Spinal ligament modification devices
A method for treating stenosis in a spine comprises percutaneously accessing the epidural space in a stenotic region of interest, compressing the thecal sac in the region of interest to form a safety zonem, inserting a tissue removal tool into tissue in the working zone, using the tool to percutaneously reduce the stenosis; and utilizing imaging to visualize the position of the tool during at least a part of the reduction step. A tissue excision system for performing percutaneous surgery, comprises a cannula comprising a tissue-penetrating member having a distal end defining an aperture on one side thereof, an occluding member slidably received on or in the cannula and closing the aperture when the occluding member is adjacent the cannula distal end, means for engaging adjacent tissue via the aperture, and cutting means for resecting a section of the engaged tissue.
1 . A tissue excision system for percutaneous surgery, comprising:
a cannula comprising a tissue-penetrating member having a distal end defining an aperture on one side thereof;
an occluding member slidably received on or in said cannula and closing said aperture when said occluding member is adjacent said cannula distal end;
a tissue-engaging device received within said cannula and adapted to engage adjacent tissue via said aperture; and
cutting means for resecting a section of said engaged tissue.
2 . The percutaneous tissue excision system of claim 1 wherein said tissue-engaging device comprises a shaft and distal and proximal ends and a tissue-engaging means at its distal end.
3 . The percutaneous tissue excision system of claim 2 wherein said tissue-engaging device includes at least one barb extending outwardly from said shaft.
4 . The percutaneous tissue excision system of claim 1 wherein said tissue-engaging device is reciprocably received in said cannula.
5 . The percutaneous tissue excision system of claim 1 wherein said tissue-engaging device is rotatably received in said cannula.
6 . The percutaneous tissue excision system of claim 1 wherein said tissue-engaging device is constructed such that it has a normal configuration that is retained by said occluding member when said occluding member is adjacent said cannula distal end and extends through said aperture when said occluding member is removed from said aperture.
7 . The percutaneous tissue excision system of claim 1 , further including means for retrieving said resected tissue from said distal tool end and a tissue-removal system for removing tissue from said retrieving means.
8 . The percutaneous tissue excision system of claim 7 wherein said tissue-removal system comprises a keyhole slot.
9 . The percutaneous tissue excision system of claim 1 wherein said tissue-engaging device comprises a hook.
10 . The percutaneous tissue excision system of claim 9 wherein said hook comprises a length of wire that has been bent through at least about 270°.
11 . The percutaneous tissue excision system of claim 1 wherein said tissue-engaging device comprises an elongate body housed within said cannula and comprising two radially extendable arms constructed such that radially extending said arms causes them to open and extend outwardly through said side aperture and retracting said arms causes them to close.
12 . The device according to claim 11 wherein said arms each include an opposing edge and at least one opposing edge includes teeth or ridges.
13 . The device according to claim 12 wherein said opposing edges comprise cutting blades.
14 . The device according to claim 12 , further including an outer cutting element slidably mounted on said cannula.
15 . The device according to claim 10 , further including a retractable tissue-retrieval device received within said elongate body.
16 . The device according to claim 14 wherein said tissue-retrieval device can be extended to the distal end of the cannula to engage a tissue sample, retracted for removal of the tissue sample, and re-extended into the outer needle.
17 . The device according to claim 14 , further including means for removing tissue from the tissue-retrieval device.
18 . The percutaneous tissue excision system of claim 1 wherein said tissue-engaging device comprises a corkscrew-shaped needle.
19 . A tissue excision system for percutaneous surgery, comprising:
a cannula comprising a tissue-penetrating member having a distal end defining an aperture on one side thereof;
an occluding member slidably received on or in said cannula and closing said aperture when said occluding member is adjacent said cannula distal end;
a tissue-engaging device received within said cannula and adapted to engage adjacent tissue via said aperture;
cutting means for resecting a section of said engaged tissue;
means for retrieving said resected tissue from said distal tool end; and
a tissue-removal system for removing tissue from said retrieving means.
20 . The percutaneous tool according to claim 28 wherein the first tissue-engaging device comprises a resilient material and is configured such that it is elastically deformed when it is constrained within said cannula.