Electrosurgical systems and methods for treating the spine

• US 6,105,581 A
• Filed: 11/14/1997
• Issued: 08/22/2000
• Est. Priority Date: 01/07/1992
• Status: Expired due to Fees

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Eggers, Philip E., Thapliyal, Hira V.
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US08/970,239
• Time in Patent Office: 1,012 Days
• Field of Search: 606/41, 606/42, 606/45-50, 607/100-105, 604/114, 128/898
• US Class Current: 128/898
• CPC Class Codes: A61B 18/12 by passing a current through the tissue to be heated, e.g. high-frequency current
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• 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 18/149 bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
• 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 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00097 one of the thermometric elements being an electrode or the heating element
• CPC Class Codes: A61B 2017/00101 using an array of thermosensors
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/22001 Angioplasty, e.g. PCTA
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2018/00029 open
• CPC Class Codes: A61B 2018/00083 low, i.e. electrically insulating
• CPC Class Codes: A61B 2018/00119 : with metal oxide nitride
• CPC Class Codes: A61B 2018/0016 : Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00178 : Electrical connectors
• CPC Class Codes: A61B 2018/00196 : reciprocating lengthwise
• CPC Class Codes: A61B 2018/00327 : Ear, nose or throat
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00434 : Neural system
• CPC Class Codes: A61B 2018/00505 : Urinary tract
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00583 : Coblation, i.e. ablation using a cold plasma
• CPC Class Codes: A61B 2018/00642 : with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/0066 : without feedback, i.e. open loop control
• CPC Class Codes: A61B 2018/00678 : upper
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00761 : Duration
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00821 : measured by a thermocouple
• CPC Class Codes: A61B 2018/00827 : Current
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• CPC Class Codes: A61B 2018/00886 : Duration
• CPC Class Codes: A61B 2018/1213 : creating an arc
• CPC Class Codes: A61B 2018/124 : switching the output to different electrodes, e.g. sequentially
• CPC Class Codes: A61B 2018/1253 : monopolar
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1273 : including multiple generators in one device
• CPC Class Codes: A61B 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/1497 : Electrodes covering only part of the probe circumference
• CPC Class Codes: A61B 2018/162 : located on the probe body
• CPC Class Codes: A61B 2018/165 : Multiple indifferent electrodes
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices
• CPC Class Codes: A61M 25/0133 : Tip steering devices
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires
• 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

Abstract

Systems and methods are provided for treating tissue within a patient'"'"'s spine, such as laminectomy/discectomy procedures for treating herniated disks, posterior lumbosacral and cervical spine fusions and the like. An electrosurgical probe includes one or more electrode terminal(s) and a return electrode coupled to a high frequency voltage supply. Electrically conductive fluid, such as isotonic saline, is delivered to the electrode terminal, and a high frequency voltage difference is applied between the electrode terminal and the return electrode to treat tissue within the spine. The isotonic saline provides a current flow path between the electrode terminal and the return electrode, and it allows for a new mechanism for ablation or molecular dissociation of tissue within the spine.

Claims

1. A method for treating tissue within a patient'"'"'s spine comprising:

positioning an electrode terminal within close proximity of a target tissue within the patient'"'"'s spine;

positioning a return electrode within close proximity of the target tissue such that the return electrode does not contact the target tissue;

delivering electrically conductive fluid to surround an exposed portion of the electrode terminal with the electrically conductive fluid; and

applying a high frequency voltage difference between the electrode terminal and return electrode to treat the target tissue.

2. The method of claim 1 further comprising positioning the return electrode within the electrically conductive fluid to complete a current flow path therebetween.

3. The method of claim 1 wherein the applying step comprises applying sufficient high frequency voltage to the electrode terminal to remove at least a portion of the target tissue.

4. The method of claim 1 wherein the applying step comprises applying sufficient high frequency voltage to the electrode terminal to vaporize at least a portion of the electrically conductive fluid surrounding the electrode terminal.

5. The method of claim 1 wherein the electrically conductive fluid is delivered to the target site before the positioning step.

6. The method of claim 1 wherein the electrically conductive fluid is delivered to the target site during the positioning step.

7. The method of claim 1 wherein the electrically conductive fluid is delivered to the target site after the positioning step.

8. The method of claim 1 wherein the electrically conductive fluid is isotonic saline.

9. The method of claim 1 further comprising effecting molecular dissociation of the target tissue.

10. The method of claim 1 wherein the target tissue comprises soft tissue on a surface of a vertebrae.

11. The method of claim 10 further comprising removing said soft tissue, and fusing adjacent vertebrae together after the removing step.

12. The method of claim 1 wherein the target tissue is a disc.

13. The method of claim 1 wherein the electrode terminal is located on a distal end of an instrument shaft and the delivering step comprises delivering the electrically conductive fluid through a lumen in the instrument shaft.

14. The method of claim 1 wherein the electrode terminal is located on a distal end of an instrument shaft and the delivering step comprises delivering the electrically conductive fluid through a separate instrument.

15. The method of claim 1 further comprising aspirating a region around the target tissue.

16. The method of claim 15 wherein the electrode terminal is located on a distal end of an instrument shaft and the aspirating step is carried out through a lumen in the instrument shaft.

17. A method for treating tissue within a patient'"'"'s spine comprising:

positioning an electrode terminal adjacent to a vertebrae within the spine, wherein the vertebrae has tissue attached thereto;

directing electrically conductive fluid to the electrode terminal;

applying a sufficient high frequency voltage between the electrode terminal and a return electrode to remove the tissue attached to the vertebrae during the applying step.

18. The method of claim 17 further comprising positioning the return electrode within close proximity of the vertebrae such that the return electrode does not contact the tissue attached to the vertebrae.

19. The method of claim 17 wherein the electrode terminal is located on a distal end of an instrument shaft and the directing step comprises delivering the electrically conductive fluid through a lumen in the instrument shaft.

20. The method of claim 17 wherein the electrode terminal is located on a distal end of an instrument shaft and the directing step comprises delivering the electrically conductive fluid through a separate instrument.

21. The method of claim 17 further comprising aspirating a region around the vertebrae.

22. The method of claim 21 wherein the electrode terminal is located on a distal end of an instrument shaft and the aspirating step is carried out through a lumen in the instrument shaft.

23. The method of claim 17 further comprising positioning the return electrode within the electrically conductive fluid to complete a current flow path between the return electrode and the electrode terminal.

24. The method of claim 17 further comprising positioning the return electrode on the outer surface of the patient'"'"'s body.