Endoscope for direct visualization of the spine and epidural space

A system for direct visualization of the spinal epidural or intra-discal space comprising:

• a disposable flexible catheter sized for percutaneous introduction into the spinal space, said catheter having an outer diameter of less than about 2.75 mm, said catheter having a proximal end a distal end for insertion into the spinal space and including a first channel extending along the entire length of the catheter and a tip adjacent the distal end, wherein said first channel is semi-circular;
• a fiber-optic bundle sized to be removably slidably received within said first channel, said bundle having a proximal end and a distal end, and including imaging fibers and light fibers for connection to a camera and a light source, respectively;
• connection means at6 the proximal end of said catheter for connecting said fiber-optic bundle to the proximal end of said catheter and for adjustably positioning the distal end of said bundle relative to the distal end of said catheter;
• tip deflection means for controllably deflecting said tip of said catheter when the distal end is in the spinal space, wherein said tip has a length dimension of less than about 2.5 cm measured from the distal end of said catheter;
• radio-opaque means at the distal ends of said catheter and said fiber-optic bundle for permitting radiographic verification of the relative position of the distal end of said bundle to the distal end of said catheter;
• and
• irrigation means for providing irrigation fluid through said catheter to the distal end of said catheter, wherein said irrigation means includes said first channel in said catheter and means for fluidly connecting said first channel to a source of irrigation fluid, whereby irrigation fluid flows around said fiber-optic bundle when it is disposed within said first channel.

A system for direct visualization of the spinal epidural or intra-discal space comprising:

• a disposable flexible catheter sized for percutaneous introduction into the spinal space, said catheter having a proximal end and a distal end for insertion into the spinal space and including a first channel extending along the entire length of the catheter and a tip adjacent the distal end;
• a fiber-optic bundle sized to be removably slidably received within said first channel, said bundle having a proximal end and a distal end, and including imaging fibers and light fibers for connection to a camera and a light source, respectively;
• connection means at the proximal end of said catheter for connecting said fiber-optic bundle to the proximal end of said catheter and for adjustably positioning t6he distal end of said bundle relative to the distal end of said catheter, wherein said connection means includes:
• clamp means for clamping said fiber-optic bundle;
• and
• means for adjusting the length distance between the distal end of said catheter and said clamp means, wherein said means for adjusting includes:
• a first housing attached to the proximal end of said catheter and defining a bore for slidably receiving said fiber-optici bundle therethrough,
• a second housing connected to said clamp means and defining a bore for receiving said fiber-optic bundle therethrough, and
• a threaded post on one of said first and second housing and a mating threaded bore defined in the other of said first and second housing, whereby said threaded post is adjustably threaded into said threaded bore to adjust the length distance between the distal end of said catheter and said clamp means;
• and
• tip deflection means for controllably deflecting said tip of said catheter when the distal end is in the spinal space.

An apparatus for controlling the viewing angle of an endoscope for direct visualization of the spinal epidural and intra-discal space, the endoscope being formed of a flexible catheter having a bendable tip and a fiber-optic bundle extending therethrough to the tip, the apparatus comprising:

• a deflection wire having a first end and a second end and having a first portion adjacent said first end disposed outside the catheter and a second portion between said first portion and said second end insertable through the catheter;
• means for securing said second end of said deflection wire to the catheter adjacent the tip thereof;
• means for moving the catheter in a first direction from the proximal end toward the tip of the catheter, wherein said means for moving includes means for limiting movement of the catheter in said first direction relative to, said means for restraining to thereby control the amount of deflection of the tip;
• and
• means for restraining said first end of said deflection wire against movement in said first direction as the catheter is moved in said first direction, wherein said means for restraining includes:
• an elongated housing defin ing a cavity therein, said housing having openings at its ends for slidably receiving the catheter therethrough;
• a sleeve within said cavity and slidably disposed about the catheter;
• means for connecting said first end of said deflection wire to said sleeve;
• and
• said housing further defining a stop surface in said cavity for restraining movement of said sleeve in said first direction;
• whereby said deflection wire is placed in tension as it is pulled at its second end by the catheter to thereby cause the tip to deflect in the direction of said means for securing.

An endoscope for direect visualization of the spinal epidural and intra-discal space having a disposable component and a reusable optical component comprising:

• a flexible disposable catheter sized for percutaneous introduction into the spinal space, said catheter having a proximal end and a distal end for insertion into the spinal space and including a first channel extending along the entire length of the catheter;
• a fiber-optic bundle sized to be removably slidably received within said first channel, said bundle having a proximal end and a distal end, and including imaging fibers and light fibers for connection to a camera and a light source, respectively;
• connection means at the proximal end of said catheter for connecting said fiber-optic bundle to the proximal end of said catheter, for rotating said bundle relative to said catheter, and for adjustably positioning the distal end of said bundle relative to the distal end of said catheter, said connection means including;
• clamp means for clamping said fiber-optic bundle;
• rotation means for rotating said fiber-optic bundle relative to said catheter;
• and
• means for advancing and retracting the distal end of said catheter with respect to said clamp means;
• and
• irrigation means for providing irrigation fluid through said catheter to the distal end of said catheter.

The system of claim 32, wherein said means for advancing and retracting includes:

• a first housing attached to the, proximal end of said catheter and defining a bore for slidably receiving said fiber-optic bundle therethrough;
• a second housing connected to said clamp means and defining a bore for receiving said fiber-optic bundle therethrough;
• and
• a threaded post on one of said first and second housing and a mating threaded bore defined in the other of said first and second housing, whereby said threaded post is adjustably threaded into said threaded bore to adjust the length distance between the distal end of said catheter and said clamp means.

A method for direct visualization of the spinal epidural and intra-discal space comprising the steps of:

• percutaneously inserting an endoscope formed of a flexible catheter with a fiber-optic bundle having both imaging and light fibers slidably disposed therein, the catheter having a deflectable tip unrelated to the fiber-optic bundle, and the fiber-optic bundle being connected to a light source and camera;
• advancing the catheter into the spinal space;
• keeping the fiber-optic bundle retracted within the catheter until the catheter tip reaches the region to be visualized;
• then extending the fiber-optic bundle relative to the catheter until the viewing end of the bundle is adjacent the end of the catheter;
• and
• radiographically verifying the position of the viewing end of the fiber-optic bundle relative to the end of the catheter.

A method for direct visualization of the spinal epidural and intra-discal space comprising the steps of:

• percutaneously inserting an endoscope formed of a flexible catheter with a fiber-optic bundle having both imaging and light fibers slidably disposed therein, the catheter having a deflectable tip unrelated to the fiber-optic bundle, and the fiber-optic bundle being connected to a light source and camera;
• advancing the catheter into the spinal space;
• keeping the fiber-optic bundleiretracted within the catheter until the catheter tip retches the region to be visualized;
• then extending the fiber-optic bundle relative to the catheter until the viewing end of he bundle is adjacent the end of the catheter;
• radiographically verifying the position of the viewing end of the fiber-optic bundle relative to the end of the catheter;
• and
• rotating the fiber-optic bundle relative to the catheter to vary the view orientation through the viewing end of the fiber-optic bundle.

A method for direct visualization of the spinal epidural and intra-discal space comprising the steps of:

• percutaneously inserting an endoscope formed of a flexible catheter with a fiber-optic bundle slidably disposed therein, the catheter having a deflectable tip and the fiber-optic bundle being connected to a light source and camera;
• advancing the catheter into the spinal space;
• keeping the fiber-optic bundle retracted within the catheter until the catheter tip reaches the region to be visualized;
• then extending the fiber-optic bundle relative to the catheter until the viewing end of the bundle is adjacent the end of the catheter;
• radiographically verifying the position of the viewing end of the fiber-optic bundle relative to the end of the catheter;
• deflecting the catheter tip to vary the viewing angle of the viewing end of the fiber-optic bundle within the spinal space;
• and
• rotating the fiber-optic bundle relative to the catheter with the tip deflected to vary the view orientation through the viewing end of the fiber-optic bundle.

A method for direct visualization of the spinal epidural and intra-discal space comprising the steps of:

• percutaneously inserting an endoscope formed of a flexible catheter with a fiber-optic bundle slidably disposed therein, the catheter having a deflectable tip and the fiber-optic bundle being connected to a light source and camera;
• advancing the catheter into the spinal space;
• keeping the fiber-optic bundle retracted within the catheter until the catheter tip reaches the region to be visualized;
• then extending the fiber-optic bundle relative to the catheter until the viewing end of the bundle is adjacent the end of the catheter;
• radiographically verifying the position of the viewing end of the fiber-optic bundle relative to the end of the catheter;
• deflecting the catheter tip to vary the viewing angle of the viewing end of the fiber-optic bundle within the spinal space;
• and
• rotating the catheter within the spinal space with the tip deflected to further vary the viewing angle.