Electrosurgical tissue treatment method

• US 9,345,537 B2
• Filed: 12/30/2010
• Issued: 05/24/2016
• Est. Priority Date: 12/30/2010
• Status: Active Grant

• Current Assignee: Avent Incorporated (Avanos Medical, Inc.)
• Original Assignee: Avent Incorporated (Avanos Medical, Inc.)
• Inventors: Harrison, Robert, Godara, Neil, Yu, Laura Man Yee
• Primary Examiner(s): Della, Jaymi
• Assistant Examiner(s): Vahdat, Khadijeh
• Application Number:
  US12/982,044
• Publication Number:
  US 20120172858A1
• Time in Patent Office: 1,972 Days
• Field of Search: 606 41- 50
• US Class Current: 1/1
• CPC Class Codes: A61B 17/22004 using mechanical vibrations, e.g. ultrasonic shock waves A61B17/225 takes precedence
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1477 Needle-like probes
• 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 18/1815 using microwaves
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00339 Spine, e.g. intervertebral disc
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00702 Power or energy
• CPC Class Codes: A61B 2018/00744 Fluid flow
• CPC Class Codes: A61B 2018/00797 measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00821 measured by a thermocouple
• CPC Class Codes: A61B 2018/00875 Resistance or impedance
• CPC Class Codes: A61B 2018/00994 combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
• CPC Class Codes: A61B 2018/1253 monopolar
• CPC Class Codes: A61B 2018/126 bipolar
• CPC Class Codes: A61B 2090/3966 Radiopaque markers visible in an X-ray image
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies

Abstract

Methods of treating spinal tissue of a patient'"'"'s body are disclosed, some including providing a system including an energy source and first and second probe assemblies, wherein each of the probe assemblies includes an electrically conductive energy delivery device electrically coupled to the energy source; inserting the energy delivery devices of the first and second probe assemblies into spaced-apart treatment sites for the spinal tissue; and delivering energy from the energy source to the spinal tissue through the energy delivery devices. Various options and modifications are possible. For example, energy may be delivered in both a bipolar manner and a monopolar manner, and at least one of the fist ad second probe assemblies may be repositioned before again delivering energy.

Claims

1. A method of treating spinal tissue of a patient'"'"'s body, the method comprising:

providing a system including an energy source having a first probe assembly and a second probe assembly, wherein the first probe assembly and the second probe assembly each include an electrically conductive energy delivery device electrically coupled to the energy source;

inserting a first introducer tube into the spinal tissue of the patient'"'"'s body lateral to a Superior Articular Process at a first insertion angle β

₁ from a saggital plane, wherein the first insertion angle β

₁ is from 20 degrees to 45 degrees;

advancing the first introducer tube until a distal tip of the first introducer tube reaches a medial border of a pedicle;

inserting a second tube at an opposing insertion angle β

₂ into the patient'"'"'s body on an opposite side of a Superior Articular Process than the first introducer such that the distal tip of the first introducer tube and a distal tip of the second introducer tube are located at spaced-apart treatment sites of the Superior Articular Process, wherein the opposing insertion angle β

₂ is substantially equal to the first angle β

₁;

inserting the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly into the first introducer tube and the second introducer tube, respectively;

delivering energy from the energy source to the spinal tissue through the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly so as to from a bipolar lesion;

repositioning at least one of the first probe assembly and the second probe assembly at a second insertion angle θ

that is less than the first insertion angle β

₁; and

delivering energy through at least one of the first probe assembly or the second probe assembly so as to from one or more monopolar lesions, wherein the one or more monopalar lesions overlap the bipolar lesion.

2. The method of claim 1, wherein the spinal tissue is selected from the group consisting of an intervertebral disc, spinal neural tissue, a vertebra, and portions thereof.

3. The method of claim 2, wherein the spinal tissue comprises an intervertebral disc and wherein the step of inserting the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly includes inserting the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly so that they are spaced-apart by a distance of less than about 15 mm.

4. The method of claim 2, wherein at least one of the first probe assembly and the second probe assembly is internally-cooled.

5. The method of claim 4, wherein the spinal tissue comprises the intervertebral disc and wherein the step of inserting the electrically conductive energy delivery devices of each of the first probe assembly at and the second probe assembly includes inserting the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly so that they are spaced-apart by a distance of less than about 35 mm.

6. The method of claim 4, further including the step of cooling at least one of the first probe assembly and the second probe assembly while the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly are located at the spaced-apart treatment sites.

7. The method of claim 4, wherein the at least one of the first probe assembly and the second probe assembly that is internally-cooled includes at least two tubular members disposed within a lumen for delivering a cooling fluid to and removing the cooling fluid from one of the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly.

8. The method of claim 2, wherein the spinal tissue comprises the intervertebral disc and wherein the step of inserting the electrically conductive energy delivery devices of the first probe assembly and the second probe assembly includes inserting at least a portion of each of the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly within a posterior annulus fibrosus of the intervertebral disc.

9. The method of claim 2, wherein the spinal tissue comprises the intervertebral disc and wherein the step of inserting the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly includes inserting the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly into opposite sides of the intervertebral disc with respect to a median plane.

10. The method of claim 1, wherein the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly is positioned along a same transverse plane such that each of the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly lies along a same coronal plane.

11. The method of claim 1, wherein the step of inserting the introducer tube is performed under an anterior-posterior fluoroscopic view.

12. The method of claim 1, wherein the energy source is an electrical generator and wherein the step of delivering energy and the step of delivering energy again includes delivering electrical current in a radio frequency range.

13. The method of claim 1, the system further including a third electrically conductive component forming a dispersive electrode, and wherein the step of delivering energy again includes delivering the energy through each of the electrically conductive energy delivery devices in a monopolar manner so that delivered energy is concentrated around each of the electrically conductive energy delivery devices.

14. The method of claim 13 whereby delivering energy to form the bipolar lesion and delivering energy again to form the one or more monopolar lesions allows for treatment of a substantial portion of the posterior annulus fibrosis.

15. The method of claim 1, wherein each of the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly has a temperature sensor associated therewith.

16. The method of claim 15, wherein each of the temperature sensors includes a thermocouple.

17. The method of claim 1, wherein the step of delivering the energy includes delivering energy in a bipolar manner at a temperature of about 50°

C. for about 15 minutes to form the bipolar lesion.

18. The method of claim 1, wherein the step of delivering energy again includes delivering the energy in a monopolar manner at a temperature of about 60°

C. for about 2 minutes to about 3 minutes to form the one or more monopolar lesions.

19. The method of claim 1, wherein the step of delivering energy and the step of delivering energy again includes a radiofrequency energy in a series of pulses.

20. The method of claim 1, wherein each surface area of the electrically conductive energy delivery devices of each of the first probe assembly and the second probe assembly is substantially the same.