PAIN TREATMENT USING WANDING OF PERCUTANEOUS SURGICAL PROBE OVER SENSORY NERVE
A method of performing a rhizotomy includes directing a surgical probe through an incision in the body of a patient, navigating a distal tip of the probe to a location adjacent a target nerve, energizing the probe to deliver energy to the target nerve, and wanding the distal tip of the probe in a plurality of directions to direct the energy at the target nerve to interrupt signal transmission by the target nerve.
1 . A method of performing a rhizotomy on at least one target sensory nerve extending along one or more boney outer surfaces that innervate a joint of a body of a patient, the method comprising:
providing a surgical probe having a distal tip, the distal tip of the surgical probe suitable for performing a percutaneous procedure;
creating an incision in the body of the patient;
directing the distal tip of the probe through the incision;
navigating the distal tip of the probe via medical imaging to a first location on a first boney outer surface adjacent a first target sensory nerve;
activating the probe;
while activating the probe, moving the distal tip of the probe in a plurality of directions over a first surface area along the first boney outer surface to interrupt function of the target sensory nerve; and
deactivating the probe,
wherein the distal tip of the electrocautery probe is sufficiently stiff to resist deformation when moved over the surface area.
2 . The method of claim 1 , wherein the target sensory nerve is a nerve that runs along the boney outer surface, and the moving the distal tip includes wanding the distal tip along the boney outer surface.
3 . The method of claim 2 , wherein the moving also includes wanding the distal tip above the boney outer surface.
4 . The method of claim 1 , wherein interrupting function of the target sensory nerve includes cauterizing of the target sensory nerve.
5 . The method of claim 1 , wherein interrupting function of the target sensory nerve includes transecting of the target sensory nerve.
6 . The method of claim 1 , wherein medical imaging includes fluoroscopy.
7 . The method of claim 1 , wherein activating the probe includes delivering energy from the probe to the target sensory nerve.
8 . The method of claim 7 , wherein delivering energy comprises delivering radio frequency energy.
9 . The method of claim 7 , wherein the energy is delivered to the target sensory nerve for a time period in a range from 3 seconds to 10 seconds.
10 . The method of claim 1 , further comprising:
delivering medication to the target sensory nerve prior to interrupting function of the nerve.
11 . The method of claim 10 , wherein the medicine comprises at least one of a local anesthetic and an anti-inflammatory medicine.
12 . The method of claim 10 , wherein the medicine comprises at least one of novocaine, bupivacaine, and methylprednisolone.
13 . The method of claim 1 , wherein the probe includes a lumen, and the medicine is delivered through the lumen.
14 . The method of claim 1 , wherein the boney outer surface includes a vertebra of a spine.
15 . The method of claim 14 , wherein the target sensory nerve is a medial branch of a dorsal ramus.
16 . The method of claim 15 , wherein the vertebra has a transverse process and a pedicle, and moving the distal tip includes wanding the distal tip along the transverse process to the pedicle.
17 . The method of claim 1 , wherein the boney outer surface includes the sacrum, and the target sensory nerve is a sensory nerve that runs along the sacrum.
18 . The method of claim 1 , wherein the joint is a sacroiliac joint.
19 . The method of claim 1 , wherein the joint is a shoulder joint.
20 . The method of claim 1 , wherein the joint is a hip joint.
21 . The method of claim 1 , wherein the joint is a knee joint.
22 . The method of claim 1 , wherein the surface area is greater than 10 mm 2 .
23 . The method of claim 1 , further comprising:
after deactivating the probe, moving the distal end of the probe to another location;
again delivering energy from the distal tip of the probe; and
while again delivering energy, moving the distal tip of the probe in a plurality of directions to direct the energy over a second surface area distinct from the first surface area to interrupt function of a second target sensory nerve.
24 . The method of claim 23 , wherein the probe is moved to another location without removing the distal tip from the incision.
25 . The method of claim 23 , wherein interrupting function of the first target nerve transects the first target nerve, and the interrupting function of the second target nerve transects the second target nerve.
26 . A method of performing a rhizotomy on a target sensory nerve that innervates a joint of a body of a patient, the target sensory nerve extending along a boney outer surface, the method comprising:
creating an incision in the body of the patient;
directing a distal tip of a percutaneously-insertable surgical probe through the incision;
navigating the distal tip of the probe via medical imaging to a location on the boney outer surface adjacent the target sensory nerve;
delivering medication to the target sensory nerve; then
activating the distal tip of the probe to delivery energy to the target sensory nerve;
while activating the distal tip of the probe, moving the distal tip of the probe over a surface area along the boney outer surface to interrupt function of the target sensory nerve.
27 . The method of claim 26 , wherein the probe is provided with a lumen, and the medication is delivered through the lumen.
28 . The method of claim 26 , wherein the medication includes at least one of a local anesthetic and an anti-inflammatory medicine.
29 . The method of claim 28 , wherein the medication comprises at least one of novocaine, bupivacaine, and methylprednisolone.