Basivertebral nerve denervation

• US 8,425,507 B2
• Filed: 09/12/2012
• Issued: 04/23/2013
• Est. Priority Date: 09/30/2002
• Status: Expired due to Term

• Current Assignee: Relievant Medsystems, Incorporated (Boston Scientific Corporation)
• Original Assignee: Relievant Medsystems, Incorporated (Boston Scientific Corporation)
• Inventors: Pellegrino, Richard, Papineau, Paula, Crombie, John S., Patel, Samit, Ryan, Thomas
• Primary Examiner(s): Peffley, Michael
• Assistant Examiner(s): GIULIANI, THOMAS ANTHONY
• Application Number:
  US13/612,561
• Publication Number:
  US 20130006233A1
• Time in Patent Office: 223 Days
• Field of Search: 606/32, 606/41, 607 98-100, 607/113, 607/115, 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 basivertebral nerve, comprising:

identifying a treatment zone within an inner cancellous bone region of a vertebral body, the treatment zone corresponding to a likely location of the basivertebral nerve within the inner cancellous bone region;

inserting a cannula having a curved bore within the inner cancellous bone region of the vertebral body,

advancing the cannula and a sharpened stylet inserted within a lumen of the cannula toward the midline of the vertebral body, thereby forming a curved path to the treatment zone;

removing the sharpened stylet from the cannula;

inserting a channeling stylet within the lumen of the cannula and advancing the channeling stylet beyond an open distal end of the cannula, wherein the channeling stylet is flexibly deformable to navigate the cannula yet rigid enough to retain a straight form upon exiting the open distal end of the cannula;

creating a linear path beyond the curved path toward the treatment zone by advancing a distal end of the channeling stylet beyond the curved path;

removing the channeling stylet;

inserting a radiofrequency (RF) probe through the cannula to the treatment zone, and

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

wherein the treatment zone is located in a region that is between 10% and 40% of the distance from the posterior wall to the anterior wall of the vertebral body.

2. The method of claim 1, wherein the RF probe comprises a bipolar RF probe having two electrodes configured to generate a current to heat tissue disposed between the two electrodes, thereby thermally ablating the portion of the basivertebral nerve.

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

4. The method of claim 1, wherein the treatment zone is heated to a temperature sufficient to cause denervation without ablation of the basivertebral nerve.

5. The method of claim 1, further comprising-withdrawing the RF probe and the cannula.

6. The method of claim 1, wherein the RF probe comprises a flexible shaft.

7. The method of claim 1, further comprising accessing the vertebral body with the sharpened stylet using a transpedicular approach.

8. The method of claim 7, wherein the sharpened stylet is adapted to penetrate bone tissue of the vertebral body.

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