Spinal Decompression Method Using Tissue Retraction

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 - 17 . (canceled)  
     
     
         18 . The method of  claim 23  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 23  wherein step d) further 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 . 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 workings 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 by: 
 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; and    e) utilizing imaging to visualize the position of the tool during at least a part of step d).    
     
     
         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 - 39 . (canceled)