Methods for electrosurgical treatment of spinal tissue

• US 7,270,659 B2
• Filed: 09/19/2005
• Issued: 09/18/2007
• 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:
  US11/230,360
• Publication Number:
  US 20060095026A1
• Time in Patent Office: 729 Days
• Field of Search: 606/32, 606/41, 607/99, 607/105, 607/113
• US Class Current: 606/32
• CPC Class Codes: A61B 18/1206 Generators 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 2017/00101 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 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 2018/00327 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 2018/00577 : 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 2018/00678 : 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 2018/1467 : 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: 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 energy-applying element of an electrosurgical probe adjacent to a target site of said interspinous tissue;

b) ablating a first portion of the target site of said interspinous tissue with said energy applying element operating in an ablation mode; and

c) heating said interspinous tissue at said target site with said energy-applying element operating in a tissue-shrinking mode, said heating being sufficient to shrink at least a second portion of said interspinous tissue.

2. The method of claim 1, wherein said energy-applying element is disposed on a distal end of a shaft of said electrosurgical probe near a return electrode such that current is induced to flow from said energy-applying element away from said interspinous tissue.

3. The method of claim 1, wherein said heating is provided by a high frequency voltage applied between said energy-applying element and a return electrode, said heating being insufficient to cause ablation of tissue.

4. The method of claim 1, further comprising:

d) providing a quantity of an electrically conductive fluid around said energy-applying element, wherein said electrically conductive fluid provides a current flow path between said energy-applying element and a return electrode.

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

6. The method of claim 4, wherein said step d) comprises delivering said electrically conductive fluid to a distal end of a shaft of said electrosurgical probe, and said step d) is performed after said positioning step and prior to said heating step.

7. The method of claim 4, wherein said electrically conductive fluid is selected from the group consisting of a gel, a liquid, and a gas.

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

C. to 70°

C.

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

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

11. The method of claim 10, wherein the ligament is selected from the group consisting of an anterior longitudinal ligament, a posterior longitudinal ligament, a supraspinous ligament, a ligamentum flavum, and an interspinous ligament.

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

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

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

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

16. The method of claim 1, wherein said interspinous tissue comprises tissue adjacent a facet joint.

17. The method of claim 1, wherein a high frequency voltage is applied between said energy-applying element and a return electrode sufficient to effect molecular dissociation of interspinous tissue.

18. The method of claim 1, further comprising:

e) prior to said step a) or after said step c), introducing a distal end of a shaft of the electrosurgical probe into an intervertebral disc; and

f) after said step e), applying high frequency voltage between said energy-applying element and a return electrode sufficient to treat an intervertebral disc.

19. The method of claim 18, wherein said step f) comprises applying a high frequency voltage between said energy-applying element and a return electrode sufficient to ablate or contract a nucleus pulposus of an intervertebral disc.

20. The method of claim 1, wherein said energy-applying element comprises an active electrode.

21. The method of claim 1, wherein said step c) comprises controlling said heating of said interspinous tissue to within a specific temperature range and to a defined depth of said interspinous tissue at said target site.

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

23. The method of claim 1, wherein said step c) comprises applying a high frequency voltage between said energy-applying element and a return electrode such that an electric current flows through at least a portion of said interspinous tissue at said target site.

24. The method of claim 1, further comprising:

advancing an introducer needle towards said target site and advancing a shaft of the electrosurgical probe through an introducer extension tube.

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