# US 2019/0167343 A1 · Devices, kits and methods relating to treatment of facet joints > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2019/0167343 A1 - Document ID: US20190167343A1 - Status: Published application - Kind: A1 - Application number: 16/271,133 - Filed: 2019-02-08 - Published: 2019-06-06 - Earliest claimed: 2013-11-13 - Assignees: Thixos LLC - Applicants: Thixos LLC - Inventors: Murray David Solsberg; Douglas Preston Beall; Ryan Erich Dean - Web page: https://patentgrep.com/patent/US20190167343A1 ## CPC - A61B 18/1482: {having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy} - A61B 17/3417: {Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating (syringe needles A61M5/32; dilators A61M29/00)} - A61B 17/3421: {Cannulas} - A61B 18/1206: {Generators therefor} - A61B 17/3439: {with means for changing the inner diameter of the cannula, e.g. expandable (A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662)} - A61B 18/1487: {Trocar-like, i.e. devices producing an enlarged transcutaneous opening} - A61B 2017/0256: {for the spine} - A61B 2017/320044: {Blunt dissectors} - A61B 2017/3454: {Details of tips} - A61B 2018/00339: {Spine, e.g. intervertebral disc} - A61B 2018/00577: {Ablation} - A61B 2217/005: with suction drainage system - A61B 2217/007: with irrigation system - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract A facet joint surgical tool for treating a facet joint synovial cyst includes rotatable members disposed side-by-side through a minimally invasive sheath and rotatable to reconfigure distal end portions between a facet joint penetration configuration with a tissue piercing tip and a facet joint retraction configuration. Facet joint synovial cysts located to an anterior side of the facet joint are treated by a posterior approach with access to the cyst through the facet joint retracted by the surgical tool. Facet joint synovial cysts located to a posterior side of the facet joint are treated by direct access from a posterior approach. ## Claims ### Claim 1 A facet joint surgical tool, comprising: a proximal portion to be disposed outside of a patient during a facet joint surgical procedure; a distal portion be disposed inside a patient during a facet joint surgical procedure; a first rotatable member comprising a first distal end portion having a first distal tip, the first rotatable member being rotatable about a first axis; and a second rotatable member comprising a second distal end portion having a second distal tip, the second rotatable member being rotatable about a second axis that is different than the first axis; the first and second rotatable members being rotatable relative to each other about the first and second axes respectively to manipulate the relative positioning of the first and second distal end portions between a facet joint penetration configuration in which the first and second distal end portions are positioned to form a piercing tip to pierce through tissue and penetrate into the facet joint and a facet joint retraction configuration in which the first and second distal end portions are positioned to retract the facet joint following penetration into the facet joint. ### Claim 2 (depends on 1) A facet joint surgical tool according to claim 1, wherein each said distal end portion of a said rotatable member comprises a beveled end of the respective said rotatable member. ### Claim 3 (depends on 1, 2) A facet joint surgical tool according to either one of claim 1 or claim 2, wherein each said rotatable member comprises a longitudinally extending insertion portion configured for insertion into the body during a surgical operation. ### Claim 4 (depends on 3) A facet joint surgical tool according to claim 3, wherein the insertion portion of each said rotatable member has a substantially uniform insertion cross-section between a proximal end of the insertion portion and the said distal end portion of the said rotatable member. ### Claim 5 (depends on 4) A facet joint surgical tool according to claim 4, wherein the uniform insertion cross-section is circular. ### Claim 6 (depends on 3, 4, 5) A facet joint surgical tool according to any one of claims 3-5, wherein the insertion portion has a longitudinal length in a range of from 20 millimeters to 200 millimeters. ### Claim 7 (depends on 6) A facet joint surgical tool according to claim 6, wherein the insertion portion of each said rotatable member has a maximum cross dimension perpendicular to the respective axis of rotation of no larger than 3.25 millimeters. ### Claim 8 (depends on 3, 4, 5, 6, 7) A facet joint surgical tool according to any one of claims 3-7, wherein the insertion portion of each said rotatable member has a longitudinally extending lumen to provide access from outside of the body to inside of the body during a surgical procedure. ### Claim 9 (depends on 8) A facet joint surgical tool according to claim 8, wherein each said lumen has a maximum cross dimension in a range of from 0.25 millimeter to 2.5 millimeters. ### Claim 10 (depends on 8, 9) A facet joint surgical tool according to either one of claim 8 or claim 9, wherein each said lumen has a longitudinal length of at least 10 millimeters. ### Claim 11 (depends on 8, 9, 10) A facet joint surgical tool according to any one of claims 8-10, wherein each said lumen comprises a circular cross-section. ### Claim 12 (depends on 8, 9, 10, 11) A facet joint surgical tool according to any one of claims 8-11, wherein at least the lumen of the first rotatable member is fluidly connected with a fluid connection hub that is connectable with a fluid manipulation device to perform a fluid manipulation selected from the group consisting of fluid injection through the said lumen and out of a distal end of the said lumen adjacent the corresponding distal tip and fluid aspiration through the lumen from the distal end of the said lumen adjacent the corresponding distal tip. ### Claim 13 A facet joint surgical tool, wherein each said lumen is fluidly connected with a different said fluid connection hub. ### Claim 14 (depends on 12, 13) A facet joint surgical tool according to either one of claim 12 or claim 13, wherein the fluid connection hub includes a luer connector. ### Claim 15 (depends on 12, 13, 14) A facet joint surgical tool according to any one of claims 12-14, comprising a fluid manipulation device with a fluid containment vessel fluidly connected with at least one said lumen through a said fluid connection hub. ### Claim 16 (depends on 15) A facet joint surgical tool according to claim 15, wherein the fluid manipulation device comprises a syringe. ### Claim 17 (depends on 15, 16) A facet joint surgical tool according to either one of claim 15 or claim 16, wherein the fluid manipulation device contains a fluid composition for use in performing a medical procedure in the vicinity of a facet joint. ### Claim 18 (depends on 17) A facet joint surgical tool according to claim 17, wherein the fluid composition comprises a member selected from the group consisting of a hyaluronidase and a collagenase. ### Claim 19 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18) A facet joint surgical tool according to any one of claims 1-18, wherein each said rotatable member comprises a hollow tube with a beveled tip. ### Claim 20 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19) A facet joint surgical tool according to any one of claims 1-19, wherein: when the said rotatable members are in the facet joint penetration configuration, the distal tips are adjoining; and when the said rotatable members are in the facet joint retraction configuration, the distal tips are separated by a separation distance of at least 0.5 millimeters. ### Claim 21 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20) A facet joint surgical tool according to any one of claims 1-20, wherein when the said rotatable members are in the facet joint retraction configuration each said rotatable member is rotated 180° relative to the facet joint penetration configuration. ### Claim 22 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21) A facet joint surgical tool according to any one of claims 1-21, wherein each said axis is a central longitudinal axis of at least a distal end portion of the respective said rotatable member. ### Claim 23 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22) A facet joint surgical tool according to any one of claims 1-22, wherein the said longitudinal axes of the said rotatable members are parallel. ### Claim 24 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23) A facet joint surgical tool according to any one of claims 1-23, wherein the said rotatable members are in external tangential contact for at least some longitudinal portion of each said rotatable member. ### Claim 25 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24) A facet joint surgical tool according to any one of claims 1-24, wherein at least the first rotatable member includes an arcuate portion located proximal of the first distal tip. ### Claim 26 (depends on 25) A facet joint surgical tool according to claim 25, wherein the arcuate portion has a radius of curvature in a range of from 5 to 25 centimeters. ### Claim 27 (depends on 25, 26) A facet joint surgical tool according to either one of claim 25 or claim 26, wherein: the first axis is a first longitudinal axis of a first longitudinal portion of the first rotatable member located distal of the arcuate portion; the first rotatable member includes a proximal portion located proximal of the arcuate portion and having a second longitudinal axis; and the first longitudinal axis and the second longitudinal axis intersect with an angle between them in a range of from 5° to 45°. ### Claim 28 (depends on 25, 26, 27) A facet joint surgical tool according to any one of claims 25-27, wherein the arcuate portion has a length along the first rotatable member in a range of from 10 to 100 millimeters. ### Claim 29 (depends on 25, 26, 27, 28) A facet joint surgical tool according to any one of claims 25-28, wherein a distal end of the arcuate portion is located a distance from the first distal tip of at least 20 millimeters. ### Claim 30 (depends on 3, 4, 5, 6, 7, 8, 9, 10, 11, 25, 26, 27, 28, 29) A facet joint surgical tool according to any one of claims 25-29, wherein the first rotatable member includes a longitudinally extending insertion portion according to any one of claims 3-11 and the arcuate portion is located proximal of the insertion portion of the first rotatable member. ### Claim 31 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30) A facet joint surgical tool according to any one of claims 1-30, comprising; a first rotation actuation handle connected to the first rotatable member and hand manipulable to rotate the first rotatable member about the first axis; and a second rotation actuation handle connected to the second rotatable member and hand manipulable to rotate the second rotatable member about the second axis. ### Claim 32 (depends on 31) A facet joint surgical tool according to claim 31, wherein when the first and second distal tips are conterminous at distal ends of the said rotatable members, the locations of connection of the first and second handles with the first and second rotatable members are at corresponding longitudinal locations along the first and second rotatable members. ### Claim 33 (depends on 31, 32) A facet joint surgical tool according to either one of claim 31 or 32, wherein each said rotation actuation handle projects laterally from the corresponding said rotatable member to only one side of the corresponding said axis of the said corresponding rotatable member. ### Claim 34 (depends on 3, 4, 5, 6, 7, 8, 9, 10, 11, 31, 32, 33) A facet joint surgical tool according to any one of claims 31-33, wherein each said rotatable member includes a longitudinally extending insertion portion according to any one of claims 3-11 and the rotation actuation handle of a said rotatable member is located proximal of the insertion portion of the said rotatable member. ### Claim 35 (depends on 25, 26, 27, 28, 31, 32, 33, 34) A facet joint surgical tool according to any one of claims 31-34, wherein the first rotatable member includes the arcuate portion of any one of claims 25-28 and the first rotation actuation handle is connected to the first rotatable member at a location distal of the arcuate portion. ### Claim 36 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35) A facet joint surgical tool according to any one of claims 1-35, comprising a sheath with an internal passage through which the said rotatable members are disposed with at least said distal tips disposed distal to a distal end of the sheath. ### Claim 37 (depends on 36) A facet joint surgical tool according to claim 36, wherein the internal passage has a minimum area cross-section through which the said rotatable members are disposed that has an aspect ratio of at least 1.5:1. ### Claim 38 (depends on 37) A facet joint surgical tool according to claim 37, wherein the aspect ratio is no larger than 3:1. ### Claim 39 (depends on 37, 38) A facet joint surgical tool according to any either one of claims 37 and 38, wherein the minimum area cross-section has an oval shape. ### Claim 40 (depends on 37, 38, 39) A facet joint surgical tool according to any one of claims 37-39, wherein the minimum area cross-section has a maximum cross dimension in a range of from 0.5 millimeter to 6.5 millimeters. ### Claim 41 (depends on 37, 38, 39, 40) A facet joint surgical tool according to any one of claims 37-40, wherein the minimum area cross-section is configured to constrain the said rotatable members in a side-by-side orientation through the minimum area cross-section, in which side-by-side orientation the said rotatable members are translatable through the minimum area cross-section in a longitudinal direction through the internal passage. ### Claim 42 (depends on 37, 38, 39, 40, 41) A facet joint surgical tool according to any one of claims 37-41, wherein within the minimum area cross-section, the said rotatable members are in side-by-side orientation with a clearance fit between the said rotatable members and the sheath of no larger than 0.5 millimeter. ### Claim 43 (depends on 37, 38, 39, 40, 41, 42) A facet joint surgical tool according to any one of claims 37-42, wherein the cross-section of the internal passage is the minimum area cross-section for at least 5 millimeters along a length of the internal passage. ### Claim 44 (depends on 36, 37, 38, 39, 40, 41, 42, 43) A facet joint surgical tool according to any one of claims 36-43, wherein the first axis and the second axis do not cross within the internal passage. ### Claim 45 (depends on 36, 37, 38, 39, 40, 41, 42, 43, 44) A facet joint surgical tool according to any one of claims 36-44, wherein the sheath has a longitudinally extending insertion portion for insertion into a patient's body during a surgical operation, the insertion portion of the sheath having a longitudinal length of at least 10 millimeters. ### Claim 46 (depends on 45) A facet joint surgical tool according to claim 45, wherein the insertion portion of the sheath has an insertion cross-section with an aspect ratio of at least 1.5:1. ### Claim 47 (depends on 45, 46) A facet joint surgical tool according to either one of claim 45 or claim 46, wherein the insertion cross-section of the sheath has a maximum cross dimension of no larger than 8 millimeters. ### Claim 48 (depends on 45, 46, 47) A facet joint surgical tool according to any one of claims 45-47, wherein the insertion portion of the sheath has an insertion cross-section that has an oval shape. ### Claim 49 (depends on 45, 46, 47, 48) A facet joint surgical tool according to any one of claims 45-48, wherein the sheath has a uniform cross-section over the entire length of the insertion portion of the sheath. ### Claim 50 (depends on 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48) A facet joint surgical tool according to any one of claims 36-48, wherein the sheath has a tapered distal end portion with an exterior cross-section that tapers to a smaller size toward a distal end of the sheath. ### Claim 51 (depends on 50) A facet joint surgical tool according to claim 50, wherein wall thickness of the sheath decreases toward the distal end of the sheath in the tapered distal end portion. ### Claim 52 (depends on 50, 51) A facet joint surgical tool according to either one of claim 50 or claim 51, wherein in the tapered distal end portion the internal passage through the sheath does not taper to a smaller size toward the distal end of the sheath. ### Claim 53 (depends on 50, 51, 52) A facet joint surgical tool according to any one of claims 50-52, wherein the tapered distal end portion begins at a location in a range of from 1 millimeter to 5 millimeters proximal of the distal end of the sheath. ### Claim 54 (depends on 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53) A facet joint surgical tool according to any one of claims 36-53, wherein a RF signal generator is connected with at least one of the first rotatable member, the second rotatable member and the sheath to provide a RF signal to the at least one of the first rotatable member, the second rotatable member and the sheath to perform RF ablation of tissue with the RF signal delivered from the distal end portion of the facet joint surgical tool. ### Claim 55 (depends on 54) A facet joint surgical tool according to claim 54, wherein the RF signal generator is connected with at least one of the rotatable members proximal of the sheath. ### Claim 56 (depends on 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55) A facet joint surgical tool according to any one of claims 36-55, wherein the sheath comprises an electrically conductive body and an electrically insulating coating covering at least an exterior portion of an insertion portion of the sheath. ### Claim 57 (depends on 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56) A facet joint surgical tool according to any one of claims 36-56, wherein: each said rotatable member has a lumen with a distal end open at the said distal end portion of the rotatable member; the said rotatable members are positioned in the facet joint penetration configuration; and the tool includes a stylet disposed through each said lumen with distal tips of the stylets blocking distal ends of the lumens. ### Claim 58 (depends on 57) A facet joint surgical tool according to claim 57, wherein each said stylet has a beveled tip that corresponds with a beveled said distal end portion of the corresponding said rotatable member. ### Claim 59 (depends on 25, 26, 27, 28, 29, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58) A facet joint surgical tool according any one of claims 36-58, comprising the arcuate portion of any one of claims 25-29, wherein the arcuate portion is disposed proximal of the sheath. ### Claim 60 (depends on 31, 32, 33, 34, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59) A facet joint surgical tool according to any one of claims 36-59, comprising the first and second rotation actuation handles of any one of claims 31-34, wherein the first and second rotation actuation handles are disposed proximal of the sheath. ### Claim 61 (depends on 1) A facet joint surgical tool according to claim 1, wherein: when the said rotatable members are in the facet joint penetration configuration, the distal tips are adjoining; and when the said rotatable members are in the facet joint retraction configuration, the distal tips are separated by a separation distance in a range of from 0.5 millimeter to 6.5 millimeters. ### Claim 62 (depends on 61) A facet joint surgical tool according to claim 61, wherein: each said rotatable member comprises a longitudinally extending insertion portion configured for insertion into the body during a surgical operation; the insertion portion has a longitudinal length in a range of from 20 millimeters to 200 millimeters; the insertion portion of each said rotatable member has a maximum cross dimension perpendicular to the respective axis of rotation of no larger than 3.25 millimeters. ### Claim 63 (depends on 62) A facet joint surgical tool according to claim 62, wherein: the insertion portion of each said rotatable member has a longitudinally extending lumen to provide access from outside of the body to inside of the body during a surgical procedure; each said lumen has a maximum cross dimension in a range of from 0.25 millimeter to 2.5 millimeters; and each said lumen has a longitudinal length of at least 10 millimeters. ### Claim 64 (depends on 63) A facet joint surgical tool according to claim 63, wherein: the facet joint surgical tool comprises a sheath with an internal passage through which the said rotatable members are disposed with at least said distal tips disposed distal to a distal end of the sheath; the internal passage has a minimum area cross-section through which the said rotatable members are disposed that has an aspect ratio of at least 1.5:1: the minimum area cross-section has a maximum cross dimension in a range of from 0.5 millimeter to 6.5 millimeters; the minimum area cross-section is sized to constrain the said rotatable members in a side-by-side orientation through the minimum cross-section, in which side-by-side orientation the said rotatable members are translatable through the minimum area cross-section in a longitudinal direction through the internal passage; and the sheath has a longitudinally extending insertion portion for insertion into a patient's body during a surgical operation, the insertion portion of the sheath having a longitudinal length of at least 10 millimeters and having disposed therethrough at least a portion of the insertion portions of the said rotatable members. ### Claim 65 (depends on 64) A facet joint surgical tool according to claim 64, wherein: the insertion portion of the sheath has an insertion cross-section with an aspect ratio of at least 1.5:1 and a maximum cross dimension in a range of from 0.7 millimeter to 8 millimeters. ### Claim 66 (depends on 65) A facet joint surgical tool according to claim 65, wherein: each said lumen of each said rotatable member is fluidly connected with a fluid connection hub that is connectable with a fluid manipulation device to perform a fluid manipulation selected from the group consisting of fluid injection through the said lumen out of a distal end of the said lumen adjacent the corresponding distal tip and fluid aspiration through the said lumen the distal end of the said lumen. ### Claim 67 (depends on 66) A facet joint surgical tool according to claim 66, comprising a syringe fluidly connected with at least one said lumen through a said fluid connection hub. ### Claim 68 (depends on 67) A facet joint surgical tool according to claim 67, wherein the syringe contains a fluid composition for use in performing a medical procedure in the vicinity of a facet joint. ### Claim 69 (depends on 68) A facet joint surgical tool according to claim 68, wherein the fluid composition comprises a member selected from the group consisting of a hyaluronidase and a collagenase. ### Claim 70 (depends on 65) A facet joint surgical tool of claim 65, wherein a RF signal generator is connected with at least one said rotatable member to provide a RF signal to at least one of the distal tips to perform a RF ablation procedure. ### Claim 71 (depends on 65) A facet joint surgical tool according to claim 65, wherein at least the first rotatable member includes an arcuate portion, the arcuate portion being located proximal of a proximal end of the sheath. ### Claim 72 (depends on 65) A facet joint surgical tool according to claim 65, wherein: the sheath has a tapered distal end portion with an exterior cross-section that tapers to a smaller size toward a distal end of the sheath; wall thickness of the sheath decreases toward the distal end of the sheath in the tapered distal end portion; and in the tapered distal end portion the internal passage through the sheath does not taper to a smaller size toward the distal end of the sheath. ### Claim 73 (depends on 65) A facet joint surgical tool according to claim 65, wherein: the said rotatable members are positioned in the facet joint penetration configuration; and the tool includes a stylet disposed through each said lumen with distal tips of the stylets blocking distal ends of the lumens. ### Claim 74 (depends on 65) A facet joint surgical tool according to claim 65, comprising: a first rotation actuation handle connected to the first rotatable member and hand manipulable to rotate the first rotatable member about the first axis; and a second rotation actuation handle connected to the second rotatable member and hand manipulable to rotate the second rotatable member about the second axis. ### Claim 75 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74) A kit useful in performance of a medical procedure in the vicinity of a facet joint, the kit comprising: the first rotatable member and second rotatable member according to any one of claims 1-74; the sheath according to any one of claims 36-60 and 64-74; wherein the first rotatable member, the second rotatable member and the sheath are assembled or assemblable into the facet joint surgical tool, or a subassembly thereof, according to any one of claims 1-74. ### Claim 76 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 75) A kit according to claim 75, comprising at least one fluid composition for use in performing a medical procedure in the vicinity of the facet joint using the surgical tool of any one of claims 1-60. ### Claim 77 (depends on 76) A kit according to claim 76, wherein the at least one fluid composition comprises an irrigation liquid. ### Claim 78 (depends on 76, 77) A kit according to either one of claim 76 or claim 77, wherein the at least one fluid composition comprises a drug for treating a condition in the vicinity of the facet joint. ### Claim 79 (depends on 76, 77, 78) A kit according to any one of claims 76-78, wherein the fluid composition comprises a member selected from the group consisting of a hyaluronidase and a collagenase. ### Claim 80 (depends on 57, 58, 75, 76, 77, 78, 79) A kit according to any one of claims 75-79, comprising the stylets according to either one of claim 57 or claim 58. ### Claim 81 (depends on 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80) A kit according to any one of claims 75-80, wherein the said rotatable members and sheath are assembled or assemblable into the facet joint surgical tool, or a subassembly thereof, according to any one of claims 36-60 and 64-74. ### Claim 82 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74) A method for performing a medical procedure in the vicinity of the facet joint, the method comprising: penetrating into a facet joint capsule of a facet joint using the facet joint surgical tool of any one of claims 1-74 with the said rotating members in the facet joint penetration configuration, the penetrating comprising advancing at least the distal tips of the said rotatable members into the facet joint capsule; after the penetrating, rotating the said rotatable members to reconfigure the said rotating members to the facet joint retraction configuration. ### Claim 83 (depends on 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 82) A method according to claim 82, wherein the facet joint surgical tool is according to any one of claims 36-60 and 64-74 and the method comprises: after the rotating, advancing the sheath from outside to inside of the facet joint capsule. ### Claim 84 (depends on 82, 83) A method according to either one of claim 82 or claim 83, comprising after the penetrating, conducting a fluid composition through a lumen of a said rotatable member to exit said lumen in the vicinity of the facet joint. ### Claim 85 (depends on 84) A method according to claim 84, comprising during the conducting, aspirating fluid from the vicinity of the facet joint through a lumen of a different one of said rotating members. ### Claim 86 (depends on 82, 83, 84, 85) A method according to any one of claims 82-85, comprising after the penetrating, conducting a medical device through a lumen of a said rotating member to the vicinity of the facet joint and performing a medical operation in the vicinity of the facet joint using the medical device. ### Claim 87 (depends on 82, 83, 84, 85, 86) A method according to any one of claims 82-86, wherein: at least one of the first and second distal end portions of the said rotating members is a RF electrode, and the method comprises operating the RF electrode to perform a RF ablation procedure on tissue in the vicinity of the facet joint. ### Claim 88 (depends on 82, 83, 84, 85, 86, 87) A method according to any one of claims 82-87, comprising treating a synovial cyst in the vicinity of the facet joint. ### Claim 89 (depends on 86) A method according to claim 86, wherein the synovial cyst is located anterior to the facet joint. ### Claim 90 A kit useful in performance of a medical procedure in the vicinity of a facet joint, the kit comprising: a first rotatable member comprising a first distal end portion having a first distal tip, the first rotatable member being rotatable about a first axis of the first rotatable member; and a second rotatable member comprising a second distal end portion having a second distal tip, the second rotatable member being rotatable about a second axis of the second rotatable member; a sheath with an internal passage through which the said rotatable members are receivable with the distal tips of the said rotatable members disposed distal to distal end of the sheath and proximal ends of the said rotatable members disposed proximal of a proximal end of the sheath, and wherein when so received through the sheath the first and second rotatable members are rotatable relative to each other about the first and second axes respectively to manipulate the relative positioning of the first and second distal end portions between a facet joint penetration configuration in which the first and second distal end portions are positioned to form a piercing tip to pierce through tissue and penetrate into the facet joint and a facet joint retraction configuration in which the first and second distal end portions are positioned to retract the facet joint following penetration into the facet joint; the sheath having a minimum area cross-section through which the said rotatable members are receivable that has an aspect ratio of at least 1.5:1 and is sized to constrain the said rotatable members in a side-by-side orientation through the minimum area cross-section with the said rotatable members being translatable through the minimum area cross-section in a longitudinal direction through the internal passage. ### Claim 91 (depends on 90) A kit according to claim 90, wherein the minimum area cross-section has a maximum cross dimension in a range of from 0.5 millimeter to 6.5 millimeters. ### Claim 92 (depends on 91) A kit according to claim 91, wherein: each said rotatable member has a longitudinally extending insertion portion for insertion into a patient's body during a surgical operation and which insertion portion is receivable through the internal passage of the sheath; each said insertion portion of each said rotatable member has a longitudinal length in a range of from 20 to 200 millimeters; each said insertion portion of each said rotatable member has a maximum cross dimension perpendicular to the respective axis of rotation of no larger than 3.25 millimeters; when the said rotatable members are in the facet joint penetration configuration, the distal tips of the distal end portions are adjoining; and when the said rotatable members are in the facet joint retraction configuration, the distal tips of the distal end portions are separated by a separation distance in a range of from 0.5 millimeters to 6.5 millimeters. ### Claim 93 (depends on 92) A kit according to claim 92, wherein each said insertion portion of each said rotatable member has a longitudinally extending lumen to provide access from outside of a patient's body to inside of a patient's body during a surgical procedure. ### Claim 94 (depends on 93) A kit according to claim 93, wherein the sheath has a longitudinally extending insertion portion for insertion into a patient's body, the insertion portion including a distal end of the sheath and further comprising: a longitudinal length of at least 10 millimeters; and an insertion cross-section with an aspect ratio of at least 1.5 and a maximum cross dimension of no larger than 8 millimeters. ### Claim 95 (depends on 94) A kit according to claim 94, wherein the insertion portion of the sheath has a tapered distal end portion with an exterior cross-section that tapers to a smaller size toward a distal end of the sheath. ### Claim 96 (depends on 94) A kit according to claim 94, wherein at least the first rotatable member includes an arcuate portion, the arcuate portion being located proximal of a proximal end of the sheath when the first rotatable member is received in the internal passage of the sheath with the first distal tip disposed distal of the distal end of the sheath. ### Claim 97 (depends on 96) A kit according to claim 96, wherein the second rotatable member does not include an arcuate portion. ### Claim 98 (depends on 94) A kit according to claim 94, comprising: a first rotation actuation handle connected to the first rotatable member and hand manipulable to rotate the first rotatable member about the first axis; and a second rotation actuation handle connected to the second rotatable member and hand manipulable to rotate the second rotatable member about the second axis; and wherein, when the first and second said rotatable members are received through the internal passage of the sheath with the first and second distal tips disposed distal of the distal end of the sheath, the first and second rotation actuation handles are disposed proximal of a proximal end of the sheath. ### Claim 99 (depends on 98) A kit according to claim 98, wherein when the first and second distal tips are conterminous at distal ends of the said rotatable members conterminously disposed distal of the distal end of the sheath, the locations of connection of the first and second handles with the first and second rotatable members are at corresponding longitudinal locations along the first and second rotatable members. ### Claim 100 (depends on 94) A kit according to claim 94, comprising first and second stylets receivable through the lumen of the first rotatable member and the second rotatable member, respectively, with the said stylets including distal tips that block distal ends of the lumens adjacent the piercing tip in the facet joint penetration configuration. ### Claim 101 (depends on 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100) A kit according to any one of claims 90-100, comprising a fluid container containing a fluid composition to be delivered through a said lumen to the vicinity of a facet joint during a surgical procedure. ### Claim 102 (depends on 101) A kit according to claim 101, wherein the fluid composition is an aqueous irrigation liquid. ### Claim 103 (depends on 101) A kit according to claim 101, wherein the fluid composition comprises a hyaluronidase. ### Claim 104 (depends on 101) A kit according to claim 101, wherein the fluid composition comprises a collagenase. ### Claim 105 (depends on 101) A kit according to claim 101, wherein a said lumen of at least one said rotatable member is fluidly connected with a fluid connection hub that is connectable with a fluid manipulation device to perform a fluid manipulation with the fluid composition selected from the group consisting of fluid injection through the lumen out of a distal end of the lumen and fluid aspiration through the lumen from the distal end of the lumen. ### Claim 106 (depends on 105) A kit according to claim 105, wherein the fluid container is a syringe prefilled with the fluid composition and that is fluidly connectable with the fluid connection hub to perform the fluid manipulation. ### Claim 107 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106) A kit according to any one of claims 90-106, comprising components assembled or assemblable into the facet joint surgical tool of any one of claims 1-74. ### Claim 108 A method for treating a tissue condition in or anterior to a facet joint, the method comprising: accessing and retracting the facet joint from a posterior side opposite the synovial cyst; and with the facet joint retracted, performing a medical procedure from the posterior side through the retracted facet joint to treat tissue in or anterior to the facet joint. ### Claim 109 (depends on 108) A method according to claim 108, wherein the medical procedure comprises applying fluid suction to the facet joint or anterior of the facet joint for aspiration of fluid. ### Claim 110 (depends on 109) A method according to claim 109, wherein the medical procedure comprises injecting a fluid composition into the facet joint to apply fluid pressure to tissue to be treated. ### Claim 111 (depends on 1109) A method according to claim 1109, wherein the tissue condition comprises a synovial cyst and the method comprises during the injecting fluid, rupturing the synovial cyst. ### Claim 112 (depends on 108) A method according to claim 108, wherein tissue condition comprises a synovial cyst and the medical procedure comprises injecting a fluid composition into the facet joint or directly into the synovial cyst, wherein the fluid composition comprises at least one component to liquefy or decompose tissue within the synovial cyst. ### Claim 113 (depends on 112) A method according to claim 112, wherein the at least one component comprises a hyaluronidase. ### Claim 114 (depends on 112) A method according to claim 112, wherein the at least one component comprises a collagenase. ### Claim 115 (depends on 112) A method according to claim 112, comprising after the injecting, removing liquid from the facet joint or directly from the synovial cyst. ### Claim 116 (depends on 115) A method according to claim 115, wherein the removing liquid comprises irrigating the facet joint with an aqueous irrigation liquid provided to the facet joint. ### Claim 117 (depends on 108) A method according to claim 108, comprising after performing the medical procedure, performing a tissue ablation to ablate at least a portion of the synovium at the posterior side of the facet joint. ### Claim 118 (depends on 117) A method according to claim 117, wherein the tissue ablation comprises RF ablation. ### Claim 119 (depends on 108) A method according to claim 108, comprising forming a artificial cavity in or adjacent to the posterior side of the facet joint to provide a volume for collection of synovial fluid as an alternative to collection on the anterior side of the facet joint. ### Claim 120 (depends on 108) A method according to claim 108, comprising: prior to the retracting, penetrating into tissue of a patient with a distal piercing tip of a facet joint surgical tool, the facet joint surgical tool comprising: a distal portion insertable into a patient during a surgical procedure; a proximal portion to remain outside of a patient during a surgical procedure; a first rotatable member comprising a first distal end portion having a first distal tip, the first rotatable member being rotatable about a first axis; and a second rotatable member comprising a second distal end portion having a second distal tip, the second rotatable member being rotatable about a second axis that is different than the first axis; and the first and second rotatable members being rotatable relative to each other about the first and second axes respectively to manipulate the relative positioning of the first and second distal end portions between a facet joint penetration configuration in which the first and second distal end portions are positioned to form the piercing tip and a facet joint retraction configuration in which the first and second distal end portions are positioned to retract tissue; after the penetrating, advancing the piercing tip through tissue of the patient to the posterior side of the facet joint; and after the advancing, performing the retracting with the facet joint surgical tool, wherein the retracting comprises rotating the said rotatable members to reposition the said distal tips from the facet joint penetration configuration to the facet joint retraction configuration to retract the facet joint. ### Claim 121 (depends on 120) A method according to claim 120, wherein each said rotatable member has a lumen to provide access from outside of the patient to inside of the patient, the lumen having a distal end adjacent the distal tip of the said rotatable member; and during the penetrating, the facet joint surgical tool comprises a stylet disposed through each said lumen with a distal end of a said stylet blocking a distal end of the corresponding lumen adjacent the piercing tip. ### Claim 122 (depends on 121) A method according to claim 121, comprising after the advancing, removing the stylets from the lumens. ### Claim 123 (depends on 120) A method according to claim 120, comprising after the rotating, advancing the sheath to retract the facet joint with the sheath. ### Claim 124 (depends on 123) A method according to claim 123, comprising, with the facet joint retracted by the sheath: removing at least one of the said rotatable members from the internal passage of the sheath comprising after the; and with the at least one of the said rotatable members removed from the internal passage, advancing an insertable surgical tool from outside of the patient through the internal passage of the sheath and out a distal end of the internal passage into the retracted facet joint. ### Claim 125 (depends on 124) A method according to claim 124, wherein the tissue condition comprises a synovial cyst and the method comprises advancing a distal end of the insertable surgical tool through the facet joint and into the synovial cyst. ### Claim 126 (depends on 124) A method according to claim 124, wherein the tissue condition comprises a synovial cyst and the insertable surgical tool comprises a RF electrode and the method comprises performing a RF ablation of tissue in the synovial cyst. ### Claim 127 (depends on 120, 121, 122, 123, 124, 125, 126) A method according to any one of claims 120-126, comprising performing the medical procedure with access to the retracted facet joint through the sheath while the facet joint is retracted by the distal tips of the said rotatable members in the retraction position or by the sheath advanced into the facet joint. ### Claim 128 (depends on 127) A method according to claim 127, wherein the medical procedure comprises injecting a fluid composition into the facet joint from a lumen of at least one of the said rotatable members disposed through the sheath. ### Claim 129 (depends on 120) A method according to claim 120, comprising RF ablation of tissue in or adjacent to the posterior side of the facet joint using at least one of the rotatable members as a RF electrode. ### Claim 130 (depends on 129) A method according to claim 129, wherein the sheath has an exterior coating of an electrically insulating material. ### Claim 131 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130) A method according to any one of claims 120-130, wherein the facet joint surgical tool is according to any one of claims 1-74. ### Claim 132 (depends on 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131) A method according to any one of claims 108-131, wherein the tissue condition comprises a synovial cyst anterior to the facet joint and the method comprises performing the medical procedure to treat the synovial cyst. ### Claim 133 A method for treating a facet joint synovial cyst, comprising introducing into tissue of the synovial cyst a fluid composition including at least one component to decompose or liquefy the tissue. ### Claim 134 (depends on 133) A method according to claim 133, wherein the at least one component comprises a hyaluronidase. ### Claim 135 (depends on 133) A method according to claim 133, wherein the at least one component comprises a collagenase. ### Claim 136 (depends on 134, 135) A method according to either one of claim 134 or claim 135, comprising after the introducing, removing tissue from the synovial cyst. ### Claim 137 (depends on 133) A method according to claim 133, wherein the synovial cyst is disposed on an anterior side of a facet joint. ### Claim 138 (depends on 133) A method according to claim 133, wherein the synovial cyst is disposed on a posterior side of a facet joint. ### Claim 139 (depends on 133) A method according to claim 133, comprising prior to the delivering, applying suction to the synovial cyst to aspirate fluid. ### Claim 140 (depends on 133) A method according to claim 133, comprising rupturing the cyst with mechanical penetration or applied fluid pressure. ### Claim 141 (depends on 133) A method according to claim 133, comprising ablating tissue of the synovial cyst. ### Claim 142 (depends on 133) A method according to claim 133, wherein the introducing comprises delivering the fluid composition to the synovial cyst or to adjacent the synovial cyst from a minimally invasive surgical tool inserted through tissue of a patient. ### Claim 143 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142) A method according to any one of claims 133-142, wherein the introducing comprises delivering the fluid composition to the synovial cyst or to adjacent the synovial cyst through a surgical tool of any one of claims 1-74. ### Claim 144 Use of a hyaluronidase for treatment of a facet joint synovial cyst. ### Claim 145 Use of a collagenase for treatment of a facet joint synovial cyst.