METHODS FOR NAVIGATING AN INSTRUMENT THROUGH BONE

• US 20150164546A1
• Filed: 08/18/2014
• Published: 06/18/2015
• Est. Priority Date: 09/26/2008
• Status: Active Grant

• Current Assignee: Relievant Medsystems, Incorporated (Boston Scientific Corporation)
• Original Assignee: Relievant Medsystems, Incorporated (Boston Scientific Corporation)
• Inventors: Pellegrino, Richard, Patel, Samit, Carrison, Harold
• Granted Patent: US 9,265,522 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• 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 to allow a probe to be delivered through the central passageway to a location beyond the curved path.

Claims

1. A method for channeling a path into bone to a treatment location in the body of a patient, comprising:

deploying a trocar through a cortical bone region and into a cancellous bone region of a vertebral body,

the trocar having a proximal end, a distal end and a central channel disposed therebetween;

wherein the trocar comprises a radial opening at or n r the distal end of the trocar, the radial opening being in communication with the central channel;

delivering a curveable cannula through said central channel and to said radial opening;

deploying the curveable cannula laterally outward from the radial opening in a curved path extending away from the trocar,

wherein the curved path is generated though at least a portion of the cancellous bone region of the vertebral body;

delivering a treatment device through a central passageway in the curveable cannula to a treatment location beyond the curved path,

wherein the treatment location comprises a basivertebral nerve associated with the vertebral body; and

delivering a therapeutic amount of thermal energy to the treatment location sufficient to denervate at least a portion of the basivertebral nerve using the treatment device.

5. The method of claim 1, further comprising:

steering the curveable cannula via a pull cord coupled to a distal tip of the curveable cannula to bias the curveable cannula in the curved path.

7. The method of claim 1, wherein the treatment device comprises a radiofrequency energy delivery probe comprising two electrodes.

8. The method of claim 1, wherein the treatment device comprises an ultrasound energy delivery device.

9. The method of claim 1, wherein the treatment device comprises a laser.

10. The method of claim 1, wherein said therapeutic amount of thermal energy is sufficient to ablate the portion of the basivertebral nerve.

11. The method of claim 1, further comprising inserting a stylet within the central channel of the trocar prior to deploying the trocar through the cortical bone region and into the cancellous bone region of the vertebral body so as to block the radial opening.

12. The method of claim 1, wherein the central channel of the trocar terminates at a ramp leading to the radial window, said ramp facilitating deployment of said curveable cannula outward from said window.

2. (canceled)

3. (canceled)

4. (canceled)

6. (canceled)

13. A method for channeling a path into bone to a treatment location in the body of a patient, comprising:

inserting an introducer through a cortical bone region and into a cancellous bone region of a vertebral body,

wherein the introducer comprises a proximal end, a distal end and a central channel extending from the proximal end to the distal end;

wherein the introducer comprises a radial opening at the distal end of the introducer, the radial opening being in communication with the central channel;

delivering a curveable cannula through the central channel and to the radial opening;

deploying the curveable cannula non-axially outward from the radial opening in a curved path extending away from the introducer,

wherein the curved path is generated though at least a portion of the cancellous bone region of the vertebral body;

delivering a treatment device through a central passageway in the curveable cannula to a treatment location beyond the curved path,

wherein the treatment location comprises an intraosseous nerve; and

delivering a therapeutic amount of thermal energy to the treatment location sufficient to treat at least a portion of the intraosseous nerve using the treatment device

14. The method of claim 13, wherein the treatment device comprises a radiofrequency energy delivery probe comprising two electrodes.

15. The method of claim 13, wherein the treatment device comprises an ultrasound energy delivery device.

16. The method of claim 13, wherein the treatment device comprises a microwave energy delivery device.

17. The method of claim 13, wherein said therapeutic amount of thermal energy is sufficient to ablate the portion of the intraosseous nerve.

18. The method of claim 13, wherein said therapeutic amount of thermal energy is sufficient to stimulate the portion of the intraosseous nerve without ablating the intraosseous nerve.

19. The method of claim 13, further comprising inserting a stylet within the central channel of the introducer prior to deploying the introducer through the cortical bone region and into the cancellous bone region of the vertebral body so as to block the radial opening.

20. A method for channeling a path into bone to a treatment location in the body of a patient, comprising:

inserting an introducer through a cortical bone region and into a cancellous bone region of the bone,

wherein the introducer comprises a proximal end, a distal end and a central channel extending from the proximal end to the distal end;

wherein the introducer comprises a lateral opening at the distal end of the introducer, the lateral opening being in communication with the central channel;

advancing a curveable cannula through the central channel and to the lateral opening;

advancing a distal portion of the curveable cannula outward from the lateral opening in a curved path extending away from the introducer,

wherein the curved path is generated though at least a portion of the cancellous bone region of the bone;

advancing a treatment device through a central passageway in the curveable cannula to a treatment location beyond the curved path,

wherein the treatment location comprises an intraosseous nerve; and

delivering a therapeutic amount of thermal energy to the treatment location sufficient to treat at least a portion of the intraosseous nerve using the treatment device

21. The method of claim 20, wherein the treatment device comprises a bipolar radiofrequency energy delivery probe comprising two electrodes.

22. The method of claim 20, wherein the treatment device comprises an ultrasound energy delivery device.

23. The method of claim 20, wherein the treatment device comprises a microwave energy delivery device.

24. The method of claim 20, wherein said therapeutic amount of thermal energy is sufficient to ablate the portion of the intraosseous nerve.