Nerve surveillance cannulae systems

• US 20030195405A1
• Filed: 05/07/2003
• Published: 10/16/2003
• Est. Priority Date: 12/23/1998
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Marino, James F., Stone, Corbett W., Christopher, Troy K., Blewett, Jeffrey J., Kelleher, Brian S.
• Granted Patent: US 7,079,883 B2
• Time in Patent Office: Days
• US Class Current: 600/373
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1487 Trocar-like, i.e. devices producing an enlarged transcutaneous opening
• CPC Class Codes: A61B 2017/3484 Anchoring means, e.g. spreading-out umbrella-like structure
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2018/00595 Cauterization
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/296 for electromyography [EMG]
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/4029 for evaluating the peripheral nervous systems A61B5/24 takes precedence
• CPC Class Codes: A61B 5/4041 Evaluating nerves condition
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes

Abstract

An expandable tip cannula system, comprising: a hollow cannula shaft having a proximal end and a distal end; and an expandable tip mounted at the distal end of the hollow cannula shaft, the expandable tip comprising a plurality of generally-triangular shaped petals held together in a radially-inwardly tapered arrangement between adjacent petals, each petal comprising a nerve sensing electrode disposed therein.

Claims

1. A nerve surveillance system for detecting the presence of nerves during minimally invasive access of a surgical target site within a living body, comprising:

a cannula having an inner lumen extending between a proximal end and a distal end, said distal end being dimensioned to be minimally invasively advanced to said surgical target site, said inner lumen being dimensioned to thereafter pass surgical instruments to said surgical target site; and

at least one nerve stimulation electrode integrally associated with said cannula and located proximate said distal end thereof, said at least one nerve stimulation electrode for delivering energy during the advancement of said distal end of said cannula to said surgical target site in an amount sufficient to depolarize nerves adjacent said distal end of said cannula such that the presence of said nerves may be detected without effecting tissue ablation or cauterization.

2. The nerve surveillance system of claim 1, wherein said distal end of said cannula is equipped with a plurality of expandable members which, upon expansion, displace tissue away from said distal end.

3. The nerve surveillance system of claim 2, wherein each of said expandable members is equipped with at least one nerve stimulation electrode.

4. The nerve surveillance system of claim 1, wherein the presence of said depolarized nerves is determined using electromyography on muscle tissue in communication with said depolarized nerves.

5. The nerve surveillance system of claim 2, further comprising a generally cylindrical member received within said inner lumen of said cannula and capable of causing said expandable members to deflect radially outwards to open said distal end of said cannula.

6. The nerve surveillance system of claim 5, wherein said generally cylindrical member comprises an inner cannula.

7. The nerve surveillance system of claim 5, wherein said generally cylindrical member comprises an obturator.

8. The nerve surveillance system of claim 6, further comprising:

an obturator dimensioned to be received within said inner cannula.

9. The nerve surveillance system of claim 2, wherein said expandable members are curved radially outwards at their distal ends.

10. The nerve surveillance system of claim 2, further comprising:

an expandable elastomer disposed over an exterior surface of said expandable members to assist in displacing tissue upon expansion of said expandable members.

11. The nerve surveillance system of claim 2, wherein said expandable members are held together by breakable seals.

12. The nerve surveillance system of claim 2, wherein said expandable members are generally triangular in shape and, before expansion, converge to form a generally conical shape at said distal end of said cannula.

13. The nerve surveillance system of claim 1, wherein said at least one nerve stimulation electrode comprises a plurality of nerve stimulation electrodes disposed radially around said distal end of said cannula.

14. The nerve surveillance system of claim 1, wherein said at least one nerve stimulation electrode comprises a plurality of nerve stimulation electrodes disposed axially with respect to one another along the length of said cannula.

15. The nerve surveillance system of claim 8, wherein said obturator protrudes from said distal end of said cannula during the passage of said distal end of said cannula to said surgical target site.

16. The nerve surveillance system of claim 15, wherein said obturator further comprises a nerve stimulation electrode at its distal end.

17. A system for detecting the presence of nerves while minimally invasively accessing a surgical target site within a living body, comprising:

a nerve surveillance instrument dimensioned to be minimally invasively advanced to said surgical target site, said nerve surveillance instrument having at least one nerve stimulation electrode integrally associated with said instrument and located proximate a distal end thereof, said at least one nerve stimulation electrode for delivering energy during the advancement of said instrument to said surgical target site in an amount sufficient to depolarize nerves adjacent said instrument such that the presence of said nerves may be detected without effecting tissue ablation or cauterization; and

a cannula having an inner lumen with a proximal end and a distal end, said inner lumen dimensioned to be slidably received over said nerve surveillance instrument and such that, upon removal of said nerve surveillance instrument, said inner lumen may be used to pass surgical instruments to said surgical target site.

18. The system of claim 17, wherein said at least one nerve stimulation electrode comprises a plurality of nerve stimulation electrodes disposed radially around said distal end of said instrument.

19. The system of claim 17, wherein said at least one nerve stimulation electrode comprises a plurality of nerve stimulation electrodes disposed axially along said distal end of said instrument.

20. The system of claim 17, further including an expandable covering disposed over said cannula which, upon expansion, displaces tissue away from said nerve surveillance instrument.

21. A method of minimally invasively providing a passageway to a surgical target site within a living body, comprising:

providing a nerve surveillance instrument dimensioned to be minimally invasively advanced to said surgical target site and slideably received within a cannula, wherein said nerve surveillance instrument is equipped with at least one nerve stimulation electrode disposed proximate a distal end thereof, and wherein said cannula has an inner lumen dimensioned to pass surgical instruments therethrough;

minimally invasively advancing said nerve surveillance probe and said cannula towards said surgical target site while energizing said at least one nerve stimulation electrode in an amount sufficient to depolarize nerves adjacent said instrument such that the presence of said nerves may be detected without effecting tissue ablation or cauterization; and

removing said nerve surveillance instrument from said inner lumen after said cannula has been advanced to said surgical target site.

22. The method of claim 21, wherein said step of advancing comprises the further sup-step of sensing the presence of said nerves in a radial direction relative to a central axis of said cannula through the use of a plurality of nerve stimulation electrodes radially disposed around said distal end of said instrument.

23. A method of detecting the presence of nerves during minimally invasive access of a surgical target site within a living body, comprising:

providing a cannula having an inner lumen extending between a proximal end and a distal end, said distal end being dimensioned to be minimally invasively advanced to said surgical target site, said inner lumen being dimensioned to pass surgical instruments therethrough;

providing at least one nerve stimulation electrode integrally associated with said cannula and located proximate said distal end thereof; and

minimally invasively advancing said distal end of said cannula to said surgical target site while delivering energy through said at least one nerve stimulation electrode in an amount sufficient to depolarize nerves adjacent said distal end of said cannula such that the presence of said nerves may be detected without effecting tissue ablation or cauterization.