Surgical instrument set for spinal facet joint treatment

Abstract

A surgical instrument set (100) is provided for performing spinal facet joint therapy, specifically for performing minimally invasive spinal facet joint or spinal facet capsule therapy and / or surgery using mechanical ablation and electromagnetic ablation and / or coagulation to relieve spinal pain. The surgical instrument set includes a first instrument (110) for performing mechanical ablation of a portion of a target spinal facet joint or spinal facet capsule, and a second instrument (120) using electromagnetic waves for ablation of tissue and / or nerves and / or portions of the target spinal facet joint or spinal facet capsule, and / or coagulation of tissue and / or portions of the target spinal facet joint or spinal facet capsule. The first instrument (110) is configured to be driven by a hand grip. The present invention further provides a method for treating back pain by performing minimally invasive spinal therapy and / or surgery, specifically for performing mechanical ablation and electromagnetic ablation and / or coagulation. The method includes the steps of advancing a first instrument (110) for performing mechanical ablation of a targeted spinal facet joint or spinal facet joint capsule, and / or advancing a second instrument (120) that utilizes electromagnetic waves to ablate tissue and / or nerves and / or portions of the targeted spinal facet joint or spinal facet joint capsule and coagulate tissue and / or portions of the targeted spinal facet joint or spinal facet joint capsule, the first instrument (110) and the second instrument (120) being used alternately, the order being determined by the treatment and / or surgery being performed.

Description

[Technical Field]

[0001] The present invention relates to a surgical instrument set for spinal facet joint treatment. In particular, the present invention relates to a surgical instrument set for use in the field of minimally invasive spinal treatment and / or surgery, such as for facet joint syndromes, using mechanical ablation and electromagnetic ablation and / or coagulation. Furthermore, the present invention relates to a method for treating lower back pain, particularly facet joint syndromes, using mechanical ablation and electromagnetic ablation and / or coagulation. [Background technology]

[0002] To understand facet joint syndrome, one must first understand its location. Facet joints are located between two vertebrae in the spine. They are the joints that allow the back to flex, resulting in bending and twisting of the back. Facet joints are unique in that they have innervation through a single nerve source. Nerves from the spine exit through the facet joints. In a healthy joint, cartilage and the synovial fluid that lubricates the joint allow the spine to move smoothly without excessive squeaking.

[0003] Facet joint syndrome can occur due to several factors, including aging, overloading of the joint (which can be due to overweight and occupation), or injury. These factors can cause the disc between the vertebrae to deteriorate and eventually buckle, narrowing the space. Excessive pressure on the surfaces of the facet joints can lead to more damage, and bone can creak against bone. The patient will experience pain when there is movement involving the spine.

[0004] Traditionally, facet joint rhizotomy or radiofrequency thermocoagulation (RFL) has been used to temporarily relieve spinal arthritis pain. RFL procedures involve cryotherapy or radiofrequency techniques to either frostbite or burn the nerve. RFL is temporary because the nerve is destroyed at a point between the dorsal root ganglion (the nerve cell body) and the motor endplate sensory receptor (the location of pain stimulation in the joint); therefore, like any peripheral nerve, this nerve gradually regenerates, and pain eventually returns. Therefore, most RFL procedures last for 4 to 8 months and, if pain returns, must be repeated throughout the patient's lifetime for effective pain relief.

[0005] For facet joint syndrome, surgery is typically considered an option only when traditional treatment options are no longer effective for the patient. Traditional open surgery for facet joint syndrome can be complicated because it requires large incisions that carry a high risk of postoperative complications. Open surgery also results in a longer recovery and rehabilitation process.

[0006] During spinal surgery, it is necessary to expose intraspinal structures by removing portions of the facet joints and facet joint capsules via a posterior or posterolateral approach. This removal of portions of the bony structure of the spine is performed to access the spinal canal, which is filled with neural structures. The neural structures within the spinal canal have a fragile tissue structure and arborization, and the central portion of the spinal canal is filled with a long sac (dura mater) filled with nerve fibers. Nerve roots branch out from this long nerve-filled sac to the left and right at each intervertebral level, while the nerve roots exit the spinal canal through tunnels or foramina on both sides.

[0007] In humans, the dural sac containing the nerve fibers and their branches is pathologically compressed at the level of the spinal canal and inside the foramen (tunnel) by: -Bulging or prolapsed disc material - Enlarged facet joints - Enlarged facet joint capsule - Synovial cyst of the facet joint - Intramedullary tumor, or -Disc buckling, which can lead to foraminal narrowing.

[0008] This compression of the dural sac and the nerve fibers within it can cause pain, numbness, or even paralysis in the patient, the most common complication being that of a herniated disc.

[0009] To reduce the risk of postoperative complications, minimally invasive spinal surgery for facet joint syndrome has become more popular in recent years because it reduces the incidence of complications and can be performed as an outpatient procedure, allowing patients to return to the comfort of their own homes the same day after surgery. Procedures for facet joint syndrome include any minimally invasive decompression procedure, such as facet joint thermal ablation, discectomy, laminotomy, and foraminal domectomy.

[0010] Discectomy aims to remove the portion of the disc that is causing compression. Thus, facet joint treatment can be described as a debridement procedure that can be performed on the facet joints of the cervical, thoracic, or lumbar vertebrae of the human spine. During facet joint debridement, the bursa between the facet joints is removed to remove the bone and denervate the joint (to prevent reinnervation).

[0011] To access the spinal canal for treatment or removal of pathological tissue, it is necessary to remove surrounding bone material. Removing a portion of the facet joint capsule and a portion of the facet bone creates an opening 6–11 mm in diameter through which a working cannula can be inserted. Through this working cannula, the surgeon can manipulate and remove pathological interspinous tissue using standard instruments, such as graspers, curettes, reamers, and lasers. Through this working cannula, the interdiscal space can also be irrigated and, if necessary, interdiscal space or cages can be inserted. After the working cannula is introduced, removal of pathological structures within the spinal canal can be further performed with the assistance of an endoscope.

[0012] Such procedures are typically performed under the control of a two-plane x-ray image intensifier, also known as "fluoroscopy."

[0013] Removing bony structures to gain access to the spinal canal is a very delicate and difficult procedure. Accidental damage or severing of the nerve sac (dura mater) or one of the branching nerve roots must be avoided at all costs, as such damage can be very dangerous and may result in irreversible patient recovery.

[0014] For the implementation of such minimally invasive spinal treatments and / or spinal surgeries, U.S. Patent Application Publication No. 2019 / 0343575A1 describes a spinal facet joint treatment system. The system includes an electrosurgical generator having a fixed operating power curve with a maximum wattage of 60 watts and a spinal facet joint treatment instrument having an elongated, rotatable shaft. The shaft has a distal end with an ablation element. The instrument is in communication with the electrosurgical generator and configured to automatically rotate between about 10 rpm and about 5000 rpm to ablate endplate sensory receptor regions with bursae in the spinal facet joints. The electrosurgical or RF generator supplies power to the ablation element while the shaft rotates or remains stationary.

[0015] The described system has the advantage of being able to perform resection, debridement, coagulation, and / or cauterization with a single instrument or system. However, many surgeons prefer to perform resection and / or debridement of the spinal facet joints or facet joint capsules with surgical instruments, such as drills or reamers, that provide tactile feedback. Furthermore, surgeons prefer to perform nerve removal while using an endoscope to visualize the treatment or surgical area. [Prior art documents] [Patent documents]

[0016] [Patent Document 1] U.S. Patent Application Publication No. 2019 / 0343575A1 Summary of the Invention [Problem to be solved by the invention]

[0017] In view of the above, it is desirable to provide a surgical instrument set that enables minimally invasive spinal treatment of facet joint syndromes and / or minimally invasive spinal surgery, which allows visualization of the treatment or surgical area during certain stages of the procedure and allows the surgeon to perform resection and / or debridement using surgical instruments that provide tactile feedback. [Means for solving the problem]

[0018] These desirabilities are addressed by a surgical instrument set for performing spinal facet joint treatment to relieve spinal pain according to claim 1. The invention also relates to a method for treating lower back pain according to claim 16. Embodiments can be found in the dependent claims, the following description and the accompanying drawings.

[0019] The present invention provides a surgical instrument set for performing spinal facet joint treatment for the relief of spinal pain, particularly for performing minimally invasive spinal facet joint or spinal facet capsule treatment and / or surgery utilizing mechanical ablation and electromagnetic ablation and / or coagulation, comprising: a first instrument for performing mechanical ablation of a portion of a target spinal facet joint or spinal facet joint capsule; a second instrument utilizing electromagnetic waves for (thermal) ablation of tissue and / or nerves and / or portions of the target spinal facet joint or facet joint capsule, and / or coagulation of tissue and / or portions of the target spinal facet joint or facet joint capsule; Equipped with The first instrument provides a surgical instrument set configured to be actuated by a hand grip.

[0020] Accordingly, the present invention provides a surgical instrument set for performing spinal facet joint treatment, particularly for performing minimally invasive spinal facet joint or spinal facet joint capsule treatment and / or surgery, which is capable of providing tactile feedback to the surgeon during the performance of this treatment or surgery, particularly during resection and / or debridement, thereby enabling removal of portions of the outer surface of the bursa and spinal facet joint in a gentle manner while protecting nerves, tissue, and / or dura mater during the medical procedure, facilitating medical treatment near highly sensitive areas of the organism or human body, thereby accelerating the post-operative healing process.

[0021] In the context of the present invention, the term "resection" in relation to the treatment or surgery being performed should be understood to refer to procedures such as polishing, (gentle) grinding, scraping, filing, grating, cleansing, and / or rasping the soft tissue of the facet joint to remove tissue and expose the underlying bone without cutting or removing bone (as opposed to a sharp cutting edge, e.g., a knife). The resection instrument can have a surface with an abrasive texture and / or configuration, which may include small teeth.

[0022] On the other hand, the term "debridement," in the context of the present invention, refers to scraping the outer bony surface of a target spinal facet joint by removal of soft tissue associated with the endplate sensory receptor areas of the joint, including bursae and tissue.

[0023] Furthermore, in the context of the present invention, the term "electromagnetic ablation" refers to thermal ablation achieved by the application of electromagnetic radiation (electromagnetic waves), such as radio frequency, microwave, infrared, visible light, ultraviolet, X-ray, and gamma rays. In this context, the use of radio frequency, specifically bipolar radio waves, has proven to be very practical and effective.

[0024] Generally, embodiments of the present invention allow for debridement of the facet joint, removing the endplate sensory receptor area, including the bursa and the outer surface of the spinal facet joint. When the bursa and the outer surface of the joint are removed, the nerves have no place to reattach to the joint, and the joint is therefore permanently denervated. In other words, the patient is permanently relieved of pain.

[0025] According to one embodiment of the present invention, a surgical instrument set comprises: a guidewire configured to be inserted through an incision made in the patient's back until it reaches the target spinal facet joint or facet joint capsule; and / or a dilator configured to be placed over the guidewire and guided by the guidewire toward the target spinal facet joint or facet joint capsule; and / or a sleeve configured to be inserted into the incision over the guidewire and / or dilator until the target spinal facet joint or facet joint capsule is reached, and to provide a working channel; The sensor may further include:

[0026] Additionally, in some embodiments, the surgical instrument set may further comprise an endoscope insertable into the working channel of the sleeve and configured to be used to visualize the target spinal facet joint or facet joint capsule before and / or after performing mechanical and / or electromagnetic ablation.

[0027] Thus, the endoscope is placed or advanced through the working channel of the sleeve toward the target spinal facet joint or facet joint capsule, and a second instrument, specifically an RF probe, is placed or advanced through the endoscope inserted into the working channel, whereby electromagnetic ablation is performed under visual control by the endoscope.

[0028] According to a further embodiment of the present invention, the sleeve may comprise a shaft extending longitudinally along the length of the sleeve and a fixation section for fixing the sleeve on the target spinal facet joint or facet joint capsule, the fixation section being located at a distal portion of the shaft, the fixation section preferably being provided on or in a lateral surface of the shaft so as to extend along a portion of the circumference of the shaft.

[0029] Thus, specifically after the correct position has been confirmed by fluoroscopy, the sleeve can be fixed, thereby immobilizing the treatment and / or surgical area on the target spinal facet joint or facet capsule.

[0030] Furthermore, in the context of the present invention, the terms "distal" and "proximal" are used in the sense normally given to those terms in connection with surgical instruments, i.e., the term "distal" refers to the end of a surgical instrument that is farther from the surgeon when the instrument is in use, and the term "proximal" refers to the end of the surgical instrument that is closer to the surgeon when the instrument is in use. In other words, the distal end is the end of the surgical instrument that is inserted first into the patient's body and is typically the end for operating each surgical side, while the proximal end is located in the surgeon's hand.

[0031] Additionally, the fixation section may include at least one notch extending a predetermined distance along the length of the sleeve from the distal end of the sleeve toward the proximal end of the sleeve.

[0032] Furthermore, in some embodiments of the present invention, the at least one cutout, preferably three cutouts, may have a length of 1 to 4 mm, preferably 2 to 3 mm, and a width of 1 to 3 mm, preferably 1.5 to 2.5 mm, where the length of the cutout is parallel to the longitudinal direction of the sleeve and the width is perpendicular to the longitudinal direction of the sleeve.

[0033] Additionally, in some embodiments of the present invention, the fixation section comprises at least one fixation pin disposed on a lateral surface of the shaft so as to extend along the length of the sleeve, wherein the at least one fixation pin preferably protrudes from the end face of the sleeve at the distal end, the fixation pin preferably protruding in the range of 0.2 mm to 2 mm, more preferably in the range of 0.5 mm to 1.5 mm.

[0034] In some embodiments, the first instrument for performing mechanical ablation may comprise a drill member having a cutting section for cutting bone, and the cutting section may be located at a distal end of the drill member.

[0035] Additionally, in some embodiments of the present invention, the drill member may include a non-cutting protective tip for protecting nerves, tissue, or dura from cutting, the non-cutting protective tip being located distal to the cutting section.

[0036] Additionally, in some embodiments of the present invention, the cutting section comprises a plurality of cutting edges disposed on the forward surface of the drill member and extending radially outward.

[0037] In some embodiments, a first instrument for performing mechanical ablation may include a handle located at a proximal end of the first instrument, specifically at the proximal end of a drill member of the first instrument. Furthermore, the handle may preferably have a spherical or curved shape to fit comfortably in a surgeon's hand. Furthermore, the handle may be removably or detachably secured to the first instrument, specifically by a threaded connection.

[0038] Furthermore, the handle of the first instrument, specifically the drill member, has a spherical or curved portion followed by a straight portion, thereby forming a mushroom-shaped portion. Furthermore, both of these portions may be hollow, and the spherical or curved portion may additionally comprise a number of through-holes. This allows for a reduction in the overall weight of the handle and an easier grip. Furthermore, the straight portion may comprise notches on its outer periphery, preferably extending parallel to the longitudinal direction of the first instrument, specifically the shaft of the first instrument.

[0039] Additionally, in some embodiments of the present invention, the handle has an at least partially spherical or curved shape with a radius in the range of 25 mm to 40 mm, preferably in the range of 30 mm to 35 mm. By providing the handle with a spherical or curved shape, force application may be improved and / or enhanced compared to conventional straight handles. Specifically, the surgeon receives improved feedback regarding the applied force.

[0040] Thus, in some embodiments, the handle may be configured to provide tactile feedback to the surgeon or operator, particularly regarding the force and / or torque being introduced or applied.

[0041] According to a further embodiment of the present invention, the second instrument may include an electromagnetic probe or an RF (radio frequency) probe or an ablation element, and further, the second instrument may include an electrosurgical generator that provides power to the electromagnetic probe, RF probe, or ablation element.

[0042] Additionally, the inner diameter of the working channel of the sleeve may be such that when a first instrument, particularly a drill member, is inserted or received therein, the first instrument or its drill member is rotatable.

[0043] The present invention further provides a method for treating lower back pain, preferably by using a surgical instrument set according to any one of the preceding claims, in particular by performing minimally invasive spinal therapy and / or surgery using mechanical ablation and electromagnetic ablation and / or coagulation.

[0044] This method is advancing a first instrument to perform mechanical ablation of the target spinal facet joint or spinal facet joint capsule; and / or advancing a second instrument that utilizes electromagnetic waves, particularly radio waves (radio frequency), and more particularly bipolar radio waves, to ablate tissue and / or nerves and / or portions of the target spinal facet joint or facet joint capsule and to coagulate tissue and / or portions of the target spinal facet joint or facet joint capsule; The first and second instruments are used in alternating order, the order being determined by the treatment and / or procedure being performed.

[0045] In other words, the first and second instruments are used separately. That is, either the first or second instrument is inserted into the working channel of the previously placed sleeve. Furthermore, the order in which the first and second instruments are used, or vice versa, is determined depending on the treatment or surgery being performed. Thus, the second instrument can be first used to ablate or remove a nerve, then the first instrument can be used to mechanically remove a portion of the target spinal facet joint or facet joint capsule, specifically by manually driving a drill element, and the first instrument can be removed from the sleeve, the target spinal facet joint or facet joint capsule can be inspected endoscopically, and if necessary, the second instrument can be used again to coagulate the spinal facet joint or facet joint capsule.

[0046] According to a further embodiment of the present invention, the method comprises the steps of: In a first step, a second instrument is used to ablate tissue and / or nerves of the target spinal facet joint or facet joint capsule; In a second step, a first instrument is used to ablate or scrape the target spinal facet joint or facet joint capsule; In a third step, a second instrument is used to coagulate tissue and / or portions of the targeted spinal facet joint or facet joint capsule.

[0047] As mentioned above, in some embodiments, an endoscope may be used before and / or after use of the first instrument and / or the second instrument to inspect and / or visualize and / or document the target spinal facet joint or facet joint capsule or the area of ​​treatment and / or surgery to be performed.

[0048] Additionally, in some embodiments, the second instrument may be positioned or advanced through the endoscope, particularly through the working channel of the endoscope, preferably under the visibility provided by the endoscope.

[0049] In some embodiments, the endoscope may be used specifically for water irrigation of the target spinal facet joint or facet capsule, thereby providing the necessary fluid for the bipolar RF probe.

[0050] Furthermore, in some embodiments, the first and / or second instruments and the endoscope may be usable simultaneously, and particularly may be insertable together into the working channel of the sleeve, for inspection or visualization of the target spinal facet joint or facet joint capsule or treatment and / or surgical area before and / or during ablation with the first and / or second instruments.

[0051] Additionally, the first instrument, specifically the drill element, may be advanced or be advanced into pathological tissue, such as, for example, enlarged facet capsule or bone, synovial cyst, or tumor, to be removed.

[0052] Additionally, in some embodiments, a guidewire, specifically a K-wire, may be first inserted into the incision, preferably taking into account the approach angle required to reach the target spinal facet joint or facet joint capsule. The guidewire may be advanced into the incision until it reaches the target spinal facet joint or facet joint capsule. The guidewire is then gently tapped into the target spinal facet joint or facet joint capsule.

[0053] Furthermore, in some embodiments, the K-wire may have a diameter in the range of 1.2 mm to 1.8 mm, preferably 1.5 mm. Increasing the diameter of the K-wire to be within the range of 1.2 mm to 1.8 mm can improve the guide stability of the K-wire and improve fixation of the K-wire.

[0054] Additionally, the method may further include the step of, after the guidewire has been positioned and its position confirmed, preferably by fluoroscopy, advancing a dilator over the guidewire toward the target spinal facet joint or facet joint capsule, and confirming the exact position of the guidewire and dilator, preferably by fluoroscopy.

[0055] In some embodiments, the method further includes inserting and advancing a sleeve having a working channel over the dilator and guidewire toward the target spinal facet joint or facet joint capsule, and fixating the sleeve to the target spinal facet joint or facet joint capsule, preferably with a fixation section provided on the sleeve.

[0056] Methods for treating lower back pain, particularly by performing minimally invasive spinal therapy and / or surgery utilizing mechanical ablation and electromagnetic ablation and / or coagulation, can use the surgical instrument set for performing spinal facet joint therapy to relieve spinal pain of the present invention. Accordingly, additional features disclosed in connection with the above description of the surgical instrument set may also apply to methods for treating lower back pain, and vice versa.

[0057] A more complete appreciation of the present invention and many of its associated advantages will be readily obtained as the same becomes better understood by reference to the following detailed description when considered in connection with the accompanying drawings, in which: [Brief explanation of the drawings]

[0058] [Figure 1] 1 is a schematic diagram of a surgical instrument during treatment of a target spinal facet joint according to the prior art. [Figure 2] 1 is a schematic isometric cross-sectional view of a portion of a surgical instrument set in accordance with a first embodiment of the present invention; [Figure 3] FIG. 1 is a schematic plan view of a portion of a surgical instrument set in accordance with a second embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0059]

[0023] The following description of the embodiments of the present disclosure will be made with reference to these drawings. It will be apparent to those skilled in the art of spinal medical procedures that the following description of the embodiments is provided solely for illustrative purposes and is not intended to limit the present disclosure. Furthermore, the features of the embodiments described below may be used to further describe the features of the devices defined in the claims.

[0060] Modifications of features may be combined to form further embodiments. Features described in individual embodiments may be implemented in a single embodiment to the extent they are mutually compatible. Similarly, features described in one embodiment may be implemented in multiple embodiments individually or in any suitable subcombination. Throughout this specification and the appended claims, singular terms such as "a," "an," and "the" include plural references unless the context clearly dictates otherwise. Identical reference numerals shown in different drawings indicate identical, corresponding, or functionally similar elements. As described hereinafter, exemplary embodiments of the present disclosure relate to a surgical instrument set for spinal facet joint treatment for the relief of spinal pain.

[0061] Unless otherwise stated, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by those skilled in the art to which the present invention pertains. Furthermore, it will be understood that terms such as those defined in commonly used dictionaries should be interpreted as having a meaning consistent with the meaning of those terms in the context of this specification and related art, and should not be interpreted in an idealized or overly conventional sense unless expressly defined herein. Well-known functions or structures may not be described in detail for simplicity and clarity.

[0062] Furthermore, when an element is referred to as being "on," "mounted," "coupled," "bonded," "contacting," or the like, the element can be directly on, mounted, coupled, bonded, or in direct contact with the other element, or intervening elements may be present. In contrast, when an element is referred to, for example, as being "directly on," "directly mounted," "directly coupled," "directly coupled," "directly bonded," or "directly in contact with," no intervening elements are present. Those skilled in the art will also understand that a reference to a structure or feature disposed "adjacent" to another feature may have portions that overlap or underlie the adjacent feature.

[0063] FIG. 1 shows a schematic diagram of a surgical instrument 200 during treatment of a target spinal facet joint (vertebral column 300) according to the prior art. As can be seen from FIG. 1, conventional surgical instruments 200 used in spinal facet joint treatment to relieve spinal pain consist of a guidewire, a sleeve 201, an endoscope 202, and a surgical tool such as a grasping forceps 203 or a drill. Traditionally, the patient is placed in a prone position, the treatment area is draped with sterile drapes, and the desired treatment location is prepped according to standard techniques. The desired treatment location is determined using fluoroscopy, and the skin is marked. In the next step, a 10-15 mm incision is made, taking into account the approach angle required to reach the target spinal facet joint. Then, using fluoroscopic guidance, a guidewire (K-wire) is advanced through the incision until it reaches the facet joint. The guidewire is gently hammered into the bone using a small hammer, while the precise location of the guidewire is confirmed using fluoroscopy. In the next step, a dilator is inserted over the guidewire to widen the channel provided for the sleeve, and then the sleeve is inserted over the dilator on the guidewire. The guidewire and / or dilator are then removed, thereby making the working channel in the sleeve accessible. If desired, an endoscope is inserted into the working channel for inspection of the target spinal facet joint or facet joint capsule. Figure 1 shows a surgical system in which an endoscope 202 can be used in conjunction with grasping forceps 203, allowing the surgeon to visualize the target spinal facet joint or facet joint capsule during treatment.

[0064] FIG. 2 shows a schematic isometric cross-sectional view of a portion of a surgical instrument set 100 according to a first embodiment of the present invention. As can be seen in FIG. 2, the surgical instrument set 100 includes a guidewire 101, specifically a K-wire, configured to be inserted into an incision made in the patient's back as described above in connection with FIG. 1. The guidewire 101 can be advanced into the incision until it reaches the target spinal facet joint or facet joint capsule. After confirming the correct position of the guidewire using fluoroscopy, the position of the guidewire is fixed, typically by gently tapping the wire 101 into the bone using a small hammer. The surgical instrument set 100 also includes a dilator 102 that is positioned over the guidewire and is configured to be guided by the guidewire as it is advanced into the target spinal facet joint or facet joint capsule. The set also includes a sleeve 103 that is configured to be inserted into the incision over the guidewire 101 and / or dilator 102 in case the guidewire 101 is removed first. As previously described, the sleeve 103 may be inserted or advanced through the incision until it reaches the target spinal facet joint or facet joint capsule. The illustrated surgical instrument set 100 further includes a hand grip 104 coupled or coupleable to the sleeve 103 to further facilitate the surgeon's advancing and / or positioning of the sleeve 103 within the incision.

[0065] Figure 3 shows a schematic plan view of a portion of a surgical instrument set 100 according to a second embodiment of the present invention. As shown in Figure 3, the set further includes a first instrument 110, which in the illustrated embodiment is a manual drill, and a second instrument 120, which in the illustrated embodiment is an electromagnetic probe capable of emitting high or high-frequency electromagnetic waves. The set further includes an endoscope 130, a plurality of guidewires or K-wires (101), and a dilator 102. Also seen in Figure 3 is that the dilator 102 includes a channel, specifically a guidewire channel 102A, that is used to guide the guidewire 101 toward the target spinal facet joint or facet joint capsule.

[0066] The drill 110 is used, for example, to perform mechanical ablation of a portion of a targeted spinal facet joint or facet joint capsule. The second instrument 120, specifically an electromagnetic probe, can be used for various purposes. First, the second instrument 120 can be used to coagulate a treated spinal facet joint or facet joint capsule. Furthermore, if desired, it can also be used to perform ablation, specifically thermal ablation, of tissue and / or nerves and / or (small) portions of the targeted spinal facet joint or facet joint capsule. The provided surgical instrument set 100 offers the opportunity to use an endoscope 30 through the same sleeve 103, which allows for inspection of the targeted treatment area, allowing for first performing a gross treatment with mechanical ablation, inspecting the treatment area, and, if necessary or desired, performing fine thermal ablation via the second instrument 120. This improves the quality of the treatment and / or surgery performed and, specifically, reduces the potential risk of nerve damage.

[0067] As shown in FIG. 3 , the sleeve 103 further includes a shaft extending longitudinally along the length of the sleeve 103 (i.e., along the insertion direction of the sleeve 103 into the incision). The shaft includes a fixation section 103B configured to fix the sleeve 103 over the target spinal facet joint or facet joint capsule. As shown in FIG. 3 , the fixation section 103B is positioned at the distal end of the shaft. The illustrated fixation section 103B consists of three notches or recesses extending a predetermined distance, within a range of 1 to 4 mm, from the distal end of the sleeve 103 into the sleeve 103, specifically along the length of the sleeve 103. Also shown in FIG. 3 , the sleeve 103 further includes a working channel 103A used to insert or advance the first instrument 110, the second instrument 120, and the endoscope 130. Preferably, however, first instrument 110 and second instrument 120 are inserted or advanced through an endoscope 130 which also includes a working channel (not shown).

[0068] As further seen in FIG. 3 , the drill 110 includes a drill member 110A having a cutting section capable of cutting bone. The cutting section is located at the distal end of the drill member 110A. The illustrated drill 110 further includes a handle 110B at the proximal end of the drill member 110A. The handle 110B has a spherical portion followed by or transitioning into a straight portion, giving the handle 110B a mushroom shape that fits comfortably in a surgeon's hand. Both of these portions are hollow, thereby reducing the weight of the handle 110B. Furthermore, the spherical portion includes multiple holes, further reducing the weight of the handle 110B and improving its tactile feel. Furthermore, the straight portion includes notches on the periphery, making it easier for the surgeon to firmly hold or grip the handle 110B. [Explanation of symbols]

[0069] 100 Surgical Instrument Sets 101 Guidewire (K-wire) 102 Dilator 102A Guidewire Channel (Dilator) 103 Sleeve 103A Working Channel 103B Fixed Section 104 Hand Grip 110 First instrument (mechanical ablation instrument) 110A Drilling element (first tool) 110B Handle (first instrument) 120 Secondary Instrument (Electromagnetic Ablation and / or Coagulation Instrument) 130 Endoscope 200 Surgical instruments (prior art) 201 Sleeve 202 Endoscope 203 Grasping forceps 300 spinal column

Claims

1. A surgical instrument set (100) for performing spinal facet joint treatment for the relief of spinal pain, particularly for performing minimally invasive spinal facet joint or spinal facet joint capsule treatment and / or surgery utilizing mechanical ablation and electromagnetic ablation and / or coagulation, comprising: a first instrument (110) for performing mechanical ablation of a portion of a target spinal facet joint or spinal facet capsule; a second electromagnetic wave instrument (120) for (thermal) ablation of tissue and / or nerves and / or portions of the target spinal facet joint or facet joint capsule, and / or coagulation of tissue and / or portions of the target spinal facet joint or facet joint capsule; Equipped with The first tool (110) is configured to be actuated by a hand grip; a sleeve (103) configured to be inserted into an incision made in the patient's back over the guidewire (101) and / or dilator (102) until the target spinal facet joint or facet joint capsule is reached, and to provide a working channel (103A); The sleeve (103) comprises a shaft extending longitudinally along the length of the sleeve (103) and a fixation section (103B) for fixing the sleeve (103) on the target spinal facet joint or spinal joint capsule, the fixation section (103B) being located at a distal portion of the shaft. Surgical instrument set (100).

2. The guide wire (101) is specifically a K-wire configured to be inserted into the incision until it reaches the target spinal facet joint or facet joint capsule; The dilator (102) is configured to be placed over the guidewire and guided by the guidewire toward the target spinal facet joint or facet joint capsule.

10. The surgical instrument set (100) of claim 1.

3. 3. The surgical instrument set (100) of claim 1 or 2, further comprising an endoscope (130) insertable into the working channel (103A) and configured for use in visualizing the target spinal facet joint or facet joint capsule before and / or after performing mechanical and / or electromagnetic (wave) ablation.

4. 4. The surgical instrument set (100) of claim 1, wherein the fixing section (103B) is provided on or in a lateral surface of the shaft so as to extend along a portion of the periphery of the shaft.

5. 5. The surgical instrument set (100) of claim 4, wherein the fixation section comprises at least one notch extending a predetermined distance along the longitudinal direction of the sleeve (103) from the distal end of the sleeve (103) toward the proximal end of the sleeve.

6. 6. The surgical instrument set (100) of claim 5, wherein the at least one incision has a length of 1 to 4 mm and a width of 1 to 3 mm.

7. 7. The surgical instrument set (100) of claim 4, wherein the fixation section comprises at least one fixation pin provided on the lateral surface of the shaft so as to extend along the longitudinal direction of the sleeve (103), the at least one fixation pin protruding from an end face of the sleeve (103) located at a distal end, the fixation pin protruding within a range of 0.2 mm to 2 mm.

8. 8. The surgical instrument set of claim 1, wherein the first instrument (110) for performing mechanical ablation comprises a drill member (110A) having a cutting section for cutting bone, the cutting section being located at a distal end of the drill member.

9. 9. The surgical instrument set of claim 8, wherein the cutting section comprises a plurality of cutting edges disposed on a forward surface of the drill member (110A) and extending radially outward.

10. 10. The surgical instrument set of claim 1, wherein the first instrument (110) for performing mechanical ablation comprises a handle (110B) located at a proximal end of the first instrument (110), specifically at a proximal end of a drill member (110A) of the first instrument (110), the handle (110B) having a spherical or curved shape to fit comfortably in a surgeon's hand.

11. 11. The surgical instrument set of claim 10, wherein the handle has a spherical or curved portion followed by a straight portion, both portions being hollow, the spherical or curved portion comprising a through hole, and the straight portion comprising a notch on an outer periphery.

12. The surgical instrument set according to claim 10 or 11, wherein the handle (110B) has an at least partially spherical or curved shape with a radius in the range of 25 mm to 40 mm.

13. 13. The surgical instrument set of claim 10, wherein the handle is configured to provide tactile feedback to the surgeon or operator, in particular tactile feedback regarding the force and / or torque being applied.

14. 14. The surgical instrument set of claim 1, wherein the second instrument (120) comprises an electromagnetic probe or an RF (radio frequency) probe or a cauterizing element, and the second instrument (120) comprises an electrosurgical generator that provides power to the electromagnetic probe, the RF probe, or the cauterizing element.

15. 11. A surgical instrument set according to claim 8 or claim 10 dependent on claim 8, wherein the inner diameter of the working channel (103A) of the sleeve (103) is such that when the first instrument (110), specifically the drill member (110A), is inserted or received therein, the first instrument (110) or its drill member (110A) is rotatable.

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