Access and tissue modification systems and methods

Abstract

Described herein are methods and systems for precisely placing and/or manipulating devices within the body by first positioning a guidewire or pullwire through the body from a first location, around a curved pathway, and out of the body through a second location, so that the distal and proximal ends of the guidewire extend from the body, then pulling a device into position using the guidewire. The device to be positioned within the body is coupled to the proximal end of the guidewire, and the device is pulled into the body by pulling on the distal end of the guidewire that extends from the body. The device may be bimanually manipulated by pulling the guidewire distally, and an attachment to the device that extends proximally, allowing control of both the proximal and the distal ends. In this manner devices (and particularly implants such as innerspinous distracters, stimulating leads, and disc slings) may be positioned and/or manipulated within the body. Devices to modify tissue may also be positioned or manipulated so that a target tissue within the body is modified.

Description

CROSS REFERENCE TO RELATED APPLICATIONS[0001]This application is a continuation-in-part to U.S. patent application Ser. No. 11 / 952,934, titled “TISSUE REMOVAL DEVICES AND METHODS”, filed on Dec. 7, 2007; which claims the benefit of U.S. Provisional Patent Application No. 60 / 869,070, titled “FLEXIBLE TISSUE REMOVAL DEVICES AND METHODS”, filed on Dec. 7, 2006.[0002]This application is a also a continuation-in-part to U.S. patent application Ser. No. 12 / 637,447, titled “DEVICES AND METHODS FOR TISSUE MODIFICATION”, filed Dec. 14, 2009; which is a continuation of U.S. patent application Ser. No. 12 / 428,369, titled “DEVICES AND METHODS FOR TISSUE MODIFICATION”, filed on Apr. 22, 2009; which is a continuation of U.S. patent application Ser. No. 11 / 251,165, titled “DEVICES AND METHODS FOR TISSUE MODIFICATION”, filed on Oct. 15, 2005, now U.S. Pat. No. 7,555,307; which claims the benefit of U.S. Provisional Application No. 60 / 619,306, titled “METHODS AND APPARATUS FOR THE TREATMENT OF TISSU...

AI Technical Summary

Problems solved by technology

This may result in shorter hospital stays, or allow outpatient treatment.

Unfortunately, the use of minimally-invasive techniques has often required a loss in control of the treatment device or implant, as the treatment sites are often deep within the body, proving both difficult to access, as well as difficult to manipulate the device when the body region is minimally invasively accessed.

In particular, finding leverage to position or manipulate minimally invasive devices once deployed has proven extremely difficult.

As a result, complex and expensive tools have been created to allow manipulation of distally-positioned devices or implants within the body.

Even in variations of minimally invasive procedures in which a second access port is used, coordination of the two access ports at the target has proven difficult, particularly when one or more devices are inserted through different access ports and required to meet at an internal site.

Finally, manipulation of implants and devices using any of these minimally invasive techniques has also proven difficult.

For example, when treating small or enclosed body regions such as joints, or regions surrounded by sensitive non-target tissue, manipulation of a device or implant within this space has been limited by the ability to control the distal end of the device from a proximal position.

This may lead to undesirable and dangerous kinking, bending, and torqueing of the access device and / or implant.

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