Devices and methods for tissue access
First Claim
1. A method of accessing a target tissue region within a spinal anatomy of a patient, the method comprising:
- advancing an access device towards the tissue region, where the access device comprises an access device body having a sharp tip at a distal end thereof, the access device body further comprising a lumen extending therethrough and exiting out of the distal end at an opening;
changing the sharp tip to a blunted tip by at least partially extending a distal portion of a second device through the distal end of the access device body; and
further advancing the access device until the blunted tip reaches the target tissue region.
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Accused Products
Abstract
Methods and apparatus are provided for selective surgical removal of tissue, e.g., for enlargement of diseased spinal structures, such as impinged lateral recesses and pathologically narrowed neural foramen. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space through an epidural needle. Once the sharp tip of the needle is in the epidural space, it is converted to a blunt tipped instrument for further safe advancement. A specially designed epidural catheter that is used to cover the previously sharp needle tip may also contain a fiberoptic cable. Further embodiments of the current invention include a double barreled epidural needle or other means for placement of a working channel for the placement of tools within the epidural space, beside the epidural instrument. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. In one variation, a tissue removal device is provided including a thin belt or ribbon with an abrasive cutting surface. The device may be placed through the neural foramina of the spine and around the anterior border of a facet joint. Once properly positioned, a medical practitioner may enlarge the lateral recess and neural foramina via frictional abrasion, i.e., by sliding the tissue removal surface of the ribbon across impinging tissues. A nerve stimulator optionally may be provided to reduce a risk of inadvertent neural abrasion. Additionally, safe epidural placement of the working barrier and epidural tissue modification tools may be further improved with the use of electrical nerve stimulation capabilities within the invention that, when combined with neural stimulation monitors, provide neural localization capabilities to the surgeon. The device optionally may be placed within a protective sheath that exposes the abrasive surface of the ribbon only in the area where tissue removal is desired. Furthermore, an endoscope may be incorporated into the device in order to monitor safe tissue removal. Finally, tissue remodeling within the epidural space may be ensured through the placement of compression dressings against remodeled tissue surfaces, or through the placement of tissue retention straps, belts or cables that are wrapped around and pull under tension aspects of the impinging soft tissue and bone in the posterior spinal canal.
286 Citations
20 Claims
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1. A method of accessing a target tissue region within a spinal anatomy of a patient, the method comprising:
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advancing an access device towards the tissue region, where the access device comprises an access device body having a sharp tip at a distal end thereof, the access device body further comprising a lumen extending therethrough and exiting out of the distal end at an opening;
changing the sharp tip to a blunted tip by at least partially extending a distal portion of a second device through the distal end of the access device body; and
further advancing the access device until the blunted tip reaches the target tissue region. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A method of accessing a target tissue region within a space in a patient, the method comprising:
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advancing an access device into the space, where the access device comprises an access device body having a sharp tip at a distal end thereof, the access device body further comprising a lumen extending therethrough and exiting out of the distal end at an opening;
advancing a distal portion of a second device adapted to blunt the sharp tip of the access device through the access device and out of the distal end;
transforming the shape of the distal portion of the second device to blunt the sharp tip the transformed distal portion preventing the sharp tip from contacting tissue; and
further advancing the access device until the blunted tip substantially reaches the target tissue. - View Dependent Claims (19, 20)
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Specification