Method for treatment of an intervertebral disc

Abstract

The present disclosure is directed to methods for relieving pain associated with an intervertebral disc having a disc nucleus pulposus and an outer annulus fibrosus surrounding the nucleus pulposus. The method includes the steps of providing an elongated thermal or electromagnetic probe member having a flexible guidable region adjacent the distal end thereof; introducing the flexible guidable region of the probe into the annulus fibrosus of the intervertebral disc; and supplying thermal or electromagnetic energy, from an energy source, to heat or induce an electromagnetic field adjacent to the annulus fibrosus sufficient to produce a thermal or electromagnetic effect on the intervertebral disc. The flexible guidable region of the probe may be introduced at a location which is in relative close proximity to the region of intervertebral disc to be thermally or electromagnetically treated.

1 . A method for relieving pain associated with an intervertebral disc having a disc nucleus pulposus and an outer annulus fibrosus surrounding the nucleus pulposus, the method comprising the steps of: 
 providing an elongated thermal or electromagnetic probe member having proximal and distal ends and defining a longitudinal axis, and having a flexible guidable region adjacent the distal end;    introducing the flexible guidable region of the probe into the annulus fibrosus of the intervertebral disc, at a location which is in relative close proximity to the region of intervertebral disc to be thermally or electromagnetically treated, whereby the flexible guidable region of the probe bends to follow a generally arcuate path through the annulus fibrosus without entering the nucleus pulposus; and    supplying thermal or electromagnetic energy, from an energy source, to heat or induce an electromagnetic field adjacent to the annulus fibrosus sufficient to produce a thermal or electromagnetic effect on the intervertebral disc.    
   
   
       2 . The method according to  claim 1 , wherein the step of introducing includes positioning the flexible guidable region of the probe adjacent the region of the intervertebral disc to be treated.  
   
   
       3 . The method according to  claim 2 , further including the step of: 
 positioning a cannula adjacent the region of the intervertebral disc to be treated; and    passing the flexible guidable region of the probe through a lumen of the cannula.    
   
   
       4 . The method according to  claim 3 , wherein the cannula includes an arcuate portion adjacent a distal end thereof and wherein, during the step of introducing the flexible guidable region of the probe, the arcuate cannula portion guides the flexible guidable region of the probe adjacent to the region to be treated.  
   
   
       5 . The method according to  claim 4 , further comprising the step of: 
 angulating the arcuate portion of the cannula to a desired orientation within the intervertebral disc.    
   
   
       6 . The method according to  claim 5 , further comprising the step of: 
 monitoring impedance of tissue to detect variations in tissue-type to thereby facilitate positioning of the flexible guidable region of the probe.    
   
   
       7 . The method according to  claim 6 , further comprising the steps of: 
 increasing an amplitude of thermal or electromagnetic energy supplied to the probe until indications of effect on the intervertebral disc are obtained; and    noting the amplitude at which the indications of effect of the intervertebral disc are obtained.    
   
   
       8 . The method according to  claim 7 , wherein when the indications of effect of the intervertebral disc are obtained for amplitudes below about 0.75 volts, the method includes the step of applying thermal energy at about 60° C.  
   
   
       9 . The method according to  claim 7 , wherein when the indications of effect of the intervertebral disc are obtained for amplitudes between about 0.75 volts and 1.25 volts, the method includes the step of applying thermal energy at about 65° C.  
   
   
       10 . The method according to  claim 7 , wherein when the indications of effect of the intervertebral disc are obtained for amplitudes above about 1.25 volts, the method includes the step of applying thermal energy at about 70° C.  
   
   
       11 . A method for relieving pain associated with an intervertebral disc having a disc nucleus pulposus and an outer annulus fibrosus surrounding the nucleus pulposus, the method comprising the steps of: 
 introducing a thermal or electromagnetic transmitting element of a thermal probe into the intervertebral disc, at a location in close proximity to the region of the intervertebral disc to be treated; and    supplying thermal or electromagnetic energy from an energy source to the thermal or electromagnetic transmitting element to produce a thermal or electromagnetic effect on the intervertebral disc.    
   
   
       12 . The method according to  claim 11 , wherein the probe includes a flexible guidable region, and wherein the method further includes the step of advancing the probe whereby the flexible guidable region of the probe follows a generally arcuate path.  
   
   
       13 . The method according to  claim 12 , wherein the step of advancing the probe includes passing the flexible guidable region along an arcuate path defined by natural striata of the annulus fibrosus.  
   
   
       14 . The method according to  claim 13 , wherein the step of advancing the probe includes extending the flexible guidable region across the region of the intervertebral disc to be treated.  
   
   
       15 . The method according to  claim 14 , further including the step of: 
 positioning a cannula adjacent the region of the intervertebral disc to be treated; and    passing the flexible guidable region of the probe through a lumen of the cannula.    
   
   
       16 . The method according to  claim 15 , wherein the cannula includes an arcuate portion adjacent a distal end thereof and wherein, during the step of introducing the flexible guidable region of the probe, the arcuate cannula portion guides the flexible guidable region of the probe adjacent to the region to be treated.  
   
   
       17 . The method according to  claim 16 , further comprising the step of: 
 angulating the arcuate portion of the cannula to a desired orientation within the intervertebral disc.    
   
   
       18 . The method according to  claim 17 , further comprising the step of: 
 monitoring impedance of tissue to detect variations in tissue-type to thereby facilitate positioning of the flexible guidable region of the probe.    
   
   
       19 . The method according to  claim 11 , further comprising the steps of: 
 increasing an amplitude of thermal or electromagnetic energy supplied to the probe until indications of effect on the intervertebral disc are obtained; and    noting the amplitude at which the indications of effect of the intervertebral disc are obtained.    
   
   
       20 . The method according to  claim 19 , wherein when the indications of effect of the intervertebral disc are obtained for amplitudes below about 0.75 volts, the method includes the step of applying thermal energy at about 60° C.  
   
   
       21 . The method according to  claim 19 , wherein when the indications of effect of the intervertebral disc are obtained for amplitudes between about 0.75 volts and 1.25 volts, the method includes the step of applying thermal energy at about 65° C.  
   
   
       22 . The method according to  claim 19 , wherein when the indications of effect of the intervertebral disc are obtained for amplitudes above about 1.25 volts, the method includes the step of applying thermal energy at about 70° C.  
   
   
       23 . The method according to  claim 11 , further including the step of introducing the thermal or electromagnetic transmitting element of the thermal probe the intervertebral disc from at least one of a medial direction and a lateral direction.  
   
   
       24 . The method according to  claim 23 , further including the step of introducing the thermal or electromagnetic transmitting element of the thermal probe into a nucleus of the intervertebral disc.