Powered tissue modification devices and methods

Abstract

A device for modifying tissue in a spine may include: a shah having a proximal portion and a distal portion, the distal portion having dimensions which allow h to be passed into an epidural space of the spine and between target and non-target tissues at least one distal force application member extending from the distal portion of the shall and configured to facilitate application of at least one of anchoring force and tensioning force to the shaft; at least one movable tissue modifying member coupled with the shaft at or near its distal portion; at least one drive member coupled with the at least one tissue modifying member to activate the at least one tissue modifying member; and at least one power transmission member coupled with the at least one drive member to deliver power to the at least one drive member.

1 . A method for modifying tissue in a spine, the method comprising,
 passing a distal portion of a tissue modification device into a spine;   positioning at least one tissue modifying member of the tissue modification device adjacent target tissue;   urging the tissue modifying member against the target tissue by applying at least one of anchoring force or tensioning force to a guidewire coupled to a distal portion of the tissue modification device; and   transmitting power to at least one drive member coupled with the at least one tissue modifying member to move the tissue modifying member and thus modify the target tissue.   
     
     
         2 . A method as in  claim 1 , wherein passing the distal portion of the tissue modification device comprises passing the device into a spinal channel selected from the group consisting of an intervertebral foramen and a central spinal canal. 
     
     
         3 . A method as in  claim 1 , wherein passing the distal portion of the tissue modification device comprises passing a distal portion of a tissue modification device into an epidural space of a spine. 
     
     
         4 . A method as in  claim 1 , wherein passing the distal portion of the tissue modification device comprises passing a distal portion of a tissue modification device between target tissue and non-target tissue. 
     
     
         5 . A method as in  claim 1 , wherein positioning at least one tissue modifying member of the tissue modification device comprises positioning at least one tissue modifying member of the tissue modification device such that the tissue modifying member faces the target tissue and does not face non-target tissue. 
     
     
         6 . A method as in  claim 1 , wherein urging the tissue modifying member against the target tissue comprises applying at least one of anchoring force or tensioning force to a distal portion of the tissue modification device while applying at least one of tensioning or anchoring force to a proximal portion of the tissue modification device. 
     
     
         7 . A method as in  claim 1 , wherein urging the tissue modifying member comprises applying anchoring force to the distal portion of the tissue modification device and applying tensioning force at or near the proximal end of the tissue modification device. 
     
     
         8 . A method as in  claim 1 , wherein urging the tissue modifying member against the target tissue comprises deploying one or more anchoring members located at or near the distal portion of the device within a patient's body. 
     
     
         9 . A method as in  claim 1 , wherein urging the tissue modifying member against the target tissue comprises deploying one or more anchoring members located at or near the distal portion of the device outside a patient's body. 
     
     
         10 . A method as in  claim 1 , wherein urging the tissue modifying member against the target tissue comprises coupling a handle to the distal portion of the tissue modification device outside the patient's body and applying the force to the handle. 
     
     
         11 . A method as in  claim 10 , wherein urging the tissue modifying member against the target tissue comprises coupling a handle to a guidewire coupled to the distal portion of the tissue modification device. 
     
     
         12 . A method as in  claim 1 , further comprising by positioning at least one shield device coupled with the tissue modification device between the device and the non-target tissue. 
     
     
         13 . A method for treating spinal stenosis by removing spinal tissue, the method comprising,
 advancing a guidewire into a patient's spine;   advancing a flexible distal portion of a tissue modification device into the patient's spine using the guidewire;   urging the tissue modifying member against the target tissue by applying at least one of anchoring force or tensioning force to the guidewire outside the patient and to a proximal end of the tissue modification device; and   transmitting power to at least one drive member coupled with the tissue modifying member to modify at least one of ligamentum flavum or bone tissue in the spine.   
     
     
         14 . A method as in  claim 13 , wherein the step of advancing a guidewire comprises advancing a guidewire into an epidural space and through an intervertebral foramen of a patient's spine. 
     
     
         15 . A method as in  claim 13 , wherein the step of advancing a guidewire comprises advancing a guidewire into a patient's spine so that opposite ends of the guidewire extend out of different regions of the patient's body. 
     
     
         16 . A method as in  claim 13 , wherein the step of advancing the flexible distal portion of the tissue modification device comprises advancing a flexible distal portion of a tissue modification device into the patient's spine using the guidewire. 
     
     
         17 . A method as in  claim 13 , wherein the step of advancing the flexible distal portion of the tissue modification device comprises advancing a flexible distal portion of a tissue modification device such that a tissue modifying member disposed along one side of the tissue modification device faces a target tissue and an atraumatic surface of the tissue modification device faces non-target tissue. 
     
     
         18 . A method as in  claim 13 , wherein the step of urging the tissue modifying member against the target tissue comprises urging the tissue modifying member against the target tissue by applying at least one of anchoring force or tensioning force to a distal handle coupled with the guidewire outside the patient and to a proximal handle coupled with a proximal end of the tissue modification device. 
     
     
         19 . A method as in  claim 13 , wherein the step of advancing the flexible distal portion of the tissue modification device comprises pulling the tissue modification device into the intervertebral foramen by pulling the guidewire. 
     
     
         20 . A method as in  claim 13 , wherein the step of transmitting power comprises transmitting power to at least one drive member coupled with the tissue modifying member to cut at least one of ligamentum flavum or bone tissue in the spine. 
     
     
         21 . A method as in  claim 13 , further comprising coupling the distal end of the tissue modification device to the guidewire.