A dilation introducer for orthopedic surgery is provided for minimally invasive access for insertion of an intervertebral implant. The dilation introducer may be used to provide an access position through Kambin's triangle from a posterolateral approach. A first dilator tube with a first longitudinal axis is provided. A second dilator tube may be introduced over the first, advanced along a second longitudinal axis parallel to but offset from the first. A third dilator tube may be introduced over the second, advanced along a third longitudinal axis parallel to but offset from both the first and the second. An access cannula may be introduced over the third dilator tube. With the first, second, and third dilator tubes removed, surgical instruments may pass through the access cannula to operate on an intervertebral disc and/or insert an intervertebral implant.

Body access device variations are described herein which may comprise a cannula configured for insertion into a body, an electrode at or near a distal end of the cannula, where the electrode is positioned to contact tissue adjacent to the distal end of the cannula during advancement into the body. The device may include another electrode, a controller in communication with the first electrode via a first lead and in communication with the second electrode via a second lead, where the first lead runs through an inner lumen of the cannula and where the device is configured to detect an impedance or a conductance of the tissue between the first electrode and the second electrode, and where the controller is configured to receive one or more signals from the tissue adjacent to the distal end of the cannula and detect a change in property of the tissue as the cannula is advanced, and where the controller is further configured to determine a position of the distal end of the cannula during advancement into the body.

A method of treating tissue includes extending a distal tip of an electrode of a surgical instrument from a body of the surgical instrument to expose the distal tip by sliding the electrode along a longitudinal axis defined by the body, delivering energy from the distal tip to tissue, and applying suction adjacent the distal end of the body with a suction pipe of the surgical instrument. The distal tip of the electrode may include a collapsible portion. Extending the distal tip of the electrode may include moving the collapsible portion to extend beyond an outer radial dimension of a nose of the surgical instrument.

Methods and systems for modulating intraosseous nerves (e.g., nerves within bone) are provided. For example, the methods and systems described herein may be used to modulate (e.g., denervate, ablate) basivertebral nerves within vertebrae. The modulation of the basivertebral nerves may facilitate treatment of chronic back pain. The modulation may be performed by a neuromodulation device (e.g., an energy delivery device).

Described herein are devices, systems and methods for treating target tissue in a patient's spine. In general, the methods include the steps of advancing a wire into the patient from a first location, through a neural foramen, and out of the patient from a second location; connecting a tissue modification device to the wire; positioning the tissue modification device through the neural foramen using the wire; modifying target tissue in the spine by moving the tissue modification device against the target tissue; and delivering an agent to modified target tissue, wherein the agent is configured to inhibit blood flow from the modified target tissue. In some embodiments, the step of modifying target tissue comprises removing target tissue located ventral to the superior articular process while avoiding non-target tissue located lateral to the superior articular process.

A kit for delivering microwave ablative energy to tissue and methods for using the kit are included. The kit includes an access catheter, an implant deployment tool, and a microwave delivery device. The implant deployment tool is configured to be inserted into the access catheter and has an implant disposed therein in a contracted state and being slidable out of a distal opening and expandable into an expanded state. The microwave delivery device is configured to deliver the microwave ablative energy to the tissue and to be advanced through the access catheter and slidably disposable within the implant when the implant is in the expanded state.

An energy delivery probe and method of using the energy delivery probe to treat a patient is provided herein. The energy delivery probe has at least one probe body having a longitudinal axis and at least a first trocar and a second trocar. Each trocar comprises at least two electrodes that are electrically insulated from each other, and each electrode is independently selectively activatable. An insulative sleeve is positioned in a coaxially surrounding relationship to each of the first trocar and the second trocar. The probe also has a switching means for independently activating at least one electrode. The method involves independently and selectively activating the first and second electrodes to form an ablation zone, then repeating the ablation by delivering energy to a second set of electrodes, producing one or more overlapping ablation zone, and eliminating the need to reposition the ablation probes.

A method of treating tissue includes extending a distal tip of an electrode of a surgical instrument from a body of the surgical instrument to expose the distal tip by sliding the electrode along a longitudinal axis defined by the body, delivering energy from the distal tip to tissue, and applying suction adjacent the distal end of the body with a suction pipe of the surgical instrument. The distal tip of the electrode may include a collapsible portion. Extending the distal tip of the electrode may include moving the collapsible portion to extend beyond an outer radial dimension of a nose of the surgical instrument.

Described herein are devices, systems and methods for treating target tissue in a patient's spine. In general, the methods include the steps of advancing a wire into the patient from a first location, through a neural foramen, and out of the patient from a second location; connecting a tissue modification device to the wire; positioning the tissue modification device through the neural foramen using the wire; modifying target tissue in the spine by moving the tissue modification device against the target tissue; and delivering an agent to modified target tissue, wherein the agent is configured to inhibit blood flow from the modified target tissue. In some embodiments, the step of modifying target tissue comprises removing target tissue located ventral to the superior articular process while avoiding non-target tissue located lateral to the superior articular process.

System and methods for channeling a path into bone include a trocar having a proximal end, distal end and a central channel disposed along a central axis of the trocar. The trocar includes a distal opening at the distal end of the trocar. The system includes a curved cannula sized to be received in the central channel, the curved cannula comprising a curved distal end configured to be extended outward from the distal opening to generate a curved path extending away from the trocar. The curved cannula has a central passageway having a diameter configured to allow a treatment device to be delivered through the central passageway to a location beyond the curved path.