Methods for electrosurgical treatment of spinal tissue

• US 20050004634A1
• Filed: 07/29/2004
• Published: 01/06/2005
• Est. Priority Date: 06/07/1995
• Status: Abandoned Application

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Woloszko, Jean, Eggers, Philip E., Hovda, David C., Thapliyal, Hira V., Ricart, Olivier
• Application Number:
  US10/903,655
• Publication Number:
  US 20050004634A1
• Time in Patent Office: Days
• US Class Current: 607/99
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• CPC Class Codes: A61B 18/149 bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
• 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 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00101 using an array of thermosensors
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/00029 open
• CPC Class Codes: A61B 2018/00083 low, i.e. electrically insulating
• CPC Class Codes: A61B 2018/00119 with metal oxide nitride
• CPC Class Codes: A61B 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00178 Electrical connectors
• CPC Class Codes: A61B 2018/00327 Ear, nose or throat
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00434 Neural system
• CPC Class Codes: A61B 2018/0044 Spinal cord
• CPC Class Codes: A61B 2018/00505 : Urinary tract
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00583 : Coblation, i.e. ablation using a cold plasma
• CPC Class Codes: A61B 2018/00589 : Coagulation
• CPC Class Codes: A61B 2018/00601 : Cutting
• CPC Class Codes: A61B 2018/00678 : upper
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00827 : Current
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1213 : creating an arc
• CPC Class Codes: A61B 2018/124 : switching the output to different electrodes, e.g. sequentially
• CPC Class Codes: A61B 2018/1253 : monopolar
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1273 : including multiple generators in one device
• CPC Class Codes: A61B 2018/1407 : Loop
• CPC Class Codes: A61B 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/162 : located on the probe body
• CPC Class Codes: A61B 2018/165 : Multiple indifferent electrodes
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

Systems, apparatus, and methods for treating spinal tissue and other body structures in open and endoscopic spine surgery to relieve symptoms, such as neck or back pain. In particular, the present invention provides methods for the controlled heating of various tissues in or around the vertebral column, including various interspinous tissues, such that spinal ligaments and cartilage surrounding the vertebrae and the facet joints are shrunk or tightened to stabilize the vertebral column of a patient. Thermal energy is applied to the target tissue in a subablation mode of an electrosurgical system to cause shrinkage of the tissue, thereby stiffening the interspinous tissue and stabilizing the vertebral column. In an exemplary embodiment, a high frequency RF voltage can be applied between one or more active electrode(s) and one or more return electrode(s) to heat a target interspinous tissue to within a temperature range at which irreversible shrinkage of the tissue occurs.

Claims

1. A method of treating an interspinous tissue of a patient, comprising:

a) positioning an active electrode adjacent to a target site of the interspinous tissue, said active electrode is disposed on the distal end of a shaft of an electrosurgical probe; and

b) heating the interspinous tissue at the target site with the active electrode by applying a high frequency voltage between the active electrode and a return electrode, the heating being sufficient to shrink at least a portion of the interspinous tissue.

2. The method of claim 1, wherein the electrosurgical probe is coupled to a high frequency power supply to provide a power supply/probe combination, the power supply/probe combination configured to operate in either an ablation mode wherein a first high frequency voltage is applied between the active electrode and the return electrode sufficient to effect molecular dissociation of the interspinous tissue, or in a subablation mode wherein a second high frequency voltage applied between the active electrode and the return electrode effects thermal heating and shrinkage of the interspinous tissue.

3. The method of claim 1 wherein the return electrode is disposed on the shaft distal end at a location proximal to the active electrode such that current is induced to flow from the active electrode away from the interspinous tissue.

4. The method of claim 1 wherein the high frequency voltage applied between the active and return electrodes is insufficient to cause ablation of tissue.

5. The method of claim 1 further comprising:

c) providing a quantity of an electrically conductive fluid around the active electrode, wherein the electrically conductive fluid provides a current flow path between the active electrode and the return electrode.

6. The method of claim 5 wherein applying a high frequency voltage between the active electrode and the return electrode heats the quantity of electrically conductive fluid, and the heated electrically conductive fluid heats the interspinous tissue at the target site.

7. The method of claim 5 wherein said step c) comprises delivering the electrically conductive fluid to the shaft distal end, and said step c) is performed after the positioning step and prior to the applying step.

8. The method of claim 1 wherein said step b) comprises heating the interspinous tissue in a controlled manner such that tissue at the target site is exposed to a temperature in the range of from about 60°

to 70°

C.

9. The method of claim 1 wherein said step b) causes shrinkage of collagen fibers of the interspinous tissue and increased rigidity of the vertebral column of the patient.

10. The method of claim 1 wherein the interspinous tissue is a ligament.

11. The method of claim 10 wherein the ligament is an anterior longitudinal ligament, a posterior longitudinal ligament, a supraspinous ligament, a ligamentum flavum, or an interspinous ligament.

12. The method of claim 1 wherein the interspinous tissue comprises cartilage or a capsule surrounding a facet joint between adjacent vertebrae.

13. The method of claim 1 wherein the interspinous tissue is located adjacent to a spinous processes.

14. The method of claim 1 wherein said step b) causes adjacent spinous processes to be drawn closer together.

15. The method of claim 1 wherein said step b) causes tightening of at least one facet joint between adjacent vertebrae.

16. The method of claim 1 wherein said interspinous tissue comprises tissue adjacent a facet joint.