NEURAL LOCATING SYSTEM

• US 20150088029A1
• Filed: 09/20/2013
• Published: 03/26/2015
• Est. Priority Date: 09/20/2013
• Status: Active Grant

• Current Assignee: Innovative Surgical Solutions, LLC (Johnson & Johnson)
• Original Assignee: Innovative Surgical Solutions, LLC (Johnson & Johnson)
• Inventors: Wybo, Christopher
• Granted Patent: US 9,622,684 B2
• Time in Patent Office: Days
• US Class Current: 600/554
• CPC Class Codes: A61B 2505/05 Surgical care
• CPC Class Codes: A61B 5/0093 Detecting, measuring or recording by applying one single type of energy and measuring its conversion into another type of energy
• CPC Class Codes: A61B 5/1104 induced by stimuli or drugs; A61B5/1102 takes precedence; investigating medicinal preparations G01N33/15
• CPC Class Codes: A61B 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• CPC Class Codes: A61B 5/4029 for evaluating the peripheral nervous systems A61B5/24 takes precedence
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 5/6844 Monitoring or controlling distance between sensor and tissue
• CPC Class Codes: A61B 5/746 Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B

Abstract

A neural monitoring system includes an elongate medical instrument, a non-invasive mechanical sensor, and a processor. The elongate medical instrument has a distal end portion configured to extend within an intracorporeal treatment area of a subject, and a plurality of electrodes disposed on the distal end portion. Each electrode is respectively configured to provide an electrical stimulus.

The non-invasive mechanical sensor is configured to be placed in mechanical communication with a muscle of the subject and to generate a mechanomyography output signal corresponding to a sensed mechanical movement of the muscle.

The processor is provided in communication with the elongate medical instrument and the mechanical sensor, and is configured to receive the mechanomyography output signal, and determine a relative direction between a nerve and the distal end portion of the elongate medical instrument using the received mechanomyography output signal.

Claims

1. A neural monitoring system comprising:

an elongate medical instrument having a distal end portion configured to extend within an intracorporeal treatment area of a subject, the elongate medical instrument including a plurality of electrodes disposed on the distal end portion, each electrode respectively being configured to provide an electrical stimulus;

a non-invasive mechanical sensor configured to be placed in mechanical communication with a muscle of the subject and to generate a mechanomyography output signal corresponding to a sensed mechanical movement of the muscle; and

a processor in communication with the elongate medical instrument and the mechanical sensor, and configured to;

receive the mechanomyography output signal; and

determine a relative direction between a nerve and the distal end portion of the elongate medical instrument via the received mechanomyography output signal, wherein the nerve innervates the muscle.

2. The system of claim 1, wherein the processor is further configured to:

provide a respective electrical stimulus to each of the plurality of electrodes, the electrical stimulus having a predetermined current magnitude;

monitor an amplitude of the received mechanomyography signal;

determine a respective distance between each of the plurality of electrodes and the nerve using the current magnitude of the electrical stimulus and the amplitude of the received mechanomyography signal; and

triangulate the respective distances to determine the relative direction.

3. The system of claim 2, wherein the processor is configured to provide the respective electrical stimulus to each of the plurality of electrodes in a sequential manner.

4. The system of claim 2, wherein the processor is configured to provide the respective electrical stimulus to each of the plurality of electrodes in a concurrent manner;

wherein each respective electrical stimulus includes a plurality of current pulses provided at a stimulation frequency; and

wherein the stimulation frequency for each respective electrical stimulus is unique.

5. The system of claim 1, wherein the non-invasive mechanical sensor includes an accelerometer, a microphone, a strain gauge, or a piezoelectric device.

6. A neural monitoring system comprising:

an elongate medical instrument having a distal end portion configured to extend within an intracorporeal treatment area of a subject, the elongate medical instrument including at least four electrodes disposed on the distal end portion, each electrode respectively being configured to provide an electrical stimulus;

a non-invasive mechanical sensor configured to be placed in mechanical communication with a muscle of the subject and to generate a mechanomyography output signal corresponding to a sensed mechanical movement of the muscle; and

a processor in communication with the elongate medical instrument and the mechanical sensor, and configured to;

receive the mechanomyography output signal; and

determine a relative direction between a nerve and the distal end portion of the elongate medical instrument via the received mechanomyography output signal, wherein the nerve innervates the muscle.

7. The system of claim 6, wherein the elongate medical instrument has a longitudinal axis extending between a proximal end portion and the distal end portion of the instrument;

and

wherein three of the at least four electrodes define a plane that is transverse to the longitudinal axis.

8. The system of claim 7, wherein one of the at least four electrodes is disposed on a distal side of the plane and is separated from the plane by a distance.

9. The system of claim 6, wherein the processor is further configured to:

provide a respective electrical stimulus to each of the at least four electrodes, the electrical stimulus having a predetermined current magnitude;

monitor an amplitude of the received mechanomyography signal;

determine a respective distance between each of the at least four electrodes and the nerve using the current magnitude of the electrical stimulus and the amplitude of the received mechanomyography signal; and

triangulate the respective distances to determine the relative direction of the nerve from the distal end portion of the elongate medical instrument.

10. The system of claim 9, wherein the processor is configured to provide the respective electrical stimulus to each of the at least four electrodes in a sequential manner.

11. The system of claim 9, wherein the processor is configured to provide the respective electrical stimulus to each of the at least four electrodes in a concurrent manner;

wherein each respective electrical stimulus includes a plurality of current pulses provided at a stimulation frequency; and

wherein the stimulation frequency for each respective electrical stimulus is unique.

12. The system of claim 6, wherein the non-invasive mechanical sensor includes an accelerometer, a microphone, a strain gauge, or a piezoelectric device.

13. A neural monitoring system comprising:

an elongate medical instrument having a distal end portion configured to extend within an intracorporeal treatment area of a subject, the elongate medical instrument including a plurality of electrodes disposed on the distal end portion, each electrode configured to selectively provide a respective electrical stimulus within the intracorporeal treatment area;

a non-invasive mechanical sensor configured to be placed in mechanical communication with a muscle of the subject and to generate a mechanomyography output signal corresponding to a sensed mechanical movement of the muscle; and

a processor in communication with the elongate medical instrument and the mechanical sensor, the processor configured to;

receive the mechanomyography output signal;

identify, via the mechanomyography output signal, a mechanical movement of the muscle that is attributable to each of the plurality of respective electrical stimuli;

determine a distance between each respective electrode and a nerve; and

determine a relative direction between the nerve and the distal end portion of the elongate medical instrument using the determined distances.

14. The system of claim 13, wherein the plurality of electrodes includes at least four electrodes.

15. The system of claim 14, wherein the elongate medical instrument has a longitudinal axis extending between a proximal end portion and the distal end portion of the instrument;

and

wherein three of the at least four electrodes define a plane that is transverse to the longitudinal axis.

16. The system of claim 15, wherein one of the at least four electrodes is disposed on a distal side of the plane and is separated from the plane by a distance.

17. The system of claim 13, wherein the processor is further configured to provide a respective electrical stimulus to each of the at least four electrodes in a sequential manner.

18. The system of claim 13, wherein the processor is further configured to provide a respective electrical stimulus to each of the at least four electrodes in a concurrent manner;

wherein each respective electrical stimulus includes a plurality of current pulses provided at a stimulation frequency; and

wherein the stimulation frequency for each respective electrical stimulus is unique.

19. The system of claim 13, wherein the non-invasive mechanical sensor includes an accelerometer, a microphone, a strain gauge, or a piezoelectric device.