METHOD FOR TREATING INTERVERTEBRAL DISC
A device is described that may be positioned at a location in an intervertebral disc for diagnosis or treatment of the disc. Treatment may include, for example, applying energy or removing material, and may decrease intradiscal pressure. Radiofrequency energy may be applied. A percutaneous method of repairing a fissure in the annulus pulposus comprises placing an energy source adjacent to the fissure and providing sufficient energy to the fissure to raise the temperature to at least about 45-70° C. and for a sufficient time to cause the collagen to weld. An intervertebral fissure also can be treated by placing a catheter with a lumen adjacent to the fissure and injecting sealant into the fissure via the catheter, thereby sealing the fissure. An intervertebral fissure additionally can be treated by providing a catheter having a distal end, a proximal end, a longitudinal axis, and an intradiscal section at the catheter's distal end on which there is at least one functional element. The next step is applying a force longitudinally to the proximal of the catheter which is sufficient to advance the intradiscal section through the nucleus pulposus and around an inner wall of an annulus fibrosus, but which force is insufficient to puncture the annulus fibrosus. Next the functional element is positioned at a selected location of the disc by advancing or retracting the catheter and optionally twisting the proximal end of the catheter. Then the functional unit treats the annular fissure. Optionally, there is an additional step of adding a substance to seal the fissure. An externally guidable intervertebral disc apparatus also is disclosed.
1 . The method comprising:
advancing a member into a nucleus pulposus of an intervertebral disc by blunt dissection, and
applying radiofrequency energy from the member to remove material of the nucleus pulposus.
2 . The method of claim 1 wherein applying radiofrequency energy removes water of the nucleus pulposus.
3 . The method of claim 1 wherein applying radiofrequency energy removes disc tissue of the nucleus pulposus.
4 . The method of claim 1 wherein applying radiofrequency energy from the member to remove material of the nucleus pulposus reduces pressure in the intervertebral disc.
5 . The method of claim 1 wherein applying radiofrequency energy from the member to remove material of the nucleus pulposus comprises ablating material of the nucleus pulposus.
6 . The method of claim 1 further comprising denervating at least a portion of the intervertebral disc with the applied radiofrequency energy.
7 . The method of claim 1 wherein advancing the member comprises advancing the member beyond a central region of the nucleus pulposus.
8 . The method of claim 1 further comprising applying rotation to a proximal region of the member to rotate a distal region of the member within the nucleus pulposus.
9 . The method of claim 1 further comprising positioning a portion of the member at an inner wall of an annulus fibrosus of the intervertebral disc.
10 . The method of claim 1 wherein applying radiofrequency energy comprises applying radiofrequency energy to an inner wall of an annulus fibrosus.
11 . The method of claim 1 wherein applying radiofrequency energy comprises applying radiofrequency energy while the member is positioned at a location adjacent an inner wall of an annulus fibrosus.
12 . The method of claim 1 wherein applying radiofrequency energy comprises applying radiofrequency energy to multiple locations in the intervertebral disc.
13 . The method of claim 12 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations simultaneously.
14 . The method of claim 12 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using separate energy delivery elements of the member.
15 . The method of claim 12 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations serially.
16 . The method of claim 12 wherein applying radiofrequency energy to multiple locations comprises applying radiofrequency energy to the multiple locations using a single energy delivery element of the member.
17 . A method comprising:
advancing a radiofrequency electrode into a nucleus pulposus of an intervertebral disc by blunt dissection, and
activating the electrode to remove material of the nucleus pulposus.
18 . The method of claim 17 wherein activating the electrode to remove material of the nucleus pulposus reduces pressure in the intervertebral disc.
19 . The method of claim 17 wherein activating the electrode to remove material of the nucleus pulposus comprises ablating material of the nucleus pulposus.
20 . The method of claim 17 wherein advancing the electrode comprises advancing the electrode beyond a central region of the nucleus pulposus.
21 . The method of claim 17 further comprising positioning the electrode at an inner wall of an annulus fibrosus of the intervertebral disc.
22 . The method of claim 17 wherein activating the electrode comprises activating the electrode while the electrode is positioned at a location adjacent an inner wall of an annulus fibrosus.
23 . The method of claim 17 wherein activating the electrode comprises delivering radiofrequency energy from the electrode to multiple locations in the intervertebral disc.
24 . The method of claim 23 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations simultaneously.
25 . The method of claim 23 wherein delivering radiofrequency energy to multiple locations comprises delivering radiofrequency energy from the electrode to the multiple locations serially.