Devices and methods for tissue access
First Claim
1. A method to achieve access to a compressed space in spinal anatomy, the method comprising:
- advancing a distal portion of a cannulated probe via a surgical incision towards a lateral recess and a neural foramen in a patient;
extending a first end of a second element from a distal end of the cannulated probe and through the neural foramen and at least partially around an anterior portion of a facet joint and posterior to a spinal disc;
extending the first end of the second element out of the patient, wherein a portion of the second element remains curved around the facet joint; and
delivering an electric current using the cannulated probe to assess the position of the cannulated probe relative to neural tissue.
14 Assignments
0 Petitions
Accused Products
Abstract
Methods are provided for access to a compressed space in the spinal anatomy. These methods may be used for selective surgical removal of tissue, e.g., for enlargement of diseased spinal structures, such as impinged lateral recesses and pathologically narrowed neural foramen. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space. In one variation, a tissue abrasion device is provided. A cannulated probe may be placed through the neural foramina of the spine and used to position a guidewire around the anterior border of a facet joint. Once properly positioned, a medical practitioner may use the guidewire with an abrasion device to enlarge the lateral recess and neural foramina. A nerve stimulator may be provided to reduce a risk of inadvertent neural abrasion.
-
Citations
30 Claims
-
1. A method to achieve access to a compressed space in spinal anatomy, the method comprising:
-
advancing a distal portion of a cannulated probe via a surgical incision towards a lateral recess and a neural foramen in a patient; extending a first end of a second element from a distal end of the cannulated probe and through the neural foramen and at least partially around an anterior portion of a facet joint and posterior to a spinal disc; extending the first end of the second element out of the patient, wherein a portion of the second element remains curved around the facet joint; and delivering an electric current using the cannulated probe to assess the position of the cannulated probe relative to neural tissue. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22)
-
-
23. A method to achieve access to a compressed space in spinal anatomy, the method comprising:
-
advancing a distal portion of a cannulated probe via a first surgical incision towards a lateral recess and a neural foramen in a patient, wherein the cannulated probe comprises an inner cannula having a distal end and an outer cannula having a distal end; pushing the distal end of the inner cannula out of the distal end of the outer cannula and extending the distal end of the inner cannula further toward the neural foramen; pushing a distal end of an elongate member out of the distal end of the inner cannula and through the neural foramen and around an anterior portion of a facet joint and posterior to a spinal disc; and pushing the distal end of the elongate member out of the patient at a second location, wherein a portion of the elongate member remains curved around the facet joint while a proximal end of the elongate member extends out of the patient through the first surgical incision. - View Dependent Claims (24, 25)
-
-
26. A method to achieve access to a compressed space in spinal anatomy, the method comprising:
-
advancing a distal portion of a cannulated probe via a first surgical incision towards a lateral recess and a neural foramen in a patient; pushing a distal end of a guidewire from a distal end of the cannulated probe, further advancing the distal end of the guidewire through the neural foramen and around an anterior portion of a facet joint and posterior to a spinal disc; pushing the distal end of the guidewire out of the patient via a second incision, wherein a portion of the guidewire remains curved around the facet joint while a proximal end of the guidewire extends out of the patient through the first surgical incision; removably coupling a distal end of a device to the proximal end of the guidewire outside of the patient after passing the guidewire through the neural foramen and around an anterior portion of a facet joint and posterior to a spinal disc; and pulling the device through the neural foramen using the guidewire, wherein the device is selected from the group consisting of a stimulation element, an abrasion element, a cutting element, a shaving element, and an ablation element. - View Dependent Claims (27, 28)
-
-
29. A method to achieve access to a compressed space in spinal anatomy, the method comprising:
-
advancing a distal portion of a cannulated probe via a surgical incision towards a lateral recess and a neural foramen in a patient; extending a first end of a second element from a distal end of the cannulated probe and through the neural foramen and at least partially around an anterior portion of a facet joint and posterior to a spinal disc; extending the first end of the second element out of the patient, wherein a portion of the second element remains curved around the facet joint; and delivering an electric current using the second element to assess the position of the second element relative to neural tissue.
-
-
30. A method to achieve access to a compressed space in spinal anatomy, the method comprising:
-
advancing a distal portion of a cannulated probe via a surgical incision towards a lateral recess and a neural foramen in a patient; extending a first end of a second element from a distal end of the cannulated probe and through the neural foramen and at least partially around an anterior portion of a facet joint and posterior to a spinal disc; extending the first end of the second element out of the patient, wherein a portion of the second element remains curved around the facet joint; attaching a tissue modification device to at least one of the ends of the second element to guide advancement of the tissue modification device into the spinal anatomy, where the tissue modifying device comprises a device selected from the group consisting of an abrasion element, a cutting element, a shaving element, an ablation element; and coupling the tissue modifying device to an apparatus having at least one gear adapted to move the tissue modifying device.
-
Specification