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    • 4. 发明申请
    • DEVICES AND METHODS FOR TISSUE REMOVAL
    • 用于组织去除的装置和方法
    • WO2006044727A2
    • 2006-04-27
    • PCT/US2005/037136
    • 2005-10-15
    • BAXANO, INC.BLEICH, Jeffery, L.SPISAK, Steven, A.HLAVKA, Edwin, J.SAADAT, VahidMILLER, David, R.YURCHENCO, James
    • BLEICH, Jeffery, L.SPISAK, Steven, A.HLAVKA, Edwin, J.SAADAT, VahidMILLER, David, R.YURCHENCO, James
    • A61B5/05
    • A61B17/320758A61B1/3135A61B17/149A61B17/1659A61B17/1671A61B17/29A61B17/320016A61B17/32002A61B17/32053A61B17/3401A61B17/3403A61B17/3421A61B17/3496A61B18/1477A61B18/1487A61B90/04A61B90/361A61B2017/00261A61B2017/00287A61B2017/003A61B2017/00867A61B2017/00907A61B2017/320004A61B2017/320044A61B2017/32006A61B2017/3445A61B2017/3447A61B2018/1407A61B2018/1425A61B2090/061A61B2090/08021A61F2/0045A61N1/0551A61N1/36017
    • 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.
    • 提供了用于选择性手术去除组织的方法和装置,例如用于扩大患病的脊柱结构,例如冲击的侧向凹陷和病理变窄的神经孔。 在一个变化中,组织可以被通过硬膜外针递送到硬膜外腔的标准小内窥镜工具进行消融,切除,去除或其它改造。 一旦尖锐尖端的针头在硬膜外腔中,就会被转换成钝头,以进一步安全的进行。 用于覆盖先前锋利的针尖的特别设计的硬膜外导管还可以包含光纤电缆。 本发明的另外的实施例包括双重硬膜外针或其他用于放置用于在硬膜外腔内的硬膜外腔内放置工具的工作通道的装置。 本发明包括能够在硬膜外腔中进行安全组织修复的特定工具,包括将相邻的脆弱神经和血管结构发生组织修饰的区域分开的屏障。 在一个实施例中,提供了一种组织磨损装置,其包括具有研磨切割表面的薄带或带。 该装置可以通过脊柱的神经孔和围绕小关节的前边缘放置。 一旦适当定位,医生可以通过摩擦磨损,即通过将带的研磨表面滑动穿过冲击组织来扩大横向凹部和神经孔。 任选地可以提供神经刺激器以减少无意神经磨损的风险。 此外,通过使用本发明中的电神经刺激能力,可以进一步改善工作屏障和硬膜外组织修饰工具的安全硬膜外放置,当与神经刺激监测器组合时,向外科医生提供神经定位能力。 该装置可选择地放置在保护套内,仅在期望组织移除的区域中暴露带的研磨表面。 此外,为了监视安全的组织去除,可以将内窥镜结合到装置中。 最后,可以通过将压缩敷料放置在重建的组织表面上,或者通过放置组织保持带,皮带或电缆,在打入的软组织和骨骼的张力方面被缠绕和拉动来确保硬膜外腔内的组织重建 在后椎管内。