Basivertebral Nerve Removal Through Fluoroscopy-Guided Needle Access
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Solution Overview
Problem
Existing BVN removal procedures face challenges in achieving safe and accurate targeting with large incisions, which can lead to complications and inefficiencies.
Innovation Solution
A method and system utilizing a bone needle, drill/awl, cup curette, pituitary rongeur, ablation probe, nerve monitoring probe, and bone graft syringe, guided by fluoroscopy, to perform precise BVN removal through a series of steps, including insertion, drilling, resection, ablation, and bone grafting, minimizing incision size.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If traditional BVN removal procedures are performed with large incisions, then the surgeon has better access and visibility, but the risk of complications increases and patient recovery is prolonged
Solution Approach 1:
The patent employs a nested instrument delivery system where multiple instruments (drill, curette, rongeur, ablation probe) are sequentially inserted through a single needle tract. The needle serves as a guide and container for subsequent instruments, allowing complex procedures to be performed through a minimal incision without requiring large surgical openings.
Solution Approach 2:
The needle acts as an intermediary tool that provides both the initial access pathway and a guide for subsequent instruments. The fluoroscopy imaging serves as an intermediary visualization method, allowing real-time guidance without requiring large incisions for direct visualization.
2Measurement precision
If fluoroscopy guidance is used for BVN targeting, then accuracy of nerve localization is improved, but the complexity of the procedure increases
Solution Approach 1:
The patent utilizes fluoroscopy to provide real-time feedback on needle and instrument positioning within the vertebral body. This allows the surgeon to verify correct placement of the needle and subsequent instruments, ensuring accurate BVN targeting while maintaining a relatively simple procedural workflow through image-guided verification at key steps.
3Length of moving object
If multiple instruments are used sequentially through a single needle, then incision size is minimized, but the time required for instrument exchanges increases
Solution Approach 1:
Multiple instruments are designed to be sequentially inserted and removed through the same needle tract. Each instrument (drill, curette, rongeur, ablation probe) can be introduced through the established needle pathway, eliminating the need for separate incisions and reducing overall procedural time despite multiple instrument exchanges.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
Enables safe and accurate BVN removal with reduced incision size, ensuring effective ablation and verification of nerve removal, and promoting bone regeneration.
Implementation Method 1
ablating and cauterizing any remaining BVN base and forming a lesion in the BVN site
Implementation Method 2
confirming the inner stylet position and depth with fluoroscopy
Data Source
AI summary
A method for removing a basivertebral nerve (BVN), includes the following sequential steps. First, inserting a bone needle into a vertebral body of a vertebra and advancing the bone needle under fluoroscopy to a BVN base site. The bone needle includes an elongated shaft having a cannula extending from a proximal end to a distal end of the shaft, and a removable bevel tipped inner stylet extending through the cannula. Next, removing the inner stylet from the cannula and inserting a drill/awl through the cannula into the BVN base site and once the drill/awl position and depth is confirmed via fluoroscopy drilling the BVN base out. Next, removing the drill/awl from the cannula and inserting a cup curette through the cannula into the BVN base site to further resect under fluoroscopy the BVN base. Next, removing the cup curette from the cannula and inserting a pituitary rongeur through the cannula into the BVN base site and removing under fluoroscopy all resected portions of the BVN base. Next, removing the pituitary rongeur from the cannula and inserting an electric ablation probe through the cannula into the BVN base site and once the ablation probe depth and position is confirmed ablating and cauterizing any remaining BVN base and forming a lesion in the BVN site. Next, removing the ablation probe from the cannula and inserting a nerve monitoring probe through the cannula into the BVN base site and testing to ensure that the BVN base has been fully removed from the BVN site and a void has been formed. Next, removing the nerve monitoring probe from the cannula and attaching a syringe filled with bone graft to the proximal end of the shaft, and filling the void formed in the BVN site with bone graft.