Methods for electrosurgical spine surgery

• US 6,277,112 B1
• Filed: 02/20/1998
• Issued: 08/21/2001
• Est. Priority Date: 07/16/1996
• 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., Underwood, Ronald A., Davison, Terry S.
• Primary Examiner(s): COHEN, LEE S
• Application Number:
  US09/026,851
• Time in Patent Office: 1,278 Days
• Field of Search: 606/41, 606/48-50, 606/32, 607/99, 607/105, 607/113, 604/35, 604/114
• US Class Current: 606/32
• 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

The present invention provides systems and methods for selectively applying electrical energy to a target location within of a patient'"'"'s body, particularly including tissue in the spine. The present invention applies high frequency (RF) electrical energy to one or more electrode terminals in the presence of electrically conductive fluid to remove, contract or otherwise modify the structure of tissue structures. In one aspect of the invention, a method is provided for treating herniated discs within a patient'"'"'s spine by applying sufficient electrical energy to the disc tissue to reduce a volume of the disc, thereby relieving pressure on a spinal nerve. In one embodiment, the high frequency voltage is sufficient to ablate a portion of the nucleus pulposis, either the extruded portion outside of the annulus or a portion or all of the pulposis within the annulus. In another embodiment, the electrode terminal is advanced into the annulus and sufficient high frequency voltage is applied to contract or shrink the collagen fibers within the nucleus pulposis. This causes the pulposis to shrink and withdraw from its impingement on the spinal nerve.

Claims

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

positioning a plurality of electrically isolated electrode terminals within close proximity of a disc in the patient'"'"'s spine;

applying a high frequency voltage difference between the electrode terminals and a return electrode, the voltage difference being sufficient to ablate a portion of the disc

independently controlling current flow from at least two of the electrode terminals based on impedance between the electrode terminals and the return electrode;

aspirating tissue fragments from the disc through an aspiration lumen within an instrument; and

applying high frequency voltage to an aspiration electrode coupled to the lumen, the high frequency voltage being sufficient to remove at least a portion of the tissue fragments.

2. The method of claim 1 further comprising:

introducing the electrode terminals through an opening in the annulus of the disc; and

applying sufficient high frequency voltage between the electrode terminals and the return electrode to ablate a portion of the nucleus pulposis.

3. The method of claim 1 further comprising:

positioning the electrode terminals adjacent an extruded portion of the disc outside of the annulus; and

applying sufficient high frequency voltage between the electrode terminals and the return electrode to ablate at least part of the extruded portion.

4. The method of claim 1 further comprising delivering electrically conductive fluid between the electrode terminals and the disc.

5. The method of claim 4 further comprising positioning the return electrode within the electrically conductive fluid to complete a current flow path between the electrode terminals and the return electrode.

6. The method of claim 4 further comprising applying sufficient voltage to the electrode terminals in the presence of the electrically conductive fluid to vaporize at least a portion of the fluid between the electrode terminals and the disc.

7. The method of claim 6 further comprising accelerating charged particles within the vaporized fluid to cause dissociation of the molecular bonds within the disc.

8. The method of claim 1 further comprising positioning the return electrode on the outer surface of the patient'"'"'s body, and conducting electrical current from the electrode terminals, through the patient'"'"'s body, to the return electrode.

9. The method of claim 1 further comprising aspirating fluid from a region around the electrode terminals.

10. The method of claim 1 further comprising aspirating tissue fragments from the disc through a plurality of openings in a mesh aspiration electrode and through the aspiration lumen in the instrument.

11. A method for treating a disc within a patient'"'"'s spine comprising:

introducing an electrode terminal through an opening in an annulus of a disc in the patient'"'"'s spine; and

applying a high frequency voltage difference between the electrode terminal and a return electrode, the voltage difference being sufficient to ablate a portion of a nucleus within the disc and reduce a volume of the disc to relieve pressure on a spinal nerve;

aspirating tissue fragments from the disc through an aspiration lumen within an instrument; and

applying high frequency voltage to an aspiration electrode coupled to the lumen, the high frequency voltage being sufficient to remove at least a portion of the tissue fragments.

12. The method of claim 11 wherein the disc is a herniated disc having an extruded portion of the nucleus, the method further comprising:

positioning the electrode terminal adjacent the extruded portion of the nucleus; and

applying sufficient high frequency voltage between the electrode terminal and the return electrode to ablate at least part of the extruded portion.

13. The method of claim 11 further comprising delivering electrically conductive fluid between the electrode terminal and the nucleus.

14. The method of claim 13 further comprising positioning the return electrode within the electrically conductive fluid to complete a current flow path between the electrode terminal and the return electrode.

15. The method of claim 13 further comprising applying sufficient voltage to the electrode terminal in the presence of the electrically conductive fluid to vaporize at least a portion of the fluid between the electrode terminal and the disc.

16. The method of claim 15 further comprising accelerating charged particles within the vaporized fluid to cause dissociation of the molecular bonds within the nucleus.

17. The method of claim 11 Further comprising positioning the return electrode on the outer surface of the patient'"'"'s body, and conducting electrical current from the electrode terminal, through the patient'"'"'s body, to the return electrode.

18. The method of claim 11 further comprising aspirating fluid from a region around the electrode terminal.

19. The method of claim 11 wherein the aspirating step is carried out by aspirating tissue fragments and fluid through a plurality of openings in the aspiration electrode.

20. The method of claim 11 wherein the electrode terminal and the aspiration electrode are a single aspiration/ablation electrode coupled to a distal end portion of the instrument, the introducing step comprising introducing the distal end portion of the instrument though the opening in the annulus.