INTRAOSSEOUS NERVE DENERVATION METHODS

• US 20120330300A1
• Filed: 07/06/2012
• Published: 12/27/2012
• Est. Priority Date: 09/30/2002
• Status: Abandoned Application

• Current Assignee: Relievant Medsystems, Incorporated (Boston Scientific Corporation)
• Original Assignee: Relievant Medsystems, Incorporated (Boston Scientific Corporation)
• Inventors: Pellegrino, Richard, Papineau, Paula, Crombie, John S., Patel, Samit, Ryan, Thomas
• Application Number:
  US13/543,721
• Publication Number:
  US 20120330300A1
• Time in Patent Office: Days
• US Class Current: 606/33
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/3415 for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters A61B17/3417 takes precedence; body piercing catheter guide needles A61M25/06
• CPC Class Codes: A61B 17/3472 for bones, e.g. intraosseus injections
• CPC Class Codes: A61B 17/8805 for introducing fluid filler into bone or extracting it A61B17/7097, A61B17/8833 take precedence
• CPC Class Codes: A61B 17/8811 characterised by the introducer tip, i.e. the part inserted into or onto the bone
• CPC Class Codes: A61B 17/8819 characterised by the introducer proximal part, e.g. cannula handle, or by parts which are inserted inside each other, e.g. stylet and cannula A61B17/8825 takes precedence
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• 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 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/16 Indifferent or passive electrodes for grounding
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00331 with preformed bends
• CPC Class Codes: A61B 2017/00867 shape memory effect
• CPC Class Codes: A61B 2018/00017 with gas
• CPC Class Codes: A61B 2018/0044 Spinal cord
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/126 bipolar
• CPC Class Codes: A61B 2018/2244 Features of optical fibre cables, e.g. claddings
• CPC Class Codes: A61N 7/00 : Ultrasound therapy lithotripsy A61B17/22, A61B17/225; massage using supersonic vibration A61H23/00 ; using ultrasound for introducing media into the body A61M37/0092

Abstract

System and methods for channeling a path into bone include a trocar having a proximal end, distal end and a central channel disposed along a central axis of the trocar. The trocar includes a radial opening at or near the distal end of the trocar. The system includes a curveable cannula sized to be received in the central channel, the curveable cannula comprising a curveable distal end configured to be extended laterally outward from the radial opening in a curved path extending away from the trocar. The curveable cannula has a central passageway having a diameter configured allow a probe to be delivered through the central passageway to a location beyond the curved path.

Claims

1. A method of denervating an intraosseous nerve, comprising:

identifying a treatment zone within a vertebral body,

within a cancellous bone region of a vertebral body;

inserting a radiofrequency (RF) device probe through an outer cortical bone region and into an inner cancellous bone region of the vertebral body to the treatment zone,

delivering an RF energy to the treatment zone within the inner cancellous bone region of the vertebral body corresponding to a location between, but exclusive of, the nerve junction and the outer cortical bone region, to denervate an intraosseous nerve,

wherein the target treatment zone is proximal to the junction and located between 60% and 90% of the distance between the anterior and posterior outer cortical walls of the vertebral body, thereby facilitating denervation of the intraosseous nerve and its branches downstream of the nerve junction by denervating a single portion of the intraosseous nerve.

2. The method of claim 1, wherein the RF probe comprises an electrode configured to deliver a therapeutic amount of RF energy to the treatment zone to denervate the intraosseous nerve.

3. The method of claim 1, wherein the RF probe comprises a bipolar RF probe having two electrodes configured to generate a current to heat tissue disposed between the two electrodes.

4. The method of claim 1, wherein the RF probe comprises a sensor to measure nerve conduction of the intraosseous nerve at the treatment zone.

5. The method of claim 1, wherein said denervation comprises ablation or necrosis of the intraosseous nerve.

6. The method of claim 1, wherein the step of inserting the energy device through the outer cortical bone region and into the inner cancellous bone region of the vertebral body to the treatment zone comprises inserting a curved cannula within the inner cancellous bone region of the vertebral body to generate a curved path within the inner cancellous bone region to the treatment zone, and inserting the energy device through a central passageway of a curved cannula and advancing a distal end of the RF probe to the treatment zone.

7. The method of claim 6, further comprising inserting a trocar through an insertion site of the skin of the subject, advancing the trocar to the vertebral body and penetrating the surface of the outer cortical bone of the vertebral body with the distal end of the trocar, inserting the curved cannula through a central channel of the trocar, and advancing a distal end of the curved cannula to the treatment zone within the inner cancellous bone region.

8. A method of denervating an intraosseous nerve, comprising:

identifying a treatment zone within a vertebral body,

within a cancellous bone region of a vertebral body;

inserting an energy delivery device through an outer cortical bone region and into an inner cancellous bone region of the vertebral body to the treatment zone,

delivering energy to the treatment zone within the inner cancellous bone region of the vertebral body corresponding to a location between, but exclusive of, the nerve junction and the outer cortical bone region, to denervate an intraosseous nerve,

wherein the treatment zone is proximal to the junction and located between 60% and 90% of the distance between the anterior and posterior outer cortical walls of the vertebral body, thereby facilitating denervation of the intraosseous nerve and its branches downstream.

9. The method of claim 8, wherein the energy delivery device comprises a radiofrequency (“

RF”

) probe.

10. The method of claim 9, wherein the RF probe comprises an electrode configured to deliver a therapeutic amount of RF energy to the treatment zone to denervate the intraosseous nerve.

11. The method of claim 9, wherein the RF probe comprises a bipolar RF probe having two electrodes configured to generate a current to heat tissue disposed between the two electrodes.

12. The method of claim 8, wherein the therapeutic energy delivery device comprises an ultrasound probe configured to deliver a therapeutic amount of ultrasonic energy to the treatment zone to denervate the intraosseous nerve.

13. The method of claim 8, wherein the therapeutic energy delivery device comprises a microwave energy probe configured to deliver a therapeutic amount of ultrasonic energy to the treatment zone to denervate the intraosseous nerve.

14. The method of claim 8, wherein the therapeutic energy delivery device comprises a sensor to measure nerve conduction of the intraosseous nerve at the treatment zone.

15. The method of claim 8, wherein said denervation comprises ablation or necrosis of the intraosseous nerve.

16. The method of claim 8, wherein the step of inserting the therapeutic energy delivery device through the outer cortical bone region and into the inner cancellous bone region of the vertebral body to the treatment zone comprises inserting a curved cannula within the inner cancellous bone region of the vertebral body to generate a curved path to the treatment zone, and inserting the therapeutic energy delivery device through a central passageway of the curved cannula and advancing a distal end of the therapeutic energy delivery device to the treatment zone.

17. The method of claim 16, further comprising inserting a trocar through an insertion site of the skin of the subject, advancing the trocar to the vertebral body and penetrating the surface of the outer cortical bone of the vertebral body with the distal end of the trocar, inserting the curved cannula through a central channel of the trocar, and advancing a distal end of the curved cannula to the treatment zone within the inner cancellous bone region.