Multiple pathways for spinal nerve root decompression from a single access point

• US 8,092,456 B2
• Filed: 01/13/2009
• Issued: 01/10/2012
• Est. Priority Date: 10/15/2005
• Status: Active Grant

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Baxano, Inc. (Baxano Surgical, Inc.)
• Inventors: Bleich, Jeffery L., Sheinberg, Michael, Wallace, Michael P.
• Primary Examiner(s): Barrett, Thomas C.
• Assistant Examiner(s): BATES, DAVID W
• Application Number:
  US12/352,978
• Publication Number:
  US 20090177241A1
• Time in Patent Office: 1,092 Days
• Field of Search: 606/74, 606/79, 606/85
• US Class Current: 606/79
• 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 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3447 : Linked multiple cannulas
• 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 1/08 : Arrangements or circuits for monitoring, protecting, controlling or indicating for external stimulators A61N1/3603; for implantable neurostimulators A61N1/36128; for heart stimulators A61N1/37; for defibrillators A61N1/3925

Abstract

A method of accessing target tissue adjacent to a spinal nerve of a patient includes the steps of accessing a spine location of the patient by entering the patient through the skin at an access location, inserting a flexible tissue modification device through the access location to the spine location, advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location, passing through the first exit location and out of the patient, advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location, and passing through the second exit location and out of the patient.

Claims

1. A method of accessing target tissue adjacent to a spinal nerve of a patient, comprising:

accessing a spine location of the patient through the skin at an access location that is anterior to the posterior aspect of the ligamentum flavum and posterior to the dura mater of the spinal cord and cauda equina;

inserting a first flexible tissue modification device through the access location to the spine location;

advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location;

passing through the first exit location and out of the patient;

advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location;

passing through the second exit location and positioning the first or second flexible device at least partially around a target tissue;

passing through the second exit location and out of the patient;

moving the first or second flexible device against the target tissue by pulling the first or second flexible device from at least one of the distal or proximal end of the first or second flexible device; and

modifying the target tissue with the first or second flexible device.

2. The method of claim 1, further comprising the step of removing the first flexible tissue modification device from the patient.

3. The method of claim 2, further comprising the step of removing the second flexible tissue modification device from the patient.

4. The method of claim 1, wherein the step of advancing the first or the second flexible tissue modification device to a first or second exit location comprises advancing the first or the second flexible tissue modification device to a first or second intervertebral foramen.

5. The method of claim 4, wherein the step of passing through a first or a second exit location comprises leaving a proximal portion of the first or the second flexible tissue modification in the first or second intervertebral foramen.

6. The method of claim 1, further comprising the steps of:

inserting the first, the second, or a third flexible device through the same access location to the spine location; and

advancing the first, the second or the third flexible device from the spine location to a third exit location.

7. The method of claim 1, wherein first exit location and the second exit location are ipsilateral to the access location.

8. The method of claim 1, wherein first exit location is ipsilateral to the access location and the second exit location is contralateral to the access location.

9. The method of claim 1, wherein first exit location and the second exit location are cephalad to the access location.

10. The method of claim 1, wherein first exit location is cephalad to the access location and the second exit location is caudal to the access location.

11. The method of claim 1, wherein the step of accessing a spine location of the patient through an access location comprises accessing a spine location of the patient through an interlaminar window of the patient.

12. The method of claim 11, wherein the step of accessing a spine location of the patient through an interlaminar window is achieved without removing a portion of the patient'"'"'s lamina.

13. The method of claim 1, wherein the step of accessing a spine location of the patient through an access location comprises advancing an access device through the access location to the spine location.

14. The method of claim 13, wherein the step of advancing the access device through the access location to the spine location comprises advancing the access device into a midline portion of the back of the patient, lateral to a spinous process, and toward the spine location.

15. The method of claim 13, wherein the step of advancing an access device through the access location to the spine location comprises advancing a needle percutaneously through the access location to the spine location.

16. The method of claim 13, wherein the step of advancing an access device through the access location to the spine location comprises advancing the access device into a lateral side of the back of the patient, through an intervertebral foramen, and toward the spine location.

17. The method of claim 13, wherein the step of advancing the first flexible device from the spine location to the first exit location comprises advancing at least a portion of a probe through the access device from the spine location toward the first exit location, and advancing a guidewire through the probe such that the guidewire is positioned at least partially around a target tissue.

18. The method of claim 17, wherein the step of passing through the first or second exit location and out of the patient comprises advancing the guidewire through the first or second exit location and exiting the patient with the guidewire.

19. The method of claim 1, wherein the step of advancing the first flexible device from the spine location to a first exit location comprises advancing the first flexible device from the spine location, anterior to a superior articular process, and through a first intervertebral foramen;

and wherein the step of advancing the first or the second flexible device from the spine location to the second exit location comprises advancing the first or second flexible device from the spine location, anterior to a superior articular process, and through a second intervertebral foramen.

20. The method of claim 1, wherein the step of advancing the first flexible device from the spine location to the first exit location comprises advancing the first flexible device from the spine location, anterior to a superior articular process and cephalad to a pedicle, and through a intervertebral foramen;

and wherein the step of advancing the first or second flexible device from the spine location to the second exit location comprises advancing the first or second flexible device from the spine location, anterior to a lamina and caudal to the pedicle, and through a second intervertebral foramen.

21. The method of claim 1, wherein the step of advancing the first or second flexible device from the spine location to the first or second exit location comprises advancing a guidewire from the spine location to the first or second exit location and pulling the flexible device around a target tissue using the guidewire.

22. The method of claim 21, wherein the step of passing through the first or second exit location and out of the patient comprises advancing through the first or second intervertebral foramen and exiting the patient percutaneously with the guidewire.

23. The method of claim 1, wherein the step of positioning the first or second flexible device at least partially around the target tissue comprises positioning the first or second flexible device anterior to a superior articular process and posterior to neuronal tissue.

24. The method of claim 23, wherein the step of positioning the first or second flexible device at least partially around the target tissue comprises positioning the flexible device within a portion of a ligamentum flavum.

25. The method of claim 1, wherein the step of moving the first or second flexible device against a target tissue by pulling the first or second flexible device from at least one of the distal or proximal end of the device comprises applying tension to both the proximal end and the distal end of the first or second flexible device to drive the flexible device against the target tissue.

26. The method of claim 25, wherein the step of advancing the first or second flexible device from the spine location to a first or second exit location comprises advancing a guidewire from the spine location to the first or second exit location, advancing the guidewire through the first or second exit location to exit the patient, and pulling the first or second flexible device around a target tissue using the guidewire.

27. The method of claim 25, wherein the step of applying tension to both the proximal end and the distal end of the first or second flexible device to drive the first or second flexible device against the target tissue comprises applying tension to the distal end of the first or second flexible device using the guidewire.

28. The method of claim 25, wherein applying tension to the distal end of the first or second flexible device using the guidewire comprises applying tension to the distal end of the guidewire external to the patient and a proximal end of the guidewire external to the patient.

29. The method of claim 1, wherein the step of modifying a target tissue with the first or second flexible device comprises modifying the target tissue with a flexible radio-frequency device.

30. The method of claim 1, wherein the step of modifying a target tissue with a first or second flexible device comprises modifying the target tissue with a flexible abrasion device.

31. The method of claim 1, wherein the step of modifying a target tissue with the flexible device comprises modifying the target tissue with a flexible rongeur device.

32. The method of claim 1, further comprising the step of detecting neuronal tissue near the first or second flexible device.

33. The method of claim 32, wherein the step of detecting neuronal tissue near the first or second flexible device comprises detecting neuronal tissue with the first or second flexible device.

34. A method of accessing target tissue adjacent to a spinal nerve of a patient, the method comprising:

accessing a spine location of the patient by entering the patient through an access location, wherein the spine location is anterior to the posterior aspect of the ligamentum flavum and posterior to the dura mater of the spinal cord and cauda equina, and the access location is lateral to the spinous process;

inserting a first flexible device through the access location, through the interlaminar window, and to the spine location;

advancing a distal portion of the first flexible device from the spine location, laterally through a first intervertebral foramen;

passing through the first intervertebral foramen and out of the patient;

inserting the first or a second flexible device through the same access location, through the interlaminar window, and to the spine location; and

advancing a distal portion of the first or second flexible device from the spine location and laterally through a second intervertebral foramen and positioning the first or second flexible device at least partially around a target tissue;

passing through the second intervertebral foramen and out of the patient;

moving the first or second flexible device against the target tissue by pulling the first or second flexible device from at least one of the distal or proximal end of the first or second flexible device; and

modifying the target tissue with the first or second flexible device.

35. The method of claim 34, wherein the step of inserting the first or second flexible device through the access location, through the interlaminar window, and to the spine location is achieved without removing a portion of the patient'"'"'s lamina.

36. The method of claim 34, wherein the step of advancing the first flexible device from the spine location and laterally through a first intervertebral foramen comprises advancing the first flexible device anterior to the ipsilateral superior articular process.

37. The method of claim 36, wherein the step of advancing the first flexible device from the spine location and laterally through a first intervertebral foramen comprises positioning the first flexible device posterior to and adjacent to a first nerve root, wherein the first nerve root exits through the first intervertebral foramen, wherein the first intervertebral foramen is defined by the same vertebra that define the interlaminar window.

38. The method of claim 37, wherein the step of positioning the first flexible device posterior to the first nerve root comprises positioning the first flexible device posterior to and adjacent to the exiting portion of the first nerve root.

39. The method of claim 34, wherein the step of advancing the first or second flexible device from the spine location and laterally through a second intervertebral foramen comprises advancing the first or second flexible device anterior to the lamina.

40. The method of claim 39, wherein the step of advancing the first or second flexible device from the spine location and laterally through a second intervertebral foramen comprises positioning the flexible device posterior to and adjacent to a second nerve root, wherein the second nerve root exits through the second intervertebral foramen, wherein the second intervertebral foramen is caudal to the first intervertebral foramen.

41. The method of claim 40, wherein the step of positioning the first or second flexible device posterior to the second nerve root comprises positioning the first or second flexible device posterior to and adjacent to the traversing portion of the second nerve root.

42. The method of claim 34, wherein the step of advancing the first flexible device from the spine location and laterally through a first intervertebral foramen comprises advancing the first flexible device anterior to a contralateral superior articular process and through a contralateral intervertebral foramen, wherein the contralateral superior articular process and the contralateral intervertebral foramen are contralateral to the access location.

43. The method of claim 34, wherein the step of advancing the first or second flexible device from the spine location, laterally through the second intervertebral foramen comprises advancing the flexible device anterior to the lamina, and through the caudal intervertebral foramen, wherein the lamina and the caudal intervertebral foramen are contralateral to the access location and the caudal intervertebral foramen is caudal to the first intervertebral foramen.

44. The method of claim 34, wherein the step of advancing the first or second flexible device from the spine location and laterally through the first or second intervertebral foramen comprises positioning the first or second flexible device at least partially around a target tissue.

45. The method of claim 44, wherein the step of positioning the first or second flexible device at least partially around the target tissue comprises positioning the first or second flexible device between within a portion of a ligamentum flavum.

46. The method of claim 34, wherein the steps of modifying the target tissue with the first or second flexible device comprises decompressing a nerve root of the patient at multiple locations along the nerve root.

47. The method of claim 46, wherein decompressing the nerve root of the patient at multiple locations along the nerve root comprises decompressing the nerve root at least two of a central canal, a lateral recess, and through the first or second intervertebral foramen.

48. A method of accessing target tissue adjacent to a spinal nerve of a patient, comprising:

accessing a spine location of the patient through the skin at an access location that is anterior to the posterior aspect of the ligamentum flavum and posterior to the dura mater of the spinal cord and cauda equina;

inserting a first flexible tissue modification device through the access location to the spine location;

advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location;

passing through the first exit location and out of the patient;

advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location;

passing through the second exit location and out of the patient; and

detecting neuronal tissue near the first or second flexible device.

49. A method of accessing target tissue adjacent to a spinal nerve of a patient, comprising:

accessing a spine location of the patient through the skin at an access location that is anterior to the posterior aspect of the ligamentum flavum and posterior to the dura mater of the spinal cord and cauda equina;

inserting a first flexible tissue modification device through the access location to the spine location;

advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location;

passing through the first exit location and out of the patient;

advancing the first flexible tissue modification device through the same access location to the spine location and to a second exit location; and

passing through the second exit location and out of the patient.