Cannulotome

Abstract

Systems and methods for treating spinal stenosis include endoscopic access devices and bone removal devices used to perform a foraminotomy or other bone removal procedures. A bone removal device includes a cannulotome with an endoscopic imaging lumen. Optionally, an endoscope retaining device can be used to facilitate advancement of the endoscope through the cannulotome.

1 .- 23 . (canceled) 
     
     
         24 . A method for spinal surgery comprising:
 inserting a cannulotome with a proximal handle, an elongate shaft with a lumen therethrough, and a tapered cutter at the distal end of the shaft through an introducer cannula;   advancing an endoscope assembly comprising an endoscope coupled to an endoscope retaining device through the lumen of the cannulotome, wherein the endoscope retaining device comprises a channel therethrough;   advancing the introducer cannula to a target spine region;   tapping the cannulotome handle with a mallet to remove bony or calcified tissue while simultaneously visualizing the removal of the tissue through a lumen of the cannulotome.   
     
     
         25 . The method of  claim 24 , further comprising infusing fluid through the channel of the endoscope retaining device to the target spine region. 
     
     
         26 . The method of  claim 24 , wherein the distal cutter of the cannulotome comprises orientation markings, and wherein advancing the endoscope assembly comprises positioning the endoscope assembly according to the orientation markings. 
     
     
         27 . The method of  claim 24 , further comprising acquiring endoscope images during or immediately after the application of force to the cannulotome. 
     
     
         28 . The method of  claim 26 , further comprising rotating the cannulotome within the introducer cannula to contact a different tissue region. 
     
     
         29 . The method of  claim 27 , further comprising drawing up the removed tissue through the cannulotome shaft lumen using a grasping tool. 
     
     
         30 . The method of  claim 28 , further comprising discarding the endoscope retaining device at the end of the procedure.