METHODS FOR ELECTROSURGICAL TREATMENT OF SPINAL TISSUE

• US 20080009847A1
• Filed: 08/21/2007
• Published: 01/10/2008
• Est. Priority Date: 06/07/1995
• Status: Abandoned Application

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Ricart, Olivier, Hovda, David, Woloszko, Jean, Eggers, Philip, Thapliyal, Hira
• Application Number:
  US11/842,294
• Publication Number:
  US 20080009847A1
• Time in Patent Office: Days
• US Class Current: 606/032
• 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

1-25. -25. (canceled)

26. A method of treating an intervertebral disc comprising:

a) positioning an active electrode of an electrosurgical probe adjacent to or within a nucleus pulposus of the intervertebral disc;

b) treating the nucleus pulposus by applying high frequency voltage between the active electrode and a return electrode;

c) withdrawing the active electrode through an annular fibrosus of the intervertebral disc; and

d) during the withdrawing step, applying a high frequency voltage between the active electrode and the return electrode sufficient to contract annulus fibrosus.

27. The method of claim 26, wherein the treating of the nucleus polposus step comprises applying a high frequency voltage between the active electrode and the return electrode sufficient to heat a portion of the nucleus polposus to a temperature between about 55°

C. and about 70°

C.

28. The method of claim 26, wherein the treating of the nucleus polposus step comprises applying a high frequency voltage between the active electrode and the return electrode sufficient to ablate a portion of the nucleus pulposus.

29. The method of claim 26 wherein the active electrode and the return electrode are disposed on the distal end of the probe.

30. The method of claim 26 wherein the return electrode is not disposed on the electrosurgical probe.

31. The method of claim 26 wherein, during the withdrawing step, applying a high frequency voltage between the active electrode and the return electrode sufficient to contract at least a portion of the annulus fibrosus.

32. The method of claim 26 wherein, during the withdrawing step, applying a high frequency voltage between the active electrode and the return electrode sufficient to heat a portion of the annulus fibrosus to a temperature between about 55°

C. and about 70°

C.

33. The method of claim 26 wherein, during the withdrawing step, applying a high frequency voltage between the active electrode and the return electrode sufficient to coagulate blood at the tissue surface of the annulus fibrosus.

34. The method of claim 26 wherein, during the withdrawing step, applying a high frequency voltage between the active electrode and the return electrode sufficient to coagulate blood at the tissue surface of the annulus fibrosus.

35. The method of claim 26 wherein, during the withdrawing step, applying a high frequency voltage between the active electrode and the return electrode sufficient to contract at least a portion of the annulus fibrosus, said high frequency voltage insufficient to cause ablation of tissue.

36. The method of claim 26, further comprising:

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

37. The method of claim 26, wherein said step d) causes shrinkage of collagen fibers of said annulus fibrosus.

38. The method of claim 26, wherein the high frequency voltage is applied between the active electrode and the return electrode sufficient to effect molecular dissociation of annulus pulposus tissue.

39. The method of claim 26, further comprising:

e) prior to said step a) introducing the electrosurgical probe into an intervertebral disc.

40. The method of claim 26, wherein said step d) comprises controlled heating of the annulus fibrosus tissue to within a specific temperature range and to a defined depth.

41. The method of claim 40, wherein the defined depth is in a range of from about 0.2 mm to 2.5 mm.

42. The method of claim 41 wherein the electrosurgical probe creates a passage through the annulus fibrosus and the application of the high frequency voltage during the withdrawing step seals the passage as the probe is withdrawn.

43. The method of claim 26, further comprising:

advancing an introducer needle towards said annulus fibrosus and advancing a shaft of the electrosurgical probe through the introducer needle.

44. The method of claim 26 wherein the high frequency voltage applied during the treating step is the same as the high frequency voltage applied during the withdrawing step.

45. The method of claim 26 wherein the high frequency voltage applied during the treating step comprises a first high frequency voltage and the frequency voltage applied during the withdrawing step comprises a second high frequency voltage.