Flexible Neural Localization Devices and Methods
First Claim
1. A bimanually controlled neural localization device capable of determining if a nerve is nearby a region of the device, the device comprising:
- a flexible elongate body;
a stimulation region on the elongate body; and
a guidewire coupler at the distal end region of the elongate body,wherein the guidewire coupler is configured such that the elongate body is removably attachable to a proximal end region of a guidewire such that the stimulation region can be pulled into position by pulling on the guidewire while the proximal end region of the guidewire is held stationary by the guidewire coupler with respect to the distal end region of the elongate body.
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Accused Products
Abstract
Described herein are devices, systems and methods for determining if a nerve is nearby a device or portion of a device. The neural stimulation tools described herein are configured to be flexible and low-profile, so that they can be used within body regions that may be tortuous or difficult to reach, such as within a compressed or partially occluded neural foramen. In most cases, these tools described herein are ribbon-shaped and adapted to be manipulated bimanually, for example, by applying force to the ends of the devices from separate locations outside of the patient'"'"'s body. Thus, in some of the exemplary neural localization devices described herein, the distal end region of the device are configured to couple to the proximal end of a guidewire. One or more surfaces of the devices may include an electrode or multi-polar network of electrodes configured to stimulate only nerves within a predetermined distance of a particular face of the device.
225 Citations
129 Claims
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1. A bimanually controlled neural localization device capable of determining if a nerve is nearby a region of the device, the device comprising:
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a flexible elongate body; a stimulation region on the elongate body; and a guidewire coupler at the distal end region of the elongate body, wherein the guidewire coupler is configured such that the elongate body is removably attachable to a proximal end region of a guidewire such that the stimulation region can be pulled into position by pulling on the guidewire while the proximal end region of the guidewire is held stationary by the guidewire coupler with respect to the distal end region of the elongate body. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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20. A bimanually controlled neural localization device capable of determining if a nerve is nearby a region of the device, the device comprising:
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a flexible elongate body; a first stimulation region on the elongate body that is configured to emit a stimulation field in a first direction from the elongate body; a second stimulation region on the elongate body that is configured to emit a stimulation field in a second direction from the elongate body, wherein the second direction is different than the first direction; and a flexible guide at the distal end of the elongate body, wherein the guide has a sharp distal end for penetrating tissue and is configured such that the stimulation region can be pulled into position by pulling on the guide. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38)
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39. A bimanually controlled neural localization device capable of determining if a nerve is nearby a region of the device, the device comprising:
a flexible elongate body, the elongate body comprising; a proximal end configured to extend out of a first portion of a patient'"'"'s body for manipulation of the proximal end; a distal flexible guide region configured to extend from a second portion of the patient'"'"'s body for manipulation of the distal end, and a stimulation region between the proximal end and distal flexible guide region, wherein the distal flexible guide region has a sharp distal end for penetrating tissue and is configured such that the stimulation region can be pulled into position by pulling on the distal flexible guide region. - View Dependent Claims (40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59)
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60. A system capable of determining if a nerve is nearby a region of a device, the system comprising:
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a bimanually controlled neural localization device, the device comprising; a flexible elongate body, a stimulation region on the elongate body, and a guidewire coupler at the distal end region of the elongate body; and a guidewire configured to removably couple to the guidewire coupler of the neural localization device such that the stimulation region can be pulled into position by pulling on the guidewire while the proximal end region of the guidewire is held stationary by the guidewire coupler with respect to the distal end region of the elongate body. - View Dependent Claims (61, 62, 63, 64)
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65. A method of determining if a nerve is nearby a region of a bimanually controlled device, the method comprising:
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passing a distal end of a neural localization device in a first direction toward a target tissue, at least partially around a target tissue, and away from the target tissue, such that a stimulation region on the neural localization device is positioned adjacent to the target tissue; energizing the stimulation region to emit a stimulation field from the elongate body; and determining if a nerve has been stimulated by the emitted field. - View Dependent Claims (66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81)
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82. A method of determining if a nerve is nearby a region of a bimanually controlled device, the method comprising:
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passing a distal tip of a guidewire into a patient, around a target tissue, and out of the patient so that proximal and distal ends of the guidewire extend from the patient; coupling the distal end of a neural localization device to the proximal end region of the guidewire such that the proximal end region of the guidewire is held stationary with respect to the distal end of a neural localization device; pulling the neural localization device into position within the patient using the guidewire; energizing a stimulation region of the device to emit a stimulation field; and determining if a nerve has been stimulated by the emitted field. - View Dependent Claims (83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101)
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102. A method of determining if a nerve is nearby a region of a device, the method comprising:
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passing a flexible distal end of a neural localization device having a stimulation region into a patient, around a target tissue, and out of the patient so that proximal and distal ends of the neural localization device extend from the patient and the stimulation region is adjacent to the target tissue; pulling on one or both of the proximal and distal ends of the neural localization device to move the stimulation region closer to the target tissue; energizing the stimulation region to emit a stimulation field in a first direction from the elongate body, wherein the first direction is toward the target tissue; pushing on one or both of the proximal and distal ends of the neural localization device to move the stimulation region away from the target tissue; energizing the stimulation region to emit a stimulation field in a second direction from the elongate body, wherein the second direction is away the target tissue; and determining the position of the nerve with respect to the elongate body. - View Dependent Claims (103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114)
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115. A method of determining if a nerve is nearby a region of a device, the method comprising:
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positioning a stimulation region of a neural localization device along a curved path such that the stimulation region is adjacent to a nerve; moving the stimulation region off of the curved path and toward the nerve; energizing the stimulation region to emit a stimulation field in a first direction from the neural localization device, wherein the first direction is toward the nerve; moving the stimulation region off of the curved path and away from the nerve; energizing the stimulation region to emit a stimulation field in a second direction from the neural localization device, wherein the second direction is away the nerve; and determining the position of the nerve with respect to the neural localization device. - View Dependent Claims (116, 117, 118, 119, 120, 121, 122, 123)
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124. A method of determining if a nerve is nearby a region of a device, the method comprising:
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advancing a flexible elongate body of a neural localization device into a patient and around a target tissue; energizing a stimulation region of the elongate body to emit a stimulation field in a first direction from the elongate body; determining a first threshold amount of energy required to stimulate a measurable response from neural tissue with the stimulation field in the first direction; energizing a stimulation region of the elongate body to emit a stimulation field in a second direction from the elongate body, wherein the second direction is different from the first direction; determining a second threshold amount of energy required to stimulate a measurable response from neural tissue with the stimulation field in the second direction; and applying a ratio of the first threshold and the second threshold, and a magnitude of one of the first threshold and the second threshold to determine if the nerve is in the first direction from the elongate body or in the second direction from the elongate body. - View Dependent Claims (125, 126, 127, 128, 129)
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Specification