Methods and apparatus are provided for selective
surgical removal of tissue, e.g., for enlargement of diseased spinal structures, such as impinged lateral recesses and pathologically narrowed neural
foramen. In one variation, tissue may be ablated, resected, removed, or otherwise remodeled by standard small endoscopic tools delivered into the
epidural space through an epidural needle. Once the sharp tip of the needle is in the
epidural space, it is converted to a blunt tipped instrument for further safe advancement. A specially designed epidural
catheter that is used to cover the previously sharp needle tip may also contain a fiberoptic cable. Further embodiments of the current invention include a double barreled epidural needle or other means for placement of a working channel for the placement of tools within the
epidural space, beside the epidural instrument. The current invention includes specific tools that enable safe tissue modification in the epidural space, including a barrier that separates the area where tissue modification will take place from adjacent vulnerable neural and vascular structures. In one variation, a tissue abrasion device is provided including a thin belt or ribbon with an
abrasive cutting surface. The device may be placed through the neural foramina of the spine and around the anterior border of a
facet joint. Once properly positioned, a
medical practitioner may enlarge the
lateral recess and neural foramina via frictional abrasion, i.e., by sliding the
abrasive surface of the ribbon across impinging tissues. A
nerve stimulator optionally may be provided to reduce a risk of inadvertent neural abrasion. Additionally, safe epidural placement of the working barrier and epidural tissue modification tools may be further improved with the use of electrical
nerve stimulation capabilities within the invention that, when combined with
neural stimulation monitors, provide neural localization capabilities to the surgeon. The device optionally may be placed within a protective sheath that exposes the
abrasive surface of the ribbon only in the area where tissue removal is desired. Furthermore, an
endoscope may be incorporated into the device in order to monitor safe tissue removal. Finally,
tissue remodeling within the epidural space may be ensured through the placement of compression dressings against remodeled tissue surfaces, or through the placement of tissue retention straps, belts or cables that are wrapped around and pull under tension aspects of the impinging
soft tissue and bone in the posterior
spinal canal.