Devices and methods for tissue modification

• US 8,579,902 B2
• Filed: 03/26/2012
• Issued: 11/12/2013
• Est. Priority Date: 10/15/2004
• Status: Active Grant

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Baxano Signal Incorporated
• Inventors: Bleich, Jeffery L., Hlavka, Edwin J., Saadat, Vahid, Spisak, Steven A., Miller, David R., Yurchenco, James R.
• Primary Examiner(s): BOLES, SAMEH RAAFAT
• Application Number:
  US13/430,500
• Publication Number:
  US 20120184809A1
• Time in Patent Office: 596 Days
• Field of Search: 606/79, 606/85, 606/103, 606/110, 606/119, 606/131, 606/163, 606171-176, 606/167
• US Class Current: 606/79
• CPC Class Codes: A61B 1/3135 for examination of the epidural or the spinal space
• CPC Class Codes: A61B 17/149 Chain, wire or band saws
• CPC Class Codes: A61B 17/1659 Surgical rasps, files, planes, or scrapers
• 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
• CPC Class Codes: A61B 2017/00907 for light
• CPC Class Codes: A61B 2017/320004 : abrasive
• CPC Class Codes: A61B 2017/320044 : Blunt dissectors
• 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
• 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: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• 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

Described herein are methods for achieving access to a compressed space in spinal anatomy. In some embodiments, a method for achieving access may include the steps of advancing a distal portion of a cannulated probe toward a neural foramen from a lateral side of the foramen, extending a first end of a elongate member from a distal end of the cannulated probe and through the neural foramen from the lateral side to a medial side of the foramen and at least partially around an anterior portion of a facet joint and posterior to a spinal disc, and extending the first end of the elongate member out of the patient, wherein a portion of the elongate member remains curved around the facet joint. In some embodiments, the method may further include the step of extending a first end of an inner cannula from a distal end of the cannulated probe.

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 toward a neural foramen from a lateral side of the foramen;

extending a first end of a elongate member from a distal end of the cannulated probe and through the neural foramen from the lateral side to a medial side of the 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 elongate member out of the patient, wherein a portion of the elongate member remains curved around the facet joint.

2. The method of claim 1, wherein the step of extending a first end of a elongate member further comprises extending a first end of a guidewire preconfigured to have a curved shape.

3. The method of claim 1, further comprising using an endoscope to advance at least one of the distal portion of the cannulated probe or the second element.

4. The method of claim 1, wherein the cannulated probe further comprises an endoscopic channel such that at least one of the advancing and extending steps is performed under endoscopic guidance.

5. The method of claim 1, further comprising the step of withdrawing the cannulated probe from the patient.

6. The method of claim 5, wherein the cannulated probe is withdrawn, leaving the elongate member in place transforaminally to provide access to the lateral recess and neural foramen.

7. The method of claim 1, further comprising attaching a tissue modification device to the first end of the elongate member and advancing the device into the spinal anatomy in a medial to lateral direction.

8. The method of claim 1, further comprising attaching a tissue modification device to the second end of the elongate member and advancing the device into the spinal anatomy in a lateral to medial direction.

9. The method of claim 1, wherein the step of extending the first end of the elongate member out of the patient comprises extending the first end of the elongate member out of the patient such that the distal end of the elongate member pierces the skin of a patient.

10. The method of claim 1, wherein the step of advancing a distal portion of a cannulated probe further comprises advancing a distal portion of a cannulated through a surgical incision.

11. The method of claim 10, wherein the elongate member is advanced through the neural foramen from the lateral side to a medial side of the foramen, at least partially around an anterior portion of a facet joint, back through the surgical incision, and out of the patient.

12. The method of claim 1, wherein visualization is used to ensure that the cannulated probe is advanced between the nerve root or ganglia and the facet joint complex.

13. The method of claim 1, wherein visualization is used to ensure that the elongate member is advanced between the nerve root or ganglia and the facet joint complex.

14. The method of claim 1, further comprising the step of making surgical incisions on either side of the foramen, wherein the elongate member is extended out of the patient through a second surgical incision.

15. The method of claim 1, further comprising the step of extending a first end of an inner cannula from a distal end of the cannulated probe and through the neural foramen from the lateral side to a medial side of the foramen and at least partially around an anterior portion of a facet joint and posterior to a spinal disc.

16. The method of claim 15, wherein the step of extending the first end of a elongate member from the first end of the cannulated probe comprises extending the first end of a elongate member from the first end of the inner cannula.

17. A method to achieve access to a compressed space in spinal anatomy, the method comprising:

advancing a distal portion of a cannulated probe toward a neural foramen in a patient from a lateral side of the foramen, 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 through a neural foramen from the lateral side toward a medial side of the foramen;

pushing a distal end of an elongate member out of the distal end of the inner cannula and through the neural foramen from the lateral side toward the medial side of the 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, 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.

18. The method of claim 17, wherein visualization is used to ensure that the cannulated probe is advanced between the nerve root or ganglia and the facet joint complex.

19. The method of claim 17, wherein visualization is used to ensure that the elongate member is advanced between the nerve root or ganglia and the facet joint complex.

20. The method of claim 17, wherein the step of pushing a distal end of an elongate member further comprises pushing a distal end of a guidewire preconfigured to have a curved shape.