Apparatus and methods for treating cervical inter-vertebral discs

• US 7,393,351 B2
• Filed: 06/18/2002
• Issued: 07/01/2008
• 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, Ormsby, Theodore C., Hovda, David C., Ellsberry, Maria
• Primary Examiner(s): Cohen; Lee S
• Application Number:
  US10/175,555
• Publication Number:
  US 20030014047A1
• Time in Patent Office: 2,205 Days
• Field of Search: 606/32, 606/41
• US Class Current: 606/32
• 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 18/1477 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 2018/00327 : 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 2018/00547 : 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 2018/00678 : 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 2018/1425 : 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

Apparatus and methods for treating an inter-vertebral disc by ablation, coagulation, shrinking, stiffening, or other treatment of disc tissue. A method of the invention includes positioning at least one active electrode within the inter-vertebral disc, and applying at least a first high frequency voltage between the active electrode(s) and one or more return electrode(s), wherein the volume of the nucleus pulposus is decreased, pressure exerted by the nucleus pulposus on the annulus fibrosus is reduced, and discogenic pain of a patient is alleviated. An apparatus of the invention includes an electrosurgical probe, an introducer needle adapted for passing the distal end of the probe therethrough, and a positioning unit for monitoring a position of the probe in relation to the introducer needle.

Claims

1. A method of treating a target tissue of an inter-vertebral disc, comprising:

a) inserting an introducer needle into the inter-vertebral disc, the introducer needle having a needle lumen therethrough and a needle distal end;

b) positioning the needle distal end with respect to the target tissue within the inter-vertebral disc;

c) positioning an active electrode of an electrosurgical probe in relation to the needle distal end, the probe including a shaft having a shaft distal end, the active electrode disposed at the shaft distal end;

d) retracting the introducer needle by at least a first distance, wherein the first distance represents a minimum distance, between the active electrode and the needle distal end, for activating the probe; and

e) after said step d), applying a high frequency voltage between the active electrode and a return electrode, the high frequency voltage sufficient to ablate or modify at least a portion of the target tissue; and

f) during said step e) axially translating the shaft distally within the inter-vertebral disc.

2. The method of claim 1, wherein said step c) comprises positioning the active electrode in relation to the needle distal end such that the active electrode is located within the needle lumen.

3. The method of claim 2, wherein said step c) comprises positioning the probe at a first probe location, wherein the active electrode is located adjacent to the needle distal end.

4. The method of claim 1, wherein said step d) is performed by actuating a positioning unit, the positioning unit adapted for moving the introducer needle relative to the probe.

5. The method of claim 4, wherein the positioning unit is adapted for sequentially positioning the probe at a plurality of locations relative to the introducer needle.

6. The method of claim 5, wherein the positioning unit is adapted for monitoring a location of the probe relative to the introducer needle.

7. The method of claim 5, wherein the positioning unit is adapted for sequentially locking the probe in each of the plurality of locations.

8. The method of claim 1, wherein said step d) comprises retracting the introducer needle such that the active electrode protrudes from the needle distal end by a distance in the range of from about 1 mm to 4 mm.

9. The method of claim 1, wherein the active electrode and the return electrode are coupled to a high frequency power supply capable of operating in at least one of an ablation mode and a sub-ablation mode.

10. The method of claim 1, wherein the active electrode and the return electrode are coupled to a high frequency power supply capable of operating in both an ablation mode and a sub-ablation mode.

11. The method of claim 10, wherein the high frequency voltage applied in said step e) is in the range of from about 70 volts RMS to 350 volts RMS in the ablation mode, and from about 20 volts RMS to 90 volts RMS in the sub-ablation mode.

12. The method of claim 1, wherein the active electrode comprises an electrode head and an electrode filament, the electrode head in the form of a wire loop.

13. The method of claim 12, wherein the electrode filament comprises of a pair of juxtaposed wires.

14. The method of claim 13, wherein the wire loop is formed by folding a wire to form the pair of juxtaposed wires, and thereafter locally separating the folded wire.

15. The method of claim 1, wherein the target tissue is selected from the group consisting of an errant fragment of the nucleus pulposus, a fissure in the annulus fibrosus, and a contained herniation of the nucleus pulposus.

16. The method of claim 1, wherein said step f) causes formation of a channel within the nucleus pulposus.

17. The method of claim 16, wherein said step e) comprises applying a first high frequency voltage sufficient to form the channel, the channel having a channel wall, and thereafter applying a second high frequency voltage, the second high frequency voltage sufficient to coagulate, stiffen, or shrink nucleus pulposus tissue adjacent to the channel wall.

18. The method of claim 1, wherein the shaft is rotatable, and the method further comprises:

g) during said step f), rotating the shaft.

19. The method of claim 1, wherein the high frequency voltage applied in said step e) is sufficient to effect treatment of the target tissue, and the treatment comprises ablation of the target tissue, stiffening of the target tissue, coagulation of the target tissue, or shrinkage of the target tissue.

20. The method of claim 1, wherein the disc is a cervical inter-vertebral disc.

21. The method of claim 1, further comprising:

g) after said step e), moving the shaft distal end with respect to the disc, and thereafter repeating said step e).

22. The method of claim 1, wherein said step e) causes the volume of the nucleus pulposus to decrease.

23. The method of claim 1, wherein the shaft is engaged within the introducer needle such that the shaft is in electrical contact with the introducer needle, and the shaft in combination with the introducer needle serves as the return electrode.

24. The method of claim 1, wherein the active electrode is expandable between an unexpanded configuration and an expanded configuration.

25. A method of treating a target tissue of an inter-vertebral disc, comprising:

a) inserting an introducer needle into the inter-vertebral disc, the introducer needle having a needle lumen therethrough and a needle distal end;

b) positioning the needle distal end with respect to the target tissue within the inter-vertebral disc;

c) positioning an active electrode of an electrosurgical probe in relation to the needle distal end, the probe including a shaft having a shaft distal end, the active electrode disposed at the shaft distal end;

d) retracting the introducer needle by at least a first distance, wherein the first distance represents a minimum distance, between the active electrode and the needle distal end, for activating the probe;

e) after said step d), applying a high frequency voltage between the active electrode and a return electrode, the high frequency voltage sufficient to ablate or modify at least a portion of the target tissue; and

,

f) prior to said step a), positioning a needle stop unit on the introducer needle to limit the depth of penetration of the introducer needle into the patient'"'"'s body.

26. A method of treating a target tissue of an inter-vertebral disc, comprising:

a) introducing a distal portion of an electrosurgical apparatus into the inter-vertebral disc, the apparatus comprising an electrosurgical probe having a shaft and an active electrode disposed on the shaft distal end, an introducer device adapted for passage of the shaft therethrough, and a positioning unit adapted for monitoring a location of the probe in relation to the introducer device;

b) positioning the active electrode into at least close proximity to the target tissue of the disc, wherein the active electrode includes an active electrode filament and an electrode head disposed on the filament distal end; and

c) applying a high frequency voltage between the active electrode and a return electrode, wherein the high frequency voltage is sufficient to ablate or modify the target tissue.

27. The method of claim 26, wherein the electrode filament comprises a pair of juxtaposed wires.

28. The method of claim 26, wherein the electrode head comprises a wire loop, the wire loop comprising a material selected from the group consisting of platinum, stainless steel, molybdenum, tungsten, titanium, molybdenum, nickel, iridium, and their alloys.

29. The method of claim 26, wherein the disc is a cervical disc.

30. The method of claim 26, wherein the active electrode and the return electrode are independently coupled to a high frequency power supply, and the high frequency power supply is capable of operating in at least an ablation mode.

31. The method of claim 26, wherein said step a) comprises:

d) positioning the distal end of the introducer device in the inter-vertebral disc, the introducer device having an introducer lumen therethrough; and

e) positioning the active electrode within the introducer lumen adjacent to the introducer device distal end.

32. The method of claim 31, further comprising:

f) after said step e) and prior to said step c), actuating the positioning unit such that the active electrode protrudes from the introducer device distal end by a distance in the range of from about 1 mm to 4 mm.

33. The method of claim 32, wherein the active electrode protrudes from the introducer device distal end by a distance up to about 20 mm.

34. The method of claim 26, further comprising:

d) during said step c), moving the probe relative to the disc.

35. The method of claim 34, wherein said step f) comprises at least one of:

rotating the shaft and axially translating the shaft.

36. The method of claim 26, wherein the high frequency power supply is switchable between an ablation mode and a sub-ablation mode, and wherein the high frequency voltage applied in said step c) is in the range of from about 70 volts RMS to 350 volts RMS in the ablation mode, and from about 20 volts RMS to 90 volts RMS in the sub-ablation mode.

37. The method of claim 26, wherein the high frequency voltage applied in said step c) is sufficient to effect ablation, stiffening, coagulation, or shrinkage of the target tissue.

38. The method of claim 26, wherein the probe further includes a connecting unit including an extension lead and a connection block, the extension lead for coupling the active electrode and the return electrode to the connection block, and a high frequency power supply coupled to the connection block.

39. The method of claim 38, wherein the extension lead is flexible, and has a diameter in the range of from about 0.5 mm to 2.5 mm, and has a length in the range of from about 50 cm to 70 cm.

40. The method of claim 26, wherein the shaft is engaged within the introducer device such that the shaft is in electrical contact with the introducer device, and the return electrode comprises the shaft in combination with the introducer device.

41. The method of claim 26, wherein the active electrode is adapted for expanding and contracting between an unexpanded configuration and an expanded configuration.

42. A method of treating a target tissue of an inter-vertebral disc, comprising:

a) introducing a distal portion of an electrosurgical apparatus into the inter-vertebral disc, the apparatus comprising an electrosurgical probe and an introducer device, the probe including a shaft having a shaft distal end and an electrically insulating spacer disposed at the shaft distal end, and an active electrode disposed distal to the spacer, wherein the introducer device includes an introducer lumen adapted for passage of the shaft therethrough, and the shaft makes electrical contact with the introducer device when the shaft is engaged within the introducer lumen;

b) positioning the active electrode in at least close proximity to the target tissue; and

c) applying a high frequency voltage between the active electrode and a return electrode, wherein the return electrode comprises the shaft in combination with the introducer device, and the high frequency voltage is sufficient to ablate or modify the target tissue.

43. The method of claim 42, wherein the active electrode includes an active electrode filament and an electrode head disposed on the filament distal end, and wherein the electrode head is expandable.