Methods for electrosurgical tissue contraction within the spine

• US 6,929,640 B1
• Filed: 02/24/2000
• Issued: 08/16/2005
• 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:
  US09/512,742
• Time in Patent Office: 2,000 Days
• Field of Search: 606/32, 606/34, 606/41, 606/49, 606/50, 607/99, 607/105, 607/113, 604/35, 604/114, 128/898
• 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 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 contract collagen fibers within the tissue structures. In one aspect of the invention, a system and method is provided for treating herniated or swollen discs within a patient'"'"'s spine by applying sufficient electrical energy to the disc tissue 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 an intervertebral disc of a patient, comprising:

a) advancing an active electrode through an annulus fibrosus of the disc to form an opening in the annulus fibrosus;

b) positioning the active electrode within a nucleus pulposus of the disc;

c) applying a high frequency voltage between the active electrode and a return electrode, wherein the voltage is sufficient to contract at least a portion of the nucleus pulposus; and

d) while continuing said step c), withdrawing the active electrode from the disc via the opening in the annulus fibrosus, wherein the voltage is sufficient to at least partially close the opening in the annulus fibrosus.

2. The method of claim 1, further comprising sealing the opening in the annulus fibrosus as a result of the voltage applied during said step d).

3. The method of claim 1, wherein the voltage is sufficient to effect contraction of collagen fibers in the nucleus pulposus or the annulus fibrosus.

4. The method of claim 1, wherein the opening in the annulus fibrosus is partially closed via contraction of collagen fibers in the annulus fibrosus.

5. The method of claim 1, wherein contraction of the nucleus pulposus is effected via contraction of collagen fibers in the nucleus pulposus.

6. The method of claim 1, further comprising:

delivering an electrically conductive fluid to the active electrode, wherein the electrically conductive fluid provides a current flow path between the active electrode and the return electrode.

7. The method of claim 1, wherein during said step c) at least a portion of the nucleus pulposus is heated to a temperature in the range of from about 60°

C. to 70°

C.

8. The method of claim 1, wherein said step c) comprises applying the voltage in the range of from about 45 volts rms to 60 volts rms.

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

positioning an energy applying element in contact with, or in close proximity to, an opening surgically created in an annulus; and

applying energy sufficient to at least partially close said opening.

10. The method of claim 9 wherein the energy applying element is an electrode.

11. The method of claim 10 further comprising:

prior to the positioning step, percutaneously introducing the electrode to the patient'"'"'s spine.

12. The method of claim 10 further comprising:

positioning a return electrode on the outer surface of the patient'"'"'s body, and conducting electric current from the electrode, through the patient'"'"'s body, to the return electrode.

13. The method of claim 10 wherein the step of positioning the electrode comprises positioning a single, active electrode in at least close proximity to the annulus.

14. The method of claim 10 further comprising:

prior to the positioning step, anteriorly introducing the electrode to the patient'"'"'s spine.

15. The method of claim 10 wherein the electrode is disposed on an instrument shaft, and wherein the applying step comprises applying a high frequency voltage between the electrode and a return electrode, the return electrode disposed on the instrument shaft.

16. The method of claim 9 wherein the step of applying is performed as the energy applying element is withdrawn from the opening.

17. The method of claim 9 wherein the step of positioning comprises positioning a plurality of electrically isolated electrode terminals in at least close proximity to the annulus.

18. The method of claim 9 wherein the opening extends completely through a wall of the annulus.