SPINAL ACCESS SYSTEM AND METHOD
First Claim
1. A method for accessing a spine of a patient, the method comprising:
- advancing a cannula into the patient to contact a distal end of the cannula with spinal tissue including at least one of ligamentum flavum or vertebral periosteum;
removeably attaching the distal end of the cannula to at least one of the ligamentum flavum, periosteum and/or bone;
advancing a flexible guide member through the cannula and through at least one of the ligamentum flavum or vertebral periosteum to position a distal portion of the guide member in the epidural space of the spine; and
advancing the distal portion of the guide member at least partway into an intervertebral foramen of the spine.
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Accused Products
Abstract
Described herein are devices and systems for accessing a spine and particularly the epidural region of the spine and methods of using these systems and devices to access the spine or regions of the spine. In particular, cannulas that may be anchored to the ligamentum flavum or the periosteum are described. Ligamentum flavum access tools are also described. These tools may be used with (or without) an anchoring cannula to penetrate the ligamentum flavum and provide access to the epidural space without risk of injury to other structures within the epidural space. The devices, methods and systems described herein are particularly useful in minimally invasive surgical (MIS) uses. The devices, methods and systems described herein may be used for performing spinal decompressions and other spinal procedures.
214 Citations
71 Claims
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1. A method for accessing a spine of a patient, the method comprising:
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advancing a cannula into the patient to contact a distal end of the cannula with spinal tissue including at least one of ligamentum flavum or vertebral periosteum; removeably attaching the distal end of the cannula to at least one of the ligamentum flavum, periosteum and/or bone; advancing a flexible guide member through the cannula and through at least one of the ligamentum flavum or vertebral periosteum to position a distal portion of the guide member in the epidural space of the spine; and advancing the distal portion of the guide member at least partway into an intervertebral foramen of the spine. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. A method for accessing a spine of a patient, the method comprising:
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advancing a cannula into the patient to contact a distal end of the cannula with spinal tissue including at least one of ligamentum flavum or vertebral periosteum; removeably attaching the distal end of the cannula to at least one of the ligamentum flavum, periosteum and/or bone; advancing a guide member through the cannula and through at least one of the ligamentum flavum or vertebral periosteum to position a distal portion of the guide member in the epidural space of the spine; and advancing a guidewire through the guide member and at least partway into an intervertebral foramen of the spine.
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16. A method for accessing an intervertebral foramen of a spine of a patient, the method comprising:
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removeably attaching a distal end of a first tissue locking cannula to spinal tissue including at least one of ligamentum flavum or vertebral periosteum and/or bone; passing at least a second tissue locking cannula over the first cannula; removeably attaching a distal end of the second cannula to the spinal tissue; removing the first cannula through the second cannula; advancing a probe through the second cannula to position a distal portion of the probe in an epidural space of the patient'"'"'s spine; advancing a curved, at least partially flexible, cannulated guide member through the probe, such that when the distal portion exits the cannula it assumes a preformed curved shape; and advancing the distal portion of the guide member at least partway into an intervertebral foramen of the spine. - View Dependent Claims (17, 18, 19)
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20. A system for accessing a spine of a patient, the system comprising:
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at least one tissue locking cannula having multiple barbs disposed at one end for removeably attaching to spinal tissue including at least one of ligamentum flavum or vertebral periosteum and/or bone; and a curved, at least partially flexible, cannulated guide member slideably passable through the cannula and having a distal portion configured to change from a straight shape within the cannula to a curved shape upon exiting the cannula, wherein the distal portion has a radius of curvature configured to position the distal portion at least partway into an intervertebral foramen of the spine when advanced through the cannula. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32)
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33. A ligamentum flavum access tool device comprising:
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an outer hypotube having a distal cutting edge; and an inner member comprising an atraumatic tissue contacting region that is movable within the outer hypotube, and extends from the outer hypotube;
wherein the inner member is configured to secure to a patient'"'"'s ligamentum flavum; anda sensor to detect entry into the epidural space. - View Dependent Claims (34, 35, 36, 37, 38, 39)
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40. A ligamentum flavum access tool device comprising:
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an elongate body; a distal tip member comprising an atraumatic tissue contacting region configured as a leading head; a cutting surface that is located proximal to the distal tip member; and a loss of resistance detector, configured to determine when the distal tip member is within the epidural space. - View Dependent Claims (41, 42, 43, 44, 45, 46)
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47. A method of accessing the spine of a patient comprising:
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anchoring the distal end of a cannula in contract with a patient'"'"'s ligamentum flavum; advancing a ligamentum flavum access tool within the cannula in a controlled manner; penetrating the ligamentum flavum with the ligamentum flavum access tool to access the epidural space; and forming an opening in the ligamentum flavum with the ligamentum flavum access tool.
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48. A method of accessing the spine of a patient comprising:
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anchoring the distal end of a cannula in contract with the patient'"'"'s ligamentum flavum; advancing a ligamentum flavum access tool distally within the cannula in a controlled manner, wherein the ligamentum flavum access tool comprises an outer hypotube having a distal cutting edge, and an inner member comprising an atraumatic tissue contacting region that is movable within the outer hypotube, and extends distally from the outer hypotube; securing the ligamentum flavum to the atraumatic tissue contacting region of the ligamentum flavum access tool; and cutting an opening in the ligamentum flavum with the cutting edge of the proximal hypotube. - View Dependent Claims (49, 50, 51, 52, 53, 54, 55, 56)
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57. A method of accessing the spine of a patient comprising:
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anchoring the distal end of a cannula in contract with the ligamentum flavum; advancing a ligamentum flavum access tool distally within the cannula in a controlled manner, wherein the ligamentum flavum access tool comprises a proximal cutting surface, a distal tip member comprising an atraumatic tissue contacting region configured as a leading head, and a loss of resistance detector; penetrating the ligamentum flavum with the atraumatic leading head of the tip region until the atraumatic leading head accesses the epidural space as determined by the loss of resistance detector; cutting the ligamentum flavum with the proximal cutting surface; and removing the ligamentum flavum access tool from the cannula. - View Dependent Claims (58, 59, 60, 61, 62, 63)
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64. A method of accessing the spine of a patient comprising:
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anchoring the distal end of a cannula in contract with the ligamentum flavum; advancing a ligamentum flavum access tool distally within the cannula in a controlled manner, wherein the ligamentum flavum access tool comprises a proximal hypotube having an expandable distal end, and a distal tip member comprising an atraumatic leading head; penetrating the ligamentum flavum with the atraumatic leading head of the tip region until the expandable distal end of the hypotube spans the ligamentum flavum; and dilating the expandable distal end of the hypotube to expand an opening in the ligamentum flavum. - View Dependent Claims (65, 66, 67, 68, 69, 70, 71)
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Specification