Method of treating intervertebral disc

• US 7,282,061 B2
• Filed: 11/14/2003
• Issued: 10/16/2007
• Est. Priority Date: 08/13/1996
• Status: Expired due to Term

• Current Assignee: NeuroTherm, Inc. (Abbott Laboratories Incorporated)
• Original Assignee: Oratec Interventions Incorporated
• Inventors: Ashley, John, Sharkey, Hugh R., Saal, Joel, Saal, Jeffrey A., Le, Le Trong
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US10/712,007
• Publication Number:
  US 20040111137A1
• Time in Patent Office: 1,432 Days
• Field of Search: 607/96, 607 98-102, 607/117, 606/41, 606 47- 50, 128/898
• US Class Current: 607/96
• CPC Class Codes: A61B 10/02 Instruments for taking cell samples or for biopsy A61B10/0038 and A61B10/0045 take precedence; needle locating or guiding means A61B17/3403; samplers for enzymology or microbiology C12M1/26; sampling or preparing biological specimens G01N33/48
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
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• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/3203 Fluid jet cutting instruments
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3496 Protecting sleeves or inner probes; Retractable tips for protecting body piercing guide needles A61M25/0612
• CPC Class Codes: A61B 17/7061 for stabilising vertebrae or discs by improving the condition of their tissues, e.g. using implanted medication or fluid exchange intraosseous injection devices A61B17/3472
• CPC Class Codes: A61B 17/8836 for heating, cooling or curing of bone cement or fluid fillers
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 18/082 Probes or electrodes therefor
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• 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 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00022 : Sensing or detecting at the treatment site
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• CPC Class Codes: A61B 2017/0011 : piezoelectric
• CPC Class Codes: A61B 2017/00119 : alarm; indicating an abnormal situation
• CPC Class Codes: A61B 2017/00261 : Discectomy
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• CPC Class Codes: A61B 2017/003 : Steerable
• CPC Class Codes: A61B 2017/00336 : with a protective sleeve, e.g. retractable or slidable
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• CPC Class Codes: A61B 2017/22044 : with a pointed tip
• CPC Class Codes: A61B 2017/22049 : Means for locking the guide wire in the catheter
• CPC Class Codes: A61B 2017/22082 : after introduction of a substance
• CPC Class Codes: A61B 2017/22087 : photodynamic
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• CPC Class Codes: A61B 2017/3445 : used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00011 : with fluids
• CPC Class Codes: A61B 2018/00267 : having a basket shaped structure
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• CPC Class Codes: A61B 2018/00595 : Cauterization
• CPC Class Codes: A61B 2018/00625 : Vaporization
• CPC Class Codes: A61B 2018/00654 : with individual control of each of a plurality of energy emitting elements
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/046 : in liquid form
• CPC Class Codes: A61B 2018/1266 : with DC current output
• CPC Class Codes: A61B 2018/1405 : Electrodes having a specific shape
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• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
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• CPC Class Codes: A61B 2090/0454 : by reflection
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• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61F 2/442 : Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2002/30677 : Means for introducing or releasing pharmaceutical products, e.g. antibiotics, into the body
• CPC Class Codes: A61F 2007/0298 : with a section for heating and a section for cooling
• CPC Class Codes: A61M 25/0084 : being one or more injection needles
• CPC Class Codes: A61M 25/0133 : Tip steering devices
• CPC Class Codes: A61M 25/0144 : having flexible regions as a result of inner reinforcement means, e.g. struts or rods
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires
• CPC Class Codes: A61M 25/0155 : with hydraulic or pneumatic means, e.g. balloons or inflatable compartments
• 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
• CPC Class Codes: A61M 25/09 : Guide wires
• CPC Class Codes: A61N 1/06 : for high-frequency therapy
• CPC Class Codes: A61N 1/40 : Applying electric fields by inductive or capacitive coupling microwave apparatus A61N5/00; Applying radio-frequency signals
• CPC Class Codes: A61N 1/403 : for thermotherapy, e.g. hyperthermia

Abstract

A device is described that may be positioned at a location in an intervertebral disc for diagnosis or treatment of the disc. Treatment may include, for example, applying energy or removing material, and may decrease intradiscal pressure. Radiofrequency energy may be applied. A percutaneous method of repairing a fissure in the annulus pulposus comprises placing an energy source adjacent to the fissure and providing sufficient energy to the fissure to raise the temperature to at least about 45-70° C. and for a sufficient time to cause the collagen to weld. An intervertebral fissure also can be treated by placing a catheter with a lumen adjacent to the fissure and injecting sealant into the fissure via the catheter, thereby sealing the fissure. An intervertebral fissure additionally can be treated by providing a catheter having a distal end, a proximal end, a longitudinal axis, and an intradiscal section at the catheter'"'"'s distal end on which there is at least one functional element. The next step is applying a force longitudinally to the proximal of the catheter which is sufficient to advance the intradiscal section through the nucleus pulposus and around an inner wall of an annulus fibrosus, but which force is insufficient to puncture the annulus fibrosus. Next the functional element is positioned at a selected location of the disc by advancing or retracting the catheter and optionally twisting the proximal end of the catheter. Then the functional unit treats the annular fissure. Optionally, there is an additional step of adding a substance to seal the fissure. An externally guidable intervertebral disc apparatus also is disclosed.

Claims

1. A method comprising:

advancing a member into a nucleus pulposus of an intervertebral disc by blunt dissection, the nucleus pulposus having a volume, and

applying radiofrequency energy from the member to decrease the volume of the nucleus pulposus.

2. The method of claim 1 wherein applying radiofrequency energy removes material of the nucleus pulposus.

3. The method of claim 1 wherein applying radiofrequency energy removes water of the nucleus pulposus.

4. The method of claim 1 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.

5. The method of claim 2 or 3 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.

6. The method of claim 1, 2, 3, or 4 wherein applying radiofrequency energy from the member to decrease the volume of the nucleus pulposus reduces pressure in the intervertebral disc.

7. The method of claim 1, 2, 3, or 4 wherein applying radiofrequency energy to decrease the volume of the nucleus pulposus comprises ablating material of the nucleus pulposus.

8. The method of claim 1, 2, 3, or 4 further comprising denervating at least a portion of the intervertebral disc with the applied radiofrequency energy.

9. The method of claim 1, 2, 3, or 4 wherein advancing the member comprises advancing the member through an introducer.

10. The method of claim 1, 2, 3, or 4 wherein advancing the member comprises advancing the member beyond a central region of the nucleus pulposus.

11. The method of claim 1, 2, 3, or 4 wherein applying radiofrequency energy comprises applying radiofrequency energy from an electrode of the member.

12. The method of claim 11 further comprising advancing the electrode beyond an introducer.

13. The method of claim 11 further comprising providing the member with a bipolar electrode configuration.

14. The method of claim 1 further comprises applying rotation to a proximal region of the member to rotate a distal region of the member within the nucleus pulposus.

15. The method of claim 1 or 14 further comprising positioning a portion of the member at an inner wall of an annulus fibrosus of the intervertebral disc.

16. The method of claim 1 or 14 wherein advancing the member comprises advancing the member along a curved path.

17. The method of claim 1 further comprising providing the member with a total length between 5 and 24 inches.

18. The method of claim 1 further comprising providing the member in the form of a catheter.

19. The method of claim 1, 2, 3, or 4 wherein applying radiofrequency energy comprises applying radiofrequency energy to an inner wall of an annulus fibrosus.

20. The method of claim 1, 2, 3, or 4 wherein applying radiofrequency energy comprises applying radiofrequency energy while the member is positioned at a location adjacent an inner wall of an annulus fibrosus.

21. The method of claim 1, 2, 3, or 4 wherein applying radiofrequency energy comprises applying radiofrequency energy to multiple locations in the intervertebral disc.

22. The method of claim 21 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations simultaneously.

23. The method of claim 21 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using separate energy delivery elements of the member.

24. The method of claim 21 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations serially.

25. The method of claim 21 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using a single energy delivery element of the member.

26. The method of claim 1, 2, 3, or 4 further comprising advancing the member along an inner wall of an annulus fibrosus.

147. The method of claim 1 wherein advancing the member into the nucleus pulposus comprises conforming the member sufficiently to an inner wall of an annulus fibrosus to contact multiple locations on the inner wall.

27. A method comprising:

advancing a member through a nucleus pulposus of an intervertebral disc beyond a central region of the nucleus pulposus, the nucleus pulposus having a volume, and

applying radiofrequency energy from the member to decrease the volume of the nucleus pulposus.

28. The method of claim 27 wherein applying radiofrequency energy removes material of the nucleus pulposus.

29. The method of claim 27 wherein applying radiofrequency energy removes water of the nucleus pulposus.

30. The method of claim 27 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.

31. The method of claim 28 or 29 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.

32. The method of claim 27, 28, 29, or 30 wherein applying radiofrequency energy from the member to decrease the volume of the nucleus pulposus reduces pressure in the intervertebral disc.

33. The method of claim 27, 28, 29, or 30 wherein applying radiofrequency energy to decrease the volume of the nucleus pulposus comprises ablating material of the nucleus pulposus.

34. The method of claim 27, 28, 29, or 30 further comprising denervating at least a portion of the intervertebral disc with the applied radiofrequency energy.

35. The method of claim 27, 28, 29, or 30 wherein advancing the member comprises advancing the member through an introducer.

36. The method of claim 27, 28, 29, or 30 wherein applying radiofrequency energy comprises applying radiofrequency energy from an electrode of the member.

37. The method of claim 36 further comprising advancing the electrode beyond an introducer.

38. The method of claim 36 further comprising providing the member with a bipolar electrode configuration.

39. The method of claim 27 further comprising applying rotation to a proximal region of the member to rotate a distal region of the member within the nucleus pulposus.

40. The method of claim 27 or 39 further comprising positioning a portion of the member at an inner wall of an annulus fibrosus of the intervertebral disc.

41. The method of claim 27 or 39 wherein advancing the member comprises advancing the member along a curved path.

42. The method of claim 27 further comprising providing the member with a total length between 5 and 24 inches.

43. The method of claim 27 further comprising providing the member in the form of a catheter.

44. The method of claim 27, 28, 29, or 30 wherein applying radiofrequency energy comprises applying radiofrequency energy to an inner wall of an annulus fibrosus.

45. The method of claim 27, 28, 29, or 30 wherein applying radiofrequency energy comprises applying radiofrequency energy while the member is positioned at a location adjacent an inner wall of an annulus fibrosus.

46. The method of claim 27, 28, 29, or 30 wherein applying radiofrequency energy comprises applying radiofrequency energy to multiple locations in the intervertebral disc.

47. The method of claim 46 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations simultaneously.

48. The method of claim 46 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using separate energy delivery elements of the member.

49. The method of claim 46 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations serially.

50. The method of claim 46 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using a single energy delivery element of the member.

51. The method of claim 27, 28, 29, or 30 further comprising advancing the member along an inner wall of an annulus fibrosus.

52. A method comprising:

advancing a radiofrequency electrode into a nucleus pulposus of an intervertebral disc by blunt dissection, the nucleus pulposus having a volume, and

activating the electrode to decrease the volume of the nucleus pulposus.

53. The method of claim 52 wherein activating the electrode to decrease the volume of the nucleus pulposus reduces pressure in the intervertebral disc.

54. The method of claim 52 or 53 wherein activating the electrode to decrease the volume of the nucleus pulposus comprises ablating material of the nucleus pulposus.

55. The method of claim 52 or 53 wherein advancing the electrode comprises advancing the electrode beyond a central region of the nucleus pulposus.

56. The method of claim 52 wherein advancing the electrode further comprises advancing a bipolar electrode configuration.

57. The method of claim 52 or 56 further comprising positioning the electrode at an inner wall of an annulus fibrosus of the intervertebral disc.

58. The method of claim 52 or 56 wherein advancing the electrode comprises advancing the electrode along a curved path.

59. The method of claim 52 or 53 wherein activating the electrode comprises activating the electrode while the electrode is positioned at a location adjacent an inner wall of an annulus fibrosus.

60. The method of claim 52 or 53 wherein activating the electrode comprises delivering radiofrequency energy from the electrode to multiple locations in the intervertebral disc.

61. The method of claim 60 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations simultaneously.

62. The method of claim 60 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations serially.

63. The method of claim 52 or 53 further comprising advancing the electrode along an inner wall of an annulus fibrosus.

64. A method comprising:

advancing a radiofrequency electrode through a nucleus pulposus of an intervertebral disc beyond a central region of the nucleus pulposus, the nucleus pulposus having a volume, and

activating the electrode to decrease the volume of the nucleus pulposus.

65. The method of claim 64 wherein activating the electrode to decrease the volume of the nucleus pulposus reduces pressure in the intervertebral disc.

66. The method of claim 64 or 65 wherein activating the electrode to decrease the volume of the nucleus pulposus comprises ablating material of the nucleus pulposus.

67. The method of claim 64 wherein advancing the electrode further comprises advancing a bipolar electrode configuration.

68. The method of claim 64 or 67 further comprising positioning the electrode at an inner wall of an annulus fibrosus of the intervertebral disc.

69. The method of claim 64 or 67 wherein advancing the electrode comprises advancing the electrode along a curved path.

70. The method of claim 64 or 65 wherein activating the electrode comprises activating the electrode while the electrode is positioned at a location adjacent an inner wall of an annulus fibrosus.

71. The method of claim 64 or 65 wherein activating the electrode comprises delivering radiofrequency energy from the electrode to multiple locations in the intervertebral disc.

72. The method of claim 71 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations simultaneously.

73. The method of claim 71 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations serially.

74. The method of claim 64 or 65 further comprising advancing the electrode along an inner wall of an annulus fibrosus.

75. A method comprising:

advancing a member into a nucleus pulposus of an intervertebral disc by blunt dissection, and

applying radio frequency energy from the member to remove material of the nucleus pulposus.

76. The method of claim 75 wherein applying radiofrequency energy removes water of the nucleus pulposus.

77. The method of claim 75 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.

78. The method of claim 76 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.

79. The method of claim 75, 76, 77, or 78 wherein applying radiofrequency energy from the member to remove material of the nucleus pulposus reduces pressure in the intervertebral disc.

80. The method of claim 75, 76, 77, or 78 wherein applying radiofrequency energy from the member to remove material of the nucleus pulposus comprises ablating material of the nucleus pulposus.

81. The method of claim 75, 76, 77, or 78 further comprising denervating at least a portion of the intervertebral disc with the applied radio frequency energy.

82. The method of claim 75, 76, 77, or 78 wherein advancing the member comprises advancing the member through an introducer.

83. The method of claim 75, 76, 77, or 78 wherein advancing the member comprises advancing the member beyond a central region of the nucleus pulposus.

84. The method of claim 75, 76, 77, or 78 wherein applying radiofrequency energy comprises applying radiofrequency energy from an electrode of the member.

85. The method of claim 84 further comprising advancing the electrode beyond an introducer.

86. The method of claim 84 further comprising providing the member with a bipolar electrode configuration.

87. The method of claim 75 further comprising applying rotation to a proximal region of the member to rotate a distal region of the member within the nucleus pulposus.

88. The method of claim 75 or 87 further comprising positioning a portion of the member at an inner wall of an annulus fibrosus of the intervertebral disc.

89. The method of claim 75 or 87 wherein advancing the member comprises advancing the member along a curved path.

90. The method of claim 75 further comprising providing the member with a total length between 5 and 24 inches.

91. The method of claim 75 further comprising providing the member in the form of a catheter.

92. The method of claim 75, 76, 77, or 78 wherein applying radiofrequency energy comprises applying radiofrequency energy to an inner wall of an annulus fibrosus.

93. The method of claim 75, 76, 77, or 78 wherein applying radiofrequency energy comprises applying radiofrequency energy while the member is positioned at a location adjacent an inner wall of an annulus fibrosus.

94. The method of claim 75, 76, 77, or 78 wherein applying radiofrequency energy comprises applying radiofrequency energy to multiple locations in the intervertebral disc.

95. The method of claim 94 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations simultaneously.

96. The method of claim 94 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using separate energy delivery elements of the member.

97. The method of claim 94 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations serially.

98. The method of claim 94 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using a single energy delivery element of the member.

99. The method of claim 75, 76, 77, or 78 further comprising advancing the member along an inner wall of an annulus fibrosus.

100. A method comprising:

advancing a member through a nucleus pulposus of an intervertebral disc beyond a central region of the nucleus pulposus, and

applying radiofrequency energy from the member to remove material of the nucleus pulposus.

101. The method of claim 100 wherein applying radiofrequency energy removes water of the nucleus pulposus.

102. The method of claim 100 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.

103. The method of claim 101 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.

104. The method of claim 100, 101, 102, or 103 wherein applying radiofrequency energy from the member to remove material of the nucleus pulposus reduces pressure in the intervertebral disc.

105. The method of claim 100, 101, 102, or 103 wherein applying radiofrequency energy from the member to remove material of the nucleus pulposus comprises ablating material of the nucleus pulposus.

106. The method of claim 100, 101, 102, or 103 further comprising denervating at least a portion of the intervertebral disc with the applied radiofrequency energy.

107. The method of claim 100, 101, 102, or 103 wherein advancing the member comprises advancing the member through an introducer.

108. The method of claim 100, 101, 102, or 103 wherein applying radiofrequency energy comprises applying radiofrequency energy from an electrode of the member.

109. The method of claim 108 further comprising advancing the electrode beyond an introducer.

110. The method of claim 108 further comprising providing the member with a bipolar electrode configuration.

111. The method of claim 100 further comprises applying rotation to a proximal region of the member to rotate a distal region of the member within the nucleus pulposus.

112. The method of claim 100 or 111 further comprising positioning a portion of the member at an inner wall of an annulus fibrosus of the intervertebral disc.

113. The method of claim 100 or 111 wherein advancing the member comprises advancing the member along a curved path.

114. The method of claim 100 further comprising providing the member with a total length between 5 and 24 inches.

115. The method of claim 100 further comprising providing the member in the form of a catheter.

116. The method of claim 100, 101, 102, or 103 wherein applying radiofrequency energy comprises applying radiofrequency energy to an inner wall of an annulus fibrosus.

117. The method of claim 100, 101, 102, or 103 wherein applying radiofrequency energy comprises applying radiofrequency energy while the member is positioned at a location adjacent an inner wall of an annulus fibrosus.

118. The method of claim 100, 101, 102, or 103 wherein applying radiofrequency energy comprises applying radiofrequency energy to multiple locations in the intervertebral disc.

119. The method of claim 118 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations simultaneously.

120. The method of claim 118 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using separate energy delivery elements of the member.

121. The method of claim 118 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations serially.

122. The method of claim 118 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using a single energy delivery element of the member.

123. The method of claim 100, 101, 102, or 103 further comprising advancing the member along an inner wall of an annulus fibrosus.

124. A method comprising:

advancing a radiofrequency electrode into a nucleus pulposus of an intervertebral disc by blunt dissection, and

activating the electrode to remove material of the nucleus pulposus.

125. The method of claim 124 wherein activating the electrode to remove material of the nucleus pulposus reduces pressure in the intervertebral disc.

126. The method of claim 124 or 125 wherein activating the electrode to remove material of the nucleus pulposus comprises ablating material of the nucleus pulposus.

127. The method of claim 124 or 125 wherein advancing the electrode comprises advancing the electrode beyond a central region of the nucleus pulposus.

128. The method of claim 124 wherein advancing the electrode further comprises advancing a bipolar electrode configuration.

129. The method of claim 124 or 128 further comprising positioning the electrode at an inner wall of an annulus fibrosus of the intervertebral disc.

130. The method of claim 124 or 128 wherein advancing the electrode comprises advancing the electrode along a curved path.

131. The method of claim 124 or 125 wherein activating the electrode comprises activating the electrode while the electrode is positioned at a location adjacent an inner wall of an annulus fibrosus.

132. The method of claim 124 or 125 wherein activating the electrode comprises delivering radiofrequency energy from the electrode to multiple locations in the intervertebral disc.

133. The method of claim 132 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations simultaneously.

134. The method of claim 132 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations serially.

135. The method of claim 124 or 125 further comprising advancing the electrode along an inner wall of an annulus fibrosus.

136. A method comprising:

advancing a radiofrequency electrode through a nucleus pulposus of an intervertebral disc beyond a central region of the nucleus pulposus, and

activating the electrode to remove material of the nucleus pulposus.

137. The method of claim 136 wherein activating the electrode to remove material of the nucleus pulposus reduces pressure in the intervertebral disc.

138. The method of claim 136 or 137 wherein activating the electrode to remove material of the nucleus pulposus comprises ablating material of the nucleus pulposus.

139. The method of claim 136 wherein advancing the electrode further comprises advancing a bipolar electrode configuration.

140. The method of claim 136 or 139 further comprising positioning the electrode at an inner wall of an annulus fibrosus of the intervertebral disc.

141. The method of claim 136 or 139 wherein advancing the electrode comprises advancing the electrode along a curved path.

142. The method of claim 136 or 137 wherein activating the electrode comprises activating the electrode while the electrode is positioned at a location adjacent an inner wall of an annulus fibrosus.

143. The method of claim 136 or 137 wherein activating the electrode comprises delivering radiofrequency energy from the electrode to multiple locations in the intervertebral disc.

144. The method of claim 143 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations simultaneously.

145. The method of claim 143 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations serially.

146. The method of claim 136 or 137 further comprising advancing the electrode along an inner wall of an annulus fibrosus.

148. A method of delivering energy to an intervertebral disc, comprising:

positioning an energy delivery device adjacent an inner wall of the disc, and

shrinking the nucleus pulposus.

149. The method of claim 148 wherein positioning the energy delivery device further comprises positioning an energy delivery element of the device adjacent a bulge in the intervertebral disc.

150. The method of claim 148 further comprising monitoring temperature.

151. The method of claim 150 further comprising controlling energy delivery based on the monitored temperature.

152. The method of claim 148 further comprising providing a catheter including the energy delivery device.

153. The method of claim 152 further comprising introducing the catheter into the intervertebral disc and advancing the catheter along the inner wall of the disc.