Neuromonitoring systems and methods
First Claim
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1. A method for neuromonitoring, comprising:
- delivering a first stimulus signal having a first pulse width and a second stimulus signal having a second pulse width to tissue including or adjacent to a nerve, the first pulse width being different from the second pulse width;
detecting, in muscle tissue, a first neuromuscular response in response to the first stimulus signal and a second neuromuscular response in response to the second stimulus signal;
determining a stimulation threshold for the nerve from the first and second pulse widths and the first and second neuromuscular responses, the stimulation threshold being an estimate of a minimum pulse width required to elicit a neuromuscular response greater than or equal to a predetermined threshold, wherein the stimulation threshold is different from the first and second pulse widths; and
communicating to a user an indicator of the stimulation threshold to indicate at least one of nerve proximity and pedicle integrity.
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Abstract
Systems, devices, and methods are described for neuromonitoring. A minimum stimulus signal required to elicit a threshold neuromuscular response is determined by delivery of stimulus signals to tissue and detection of neuromuscular responses in muscle tissue. The strength of the delivered stimulus signals is varied, for example by adjusting the current amplitude or pulse width of the signals, and muscle responses are measure, for example by detecting EMG signals. The delivered stimuli and corresponding responses are then used to determine a stimulation threshold. The stimulation threshold may be used to indicate at least one of nerve proximity and pedicle integrity.
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Citations
26 Claims
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1. A method for neuromonitoring, comprising:
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delivering a first stimulus signal having a first pulse width and a second stimulus signal having a second pulse width to tissue including or adjacent to a nerve, the first pulse width being different from the second pulse width; detecting, in muscle tissue, a first neuromuscular response in response to the first stimulus signal and a second neuromuscular response in response to the second stimulus signal; determining a stimulation threshold for the nerve from the first and second pulse widths and the first and second neuromuscular responses, the stimulation threshold being an estimate of a minimum pulse width required to elicit a neuromuscular response greater than or equal to a predetermined threshold, wherein the stimulation threshold is different from the first and second pulse widths; and communicating to a user an indicator of the stimulation threshold to indicate at least one of nerve proximity and pedicle integrity. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. A method for neuromonitoring, comprising:
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delivering by a stimulating electrode located on a surgical accessory first and second stimulation signals to tissue including or adjacent to a nerve; detecting by a sensor associated with muscle tissue associated with the nerve respective first and second neuromuscular responses elicited by the first and second stimulation signals; calculating a stimulation threshold for the nerve by extrapolation from the respective first and second neuromuscular responses, wherein the stimulation threshold is different from the first and second stimulation signals; and communicating an indicator of the stimulation threshold to a user to indicate one of nerve proximity and pedicle integrity. - View Dependent Claims (25, 26)
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Specification