GUIDEWIRE EXCHANGE SYSTEMS TO TREAT SPINAL STENOSIS

• US 20080275458A1
• Filed: 05/27/2008
• Published: 11/06/2008
• Est. Priority Date: 10/15/2004
• Status: Active Grant

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Baxano, Inc. (Baxano Surgical, Inc.)
• Inventors: Leguidleguid, Roy, Bleich, Jeffery L., Schmitz, Gregory P., Bleam, Jefferey
• Granted Patent: US 8,257,356 B2
• Time in Patent Office: Days
• US Class Current: 606/103
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• 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 17/320708 Curettes, e.g. hollow scraping instruments
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• 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 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3496 Protecting sleeves or inner probes; Retractable tips for protecting body piercing guide needles A61M25/0612
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1487 Trocar-like, i.e. devices producing an enlarged transcutaneous opening
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00287 Bags for minimally invasive surgery
• CPC Class Codes: A61B 2017/003 Steerable
• 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 2017/00469 for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/00867 shape memory effect
• CPC Class Codes: A61B 2017/320004 : abrasive
• CPC Class Codes: A61B 2017/320044 : Blunt dissectors
• CPC Class Codes: A61B 2017/32006 : with a cutting strip, band or chain, e.g. like a chainsaw
• CPC Class Codes: A61B 2018/1407 : Loop
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/08021 : of the patient or his organs
• CPC Class Codes: A61B 90/04 : Protection of tissue around surgical sites against effects of non-mechanical surgery, e.g. laser surgery protection of eyes against laser radiation A61F9/022
• CPC Class Codes: A61M 25/09041 : Mechanisms for insertion of guide wires
• CPC Class Codes: A61M 25/0905 : extendable, e.g. mechanisms for extension
• CPC Class Codes: A61N 1/0551 : Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 2001/0578 : having means for removal or extraction

Abstract

Guidewire exchange systems, devices and methods, for positioning and actuating surgical devices in a desired position between two tissues in a patient'"'"'s body are described. A guidewire may be coupled to a surgical device for positioning and actuating (e.g., urging against a target tissue). The guidewire may be exchanged between different surgical devices during the same procedure, and the guidewire and surgical devices may be releaseably or permanently coupled. The surgical device generally includes one or more guidewire coupling members. A system may include a guidewire and a surgical device having a guidewire coupling member. Methods, devices and systems may be used in open, less-invasive or percutaneous surgical procedures.

Claims

1. A method of exchanging a surgical device while treating a patient, the method comprising:

advancing a guidewire at least partially around a target tissue in a patient so that the proximal end of the guidewire extends from a first site on the patient and the distal end of the guidewire extends from a second site on the patient;

coupling the proximal end of the guidewire on or near the distal end of a first surgical device;

positioning the first surgical device by pulling the distal end of the guidewire;

de-coupling the proximal end of the guidewire from the first surgical device;

coupling the proximal end of the guidewire to a second surgical device; and

positioning the second surgical device by pulling the distal end of the guidewire.

2. The method of claim 1, further comprising withdrawing the first surgical device from the patient by pulling on the proximal end of the first surgical device.

3. The method of claim 1, further comprising urging the first surgical device against the target tissue by applying tension to either or both of the first surgical device extending from the first site and the guidewire extending from the second site.

4. The method of claim 1, further comprising urging the second surgical device against the target tissue by applying tension to either or both of the second surgical device extending from the first site and the guidewire extending from the second site.

5. The method of claim 1, wherein the first surgical device comprises an elongate surgical device having a flexible distal end.

6. The method of claim 1, wherein the step of advancing the guidewire comprises advancing the guidewire through a spinal foramen.

7. The method of claim 1, wherein the step of advancing the guidewire comprises confirming that a non-target nerve is not between the target tissue and the path of the guidewire.

8. The method of claim 7, wherein the step of confirming that a non-target nerve is not between the target tissue and the path of the guidewire comprises applying electrical energy to the tissue.

9. A method of exchanging a surgical device while treating a patient, the method comprising:

advancing a guidewire through an intervertebral foramen and at least partially around a target tissue in a patient so that the proximal end of the guidewire extends from a first site on the patient and the distal end of the guidewire extends from a second site on the patient;

coupling the proximal end of the guidewire on or near the distal end of a first surgical device;

pulling the distal end of the guidewire to position the first surgical device adjacent the target tissue;

removing the first surgical device from the patient while leaving the guidewire in the patient;

de-coupling the proximal end of the guidewire from the first surgical device;

coupling the proximal end of the guidewire to a second surgical device; and

pulling the distal end of the guidewire to position the second surgical device.

10. A method of treating a patient, the method comprising:

advancing a distal end of a guidewire into the patient'"'"'s body from a first site;

advancing the distal end at least partially around a target tissue;

extending the distal end of the guidewire out of the body from a second site, while maintaining a proximal end of the guidewire outside the body at the first site;

coupling the proximal end of the guidewire on or near a distal end of a surgical device; and

pulling the distal end of the guidewire to guide at least a portion of the surgical device to a desired position adjacent to the target tissue.

11. The method of claim 10, wherein the step of coupling the proximal end of the guidewire on or near the distal end of the surgical device comprises coupling the proximal end of the guidewire to the surgical device with at least one coupling member.

12. The method of claim 10, wherein the step of coupling the proximal end of the guidewire on or near the distal end of the surgical device comprises engaging a guidewire coupling member on the surgical device with the distal end of the guidewire.

13. The method of claim 10, further comprising locking the proximal end of the guidewire on or near a distal end of a surgical device.

14. The method of claim 10, further comprising urging the surgical device against the target tissue by applying tension to either or both of the surgical device extending from the first site and the guidewire extending from the second site.

15. The method of claim 10, further comprising performing a surgical procedure on the target tissue using the surgical device.

16. The method of claim 15, wherein the step of performing a surgical procedure comprises reciprocating the surgical device by pulling on either or both of the surgical device extending from the first site and the guidewire extending from the second site.

17. The method of claim 10, further comprising withdrawing the surgical device proximally from the patient.

18. The method of claim 10, further comprising de-coupling the proximal end of the guidewire from the surgical device and coupling the proximal end of the guidewire on or near a distal end of a second surgical device.

19. A method for guiding at least a portion of a surgical device to a desired position between two tissues in a patient'"'"'s body, the method comprising:

advancing a distal end of a guidewire into the patient'"'"'s body, between two tissues, and out of the body, while maintaining a proximal end of the guidewire outside the body;

coupling the proximal end of the guidewire with at least one coupling member on or near a distal end of a surgical device; and

pulling the distal end of the guidewire to guide at least a portion of the surgical device to a desired position between the two tissues.

20. A method for performing a procedure on a target tissue in a patient'"'"'s body, the method comprising:

coupling a proximal end of a guidewire with at least one coupling member on or near a distal end of a surgical device;

pulling a distal end of the guidewire to guide at least a portion of the surgical device to a desired position between the two tissues, such that an active portion of the surgical device faces target tissue and an atraumatic portion of the surgical device faces non-target tissue; and

performing a procedure on the target tissue, using the surgical device.