Method for manipulating tissue of an intervertebral disc

• US 5,980,504 A
• Filed: 06/24/1997
• Issued: 11/09/1999
• Est. Priority Date: 08/13/1996
• Status: Expired due to Term

• Current Assignee: NeuroTherm, Inc. (Abbott Laboratories)
• Original Assignee: Oratec Interventions Incorporated (Smith & Nephew PLC)
• Inventors: Sharkey, Hugh J., Ashley, John, Saal, Joel, Saal, Jeffrey, Le, Le Trong
• Primary Examiner(s): MCDERMOTT, CORRINE MARIE
• Application Number:
  US08/881,527
• Time in Patent Office: 868 Days
• Field of Search: 604/49, 604/51, 604/95
• US Class Current: 604/510
• CPC Class Codes: A61B 10/02 Instruments for taking cell samples or for biopsy A61B10/0038 and A61B10/0045 take precedence; needle locating or guiding means A61B17/3403; samplers for enzymology or microbiology C12M1/26; sampling or preparing biological specimens G01N33/48
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• 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 17/3203 Fluid jet cutting instruments
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3496 Protecting sleeves or inner probes; Retractable tips for protecting body piercing guide needles A61M25/0612
• CPC Class Codes: A61B 17/7061 for stabilising vertebrae or discs by improving the condition of their tissues, e.g. using implanted medication or fluid exchange intraosseous injection devices A61B17/3472
• CPC Class Codes: A61B 17/8836 for heating, cooling or curing of bone cement or fluid fillers
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 18/082 Probes or electrodes therefor
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• 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 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• 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 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00084 : Temperature
• CPC Class Codes: A61B 2017/0011 : piezoelectric
• CPC Class Codes: A61B 2017/00119 : alarm; indicating an abnormal situation
• CPC Class Codes: A61B 2017/00261 : Discectomy
• CPC Class Codes: A61B 2017/00274 : Prostate operation, e.g. prostatectomy, turp, bhp treatment
• CPC Class Codes: A61B 2017/003 : Steerable
• CPC Class Codes: A61B 2017/00336 : with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/00455 : Orientation indicators, e.g. recess on the handle
• CPC Class Codes: A61B 2017/00867 : shape memory effect
• CPC Class Codes: A61B 2017/22044 : with a pointed tip
• CPC Class Codes: A61B 2017/22049 : Means for locking the guide wire in the catheter
• CPC Class Codes: A61B 2017/22082 : after introduction of a substance
• CPC Class Codes: A61B 2017/22087 : photodynamic
• CPC Class Codes: A61B 2017/2905 : flexible
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/320008 : Scrapers
• CPC Class Codes: A61B 2017/320044 : Blunt dissectors
• CPC Class Codes: A61B 2017/3445 : used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00011 : with fluids
• CPC Class Codes: A61B 2018/00267 : having a basket shaped structure
• CPC Class Codes: A61B 2018/00434 : Neural system
• CPC Class Codes: A61B 2018/0044 : Spinal cord
• CPC Class Codes: A61B 2018/00547 : Prostate
• CPC Class Codes: A61B 2018/00625 : Vaporization
• CPC Class Codes: A61B 2018/00654 : with individual control of each of a plurality of energy emitting elements
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/046 : in liquid form
• CPC Class Codes: A61B 2018/1266 : with DC current output
• CPC Class Codes: A61B 2018/1405 : Electrodes having a specific shape
• CPC Class Codes: A61B 2018/1407 : Loop
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2018/1435 : Spiral
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/1807 : using light other than laser radiation
• CPC Class Codes: A61B 2090/0454 : by reflection
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/3937 : Visible markers
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61F 2/442 : Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2002/30677 : Means for introducing or releasing pharmaceutical products, e.g. antibiotics, into the body
• CPC Class Codes: A61F 2007/0298 : with a section for heating and a section for cooling
• CPC Class Codes: A61M 25/0084 : being one or more injection needles
• CPC Class Codes: A61M 25/0133 : Tip steering devices
• CPC Class Codes: A61M 25/0144 : having flexible regions as a result of inner reinforcement means, e.g. struts or rods
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires
• CPC Class Codes: A61M 25/0155 : with hydraulic or pneumatic means, e.g. balloons or inflatable compartments
• CPC Class Codes: A61M 25/0158 : with magnetic or electrical means, e.g. by using piezo materials, electroactive polymers, magnetic materials or by heating of shape memory materials
• CPC Class Codes: A61M 25/09 : Guide wires
• CPC Class Codes: A61N 1/06 : for high-frequency therapy
• CPC Class Codes: A61N 1/40 : Applying electric fields by inductive or capacitive coupling microwave apparatus A61N5/00; Applying radio-frequency signals

Abstract

An externally guidable intervertebral disc apparatus manipulates disc tissue present at a selected location of an intervertebral disc, comprising a catheter having a distal end, a proximal end, and a longitudinal axis, the catheter having an intradiscal section at the distal end of the catheter, the intradiscal section being extendible into the disc, having sufficient rigidity to be advanceable through the nucleus pulposus of the disc under a force applied longitudinally to the proximal end, having sufficient flexibility in a direction of the disc plane to be compliant with the inner wall, having insufficient penetration ability to be advanceable through the inner wall of the annulus fibrosus under the applied force; and a functional element located in the intradiscal section for adding or removing energy or a material at the selected location of the disc. Methods of using the apparatus are also disclosed.

Claims

1. A method of manipulating a disc tissue of an intervertebral disc, the disc having a nucleus pulposus, and annulus fibrosus, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element inner wall of the annulus fibrosus by applying a sufficient force to advance the functional element through the nucleus pulposus to the inner wall of the annulus, which force is insufficient to puncture the annulus fibrosus; and

performing a function on the disc tissue using the functional element.

2. The method of claim 1, wherein the functional element includes a lumen.

3. The method of claim 1, wherein the step of providing a catheter is followed by the steps of:

providing an introducer with a proximal end and a distal end and having an introducer lumen with a distal opening at a terminus of the introducer;

inserting the introducer into the disc so that the proximal end of the introducer is external to the body and the distal opening of the introducer lumen is internal to the body; and

slidably inserting the catheter into the introducer.

4. The method of claim 3, wherein the distal end of the introducer is internal to the nucleus pulposus.

5. The method of claim 3, wherein the distal end of the introducer is adjacent to an opening in the annulus fibrosus communicating with the nucleus pulposus.

6. A method of manipulating a disc tissue at a selected location of the intervertebral disc, the disc having a nucleus pulposus, an annulus fibrosus, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element at the selected location of the disc by applying a sufficient force to advance the distal end of the catheter through the nucleus pulposus and adjacent the inner wall of the annulus, which force is insufficient to puncture the annulus fibrosus; and

performing a function selected from the group consisting of adding material and removing material on the disc tissue at the selected location of the disc using the functional element.

7. A method of manipulating a disc tissue of an intervertebral disc, the disc having a nucleus pulposus, an annulus fibrosus, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element along the inner wall of the annulus fibrosus by applying a sufficient force to advance the distal end of the catheter through the nucleus pulposus and adjacent the inner wall of the annulus, which force is insufficient to puncture the annulus fibrosus; and

performing a function on the disc tissue along the inner wall of the annulus fibrosus using the functional element.

8. A method of manipulating a disc tissue of an intervertebral disc, the disc having a nucleus pulposus, an annulus fibrosus, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element at a location selected from the group consisting of posterior medial inner, posterior lateral, anterior lateral and anterior medial wall of the annulus fibrosus or combinations thereof by applying a sufficient force to advance the distal end of the catheter through the nucleus pulposus and adjacent the inner wall of the annulus, which force is insufficient to puncture the annulus fibrosus; and

performing a function on the disc tissue using the functional element at the selected location.

9. A method of manipulating a disc tissue of an intervertebral disc, the disc having a nucleus pulposus, an annular fibrosus, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element at a first selected location of the disc by applying a sufficient force to advance the distal end of the catheter through the nucleus pulposus and adjacent the inner wall of the annulus, which force is insufficient to puncture the annulus fibrosus;

performing a function on the disc tissue at the first selected location of the disc using the functional element;

positioning the functional element at a second selected location; and

performing a function on the disc tissue at the second selected location of the disc using the functional element.

10. A method of manipulating a disc tissue at a selected location of an intervertebral disc, the disc having a nucleus pulposus, an annulus fibrosis, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element at the selected location of the disc by applying a sufficient force to advance the distal end of the catheter through the nucleus pulposus and adjacent the inner wall of the annulus such that the catheter conforms sufficiently to the inner wall of the annulus fibrosus to contact multiple locations on the inner wall; and

performing a function on the disc tissue at the selected location of the disc using the functional element.

11. A method of manipulating a disc tissue of an intervertebral disc, the disc having a nucleus pulposus, an annulus fibrosus, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element at an outer annulus/dural interface of the disc by applying a sufficient force to advance the distal end of the catheter through the nucleus pulposus and adjacent the inner wall of the annulus, which force is insufficient to puncture the annulus fibrosus; and

performing a function on the disc tissue using the functional element.

12. A method of manipulating a disc tissue of an intervertebral disc, the disc having a nucleus pulposus, an annulus fibrosus, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element at a posterior longitudinal ligament/annulus fibrosus interface of the disc by applying a sufficient force to advance the distal end of the catheter through the nucleus pulposus and adjacent the inner wall of the annulus, which force is insufficient to puncture the annulus fibrosus; and

performing a function on the disc tissue using the functional element.

13. A method of manipulating a disc tissue at a selected location of an intervertebral disc, the disc having a nucleus pulposus, an annulus fibrosus, and an inner wall of the annulus fibrosus, the method comprising:

providing a catheter having a functional element adjacent a distal end of the catheter and a proximal end for externally guiding the distal end of the catheter within an intervertebral disc;

positioning the functional element at the selected location of the disc by twisting the proximal end of the catheter and applying a sufficient force to advance the distal end of the catheter through the nucleus pulposus and adjacent the inner wall of the annulus, which force is insufficient to puncture the annulus fibrosus; and

performing a function on the disc tissue at the selected location of the disc using the functional element.