Access and tissue modification systems and methods

• US 9,320,618 B2
• Filed: 10/25/2013
• Issued: 04/26/2016
• Est. Priority Date: 10/15/2004
• Status: Active Grant

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Amendia, Inc. (Spinal Elements, Inc.)
• Inventors: Schmitz, Gregory P., Wallace, Michael P., Bleich, Jeffery L., Arcenio, Gregory B., Leguidleguid, Ronald, Leguidleguid, Roy, Bleam, Jefferey, Tang, Winnie, Borgstrom, Amie R.
• Primary Examiner(s): BOLES, SAMEH RAAFAT
• Application Number:
  US14/064,085
• Publication Number:
  US 20140107709A1
• Time in Patent Office: 914 Days
• Field of Search: 606/79, 606/85, 606/103, 606/110, 606/119, 606/131, 606/1, 606/63, 606171-176, 606/167
• US Class Current: 1/1
• CPC Class Codes: A61B 10/0275 with sample notch, e.g. on the side of inner stylet
• CPC Class Codes: A61B 10/0283 with vacuum aspiration, e.g. caused by retractable plunger or by connected syringe A61B10/025, A61B10/0266 take precedence
• 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 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/149 Chain, wire or band saws
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1611 the two jaw elements being integral with respective elongate shaft elements
• CPC Class Codes: A61B 17/1626 Control means; Display units
• CPC Class Codes: A61B 17/1635 for grafts, harvesting or transplants
• 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 17/1757 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 17/3207 Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions A61B17/32037 takes precedence; endoscopic cutting instruments A61B17/320016
• CPC Class Codes: A61B 17/320708 Curettes, e.g. hollow scraping instruments
• 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 17/320783 through side-hole, e.g. sliding or rotating cutter inside catheter
• 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 17/3468 : for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• 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 17/683 : comprising bone transfixation elements, e.g. bolt with a distal cooperating element such as a nut
• CPC Class Codes: A61B 17/7065 : Devices with changeable shape, e.g. collapsible or having retractable arms to aid implantation; Tools therefor
• CPC Class Codes: A61B 17/7068 : Devices comprising separate rigid parts, assembled in situ, to bear on each side of spinous processes; Tools therefor
• CPC Class Codes: A61B 17/7092 : for checking pedicle hole has correct depth or has an intact wall pedicle drill depth limiters A61B17/1626
• CPC Class Codes: A61B 17/842 : Flexible wires, bands or straps A61B17/72, A61B17/82, A61B17/86 take precedence
• CPC Class Codes: A61B 17/8897 : Guide wires or guide pins
• 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 18/14 : Probes or electrodes therefor
• 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 18/20 : using laser
• CPC Class Codes: A61B 2017/00039 : Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• 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 2017/00349 : Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00469 : for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61B 2017/00477 : Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/00557 : inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00867 : shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/00986 : Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
• CPC Class Codes: A61B 2017/0225 : flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/320004 : abrasive
• CPC Class Codes: A61B 2017/320008 : Scrapers
• 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 2017/320069 : for ablating tissue
• CPC Class Codes: A61B 2017/32007 : with suction or vacuum means
• 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 2018/00595 : Cauterization
• CPC Class Codes: A61B 2018/00601 : Cutting
• CPC Class Codes: A61B 2018/1407 : Loop
• CPC Class Codes: A61B 2018/1412 : Blade
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2018/1465 : Deformable electrodes
• CPC Class Codes: A61B 2034/2048 : using an accelerometer or inertia sensor
• CPC Class Codes: A61B 2090/0427 : Prevention of contact
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/08021 : of the patient or his organs
• CPC Class Codes: A61B 5/1076 : for measuring dimensions inside body cavities, e.g. using catheters A61B3/1005 takes precedence
• CPC Class Codes: A61B 5/1101 : Detecting tremor
• CPC Class Codes: A61B 5/389 : Electromyography [EMG]
• CPC Class Codes: A61B 5/395 : Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 5/407 : Evaluating the spinal cord A61B5/4896 takes precedence
• CPC Class Codes: A61B 5/7207 : of noise induced by motion artifacts
• 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 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61F 2/0063 : Implantable repair or support meshes, e.g. hernia meshes
• CPC Class Codes: A61F 2/4611 : of spinal prostheses
• CPC Class Codes: A61M 25/09041 : Mechanisms for insertion of guide wires
• CPC Class Codes: A61M 25/0905 : extendable, e.g. mechanisms for extension
• CPC Class Codes: A61N 1/0551 : Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 2001/0578 : having means for removal or extraction

Abstract

Described herein are methods and systems for precisely placing and/or manipulating devices within the body by first positioning a guidewire or pullwire. The device to be positioned within the body is coupled to the proximal end of the guidewire, and the device is pulled into the body by pulling on the distal end of the guidewire that extends from the body. The device may be bimanually manipulated by pulling the guidewire distally, and an attachment to a device that extends proximally, allowing control of both the proximal and the distal ends. In this manner devices (and particularly implants such as innerspinous distracters, stimulating leads, and disc slings) may be positioned and/or manipulated within the body. Guidewire exchange systems, devices and methods are also described. A guidewire may be exchanged between different surgical devices and may be releaseably or permanently coupled.

Claims

1. A method of performing a spinal fusion procedure on a patient, the method comprising:

inserting an access probe to the patient'"'"'s spine;

passing a guide wire through the access probe and through an opening in the spine;

removing the access probe from the spine while leaving the guide wire in the spine;

coupling a sizing device to the guide wire; and

pulling the sizing device to the spine with the guide wire, wherein coupling the sizing device to the guide wire comprises coupling the sizing device to a proximal end of the guide wire so that the sizing device may be pulled to the spine by pulling the distal end of the guide wire; and

coupling a rod to the guide wire; and

pulling the rod between two or more pedicle screws in the spine with the guide wire.

2. The method of claim 1, wherein inserting the access probe comprises inserting the access probe from a first side of the spine so that a distal end of the access probe extends to a contralateral side of the spine.

3. The method of claim 1, wherein passing the guide wire through the access probe comprises pushing the guide wire through the access probe so that a proximal end of the guide wire extends from the patient'"'"'s back at a first location, and a distal end of the guide wire extends from the patient'"'"'s back at a second location.

4. The method of claim 1, wherein removing the access probe comprises holding a distal end of the guide wire extending from the patient while withdrawing the access probe over a proximal end of the guide wire.

5. The method of claim 1, further comprising coupling a handle to a distal end of the guide wire extending from the patient'"'"'s back at a first location while a proximal end of the guide wire extends from the patient'"'"'s back at a second location.