WO2001062168A9 - Apparatus and method for accessing and performing a function within an intervertebral disc - Google Patents
Apparatus and method for accessing and performing a function within an intervertebral discInfo
- Publication number
- WO2001062168A9 WO2001062168A9 PCT/US2001/005946 US0105946W WO0162168A9 WO 2001062168 A9 WO2001062168 A9 WO 2001062168A9 US 0105946 W US0105946 W US 0105946W WO 0162168 A9 WO0162168 A9 WO 0162168A9
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- guide wire
- disc
- catheter
- energy
- distal portion
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00261—Discectomy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
- A61B2017/22042—Details of the tip of the guide wire
- A61B2017/22044—Details of the tip of the guide wire with a pointed tip
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
- A61B2017/22049—Means for locking the guide wire in the catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
- A61B2017/3488—Fixation to inner organ or inner body tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips
- A61M25/0082—Catheter tip comprising a tool
- A61M25/0084—Catheter tip comprising a tool being one or more injection needles
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/09—Guide wires
Definitions
- This invention relates to methods and apparatuses for modifying intervertebral disc tissue and more particularly to the treatment of annular fissures and disc defects using percutaneous techniques to avoid major surgical intervention.
- 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 herniations with contained or escaped extrusions, and (iii) chronic, circumferential bulging discs.
- Disc fissures occur rather easily after structural degeneration of fibrous components of the annulus fibrosus during a part of the normal aging process that may be accelerated by trauma. Sneezing, bending or just attrition can tear these degenerated annulus fibrosus 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 leak out of the contained intervertebral disk and irritate surrounding structures.
- Disc fissures can also 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 such as the corresponding nerve root. In addition to nerve root compression, escaped nucleus pulposus contents may chemically irritate neural structures.
- Figures 1A and 1B illustrate a cross-sectional anatomical view of a vertebra and associated disc and a lateral view of a portion of a lumbar and thoracic spine, respectively.
- FIG. 1A Structures of a typical cervical vertebra (superior aspect) are shown in Figure 1A: 104-lamina; 106-spinal cord; 108-dorsal root of the spinal nerve; 114-ventral root of the spinal nerve; 116-posterior longitudinal ligament; 118-intervertebral disc; 120-nucleus pulposus; 122-annulus fibrosus; 123-anterior longitudinal ligament; 126-vertebral body; 128-pedicle; 130-vertebral artery; 132-vertebral veins; 134- superior articular facet; 136-posterior lateral portion of the annulus; 138- posterior medial portion of the annulus; and 149-spinous process.
- FIG. 1A one side of the intervertebral disc 118 is not shown so that the anterior vertebral body 126 can be seen.
- FIG. 1B is a lateral aspect of the lower portion of a typical spinal column showing the entire lumbar region and part of the thoracic region and displaying the following structures: 118-intervertebral disc; 126-vertebral body; 142-spinous process; 170-inferior vertebral notch; 110-spinal nerve; 174-superior articular process; 176-lumbar curvature; and 180-sacrum.
- FIG. 1D is an overhead view of an instrument introduced by the posterior lateral approach.
- annular fissures or herniations can be treated or repaired. It would be further desirable to provide a modular exchange system to address various functions such as delivery of energy, delivery of medicaments, removal of material or providing access for physical and chemical modification of the nucleus and annulus.
- an apparatus for accessing a selected section of an intervertebral disc.
- the apparatus comprises a catheter having a lumen; and a guide wire having a distal portion and a proximal portion, and configured to be positioned within and moved relative to the lumen of the catheter; wherein the guide wire is capable of navigating itself within an intradiscal section of the intervertebral disc adjacent an inner wall of an annulus of the disc to the selected section of the disc and the catheter is capable of being advanced relative to the guide wire such that the catheter follows a path of the guide wire within the intradiscal section of the disc adjacent the inner wall of the annulus of the disc to the selected section.
- the guide wire is built to possess (a) sufficient rigidity to be advanceable through a nucleus pulposus and around the inner wall of an annulus fibrosus under a force applied longitudinally to the proximal end of the core wire, (b) insufficient penetration ability to be advanceable out through the annulus fibrosus under the applied force, and (c) sufficient flexibility in a direction of a disc plane to be compliant with the inner wall.
- the distal portion of the guide wire includes a spring coil to adjust flexibility of the guide wire.
- a forming ribbon may be incorporated the distal portion of the guide wire to support the spring coil.
- the spring coil may be fully coated with Teflon or other biocompatible materials.
- the distal portion of the guide wire may be tapered to a smaller diameter toward the distal end.
- the distal portion of the guide wire has a distal tip at the extremity of the distal portion of the guide.
- the distal portion of the guide wire may have one or more flat sides.
- the distal tip may be configured to be non-piercing through an annulus fibrosus, for example, including a blunt tip or a rolling ball tip.
- the distal tip may also include a locking mechanism for securing the guide wire within the selected section of the intravertebral disc, such as within an intradiscal section of the disc adjacent an inner wall of an annulus of the disc.
- the locking mechanism may a retractable hook or comprises a plurality of directional hooks.
- the guide wire may be capable of cross-locking itself once the guide wire is advanced to the selected section of the disc.
- the proximal portion of the guide wire may preferably have an outer diameter between about 0.005- 0.025 inches.
- the distal portion of the guide wire may preferably have an outer diameter between about 0.002-0.012 inches.
- the proximal portion of the guide wire may preferably be between about 10-15 inch long.
- the distal portion of the guide wire may preferably be between about 0.2-1.2 inch long.
- Tdistal portion of the guide wire may preferably have a length at least one-half of a diameter of the nucleus pulposus.
- the apparatus of the present invention may further include a dialator sheath configured to be slid or passed over the guide wire for introducing the catheter onto the guide wire.
- the guide wire of the apparatus may be actively steerable. At least a portion of guide wire may be radiographically visible.
- the guide wire of the apparatus may have a bending stiffness as measured in Taber stiffness units preferably between about 2 - 400 and more preferably about 3 - 150 units in a desired bending plane.
- the distal portion of the guide wire may have a column strength preferably between about 0.2 - 7 kg, and more preferably between about 0.7 -4 kg.
- the catheter of the apparatus may further includes a functional element for performing a function adjacent the selected section, such as delivering energy, adding material and removing material.
- the functional element may also be an irrigation lumen extending from a proximal end of the catheter to the intradiscal section.
- the functional element may comprise a thermal energy delivery device.
- a thermal energy source may be operably attached to the thermal energy delivery device through the catheter.
- the thermal energy delivery devices include, but are not limited to, microwave probs, optical fibers, radio frequency electrodes, thermal resistive heaters, integrated circuits and ultrasound emitters.
- the functional element may be capable of delivering a controlled amount of energy at or near the fissure such that no vaporization occurs at or near the fissure when energy is delivered by the functional element.
- the functional element may be capable of delivering a controlled amount of energy at or near the fissure such that no material other than water is removed at or near the fissure when energy is delivered by the functional element.
- the functional element may be capable of delivering a controlled amount of energy at or near the fissure such that no destructive lesion is formed on a disc at or near the fissure when energy is delivered by the functional element.
- the catheter of the apparatus may further comprise at least one sensor capable of monitoring temperature, power, voltage or a combination thereof and the input from the sensor controls energy supplied to the thermal energy device.
- a method of treating an intervertebral disc comprises: causing a guide wire to navigate itself within an intradiscal section of the intervertebral disc adjacent an inner wall of an annulus of the disc to a selected section of the disc; taking a catheter which has the guide wire positioned within a lumen of the catheter; and advancing the catheter relative to the guide wire such that the catheter follows a path of the guide wire within the intradiscal section of the disc adjacent the inner wall of the annulus of the disc to the selected section.
- the step of causing the guide wire to navigate itself may be applying a longitudinal force to the guide wire which is sufficient to advance the guide wire through the nucleus pulposus and around the inner wall of an annulus fibrosus, but which force is insufficient for guide wire to puncture the annulus fibrosus.
- the selected section of the disc may be a posterior medial, posterior lateral, anterior lateral, or anterior medial section of the annulus fibrosus, or a combination thereof.
- the method may further include a step of performing a function adjacent the selected section by using a catheter that include a functional element for performing the function.
- the function may be delivering energy, adding material and removing material.
- the functional element may be a heating element coupled with a temperature sensor.
- a heating element may be a coil heating element, a flat heating element, or a flex ribbon heating element.
- the guide wire itself may include a heating element.
- the method according to the present invention may further include a step of using the function to treat annular fissures, for example, by adding sufficient energy to the selected section of the disc.
- the sufficient energy may be added to shrink the collagen component of the annulus fibrosus around the fissure or to cauterize granulation tissue in the fissure.
- the functional element may be a lumen capable of delivering or aspirating material.
- the method includes a further step of placing a material in the disc.
- a material may be electrolyte solutions, contrast media, pharmaceutical agents, chemonucleolytic enzymes, hydrogel, osteoinductive substances, chondrocyte-inductive substances, sealants, collagen, fibrinogen and thrombin, and any combination thereof.
- an advantage of the invention is to provide a simple and maneuverable apparatus for accessing the interior of an intervertebral disc.
- the apparatus should be able to advance and navigate through the nucleus pulposus and along the annulus fibrosus to provide access to the site of the annular fissure.
- Still a further advantage of the invention is to provide a device which has a distal end that is inserted into the disc and access the posterior, posterior lateral and posterior medial regions of the inner wall of the annulus fibrosus.
- Another advantage of the invention is to provide an apparatus and method which is exchangeable over the access portion of the invention to provide various functions within the intervertebral disc such as diagnostic viewing, energy delivery, mechanical manipulation, removal or addition of material, delivery of medicament and pain management.
- the construction of the separate guide wire and catheter is advantageous in that both structural units may be designed separately without relying on a single structure for both support and treatment.
- FIG. 1A is a superior cross-sectional anatomical view of a cervical disc and associated vertebral structure.
- FIG. 1B is a lateral anatomical view of a portion of a lumbar spine.
- FIG. 1C is a posterior-lateral anatomical view of two adjacent lumbar vertebrae.
- FIG. 1D is a superior cross-sectional view of a specified posterior lateral approach into a herniated intervertebral disc.
- FIG. 2 is a cross-sectional view of an intervertebral disc with a portion of an intervertebral apparatus of the present invention inserted into an intervertebral disc with a fissure along a posterior aspect of the annulus fibrosus.
- FIG. 3 is a plan view of a guide wire of the invention showing a central portion, a distal flexible section and a distal tip.
- FIG. 4A is a cross-sectional view of the guide wire of the present invention including a specific embodiment of a tapered guide wire at the distal flexible section.
- FIG. 4B is a cross-sectional view of the guide wire of FIG. 4A with a treatment catheter positioned proximally over the guide wire.
- FIG. 4C is a cross-sectional view of a specific embodiment of the guide wire of the present invention with a ribbon-shaped core section at the distal flexible section.
- FIG. 5A illustrates a partial cross-sectional view of the intervertebral disc with an introducer inserted into the disc.
- FIG. 5B is a partial cross-sectional view of the guide wire of the present invention inserted through the introducer of FIG. 5A and navigated and positioned along a specified posterior aspect of the intervertebral disc.
- FIG. 5C is a cross-sectional view of the core wire of FIG. 5B remaining in place at after the introducer is removed.
- FIG. 5D is a cross-sectional view of the guide wire of FIG. 5B with a dialator sheath inserted into the intervertebral disc over the guide wire.
- FIG. 5E is a partial cross-sectional view of the guide wire and dialator sheath of FIG. 5D with a treatment catheter inserted over the guide wire to the desired treatment site along the posterior aspect of the intervertebral disc.
- FIG. 5F is a partial cross-sectional view of the guide wire and treatment catheter of FIG. 5E after the sheath is removed.
- FIG. 5G is a cross-sectional view of a specific embodiment of the apparatus of the present invention wherein the treatment catheter remains within the dialator sheath and the guide wire is removed.
- FIG. 6A is a partial cross-sectional view of a specific embodiment of the apparatus of the invention illustrating a guide wire with a distal locking tip within a dialator sheath.
- FIG. 6B is a partial cross-sectional view of the apparatus of FIG. 6A with the dialator removed.
- FIG. 7A is a partial cross-sectional view of a specific embodiment of the apparatus according to the present invention illustrating a guide wire with a preformed shape which crosses through the nucleus to lock on an anterior aspect of the intervertebral disc within the dialator.
- FIG. 7B is a partial cross-sectional view of the apparatus of FIG. 7A illustrating the removal of the dialator.
- FIG. 8A is an illustration of the guide wire and introducer according to the present invention with a section of the distal portion of the treatment catheter being extended over the guide wire.
- FIG. 8B is a detailed longitudinal cross-sectional view of the distal portion treatment catheter of FIG. 8A over the guide wire having a heating element and a temperature sensor.
- FIG. 8C is a cross-sectional view of the distal portion of the treatment catheter of FIG. 8B showing the guide wire placement within the catheter.
- FIG. 9A is a cross-sectional view of a specific embodiment the distal tip of the guide wire according to the present invention with a hook locking tip.
- FIG. 9B is a detailed cross-sectional view of the distal tip of the guide wire of FIG. 9A showing the hook locking tip retracted within the distal tip.
- FIG. 10 is a plan view of a specific embodiment of the guide wire of the present invention with a coil at the distal flexible portion and a directional hook locking tip.
- FIG. 11 is a simplified plan view of a guide wire using a pre- shaped form to retain a curved shape after deployment.
- FIG. 12A is a plan view of the heating element of the treatment catheter of FIG. 8B with a helical coil structure.
- FIG. 12B is a plan view of a specific embodiment of the heating element of the catheter of FIG. 8B with a flat structure.
- FIG. 12C is a plan view of a specific embodiment of the heating element of the catheter of FIG. 8B with a ribbon structure.
- FIG. 12D is a plan view of a specific embodiment of the heating element of the catheter of FIG. 8B using a distal portion of the guide wire as a monofilament heating element.
- the present invention provides novel apparatus and methods for accessing and performing functions within an intervertebral disc, particularly for treating intervertebral disc disorders such as sealing fissures of the annulus fibrosus, which may or may not be accompanied with contained or escaped extrusions.
- the present invention may also involve the removal or addition of material to the intervertebral disc.
- an apparatus is provided for accessing a selected section of an intervertebral disc.
- the apparatus comprises a catheter having a lumen; and a guide wire having a distal portion and a proximal portion, and configured to be positioned within and moved relative to the lumen of the catheter; wherein the guide wire is capable of navigating itself within an intradiscal section of the intervertebral disc adjacent and/or through an inner wall of an annulus of the disc to the selected section of the disc and the catheter is capable of being advanced relative to the guide wire such that the catheter follows a path of the guide wire within the intradiscal section of the disc to the selected section.
- the guide wire is built to possess (a) sufficient rigidity to be advanceable through a nucleus pulposus and through and/or around the inner wall of an annulus fibrosus under a force applied longitudinally to the proximal end of the core wire, (b) insufficient penetration ability to be advanceable out through the annulus fibrosus under the applied force, and (c) sufficient flexibility in a direction of a disc plane to be compliant with the inner wall.
- the distal portion of the guide wire includes a spring coil to adjust flexibility of the guide wire.
- a forming ribbon may be incorporated the distal portion of the guide wire to support the spring coil.
- the spring coil may be fully coated with Teflon or other biocompatible materials.
- the distal portion of the guide wire may be tapered to a smaller diameter toward the distal end.
- the distal portion of the guide wire has a distal tip at the extremity of the distal portion of the guide.
- the distal portion of the guide wire may have one or more flat sides.
- the distal tip may be configured to be non-piercing through an annulus fibrosus, for example, including a blunt tip or a rolling ball tip.
- the distal tip may also include a locking mechanism for securing the guide wire within the selected section of the intervertebral disc, such as within an intradiscal section of the disc adjacent an inner wall of an annulus of the disc.
- the locking mechanism may a retractable hook or comprise a plurality of directional hooks.
- the guide wire may be capable of cross-locking itself once the guide wire is advanced to the selected section of the disc.
- the proximal portion of the guide wire may preferably have an outer diameter between about 0.005- 0.025 inches.
- the distal portion of the guide wire may preferably have an outer diameter between about 0.002-0.012 inches.
- the proximal portion of the guide wire may preferably be between about 10-15 inch long.
- the distal portion of the guide wire may preferably be between about 0.2-1.2 inch long.
- the distal portion of the guide wire may preferably have a length at least one-half of a diameter of the nucleus pulposus.
- the apparatus of the present invention may further include a dialator sheath configured to be slid or passed over the guide wire for introducing the catheter onto the guide wire.
- the guide wire of the apparatus may be actively steerable. At least a portion of guide wire may be radiographically visible.
- the guide wire of the apparatus may have a bending stiffness as measured in Taber stiffness units preferably between about 2 - 400 and more preferably about 3 - 150 units in a desired bending plane.
- the distal portion of the guide wire may have a column strength preferably between about 0.2 - 7 kg, and more preferably between about 0.7 -4 kg.
- the catheter of the apparatus may further includes a functional element for performing a function adjacent the selected section, such as delivering energy, adding material and removing material.
- the functional element may also be an irrigation lumen extending from a proximal end of the catheter to the intradiscal section.
- the functional element may comprise a thermal energy delivery device.
- a thermal energy source may be operably attached to the thermal energy delivery device through the catheter. Examples of the thermal energy delivery devices include, but are not limited to, microwave probes, optical fibers, radio frequency electrodes, plasma and/or ion generators, and ultrasound emitters.
- the functional element may be capable of delivering a controlled amount of energy at or near the fissure such that no vaporization occurs at or near the fissure when energy is delivered by the functional element.
- the functional element may be capable of delivering a controlled amount of energy at or near the fissure such that no material other than water is removed at or near the fissure when energy is delivered by the functional element.
- the functional element may be capable of delivering a controlled amount of energy at or near the fissure such that no destructive lesion is formed on a disc at or near the fissure when energy is delivered by the functional element.
- the catheter of the apparatus may further comprise at least one sensor capable of monitoring temperature, power, voltage or a combination thereof and the input from the sensor controls energy supplied to the thermal energy device.
- an apparatus of the present invention is in the form of an externally guidable guide wire and a catheter with a lumen for accessing and modifying the intradiscal structure and environment within or a selected location of an intervertebral disc having a nucleus pulposus and an annulus fibrosus, the annulus having an inner wall.
- Use of various exchange-type catheters for different functions provides a variable and highly modifiable treatment system for delivering energy, adding or removing material from the intervertebral disc.
- the nucleus pulposus can be considered as having a given diameter in a disc plane between opposing sections of the inner wall. This nucleus pulposus diameter measurement allows instrument sizes (and components of instruments) designed for one size disc to be readily converted to sizes suitable for an instrument designed for a different size of disc such as the difference between cervical and lumbar discs.
- the operational portions of the apparatus of the present invention is guided to a location in or near the annular fissure in the annulus of the intervertebral disc using techniques using techniques and apparatuses typical of percutaneous interventions.
- the apparatus of the invention can be used with any insertional apparatus that provides access and proximity to the intervertebral disc, including many such insertional apparatuses known in the art, the term "introducer" is used to describe this aid to the apparatus and method.
- An introducer has an internal introducer lumen with a distal opening at a terminus of the introducer to allow insertion and subsequent manipulation of the operational portions of the apparatus through the body into and within the interior of a disc.
- a method of treating an intervertebral disc comprises: causing a guide wire to navigate itself within an intradiscal section of the intervertebral disc adjacent an inner wall of an annulus of the disc to a selected section of the disc; taking a catheter which has the guide wire positioned within a lumen of the catheter; and advancing the catheter relative to the guide wire such that the catheter follows a path of the guide wire within the intradiscal section of the disc adjacent the inner wall of the annulus of the disc to the selected section.
- the step of causing the guide wire to navigate itself may be applying a longitudinal force to the guide wire which is sufficient to advance the guide wire through the nucleus pulposus and through and/or around the inner wall of an annulus fibrosus, but which force is insufficient for guide wire to puncture the annulus fibrosus.
- the selected section of the disc may be a posterior medial, posterior lateral, anterior lateral, or anterior medial section of the annulus fibrosus, or a combination thereof.
- the method may further include a step of performing a function adjacent the selected section by using a catheter that include a functional element for performing the function.
- the function may be delivering energy, adding material and removing material.
- the functional element may be a heating element coupled with a temperature sensor.
- a heating element may be a coil heating element, a flat heating element, or a flex ribbon heating element.
- the guide wire itself may include a heating element.
- the method according to the present invention may further include a step of using the function to treat annular fissure, for example, by adding sufficient energy to the selected section of the disc.
- the sufficient energy may be added to shrink the collagen component of the annulus fibrosus around the fissure or to cauterize granulation tissue in the fissure and thus, stimulate a healing response by the body.
- the functional element may be a lumen capable of delivering or aspirating material. According, the method includes a further step of placing a material in the disc.
- Such a material may be electrolyte solutions, contrast media, pharmaceutical agents, chemonucleolytic enzymes, hydrogel, osteoinductive substances, chondrocyte-inductive substances, sealants, collagen, fibrinogen and thrombin, and any combination thereof.
- the method of the present invention which involves accessing the nucleus pulposus of an intervertebral disc is easily carried out with an apparatus according to the present invention.
- an introducer is provided that is located in a patient's body so that its proximal end is external to the body and the distal opening of its lumen is internal to the body and (1) internal to the annulus fibrosus or (2) adjacent to an annular opening leading to the nucleus pulposus, such as an annular tear or trocar puncture that communicates with the nucleus pulposus.
- a guide wire is slid into position within and through the introducer lumen so that a distal tip of the guide wire is positioned at the selected location of the disc by advancing or retracing the guide wire in the introducer lumen and optionally twisting the proximal end of the guide wire to precisely navigate the guide wire.
- the distal portion of the guide wire will curve along the inner wall of the annulus fibrosus as it is navigated and is selectively guided to an annular tear or fissure at selected locations within the intervertebral disc.
- a treatment catheter with a lumen for at least the guide wire is positioned over the guide wire and slid over the guide wire and navigated to the distal most portion of the guide wire within the disc.
- the treatment catheter is configured to provide a function selected from ablation or shrinkage, delivery of medicaments, suction, viewing or monitoring within the disc, ultrasound delivery for treatment, mechanical manipulation, and/or ionization of disc tissue.
- the treatment catheter may also be "exchanged" such that various treatment modalities incorporated into separate catheters can be positioned and slid over the guide wire to provide various treatments without removal of the guide wire thereby providing less trauma to the patient.
- exchangeability and versatility of the apparatus maximizes the variety of functions to be performed within the intradiscal section of the disc without potentially costly construction of various catheters each having a built-in guide wire.
- FIG. 2 the anatomy of an intervertebral disc is illustrated with an apparatus according to the present invention inserted into the disc.
- Structures of the disc are identified and described by these anatomical designations: 136 — posterior lateral inner annulus, 138 — posterior medial inner annulus, 122 — annulus fibrosus, 120 — nucleus pulposus, 146 — annulus/dural interface, 148 — annulus/posterior longitudinal ligament interface, 150 — anterior lateral inner annulus, and 152 — anterior medial inner annulus.
- the method and treatment according to the present invention are approached from the posterior aspect 103 of the intervertebral disc towards the anterior aspect 102 of the disc.
- FIG. 2 illustrates the mechanical characteristics of flexible distal section 30 of guide wire 10 are selected to have (1) sufficient column strength along the longitudinal axis of the guide wire to be able to advance and push through the nucleus pulposus 120 and (2) different flexural strengths along two axes orthogonal to the longitudinal axis to allow controlled bending of the guide wire 10. These parameters make the guide wire easily conformable and guidable along or directly through inner wall 22 of the annulus fibrosus 122 to reach a desired location, such as the posterior wall along posterior medial annulus 138. Distal tip 20 of the guide wire 10 is preferably anti-traumatic such that the guide wire does not penetrate through the fissures or tears 44 in the annulus.
- Guide wire 310 is illustrated in one embodiment in FIG. 3.
- the guide wire 310 consists of a core with a generally constant diameter from a proximal portion to a distal tip 320.
- a flexible distal portion 330 is located at or near the distal tip 320 of guide wire 320.
- a coil 315 is positioned at or near the distal tip such that a differential flexibility characteristic allows the guide wire to navigate through the nucleus pulposus of the disc.
- the guide wire 410 is configured with a tapering section 411 which provides a differential bending stiffness through the distal portion 425 of the guide wire.
- Flexible distal portion 430 is comprised of a coil 415 which allows the tapering section 415 curve and navigate along the wall of the annulus.
- Blunt distal tip 420 limits and prevents the distal tip from penetrating large fissures in the annulus fibrosus.
- the catheter 400 is shown with a lumen 401 which is large enough to pass over the guide wire 410.
- the catheter 400 is sized to pass over the distal portion 425 and flexible distal portion 430 and distal tip 420. It is preferable that the catheter 400 have a larger diameter than the entire core guide wire 410 such that the distal end of the catheter may extend beyond the placement of the distal end 420 of guide wire 410.
- FIG. 4C is another specific embodiment of the guide wire 410 wherein the distal tip portion 425 has flat core 412 at the distal end through flexible distal portion 430.
- the flattened ribbon configuration of flat core 412 allows the coils around distal tip 415 to have even greater flexibility when navigating through the nucleus of the intervertebral disc.
- the distal tip 420 is a blunt tip to provide an anti-penetration characteristic.
- distal tip 420 may be configured as a ball which is soldered to the flat core 412 for protection and steerability of the core wire 410.
- the intervertebral disc is illustrated with a posterior aspect 103 and an anterior aspect 102.
- the introducer 540 is inserted through the body into the nucleus pulposus 120 of the disc.
- the introducer needle has a hub 545 which is located outside of the patients body to receive and guide the core wire.
- the introducer is preferrably not inserted into the annulus fibrosus 122 but can be positioned either away from the fissures or tear 44 or on the same posterior aspect (not shown).
- FIG. 5B demonstrates the guide wire 510 inserted through the hub 545 and introducer 540 through the body to the nucleus pulposus 120.
- the guide wire 510 has sufficient rigidity and tortional characteristics such that the guide wire is advanced through the introducer 540 and navigates along or through the inner wall of the annulus fibrosus.
- the distal portion 530 of the guide wire is then positioned along the annular fissure or tear before treatment.
- FIG. 5C illustrates the guide wire 510 remaining in place after the introducer is removed, thus leaving no sharpened structures along the path of the guide wire.
- the distal portion 530 remains placed along the posterior inner wall of the annulus near the tear.
- a dialator sheath 550 is inserted over the guide wire 510.
- Sheath 550 performs a similar function as a guiding catheter which is known in the art.
- the sheath supports the catheter (not shown) and guide wire when the catheter is advanced through the body percutaneously and also protects the catheter from any collateral damage that may be associated when the catheter is inserted over the guide wire.
- Sheath 550 also provides a conduit for the catheter into the nucleus in the event that the catheter would encounter some resistance which could damage the treatment modalities associated with the catheter.
- the catheter 500 is inserted into the disc through sheath 550.
- Catheter has a distal portion 531 which is configured to a desired treatment modality and function such as ablation of nucleus pulposus material by the delivery of energy, shrinkage of associated collagen structures near the annular fissure or tear 44 by delivery of energy, suction of extraneous herniated material, delivery of medicaments for the relief of pain associated with a fissure or herniation, insertion of a balloon catheter for expansion of the nuclear material, ultrasound monitoring, visual monitoring of the nucleus or annulus via fiber optic or diagnostic delivery of fluoroscopic solutions.
- a desired treatment modality and function such as ablation of nucleus pulposus material by the delivery of energy, shrinkage of associated collagen structures near the annular fissure or tear 44 by delivery of energy, suction of extraneous herniated material, delivery of medicaments for the relief of pain associated with a fissure or herniation, insertion of a balloon catheter for expansion of the nuclear material,
- the catheter 500 includes a heating element at or near the distal portion 531 such that the annular fissure may be treated with thermal energy such that the fissure is sealed.
- the guide wire 510 may remain in place and catheter 500 may be "exchanged" such that different functional catheters as described above may be inserted and withdrawn to perform a specific function or a variety of separate functions. This is advantageous in that the traumatic effect of a percutaneous surgical procedure is limited in that a single surgical site may provide various treatments without the need for multiple surgical sites.
- FIG. 5F illustrates the removal of the sheath 550 of FIG. 5E such that the guide wire 510 remains within the nucleus pulposus and the flexible distal portion remains positioned along the posterior inner wall of the annulus.
- the catheter 500 remains in place over guide wire 510 and the desired function may be performed along the desired portion of the intervertebral disc.
- FIG. 5G An alternative embodiment of the apparatus of the present invention is illustrated in FIG. 5G.
- the sheath 550 remains in place percutaneously with catheter 500.
- the guide wire is removed from the inner lumen of the catheter 500.
- Distal tip 531 of the catheter remains in place due to the semisolid characteristics of the nucleus pulposus 120.
- the desired function may still be performed along the inner wall such as at the annular fissure 44.
- the guide wire 510 component has a preferable tensile strength of 600-2000 Mpa.
- the percent elongation of the guide wire is from 5-100 with a desired geometry of 0.2 - 2.3 mm. Preferably, there is little conductivity
- Tensile strength and % elongation can be measured according to ASTME8 (tension test of metallic materials). Conductivity and resistivity can be determined by procedures to be found in ASTM Vol. 2.03 for electrothermal properties.
- the heating element has at least a 300 Mpa tensile strength with a % elongation of 20%.
- the conductivity of the heating element is preferably in the range of 0.025-0.2 cal/cm2/cm/sec/C with a resistivity of 500-1500.
- the diameter of the guide wire is preferably between 0.0020 -
- the actual dimensions of the guide wire will vary with the stiffness and tensile strength of the material used to form the guide wire.
- the guide wire may also have various other shapes other than tapered or a flattened ribbon such as triangular, oval, wedge or rectangular in cross-sectional shape.
- the guide wire preferably has a total length greater than or at least equal to the length of the catheter.
- the guide wire may be manufactured from a high strength alloy containing cobalt, nickel, chromium or to a composite product having a portion formed of an alloy and a pseudoelastic alloy such as NiTi (NITINOL).
- the catheter has a diameter in the range between 0.0020 - 0.0068 inches with a 0.0038 inch preferred diameter.
- the catheter sheath is preferably polyimide but may be any biocompatible material such as polyurethane, polyester, rayon, polyamide and silicone.
- the sheath may be a braided structure such that the flexibility of the catheter may be adjusted by varying the tightness of each braided section.
- the length of the catheter is in the range of 3.9 inches to 23.6 inches (10 cm to 60 cm, respectively).
- the interior of the catheter may also be coated such that the outer sheath has support characteristics.
- coatings include but are not limited to silicone, polyimide and the like.
- the inner lining and coating also provide for a smooth gliding over the guide wire to prevent kinking or snagging of the catheter.
- FIG. 6A a specific embodiment of the core guide wire 610 with a distal hooking tip 635 is illustrated to fix the modular guide wire to the interior annulus wall after final position is achieved.
- the guide wire 610 is inserted through the introducer (not shown) and navigated to a desired portion along the inner wall of the annulus.
- Distal locking tip 635 is inserted and held in place such that the distal portion 630 remains in place.
- the catheter 600 slides through sheath 640 into the nucleus 120 of the intervertebral disc.
- the distal portion 631 of catheter 600 is positioned at the annular fissure 44 for performing a function as described above.
- FIG. 6B illustrates the catheter 700 placed within the intervertebral disc with sheath 650 removed.
- the guide wire has a cross- locking configures to fix the modular guide wire to the interior annulus wall.
- FIG. 7A illustrates a guide wire 710 passing through a introducer sheath 750 and being navigated along the annulus wall and locked into place with distal locking tip 735. Flexible distal portion 730 is crossed- over the guide wire 710 and locked into an anterior portion of the disc. The catheter 700 is slid over the guide wire 710 to place distal portion 731 within the nucleus pulposus along annular fissure 44.
- FIG. 7B illustrates the catheter 700 in place without the sheath 750.
- FIG. 8A depicts one specific embodiment of a catheter 800 over guide wire 810.
- Guide wire 810 is placed within intervertebral disc 118 and distal portion 830 and distal tip 820 are positioned along the posterior inner wall of the annulus.
- Sheath 850 is placed into the intervertebral disc 118 for introduction of catheter 800.
- Distal portion 831 of the catheter 800 is shown over the guide wire 810.
- FIG. 8B illustrates the catheter 800 in cross- section according to the present invention over a section of the guide wire 810.
- the distal tip 821 of heating catheter 820 has an opening into the lumen for passing over the guide wire 810.
- the internal lumen near the distal portion 831 contains a heating coil 860 for resistive heating.
- the heating coil 860 is electrically connected to an electrosurgical generator at the proximal portion of the catheter (not shown).
- a thermal sensor 870 such as a thermocouple is also positioned at the distal portion 830 of the catheter 800.
- a potting material can be used to fix the position of the thermal sensor 870 and provide a larger area from which to measure the temperature within the area.
- the thermal sensor 870 is connected by conductor 872 to a sensor located preferably within the electrosurgical generator but may be a separate unit.
- the sensor is of conventional design, including but not limited to a thermistor, T type thermocouple with copper constantan junction, J type, E type, and K type thermocouples, fiber optics, resistive wires, infrared detectors, integrated circuits and the like.
- FIG. 8C shows a detailed cross-section of the arrangement of the guide wire 810 within catheter 800. Electrical conductor 862 is connected to heating element 860. Thermal sensor 870 is illustrated within the cross-section of the catheter.
- the arrangement of the conductors, thermal sensors and guide wire within the catheter are meant for illustration only and any suitable arrangement will be appreciated by those skilled in the art.
- FIG. 9A and 9B illustrate another specific embodiment of a distal tip of a core guide wire according to the invention.
- Guide wire 910 may be configured to have a locking distal tip 935. Hooking element 934 extends out of distal tip 935 to anchor the tip within the annular wall.
- FIG. 9B illustrates the hooking element 934 retracted into a lumen within the distal portion 930 of the guide wire 910.
- FIG. 10 is another specific embodiment of the present invention with a substantially constant diameter core guide wire 1010 with a flexible distal portion 1030.
- the flexible distal portion further has coils 1015 for added flexibility at the distal tip.
- Distal tip 1035 is a locking tip with hooks 1036 along an edge of the distal tip.
- the hooks 1036 are oriented such that a clockwise twist of the guide wire 1010 will lock the tip into the annulus inner wall. A counterclockwise twist will release the guide wire from being locked.
- the guide wire 1110 is substantially straight along a proximal portion of the core wire.
- the distal portion 1130 is pre-shaped into a curve shaped such that distal tip 1120 will curve toward the guide wire after deployment such as in the cross-locking embodiment described above in FIG. 7A. It will be appreciated that any pre-shaped configuration may be used to define the distal portion of the guide wire.
- FIG. 12 various thermal energy elements are illustrated.
- the thermal energy element may be positioned around an exterior of the catheter or within the lumen of the catheter as depicted in FIG. 8B.
- the thermal energy element may be an integrated structural element with the catheter sheath or the element may be separately constructed as a circuit and mounted to the catheter by epoxy or other attachment method known within the art.
- the thermal energy element may also be biased in that the element may be mounted differentially along one side of the catheter such that a preferential treating occurs substantially along only a portion of the catheter.
- Suitable materials for the heating element include but are not limited to stainless steel, NITINOL, nickel/chromium allows, platinum and the like.
- the heating element may also be a polymeric structure with differing flex characteristics to provide some support to the catheter near the distal tip.
- the thermal energy element 1260 is a resistive heating coil.
- the resistive material is electrically insulated and substantially no current escapes into the body. With increasing levels of current, element 1260 may heat the annulus to greater temperature levels without a change in the structure of the coil.
- a specific embodiment of a temperature level is approximately 55C at a specific target site such as an annular fissure. The range for heat is from 45C to 75C.
- sufficient energy is delivered to the intervertebral disc to heat and shrink the collage component of the annulus fibrosus and/or nucleus pulposus but not to ablate any surrounding tissue adjacent to the catheter.
- the heating coil is configured to seal the fissure without damage to surrounding tissue. It is believed that the injury to the intervertebral disc tissue and the body's own healing response leads to a marked improvement
- FIG. 12B illustrates a heating element 1261 which is a flat element.
- the flat elements may be etched onto a surface of the catheter or separate element to be bonded to the catheter by chemical etching, electrochemical etching, photo etching or physical etching. Additionally, the flat heating elements 1261 may be chemically, electrically or physically deposited onto the surface. Similarly in FIG. 12C, the heating element may be in the form of a flex ribbon heating element 1262.
- Each heating element 1261 may be individually connected to the electrosurgical generator to delivery power and energy either in parallel or series such that the energy is delivered between each element and through the tissue.
- FIG. 12D illustrates a heating element comprised of a section of the core guide wire 1210 in the form of a monofilament 1263.
- a proximal portion 1265 of the guide wire has insulation to prevent heating of the guide wire at that portion.
- Distal portion 1220 is used as the heating element to deliver thermal energy to the desired site.
- a radiographically opaque marking device can be included in the distal portion of the catheter (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 catheter 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
- temperatures delivered through the heating element may be detected at sensors to provide feedback for maintaining a selected power in the electrosurgical generator.
- the actual temperatures are measured at temperature measurement device, and the temperatures are displayed at user interface and display.
- a control signal is generated by controller that is related to the actually measured temperature and a desired temperature.
- the control signal is used by power circuits to adjust the power output in an appropriate amount in order to maintain the desired temperature delivered at the respective sensor.
- a multiplexer can be included to measure current, voltage, and temperature at the sensors so that appropriate energy can be delivered to resistive heating elements.
- the core of the guide wire can also provide the function of differential flexibility by varying the thickness in one or more dimensions (for example, the "thin” dimension, the “thick” dimension, or both) along the length of the guide wire.
- a guide wire that tapers (becomes gradually thinner) toward the distal tip of the guide wire will be more flexible and easier to bend at the tip than it is at other locations along the guide wire.
- a guide wire that has a thicker or more rounded tip than more proximal portions of the mandrel will resist bending at the tip but aid bending at more proximal locations. Thickening (or thinning) can also occur in other locations along the guide wire.
- Control of the direction of bending can be accomplished by making the guide wire more round, i.e., closer to having 1 :1 diameter ratios; flatter in different sections of the guide wire; or by varying the absolute dimensions (increasing or decreasing the diameter).
- Such control over flexibility allows instruments within a catheter over the guide wire to be designed that minimize bending in some desired locations (such as the location of connector of an electrical element to avoid disruption of the connection) while encouraging bending in other locations (e.g., between sensitive functional elements).
- a guide wire that is uniformly flexible along its entire length is variably flexibility along its entire length, or has alternating more flexible and less flexible segment(s), is readily obtained simply by manufacturing the guide wire with appropriate thickness at different distances and in different orientations along the length of the guide wire.
- Such a catheter will have two or more different radii of curvature in different segments of the guide wire and catheter under the same bending force.
- guide wires Some characteristics of alternative guide wires include steerability with a 1 :1 torque response; formability with a ribbon to allow the physician to shape a "J" curve on the tip.
- the guide wire also has flexible characteristics in order to negotiate tortuous anatomy and tight lesions without damaging the guide wire or associated catheter.
- the guide wire may also be tracked to that a balloon catheter is able to move over the wire with minimum resistance.
- the guide wire is also preferably radiopaque so as to be visible under fluoroscopy.
Abstract
Description
Claims
Priority Applications (7)
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AU2001243264A AU2001243264B2 (en) | 2000-02-25 | 2001-02-23 | Apparatus and method for accessing and performing a function within an intervertebral disc |
DE60114574T DE60114574T2 (en) | 2000-02-25 | 2001-02-23 | DEVICE FOR ACCESSING AND PERFORMING OPERATIONS IN A INTERMEDIATE WHEEL |
AT01916210T ATE308274T1 (en) | 2000-02-25 | 2001-02-23 | DEVICE FOR ACCESSING AND PERFORMING OPERATIONS IN AN INTERVERBAL DISK |
EP01916210A EP1259167B1 (en) | 2000-02-25 | 2001-02-23 | Apparatus for accessing and performing a function within an intervertebral disc |
JP2001561238A JP2003523258A (en) | 2000-02-25 | 2001-02-23 | Apparatus and method for penetrating and performing functions within a disc |
AU4326401A AU4326401A (en) | 2000-02-25 | 2001-02-23 | Apparatus and method for accessing and performing a function within an intervertebral disc |
CA002399933A CA2399933A1 (en) | 2000-02-25 | 2001-02-23 | Apparatus and method for accessing and performing a function within an intervertebral disc |
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9474573B2 (en) | 2002-03-05 | 2016-10-25 | Avent, Inc. | Electrosurgical tissue treatment device |
US9492151B2 (en) | 2005-10-15 | 2016-11-15 | Amendia, Inc. | Multiple pathways for spinal nerve root decompression from a single access point |
Families Citing this family (171)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6602248B1 (en) * | 1995-06-07 | 2003-08-05 | Arthro Care Corp. | Methods for repairing damaged intervertebral discs |
US6073051A (en) * | 1996-08-13 | 2000-06-06 | Oratec Interventions, Inc. | Apparatus for treating intervertebal discs with electromagnetic energy |
US6726684B1 (en) * | 1996-07-16 | 2004-04-27 | Arthrocare Corporation | Methods for electrosurgical spine surgery |
US7357798B2 (en) * | 1996-07-16 | 2008-04-15 | Arthrocare Corporation | Systems and methods for electrosurgical prevention of disc herniations |
US6832997B2 (en) | 2001-06-06 | 2004-12-21 | Oratec Interventions, Inc. | Electromagnetic energy delivery intervertebral disc treatment devices |
US6733496B2 (en) * | 2001-06-06 | 2004-05-11 | Oratec Interventions, Inc. | Intervertebral disc device employing flexible probe |
US6126682A (en) * | 1996-08-13 | 2000-10-03 | Oratec Interventions, Inc. | Method for treating annular fissures in intervertebral discs |
US6726685B2 (en) | 2001-06-06 | 2004-04-27 | Oratec Interventions, Inc. | Intervertebral disc device employing looped probe |
JP2002506672A (en) | 1998-03-19 | 2002-03-05 | オーレイテック インターヴェンションズ インコーポレイテッド | Catheter for delivering energy to the surgical site |
US7449019B2 (en) * | 1999-01-25 | 2008-11-11 | Smith & Nephew, Inc. | Intervertebral decompression |
US7615076B2 (en) | 1999-10-20 | 2009-11-10 | Anulex Technologies, Inc. | Method and apparatus for the treatment of the intervertebral disc annulus |
US7052516B2 (en) | 1999-10-20 | 2006-05-30 | Anulex Technologies, Inc. | Spinal disc annulus reconstruction method and deformable spinal disc annulus stent |
US7004970B2 (en) | 1999-10-20 | 2006-02-28 | Anulex Technologies, Inc. | Methods and devices for spinal disc annulus reconstruction and repair |
US8128698B2 (en) | 1999-10-20 | 2012-03-06 | Anulex Technologies, Inc. | Method and apparatus for the treatment of the intervertebral disc annulus |
US8632590B2 (en) | 1999-10-20 | 2014-01-21 | Anulex Technologies, Inc. | Apparatus and methods for the treatment of the intervertebral disc |
US7951201B2 (en) | 1999-10-20 | 2011-05-31 | Anulex Technologies, Inc. | Method and apparatus for the treatment of the intervertebral disc annulus |
US6592625B2 (en) | 1999-10-20 | 2003-07-15 | Anulex Technologies, Inc. | Spinal disc annulus reconstruction method and spinal disc annulus stent |
US7935147B2 (en) | 1999-10-20 | 2011-05-03 | Anulex Technologies, Inc. | Method and apparatus for enhanced delivery of treatment device to the intervertebral disc annulus |
US6638276B2 (en) | 2001-06-06 | 2003-10-28 | Oratec Interventions, Inc. | Intervertebral disc device employing prebent sheath |
US20030069569A1 (en) * | 2001-08-29 | 2003-04-10 | Burdette Everette C. | Ultrasound device for treatment of intervertebral disc tissue |
US6757565B2 (en) | 2002-02-08 | 2004-06-29 | Oratec Interventions, Inc. | Electrosurgical instrument having a predetermined heat profile |
CA2475901A1 (en) * | 2002-02-12 | 2003-08-21 | Oratec Interventions, Inc. | Radiofrequency arthroscopic ablation device |
US8518036B2 (en) | 2002-03-05 | 2013-08-27 | Kimberly-Clark Inc. | Electrosurgical tissue treatment method |
US8043287B2 (en) | 2002-03-05 | 2011-10-25 | Kimberly-Clark Inc. | Method of treating biological tissue |
US8882755B2 (en) | 2002-03-05 | 2014-11-11 | Kimberly-Clark Inc. | Electrosurgical device for treatment of tissue |
US7294127B2 (en) | 2002-03-05 | 2007-11-13 | Baylis Medical Company Inc. | Electrosurgical tissue treatment method |
US6736835B2 (en) | 2002-03-21 | 2004-05-18 | Depuy Acromed, Inc. | Early intervention spinal treatment methods and devices for use therein |
US20080287939A1 (en) * | 2002-07-10 | 2008-11-20 | Appling William M | Endovascular thermal treatment device with flexible guide tip and method |
US8808284B2 (en) | 2008-09-26 | 2014-08-19 | Relievant Medsystems, Inc. | Systems for navigating an instrument through bone |
US6907884B2 (en) | 2002-09-30 | 2005-06-21 | Depay Acromed, Inc. | Method of straddling an intraosseous nerve |
US8361067B2 (en) | 2002-09-30 | 2013-01-29 | Relievant Medsystems, Inc. | Methods of therapeutically heating a vertebral body to treat back pain |
US8613744B2 (en) | 2002-09-30 | 2013-12-24 | Relievant Medsystems, Inc. | Systems and methods for navigating an instrument through bone |
US7258690B2 (en) | 2003-03-28 | 2007-08-21 | Relievant Medsystems, Inc. | Windowed thermal ablation probe |
CA2504591C (en) * | 2002-11-05 | 2011-09-13 | Spineology Inc. | A semi-biological intervertebral disc replacement system |
US8066700B2 (en) * | 2003-01-31 | 2011-11-29 | Smith & Nephew, Inc. | Cartilage treatment probe |
AU2004291023B2 (en) | 2003-01-31 | 2010-03-04 | Smith & Nephew, Inc. | Cartilage treatment probe |
AU2004212942A1 (en) | 2003-02-14 | 2004-09-02 | Depuy Spine, Inc. | In-situ formed intervertebral fusion device |
US7794456B2 (en) | 2003-05-13 | 2010-09-14 | Arthrocare Corporation | Systems and methods for electrosurgical intervertebral disc replacement |
US7344716B2 (en) * | 2003-05-13 | 2008-03-18 | Depuy Spine, Inc. | Transdiscal administration of specific inhibitors of pro-inflammatory cytokines |
WO2007079242A2 (en) * | 2005-12-29 | 2007-07-12 | Highgate Orthopedics, Inc. | Devices and methods for bony fixation and disk repair and replaceme |
US7708733B2 (en) | 2003-10-20 | 2010-05-04 | Arthrocare Corporation | Electrosurgical method and apparatus for removing tissue within a bone body |
US8895540B2 (en) | 2003-11-26 | 2014-11-25 | DePuy Synthes Products, LLC | Local intraosseous administration of bone forming agents and anti-resorptive agents, and devices therefor |
US8235968B2 (en) | 2004-04-13 | 2012-08-07 | Gyrus Acmi, Inc. | Atraumatic ureteral access sheath |
US8535293B2 (en) | 2004-04-13 | 2013-09-17 | Gyrus Acmi, Inc. | Atraumatic ureteral access sheath |
US7452351B2 (en) * | 2004-04-16 | 2008-11-18 | Kyphon Sarl | Spinal diagnostic methods and apparatus |
US7824390B2 (en) * | 2004-04-16 | 2010-11-02 | Kyphon SÀRL | Spinal diagnostic methods and apparatus |
US8257311B2 (en) * | 2004-04-23 | 2012-09-04 | Leonard Edward Forrest | Method and device for treatment of the spine |
US8292931B2 (en) * | 2004-04-23 | 2012-10-23 | Leonard Edward Forrest | Method and device for placing materials in the spine |
JP5001833B2 (en) | 2004-04-23 | 2012-08-15 | フォレスト,レナード・エドワード | Apparatus and method for treatment or removal of an intervertebral disc |
US8062300B2 (en) | 2006-05-04 | 2011-11-22 | Baxano, Inc. | Tissue removal with at least partially flexible devices |
US8257356B2 (en) | 2004-10-15 | 2012-09-04 | Baxano, Inc. | Guidewire exchange systems to treat spinal stenosis |
US9101386B2 (en) | 2004-10-15 | 2015-08-11 | Amendia, Inc. | Devices and methods for treating tissue |
US7578819B2 (en) | 2005-05-16 | 2009-08-25 | Baxano, Inc. | Spinal access and neural localization |
US20100331883A1 (en) | 2004-10-15 | 2010-12-30 | Schmitz Gregory P | Access and tissue modification systems and methods |
US7553307B2 (en) | 2004-10-15 | 2009-06-30 | Baxano, Inc. | Devices and methods for tissue modification |
US20110190772A1 (en) | 2004-10-15 | 2011-08-04 | Vahid Saadat | Powered tissue modification devices and methods |
US9247952B2 (en) | 2004-10-15 | 2016-02-02 | Amendia, Inc. | Devices and methods for tissue access |
US7738969B2 (en) | 2004-10-15 | 2010-06-15 | Baxano, Inc. | Devices and methods for selective surgical removal of tissue |
US7938830B2 (en) | 2004-10-15 | 2011-05-10 | Baxano, Inc. | Powered tissue modification devices and methods |
US8221397B2 (en) | 2004-10-15 | 2012-07-17 | Baxano, Inc. | Devices and methods for tissue modification |
EP1799129B1 (en) | 2004-10-15 | 2020-11-25 | Baxano, Inc. | Devices for tissue removal |
US8430881B2 (en) | 2004-10-15 | 2013-04-30 | Baxano, Inc. | Mechanical tissue modification devices and methods |
US8048080B2 (en) | 2004-10-15 | 2011-11-01 | Baxano, Inc. | Flexible tissue rasp |
US7887538B2 (en) | 2005-10-15 | 2011-02-15 | Baxano, Inc. | Methods and apparatus for tissue modification |
ATE524121T1 (en) | 2004-11-24 | 2011-09-15 | Abdou Samy | DEVICES FOR PLACING AN ORTHOPEDIC INTERVERTEBRAL IMPLANT |
US7386350B2 (en) * | 2005-01-11 | 2008-06-10 | Vilims Bradley D | Combination electrical stimulating and infusion medical device |
US20060155343A1 (en) * | 2005-01-11 | 2006-07-13 | Vilims Bradley D | Combination electrical stimulating and infusion medical device and method |
US8066702B2 (en) | 2005-01-11 | 2011-11-29 | Rittman Iii William J | Combination electrical stimulating and infusion medical device and method |
US20080009927A1 (en) * | 2005-01-11 | 2008-01-10 | Vilims Bradley D | Combination Electrical Stimulating and Infusion Medical Device and Method |
US7945331B2 (en) * | 2005-01-11 | 2011-05-17 | Bradley D. Vilims | Combination electrical stimulating and infusion medical device and method |
US7803142B2 (en) | 2005-02-02 | 2010-09-28 | Summit Access Llc | Microtaper needle and method of use |
US7608108B2 (en) * | 2005-04-29 | 2009-10-27 | Jmea Corporation | Tissue repair system |
US7632313B2 (en) | 2005-04-29 | 2009-12-15 | Jmea Corporation | Disc repair system |
US8702718B2 (en) | 2005-04-29 | 2014-04-22 | Jmea Corporation | Implantation system for tissue repair |
EP1922006A2 (en) * | 2005-05-26 | 2008-05-21 | Smith & Nephew, Inc. | Electrothermal intervertebral disc treatment |
US7988735B2 (en) * | 2005-06-15 | 2011-08-02 | Matthew Yurek | Mechanical apparatus and method for delivering materials into the inter-vertebral body space for nucleus replacement |
US8366773B2 (en) | 2005-08-16 | 2013-02-05 | Benvenue Medical, Inc. | Apparatus and method for treating bone |
US7670375B2 (en) | 2005-08-16 | 2010-03-02 | Benvenue Medical, Inc. | Methods for limiting the movement of material introduced between layers of spinal tissue |
US8092456B2 (en) | 2005-10-15 | 2012-01-10 | Baxano, Inc. | Multiple pathways for spinal nerve root decompression from a single access point |
US8062298B2 (en) | 2005-10-15 | 2011-11-22 | Baxano, Inc. | Flexible tissue removal devices and methods |
US20080086034A1 (en) | 2006-08-29 | 2008-04-10 | Baxano, Inc. | Tissue Access Guidewire System and Method |
US8273005B2 (en) * | 2006-02-02 | 2012-09-25 | Samy Abdou | Treatment of pain, neurological dysfunction and neoplasms using radiation delivery catheters |
US7879034B2 (en) | 2006-03-02 | 2011-02-01 | Arthrocare Corporation | Internally located return electrode electrosurgical apparatus, system and method |
US7662177B2 (en) | 2006-04-12 | 2010-02-16 | Bacoustics, Llc | Apparatus and methods for pain relief using ultrasound waves in combination with cryogenic energy |
US8003156B2 (en) | 2006-05-04 | 2011-08-23 | Advanced Cardiovascular Systems, Inc. | Rotatable support elements for stents |
US8075556B2 (en) * | 2006-05-23 | 2011-12-13 | Andres Betts | High frequency epidural neuromodulation catheter for effectuating RF treatment in spinal canal and method of using same |
US7942809B2 (en) * | 2006-05-26 | 2011-05-17 | Leban Stanley G | Flexible ultrasonic wire in an endoscope delivery system |
US20070282300A1 (en) * | 2006-06-05 | 2007-12-06 | Mohamed Attawia | Intervertebral Disc Puncture and Treatment System |
JP4181599B2 (en) * | 2006-12-27 | 2008-11-19 | メドトロニックソファモアダネック株式会社 | Puncture device |
US20080125747A1 (en) * | 2006-11-28 | 2008-05-29 | Smith & Nephew, Inc.-Tn | Passive thermal spine catheter |
US8105382B2 (en) | 2006-12-07 | 2012-01-31 | Interventional Spine, Inc. | Intervertebral implant |
EP2124777A4 (en) | 2007-02-21 | 2013-06-05 | Benvenue Medical Inc | Devices for treating the spine |
CA2678006C (en) | 2007-02-21 | 2014-10-14 | Benvenue Medical, Inc. | Devices for treating the spine |
US20080228135A1 (en) * | 2007-03-05 | 2008-09-18 | Elizabeth Ann Snoderly | Apparatus for treating a damaged spinal disc |
US10166066B2 (en) | 2007-03-13 | 2019-01-01 | University Of Virginia Patent Foundation | Epicardial ablation catheter and method of use |
WO2008118737A1 (en) * | 2007-03-22 | 2008-10-02 | University Of Virginia Patent Foundation | Electrode catheter for ablation purposes and related method thereof |
US8216221B2 (en) * | 2007-05-21 | 2012-07-10 | Estech, Inc. | Cardiac ablation systems and methods |
US8226619B2 (en) * | 2007-06-15 | 2012-07-24 | Kyphon Sarl | Systems and methods for needle access to an intervertebral disc |
US8900307B2 (en) | 2007-06-26 | 2014-12-02 | DePuy Synthes Products, LLC | Highly lordosed fusion cage |
WO2009009621A2 (en) * | 2007-07-09 | 2009-01-15 | Baxano, Inc. | Spinal access system and method |
EP2194861A1 (en) | 2007-09-06 | 2010-06-16 | Baxano, Inc. | Method, system and apparatus for neural localization |
WO2009062061A1 (en) | 2007-11-09 | 2009-05-14 | University Of Virginia Patent Foundation | Steerable epicardial pacing catheter system placed via the subxiphoid process |
US8192436B2 (en) | 2007-12-07 | 2012-06-05 | Baxano, Inc. | Tissue modification devices |
EP2471493A1 (en) | 2008-01-17 | 2012-07-04 | Synthes GmbH | An expandable intervertebral implant and associated method of manufacturing the same |
BRPI0910325A8 (en) | 2008-04-05 | 2019-01-29 | Synthes Gmbh | expandable intervertebral implant |
US9314253B2 (en) | 2008-07-01 | 2016-04-19 | Amendia, Inc. | Tissue modification devices and methods |
MX348805B (en) | 2008-07-14 | 2017-06-28 | Baxano Inc | Tissue modification devices. |
US8379897B2 (en) * | 2008-09-17 | 2013-02-19 | Daniel R. Schumaier | Hearing assistance device having reduced mechanical feedback |
AU2009296474B2 (en) | 2008-09-26 | 2015-07-02 | Relievant Medsystems, Inc. | Systems and methods for navigating an instrument through bone |
US10028753B2 (en) | 2008-09-26 | 2018-07-24 | Relievant Medsystems, Inc. | Spine treatment kits |
US8163022B2 (en) | 2008-10-14 | 2012-04-24 | Anulex Technologies, Inc. | Method and apparatus for the treatment of the intervertebral disc annulus |
US9161773B2 (en) | 2008-12-23 | 2015-10-20 | Benvenue Medical, Inc. | Tissue removal tools and methods of use |
US8470043B2 (en) * | 2008-12-23 | 2013-06-25 | Benvenue Medical, Inc. | Tissue removal tools and methods of use |
US8535327B2 (en) | 2009-03-17 | 2013-09-17 | Benvenue Medical, Inc. | Delivery apparatus for use with implantable medical devices |
US9526620B2 (en) | 2009-03-30 | 2016-12-27 | DePuy Synthes Products, Inc. | Zero profile spinal fusion cage |
US9642534B2 (en) | 2009-09-11 | 2017-05-09 | University Of Virginia Patent Foundation | Systems and methods for determining location of an access needle in a subject |
US8211126B2 (en) * | 2009-09-22 | 2012-07-03 | Jmea Corporation | Tissue repair system |
US9113950B2 (en) | 2009-11-04 | 2015-08-25 | Regenerative Sciences, Llc | Therapeutic delivery device |
US8764806B2 (en) | 2009-12-07 | 2014-07-01 | Samy Abdou | Devices and methods for minimally invasive spinal stabilization and instrumentation |
US9393129B2 (en) | 2009-12-10 | 2016-07-19 | DePuy Synthes Products, Inc. | Bellows-like expandable interbody fusion cage |
US8460319B2 (en) | 2010-01-11 | 2013-06-11 | Anulex Technologies, Inc. | Intervertebral disc annulus repair system and method |
US8979838B2 (en) | 2010-05-24 | 2015-03-17 | Arthrocare Corporation | Symmetric switching electrode method and related system |
US8979860B2 (en) | 2010-06-24 | 2015-03-17 | DePuy Synthes Products. LLC | Enhanced cage insertion device |
US9282979B2 (en) | 2010-06-24 | 2016-03-15 | DePuy Synthes Products, Inc. | Instruments and methods for non-parallel disc space preparation |
EP2588034B1 (en) | 2010-06-29 | 2018-01-03 | Synthes GmbH | Distractible intervertebral implant |
US20120065634A1 (en) * | 2010-09-14 | 2012-03-15 | Korea University Industrial & Academic Collaboration Foundation | Method of treating an inter-vertebral disc |
US9402732B2 (en) | 2010-10-11 | 2016-08-02 | DePuy Synthes Products, Inc. | Expandable interspinous process spacer implant |
DE102010049455A1 (en) * | 2010-10-22 | 2012-04-26 | Igor Nikiforov | Instrument for minimally invasive surgery in the field of spinal fusion on the human or animal body |
KR101219710B1 (en) * | 2010-11-29 | 2013-01-08 | 광주과학기술원 | Probe and Device for Inspecting Abnormality of an Intervertebral Disc |
US9486275B2 (en) | 2010-12-30 | 2016-11-08 | Avent, Inc. | Electrosurgical apparatus having a sensor |
US8814873B2 (en) | 2011-06-24 | 2014-08-26 | Benvenue Medical, Inc. | Devices and methods for treating bone tissue |
JP6243839B2 (en) | 2011-06-29 | 2017-12-06 | バイオリストーラティブ セラピーズ, インコーポレイテッド | Brown adipocyte composition and method |
US8845728B1 (en) | 2011-09-23 | 2014-09-30 | Samy Abdou | Spinal fixation devices and methods of use |
WO2013101772A1 (en) | 2011-12-30 | 2013-07-04 | Relievant Medsystems, Inc. | Systems and methods for treating back pain |
US20130226240A1 (en) | 2012-02-22 | 2013-08-29 | Samy Abdou | Spinous process fixation devices and methods of use |
US9198767B2 (en) | 2012-08-28 | 2015-12-01 | Samy Abdou | Devices and methods for spinal stabilization and instrumentation |
US10588691B2 (en) | 2012-09-12 | 2020-03-17 | Relievant Medsystems, Inc. | Radiofrequency ablation of tissue within a vertebral body |
US9320617B2 (en) | 2012-10-22 | 2016-04-26 | Cogent Spine, LLC | Devices and methods for spinal stabilization and instrumentation |
EP2914186B1 (en) | 2012-11-05 | 2019-03-13 | Relievant Medsystems, Inc. | Systems for creating curved paths through bone and modulating nerves within the bone |
AU2014209124A1 (en) | 2013-01-28 | 2015-09-17 | Cartiva, Inc. | Systems and methods for orthopedic repair |
US9737294B2 (en) | 2013-01-28 | 2017-08-22 | Cartiva, Inc. | Method and system for orthopedic repair |
US9522070B2 (en) | 2013-03-07 | 2016-12-20 | Interventional Spine, Inc. | Intervertebral implant |
US10085783B2 (en) | 2013-03-14 | 2018-10-02 | Izi Medical Products, Llc | Devices and methods for treating bone tissue |
US9814488B2 (en) | 2013-03-15 | 2017-11-14 | Globus Medical, Inc. | Surgical probe incorporating a dilator |
US9724151B2 (en) | 2013-08-08 | 2017-08-08 | Relievant Medsystems, Inc. | Modulating nerves within bone using bone fasteners |
US10022113B2 (en) | 2013-09-20 | 2018-07-17 | Fred F. Naraghi | Methods, systems, and devices for the treatment of stenosis |
US10314605B2 (en) | 2014-07-08 | 2019-06-11 | Benvenue Medical, Inc. | Apparatus and methods for disrupting intervertebral disc tissue |
JP6751842B2 (en) * | 2014-11-28 | 2020-09-09 | 三友集団株式会社 | Biological heating equipment |
US10022243B2 (en) | 2015-02-06 | 2018-07-17 | Benvenue Medical, Inc. | Graft material injector system and method |
US11426290B2 (en) | 2015-03-06 | 2022-08-30 | DePuy Synthes Products, Inc. | Expandable intervertebral implant, system, kit and method |
US10857003B1 (en) | 2015-10-14 | 2020-12-08 | Samy Abdou | Devices and methods for vertebral stabilization |
US10792473B2 (en) | 2016-03-16 | 2020-10-06 | St. Jude Medical Coordination Center Bvba | Core wire having a flattened portion to provide preferential bending |
US11510788B2 (en) | 2016-06-28 | 2022-11-29 | Eit Emerging Implant Technologies Gmbh | Expandable, angularly adjustable intervertebral cages |
US11596522B2 (en) | 2016-06-28 | 2023-03-07 | Eit Emerging Implant Technologies Gmbh | Expandable and angularly adjustable intervertebral cages with articulating joint |
US10973648B1 (en) | 2016-10-25 | 2021-04-13 | Samy Abdou | Devices and methods for vertebral bone realignment |
US10744000B1 (en) | 2016-10-25 | 2020-08-18 | Samy Abdou | Devices and methods for vertebral bone realignment |
US10888433B2 (en) | 2016-12-14 | 2021-01-12 | DePuy Synthes Products, Inc. | Intervertebral implant inserter and related methods |
US10758286B2 (en) | 2017-03-22 | 2020-09-01 | Benvenue Medical, Inc. | Minimal impact access system to disc space |
US10398563B2 (en) | 2017-05-08 | 2019-09-03 | Medos International Sarl | Expandable cage |
US11344424B2 (en) | 2017-06-14 | 2022-05-31 | Medos International Sarl | Expandable intervertebral implant and related methods |
US10940016B2 (en) | 2017-07-05 | 2021-03-09 | Medos International Sarl | Expandable intervertebral fusion cage |
US11583327B2 (en) | 2018-01-29 | 2023-02-21 | Spinal Elements, Inc. | Minimally invasive interbody fusion |
WO2019178575A1 (en) | 2018-03-16 | 2019-09-19 | Benvenue Medical, Inc. | Articulated instrumentation and methods of using the same |
US11179248B2 (en) | 2018-10-02 | 2021-11-23 | Samy Abdou | Devices and methods for spinal implantation |
US11446156B2 (en) | 2018-10-25 | 2022-09-20 | Medos International Sarl | Expandable intervertebral implant, inserter instrument, and related methods |
JP2022523748A (en) | 2019-02-01 | 2022-04-26 | ディスクキャス・エルエルシー | A method of delivering a therapeutic agent directly into the annulus fibrosus of a medical delivery device and an intervertebral disc. |
CA3150339A1 (en) | 2019-09-12 | 2021-03-18 | Brian W. Donovan | Systems and methods for tissue modulation |
US11426286B2 (en) | 2020-03-06 | 2022-08-30 | Eit Emerging Implant Technologies Gmbh | Expandable intervertebral implant |
US20230309929A1 (en) * | 2020-06-19 | 2023-10-05 | Boston Scientific Medical Device Limited | Deflectable elongated guidewire assembly |
US11850160B2 (en) | 2021-03-26 | 2023-12-26 | Medos International Sarl | Expandable lordotic intervertebral fusion cage |
US11752009B2 (en) | 2021-04-06 | 2023-09-12 | Medos International Sarl | Expandable intervertebral fusion cage |
Family Cites Families (114)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2090923A (en) | 1937-08-24 | Electrodic endoscopic instrtjment | ||
US3178728A (en) | 1962-10-22 | 1965-04-20 | Robert W Christensen | Surgical prosthesis for the temporomandibular joint |
US3579643A (en) | 1968-12-12 | 1971-05-25 | Douglas H Morgan | Artificial articular eminence for the mandibular joint |
US3938198A (en) | 1970-08-04 | 1976-02-17 | Cutter Laboratories, Inc. | Hip joint prosthesis |
SE391122B (en) | 1971-01-25 | 1977-02-07 | Cutter Lab | PROTESTS IN THE FORM OF A SPINE BONIC DISC AND PROCEDURES FOR MANUFACTURE THEREOF |
US3886600A (en) | 1971-07-15 | 1975-06-03 | Cutter Lab | Joint prosthesis |
US3856015A (en) | 1972-01-21 | 1974-12-24 | J Iglesias | Stabilized cutting loop for resectoscope |
US3879767A (en) | 1972-01-26 | 1975-04-29 | Cutter Lab | Prosthesis for articulating body structures |
US3945375A (en) | 1972-04-04 | 1976-03-23 | Surgical Design Corporation | Rotatable surgical instrument |
US3776230A (en) | 1973-04-18 | 1973-12-04 | C Neefe | Method of rapidly reshaping the cornea to eliminate refractive errors |
DE2340546A1 (en) | 1973-08-10 | 1975-02-27 | Pfaudler Werke Ag | METALLIC IMPLANT AND PROCEDURE FOR ITS MANUFACTURING |
US3992725A (en) | 1973-11-16 | 1976-11-23 | Homsy Charles A | Implantable material and appliances and method of stabilizing body implants |
US4043342A (en) | 1974-08-28 | 1977-08-23 | Valleylab, Inc. | Electrosurgical devices having sesquipolar electrode structures incorporated therein |
US4129470A (en) | 1974-10-17 | 1978-12-12 | Homsy Charles A | Method of preparing a porous implantable material from polytetrafluoroethylene and carbon fibers |
US4085466A (en) | 1974-11-18 | 1978-04-25 | National Research Development Corporation | Prosthetic joint device |
US4074718A (en) | 1976-03-17 | 1978-02-21 | Valleylab, Inc. | Electrosurgical instrument |
US4134406A (en) | 1976-10-19 | 1979-01-16 | Iglesias Jose J | Cutting loop for suction resectoscopes |
US4326529A (en) | 1978-05-26 | 1982-04-27 | The United States Of America As Represented By The United States Department Of Energy | Corneal-shaping electrode |
US4224697A (en) | 1978-09-08 | 1980-09-30 | Hexcel Corporation | Constrained prosthetic knee |
US4224696A (en) | 1978-09-08 | 1980-09-30 | Hexcel Corporation | Prosthetic knee |
US4315510A (en) | 1979-05-16 | 1982-02-16 | Cooper Medical Devices Corporation | Method of performing male sterilization |
GB2053691B (en) | 1979-07-24 | 1983-04-27 | Wolf Gmbh Richard | Endoscopes |
US4375220A (en) | 1980-05-09 | 1983-03-01 | Matvias Fredrick M | Microwave applicator with cooling mechanism for intracavitary treatment of cancer |
US4344193A (en) | 1980-11-28 | 1982-08-17 | Kenny Charles H | Meniscus prosthesis |
US4476862A (en) | 1980-12-08 | 1984-10-16 | Pao David S C | Method of scleral marking |
US4381007A (en) | 1981-04-30 | 1983-04-26 | The United States Of America As Represented By The United States Department Of Energy | Multipolar corneal-shaping electrode with flexible removable skirt |
US4483338A (en) | 1981-06-12 | 1984-11-20 | Raychem Corporation | Bi-Polar electrocautery needle |
US4397314A (en) | 1981-08-03 | 1983-08-09 | Clini-Therm Corporation | Method and apparatus for controlling and optimizing the heating pattern for a hyperthermia system |
US5370675A (en) | 1992-08-12 | 1994-12-06 | Vidamed, Inc. | Medical probe device and method |
US5085657A (en) | 1983-03-14 | 1992-02-04 | Ben Simhon Haim | Electrosurgical instrument |
US4590934A (en) | 1983-05-18 | 1986-05-27 | Jerry L. Malis | Bipolar cutter/coagulator |
US4894063A (en) | 1983-05-24 | 1990-01-16 | Baxter International Inc. | Barrier layer for implantable tendons and ligaments |
US4517975A (en) | 1983-06-06 | 1985-05-21 | Garito Jon C | Electrosurgical electrode for matrisectomy |
US4517965A (en) | 1983-06-27 | 1985-05-21 | Ellison Arthur E | Tissue retractor |
US4593691A (en) | 1983-07-13 | 1986-06-10 | Concept, Inc. | Electrosurgery electrode |
US5114402A (en) | 1983-10-31 | 1992-05-19 | Catheter Research, Inc. | Spring-biased tip assembly |
US4601705A (en) | 1983-10-31 | 1986-07-22 | Mccoy William C | Steerable and aimable catheter |
US4944727A (en) | 1986-06-05 | 1990-07-31 | Catheter Research, Inc. | Variable shape guide apparatus |
US4873976A (en) | 1984-02-28 | 1989-10-17 | Schreiber Saul N | Surgical fasteners and method |
US4651734A (en) | 1985-02-08 | 1987-03-24 | The United States Of America As Represented By The United States Department Of Energy | Electrosurgical device for both mechanical cutting and coagulation of bleeding |
US4811733A (en) | 1985-03-14 | 1989-03-14 | Baxter Travenol Laboratories, Inc. | Electrosurgical device |
US4976709A (en) | 1988-12-15 | 1990-12-11 | Sand Bruce J | Method for collagen treatment |
US5304169A (en) | 1985-09-27 | 1994-04-19 | Laser Biotech, Inc. | Method for collagen shrinkage |
US4884572A (en) | 1986-05-20 | 1989-12-05 | Concept, Inc. | Tack and applicator for treating torn bodily material in vivo |
US4895148A (en) | 1986-05-20 | 1990-01-23 | Concept, Inc. | Method of joining torn parts of bodily tissue in vivo with a biodegradable tack member |
DE3643362A1 (en) | 1986-12-18 | 1988-06-23 | Frimberger Erintrud | PROBE FOR INTRODUCTION IN HUMAN OR ANIMAL BODIES, IN PARTICULAR PAPILLOTOM |
US4815462A (en) | 1987-04-06 | 1989-03-28 | Clark Vickie J | Lipectomy device |
US4838859A (en) | 1987-05-19 | 1989-06-13 | Steve Strassmann | Steerable catheter |
DE3855054T2 (en) | 1987-05-26 | 1996-07-18 | Sumitomo Pharma | Device for the administration of solid preparations |
JPH01139081A (en) | 1987-11-27 | 1989-05-31 | Olympus Optical Co Ltd | Apparatus for radiating laser beam |
US4907585A (en) | 1987-12-03 | 1990-03-13 | Schachar Ronald A | Method for improving farsightedness |
US5201731A (en) | 1988-03-30 | 1993-04-13 | Hakky Said I | Laser resectoscope with ultransonic imaging means |
US4955882A (en) | 1988-03-30 | 1990-09-11 | Hakky Said I | Laser resectoscope with mechanical and laser cutting means |
US4907589A (en) | 1988-04-29 | 1990-03-13 | Cosman Eric R | Automatic over-temperature control apparatus for a therapeutic heating device |
US4998933A (en) | 1988-06-10 | 1991-03-12 | Advanced Angioplasty Products, Inc. | Thermal angioplasty catheter and method |
US5178620A (en) | 1988-06-10 | 1993-01-12 | Advanced Angioplasty Products, Inc. | Thermal dilatation catheter and method |
US5191883A (en) | 1988-10-28 | 1993-03-09 | Prutech Research And Development Partnership Ii | Device for heating tissue in a patient's body |
US4966597A (en) | 1988-11-04 | 1990-10-30 | Cosman Eric R | Thermometric cardiac tissue ablation electrode with ultra-sensitive temperature detection |
US5192267A (en) | 1989-01-23 | 1993-03-09 | Nadiv Shapira | Vortex smoke remover for electrosurgical devices |
JPH0770642B2 (en) | 1989-03-30 | 1995-07-31 | 三菱電機株式会社 | Semiconductor device |
US5009656A (en) | 1989-08-17 | 1991-04-23 | Mentor O&O Inc. | Bipolar electrosurgical instrument |
US5284479A (en) | 1989-08-30 | 1994-02-08 | N.V. Nederlandsche Apparatenfabriek Nedap | Implanter |
US5007908A (en) | 1989-09-29 | 1991-04-16 | Everest Medical Corporation | Electrosurgical instrument having needle cutting electrode and spot-coag electrode |
US5213097A (en) | 1989-10-24 | 1993-05-25 | Zewa Ag | Apparatus for the treatment of diseases of the walls of opening or cavities of the body |
US5201730A (en) | 1989-10-24 | 1993-04-13 | Surgical Technologies, Inc. | Tissue manipulator for use in vitreous surgery combining a fiber optic endoilluminator with an infusion/aspiration system |
US5242439A (en) | 1990-01-12 | 1993-09-07 | Laserscope | Means for inserting instrumentation for a percutaneous diskectomy using a laser |
US5084043A (en) | 1990-01-12 | 1992-01-28 | Laserscope | Method for performing a percutaneous diskectomy using a laser |
US5201729A (en) | 1990-01-12 | 1993-04-13 | Laserscope | Method for performing percutaneous diskectomy using a laser |
US5098430A (en) | 1990-03-16 | 1992-03-24 | Beacon Laboratories, Inc. | Dual mode electrosurgical pencil |
US5103804A (en) | 1990-07-03 | 1992-04-14 | Boston Scientific Corporation | Expandable tip hemostatic probes and the like |
US5186181A (en) | 1990-07-27 | 1993-02-16 | Cafiero Franconi | Radio frequency thermotherapy |
US5100402A (en) | 1990-10-05 | 1992-03-31 | Megadyne Medical Products, Inc. | Electrosurgical laparoscopic cauterization electrode |
US5085659A (en) | 1990-11-21 | 1992-02-04 | Everest Medical Corporation | Biopsy device with bipolar coagulation capability |
US5320115A (en) | 1991-01-16 | 1994-06-14 | Applied Biological Concepts | Method and apparatus for arthroscopic knee surgery |
US5152748A (en) | 1991-03-04 | 1992-10-06 | Philippe Chastagner | Medical catheters thermally manipulated by fiber optic bundles |
US5269797A (en) * | 1991-09-12 | 1993-12-14 | Meditron Devices, Inc. | Cervical discectomy instruments |
US5762629A (en) * | 1991-10-30 | 1998-06-09 | Smith & Nephew, Inc. | Oval cannula assembly and method of use |
US5323778A (en) | 1991-11-05 | 1994-06-28 | Brigham & Women's Hospital | Method and apparatus for magnetic resonance imaging and heating tissues |
US5261906A (en) | 1991-12-09 | 1993-11-16 | Ralph Pennino | Electro-surgical dissecting and cauterizing instrument |
US5275151A (en) | 1991-12-11 | 1994-01-04 | Clarus Medical Systems, Inc. | Handle for deflectable catheter |
US5366443A (en) | 1992-01-07 | 1994-11-22 | Thapliyal And Eggers Partners | Method and apparatus for advancing catheters through occluded body lumens |
US6277112B1 (en) * | 1996-07-16 | 2001-08-21 | Arthrocare Corporation | Methods for electrosurgical spine surgery |
US5230334A (en) | 1992-01-22 | 1993-07-27 | Summit Technology, Inc. | Method and apparatus for generating localized hyperthermia |
US5267994A (en) | 1992-02-10 | 1993-12-07 | Conmed Corporation | Electrosurgical probe |
US5242441A (en) | 1992-02-24 | 1993-09-07 | Boaz Avitall | Deflectable catheter with rotatable tip electrode |
US5279559A (en) | 1992-03-06 | 1994-01-18 | Aai Corporation | Remote steering system for medical catheter |
WO1993020878A1 (en) | 1992-04-10 | 1993-10-28 | Cardiorhythm | Shapable handle for steerable electrode catheter |
US5352868A (en) | 1992-05-01 | 1994-10-04 | Hemostatic Surgery Corporation | Resistance feedback controlled power supply |
US5308311A (en) | 1992-05-01 | 1994-05-03 | Robert F. Shaw | Electrically heated surgical blade and methods of making |
US5311858A (en) | 1992-06-15 | 1994-05-17 | Adair Edwin Lloyd | Imaging tissue or stone removal basket |
US5857996A (en) * | 1992-07-06 | 1999-01-12 | Catheter Imaging Systems | Method of epidermal surgery |
US5354331A (en) | 1992-07-15 | 1994-10-11 | Schachar Ronald A | Treatment of presbyopia and other eye disorders |
US5401272A (en) | 1992-09-25 | 1995-03-28 | Envision Surgical Systems, Inc. | Multimodality probe with extendable bipolar electrodes |
US5342357A (en) | 1992-11-13 | 1994-08-30 | American Cardiac Ablation Co., Inc. | Fluid cooled electrosurgical cauterization system |
US5334193A (en) | 1992-11-13 | 1994-08-02 | American Cardiac Ablation Co., Inc. | Fluid cooled ablation catheter |
US5348554A (en) | 1992-12-01 | 1994-09-20 | Cardiac Pathways Corporation | Catheter for RF ablation with cooled electrode |
US6165139A (en) * | 1993-03-01 | 2000-12-26 | Fonar Corporation | Remotely steerable guide wire with external control wires |
US5364395A (en) | 1993-05-14 | 1994-11-15 | West Jr Hugh S | Arthroscopic surgical instrument with cauterizing capability |
US5415633A (en) | 1993-07-28 | 1995-05-16 | Active Control Experts, Inc. | Remotely steered catheterization device |
US5423806A (en) | 1993-10-01 | 1995-06-13 | Medtronic, Inc. | Laser extractor for an implanted object |
US5433739A (en) | 1993-11-02 | 1995-07-18 | Sluijter; Menno E. | Method and apparatus for heating an intervertebral disc for relief of back pain |
US5728122A (en) * | 1994-01-18 | 1998-03-17 | Datascope Investment Corp. | Guide wire with releaseable barb anchor |
US5382247A (en) | 1994-01-21 | 1995-01-17 | Valleylab Inc. | Technique for electrosurgical tips and method of manufacture and use |
US5437661A (en) | 1994-03-23 | 1995-08-01 | Rieser; Bernhard | Method for removal of prolapsed nucleus pulposus material on an intervertebral disc using a laser |
US5885217A (en) * | 1995-01-20 | 1999-03-23 | Tyco Group S.A.R.L. | Catheter introducer |
US6264650B1 (en) * | 1995-06-07 | 2001-07-24 | Arthrocare Corporation | Methods for electrosurgical treatment of intervertebral discs |
US6007570A (en) * | 1996-08-13 | 1999-12-28 | Oratec Interventions, Inc. | Apparatus with functional element for performing function upon intervertebral discs |
US6073051A (en) | 1996-08-13 | 2000-06-06 | Oratec Interventions, Inc. | Apparatus for treating intervertebal discs with electromagnetic energy |
US5836892A (en) * | 1995-10-30 | 1998-11-17 | Cordis Corporation | Guidewire with radiopaque markers |
US6126682A (en) | 1996-08-13 | 2000-10-03 | Oratec Interventions, Inc. | Method for treating annular fissures in intervertebral discs |
ATE339917T1 (en) * | 1996-10-23 | 2006-10-15 | Oratec Interventions Inc | DEVICE FOR TREATING INTERVERBEL DISCS |
US5916166A (en) * | 1996-11-19 | 1999-06-29 | Interventional Technologies, Inc. | Medical guidewire with fully hardened core |
US5980471A (en) * | 1997-10-10 | 1999-11-09 | Advanced Cardiovascular System, Inc. | Guidewire with tubular connector |
US6428512B1 (en) * | 2000-10-10 | 2002-08-06 | Advanced Cardiovascular Systems, Inc. | Guidewire with improved lesion measurement |
-
2001
- 2001-02-22 US US09/792,628 patent/US7069087B2/en not_active Expired - Fee Related
- 2001-02-23 WO PCT/US2001/005946 patent/WO2001062168A2/en active IP Right Grant
- 2001-02-23 AT AT01916210T patent/ATE308274T1/en not_active IP Right Cessation
- 2001-02-23 AU AU2001243264A patent/AU2001243264B2/en not_active Ceased
- 2001-02-23 DE DE60114574T patent/DE60114574T2/en not_active Expired - Lifetime
- 2001-02-23 CA CA002399933A patent/CA2399933A1/en not_active Abandoned
- 2001-02-23 AU AU4326401A patent/AU4326401A/en active Pending
- 2001-02-23 EP EP01916210A patent/EP1259167B1/en not_active Expired - Lifetime
- 2001-02-23 JP JP2001561238A patent/JP2003523258A/en active Pending
- 2001-06-18 US US09/884,859 patent/US6878155B2/en not_active Expired - Fee Related
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9474573B2 (en) | 2002-03-05 | 2016-10-25 | Avent, Inc. | Electrosurgical tissue treatment device |
US9492151B2 (en) | 2005-10-15 | 2016-11-15 | Amendia, Inc. | Multiple pathways for spinal nerve root decompression from a single access point |
Also Published As
Publication number | Publication date |
---|---|
AU4326401A (en) | 2001-09-03 |
EP1259167B1 (en) | 2005-11-02 |
DE60114574D1 (en) | 2005-12-08 |
US7069087B2 (en) | 2006-06-27 |
DE60114574T2 (en) | 2006-07-27 |
WO2001062168A3 (en) | 2002-03-28 |
CA2399933A1 (en) | 2001-08-30 |
ATE308274T1 (en) | 2005-11-15 |
US20020022830A1 (en) | 2002-02-21 |
AU2001243264B2 (en) | 2006-02-02 |
US6878155B2 (en) | 2005-04-12 |
WO2001062168A8 (en) | 2001-10-25 |
WO2001062168A2 (en) | 2001-08-30 |
JP2003523258A (en) | 2003-08-05 |
EP1259167A2 (en) | 2002-11-27 |
US20020019626A1 (en) | 2002-02-14 |
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