Percutaneous Methods For Spinal Stenosis and Foraminal Stenosis

Abstract

The present invention is a method for performing a percutaneous laminoplasty that includes entering a first introducer needle introducing a first tool wire into an epidural space above a selected lamina, entering a first catcher exit needle that that is caught with the first introducer needle and pulled through a patient body and entering a second introducer needle introducing a second tool wire into the epidural space below the selected lamina. The method also includes entering a second catcher exit needle that is caught within the epidural space and pulled through the patient body, moving the caught first introducer needle and the first catcher exit needle back and forth to cut the lamina and moving the caught second introducer needle and the second catcher exit needle back and forth to cut the lamina. There is also a method for performing a percutaneous foraminoplasty.

1 . A method for performing percutaneous laminoplasty that utilizes a selected one of a local anesthesia and a segmental anesthesia while a patient is awake and in a prone position, comprising the steps of:
 entering a first introducer epidural needle that includes a proximal end outside of the patient, a distal end, a first hollow internal diameter and a first penetrating perforating tip, the first penetrating perforating tip is disposed on the distal end, the first hollow internal diameter allows one or more first wire tools to pass through the introducer epidural needle, the first penetrating perforating tip is percutaneously placed into an epidural space of a spine on a first side allowing the one or more first wire tools to be introduced and entered into the epidural space of a selected right lamina of the spine above a targeted vertebra with a side, where a spinous process divides a right lamina and a left lamina of the target vertebra;   entering a first exit epidural needle that includes a proximal end outside of the patient, a distal end, a second hollow internal diameter and a second penetrating perforating tip, the second penetrating perforating tip is disposed on the distal end, the second hollow internal diameter allows a one or more second wire tools to pass through the exit epidural needle, the second penetrating perforating tip is percutaneously placed into the epidural space of the spine that introduces and enters the second wire tools below the selected right lamina of the side of the targeted vertebra where the first introducer epidural needle is entered in the epidural space of the spine above the selected right lamina, the first penetrating perforating tip and the second penetrating perforating tip in the epidural space resulting in the first penetrating perforating tip and the second penetrating perforating tip facing each other, the first penetrating perforating tip and the second penetrating perforating tip centering the right lamina;   introducing a first hook-like grasper tool with a distal end and a proximal end outside of the patient, the distal end of the first hook-like grasper tool is a selected one of manually extended and mechanically extended through the first hollow internal diameter of the first exit epidural needle, the distal end of the first hook-like grasper tool attaches the one or more first wire tools introduced through the first introducer epidural needle within the epidural space, the one or more first wire tools and the first hook-like grasper tool are pulled through the first exit epidural needle and out of a patient body, the attached first hook-like grasper tool and the one or more first wire tools engaging below the selected right lamina of the target vertebra, where a spinous process divides the right lamina and the left lamina, the one or more first wire tools having a curved middle portion, the curved middle portion lying adjacent to the inferior aspect of right lamina, the curved middle portion cuts the right lamina of the target vertebra in an anterior to posterior direction;   entering a second introducer epidural needle that includes a proximal end outside of the patient, a distal end, a third hollow internal diameter and a third penetrating perforating tip disposed on the distal end, the third hollow internal diameter allows one or more third wire tools to pass through the second introducer epidural needle, the third penetrating perforating tip is percutaneously placed into the epidural space of the spine allowing the one or more third wire tools to be introduced and entered into the epidural space of a selected left lamina of the spine above a targeted vertebra with a side, where a spinous process divides the right lamina and the left lamina;   entering a second exit epidural needle that includes a proximal end outside of the patient, a distal end, a fourth hollow internal diameter, a fourth penetrating perforating tip disposed on the distal end that is a selected one of manually extended and mechanically extended, the fourth hollow internal diameter allows a selected one or more fourth wire tools to pass through the second exit epidural needle, the fourth penetrating perforating tip is percutaneously placed into the epidural space of the spine that introduces and enters the one or more fourth wire tools below the side of the targeted vertebra where the second introducer epidural needle is entered into the epidural space of the spine of the selected left lamina, the third penetrating perforating tip and the fourth penetrating perforating tip in the epidural space resulting in the third penetrating perforating tip and the fourth penetrating perforating tip facing each other, the third penetrating perforating tip and the fourth penetrating perforating tip centering the left lamina;   introducing a second hook-like grasper wire tool with a distal end and a proximal end outside of the patient, the distal end of the second hook-like grasper tool is a selected one of manually extended and mechanically extended through the fourth hollow internal diameter of the second exit epidural needle, the second hook-like grasper tool attaches the selected one or more third wire tools introduced through the second introducer epidural needle within the epidural space, the selected one or more third wire tools is pulled through the second exit needle and out of a patient body, the attached second hook-like grasper tool and the one or more third wire tools engaging a selected left lamina, the one or more third wire tools having a curved middle portion lying adjacent to the inferior aspect of left lamina, the curved middle portion cuts the left lamina of the target vertebra in an anterior to posterior direction; and   implementing a plurality of safety mechanisms that include an intraoperative electromyogram, one or more nerve conduction studies and one or more nerve sensors to achieve a safe percutaneous environment.   
     
     
         2 . The method according to  claim 1 , wherein the third hollow internal diameter allows a selected one or more first fluids and first medicines to pass through the second introducer epidural needle. 
     
     
         3 . The method according to  claim 1 , wherein the fourth hollow internal diameter allows a selected one or more second fluids and second medicines to pass through the second exit epidural needle. 
     
     
         4 . The method according to  claim 1 , wherein the introducer epidural needles are a selected one of a flat tipped introducer epidural needle, a curved introducer epidural needle, a rigid introducer epidural needle, a c-shaped introducer epidural needle, an expandable introducer epidural needle and a flexible introducer epidural needle. 
     
     
         5 . The method according to  claim 1 , wherein the introducer epidural needles have a selected one of a curved penetrating perforating tip and a penetrating perforating straight tip. 
     
     
         6 . The method according to  claim 1 , wherein the introducer epidural needles have a hollow tube that is a protective sheath. 
     
     
         7 . The method according to  claim 1 , wherein the one or more wire tools are a selected one from the group of a guide wire, a thread wire, a bone temperature sensor and a twisted wire. 
     
     
         8 . The method according to  claim 1 , wherein the one or more wire tools are made of a selected one of metal, plastic, nylon and rubber. 
     
     
         9 . The method according to  claim 1 , wherein the one or more wire tools have a selected one of bone cutting and one or more abrasive properties that spares nerves and dura when cutting. 
     
     
         10 . The method according to  claim 1 , wherein the one or more wire tools are utilized to modify tissue, to cut tissue and to cut bone. 
     
     
         11 . The method according to  claim 1 , wherein the one or more wire tools are a selected one of one or more bone-cutting devices, one or more t-saw wires, one or more bone cutting wires and a saw device. 
     
     
         12 . The method according to  claim 1 , wherein the one or more wire tools includes an expanding hollow lumen that allows one or more wires, fluids, and medical devices to pass through the expanding hollow lumen. 
     
     
         13 . The method according to  claim 12 , wherein the one or more wire tools includes a plurality of channels and a plurality of apertures to be passed through the expanding hollow lumen to irrigate one or more anatomical areas of the spine. 
     
     
         14 . The method according to  claim 13 , wherein the one or more anatomical areas of the spine are irrigated with cold water. 
     
     
         15 . The method according to  claim 12 , wherein the expanding hollow lumen is made of a selected one of a plastic and a malleable polymer. 
     
     
         16 . The method according to  claim 1 , wherein the one or more wire tools provide suction. 
     
     
         17 . The method according to  claim 1 , wherein the one or more wire tools are a selected one of left in the epidural space, removed immediately from the epidural space and removed at a later date from the epidural space. 
     
     
         18 . The method according to  claim 1 , wherein the one or more wire tools have a plurality of grooves that pick-up bone debris osteophytes and carry the bone debris osteophytes outside the patient body by a selected one of pushing and pulling of the one or more wire tools. 
     
     
         19 . The method according to  claim 1 , wherein the one or more wire tools are an expanding balloon. 
     
     
         20 . The method according to  claim 19 , wherein the expanding balloon is a selected one of radio-opaque and radiolucent, the expanding balloon provides a larger target to the exit epidural needle. 
     
     
         21 . The method according to  claim 1 , wherein the one or more wire tools are a selected one of a plurality of pieces and one continuous piece. 
     
     
         22 . The method according to  claim 1 , wherein the one or more wire tools are a selected one of radiolucent and radiopaque. 
     
     
         23 . The method according to  claim 1 , wherein the one or more wire tools are a selected one or more of being magnetic, having one or more electromagnetic capabilities, generating heat, being coupled to a medical device that has a laser eliciting capability, producing a laser, being motorized, vibrating independently and vibrating at one or more calculated rhythms. 
     
     
         24 . The method according to  claim 1 , wherein the epiduroscope has an ultrasound guided capability and a wireless capability to transmit data. 
     
     
         25 . The method according to  claim 1 , wherein the hook-like grasper tools is a pair of grasping forceps. 
     
     
         26 . The method according to  claim 1 , wherein the hook-like grasper tools is a selected one or more of having a fork-shape, having one or more apertures, having a locking device, having a selected one of a closing door and a pinching door, having a sticky substance and having a selected one of magnetic properties and electromagnetic properties. 
     
     
         27 . The method according to  claim 1 , wherein the hook-like grasper tools sutures a selected one of a wire, a lead and a tool at more than one level along the spinal cord, accommodates a pain pump lead and accommodates a spinal cord stimulator lead. 
     
     
         28 . The method according to  claim 1 , wherein the hook-like grasper tools attaches a selected one or more of one or more wires, leads, medical devices and desired target tissue by using a selected one of suture wire, one or more buttons, one or more bolsters, one or more bridges and thread. 
     
     
         29 . The method according to  claim 1 , wherein the method is replicated on one or more spinal cord levels that include cervical, thoracic, lumbar and sacral regions on the patient body. 
     
     
         30 . The method according to  claim 1 , wherein the method is performed under a selected one of X-Ray, fluoroscopy, ultrasound, CT, MRI, and 3D-MRI. 
     
     
         31 . The method according to  claim 1 , wherein the spinous process is cut to replace a selected one of the left lamina and the right lamina. 
     
     
         32 . A method for performing percutaneous foraminoplasty that utilizes a selected one of a local anesthesia and a segmental anesthesia while a patient is awake and in a prone position, the method for performing percutaneous laminoplasty performed on a selected one of a first side and a second side of a spine, comprising the steps of:
 entering a first introducer epidural needle that includes a proximal end outside of the patient, a distal end, a first hollow internal diameter and a first penetrating perforating tip, the first penetrating perforating tip is disposed on the distal end, the first hollow internal diameter allows one or more first wire tools to pass through the first introducer epidural needle, the first penetrating perforating tip is percutaneously placed into the epidural space of a spine on a first side allowing the one or more first wire tools to be introduced and entered into the epidural space of a selected right lamina of the spine above a targeted vertebra with a side, where a spinous process divides a right lamina and a left lamina;   entering a first exit epidural needle that includes a proximal end outside of the patient, a distal end, a second hollow internal diameter and a second penetrating perforating tip, the second penetrating perforating tip is disposed on the distal end, the second hollow internal diameter allows one or more second wire tools to pass through the exit epidural needle, the second penetrating perforating tip is percutaneously placed into the neuroforaminal space of the spine a selected one level above, one level below and at an adjacent level to the selected right lamina of a targeted vertebra, the second penetrating perforating tip introduces and enters the second wire tools into the neuroforaminal space of the spine a selected one level above, one level below and at an adjacent level to the selected right lamina of a targeted vertebra, the first penetrating perforating tip in the epidural space of a selected right lamina of the spine above a targeted vertebra with a side, where a spinous process divides a right lamina and left lamina and the second penetrating perforating tip in the neuroforaminal space of the spine a selected one level above, one level below and at an adjacent level to the selected right lamina of a targeted vertebra, resulting in the first penetrating perforating tip and the second penetrating perforating tip facing each other, the first penetrating perforating tip and the second penetrating perforating tip centering the neuroforaminal canal of the right side of the target vertebra;   introducing a first hook-like grasper tool with a distal end and a proximal end outside of the patient, the distal end of the first hook-like grasper wire tool is a selected one of manually extended and mechanically extended through the first hollow internal diameter of the first exit epidural needle, the distal end of the first hook-like grasper wire tool attaches the one or more first wire tools introduced through the first introducer epidural needle within the neuroforaminal space of the spine a selected one level above, one level below and at an adjacent level to the selected right lamina of a targeted vertebra, the one or more first wire tools and the first hook-like grasper tool are pulled through the first exit epidural needle and out of a patient body, the one or more first wire tools having a curved middle portion, the curved middle portion lying adjacent to the neuroforamen and neuroforaminal canal, the curved middle portion cuts one or more boney structures of the neuroforamen and the neuroforaminal canal ; and   implementing a plurality of safety mechanisms that include an intraoperative electromyogram, one or more nerve conduction studies and one or more nerve sensors to achieve a safe percutaneous environment.   
     
     
         33 . The method according to  claim 32 , wherein the first hollow internal diameter allows a selected one or more first fluids and first medicines to pass through the first introducer epidural needle. 
     
     
         34 . The method according to  claim 32 , wherein the second hollow internal diameter allows a selected one or more second fluids and second medicines to pass through the second exit epidural needle. 
     
     
         35 . The method according to  claim 32 , wherein the introducer epidural needles are a selected one of a flat tipped introducer epidural needle, a curved introducer epidural needle, a rigid introducer epidural needle, a c-shaped introducer epidural needle, an expandable introducer epidural needle and a flexible introducer epidural needle. 
     
     
         36 . The method according to  claim 32 , wherein the introducer epidural needles have a selected one of a curved penetrating perforating tip and a penetrating perforating straight tip. 
     
     
         37 . The method according to  claim 32 , wherein the introducer epidural needles have a hollow tube that is a protective sheath. 
     
     
         38 . The method according to  claim 32 , wherein the one or more wire tools are a selected one from the group of a guide wire, a thread wire, a bone temperature sensor and a twisted wire. 
     
     
         39 . The method according to  claim 32 , wherein the one or more wire tools are made of a selected one of metal, plastic, nylon and rubber. 
     
     
         40 . The method according to  claim 32 , wherein the one or more wire tools have a selected one of bone cutting and one or more abrasive properties that spares nerves and dura when cutting. 
     
     
         41 . The method according to  claim 32 , wherein the one or more wire tools are utilized to modify tissue, to cut tissue and to cut bone. 
     
     
         42 . The method according to  claim 32 , wherein the one or more wire tools are a selected one of one or more bone-cutting devices, one or more t-saw wires, one or more bone cutting wires and a saw device. 
     
     
         43 . The method according to  claim 32 , wherein the one or more wire tools includes an expanding hollow lumen that allows one or more wires, fluids, and medical devices to pass through the expanding hollow lumen. 
     
     
         44 . The method according to  claim 43 , wherein the one or more wire tools includes a plurality of channels and a plurality of apertures to be passed through the expanding hollow lumen to irrigate one or more anatomical areas of the spine. 
     
     
         45 . The method according to  claim 44 , wherein the one or more anatomical areas of the spine are irrigated with cold water. 
     
     
         46 . The method according to  claim 43 , wherein the expanding hollow lumen is made of a selected one of a plastic and a malleable polymer. 
     
     
         47 . The method according to  claim 32 , wherein the one or more wire tools provide suction. 
     
     
         48 . The method according to  claim 32 , wherein the one or more wire tools are a selected one of left in the epidural space, removed immediately from the epidural space and removed at a later date from the epidural space. 
     
     
         49 . The method according to  claim 32 , wherein the one or more wire tools have a plurality of grooves that pick-up bone debris osteophytes and carry the bone debris osteophytes outside the patient body by a selected one of pushing and pulling of the one or more wire tools. 
     
     
         50 . The method according to  claim 32 , wherein the one or more wire tools are an expanding balloon. 
     
     
         51 . The method according to  claim 50 , wherein the expanding balloon is a selected one of radio-opaque and radiolucent, the expanding balloon provides a larger target to the exit epidural needle. 
     
     
         52 . The method according to  claim 32 , wherein the one or more wire tools are a selected one of a plurality of pieces and one continuous piece. 
     
     
         53 . The method according to  claim 32 , wherein the one or more wire tools are a selected one of radiolucent and radiopaque. 
     
     
         54 . The method according to  claim 32 , wherein the one or more wire tools are a selected one or more of being magnetic, having one or more electromagnetic capabilities, generating heat, being coupled to a medical device that has a laser eliciting capability, producing a laser, being motorized, vibrating independently and vibrating at one or more calculated rhythms. 
     
     
         55 . The method according to  claim 32 , wherein the epiduroscope has an ultrasound guided capability and a wireless capability to transmit data. 
     
     
         56 . The method according to  claim 32 , wherein the hook-like grasper tools is a pair of grasping forceps. 
     
     
         57 . The method according to  claim 32 , wherein the hook-like grasper tools is a selected one or more of having a fork-shape, having one or more apertures, having a locking device, having a selected one of a closing door and a pinching door, having a sticky substance and having a selected one of magnetic properties and electromagnetic properties. 
     
     
         58 . The method according to  claim 32 , wherein the hook-like grasper tools sutures a selected one of a wire, a lead and a tool at more than one level along the spinal cord, accommodates a pain pump lead and accommodates a spinal cord stimulator lead. 
     
     
         59 . The method according to  claim 32 , wherein the hook-like grasper tools attaches a selected one or more of one or more wires, leads, medical devices and desired target tissue by using a selected one of suture wire, one or more buttons, one or more bolsters, one or more bridges and thread. 
     
     
         60 . The method according to  claim 32 , wherein the method is replicated on one or more spinal cord levels that include cervical, thoracic, lumbar and sacral regions on the patient body. 
     
     
         61 . The method according to  claim 32 , wherein the method is performed under a selected one of X-Ray, fluoroscopy, ultrasound, CT, MRI, and 3D-MRI.