Methods and apparatus for treating back pain
Apparatus and methods for treating back pain of a patient by denervation of an intervertebral disc or a region of the posterior longitudinal ligament by the controlled application of heat to a target tissue. In one embodiment, the invention may include a procedure combining both decompression of a disc, and denervation of the annulus fibrosus. In one embodiment, a method of the invention includes positioning an active electrode of an electrosurgical instrument in at least close proximity to an intervertebral disc, and applying at least a first high frequency voltage between the active electrode and a return electrode, wherein nervous tissue within the annulus fibrosus is inactivated, and discogenic pain of the patient is alleviated. In one embodiment, the invention includes positioning a first electrode of a dual-shaft electrosurgical instrument at a first location in relation to a target disc, positioning a second electrode of the instrument at a second location, and applying a high frequency voltage between the first and second electrodes, wherein the first and second electrodes are disposed on separate shafts of the instrument.
1 . A method for treating discogenic pain, comprising:
a) providing access to an annulus fibrosus of a disc;
b) advancing an electrosurgical probe into contact or nearby said annulus fibrosus, the electrosurgical probe having a distal section and a distal tip, said distal tip having a tissue treatment surface, said probe further comprising at least one return electrode and at least one active electrode protruding from said tissue treatment surface; and
c) applying a high frequency voltage difference between said active electrode and said return electrode sufficient to shrink disc tissue.
2 . The method of claim 1 , wherein said tissue treatment surface is substantially planar.
3 . The method of claim 1 , wherein the at least one active electrode is at least two active electrodes and the at least one return electrode is at least two return electrodes.
4 . The method of claim 3 , comprising an equal number of active and return electrodes.
5 . The method of claim 1 , wherein said probe comprises a shaft distal section that forms an angle with said distal tip.
6 . The method of claim 5 , wherein said angle is between 30 and 60 degrees.
7 . The method of claim 1 wherein said providing access of step a) is performed by open surgery.
8 . The method of claim 1 wherein said providing access of step a) is performed by percutaneous surgery.
9 . The method of claim 1 wherein said applying energy of step c) is performed by applying energy to outer layers of said annulus.
10 . The method of claim 9 wherein said access of step a) is provided without penetrating the nucleus pulposus.
11 . An electrosurgical apparatus, comprising:
a spatula-shaped distal section, said distal section comprising a body portion having a first axis, and a substantially planar tissue treatment section, said tissue treatment section distal to said body portion and having a second axis wherein said first axis and second axis form an angle in a range from 30 to 60 degrees;
an active electrode disposed on said tissue treatment surface;
a return electrode disposed on the tissue treatment surface of said distal tip; and
a connector to electrically couple said active electrode and said return electrode to a voltage supplier adapted to supply a high frequency voltage difference sufficient to shrink collagen layers of a disc without ablating said disc tissue.
12 . The apparatus of claim 11 comprising a plurality active electrodes and a plurality of return electrodes.
13 . The apparatus of claim 12 comprising equal number of active and return electrodes.
14 . The apparatus of claim 11 wherein said angle is in the range of 40 to 50 degrees.
15 . The apparatus of claim 11 wherein said distal section is an integral injection molded component.
16 . The apparatus of claim 11 wherein said connector includes a connecting wire for each of said electrodes.
17 . The apparatus of claim 13 wherein said active electrodes are diagonally arranged on said planar tissue treatment surface.
18 . The apparatus of claim 13 wherein said active and return electrodes are made of ball wires, each of said ball wires having a wire shaft and a distal sphere-shaped head wherein at least a portion of the head protrudes from said tissue treatment surface.