Method of epidermal surgery

5857996
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Inventors

Snoke, Phillip Jack

Application #

957998

Filed

Oct-22-1997

Published

Jan-12-1999

Current US Class

128/898
604/28
604/512

International Classes

A61M 001/00

Field of Search

604/28 604/48 604/49 604/51 604/53 604/54 604/95 128/898

Assignee

Catheter Imaging Systems (Atlanta, GA)

Examiners

Stright, Jr.; Ronald

Attorney, Agent or Firm

Allen, Dyer, Doppelt, Milbrath & Gilchrist

US Patent References

3948251   Flexible tube endos...
4273111   Endoscope with be...
4279245   Flexible tube
4327723   Catheter shield
4344092   Miniature video ca...
4353358   Sigmoidoscope
4390012   Rigid type endosco...
4413278   Optical coupling a...
4417886   Catheter introductio...
4421106   Fiber scope for bio...
4433675   Light supply appar...
4475539   Endoscopic televisi...
4483326   Curvature control...
4515592   Catheter shield
4539586   Connector module f...
4543090   Steerable and aim...
4545374   Method and instru...
4573448   Method for decomp...
4577621   Endoscope having...
4580551   Flexible plastic tub...
4587972   Device for diagnost...
4589404   Laser endoscope
4590923   Arthroscope-video c...
4601284   Endoscope connect...
4611888   Coupler for surgica...
4625713   Instrument incorpor...
4644960   Device for making...
4649904   Biopsy seal
4651202   Video endoscope sy...
4653476   Instrument insert for...
4713057   Mechanical assist...
4737142   Instrument for exa...
4745908   Inspection instrume...
4748969   Multi-lumen core d...
4750475   Operating instrume...
4753222   Endoscopic flexible...
4758222   Steerable and aim...
4776844   Medical tube
4782819   Optical catheter
4791912   Endoscope
4793326   Endoscope having...
4797737   Imaging apparatus...
4799496   Guide wire handle
4808157   Multi-lumen epidur...
4815450   Endoscope having...
4834710   Catheter shield and...
4844053   Flexible tubular de...
4853773   Endoscope signal...
4867529   Super-thin fiberscope
4884133   Endoscope light so...
4890602   Endoscope constru...
4893613   Endoscope constru...
4901142   Video scope system
4904237   Apparatus for the e...
4905666   Bending device for...
4906230   Steerable catheter tip
4911148   Deflectable-end en...
4919112   Low-cost semi-dispo...
4919653   Device for locating...
4920413   Blood-vessel endosc...
4924856   Endoscope light so...
4930521   Variable stiffness es...
4933816   Inspection/detection...
4934340   Device for guiding...
4954129   Hydrodynamic clot...
4968295   Method of separati...
4968298   Interspace irrigator
4972828   Endoscope having...
4973312   Method and system...
4973329   Assembly of wire in...
4979496   Endoscope for bile...
4983165   Guidance system fo...
4989582   Winding type endo...
4996974   Adjustable steering...
5004456   In-dwelling catheter
5010875   Intravascular endo...
5024655   Epidural catheter a...
5042915   Light source appar...
5053046   Dural sealing need...
5058568   Flexible endoscope
5084043   Method for perform...
5085631   Method and kit for...
5090959   Imaging balloon di...
5101807   Endoscope connect...
5125906   Hand-held device f...
5131382   Endoscopic percut...
5134469   Endoscope light so...
5143475   Bending device
5151096   Laser catheter diffu...
5167221   Bending device
5188594   Method of administ...
5195541   Method of performi...
5197649   Gastrointestinal en...
5199417   Endoscope having...
5199950   Medical instrument
5215105   Method of treating...
5217454   Laser delivery cath...
5232442   Method and appar...
5267573   Guidewire extender
5273535   Catheter with electr...
5275151   Handle for deflecta...
5328467   Catheter having a t...
5342299   Steerable catheter
5344397   Cholangiogram cat...
5354266   Method of epidural...
5396880   Endoscope for dire...
5399164   Catheter having a...
5415158   Flexible endoscope...
5423311   Catheter imaging a...
5437636   Steerable catheter...
5526820   Catheter with integr...
5531687   Steerable catheter
 

Referenced by:

View Backward References

Other References

AngioLaz Ultra-Vu.TM., Angiolaz Epidural Ultra-Vu Scope. Anesthesiology Pain Management in the 21.sup.st Century: An Anesthesiologist's Look into the Crystal Ball, Steven D. Waldman, M.D. Eighteen-Gauge Microscopic-Telescopic Needle Endoscope with Electrode Channel: Potential Clinical and Research Application, Charles P. Olinger, M.D. and R. L. Ohlhaber, Surg. Neuol. vol. 2, May 1974. "The Dorsomedian Connective Tissue Band in the Lumbar Epidural Space of Humans: An Anatomical Study Using Epiduroscopy in Autopsy Cases" Rune Blomberg, M.D. 1986 by the International Anesthesia Research Society. Physiology, Pathophysiology and Pharmacology of Local Anaethetics Used in Regional Anaesthesia, presented by B. G. Covino and G. T. Tucker. Hogan, Quinn H., M.D., "Lumbar Epidural Anatomy", Anesthesiology, vol. 75, pp. 767-775 (1991). Pick et al., "Endoscopic Examinations and Computed Tomography Concerning Cervical Spine Positioning in Treatment of Acute Cervical Spine Injuries", Archives of Orthopaedic and Traumatic Surgery, vol. 97, pp. 43-49 (1980). Pool, Lawrence J., "Direct Visualation of Dorsal Nerve Roots of the Cauda Equina by Means of Myeloscpe", Archives of Neurology and Psychiatry, pp. 1308-1312. Harrison et al., "Resin Injection Studies of the Extradural Space", British Journal of Anaesthesia, vol. 57, pp. 333-336 (1985). Blomberg, R., "A Method for Epiduroscopy and Spinaloscopy", Acta Anaesthesiology Scand, vol. 29, pp. 113-116 (1985). Ooi et al., "Myeloscopy, with Special Reference to Blood Flow Changes in the Cauda Equina During Lasegue's Test", Int'l Orthopaedics (SICOT), vol. 4, pp. 307-311 (1981). Shimoji et al., "Observation of Spinal Canal and Cisternae with the Newly Developed Small-diameter, Flexible Fiberscopes", Anesthesiology, vol. 75, pp. 341-344 (1991). Blomberg et al., "The Lumbar Epidural Space in Patients Examined with Epiduroscopy", Aneth Analg, vol. 68, pp. 157-160 (1989). Stern, Lincoln E., "The Spinascope: A New Instrument for Visualizing the Spinal Canal and Its Contents", Medical Record, pp. 31-32 (1936). Ooi et al., "Myeloscopy", Int'l Orthopaedics (SICOT), vol. 1, pp. 107-111 (1977). Burman, Michael S., "The Direct Visualization of the Spinal Canal and Its Contents", pp. 695-696. Pool, Lawrence J., "Myeloscopy: Intraspinal Endoscop," Surgery, vol. 11, pp. 169-182 (Feb. 1942). Shimoji et al., "Observation of Spinal Canal and Cisternae with the Newly Developed Small-diameter, Flexible Fiberscopes," Anesthesiology, vol. 75, pp. 341-344, (1991). Waldman, Steven D., "Pain Management in the 21st Century: An Anesthesiologist's Look Into the Crystal Ball," American Journal of Pain Management, vol. 1 (Oct. 1991). Hillmer, Michael, "Back Talk," Spirit, p. 32 (Oct. 1991). Springer, Ilene, "Back Talk," pp. 114, 118, 122. Shantha 3et al., "Subdural Blood Patch for Spinal Headache," The New England Journal of Medicine, vol. 325, No. 17, pp. 1252-1253 (Oct. 1991). Caudal Analgesia, pp. 264-265. "Actual Position of Spinal and Epidural Anaesthesia," pp. 42-43. "Insertion of the Catheter," Continuous Epidual Analgesia, pp. 218-223. "Sacral Epidual (Caudal) Block," Principles and Practice of Regional Anaesthesia, pp. 105-106, 108. "Spinal Analgesia," Anatomy, p. 61. Fortuna, Armando, "Caudal Epidual Anethesia in Latin-America," p. 928. Bromage, Drugs and Equipment, pp. 333-334. Blomberg et al., "The Lumbar Epidural Space in Patients Examined with Epiduroscopy," Anesth. Analg., vol. 68, pp. 157-160 (1989). Hogan et al., "Epidual Steroids and the Outcomes Movement," Pain Digest, vol. 1, pp. 269-270 (1992). "Epidural Endoscopy Excerpts and Comments" Yale University School of Medicine, Center for Pain Management:; Apr. 1992. "Exploring Epidural Endoscopy" Diagnostic Images Using the Ultra-Vu.TM. Scopy in Pain Management Applications; Apr. 1992. "Exploring Epidural Endoscopy" Diagnostic Imnages Using the Ultra-Vu.TM. Scopy: Apr. 1992. "Experimental Procedures at Yale University by Dr. Randy Rizor," Apr. 16, 1992--Tape 1 of 3. Experimental Procedures at Yale University by Dr. Randy Rizor, Apr. 6, 1992--Tape 2 of 3. "Experimental Procedures at Yale University by Dr. Randy Rizor," Apr. 16, 1992--Tape 3 of 3. Seldinger, Sven I., "Catheter Replacement of the Needle in Percutaneous Arteriography," American Journal of Roentgenology, vol. 142, pp. 5-7 (1984). Declaration of Dr. Dennis W. Coombs dated Sep. 19, 1996 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc. pp. 1-4. Declaration of Dr. Yasin Kahn in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-2.Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc. Declaration of Dr. Luke M. Kitahata dated Nov. 1 Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-3. Declaration of Ronald G. Seifert dated Nov. 18, 1996 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging, Inc., pp. 1-2. Affidavit of Thomas R. Long executed Nov. 11, 1996 in Myelotec, Inc., and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-17. Deposition of Jack Snoke, dated 24 Oct. 1996, in Myelotec, Inc. and Edward J. Lortie Jr., v. Catheter Imaging Systems, Inc., pp. 1-11. Affidavit of Geoffrey Harrison Galley executed Sep. 7, 1994 pp. 1-7. Affidavit of Vernon Milton Levey executed Sep. 7, 1994 pp. 1-2. Affidavit of Paul Z. Lundbergh dated Sep. 12, 1996 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., (3 pages and attached Exhibits A and B). Affidavit of Hurley J. Blakeney dated Oct. 6, 1996, in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-7. Affidavit of Allen Elphick executed Nov. 11, 1996 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-3. Affidavit of David Clatworthy executed Nov. 6, 1996 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-7. Angio Laz Ultra-Vu.TM. brochure, pp. 1-3. Deposition of Adib Issaac Khoury dated Oct. 10, 1996 Condensed Transcript and Concordance in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-17. Deposition of P. Jack Snoke Oct. 24, 1996 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-99. Exhibits 1-13 to Deposition of P. Jack Snoke Oct. 24, 1996 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-68. Videotape Depostion of Lloyd Saberski, M.D., Nov. 7, 1996, in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-118. Deposition of Ron Luther, Nov. 6, 1996, Condensed Transcript and Concordance in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-9. Cirriculm Vitae of Neil Kahanovitz, M.D. pp. 1-31. Deposition of Neil Kahanovitz, M.D. Nov. 15, 1996, Condensed Transcript and Concordance in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-9. Deposition of Dan Page, Nov. 15, 1996. Condensed Transcript and Concordance in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-7. Deposition of Edward J. Lortie, Jun. 30, 1994 in Catheter Imaging Systems, Inc., v. Edward J. Lortie, Jr., Civil Action E23514, pp. 1-129. Deposition of Edward J. Lortie, Jun. 30, 1994 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-153. "Dynspace Systems, Inc. Introduces The New England Epidural Ultra VU* Scope System" from ASA Mee4ting San Francisco, CA Oct. 28-31, 1991 pp. 1-4. "Epidual Endoscopy Excerpts and Comments" Yale University School of Medicine, Center for Pain Managment; Apr. 1992. "Exploring Epidural Endoscopy" The Ultra-Vu.TM. Scope in Pain Management Application Experimental Procedures at Yale University by Dr. Randy Rizor, Apr. 6, 1992--Tape 1 of 3 ons; Apr. 1992. "Experimental Procedures at Yale University by Dr. Randy Rizor," Apr. 6, 1992--Tape 1 of 3. "Experimental Procedures at Yale University by Dr. Randy Rizor," Apr. 6, 1992--Tape 2 of 3. "Experimental Procedures at Yale University by Dr. Randy Rizor," Apr. 6, 1992--Tape 3 of 3. Affidavit of Randy Frank Rizor, M.D. executed Sep. 20, 1996 in Myelotec, Inc. and Edward J. Lortie, Jr., v. Catheter Imaging Systems, Inc., pp. 1-5. Second Affidavit of Randy Frank Rizor, M.D. dated Nov. 13, 1996. Catheter Imaging Systems, Inc. v. Myelotec, Inc. and Edward J. Lortie, Jr., Civil Action 1-97-CV-0025 Notice of Petitioner's Motion to Confirm Arbitration Award filed in U. S. Patents 5,354,266 and 5,496,269. "Epidural Endoscopy Execpts and Comments" Yale University School of Medicine, Center for Pain Management; Apr. 1992. "Exploring Epidural Endoscopy" The Ultra-Vu.TM. Scope in Pain Management Applications; Apr. 1992. "Exploring Epidural Endoscopy" Diagnostic Images Using the Ultra-Vu.TM. Scope; Apr. 1992. "Experimental Procedures at Yale University by Dr. Randy Rizor", Apr. 6, 1992--Tape 1 of 3. "Experimental Procedures at Yale University by Dr. Randy Rizor", Apr. 6, 1992--Tape 2 of 3. "Experimental Procedures at Yale University by Dr. Randy Rizor", Apr. 6, 1992--Tape 3 of 3. "Notice of Arbitration Award" Pursuit to 37 CFR 1.335 and 35 U.S.C. .sctn. 294 In re U.S. Patent of: Phillip Jack Snoke Serial No.: 08/321,174--Patent No.: 5,496,269 For: Method of Epidural Surgery. "Notice of Arbitration Award" pursuant to 37 CFR 1.3335 and 35 U.S.C. .sctn. 294 In re U.S. Patent of: Phillip Jack Snoke Serial No.: 08/129,331--Patent No.: 5,354,266 For: Method of Epidural Surgery. Seldinger, Sven I., "Catheter Replacement of the Needle in Percutaneous Arteriography", American Journal of Roentgenology, vol. 142, pp. 5-7 (1984). Shimoji et al., "Observation of Spinal Canal and Cisternae with the Newly Developed Small-diameter, Flexible Fiberscopes", Anesthesiology, vol. 75, pp. 341-344, (1991). Waldman, Steven D., "Pain Management in the 21st Century: An Anesthesiologist's Look Into the Crystal Ball", American Journal of Pain Management, vol. 1 (Oct. 1991). Hillmer, Michael, "Back Talk", Spirit, p. 32 (Sep. 1991). Springer, Ilene, "Back Talk", pp. 114, 118, 122. Shantha et al., "Subdural Blood Patch for Spinal Headache", The New England Journal of Medicine, vol. 325, No. 17, pp. 1252-1253 (Sep. 1991). Caudal Analgesia, pp. 264-265. "Actual Position of Spinal and Epidural Anaesthesia", pp. 42-43. "Sacral Epidural (Caudal) Block", Principles and Practice of Regional Anaesthesia, pp. 105-106, 108. Fortuna, Armando, "Caudal Epidural Anesthesia in Latin-America", p. 928. Bromage, Drugs and Equipment, pp. 333-334. Blomberg et al., "The Lumbar Epidural Space in Patients Examined with Epiduroscopy", Anesth Analq, vol. 68, pp. 157-160 (1989). Hogan et al., "Epidural Steroids and the Outcomes Movement", Pain Digest, vol. 1, pp. 269-270 (1992). Hogan, Quinn H., M.D., "Lumbar Epidural Anatomy", Anesthesiology, vol. 75, pp. 767-775 (1991). Pool, Lawrence J., "Direct Visualization of Dorsal Nerve Roots of the Cauda Equina by Means of Myeloscope", Archives of Neurology and Psychiatry, pp. 1308-1312. Harrison et al., "Resin Injection Studies of the Lumbar Extradural Space", British Journal of Anaesthesia, vol. 57, pp. 333-336 (1985). Blomberg, R., "A Method for Epiduroscopy and Spinaloscopy", Acta Anaesthesiology Scand, vol. 29, pp. 113-116 (1985). Ooi et al., "Myeloscopy, with Special Reference to Blood Flow Changes in the Cauda Equina During Lasegue's Test", Int'l Orthopaedics (SICOT), vol. 4, pp. 307-311 (1981). Shimoji et al., "Observation of Spinal Canal and Cisternae with the Newly Developed Small-diameter, Flexible Fiberscopes", Anesthesiology, vol. 75, pp. 341-344 (1991). Blomberg et al., "The Lumbar Epidural Space in Patients Examined with Epiduroscopy", aneth Analg, vol. 68, pp. 157-160 (1989). Stern, Lincoln E., "The Spinascope: A New Instrument for Visualizing the Spinal Canal and Its Contents", Medical Record, pp. 31-32 (1936). Ooi et al., "Myeloscopy", Int'l Orthopaedics (SICOT), vol. 1, pp. 107-111 (1977). Burman, Michael S., "The Direct Visualization of the Spinal Canal and Its Contents", pp. 695-696. Pool, Lawrence J., "Myeloscopy: Intraspinal Endoscopy", Surgery, vol. 11, pp. 169-182 (Feb. 1942).

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Abstract
A method of epidural surgery is provided that improves visibility in the epidural space of a patient for more effectively conducting therapeutic surgery therein. The method includes the steps of distending a portion of the epidural space of a patient by filling the portion of the epidural space with a fluid supplied from a catheter and positioning a portion of an optical scope in the distended portion of the epidural space by inserting the optical scope through the same catheter that supplies the distending fluid to thereby provide a visual image of the epidural space.
 
Claims
That which is claimed is:

1. A method of epidural surgery comprising the steps of:

distending a portion of the epidural space of a patient by providing the portion of the epidural space with a fluid supplied from a catheter positioned in the epidural space to thereby improve visual imaging of the epidural space.

2. A method of epidural surgery according to claim 1, further comprising the step of performing a therapeutic treatment on a problem area within the distended portion of the epidural space.



Description
FIELD OF THE INVENTION

This invention relates to surgical methods, and more particularly to methods of epidural surgery in and around the epidural space.

BACKGROUND OF THE INVENTION

Back pain, and particularly lower back pain, is a major expense to society and is one of the most common disabling problems of those of working age. Injuries to the back vary from herniated disks of the spine to muscle strains and nerve damage. In the back or posterior end of the human body, the epidural space is potential space located in and extending the length of the spine. The epidural space is defined along one edge or side by the dura mater which surrounds the spinal cord. The epidural space is further defined along a second edge or side by the periosteum of the bony vertebrae or by the ligamentum-flavum at the vertebr