DEVICES AND METHODS FOR TISSUE MODIFICATION
First Claim
1. A method for treating spinal stenosis, the method comprising:
- advancing a wire from a first point outside of a patient and through at least one of the patient'"'"'s lateral recess, spinal neural foramina, or central canal of the spine, around at least part of a target tissue, and passing the distal end of the wire out of the patient from a second point, whereby both ends of the wire are external to the patient;
visually confirming that the spinal nerve nearest the target tissue is positioned anterior to the path of the wire using an image guidance member;
positioning a tissue modification device adjacent to the target tissue using the wire; and
modifying the target tissue with the tissue modification device.
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Abstract
Methods and apparatus are provided for selective surgical removal of tissue. 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. The sharp tip of the needle in the epidural space, can be converted to a blunt tipped instrument for further safe advancement. 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. A nerve stimulator may be provided to reduce a risk of inadvertent neural abrasion.
115 Citations
22 Claims
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1. A method for treating spinal stenosis, the method comprising:
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advancing a wire from a first point outside of a patient and through at least one of the patient'"'"'s lateral recess, spinal neural foramina, or central canal of the spine, around at least part of a target tissue, and passing the distal end of the wire out of the patient from a second point, whereby both ends of the wire are external to the patient; visually confirming that the spinal nerve nearest the target tissue is positioned anterior to the path of the wire using an image guidance member; positioning a tissue modification device adjacent to the target tissue using the wire; and modifying the target tissue with the tissue modification device. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A method of treating spinal stenosis, the method comprising:
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advancing a guidewire from a first point outside of a patient, towards a target tissue, through a spinal neural foramina and around at least part of the target tissue, and passing the distal end of the guidewire out of the patient from a second point, whereby both ends of the guidewire are external to the patient; advancing an image guidance member towards the target tissue along the same pathway through the patient as the guidewire; visually confirming that the pathway of the guidewire through the patient passes anterior to the facet joint complex but posterior to the nerve root or ganglion nearest the target tissue; positioning a tissue modification device adjacent to the target tissue using the guidewire; and modifying the target tissue with the tissue modification device. - View Dependent Claims (15, 16, 17, 18, 19)
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20. A method of treating spinal stenosis, the method comprising:
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advancing a tissue access instrument into the patient from a first point outside of the patient and towards a spinal neural foramen; advancing a wire through the tissue access instrument, towards a target tissue, through the spinal neural foramina and around at least part of the target tissue, and passing the distal end of the guidewire out of the patient from a second point, whereby both ends of the wire are external to the patient; advancing an image guidance member along the tissue access instrument towards the target tissue; visually confirming that the pathway of the wire through the patient passes anterior to the facet joint complex but posterior to the nerve root or ganglion nearest the target tissue; positioning a tissue modification device adjacent to the target tissue using the guidewire; and modifying the target tissue with the tissue modification device.
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21. A method of treating spinal stenosis, the method comprising:
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advancing a tissue access instrument into the patient from a first point outside of the patient and towards a spinal neural foramen; visually confirming that the pathway of the tissue access instrument through the patient passes anterior to the facet joint complex but posterior to the nerve root or ganglion nearest the target tissue; advancing a wire through the tissue access instrument, towards a target tissue, through the spinal neural foramina and around at least part of the target tissue, and passing the distal end of the guidewire out of the patient from a second point, whereby both ends of the wire are external to the patient; positioning a tissue modification device adjacent to the target tissue using the guidewire; and modifying the target tissue with the tissue modification device. - View Dependent Claims (22)
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Specification