Method of treating an intraosseous nerve

Abstract

This invention relates to a method of straddling an intraosseous nerve with an energy transmitting device to improve the therapeutic treatment of the nerve.

We claim: 
     
       1. A method of therapeutically treating a vertebral body having an outer cortical bone region, an inner cancellous bone region, and a basivertebral nerve BVN, comprising the steps of:
 providing a probe configured to deploy an energy device having an electrode;   the probe comprising a longitudinal bore extending from a proximal end of the probe toward a distal end of the probe;   the probe comprising a recess in communication with said bore, said recess forming a lateral opening at or near the distal end of the probe;   the probe further comprising a pivotable member;   the pivotable member having a fixed end pivotably secured to the probe at a distal location within the recess of the probe, and a free end configured to be seated in said recess;   wherein the pivotable member comprises an undeployed mode where the free end extends proximally from the fixed end within said recess, and a deployed mode where the free end is configured to pivot about said fixed end and extend outward from said probe;   articulating the pivotable member from the undeployed mode to the deployed mode to facilitate delivery of the energy device along a path associated with the free end of the pivotable member into the cancellous bone region of the vertebral body; and   applying a sufficiently high frequency voltage to the electrode to heat the BVN.   
     
     
       2. A method as recited in  claim 1 , the BVN having a trunk extending from the outer cortical bone region and into the inner cancellous bone region and branches extending from the trunk to define a BVN junction, wherein therapeutically heating the BVN comprises:
 depositing therapeutic energy within the inner cancellous bone region of the vertebral body.   
     
     
       3. The method of  claim 2 , wherein the therapeutic energy is deposited in a region of the vertebral body located between 60% and 90% of the distance between the posterior and anterior ends of the vertebral body. 
     
     
       4. The method of  claim 3 , wherein said therapeutic energy is deposited in a region of the vertebral body located between 60% and 90% of the distance from the anterior wall to the posterior wall of the vertebral body. 
     
     
       5. The method of  claim 2 , wherein said therapeutic energy deposited includes a region that is proximal of the BVN junction. 
     
     
       6. The method of  claim 2 , wherein said therapeutic energy is deposited within a region that is at least 1 cm in diameter. 
     
     
       7. The method of  claim 2 , wherein said therapeutic energy deposited comprises a steady-state heated zone having a peak temperature of between 80 degrees C. and 95 degrees C. 
     
     
       8. The method of  claim 7 , wherein said steady-state heated zone heats at least 1 cc of bone to a temperature of at least 50 degrees C. 
     
     
       9. The method of  claim 2 , wherein the method is performed to treat pain in a patient diagnosed with pain. 
     
     
       10. The method of  claim 1 , wherein the method is performed to treat pain in a patient diagnosed with pain. 
     
     
       11. The method of  claim 1 , wherein the pivotable member in the undeployed mode is entirely contained within said recess. 
     
     
       12. The method of  claim 1 , wherein articulating the pivotable member from the undeployed mode to the deployed mode comprises advancing a member distally along said bore to push the free end of the of the pivotable member laterally out the recess. 
     
     
       13. The method of  claim 1 , wherein the free end of the pivotable member deploys pivotably outward from the recess into the cancellous bone region. 
     
     
       14. A method of therapeutically treating a vertebral body having an outer cortical bone region, an inner cancellous bone region, and a basivertebral nerve BVN, comprising the steps of:
 providing a probe configured to deploy an energy device comprising an electrode;   the probe comprising a longitudinal bore extending from a proximal end of the probe toward a distal end of the probe;   the probe comprising a recess in communication with said bore, said recess forming an opening at or near the distal end of the probe;   the probe further comprising a pivotable member;   the pivotable member having a fixed end secured to the probe at a location within the recess of the probe, and a free end configured to be extended out of the opening of the probe;   wherein the pivotable member comprises an undeployed mode where the free end is not in an articulated configuration, and a deployed mode where the free end is configured to extend outward from the opening of said probe into the articulated configuration;   articulating the pivotable member from the undeployed mode to the deployed mode to facilitate delivery of the energy device along a path associated with the free end of the pivotable member into the cancellous bone region of the vertebral body; and   applying a sufficiently high frequency voltage to the electrode to heat the BVN to a temperature between 80 degrees Celsius and 95 degrees Celsius and sufficient to denervate the BVN,   wherein the frequency of the voltage is between 400 kHz and 600 kHz,   wherein the probe comprises a sharp distal tip, and   wherein the probe comprises a temperature sensor.   
     
     
       15. The method of claim 14, wherein the electrode comprises an active electrode and wherein the probe further comprises a return electrode. 
     
     
       16. The method of claim 14, wherein the applied high frequency voltage is configured to form a heating zone having a diameter of between 0.5 cm and 2.0 cm. 
     
     
       17. The method of claim 14, wherein the probe has a length between 5 and 30 cm and a diameter between 0.2 mm and 10 mm. 
     
     
       18. The method of claim 14, further comprising:
 piercing skin of a patient with a cannulated needle, the cannulated needle comprising a cannula and a stylet inserted within the cannula until a distal tip of the stylet extends beyond a distal opening of the cannula;   advancing the cannulated needle so that the distal tip of the stylet enters within the cancellous bone region of the vertebral body;   withdrawing the stylet from the cannula; and   inserting at least a distal portion of the probe through a bore of the cannula and out of the distal opening of the cannula.