SYSTEM AND METHODS FOR DETERMINING NERVE PROXIMITY, DIRECTION, AND PATHOLOGY DURING SURGERY
First Claim
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1. A method of establishing an operative corridor for spinal surgery, comprising:
- mounting a plurality of EMG electrodes proximate to selected leg muscles;
activating a nerve monitoring system that outputs a stimulation current signal to one or more surgical access instruments and that, in response to signals from the EMG electrodes, displays a stimulation current threshold which is indicative of nerve proximity and further displays EMG waveforms;
advancing an initial dilating assembly through bodily tissue having neural structures in a selected path toward a targeted intervertebral disc of a spine, the initial dilating assembly comprising an initial dilator cannula and a removable inner element having at least one stimulation electrode that delivers the stimulation signal to the bodily tissue prior to accessing the spine;
during advancement of the initial dilating assembly through the bodily tissue and prior to accessing the spine, viewing the stimulation current threshold on a display device of the nerve monitoring system when the stimulation signal is delivered to the bodily tissue prior to accessing the spine;
inserting a guide wire through a lumen of the initial dilator cannula after the initial dilator cannula is advanced through the bodily tissue so that the guide wire penetrates an annulus of the targeted intervertebral disc of the spine;
advancing a plurality of sequential dilator cannulas along the selected path toward the targeted intervertebral disc of the spine after the guide wire engages the annulus of the disc;
advancing a working corridor instrument over an outermost dilator cannula of the plurality of sequential dilator cannulas toward the targeted intervertebral disc of the spine after; and
establishing an operative corridor to the targeted intervertebral disc of the spine using the working corridor instrument.
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Abstract
The present invention involves systems and methods for determining nerve proximity, nerve direction, and pathology relative to a surgical instrument based on an identified relationship between neuromuscular responses and the stimulation signal that caused the neuromuscular responses.
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Citations
25 Claims
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1. A method of establishing an operative corridor for spinal surgery, comprising:
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mounting a plurality of EMG electrodes proximate to selected leg muscles; activating a nerve monitoring system that outputs a stimulation current signal to one or more surgical access instruments and that, in response to signals from the EMG electrodes, displays a stimulation current threshold which is indicative of nerve proximity and further displays EMG waveforms; advancing an initial dilating assembly through bodily tissue having neural structures in a selected path toward a targeted intervertebral disc of a spine, the initial dilating assembly comprising an initial dilator cannula and a removable inner element having at least one stimulation electrode that delivers the stimulation signal to the bodily tissue prior to accessing the spine; during advancement of the initial dilating assembly through the bodily tissue and prior to accessing the spine, viewing the stimulation current threshold on a display device of the nerve monitoring system when the stimulation signal is delivered to the bodily tissue prior to accessing the spine; inserting a guide wire through a lumen of the initial dilator cannula after the initial dilator cannula is advanced through the bodily tissue so that the guide wire penetrates an annulus of the targeted intervertebral disc of the spine; advancing a plurality of sequential dilator cannulas along the selected path toward the targeted intervertebral disc of the spine after the guide wire engages the annulus of the disc; advancing a working corridor instrument over an outermost dilator cannula of the plurality of sequential dilator cannulas toward the targeted intervertebral disc of the spine after; and establishing an operative corridor to the targeted intervertebral disc of the spine using the working corridor instrument. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. A method of establishing an operative corridor for spinal surgery, comprising:
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mounting a plurality of EMG electrodes proximate to selected leg muscles; activating a nerve monitoring system that outputs a stimulation current signal to one or more surgical access instruments and that, in response to signals from the EMG electrodes, displays a stimulation current threshold which is indicative of nerve proximity and further displays EMG waveforms; advancing a plurality of sequential dilator cannulas through bodily tissue having neural structures in a selected path toward a targeted intervertebral disc of a spine, each of the sequential dilator cannulas having at least one stimulation electrode that delivers the stimulation signal to the bodily tissue before reaching the spine; during advancement of each respective sequential dilator cannula through the bodily tissue, viewing the stimulation current threshold on a display device of the nerve monitoring system for an indication of nerve proximity when the stimulation signal is delivered to the bodily tissue from the respective sequential dilator cannula; advancing a working corridor instrument over an outermost dilator cannula of the plurality of sequential dilator cannulas toward the targeted intervertebral disc of the spine; and establishing an operative corridor to the targeted intervertebral disc of the spine using the working corridor instrument. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18, 19)
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20. A method of establishing an operative corridor for spinal surgery, comprising:
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mounting a plurality of EMG electrodes proximate to selected leg muscles; activating a nerve monitoring system that outputs a stimulation current signal to one or more surgical access instruments and that displays neuromuscular response information in response to signals from the EMG electrodes; advancing an initial dilating assembly through bodily tissue having neural structures in a selected path toward a targeted intervertebral disc of a spine, the initial dilating assembly comprising an initial dilator cannula and a removable inner element having at least one stimulation electrode that delivers the stimulation signal to the bodily tissue prior to accessing the spine; during advancement of the initial dilating assembly through the bodily tissue and prior to accessing the spine, monitoring the neuromuscular response information displayed by the nerve monitoring system when the stimulation signal is delivered to the bodily tissue prior to accessing the spine; inserting a guide wire through a lumen of the initial dilator cannula after the initial dilator cannula is advanced through the bodily tissue so that the guide wire penetrates an annulus of the targeted intervertebral disc of the spine; advancing a plurality of sequential dilator cannulas along the selected path toward the targeted intervertebral disc of the spine after the guide wire engages the annulus of the disc; advancing a working corridor instrument over an outermost dilator cannula of the plurality of sequential dilator cannulas toward the targeted intervertebral disc of the spine; and establishing an operative corridor to the targeted intervertebral disc of the spine using the working corridor instrument. - View Dependent Claims (21, 22, 23, 24, 25)
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Specification