公开(公告)号：US20070225703A1

公开(公告)日：2007-09-27

申请号：US11687558

申请日：2007-03-16

申请人： Gregory Schmitz ,  Jeffrey Bleich ,  Steven Spisak ,  Roy Leguidleguid ,  Jefferey Bleam

发明人： Gregory Schmitz ,  Jeffrey Bleich ,  Steven Spisak ,  Roy Leguidleguid ,  Jefferey Bleam

IPC分类号： A61F5/00

CPC分类号： A61B17/1671 ,  A61B17/00234 ,  A61B17/02 ,  A61B17/149 ,  A61B17/1659 ,  A61B17/1757 ,  A61B17/32 ,  A61B17/320016 ,  A61B17/32002 ,  A61B17/3421 ,  A61B2017/00261 ,  A61B2017/00867 ,  A61B2017/320004 ,  A61B2017/32006 ,  A61B2017/3488 ,  A61B2090/08021

摘要： A device for modifying tissue in a patient may include: an elongate body having a rigid proximal portion and a flexible distal portion having first and second major surfaces; a proximal handle coupled with the proximal portion of the body; one or more tissue modifying members disposed along the first major surface of the distal portion of the body; a guidewire coupled with and extending from the distal portion of the body; and a distal handle removably couplable with the guidewire outside the patient.

摘要翻译： 用于修改患者组织的装置可以包括：细长体，其具有刚性近端部分和具有第一和第二主表面的柔性远侧部分; 与所述主体的近侧部分联接的近侧手柄; 沿着身体远端部分的第一主表面设置的一个或多个组织修改构件; 与所述主体的所述远端部分连接并从所述远端部分延伸的导丝; 以及远端手柄，其可拆卸地与患者外部的导丝联接。

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：US20060241648A1

公开(公告)日：2006-10-26

申请号：US11375265

申请日：2006-03-13

申请人： Jeffery Bleich ,  Vahid Saadat ,  Steven Spisak ,  John Ashley

发明人： Jeffery Bleich ,  Vahid Saadat ,  Steven Spisak ,  John Ashley

IPC分类号： A61B17/58

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 modifying tissue in a patient may involve one or more of the following steps: advancing at least a distal portion of at least one elongate, at least partially flexible tissue modification device into a patient and between one or more target tissues and one or more non-target tissues; positioning at least one tissue modifying member of the tissue modification device adjacent the target tissue such that the tissue modifying member(s) face the target tissue and do not face the non-target tissue; applying an anchoring force to the tissue modification device at or near the distal portion or a proximal portion of the device; applying a tensioning force to the tissue modification device at or near an opposite end of the device relative to the end to which anchoring force is applied, while maintaining the anchoring force, to urge the tissue modifying member(s) against the target tissue; and modifying the target tissue, using the tissue modifying member(s), while preventing the tissue modifying member(s) from extending significantly beyond the target tissue toward the proximal or distal portion of the tissue modification device during tissue modification.

摘要翻译： 用于修改患者组织的方法可以涉及一个或多个以下步骤：将至少一个细长的，至少部分柔性的组织改变装置的至少远端部分推进到患者体内，并将一个或多个靶组织与一个或多个靶组织 更多的非靶组织; 将所述组织改变装置的至少一个组织修改构件定位成邻近所述目标组织，使得所述组织修改构件面向所述靶组织并且不面向所述非靶组织; 在组件修改装置的远端部分或近端部分处或附近施加锚定力; 在保持锚固力的同时相对于施加锚定力的端部在装置的相对端处或附近施加张力，以促使组织修改构件抵靠目标组织; 以及在组织改变期间，使组织改变部件改变目标组织，同时防止组织改变部件显着地超出目标组织向组织改变装置的近端或远端部分延伸。

公开(公告)号：US20070260252A1

公开(公告)日：2007-11-08

申请号：US11687548

申请日：2007-03-16

申请人： Gregory Schmitz ,  Jeffery Bleich ,  Steven Spisak ,  Roy Leguidleguid ,  Jefferey Bleam

发明人： Gregory Schmitz ,  Jeffery Bleich ,  Steven Spisak ,  Roy Leguidleguid ,  Jefferey Bleam

IPC分类号： A61B17/32

CPC分类号： A61B17/1659 ,  A61B17/149 ,  A61B17/1671 ,  A61B2017/32006

摘要： A device for modifying tissue in a patient may include: an elongate body having a rigid proximal portion and a flexible distal portion having first and second major surfaces; a proximal handle coupled with the proximal portion of the body; one or more tissue modifying members disposed along the first major surface of the distal portion of the body; a guidewire coupled with and extending from the distal portion of the body; and a distal handle removably couplable with the guidewire outside the patient.

摘要翻译： 用于修改患者组织的装置可以包括：细长体，其具有刚性近端部分和具有第一和第二主表面的柔性远侧部分; 与所述主体的近侧部分联接的近侧手柄; 沿着身体远端部分的第一主表面设置的一个或多个组织修改构件; 与所述主体的所述远端部分连接并从所述远端部分延伸的导丝; 以及远端手柄，其可拆卸地与患者外部的导丝联接。

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。