Multiple pathways for spinal nerve root decompression from a single access point

• US 9,125,682 B2
• Filed: 02/01/2013
• Issued: 09/08/2015
• Est. Priority Date: 10/15/2005
• Status: Expired due to Fees

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Amendia, Inc. (Spinal Elements, Inc.)
• Inventors: Bleich, Jeffery L., Sheinberg, Michael, Wallace, Michael P.
• Primary Examiner(s): BATES, DAVID W
• Application Number:
  US13/757,599
• Publication Number:
  US 20130150855A1
• Time in Patent Office: 949 Days
• US Class Current: 1/1
• 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 17/025 Joint distractors
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• 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 2017/0225 flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/0256 for the spine
• 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 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: A61N 1/0551 : Spinal or peripheral nerve electrodes

Abstract

A method of accessing target tissue adjacent to a spinal nerve of a patient includes the steps of accessing a spine location of the patient by entering the patient through the skin at an access location, inserting a flexible tissue modification device through the access location to the spine location, advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location, passing through the first exit location and out of the patient, advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location, and passing through the second exit location and out of the patient.

Claims

1. A method of accessing target tissue of a patient, comprising:

accessing, through an access location, a spine location of the patient;

inserting a first flexible device through the access location to the spine location;

advancing a distal portion of the first flexible device from the spine location to a first exit location;

passing the distal portion of the first flexible device through the first exit location and out of the patient;

inserting the first flexible device or a second flexible device through a second access location to the spine location;

advancing a distal portion of the first flexible device or the second flexible device from the spine location to the first exit location;

passing the distal portion of the first flexible device or the second flexible device through the first exit location and out of the patient; and

pulling a tissue modification element through the first access location to the spine location and positioning the tissue modification element at least partially around a target tissue and modifying the target tissue with the tissue modification element.

2. The method of claim 1, wherein advancing the distal portion of the first flexible device from the spine location to the first exit location comprises pulling the distal portion of a tissue modification device from the spine location to the first exit location.

3. The method of claim 1, further comprising pulling in a tissue modification element through the second access location to the spine location and positioning the tissue modification element at least partially around a target tissue and modifying the target tissue with the tissue modification element.

4. The method of claim 1, wherein advancing the distal portion of the first flexible device or the second flexible device from the spine location to the first exit location comprises pulling the distal portion of a tissue modification device from the spine location to the first exit location.

5. A method of accessing target tissue of a patient, the method comprising:

accessing a spine location of the patient by entering the patient through a first access location;

inserting a first flexible tissue modification device through the first access location to the spine location;

advancing a distal portion of the first flexible tissue modification device from the spine location to an exit location;

passing the distal portion of the first flexible tissue modification device through the exit location and out of the patient;

inserting the first or a second flexible tissue modification device through a second access location to the spine location;

advancing a distal portion of the first or a second flexible tissue modification device from the spine location to the same exit location; and

passing the distal portion of the first or the second flexible tissue modification device through the same exit location and out of the patient;

wherein advancing the first or second flexible tissue modification device from the spine location to the exit location comprises advancing the first or second flexible tissue modification device from the spine location to an interlaminar window.

6. The method of claim 5, further comprising accessing a spine location of the patient through a third access location;

inserting the first, the second or a third flexible device through the third access location to the spine location; and

advancing the first, second or third flexible device from the spine location to the same exit location.

7. The method of claim 5, wherein the spine location is anterior to the posterior aspect of the ligamentum flavum and posterior to the dura mater of the spinal cord and cauda equina.

8. A method of accessing target tissue adjacent to a spinal nerve of a patient, comprising:

accessing a spine location of the patient by entering the patient through a first access location, wherein the spine location is anterior to the posterior aspect of the ligamentum flavum and posterior to the dura mater of the spinal cord and cauda equina;

inserting a first flexible tissue modification device through the first access location to the spine location;

pulling a distal portion of the first flexible tissue modification device from the spine location toward an exit location using a first guidewire extending from the exit location;

inserting the first or a second flexible tissue modification device through a second access location to the spine location;

pulling a distal portion of the first or a second flexible tissue modification device from the spine location toward the same exit location;

using the first or a second guidewire extending from the same exit location.

9. The method of claim 8, further comprising using the first flexible tissue modification device to modify tissue at the spine location.

10. The method of claim 8, further comprising using the second flexible tissue modification device to modify tissue at the spine location.

11. The method of claim 8, further comprising removing the first flexible tissue modification device before inserting the second flexible tissue modification device.

12. The method of claim 8, further comprising inserting a distal end of the first guidewire from the first access location and out of the same exit location.

13. The method of claim 8, further comprising inserting the distal end of the first guidewire or a distal end of a second guidewire from the second access location and out of the same exit location.

14. The method of claim 8, wherein pulling the distal portion of the first flexible tissue modification device from the spine location towards the exit location comprises positioning the tissue modification element at least partially around a target tissue and modifying the target tissue with the tissue modification element.