Method of using neural stimulation during nucleoplasty procedures
The present disclosure relates to methods of performing nucleoplasty including the step of providing an elongated thermal or electromagnetic probe having a proximal end, a distal end and having a guidable region adjacent the distal end thereof. The method further includes the steps of introducing the guidable region of the probe into a nucleus of an intervertebral disc; activating the probe; increasing the amplitude of the activated probe until an effect is obtained on a nervous system; and noting the amplitude at which the effect on the nucleus is observed. The method further includes the step of re-activating the probe to treat the nucleus, wherein the probe is activateable up to the amplitude at which the effect on the nervous system indicates that damage to critical nerve tissue is avoided.
1 . A method for performing a nucleoplasty comprising the steps of:
providing an elongated thermal or electromagnetic probe having a proximal end, a distal end and having a guidable region adjacent the distal end thereof;
introducing the guidable region of the probe into a nucleus of an intervertebral disc;
activating the probe;
increasing the amplitude of the activated probe until an effect is obtained on the nervous system;
noting the amplitude at which the effect on the nervous system is observed; and
re-activating the probe to treat the nucleus, wherein the probe is activateable up to the amplitude that is dictated by a threshold amplitude of the nervous system stimulation.
2 . The method according to claim 1 , wherein the probe is initially activated in a simulate mode.
3 . The method according to claim 2 , further comprising the step of introducing the guidable region of the probe into one of a posterior and posterior-lateral location of the intervertebral disc.
4 . The method according to claim 1 , wherein a maximum level of initial activation of the probe is to a level where threshold indications of effect are transmitted to the spinal cord.
5 . The method according to claim 4 , wherein the threshold level of initial activation of the probe is dependent on a length of the guidable region of the probe.
6 . The method according to claim 1 , further comprising the steps of:
providing an introducer cannula having at least an electrically conductive distal end;
introducing the introducer cannula into the intervertebral disc; and
monitoring an impedance of tissue adjacent the distal end of the introducer cannula to determine when the distal end of the introducer cannula is positioned within the nucleus.
7 . The method according to claim 6 , further comprising the step of introducing the probe through the introducer cannula such that the guidable region thereof extends from the distal end of the introducer cannula and into the nucleus.
8 . The method according to claim 7 , further comprising the steps of:
providing a stylet selectively positionable in the introducer cannula to occlude the introducer cannula during introduction into the intervertebral disc; and
removing the stylet from the introducer cannula prior to introduction of the guidable region of the probe into the introducer cannula.
9 . The method according to claim 6 , further comprising the step of monitoring the location of the distal end of the introducer cannula using fluoroscopic techniques.
10 . The method according to claim 8 , further comprising the step of connecting at least one of the guidable region of the probe and the distal end of the introducer cannula to a generator.
11 . A method of performing a nucleoplasty comprising the steps of:
providing a generator;
providing an apparatus for performing the nucleoplasty, the apparatus including:
an introducer cannula having at least an electrically conductive distal end;
a stylet selectively positionable in the introducer cannula to occlude the introducer cannula during introduction of the introducer cannula into an intervertebral disc; and
an elongated thermal or electromagnetic probe having a proximal end, a distal end and having a guidable region adjacent the distal end thereof;
introducing the introducer cannula having the stylet positioned therewithin into the intervertebral disc;
monitoring an impedance of tissue adjacent the distal end of the introducer cannula to determine when the distal end of the introducer cannula is positioned within the nucleus;
removing the stylet from the introducer cannula prior to introduction of the guidable region of the probe into the introducer cannula;
introducing the probe through the introducer cannula such that the guidable region thereof extends from the distal end of the introducer cannula and into the nucleus;
activating the probe;
increasing the amplitude of the activated probe until an effect is obtained in the nervous system;
noting the amplitude at which the effect on the nervous system is observed; and
re-activating the probe to treat the nucleus, wherein the probe is activateable up to the amplitude that is dictated by a threshold amplitude of nervous system stimulation.
12 . The method according to claim 11 , wherein the probe is initially activated in a stimulate mode.
13 . The method according to claim 12 , further comprising the step of introducing the guidable region of the probe into one of a posterior and posterior-lateral location of the intervertebral disc.
14 . The method according to claim 11 , wherein a threshold level of initial activation of the probe is to a level where no indications of effect are transmitted to the spinal cord.
15 . The method according to claim 14 , wherein the threshold level of initial activation of the probe is dependent on a length of the guidable region of the probe.
16 . A method of using neural stimulation during nucleoplasty procedures for confirming the placement of a probe in a nucleus of an intervertebral disc comprises the steps of:
providing a generator;
providing an apparatus for performing a nucleoplasty, the apparatus including:
an introducer cannula having at least an electrically conductive distal end, wherein the distal end of the introducer cannula is electrically connected to the generator;
introducing the introducer cannula into the intervertebral disc; and
monitoring an impedance of tissue adjacent the distal end of the introducer cannula to determine when the distal end of the introducer cannula is positioned within the nucleus.
17 . The method according to claim 16 , wherein the apparatus further includes an elongated thermal or electromagnetic probe having a guidable region adjacent a distal end thereof; and
the method further including the steps of:
introducing the probe through the introducer cannula such that the guidable region thereof extends from the distal end of the introducer cannula and into the nucleus;
activating the probe;
increasing the amplitude of the activated probe until an effect is obtained in the nervous system;
noting the amplitude at which the effect on the nucleus is observed; and
re-activating the probe to treat the nucleus, wherein the probe is activateable up to the amplitude that is dictated by a threshold amplitude of nervous system stimulation.
18 . The method according to claim 17 , wherein the apparatus further includes a stylet selectively positionable in the introducer cannula to occlude the introducer cannula during introduction of the introducer cannula into an intervertebral disc; and
the method further including the steps of:
introducing the introducer cannula having the stylet positioned therewithin into the intervertebral disc; and
removing the stylet from the introducer cannula prior to introduction of the guidable region of the probe into the introducer cannula.