Neurophysiology monitoring system configured for rapid stimulation threshold acquisition

• US 8,500,653 B2
• Filed: 06/26/2012
• Issued: 08/06/2013
• Est. Priority Date: 09/22/2005
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Farquhar, Allen
• Primary Examiner(s): Hindenburg, Max
• Assistant Examiner(s): Pani, John
• Application Number:
  US13/533,919
• Publication Number:
  US 20120271191A1
• Time in Patent Office: 406 Days
• Field of Search: 600/554, 600546-548, 607/39, 607/40, 607/48, 607/61, 607/66, 607 68- 76, 607115-118, 607/148
• US Class Current: 600/554
• CPC Class Codes: A61B 5/388 Nerve conduction study, e.g. detecting action potential of peripheral nerves
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/395 Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 5/4041 Evaluating nerves condition
• CPC Class Codes: A61B 5/407 Evaluating the spinal cord A61B5/4896 takes precedence

Abstract

The present invention relates generally to systems and algorithms aimed at neurophysiology monitoring, and more particularly to a system capable of quickly finding stimulation thresholds over multiple channels of a neurophysiology monitoring system. For example, the neurophysiology monitoring system may be configured to omit stimulation pulses when the neuromuscular response is predictable.

Claims

1. A neuromonitoring system for performing multi-channel neurophysiologic assessments, comprising:

a stimulator configured to deliver at least one electrical stimulation signal to a patient;

at least one sensor adapted to be coupled to a myotome, said sensor configured to detect a neuromuscular response evoked by said electrical stimulation signal;

a control unit in communication with said stimulator and said at least one sensor, said control unit being configured to;

(a) direct transmission of the at least one electrical stimulation signal from said stimulator,

(b) receive evoked neuromuscular response data from the sensor,

(c) determine a threshold current level on a first channel of said neuromonitoring system, said first channel associated with a first myotome, wherein determining the threshold current level on the first channel includes;

delivering stimulation signals within tissue and monitoring neuromuscular responses on said first channel to determine when said stimulation signals evoke a significant neuromuscular response, wherein said stimulation signals are delivered as a sequence of pulses and wherein a current level of each pulse is adjusted from an immediately preceding pulse until a current level required to evoke a significant neuromuscular response is determined,

(d) determine a threshold current level on a second channel of the neuromonitoring device, said second channel associated with a second myotome, wherein determining the threshold current level on the second channel includes;

delivering stimulation signals within tissue and monitoring neuromuscular responses on said second channel to determine when said stimulation signals evoke a significant neuromuscular response wherein said stimulation signals are delivered as a sequence of pulses and wherein a current level of each pulse is adjusted from an immediately preceding pulse until a current level required to evoke said significant neuromuscular response is determined and omitting one or more pulses from the sequence of pulses when a neuromuscular response to the omitted pulse is predictable based upon data obtained while determining the threshold current level of the first channel; and

(e) communicate the threshold current levels to a user.

2. The neuromonitoring system of claim 1, wherein said significant neuromuscular response is the threshold current level required to evoke a significant neuromuscular response of a predetermined magnitude measured as a peak-to-peak voltage.

3. The neuromonitoring system of claim 2, wherein said predetermined magnitude is a peak-to-peak voltage from within the range of 20 uV to 100 uV.

4. The neuromonitoring system of claim 1, wherein the control unit is further configured to determine a threshold current level on at least one additional channel of the neuromonitoring system, each additional channel associated with a myotome, wherein determining the threshold current level on each additional channel includes:

delivering stimulation signals within tissue and monitoring neuromuscular responses on said additional channel to determine when said stimulation signals evoke a significant neuromuscular response wherein said stimulation signals are delivered as a sequence of pulses and wherein a current level of each pulse is adjusted from an immediately preceding pulse until a current level required to evoke said significant neuromuscular response is determined, and omitting one or more pulses from the sequence of pulses when a neuromuscular response to the omitted pulse is predictable based upon data obtained while determining the threshold current level of another channel.

5. The neuromonitoring system of claim 1, wherein the control unit executes an algorithm to determine a threshold current level for each channel.

6. The neuromonitoring system of claim 5, wherein said algorithm is biased to find one of a threshold current level on a channel with a lowest threshold and a threshold current level on a channel with a highest threshold prior to finding threshold current levels on any remaining channels.

7. The neuromonitoring system of claim 6, wherein said algorithm operates by assigning a channel specific status to each pulse comprising a current level, said status being one of a first status and a second status, said first status applying to a current level which evoked a neuromuscular response one of equal to and greater than said significant neuromuscular response, said second status applied to a current that evokes a response less than said significant neuromuscular response.

8. The neuromonitoring system of claim 7, wherein said algorithm determines said status of a pulse by at least one of stimulating at a current level and measuring the magnitude of the neuromuscular response, and inferring the status based on previously obtained data, said previously obtained data including a neuromuscular response measured on one channel in relation to a pulse delivered to a threshold current level on another channel.

9. The neuromonitoring system of claim 7, wherein said first status is assigned without directing a pulse at a current level if said current level is one of equal to and greater than a current level previously assigned said first status on an applicable channel.

10. The neuromonitoring system of claim 7, wherein said second status is assigned without directing a pulse at a current level if said current level is less than a current level previously assigned said second status on an applicable channel.

11. The neuromonitoring system of claim 7, wherein said algorithm is based on successive approximation.

12. The neuromonitoring system of claim 7, wherein said algorithm comprises a first step of establishing a bracket within which a threshold current level must lie and a second step of bisecting the bracket to a predetermined width.

13. The neuromonitoring system of claim 12, wherein said bracketing step is carried out for each channel before the algorithm transitions to said bisection step.

14. The neuromonitoring system of claim 12, wherein said first step of establishing a bracket and said second step of bisecting the bracket are completed on one channel before beginning the steps again on another channel.

15. The neuromonitoring system of claim 14, wherein said first bracket is determined by assigning on each channel one of said first status and said second status to a series of pulses of successively doubling stimulation current levels, wherein an upper boundary of said first bracket comprises a first stimulation current level assigned said first status and a lower boundary of said first bracket comprises a last stimulation current level assigned said second status.

16. The neuromonitoring system of claim 15, wherein said first bracket is bisected on each channel by assigning one of said first status and said second status to a stimulation current level at the midpoint of said first bracket, said midpoint forming a second bracket with one of said upper boundary and said lower boundary of said first bracket, said midpoint forming a lower boundary of said second bracket when said midpoint is assigned said second status and said midpoint forming an upper boundary of said second bracket when said midpoint is assigned said first status.

17. The neuromonitoring system of claim 1, wherein the control unit directs automatic adjustment of the current levels of said stimulation signals in a first sequence to establish a bracket which contains the threshold current level on the first channel.

18. The neuromonitoring system of claim 17, wherein the current levels of said stimulation signals are automatically adjusted in a second sequence to establish a bracket which contains the threshold current level on the second channel, wherein at least one of said stimulation current levels in said second sequence equals one of said pulses comprising a stimulation current level in said first sequence, and said pulse is omitted from said second sequence.

19. The neuromonitoring system of claim 1, wherein said communication is accomplished by a display linked to said control unit, said display configured to display at least one of alpha-numeric, graphic, and color based indicia to communicate the threshold current level results.

20. The neuromonitoring system of claim 1, wherein the control unit determines a threshold current level for each of between two and eight channels.

21. The neuromonitoring system of claim 1, wherein said neuromuscular responses are EMG responses.