TISSUE MODIFICATION DEVICES AND METHODS

• US 20130150856A1
• Filed: 02/01/2013
• Published: 06/13/2013
• Est. Priority Date: 07/01/2008
• Status: Active Grant

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Amie R. Borgstrom, Michael P Wallace, Robert Garabedian, Roy Leguidleguid
• Inventors: WALLACE, Michael P., MIMRAN, Ronnie I., BORGSTROM, Amie R., GARABEDIAN, Robert, LEGUIDLEGUID, Roy
• Granted Patent: US 9,314,253 B2
• Time in Patent Office: Days
• US Class Current: 606/79
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• 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 17/7032 Screws or hooks with U-shaped head or back through which longitudinal rods pass
• CPC Class Codes: A61B 17/7062 Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs rib fixation devices A61B17/8076; Tools for such devices
• CPC Class Codes: A61B 17/864 hollow, e.g. with socket or cannulated
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable for prosthetic joint-implanting tools A61F2/4603
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop
• CPC Class Codes: A61B 2017/32006 with a cutting strip, band or chain, e.g. like a chainsaw
• CPC Class Codes: A61B 2090/08021 of the patient or his organs
• CPC Class Codes: A61B 5/4893 Nerves

Abstract

Devices and methods for cutting tissue in a patient. In some embodiments, a bimanually controlled device may include a tissue modification region; one or more (e.g., two) flexible elongate length of cable that extend proximally to distally, a tissue modification region along a portion of the length of cable; and a guidewire coupler at the distal end of the device for attaching the distal end of the tissue modification device to the proximal end of a guidewire. Method of using these devices (including devices having two or more parallel length of cutting regions) to cut tissue (e.g., spinal lamina) are also described.

Claims

1. A bimanually controlled tissue modification device for cutting tissue in a patient, the device comprising:

an elongate body having a tissue modification region, wherein the elongate body comprises a flexible elongate length of cable extending proximally to distally;

a tissue modification region along a portion of the length of the elongate body, wherein the tissue modification region comprises a plurality of cutting members positioned along the length of the tissue modification region;

a guidewire coupler at the distal end region of the device configured to secure to a tip of a guidewire so that the guidewire be pulled distally to cut tissue with the tissue modification region.

2. The device of claim 1, wherein the cutting members and the cable are integrally formed.

3. The device of claim 1, wherein the cutting members are coupled to the cable.

4. The device of claim 1, wherein the tissue modification region is configured to be actuated by pulling on a proximal handle and pulling distally on a guidewire coupled to the guidewire coupler.

5. The device of claim 1, wherein the guidewire coupler is configured such that the device is removably attachable to a proximal end region of a guidewire such that the tissue modification region can be pulled into position by pulling on the guidewire while the proximal end region of the guidewire is secured to the guidewire coupler.

6. The device of claim 1, wherein at least one cutting member comprises an elongate wire having a helical cutting edge along the length of the wire.

7. A method of cutting a target tissue within a patient'"'"'s body, the method comprising:

passing a probe into a patient'"'"'s body and extending a distal region of the probe at least partially around a tissue to be cut so that the probe assumes a first position;

passing a guidewire through the probe distally so that a distal portion of the guidewire extends from the patient;

coupling a proximal end of the guidewire to a guidewire coupler at the distal end of a tissue modification device having a flexible cable forming an elongate body, wherein the elongate body includes a tissue modification region having a plurality of cutting elements thereon;

pulling the guidewire to position the tissue modification device on one side of the target tissue; and

reciprocating the tissue modification device to cut through the target tissue.

8. The method of claim 7, further comprising notching the tissue prior to passing the probe.

9. The method of claim 7, wherein passing a probe into a patient'"'"'s body comprises extending a tip region of a probe into an interlaminar window.

10. The method of claim 7, further comprising removing the probe from the patient while the guidewire, tissue modification device or guidewire coupled to the tissue modification device is in the patient.

11. The method of claim 7, further comprising coupling a proximal handle to the tissue modification device after it has been pulled into position on one side of the target tissue.

12. The method of claim 7, wherein coupling a proximal end of the guidewire to the distal end of a tissue modification device comprises hooking an enlarged distal end member of the guidewire into the guidewire coupler.

13. The method of claim 7, further comprising extending the distal end of the tissue modification device from the patient, and coupling a distal handle to the distal end of the tissue modification device.

14. The method of claim 7, further comprising coupling a distal handle to the guidewire while the guidewire is coupled to the tissue modification device.

15. The method of claim 7, wherein reciprocating comprises pulling on the guidewire while the guidewire is coupled to the tissue modification device.

16. The method of claim 7, further comprising cutting a second region of the target tissue and removing the target tissue.

17. The method of claim 7, further comprising verifying that a nerve is not positioned between the guidewire and the target tissue.

18. A method of cutting a target tissue within a patient'"'"'s body to perform a laminectomy, the method comprising:

passing a probe into a patient'"'"'s body so that the probe extends at least partially through an interlaminar window bounded by a lamina;

passing a distal end of a tissue modification device through the probe within the intrerlaminar window, wherein the tissue modification device comprises a flexible cable forming an elongate body including a tissue modification region having a plurality of cutting elements positioned thereon;

removing the probe from the patient'"'"'s body leaving the tissue modification device in position;

attaching a distal handle to the tissue modification device; and

reciprocating the tissue modification device to cut the lamina.

19. The method of claim 18, further comprising notching the lamina prior to passing the tissue modification device.

20. The method of claim 18, wherein passing the probe comprises passing the probe caudal to cephalad.

21. The method of claim 18, wherein passing the probe comprises passing the probe cephalad to caudal.

22. The method of claim 18, further comprising creating a gutter in a lamina that is contralateral to the lamina cut by the tissue modification device.

23. The method of claim 18, further comprising removing the lamina after it has been cut.

24. The method of claim 18, wherein passing a distal end of a tissue modification device comprises passing a pair of cutting wires through the probe and placing the wires to cut through different regions of the lamina.