Methods for electrosurgical treatment of spinal tissue

• US 6,772,012 B2
• Filed: 05/03/2001
• Issued: 08/03/2004
• Est. Priority Date: 06/07/1995
• Status: Expired due to Fees

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Woloszko, Jean, Eggers, Philip E., Hovda, David C., Thapliyal, Hira V., Ricart, Olivier
• Primary Examiner(s): COHEN, LEE S
• Application Number:
  US09/848,843
• Publication Number:
  US 20010032001A1
• Time in Patent Office: 1,188 Days
• Field of Search: 606/32, 606/41, 607/99, 607/105, 607/113
• US Class Current: 607/99
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• 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 18/1477 Needle-like probes
• 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 2017/00101 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 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00274 Prostate operation, e.g. prostatectomy, turp, bhp treatment
• 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 2018/00291 : using suction
• 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 2018/0044 : Spinal cord
• CPC Class Codes: A61B 2018/00505 : Urinary tract
• CPC Class Codes: A61B 2018/00547 : Prostate
• 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 2018/00589 : Coagulation
• CPC Class Codes: A61B 2018/00601 : Cutting
• CPC Class Codes: A61B 2018/00607 : Coagulation and cutting with the same instrument
• 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 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00827 : Current
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• 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 2018/1407 : Loop
• CPC Class Codes: A61B 2018/1425 : Needle
• 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 2018/162 : located on the probe body
• CPC Class Codes: A61B 2018/165 : Multiple indifferent electrodes
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

Systems, apparatus, and methods for treating spinal tissue and other body structures in open and endoscopic spine surgery to relieve symptoms, such as neck or back pain. In particular, the present invention provides methods for the controlled heating of various tissues in or around the vertebral column, including various interspinous tissues, such that spinal ligaments and cartilage surrounding the vertebrae and the facet joints are shrunk or tightened to stabilize the vertebral column of a patient. Thermal energy is applied to the target tissue in a subablation mode of an electrosurgical system to cause shrinkage of the tissue, thereby stiffening the interspinous tissue and stabilizing the vertebral column. In an exemplary embodiment, a high frequency RF voltage can be applied between one or more active electrode(s) and one or more return electrode(s) to heat a target interspinous tissue to within a temperature range at which irreversible shrinkage of the tissue occurs.

Claims

1. A method of treating an interspinous tissue of a patient, comprising:

a) positioning an active electrode adjacent to a target site of the interspinous tissue, said active electrode is disposed on the distal end of a shaft of an electrosurgical probe;

b) heating the interspinous tissue at the target site with the active electrode by applying a high frequency voltage between the active electrode and a return electrode, the heating being sufficient to shrink at least a portion of the interspinous tissue; and

wherein the electrosurgical probe is coupled to a high frequency power supply to provide a power supply/probe combination, the power supply/probe combination configured to operate in either an ablation mode wherein a first high frequency voltage is applied between the active electrode and the return electrode sufficient to effect molecular dissociation of the interspinous tissue, or in a subablation mode wherein a second high frequency voltage applied between the active electrode and the return electrode effects thermal heating and shrinkage of the interspinous tissue.

2. The method of claim 1 wherein the return electrode is disposed on the shaft distal end at a location proximal to the active electrode such that current is induced to flow from the active electrode away from the interspinous tissue.

3. The method of claim 1 wherein the high frequency voltage applied between the active and return electrodes is insufficient to cause ablation of tissue.

4. The method of claim 1 further comprising:

c) providing a quantity of an electrically conductive fluid around the active electrode, wherein the electrically conductive fluid provides a current flow path between the active electrode and the return electrode.

5. The method of claim 4 wherein applying a high frequency voltage between the active electrode and the return electrode heats the quantity of electrically conductive fluid, and the heated electrically conductive fluid heats the interspinous tissue at the target site.

6. The method of claim 4 wherein said step c) comprises delivering the electrically conductive fluid to the shaft distal end, and said step c) is performed after the positioning step and prior to the applying step.

7. The method of claim 4 wherein the electrically conductive fluid comprises a gel, a liquid, or a gas.

8. The method of claim 1 wherein said step b) comprises heating the interspinous tissue in a controlled manner such that tissue at the target site is exposed to a temperature in the range of from about 60°

to 70°

C.

9. The method of claim 1 wherein said step b) causes shrinkage of collagen fibers of the interspinous tissue and increased rigidity of the vertebral column of the patient.

10. The method of claim 1 wherein the interspinous tissue is a ligament.

11. The method of claim 10 wherein the ligament is an anterior longitudinal ligament, a posterior longitudinal ligament, a supraspinous ligament, a ligamentum flavum, or an interspinous ligament.

12. The method of claim 1 wherein the interspinous tissue comprises cartilage or a capsule surrounding a facet joint between adjacent vertebrae.

13. The method of claim 1 wherein the interspinous tissue is located adjacent to a spinous processes.

14. The method of claim 1 wherein said step b) causes adjacent spinous processes to be drawn closer together.

15. The method of claim 1 wherein said step b) causes tightening of at least one facet joint between adjacent vertebrae.

16. The method of claim 1 further comprising:

d) prior to said step a) or after said step b), introducing the shaft distal end into an intervertebral disc; and

e) after said step d), applying high frequency voltage between the active electrode and the return electrode sufficient to treat the intervertebral disc.

17. The method of claim 16, wherein said step e) comprises applying a high frequency voltage between the active electrode and the return electrode sufficient to ablate or contract a nucleus pulposus of the intervertebral disc.

18. The method of claim 1 wherein the high frequency voltage is in the range of from about 20 volts RMS to 90 volts RMS.

19. The method of claim 1 wherein said step b) comprises controlled heating of the interspinous tissue to within a specific temperature range and to a defined depth of the interspinous tissue at the target site.

20. The method of claim 1 wherein said step b) comprises heating the interspinous tissue at the target site to a depth in the range of from about 0.2 mm to 2.5 mm.

21. The method of claim 1 wherein said step b) comprises applying a high frequency voltage between the active electrode and a return electrode such that an electric current flows through at least a portion of the interspinous tissue at the target site.

22. The method of claim 1, further comprising:

advancing an introducer needle towards the target site.

23. The method of claim 1 wherein said step a) comprises advancing a shaft of an electrosurgical probe through an introducer needle.

24. The method of claim 23 wherein said step a) is performed percutaneously.

25. The method of claim 1 wherein said step a) comprises advancing a shaft of an electrosurgical probe through an introducer extension tube.

27. The method of claim 2, wherein the active electrode and the return electrode are disposed on the shaft distal end of the electrosurgical probe, the return electrode spaced from the active electrode;

the method further comprises providing an electrically conductive fluid between the active electrode and the return electrode, and the electrically conductive fluid is heated by applying the first high frequency voltage between the active electrode and the return electrode.

28. The method of claim 27, wherein applying the first high frequency voltage between the active electrode and the return electrode generates a plume of heated fluid which is directed towards the target tissue.

29. The method of claim 27 wherein the heated fluid elevates the temperature of the target tissue sufficiently to cause hydrothermal shrinkage of collagen fibers within the target tissue.

26. A method of treating a target tissue of the vertebral column of a patient, comprising:

positioning an active electrode adjacent to the target tissue, wherein said active electrode is disposed on a shaft distal end of an electrosurgical probe;

applying a first high frequency voltage between the active electrode and a return electrode, wherein the target tissue undergoes controlled thermal heating to a temperature in the range of from about 45°

to 90°

C. such that at least a portion of the target tissue is shrunk, whereby the vertebral column is substantially stabilized; and

prior to the positioning step or after the applying step, introducing said shaft distal end into an intervertebral disc; and

after the introducing step, applying a second high frequency voltage between the active electrode and the return electrode sufficient to treat the intervertebral disc.

30. The method of claim 26 wherein applying the first high frequency voltage effects controlled thermal heating of the target tissue to a depth in the range of from about 0.2 to 5.0 mm.

31. The method of claim 26, wherein applying the first high frequency voltage effects heating of the target tissue to a temperature in the range of from about 60°

to 70°

C.

32. The method of claim 26, wherein the target tissue comprises interspinous tissue, and the controlled thermal heating is sufficient to irreversibly shrink and stiffen the interspinous tissue, whereby at least one joint between adjacent vertebrae of the vertebral column is stabilized.

33. The method of claim 32, wherein the interspinous tissue comprises an interspinous ligament.

34. The method of claim 26, wherein the first high frequency voltage is in the range of from about 20 volts RMS to 90 volts RMS.

35. A method of treating an interspinous tissue of a patient, comprising:

positioning an active electrode adjacent to a target site of the interspinous tissue wherein the active electrode is disposed on the distal end of a shaft of an electrosurgical probe; and

heating the interspinous tissue at the target site by applying a first high frequency voltage between the active electrode and a return electrode, the heating being sufficient to shrink at least a portion of the interspinous tissue

prior to the positioning step or after the heating step, introducing the shaft distal end into an intervertebral disc; and

after the introducing step, applying a second high frequency voltage between the active electrode and the return electrode sufficient to treat the intervertebral disc.

36. The method of claim 35 wherein the return electrode is disposed on the shaft distal end at a location proximal to the active electrode such that current is induced to flow from the active electrode away from the interspinous tissue.

37. The method of claim 35 wherein the first high frequency voltage applied between the active and return electrodes is insufficient to cause ablation of tissue.

38. The method of claim 35 further comprising:

providing a quantity of an electrically conductive fluid around the active electrode, wherein the electrically conductive fluid provides a current flow path between the active electrode and the return electrode.

39. The method of claim 38 wherein applying a first high frequency voltage between the active electrode and the return electrode heats the quantity of electrically conductive fluid, and the heated electrically conductive fluid heats the interspinous tissue at the target site.

40. The method of claim 38 wherein providing the quantity of electrically conductive fluid comprises delivering the electrically conductive fluid to the shaft distal end, and the providing step is performed after the positioning step and prior to the applying a first high frequency voltage step.

41. The method of claim 35 wherein the heating step comprises heating the interspinous tissue in a controlled manner such that tissue at the target site is exposed to a temperature in the range of from about 60°

to 70°

C.

42. The method of claim 35 wherein the heating step causes shrinkage of collagen fibers of the interspinous tissue and increased rigidity of the vertebral column of the patient.

43. The method of claim 35 wherein the interspinous tissue is a ligament.

44. The method of claim 43 wherein the ligament is an anterior longitudinal ligament, a posterior longitudinal ligament, a supraspinous ligament, a ligamentum flavum, or an interspinous ligament.

45. The method of claim 35 wherein the interspinous tissue comprises cartilage or a capsule surrounding a facet joint between adjacent vertebrae.

46. The method of claim 35 wherein the interspinous tissue is located adjacent to a spinous processes.

47. The method of claim 35 wherein the heating step causes adjacent spinous processes to be drawn closer together.

48. The method of claim 35 wherein the heating step causes tightening of at least one facet joint between adjacent vertebrae.

49. The method of claim 35, wherein applying the second high frequency voltage is sufficient to ablate or contract a nucleus pulposus of the intervertebral disc.

50. The method of claim 38 wherein the electrically conductive fluid comprises a gel, a liquid, or a gas.

51. The method of claim 35 wherein the first high frequency voltage is in the range of from about 20 volts RMS to 90 volts RMS.

52. The method of claim 35 wherein the heating step comprises controlled heating of the interspinous tissue to within a specific temperature range and to a defined depth of the interspinous tissue at the target site.

53. The method of claim 35 wherein said heating step comprises heating the interspinous tissue at the target site to a depth in the range of from about 0.2 mm to 2.5 mm.

54. The method of claim 35 wherein the heating step is carried out such that an electric current flows through at least a portion of the interspinous tissue at the target site.

55. The method of claim 35 wherein the positioning step comprises advancing said shaft of an electrosurgical probe through an introducer needle.

56. The method of claim 35 wherein the positioning step comprises advancing said shaft of an electrosurgical probe through an introducer extension tube.

57. The method of claim 55 wherein the positioning step is performed percutaneously.

58. The method of claim 35 wherein said introducing step is performed prior to said positioning step.

59. The method of claim 35 wherein said introducing step is performed subsequent to said positioning step.