Denervation methods

• US 9,023,038 B2
• Filed: 12/20/2013
• Issued: 05/05/2015
• Est. Priority Date: 09/30/2002
• Status: Expired due to Fees

• Current Assignee: Relievant Medsystems, Incorporated (Boston Scientific Corporation)
• Original Assignee: Relievant Medsystems, Incorporated (Boston Scientific Corporation)
• Inventors: Pellegrino, Richard, Patel, Samit, Carrison, Harold
• Primary Examiner(s): Peffley, Michael
• Assistant Examiner(s): GIULIANI, THOMAS ANTHONY
• Application Number:
  US14/136,763
• Publication Number:
  US 20140316405A1
• Time in Patent Office: 501 Days
• Field of Search: 606/41, 607/99, 607/101, 607/117
• US Class Current: 606/41
• CPC Class Codes: A61B 17/1642 for producing a curved bore
• CPC Class Codes: A61B 17/1671 for the spine
• 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 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 17/3472 for bones, e.g. intraosseus injections
• CPC Class Codes: A61B 17/8805 for introducing fluid filler into bone or extracting it A61B17/7097, A61B17/8833 take precedence
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1487 Trocar-like, i.e. devices producing an enlarged transcutaneous opening
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 18/16 Indifferent or passive electrodes for grounding
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 2017/00331 with preformed bends
• CPC Class Codes: A61B 2017/3405 using mechanical guide means
• CPC Class Codes: A61B 2017/3454 Details of tips
• CPC Class Codes: A61B 2018/00017 with gas
• CPC Class Codes: A61B 2018/00339 Spine, e.g. intervertebral disc
• CPC Class Codes: A61B 2018/0044 Spinal cord
• CPC Class Codes: A61B 2018/00565 : Bone
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1475 : Electrodes retractable in or deployable from a housing
• CPC Class Codes: A61F 7/007 : characterised by electric heating
• CPC Class Codes: A61N 1/0551 : Spinal or peripheral nerve electrodes

Abstract

System and methods for channeling a path into bone include a trocar having a proximal end, distal end and a central channel disposed along a central axis of the trocar. The trocar includes a radial opening at or near the distal end of the trocar. The system includes a curveable cannula sized to be received in the central channel, the curveable cannula comprising a curveable distal end configured to be extended laterally outward from the radial opening in a curved path extending away from the trocar. The curveable cannula has a central passageway having a diameter configured allow a probe to be delivered through the central passageway to a location beyond the curved path.

Claims

1. A method of denervating a nerve within a vertebral body, comprising:

inserting a curved stylet within a lumen of a curved cannula such that a distal end of the curved stylet extends beyond an open distal end of the curved cannula;

inserting the curved cannula and the curved stylet together within an inner cancellous bone region of the vertebral body;

advancing the curved cannula and the curved stylet together toward a midline of the vertebral body, thereby forming a curved path within the inner cancellous bone region of the vertebral body;

removing the curved stylet from the curved cannula;

inserting a channeling stylet within the lumen of the curved cannula,

wherein the channeling stylet is flexibly deformable to navigate the curved cannula yet retain a straight form upon exiting the open distal end of the curved cannula;

advancing a distal end of the channeling stylet out of the open distal end of the curved cannula and beyond the curved path to form a linear path;

removing the channeling stylet;

inserting an energy delivery device through the curved cannula and positioning a distal end of the energy delivery device within the linear path, and

delivering energy to the inner cancellous bone region of the vertebral body sufficient to denervate at least a portion of a basivertebral nerve within the vertebral body.

2. The method of claim 1, wherein the energy delivery device comprises a bipolar radiofrequency energy delivery probe having two electrodes configured to generate a current to heat tissue disposed between the two electrodes.

3. The method of claim 1, wherein said denervation comprises ablation or necrosis of the basivertebral nerve.

4. The method of claim 1, further comprising removing the energy delivery device and the cannula.

5. The method of claim 1, wherein the energy delivery device comprises a flexible shaft.

6. The method of claim 1, wherein said denervation of the portion of the basivertebral nerve denervates an entire downstream portion of the basivertebral nerve.

7. The method of claim 1, wherein the energy delivery device is configured to deliver ultrasound energy.

8. The method of claim 1, wherein the energy delivery device is configured to deliver laser energy.

9. A method of denervating a nerve within a vertebral body, comprising:

inserting a curved stylet within a lumen of a curved cannula;

inserting the curved cannula and the curved stylet together within an inner cancellous bone region of the vertebral body through an introducer;

forming a curved path toward a treatment location within the inner cancellous bone region by advancing the curved cannula and the curved stylet together toward the treatment location;

removing the curved stylet from the curved cannula;

inserting a straight channeling stylet within the lumen of the curved cannula,

advancing a distal end of the straight channeling stylet out of an open distal end of the curved cannula and beyond an end of the curved path to form a linear working channel at the treatment location;

removing the straight channeling stylet;

inserting a treatment device through the curved cannula and positioning a distal end of the treatment device within the linear working channel, and

denervating at least a portion of a basivertebral nerve using the treatment device.

10. The method of claim 9, further comprising inserting a distal end of the introducer through cortical bone of the vertebral body to the inner cancellous bone region.

11. The method of claim 9, wherein the treatment device comprises an energy delivery device.

12. The method of claim 11, wherein the energy delivery device comprises a bipolar radiofrequency energy delivery probe having two electrodes configured to generate a current to heat tissue disposed between the two electrodes.

13. The method of claim 11, wherein the energy delivery device is configured to deliver ultrasound energy.

14. The method of claim 11, wherein the energy delivery device is configured to deliver laser energy.

15. The method of claim 9, wherein the treatment device comprises a fluid delivery device.

16. The method of claim 9, wherein the straight channeling stylet retains a straight form upon exiting the curved cannula.

17. The method of claim 9, further comprising performing a diagnostic evaluation of the treatment location.