System and Methods for Diagnosis and Treatment of Discogenic Lower Back Pain
First Claim
1. A method of treating discogenic lumbar back pain in a patient comprising:
- positioning a plurality of electrodes within an anterior epidural space of the patient to a position adjacent to a posterior longitudinal ligament and/or a posterior annulus fibrosus;
generating one or more electrical impulses with a pulse generator; and
transmitting the electrical impulses through said electrodes to one or more nerves in said posterior longitudinal ligament and/or said posterior annulus fibrosus;
wherein the electrical impulses are sufficient to cause one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus to inhibit an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus; and
wherein the electrical impulses at least partially relieve the pain without producing irreversible damage in any tissue of the patient.
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Abstract
Methods and devices to treat discogenic lumbar back pain are disclosed. Electrodes are implanted within the anterior epidural space of the patient. A pulse generator that is connected to the electrodes delivers electrical impulses to sympathetic nerves located within the posterior longitudinal ligament (PLL) of the lumbar spine and outer posterior annulus fibrosus of the intervertebral disc. In alternate embodiments, energy directed to nerves in the PLL may be from light or mechanical vibrations, or the nerves may be cooled. The electrodes may also be used diagnostically to correlate spontaneous nerve activity with spinal movement, fluctuations in autonomic tone and the patient'"'"'s experience of pain. The electrodes may also be used to generate diagnostic evoked potentials. The diagnostic data are used to devise parameters for the therapeutic nerve stimulation. Automatic analysis of the data may be incorporated into a closed-loop system that performs the nerve stimulation automatically.
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Citations
40 Claims
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1. A method of treating discogenic lumbar back pain in a patient comprising:
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positioning a plurality of electrodes within an anterior epidural space of the patient to a position adjacent to a posterior longitudinal ligament and/or a posterior annulus fibrosus; generating one or more electrical impulses with a pulse generator; and transmitting the electrical impulses through said electrodes to one or more nerves in said posterior longitudinal ligament and/or said posterior annulus fibrosus; wherein the electrical impulses are sufficient to cause one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus to inhibit an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus; and
wherein the electrical impulses at least partially relieve the pain without producing irreversible damage in any tissue of the patient. - View Dependent Claims (2, 3, 4)
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5. A method of treating discogenic lumbar back pain in a patient comprising:
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positioning a plurality of electrodes within an anterior epidural space of the patient to a position adjacent to a posterior longitudinal ligament and/or a posterior annulus fibrosus; generating one or more electrical impulses with a pulse generator; and transmitting the electrical impulses through said electrodes to one or more nerves in said posterior longitudinal ligament and/or said posterior annulus fibrosus; wherein the electrical impulses are sufficient to inhibit one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus from promoting an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus; and
wherein the electrical impulses at least partially relieve the pain without producing irreversible damage in any tissue of the patient. - View Dependent Claims (6, 7, 8)
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9. A device for treating discogenic lumbar back pain in a patient comprising:
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a plurality of electrodes that is coupled to an electrical pulse generator;
wherein the plurality of electrodes is configured to be positioned within an anterior epidural space of the patient at a position adjacent to a posterior longitudinal ligament and/or a posterior annulus fibrosus;
wherein the pulse generator is configured to transmit electrical impulses through said electrodes to at least partially relieve the pain without producing irreversible damage in any tissue of the patient; and
wherein the electrical impulses may be selected to have a Configuration A or an alternate Configuration B;wherein for the Configuration A the electrical impulses cause one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus to inhibit an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus; and wherein for the alternate Configuration B the electrical impulses inhibit one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus from promoting an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30)
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31. A method of treating discogenic lumbar back pain in a patient comprising:
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positioning a plurality of electrodes within an anterior epidural space of the patient to a position adjacent to a posterior longitudinal ligament and/or a posterior annulus fibrosus; measuring an activity of one or more nerves in said posterior longitudinal ligament and/or posterior annulus fibrosus with said electrodes;
generating energy impulses with a pulse generator; and
transmitting said energy impulses to within said posterior longitudinal ligament and/or posterior annulus fibrosus or to a vicinity of said posterior longitudinal ligament and/or posterior annulus fibrosus;
wherein said nerve activity measurement is used to devise said energy impulses; and
wherein the energy impulses are used to at least partially relieve the pain in the patient. - View Dependent Claims (32, 33, 34, 35, 36, 37, 38)
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39. A method for treating a patient having a spine comprising an epidural space and a posterior longitudinal ligament, wherein the patient has a diseased vertebral disc, wherein the method includes:
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implanting a neurostimulation lead within an anterior portion of the epidural space adjacent to the posterior longitudinal ligament, wherein the neurostimulation lead has a plurality of electrodes that are adjacent to the diseased vertebral disc, wherein the neurostimulation lead is a paddle lead and the plurality of electrodes are disposed on the same side of the paddle lead, wherein the paddle lead is implanted such that the electrodes face the posterior longitudinal ligament; and wherein said treating is performed by a person who may select among treatment neurostimulations comprising;
(1) direct inhibition of initiation and/or propagation of an action potential in one or more afferent nociceptor nerves;
(2) promotion of initiation and/or propagation of an action potential in one or more sympathetic nerves in said posterior longitudinal ligament, whereby initiation and/or propagation of an action potential in one or more afferent nociceptor nerves is caused to be secondarily inhibited; and
(3) inhibition of initiation and/or propagation of an action potential in one or more sympathetic nerves in said posterior longitudinal ligament, whereby said inhibited sympathetic nerve is hindered from secondarily promoting initiation and/or propagation of an action potential in one or more afferent nociceptive nerves.
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40. A method for treating a patient having a spine comprising an epidural space and a posterior longitudinal ligament, wherein the patient has a diseased vertebral disc, wherein the method includes:
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implanting a neurostimulation lead within an anterior portion of the epidural space adjacent to the posterior longitudinal ligament, wherein the neurostimulation lead has a plurality of electrodes that are adjacent to the diseased vertebral disc;
wherein the neurostimulation lead may be a percutaneous or paddle lead and the plurality of electrodes are disposed on the same side of the lead, wherein the lead is implanted such that the electrodes face the posterior longitudinal ligament;and wherein said treating is performed by a person who may select among treatment neurostimulations comprising;
direct inhibition of initiation and/or propagation of an action potential in one or more afferent nociceptor nerves, wherein said afferent nerves are caused to increase their mechanical force threshold above which said afferent nerves initiate and/or propagate an action potential.
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Specification