Patent Grant
8430881
1. Field of the Invention
The present invention relates to methods and apparatus for modifying tissue in a patient.
Many pathological conditions in the human body may be caused by enlargement, movement, displacement and/or a variety of other changes of bodily tissue, causing the tissue to press against (or “impinge on”) one or more otherwise normal tissues or organs. For example, a cancerous tumor may press against an adjacent organ and adversely affect the functioning and/or the health of that organ. In other cases, bony growths (or “bone spurs”), arthritic changes in bone and/or soft tissue, redundant soft tissue, or other hypertrophic bone or soft tissue conditions may impinge on nearby nerve and/or vascular tissues and compromise functioning of one or more nerves, reduce blood flow through a blood vessel, or both. Other examples of tissues which may grow or move to press against adjacent tissues include ligaments, tendons, cysts, cartilage, scar tissue, blood vessels, adipose tissue, tumor, hematoma, and inflammatory tissue.
One specific example of a condition caused by tissue impingement is spinal stenosis. Spinal stenosis occurs when neural tissue and/or vascular tissue in the spine become impinged by one or more structures pressing against them (“neural and/or neurovascular impingement”), causing one or more symptoms. This impingement of tissue may occur in one or more of several different areas in the spine, such as in the central spinal canal (the vertical passage through which the spinal cord and cauda equina extends), the lateral recesses of the spinal canal, or one or more intervertebral foramina (the openings through which nerve roots branching from the spinal cord pass).
For explanatory purposes,
One common cause of spinal stenosis is buckling and thickening of the ligamentum flavum (one of the ligaments attached to and connecting the vertebrae), as shown in
In the United States, spinal stenosis occurs with an incidence of between 4% and 6% of adults aged 50 and older and is the most frequent reason cited for back surgery in patients aged 60 and older. Conservative approaches to the treatment of symptoms of spinal stensosis include systemic medications and physical therapy. Epidural steroid injections may also be utilized, but they do not provide long lasting benefits. When these approaches are inadequate, current treatment for spinal stenosis is generally limited to invasive surgical procedures to remove vertebral ligament, cartilage, bone spurs, synovial cysts, cartilage, and bone to provide increased room for neural and neurovascular tissue. The standard surgical procedure for spinal stenosis treatment includes laminectomy (complete removal of the lamina (see
Removal of vertebral bone, as occurs in laminectomy and facetectomy, often leaves the effected area of the spine very unstable, leading to a need for an additional highly invasive fusion procedure that puts extra demands on the patient's vertebrae and limits the patient's ability to move. In a spinal fusion procedure, the vertebrae are attached together with some kind of support mechanism to prevent them from moving relative to one another and to allow adjacent vertebral bones to fuse together. Unfortunately, a surgical spine fusion results in a loss of ability to move the fused section of the back, diminishing the patient's range of motion and causing stress on the discs and facet joints of adjacent vertebral segments.
While laminectomy, facetectomy, discectomy, and spinal fusion frequently improve symptoms of neural and neurovascular impingement in the short term, these procedures are highly invasive, diminish spinal function, drastically disrupt normal anatomy, and increase long-term morbidity above levels seen in untreated patients.
Therefore, it would be desirable to have less invasive methods and devices for addressing neural and neurovascular impingement in a spine. Ideally, methods and devices for addressing impingement in spine would treat one or more target tissues while preventing unwanted effects on adjacent or nearby non-target tissues. Also ideally, such methods and devices would be minimally invasive and reduce impingement without removing significant amounts of vertebral bone, joint, or other spinal support structures, thereby avoiding the need for spinal fusion and, ideally, reducing the long-term morbidity levels resulting from currently available surgical treatments. It may also be advantageous to have less invasive methods and devices for modifying target tissues in parts of the body other than the spine while preventing modification of non-target tissues. At least some of these objectives will be met by the present invention.
2. Description of Background Art
Flexible wire saws and chain saws, such as threadwire saws (T-saws) and Gigli saws, have been used since the late 1800s to saw through or file/abrade bone and other tissue in the human body. See, for example, Brunori A et al., “Celebrating the Centenial (1894-1994): Leonardo Gigli and His Wire Saw,” J Neurosurg 82:1086-1090, 1995. An example of one such saw is described in U.S. Pat. No. 8250, issued to P. A. Stohlmann on Nov. 28, 1876. A description of using a T-saw to cut vertebral bone is provided in Kawahara N et al., “Recapping T-Saw Laminoplasty for Spinal Cord Tumors,” SPINE Volume 24, Number 13, pp. 1363-1370.
A method and apparatus for treating spinal stenosis is described in PCT Patent Application Pub. No. WO 01/08571. A surgical instrument for removing cartilage from a knee cavity is described in U.S. Pat. No. 3,835,859.
In various embodiments, the present invention provides methods, apparatus and systems for modifying tissue in a patient. Generally, the methods, apparatus and systems may involve using an elongate, at least partially flexible tissue modification device having one or more tissue modifying members to modify one or more target tissues. The tissue modification device may be configured such that when the tissue modification member (or members) is in a position for modifying target tissue, one or more sides, surfaces or portions of the tissue modification device configured to avoid or prevent damage to non-target tissue will face non-target tissue. In various embodiments, during a tissue modification procedure, an anchoring force may be applied at or near either a distal portion or a proximal portion of the tissue modification device, either inside or outside the patient. Pulling or tensioning force may also be applied to the unanchored end of the device to urge the tissue modifying member(s) against target tissue. The tissue modifying members may then be activated to modify tissue while being prevented from extending significantly beyond the target tissue in a proximal or distal direction. In some embodiments, the tissue modifying members may be generally disposed along a length of the tissue modification device that approximates a length of target tissue to be modified.
By “applying an anchoring force,” it is meant that a force is applied to maintain a portion of a device, or the device as a whole, substantially stable or motion-free. Applying an anchoring force is, therefore, not limited to preventing all movement of a device, and in fact, a device to which an anchoring force is applied may actually move in one or more directions in some embodiments. In other embodiments, an anchoring force is applied to maintain a portion of a device substantially stable, while another portion of the device is allowed to move more freely. As will be described in further detail below, applying an anchoring force in one embodiment involves a user of a device grasping the device at or near one of its ends. In other embodiments, devices may use one or more anchoring members to apply an anchoring force. In a number of embodiments, an anchoring force may be applied with or against one or more tissues of a patient's body, and the tissue(s) may often move even as they apply (or help apply) the force. Thus, again, applying an anchoring force to a device does not necessarily mean that all motion of the device is eliminated. Of course, in some embodiments, it may be possible and desirable to eliminate all movement or substantially all movement of a device (or portion of a device), and in some embodiments anchoring force may be used to do so.
Methods, apparatus and systems of aspects of the present invention generally provide for tissue modification while preventing unwanted modification of, or damage to, surrounding tissues. Tensioning the tissue modification device by applying anchoring force at or near one end and applying tensioning or pulling force at or near the opposite end may enhance the ability of tissue modification members of the device to work effectively within a limited treatment space. Applying tensioning force to a predominantly flexible device may also allow the device to have a relatively small profile, thus facilitating its use in less invasive procedures and in other procedures in which alternative approaches to target tissue may be advantageous.
In some embodiments, the described methods, apparatus and systems may be used to modify tissue in a spine, such as for treating neural impingement, neurovascular impingement and/or spinal stenosis. In alternative embodiments, target tissues in other parts of the body may be modified.
In one aspect of the present invention, 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.
In another aspect of the present invention, a device for modifying one or more tissues in a patient may include: an elongate, flexible body having a proximal portion and a distal portion; at least one blade disposed along one side of the elongate body; 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.
In another aspect of the present invention, a method for modifying tissue in a patient may involve: 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 blade of the tissue modification device adjacent the target tissue such that the blade(s) face the target tissue and do not face the non-target tissue; applying at least one of anchoring and tensioning force to the tissue modification device at or near its proximal and distal portions to urge the blade(s) against the target tissue; and moving the at least one blade to cut the target tissue.
These and other aspects and embodiments are described more fully below in the Detailed Description, with reference to the attached Drawings.
Methods, apparatus and systems for modifying tissue in a patient are provided. Although the following description and accompanying drawing figures generally focus on tissue modification in spine, in various alternative embodiments any of a number of tissues in any of a number of anatomical locations in a patient may be modified.
Referring to
Generally, tissue modification device 102 may be advanced to a position in the spine such that tissue modifying member 110 faces target tissue to be modified, such as buckled, thickened or otherwise impinging ligamentum flavum tissue as shown in
In some embodiments, once tissue modification device 102 is positioned such that tissue modifying member 110 faces target tissue and protective surface 112 faces non-target tissue, an anchoring force may be applied at or near distal portion 109 of elongate body 108, either inside or outside the patient's body. A tensioning force may also be applied at or near proximal portion 107 of elongate body 108, such as by pulling on handle 104 (one-directional arrows), and actuator 106 may be used (two-headed arrow) to activate tissue modifying member(s) 110 to modify target tissue. In the example shown, anchoring force is applied near distal portion 109 by a user's hand 244, and handle 104 is pulled proximally (arrows) to apply tensioning force. In an alternative embodiment, hand 244 may grasp guide member 116 at or near its distal portion 117 and thus apply anchoring force to it, thus also applying anchoring force to elongate body 108. In one variation of such an embodiment, elongate body 108 or handle 104 may optionally be adjustably clamped to guide member 116 to further enhance or facilitate application of anchoring force to elongate body 108. Tissue modification via tissue modifying members 110 may include cutting, ablating, dissecting, repairing, reducing blood flow in, shrinking, shaving, burring, biting, remodeling, biopsying, debriding, lysing, debulking, sanding, filing, planing, heating, cooling, vaporizing, delivering a drug to, and/or retracting the target tissue. Once tissue has been modified, tissue modification device 102 and any introducer devices 114, guide members 116 or other devices may be removed from the patient.
In various embodiments of the apparatus, tissue modifying member(s) 110 may be disposed along any suitable length of body 108. In one embodiment, for example, such as an embodiment of the device to be used in a spinal treatment, tissue modifying members 110 may be disposed along a length of the device measuring no longer than 10 cm, and preferably no more than 6 cm, and even more preferably no more than 3 cm. In various embodiments, tissue modifying member(s) 110 may include a rongeur, a curette, a scalpel, one or more cutting blades, a scissors, a forceps, a probe, a rasp, a file, an abrasive element, one or more small planes, an electrosurgical device, a bipolar electrode, a unipolar electrode, a thermal electrode, a rotary powered mechanical shaver, a reciprocating powered mechanical shaver, a powered mechanical burr, a laser, an ultrasound crystal, a cryogenic probe, a pressurized water jet, a drug dispensing element, a needle, a needle electrode, or some combination thereof. In various embodiments, all tissue modifying members 110 may be mobile relative to the elongate body, all may be static, or some may be mobile and some may be static. These and other aspects and embodiments are described further below.
Turning now to
In various embodiments, elongate body 108 may have any number of dimensions, shapes, profiles and amounts of flexibility. For example, distal portion 109 is shown having a curved shape to demonstrate that at least a portion of elongate body 108 may be flexible. In various embodiments, elongate body 108 may have one or more of a round, ovoid, ellipsoid, flat, cambered flat, rectangular, square, triangular, symmetric or asymmetric cross-sectional shape. As shown in
In one embodiment, elongate body 108 is predominantly flexible along its length and comprises any suitable flexible material, such as thin, flexible metals, plastics, fabrics or the like. In some embodiments, it may be advantageous to include one or more rigid sections in elongate body 108, such as to impart pushability to a portion of body 108 or to facilitate application of force to tissue modification members 110 without causing unwanted bending or kinking of elongate body 108. In such embodiments, rigidity may be conferred by using additional materials in body 108 or by making the rigid portions thicker or wider or of a different shape.
Handle 104 may have any suitable configuration according to various embodiments. Similarly, actuator 106 may include any of a number of actuation devices in various embodiments. In the embodiment shown in
Blades 110 include a distal 110a and a proximal blade 110b that reside at the distal and proximal edges, respectively, of window 111 of elongate body 108. Window 111 of body 108 may accommodate both soft and hard tissue when the device is forcibly applied to the surface of a target tissue site. The top view of the distal portion of elongate body 108, shown in
In one embodiment, distal blade 110a is coupled with two pull-wires 118, as seen in
Referring now to
Blades 110 may be made from any suitable metal, polymer, ceramic, or combination thereof. Suitable metals, for example, may include but are not limited to stainless steel, nickel-titanium alloy, tungsten carbide alloy, or cobalt-chromium alloy, for example, Elgiloy™ (Elgin Specialty Metals, Elgin, Ill., USA), Conichrome™ (Carpenter Technology, Reading, Pa., USA), or Phynox™ (Imphy SA, Paris, France). In some embodiments, materials for the blades or for portions or coatings of the blades may be chosen for their electrically conductive or thermally resistive properties. Suitable polymers include but are not limited to nylon, polyester, Dacron™, polyethylene, acetal, Delrin™ (DuPont, Wilmington, Del.), polycarbonate, nylon, polyetheretherketone (PEEK), and polyetherketoneketone (PEKK). In some embodiments, polymers may be glass-filled to add strength and stiffness. Ceramics may include but are not limited to aluminas, zirconias, and carbides. In various embodiments, blades 110 may be manufactured using metal injection molding (MIM), CNC machining, injection molding, grinding and/or the like. Pull wires 118 be made from metal or polymer and may have circular, oval, rectangular, square or braided cross-sections. In some embodiments, a diameter of a pull wire 118 may range from about 0.001″-0.050″, and more preferably from about 0.010″-0.020″.
Depending on the tissue to be treated or modified, activating blades 110 (or other tissue modifying members in alternative embodiments) may cause them to modify target tissue along an area having any of a number of suitable lengths. In use, it may also be advantageous to limit the extent of action of blades 110 or other tissue modifying members to a desired length of tissue, thus not allowing blades 110 to affect tissue beyond that length. In so limiting the effect of blades, unwanted modification of, or damage to, surrounding tissues and structures may be limited or even eliminated. In one embodiment, for example, where the tissue modification device is used to modify tissue in a spine, blades 110 may operate along a length of target tissue of no more than 10 cm, and preferably no more than 6 cm, and even more preferably no more than 3 cm. Of course, in other parts of the body and to address other tissues, different tissue modification devices may be used and tissue modifying members may have many different lengths of activity. In one embodiment, to facilitate proper location of tissue modifying members, such as blades 110, relative to target tissue, the tissue modifying members and/or the elongate body and/or one or more additional features intended for just such a purpose may be composed of a material readily identifiable via x-ray, fluoroscopic, magnetic resonance or ultrasound imaging techniques.
In various embodiments, a number of different techniques may be used to prevent blades 110 (or other tissue modifying members) from extending significantly beyond the target tissue. In one embodiment, for example, preventing blades 110 from extending significantly beyond the target tissue involves holding tissue modification device 102 as a whole predominantly stable to prevent device 102 from translating in a direction toward its proximal portion or toward its distal portion while activating blades 110. Holding device 102 stable is achieved by anchoring one end of the device and applying tensioning force at or near the other end, as described further below.
In the embodiment shown in
Referring now to
Elongate body 208 may be fabricated from any suitable material and have any of a number of configurations. In one embodiment, body 208 comprises a metal tube with a full-thickness slit (to unfold the tube into a flat form--not shown) or stiffening element (not shown). The split tube provides for a simple manufacturing process as well as a conductive pathway for bi-polar RF operation. The tube may include a waist region 220.
Referring to
In one embodiment, wire loop 210 may be housed within elongate body 208 during delivery of tissue modification device 202 into a patient, and then caused to extend up out of window 211, relative to the rest of body 208, to remove tissue. Wire loop 210 may also be flexible so that it may pop or bow up out of window 211 and may deflect when it encounters hard tissue surfaces. Wire loop 210 may have any of a number of shapes, such as curved, flat, spiral or ridged. Wire loop 210 may have a diameter similar to the width of body 208, while in alternative embodiments it may expand when extended out of window 211 to have a smaller or larger diameter than that of body 208. Pull wires (not shown) may be retracted proximally, in a manner similar to that described above, in order to collapse wire loop 210, decrease the diameter and lower the profile of the wire loop 210, and/or pull wire loop 210 proximally to remove tissue or be housed within body 208. The low profile of the collapsed wire loop 210, facilitates insertion and removal of tissue modification device 202 prior to and after tissue modification. As the wire loop 210 diameter is reduced, support tubes 218 deflect toward the center of elongate body 208.
In an alternative embodiment (not shown), tissue modification device 202 may include multiple RF wire loops 210 or other RF members. In another embodiment, device 202 may include one or more blades as well as RF wire loop 210. In such an embodiment, wire loop 210 may be used to remove or otherwise modify soft tissues, such as ligamentum flavum, or to provide hemostasis, and blades may be used to modify hard tissues, such as bone. In other embodiments, as described further below, two separate tissue modification devices (or more than two devices) may be used in one procedure to modify different types of tissue, enhance modification of one type of tissue or the like.
In other alternative embodiments, tissue modification devices 202 may include tissue modifying members such as a rongeur, a curette, a scalpel, a scissors, a forceps, a probe, a rasp, a file, an abrasive element, one or more small planes, a rotary powered mechanical shaver, a reciprocating powered mechanical shaver, a powered mechanical burr, a laser, an ultrasound crystal a cryogenic probe, a pressurized water jet, a drug dispensing element, a needle, a needle electrode, or some combination thereof. In some embodiments, for example, it may be advantageous to have one or more tissue modifying members that stabilize target tissue, such as by grasping the tissue or using tissue restraints such as barbs, hooks, compressive members or the like. In one embodiment, soft tissue may be stabilized by applying a contained, low-temperature substance (for example, in the cryo-range of temperatures) that hardens the tissue, thus facilitating resection of the tissue by a blade, rasp or other device. In another embodiment, one or more stiffening substances or members may be applied to tissue, such as bioabsorbable rods.
Referring now to
In
Referring to
In various alternative embodiments, certain of the above-described steps may be carried out in different order. For example, in one embodiment the distal portion of elongate body 108 may be anchored within or outside the patient before the tissue modifying members are positioned adjacent the target tissue. In another alternative embodiment, the proximal portion of device 102 may be anchored, and the tensioning force may be applied to the distal portion of device 102. In yet another embodiment, tensioning force may be applied to both ends of the device. In yet another embodiment, a second handle and actuator may be coupled with the distal end of body 108 after it exits the patient's back, allowing tensioning forces as well as tissue modifying actuation to occur at both the proximal and distal portions of device 102. By anchoring one end of device 102 and applying tensioning force to the opposite end, contact of the tissue modifying members with the target tissue is enhanced, thus reducing or eliminating the need for translating or otherwise moving device 102 as a whole and reducing the overall profile and the resulting access pathway required to position the device. Reducing movement and profile of device 102 and using tissue modifying members confined to a relatively small area of device 102 helps facilitate target tissue modification while minimizing or eliminating damage to surrounding tissues or structures.
As mentioned above, tissue may be modified using one tissue modification device or multiple devices, according to various embodiments. In one embodiment, for example, an RF electrosurgical tissue modification device may be used in the patient to remove soft tissue such as ligament, and a bladed tissue modification device such as a rongeur may then be used to remove additional soft tissue, calcified soft tissue, or hard tissue such as bone. In some embodiments, such multiple devices may be inserted, used and removed serially, while in alternative embodiments such devices may be inserted into the patient at the same time to be used in combination.
Referring to
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Referring to
Once introducer sheath 114 is in place, one or more curved or steerable guide devices 318 may be advanced through it to desired positions in and/or through the spine, as shown in
Once tissue modification device 102 is in a desired position, tissues which may be modified in various embodiments include, but are not limited to, ligament, tendon, tumor, cyst, cartilage, scar, “bone spurs,” inflammatory and bone tissue. In some embodiments, modifying the target tissue reduces impingement of the tissue on a spinal cord, a branching nerve or nerve root, a dorsal root ganglia, and/or vascular tissue in the spine. Actuator 106 on handle 104 is activated to modify target tissue using tissue modification member(s) 110, while elongate body 108 is held relatively stable by hand 244 and by tension force applied to handle 104.
In various embodiments, the system and method described immediately above may include additional features or steps, may have fewer features or steps, may have an alternate order of implementation of steps, or may have different features or steps. For example, in some embodiments placement of device 102 will be performed in a medial-to-lateral direction (relative to the patient), while in alternative embodiments device placement will be performed lateral-to-medial. In some embodiments, one or more components of the system described may be anchored to the patient, such as guide member 116 or introducer sheath 114. In various embodiments, one or more guide members 116 may include one or more wires, rails or tracks and may be inserted through guide device 318, introducer sheath 114 without guide device 318, cannula 300, an epidural needle, a lumen of an endoscope, a lumen of a tissue shield or barrier device, a curved guide device 318 placed through a lumen of an endoscope, or the like. In other embodiments, for example, guide device 318 may be placed through introducer cannula 300 and then introducer sheath 114 may be passed over guide device 318. Tissue modification device 102 may similarly be inserted with or without using any of these devices or components in various combinations. Various guidewires 312, guide devices 318 and/or guide members 116 may be pre-shaped to have one or more curves, may be steerable, and/or may include one or more rails, tracks, grooves, lumens, slots, partial lumens, or some combination thereof.
In some embodiments, tissue modification device 102 is inserted through one or more hollow devices as described above (such as introducer sheath 114, as shown, or cannula 300 in an alternative embodiment) in such a way that device 102 expands upon extending out of a distal portion of the hollow delivery device thereby assuming a wider profile for modifying a greater amount of target tissue from a single location. In an alternative embodiment, device 102 retains the same overall profile during insertion and during use. In some embodiments, one or more delivery devices will remain in the patient during use of tissue modification device 102, while in alternative embodiments all delivery devices are removed from the patient when tissue modification device 102 is operating. In some embodiments, tissue modification device 102 may be slidably coupled with one or more delivery devices during delivery and/or during use. In one embodiment, tissue modification device 102 is advanced through introducer sheath 114 and sheath 114 is used as an irrigation and evacuation lumen to irrigate the area of the target tissue and evacuate removed tissue and other debris, typically by applying a vacuum. In alternative embodiments, tissue modification device 102 may include an irrigation and/or evacuation lumen to irrigate an area of the target tissue and evacuate removed tissue and other debris.
Some embodiments of an access system for facilitating tissue modification may further include one or more visualization devices (not shown). Such devices may be used to facilitate placement of the access system for introducing the tissue modification device, to facilitate tissue modification itself, or any combination of these functions. Examples of visualization devices that may be used include flexible, partially flexible, or rigid fiber optic scopes, rigid rod and lens-endoscopes, CCD or CMOS chips at the distal portion of rigid or flexible probes, LED illumination, fibers or transmission of an external light source for illumination or the like. Such devices may be slidably couplable with one or more components of an access system or may be slidably or fixedly coupled with a tissue modification device. In other embodiments, additional or alternative devices for helping position, use or assess the effect of a tissue modification device may be included. Examples of other such devices may include one or more neural stimulation electrodes with EMG or SSEP monitoring, ultrasound imaging transducers external or internal to the patient, a computed tomography (CT) scanner, a magnetic resonance imaging (MRI) scanner, a reflectance spectrophotometry device, and a tissue impedance monitor disposed across a bipolar electrode tissue modification member or disposed elsewhere on a tissue modification device or disposed on the access system.
Referring now to
In some embodiments, a curved and cannulated thin, blunt probe may be placed directly through the open incision into the epidural space of the spine, or alternatively may be placed through introducer sheath 414. The probe tip may be advanced to or through a neural foramen. Such a probe may be similar in shape, for example, to a Woodson elevator, Penfield 3, hockey stick probe, ball tipped probe, or the like. In alternative embodiments, probes that may be manually bent to change their shapes, or probes with articulating tips, or probes with shape lock portions, and/or probes having grooves instead of cannulas may be used.
As shown in
Referring now to
In various alternative embodiments, open surgical access may be through exposure down to a vertebral lamina, through ligamentum flavum without lamina removal, through ligamentum flavum with partial or complete lamina removal, through ligamentum flavum with or without lamina removal with partial or complete medial facet joint removal, through open exposure and out through skin laterally, through open exposure and back out through the open exposure, or through a lateral open exposure that accesses the neural foramen from the lateral side. One or more visualization devices may be used with open surgical access procedures as well as with percutaneous or other less invasive procedures. In another alternative embodiment (not shown), a tissue modification device may be placed in the patient directly, without any introduction devices.
Referring now to
Optionally, in some embodiments, tissue modification devices or systems may further include one or more tissue barriers (or “shields”) for further protecting non-target tissues. Such barriers may be slidably coupled with, fixedly coupled with, or separate from the tissue modification devices with which they are used. In various embodiments, a barrier may be delivered between target and non-target tissues before delivering the tissue modification device, may be delivered along with the tissue modification device, or may be delivered after delivery of the tissue modification device but before the device is activated or otherwise used to modify target tissue. Generally, such a barrier may be interposed between the non-target tissue and one or more tissue modification devices to prevent unwanted damage of the non-target tissue.
Referring now to
The embodiment shown in
In the embodiments described previously or in any other embodiments described herein, blades may be fabricated from metals, polymers, ceramics, composites or any other suitable material or combination of materials. According to various embodiments, suitable metals for blades may include, but are not limited to, stainless steel, nickel-titanium alloy, or cobalt-chromium alloy, for example, Elgiloy™ (Elgin Specialty Metals, Elgin, Ill., USA), Conichrome™ (Carpenter Technology, Reading, Pa., USA), or Phynox™ (Imphy S A, Paris, France). Polymer materials include nylon, polyester, Dacron™ , polyethylene, acetal, Delrin™ (DuPont), polycarbonate, nylon, polyetheretherketone (PEEK), and polyetherketoneketone (PEKK). In some embodiments where polymers are used, such polymers may be glass-filled or carbon-filled to add strength and stiffness. Ceramics may include, but are not limited to, aluminas, zirconias, and carbides. Blades may be manufactured using skills known in the art, for example, metal injection molding (MIM), CNC machining, injection molding, grinding, electrodischarge madhining (EDM), sheet metal bending, etching, electrodeposition, or the like. Pull wires 1011 may similarly be fabricated from any suitable material and may have any of a number of suitable shapes and dimension. In some embodiments, for example, pull wires 1011 may be made from metal or polymer and may have substantially circular, oval, rectangular or square cross sections, although this is by no means a comprehensive list. In some embodiments, pull wires 1011 may range in diameter from about 0.001 inches to about 0.10 inches, and more preferably between about 0.010 inches and 0.020 inches. Other portions of a tissue modification device, such as a cover over one or more blades or other features, may be made of any suitable material now known or hereafter discovered. A blade cover, for example, may be fabricated in various embodiments of one or more polymeric materials, such as nylon, silicone, polyetheretherketone (PEEK), polyetherketoneketone (PEKK), polytetrafluoroethylene (PTFE), polyurethane (Tecothane,), Pebax (co, USA), polycarbonate, Delrin (co, USA), high-density polyethylene (HDPE), low-density polyethylene (LDPE), HMWPE, UHMWPE, or the like. In some embodiments, one or more materials may be chosen for their compatibility with one or more imaging techniques or systems, such as magnetic resonance imaging (MRI), for example.
In various embodiments, elongate body 1005 may include one or more hollow chambers (not shown) at or near a distal portion of body 1005. Such hollow chamber(s) may serve any of a number of suitable functions. In some embodiments, for example, a chamber may be located distal and/or proximal to one or more blades 1008a, 1008b and may serve to collect removed tissue during and/or after a tissue modification procedure. In some embodiments, one or more blades 1008a, 1008b may help push removed tissue into such a chamber or chambers. In some embodiments, one or more chambers may house one or more blades 1008a, 1008b, such that blades 1008a, 1008b are housed within the chamber(s) while elongate body 1005 is passed into a patient and between target and non-target tissues. Once elongate body 1005 is in a desired position, blades 1008a, 1008b may then be deployed out of one or more windows or similar openings in the chamber(s) to remove or otherwise modify tissue. Such chambers may include, in various embodiments, a hollow distal portion or nosecone of elongate body 1005, a hollow portion of elongate body 1005 just proximal to proximal cutting blade 1008b, and/or the like.
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In one alternative embodiment (not pictured), similar to that in
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In yet another embodiment, and with reference now to
Although various illustrative embodiments are described above, any of a number of changes may be made to various embodiments without departing from the scope of the invention as described by the claims. For example, the order in which various described method steps are performed may often be changed in alternative embodiments, and in other alternative embodiments one or more method steps may be skipped altogether. Optional features of various device and system embodiments may be included in some embodiments and not in others. For example, in many of the embodiments described above, one or more abrasive tissue modifying members may be substituted for one or more bladed tissue modifying members or vice versa. These an many other modifications may be made to many of the described embodiments. Therefore, the foregoing description is provided primarily for exemplary purposes and should not be interpreted to limit the scope of the invention as it is set forth in the claims.
The present application is a continuation-in-part of U.S. patent application Ser. No. 11/375,265, entitled “Methods and Apparatus for Tissue Modification,” filed on Mar. 13, 2006, the entire disclosure of which is hereby incorporated by reference, which is a continuation-in-part of PCT Patent Application No. PCT/US2005/037136, filed Oct. 15, 2005, which claimed the benefit of: U.S. Provisional Patent Application No. 60/619,306, filed on Oct. 15, 2004; U.S. Provisional Patent Application No. 60/622,865, filed on Oct. 28, 2004; U.S. Provisional Patent Application No. 60/681,719, filed on May 16, 2005; U.S. Provisional Patent Application No. 60/681,864, filed on May 16, 2005; and U.S. Provisional Patent Application No. 60/685,190, filed on May 27, 2005. PCT Patent Application Pub. No. PCT/US2005/037136, which was incorporated fully by reference in the above-referenced U.S. patent application Ser. No. 11/375,265, is also incorporated fully by reference herein.
| Number | Name | Date | Kind |
|---|---|---|---|
| 184804 | Stohlmann | Nov 1876 | A |
| 289104 | How | Nov 1883 | A |
| 863389 | Harkin | Aug 1907 | A |
| 1039487 | Casebolt | Sep 1912 | A |
| 1201467 | Hoglund | Oct 1916 | A |
| 1374638 | De Cew et al. | Apr 1921 | A |
| 1543195 | Thygesen | Jun 1925 | A |
| 1690812 | Bertels | Nov 1928 | A |
| 1938200 | Wells | Dec 1933 | A |
| 2243757 | Kohls et al. | May 1941 | A |
| 2269749 | Wilkie | Jan 1942 | A |
| 2372553 | Coddington | Mar 1945 | A |
| 2437697 | Kalom | Mar 1948 | A |
| 2516882 | Kalom | Aug 1950 | A |
| 2704064 | Fizzell | May 1955 | A |
| 2820281 | Amsen | Jan 1958 | A |
| 2843128 | Storz | Jul 1958 | A |
| 2982005 | Booth | May 1961 | A |
| RE25582 | Davies | May 1964 | E |
| 3150470 | Barron | Sep 1964 | A |
| 3200814 | Taylor et al. | Aug 1965 | A |
| 3389447 | Theobald et al. | Jun 1968 | A |
| 3491776 | Fleming | Jan 1970 | A |
| 3495590 | Zeiller | Feb 1970 | A |
| 3528152 | Funakubo et al. | Sep 1970 | A |
| 3624484 | Colyer | Nov 1971 | A |
| 3640280 | Slanker et al. | Feb 1972 | A |
| 3651844 | Barnes | Mar 1972 | A |
| 3664329 | Naylor | May 1972 | A |
| 3682162 | Colyer | Aug 1972 | A |
| 3699729 | Garvey et al. | Oct 1972 | A |
| 3752166 | Lyon et al. | Aug 1973 | A |
| 3774355 | Dawson et al. | Nov 1973 | A |
| 3830226 | Staub et al. | Aug 1974 | A |
| 3835859 | Roberts et al. | Sep 1974 | A |
| 3956858 | Catlin et al. | May 1976 | A |
| 3957036 | Normann | May 1976 | A |
| 3978862 | Morrison | Sep 1976 | A |
| 3999294 | Shoben | Dec 1976 | A |
| 4015931 | Thakur | Apr 1977 | A |
| 4099519 | Warren | Jul 1978 | A |
| 4108182 | Hartman et al. | Aug 1978 | A |
| 4160320 | Wikoff | Jul 1979 | A |
| 4172440 | Schneider et al. | Oct 1979 | A |
| 4203444 | Bonnell et al. | May 1980 | A |
| 4207897 | Lloyd et al. | Jun 1980 | A |
| 4259276 | Rawlings | Mar 1981 | A |
| 4405061 | Bergandy | Sep 1983 | A |
| D273806 | Bolesky et al. | May 1984 | S |
| 4464836 | Hissa | Aug 1984 | A |
| 4502184 | Karubian | Mar 1985 | A |
| 4515168 | Chester et al. | May 1985 | A |
| 4518022 | Valdes et al. | May 1985 | A |
| 4545374 | Jacobson | Oct 1985 | A |
| 4573448 | Kambin | Mar 1986 | A |
| 4580545 | Dorsten | Apr 1986 | A |
| 4590949 | Pohndorf | May 1986 | A |
| 4616660 | Johns | Oct 1986 | A |
| 4621636 | Fogarty | Nov 1986 | A |
| 4625725 | Davison et al. | Dec 1986 | A |
| 4660571 | Hess et al. | Apr 1987 | A |
| 4678459 | Onik et al. | Jul 1987 | A |
| 4690642 | Kyotani | Sep 1987 | A |
| 4700702 | Nilsson | Oct 1987 | A |
| 4709699 | Michael et al. | Dec 1987 | A |
| 4741343 | Bowman | May 1988 | A |
| 4750249 | Richardson | Jun 1988 | A |
| 4794931 | Yock | Jan 1989 | A |
| 4808157 | Coombs | Feb 1989 | A |
| 4817628 | Zealear et al. | Apr 1989 | A |
| 4856193 | Grachan | Aug 1989 | A |
| 4867155 | Isaacson | Sep 1989 | A |
| 4872452 | Alexson | Oct 1989 | A |
| 4873978 | Ginsburg | Oct 1989 | A |
| 4883460 | Zanetti | Nov 1989 | A |
| 4894063 | Nashe | Jan 1990 | A |
| 4912799 | Coleman, Jr. | Apr 1990 | A |
| RE33258 | Onik et al. | Jul 1990 | E |
| 4943295 | Hartlaub et al. | Jul 1990 | A |
| 4946462 | Watanabe | Aug 1990 | A |
| 4957117 | Wysham | Sep 1990 | A |
| 4962766 | Herzon | Oct 1990 | A |
| 4973329 | Park et al. | Nov 1990 | A |
| 4990148 | Worrick, III et al. | Feb 1991 | A |
| 4994036 | Biscoping et al. | Feb 1991 | A |
| 4994072 | Bhate et al. | Feb 1991 | A |
| 4995200 | Eberhart | Feb 1991 | A |
| 5019082 | Frey et al. | May 1991 | A |
| 5025787 | Sutherland et al. | Jun 1991 | A |
| 5026379 | Yoon | Jun 1991 | A |
| 5026386 | Michelson | Jun 1991 | A |
| 5078137 | Edell et al. | Jan 1992 | A |
| 5089003 | Fallin et al. | Feb 1992 | A |
| 5100424 | Jang et al. | Mar 1992 | A |
| 5108403 | Stern | Apr 1992 | A |
| 5125928 | Parins et al. | Jun 1992 | A |
| 5147364 | Comparetto | Sep 1992 | A |
| 5152749 | Giesy et al. | Oct 1992 | A |
| 5161534 | Berthiaume | Nov 1992 | A |
| 5163939 | Winston | Nov 1992 | A |
| 5176649 | Wakabayashi | Jan 1993 | A |
| 5178145 | Rea | Jan 1993 | A |
| 5178161 | Kovacs | Jan 1993 | A |
| 5191888 | Palmer et al. | Mar 1993 | A |
| 5195507 | Bilweis | Mar 1993 | A |
| 5201704 | Ray | Apr 1993 | A |
| 5215105 | Kizelshteyn et al. | Jun 1993 | A |
| 5219358 | Bendel et al. | Jun 1993 | A |
| 5234435 | Seagrave, Jr. | Aug 1993 | A |
| 5242418 | Weinstein | Sep 1993 | A |
| 5250035 | Smith et al. | Oct 1993 | A |
| 5255691 | Otten | Oct 1993 | A |
| 5271415 | Foerster et al. | Dec 1993 | A |
| 5281218 | Imran | Jan 1994 | A |
| 5284153 | Raymond et al. | Feb 1994 | A |
| 5284154 | Raymond et al. | Feb 1994 | A |
| 5300077 | Howell | Apr 1994 | A |
| 5325868 | Kimmelstiel | Jul 1994 | A |
| 5341807 | Nardella | Aug 1994 | A |
| 5351679 | Mayzels et al. | Oct 1994 | A |
| 5353784 | Nady-Mohamed | Oct 1994 | A |
| 5353789 | Schlobohm | Oct 1994 | A |
| 5353802 | Ollmar | Oct 1994 | A |
| 5360441 | Otten | Nov 1994 | A |
| 5365928 | Rhinehart et al. | Nov 1994 | A |
| 5374261 | Yoon | Dec 1994 | A |
| 5383879 | Phillips | Jan 1995 | A |
| 5385146 | Goldreyer | Jan 1995 | A |
| 5387218 | Meswania | Feb 1995 | A |
| 5396880 | Kagan et al. | Mar 1995 | A |
| 5421348 | Larnard | Jun 1995 | A |
| 5423331 | Wysham | Jun 1995 | A |
| 5437661 | Rieser | Aug 1995 | A |
| 5439464 | Shapiro | Aug 1995 | A |
| 5441044 | Tovey et al. | Aug 1995 | A |
| 5441510 | Simpson et al. | Aug 1995 | A |
| 5454815 | Geisser et al. | Oct 1995 | A |
| 5456254 | Pietroski et al. | Oct 1995 | A |
| 5496325 | McLees | Mar 1996 | A |
| 5512037 | Russell et al. | Apr 1996 | A |
| 5515848 | Corbett, III et al. | May 1996 | A |
| 5531749 | Michelson | Jul 1996 | A |
| 5534009 | Lander | Jul 1996 | A |
| 5546958 | Thorud et al. | Aug 1996 | A |
| 5554110 | Edwards et al. | Sep 1996 | A |
| 5555892 | Tipton | Sep 1996 | A |
| 5560372 | Cory | Oct 1996 | A |
| 5562695 | Obenchain | Oct 1996 | A |
| 5571181 | Li | Nov 1996 | A |
| 5582618 | Chin et al. | Dec 1996 | A |
| 5598848 | Swanson et al. | Feb 1997 | A |
| 5620447 | Smith et al. | Apr 1997 | A |
| 5630426 | Eggers et al. | May 1997 | A |
| 5634475 | Wolvek | Jun 1997 | A |
| 5643304 | Schechter et al. | Jul 1997 | A |
| 5651373 | Mah | Jul 1997 | A |
| 5656012 | Sienkiewicz | Aug 1997 | A |
| 5680860 | Imran | Oct 1997 | A |
| 5681324 | Kammerer et al. | Oct 1997 | A |
| 5697889 | Slotman et al. | Dec 1997 | A |
| 5709697 | Ratcliff et al. | Jan 1998 | A |
| 5725530 | Popken | Mar 1998 | A |
| 5735792 | Vanden Hoek et al. | Apr 1998 | A |
| 5755732 | Green et al. | May 1998 | A |
| 5759159 | Masreliez | Jun 1998 | A |
| 5762629 | Kambin | Jun 1998 | A |
| 5766168 | Mantell | Jun 1998 | A |
| 5769865 | Kermode et al. | Jun 1998 | A |
| 5775331 | Raymond et al. | Jul 1998 | A |
| 5779642 | Nightengale | Jul 1998 | A |
| 5788653 | Lorenzo | Aug 1998 | A |
| 5792044 | Foley et al. | Aug 1998 | A |
| 5795308 | Russin | Aug 1998 | A |
| 5800350 | Coppleson et al. | Sep 1998 | A |
| 5803902 | Sienkiewicz et al. | Sep 1998 | A |
| 5803904 | Mehdizadeh | Sep 1998 | A |
| 5807263 | Chance | Sep 1998 | A |
| 5810744 | Chu et al. | Sep 1998 | A |
| 5813405 | Montano, Jr. et al. | Sep 1998 | A |
| 5824040 | Cox et al. | Oct 1998 | A |
| 5830151 | Hadzic et al. | Nov 1998 | A |
| 5830157 | Foote | Nov 1998 | A |
| 5830188 | Abouleish | Nov 1998 | A |
| 5833692 | Cesarini et al. | Nov 1998 | A |
| 5836948 | Zucherman et al. | Nov 1998 | A |
| 5843110 | Dross et al. | Dec 1998 | A |
| 5846196 | Siekmeyer et al. | Dec 1998 | A |
| 5846244 | Cripe | Dec 1998 | A |
| 5851191 | Gozani | Dec 1998 | A |
| 5851209 | Kummer et al. | Dec 1998 | A |
| 5851214 | Larsen et al. | Dec 1998 | A |
| 5853373 | Griffith et al. | Dec 1998 | A |
| 5865844 | Plaia et al. | Feb 1999 | A |
| 5868767 | Farley et al. | Feb 1999 | A |
| 5879353 | Terry | Mar 1999 | A |
| 5885219 | Nightengale | Mar 1999 | A |
| 5895417 | Pomeranz et al. | Apr 1999 | A |
| 5897583 | Meyer et al. | Apr 1999 | A |
| 5899909 | Claren et al. | May 1999 | A |
| 5904657 | Unsworth et al. | May 1999 | A |
| 5916173 | Kirsner | Jun 1999 | A |
| 5918604 | Whelan | Jul 1999 | A |
| 5919190 | VanDusseldorp | Jul 1999 | A |
| 5928158 | Aristides | Jul 1999 | A |
| 5928159 | Eggers et al. | Jul 1999 | A |
| 5941822 | Skladnev et al. | Aug 1999 | A |
| 5961522 | Mehdizadeh | Oct 1999 | A |
| 5972013 | Schmidt | Oct 1999 | A |
| 5976110 | Greengrass et al. | Nov 1999 | A |
| 5976146 | Ogawa et al. | Nov 1999 | A |
| 6002964 | Feler et al. | Dec 1999 | A |
| 6004326 | Castro et al. | Dec 1999 | A |
| 6004330 | Middleman et al. | Dec 1999 | A |
| 6010493 | Snoke | Jan 2000 | A |
| 6015406 | Goble et al. | Jan 2000 | A |
| 6022362 | Lee et al. | Feb 2000 | A |
| 6030383 | Benderev | Feb 2000 | A |
| 6030401 | Marino | Feb 2000 | A |
| 6038480 | Hrdlicka et al. | Mar 2000 | A |
| 6048345 | Berke et al. | Apr 2000 | A |
| 6068642 | Johnson et al. | May 2000 | A |
| 6073051 | Sharkey et al. | Jun 2000 | A |
| 6099514 | Sharkey et al. | Aug 2000 | A |
| 6102930 | Simmons, Jr. | Aug 2000 | A |
| 6106558 | Picha | Aug 2000 | A |
| 6113534 | Koros et al. | Sep 2000 | A |
| D432384 | Simons | Oct 2000 | S |
| 6132387 | Gozani et al. | Oct 2000 | A |
| 6136014 | Sirimanne et al. | Oct 2000 | A |
| 6142993 | Whayne et al. | Nov 2000 | A |
| 6142994 | Swanson et al. | Nov 2000 | A |
| 6146380 | Racz et al. | Nov 2000 | A |
| 6152894 | Kubler | Nov 2000 | A |
| 6169916 | West | Jan 2001 | B1 |
| 6205360 | Carter et al. | Mar 2001 | B1 |
| 6214001 | Casscells et al. | Apr 2001 | B1 |
| 6214016 | Williams et al. | Apr 2001 | B1 |
| 6236892 | Feler | May 2001 | B1 |
| 6251115 | Williams et al. | Jun 2001 | B1 |
| 6256540 | Panescu et al. | Jul 2001 | B1 |
| 6259945 | Epstein et al. | Jul 2001 | B1 |
| 6261582 | Needham et al. | Jul 2001 | B1 |
| 6266551 | Osadchy et al. | Jul 2001 | B1 |
| 6266558 | Gozani et al. | Jul 2001 | B1 |
| 6267760 | Swanson | Jul 2001 | B1 |
| 6272367 | Chance | Aug 2001 | B1 |
| 6277094 | Schendel | Aug 2001 | B1 |
| 6280447 | Marino et al. | Aug 2001 | B1 |
| 6292702 | King et al. | Sep 2001 | B1 |
| 6298256 | Meyer | Oct 2001 | B1 |
| 6312392 | Herzon | Nov 2001 | B1 |
| 6324418 | Crowley et al. | Nov 2001 | B1 |
| 6324432 | Rigaux et al. | Nov 2001 | B1 |
| 6325764 | Griffith et al. | Dec 2001 | B1 |
| 6334068 | Hacker | Dec 2001 | B1 |
| 6343226 | Sunde et al. | Jan 2002 | B1 |
| 6358254 | Anderson | Mar 2002 | B1 |
| 6360750 | Gerber et al. | Mar 2002 | B1 |
| 6364886 | Sklar | Apr 2002 | B1 |
| 6368324 | Dinger et al. | Apr 2002 | B1 |
| 6370411 | Osadchy et al. | Apr 2002 | B1 |
| 6370435 | Panescu et al. | Apr 2002 | B2 |
| 6383509 | Donovan et al. | May 2002 | B1 |
| 6390906 | Subramanian | May 2002 | B1 |
| 6391028 | Fanton et al. | May 2002 | B1 |
| 6416505 | Fleischman et al. | Jul 2002 | B1 |
| 6423071 | Lawson | Jul 2002 | B1 |
| 6423080 | Gellman et al. | Jul 2002 | B1 |
| 6425859 | Foley et al. | Jul 2002 | B1 |
| 6425887 | McGuckin et al. | Jul 2002 | B1 |
| 6436101 | Hamada | Aug 2002 | B1 |
| 6442848 | Dean | Sep 2002 | B1 |
| 6446621 | Svensson | Sep 2002 | B1 |
| 6451335 | Goldenheim et al. | Sep 2002 | B1 |
| 6454767 | Alleyne | Sep 2002 | B2 |
| 6464682 | Snoke | Oct 2002 | B1 |
| 6466817 | Kaula et al. | Oct 2002 | B1 |
| 6468289 | Bonutti | Oct 2002 | B1 |
| 6470209 | Snoke | Oct 2002 | B2 |
| 6478805 | Marino et al. | Nov 2002 | B1 |
| 6487439 | Skladnev et al. | Nov 2002 | B1 |
| 6488636 | Bryan et al. | Dec 2002 | B2 |
| 6491646 | Blackledge | Dec 2002 | B1 |
| 6500128 | Marino | Dec 2002 | B2 |
| 6500189 | Lang et al. | Dec 2002 | B1 |
| 6512958 | Swoyer et al. | Jan 2003 | B1 |
| 6516223 | Hofmann | Feb 2003 | B2 |
| 6520907 | Foley et al. | Feb 2003 | B1 |
| 6527786 | Davis et al. | Mar 2003 | B1 |
| 6533749 | Mitusina et al. | Mar 2003 | B1 |
| 6535759 | Epstein et al. | Mar 2003 | B1 |
| 6540742 | Thomas et al. | Apr 2003 | B1 |
| 6540761 | Houser | Apr 2003 | B2 |
| 6546270 | Goldin et al. | Apr 2003 | B1 |
| 6558353 | Zohmann | May 2003 | B2 |
| 6562033 | Shah et al. | May 2003 | B2 |
| 6564078 | Marino et al. | May 2003 | B1 |
| 6564079 | Cory et al. | May 2003 | B1 |
| 6564088 | Soller et al. | May 2003 | B1 |
| 6569160 | Goldin et al. | May 2003 | B1 |
| 6575979 | Cragg | Jun 2003 | B1 |
| 6579291 | Keith et al. | Jun 2003 | B1 |
| 6584345 | Govari | Jun 2003 | B2 |
| 6592559 | Pakter et al. | Jul 2003 | B1 |
| 6595932 | Ferrera | Jul 2003 | B2 |
| 6597955 | Panescu et al. | Jul 2003 | B2 |
| 6606523 | Jenkins | Aug 2003 | B1 |
| 6607530 | Carl et al. | Aug 2003 | B1 |
| 6609018 | Cory et al. | Aug 2003 | B2 |
| 6610066 | Dinger et al. | Aug 2003 | B2 |
| 6620129 | Stecker et al. | Sep 2003 | B2 |
| 6622731 | Daniel et al. | Sep 2003 | B2 |
| 6624510 | Chan et al. | Sep 2003 | B1 |
| 6626916 | Yeung et al. | Sep 2003 | B1 |
| 6632184 | Truwit | Oct 2003 | B1 |
| 6638233 | Corvi et al. | Oct 2003 | B2 |
| RE38335 | Aust et al. | Nov 2003 | E |
| 6648883 | Francischelli et al. | Nov 2003 | B2 |
| 6666874 | Heitzmann et al. | Dec 2003 | B2 |
| 6673063 | Brett | Jan 2004 | B2 |
| 6673068 | Berube | Jan 2004 | B1 |
| 6678552 | Pearlman | Jan 2004 | B2 |
| 6682535 | Hoogland | Jan 2004 | B2 |
| 6682536 | Vardi et al. | Jan 2004 | B2 |
| 6685709 | Sklar | Feb 2004 | B2 |
| 6699246 | Zucherman et al. | Mar 2004 | B2 |
| 6723049 | Skladnev et al. | Apr 2004 | B2 |
| 6726531 | Harrel | Apr 2004 | B1 |
| 6726685 | To et al. | Apr 2004 | B2 |
| 6733496 | Ashley et al. | May 2004 | B2 |
| 6736815 | Ginn | May 2004 | B2 |
| 6736835 | Pellegrino et al. | May 2004 | B2 |
| 6746451 | Middleton et al. | Jun 2004 | B2 |
| 6752814 | Gellman et al. | Jun 2004 | B2 |
| 6760616 | Hoey et al. | Jul 2004 | B2 |
| 6772012 | Ricart et al. | Aug 2004 | B2 |
| 6776765 | Soukup et al. | Aug 2004 | B2 |
| 6788966 | Kenan et al. | Sep 2004 | B2 |
| 6790210 | Cragg et al. | Sep 2004 | B1 |
| 6805695 | Keith et al. | Oct 2004 | B2 |
| 6805697 | Helm et al. | Oct 2004 | B1 |
| 6807444 | Tu et al. | Oct 2004 | B2 |
| 6830561 | Jansen et al. | Dec 2004 | B2 |
| 6830570 | Frey et al. | Dec 2004 | B1 |
| 6832111 | Tu et al. | Dec 2004 | B2 |
| 6845264 | Skladnev et al. | Jan 2005 | B1 |
| 6847849 | Mamo et al. | Jan 2005 | B2 |
| 6851430 | Tsou | Feb 2005 | B2 |
| 6865409 | Getsla et al. | Mar 2005 | B2 |
| 6872204 | Houser | Mar 2005 | B2 |
| 6875221 | Cull | Apr 2005 | B2 |
| 6882879 | Rock | Apr 2005 | B2 |
| 6884220 | Aviv et al. | Apr 2005 | B2 |
| 6890353 | Cohn et al. | May 2005 | B2 |
| 6895283 | Erickson et al. | May 2005 | B2 |
| 6899716 | Cragg | May 2005 | B2 |
| 6907884 | Pellegrino et al. | Jun 2005 | B2 |
| 6911003 | Anderson et al. | Jun 2005 | B2 |
| 6911016 | Balzum et al. | Jun 2005 | B2 |
| 6916328 | Brett | Jul 2005 | B2 |
| 6923813 | Phillips et al. | Aug 2005 | B2 |
| 6929647 | Cohen | Aug 2005 | B2 |
| 6949104 | Griffis et al. | Sep 2005 | B2 |
| 6962587 | Johnson et al. | Nov 2005 | B2 |
| 6971986 | Staskin et al. | Dec 2005 | B2 |
| 6972199 | Lebouitz et al. | Dec 2005 | B2 |
| 6973342 | Swanson | Dec 2005 | B1 |
| 6976986 | Berube | Dec 2005 | B2 |
| 6991643 | Saadat | Jan 2006 | B2 |
| 6994693 | Tal | Feb 2006 | B2 |
| 6997934 | Snow et al. | Feb 2006 | B2 |
| 6999820 | Jordan | Feb 2006 | B2 |
| 7001333 | Hamel et al. | Feb 2006 | B2 |
| 7008431 | Simonson | Mar 2006 | B2 |
| 7010352 | Hogan | Mar 2006 | B2 |
| 7011635 | Delay | Mar 2006 | B1 |
| 7011663 | Michelson | Mar 2006 | B2 |
| 7014616 | Ferrera | Mar 2006 | B2 |
| 7033373 | de la Torre et al. | Apr 2006 | B2 |
| 7041099 | Thomas et al. | May 2006 | B2 |
| 7047084 | Erickson et al. | May 2006 | B2 |
| 7048682 | Neisz et al. | May 2006 | B2 |
| 7050848 | Hoey et al. | May 2006 | B2 |
| 7063682 | Whayne et al. | Jun 2006 | B1 |
| 7070556 | Anderson et al. | Jul 2006 | B2 |
| 7070596 | Woloszko et al. | Jul 2006 | B1 |
| 7079883 | Marino et al. | Jul 2006 | B2 |
| 7081122 | Reiley et al. | Jul 2006 | B1 |
| 7087053 | Vanney | Aug 2006 | B2 |
| 7087058 | Cragg | Aug 2006 | B2 |
| 7107104 | Keravel et al. | Sep 2006 | B2 |
| 7118576 | Gitis et al. | Oct 2006 | B2 |
| 7141019 | Pearlman | Nov 2006 | B2 |
| 7166073 | Ritland | Jan 2007 | B2 |
| 7166081 | McKinley | Jan 2007 | B2 |
| 7166107 | Anderson | Jan 2007 | B2 |
| 7169107 | Jersey-Willuhn et al. | Jan 2007 | B2 |
| 7189240 | Dekel | Mar 2007 | B1 |
| 7198598 | Smith et al. | Apr 2007 | B2 |
| 7198626 | Lee et al. | Apr 2007 | B2 |
| 7207949 | Miles et al. | Apr 2007 | B2 |
| 7211082 | Hall et al | May 2007 | B2 |
| 7214186 | Ritland | May 2007 | B2 |
| 7214197 | Prass | May 2007 | B2 |
| 7216001 | Hacker et al. | May 2007 | B2 |
| 7223278 | Davison et al. | May 2007 | B2 |
| 7236832 | Hemmerling et al. | Jun 2007 | B2 |
| 7239911 | Scholz | Jul 2007 | B2 |
| 7270658 | Woloszko et al. | Sep 2007 | B2 |
| 7282061 | Sharkey et al. | Oct 2007 | B2 |
| 7337005 | Kim et al. | Feb 2008 | B2 |
| 7337006 | Kim et al. | Feb 2008 | B2 |
| 7470236 | Kelleher et al. | Dec 2008 | B1 |
| 7494473 | Eggers et al. | Feb 2009 | B2 |
| 7503920 | Siegal | Mar 2009 | B2 |
| 7507218 | Aliski et al. | Mar 2009 | B2 |
| 7641658 | Shaolian et al. | Jan 2010 | B2 |
| 7655026 | Justis et al. | Feb 2010 | B2 |
| 7666186 | Harp | Feb 2010 | B2 |
| 7666209 | Zucherman et al. | Feb 2010 | B2 |
| 7857813 | Schmitz et al. | Dec 2010 | B2 |
| 7887538 | Bleich et al. | Feb 2011 | B2 |
| 7918849 | Bleich et al. | Apr 2011 | B2 |
| 7938830 | Saadat et al. | May 2011 | B2 |
| 8192435 | Bleich | Jun 2012 | B2 |
| 8192436 | Schmitz | Jun 2012 | B2 |
| 20010014806 | Ellman et al. | Aug 2001 | A1 |
| 20010025192 | Gerber et al. | Sep 2001 | A1 |
| 20010039419 | Francischelli et al. | Nov 2001 | A1 |
| 20010049527 | Cragg | Dec 2001 | A1 |
| 20010053885 | Gielen et al. | Dec 2001 | A1 |
| 20020016555 | Ritchart et al. | Feb 2002 | A1 |
| 20020019637 | Frey et al. | Feb 2002 | A1 |
| 20020022788 | Corvi et al. | Feb 2002 | A1 |
| 20020029060 | Hogendijk | Mar 2002 | A1 |
| 20020106681 | Wexler et al. | Aug 2002 | A1 |
| 20020138091 | Pflueger | Sep 2002 | A1 |
| 20020165590 | Crowe et al. | Nov 2002 | A1 |
| 20020183647 | Gozani et al. | Dec 2002 | A1 |
| 20030023190 | Cox | Jan 2003 | A1 |
| 20030045808 | Kaula et al. | Mar 2003 | A1 |
| 20030074037 | Moore et al. | Apr 2003 | A1 |
| 20030105503 | Marino | Jun 2003 | A1 |
| 20030109871 | Johnson et al. | Jun 2003 | A1 |
| 20030113906 | Sangha et al. | Jun 2003 | A1 |
| 20030130655 | Woloszko et al. | Jul 2003 | A1 |
| 20030130738 | Hovda et al. | Jul 2003 | A1 |
| 20030167021 | Shimm | Sep 2003 | A1 |
| 20030187368 | Sata et al. | Oct 2003 | A1 |
| 20030188749 | Nichols et al. | Oct 2003 | A1 |
| 20030208206 | Gitis et al. | Nov 2003 | A1 |
| 20030212400 | Bloemer et al. | Nov 2003 | A1 |
| 20030225412 | Shiraishi | Dec 2003 | A1 |
| 20030225415 | Richard | Dec 2003 | A1 |
| 20040006379 | Brett | Jan 2004 | A1 |
| 20040006391 | Reiley | Jan 2004 | A1 |
| 20040019359 | Worley et al. | Jan 2004 | A1 |
| 20040024399 | Sharps et al. | Feb 2004 | A1 |
| 20040030330 | Brassell et al. | Feb 2004 | A1 |
| 20040049179 | Francischelli et al. | Mar 2004 | A1 |
| 20040049208 | Hill et al. | Mar 2004 | A1 |
| 20040054368 | Truckai et al. | Mar 2004 | A1 |
| 20040059247 | Urmey | Mar 2004 | A1 |
| 20040064058 | McKay | Apr 2004 | A1 |
| 20040067000 | Bates et al. | Apr 2004 | A1 |
| 20040097927 | Yeung et al. | May 2004 | A1 |
| 20040098074 | Erickson et al. | May 2004 | A1 |
| 20040102721 | McKinley | May 2004 | A1 |
| 20040106940 | Shaolian et al. | Jun 2004 | A1 |
| 20040111084 | Brett | Jun 2004 | A1 |
| 20040116977 | Finch et al. | Jun 2004 | A1 |
| 20040122433 | Loubens et al. | Jun 2004 | A1 |
| 20040122459 | Harp | Jun 2004 | A1 |
| 20040122482 | Tung et al. | Jun 2004 | A1 |
| 20040127893 | Hovda | Jul 2004 | A1 |
| 20040127963 | Uchida et al. | Jul 2004 | A1 |
| 20040133208 | Weikel et al. | Jul 2004 | A1 |
| 20040143165 | Alleyne | Jul 2004 | A1 |
| 20040143280 | Suddaby | Jul 2004 | A1 |
| 20040162609 | Hossainy et al. | Aug 2004 | A1 |
| 20040167444 | Laroya et al. | Aug 2004 | A1 |
| 20040167553 | Simpson et al. | Aug 2004 | A1 |
| 20040181150 | Evans et al. | Sep 2004 | A1 |
| 20040199084 | Kelleher et al. | Oct 2004 | A1 |
| 20040199159 | Lee et al. | Oct 2004 | A1 |
| 20040199166 | Schmieding et al. | Oct 2004 | A1 |
| 20040225233 | Frankowski | Nov 2004 | A1 |
| 20040260358 | Vaughan et al. | Dec 2004 | A1 |
| 20050027199 | Clarke | Feb 2005 | A1 |
| 20050033393 | Daglow | Feb 2005 | A1 |
| 20050049592 | Keith et al. | Mar 2005 | A1 |
| 20050060006 | Pflueger et al. | Mar 2005 | A1 |
| 20050075578 | Gharib et al. | Apr 2005 | A1 |
| 20050149034 | Assell et al. | Jul 2005 | A1 |
| 20050149035 | Pimenta et al. | Jul 2005 | A1 |
| 20050149154 | Cohen et al. | Jul 2005 | A1 |
| 20050171587 | Daglow et al. | Aug 2005 | A1 |
| 20050182454 | Gharib et al. | Aug 2005 | A1 |
| 20050187537 | Loeb et al. | Aug 2005 | A1 |
| 20050197661 | Carrison et al. | Sep 2005 | A1 |
| 20050203599 | Garabedian et al. | Sep 2005 | A1 |
| 20050209610 | Carrison | Sep 2005 | A1 |
| 20050209617 | Koven et al. | Sep 2005 | A1 |
| 20050209622 | Carrison | Sep 2005 | A1 |
| 20050216023 | Aram et al. | Sep 2005 | A1 |
| 20050222598 | Ho et al. | Oct 2005 | A1 |
| 20050222647 | Wahlstrand et al. | Oct 2005 | A1 |
| 20050234425 | Miller et al. | Oct 2005 | A1 |
| 20050256423 | Kirsner | Nov 2005 | A1 |
| 20050261692 | Carrison et al. | Nov 2005 | A1 |
| 20050277942 | Kullas et al. | Dec 2005 | A1 |
| 20050283148 | Janssen et al. | Dec 2005 | A1 |
| 20050283204 | Buhlmann et al. | Dec 2005 | A1 |
| 20060004369 | Patel et al. | Jan 2006 | A1 |
| 20060015035 | Rock | Jan 2006 | A1 |
| 20060025702 | Sterrantino et al. | Feb 2006 | A1 |
| 20060025703 | Miles et al. | Feb 2006 | A1 |
| 20060025797 | Lock et al. | Feb 2006 | A1 |
| 20060030854 | Haines | Feb 2006 | A1 |
| 20060036211 | Solsberg et al. | Feb 2006 | A1 |
| 20060036271 | Schomer et al. | Feb 2006 | A1 |
| 20060036272 | Solsberg et al. | Feb 2006 | A1 |
| 20060058732 | Harp | Mar 2006 | A1 |
| 20060064101 | Arramon | Mar 2006 | A1 |
| 20060079919 | Harp | Apr 2006 | A1 |
| 20060085048 | Cory et al. | Apr 2006 | A1 |
| 20060085049 | Cory et al. | Apr 2006 | A1 |
| 20060089609 | Bleich et al. | Apr 2006 | A1 |
| 20060089633 | Bleich et al. | Apr 2006 | A1 |
| 20060089640 | Bleich et al. | Apr 2006 | A1 |
| 20060089650 | Nolde | Apr 2006 | A1 |
| 20060089688 | Panescu | Apr 2006 | A1 |
| 20060094976 | Bleich | May 2006 | A1 |
| 20060095026 | Ricart et al. | May 2006 | A1 |
| 20060095028 | Bleich | May 2006 | A1 |
| 20060095059 | Bleich et al. | May 2006 | A1 |
| 20060100651 | Bleich | May 2006 | A1 |
| 20060122458 | Bleich | Jun 2006 | A1 |
| 20060122620 | Kim | Jun 2006 | A1 |
| 20060122653 | Bradley et al. | Jun 2006 | A1 |
| 20060122654 | Bradley et al. | Jun 2006 | A1 |
| 20060135882 | Bleich | Jun 2006 | A1 |
| 20060142753 | Francischelli et al. | Jun 2006 | A1 |
| 20060149278 | Abdou | Jul 2006 | A1 |
| 20060161189 | Harp | Jul 2006 | A1 |
| 20060173374 | Neubardt et al. | Aug 2006 | A1 |
| 20060184175 | Schomer et al. | Aug 2006 | A1 |
| 20060195107 | Jones et al. | Aug 2006 | A1 |
| 20060200153 | Harp | Sep 2006 | A1 |
| 20060200154 | Harp | Sep 2006 | A1 |
| 20060200155 | Harp | Sep 2006 | A1 |
| 20060200219 | Thrope et al. | Sep 2006 | A1 |
| 20060206115 | Schomer et al. | Sep 2006 | A1 |
| 20060206117 | Harp | Sep 2006 | A1 |
| 20060206118 | Kim et al. | Sep 2006 | A1 |
| 20060206178 | Kim | Sep 2006 | A1 |
| 20060224060 | Garell et al. | Oct 2006 | A1 |
| 20060224078 | Hoey et al. | Oct 2006 | A1 |
| 20060235451 | Schomer et al. | Oct 2006 | A1 |
| 20060235452 | Schomer et al. | Oct 2006 | A1 |
| 20060241648 | Bleich et al. | Oct 2006 | A1 |
| 20060258951 | Bleich et al. | Nov 2006 | A1 |
| 20060264952 | Nelson et al. | Nov 2006 | A1 |
| 20060264994 | Schomer et al. | Nov 2006 | A1 |
| 20060276720 | McGinnis et al. | Dec 2006 | A1 |
| 20060276802 | Vresilovic et al. | Dec 2006 | A1 |
| 20060276836 | Bergin et al. | Dec 2006 | A1 |
| 20070010717 | Cragg | Jan 2007 | A1 |
| 20070016097 | Farquhar et al. | Jan 2007 | A1 |
| 20070016185 | Tullis et al. | Jan 2007 | A1 |
| 20070027464 | Way et al. | Feb 2007 | A1 |
| 20070027514 | Gerber | Feb 2007 | A1 |
| 20070049962 | Marino et al. | Mar 2007 | A1 |
| 20070055215 | Tran et al. | Mar 2007 | A1 |
| 20070055262 | Tomita et al. | Mar 2007 | A1 |
| 20070055263 | Way et al. | Mar 2007 | A1 |
| 20070106219 | Grabinsky | May 2007 | A1 |
| 20070123888 | Bleich et al. | May 2007 | A1 |
| 20070123890 | Way et al. | May 2007 | A1 |
| 20070162044 | Marino | Jul 2007 | A1 |
| 20070162061 | Way et al. | Jul 2007 | A1 |
| 20070162062 | Norton et al. | Jul 2007 | A1 |
| 20070166345 | Pavcnik et al. | Jul 2007 | A1 |
| 20070198019 | Schomer et al. | Aug 2007 | A1 |
| 20070213583 | Kim et al. | Sep 2007 | A1 |
| 20070213584 | Kim et al. | Sep 2007 | A1 |
| 20070213734 | Bleich et al. | Sep 2007 | A1 |
| 20070213735 | Saadat et al. | Sep 2007 | A1 |
| 20070213795 | Bradley et al. | Sep 2007 | A1 |
| 20070225703 | Schmitz et al. | Sep 2007 | A1 |
| 20070255162 | Abboud et al. | Nov 2007 | A1 |
| 20070260252 | Schmitz et al. | Nov 2007 | A1 |
| 20070270795 | Francischelli et al. | Nov 2007 | A1 |
| 20070270865 | Arnin et al. | Nov 2007 | A1 |
| 20080033465 | Schmitz et al. | Feb 2008 | A1 |
| 20080051812 | Schmitz et al. | Feb 2008 | A1 |
| 20080058874 | Westlund et al. | Mar 2008 | A1 |
| 20080125621 | Gellman et al. | May 2008 | A1 |
| 20080125709 | Chang et al. | May 2008 | A1 |
| 20080146867 | Gellman et al. | Jun 2008 | A1 |
| 20080161810 | Melkent | Jul 2008 | A1 |
| 20080197024 | Simpson et al. | Aug 2008 | A1 |
| 20080288005 | Jackson | Nov 2008 | A1 |
| 20080319459 | Al-najjar | Dec 2008 | A1 |
| 20090018610 | Gharib et al. | Jan 2009 | A1 |
| 20090105604 | Bertagnoli et al. | Apr 2009 | A1 |
| 20090138056 | Anderson et al. | May 2009 | A1 |
| 20090143829 | Shluzas | Jun 2009 | A1 |
| 20090177112 | Gharib et al. | Jul 2009 | A1 |
| 20090182382 | Justis et al. | Jul 2009 | A1 |
| 20090204119 | Bleich et al. | Aug 2009 | A1 |
| 20090209879 | Kaula et al. | Aug 2009 | A1 |
| 20100010334 | Bleich et al. | Jan 2010 | A1 |
| 20100057087 | Cha | Mar 2010 | A1 |
| 20100094231 | Bleich et al. | Apr 2010 | A1 |
| 20100274250 | Wallace et al. | Oct 2010 | A1 |
| 20100331883 | Schmitz et al. | Dec 2010 | A1 |
| 20100331900 | Garabedian et al. | Dec 2010 | A1 |
| 20110004207 | Wallace et al. | Jan 2011 | A1 |
| 20110046613 | Schmitz et al. | Feb 2011 | A1 |
| 20110060314 | Wallace et al. | Mar 2011 | A1 |
| 20110112539 | Wallace et al. | May 2011 | A1 |
| 20110160731 | Bleich et al. | Jun 2011 | A1 |
| 20110160772 | Arcenio et al. | Jun 2011 | A1 |
| 20110190772 | Saadat | Aug 2011 | A1 |
| 20110196257 | Schmitz et al. | Aug 2011 | A1 |
| 20110224709 | Bleich | Sep 2011 | A1 |
| 20120016368 | Bleich et al. | Jan 2012 | A1 |
| 20120022538 | Schmitz et al. | Jan 2012 | A1 |
| 20120065639 | Schmitz et al. | Mar 2012 | A1 |
| 20120078255 | Bleich et al. | Mar 2012 | A1 |
| 20120095468 | Wallace et al. | Apr 2012 | A1 |
| 20120123294 | Sun et al. | May 2012 | A1 |
| 20120143206 | Wallace et al. | Jun 2012 | A1 |
| Number | Date | Country |
|---|---|---|
| 32094031 | Sep 1983 | DE |
| 40 36 804 | May 1992 | DE |
| 359883 | Mar 1990 | EP |
| 1304080 | Apr 2003 | EP |
| 1340467 | Sep 2003 | EP |
| 1207794 | May 2004 | EP |
| 1315463 | May 2005 | EP |
| 1611851 | Jan 2006 | EP |
| 1006885 | Sep 2006 | EP |
| 2706309 | Dec 1994 | FR |
| 2960140 | Oct 1999 | JP |
| 23116868 | Apr 2003 | JP |
| 24065380 | Mar 2004 | JP |
| 2107459 | Mar 1998 | RU |
| WO9222259 | Dec 1992 | WO |
| WO-9622057 | Jul 1996 | WO |
| WO9714362 | Apr 1997 | WO |
| WO9734536 | Sep 1997 | WO |
| WO9918866 | Apr 1999 | WO |
| WO-9921500 | May 1999 | WO |
| WO-0067651 | Nov 2000 | WO |
| WO 0108571 | Feb 2001 | WO |
| WO0162168 | Aug 2001 | WO |
| WO0207901 | Jan 2002 | WO |
| WO0234120 | May 2002 | WO |
| WO02076311 | Oct 2002 | WO |
| WO03026482 | Apr 2003 | WO |
| WO03066147 | Aug 2003 | WO |
| WO2004002331 | Jan 2004 | WO |
| WO 2004028351 | Apr 2004 | WO |
| WO2004043272 | May 2004 | WO |
| WO2004056267 | Jul 2004 | WO |
| WO2004078066 | Sep 2004 | WO |
| WO2004080316 | Sep 2004 | WO |
| WO2004096080 | Nov 2004 | WO |
| WO-2005009300 | Feb 2005 | WO |
| WO2005057467 | Jun 2005 | WO |
| WO 2005077282 | Aug 2005 | WO |
| WO2005089433 | Sep 2005 | WO |
| WO2006009705 | Jan 2006 | WO |
| WO2006015302 | Feb 2006 | WO |
| WO2006017507 | Feb 2006 | WO |
| WO2006039279 | Apr 2006 | WO |
| WO2006042206 | Apr 2006 | WO |
| WO2006044727 | Apr 2006 | WO |
| WO2006047598 | May 2006 | WO |
| WO2006058079 | Jun 2006 | WO |
| WO2006058195 | Jun 2006 | WO |
| WO2006062555 | Jun 2006 | WO |
| WO2006086241 | Aug 2006 | WO |
| WO2006099285 | Sep 2006 | WO |
| WO2006102085 | Sep 2006 | WO |
| WO2007008709 | Jan 2007 | WO |
| WO2007021588 | Feb 2007 | WO |
| WO2007022194 | Feb 2007 | WO |
| WO2007059343 | Feb 2007 | WO |
| WO2007067632 | Jun 2007 | WO |
| WO2008008898 | Jan 2008 | WO |
| Entry |
|---|
| Tomita, et al. The Threadwire Saw: a New Device for Cutting Bone. Dec. 1996. Journal of Bone and Joint Surgery, Inc. vol. 78-A, No. 12. pp. 1915-1917. |
| Baumgart et al., “Indikation and Technik der Knochendurchtrennung,” Der Chirurg, 1998, vol. 69:1188-1196. (in German with Eng Summary). |
| Bohinski et al., “Novel use of a threadwire saw for high sacral amputation,” Journal of neurosurgery: Spine, 2005, vol. 3, 71R78. |
| Burrows, Harold, “Surgical instruments and appliances used in operations,” Faber and Faber, London, 1937, total pp. 4. |
| Dammann, Gordon, Pictorial Encyclopedia of Civil War Medical Instruments and Equipment, Pictorial Histories Publishing Company, Missoula, Montana, 1983, Total pp. 2. |
| Edwards et al; “T-Saw Laminoplasty for the Management of Cervical Spondylotic Myelopathy,” SPINE, Lippincott Williams & Wilkins, Inc., 2000, vol. 25 (14): 1788R1794. |
| Eralp et al., “A comparison of two osteotomy techniques for tibial lengthening,” Archives of orthopaedic and trauma surgery, 2004, vol. 124:298R300. |
| Goel, Atul, “Neurosurgical forum, Supraorbital Craniotomy,” Journal of Neurosurgery, 1994, vol. 81, 642-643. |
| Gore Smoother User Manual, W. L. Gore & Associates, Inc. Flagstaff, AZ, Dec. 1999,Total pp. 3. |
| Hata et al; “A less invasive surgery for rotator cuff tear: Mini-open repair,” Journal of Shoulder and Elbow Surgery, 2001, vol. 10 No. 1, 11-16. |
| Jun, Byung-Yoon, “Posterior Lumbar Interbody Fusion With Restoration of Lamina and Facet Fusion,” SPINE, Lippincott Williams & Wilkins, Inc., 2000, vol. 25 No. 8, 917R922. |
| Martin-Benlloch et al., “Expansive Laminoplasty as a Method for Managing Cervical Multilevel Spondylotic Myelopathy,” Spine, Lippincott Williams & Wilkins, Inc., 2003, vol. 28 No. 7, 680R684. |
| Miyamoto et al., “Kyphectomy Using a Surgical Threadwire (T-saw) for Kyphotic Deformity in a Child With Myelomeningocele,” SPINE, Lippincott Williams & Wilkins, Inc., 2003, vol. 28 No. 10, E187RE190. |
| Abdel-Wanis et al., “Tumor growth potential after tumoral and instrumental contamination: an in-vivo comparative study of T-saw, Gigli saw, and scalpel,” Journal of orthopaedic science, 2001, vol. 6, 424R429. |
| Mopec Bone-Cutting tool, Product brochure, Total pp. 4. |
| Nakagiri et al., “Thoracoscopic Rib Resection Using a Gigli Saw,” The Annals of Thoracic Surgery, 2005, vol. 80, 755R756. |
| Osaka et al., “Clinical significance of a wide excision policy for sacrococcygeal chordoma,” J Cancer Res Clin Oncol, 2005, Total pp. 6. |
| Paley et al., “Percutaneous Osteotomies,” Orthopedic Clinics of North America, 1991, vol. 22 No. 4, 613-624. |
| Pancoast, Joseph, “A Treatise on Operative Surgery,” Carey and Hart, Philadelphia,1844, Total pp. 11. |
| Park et al; “Cases of the Excision of Carious Joints,” John Scrymgeour, Glasgow, 1806, Total pp. 6. |
| Peavy et al., “Comparison of Cortical Bone Ablations by Using Infrared Laser Wavelengths 2.9 to 9.2 μm, Lasers in Surgery and Medicine,” 1999, vol. 26, 421R434. |
| Peltier, Leonard Orthopedics: A History and Iconography, Norman Publishing, San Francisco, 1993, Total pp. 3. |
| Rutkow, Ira, “Surgery an Illustrated History,” Mosby'Year Book, Inc., St. Louis, 1993, Total pp. 4. |
| Schwieger et al., “Abrasive Water Jet Cutting as a New Procedure for Cutting Cancellous Bone'In Vitro Testing in Comparison with the Oscillating Saw,” Wiley Interscience, www.interscience,wiley.com, Sep. 20, 2004, 223-228. |
| Sen, Cengiz, Tibia proksimalinde Gigli testeresi ile yapilanperkütan osteotominin güvenilirligi: Kadavra calismasi, Acta orthopaedica et traumatologica turcica, 2002, vol. 36, 136-140; (in Russian w/ Eng Summary). |
| Shiraishi et al., “Results of Skip Laminectomy—Minimum 2-Year Follow-up Study Compared With Open-Door Laminoplasty,” Spine, Lippincott Williams & Wilkins, Inc., 2003, vol. 28 No. 24, 2667-2672. |
| Shiraishi T., “A new technique for exposure of the cervical spine laminae,” Journal of neurosurgery. Spine, 2002, vol. 96(1), 122-126. |
| Shiraishi T., Skip laminectomy—a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes: a preliminary report, Spine, 2002, vol. 2(2), 108-115. |
| Skippen et al., “The Chain Saw R A Scottish Invention,” Scottish Medical Journal, 2004, vol. 49(2), 72-75. |
| Stevens et al., “Calvarial Bone Graft Harvest Using the Gigli Saw,” Journal of Oral and Maxillofacial Surgery, 1998, vol. 56, 798-799. |
| Takada et al., “Unusual Metastasis to the Cauda Equina From Renal Cell Carcinoma,” SPINE, Lippincott Williams & Wilkins, Inc., 2003, vol. 28 No. 6, E114RE117. |
| Paktiss et al., “Afghan Percutaneous Osteotomy,” Journal of Pediatric Orthopaedics, Raven Press Ltd, New York, 1993, vol. 13 No. 4, 531-533. |
| Tomita et al., “The Threadwire Saw: a New Device for Cutting Bone,” The Journal of Bone and Joint Surgery, 1996, vol. 78, 1915-1917. |
| Truax, Charles, “The Mechanics of Surgery,” Chicago, IL; 1899, Total pp. 3. |
| Wilkins, Robert H, “Neurosurgical Classics,” Johnson Reprint Corporation, New York, 1965, 377-382. |
| Bleich et al; U.S. Appl. No. 11/952,934 entitled “Tissue Removal Devices and Methods,” filed Dec. 7, 2007. |
| Schmitz et al; U.S. Appl. No. 11/468,247 entitled “Tissue access guidewire system and method,” filed Aug. 29, 2006. |
| Schmitz et al; U.S. Appl. No. 11/468,252 entitled “Tissue access guidewire system and method,” filed Aug. 29, 2006. |
| Schmitz et al; U.S. Appl. No. 11/538,345 entitled “Articulating Tissue Cutting Device,” filed Oct. 3, 2006. |
| Schmitz et al; U.S. Appl. No. 11/843,561 entitled “Surgical Probe and Method of Making,” filed Aug. 22, 2007. |
| Schmitz et al; U.S. Appl. No. 11/870,370 entitled “Percutaneous Spinal Stenosis Treatment,” filed Oct. 10, 2007. |
| Schmitz et al; U.S. Appl. No. 12/060,229 entitled “Method, system, and apparatus for neural localization,” filed Mar. 31, 2008. |
| Barer, Malvin, Instrument to Enhance Passage of the Gigli Saw, Journal of Pediatric Orthopedics, 1984, vol. 4, pp. 762-763. |
| Brunori, Andrea, et al., Celebrating the Centennial (1894-1994): Leonardo Gigli and His Wire Saw, J. Neurosurg, Jun. 1995, vol. 82, pp. 1086-1090. |
| Fujita, Takuya, et al., Chordoma in the Cervical Spine Managed With En Bloc Excision, SPINE, 1999, vol. 24, No. 17, pp. 1848-1851. |
| Hara, Masahito, et al., En Bloc Laminoplasty Performed with Threadwire Saw: Technical Note, Neurosurgery, Jan. 2001, vol. 48, No. 1, pp. 235-239. |
| Honl, Matthias, et al., The Use of Water-Jetting Technology in Prostheses Revision Surgery—First Results of Parameter Studies on Bone and Bone Cement, Journal of Biomedical Materials Research; Applied Biomaterials, vol. 53, Issue 6, published online Nov. 20, 2000, pp. 781-790. |
| Kawahara, Norio, et al., Recapping T-Saw Laminoplasty for Spinal Cord Tumors, SPINE, 1999, vol. 24, No. 13, pp. 1363-1370. |
| Reckling, Frederick W., Modified Stethoscope Earpiece Makes Excellent Gigli Saw Guide, Orthopaedic Surgery, Department of Surgery, University of Kansis Medical Center, Kansis City, Dec. 1972, vol. 54-A, No. 8, pp. 1787-1788. |
| Tomita, K., et al., Total En Bloc Spondylectomy and Circumspinal Decompression for Solitary Spinal Metastasis, International Medical Society of Paraplegia, 1994, vol. 32, pp. 36-46. |
| Tomita, K., et al., Total En Bloc Spondylectomy for Solitary Spinal Metastases, International Orthopaedics, 1994, vol. 18, pp. 291-298. |
| Tomita, Katsuro, et al., Expansive Midline T-Saw Laminoplasty (Modified Spinous Process-Splitting) for the Management of Cervical Myelopathy; SPINE, 1998, vol. 23, No. 1, p. 32-37. |
| Tomita et al., “The Use of the T-Saw for Expansive Midline laminoplasty in the Treatment of Cervical Myelopathy,” Orthopedics and Traumatology, No. 3, pp. 169-178, 2002. |
| Bleich, et al.; U.S. Appl. No. 12/127,535 entitled “Guidewire exchange systems to treat spinal stenosis,” filed May 27, 2008. |
| Bleich, et al.; U.S. Appl. No. 12/140,201 entitled “Devices and methods for measuring the space around a nerve root,” filed Jun. 16, 2008. |
| Schmitz et al.; U.S. Appl. No. 12/170,392 entitled “Spinal access system and method,” filed Jul. 9, 2008. |
| Fessler, Richard G., “Minimally Invasive Microendoscopic Decompressive Laminotomy for Lumbar Stenosis” [online], Copyright © 2006 American Association of Neurological Surgeons, Online CME Course, [Retrieved on Jun. 29, 2006], Retrieved from the Internet: <URL: http://www.aans.emedtrain.com/lumbar—stenosis/lumbarStenosis.swf>. |
| Ellman Int. Disc-FX System Accessories K052241 [online] Retrieved from the internet: <URL: http://www.ellman.com/medical/ >. |
| Codman Laminectomy Shaver (a Johnson & Johnson company www.codman.com) catalogue, pp. 416-431, [online] Retrieved from the internet: <URL: http://www.codman.com/PDFs/Catalog—04—R.pdf >. |
| Zeppelin Laminectomy Rongeur K901372, [online] Retrieved from the internet: <URL: http://www.zeppelin-medical.com/download/instruments.pdf>. |
| Integra Ruggles™ Kerrison Rongeurs [online] Retrieved from the internet: <URL: http://www.integra-ls.com/product/?product=22>. |
| US Surgical Kerrison Spinal Rongeur K943116 [online] Retrieved from the internet: <URL: http://www.ussurg.com/uss/index.html>. |
| Schmitz et al.; U.S. Appl. No. 12/324,147 entitled “Tissue modification devices,” filed Nov. 26, 2008. |
| Schmitz et al.; U.S. Appl. No. 12/352,385 entitled “Devices, methods and systems for neural localization,” filed Jan. 12, 2009. |
| Bleich et al.; U.S. Appl. No. 12/352,978 entitled “Multiple pathways for spinal nerve rood decompression from a single access point,” filed Jan. 13, 2009. |
| Bleich, Jeffrey; U.S. Appl. No. 12/357,289 entitled “Devices and methods for selective surgical removal of tissue,” filed Jan. 21, 2009. |
| Bleich et al.; U.S. Appl. No. 13/112,918 entitled “Methods, Systems and Devices for Carpal Tunnel Release”, filed May 20, 2011. |
| US Surgical Kerrison Spinal Rongeur K943116 [online] Retrieved from the Internet <URL: http://www.ussurg.com/uss/index.html>. Jul. 27, 1994. |
| Zeppelin Laminectomy Rongeur K901372, [online] Retrieved from the Internet: <URL: http://www.zeppelin-medical.com/download/instruments.pdf>. Oct. 24, 2006. |
| Ellman Int. Disc-FX System Accessories K052241 [online] Retrieved from the Internet <URL: http://www.ellman.com/ medical/ >. Feb. 27, 2006. |
| Ohta et al., “Superimposed Mechanomygraphic Response at Different Contraction Intensity in Medial Gastrocnemius and Soleus Muscles,” International Journal of Sport and Health Science: vol. 5, 63-70, 2007. |
| Schwieger et al., “Abrasive Water Jet Cutting as a New Procedure for Cutting Cancellous Bone—In Vitro Testing in Comparison with the Oscillating Saw,” Wiley Interscience, www.interscience,wiley.com, Sep. 20, 2004, 223-228. |
| Mopec Bone-Cutting tool, Product brochure, Total pp. 4. First accessed Dec. 15, 2005. |
| Codman Laminectomy Shaver (a Johnson & Johnson company www.codman.com) catalogue, pp. 416-431, [online] Retrieved from the internet: <URL: http:llwww.codman.com/PDFs/Catalog—04—R.pdf>. First accessed Oct. 24, 2006. |
| Integra Ruggles TM Kerrison Rongeurs [online] Retrieved from the Internet <URL: http://www.integra-ls.com/products!? product=22>. First accessed Oct. 24, 2006. |
| Herkowitz, “The Cervical Spine Surgery Atlas”, Herkowitz, “The Cervical Spine Surgery Atlas”, 2004, 2nd Edition Jan. 1, 2004, 203-206, 208. |
| Schmitz et al.; U.S. Appl. No. 13/267,683 entitled “Flexible Tissue Removal Devices and Methods,” filed Oct. 6, 2011. |
| Wallace et al.; U.S. Appl. No. 13/338,134 entitled “Surgical Tools for Treatment of Spinal Stenosis,” filed Dec. 27, 2011. |
| Bleich et al.; U.S. Appl. No. 13/484,744 entitled “Devices and Methods for Tissue Modification,” filed May 31, 2012. |
| Bleich et al.; U.S. Appl. No. 13/430,500 entitled “Devices and Methods for Tissue Modification,” filed Mar. 26, 2012. |
| Garabedian et al.; U.S. Appl. No. 13/437,214 entitled “Flexible Tissue Rasp,” filed Apr. 2, 2012. |
| Number | Date | Country | |
|---|---|---|---|
| 20070213733 A1 | Sep 2007 | US | |
| 20120078253 A9 | Mar 2012 | US |
| Number | Date | Country | |
|---|---|---|---|
| 60619306 | Oct 2004 | US | |
| 60622865 | Oct 2004 | US | |
| 60681719 | May 2005 | US | |
| 60681864 | May 2005 | US | |
| 60685190 | May 2005 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 11375265 | Mar 2006 | US |
| Child | 11405848 | US | |
| Parent | PCT/US2005/037136 | Oct 2005 | US |
| Child | 11375265 | US |
