Methods & systems for intraoperatively monitoring nerve & muscle frequency latency and amplitude
First Claim
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1. A method for monitoring and assessing the function of an at-risk nerve in a subject during a surgical procedure, comprising the steps of:
- a. obtaining a baseline spontaneously occurring electromyography activity (sEMG) recording;
then serially, throughout the procedure, obtaining a plurality of mechanically elicited electromyography activity (mEMG) recordings; and
therefrom obtaining a plurality of real-time mEMG/sEMG comparisons between the serially obtained mEMG recordings and the sEMG recording;
b. obtaining a baseline spontaneously occurring nerve action potential (sNAP) recording;
then serially, throughout the procedure, recording a plurality of mechanically elicited nerve action potential (mNAP) recordings; and
therefrom obtaining a plurality of real-time mNAP/ sNAP comparisons between the serially obtained mNAP recordings and the sNAP recording;
c. serially, throughout the procedure, electrically stimulating a (sciatic) nerve portion and following each act of stimulating, obtaining a plurality of electrically elicited compound muscle action potential (eCMAP) recordings, and a plurality of electrically elicited compound nerve action potential (eNAP) recordings; and
therefrom obtaining a plurality of real-time eCMAP/eCMAP comparisons between the serially obtained eCMAP recordings and a plurality of real-time eNAP/eNAP comparisons between the serially obtained eNAP recordings,wherein the obtained mEMG, sEMG, mNAP, sNAP, eCMAP, eNAP recordings, and the mEMG/sEMG, mNAP/sNAP, eCMAP/eCMAP and eNAP/eNAP comparisons are displayed by means of one or more of a plurality of real-time trend displays, and a processor adapted and configured to receive and store in a plurality of real-time data acquisition buffers the obtained mEMG, sEMG, mNAP, sNAP, eCMAP, eNAP recordings, and receive and store in a plurality of real-time comparison buffers the mEMG/sEMG, mNAP/sNAP, eCMAP/eCMAP and eNAP/eNAP comparisons, said processor being in communication with said real-time trend displays, andwherein said real-time trend displays comprise;
one or a plurality of baseline data windows wherein one or more baseline data are displayed;
one or more amplitude waveform windows wherein one or more amplitude waveforms are displayed with respect to time;
one or a plurality of latency waveform windows wherein one or more latency waveforms are displayed with respect to time;
one or a plurality of frequency waveform windows wherein one or more frequency waveforms are displayed with respect to time; and
one or a plurality of real-time digital value analysis windows, wherein recorded analog data converted to digital values are displayed with respect to time, said digital value analysis windows providing a plurality of evaluations in real-time.
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Abstract
Methods and systems are provided for neurophysiological assessment, specifically nerve and nerve root conduction frequencies, latencies and amplitudes, with respect to surgical intervention and insult. Real-time trends in waveforms are captured, and warnings of pathological changes reported, displayed and audibilized.
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Citations
32 Claims
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1. A method for monitoring and assessing the function of an at-risk nerve in a subject during a surgical procedure, comprising the steps of:
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a. obtaining a baseline spontaneously occurring electromyography activity (sEMG) recording;
then serially, throughout the procedure, obtaining a plurality of mechanically elicited electromyography activity (mEMG) recordings; and
therefrom obtaining a plurality of real-time mEMG/sEMG comparisons between the serially obtained mEMG recordings and the sEMG recording;b. obtaining a baseline spontaneously occurring nerve action potential (sNAP) recording;
then serially, throughout the procedure, recording a plurality of mechanically elicited nerve action potential (mNAP) recordings; and
therefrom obtaining a plurality of real-time mNAP/ sNAP comparisons between the serially obtained mNAP recordings and the sNAP recording;c. serially, throughout the procedure, electrically stimulating a (sciatic) nerve portion and following each act of stimulating, obtaining a plurality of electrically elicited compound muscle action potential (eCMAP) recordings, and a plurality of electrically elicited compound nerve action potential (eNAP) recordings; and
therefrom obtaining a plurality of real-time eCMAP/eCMAP comparisons between the serially obtained eCMAP recordings and a plurality of real-time eNAP/eNAP comparisons between the serially obtained eNAP recordings,wherein the obtained mEMG, sEMG, mNAP, sNAP, eCMAP, eNAP recordings, and the mEMG/sEMG, mNAP/sNAP, eCMAP/eCMAP and eNAP/eNAP comparisons are displayed by means of one or more of a plurality of real-time trend displays, and a processor adapted and configured to receive and store in a plurality of real-time data acquisition buffers the obtained mEMG, sEMG, mNAP, sNAP, eCMAP, eNAP recordings, and receive and store in a plurality of real-time comparison buffers the mEMG/sEMG, mNAP/sNAP, eCMAP/eCMAP and eNAP/eNAP comparisons, said processor being in communication with said real-time trend displays, and wherein said real-time trend displays comprise;
one or a plurality of baseline data windows wherein one or more baseline data are displayed;
one or more amplitude waveform windows wherein one or more amplitude waveforms are displayed with respect to time;
one or a plurality of latency waveform windows wherein one or more latency waveforms are displayed with respect to time;
one or a plurality of frequency waveform windows wherein one or more frequency waveforms are displayed with respect to time; and
one or a plurality of real-time digital value analysis windows, wherein recorded analog data converted to digital values are displayed with respect to time, said digital value analysis windows providing a plurality of evaluations in real-time. - 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, 24, 25, 26, 27, 28, 29, 30, 31, 32)
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Specification