Ligament Decompression Tool with Tissue Engaging Device

Abstract

A method for treating stenosis in a spine comprises percutaneously accessing the epidural space in a stenotic region of interest, compressing the thecal sac in the region of interest to form a safety zonem, inserting a tissue removal tool into tissue in the working zone, using the tool to percutaneously reduce the stenosis; and utilizing imaging to visualize the position of the tool during at least a part of the reduction step. A tissue excision system for performing percutaneous surgery, comprises a cannula comprising a tissue-penetrating member having a distal end defining an aperture on one side thereof, an occluding member slidably received on or in the cannula and closing the aperture when the occluding member is adjacent the cannula distal end, means for engaging adjacent tissue via the aperture, and cutting means for resecting a section of the engaged tissue.

1 . A tissue excision system for percutaneous surgery, comprising: 
 a cannula comprising a tissue-penetrating member having a distal end defining an aperture on one side thereof;    an occluding member slidably received on or in said cannula and closing said aperture when said occluding member is adjacent said cannula distal end;    means for engaging adjacent tissue via said aperture; and    cutting means for resecting a section of said engaged tissue.    
     
     
         2 . The percutaneous tissue excision system of  claim 1  wherein said engaging means comprises a tissue-engaging needle having a shaft and distal and proximal ends, and wherein said tissue-engaging needle is adapted for insertion through said cannula, said tissue-engaging needle comprising at least one barb extending outwardly from said shaft.  
     
     
         3 . The percutaneous tissue excision system of  claim 1  wherein said engaging means is reciprocably received in said cannula.  
     
     
         4 . The percutaneous tissue excision system of  claim 1  wherein said engaging means is rotatably received in said cannula.  
     
     
         5 . The percutaneous tissue excision system of  claim 1  wherein said engaging means is constructed such that it has a normal configuration that is retained by said occluding member when said occluding member is adjacent said cannula distal end and extends through said aperture when said occluding member is removed from said aperture.  
     
     
         6 . The percutaneous tissue excision system of  claim 1 , further including means for retrieving said resected tissue from said distal tool end and a tissue-removal system for removing tissue from said retrieving means.  
     
     
         7 . The percutaneous tissue excision system of  claim 6  wherein said tissue-removal system comprises a keyhole slot.  
     
     
         8 . The percutaneous tissue excision system of  claim 1  wherein the first tissue-engaging device comprises a hook.  
     
     
         9 . The percutaneous tissue excision system of  claim 17  wherein said hook comprises a length of wire that has been bent through at least about 270°.  
     
     
         10 . The percutaneous tissue excision system of  claim 1  wherein said engaging means comprises an elongate body housed within said cannula and comprising two radially extendable arms constructed such that radially extending said arms causes them to open and extend outwardly through said side aperture and retracting said arms causes them to close.  
     
     
         11 . The device according to  claim 10  wherein said arms each include an opposing edge and at least one opposing edge includes teeth or ridges.  
     
     
         12 . The device according to  claim 10  wherein said opposing edges comprise cutting blades.  
     
     
         13 . The device according to  claim 10 , further including a outer cutting element slidably mounted on said cannula.  
     
     
         14 . The device according to  claim 10 , further including a retractable tissue-engaging device received within said elongate body.  
     
     
         15 . The device according to  claim 14  wherein said tissue-engaging device can be extended to the distal end of the cannula to engage a tissue sample, retracted for removal of the tissue sample, and re-extended into the cannula.  
     
     
         16 . The device according to  claim 14 , further including means for removing tissue from the tissue-engaging device.  
     
     
         17 . A method for treating stenosis in a spine, the spine including a thecal sac and a canal and an epidural space therebetween, the stenosis determining a region of interest in the spine, comprising the steps of: 
 a) percutaneously accessing the epidural space in the region of interest;    b) compressing the thecal sac in the region of interest by injecting a fluid to form a safety zone and establish a working zone, the safety zone lying between the working zone and the thecal sac;    c) inserting a tissue removal tool into tissue in the working zone;    d) using the tool to percutaneously reduce the stenosis; and    e) utilizing imaging to visualize the position of the tool during at least a part of step d).    
     
     
         18 . The method of  claim 17  wherein the tool comprises: 
 a cannula comprising a tissue-penetrating member having a distal end defining an aperture on one side thereof;    an occluding member slidably received on or in said cannula and closing said aperture when said occluding member is adjacent said cannula distal end;    means for engaging adjacent tissue via said aperture; and    cutting means for resecting a section of said engaged tissue.    
     
     
         19 . The method of  claim 18  wherein the tool further includes means for retrieving said resected tissue from said distal tool end and a tissue-removal system for removing tissue from said retrieving means.  
     
     
         20 . The method of  claim 17  wherein step d) comprises 
 d1) engaging a tissue sample in the working zone;    d2) excising the tissue sample;    d3) removing the tissue sample from the working zone; and    d4) repeating steps d1) through d3) until a desired amount of tissue has been removed.    
     
     
         21 . The method of  claim 20  wherein the tissue sample comprises tissue selected from the group consisting of the ligamentum flavum, fat, and bone.  
     
     
         22 . The method of  claim 20  wherein step d) is carried out without repositioning the device in the tissue.  
     
     
         23 . The method of  claim 20  wherein step d) comprises 
 di) providing an anchor having first and second tissue-engaging ends;    dii) engaging the ligamentum flavum with said first tissue-engaging end;    diii) using said engaged first end to pull at least a portion of the ligamentum flavum into a desired position; and    div) using said second tissue-engaging end to anchor said anchor such that said ligamentum flavum is retained in a desired position.    
     
     
         24 . The method of  claim 23  wherein step div) comprises anchoring said anchor to paraspinous tissue.  
     
     
         25 . The method of  claim 23  wherein step div) comprises anchoring said anchor to bone.  
     
     
         26 . The method of  claim 23  wherein the injected fluid includes a contrast medium.  
     
     
         27 . The method of  claim 23  wherein the injected fluid has a temperature-dependent viscosity and is more viscous at 37° C. than at 30° C.  
     
     
         28 . A kit for performing a procedure on a spines the spine including an epidural space containing a thecal sac, the kit comprising: 
 an insertion member for accessing the epidural space;    an expandable device adapted to be inserted into the epidural space by the insertion member and expanded so as to compress a portion of the thecal sac and provide a safety zone within the epidural space.    
     
     
         29 . The kit according to  claim 28  wherein said expandable device comprises a volume of a contrast medium.  
     
     
         30 . The kit according to  claim 29  wherein the contrast medium comprises a radio-opaque non-ionic myelographic contrast medium.  
     
     
         31 . The kit according to  claim 28  wherein said expandable device comprises a volume of a medium that is injectable at ambient temperatures and more viscous at body temperature.  
     
     
         32 . The method according to  claim 28  wherein the contrast medium includes a bioactive agent.  
     
     
         33 . The method according to  claim 28  wherein the contrast medium includes a steroid.  
     
     
         34 . The kit according to  claim 28 , further including a surgical device.  
     
     
         35 . The kit according to  claim 34  wherein said surgical device comprises: 
 a cannulated scalpel having a side aperture proximal its distal end;    an elongate body housed within said cannulated scalpel and comprising two radially extendable arms constructed such that radially extending said arms causes them to extend outward through said side aperture and retracting said arms causes them to close.    
     
     
         36 . The kit according to  claim 34  wherein said surgical device comprises a tool including means for engaging the ligamentum flavum and means for resecting a section of the ligamentum flavum.  
     
     
         37 . The kit according to  claim 34  wherein said surgical device comprises. 
 a cannula a side aperture proximal its distal end;    a barbed member coaxially received within said cannula; and    a cutting member received on said cannula.    
     
     
         38 . The kit according to  claim 34  wherein said surgical device includes means for engaging a first anatomical structure and means for affixing said first anatomical structure to a second anatomical structure.  
     
     
         39 . The kit according to  claim 34  wherein said surgical device includes means for engaging and retracting the ligamentum flavum and means for anchoring the retracted ligamentum flavum.