Devices and methods for selective surgical removal of tissue

• US 7,738,969 B2
• Filed: 01/21/2009
• Issued: 06/15/2010
• Est. Priority Date: 10/15/2004
• Status: Active Grant

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Baxano, Inc. (Baxano Surgical, Inc.)
• Inventors: Bleich, Jeffery L.
• Primary Examiner(s): Hindenburg; Max
• Assistant Examiner(s): Dougherty; Sean P
• Application Number:
  US12/357,289
• Publication Number:
  US 20090125036A1
• Time in Patent Office: 510 Days
• Field of Search: 600/547, 600/554, 600/585, 600/373, 600/562, 600/564, 600/570, 606/37, 606/39, 606/53, 607/43, 607116-118
• US Class Current: 607/117
• CPC Class Codes: A61B 17/1671 for the spine
• 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 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• CPC Class Codes: A61B 17/3401 Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia local anaesthesia A61M19/00
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• 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 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1487 Trocar-like, i.e. devices producing an enlarged transcutaneous opening
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00287 Bags for minimally invasive surgery
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/320004 abrasive
• CPC Class Codes: A61B 2017/320044 Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2017/32006 with a cutting strip, band or chain, e.g. like a chainsaw
• CPC Class Codes: A61B 2018/1407 Loop
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/08021 : of the patient or his organs
• CPC Class Codes: A61B 90/04 : Protection of tissue around surgical sites against effects of non-mechanical surgery, e.g. laser surgery protection of eyes against laser radiation A61F9/022
• CPC Class Codes: A61F 2/0045 : Support slings
• CPC Class Codes: A61N 1/0551 : Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36017 : with leads or electrodes penetrating the skin

Abstract

Methods and apparatus are provided for selective surgical removal of tissue. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space through an epidural needle. The sharp tip of the needle in the epidural space, can be converted to a blunt tipped instrument for further safe advancement. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. A nerve stimulator may be provided to reduce a risk of inadvertent neural abrasion.

Claims

1. A method for protecting tissue adjacent to target anatomy in a patient, the method comprising:

accessing a neural foramina of a patient'"'"'s spine;

passing a wire from outside of the patient, through the foramina, and out of the patient.

positioning a protective barrier within the neural foramina using the wire;

positioning a tissue abrasion device within the neural foramina using the wire; and

applying tension to the abrasion device to modify the tissue by urging the abrasion device against a target tissue by pulling on a proximal and a distal end of the abrasion device.

2. The method of claim 1, further comprising applying electrical current to determine a location of a nerve in the neural foramina relative to the abrasion device.

3. The method of claim 1, wherein the step of accessing the neural foramina comprises percutaneously accessing the neural foramina.

4. The method of claim 1, wherein the step of positioning the abrasion device comprises connecting the abrasion device to the wire and pulling the wire.

5. The method of claim 1, wherein the step of positioning the protective barrier comprises expanding the protective barrier within the neural foramina to cover tissue in one region of the neural foramina.

6. The method of claim 1, wherein the step of applying tension to the abrasion device comprises sliding the abrasion device across a target tissue.

7. The method of claim 1, wherein the protective barrier is coupled to the tissue abrasion device.

8. A method for protecting tissue adjacent to target anatomy in a patient, the method comprising:

accessing a neural foramina of a patient'"'"'s spine;

passing a wire from outside of the patient at a first site, through the foramina, and out of the patient at a second site;

positioning a protective barrier within the neural foramina using the wire;

positioning a tissue abrasion device within the neural foramina using the wire; and

applying tension to the abrasion device to urge the abrasion device against a target tissue to modify the target tissue by pulling on the proximal and distal ends of the abrasion device.

9. The method of claim 8, further comprising applying electrical current to determine a location of a nerve in the neural foramina relative to the abrasion device.

10. The method of claim 8, wherein the step of accessing the neural foramina comprises percutaneously accessing the neural foramina.

11. The method of claim 8, wherein the step of positioning the abrasion device comprises connecting the abrasion device to the wire and pulling the wire.

12. The method of claim 8, wherein the step of positioning the protective barrier comprises expanding the protective barrier within the neural foramina to cover tissue in one region of the neural foramina.

13. The method of claim 8, wherein the step of applying tension to the abrasion device comprises applying tension to both a proximal and a distal end of the abrasion device from outside of the patient.

14. The method of claim 8, wherein the step of applying tension to the abrasion device comprises sliding the abrasion device across the target tissue.

15. The method of claim 8, wherein the protective barrier is coupled to the tissue abrasion device.

16. A method for protecting tissue adjacent to target anatomy in a patient, the method comprising:

accessing a neural foramina of a patient'"'"'s spine;

passing a wire from outside of the patient at a first site, through the foramina, and out of the patient at a second site;

positioning a tissue abrasion device having a protective surface within the neural foramina using the wire; and

applying tension to the abrasion device to urge the abrasion device against a target tissue to modify the target tissue by pulling on proximal and distal ends of the abrasion device.