Safe cutting heads and systems for fast removal of a target tissue

• US 9,119,659 B2
• Filed: 08/22/2012
• Issued: 09/01/2015
• Est. Priority Date: 12/03/2011
• Status: Active Grant

• Current Assignee: Depuy Synthes Products Incorporated (Johnson & Johnson)
• Original Assignee: Ouroboros Medical Inc.
• Inventors: To, John
• Primary Examiner(s): COLEY, ZADE JAMES
• Application Number:
  US13/592,307
• Publication Number:
  US 20130144292A1
• Time in Patent Office: 1,105 Days
• Field of Search: 606 79- 80, 606 83- 86 R, 606/159, 606167-185, 606205-211
• US Class Current: 1/1
• 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 17/3205 Excision instruments
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00738 part of the tool being offset with respect to a main axis, e.g. for better view for the surgeon
• CPC Class Codes: A61B 2017/320064 with tissue or sample retaining means
• CPC Class Codes: A61B 2090/08021 of the patient or his organs
• CPC Class Codes: A61B 2217/002 Auxiliary appliance
• CPC Class Codes: A61F 2/44 for the spine, e.g. vertebrae, spinal discs
• CPC Class Codes: A61F 2002/444 for replacing the nucleus pulposus

Abstract

A safe and efficient cutting heads for removing a target tissue from a subject during a surgical procedure are provided, the cutting heads composing a part of systems that address several problems, including clogging of state-of-the-art systems during removal of such tissue, for example. The target tissue can include any tissue that is accessible through a small surgical opening, for example, a joint tissue such as a meniscus or an intervertebral tissue, such as a nucleus pulposus. The devices can be referred to as orthopedic tissue removal devices having cutting heads associated with vacuum systems, making the systems useful in several procedures, including X-LIF (lateral approach to an intervertebral fusions) procedures, T-LIF (transforaminal approach to intervertebral fusions) procedures, P-LIF (posterior approach to intervertebral fusions), and a percutaneous, transforaminal approach (Kambin triangle access).

Claims

1. A tubular cutting head for removing a nucleus pulposus of a subject, the cutting head comprising

an outer perimeter that circumscribes a lumen through the cutting head, the lumen having a central axis and in an operable communication with an at least substantially rigid tube;

and,

a cutting surface on a distal perimeter of the cutting head, the cutting surface having

a forward cutting blade having a forward-directed cutting surface on a distal edge of the outer perimeter, the forward cutting blade configured for (i) cutting the nucleus pulposus tissue in a forward stroke of the cutting head and (ii) excising and directing entry of the excised nucleus pulposus tissue into the lumen on the forward stroke;

and,

a blade guard positioned distal to the forward cutting blade and configured to guard an annulus fibrosis tissue from the forward cutting blade upon the forward stroke, the blade guard configured with

a first laterally-directed cutting surface configured for cutting the nucleus pulposus in a first transverse stroke of the cutting head in a first transverse direction, the first laterally-directed cutting surface adapted as a directional shift from the forward cutting direction of the forward cutting blade to the first transverse direction of the first laterally-directed cutting surface, the first laterally-directed cutting surface including an apex pointing away from a plane that geometrically bisects the blade guard and the central axis; and

,

a second laterally-directed cutting surface opposing the first laterally-directed cutting surface and configured for cutting the nucleus pulposus in a second transverse stroke of the cutting head in a second transverse direction, the second laterally-directed cutting surface adapted as a directional shift from the forward cutting direction of the forward cutting blade to the second transverse direction of the second laterally-directed cutting surface, the second laterally-directed cutting surface including an apex pointing away from the plane that geometrically bisects the blade guard and the central axis.

2. The cutting head of claim 1, wherein the blade guard also has a backward cutting blade having a backward-directed cutting surface and configured with a barb to hook nucleus pulposus tissue for removal of the nucleus pulposus tissue in a backward stroke of the cutting head.

3. The cutting head of claim 1, wherein the first laterally-directed cutting surface, second laterally-directed cutting surface, or both also has a plurality of laterally-directed, serrated cutting surfaces.

4. The cutting head of claim 1, wherein the blade guard also has a backward cutting blade having a backward-directed cutting surface and configured with a barb to hook nucleus pulposus tissue for removal of the nucleus pulposus tissue in a backward stroke of the cutting head;

and, a plurality of sharp lateral cutting surfaces positioned on the blade guard, each of the lateral cutting surfaces adapted as the directional shift from a forward-directed cutting surface of the forward cutting blade.

5. The cutting head of claim 1, wherein the cutting head is formed from a single tube.

21. A method of removing a nucleus pulposus tissue from a subject, the method comprising:

creating an opening in a subject for access to a nucleus pulposus tissue;

inserting the cutting head of claim 1 through the opening to access the nucleus pulposus tissue in the subject;

forcing the cutting head in a forward direction on a surface comprising the nucleus pulposus tissue to remove the nucleus pulposus tissue, the forward direction including a force vector that moves (i) at least substantially on a plane containing the central axis of the lumen of the cutting head to excise the nucleus pulposus tissue and direct entry of the excised nucleus pulposus tissue into the lumen of the cutting head when forcing the cutting head in the forward direction, (ii) at least substantially on the surface comprising the nucleus pulposus tissue, and (iii) toward the annulus fibrosis tissue that is protected by the blade guard;

capturing the nucleus pulposus tissue in the lumen of the cutting head when forcing the cutting head in the forward direction; and

,

removing the excised nucleus pulposus tissue through the lumen and out of the subject through a suction assembly.

22. The method of claim 21, the cutting head further comprising a backward cutting blade having a backward-directed cutting surface and configured with a barb to hook nucleus pulposus tissue for removal of the nucleus pulposus tissue in a backward stroke of the cutting head, and the method further comprising forcing the cutting head in a backward direction on a surface comprising the nucleus pulposus tissue to remove the nucleus pulposus tissue, the backward direction including a force vector that moves (i) at least substantially on a plane containing the central axis of the lumen of the cutting head, (ii) at least substantially on the surface comprising the nucleus pulposus tissue, and (iii) away from the annulus fibrosis tissue that is protected by the blade guard.

23. The method of claim 21, further comprising forcing the cutting head in a transverse direction on a surface comprising the nucleus pulposus tissue to remove the nucleus pulposus tissue, the transverse direction including a force vector that moves (i) at an angle ranging from about 15°

to about 150°

from a plane containing the central axis of the lumen of the cutting head, (ii) at least substantially on the surface comprising the nucleus pulposus tissue, and (iii) in contact with the annulus fibrosis tissue that is protected by the blade guard.

24. The method of claim 2, wherein the cutting head is formed from a single tube.

6. A surgical, nucleus pulposus removal system, comprising:

a tubular cutting head adapted for removing a target tissue of a subject, the cutting head having

an outer perimeter that circumscribes a lumen through the cutting head, the lumen having a central axis and in an operable communication with an at least substantially rigid tube;

a cutting surface on a distal perimeter of the tubular cutting head, the cutting surface having

a forward cutting blade having a forward-directed cutting surface on a distal edge of the outer perimeter, the forward cutting blade configured for (i) cutting the nucleus pulposus tissue in a forward stroke of the cutting head and (ii) excising and directing entry of the excised nucleus pulposus tissue into the lumen on the forward stroke; and

,

a blade guard positioned distal to the forward cutting blade and configured to guard an annulus fibrosis tissue from the forward cutting blade upon the forward stroke, the blade guard configured with

a first laterally-directed cutting surface configured for cutting the nucleus pulposus in a first transverse stroke of the cutting head in a first transverse direction, the first laterally-directed cutting surface adapted as a directional shift from the forward cutting direction of the forward cutting blade to the first transverse direction of the first laterally-directed cutting surface, the first laterally-directed cutting surface including an apex pointing away from a plane that geometrically bisects the blade guard and the central axis; and

,

a second laterally-directed cutting surface opposing the first laterally-directed cutting surface and configured for cutting the nucleus pulposus in a second transverse stroke of the cutting head in a second transverse direction, the second laterally-directed cutting surface adapted as a directional shift from the forward cutting direction of the forward cutting blade to the second transverse direction of the second laterally-directed cutting surface, the second laterally-directed cutting surface including an apex pointing away from the plane that geometrically bisects the blade guard and the central axis,

wherein, the cutting head is configured for an operable communication between the lumen and a source of a suction, the outer perimeter adapted to circumscribe a flow of suction through the cutting head;

and,

a suction assembly in operable communication with the cutting head, the suction assembly comprising an at least substantially rigid suction tube with a central axis and creating the flow of suction for removing the excised nucleus pulposus tissue through the lumen and out of the subject.

7. The system of claim 6, wherein the blade guard is also the backward cutting blade, the guard having a double-edged blade tip that points back into the lumen at an angle, θ

₂, of greater than 90°

to trap tissue, cut tissue, or trap and cut tissue in the lumen in the backwards stroke of the cutting head.

8. The system of claim 6, wherein the central axis of the lumen is at an angle, θ

₁, ranging from about 5°

to about 90°

from the central axis of the rigid suction tube, and the forward cutting blade is located about 3 mm to about 25 mm from the vertex of the angle, θ

₁.

9. The system of claim 6, wherein the central axis of the lumen has a point of exit at the forward cutting blade, and the point of exit is located at a transverse distance of about 3 mm to about 25 mm that is orthogonal to the central axis of the rigid suction tube.

10. The system of claim 6, wherein the central axis of the lumen is at an angle, θ

₁, ranging from 1°

to 180°

from the central axis of the rigid suction tube, and the forward cutting blade is located 3 mm to 25 mm from the vertex of the angle, θ

₁;

wherein, an additional angle, θ

₃, is located 5 mm to 25 mm proximal to θ

₁;

angles θ

₁ and θ

₃ are independently selected to range from about 0°

to about 180°

, with the limitation that

(i) the net angle, θ

₄, between the central axis of the lumen of the cutting head and the central axis of the rigid suction tube located proximal to θ

₃ ranges from 0°

to 90°

; and

,

(ii) the central axis of the lumen has a point of exit at the forward cutting blade, and the point of exit is located at a transverse distance of about 3 mm to about 25 mm that is orthogonal to the central axis of the rigid suction tube.

11. The system of claim 6, wherein the cutting head is formed from a single tube.

12. A surgical, tissue removal system for a discectomy, comprising:

a tubular cutting head adapted for removing a nucleus pulposus tissue from a subject, the cutting head having

an outer perimeter that circumscribes a lumen through the cutting head, the lumen having a central axis and in an operable communication with an at least substantially rigid tube;

a cutting surface on a distal perimeter of the tubular cutting head, the cutting surface having

a forward cutting blade having a forward-directed cutting surface on a distal edge of the outer perimeter and configured for (i) cutting and excising the nucleus pulposus tissue in a forward stroke of the cutting head and (ii) directing entry of the cut and excised nucleus pulposus into the lumen on the forward stroke;

and,

a blade guard positioned distal to the forward cutting blade and configured to guard an annulus fibrosis tissue from the forward cutting blade upon the forward stroke, the blade guard including a transverse cutting blade having a plurality of laterally-directed cutting surfaces including a first laterally-directed cutting surface and a second laterally-directed cutting surface that opposes the first laterally-directed cutting surface, the first laterally-directed cutting surface and the second laterally-directed cutting surface each configured for cutting and excising the nucleus pulposus in a respective first and second transverse stroke of the cutting head, each of the laterally-directed cutting surfaces adapted as a directional shift from the forward-directed cutting surface of the forward cutting blade to a laterally-directed cutting surface, the first laterally-directed cutting surface and the second laterally-directed cutting surface each including an apex pointed away from a plane that geometrically bisects the blade guard and the central axis;

and,

a suction assembly in operable communication with the cutting head, the suction assembly comprising an at least substantially rigid suction tube with a central axis and creating the flow of suction for removing the nucleus pulposus tissue through the lumen and out of the subject.

13. The system of claim 12, wherein the central axis of the lumen of the cutting head is at an angle, θ

₁, ranging from about 5°

to about 90°

from the central axis of the rigid suction tube, and the forward cutting blade is located about 3 mm to about 25 mm from the vertex of the angle, θ

₁.

14. The system of claim 12, wherein the central axis of the lumen of the cutting head has a point of exit at the forward cutting blade, and the point of exit is located at a transverse distance of about 3 mm to about 25 mm that is orthogonal to the central axis of the rigid suction tube.

15. The system of claim 12, wherein the plurality of cutting surfaces include serrations.

16. The system of claim 12, wherein the central axis of the lumen is at an angle, θ

₁, ranging from 1°

to 180°

from the central axis of the rigid suction tube, and the forward cutting blade is located 3 mm to 25 mm from the vertex of the angle, θ

₁;

wherein, an additional angle, θ

₃, is located 5 mm to 25 mm proximal to θ

₁;

angles θ

₁ and θ

₃ are independently selected to range from about 0°

to about 180°

, with the limitation that

(i) the net angle, θ

₄, between the central axis of the lumen of the cutting head and the central axis of the rigid suction tube located proximal to θ

₃ ranges from 0°

to 90°

; and

,

(ii) the central axis of the lumen has a point of exit at the forward cutting blade, and the point of exit is located at a transverse distance of about 3 mm to about 25 mm that is orthogonal to the central axis of the rigid suction tube.

17. The system of claim 12, further comprising a backward cutting blade having a backward-directed cutting surface and configured with a barb to hook nucleus pulposus tissue for removal of the nucleus pulposus tissue in a backward stroke of the cutting head, wherein the backward cutting blade is configured as a talon, positioned on the distal edge of the outer perimeter for cutting the nucleus pulposus tissue in the backward stroke of the cutting head.

18. The system of claim 12, wherein the blade guard is also a backward cutting blade, the guard having a double-edged blade tip point back into the lumen at an angle, θ

₂, of greater than 90°

to trap tissue, cut tissue, or trap and cut tissue in the lumen in the backwards stroke of the cutting head.

19. The system of claim 12, wherein the cutting surface is serrated, and the transverse cutting blade has two opposing laterally-directed cutting surfaces adapted as a directional shift from the forward-directed cutting surface of the forward cutting blade to each of the two opposing respective sharp laterally-directed cutting surfaces for cutting the nucleus pulposus tissue in the transverse stroke of the cutting head.

20. The system of claim 12, wherein the cutting head is formed from a single tube.