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

• US 8,366,712 B2
• Filed: 12/06/2011
• Issued: 02/05/2013
• 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): Truong, Kevin T
• Assistant Examiner(s): BATES, DAVID W
• Application Number:
  US13/312,272
• Publication Number:
  US 20120078255A1
• Time in Patent Office: 427 Days
• Field of Search: 606/74, 606/79, 606/84, 606/85
• US Class Current: 606/79
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• 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 2017/0225 flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/0256 for the spine
• 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: A61N 1/0551 : Spinal or peripheral nerve electrodes

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 of a patient, comprising:

accessing, through an access location, a spine location of the patient;

inserting a flexible device through the access location to the spine location;

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

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

pulling in a tissue modification element through the access location to the spine location and positioning the tissue modification element at least partially around a target tissue;

modifying the target tissue with the tissue modification element;

advancing a distal portion of the flexible device from the spine location to a second exit location;

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

pulling in the first or a second tissue modification element through the access location to the spine location and positioning the tissue modification element at least partially around a second target tissue; and

modifying the second target tissue with the tissue modification element.

2. The method of claim 1, wherein the step of modifying the target tissue with the first or second tissue modification element comprises decompressing a nerve root of the patient at multiple locations along the nerve root.

3. The method of claim 2, 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 an intervertebral foramen.

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

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

6. The method of claim 5, wherein the step of advancing the probe through the access location to the spine location comprises advancing the flexible device through the probe to the spine location.

7. The method of claim 6, wherein the flexible device is a guidewire.

8. The method of claim 7, 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.

9. The method of claim 1, wherein the flexible device is a guidewire.

10. The method of claim 9, wherein the step of pulling in the first or a second tissue modification element comprises pulling the tissue modification element at least partially around the target tissue using the guidewire.

11. The method of claim 9, wherein the step of pulling in the first or a second tissue modification element comprises pulling in the tissue modification element that is integrally connected to a proximal end of the guidewire.

12. The method of claim 9, wherein the step of pulling in the first or a second tissue modification element comprises pulling in the tissue modification element having a guidewire coupler at the distal end that is coupled to a proximal end of the guidewire.

13. The method of claim 12, wherein the step of passing through the first or second exit location and out of the patient comprises exiting the patient percutaneously with the guidewire.

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

15. The method of claim 1, further comprising the step of detecting neural tissue near the first or second tissue modification element.

16. The method of claim 15, wherein the step of detecting neural tissue near the first or second tissue modification device comprises detecting neural tissue with the first or second tissue modification device.

17. The method of claim 15, further comprising pulling in a neural localization element through the access location to the spine location and positioning the neural localization element at least partially around a target tissue and detecting neural tissue with the neural localization element.

18. The method of claim 17, wherein the step of pulling in a neural localization element comprises pulling the neural localization element at least partially around a target tissue using the guidewire.

19. The method of claim 1, wherein the step of passing through the first exit location and out of the patient comprises passing through the skin and out of the patient.

20. A method of accessing target tissue 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 flexible device through the access location to the spine location;

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

pulling in a tissue modification element through the access location to the spine location and positioning the tissue modification element at least partially around a target tissue;

modifying the target tissue with the tissue modification element;

advancing a distal portion of the flexible device from the spine location, through a second intervertebral foramen, and out of the patient;

pulling in the first or a second tissue modification element through the access location to the spine location and positioning the tissue modification element at least partially around a second target tissue; and

modifying the second target tissue with the tissue modification element.

21. The method of claim 20, wherein the step of inserting the flexible device through the access location comprises inserting the flexible device through an interlaminar window of the patient and to the spine location.

22. The method of claim 20, wherein the step of advancing the flexible device from the spine location comprises advancing the flexible device laterally from the spine location through the first intervertebral foramen.

23. The method of claim 20, wherein the step of advancing the flexible device from the spine location through a first intervertebral foramen comprises positioning the flexible device posterior to and adjacent to a first nerve root, wherein the first nerve root exits through the first intervertebral foramen.

24. The method of claim 20, wherein the step of advancing the flexible device from the spine location 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.

25. The method of claim 20, wherein the step of advancing a distal portion of the flexible device out of the patient comprises advancing a distal portion of the flexible device through the skin and out of the patient.