Methods and apparatus for treating back pain

A method for treating discogenic pain, comprising:

• a) advancing an electrosurgical probe comprising an energy-applying element from a location outside an intervertebral disc towards an annulus fibrosus of the disc;
• b) positioning said energy-applying element within the posterior of the annulus fibrosus and positioning a return electrode adjacent to an external surface of the posterior region of the annulus fibrosus;
• and
• c) electrosurgically coagulating nerve tissue within the posterior of the annulus fibrosus by applying heat using said energy-applying element, whereby the pain is alleviated.

A method for denervating an intervertebral disc, comprising:

• a) advancing an electrosurgical probe comprising an energy-applying element from a location outside an intervertebral disc towards a nucleus pulposus of the disc;
• b) positioning said energy-applying element within the nucleus pulposus of the disc;
• c) electrosurgically treating the nucleus pulposus of the disc by applying a first high frequency voltage at the energy-applying element;
• d) advancing the energy-applying element of an electrosurgical instrument from a location outside the disc towards a posterior region of an annulus fibrosus of the disc;
• e) positioning the energy-applying element within the annulus fibrosus;
• and
• f) applying a high frequency voltage between the energy-applying element and a return electrode to coagulate tissue within the annulus fibrosus, wherein the posterior region of the annulus fibrosus is denervated.

A method for denervating an intervertebral disc, comprising:

• a) advancing the energy-applying element of an electrosurgical instrument from a location outside the disc towards a posterior region of an annulus fibrosus of the disc, wherein the energy-applying element is disposed on a distal end of a first shaft;
• b) positioning the energy-applying element within the annulus fibrosus at a location adjacent to the posterior of the nucleus pulposus of the disc;
• c) applying a high frequency voltage between the energy-applying element and a return electrode to coagulate tissue within the annulus fibrosus, wherein the posterior region of the annulus fibrosus is denervated, and wherein the return electrode is disposed on a distal end of a second shaft;
• and
• d) advancing the distal end of the second shaft to a location adjacent to an outer wall of the annulus fibrosus.

A method for treating an intervertebral disc, comprising:

• a) advancing a first electrosurgical probe comprising a first energy-applying element from a location outside an intervertebral disc towards a nucleus pulposus of the disc;
• b) positioning said first energy-applying element within the nucleus pulposus of the disc;
• c) electrosurgically treating the nucleus pulposus of the disc by applying a first high frequency voltage at the first energy-applying element;
• d) advancing an energy-applying element of a second electrosurgical instrument from a location outside the intervertebral disc into the annulus fibrosus;
• and
• e) electrosurgically coagulating collagen within the posterior of the annulus fibrosus by applying heat with a second energy-applying element of said second electrosurgical instrument.

A method for treating back pain, comprising:

• a) electrosurgically applying heat at a target tissue within a posterior region of an annulus fibrosus of an intervertebral disc via an electrosurgical probe;
• b) controlling the temperature to which the target tissue is exposed, such that the target tissue is exposed to a temperature in the range of from about 43° C. to 53° C.;
• and
• c) as a result of said steps a) and b), denervating at least a portion of the target tissue by coagulating nerve tissue therein, whereby the pain is alleviated;
• and
• wherein the probe includes an active electrode disposed on a working end of a first shaft of the probe and a return electrode disposed on a working end of a second shaft of the probe, and, prior to step a), the method further comprises:
• d) advancing the working end of the first shaft through a portion of the annulus fibrosus such that the active electrode is positioned within the annulus fibrosus at a first location adjacent to the posterior of the nucleus pulposus;
• and
• e) advancing the working end of the second shaft towards the posterior of the annulus fibrosus such that the return electrode is positioned external to the annulus fibrosus at a second location adjacent to the posterior of the disc.

A method for treating an intervertebral disc, comprising:

• a) providing an electrosurgical instrument, the instrument having a first shaft and a second shaft, the first shaft having a first electrode disposed at the first shaft distal end, and the second shaft having a second electrode disposed at the second shaft distal end;
• b) positioning the first electrode at a first location, the first location within the annulus fibrosus adjacent to a posterior region of a nucleus pulposus of the disc;
• c) positioning the second electrode at a second location, the second location spaced from the first location in a direction towards the posterior of the disc;
• and
• d) applying a high frequency voltage between the first electrode and the second electrode, wherein a portion of the annulus fibrosus is at least partially denervated.