fibrosus.

17. The method of claim 13 wherein the probe further comprises a therapeutic element, the diagnostic element is an optical element, and the therapeutic element delivers energy via an active electrode.

18. The method of claim 1 wherein the probe further comprises a therapeutic element.

19. The method of claim 1 wherein the diagnostic element provides both visualization for guiding the probe through the disc and for diagnosis of the pathologic region within the disc.

20. The method of claim 1 wherein the diagnostic element is adapted to utilize an analytical technique selected from the group consisting of Raman spectroscopy, fluorescence, autofluorescence, reflected light, impedence, MRI and ultrasound as a means for identifying or analyzing the pathologic region.

21. The method of claim 20 wherein the probe comprises at least two different diagnostic elements.

22. The method of claim 21 wherein the two different diagnostic elements are adapted to respectively utilize the analytic techniques of reflected light and autofluoroscence.

23. The method of claim 1 wherein the probe further comprises a therapeutic element selected from the group consisting of:

i) an element capable of delivering energy to tissue in a therapeutic amount,

ii) an element capable of delivering or removing a material from a location adjacent the element'"'"'s location in the probe;

iii) a mechanical grasping tool for removing or depositing a solid; and

iv) a guidance tool for allowing passage of other devices.

24. The method of claim 23 wherein the therapeutic element is an energy delivery element.

25. The method of claim 24 wherein the energy delivery element is selected from the group consisting of a laser, a ultrasound element comprising an ultrasound transducer, a microwave element, and an RF energy element.

26. The method of claim 24 wherein the therapeutic element is an RF energy element comprising an active electrode and a return electrode.

27. The method of claim 26 wherein the active and return electrodes are disposed on the same probe.

28. The method of claim 1 wherein the step of activating the diagnostic element to identify the pathologic region comprises the substep of performing analysis of information received from a passive sensor by comparing the information against a comparable tissue property information in a computer data base.

29. A method of therapeutically treating an intervertebral disc having a pathologic region, the method comprising the steps of:

a) navigating a probe having a diagnostic element and a therapeutic element to a first position within or adjacent to the disc,

b) activating the diagnostic element to identify the pathologic region within the disc,

c) navigating the probe to a second position closer to the pathologic region identified in step b), and

d) activating the therapeutic element to treat the pathologic region.

30. The method of claim 29 further comprising the step of:

d) activating the diagnostic element to confirm the therapeutic treatment of the pathologic tissue.

31. An apparatus for treating spinal pathologies, comprising:

a) a combined diagnostic and therapeutic probe having a diagnostic element and a therapeutic element, and a proximal end,

b) a first cable having a diagnostic signal conduit and a therapy delivery conduit, and first and second ends, the first end of the cable being attached to the proximal end of the probe,

c) a power source having an input/output port adapted to provide therapeutic energy to the probe, and to receive and transmit diagnostic signals from and to the probe, the port being attached to the second end of the first cable, and

d) a video monitor connected to the signal output port adapted to display the diagnostic signals.

32. A probe for diagnosing and therapeutically treating a pathologic region within an intervertebral disc, comprising:

a) a diagnostic element adapted to identify the pathologic region, and

b) a therapeutic element adapted to therapeutically treat the pathologic region.

33. The probe of claim 32 wherein the diagnostic element provides both visualization for guiding the probe through the disc and for diagnosis of the pathologic region within the disc.

34. The probe of claim 32 wherein the diagnostic element is selected from the group consisting of a Raman spectroscope, a fluoroscope, an autofluoroscope, a reflected light sensor, a frequency sensor, a coil adapted for MRI reception, and an ultrasound transducer.

35. The probe of claim 32 further comprising a second different diagnostic element.

36. The probe of claim 35 wherein the two different diagnostic elements include a reflected light sensor and a autofluoroscope.

37. The probe of claim 32 wherein the therapeutic element is selected from the group consisting of:

i) an element capable of delivering energy to tissue in a therapeutic amount,

ii) an element capable of delivering or removing a material from a location adjacent the element'"'"'s location in the probe;

iii) a mechanical grasping tool for removing or depositing a solid; and

iv) a guidance tool for allowing passage of other devices.

38. The probe of claim 32 wherein the therapeutic element is an energy delivery element.

39. The probe of claim 38 wherein the energy delivery element is selected from the group consisting of a laser, a ultrasound element comprising an ultrasound transducer, a microwave element, and an RF energy element.

40. The probe of claim 32 wherein the therapeutic element is an Rf energy element comprising an active electrode and a return electrode.

41. The probe of claim 40 wherein the active and return electrodes are disposed on the same probe.

42. An apparatus for treating an intervertebral disc having a pathologic region, comprising:

a) a probe adapted to be positioned in or adjacent to a spinal disc, the probe comprising a diagnostic element comprising a sensor adapted to receive a signal from a target tissue and transmit the signal, and

b) a computer adapted to receive and analyze the signal transmitted by the sensor, the computer further comprising a data base.

43. The apparatus of claim 42 wherein the probe further comprises a therapeutic element.

44. The apparatus of claim 42 wherein the sensor is a passive fiber.

45. The apparatus of claim 44 wherein the passive fiber is an optical fiber through which energy reflected or emitted from a target tissue is received by the sensor as a signal.

46. The method of claim 42 wherein the diagnostic element further comprises an active element.

47. The apparatus of claim 46 further comprising:

c) a video display adapted to display a report from the computer.

48. The apparatus of claim 47 wherein the active element transmits light to the target tissue so that the sensor can record the tissue response thereto.

49. The apparatus of claim 47 wherein the active element is an active fiber through which energy is transmitted from a power source onto the target tissue.

50. The apparatus of claim 47 wherein the active fiber is a first optical fiber and the sensor is a second optical fiber.

51. The apparatus of claim 42 wherein the diagnostic element further comprises an active fiber adapted to transmit energy to the target tissue, and the sensor is a passive fiber adapted to receive energy transmitted by or reflected from the target tissue.

52. The apparatus of claim 42 wherein the diagnostic element is adapted to utilize an analytical technique selected from the group consisting of Raman spectroscopy, fluorescence, autofluorescence, reflected light, impedance, MRI and ultrasound as a means for identifying or analyzing the pathologic region.

53. The apparatus of claim 52 wherein the database includes a tissue property data base.

54. The apparatus of claim 53 wherein the computer includes software adapted to perform an analysis of the signal received from the sensor against the tissue property database.

55. The apparatus of claim 54 wherein the data base comprises information on tissue properties of normal tissue and pathologic tissue.

56. The apparatus of claim 54 wherein the data base comprises information on tissue properties of different types of tissue.

57. The apparatus of claim 54 wherein the data base comprises information on tissue properties of treated tissue.

58. The apparatus of claim 54 further comprising a feedback mechanism for insuring that the targeted pathologic tissue has been sufficiently treated.

59. A method of therapeutically treating an intervertebral disc having a pathologic region, the method comprising the steps of:

a) positioning a probe having a diagnostic element and a therapeutic element within or adjacent to the disc, the diagnostic element comprising a sensor and an active element,

b) transmitting energy through the active element to target tissue to produce a signal from the pathologic region,

c) transmitting the signal through the sensor,

d) evaluating the signal to identify the pathologic region, and

e) therapeutically treating the identified pathologic region.

60. The method of claim 59 wherein the therapeutic element of the probe performs step e).