Spinal ligament modification

• US 20060036272A1
• Filed: 07/29/2005
• Published: 02/16/2006
• Est. Priority Date: 07/29/2004
• Status: Active Grant

• Current Assignee: Vertos Medical, Inc.
• Original Assignee: X-Sten Incorporated
• Inventors: Schomer, Donald, Solsberg, Murray D.
• Granted Patent: US 7,896,879 B2
• Time in Patent Office: Days
• US Class Current: 606/170
• CPC Class Codes: A61B 10/0233 Pointed or sharp biopsy instruments
• CPC Class Codes: A61B 10/0275 with sample notch, e.g. on the side of inner stylet
• CPC Class Codes: A61B 10/0283 with vacuum aspiration, e.g. caused by retractable plunger or by connected syringe A61B10/025, A61B10/0266 take precedence
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/320783 through side-hole, e.g. sliding or rotating cutter inside catheter
• CPC Class Codes: A61B 17/3401 Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia local anaesthesia A61M19/00
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 2010/045 Needles pointed biopsy devices with vacuum aspiration A61B10/0283
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0437 the barbs being resilient or spring-like
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/06176 : with protrusions, e.g. barbs
• CPC Class Codes: A61B 2017/320008 : Scrapers
• CPC Class Codes: A61B 2017/32004 : having a laterally movable cutting member at its most distal end which remains within the contours of said end
• CPC Class Codes: A61B 2017/320064 : with tissue or sample retaining means

Abstract

A method for treating stenosis in a spine comprises percutaneously accessing the epidural space in a stenotic region of interest, compressing the thecal sac in the region of interest to form a safety zonem, inserting a tissue removal tool into tissue in the working zone, using the tool to percutaneously reduce the stenosis; and utilizing imaging to visualize the position of the tool during at least a part of the reduction step. A tissue excision system for performing percutaneous surgery, comprises a cannula comprising a tissue-penetrating member having a distal end defining an aperture on one side thereof, an occluding member slidably received on or in the cannula and closing the aperture when the occluding member is adjacent the cannula distal end, means for engaging adjacent tissue via the aperture, and cutting means for resecting a section of the engaged tissue.

Claims

1. A method for treating stenosis in a spine, the spine including a thecal sac and a canal and an epidural space therebetween, the stenosis determining a region of interest in the spine, comprising the steps of:

a) percutaneously accessing the epidural space in the region of interest;

b) compressing the thecal sac in the region of interest by injecting a fluid to form a safety zone and establish a working zone, the safety zone lying between the working zone and the thecal sac;

c) inserting a tool into tissue in the working zone;

d) using the tool to percutaneously reduce the stenosis; and

e) utilizing imaging to visualize the position of the tool during at least a part of step d).

2. The method of claim 1 wherein the tool comprises:

a cannula comprising a tissue-penetrating member having a distal end defining an aperture on one side thereof;

an occluding member slidably received on or in said cannula and closing said aperture when said occluding member is adjacent said cannula distal end;

means for engaging adjacent tissue via said aperture; and

cutting means for resecting a section of said engaged tissue.

3. The method of claim 2 wherein the tool further includes means for retrieving said resected tissue from said distal tool end and a tissue-removal system for removing tissue from said retrieving means.

4. The method of claim 1 wherein step d) comprises

d1) engaging a tissue sample in the working zone;

d2) excising the tissue sample;

d3) removing the tissue sample from the working zone; and

d4) repeating steps d1) through d3) until a desired amount of tissue has been removed.

5. The method of claim 4 wherein the tissue sample comprises tissue selected from the group consisting of the ligamentum flavum, fat, and bone.

6. The method of claim 4 wherein step d) is carried out without repositioning the device in the tissue.

7. The method of claim 4 wherein step d) comprises

di) providing an anchor having first and second tissue-engaging ends;

dii) engaging the ligamentum flavum with said first tissue-engaging end;

diii) using said engaged first end to pull at least a portion of the ligamentum flavum into a desired position; and

div) using said second tissue-engaging end to anchor said anchor such that said ligamentum flavum is retained in a desired position.

8. The method of claim 7 wherein step div) comprises anchoring said anchor to paraspinous tissue.

9. The method of claim 7 wherein step div) comprises anchoring said anchor to bone.

10. The method of claim 1 wherein the injected fluid includes a contrast medium.

11. The method of claim 10 wherein the injected fluid has a temperature-dependent viscosity and is more viscous at 37°

C. than at 30°

C.

12. The method of claim 1 wherein the tool includes an outer cannulated scalpel, a tissue-engaging means received in said scalpel, and a cutting element.

13. The method of claim 12 wherein the tool further includes means for removing tissue from the tissue-engaging means.

14. The method of claim 12 wherein the tissue-engaging means comprises a resilient hook.