Neural monitoring system

• US 8,882,679 B2
• Filed: 05/24/2013
• Issued: 11/11/2014
• Est. Priority Date: 10/18/2007
• Status: Active Grant

• Current Assignee: Innovative Surgical Solutions, LLC (Johnson & Johnson)
• Original Assignee: Innovative Surgical Solutions, LLC (Johnson & Johnson)
• Inventors: Bartol, Stephen, Wybo, Christopher
• Primary Examiner(s): Dougherty, Sean P
• Assistant Examiner(s): Stout, Michael C
• Application Number:
  US13/901,676
• Publication Number:
  US 20130253364A1
• Time in Patent Office: 536 Days
• Field of Search: 600/554, 600/559, 600/300
• US Class Current: 600/554
• CPC Class Codes: A61B 2505/05 Surgical care
• CPC Class Codes: A61B 2560/0276 Determining malfunction
• CPC Class Codes: A61B 2560/0412 Low-profile patch shaped housings
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/1104 induced by stimuli or drugs; A61B5/1102 takes precedence; investigating medicinal preparations G01N33/15
• CPC Class Codes: A61B 5/1106 to assess neuromuscular blockade, e.g. to estimate depth of anaesthesia
• 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 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/395 Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 5/4029 for evaluating the peripheral nervous systems A61B5/24 takes precedence
• CPC Class Codes: A61B 5/4519 Muscles A61B5/389, A61B5/224 take precedence
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 5/6828 Leg
• CPC Class Codes: A61B 5/6843 Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61B 5/7217 of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives

Abstract

A neural monitoring system for detecting an induced response of a muscle to a stimulus provided within an intracorporeal treatment area of a human subject includes a mechanical sensor configured to be placed in mechanical communication with the muscle and to generate a mechanomyography output signal corresponding to a sensed mechanical movement of the muscle, and a receiver in communication with the mechanical sensor. The receiver is configured to: receive the mechanomyography output signal from the mechanical sensor; compute a time derivative of the sensed muscle movement from the mechanomyography output signal; compare the computed time derivative to a threshold; and indicate that the sensed mechanical movement of the muscle was induced by the provided intracorporeal stimulus if the computed time derivative exceeds the threshold.

Claims

1. A neural monitoring system for detecting an induced response of a muscle to a stimulus provided within an intracorporeal treatment area of a human subject, the intracorporeal treatment area including a nerve that innervates the muscle, the neural monitoring system comprising:

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

a receiver in communication with the mechanical sensor and configured to;

receive the mechanomyography output signal from the mechanical sensor;

compute a time derivative of the sensed muscle movement from the mechanomyography output signal;

compare the computed time derivative to a first threshold; and

indicate that the sensed mechanical movement of the muscle was induced by the provided intracorporeal stimulus if the computed time derivative exceeds the first threshold.

2. The neural monitoring system of claim 1, further comprising a stimulator configured to extend within the intracorporeal treatment area and to provide the stimulus therein.

3. The neural monitoring system of claim 2, wherein the provided stimulus is an electrical stimulus.

4. The neural monitoring system of claim 3, wherein the receiver is further configured to:

receive an indication of a magnitude of the provided intracorporeal stimulus;

determine a magnitude of an acceleration of the muscle from the mechanomyography output signal; and

determine a proximity between the stimulator and the nerve from the magnitude of the provided intracorporeal stimulus and the magnitude of acceleration of the muscle.

5. The neural monitoring system of claim 4, wherein the receiver is further configured to:

compare the determined proximity to a second threshold; and

provide an alert if the determined proximity is less than the second threshold and the computed time derivative exceeds the first threshold.

6. The neural monitoring system of claim 2, wherein the stimulator is an invasive medical instrument.

7. The neural monitoring system of claim 6, wherein the invasive medical instrument includes a retractor.

8. The neural monitoring system of claim 1, further comprising an electrical sensor configured to be placed in electrical communication with the muscle and to generate an electromyography output signal corresponding to a sensed electrical potential of the muscle.

9. The neural monitoring system of claim 8, wherein the mechanical sensor and the electrical sensor are included in a single sensing device.

10. The neural monitoring system of claim 9, wherein the receiver is configured to determine if the sensing device is in physical contact with the human subject by monitoring the electromyography output signal for the presence of free-running electromyography activity.

11. The neural monitoring system of claim 10, wherein the receiver is further configured to provide an alert if the sensing device is not in physical contact with the human subject.

12. The neural monitoring system of claim 1, wherein the receiver is in wireless data communication with the mechanical sensor.

13. A method of detecting an induced response of a muscle to a stimulus provided within an intracorporeal treatment area of a human subject, the intracorporeal treatment area including a nerve that innervates the muscle, the method comprising:

receiving a mechanomyography output signal from a mechanical sensor in mechanical communication with the muscle, the mechanomyography output signal corresponding to a mechanical movement of the muscle sensed by the mechanical sensor;

computing a time derivative of the sensed muscle movement from the mechanomyography output signal;

comparing the computed time derivative to a first threshold; and

indicating that the sensed mechanical movement of the muscle was induced by the provided intracorporeal stimulus if the computed time derivative exceeds the first threshold.

14. The method of claim 13, further comprising providing the stimulus within the intracorporeal treatment area of the human subject using a stimulator configured to extend within the intracorporeal treatment area of the human subject.

15. The method of claim 14, wherein the stimulus is an electrical stimulus.

16. The method of claim 15, further comprising:

receiving an indication of a magnitude of the provided stimulus;

determining a magnitude of an acceleration of the muscle from the mechanomyography output signal;

determining a proximity between the stimulator and the nerve from the magnitude of the provided intracorporeal stimulus and the magnitude of acceleration of the muscle.

17. The method of claim 16, further comprising:

comparing the determined proximity to a second threshold; and

providing an alert if the determined proximity is less than the second threshold and the computed time derivative exceeds the first threshold.

18. The method of claim 16, further comprising:

comparing the determined proximity to a second threshold; and

injecting a local anesthetic within the treatment area if the determined proximity is less than the second threshold and the computed time derivative exceeds the first threshold.

19. A neural monitoring system for detecting an induced response of a muscle to a stimulus provided within an intracorporeal treatment area of a human subject, the intracorporeal treatment area including a nerve that innervates the muscle, the neural monitoring system comprising:

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

a receiver in communication with the mechanical sensor and configured to;

receive the mechanomyography output signal from the mechanical sensor;

determine a magnitude of acceleration of the muscle from the mechanomyography output signal;

determine a magnitude of the provided intracorporeal stimulus;

compute a time derivative of the sensed muscle movement from the mechanomyography output signal;

compare the computed time derivative to a first threshold;

determine a proximity between the stimulator and the nerve from the magnitude of the provided intracorporeal stimulus and the magnitude of acceleration of the muscle;

compare the determined proximity to a second threshold; and

provide an alert if the determined proximity is less than the second threshold and the computed time derivative exceeds the first threshold.

20. The neural monitoring system of claim 19, further comprising a stimulator configured to extend within the intracorporeal treatment area and to provide the stimulus therein.