Image guided spinal decompression with contralateral oblique view
The present invention relates to a flexible surgical system for endoscopic spinal decompression and methods thereof. Various methods of accessing the epidural space with this instrument are described. The system design enables placement of the device through several approaches. It is then advanced under direct visualization or fluoroscopic (X-Ray), for example, into areas of the spine including lumbar (low back), thoracic (mid and upper back) and cervical (neck). The pathologies encroaching upon the spinal space can then be visualized wherein the epidural membrane can optionally be displaced to further aid in visualization. The membrane can be used to protect regions of tissue adjacent the site to tissue removal.
1 . A device for surgical removal of a spinal stenosis, comprising:
a tubular tissue removal device having an opening at a distal end to be inserted into the patient from one or more contralateral oblique angles along one or more insertion axes that extends across a midline of the spine at a treatment level relative to the spine such that the distal end is directed to a position to remove the spinal stenosis, the tubular tissue removal device having an internal cavity within a cannula configured to capture at least a portion of the spinal stenosis to be removed and a cutting tool configured to move to separate the captured portion within the cannula from remaining spinal stenosis tissue; and
a fluoroscopic visualization device positioned to image a field of view along one or more axes including along at least one of the insertion axes at one of the contralateral oblique angles including a position of the spinal stenosis and the tissue removal device that is configured for insertion into the patient along the plurality of insertion axes with different orientations to capture additional portions of the spinal stenosis.
2 . The device of claim 1 wherein the cannula comprises a bone removal tool.
3 . The device of claim 1 wherein the tissue removal device further comprises an imaging device positioned within a tubular body having a working channel through which the tissue removal device is inserted.
4 . The device of claim 1 wherein the tissue removal device is configured for insertion into the patient along axes with multiple superior and inferior orientations to compress the length of tissue in the spinal stenosis area and adjacent laminae in the spinal stenosis area posterior to a ventral interlaminar line (VILL).
5 . The device of claim 1 wherein the one or more contralateral oblique axes are in a range of 35 to 45 degrees relative to the spine.
6 . The device of claim 1 wherein the tissue removal device is a manual tool or wherein the tissue removal tool is an automated ultrasonic tool such that the tool includes a helical element.
7 . The device of claim 1 further comprising a display to view insertion of the tissue removal device under fluoroscopic examination.
8 . The device of claim 4 wherein the visualization device comprises a detector and a display for displaying an image of the tissue removal device relative to the VILL.
9 . The device of claim 1 wherein the tissue removal device is configured for percutaneous insertion into the spinal region along a second contralateral oblique angle on a different insertion axis.
10 . The device of claim 1 further comprising an imaging device inserted through the cannula to further visualize placement of the tissue removal device relative to the spinal stenosis wherein a decompression tool is advanced.
11 . A method for treating a spinal stenosis comprising:
inserting tubular cannula with a stylet into a spinal region of a patient along a contralateral oblique axis, the tubular cannula having a distal end positioned to guide a tissue removal device during removal of a spinal stenosis of the patient wherein the spinal region is visualized with a fluoroscopic visualization device oriented along the contralateral oblique axis to position a distal end of the tubular tissue removal device within the spinal region;
removing the stylet and introducing the tissue removal device into the cannula for positioning within the spinal region along the contralateral oblique axis that extends relative to a ventral interlaminar line (VILL) of the patient to access a spinal stenosis area, the tissue removal device including a moving cutting element that cuts spinal stenosis tissue retained in the cannula;
removing a first portion of the spinal stenosis from the spinal stenosis area with the cannula and tissue removal device as the tissue removal device is moved along the contralateral oblique axis; and
further inserting the cannula and tissue removal device with visualization into the spinal stenosis area at a different contralateral oblique axis to remove a further portion of the spinal stenosis from the patient.
12 . The method of claim 11 further comprising introducing a membrane under direct or fluoroscopic visualization to position the membrane between the spinal stenosis and epidural tissue such that portions of the spinal stenosis anterior to the VILL are removed with the tissue removal device.
13 . The method of claim 11 further comprising inserting a cutting tool using the tubular tissue removal device.
14 . The method of claim 11 further comprising removing at least a portion of tissue positioned in the epidural space from the spinal stenosis using at least one of manual removal or automated removal using an ultrasonic tool or a tool rotating relative to the spinal stenosis.
15 . The method of claim 11 , wherein inserting the tissue removal device occurs along axes with multiple superior and inferior orientations to compress the length of tissue in the spinal stenosis area relative to laminae adjacent the spinal stenosis area.
16 . The method of claim 11 further comprising visualizing the epidural space with a detector and displaying an image of the distal end of the cannula accessing the epidural space, and wherein at least one view of the epidural space comprises viewing along an anterior-posterior (AP) projection of the spinal region wherein contact of the cannula with bone can be visualized and advancing the cannula past to bone to contact a superior articulate process (SAP) or a foramen of the spinal region.
17 . The method of claim 11 wherein introducing tubular tissue removal device into the spinal region along the contralateral oblique axis of the patient to access a spinal stenosis area further comprises insertion along the contralateral oblique axis within in a range of 35 to 45 degrees relative to a midline of a spine of the patient.
18 . A kit for treatment of a spinal stenosis comprising;
a rigid cannula having a diameter to access a spinal stenosis to be at least partially removed from a patient, a distal end of the cannula having a distal cutting region for insertion along a contralateral oblique axis of a spine of a patient to at least a spinolaminar junction of the spine;
a stylet for placement with the cannula and along said contralateral oblique axis, the stylet having a distal cutting surface that can be extended beyond the distal end of the cannula wherein a stop limits advancement of the stylet beyond a fixed distance distally of the cannula; and
a tissue removal device to be inserted through the cannula upon removal of the stylet, the cannula and tissue removal device having an internal tube channel to receive spinal stenotic tissue upon insertion of the tissue removal device into the spinal stenosis, the tissue removal device having a distal cutting element within the internal tube channel such that the stenotic tissue is is-retained in the internal tube channel upon rotation relative to the spinal stenosis.
19 . The kit of claim 18 wherein the distal cutting element further comprises an element that rotates within surrounding tissue, the tissue removal device being removable along the contralateral oblique axis to extract stenotic tissue from the spinal stenosis.
20 . The kit of claim 18 further comprising a bone removal tool to remove bone along the contralateral oblique axis along a delivery path of the cannula to the spinal stenosis.