An intervertebral disc device is provided comprising a distal probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal end from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc.
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63. A method for accessing an intervertebral disc, the method comprising:
inserting an elongated probe into an intervertebral disc, the probe including a distal section that includes a tip and a flexible section, the flexible section bending as a result of pressure from tissue in the intervertebral disc such that a portion proximal of the tip leads distal insertion; and advancing the probe through the intervertebral disc with the portion proximal of the tip leading distal advancement.
42. An intervertebral disc device comprising:
a probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal section from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc, wherein the neck is formed of a flexible coil.
48. An intervertebral disc device comprising:
a probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal section from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc, wherein the distal tip is attached to the neck of the probe by a spring.
45. An intervertebral disc device comprising:
a probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal section from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc, wherein the distal tip is asymmetrical about a longitudinal axis of the probe.
51. An intervertebral disc device comprising:
a probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal section from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc, wherein the distal tip is attached to the neck of the probe by a pivot mechanism.
54. An intervertebral disc device comprising:
a probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal section from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc, wherein the distal tip is attached to the neck of the probe by a ball and socket mechanism.
1. An intervertebral disc device comprising:
a probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal end from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc, wherein the flexible neck is predisposed to bending in opposing directions along a single plane relative to a longitudinal axis of the probe.
39. An intervertebral disc device comprising:
a probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal section from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc, wherein the flexible neck is predisposed to bending in at least two directions along at least two different planes relative to a longitudinal axis of the probe.
57. An intervertebral disc device comprising:
a probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal section from piercing an internal wall of the intervertebral disc; a connector system which enables an introducer to be removably attached to the connector system, the probe being positionable within the introducer for delivery within the intervertebral disc with assistance of the introducer; and a proximal handle for externally guiding the probe within an intervertebral disc.
60. A method for treating an interior of an intervertebral disc comprising:
inserting an introducer through a skin of a person such that a distal end of the introducer travels within the person via a posterior lateral approach to an intervertebral disc such that the distal end of the introducer is positioned in or adjacent an intervertebral disc; extending a probe from the distal end of the introducer such that the probe is positioned within the intervertebral disc, the probe having a flexible neck adjacent a distal tip of the probe such that the flexibility of the neck of the probe causes the probe to bend within the intervertebral disc such that the distal tip trails behind a portion of the probe as the probe is advanced through tissue within an intervertebral disc, wherein the distal tip is asymmetrical about a longitudinal axis of the probe which predisposes the probe to bend in a particular direction relative to the longitudinal axis of the probe; and treating tissue within the interior of the intervertebral disc using the probe.
25. A method for treating an interior of an intervertebral disc comprising:
inserting an introducer through a skin of a person such that a distal end of the introducer travels within the person via a posterior lateral approach to an intervertebral disc such that the distal end of the introducer is positioned in or adjacent an intervertebral disc; extending a probe from the distal end of the introducer such that the probe is positioned within the intervertebral disc, the probe having a flexible neck adjacent a distal tip of the probe such that the flexibility of the neck of the probe causes the probe to bend within the intervertebral disc such that the distal tip trails behind a portion of the probe as the probe is advanced through tissue within an intervertebral disc, wherein the flexible neck is predisposed to bending in opposing directions along a single plane relative to a longitudinal axis of the probe, and extending the probe causes the probe to bend along one of the opposing directions; and treating tissue within the interior of the intervertebral disc using the probe.
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The present application is related to co-pending application Ser. No. 09/876,833, filed Jun. 6, 2001, to Kevin To et al., entitled "INTERVERTEBRAL DISC DEVICE EMPLOYING LOOPED PROBE," and to Ser. No. 09/876,827, filed Jun. 6, 2001, to Hugh Sharkey et al., entitled "INTERVERTEBRAL DISC DEVICE EMPLOYING PREBENT SHEATH," and to Ser. No. 09/876,831, filed Jun. 6, 2001, to Andy Uchida et al., entitled "ELECTROMAGNETIC ENERGY DELIVERY INTERVERTEBRAL DISC TREATMENT DEVICES."
1. Field of the Invention
This invention relates to methods and apparatuses for accessing and modifying intervertebral disc tissue and more particularly to accessing and modifying intervertebral disc tissue using percutaneous techniques that avoid major surgical intervention.
2. Description of Related Art
Intervertebral disc abnormalities have a high incidence in the population and may result in pain and discomfort if they impinge on or irritate nerves. Disc abnormalities may be the result of trauma, repetitive use, metabolic disorders and the aging process and include such disorders but are not limited to degenerative discs (i) localized tears or fissures in the annulus fibrosus, (ii) localized disc hemniations with contained or escaped extrusions, and (iii) chronic, circumferential bulging disc.
Disc fissures occur rather easily after structural degeneration (a part of the aging process that may be accelerated by trauma) of fibrous components of the annulus fibrosus. Sneezing, bending or just attrition can tear these degenerated annulus fibers, creating a fissure. The fissure may or may not be accompanied by extrusion of nucleus pulposus material into or beyond the annulus fibrosus. The fissure itself may be the sole morphological change, above and beyond generalized degenerative changes in the connective tissue of the disc. Even if there is no visible extrusion, biochemicals within the disc may still irritate surrounding structures. Disc fissures can be debilitatingly painful. Initial treatment is symptomatic, including bed rest, pain killers and muscle relaxants. More recently, spinal fusion with cages have been performed when conservative treatment did not relieve the pain. The fissure may also be associated with a herniation of that portion of the annulus.
With a contained disc herniation, there are no free nucleus fragments in the spinal canal. Nevertheless, even a contained disc herniation is problematic because the outward protrusion can press on the spinal nerves or irritate other structures. In addition to nerve root compression, escaped nucleus pulposus contents may chemically irritate neural structures. Current treatment methods include reduction of pressure on the annulus by removing some of the interior nucleus pulposus material by percutaneous nuclectomy. However, complications include disc space infection, nerve root injury, hematoma formation, instability of the adjacent vertebrae and collapse of the disc from decrease in height.
Another disc problem occurs when the disc bulges outward circumferentially in all directions and not just in one location. Over time, the disc weakens and takes on a "roll" shape or circumferential bulge. Mechanical stiffness of the joint is reduced and the joint may become unstable. One vertebra may settle on top of another. This problem continues as the body ages and accounts for shortened stature in old age. With the increasing life expectancy of the population, such degenerative disc disease and impairment of nerve function are becoming major public health problems. As the disc "roll" extends beyond the normal circumference, the disc height may be compromised, foramina with nerve roots are compressed. In addition, osteophytes may form on the outer surface of the disc roll and further encroach on the spinal canal and foramina through which nerves pass. The condition is called lumbar spondylosis.
It has been thought that such disc degeneration creates segmental instability which disturbs sensitive structures which in turn register pain. Traditional, conservative methods of treatment include bed rest, pain medication, physical therapy or steroid injection. Upon failure of conservative therapy, spinal pain (assumed to be due to instability) has been treated by spinal fusion, with or without instrumentation, which causes the vertebrae above and below the disc to grow solidly together and form a single, solid piece of bone. The procedure is carried out with or without discectomy. Other treatment include discectomy alone or disc decompression with or without fusion. Nuclectomy can be performed by removing some of the nucleus to reduce pressure on the annulus. However, complications include disc space infection, nerve root injury, hematoma formation, and instability of adjacent vertebrae.
These interventions have been problematic in that alleviation of back pain is unpredictable even if surgery appears successful. In attempts to overcome these difficulties, new fixation devices have been introduced to the market, including but not limited to pedicle screws and interbody fusion cages. Although pedicle screws provide a high fusion success rate, there is still no direct correlation between fusion success and patient improvement in function and pain. Studies on fusion have demonstrated success rate of between 50% and 67% for pain improvement, and a significant number of patients have more pain postoperatively. Therefore, different methods of helping patients with degenerative disc problems need to be explored.
One of the challenges associated with treating intervertebral discs is accessing them via percutaneous methods. To appreciate the difficulty presented, the anatomical structure of the spine and an intervertebral disc is illustrated and described below.
The presence of the spinal cord and the posterior portion of the vertebral body, including the spinous process, and superior and inferior articular processes, prohibit introduction of a needle or trocar from a directly posterior position. This is important because the posterior disc wall is the site of symptomatic annulus tears and disc protrusions/extrusions that compress or irritate spinal nerves for most degenerative disc syndromes.
The annulus fibrosus 122 is comprised primarily of tough fibrous material, while the nucleus pulposus 120 is comprised primarily of an amorphous colloidal gel. There is a transition zone between the annulus fibrosus 122 and the nucleus pulposus 120 made of both fibrous-like material and amorphous colloidal gel. The border between the annulus fibrosus 122 and the nucleus pulposus 120 becomes more difficult to distinguish as a patient ages, due to degenerative changes. This process may begin as early as 30 years of age. For purposes of this specification, the inner wall of the annulus fibrosus can include the young wall comprised primarily of fibrous material as well as the transition zone which includes both fibrous material and amorphous colloidal gels (hereafter collectively referred to as the "inner wall of the annulus fibrosus"). Functionally, the location at which there is an increase in resistance to probe penetration and which is sufficient to cause bending of the distal portion of the probe into a radius less than that of the internal wall 22 of the annulus fibrosus is considered to be the "inner wall of the annulus fibrosus".
As with any medical instrument and method, not all patients can be treated, especially when their disease or injury is too severe. There is a medical gradation of degenerative disc disease (stages 1-5). See, for example, Adams et al., "The Stages of Disc Degeneration as Revealed by Discograms," J. Bone and Joint Surgery, 68, 36-41 (1986). As these grades are commonly understood, the methods of instrument navigation described herein would probably not be able to distinguish between the nucleus and the annulus in degenerative disease of grade 5. In any case, most treatment is expected to be performed in discs in stages 3 and 4, as stages 1 and 2 are asymptomatic in most patients, and stage 5 may require disc removal and fusion.
It is well known to those skilled in the art that percutaneous access to the disc is achieved by placing an introducer into the disc from this posterior lateral approach, but the triangular window does not allow much room to maneuver. Once the introducer pierces the tough annulus fibrosus, the introducer is fixed at two points along its length and has very little freedom of movement. Thus, with the exception of devices such as those described in U.S. Pat. Nos. 6,135,999; 6,126,682; 6,122,549; 6,099,514; 6,095,149; 6,073,051; 6,007,570; 5,980,504 (which are each incorporated herein by reference), the posterior lateral approach has only allowed access to small central and anterior portions of the nucleus pulposus.
The present invention provides devices and methods which are designed to more efficiently access and treat the interior of intervertebral discs by the posterior lateral approach.
The present invention relates to various embodiments of intervertebral disc devices and their methods of use.
According to one embodiment, the intervertebral disc device comprises a distal probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising a flexible neck which tapers in a proximal to distal direction, and a distal tip which is larger in cross sectional diameter than the flexible neck adjacent the distal tip, the flexible neck and distal tip serving to prevent the probe distal end from piercing an internal wall of the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc.
The flexible neck may optionally be designed such that it is not predisposed to bending in any direction relative to a longitudinal axis of the probe. Alternatively, the flexible neck may be designed to be predisposed to bending along a single plane relative to a longitudinal axis of the probe. Alternatively, the flexible neck may be designed to be predisposed to bending in opposing directions along a single plane relative to a longitudinal axis of the probe. Alternatively, the flexible neck may be designed to be predisposed to bending in at least two different directions along at least two different planes relative to a longitudinal axis of the probe.
According to this embodiment, the flexible neck may optionally have a round cross section. Alternatively, or in addition, the flexible neck may optionally have at least one flat surface extending along a longitudinal axis of the neck. In one variation, the flexible neck has two flat surfaces extending along a longitudinal axis of the neck on opposing sides of the neck.
Also according to this embodiment, the neck may optionally be formed of a flexible coil.
According to this embodiment, the distal tip may optionally have a larger cross sectional diameter than a largest cross sectional diameter of the flexible neck. The distal tip may be symmetrical or asymmetrical. In certain variations, the distal tip is dome shaped or has a flat surface perpendicular to a longitudinal axis of the probe.
The distal tip may be attached to the neck of the probe by a variety of mechanisms including, for example, a spring or a pivot mechanism such as a ball and socket mechanism.
In one preferred variation, the flexibility of the neck of the probe is designed such that it causes the probe to bend and the distal tip to trail behind a portion of the probe as the probe is advanced through tissue within an intervertebral disc. The shape of the distal tip may also contribute to the distal tip trailing behind a portion of the probe.
In another embodiment, an intervertebral disc device is provided comprising: a distal probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising an active electrode and a return electrode which are each spirally wrapped around the probe such that there are multiple alternating bands of the same active and return electrodes positioned longitudinally along the length of the distal section of the probe, the active and return electrodes being adapted to deliver bipolar electromagnetic energy to tissue within the intervertebral disc; and a proximal handle for externally guiding the probe within an intervertebral disc.
According to this embodiment, the distal section of the probe may be predisposed to forming a loop.
In another embodiment, an intervertebral disc device is provided comprising: a distal probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe being predisposed to forming a loop when extended from the distal end of the introducer, the looping portion of the probe comprising an active electrode and a return electrode which are positioned on the probe such that the active and return electrodes are on opposing sides of the probe loop; and a proximal handle for externally guiding the probe within an intervertebral disc.
In yet another embodiment, an intervertebral disc device is provided comprising: a distal probe sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the probe comprising separate active and return electrode elements which are predisposed to bending away from each other when extended from the distal end of the introducer; and a proximal handle for externally guiding the probe within an intervertebral disc.
In another embodiment, an intervertebral disc device is provided comprising: a distal sheath sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the sheath being predisposed to adopting a bent configuration when extended from the introducer; a probe adapted to be extended from a distal end of the sheath, the bent section of the sheath causing the probe to adopt a same bent configuration; and a proximal handle for externally guiding the probe within an intervertebral disc.
In another embodiment, an intervertebral disc device is provided comprising: a distal sheath sized to be extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the sheath being predisposed to adopting a bent configuration when extended from the introducer; a guide wire adapted to be extended from a distal end of the sheath, the bent section of the sheath causing the guide wire to adopt a same bent configuration; a probe adapted to be extended from a distal end of the sheath over the guide wire, the bent section of the sheath causing the probe to adopt a same bent configuration; and a proximal handle for externally guiding the probe within an intervertebral disc.
According to one variation of this embodiment, a distal section of the probe comprises an active electrode and a return electrode which are each spirally wrapped around the probe such that there are multiple alternating bands of the same active and return electrodes positioned longitudinally along the length of the distal section of the probe, the active and return electrodes being adapted to deliver bipolar electromagnetic energy to tissue within the intervertebral disc. Optionally, the distal section of the probe may be predisposed to forming a loop. When the distal section of the probe is predisposed to forming a loop when extended from the distal end of the introducer, the looping portion of the probe may comprise an active electrode and a return electrode which are positioned on the probe such that the active and return electrodes are on opposing sides of the probe loop.
According to another variation of this embodiment, a distal section of the probe comprises separate active and return electrode elements which are predisposed to bending away from each other when extended from the distal end of the introducer.
In another embodiment, an intervertebral disc device is provided comprising: a probe capable of being extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, the probe forming a loop when extended from the distal end of the introducer, the loop having first and second proximal ends external to the introducer which are brought together adjacent the introducer distal end to form the loop by the proximal ends being either attached to or entering the distal end of the introducer; and a proximal handle for externally causing the probe to be extended from the distal end of the introducer and externally guiding the probe within an intervertebral disc.
According to this embodiment, the device may optionally further include an introducer, the first proximal end of the probe being attached to the introducer adjacent a distal end of the introducer, the second proximal end of the probe being extendable from the introducer distal end to form the loop. According to this variation, the first proximal end of the probe may optionally be attached to the introducer adjacent the distal end of the introducer by a guide wire lead. Alternatively, the first and second proximal ends of the probe may each be separately extendable from the introducer distal end to form the loop. When the first and second proximal ends of the probe are each separately extendable from the introducer distal end to form the loop, the first and second proximal ends of the probe may have different cross sectional geometries. According to this variation, the different cross sectional geometries of the first and second proximal ends may be selected such that the cross sectional geometry of the first proximal end is a compliment of the cross sectional geometry of the second proximal end.
In another embodiment, an intervertebral disc device is provided comprising: a guide wire capable of being extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, the guide wire forming a loop when extended from the distal end of the introducer, the loop having first and second proximal ends external to the introducer which are brought together adjacent the introducer distal end to form the loop by the proximal ends being either attached to or entering the distal end of the introducer; a probe capable of being extended over the guide wire from the distal end of the introducer; and a proximal handle for externally causing the guide wire and probe to be extended from the distal end of the introducer and externally guiding the guide wire and probe within an intervertebral disc.
In one variation of this embodiment, the device further includes an introducer, the first proximal end of the guide wire being attached to the introducer adjacent a distal end of the introducer, the second proximal end of the guide wire being extendable from the introducer distal end to form the loop. In another variation, the first and second proximal ends of the guide wire are each separately extendable from the introducer distal end to form the loop.
In another embodiment, an intervertebral disc device is provided comprising: guide wire capable of being extended from a distal end of an introducer that is percutaneously delivered into an interior of an intervertebral disc, a distal section of the guide wire being predisposed to forming a loop when extended from the distal end of the introducer, the looped distal section of the guide wire serving to localize the looped distal section within the intervertebral disc; a probe capable of being extended over the guide wire from the distal end of the introducer, the probe and guide wire being extendable in combination such that position of the looped distal section of the guide wire is not changed; and a proximal handle for externally causing the guide wire and probe to be extended from the distal end of the introducer and externally guiding the guide wire and probe within an intervertebral disc.
According to any of the above embodiments, the device may further include flexible tubing operably interconnecting the proximal handle with the distal probe. The probe and/or guide wire may optionally extend within the flexible tubing to the handle.
Also according to any of the above embodiments, the device may further include a connector system which enables an introducer to be removeably attached to the connector system, the probe being positionable within the introducer for delivery within the intervertebral disc with the assistance of the introducer.
According to any of the above embodiments, the device may further include a probe or guide wire with a mechanism for securing the probe or guide wire within the selected section of the intervertebral disc. The mechanism may be a curved portion adjacent the distal end capable of anchoring the probe or guide wire into tissue. The curved distal portion preferably forms a distal end of the probe or guide wire. The curved distal portion is optionally retractable and optionally divides into multiple separate curved portions, such as to form a treble hook.
Also according to any of the above embodiments, the probe may further include a functional element which performs a function. A wide variety of functions may be performed by the functional element including, but not limited to, transmitting energy to tissue within an intervertebral disc, delivering material to within an intervertebral disc, and removing material within an intervertebral disc.
When the function element transmits energy, the probe may further include an electromagnetic energy device capable of supplying energy within the intervertebral disc. The electromagnetic energy device may be capable of delivering energy selected from group consisting of coherent and incoherent light and radiofrequency (RF), microwave and ultrasound waves. When delivering RF energy, the electromagnetic energy device comprises electrodes adapted to deliver RF energy. The RF electrodes may adopt a monopolar or bipolar configuration. The electromagnetic energy device may also comprise a resistive heating mechanism.
Also according to any of the above embodiments, the handle may further comprise a probe control element for controlling the movement of the probe adjacent a distal end of the device. The device may also comprise a guide wire control element for controlling the movement of the guide wire adjacent a distal end of the device.
Methods are also provided for employing the various devices of the present invention to treat an interior of an intervertebral disc.
In one embodiment, the method comprises inserting an introducer through a skin of a person such that the distal end of the introducer travels within the person via a posterior lateral approach to an intervertebral disc such that a distal end of the introducer is positioned in or adjacent an intervertebral disc; extending a probe from a distal end of the introducer such that the probe is positioned within the intervertebral disc; and treating tissue within the interior of the intervertebral disc using the probe. The probe that is extended from the introducer may have any of the various probe designs described herein.
In another embodiment, the method comprises inserting an introducer through a skin of a person such that the distal end of the introducer travels within the person via a posterior lateral approach to an intervertebral disc such that a distal end of the introducer is positioned in or adjacent an intervertebral disc; extending a guide wire from a distal end of the introducer such that the guide wire is positioned within the intervertebral disc; extending a probe over the guide wire, and treating tissue within the interior of the intervertebral disc using the probe. The guide wire and probe that are extended from the introducer may have any of the various guide wire and probe designs described herein.
In another embodiment of the invention, a method for delivering a probe is provided. The method comprises extending a guide wire into an intervertebral disc such that the guide wire is positioned within the intervertebral disc adjacent an inner wall of the disc; attaching a distal portion of the guide wire to the inner wall; and extending a probe over the guide wire. The guide wire and probe that are extended may have any of the various guide wire and probe designs described herein.
According to this embodiment, the step of attaching the distal portion of the guide wire may be accomplished by inserting a portion of the guide wire into the tissue of the inner wall of an intervertebral disc such that the distal portion is held in place and retained by the tissue of the inner wall of the disc. In this regard, a variety of attachment mechanisms may be employed. For example, the step of attaching the distal portion of the guide wire may be by hooking the attachment mechanism into the tissue of the inner wall of the disc. The attachment mechanism may be a curved distal portion of the guide wire.
All of the above embodiments involving attaching the guide wire to the inner wall of an intervertebral disc may be adapted where the probe instead of the guide wire comprises an attachment mechanism for attaching the probe to the inner wall.
The present invention provides methods and devices for accessing and treating intervertebral discs. In general, the devices according to the present invention are externally guidable percutaneous intervertebral disc devices. As such, these devices are used to traverse the patent's skin and access an intervertebral disc through the tissue positioned between the patient's skin and the intervertebral disc. Entry into the intervertebral disc is achieved by a posterior lateral approach.
1. Overview of the Intervertebral Disc Treatment Device
As illustrated in
Flexible tubing 226 attaches the handle 212 to a connector system 228 which remains external to the body. As illustrated, the connector system 228 may allow different external tools to be attached to the device. In this case a fluid injection tool 232 is depicted. A probe and a guide wire may optionally extend from a distal portion of the device through the flexible tubing to the handle. Alternatively, only mechanisms for controlling the probe and guide wire may extend from the distal portion of the device through the flexible tubing to the handle.
Insertion of flexible tubing between the handle 212 and the connector system 228 serves to physically isolate movements of the handle 212 from the portion of the device which is inserted into the patient. As a result, the patient is less prone to perceive a manipulation of the device within the patient as a result of movement of the handle.
The distal portion of the devices of the present invention may be delivered through the skin of a patient and into an intervertebral disc using techniques typical of percutaneous interventions. The connector system 228 allows an introducer 230 to be removably coupled to the device to facilitate delivery of the distal portion of the device through a patient's skin to within an intervertebral disc. As illustrated, a luer fitting 234 may be used as the attachment mechanism for the introducer.
The term introducer is used herein to indicate that the device of the invention can be used with any insertional apparatus that provides proximity to the disc, including many such insertional apparatuses known in the art. An introducer has an internal introducer lumen with a distal opening 238 at a terminus of the introducer to allow insertion (and manipulation) of the operational parts of the device into (and in) the interior of a disc.
The introducer, in its simplest form, can consist of a hollow needle-like device (optionally fitted with an internal removable obturator or trocar to prevent clogging during initial insertion) or a combination of a simple exterior cannula that fits around a trocar. The result is essentially the same: placement of a hollow tube (the needle or exterior cannula after removal of the obturator or trocar, respectively) through skin and tissue to provide access into the annulus fibrosus. The hollow introducer acts as a guide for introducing instrumentation. More complex variations exist in percutaneous instruments designed for other parts of the body and can be applied to design of instruments intended for disc operations. Examples of such obturators are well known in the art. A particularly preferred introducer is a 17- or 18-gauge, thin-wall needle with a matched obturator, which after insertion is replaced with a probe of the present invention.
The devices of the present invention further include a probe 236 which may be extended and retracted relative to the distal opening 238 of the introducer 230. For example, a distal section of the probe 236 is shown to be retracted into the introducer in
As illustrated in
It is noted that many probe devices access a section of tissue in the patient's body by being delivered within the lumen of a body vessel such as a vein or artery. Although the devices of the present invention are said to include a probe, the devices of the present invention do not rely upon accessing a section of tissue in the patient's body by being delivered within the lumen of a body vessel. Rather, "probe" is used herein to describe the distal portion of the device which is extended into the intervertebral disc from the introducer.
The probe may optionally include functional elements which perform different functions, such as transmitting energy and/or material from a location external to the body to a location internal to the disc being accessed upon. Alternatively, material can be transported in the other direction to remove material from the disc, such as removing material by aspiration. The device allows the functional elements to be controllably positioned and manipulated within the guided by manipulation of the handle.
The probe is adapted to slidably advance through the introducer lumen, the probe having a distal section which is extendible through the distal opening at the terminus of the introducer into the disc. Although the length of the distal section can vary with the intended function of the device, as explained in detail below, a typical distance of extension is at least one-half the diameter of the nucleus pulposus, preferably in the range of one-half to one and one-half times the circumference of the nucleus.
In order that the functional elements of the probe can be readily guided to the desired location within a disc, the distal section of the probe is manufactured with sufficient rigidity to avoid collapsing upon itself while being advanced through the nucleus pulposus. The distal section, however, has insufficient rigidity to puncture the annulus fibrosus under the same force used to advance the probe through the nucleus pulposus and around the inner wall of the annulus fibrosus. Absolute penetration ability will vary with sharpness and stiffness of the distal tip of the distal section, but in all cases, a probe of the present invention will advance more readily through the nucleus pulposus than through the annulus fibrosus.
The inability of the distal section of the probe to pierce the annulus can be the result of either the shape of the distal tip of the probe and/or the flexibility of distal portion. The distal tip is considered sufficiently blunt when it does not penetrate the annulus fibrosus but is deflected back into the nucleus pulposus or to the side around the inner wall of the annulus when the distal tip is advanced. Several novel distal tip embodiments are described herein.
2. Design Features of Intervertebral Disc Devices
The devices according to the present invention comprise multiple novel features including, but not being limited to (a) flexible necks adjacent the distal ends of the devices, (b) distal tips which facilitate navigation of the device within an intervertebral disc, (c) attachment mechanisms for the distal tips to the necks, (d) energy delivery mechanisms used with the devices for treating intervertebral discs, and (e) mechanisms for deploying the probe distal end within an intervertebral disc. Each of these different novel features are described herein.
One feature of the probe employed in the device of the present invention is the inability of the distal section of the probe to pierce the annulus. This may be achieved either by the design of the neck of the probe, (i.e., the section of the distal section proximal to the distal tip) or by the design of the distal tip of the probe. The design of the neck and distal tip of the probe can also be utilized to facilitate navigation of the device within the intervertebral disc.
Rendering the neck flexible can be accomplished by using a series of different neck designs, any of which may be employed in the present invention. For example,
By contrast,
It is noted with regard to the neck, distal tip and attachment mechanisms that any combination of the three may be used since it is anticipated that one may wish to alter the navigation behavior of the probe within the nucleous pulposus by manipulating these three variables.
Referring back to
It is noted that although
It is noted with regard to the above embodiments that the distal portion of the probe and/or the guide wire may be pre-bent, if desired. "Pre-bent" or "biased" means that a portion of the probe, guide wire, or other structural element under discussion, is made of a spring-like material that is bent in the absence of external stress but which, under selected stress conditions (for example, while the probe is inside the introducer), is linear. The un-stressed wire loop diameter preferably has a diameter between about 0.025-1 inch, more preferably between about 0.05-0.75 inch, or most preferably between about 0.1-0.5 inch. The diameter of the guide wire preferably has a diameter between about 0.005-0.05 inch, more preferably between about 0.007-0.035 inch, or most preferably between about 0.009-0.025 inch. Such a biased distal portion can be manufactured from either spring metal or super elastic memory material (such as Tinel® nickel-titanium alloy, Raychem Corp., Menlo Park Calif.). The introducer (at least in the case of a spring-like material for forming the probe) is sufficiently strong to resist the bending action of the bent distal end and maintain the biased distal portion in alignment as it passes through the introducer. Compared to unbiased probes, a probe or guide wire with a biased distal portion encourages advancement of the probe or guide wire substantially in the direction of the bend relative to other lateral directions. Biasing the probe or guide wire distal end also further decreases likelihood that the distal end of the probe or guide wire will be forced through the annulus fibrosus under the pressure used to advance the probe.
In addition to biasing the distal section of the probe or guide wire prior to insertion into an introducer, the distal section of the probe or guide wire can be provided with a mechanical mechanism for deflecting the distal section, such as a wire that deflects the distal section in the desired direction upon application of force to the proximal end of the deflection wire. Any device in which bending of the distal end of a probe or guide wire is controlled by the physician is "actively settable." In addition to a distal section that is actively settable by action of a wire, other methods of providing a bending force at the distal section can be used, such as hydraulic pressure and electromagnetic force (such as heating a shaped memory alloy to cause it to contract). Any of a number of techniques can be used to provide selective bending of the probe in one lateral direction.
Optionally, a sheath may be employed in combination with the probe (or guide wire) to facilitate directing movement of the probe within a disc. The sheath can be made of a variety of different materials including but not limited to polyester, rayon, polyamide, polyurethane, polyethylene, polyamide and silicone.
Since the purpose of the devices of the present invention is to treat tissue within an intervertebral disc by operation of the device adjacent to or inside the disc, one or more functional elements may be provided in or on the distal section of the probe to carry out that purpose.
Non-limiting examples of functional elements include any element capable of aiding diagnosis, delivering energy, or delivering or removing a material from a location adjacent the element's location in or on the probe, such as an opening in the probe for delivery of a fluid (e.g., dissolved collagen to seal the fissure) or for suction, a thermal energy delivery device (heat source), a mechanical grasping tool for removing or depositing a solid, a cutting tool (which includes all similar operations, such as puncturing), a sensor for measurement of a function (such as electrical resistance, temperature, or mechanical strength), or a functional element having a combination of these functions.
The functional element can be at varied locations on the distal section of the probe, depending on its intended use. Multiple functional elements can be present, such as multiple functional elements of different types (e.g., a heat source and a temperature sensor) or multiple functional elements of the same type (e.g., multiple heat sources spaced along the intradiscal portion).
One of the possible functional elements present on the distal section of the probe is a thermal energy delivery device. A variety of different types of thermal energy can be delivered including but not limited to resistive heat, radiofrequency (RF), coherent and incoherent light, microwave, ultrasound and liquid thermal jet energies. In these embodiments, the electrode array length is preferably 0.2-5 inches long, more preferably 0.4-4 inches long, and most preferably 0.5-3 inches long.
Some embodiments of the device have an interior infusion lumen. Infusion lumen is configured to transport a variety of different media including but not limited to electrolytic solutions (such as normal saline), contrast media (such as Conray meglumine iothalamate), pharmaceutical agents, disinfectants, filling or binding materials such as collagens or cements, chemonucleolytic agents, and the like, from a reservoir exterior to the patient to a desired location within the interior of a disc (i.e., the fissure). Further, the infusion lumen can be used as an aspiration lumen to remove nucleus material or excess liquid or gas (naturally present, present as the result of a liquefying operation, or present because of prior introduction) from the interior of a disc. When used to transport a fluid for irrigation of the location within the disc, the infusion lumen is sometimes referred to as an irrigation lumen. Infusion lumen can be coupled to medium reservoir through the probe.
Optionally, one or more sensor lumens may be included. An example of a sensor lumen is a wire connecting a thermal sensor at a distal portion of the probe to control elements attached to a connector in the proximal handle of the probe.
Energy directing devices may also optionally be included, such as thermal reflectors, optical reflectors, thermal insulators, and electrical insulators. An energy directing device may be used to limit thermal and/or electromagnetic energy delivery to a selected site of the disc and to leave other sections of the disc substantially unaffected. An energy directing device can be positioned on an exterior surface of the distal section of the probe, as well as in an internal portion of the probe. For example, energy can be directed to the walls of a fissure to cauterize granulation tissue and to shrink the collagen component of the annulus, while the nucleus is shielded from excess heat.
Therapeutic and/or diagnostic agents may be delivered within the disc via the probe. Examples of agents that may be delivered include, but are not limited to, electromagnetic energy, electrolytic solutions, contrast media, pharmaceutical agents, disinfectants, collagens, cements, chemonucleolytic agents and thermal energy.
In one embodiment, the device includes markings which indicate to the physician how far the probe has been advanced into the nucleus. Such a visible marking can be positioned on the handle or on the flexible tubing. Preferred are visible markings every centimeter to aid the physician in estimating the probe tip advancement.
If desired, visible markings can also be used to show twisting motions of the probe to indicate the orientation of the bending plane of the distal portion of the probe. It is preferred, however, to indicate the distal bending plane by the shape and feel of the proximal end of the probe assembly. The probe can be attached to or shaped into a handle that fits the hand of the physician and also indicates the orientation of the distal bending plane. Both the markings and the handle shape thus act as control elements to provide control over the orientation of the bending plane; other control elements, such as plungers or buttons that act on mechanical, hydrostatic, electrical, or other types of controls, can be present in more complex embodiments of the invention.
Additionally, a radiographically opaque marking device can be included in the distal portion of the probe (such as in the tip or at spaced locations throughout the intradiscal portion) so that advancement and positioning of the intradiscal section can be directly observed by radiographic imaging. Such radiographically opaque markings are preferred when the intradiscal section is not clearly visible by radiographic imaging, such as when the majority of the probe is made of plastic instead of metal. A radiographically opaque marking can be any of the known (or newly discovered) materials or devices with significant opacity. Examples include but are not limited to a steel mandrel sufficiently thick to be visible on fluoroscopy, a tantalum/polyurethane tip, a gold-plated tip, bands of platinum, stainless steel or gold, soldered spots of gold and polymeric materials with radiographically opaque filler such as barium-sulfate. A resistive heating element or an RF electrode(s) may provide sufficient radio-opacity in some embodiments to serve as a marking device.
It is noted that the distal section of the probe 1016 shown in
Also shown in
It is noted that other energy delivery devices may also be used with the intervertebral disc treatment devices of the present invention beyond those described with regard to
When the device is used as a resistive heating device, the amount of thermal energy delivered to the tissue is a function of (i) the amount of current passing through heating element, (ii) the length, shape, and/or size of heating element, (iii) the resistive properties of heating element, (iv) the gauge of heating element, and (v) the use of cooling fluid to control temperature. All of these factors can be varied individually or in combination to provide the desired level of heat. Power supply associated with heating element may be battery based. The probe can be sterilized and may be disposable.
In some embodiments, thermal energy is delivered to a selected section of the disc in an amount that does not create a destructive lesion to the disc, other than at most a change in the water content of the nucleus pulposus. In one embodiment there is no removal and/or vaporization of disc material positioned adjacent to an energy delivery device positioned in a nucleus pulposus. Sufficient thermal energy is delivered to the disc to change its biochemical and/or biomechanical properties without structural degradation of tissue.
Thermal energy may be used to cauterize granulation tissue which is pain sensitive and forms in a long-standing tear or fissure. Additionally or alternatively, thermal energy is used to seal at least a part of the fissure. To do that, the disc material adjacent to the fissure is typically heated to a temperature in the range of 45-70 degree C. which is sufficient to shrink and weld collagen. In one method, tissue is heated to a temperature of at least 50 degree C. for times of approximately one, two, three minutes, or longer, as needed to shrink the tissue back into place.
Delivery of thermal energy to the nucleus pulposus removes some water and permits the nucleus pulposus to shrink. This reduces a "pushing out" effect that may have contributed to the fissure. Reducing the pressure in the disc and repairing the fissure may help stabilize the spine and reduce pain.
Global heating of the disc also can be used to cauterize the granulation tissue and seal the fissure. In this embodiment of the method, the heating element is positioned away from the annulus but energy radiates to the annulus to raise the temperature of the tissue around the fissure. This global heating method can help seal a large area or multiple fissures simultaneously.
While the present invention is disclosed with reference to preferred embodiments and examples detailed above, it is to be understood that these examples are intended in an illustrative rather than limiting sense, as it is contemplated that modifications will readily occur to those skilled in the art, which modifications will be within the spirit of the invention and the scope of the appended claims. Any patents, papers, and books cited in this application are to be incorporated herein in their entirety.
Sharkey, Hugh, Ashley, John, Uchida, Andy
Patent | Priority | Assignee | Title |
Patent | Priority | Assignee | Title |
2090923, | |||
3178728, | |||
3579643, | |||
3776230, | |||
3856015, | |||
3867728, | |||
3879767, | |||
3886600, | |||
3938198, | Aug 04 1970 | Cutter Laboratories, Inc. | Hip joint prosthesis |
3945375, | Sep 16 1968 | SURGICAL DESIGN CORPORATION | Rotatable surgical instrument |
3987499, | Aug 10 1973 | PFAUDLER COMPANIES, INC , A CORP OF DE | Surgical implant and method for its production |
3992725, | May 20 1971 | TRANQUIL PROSPECTS, LTD , A COMPANY OF THE BRITISH VIRGIN ISLANDS | Implantable material and appliances and method of stabilizing body implants |
4043342, | Aug 28 1974 | Valleylab, Inc. | Electrosurgical devices having sesquipolar electrode structures incorporated therein |
4074718, | Mar 17 1976 | Valleylab, Inc. | Electrosurgical instrument |
4085466, | Nov 18 1974 | British Technology Group Limited | Prosthetic joint device |
4129470, | May 20 1971 | TRANQUIL PROSPECTS, LTD , A COMPANY OF THE BRITISH VIRGIN ISLANDS | Method of preparing a porous implantable material from polytetrafluoroethylene and carbon fibers |
4134406, | Oct 19 1976 | Cutting loop for suction resectoscopes | |
4224696, | Sep 08 1978 | KAMPNER, STANLEY L , M D | Prosthetic knee |
4224697, | Sep 08 1978 | KAMPNER, STANLEY L , M D | Constrained prosthetic knee |
4326529, | May 26 1978 | UNITED STATES AMERICA, THE, AS REPRESENTED BY THE DEPARTMENT OF ENERGY | Corneal-shaping electrode |
4344193, | Nov 28 1980 | Meniscus prosthesis | |
4362160, | Jul 24 1979 | Richard Wolf GmbH | Endoscopes |
4375220, | May 09 1980 | Microwave applicator with cooling mechanism for intracavitary treatment of cancer | |
4381007, | Apr 30 1981 | United States Department of Energy | Multipolar corneal-shaping electrode with flexible removable skirt |
4397314, | Aug 03 1981 | NATIONSBANK OF TEXAS, N A | Method and apparatus for controlling and optimizing the heating pattern for a hyperthermia system |
4476862, | Feb 05 1979 | Method of scleral marking | |
4483338, | Jun 12 1981 | Medtronic, Inc | Bi-Polar electrocautery needle |
4517965, | Jun 27 1983 | Tissue retractor | |
4517975, | Jun 06 1983 | Ellman International, Inc | Electrosurgical electrode for matrisectomy |
4590934, | May 18 1983 | VALLEY FORGE SCIENTIFIC CORP , 2570 BOULEVARD OF THE GENERALS, NORRISTOWN, PA 19403; MALIS, LEONARD I , 219-44 PECK AVENUE, HOLLIS, HILLS, NY, 11427; PACKAGING SERVICE CORPORATION OF KENTUCKY, 3001 WEST KENTUCKY STREET, LOUISVILLE, KY 40211, A KY CORP | Bipolar cutter/coagulator |
4593691, | Jul 13 1983 | CONCEPT, INC , 12707 U S 19 SOUTH, CLEARWATER, FLORIDA 33546 A FLORIDA CORP | Electrosurgery electrode |
4597379, | May 16 1979 | Cabot Technology Corporation | Method of coagulating muscle tissue |
4601705, | Oct 31 1983 | BRIAN GLASGOW MEMORIAL FOUNDATION, THE, A CHARITABLE TRUST; CATHETER RESEARCH, INC , AN IN CORP | Steerable and aimable catheter |
4651734, | Feb 08 1985 | University of California | Electrosurgical device for both mechanical cutting and coagulation of bleeding |
4811733, | Mar 14 1985 | Baxter Travenol Laboratories, Inc. | Electrosurgical device |
4811743, | Apr 21 1987 | Cordis Corporation | Catheter guidewire |
4815462, | Apr 06 1987 | Smith & Nephew, Inc | Lipectomy device |
4838859, | May 19 1987 | STRASSMANN, STEVE | Steerable catheter |
4846175, | Dec 18 1986 | ERINTRUD FRIMBERGER, A CORP OF WEST GERMANY | Probe for introduction into the human or animal body, in particular a papillotome |
4873976, | Feb 28 1984 | Surgical fasteners and method | |
4894063, | May 24 1983 | Baxter International Inc | Barrier layer for implantable tendons and ligaments |
4895148, | May 16 1988 | Concept, Inc. | Method of joining torn parts of bodily tissue in vivo with a biodegradable tack member |
4907585, | Dec 03 1987 | Method for improving farsightedness | |
4907589, | Apr 29 1988 | Sherwood Services AG | Automatic over-temperature control apparatus for a therapeutic heating device |
4924865, | May 20 1986 | Concept, Inc. | Repair tack for bodily tissue |
4944727, | Oct 31 1983 | BRIAN GLASGOW MEMORIAL FOUNDATION, THE, A CHARITABLE TRUST; CATHETER RESEARCH, INC , AN IN CORP | Variable shape guide apparatus |
4950234, | May 26 1987 | SUMITOMO PHARMACEUTICALS COMPANY, LIMITED, NO 40, DOSHO-MACHI 2-CHOME, HIGASHI-KU, OSAKA-SHI, OSAKA-FU, JAPAN; NISSHO CORPORATION, 9-3, HONJO-NISHI 3-CHOME, OYODO-KU, OSAKA-SHI, OSAKA-FU, JAPAN | Device for administering solid preparations |
4950267, | Nov 27 1987 | Olympus Optical Co., Ltd. | Laser beam treatment device for an endoscope |
4955882, | Mar 30 1988 | CANOX INTERNATIONAL, LTD | Laser resectoscope with mechanical and laser cutting means |
4966597, | Nov 04 1988 | Sherwood Services AG | Thermometric cardiac tissue ablation electrode with ultra-sensitive temperature detection |
4976709, | Sep 27 1985 | RJW ACQUISTIONS, L C , D B A 20 20 TECHNOLOGIES, INC | Method for collagen treatment |
4976715, | May 20 1986 | Concept, Inc. | Repair tack for bodily tissue |
4998933, | Jun 10 1988 | Arthrocare Corporation | Thermal angioplasty catheter and method |
5007908, | Sep 29 1989 | GYRUS ACMI, INC | Electrosurgical instrument having needle cutting electrode and spot-coag electrode |
5009656, | Aug 17 1989 | XOMED, INC | Bipolar electrosurgical instrument |
5084043, | Jan 12 1990 | LASERSCOPE, A CORP OF CA | Method for performing a percutaneous diskectomy using a laser |
5085657, | Mar 14 1983 | Electrosurgical instrument | |
5085659, | Nov 21 1990 | Everest Medical Corporation | Biopsy device with bipolar coagulation capability |
5098430, | Mar 16 1990 | WELLS FARGO BANK, NATIONAL ASSOCIATION FLAIR INDUSTRIAL PARK RCBO | Dual mode electrosurgical pencil |
5100402, | Oct 05 1990 | MEGADYNE MEDICAL PRODUCTS, INC | Electrosurgical laparoscopic cauterization electrode |
5103804, | Jul 03 1990 | Boston Scientific Scimed, Inc | Expandable tip hemostatic probes and the like |
5114402, | Oct 31 1983 | Catheter Research, Inc. | Spring-biased tip assembly |
5152748, | Mar 04 1991 | Medical catheters thermally manipulated by fiber optic bundles | |
5178620, | Jun 10 1988 | Arthrocare Corporation | Thermal dilatation catheter and method |
5186181, | Jul 27 1990 | Radio frequency thermotherapy | |
5191883, | Oct 28 1988 | Boston Scientific Scimed, Inc | Device for heating tissue in a patient's body |
5192267, | Jan 23 1989 | Vortex smoke remover for electrosurgical devices | |
5201729, | Jan 12 1990 | Laserscope | Method for performing percutaneous diskectomy using a laser |
5201730, | Oct 24 1989 | Alcon Research, Ltd | Tissue manipulator for use in vitreous surgery combining a fiber optic endoilluminator with an infusion/aspiration system |
5201731, | Mar 30 1988 | 3H INCORPORATED | Laser resectoscope with ultransonic imaging means |
5213097, | Oct 24 1989 | Zewa AG | Apparatus for the treatment of diseases of the walls of opening or cavities of the body |
5230334, | Jan 22 1992 | Summit Technology, Inc. | Method and apparatus for generating localized hyperthermia |
5242439, | Jan 12 1990 | Laserscope | Means for inserting instrumentation for a percutaneous diskectomy using a laser |
5242441, | Feb 24 1992 | Deflectable catheter with rotatable tip electrode | |
5261906, | Dec 09 1991 | ENDODYNAMICS, INC | Electro-surgical dissecting and cauterizing instrument |
5267994, | Feb 10 1992 | Conmed Corporation | Electrosurgical probe |
5275151, | Dec 11 1991 | Clarus Medical, LLC | Handle for deflectable catheter |
5279559, | Mar 06 1992 | FIRST UNION COMMERCIAL CORPORATION | Remote steering system for medical catheter |
5284479, | Aug 30 1989 | N.V. Nederlandsche Apparatenfabriek NEDAP | Implanter |
5304169, | Sep 27 1985 | RJW ACQUISTIONS, L C , D B A 20 20 TECHNOLOGIES, INC | Method for collagen shrinkage |
5308311, | May 01 1992 | GYRUS ACMI, INC | Electrically heated surgical blade and methods of making |
5311858, | Jun 15 1992 | Imaging tissue or stone removal basket | |
5320115, | Jan 16 1991 | PFIZER HOSPITAL PRODUCTS GROUP, INC | Method and apparatus for arthroscopic knee surgery |
5323778, | Nov 05 1991 | BRIGHAM AND WOMEN S HOSPITAL | Method and apparatus for magnetic resonance imaging and heating tissues |
5334193, | Nov 13 1992 | American Cardiac Ablation Co., Inc.; AMERICAN CARDIAC ABLATION, CO , INC | Fluid cooled ablation catheter |
5342357, | Nov 13 1992 | American Cardiac Ablation Co., Inc.; AMERICAN CARDIAC ABLATION CO , INC | Fluid cooled electrosurgical cauterization system |
5348554, | Dec 01 1992 | Boston Scientific Scimed, Inc | Catheter for RF ablation with cooled electrode |
5352868, | May 01 1992 | GYRUS ENT L L C | Resistance feedback controlled power supply |
5354331, | Jul 15 1992 | REFOCUS OCULAR, INC | Treatment of presbyopia and other eye disorders |
5364395, | May 14 1993 | HS WEST INVESTMENTS, LLC | Arthroscopic surgical instrument with cauterizing capability |
5366443, | Jan 07 1992 | Arthrocare Corporation | Method and apparatus for advancing catheters through occluded body lumens |
5366490, | Aug 12 1992 | VIDAMED, INC , A DELAWARE CORPORATION | Medical probe device and method |
5382247, | Jan 21 1994 | Covidien AG; TYCO HEALTHCARE GROUP AG | Technique for electrosurgical tips and method of manufacture and use |
5397304, | Apr 10 1992 | Medtronic CardioRhythm | Shapable handle for steerable electrode catheter |
5401272, | Sep 25 1992 | Hologic, Inc; Biolucent, LLC; Cytyc Corporation; CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP; SUROS SURGICAL SYSTEMS, INC ; Third Wave Technologies, INC; Gen-Probe Incorporated | Multimodality probe with extendable bipolar electrodes |
5415633, | Jul 28 1993 | ACTIVE CONTROL EXPERTS, INC | Remotely steered catheterization device |
5423806, | Oct 01 1993 | Medtronic, Inc.; Medtronic, Inc | Laser extractor for an implanted object |
5433739, | Nov 02 1993 | Covidien AG; TYCO HEALTHCARE GROUP AG | Method and apparatus for heating an intervertebral disc for relief of back pain |
5437661, | Mar 23 1994 | Method for removal of prolapsed nucleus pulposus material on an intervertebral disc using a laser | |
5437662, | Nov 13 1992 | American Cardiac Ablation Co., Inc. | Fluid cooled electrosurgical cauterization system |
5451223, | Mar 14 1983 | Electrosurgical instrument | |
5458596, | May 06 1994 | Oratec Interventions, Inc | Method and apparatus for controlled contraction of soft tissue |
5464023, | Jan 31 1994 | Cordis Corporation | Magnetic exchange device for catheters |
5465737, | Oct 22 1993 | REFOCUS OCULAR, INC | Treatment of presbyopia and other eye disorders |
5472426, | Sep 12 1991 | AOB PROPERTIES LIMITED PARTNERSHIP | Cervical discectomy instruments |
5484403, | Apr 05 1994 | AVID IDENTIFICATION SYSTEMS, INC | Hypodermic syringe for implanting solid objects |
5484432, | Sep 27 1985 | RJW ACQUISTIONS, L C , D B A 20 20 TECHNOLOGIES, INC | Collagen treatment apparatus |
5484435, | Jan 15 1992 | BIRTCHER MEDICAL SYSTEMS, INC | Bipolar electrosurgical instrument for use in minimally invasive internal surgical procedures |
5487757, | Jul 20 1993 | Medtronic CardioRhythm | Multicurve deflectable catheter |
5498258, | Sep 13 1994 | CANOX INTERNATIONAL, LTD | Laser resectoscope with laser induced mechanical cutting means |
5500012, | Jul 15 1992 | LIGHTWAVE ABLATIOIN SYSTEMS | Ablation catheter system |
5507812, | Dec 28 1992 | Modular prosthetic ligament | |
5514130, | Oct 11 1994 | Oratec Interventions, Inc | RF apparatus for controlled depth ablation of soft tissue |
5520645, | Oct 28 1994 | Avantec Vascular Corporation | Low profile angioplasty catheter and/or guide wire and method |
5524338, | Oct 22 1991 | ADVANCED NEUROMODULATION SYSTEMS, INC | Method of making implantable microelectrode |
5527331, | Oct 13 1994 | FemRx | Method for prostatic tissue resection |
5542920, | Sep 12 1994 | IPSEN PHARMA S A S | Needle-less parenteral introduction device |
5569242, | May 06 1994 | Syneron Medical, Ltd | Method and apparatus for controlled contraction of soft tissue |
5582609, | Oct 14 1993 | EP Technologies, Inc. | Systems and methods for forming large lesions in body tissue using curvilinear electrode elements |
5599346, | Nov 08 1993 | AngioDynamics, Inc | RF treatment system |
5630839, | Oct 22 1991 | ADVANCED NEUROMODULATION SYSTEMS, INC | Multi-electrode cochlear implant and method of manufacturing the same |
5673707, | Sep 23 1994 | BOSTON SCIENTIFIC CORPORATION NORTHWEST TECHNOLOGY CENTER, INC | Enhanced performance guidewire |
5681282, | Jan 07 1992 | Arthrocare Corporation | Methods and apparatus for ablation of luminal tissues |
5683366, | Jan 07 1992 | Arthrocare Corporation | System and method for electrosurgical tissue canalization |
5688270, | Jul 22 1993 | Ethicon Endo-Surgery,Inc. | Electrosurgical hemostatic device with recessed and/or offset electrodes |
5697281, | Oct 09 1991 | Arthrocare Corporation | System and method for electrosurgical cutting and ablation |
5697536, | Jan 07 1992 | Arthrocare Corporation | System and method for electrosurgical cutting and ablation |
5697882, | Jan 07 1992 | Arthrocare Corporation | System and method for electrosurgical cutting and ablation |
5697909, | May 10 1994 | Arthrocare Corporation | Methods and apparatus for surgical cutting |
5718702, | Aug 12 1992 | SOMNUS MEDICAL TECHNOLOGIES, INC | Uvula, tonsil, adenoid and sinus tissue treatment device and method |
5785705, | Oct 11 1994 | Oratec Interventions, Inc. | RF method for controlled depth ablation of soft tissue |
5807306, | Nov 09 1992 | VENTION MEDICAL ADVANCED COMPONENTS, INC | Polymer matrix drug delivery apparatus |
5810802, | Aug 08 1994 | E.P. Technologies, Inc. | Systems and methods for controlling tissue ablation using multiple temperature sensing elements |
5810809, | Jan 13 1997 | Enhanced Orthopaedic Technologies, Inc. | Arthroscopic shaver incorporating electrocautery |
5836892, | Oct 30 1995 | Cordis Corporation | Guidewire with radiopaque markers |
5836947, | Oct 07 1994 | EP Technologies, Inc | Flexible structures having movable splines for supporting electrode elements |
5871469, | Jan 07 1992 | Arthro Care Corporation | System and method for electrosurgical cutting and ablation |
5871501, | Jun 07 1995 | ST JUDE MEDICAL, INC | Guide wire with releasable barb anchor |
5882346, | Jul 15 1996 | Cardiac Pathways Corporation | Shapable catheter using exchangeable core and method of use |
5885217, | Jan 20 1995 | Mozarc Medical US LLC | Catheter introducer |
5885278, | Oct 07 1994 | EP Technologies, Inc | Structures for deploying movable electrode elements |
5910129, | Dec 19 1996 | EP Technologies, Inc. | Catheter distal assembly with pull wires |
5916166, | Nov 19 1996 | SciMed Life Systems, INC | Medical guidewire with fully hardened core |
5935123, | Nov 08 1993 | AngioDynamics, Inc | RF treatment apparatus |
5980471, | Oct 10 1997 | Advanced Cardiovascular Systems, INC | Guidewire with tubular connector |
5980504, | Oct 23 1996 | NEUROTHERM, INC | Method for manipulating tissue of an intervertebral disc |
5993424, | Aug 05 1996 | CARDINAL HEALTH SWITZERLAND 515 GMBH | Guidewire having a distal tip that can change its shape within a vessel |
6004319, | Jun 23 1995 | Gyrus Medical Limited | Electrosurgical instrument |
6007570, | Oct 23 1996 | NEUROTHERM, INC | Apparatus with functional element for performing function upon intervertebral discs |
6010493, | Jul 06 1992 | Catheter Imaging Systems | Method of epidural surgery |
6014579, | Jul 21 1997 | Boston Scientific Scimed, Inc | Endocardial mapping catheter with movable electrode |
6023638, | Jul 28 1995 | Boston Scientific Scimed, Inc | System and method for conducting electrophysiological testing using high-voltage energy pulses to stun tissue |
6033397, | Mar 05 1996 | Covidien LP | Method and apparatus for treating esophageal varices |
6048329, | Dec 19 1996 | EP Technologies, Inc. | Catheter distal assembly with pull wires |
6056744, | Jun 24 1994 | Mederi Therapeutics, Inc | Sphincter treatment apparatus |
6073051, | Jun 24 1997 | NEUROTHERM, INC | Apparatus for treating intervertebal discs with electromagnetic energy |
6095149, | Oct 23 1996 | NEUROTHERM, INC | Method for treating intervertebral disc degeneration |
6099514, | Oct 23 1996 | NEUROTHERM, INC | Method and apparatus for delivering or removing material from the interior of an intervertebral disc |
6106522, | Oct 13 1993 | EP Technologies, Inc. | Systems and methods for forming elongated lesion patterns in body tissue using straight or curvilinear electrode elements |
6122549, | Oct 23 1996 | NEUROTHERM, INC | Apparatus for treating intervertebral discs with resistive energy |
6126682, | Oct 23 1996 | NEUROTHERM, INC | Method for treating annular fissures in intervertebral discs |
6135999, | Feb 12 1997 | Oratec Interventions, Inc | Concave probe for arthroscopic surgery |
6165139, | Mar 01 1993 | Fonar Corporation | Remotely steerable guide wire with external control wires |
6217528, | Feb 11 1999 | Boston Scientific Scimed, Inc | Loop structure having improved tissue contact capability |
6224592, | Jan 07 1992 | Arthrocare Corporation | Systems and methods for electrosurgical tissue treatment in conductive fluid |
6241754, | Oct 15 1993 | EP Technologies, Inc. | Composite structures and methods for ablating tissue to form complex lesion patterns in the treatment of cardiac conditions and the like |
6245061, | Jun 07 1995 | EP Technologies, Inc. | Tissue heating and ablation systems and methods using self-heated electrodes |
6258086, | Oct 23 1996 | NEUROTHERM, INC | Catheter for delivery of energy to a surgical site |
6261311, | Oct 23 1996 | NEUROTHERM, INC | Method and apparatus for treating intervertebral discs |
6264650, | Jun 07 1995 | Arthrocare Corporation | Methods for electrosurgical treatment of intervertebral discs |
6270476, | Apr 23 1999 | Medtronic Cryocath LP | Catheter |
6273886, | Feb 19 1998 | Mederi RF, LLC; HORIZON CREDIT II LLC | Integrated tissue heating and cooling apparatus |
6277112, | Jul 18 1996 | Arthrocare Corporation | Methods for electrosurgical spine surgery |
6283960, | Oct 24 1995 | Oratec Interventions, Inc | Apparatus for delivery of energy to a surgical site |
6290715, | Oct 23 1996 | NEUROTHERM, INC | Method for delivering energy adjacent the inner wall of an intervertebral disc |
6304785, | Oct 27 1998 | Huntington Medical Research Institutes | Electrode insertion tool |
6308091, | Dec 03 1993 | Mapping and ablation catheter system | |
6332880, | Dec 19 1996 | EP Technologies, Inc | Loop structures for supporting multiple electrode elements |
6355032, | Jun 07 1995 | Arthrocare Corporation | Systems and methods for selective electrosurgical treatment of body structures |
6416508, | May 10 1993 | Arthrocare Corporation | Methods for electrosurgical tissue treatment in conductive fluid |
6428512, | Oct 10 2000 | Advanced Cardiovascular Systems, Inc. | Guidewire with improved lesion measurement |
6440127, | Feb 11 1998 | COSMAN COMPANY, INC | Method for performing intraurethral radio-frequency urethral enlargement |
6440129, | May 05 1998 | Cardiac Pacemakers, Inc. | Electrode having non-joined thermocouple for providing multiple temperature-sensitive junctions |
20010031963, | |||
20010056278, | |||
20020022830, | |||
20020065541, | |||
20020120259, | |||
CA2188668, | |||
DE2164473, | |||
DE3511107, | |||
DE3632197, | |||
EP257116, | |||
EP274705, | |||
EP439263, | |||
EP479482, | |||
EP521595, | |||
EP542412, | |||
EP558297, | |||
EP566450, | |||
EP572131, | |||
EP682910, | |||
EP729730, | |||
EP737487, | |||
EP783903, | |||
FR1122634, | |||
FR2645008, | |||
GB1340451, | |||
JP542166, | |||
SU637118, | |||
WO8202488, | |||
WO8502762, | |||
WO9205828, | |||
WO9210142, | |||
WO9301774, | |||
WO9316648, | |||
WO9320984, | |||
WO9501814, | |||
WO9510981, | |||
WO9513113, | |||
WO9518575, | |||
WO9520360, | |||
WO9525471, | |||
WO9530373, | |||
WO9530377, | |||
WO9534259, | |||
WO9611638, | |||
WO9632051, | |||
WO9632885, | |||
WO9634559, | |||
WO9634568, | |||
WO9634571, | |||
WO9639914, | |||
WO9706855, | |||
WO9807468, | |||
WO9811944, | |||
WO9817190, | |||
WO9918878, | |||
WO9947058, |
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