US2011213356A1PendingUtilityA1
Methods and systems for spinal radio frequency neurotomy
Individually held — no corporate assignee on recordPriority: Nov 5, 2009Filed: Nov 5, 2010Published: Sep 1, 2011
Est. expiryNov 5, 2029(~3.3 yrs left)· nominal 20-yr term from priority
A61B 2018/00434A61B 2018/1467A61B 2090/376A61B 2018/00821A61B 2018/00577A61B 2018/00595A61B 2018/00791A61B 2018/00875A61B 18/1206A61B 2018/126A61B 2018/1253A61B 2018/00642A61B 2090/3762A61B 18/1477
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Claims
Abstract
Methods and systems for spinal radio frequency neurotomy. Systems include needles capable of applying RF energy to target volumes within a patient. Such target volumes may contain target medial branch nerves along vertebrae or rami proximate the sacrum. Such procedures may be used to ablate or cauterize a portion of the targeted nerve, thus blocking the ability of the nerve to transmit signals to the central nervous system. Disclosed needles may be operable to asymmetrically, relative to a central longitudinal axis of the needle, apply RF energy. Such asymmetry facilitates procedures where a tip of the needle is placed proximate to anatomical structures for location verification. Then RF energy may be applied in a selectable direction relative to the needle tip to ablate volumes that include the targeted medial branch nerves or rami, thus denervating facet joints or the sacroiliac joint, respectively, to relieve pain in a patient.
Claims
exact text as granted — not AI-modified1 . A needle for insertion into a patient during an RF ablation procedure, the needle comprising:
a hub; an elongate member fixed to the hub; a tip fixed to the elongate member at a distal end of the needle, wherein the tip is shaped to pierce tissue of the patient; a plurality of filaments disposed within at least a portion of the elongate member; an actuator interconnected to the plurality of filaments, wherein the actuator includes one of a helical track and a helical thread on an internal surface thereof, wherein the hub includes a corresponding other one of the helical track and helical thread on an external surface thereof, wherein upon rotation of the actuator relative to the hub, the actuator is advanced or retracted relative to the hub and moves the plurality of filaments between a retracted position and a deployed position relative to the tip; and a lumen within the elongate member, wherein the lumen and the tip are configured to accept an RF probe such that an electrode of an inserted RF probe, the tip, and the first and second filaments are operable to form a single monopolar RF electrode.
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7 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , wherein the RF probe comprises a temperature sensor.
8 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , wherein said lumen is in fluid communication with a fluid port in the tip.
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15 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , further comprising a slide member fixedly connected to the plurality of filaments, wherein upon rotation of the actuator relative to the slide Member and relative to the hub, the actuator moves in tandem relation with the slide member along a longitudinal axis of the needle and the plurality of filaments are advanced or retracted relative to the hub.
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23 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , wherein the plurality of filaments consists of a first filament and a second filament, wherein the needle contains no filaments other than the plurality of filaments, wherein when the first and second filaments are in their respective deployed positions, a midpoint between a distal end of the first filament and a distal end of the second filament are offset from a central longitudinal axis of the elongate member.
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26 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , wherein each filament of the needle comprises a distal end, and wherein, in their respective deployed positions, each said filament distal end defines a vertex of a polygon; wherein a centroid of the polygon is offset from a central longitudinal axis of the elongate member.
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28 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , wherein when the plurality of filaments are in a deployed position, the tip comprises an angle of at least 200 degrees about a central longitudinal axis of the elongate member that is free of filaments.
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30 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , wherein each filament of the needle comprises a distal end, and wherein, in their respective deployed positions, each said filament distal end is disposed distal to a distal end of the tip.
31 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 22 , wherein the average of all the points is offset from the central ongitudinal axis of the elongate member.
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34 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 22 , wherein each said point is on a common side of a plane that contains the central longitudinal axis.
35 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , wherein, when the plurality of filaments are in the deployed position, each of the plurality of filaments points in an at least partially distal direction.
36 . A needle for insertion into a patient during an RF ablation procedure as recited in claim 1 , wherein, when the plurality of filaments are in the deployed position, portions of each filament extend outwardly and away from the tip and the portions are each straight.
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111 . A method of performing spinal RF neurotomy in a patient, the method comprising:
moving a tip of a needle to a first position proximate to a target nerve along the spine of the patient; after moving the tip, advancing a plurality of filaments to a deployed position relative to the tip; and after advancing the plurality of filaments, applying RF energy to the tip and to the plurality of filaments, wherein applying the RF energy comprises ablating a first volume comprising at least a portion of the target nerve.
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113 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , wherein the target nerve is a medial branch nerve and wherein the first position is between the transverse and superior articular processes of a lumbar vertebra.
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117 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , further comprising imaging the tip of the needle to verify position of the tip of the needle relative to the target nerve.
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120 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , further comprising rotating the needle about an axis parallel to a central longitudinal axis of the needle to position the tip in a predetermined orientation relative to the target nerve.
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133 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , further comprising:
during applying the RF energy, monitoring a temperature proximate to the target nerve: and adjusting a parameter of the RF energy.
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137 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , further comprising:
inserting an RF probe through a lumen within the needle wherein an electrode of the RF probe, the tip, and the plurality of filaments form a monopolar electrode; and passing fluid through the lumen and through a fluid port in the tip.
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141 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , further comprising:
retracting the plurality of filaments to a retracted position relative to the tip; after retracting the plurality of filaments and with the tip in the first position, rotating the needle about a central longitudinal axis of the needle to re-orient the plurality of filaments; after rotating the needle, re-advancing the plurality of filaments to the deployed position; and after re-advancing the plurality of filaments, re-applying RF energy to the tip and to the plurality of filaments, wherein re-applying the RF energy comprises ablating a second volume proximate to the tip.
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146 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , wherein the first position is proximate to a vertebra and wherein moving the tip of the needle to the first position comprises:
contacting a surface of the vertebra with the tip; and after contacting the surface, moving the needle away from the surface of the vertebra a predetermined distance.
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178 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , wherein the target nerve a medial branch nerve and wherein the first position is proximate to a superior surface of a transverse process of a thoracic vertebra.
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183 . A method of performing spinal RF neurotomy in a patient as recited in claim 178 , wherein the thoracic vertebra is a thoracic vertebra selected from the group consisting of T5, T6, T7, and T8.
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194 . A method of performing cervical medial branch RF neurotomy on a third occipital nerve of a patient, the method comprising:
a. positioning the patient in a prone position; b. targeting a side of the C2/3 Z-joint; c. rotating the head of the patient away from the targeted side; d. locating the lateral aspect of the C2/3 Z-joint; e. moving, after steps a, b, c and d, a tip of a needle over the most lateral aspect of bone of the articular pillar at the juncture of the C2/3 z-joint to a first position contacting bone proximate to the most posterior and lateral aspect of the z-joint complex; f. retracting, after step e, the tip of the needle a predetermined distance from the first position; g. extending, after step f, a plurality of filaments outwardly from the tip and towards the lateral aspect of the C2/3 z-joint such that the plurality of filaments are positioned straddling the lateral joint lucency and posterior, to the C2/3 neural foramen; h. applying, after step g, RF energy to the tip and the plurality of filaments, wherein the applying the RF energy generates heat that ablates a portion of the third occipital nerve.
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202 . A method of performing spinal RF neurotomy in a patient as recited in claim 111 , wherein advancing the plurality of filaments to the deployed position relative to the tip comprises rotating an actuator interconnected to the plurality of filaments.Join the waitlist — get patent alerts
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