Denervation methods

Abstract

System and methods for channeling a path into bone include a trocar having a proximal end, distal end and a central channel disposed along a central axis of the trocar. The trocar includes a radial opening at or near the distal end of the trocar. The system includes a curveable cannula sized to be received in the central channel, the curveable cannula comprising a curveable distal end configured to be extended laterally outward from the radial opening in a curved path extending away from the trocar. The curveable cannula has a central passageway having a diameter configured allow a probe to be delivered through the central passageway to a location beyond the curved path.

1 . (canceled) 
     
     
         2 . A method of treating a vertebral body associated with back pain in a subject, the method comprising:
 identifying a target treatment zone within an inner cancellous bone region of a vertebral body;   transpedicularly inserting a trocar through an outer cortical bone region of the vertebral body and into the inner cancellous bone region of the vertebral body;   inserting a bipolar radiofrequency probe through the trocar to the target treatment zone;   positioning at least one electrode of the bipolar radiofrequency probe at a location that is radially offset from a longitudinal axis of the trocar; and   causing the bipolar radiofrequency probe to generate heat within the target treatment zone sufficient to treat an intraosseous nerve within the target treatment zone.   
     
     
         3 . The method of  claim 2 , wherein the heat generated is sufficient to denervate the intraosseous nerve. 
     
     
         4 . The method of  claim 2 , wherein the heat generated is sufficient to ablate the intraosseous nerve. 
     
     
         5 . The method of  claim 2 , wherein the heat generated is sufficient to necrose the intraosseous nerve. 
     
     
         6 . The method of  claim 2 , wherein the bipolar radiofrequency probe is flexible. 
     
     
         7 . The method of  claim 2 , wherein the step of positioning the at least one electrode comprises advancing the bipolar radiofrequency probe along a curved path 
     
     
         8 . The method of  claim 2 , further comprising penetrating a skin of the subject. 
     
     
         9 . The method of  claim 2 , wherein the intraosseous nerve is a basivertebral nerve. 
     
     
         10 . A method of therapeutically treating a vertebral body having an outer cortical bone region and an inner cancellous bone region, and a basivertebral nerve (BVN) having a trunk extending from the outer cortical bone region into the inner cancellous region and branches extending from the trunk to define a BVN junction, the method comprising:
 a) inserting an energy device into the vertebral body, and   b) exclusively depositing energy within the inner cancellous bone region of the vertebral body between, but exclusive of the BVN junction and the outer cortical bone region, to denervate the BVN.   
     
     
         11 . The method of  claim 10 , wherein the energy device comprises two electrodes. 
     
     
         12 . The method of  claim 11 , further comprising placing the two electrodes in a posterior region of the vertebral body. 
     
     
         13 . The method of  claim 11 , further comprising placing the two electrodes in a region of the vertebral body located between 60% and 90% of the distance between the anterior and posterior ends of the vertebral body. 
     
     
         14 . A system for therapeutically heating a vertebral body to treat back pain, comprising:
 a cannula configured to be inserted through the outer cortical bone region of the vertebral body and into the inner cancellous bone region of the vertebral body;   a flexible energy delivery probe having two electrodes that is sized and configured to be inserted within a central passageway of the cannula, and   an energy delivery source coupled to the two electrodes, wherein said two electrodes are configured to deliver thermal energy to an intraosseous nerve within the vertebral body sufficient treat the intraosseous nerve.   
     
     
         15 . The system of  claim 14 , wherein said energy device comprises a bipolar radiofrequency device and the two electrodes comprise an active electrode and a return electrode. 
     
     
         16 . The system of  claim 14 , wherein the thermal energy is sufficient to ablate the intraosseous nerve. 
     
     
         17 . The system of  claim 14 , wherein the thermal energy is sufficient to denervate the intraosseous nerve. 
     
     
         18 . The system of  claim 14 , wherein the thermal energy is sufficient to necrose the intraosseous nerve. 
     
     
         19 . The system of  claim 14 , wherein the intraosseous nerve is a basivertebral nerve.