Neuromonitoring systems and methods
First Claim
1. A method of neuromonitoring, comprising:
- delivering test stimulus signals to different combinations of stimulating electrodes disposed at or near a dermatome or myotome innervated by a first nerve, wherein each of the different combinations of stimulating electrodes have a known configuration;
receiving nerve response signals detected by a response sensor disposed in tissue near the first nerve, wherein each of the nerve response signals corresponds to one of the test stimulus signals delivered to one of the different combinations of stimulating electrodes;
measuring a nerve response time associated with each of the nerve response signals using a calibration sensor;
determining a characteristic of the first nerve based on the nerve response signals and corresponding nerve response times;
determining a distance between the different combinations of stimulating electrodes and the first nerve based on the characteristic and nerve response time of the first nerve; and
using a processor, processing the test stimulus signals and nerve response signals to automatically select an optimum one of the different combinations of stimulating electrodes, wherein processing the test stimulus signals comprises determining a response latency associated with each stimulating electrode of the different combinations of stimulating electrodes;
synchronizing test stimulus signals for the selected combination of stimulating electrodes, wherein synchronizing the stimulus signals comprises delivering or delaying the test stimulus signal depending on the determined response latencies; and
communicating an indication of a location of the nerve to a user, wherein the location is determined using the distance between the different combinations of stimulating electrodes and the first nerve.
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Accused Products
Abstract
Systems, devices and methods are provided for neuromonitoring, particularly neuromonitoring to reduce the risks of contacting or damaging nerves or causing patient discomfort during and after surgical procedures, including spinal surgeries. The neuromonitoring procedures include monitoring for the presence of or damage to sensory nerves, and optionally includes additional monitoring for motor nerves. In some systems, including systems that monitor for both sensory and motor nerves, components of the monitoring systems (e.g., stimulating electrodes and response sensors), may be combined with one or more surgical instruments. The systems, devices, and methods provide for pre-surgical assessment of neural anatomy and surgical planning, intraoperative monitoring of nerve condition, and post-operative assessment of nerve position and health.
93 Citations
14 Claims
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1. A method of neuromonitoring, comprising:
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delivering test stimulus signals to different combinations of stimulating electrodes disposed at or near a dermatome or myotome innervated by a first nerve, wherein each of the different combinations of stimulating electrodes have a known configuration; receiving nerve response signals detected by a response sensor disposed in tissue near the first nerve, wherein each of the nerve response signals corresponds to one of the test stimulus signals delivered to one of the different combinations of stimulating electrodes; measuring a nerve response time associated with each of the nerve response signals using a calibration sensor; determining a characteristic of the first nerve based on the nerve response signals and corresponding nerve response times; determining a distance between the different combinations of stimulating electrodes and the first nerve based on the characteristic and nerve response time of the first nerve; and using a processor, processing the test stimulus signals and nerve response signals to automatically select an optimum one of the different combinations of stimulating electrodes, wherein processing the test stimulus signals comprises determining a response latency associated with each stimulating electrode of the different combinations of stimulating electrodes; synchronizing test stimulus signals for the selected combination of stimulating electrodes, wherein synchronizing the stimulus signals comprises delivering or delaying the test stimulus signal depending on the determined response latencies; and communicating an indication of a location of the nerve to a user, wherein the location is determined using the distance between the different combinations of stimulating electrodes and the first nerve. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A system of neuromonitoring, the system comprising memory coupled to at least one processor configured to:
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deliver test stimulus signals to different combinations of stimulating electrodes disposed at or near a dermatome or myotome innervated by a first nerve, wherein each of the different combinations of stimulating electrodes have a known configuration; processing nerve response signals detected by a response sensor disposed in tissue near the first nerve, wherein each of the nerve response signals corresponds to one of the test stimulus signals delivered to one of the different combinations of stimulating electrodes; measure a nerve response time associated with each of the nerve response signals using a calibration sensor; synchronizing test stimulus signals for a selected combination of stimulating electrodes based on the measured nerve response times; determine a characteristic of the first nerve based on the nerve response signals and corresponding nerve response times; determine a distance between the different combinations of stimulating electrodes and the first nerve based on the characteristic and nerve response time of the first nerve; and communicate an indication of a location of the nerve to a user, wherein the location is determined using the distance between the different combinations of stimulating electrodes and the first nerve.
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Specification