Abstract: A method of accessing target tissue adjacent to a spinal nerve of a patient includes the steps of accessing a spine location of the patient by entering the patient through the skin at an access location, inserting a flexible tissue modification device through the access location to the spine location, advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location, passing through the first exit location and out of the patient, advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location, and passing through the second exit location and out of the patient.

Abstract: 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.

Abstract: A method for locating neural tissue in a patient body may involve: advancing a probe along a natural tissue interface between the neural tissue and another tissue in the body, the probe having a first surface oriented toward the neural tissue and a second surface oriented away from the neural tissue; delivering a first electrical current to a first electrode along the first surface of the probe; delivering a second electrical current to a second electrode along the second surface of the probe; and verifying that the first surface of the advanced probe remains oriented toward the neural tissue and the second surface remains oriented away from the neural tissue by monitoring neural response to the first and second electrical currents.

Abstract: Described herein are devices, systems and methods for cutting tissue in a patient. In some embodiments, a tissue modification region of a device includes a pair of flexible elongate cutting members extending along the length of the tissue modification region. Each elongate cutting member may be configured to cut a discrete trough into tissue to a depth that is greater than the thickness of the cutting member. In some embodiments, the device includes a spacer. The spacer may be sized and configured to operate in one of two modes. A first mode, in which the spacer is coupled to the cutting members such that it holds a portion of each of the two cutting members a distance from one another, and a second mode, in which at least a portion of the spacer is moved away from a cutting member to allow the cutting members to cut further into tissue.

Abstract: Described herein are devices and methods for cutting tissue in a patient. In some embodiments, a bimanually controlled device may include a tissue modification region; at least two flexible elongate lengths of cable that extend substantially adjacent to each other proximally to distally; a plurality of rungs extending between the lengths of cable; and a pair of flexible elongate cutting members extending along the length of the tissue modification region of the device. Each elongate cutting member has a thickness cuts a discrete trough into tissue to a depth that is greater than the thickness of the cutting member. The device may further include a substrate sized and configured to releasably hold the cutting members a distance from one another and a pair of couplers positioned toward an outer edge region of the substrate and configured to releasably secure a cutting member to the outer edge region of the substrate.

Abstract: Described herein are methods and systems for precisely placing and/or manipulating devices within the body by first positioning a guidewire or pullwire. The device to be positioned within the body is coupled to the proximal end of the guidewire, and the device is pulled into the body by pulling on the distal end of the guidewire that extends from the body. The device may be bimanually manipulated by pulling the guidewire distally, and an attachment to a device that extends proximally, allowing control of both the proximal and the distal ends. In this manner devices (and particularly implants such as innerspinous distracters, stimulating leads, and disc slings) may be positioned and/or manipulated within the body. Guidewire exchange systems, devices and methods are also described. A guidewire may be exchanged between different surgical devices and may be releaseably or permanently coupled.

Abstract: Described herein are tissue manipulation devices having a tight bipole network. In particular, described herein are smart tools such as rongeurs configured to sense the presence of a nerve or portion of nerve. Tissue may be cut (or otherwise manipulated) by using a tool having a tight bipolar network to sense when a nerve or portion of a nerve is in the tool prior to cutting. Also described are systems for determining if a nerve is nearby an insertable tool. These systems typically include a tool with a neurostimulation electrode, an accelerometer configured to detect muscle twitch, and a feedback controller to provide feedback indicating if the tool is near a nerve. Methods of controlling insertion of a tool using feedback from such a system are also described.

Abstract: A method of accessing target tissue adjacent to a spinal nerve of a patient includes the steps of accessing a spine location of the patient by entering the patient through the skin at an access location, inserting a flexible tissue modification device through the access location to the spine location, advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location, passing through the first exit location and out of the patient, advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location, and passing through the second exit location and out of the patient.

Abstract: Described herein are devices, systems and methods for determining if a nerve is nearby a device or a region of a device. In general, a device for determining if a nerve is nearby a device includes an elongate body having an outer surface with one or more bipole pairs arranged on the outer surface. Bipole pairs may also be referred to as tight bipoles. The bipole pairs may be arranged as a bipole network, and may include a cathode and an anode that are spaced relatively close together to form a limited broadcast field. In general, the broadcast filed is a controlled or “tight” broadcast field that extends from the bipole pair(s). Methods of using these devices and system are also described.

Abstract: Described herein are devices, systems and methods for determining if a nerve is nearby a device or a region of a device. In general, a device for determining if a nerve is nearby a device includes an elongate body having an outer surface with one or more bipole pairs arranged on the outer surface. Bipole pairs may also be referred to as tight bipoles. The bipole pairs may be arranged as a bipole network, and may include a cathode and an anode that are spaced relatively close together to form a limited broadcast field. In general, the broadcast filed is a controlled or “tight” broadcast field that extends from the bipole pair(s). Methods of using these devices and system are also described.

Abstract: 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.

Abstract: Described herein are methods for achieving access to a compressed space in spinal anatomy. In some embodiments, a method for achieving access may include the steps of advancing a distal portion of a cannulated probe toward a neural foramen from a lateral side of the foramen, extending a first end of a elongate member from a distal end of the cannulated probe and through the neural foramen from the lateral side to a medial side of the foramen and at least partially around an anterior portion of a facet joint and posterior to a spinal disc, and extending the first end of the elongate member out of the patient, wherein a portion of the elongate member remains curved around the facet joint. In some embodiments, the method may further include the step of extending a first end of an inner cannula from a distal end of the cannulated probe.

Abstract: 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.

Abstract: Described herein are elongate device for modifying tissue having a plurality of flexibly connected rungs or links, and methods of using them, including methods of using them to decompress stenotic spinal tissue. These devices may be included as part of a system for modifying tissue. In general, these devices include a plurality of blades positioned on (or formed from) rungs that are flexibly connected. The rungs are typically rigid, somewhat flat and wider than they are long (e.g., rectangular). The rungs may be arranged, ladder like, and may be connected by a flexible connector substrate or between two or more cables. Different sized rungs may be used. The blades (on the rungs) may be arranged in a staggered arrangement. A tissue-collection or tissue capture element (e.g., chamber, bag, or the like) may be used to collect the cut or modified tissue. In some variations the tissue modification devices may have a non-linear axial shape, or may be converted from a first axial shape to a second axial shape.

Abstract: Methods and apparatus are provided for selective surgical removal of tissue, e.g., for enlargement of diseased spinal structures. The current invention includes specific tools that enable safe tissue modification in 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 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.

Abstract: Described herein are devices and methods for cutting tissue in a patient. In some embodiments, a bimanually controlled device may include a tissue modification region; at least two flexible elongate lengths of cable that extend substantially adjacent to each other proximally to distally; a plurality of rungs extending between the lengths of cable; and a pair of flexible elongate cutting members extending along the length of the tissue modification region of the device. Each elongate cutting member has a thickness cuts a discrete trough into tissue to a depth that is greater than the thickness of the cutting member. The device may further include a substrate sized and configured to releasably hold the cutting members a distance from one another and a pair of couplers positioned toward an outer edge region of the substrate and configured to releasably secure a cutting member to the outer edge region of the substrate.

Abstract: A method of accessing target tissue adjacent to a spinal nerve of a patient includes the steps of accessing a spine location of the patient by entering the patient through the skin at an access location, inserting a flexible tissue modification device through the access location to the spine location, advancing a distal portion of the first flexible tissue modification device from the spine location to a first exit location, passing through the first exit location and out of the patient, advancing the first or a second flexible tissue modification device through the same access location to the spine location and to a second exit location, and passing through the second exit location and out of the patient.

Abstract: Described herein are elongate devices for modifying tissue having a plurality of flexibly connected rungs or links, and methods of using them, including methods of using them to decompress stenotic spinal tissue. These devices may be included as part of a system for modifying tissue. In general, these devices include a plurality of blades positioned on (or formed from) rungs that are flexibly connected. The rungs are typically rigid, somewhat flat and wider than they are long (e.g., rectangular). The rungs may be arranged, ladder like, and may be connected by a flexible connector substrate or between two or more cables. Different sized rungs may be used. The blades (on the rungs) may be arranged in a staggered arrangement. A tissue-collection or tissue capture element may be used to collect the cut or modified tissue.

Abstract: A device for removing tissue from a patient may include an elongate flexible body having a proximal end, a distal end, and a longitudinal axis therebetween, the elongate body having opposed first and second major surfaces with a lateral orientation across the axis, and a plurality of blades distributed laterally across the first major surface. Each blade may have a first end adjacent the first surface and extending to a cantilevered second end, a first edge between the first and second ends of the blade being oriented toward the distal end of the elongate body, a second edge between the first and second ends of the blade being oriented toward the proximal end of the elongate body, a height of the blade between its first and second ends, and an axial length of the blade between its first and second edges.

Abstract: 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.