Devices, kits and methods for basivertebral nerve ablation via the lateral wall of the vertebral body

Abstract

Described herein is a trocar, kits and methods for basivertebral nerve ablation. The trocar is configured for an insertion in the back of the patient in a posterior to anterior direction, caudal or cranial to a traverse process of a vertebra of the patient to reach a lateral surface of a vertebral body of the vertebra. The trocar comprises a curved distal tip having a length and a curve configured to provide a desired insertion angle at a bone entry point located on the lateral wall of the vertebral body. The trocar is also configured to be used, and packaged as a kit, with devices such as stylet, a cannula, a drill and a probe, which may all be introduced inside the trocar. Also described are methods to carry out basivertebral nerve ablation by entering inside the vertebral body via the lateral wall of the vertebral body.

Description

DEVICES, KITS AND METHODS FOR BASIVERTEBRAL NERVE ABLATION VIA THE LATERAL WALL OF THE VERTEBRAL BODYCROSS REFERENCE TO RELATED APPLICATION

[0001] The present patent application claims priority to application serial number US 63 / 517,960 filed on August 07, 2023, the content of which is incorporated herein in its entirety.FIELD OF THE INVENTION

[0002] The invention relates to the field of spinal surgical procedures, and more particularly to surgical procedures requiring to access the interior of a patient’s vertebra such as basivertebral nerve ablation.BACKGROUND OF THE INVENTION

[0003] Vertebrogenic pain is a specific type of low back pain caused by the damage of vertebral endplates. Basivertebral nerve (BVN) ablation is a spinal surgical procedure by which the BVN is ablated when that nerve is source of chronic back pain as is often the case for vertebrogenic pain.

[0004] Different approaches and medical devices currently exist to perform various types of spinal surgical procedures as those described in patents EP 2 386 260, patent US 8,192,435, patent US 10,524,819 and patent applications US 2012 / 0221007 and US 2021 / 0236191. However these devices are not configured for intravertebral surgical procedures, let alone BVN ablation.

[0005] Although the existing procedures often aim to be as minimally invasive as possible, there is still room for improvement. Indeed, one of the challenges in keeping such procedures minimally invasive is the posterior and central location of the BVN within the vertebral body, which is in close proximity to the spinal canal. The BVN trunk is positioned in the posterior third of the vertebral body, approximatively 1 cm ventral to the posterior wall of the vertebral body, thereby often requiring a curved system to be able to safely reach the targeted site.

[0006] Procedures that currently exist use a trocar of about 4.2 mm in diameter, that passes through the pedicle of the vertebra. The pedicle is a narrow hard bone funnel-like structure. The limited width of the pedicle limits the ability to orient the trocar inside the vertebral body. The axis of the trocar cannot coincide with the basivertebral nerve trunk, which is the targeted location for the ablation probe, because the BVN trunk is too close to the posterior wall of the vertebral body. Once the trocar has reached the vertebral body posterior wall, a pre-curved cannula of a diameter of about 3 mm typically made of plastic (and its stylet, curved or straight) is pushed into the lumen of the trocar and forced into the cancellous bone to form a tight curved channel of a radius of curvature of about 10 mm to reach the BVN trunk.

[0007] The endplate inflammation associated with the vertebral body condition affecting patients with vertebrogenic pain can cause densification of the bone, also called osteosclerosis. This may lead to difficulty in manoeuvring the instruments in the cancellous bone.

[0008] The presence of bone sclerosis often results in a reduction of the expected curvature in the cancellous bone of the vertebral body, leading to a discernible variance between the targeted ablation location and the actual ablation site. A larger ablation lesion volume is required if the probe doesn’t land at the right location to reach the BVN trunk, which leads to weakening of the vertebral body, and potential vertebral compression fractures. Multiple fractures have been reported on the FDA “Manufacturer and User Facility Device Experience”, following BVN ablations with current devices.

[0009] A frequently observed complication associated with this procedure is the interaction between the curved instruments and the straight trocar. As the instruments are withdrawn from the trocar, their shafts tend to come into contact with, and often snag on, the trocar’s sharp edges. Given that the cannula and probe shafts are made of plastic, i.e., a material generally less durable than the stainless steel of the trocar, they can snag on the trocar’s sharp edge when they interact with the trocar. This results in a notch in the plastic material. This notch can lead to recurrent snagging each time the instrument is subsequently inserted and retracted. At the end of the procedure, when the instruments are retracted, snagging can result in the severing of a segment from the curved instrument,which may then unintentionally remain inside the patient. Such an occurrence is contrary to the instrument’s design, as it is not intended to deposit fragments within the patient’s body, given that it is not an implantable device. Multiple incidents involving instruments debris left in the patient’s body have also been reported on the FDA “Manufacturer and User Facility Device Experience” following BVN ablations with current devices.

[0010] Another challenge with existing devices is to maintain the pre-curved cannula’s elastic deformation as it is inserted into the straight lumen of the trocar. This requires a material or design that is flexible, a characteristic that contrasts with the need for the cannula to maintain its stiffness and shape in order to create a curved channel in the bone. Also, in cases where a patient has undergone prior spinal fusion with screws implanted in their pedicles, the accessibility of the trocar to the pedicles is compromised. This obstruction effectively eliminates the feasibility of performing this particular procedure.

[0011] Lastly, the larger size of the introducer passing through a transpedicular approach also may generate long post-procedural discomfort as it passes very close to the medial branch nerve and just superiorly to the exiting spinal nerve.

[0012] Accordingly, is a need to improve current intravertebral surgical procedures, such as BVN ablation, with simpler, less invasive and more reliable medical devices and methods. There is particularly a need for a BVN ablation procedure that requires less invasive instruments, and / or instruments that are more precise and capable of providing a more localized ablation, reducing risks to weaken the vertebral body.

[0013] Yet, there is a need for devices and methods that may be used for, or in the context of, various surgical interventions requiring to access the interiorof a vertebra, such as vertebral augmentation, vertebroplasty, kyphoplasty, tumor ablation close to / in contact with the posterior wall of a vertebra, and / or any other surgical procedure requiring a path / channel inside a vertebra, especially in the posterior portion of the vertebral body (e.g. for an instrument, injecting a fluid, for installing an implant, for cementing the bone, etc.).

[0014] Accordingly, there is also a need for vertebra-related procedures that are faster than existing procedures, that may allow to treat multiple vertebrae simultaneously, and / orthat may allow to position instruments to their targeted locations faster, and / or that avoids risks of deposition of fragments of material within the patient’s body.

[0015] There is particularly a need for methods of basivertebral nerve ablation wherein entry inside the vertebral body is not via the pedicle of the vertebra but via the lateral wall of the vertebral body.

[0016] There is also a need for BVN ablation devices and assemblies, including one or more of a trocar, a stylet, a cannula, a probe, guidewire, drill, etc. that have been configured for an entry point inside the vertebra via its lateral wall of the vertebral body.

[0017] The present invention addresses these needs and other needs as it will be apparent from the review of the disclosure and description of the features of the invention hereinafter.BRIEF SUMMARY OF THE INVENTION

[0018] According to one aspect, the invention relates to a trocar for basivertebral nerve ablation in a patient, the trocar comprising a handle, and a rigid and hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, a lumen extending inside the shaft from the proximal end to the distal tip, wherein the lumen of the shaft is adapted to receive and guide at least one of a bone penetration device and a bone channeling device, from the proximal end of the shaft towards its distal tip, and wherein the trocar is configured for an insertion in the back of the patient in a posterior to anterior direction, caudal or cranial to a traverse process of a vertebra of the patient to reach a lateral surface of a vertebral body of the vertebra, said introduction further requiring positioning of the distal tip of the hollow shaft on the lateral wall surface of the vertebral body at a bone entry point, said bone entry point being defined by a linear projection between a basivertebral nerve ablation site towards the lateral wall surface of the vertebral body, wherein saidlinear projection is substantially tangential to the curved distal portion of the shaft, and wherein the curved distal portion of the shaft comprises a length and a curve configured to both (i) provide a desired insertion angle at the bone entry point and (ii) direct the at least one bone penetration device and bone channeling device substantially along said tangential linear projection towards the basivertebral nerve ablation site.

[0019] According to another related aspect, the invention relates to a trocar for basivertebral nerve ablation, comprising a handle, and a rigid and hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, a lumen extending inside the shaft from the proximal end to the distal tip, wherein the lumen of the shaft is adapted to receive and guide at least one of a bone penetration device and a bone channeling device, from proximal end of the shaft towards its distal tip, and wherein the trocar is configured for an insertion in the back of the patient in a posterior to anterior direction, caudal or cranial to a traverse process of a vertebra of the patient to reach a lateral surface of a vertebral body of the vertebra said introduction further requiring positioning of the distal tip of the hollow shaft on the lateral wall surface of the vertebral body at a bone entry point defined by a curved projection between a basivertebral nerve ablation site towards the lateral wall surface of the vertebral body, and wherein the curved distal portion of the shaft comprises a length and a curve configured to both (i) provide a desired insertion angle at the bone entry point and (ii) provide said curved projection to direct the at leastone bone penetration device and bone channeling device substantially along said curved projection towards the basivertebral nerve ablation site.

[0020] According to another related aspect, the invention relates to a kit for basivertebral nerve ablation, the kit comprising a trocar, and at least one of a bone penetration device and a bone channeling device; the trocar comprising a handle, and a rigid and hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, a lumen extending inside the shaft from the proximal end to the distal tip, wherein the lumen of the shaft is adapted to receive and guide the bone penetration device and the bone channeling device, from its proximal end towards its distal tip, the bone penetration device comprising an elongated stem extending from a proximal end to a sharp distal tip, wherein the elongated stem comprises a diameter sized to slide inside the lumen of the trocar, is deformable to move along the curved distal portion of the trocar, is longer than the trocar, such that the sharp distal tip of the elongated stem projects out the distal tip of the hollow shaft when inserted therein, and wherein said sharp distal tip is sufficiently rigid to pierce through the lateral wall of a patient vertebral body,the bone channeling device comprising an elongated rod extending from a proximal end to a distal tip wherein the elongated rod has a diameter sized to slide inside the lumen of the trocar, is deformable to move along the curved distal portion of the trocar, is longer than the hollow shaft of the trocar, such that the distal tip of the elongated rod projects out the distal tip of the trocar when inserted therein, wherein the bone channeling device optionally comprises nerve ablation capabilities; and wherein the sharp distal tip of the bone channeling is sufficiently rigid to pierce through the lateral wall of the vertebral body of a patient.

[0021] According to another related aspect, the invention relates to abone piercing device comprising: an elongated stem extending from a proximal end to a cutting distal tip, wherein the elongated stem is configured and sized to slide inside the lumen of a trocar, and wherein said cutting distal tip comprises a pointy shape and a first diameter, and wherein said cutting distal tip is configured to create a hole having a second diameter larger than said first diameter.

[0022] According to another related aspect, the invention relates to a nerve ablation assembly comprising: a nerve ablation device comprising an elongated wire comprising a proximal end, an intermediate section and a distal tip, the wire extending from the proximal end to the distal tip, wherein the intermediate section provides for electrical insulation, andwherein the distal tip comprises an end section for conducting electricity, a bone channeling device comprising an elongated rod extending from a proximal end to a distal tip, the distal tip being configured for an insertion inside a patient vertebral body at a basivertebral nerve ablation site, wherein said rod comprises a lumen extending inside the rod from the proximal end to the distal tip thereof, said lumen being sized to receive the nerve ablation device; wherein the elongated rod provides for electrical insulation, and wherein the distal tip extends at a distal end of the rod, the distal tip conducting electricity.

[0023] According to another related aspect, the invention relates to a stylet for an intravertebral medical procedure, comprising an elongated shaft comprising an internal core covered by an external layer, wherein said external layer is made of a material more flexible that said internal core.

[0024] According to another related aspect, the invention relates to acannula and stylet assembly for an intravertebral medical procedure, comprising: the cannula comprising an elongated hollow rod extending from a proximal end to a curved distal tip, wherein the hollow rod defines a lumen extending inside the rod from the proximal end to the curved distal tip, said lumen being sized to receive and guide the stylet from the proximal end to the curved distal tip; the stylet comprising an elongated stem extending from a proximal end to a curved distal tip, wherein the elongated stem o comprises a diameter sized to slide inside the lumen of the cannula, o is deformable to move along the curved distal tip of the cannula, o is longer than the cannula, such that the curved distal tip of the elongated stem projects out the distal tip of the hollow rod when inserted therein, wherein the curved distal tip of the cannula and the curved distal tip of the stylet have different curvatures, andwherein rotating the stylet about the cannula changes a resulting curved distal tip of the cannula and stylet assembly.

[0025] According to another related aspect, the invention relates to a method of positioning a trocar for an intravertebral medical procedure, comprising: providing a trocar comprising a curved distal tip, inserting the trocar in a patient’s body in a posterior to anterior direction, caudal or cranial to a transverse process of a patient’s vertebra, such that the curved distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the vertebra.

[0026] According to another related aspect, the invention relates to a method of positioning a bone penetration device for an intravertebral medical procedure, comprising: providing a trocar and a bone penetration device, wherein the trocar comprises a hollow shaft, the hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, the hollow shaft further comprising a lumen extending inside the shaft from the proximal end to the distal tip, the lumen being adapted to receive and guide a bone penetration device, from the proximal end towards the distal tip of the trocar. wherein the bone penetration device comprises an elongated stem extending from a proximal end to a sharp distal tip, inserting the bone penetration device inside the trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining a trocar-penetration device assembly; and inserting the trocar-penetration device assembly in a posterior to anterior direction, caudal or cranial to a transverse process of a patient’s vertebra, such that the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the vertebra.

[0027] According to another related aspect, the invention relates to a method for basivertebral nerve ablation, comprising: providing a trocar comprising a hollow shaft, the hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, the hollow shaft further comprising a lumen extending inside the shaft from the proximal end to the distal tip, the lumen being adapted to receive and guide a guidewire and a bone penetration device, from its proximal end towards its distal tip; providing a guidewire configured to pierce the skin and be inserted in the back patient’s body, wherein the guidewire is sized to slide inside the lumen of the trocar; inserting the guidewire in the back patient’s body in a posterior to anterior direction, caudal or cranial to a transverse process of a patient’s vertebra until the guidewire reaches an entry point on a lateral side of a vertebral body of the vertebra or until the guide wire reaches a reference point on a traverse process of the vertebra; sliding the distal tip of the trocar over the guidewire until said distal tip reaches the entry point on the lateral side of the vertebral body or reaches the reference point; removing said guidewire; providing a bone penetration device comprising an elongated stem extending from a proximal end to a sharp distal tip, inserting the bone penetration device inside the lumen of the trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining a trocar-penetration device assembly; and inserting the trocar-penetration device assembly in a posterior to anterior direction, caudal or cranial to said transverse process, such that the distaltip of the trocar is positioned at a predefined entry point located on a lateral wall of the patient’s vertebral body.

[0028] According to another related aspect, the invention relates to a method of positioning multiple bone penetration devices on multiple vertebrae for an intravertebral medical procedure on multiple vertebrae concurrently or simultaneously, comprising: providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; and inserting each of the trocar-penetration device assemblies in a posterior to anterior direction, caudal or cranial to a transverse process of at least two different vertebrae of the patient, such that for each trocar-penetration assembly the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the patient vertebrae.

[0029] According to another related aspect, the invention relates to a method of positioning multiple bone penetration devices for an intravertebral medical procedure on a single vertebra, comprising: providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; and inserting each of the trocar-penetration device assemblies in a posterior to anterior direction, caudal or cranial to a transverse process of a single vertebra of the patient, such that for each trocar-penetration assembly the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the patient vertebra.

[0030] According to another related aspect, the invention relates to a method of positioning multiple bone penetration devices for an intravertebral medical procedure on a single vertebra, comprising: providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; and inserting each of the trocar-penetration device assemblies in a posterior to anterior direction, such that for each trocar-penetration assembly the distal tip of the trocar is positioned at a predefined entry point located either (i) on a lateral wall of a vertebral body or (ii) at a same level or above sacral ala of the patient vertebra.

[0031] According to another related aspect, the invention relates to a method for basivertebral nerve (BVN) ablation, the method comprising performing BVN ablation on multiple vertebrae simultaneously and / or concurrently.

[0032] According to another related aspect, the invention relates to the use of a trocar as defined herein, use of a kit as defined herein, use of a bone penetration device as defined herein, use a nerve ablation assembly as defined herein, use of a stylet as defined herein, and / or use a cannula and stylet assembly as defined herein, for basivertebral nerve ablation in a human patient in need thereof.

[0033] According to another related aspect, the invention relates to the use of a trocar as defined herein, use of a kit as defined herein, use of a bone penetration device as defined herein, use a nerve ablation assembly as defined herein, use of a stylet as defined herein, and / or use a cannula and stylet assembly as defined herein,

[0034] According to another related aspect, the invention relates to the use of a trocar as defined herein, use of a kit as defined herein, use of a bone penetration device as defined herein, use a nerve ablation assembly as defined herein, use of a stylet as defined herein, and / or use a cannula and stylet assembly as defined herein, for performingbasivertebral nerve (BVN) ablation on multiple vertebrae simultaneously and / or concurrently.

[0035] Additional aspects, advantages and features of the present invention will become more apparent upon reading of the following non-restrictive description of preferred embodiments which are exemplary and should not be interpreted as limiting the scope of the invention.BRIEF DESCRIPTION OF THE DRAWINGS

[0036] For the invention to be readily understood, embodiments of the invention are illustrated by way of example in the accompanying drawings.

[0037] Fig. 1 is a transverse view of a vertebra and a top elevation view of a BVN ablation assembly from the prior art.

[0038] Fig. 2 is a transverse view of a vertebra and a top elevation view of a trocar and stylet contacting the lateral wall of a vertebra, in accordance with one embodiment of the present invention.

[0039] Fig. 3 is a transverse view of a vertebra and a top elevation view of a trocar and stylet contacting the lateral wall of a vertebra, the figure further displaying a linear insertion trajectory inside the vertebra to reach a site of ablation, in accordance with one embodiment of the present invention.

[0040] Fig. 4 is a transverse view of a vertebra and a top elevation view of a trocar and stylet contacting the lateral wall of a vertebra, vertebra, the figure further displaying a curved insertion trajectory inside the vertebra to reach a site of ablation, in accordance with another embodiment of the present invention.

[0041] Fig. 5 is a side elevation view of the shaft of a trocar and its geometry, in accordance with one embodiment of the present invention.

[0042] Figs. 6A, 6B and 6C are side elevation views of different configurations of a stylet, in accordance with embodiments of the present invention.

[0043] Fig. 7A and 7B are side elevation views of a trocar (Fig. 7A) and a stylet inserted into the trocar (Fig. 7B), in accordance with embodiments of the present invention.

[0044] Fig. 8 is a transverse view of a vertebra and a top elevation view of the trocar and its stylet, contacting the lateral wall of a vertebra, in accordance with one embodiment of the present invention.

[0045] Figs. 9A and 9B are side elevation views of two different configurations of a cannula, in accordance with embodiments of the present invention.

[0046] Figs. 10A and 10B are elevation views of different configurations of the assembly of a cannula and its stylet, in accordance with embodiments of the present invention.

[0047] Fig. 11 is a transverse view of a vertebra and a top elevation view of an assembly comprising a trocar, a cannula and its stylet, with a straight trajectory inside the vertebral body, in accordance with one embodiment of the present invention.

[0048] Fig. 12 is a transverse view of a vertebra and a top elevation view of a trocar, a cannula and its stylet, with a curved trajectory in the vertebral body, in accordance with one embodiment of the present invention.

[0049] Fig. 13 is a side elevation view of a probe, in accordance with one embodiment of the present invention.

[0050] Fig. 14 is a transverse view of a vertebra and a top elevation view of the tip of a coaxial bipolar probe assembly inside a vertebra, in accordance with one embodiment of the present invention.

[0051] Fig 15 is a transverse view of a vertebra and a top elevation view of an assembly comprising of a probe, a cannula and a trocar, with a straight trajectory inside the vertebral body, in accordance with one embodiment of the present invention.

[0052] Fig 16 is a transverse view of a vertebra and a top elevation view of an assembly comprising a probe, a cannula and a trocar, with a curved trajectory inside the vertebral body, in accordance with one embodiment of the present invention.

[0053] Fig 17 is a transverse view of a vertebra and a top elevation view of an assembly comprising a probe, a cannula with a Luer lock connector, and a trocar with a straight trajectory inside the vertebral body, in accordance with one embodiment of the present invention.

[0054] Figs. 18A and 18B are transverse views of a vertebra and top elevation views of assemblies comprising a probe, a cannula and a trocar with a straight trajectory inside the vertebral body, the assembly further comprising one and two spacers, respectively, in accordance with embodiments of the present invention.

[0055] Fig. 19 is a transverse view of a vertebra and an exploded view of an electrode with an assembly comprising a hollow probe, a cannula, a trocar, and an electrode with a straight trajectory inside the vertebral body, in accordance with one embodiment of the present invention.

[0056] Fig. 20 is a transverse view of a vertebra and a top elevation view of an assembly comprising an electrode, a hollow probe, a cannula, and a trocar, with a straight trajectory inside the vertebral body, in accordance with one embodiment of the present invention.

[0057] Fig. 21 is a transverse view of a vertebra and a top elevation view of a syringe and its needle serving as a guidewire, the needle being inserted in the body and being anchored or referenced to transverse process of a patient’s vertebra, in accordance with embodiments of the present invention.

[0058] Fig. 22 is a transverse view of a vertebra and a top elevation view of a trocar being inserted over a guidewire, in accordance with one embodiment of the present invention.

[0059] Figs. 23A and 23B are transverse views of a vertebra and top elevation views of a trocar positioned at the transverse process of a vertebra, with and without a guidewire needle respectively, in accordance with one embodiment of the present invention.

[0060] Fig. 24A and 24B are transverse views of a vertebra and top elevation views of an insertion of a stylet in a trocar positioned at the transverse process of a vertebra, in accordance with one embodiment of the present invention.

[0061] Fig. 25 is a transverse view of a vertebra and a top elevation view of an assembly comprising a trocar and a stylet contacting the lateral wall of a vertebra, in accordance with one embodiment of the present invention.

[0062] Figs. 26A and 26B are transverse views of a vertebra and respectively a top exploded view and a top elevation view of a drill, a cannula, a trocar and spacers, the assembly contacting the lateral wall of a vertebra, in accordance with embodiments of the present invention.

[0063] Figs. 27A and 27B are transverse views of a vertebra and top elevation views of an assembly comprising a drill, a cannula and a trocar with a straight trajectory inside the vertebral body, the assembly further comprising a spacer (Fig. 27A) or the spacer having been removed (Fig. 27B), in accordance with embodiments of the present invention.

[0064] Figs. 28A and 28B are transverse views of a vertebra and respectively an exploded and an elevation view of an assembly comprising a probe, a cannula and a trocar with a straight trajectory inside the vertebral body, in accordance with embodiments of the present invention.

[0065] Figs. 29A to 29C are side elevation views of a drill tip, in accordance with embodiments of the present invention.

[0066] Fig. 29D is a bottom view of the drill tip of Fig. 29B, in accordance with one embodiment of the present invention.

[0067] Figs. 30A, 30B and 30C are side views of a drill tip at different moments during the drilling, in accordance with embodiments of the present invention.

[0068] Fig. 31 is a perspective view of multiple vertebrae and a multi-assembly of a trocar, a cannula and a probe for the ablation of the BVN, in accordance with one embodiment of the present invention.

[0069] Fig. 32 is a top side perspective view of a base, in accordance with one embodiment of the present invention.

[0070] Fig. 33 is a top side perspective view of a trocar inserted into a base deposited on the skin of a patient, in accordance with one embodiment of the present invention.

[0071] Fig. 34 is a top elevation view of an assembly comprising of a stylet, a cannula, and a trocar with a straight trajectory inside the vertebral body, the assembly being inserted into a base deposited on the skin of a patient, in accordance with one embodiment of the present invention.

[0072] Fig. 35 is an elevation view of an assembly comprising a probe, a cannula, and a trocar with a straight trajectory inside the vertebral body, the assembly being inserted into a base deposited on the skin of a patient, in accordance with one embodiment of the present invention.DETAILED DESCRIPTION OF EMBODIMENTS

[0073] In the following description of the embodiments, references to the accompanying drawings are illustrations of an example by which the invention may be practised. It will be understood that other embodiments may be made without departing from the scope of the invention disclosed. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the invention belongs.General overview

[0074] Existing intravertebral surgical procedures are not optimal at least because they could be less invasive, they take too much time and they are risky for the patients. One of such particular intravertebral procedure is basivertebral nerve (BVN) ablation. The basivertebral nerve (BVN) is the nerve located within the vertebral body that mediates pain fiber afferents back to the brain. Basivertebral nerve ablation (BVNA) is the procedure / surgery that ablate this nerve to disconnect the source of back pain, often chronic and referred to as vertebrogenic back pain.

[0075] For current basivertebral nerve (BVN) ablation the entry inside the vertebral body typically occurs via the pedicle of the patient’s vertebra as exemplified in Fig. 1. Fig. 1 shows a patient’s vertebral body 21 , two pedicles 22 and the trunk of the BVN 24. The trunk of the BVN 24 is located in the posterior portion of the vertebral body 21 , with its nerve endings expanding on both upper and lower endplates of the vertebra. In existing prior art devices, a straight trocar 11 and its stylet are introduced in the vertebra by passing through one of the two pedicles 22 until it reaches the vertebral body 21 , then the stylet is removed. A curved cannula 13 and its stylet are next introduced in the straight trocar 11 to create a curved channel in the cancellous bone, until the device reaches the trunk of the basivertebral nerve 24. The stylet is then removed to expose the basivertebral nerve. A bipolar probe 14 is inserted in the cannula 13 and ablation of the basivertebral nerve is performed by heat using a radiofrequency (RF) generator. All the instruments are removed at the end of the ablation.

[0076] In contradistinction with existing techniques, the present invention provides devices and means to carry out basivertebral nerve ablation by entering inside the vertebral body not via pedicle(s) of the vertebra, but via the lateral wall of the vertebral body.

[0077] The present invention uses methods and devices where the curvature required to reach the interiorof the vertebra (e.g., the BVN) is positioned within the soft tissue rather than in the vertebra itself. This different approach provides numerous benefits including, but not limited to, reducing the time and / or complexity of the surgical procedures, reducingpatient discomfort during and / or after the procedure, providing a more localized ablation, allowing to treat multiple vertebrae simultaneously, etc.

[0078] The approach proposed by the invention also facilitates access to the interior of the vertebra, including the BVN trunk location, even in patients with pre-existing spinal screws in their pedicles. Moreover, if initial attempts do not accurately reach the BVN trunk, the instruments can be strategically reoriented along the lateral wall of the vertebral body. From this lateral position, a new channel can be created within the cancellous bone to successfully reach the intended ablation site.Bone penetration devices and Bone channelling devices

[0079] The present invention makes use of one or more “bone penetration device” and of one or more “bone channeling device”.

[0080] As used herein, the term “bone penetration device” generally refers to a device that is used to pierce through the vertebra (e.g., piercing the lateral wall of the vertebral body). This term may encompass one single device such as a stylet, a cannula, a probe, a drill, or encompass a device assembly such as a stylet and a cannula, a drill and a cannula, or a probe and a cannula. The bone penetration device may have a given geometry to help dictate a desired trajectory.

[0081] As used herein, the term “bone channeling device” generally refers to a device that is used to create a channel inside the vertebral body, to guide instruments to the BVN ablation site (e.g., BVN trunk). This term may encompass one single device such as a stylet, a cannula, a probe, a drill, or it may encompass a device assembly such a stylet 100 and a cannula, or a drill and a cannula, or a probe and a cannula.

[0082] Therefore, in the present description, the terms “bone penetration device” and “bone channeling device” are used in a general manner to encompass one or more devices having desired structural features. As such, for simplicity, referral number is provided in the present description for the particular devices (or assembly(ies)) falling within these general definitions. Particular examples of these, including a stylet 100, a cannula 300, a probe 400, a drill 800, an electrode 900 and combinations thereof assembled in different manners are illustrated in Figs. 2 to 35.

[0083] In a general manner, the bone penetration device comprises an elongated stem extending from a proximal end to a sharp distal tip. The stem comprises a diameter sized to slide inside the lumen of the trocar 200, and it is made of a deformable material to move along the curved distal portion of the trocar 200. The bone penetration device may also be configured such that the elongated stem extends further than the trocar 200, such that the sharp distal tip of the elongated stem projects out of the distal tip of the hollow shaft of the trocar 200, when the bone penetration device is inserted into the trocar 200. The bone penetration device preferably includes a sharp distal tip which is sufficiently rigid to pierce through the lateral wall of the vertebral body of a patient. In some embodiments, the bone penetration device comprises a lumen sized for receiving and guiding a bone channeling device.

[0084] In a general manner, the bone channeling device comprises an elongated rod extending from a proximal end to a distal tip, where the rod has a diameter allowing it to slide and be advanced inside the lumen of the trocar, and allowing it to deform along the curved distal portion of the trocar 200. The bone channeling device may further comprise a longer rod than the hollow shaft of the trocar 200, such that when the bone channeling device is inserted into the trocar 200, the distal tip of the elongated rod projects out of the distal tip of the trocar to create the channel inside the vertebral body. The bone channeling device may further comprise a lumen sized to receive and guide the nerve ablation device. The lumen of the bone channeling device may further be used to inject a fluid to the location of the ablation.

[0085] In embodiments, the bone penetration device and / or the bone channeling device comprises a curved distal tip. As described hereinafter (e.g. see Figs. 12 and 16 showing a curved cannula or probe), in such embodiments, the distal tip of the bone penetration device and / or the distal tip of the bone channeling will travel inside the vertebra in a curved trajectory inside the vertebral body towards the basivertebral nerve ablation site.

[0086] In embodiments, the elongated stem of the bone penetration device further comprises a lumen sized for receiving and guiding the bone channeling device.

[0087] In embodiments, the elongated rod of the bone channeling device comprises a lumen extending from the proximal end to the distal tip thereof. In one embodiment the lumen is configured for injecting a fluid therein. In one embodiment the lumen is sized for receiving and guiding a nerve ablation device as defined hereinafter.

[0088] In embodiments, the elongated rod of the bone channeling device is made of a material conducting electricity, and wherein said rod is covered by an electrical insulating material but for a portion of its distal tip.

[0089] In embodiments, the elongated rod of the bone channeling device comprises a flexible distal portion, wherein said curved portion straightens when sliding the bone channeling device inside the trocar, and wherein said curved portion returns at a curved configuration once exiting the distal tip of the trocar.

[0090] In embodiments the bone channeling device further comprises an upper handle coupled to the proximal end of the rod, the handle defining a T-shape with the elongated rod, the handle providing a grip for manipulation of the bone channeling device by a user. In embodiments the upper handle comprises a substantially horizontal and rigid bar coupled to the proximal end of the rod, the bar, and the bar comprises lateral extensions defining said T-shape with the elongated rod. Preferably, these lateral extensions are configured for providing a pulling grip to fingers of a user. The handle may also comprises a central opening in fluid communication with the lumen of the elongated rod.

[0091] The upper handle may further comprises a fluid entry port in fluid communication with the lumen of the elongated rod for injecting a fluid inside the bone channeling device as described hereinafter. The fluid entry port may comprise a locking connector such as a Luer lock connector.

[0092] The bone channeling device may further comprise nerve ablation capabilities. In such embodiment, the distal tip of the nerve ablation device comprises an electrical active tip. The electrical active tip may comprise at least one of a temperature sensor and an electrode.

[0093] Accordingly, the bone channeling device may further comprise nerve ablation capabilities and may thus be considered as a “nerve ablation device”, including but not limited to a radiofrequency probe or an electrode as illustrated in Figs. 13 to 17, 18A, 18B, 19, 20, 28A, 28B, 31 and 35).

[0094] In embodiments, such electrode is a monopolar electrode, a bipolar electrode or a coaxial bipolar electrode. In embodiments, the electrode is a bipolar electrode comprising an active section, a return section, an insulating section.Particular examples of stylet(s), probe(s), drill(s), and electrode(s)

[0095] The following section provides more details about bone penetration device(s) and bone channeling device(s), in accordance with the invention, as it refers to particular embodiments of suitable stylet(s), probe(s), drill(s), and electrode(s).

[0096] Referring now to the drawings and more particularly to Fig. 2, there is illustrated a vertebra 20 having a vertebral body 21 and two transverse processes 23. Also added to Fig. 2 are the Posterior P and Anterior A orientations. The BVN trunk 24 is located inside the vertebral body 21. In accordance with the invention, the medical instruments for the BVN ablation, such as stylet 100 and a trocar 200, are introduce in a patient’s back and are moved in the patient’s body along a curved trajectory T until they reach the lateral wall 25 of the vertebral body 21. Advantageously, and as will be described hereinafter, the devices and methods of the present invention may be used by moving the instruments inside the vertebral body 21 along a linear trajectory (Fig. 3) or in a curved trajectory (Fig. 4).

[0097] Referring to Fig. 7A, a configuration of a trocar 200 is shown. The trocar 200 has a rigid and hollow shaft 210, also known as awl, and a handle 220. The shaft comprises a proximal end 218, a straight elongated portion 216, a curved distal portion 214 and a distal tip 212. The shaft 210 is hollow as it defines a lumen (not shown) extending inside the shaft from the proximal end to the distal tip. As illustrated, the lumen adapted to receive and guide the bone penetration device(s) an / or the bone channeling device (s), and combination thereof, from its proximal end 218 towards its distal tip 212. For instance, the lumen 222 defines a passage for devices such as the stylet 100, thecannula 300, the probe 400, the drill 800 and / or the electrode 900. In embodiment, the lumen of the shaft 210 has an internal diameter of about 1.6 mm to about 2 mm, or about 0.5 mm to about 7 mm, or about 1.8 mm. The shaft 210 can be round, squared, etc. In some embodiments, a coating may be present to reduce friction and / or provide electrical insulation. The shaft 210 may also have a sharp tip 212, that may also be referred to as a pointy end, etc. A sharp tip 212 is useful to pierce through soft tissue to reach the body of the vertebra. The sharp tip 212 is thus made of an appropriate material including, medical-grade metals, such as but not limited to stainless steel, titanium, nitinol, or a medical grade plastic (e.g., polyether ether ketone (PEEK), polyetherimide (PEI; branded as ULTEM™) and the like. In one particular embodiment the shaft has a blunt end and is used in combination with a stylet having a pointy end capable of piercing the soft tissue.As the access trajectory T (Figs. 3 and 4) is curved, and as the trocar 200 is one of the guiding components, the shaft 210 must have a native curvature, that is defined by a curved distal portion 214 adjacent to the tip 212. The curved distal portion of the shaft 214 is configured to provide a desired insertion angle at the entry point and direct devices inserted therein along a projection extending from the entry point on the lateral wall surface of the vertebral body to the basivertebral nerve ablation site. As explained hereinafter, in one embodiment that projection is linear and substantially tangential to the curved distal portion of the shaft. In another embodiment that projection is curved and substantially tangential to the curved distal portion of the shaft.

[0098] Referring to Fig. 5 showing the curved distal portion 214 of the trocar 200, the trocar comprises an axis S defined by the straight elongated portion the shaft 216, and the curved distal portion 214 comprises a bent or radius of curvature R and an angle of curvature a. The radius of curvature R is the radius of the osculating circle at a given point on a curve, and it represents how pronounced is the curve at the bent R. The angle of curvature a is calculated between the axis A and the tangential linear projection C of the distal tip 212 of the trocar 200. In embodiments the bent or radius of curvature R is of about 15 mm to about 50 mm, or about 5 mm to about 100 mm, or about 35 mm. In embodiments, the angle of curvature a is about 45 degrees to about 90 degrees, or about 15 degrees to about 120 degrees, or about 75 degrees.Notwithstanding the above, it is to be understood that the present invention is not limited to a definite curvature shape or length, as the curvature may have different forms (e.g., circular, elliptical, parabolic, hyperbolic, etc.). It may also be envisioned to provide a curved distal portion 214 with a straight linear portion at a distal tip thereof or to provide a curved distal portion comprising a bent.

[0099] Referring to Fig. 7A, the shaft 210 has a straight segment 216. As components may have to deform when displaced or advanced along the trocar 200, the shaft 210 is preferably made of a rigid material that will not deform, such as medical-grade metals, such as but not limited to stainless steel, titanium, nitinol, or a medical-grade plastic (e.g., polyether ether ketone (PEEK), polyetherimide (PEI; branded as ULTEM™) and the like.[000100] Also shown in Fig. 7A, trocar comprises a handle 220 coupled to the proximal end of the shaft 210. The handle 220 and the shaft 210 defines a T-shape which provides a grip for the manipulation of the trocar 200 by a user, i.e., a grip sufficient for providing a pushing, a pulling grip and / or a rotating grip to a user when removing the trocar 200 at the end of the BVN ablation procedure. For instance, the handle 220 may have a width of at least 3 cm, or about 5 cm to about 20 cm, or about 8 cm to about 12 cm, about 10 cm, In the figures, the T-shape defines a mushroomlike shape providing recess 226 on each side for positioning fingers of a user. Those skilled in the art understand that many other configurations of a handle are possible, and not limited to a T-shape, including rounded handle shaped like a knob, or additional T-shapes comprising branches that can expand upwards or downwards. The handle 220 defines a guide channel 222 in fluid communication with the lumen of the shaft 210, such that devices may enter the trocar 200, or such that fluids may be injected via the opening of the guide channel 222 in the handle 220. Examples of fluids that could be injected include, but are not limited to, a fluoroscopy marker agent, a contrast agent, a therapeutical agent, an anesthetic agent, an ablation agent, a bone cement, and a cooling fluid.[000101] In accordance with the invention, the trocar is used in combination with one or more bone penetration device and / or of one or more bone channeling device.[000102] In embodiments wherein the entry point is at a pinpoint location defined by a tangential linear projection of the trunk of the BVN towards the lateral wall surface of the vertebral body, such as depicted in Fig. 3, the bone channeling device has a straight distal portion to direct the bone channeling device to the BVN ablation site using a straight trajectory. In some embodiments where the entry point is located at a pinpoint location defined by a curved projection of the BVN towards the lateral wall surface of the vertebral body, as shown in Fig. 4, the bone channeling device has a curved distal portion to provide a desired insertion angle at the entry point and to direct the curved distal tip of the bone channeling device towards the BVN trunk using a curved trajectory.[000103] In embodiments (not illustrated), the elongated rod of the bone channeling device further comprises a lumen extending from the proximal end to the distal tip for injecting a fluid to the distal tip. A connector (e.g., Luer lock) may be present at the proximal end for easing such injection (e.g., with a syringe).[000104] In particular embodiments, the trocar 200 serves as a guide for the stylet 100 and / or the cannula 300 and / or the drill 800, and is shaped to define the trajectory T of displacement of the stylet 100 and / or the cannula 300 and / or the drill 800, and of other components such as the probe 400 or electrode 900. The cannula 300 may be used to guide other instruments to the BVN, and may also define a channel for supplying fluids to the ablation location, such as a fluoroscopic agent, medication, etc. In some embodiments, the BVN can be reached by the combination of the stylet 100 and the trocar 200. The probe 400 may be used to perform the ablation, in different ways as explained below. The spacer(s) 500 is(are) optionally present to control a depth of penetration of some components, relative to trocar 200 and / or cannula 300. The base 600 is optionally present to help hold the trocar 200 with respect to the human body, and hence may add stability to the curved access system during the ablation procedure. The guidewire 710 is also optionally present to help guide the path of the trocar 200 from the skin to an intermediate location on a transverse process 23 of the vertebra 20 and / or up to the lateral wall 25 of the vertebral body 21.[000105] Referring to Figs. 6A to 6C, different configurations of the stylet 100 are provided. The stylet 100 has a shaft 110 and a handle 120. The shaft 110 has a sharptip 112, that, may also be referred to as a pointy end, spear, etc. The sharp tip 112 must pierce through cortical bone, and is thus made of an appropriate material, such as a medical-grade metal including, but not limited to, stainless steel, titanium, and nitinol. In Fig. 6A, the shaft 110 is shown as being straight, from the sharp tip 112 to the handle 120. As the access trajectory T (Figs. 3 and 4) is curved, the shaft 110 must however have the capacity of deforming when moved along the trocar 200. As shown in Figs. 6B and 6C, the shaft 110 may also have a native curvature, that may be achieved by the presence of a curved segment 114 adjacent to the tip 112. The shaft 110 may also have a straight segment 116. In spite of the presence of curved segment 114, the shaft 110 may nevertheless have to deform when displaced within the trocar 200. In some embodiments, the deformation is elastic. In some embodiments, the material made for all of the shaft 110, except the tip 112, differs from the material of the tip 112, as the tip 112 may have greater hardness, while a remainder of the shaft 110 may exhibit greater flexibility or higher level of elastic deformation.[000106] In one particular embodiment, stylet 100 has both flexible and rigid properties. Indeed, in such embodiment the stylet 100 deforms when introduced in the curved cannula and it is also rigid to piece the vertebral body. As such, the shaft 110 of stylet 100 may comprise of a composite material including, but not limited to, an internal core (e.g. metal) and an external layer (e.g. plastic) that is more flexible than the metal core. Such a composite composition will maximize the stiffness and strength the shaft, while making sure it can be bent to a given curvature radius without undergoing deformation. In one particular embodiment, the shaft 110 of the stylet 100 is manufactured like a composite wire and comprises a metal wire core (e.g., stainless steel) with an outer plastic sheath (e.g., PEEK). In some embodiments, the shaft is made of medical-grade metal, such as, but not limited to stainless steel, titanium or nitinol, or a medical grade plastic (e.g., polyether ether ketone (PEEK), polyetherimide (PEI; branded as ULTEM™) and the like. Those skilled in the art understand that many other arrangements are possible as well.[000107] Accordingly, in one additional particular aspect, the invention concerns a stylet for an intravertebral medical procedure, the stylet comprising an elongated shaftcomprising an internal core covered by an external layer. The external layer is made of a material more flexible that said internal core. This configuration provides an elongated shaft which can bent to a desired given curvature radius without undergoing deformation. In embodiments the external layer is made of medical grade plastic and the internal core is made of metal. In embodiments, the desired given curvature radius is the same (or substantially similar) to the radius of curvature R of the curved distal portion 214 of the trocar 200. In embodiments, the stylet has a shaft of about 1.6 mm in diameter, the internal core consists of a 1 mm diameter stainless steel wire, and the external layer comprises a bonded 0.3 mm plastic layer, preferably PEEK. Such configuration provides for a good flexibility, while offering substantial axial rigidity.[000108] In some embodiments, when the stylet 100 is inserted in the trocar 200, the shaft 110 has an outer diameter about 1 .5 mm to about 2 mm, or about 1 mm to about 3 mm, or about 0.5 mm to about 5 mm, or about 1 .6 mm. In some embodiments, when the stylet 100 is inserted in the cannula 300, the shaft 110 has an outer diameter of about 0.75 mm to about 1.5 mm, or about 0.5 mm to about 3 mm, or about 1 mm. The shaft 110 can be round, squared, etc. In some embodiments, a coating may be present to reduce friction and / or provide electrical insulation.[000109] Like for the handle 220 of the trocar 200, the handle 120 of the stylet 100 may have any appropriate shape. In some embodiments, the handle 120 may have a generally flat top 122, or frustospherical top, as a user may apply an impact force onto the handle 120 in the piercing action. By having a larger top, as shown, it may be easier to apply an impact onto the handle 120. A frustoconical connector 124 may be present to interface the top 122 to the shaft 110.[000110] Figs. 7B and 8 show the assembly of the trocar 200 and the stylet 100, with the size of the shaft 110 being determined for the sharp tip 112 to extend out of the tip 212 of the shaft 210 of the trocar 200, to pierce through the cortical bone of the vertebral body 21 of the vertebra 20. Therefore, the trocar 200 may be positioned in the appropriate location against the vertebra 20 for its tip 212 to be against the vertebral body 21. For example, the positioning follows the trajectory T, cranial or caudal to one of the transverse processes 23, and the positioning may be donethrough appropriate navigating and / or imaging (e.g., fluoroscopy) and / or by using a guidewire 710. If a guide wire is used, the stylet 100 may be inserted after removal of the guidewire, to be moved along the shaft 210, for its tip 112 to abut against the vertebral body 21. If no guidewire is used, then the stylet 100 is inserted in the trocar 200 prior to the insertion of the trocar 200 inside the body. Once the trocar-stylet assembly is in place and abutting against the vertebral body 21 an impact force on the top 122 of the stylet may cause a hole in the cortical bone layer of the vertebral body 21 at the desired location.[000111] In embodiment of Fig. 8, the tip 212 of the trocar 200 is generally positioned at a mid height of the vertebral body 21 of the vertebra 20. The tip 212 of the trocar 200 may also be positioned relative to the anterior-posterior direction such that the tangential straight projection of the tip 212 aims at a target that is about 10 mm ventral to the posterior wall of the vertebral body 21 , as shown on Fig. 3, the target location being centered in sagittal plane of the vertebra 20. However, this is merely given as an example, as the tip 212 may be even more anteriorly positioned, with a curved segment of the cannula 300 (e.g., Fig. 9B) having a posterior component to redirect the probe 400 posteriorly. Fig. 12 gives one such example, with generally the same target as that of Fig. 11. The target may also be reached by the depth of insertion of the probe 400 in the cannula 300. The shaft 210 of the trocar 200 may be caudal or cranial to the transverse processes 23, and may pass right or left of the vertebra 20.[000112] Referring to Figs. 9A and 9B, different configurations of the cannula 300 are shown. The cannula 300 has a shaft 310 and a handle 320. The shaft 310 is hollow as it defines a fluid passage for other components, such as the stylet 100, the probe 400 and the electrode 900, with an open end being at the tip 312. In embodiment, the shaft 310 has an outer diameter of about 1.5 mm to about 2 mm, or about 1 mm to about 3 mm, or about 0.5 mm to about 5 mm, or about 1.6 mm. In embodiment, the lumen of the shaft 310 has an inner diameter of about 0.75 mm to about 1.5 mm, or about 0.5 mm to about 3 mm, or about 1 mm. The shaft 310 can be round, squared, etc. In some embodiments, a coating may be present to reduce friction and / or provide electrical insulation. In Fig. 9A, the shaft 310 is shown as being straight, from the tip 312 to the handle 320. Again, as the access trajectory T (Fig. 4) is curved, the shaft310 must have the capacity of deforming when moved along the trocar 200. Both a straight (Fig. 9A) and a curved cannula (Fig. 9B) can also deform if a curved stylet 100 is inserted in the cannula (See. Figs. 6B - 6C).[000113] As shown in Fig. 9B, the shaft 310 may also have a native curvature, that may be achieved by the presence of a curved segment 314 adjacent to the tip 312. The shaft 310 may also have a straight segment 316. In spite of the presence of curved segment 314, the shaft 310 has to deform when displaced within the trocar 200. In a variant, the deformation is elastic. In some embodiments, the cannula 300 makes it possible to enlarge the hole formed by the stylet 100, or drill 800, or spear, etc. in the vertebral body. In other embodiments, the cannula 300 remains in place to help preserve the path through the cancellous bone of the vertebral body for the next inserted instrument.[000114] The handle 320 may define a guide channel 322 in fluid communication with the lumen of the shaft 310, such that devices may enter the cannula 300 or fluids may be injected, such as but not limited to fluoroscopy market agents, therapeutical agents or cooling fluids, via the opening of the guide channel 322 in the handle 320. The handle 320 is coupled to the proximal end of the cannula 300. Like for the handle 220 of the trocar 200, the handle 320 and the shaft 310 may have any appropriate shape providing a grip for the manipulation of the cannula 300 by a user, i.e., a grip sufficient for providing a pushing, a pulling grip and / or a rotating grip to a user when removing the cannula 300 at the end of the BVN ablation procedure. For instance, the handle 320 may have a width of at least 3 cm, or about 5 cm to about 20 cm, or about 8 cm to about 12 cm, or about 10 cm, for providing a pulling grip to a user when removing the cannula 300 at the end of the BVN ablation procedure. In some embodiments, the cannula 300 is made of medical-grade plastic, such as but not limited to PEEK. In other embodiments, the cannula 300 is made of a medical-grade metal, such as but not limited to stainless steel, titanium, or nitinol.[000115] As shown in Fig. 17, a Luer lock connector 330 or equivalent port or passage may be present in the handle 320, and be in fluid communication with the lumen of the shaft 310 of the cannula 300, or with the lumen of the shaft 210 of thetrocar 200. The Luer lock connector 330 may be found at the distal end of the trocar 200 or cannula 300 to be aligned with their respective lumen, or it may be positioned anywhere on the handle 220 of the trocar 200, or on the handle 320 of the cannula 300. The Luer lock connector 330 or equivalent may therefore serve to inject a fluid (e.g., marker agent for fluoroscopy, bone cement, therapy agent, cooling fluid, etc.). Alternatively the Luer lock connector or equivalent could be in the probe 400.[000116] Figs. 10A and 10B show the assembly of the cannula 300 and the stylet 100, with the size of the shaft 110 of the stylet being determined for the sharp tip 112 to extend out of the tip 312 of the shaft 310 of the cannula 300, to pierce through the cancellous bone of the vertebral body 21 of the vertebra 20, and optionally the cortical layer of the wall of the vertebral body if not already pierced. Furthermore, since a stylet made of metal is most likely stiffer than a cannula made of plastic, those skilled in the art understands that a straight cannula 300 with a curved stylet 100 can produce a curved assembly. Thus, in some embodiments, the cannula 300 actively contributes to the trajectory of the stylet 100 after the piercing of the cortical bone has been achieved. Hence, in a sequence, the assembly of the trocar 200 and of the stylet 100 as in Fig. 8 pierce through the cortical bone of the vertebral body 21. Then, after the removal of the stylet 100 from the trocar 200, the cannula 300 and its stylet 100 (other than the one used in combination with the trocar 200) are inserted and pass through the pierced hole in the cortical bone layer of the vertebral body 21 and open a channel in the cancellous bone. The stylet 100 used in combination with the cannula 300 may be used to penetrate into the cancellous bone, in the manner shown in Fig. 11 or in Fig. 12, depending on the geometry of the cannula 300, depending on the selected trajectory. The displacement and hammering of the cannula 300 may be done using appropriate navigation techniques and / or guidance, such as by fluoroscopy.[000117] It is also possible to steer the cannula 300 by changing its curvature. One way to achieve this it is by having a difference in curvature between the stylet 100 and the cannula 300. For example, a tight bend stylet inserted in a larger bend cannula 300 may result in an assembly with a bend radius that is between the bend of the stylet 100 and the bend of the cannula 300. If inserted in opposite directions, the bend of the assembly may be larger than the initial bend of the cannula 300. It may also bepossible to rotate the stylet 100 with reference to the cannula 300 to change the curvature during the procedure to aim at the target (increasing or reducing the curvature).[000118] Accordingly, one additional aspect of the invention concerns a cannula and stylet assembly for an intravertebral medical procedure. In one embodiment, the cannula comprises an elongated hollow rod extending from a proximal end to a curved distal tip. The hollow rod defines a lumen extending inside the rod from the proximal end to the curved distal tip, and the lumen is sized to receive and guide the stylet from the proximal end to the curved distal tip. In one embodiment, the stylet comprises an elongated stem extending from a proximal end to a curved distal tip. The elongated stem comprises a diameter sized to slide inside the lumen of the cannula, it is deformable to move along the curved distal tip of the cannula, and it is longer than the cannula, such that the curved distal tip of the elongated stem projects out the distal tip of the hollow rod when inserted therein. Also, the curved distal tip of the cannula and the curved distal tip of the stylet have different curvatures such that when rotating the stylet about the cannula, that rotation changes a resulting curved distal tip of the cannula / stylet assembly. In a preferred embodiment, the stylet has a smaller curvature than the curvature of the cannula.[000119] Fig. 27B shows the assembly of the trocar 200, the cannula 300 and the drill 800 having an elongated shaft 830 terminated by a drill tip 820. The size of the shaft 830 is selected such that the drill bit tip 820 extends out of the tip 312 of the shaft 310 of the cannula 300. In some embodiments, the drill 800 can be used instead of a stylet to drill through the cortical bone of the vertebral body 21 of the vertebra 20. The drill 800 may be inserted into the cannula 300, and moved along the shaft 310, for its tip 820 to abut against the vertebral body 21 . As the access trajectory T (Figs. 3 and 4) is curved, the shaft 830 must however have the capacity to deform when moved along the trocar 200 and cannula 300. Activation of the drill 800 may cause a hole to be drilled in the cortical bone at the entry point. The drill 800 can be manually powered, electrically powered, battery powered, etc. The sharp tip 820 must drill through cortical bone and has to be flexible and elastic. In some embodiments, the outer diameter of the shaft 830 is about 0.75 mm to about 1 .5 mm, or about 0.5 mm to about 3 mm, or about 1 mm. In one particular embodiment, the shaft is manufactured like a compositewire and comprises a metal wire core (e.g., stainless steel) with an outer plastic sheath (e.g., PEEK). In some embodiments, the shaft 830 is made of medical-grade metal, such as, but not limited to stainless steel, titanium or nitinol. The shaft 830 can be round, squared, etc. In some embodiments, a coating may be present to reduce friction and / or provide electrical insulation.[000120] The drill bit tip 820 can have any suitable configurations. In embodiments the drill bit tip 820 is a prolongation of the drill shaft 830, and configured like common double bevels and pivot drill types. In embodiments the drill bit tip 820 is of a type having an off-axis and a positive rake angle cutting edge as described for the bone piercing device 1400 hereinafter. The drill bit tip 820 and the drill shaft 830 can be made of medical-grade metal including, but not limited to, stainless steel, titanium or nitinol. Preferably the drill shaft 830 comprises a low-friction coating allowing it to slide and rotate more easily with regards to the other instruments and in the tissue and increase the comfort of the patient.[000121] As used herein, the term “nerve ablation device” generally refers to a device that is used to “heat”, “burn” or “ablate” the BVN. This term encompasses devices such as a probe 400 and an electrode 900. The nerve ablation device is flexible to move along the curved distal tip 214 of the trocar 200. In some embodiments, the bone channeling device has ablation capabilities and is thus also the nerve ablation device. In some embodiments, the nerve ablation device comprises at least one temperature sensor at a distal portion thereof (e.g., a few mm from its distal tip).[000122] Referring to Fig. 13, in the illustrated embodiment the probe 400 has a shaft 410 and a head unit 420, shown as being wired via wire 430 to be powered by an energy delivery source, e.g. a waveform generator, a radiofrequency (RF) generator, etc. The shaft 410 has an active tip 412, that may be used in different possible ways to perform the ablation. The shaft 410 is shown as being straight, from the active tip 412 to the head unit 420. As the access trajectory T (Figs. 3 and 4) is curved, the shaft 410 has the capacity of deforming when moved along the cannula 300 (or trocar in an embodiment). In one particular embodiment, the shaft 410 is manufactured like a composite wire and comprises a metal wire core (e.g., stainless steel) with an outerplastic sheath (e.g., PEEK). In some embodiments, the shaft 410 is made of medicalgrade metal, such as, but not limited to stainless steel, titanium or nitinol, with an insulation coating, except on the distal tip 412. Those skilled the art understands that many other arrangements are possible as well. In some embodiments, the shaft 410 has an outer diameter about 0.75 mm to about 1.5 mm, or about 0.5 mm to about 3 mm, or about 1 mm. The shaft 410 can be round, squared, etc. In some embodiments, a coating may be present to reduce friction and / or provide electrical insulation.[000123] Fig. 15 shows the probe 400 in the assembly of trocar 200 and cannula 300 of Fig. 9A. Fig. 16 shows the probe 400 in the assembly of trocar 200 and cannula 300 of Fig. 9B. As depicted in Figs. 15 and 16, the active tip 412 of the probe 400 is at the BVN trunk targeted location, such that its activation may perform the ablation.[000124] The probe 400 can operate using different technologies. In some embodiments, the probe 400 may be a commercially available tube that receives an electrode (e.g., also possibly commercially available). The electrode may already include an integrated thermocouple or equivalent temperature sensor.[000125] In a variant, the probe 400 is a monopolar probe. The active tip 412 is exposed or about 8 mm to about 15 mm, or about 3 mm to about 30 mm, or about 10 mm. The rest of the flexible shaft 410 may be covered by a sheath, for electrical insulation. There may be one or more thermocouples at the active tip 412 to monitor a temperature during ablation. In some embodiments, a ground is achieved by a grounding pad applied elsewhere on the patient, such as on the thigh.[000126] When activated, the active tip 412 may receive on or more of a sinusoidal tension waveform at high frequency (e.g., ~460 kHz), a pulsed waveform, a modulated waveform, a continuous waveform, a squared waveform, a triangular waveform, etc. to ablate the BVN. Temperature at the ablation site can be monitored via the thermocouple or via other temperature sensing devices, and energy delivery is modulated to maintain the predefined temperature pattern, with the waveform generator controlling same. Ablation energy delivered at the ablation site may also be monitored and / or controlled by any other suitable means or metrics including, but notlimited to, via the RF generator (e.g., measurements of impedance, current, tension, power, total energy, etc.).[000127] In another variant, the active tip 412 is bipolar, in that it has the “active” electrode and the “return” electrode, separated by an insulator. Again, there may be temperature sensing, e.g. a thermocouple(s) at the distal end of the probe 400 to monitor the temperature of the ablation. In this configuration, there is no grounding pad on the thigh of the patient. The distal tip can be the “active” electrode, and the proximal ring the “return” electrode, or it can be the opposite.[000128] In yet another variant, the probe 400 is monopolar with the tip 312 of the cannula 300 acting as a second electrode, as shown in Fig. 14. Thus, the active electrode 418 may be at the tip 412 of the probe 400, while the return electrode may be the tip 334 of the cannula, separated by an insulated section 416 at the distal portion of the probe 400, distal to the cannula 300 tip 312. The canula 300 also comprise an insulated section 332 proximal to the tip 312. The probe 400 is monopolar with the distal tip of the cannula 300 acting as the second electrode. For example, the “active” electrode 418 is the distal tip of the probe, and the “return” electrode 334 is the distal annular end of the cannula 300, separated by the insulated section 416 (the insulation found on the shaft of the probe 410, the cannula shaft has also an insulator 332). Preferably, there is a thermocouple (or a multitude of) at the distal end of the probe to monitor the temperature of the ablation. In this configuration, there is no grounding pad on the thigh of the patient. The distal tip of the probe 400 can be the “active” electrode 418, and distal tip of the cannula the “return” electrode 334, or it can be the opposite (“active’7”return”). There is a lead on the handle of the cannula to connect to the RF generator. It can be possible to have a connection at the proximal end of the probe for the probe to carry both polarity to the waveform generator, or for the cannula to carry both polarities to the waveform generator.[000129] The probe 400 may also have a passive configuration. This may include a hollow shaft in which a smaller electrode is received, as shown in Figs. 19 and 20. In some embodiments, the hollow probe 1000 can act as a smaller cannula that receives the shaft of the smaller electrode 900. The hollow probe 1000 is used as a passiveelectrode, it has a metal tip, with the rest of its shaft recovered by an insulation sheath (e.g., plastic). The smaller electrode 900 inserted in the hollow probe has a thermocouple at its distal tip and is connected to the RF generator. When the electrode 900 is inserted into the hollow probe 1000, it energizes the hollow probe 1000 so its tip can ablate the BVN trunk. The smaller electrode 900 can be disposable or reusable. The smaller electrode 900 can have one or more thermocouples or temperature sensor(s) at its distal end 910.[000130] In accordance with the present invention, using a probe that is monopolar (Figs. 15 and 16) and / or using a probe having a coaxial bipolar configuration (Fig. 14) enables the use of a probe of a smaller diameter which leads to the use of smaller instruments surrounding the probe, and, consequently, advantageously cause smaller bone perforations.[000131] Referring to Figs. 15 and 16, near the BVN ablation zone the probe can have a straight trajectory as shown in Fig. 15, or a curved trajectory as shown in Fig. 16. The trajectory may depend on the configuration of the cannula 300 being used and / or the probe 400 (i.e., straight or curved). Those skilled in the art can appreciate that once a channel has been created in cancellous bone by the cannula 300, the straight or curved trajectory will remain in the cancellous bone even if the stylet or drill is removed from the canula, such that the probe will end up at a right place in the ablation zone.[000132] One or more spacer(s) may also be provided to control a depth of penetration of the bone penetration device(s) and / or the bone channeling device(s) inside the trocar and vertebra (e.g., to properly position the active tip 412 of the probe 400 into the vertebral body 21 of the vertebra 20). As such, the spacers are configured to cooperate with the trocar, the bone penetration device and / or the bone channeling device, in order to control a depth of penetration of the bone penetration device and / or the bone channeling device inside the trocar. In embodiments the spacer is removable and configured to be positioned between (i) the trocar and the bone penetration device, (ii) the trocar and the bone channeling device, (iii) two different bone penetration devices, (iv) two different bone channeling devices positioned, and / or (v) a bone penetration device and a bone channeling device. The spacer may consist ofa piece of rigid material (e.g., plastic) having a height providing a desired spacing, the spacer leaving a central passage for the bone penetration device(s) and / or the bone channeling device(s). For instance, referring to Fig. 18A, a spacer 500 may be provided between the trocar 200 and the cannula 300, and may optionally be provided between the head unit 420 of the probe 400 and the handle 320 of the cannula 300. To provide the desired spacing, the spacer may have any suitable configuration such as a stop, a flip-lever, a screwed stop, a washer, etc. as long as it leaves a central passage for device(s) being used.[000133] Referring to Fig. 18B, the spacer 500 is between the head unit 420 of the probe 400 and the handle 320 of the cannula 300, again to control the depth of penetration of the active tip 412 of the probe 400 into the vertebral body 21 of the vertebra 20. The spacers 500 may be tubular and / or define a central passage for the shaft 410 of the probe 400, and for the shaft 310 of the cannula 300. A longitudinal slot 510 may be present to allow lateral positioning of the spacer 500 onto the shafts 310 and / or 410. In a variant, it is possible to use the probe 400 as spear instead of the stylet 100, if the active tip 412 is pointy enough to pierce the cortical and cancellous bone. The spacer(s) 500 is(are) there to ensure the tip 412 of the probe 400 is located at the right place at the right moment (e.g. barely projecting from the trocar 200 when piercing the cortical bone).[000134] Though optional, the spacer(s) 500 can be used to ensure the tips are aligned when pushing / hammering the curved access system in place. The spacer(s) 500 is(are) illustrated in a simplified representation in the figures, but they could be integrated to the handles (flipping lever, telescopic stopper, etc.). Spacers are removed or disengaged in a specific order to locate the components.[000135] Referring to Figs. 32 and 33, the base 600 is shown. As can be appreciated, the base is configured to be applied against the skin 30 of the patient and support the trocar 200. In the illustrated embodiment, the base 600 has a central hub 610, with four legs 620 projecting from the hub 610 and being deposited on the skin 30 of the patient, as shown in Fig. 33. There are four legs shown, but more or fewer legs may be present. Also, the base 600 does not need to have legs. Thecentral hub 610 may optionally hover above the skin, and defines a passage for the various components of the curved access system that penetrate the skin, such as the stylet 100, the trocar 200, the cannula 300 and / or the probe 400. However, in numerous embodiments, these various components are interfaced to the central hub 610 via the trocar 200. A locking mechanism may be present in the central hub 610 to fix the trocar 200 relative to the base 600. For example, the locking mechanism may be embodied by a set screw 630 that is threadingly engaged into a threaded hole in the central hub 610, a free end of the set screw 630 entering the passage of the central hub 610 to contact the outer surface of the shaft 210 of the trocar 200. The central hub 610 may further include a ball joint, with split ball 612 in a complementary socket 614 to allow rotational movement and thus orientation adjustments for the passage of the central hub 610. This spherical joint may be blocked by the set screw 630, the set screw 630 also blocking axial and rotational movements of the trocar 200.[000136] Fig. 34 illustrates the base 600 as supporting the trocar 200, the cannula 300 and a stylet 100. Fig. 35 illustrates the base 600 as supporting the trocar 200, the cannula 300 and the probe 400.[000137] Though optional, a guidewire can be used to aid the insertion of the trocar 200. In one embodiment, the guidewire comprises an elongated straight and flexible rod configured to pierce the skin and be inserted in the back patient’s body until it reaches a refence point and / or until it reaches the entry point. The guidewire is sized to slide inside the lumen of the trocar. In embodiments, the guidewire consists of a wire, a needle, a tube or a rod. In embodiments, the guidewire comprises a distal tip configured to be anchored on the lateral wall of a patient vertebral body and / or the traverse process of the patient vertebral body. In embodiments, the distal tip of the guidewire comprises a cone shaped end comprising a screw thread for anchoring on bone.[000138] Figs. 21 to 23 illustrate the insertion of a needle serving as a guidewire 710 to aid the insertion of the trocar 200 at its desired location on the lateral wall of the vertebra.[000139] In one particular embodiment, a syringe 700 comprising a needle serving as a guidewire 710 is entered at the skin 30 approximatively 1 cm cranial to the lateral portion of the transverse process of the vertebra (Fig. 21). The needle / guidewire 710 will aim medially along the junction between the transverse process and the pedicle. Local anesthetic is injected slowly as the needle / guidewire 710 is advancing toward the transverse process / pedicle junction. The needle / guidewire 710 is designed to be separated (e.g., removed, broke) at a specific location of its proximal tip 720. In embodiments, there can be an over molded plastic part at a separation location to avoid having a sharp end, as long as the over molded portion is smaller than the lumen of the device slipped over it. In other embodiments, guidewires such as Kirschner wires can be used to guide surgery instruments. Once the needle / guidewire 710 is in place, and the proximal tip 720 is separated from the syringe, the trocar 200 can be aligned and pushed over the needle / guidewire 710 until it reaches the transverse process 23 (Fig. 22 and Fig. 23A). Once the trocar 200 reaches the transverse process 23 (Fig. 23A), the needle / guidewire 710 can be removed from the patient skin, and the trocar 200 can slide along the wall of the vertebra 20 until the trocar 200 reaches the entry point located on the wall of the vertebral body (Fig. 23B). Advantageously, the detachable syringe needle 710 may be used during the procedure to inject a local anesthetic or else, at the desired location.[000140] In embodiments, low-friction hydrophobic or hydrophilic coating are be added to the needle / guidewire 710, and / or to one or more of the other instruments (e.g., trocar, stylet, probe, etc.) to increase patient comfort and reduce the force needed to slide one instrument over another. Other coatings may also be possible, such as but not limited to coatings for electric insulation, color coding, markings, radiopaque markings, etc., for all instruments.Kits[000141] Another aspect of the invention concerns kits for basivertebral nerve ablation, the kits comprising a trocar, and at least one of a bone penetration device and a bone channeling device. In embodiments, the kit comprises both a bone penetration deviceand a bone channeling device. In embodiments, the kit comprises two bone penetration devices and / or two channeling devices.[000142] In one embodiment the trocar is as illustrated in Fig. 7A comprises a handle 220, and a rigid and hollow shaft 210. The rigid and hollow shaft 210 comprises a proximal end 218, a straight elongated portion 216, a curved distal portion 214 and a distal tip 212, a lumen 222 extending inside the shaft from the proximal end 218 to the distal tip 212. The lumen 222 of the shaft is adapted to receive and guide the bone penetration device and the bone channeling device, from its proximal end 218 towards its distal tip 212.[000143] In accordance with this kit, the bone penetration device may be a cannula, a stylet, a drill, a radiofrequency probe, a spear, or any combination thereof. Those are as defined hereinbefore.[000144] In accordance with this kit, the bone channeling device may be a cannula, a stylet, a drill, a spear or a probe, and a combination thereof. Those are as defined hereinbefore.[000145] The kit of the invention may further comprising at least one of a guidewire, a base and a spacer.Methods for an intravertebral medical[000146] As indicated hereinbefore, the devices and procedures described herein may find utility for various surgical interventions requiring to get access to the posterior wall of a vertebra and / or the interior of a vertebra. This may include spinal surgical procedures such as BVN ablation, vertebral augmentation, vertebroplasty, kyphoplasty, tumor ablation close to / in contact with the posterior wall of a vertebra, as well as any other surgical procedures requiring a path / channel for instrument(s), injecting a fluid, delivery of a cement, delivery of an implant, etc. The present invention is unique thanks to a curved access system and / or curved trajectory which allows to reach locations in the VB that were not possible with other existing instruments.[000147] Accordingly, one aspect of the invention concerns a method of positioning a trocar for an intravertebral medical procedure. In one embodiment the method comprises providing a trocar comprising a curved distal tip, and inserting the trocar in a patient’s body in a posterior to anterior direction, caudal or cranial to a transverse process of a patient’s vertebra, such that the curved distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a patient’s vertebral body. In one embodiment, the trocar comprises a shaft having a lumen adapted to receive and guide a bone penetration device, and the method further comprises providing a bone penetration device comprising an elongated stem extending from a proximal end to a sharp distal tip, inserting the bone penetration device inside the trocar until the sharp distal tip of the bone penetration device pierces through the vertebral body.[000148] According to another related aspect, the invention concerns a method of positioning a bone penetration device for an intravertebral medical procedure. In one embodiment the method requires a trocar and a bone penetration device. The trocar comprises a hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip. The hollow shaft further comprises a lumen extending inside the shaft from the proximal end to the distal tip, the lumen being adapted to receive and guide the bone penetration device, from the proximal end towards the distal tip of the trocar. The bone penetration device comprises an elongated stem extending from a proximal end to a sharp distal tip. The bone penetration device is inserted inside the trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining a trocar-penetration device assembly. Next the trocar-penetration device assembly is inserted in a posterior to anterior direction, caudal or cranial to a transverse process of a patient’s vertebra, such that the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of the patient’s vertebral body. If desired, the trocar-penetration device assembly may be inserted further inside the body of the patient such that the sharp distal tip of the bone penetration device transpierce the cortical layer of the vertebral body. In one embodiment the method further comprises inserting the trocar-penetration device assembly further inside the body of the patient such that the sharp distal tip of the bone penetration device pierces through the vertebral body. In embodiments, the bone penetration device is a stylet, a device assembly comprising astylet and a cannula, a device assembly comprising a drill and a cannula, or a device assembly comprising a probe and a cannula. In one embodiment, the intravertebral medical procedure comprises a basivertebral nerve ablation.[000149] In accordance with another related aspect, the intravertebral medical procedure comprises a BVN ablation. Accordingly one particular aspect of the invention concerns a curved access system for BVN ablation, that may have various components described herein, the components also known as medical or surgical devices, tools, instruments, subcomponents, etc. The curved access system may include a bone penetration device, a bone channeling device, and a nerve ablation device. Examples of these devices may include a stylet 100, a trocar 200, a cannula 300, a probe 400, a guidewire 710, a drill 800, an electrode 900, and / or any combination thereof. Additional components may include spacer(s) 500 and a base 600. These components may be made available individually, or as a kit, etc. In a variant, a single device, such as a trocar 200, may be made available with multiple other devices of a same kind, such as stylets of different sizes, different geometries, etc. This may be possible for other ones of the components of the curved access system described above.[000150] The BVN ablation may comprise introducing a bone penetration device and / or a bone channeling device in the back of a patient, with the trajectory of the introduction being caudal (i.e., inferior) or cranial (superior) to one of the two transverse process 23 of the patient vertebra 20. The introduction of the bone penetration device and the bone channeling device inside the patient’s back may also be at a definite entry point on the lateral wall of the vertebral body. In some embodiments, the entry point is at a pinpoint location defined by a tangential linear projection extending from the trunk of the BVN towards the lateral wall surface of the vertebral body, as shown in Fig. 3. In some embodiments, the entry point is at a pinpoint location defined by a curved projection of the trunk of the BVN towards the lateral wall surface of the vertebral body, as shown in Fig. 4. As is known to medical personal in the field, the BVN trunk originates from the posterior wall of the vertebral body up until approximately a third to a half of the depth of the vertebral body. Then, branches to the cranial and caudal endplates. In embodiments, the ablation site is centered laterally and centered in between the vertebral endplates, and it is located at about 10% to 50% of the vertebral body depthanteriorly to the posterior wall of the vertebral body, preferably about 1 / 3 of the depth of the vertebral body anteriorly to the posterior wall, or about 1 cm anteriorly to the posterior wall.[000151] In some embodiments, the BVN ablation may be used in accordance with a method that may be described as being a method of ablating a basivertebral nerve in a vertebra, and that may include inserting a trocar in a posterior to anterior direction, caudal or cranial to a transverse process of the vertebra, such that the distal tip 212 of the trocar 200 is positioned at a predefined entry point located on a lateral wall of the patient’s vertebral body; inserting a bone penetration device inside the trocar 200 such that the sharp distal tip of the bone penetration device pierces through the vertebral body at an entry point and along a desired angle for providing a tangential linear or curved projection extending from the BVN towards said entry point; inserting the sharp distal tip of the bone penetration device inside the vertebral body; injecting energy at the ablation site; and removing the devicesZinstrument(s) from the patient.[000152] In some embodiments, the BVN ablation may be used in accordance with a method that may be described as being a method of ablating a basivertebral nerve in a vertebra, and that include inserting a trocar in a posterior to anterior direction, caudal or cranial to a transverse process of the vertebra, such that the distal tip 212 of the trocar 200 is positioned at a predefined entry point located on a lateral wall of the patient’s vertebral body; inserting a bone penetration device inside the trocar 200 such that the sharp distal tip of the bone penetration device pierces through the vertebral body at an entry point and along a desired angle for providing a tangential linear or curved projection extending from the BVN towards said entry point; inserting the sharp distal tip of the bone penetration device inside the vertebral body; removing the bone penetration device from the trocar 200; inserting the nerve ablation device inside the trocar such that the distal tip of the nerve ablation device reaches the nerve ablation site; injecting energy at the basivertebral nerve ablation site; and removing the nerve ablating device.[000153] According to one particular aspect, there is provided a method for basivertebral nerve ablation in a patient, comprising:providing a trocar comprising a hollow shaft, the hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, the hollow shaft further comprising a lumen extending inside the shaft from the proximal end to the distal tip, the lumen being adapted to receive and guide a guidewire and a bone penetration device, from its proximal end towards its distal tip; providing a guidewire configured to pierce the skin and be inserted in the back patient’s body, wherein the guidewire is sized to slide inside the lumen of the trocar; inserting the guidewire in the back of the patient’s body in a posterior to anterior direction, caudal or cranial to a transverse process of a vertebra of the patient until the guidewire reaches an entry point on a lateral side of the vertebral body or until the guide wire reaches a reference point on a traverse process of the vertebra; sliding the distal tip of the trocar over the guidewire until said distal tip reaches the entry point on a lateral side of the vertebral body or reaches the reference point; removing said guidewire; providing a bone penetration device comprising an elongated stem extending from a proximal end to a sharp distal tip, inserting the bone penetration device inside the lumen of the trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining a trocar-penetration device assembly; inserting the trocar-penetration device assembly in a posterior to anterior direction, caudal or cranial to said transverse process, such that the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of the patient’s vertebral body.[000154] According to one embodiment, the method further comprises inserting the trocar-penetration device assembly further inside the body of the patient such that the sharp distal tip of the bone penetration device pierces through the vertebral body.[000155] According to another embodiment, the method further the bone penetration device pierces the vertebral body at the predefined entry point entry point with a desired angle for providing a projection extending from the basivertebral nerve towards said predefined entry point. According to one embodiment, the projection is linear and substantially tangential to the curved distal portion of the shaft. According to another embodiment, the projection is curved and extends from a basivertebral nerve ablation site towards the lateral wall surface of the vertebral body.[000156] According to another embodiment, the method further comprises providing a bone channeling device comprising a curved distal tip, and introducing the bone channeling device inside the trocar such that curved distal tip of the bone channeling device follows substantially said curved projection to the basivertebral nerve ablation site.[000157] According to another embodiment, the method further comprises inserting the sharp distal tip of the bone penetration device further inside the vertebral body until the distal tip reaches the basivertebral nerve ablation, and injecting energy at a basivertebral nerve ablation site.[000158] According to another embodiment, the method further comprises: removing the bone penetration device from the trocar after piercing the vertebral body, providing a nerve ablation device comprising an elongated rod extending from a proximal end to a distal tip, the distal tip of the nerve ablation device comprising nerve ablation capabilities; inserting the nerve ablation device inside the trocar until the distal tip of the nerve ablation device reaches a basivertebral nerve ablation site, and injecting energy at the distal tip of the nerve ablation device.[000159] According to another embodiment, the guidewire is introduced about one width of the vertebral body away from the sagittal plane.[000160] According to another embodiment, the method further comprises injecting a local anesthetic during the insertion of the guidewire.[000161] According to another embodiment, the method further comprises monitoring positioning of the guidewire, trocar, bone penetration device, bone channeling device and / or nerve ablation device by fluoroscopy, X-rays, CT-scan, ultrasound, MRI or other imaging guidance.[000162] According to another embodiment, the method further comprises removing the ablation device, bone channeling device, bone penetration device and / or trocar after said basivertebral nerve ablation.Multiple BVN ablation[000163] The pain originating from the vertebral endplates is thought to be heavily related to the intervertebral disc resulting in frequent involvement of two or more vertebral bodies. This may lead to procedures / interventions / ablations on two or more vertebral bodies. There is thus a need to perform multiple ablations simultaneously / concurrently when multiple ablations are necessary to provide efficient pain relief to a patient. Multiple simultaneous ablation will result in an overall shorter surgical procedure and will increase the comfort of the patient.[000164] Accordingly, another aspect of the invention concerns simultaneous or concurrent tissue ablation, including BVN, across multiple vertebral levels. Fig. 31 illustrates that concept. This embodiment shows a system 1100 for penetrating a plurality of vertebra 1 (four in the figure) from both sides. Each vertebra is penetrated by a BVN ablation assembly comprising a trocar 200, a canula 300 and a probe 400 connected to an energy generator with a wire 430. In this setup, the probes 400 inserted through the vertebras 1 can execute concurrent tissue and / or BVN ablation by transmitting energy to each probe 400 simultaneously. Each wire 430 connecting the probes 400 may link to a multi-channel generator or to individual generators, depending on the specific embodiment. In one embodiment, this is achievable by employing a multi-channel RF generator. In another embodiment, this is achievable by utilizing several generators operating independently. As can be appreciated, with such system 1100 multiple ablations can be performed on multiple levels at the same time, thereby increasing the BVN procedural efficiency.[000165] Many different types of probes may be used for simultaneous or concurrent tissue ablation in accordance with the invention. The probes 400 can come in a variety of designs, including, but not limited to, monopolar, synchronized monopolar, bipolar, or paired monopolar configurations. When using monopolar or synchronized monopolar probes, a common ground return may be placed on the patient's thigh. In contrast, bipolar probes may operate without a shared ground patch, as the return electrode may be incorporated into the probe itself. For paired monopolar setups, one probe may function as the active electrode and the other may serve as the return.[000166] Therefore, one particular aspect of the invention concerns a method of positioning multiple bone penetration devices on multiple vertebrae concurrently or simultaneously for an intravertebral medical procedure. In one embodiment the method comprises providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; and inserting each of the trocarpenetration device assemblies in a posterior to anterior direction, caudal or cranial to a transverse process of at least two different vertebrae of the patient, such that for each trocar-penetration assembly the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the patient vertebrae.[000167] Another related particular aspect of the invention concerns a method of positioning multiple bone penetration devices for an intravertebral medical procedure on a single vertebra. In one embodiment the method comprises: providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; and inserting each of the trocar-penetration device assemblies in a posterior to anterior direction, such that for each trocar-penetration assembly the distal tip of the trocar is positioned at a predefined entry point located either (i) on a lateral wall of a vertebral body or (ii) at a level or above sacral ala of the patient vertebra.[000168] Another related particular aspect of the invention concerns a method for basivertebral nerve (BVN) ablation, the method comprising performing said BVN ablation on multiple vertebrae simultaneously and / or concurrently.Absence of traverse[000169] The methods of the invention described herein are amenable to intravertebral medical procedures for which the vertebra does not possess traversal processes (e.g., vertebra S1 , removal of the traverse process following a fracture, etc. ). In such circumstances, reference to the traversal process(es) during insertion of the trocar and / or trocar-penetration device assembly can be omitted. One particular example is the method of positioning multiple bone penetration devices for an intravertebral medical procedure on a single vertebra defined hereinbefore. In such case the inserting step would then read as follows: providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; and inserting each of the trocarpenetration device assemblies in a posterior to anterior direction, such that for each trocarpenetration assembly the distal tip of the trocar is positioned at a predefined entry point located either (i) on a lateral wall of a vertebral body or (ii) at a same level or above sacral ala of the patient vertebra.Bone piercing device[000170] Another aspect of the invention concerns a bone piercing device. Advantageously, that device is configured to drill and pierce a patient vertebral body. One particular example is illustrated in Figs. 29A-29D and Figs. 30A-30C.[000171] In one embodiment the bone piercing device 1400 comprises an elongated stem 1410 extending from a proximal end to a cutting distal tip 1420. The elongated stem 1410 is preferably configured and sized to slide inside the lumen of a trocar (e.g., trocar 200 as defined herein), or inside the lumen of the cannula (e.g., cannula 300 as defined herein). The cutting distal tip 1420 has a pointy shape and has a first diameter D1 , The cutting distal tip 1420 is configured to create a hole 1300 having a second diameter D2larger than the first diameter D1. In embodiments, the cutting distal tip 1420 is configured to provide a positive rake angle p.[000172] Figs. 29A to 29D show an example of bone piercing device 1400 comprising an off-axis positive rake angle cutting distal tip 1420. In the illustrated embodiment, the cutting distal tip 1420 has a configuration comprising a rake angle p, a relief angle y and a point angle 0. In embodiments, the rake angle p is about 10 degrees to about 20 degrees, or about 1 degree to about 45 degrees, or about 15 degrees. In embodiments, the relief angle y is about 10 degrees to about 30 degrees, or about 1 degree to about 45 degrees, or about 20 degrees. In embodiments, the point angle 0 is about 30 degrees to about 60 degrees, or about 15 degrees to about 75 degrees, or about 45 degrees. The illustrated cutting distal tip 1420 also has a cutting edge 1430. Preferably, the cutting edge 1430 has a length L2 that is greater than the thickness of the cortical layer of a vertebra (e.g. about 0.3 mm). In embodiments, the cutting edge 1430 has a length L2 of about 0.5 mm to about 2.5 mm, or about 0.3 mm to about 5 mm, or about 1 mm. The length L1 will have a width dependent from the combination of the relief angle y and the point angle 0. In embodiments, the cutting edge 1430 has a width L1 of less than 1 mm, or about 0.1 mm to about 1 mm.[000173] Figs. 30A to 30C show an exemplary functioning of the bone piercing device 1400 comprising an off-axis positive rake angle cutting distal tip 1420 as shown in Figs. 29A to 29D. As illustrated the cutting distal tip 1420 comprises a drill axis DA and an offset hole axis HA that is substantially tangential to the outer surface of the drill shaft and coincident (or almost coincident) with the distal tip of the cutting edge 1430. Therefore, in accordance with that illustrated embodiment the cutting edge 1430 makes contact with the material 1200 to be drilled and penetrate the material along the hole axis HA. Rotation of the elongated stem 1410 (clockwise rotation as shown by arrow in Fig. 30A) causes cutting of the material 1200 by the cutting edge 1430 to carve a hole 1300 around the hole axis HA. The cutting distal tip 1420 therefore does not revolve on the drill axis DA defined by the center of the elongated stem 1410, but along the offset hole axis HA having the distal tip of the cutting edge 1430 at its center.[000174] The drill axis DA and the hole axis HA are not necessarily parallel. The drill axis DA rotates around the hole axis HA. The cutting edge 1430 rotates around the axis of rotation HA and cuts the material 1200 to be drilled, forming a hole 1300 having a diameter D2 larger than the diameter D1 of the cutting distal tip 1420. Also, when bone piercing device 1400 is used in combination with a trocar (such as trocar 200) a slight oscillation of the distal tip of the trocar may be expected when the bone piercing device 1400 penetrates the cortical layer of the lateral wall of the vertebral body. Preferably, the length L2 of the vertical projection of the cutting edge 1430 (i.e. the length L of the cutting edge projected on a plane parallel to the axis of the elongated stem 1410) is greater than the thickness of the cortical layer of the bone to ensure proper engagement of the cutting edge 1430 and chip clearing.[000175] The elongated stem 1410 and the cutting distal tip 1420 is preferably made of a suitable medical-grade metal including, but not limited to, stainless steel, titanium or nitinol. The elongated stem 1410 and / or cutting distal tip 1420 may comprise a low- friction coating allowing to slide more easily in the tissue and increase the comfort of the patient.Nerve ablation assembly[000176] Another aspect of the invention concerns a nerve ablation assembly comprising a nerve ablation device and a bone channeling device[000177] In embodiments the nerve ablation device is as defined hereinbefore, and the bone channeling device as defined hereinbefore. As such, one may refer to the above description of these devices for particular referral number.[000178] In one particular embodiment the nerve ablation device comprises an elongated wire comprising a proximal end, an intermediate section and a distal tip, the wire extending from the proximal end to the distal tip. The intermediate section is configured to provide for electrical insulation, and the distal tip comprises an end section for conducing electricity.[000179] In one particular embodiment the bone channeling device comprises an elongated rod extending from a proximal end to a distal tip. In embodiments the distal tip is configured for an insertion inside a patient vertebral body at a basivertebral nerve ablation site. The rod comprises a lumen extending inside the rod from the proximal end to the distal tip thereof, the lumen being sized to receive the nerve ablation device. The bone channeling device is configured such that its elongated rod provides for electrical insulation. The bone channeling device is also configured such that distal tip extends at a distal end of the rod, the distal tip conducting electricity.[000180] Preferably, the nerve ablation assembly functions as a coaxial bipolar probe assembly for conducting electricity at a basivertebral nerve ablation site as illustrated in Fig. 14. In that embodiment, electric current is conducted between the distal tip of the nerve ablation device and the distal tip of the rod. In embodiments the nerve ablation device and the distal tip of the rod function alternately as an active electrode and a return electrode.[000181] The distal tip can be the “active” electrode, and the proximal ring the “return” electrode, or it can be the opposite.[000182] The bone channeling devices and the nerve ablation device are preferably configured for connection to a radiofrequency generator.[000183] In embodiments, the distal tip of the nerve ablation device comprises at least one temperature sensor to monitor temperature at the basivertebral nerve ablation site (e.g. a thermocouple). In embodiments, at least one temperature sensor (e.g. a thermocouple) is located at a distal end of the bone channeling device.[000184] The above description is meant to be exemplary only, and one skilled in the art will recognize that changes may be made to the embodiments described without departing from the scope of the invention disclosed. Still other modifications which fall within the scope of the present invention will be apparent to those skilled in the art, in light of a review of this disclosure, and such modifications are intended to fall within the appended claims.[000185] Those skilled in the art will recognize, or be able to ascertain, using no more than routine experimentation, numerous equivalents to the specific procedures, embodiments, claims, and examples described herein. Such equivalents are considered to be within the scope of this invention and covered by the claims appended hereto. The invention is further illustrated by the following examples, which should not be construed as further or specifically limiting.EXAMPLES1 Surgical procedure for BVN ablation using a stylet[000186] The following provides an example of a particular surgical procedure for aBVN ablation:1 . The patient is lying on the OR table in a prone position, the patient is prepared for the intervention (local disinfectant scrubbing, sterile draping, etc.).2. Xray images are taken with a C-Arm Fluoroscope in the Anterior / Posterior orientation, the practitioner uses a metal device (needle, stylet, trocar, etc.) to locate the position of the target structure (left side of the L4 Vertebra for example). The metal device is radiopaque and the tip of the metal device helps the practitioner evaluate the skin entry point for the instruments (e.g. the shape of the metal device is projected over the patient Xray).3. The practitioner introduces the needle / guidewire 710 at the desired location, about 1 width of the vertebral body away from the sagittal plane.4. The practitioner injects local anesthetic during the insertion of the needle / guidewire 710.5. The practitioner advances the needle / guidewire 710 up to the junction between the transverse process 23 and the pedicle 22 (can inject local anesthetic). The practitioner confirms the location with the fluoroscopy, as shown in Fig. 21.6. The practitioner breaks the needle / guidewire 710 at the proximal end 720 and removes the syringe body 730. The needle / guidewire 710 stays in place.The trocar distal tip 212 is aligned with the proximal end of the needle / guidewire 720. The trocar shaft 216 is fitted over the needle / guidewire 710, as shown in Fig. 22. The trocar 20 is pushed over the needle / guidewire 710 until it reaches the junction between the transverse process 23 and the pedicle 22, as shown in Fig. 23A. The practitioner confirms the location with the fluoroscopy. The needle / guidewire 710 is removed, as shown in Fig. 23B. The stylet 100 is introduced in the trocar 200, as shown in Figs. 24A and 24B. It provides a sharp tip to the assembly and limits the clogging of the trocar lumen (plug the hole). The trocar 200 and its stylet 100 are passed below (caudal) (or over (cranial)) the transverse process 23 and then advance to their “final” position, as shown in Fig. 25. The practitioner confirms the location with the fluoroscopy. Next, pressure is applied to the top of the stylet handle to force its distal tip to pierce the vertebral body's cortical lateral wall. The trocar stylet is removed. The cannula 300 and its drill 800 are aligned and then inserted in the lumen of the trocar 200. Two spacers are used to: 1) Align the tip of the drill 820 with the tip of the cannula 300; and 2) Align the tip of the cannula 300 with the tip of the trocar 200, as shown in Figs. 26A and 26B. The drill 820 and the cannula 300 are pushed (and rotated if required) until the handles bottom up against the spacers, and the drill distal tip 820 is inserted in the vertebral body (in the hole created by the stylet 100). The practitioner confirms the location with the fluoroscopy. The spacer used to ensure that the tip of the cannula is aligned (slightly protruding) with the tip of the trocar is removed. The drill and the cannula (with their spacer) are pushed (and rotated if required) further toward the BVN trunk to create a channel in the cancellous bone of the vertebral body, as shown in Fig. 27A. The practitioner confirms the location with the fluoroscopy.15. The spacer used to ensure that the tip of the drill is aligned (slightly protruding) with the tip of the cannula is removed. The drill is pushed further toward the BVN trunk past the sagittal plane to create room (a channel) for the ablation probe, as shown in Fig. 27B. The practitioner confirms the location with the fluoroscopy.16. The drill is removed from the cannula. The trocar and the cannula stay in place.17. Optional step: Fluid is injected at the ablation site. A syringe is connected to the top of the cannula handle through a Luer lock connector, fluid is pushed through the cannula lumen. Fluid can have one or more of these functions / compositions: anesthetic, contrast, therapeutic agent, ablation agent, chemical ablation, bone cement, exothermic chemical reaction, etc. The practitioner confirms the location of the fluid with the fluoroscopy.18. An ablation probe 400 is aligned and then inserted in the lumen of the cannula. It is pushed until it reaches its final location, where the electrode of the probe (the portion that is electrically connected to the tissue) is centered about the sagittal plane (presumed position of the BVN trunk). The handle of the cannula can be pushed and / or pulled to ensure that the probe is properly exposed (the cannula doesn’t cover the electrode of the probe, markings or hard stops can be used) and that the probe is aligned (Fig. 28A) and then properly positioned, as shown in Fig. 28B. The practitioner confirms the location of the probe with the fluoroscopy.19. Ablation energy is conducted in the probe to perform the ablation.20. The ablation probe 400 is removed.21. Optional step: Fluid is injected at the ablation site. A syringe is connected to the top of the cannula handle through a luer lock connector, fluid is pushed through the cannula lumen. Fluid can have one or more of these functions / compositions: anesthetic, contrast, therapeutic agent, chemical ablation, bone cement, etc. The practitioner confirms the location of the fluid the fluoroscopy.22. The cannula 300 is removed.23. The trocar 200 is removed.24. The skin incision is cleaned, and a band-aid is applied.25. Draped are removed, instruments are disposed of according to standard procedures.[000187] As described and illustrated in Fig. 31 , it is envisionable in accordance with the present invention to perform BVN ablation inside multiple vertebras simultaneously or concurrently. Accordingly, in such case steps 1 to 18 above are repeated for each vertebra and step 19 is performed in multiple vertebras.Surgical procedure for BVN ablation not requiring a stylet[000188] The following in an alternative example of BVN wherein some steps have been omitted, modified and / or added compared to Example 1. In this alternative procedure, the bone penetration device and the bone channeling device are combined into the same device (combination of devices); the cannula and its stylet are used to pierce the cortical vertebral body wall AND advance in the cancellous vertebral body bone to create a channel for the ablation probe.1 . The patient is lying on the OR table in a prone position, the patient is prepared for the intervention (local disinfectant scrubbing, sterile draping, etc.).2. Xray images are taken with a C-Arm Fluoroscope in the Anterior / Posterior orientation, the practitioner uses a metal device (needle, stylet, trocar, etc.) to locate the position of the target structure (left side of the L4 Vertebra for example). The metal device is radiopaque and the tip of the metal device helps the practitioner evaluate the skin entry point for the instruments (the shape of the metal device is projected over the patient Xray).3. The practitioner introduces the needle / guidewire 71 O at the desired location, about 1 width of the vertebral body away from the sagittal plane.4. The practitioner injects local anesthetic during the insertion of the needle / guidewire 710.5. The practitioner advances the needle / guidewire 710 up to the junction between the transverse process 23 and the pedicle 22 (can inject local anesthetic). The practitioner confirms the location with the fluoroscopy, as shown in Fig. 21.6. The practitioner separates the needle / guidewire 710 at the proximal end 720 and removes the syringe body 730. The needle / guidewire 710 stays in place.7. The trocar distal tip 212 is aligned with the proximal end of the needle / guidewire 720. The trocar shaft 216 is fitted over the needle / guidewire 710, as shown in Fig. 22.8. The trocar 20 is pushed over the needle / guidewire 710 until it reaches the junction between the transverse process 23 and the pedicle 22, as shown in Fig. 23A. The practitioner confirms the location with the fluoroscopy.9. The needle / guidewire 710 is removed, as shown in Fig. 23B.10. The cannula 300 and the drill 800 are introduced in the trocar 200. Two spacers are used to 1) Align the tip of the drill 820 with the tip of the cannula, and 2) Align the tips of the drill 820 and cannula 300 with the tip of the trocar. The cannula 300 and the drill 800 provide a sharp tip to the assembly and limit the clogging of the trocar lumen (plug the hole).11 . The trocar 200, the cannula 300 and the drill 800 separated by the spacers 500 are passed below (caudal) (or over (cranial)) the transverse process 23 and then advance to a desired position on the vertebral wall. The practitioner confirms the location with the fluoroscopy.12. The tip of the drill 820 has a sharp drill shape. The handle of the drill 810 is turned clockwise and pushed simultaneously to pierce the lateral cortical wall of the vertebral body, until the handles bottom up against the spacers, and the drill distaltip 820 is inserted in the vertebral body (pierce the cortical shell) , as shown in Fig. 26B. The practitioner confirms the location with the fluoroscopy. The spacer used to ensure that the tips of the cannula is aligned (slightly protruding) with the tip of the trocar is removed. The drill and the cannula (with their spacer) are pushed (and rotated if required) further toward the BVN trunk to create a channel in the cancellous bone of the vertebral body, as shown in Fig. 27 A. The practitioner confirms the location with the fluoroscopy. The spacer used to ensure that the tip of the drill is aligned (slightly protruding) with the tip of the cannula is removed. The drill is pushed further toward the BVN trunk past the sagittal plane to create room (a channel) for the ablation probe, as shown in Fig. 27B. The practitioner confirms the location with the fluoroscopy. The drill is removed from the cannula. The trocar and the cannula stay in place. Optional step: Fluid is injected at the ablation site. A syringe is connected to the top of the cannula handle through a Luer lock connector, fluid is pushed through the cannula lumen. Fluid can have one or more of these functions / compositions: anesthetic, contrast, therapeutic agent, ablation agent, chemical ablation, bone cement, etc. The practitioner confirms the location of the fluid with the fluoroscopy. An ablation probe 400 is aligned and then inserted in the lumen of the cannula. It is pushed until it reaches its final location, where the electrode of the probe (the portion that is electrically connected to the tissue) is centered about the sagittal plane (presumed position of the BVN trunk). The handle of the cannula can be pushed and / or pulled to ensure that the probe is properly exposed (the cannula doesn’t cover the electrode of the probe, markings or hard stops can be used) and that the probe is aligned (Fig. 28A) and then properly positioned, as shown in Fig. 28B. The practitioner confirms the location of the probe with the fluoroscopy. Ablation energy is conducted in the probe to perform the ablation The ablation probe 400 is removed.20. Optional step: Fluid is injected at the ablation site. A syringe is connected to the top of the cannula handle through a Luer lock connector, fluid is pushed through the cannula lumen. Fluid can have one or more of these functions / compositions: anesthetic, contrast, therapeutic agent, chemical ablation, bone cement, etc. The practitioner confirms the location of the fluid with the fluoroscopy.21. The cannula 300 is removed.22. The trocar 200 is removed.23. The skin incision is cleaned, and a band-aid is applied.24. Draped are removed, instruments are disposed of according to standard procedures.[000189] As described and illustrated in Fig. 31 , it is envisionable in accordance with the present invention to perform BVN ablation inside multiple vertebras simultaneously or concurrently. Accordingly, in such case steps 1 to 18 above are repeated for each vertebra and step 19 is performed in multiple vertebras.[000190] Headings are included herein for reference and to aid in locating certain sections. These headings are not intended to limit the scope of the concepts described therein, and these concepts may have applicability in other sections throughout the entire specification. Thus, the present invention is not intended to be limited to the embodiments shown herein but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.[000191] The singular forms “a”, “an” and “the” include corresponding plural references unless the context clearly dictates otherwise. Thus, for example, reference to "a device" includes one or more of such devices and reference to "the method" includes reference to equivalent steps and methods known to those of ordinary skill in the art that could be modified or substituted for the methods described herein.[000192] Unless otherwise indicated, all numbers expressing quantities of ingredients, reaction conditions, concentrations, properties, and so forth used in the specification and claims are to be understood as being modified in all instances by the term “about”. At the very least, each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. Accordingly, unless indicated to the contrary, the numerical parameters set forth in the present specification and attached claims are approximations that may vary depending upon the properties sought to be obtained. Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the embodiments are approximations, the numerical values set forth in the specific examples are reported as precisely as possible.Any numerical value, however, inherently contains certain errors resulting from variations in experiments, testing measurements, statistical analyses, and such.[000193] It is understood that the examples and embodiments described herein are for illustrative purposes only and that various modifications or changes in light thereof will be suggested to persons skilled in the art and are to be included within the present invention and scope of the appended claims.

Claims

CLAIMS:1 . A trocar for basivertebral nerve ablation in a patient, the trocar comprising a handle, and a rigid and hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, a lumen extending inside the shaft from the proximal end to the distal tip, wherein the lumen of the shaft is adapted to receive and guide at least one of a bone penetration device and a bone channeling device, from the proximal end of the shaft towards its distal tip, and wherein the trocar is configured for an insertion in the back of the patient in a posterior to anterior direction, caudal or cranial to a traverse process of a vertebra of the patient to reach a lateral surface of a vertebral body of the vertebra, said introduction further requiring positioning of the distal tip of the hollow shaft on the lateral wall surface of the vertebral body at a bone entry point, said bone entry point being defined by a linear projection between a basivertebral nerve ablation site towards the lateral wall surface of the vertebral body, wherein said linear projection is substantially tangential to the curved distal portion of the shaft, and wherein the curved distal portion of the shaft comprises a length and a curve configured to both (i) provide a desired insertion angle at the bone entry point and (ii) direct the at least one bone penetration device and bone channeling device substantially along said tangential linear projection towards the basivertebral nerve ablation site.

2. A trocar for basivertebral nerve ablation, comprising a handle, and a rigid and hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, a lumen extending inside the shaft from the proximal end to the distal tip,wherein the lumen of the shaft is adapted to receive and guide at least one of a bone penetration device and a bone channeling device, from proximal end of the shaft towards its distal tip, and wherein the trocar is configured for an insertion in the back of the patient in a posterior to anterior direction, caudal or cranial to a traverse process of a vertebra of the patient to reach a lateral surface of a vertebral body of the vertebra said introduction further requiring positioning of the distal tip of the hollow shaft on the lateral wall surface of the vertebral body at a bone entry point defined by a curved projection between a basivertebral nerve ablation site towards the lateral wall surface of the vertebral body, and wherein the curved distal portion of the shaft comprises a length and a curve configured to both (i) provide a desired insertion angle at the bone entry point and (ii) provide said curved projection to direct the at least one bone penetration device and bone channeling device substantially along said curved projection towards the basivertebral nerve ablation site.

3. The trocar of claim 1 or 2, wherein the curved distal portion has a radius of curvature of about 10 mm to about 50 mm, and an angle of curvature of about 30 degrees to about 120 degrees.

4. The trocar of any one of claims 1 to 3, wherein the curved distal portion has a radius of curvature of about 35 mm and an angle of curvature of about 75 degrees.

5. The trocar of any one of claims 1 to 4, wherein the lumen of the shaft has a diameter of about 1 mm to about 5 mm.

6. The trocar of any one of claims 1 to 5, wherein the rigid and hollow shaft is made of a material selected from the group consisting of a medical-grade metal or a medical grade plastic.

7. The trocar of claim 6, wherein the medical-grade metal is stainless steel, titanium or nitinol, and wherein the medical grade plastic is polyether ether ketone (PEEK) or polyetherimide.

8. The trocar of any one of claims 1 to 7, wherein the handle is coupled to the proximal end of the trocar, the handle defining a T-shape with the rigid and hollow shaft and providing a grip for manipulation of the trocar by a user.

9. The trocar of claim 8, wherein the handle comprises: a rigid bar coupled to the proximal end of the trocar and substantially perpendicular to the straight elongated portion of the trocar, the bar comprising lateral extensions defining said T-shape with the straight elongated portion of the shaft of the trocar, the lateral extensions being configured for providing a pulling grip to fingers of a user, and a central opening in fluid communication with the lumen of the trocar.

10. The trocar of claim 9, wherein the handle further comprises a fluid entry port in fluid communication with the lumen of the rigid and hollow shaft for injecting a fluid inside the trocar.11 . The trocar of claim 10, wherein the fluid entry port comprises a locking connector.

12. A kit for basivertebral nerve ablation, the kit comprising a trocar, and at least one of a bone penetration device and a bone channeling device; the trocar comprising a handle, and a rigid and hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, a lumen extending inside the shaft from the proximal end to the distal tip,wherein the lumen of the shaft is adapted to receive and guide the bone penetration device and the bone channeling device, from its proximal end towards its distal tip, the bone penetration device comprising an elongated stem extending from a proximal end to a sharp distal tip, wherein the elongated stem comprises a diameter sized to slide inside the lumen of the trocar, is deformable to move along the curved distal portion of the trocar, is longer than the trocar, such that the sharp distal tip of the elongated stem projects out the distal tip of the hollow shaft when inserted therein, and wherein said sharp distal tip is sufficiently rigid to pierce through the lateral wall of a patient vertebral body, the bone channeling device comprising an elongated rod extending from a proximal end to a distal tip wherein the elongated rod has a diameter sized to slide inside the lumen of the trocar, is deformable to move along the curved distal portion of the trocar, is longer than the hollow shaft of the trocar, such that the distal tip of the elongated rod projects out the distal tip of the trocar when inserted therein, wherein the bone channeling device optionally comprises nerve ablation capabilities; and wherein the sharp distal tip of the bone channeling is sufficiently rigid to pierce through the lateral wall of the vertebral body of a patient.

13. The kit of claim 12, wherein said kit comprises both a bone penetration device and a bone channeling device.

14. The kit of claim 12, wherein said kit comprises two bone penetration devices and / or two channeling devices.

15. The kit of any one of claims 12 to 14, wherein: the trocar is configured for introduction in the back of a patient and configured for precise positioning of its distal tip at a bone entry point located on a lateral wall of the patient’s vertebral body, said bone entry point being defined by a linear projection between a basivertebral nerve ablation site towards the lateral wall surface of the vertebral body, wherein said linear projection is substantially tangential to the curved distal portion of the shaft; and wherein the curved distal portion of the shaft comprises a length and a curve configured to both (i) provide a desired insertion angle at said bone entry point and (ii) direct the sharp distal tip of the bone penetration device and / or direct the distal tip of the bone channeling device substantially along said tangential linear projection towards the basivertebral nerve ablation site.

16. The kit of any one of claims 12 to 15, wherein the bone penetration device and / or the bone channeling device comprises a curved distal tip.

17. The kit of claim 16, wherein said bone entry point is defined by a curved projection of a basivertebral nerve ablation site towards the lateral wall surface of the vertebral body, and wherein the curved distal portion of the shaft of the trocar comprises a length and a curve configured to both (i) provide a desired insertion angle at the entry point and (ii) direct the curved distal tip of the bone penetration device and / or direct the curved distal tip of the bonechanneling device substantially along said curved projection towards the basivertebral nerve ablation site.

18. The kit of claim any one of claims 12 to 17, wherein the bone penetration device comprises an elongated stem extending from a proximal end to a sharp distal tip, wherein the elongated stem comprises a diameter sized to slide inside the lumen of the trocar, is deformable to move along the curved distal portion of the trocar, is longer than the trocar, such that the sharp distal tip of the elongated stem projects out the distal tip of the hollow shaft when inserted therein, and wherein said sharp distal tip is sufficiently rigid to pierce through the lateral wall of the vertebral body of a patient.

19. The kit of claim 18, the elongated stem of the bone penetration device further comprises a lumen sized for receiving and guiding the bone channeling device.

20. The kit of claim 18, wherein the sharp distal tip of the elongated stem is curved to access the basivertebral nerve with a curved trajectory inside the vertebral body.21 . The kit of any one of claims 12 to 17, wherein the bone penetration device consists of at least one of a cannula, a stylet, a drill, a radiofrequency probe, a spear, and any combination thereof.

22. The kit of claim of any one of claims 12 to 21 , wherein the bone channeling device comprises: an elongated rod extending from a proximal end to a distal tip, wherein the elongated rod has a diameter sized to slide inside the lumen of the trocar, is deformable to move along the curved distal portion of the trocar, is longer than the hollow shaft of the trocar, such that the distal tip of the elongated rod projects out the distal tip of the trocar when inserted therein.

23. The kit of claim 22, wherein the elongated rod comprises a lumen extending from the proximal end to the distal tip thereof, wherein said lumen is sized for receiving and guiding a nerve ablation device and / or wherein said lumen is configured for injecting a fluid therein.

24. The kit of claim 23, wherein the nerve ablation device consists of a radiofrequency probe or an electrode.

25. The kit of any one of claims 22 to 24, wherein the bone channeling device further comprises nerve ablation capabilities.

26. The kit of claim 24 or 25, wherein the elongated rod is made of a material conducting electricity, and wherein said rod is covered by an electrical insulating material but for a portion of its distal tip.

27. The kit of any one of claim 22 to 26, wherein the elongated rod comprises a flexible distal portion, wherein said curved portion straightens when sliding the bone channeling device inside the trocar, and wherein said curved portion returns at a curved configuration once exiting the distal tip of the trocar.

28. The kit of claim of any one of claims 12 to 27, wherein the distal tip of the elongated rod is sufficiently rigid to pierce through the lateral wall of the vertebral body.

29. The kit of any one of claim 22 to 28, wherein, the bone channeling device further comprises an upper handle coupled to said proximal end, the handle defining a T- shape with the elongated rod, the handle providing a grip for manipulation of the bone channeling device by a user.

30. The kit of claim 29, wherein said upper handle comprises a substantially horizontal and rigid bar coupled to said proximal end, the bar, the bar comprising lateral extensions defining said T-shape with the elongated rod, the lateral extensions being configured for providing a pulling grip to fingers of a user, and a central opening in fluid communication with the lumen of the elongated rod.

31. The kit of claim 30, wherein the upper handle further comprises a fluid entry port in fluid communication with the lumen of the elongated rod for injecting a fluid inside the spinal channeling device.

32. The kit of claim 31 , wherein the fluid is selected from the group comprising a fluoroscopy marker agent, a contrast agent, a therapeutical agent, an anesthetic agent, an ablation agent, a bone cement, and a cooling fluid.

33. The kit of claim 31 or 32, wherein the fluid entry port comprises a locking connector.

34. The kit of claim 33, wherein the locking connector is a Luer lock connector.

35. The kit of claim of any one of claims 22 to 34, wherein the elongated rod of the bone channeling device further comprises a lumen extending from the proximal end to the distal tip thereof, wherein said lumen is configured for injecting a fluid therein.

36. The kit of claim of any one of claims 22 to 35, wherein the bone channeling device further comprises nerve ablation capabilities, and wherein the distal tip of the nerve ablation device comprises an electrical active tip.

37. The kit of claim 36, wherein said electrical active tip comprises at least one of a temperature sensor and an electrode.

38. The kit of claim 37, wherein the electrode is a monopolar electrode, a bipolar electrode or a coaxial bipolar electrode.

39. The kit of claim 36, wherein the electrode is a bipolar electrode comprising an active section, a return section, an insulating section.

40. The kit of claim 39, wherein electric current is conducted alternately between the active section and the return section to generate heat.41 . The kit of any one of claims 22 to 40, said kit further comprising at least one of a guidewire, a base and a spacer.

42. The kit of claim 41 , wherein the guidewire comprises an elongated straight and flexible rod configured to pierce the skin and be inserted in the back patient’s body to a reference point and / or reach the entry point.

43. The kit of claim 42, wherein the guidewire is sized to slide inside the lumen of the trocar.

44. The kit of any one of claims 41 to 43, wherein the guidewire consists of a wire, a needle, a tube or a rod.

45. The kit of any one of claims 41 to 44, wherein the guidewire comprises a distal tip configured to be anchored on the lateral wall of a patient vertebral body and / or the traverse process of the patient vertebral body.

46. The kit of claim 45, wherein said distal tip comprises a cone shaped end comprising a screw thread for anchoring on bone.

47. The kit of any one of claims 41 to 46 wherein the base is configured to be applied against the skin of the patient and support the trocar.

48. The kit of claim 47, wherein the base comprises a central hub with legs projecting from the central hub, the legs comprising a free end to be applied against the skin of the patient, the central hub comprising a passage for introducing and supporting the trocar.

49. The kit of claim 48, wherein the central hub of the base further comprises a locking mechanism to stably fix the trocar relative to the base.

50. The kit of any one of claims 41 to 49, wherein the spacer is configured to cooperate with the trocar, the bone penetration device and / or the bone channeling device, in order to control a depth of penetration of the bone penetration device and / or the bone channeling device inside the trocar.

51. The kit of claim 50, wherein the spacer is removable and configured to be positioned between (i) the trocar and the bone penetration device, (ii) the trocar and the bone channeling device, (iii) two different bone penetration devices, (iv) two different bone channeling devices positioned, and / or (v) bone penetration device and a bone channeling device.

52. The kit of claim 50 or 51 , wherein the spacer consist of a piece of rigid material having a height providing a desired spacing, the spacer leaving a central passage for the bone penetration device(s) and / or the bone channeling device(s).

53. A bone piercing device comprising: an elongated stem extending from a proximal end to a cutting distal tip, wherein the elongated stem is configured and sized to slide inside the lumen of a trocar, and wherein said cutting distal tip comprises a pointy shape and a first diameter, and wherein said cutting distal tip is configured to create a hole having a second diameter larger than said first diameter.

54. The bone piercing device of claim 53, wherein the pointy shaped cutting end provides a positive rake angle.

55. The bone piercing device of claim 53 or 54, wherein the cutting distal tip comprises a rake angle p, a relief angle y and a point angle 0, and wherein: the rake angle p is about 10 degrees to about 20 degrees, or about 1 degree to about 45 degrees, or about 15 degrees; the relief angle y is about 10 degrees to about 30 degrees, or about 1 degree to about 45 degrees, or about 20 degrees; and the point angle 0 is about 30 degrees to about 60 degrees, or about 15 degrees to about 75 degrees, or about 45 degrees.

56. The bone piercing device of any one of claims 53 to 55, wherein said cutting distal tip is made of a material selected from the group consisting of a medical grade metal or medical grade plastic.

57. A nerve ablation assembly comprising: a nerve ablation device comprising an elongated wire comprising a proximal end, an intermediate section and a distal tip, the wire extending from the proximal end to the distal tip, wherein the intermediate section provides for electrical insulation, and wherein the distal tip comprises an end section for conducting electricity, a bone channeling device comprising an elongated rod extending from a proximal end to a distal tip, the distal tip being configured for an insertion inside a patient vertebral body at a basivertebral nerve ablation site, wherein said rod comprises a lumen extending inside the rod from the proximal end to the distal tip thereof, said lumen being sized to receive the nerve ablation device; wherein the elongated rod provides for electrical insulation, and wherein the distal tip extends at a distal end of the rod, the distal tip conducting electricity.

58. The nerve ablation assembly of claim 57, wherein said nerve ablation assembly functions as a coaxial bipolar electrode for conducting electricity at a basivertebral nerve ablation site.

59. The nerve ablation assembly of claim 57 or 58, wherein an electric current is conducted between the distal tip of the nerve ablation device and the distal tip of the rod.

60. The nerve ablation assembly of claim 59, wherein the distal tip of the nerve ablation device and the distal tip of the rod function alternately as an active electrode and a return electrode.61 . The nerve ablation assembly of any one of claims 57 to 60, wherein a least one of the bone channeling devices and the nerve ablation device is configured for connection to a radiofrequency generator.

62. The nerve ablation assembly of any one of claims 57 to 61 wherein the distal tip of the nerve ablation device comprises at least one temperature sensor to monitor temperature at the basivertebral nerve ablation site.

63. A stylet for an intravertebral medical procedure, comprising: an elongated shaft comprising an internal core covered by an external layer, wherein said external layer is made of a material more flexible that said internal core.

64. A cannula and stylet assembly for an intravertebral medical procedure, comprising: the cannula comprising an elongated hollow rod extending from a proximal end to a curved distal tip, wherein the hollow rod defines a lumen extending inside the rod from the proximal end to the curved distal tip, said lumen being sized to receive and guide the stylet from the proximal end to the curved distal tip; the stylet comprising an elongated stem extending from a proximal end to a curved distal tip, wherein the elongated stem o comprises a diameter sized to slide inside the lumen of the cannula, o is deformable to move along the curved distal tip of the cannula,o is longer than the cannula, such that the curved distal tip of the elongated stem projects out the distal tip of the hollow rod when inserted therein, wherein the curved distal tip of the cannula and the curved distal tip of the stylet have different curvatures, and wherein rotating the stylet about the cannula changes a resulting curved distal tip of the cannula and stylet assembly.

65. The cannula and stylet assembly of claim 64, wherein the stylet has a smaller curvature than the curvature of the cannula.

66. A method of positioning a trocar for an intravertebral medical procedure, comprising: providing a trocar comprising a curved distal tip, inserting the trocar in a patient’s body in a posterior to anterior direction, caudal or cranial to a transverse process of a patient’s vertebra, such that the curved distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the vertebra.

67. The method of claim 66, wherein the trocar comprises a shaft having a lumen adapted to receive and guide a bone penetration device, the method further comprising providing a bone penetration device comprising an elongated stem extending from a proximal end to a sharp distal tip, and inserting the bone penetration device inside the trocar until the sharp distal tip of the bone penetration device pierces through the vertebral body.

68. A method of positioning a bone penetration device for an intravertebral medical procedure, comprising: providing a trocar and a bone penetration device, wherein the trocar comprises a hollow shaft, the hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, the hollow shaft further comprising a lumen extending inside the shaft from the proximal end to the distaltip, the lumen being adapted to receive and guide a bone penetration device, from the proximal end towards the distal tip of the trocar. wherein the bone penetration device comprises an elongated stem extending from a proximal end to a sharp distal tip, inserting the bone penetration device inside the trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining a trocar-penetration device assembly; and inserting the trocar-penetration device assembly in a posterior to anterior direction, caudal or cranial to a transverse process of a patient’s vertebra, such that the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the vertebra.

69. The method of claim 68, further comprising inserting the trocar-penetration device assembly further inside the body of the patient such that the sharp distal tip of the bone penetration device pierces through the vertebral body.

70. The method of claim 68 or 69, wherein the bone penetration device is selected from the group consisting of a stylet, a drill, a probe, a device assembly comprising a stylet and a cannula, a device assembly comprising a drill and a cannula, and a device assembly comprising a probe and a cannula.

71. The method of any one of claims 68 to 70, wherein the intravertebral medical procedure comprises a basivertebral nerve ablation.

72. A method for basivertebral nerve ablation, comprising: providing a trocar comprising a hollow shaft, the hollow shaft comprising a proximal end, a straight elongated portion, a curved distal portion and a distal tip, the hollow shaft further comprising a lumen extending inside the shaft from the proximal end to the distal tip, the lumen being adapted toreceive and guide a guidewire and a bone penetration device, from its proximal end towards its distal tip; providing a guidewire configured to pierce the skin and be inserted in the back patient’s body, wherein the guidewire is sized to slide inside the lumen of the trocar; inserting the guidewire in the back patient’s body in a posterior to anterior direction, caudal or cranial to a transverse process of a patient’s vertebra until the guidewire reaches an entry point on a lateral side of a vertebral body of the vertebra or until the guide wire reaches a reference point on a traverse process of the vertebra; sliding the distal tip of the trocar over the guidewire until said distal tip reaches the entry point on the lateral side of the vertebral body or reaches the reference point; removing said guidewire; providing a bone penetration device comprising an elongated stem extending from a proximal end to a sharp distal tip, inserting the bone penetration device inside the lumen of the trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining a trocar-penetration device assembly; inserting the trocar-penetration device assembly in a posterior to anterior direction, caudal or cranial to said transverse process, such that the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of the patient’s vertebral body.

73. The method of claim 72, further comprising inserting the trocar-penetration device assembly further inside the body of the patient such that the sharp distal tip of the bone penetration device pierces through the vertebral body.

74. The method of claim 72 or 73, wherein the bone penetration device pierces the vertebral body at the predefined entry point with a desired angle for providing a projection extending from the basivertebral nerve towards said predefined entry point.

75. The method of claim 74, wherein said projection is linear and substantially tangential to the curved distal portion of the shaft.

76. The method of claim 74, wherein said projection is curved and extends from a basivertebral nerve ablation site towards the lateral wall surface of the vertebral body.

77. The method of claim 76, further comprising: providing a bone channeling device comprising a curved distal tip; and introducing the bone channeling device inside the trocar such that curved distal tip of the bone channeling device follows substantially said curved projection to the basivertebral nerve ablation site.

78. The method of any one of claims 72 to 77, further comprising: inserting the sharp distal tip of the bone penetration device further inside the vertebral body until said distal tip reaches the basivertebral nerve ablation; and injecting energy at a basivertebral nerve ablation site.

79. The method any one of claims 72 to 77, further comprising: removing the bone penetration device from the trocar after piercing the vertebral body, providing a nerve ablation device comprising an elongated rod extending from a proximal end to a distal tip, the distal tip of the nerve ablation device comprising nerve ablation capabilities; inserting the nerve ablation device inside the trocar until the distal tip of the nerve ablation device reaches a basivertebral nerve ablation site, and injecting energy at the distal tip of the nerve ablation device.

80. The method of claim 79, wherein the guidewire is introduced about one width of the vertebral body away from the sagittal plane.81 . The method of claim 79 or 80, further comprising injecting a local anesthetic during the insertion of the guidewire.

82. The method of any one of claims 72 to 81 , further comprising monitoring positioning of the guidewire, trocar, bone penetration device, bone channeling device and / or nerve ablation device by fluoroscopy, X-rays, CT-scan, ultrasound, MRI or other imaging guidance.

83. The method of any one of claims 72 to 82, further comprising the steps of removing the ablation device, bone channeling device, bone penetration device and / or trocar after said basivertebral nerve ablation.

84. The method any one of claims 72 to 83, wherein the basivertebral nerve ablation site is at the trunk of the basivertebral nerve.

85. A method of positioning multiple bone penetration devices on multiple vertebrae for an intravertebral medical procedure on multiple vertebrae concurrently or simultaneously, comprising: providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; and inserting each of the trocar-penetration device assemblies in a posterior to anterior direction, caudal or cranial to a transverse process of at least two different vertebrae of the patient, such that for each trocar-penetration assembly the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the patient vertebrae.

86. A method of positioning multiple bone penetration devices for an intravertebral medical procedure on a single vertebra, comprising: providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; andinserting each of the trocar-penetration device assemblies in a posterior to anterior direction, caudal or cranial to a transverse process of a single vertebra of the patient, such that for each trocar-penetration assembly the distal tip of the trocar is positioned at a predefined entry point located on a lateral wall of a vertebral body of the patient vertebra.

87. The method of claim 86, wherein said at least two trocar-penetration device assemblies are inserted along the same transverse process such that the distal tip of each trocar is positioned on a same side of the lateral wall of the vertebral body.

88. The method of claim 86, wherein said at least two trocar-penetration device assemblies are inserted along two different transverse processes such that the distal tip of each trocar is positioned on different sides of the vertebral body.

89. A method of positioning multiple bone penetration devices for an intravertebral medical procedure on a single vertebra, comprising: providing at least two trocars and at least two bone penetration devices; inserting each of the bone penetration device inside a corresponding trocar until the sharp distal tip of the bone penetration device extends outside the trocar, thereby obtaining at least two trocar-penetration device assemblies; and inserting each of the trocar-penetration device assemblies in a posterior to anterior direction, such that for each trocar-penetration assembly the distal tip of the trocar is positioned at a predefined entry point located either (i) on a lateral wall of a vertebral body or (ii) at a same level or above sacral ala of the patient vertebra.

90. The method of any one of claims 85 to 89, wherein said intravertebral medical procedure comprises basivertebral nerve (BVN) ablation.

91. A method for basivertebral nerve (BVN) ablation, the method comprising performing BVN ablation on multiple vertebrae simultaneously and / or concurrently.

92. Use of a trocar as defined in any one of claims 1 to 11 , a kit as defined in any one of claims 12 to 51 , a bone piercing device as defined in any one of claims 53 to 56, a nerve ablation assembly as defined in any one of claims 57 to 63, a stylet as defined in claim 63, and / or a cannula and stylet assembly as defined in claim 64 or 65, for basivertebral nerve ablation in a human patient in need thereof.

93. Use of a trocar as defined in any one of claims 1 to 11 , a kit as defined in any one of claims 12 to 51 , a bone piercing device as defined in any one of claims 53 to 56, a nerve ablation assembly as defined in any one of claims 57 to 63, a stylet as defined in claim 63, and / or a cannula and stylet assembly as defined in claim 64 or 65, for performing a surgical intervention requiring to access the interior of a patient’s vertebra.

94. The use of claim 93, wherein said surgical intervention is selected from the group consisting of vertebral augmentation, vertebroplasty, kyphoplasty, tumor ablation.

95. The use of claim 93 or 94, comprising basivertebral nerve (BVN) ablation on multiple vertebrae simultaneously and / or concurrently.

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