Devices and methods for tissue modification

• US 7,553,307 B2
• Filed: 10/15/2005
• Issued: 06/30/2009
• Est. Priority Date: 10/15/2004
• Status: Active Grant

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Baxano, Inc. (Baxano Surgical, Inc.)
• Inventors: Bleich, Jeffery L., Hlavka, Edwin J.
• Primary Examiner(s): Peffley; Michael
• Assistant Examiner(s): HUPCZEY, JR, RONALD JAMES
• Application Number:
  US11/251,165
• Publication Number:
  US 20060089609A1
• Time in Patent Office: 1,354 Days
• Field of Search: 606/1, 606/32, 606/39, 606 41- 50, 606/79, 606/103, 606/108, 606/117, 606/167, 606/170, 600/104, 600/101, 600/210, 600/544, 600/546, 600/547, 604/272, 601/32
• US Class Current: 606/1
• 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 for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/320004 abrasive
• 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 2017/3445 : used as instrument channel for multiple instruments catheters A61B2017/22072
• 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: 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

Methods and apparatus are provided for selective surgical removal of tissue. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space through an epidural needle. The sharp tip of the needle in the epidural space, can be converted to a blunt tipped instrument for further safe advancement. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. A nerve stimulator may be provided to reduce a risk of inadvertent neural abrasion.

Claims

1. A method for treating tissue of a patient, the method comprising:

percutaneously advancing a tissue access instrument into a patient and toward a target tissue through a first point, around at least part of the target tissue, and out of the patient through a second point, whereby both ends of the tissue access instrument are external to the patient;

identifying substantially adjacent neural tissue;

positioning a tissue modification device adjacent to the target tissue using the access instrument; and

modifying the target anatomy tissue with the tissue modification device.

2. The method of claim 1, wherein the target tissue comprises spinal tissue.

3. The method of claim 2, wherein percutaneously advancing the instrument around the target tissue comprises

advancing a wire through a neural foramen and around a single facet joint complex of the patient'"'"'s spine, and

wherein positioning the tissue modification device comprises:

connecting the tissue modification device to one end of the wire; and

pulling the tissue modification device through the neural foramen and around the single facet joint; and

wherein modifying the target tissue with the tissue modification device comprises moving the tissue modification device against the tissue.

4. The method of claim 2, wherein percutaneously advancing the instrument around the target tissue comprises advancing a wire through a neural foramen and around a single facet joint complex of the patient'"'"'s spine, and wherein positioning the tissue modification device comprises passing the tissue modification device over the wire.

5. The method of claim 1, wherein modifying the tissue comprises using a tissue modification device selected from the group consisting of a radiofrequency device, a rasp, a ronguer, a grasper, a burr, a sander, a drill, a shaver, and an abrasive device.

6. The method of claim 1, further comprising applying tension to at least one end of the access instrument to urge the tissue modification device against the target tissue being modified.

7. The method of claim 1, wherein identifying substantially adjacent neural tissue comprises sending electrical current from at least one electrode coupled with the tissue modification device.

8. The method of claim 7, wherein sending the electrical current comprises sending electrical current from an electrode coupled with a backside of the tissue modification device.

9. The method of claim 8, wherein sending the electrical current further comprises sending current from an electrode coupled with a tissue treatment surface of the tissue modification device.

10. The method of claim 7, further comprising monitoring the patient for neural stimulation in order to confirm placement of the tissue modification device.

11. The method of claim 1, further comprising applying a medication or bioactive component to the target tissue.

12. The method of claim 11, wherein the medication or bioactive component is selected from the group consisting of steroids, procoagulants, bone wax, and adhesion barriers.

13. A method for removing tissue in a spine of a patient, the method comprising:

advancing a wire into the patient from a first point, through a neural foramen and around the anterior aspect of a single facet joint complex of the spine, and out of the patient from a second point;

connecting a tissue modification device to the wire;

positioning a tissue modification device through the neural foramen and around the anterior aspect of the single facet join complex, using the wire; and

modifying tissue in the spine by moving the tissue modification device against the tissue, while inhibiting damage to non-target tissue in the spine with an atraumatic surface of the tissue modification device.

14. The method of claim 13, wherein modifying the tissue comprises using a tissue modification device selected from the group consisting of a cautery device, a laser, a rasp, a ronguer, a grasper, a burr, a sander, a drill, a shaver, an abrasive device, and a probe.