公开(公告)号：US20070123888A1

公开(公告)日：2007-05-31

申请号：US11429377

申请日：2006-05-04

申请人： Jeffery Bleich ,  Edwin Hlavka

发明人： Jeffery Bleich ,  Edwin Hlavka

IPC分类号： A61B17/00

CPC分类号： A61B17/1659 ,  A61B17/00234 ,  A61B17/02 ,  A61B17/1671 ,  A61B17/1757 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/3421 ,  A61B2017/00261 ,  A61B2017/00867 ,  A61B2017/32006 ,  A61B2017/3488 ,  A61B2090/08021

摘要： Methods and devices are described for modifying tissue in a spine of a patient to treat or alleviate spinal stenosis. In one embodiment, a method may include: advancing at least a distal portion of an elongate tissue modification device into an epidural space and between target tissue and non-target tissue in the spine; positioning the tissue modification device so that at least one abrasive surface of the device faces target tissue and at least one non-abrasive surface faces non-target tissue; applying tensioning force at or near separate distal and proximal portions of the tissue modification device; and translating the tissue modification device back and forth while maintaining at least some tensioning force to abrade at least a portion of the target tissue with the at least one abrasive surface. Unwanted damage to the non-target tissue may be prevented via the at least one non-abrasive surface.

摘要翻译： 描述了用于修改患者脊柱中的组织以治疗或减轻脊柱狭窄的方法和装置。 在一个实施例中，一种方法可以包括：将细长组织修饰装置的至少远端部分推进到脊柱中的硬膜外腔和目标组织与非靶组织之间; 定位组织改变装置使得装置的至少一个研磨表面面向靶组织，并且至少一个非研磨表面面向非靶组织; 在组织改变装置的分离的远侧和近端部分处或附近施加张紧力; 并且在保持至少一些张紧力的同时使所述组织改变装置来回移动，以利用所述至少一个研磨表面磨蚀所述目标组织的至少一部分。 可以通过至少一个非研磨表面来防止对非目标组织的不良伤害。

公开(公告)号：US20070213735A1

公开(公告)日：2007-09-13

申请号：US11406486

申请日：2006-04-17

申请人： Vahid Saadat ,  Jeffery Bleich ,  Kenneth Michlitsch ,  John Ashley

发明人： Vahid Saadat ,  Jeffery Bleich ,  Kenneth Michlitsch ,  John Ashley

IPC分类号： A61B17/00

CPC分类号： A61B17/1659 ,  A61B17/00234 ,  A61B17/02 ,  A61B17/1671 ,  A61B17/1757 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/3421 ,  A61B2017/00261 ,  A61B2017/00867 ,  A61B2017/32006 ,  A61B2017/3488 ,  A61B2090/08021

摘要： A device for modifying tissue in a spine may include: a shaft having a proximal portion and a distal portion, the distal portion having dimensions which allow it to be passed into an epidural space of the spine and between target and non-target tissues; at least one distal force application member extending from the distal portion of the shaft and configured to facilitate application of at least one of anchoring force and tensioning force to the shaft; at least one movable tissue modifying member coupled with the shaft at or near its distal portion; at least one drive member coupled with the at least one tissue modifying member to activate the at least one tissue modifying member; and at least one power transmission member coupled with the at least one drive member to deliver power to the at least one drive member.

摘要翻译： 用于修改脊柱中的组织的装置可以包括：具有近端部分和远侧部分的轴，所述远端部分具有允许其进入脊柱的硬膜外腔中以及靶和非靶组织之间的尺寸; 至少一个远端力施加构件，其从所述轴的远侧部分延伸并且构造成便于将锚固力和张紧力中的至少一个施加到所述轴; 至少一个可动组织修改构件，其在远端部分处或其附近与所述轴联接; 至少一个驱动构件与所述至少一个组织修改构件联接以激活所述至少一个组织修改构件; 以及与所述至少一个驱动构件联接的至少一个动力传递构件，以向所述至少一个驱动构件输送动力。

公开(公告)号：US20060135882A1

公开(公告)日：2006-06-22

申请号：US11250369

申请日：2005-10-15

申请人： Jeffery Bleich

发明人： Jeffery Bleich

IPC分类号： A61B5/04 ,  A61H1/02

CPC分类号： A61B17/320758 ,  A61B17/149 ,  A61B17/1659 ,  A61B17/1671 ,  A61B17/29 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/32053 ,  A61B17/3401 ,  A61B17/3403 ,  A61B17/3421 ,  A61B17/3496 ,  A61B18/1477 ,  A61B18/1487 ,  A61B90/04 ,  A61B2017/00261 ,  A61B2017/00287 ,  A61B2017/003 ,  A61B2017/00867 ,  A61B2017/320004 ,  A61B2017/320044 ,  A61B2017/32006 ,  A61B2017/3445 ,  A61B2017/3447 ,  A61B2018/1407 ,  A61B2018/1425 ,  A61B2090/061 ,  A61B2090/08021 ,  A61F2/0045 ,  A61N1/0551 ,  A61N1/36017

摘要： Methods and apparatus are provided for selective surgical removal of tissue. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space through an epidural needle. The sharp tip of the needle in the epidural space, can be converted to a blunt tipped instrument for further safe advancement. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. A nerve stimulator may be provided to reduce a risk of inadvertent neural abrasion.

公开(公告)号：US20060095059A1

公开(公告)日：2006-05-04

申请号：US11251199

申请日：2005-10-15

申请人： Jeffery Bleich ,  Edwin Hlavka ,  Vahid Saadat ,  Steven Spisak ,  David Miller ,  James Yurchenco

发明人： Jeffery Bleich ,  Edwin Hlavka ,  Vahid Saadat ,  Steven Spisak ,  David Miller ,  James Yurchenco

IPC分类号： A61B17/32

CPC分类号： A61B17/320758 ,  A61B1/3135 ,  A61B17/149 ,  A61B17/1659 ,  A61B17/1671 ,  A61B17/29 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/32053 ,  A61B17/3401 ,  A61B17/3403 ,  A61B17/3421 ,  A61B17/3496 ,  A61B18/1477 ,  A61B18/1487 ,  A61B90/04 ,  A61B90/361 ,  A61B2017/00261 ,  A61B2017/00287 ,  A61B2017/003 ,  A61B2017/00867 ,  A61B2017/00907 ,  A61B2017/320004 ,  A61B2017/320044 ,  A61B2017/32006 ,  A61B2017/3445 ,  A61B2017/3447 ,  A61B2018/1407 ,  A61B2018/1425 ,  A61B2090/061 ,  A61B2090/08021 ,  A61F2/0045 ,  A61N1/0551 ,  A61N1/36017

摘要： Methods and apparatus are provided for selective surgical removal of tissue, e.g., for enlargement of diseased spinal structures, such as impinged lateral recesses and pathologically narrowed neural foramen. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space through an epidural needle. Once the sharp tip of the needle is in the epidural space, it is converted to a blunt tipped instrument for further safe advancement. A specially designed epidural catheter that is used to cover the previously sharp needle tip may also contain a fiberoptic cable. Further embodiments of the current invention include a double barreled epidural needle or other means for placement of a working channel for the placement of tools within the epidural space, beside the epidural instrument. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. In one variation, a tissue abrasion device is provided including a thin belt or ribbon with an abrasive cutting surface. The device may be placed through the neural foramina of the spine and around the anterior border of a facet joint. Once properly positioned, a medical practitioner may enlarge the lateral recess and neural foramina via frictional abrasion, i.e., by sliding the abrasive surface of the ribbon across impinging tissues. A nerve stimulator optionally may be provided to reduce a risk of inadvertent neural abrasion. Additionally, safe epidural placement of the working barrier and epidural tissue modification tools may be further improved with the use of electrical nerve stimulation capabilities within the invention that, when combined with neural stimulation monitors, provide neural localization capabilities to the surgeon. The device optionally may be placed within a protective sheath that exposes the abrasive surface of the ribbon only in the area where tissue removal is desired. Furthermore, an endoscope may be incorporated into the device in order to monitor safe tissue removal. Finally, tissue remodeling within the epidural space may be ensured through the placement of compression dressings against remodeled tissue surfaces, or through the placement of tissue retention straps, belts or cables that are wrapped around and pull under tension aspects of the impinging soft tissue and bone in the posterior spinal canal.

公开(公告)号：US20060089640A1

公开(公告)日：2006-04-27

申请号：US11251204

申请日：2005-10-15

申请人： Jeffery Bleich ,  Edwin Hlavka

发明人： Jeffery Bleich ,  Edwin Hlavka

IPC分类号： A61B18/18

CPC分类号： A61B17/320758 ,  A61B17/149 ,  A61B17/1659 ,  A61B17/1671 ,  A61B17/29 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/32053 ,  A61B17/3401 ,  A61B17/3403 ,  A61B17/3421 ,  A61B17/3496 ,  A61B18/1477 ,  A61B18/1487 ,  A61B90/04 ,  A61B2017/00261 ,  A61B2017/00287 ,  A61B2017/003 ,  A61B2017/00867 ,  A61B2017/320004 ,  A61B2017/320044 ,  A61B2017/32006 ,  A61B2017/3445 ,  A61B2017/3447 ,  A61B2018/1407 ,  A61B2018/1425 ,  A61B2090/061 ,  A61B2090/08021 ,  A61F2/0045 ,  A61N1/0551 ,  A61N1/36017

摘要： Methods and apparatus are provided for selective surgical removal of tissue. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space through an epidural needle. The sharp tip of the needle in the epidural space, can be converted to a blunt tipped instrument for further safe advancement. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. A nerve stimulator may be provided to reduce a risk of inadvertent neural abrasion.

公开(公告)号：US20120078253A9

公开(公告)日：2012-03-29

申请号：US11405848

申请日：2006-04-17

申请人： Jeffery Bleich ,  Vahid Saadat ,  Roy Leguidleguid ,  Jefferey Bleam

发明人： Jeffery Bleich ,  Vahid Saadat ,  Roy Leguidleguid ,  Jefferey Bleam

IPC分类号： A61B17/16

CPC分类号： A61B17/1659 ,  A61B17/00234 ,  A61B17/02 ,  A61B17/1671 ,  A61B17/1757 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/3421 ,  A61B2017/00261 ,  A61B2017/00867 ,  A61B2017/32006 ,  A61B2017/3488 ,  A61B2090/08021

摘要： A device for modifying one or more tissues in a patient's spine may include: an elongate, at least partially flexible body having a proximal portion and a distal portion, wherein at least the distal portion has dimensions that allow it to be passed into an epidural space and between target and non-target tissues of the spine; at least one movable blade disposed along one side of the elongate body; at least one actuator coupled with the at least one blade and disposed at or near the proximal or distal portion of the body for moving the blade(s) to modify one or more target tissues, wherein the at least one actuator is configured to move the blade(s) without significantly translating the elongate body proximally or distally; and means at or near the proximal and distal portions of the elongate body for facilitating application of at least one of anchoring force and tensioning force to the body to urge the at least one blade against the target tissue.

摘要翻译： 用于修改患者脊柱中的一个或多个组织的装置可以包括：细长的至少部分柔性的身体，其具有近端部分和远端部分，其中至少远端部分具有允许其进入硬膜外腔的尺寸 和脊柱的靶和非靶组织之间; 沿着所述细长体的一侧设置的至少一个可动刀片; 至少一个致动器，其与所述至少一个叶片耦合并且设置在所述主体的近端或远端部分处或附近，用于移动所述叶片以修改一个或多个目标组织，其中所述至少一个致动器被配置成使所述至少一个致动器移动 刀片不在近侧或远端显着地平移细长体; 以及在所述细长体的近端部分和远端部分附近的装置，用于便于将至少一个锚定力和张紧力施加到身体以将至少一个刀片推向靶组织。

公开(公告)号：US20070213734A1

公开(公告)日：2007-09-13

申请号：US11405859

申请日：2006-04-17

申请人： Jeffery Bleich ,  Steven Spisak ,  Vahid Saadat ,  Ronald Leguidleguid ,  Jeffery Bleam ,  Michael Drews ,  James Yurchenco

发明人： Jeffery Bleich ,  Steven Spisak ,  Vahid Saadat ,  Ronald Leguidleguid ,  Jeffery Bleam ,  Michael Drews ,  James Yurchenco

IPC分类号： A61B17/16

CPC分类号： A61B17/1659 ,  A61B17/00234 ,  A61B17/02 ,  A61B17/1671 ,  A61B17/1757 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/3421 ,  A61B2017/00261 ,  A61B2017/00867 ,  A61B2017/32006 ,  A61B2017/3488 ,  A61B2090/08021

摘要： A method for preventing unwanted damage to tissue in a spine of a patient during a tissue modification procedure may involve: advancing at least a distal portion of at least one barrier member over at least one guide member into an epidural space of the patient's spine; positioning at least an expanded portion of the barrier member between target tissue and non-target tissue; and performing at least one tissue modification procedure on the target tissue, using at least one tissue modification device. Generally, at least part of the barrier member may be disposed between the tissue modification device and the non-target tissue to prevent unwanted damage to the non-target tissue. In various embodiments, at least part of a barrier member may be advanced through a sheath- or catheter-like delivery device and may either automatically expand or be expandable from a collapsed configuration to an expanded configuration.

摘要翻译： 一种用于防止在组织改变过程期间对患者的脊柱中的组织的不期望的损伤的方法可以包括：使至少一个阻挡构件的至少一个阻挡构件的至少一个远端部分在至少一个引导构件上前进到患者脊柱的硬膜外腔中; 将所述阻挡构件的至少扩大部分定位在目标组织和非目标组织之间; 以及使用至少一个组织修改装置对所述靶组织进行至少一个组织修饰程序。 通常，阻挡构件的至少一部分可以设置在组织修改装置和非目标组织之间，以防止对非目标组织的不必要的损坏。 在各种实施例中，阻挡构件的至少一部分可以通过护套或导管状递送装置前进，并且可以自动地膨胀或者可以从折叠构型扩展到扩张构型。

公开(公告)号：US20060094976A1

公开(公告)日：2006-05-04

申请号：US11250332

申请日：2005-10-15

申请人： Jeffery Bleich

发明人： Jeffery Bleich

IPC分类号： A61B5/05

CPC分类号： A61B17/320758 ,  A61B17/149 ,  A61B17/1659 ,  A61B17/1671 ,  A61B17/29 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/32053 ,  A61B17/3401 ,  A61B17/3403 ,  A61B17/3421 ,  A61B17/3496 ,  A61B18/1477 ,  A61B18/1487 ,  A61B90/04 ,  A61B2017/00261 ,  A61B2017/00287 ,  A61B2017/003 ,  A61B2017/00867 ,  A61B2017/320004 ,  A61B2017/320044 ,  A61B2017/32006 ,  A61B2017/3445 ,  A61B2017/3447 ,  A61B2018/1407 ,  A61B2018/1425 ,  A61B2090/061 ,  A61B2090/08021 ,  A61F2/0045 ,  A61N1/0551 ,  A61N1/36017

摘要： Methods and apparatus are provided for selective surgical removal of tissue, e.g., for enlargement of diseased spinal structures, such as impinged lateral recesses and pathologically narrowed neural foramen. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the epidural space through an epidural needle. Once the sharp tip of the needle is in the epidural space, it is converted to a blunt tipped instrument for further safe advancement. A specially designed epidural catheter that is used to cover the previously sharp needle tip may also contain a fiberoptic cable. Further embodiments of the current invention include a double barreled epidural needle or other means for placement of a working channel for the placement of tools within the epidural space, beside the epidural instrument. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. In one variation, a tissue removal device is provided including a thin belt or ribbon with an abrasive cutting surface. The device may be placed through the neural foramina of the spine and around the anterior border of a facet joint. Once properly positioned, a medical practitioner may enlarge the lateral recess and neural foramina via frictional abrasion, i.e., by sliding the tissue removal surface of the ribbon across impinging tissues. A nerve stimulator optionally may be provided to reduce a risk of inadvertent neural abrasion. Additionally, safe epidural placement of the working barrier and epidural tissue modification tools may be further improved with the use of electrical nerve stimulation capabilities within the invention that, when combined with neural stimulation monitors, provide neural localization capabilities to the surgeon. The device optionally may be placed within a protective sheath that exposes the abrasive surface of the ribbon only in the area where tissue removal is desired. Furthermore, an endoscope may be incorporated into the device in order to monitor safe tissue removal. Finally, tissue remodeling within the epidural space may be ensured through the placement of compression dressings against remodeled tissue surfaces, or through the placement of tissue retention straps, belts or cables that are wrapped around and pull under tension aspects of the impinging soft tissue and bone in the posterior spinal canal.