Multi-channel stimulation threshold detection algorithm for use with neurophysiology monitoring systems

• US 10,441,183 B2
• Filed: 12/04/2015
• Issued: 10/15/2019
• Est. Priority Date: 09/22/2005
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Farquhar, Allen
• Primary Examiner(s): Fernandes, Patrick
• Application Number:
  US14/959,850
• Publication Number:
  US 20160081570A1
• Time in Patent Office: 1,411 Days
• CPC Class Codes: A61B 5/388 Nerve conduction study, e.g. detecting action potential of peripheral nerves
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/395 Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 5/4041 Evaluating nerves condition
• CPC Class Codes: A61B 5/407 Evaluating the spinal cord A61B5/4896 takes precedence

Abstract

The present invention relates generally to an algorithm aimed at neurophysiology monitoring, and more particularly to an algorithm capable of quickly finding stimulation thresholds over multiple channels of a neurophysiology monitoring system.

Claims

1. A method for performing neurophysiologic assessments, comprising:

determining a threshold current level on a first channel of a neuromonitoring device, wherein the threshold current level is a stimulation current level at which a nerve tissue depolarizes, said first channel associated with a first myotome, wherein the neuromonitoring device is in communication with (i) a control unit, (ii) a patient module, and (iii) a motor evoked potential stimulator, wherein determining the threshold current level on the first channel includes;

delivering stimulation signals, via at least one of the patient module and the motor evoked potential stimulator, within tissue, and monitoring, via the control unit, neuromuscular responses on said first channel to determine when said stimulation signals evoke a significant neuromuscular response, wherein the significant neuromuscular response comprises a peak-to-peak voltage that is greater than a threshold voltage corresponding to the threshold current level, wherein said stimulation signals are delivered as a sequence of pulses and wherein a current level of each pulse is adjusted from an immediately preceding pulse until the threshold current level required to evoke the significant neuromuscular response is determined;

and omitting one or more pulses from the sequence of pulses when the neuromuscular response to an omitted pulse is predictable based upon data obtained, at the control unit, while determining the threshold current level of the first channel, wherein the data obtained comprises one or more stimulation current levels corresponding to the delivered stimulation signals.

2. The method of claim 1, wherein determining the threshold current level for the first channel comprises establishing a bracket within which the threshold current level must lie.

3. The method of claim 1, wherein determining the threshold current level for the first channel comprises bisecting to a predetermined range a bracket established on the first channel.

4. The method of claim 1, wherein determining the threshold current level further comprises:

assigning a specific status to each pulse, said status being one of a first status and a second status, said first status applying to a first current level which evokes a first neuromuscular response one of equal to and greater than a predetermined magnitude and said second status applying to a second current level which evokes a second neuromuscular response less than said predetermined magnitude.

5. The method of claim 4, wherein assigning the specific status to each pulse comprises at least one of (i) stimulating at a given current level and measuring a magnitude of a corresponding neuromuscular response, and (ii) inferring the first status or the second status based on the previously obtained data.

6. The method of claim 5, wherein said first status is assigned without directing a pulse at said given current level if said given current level is one of equal to and greater than a previous current level assigned to said first status on the first channel.

7. The method of claim 5, wherein said second status is assigned without directing a pulse of the sequence of pulses at said given current level if said given current level is less than a previous current level assigned to said second status on the first channel.

8. The method of claim 5, wherein determining the threshold current level further comprises a first step of establishing a bracket within which the threshold current level must lie and a second step of bisecting the bracket to a predetermined width.

9. The method of claim 8, wherein said first step of establishing the bracket is carried out before said second step of bisecting the bracket.

10. The method of claim 5, wherein a first bracket is determined by assigning one of said first status and said second status to a series of pulses of the sequence of pulses of successively doubling stimulation current levels, wherein an upper boundary of said first bracket comprises a first stimulation current level assigned said first status and a lower boundary of said first bracket comprises a last stimulation current level assigned said second status.

11. The method claim 10, wherein said first bracket is bisected by assigning one of said first status and said second status to a stimulation current level at the midpoint of said first bracket, said midpoint forming a second bracket with one of said upper boundary and said lower boundary of said first bracket, said midpoint forming a lower boundary of said second bracket when said midpoint is assigned said second status and said midpoint forming an upper boundary of said second bracket when said midpoint is assigned said first status.

12. The method of claim 1, further comprising:

displaying on a display linked to said control unit at least one of alpha-numeric, graphic, and color based indicia to communicate results of the threshold current level.

13. The method of claim 12, wherein said display includes a graphical user interface, further comprising:

inputting user instructions including one or more of starting stimulation, stopping stimulation, selecting a function, and adjusting system parameters.

14. The method of claim 1, wherein delivering the stimulation signals within tissue comprises delivering the stimulation signals to a motor cortex via the motor evoked potential stimulator.

15. The method of claim 14, further comprising:

comparing a later threshold current level to an earlier threshold current level to indicate a health of a spinal cord.

16. The method of claim 1, further comprising:

retracting a nerve out of a surgical corridor using a nerve retractor electrically coupled to said patient module.

17. The method of claim 16, further comprising:

comparing a later threshold current level to an earlier threshold current level to indicate a pathology of the nerve.

18. The method claim 1, wherein said neuromuscular responses are electromyography responses.

19. The method claim 18, further comprising:

assigning a specific status to each pulse, said status being one of a first status and a second status, said first status applying to a first current level which evokes a first electromyography response equal to or greater than a predetermined magnitude and said second status applying to a second current level which evokes a second electromyography response less than said predetermined magnitude.

20. The method claim 19, wherein assigning the specific status to each pulse comprises at least one of (i) stimulating at a given current level and measuring a magnitude of a corresponding electromyography response, and (ii) inferring the first status or the second status based on previously obtained data.