System and method for electrical stimulation of the lumbar vertebral column
First Claim
1. A method for relieving a 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 a vicinity of one or more nerves in said posterior longitudinal ligament and/or posterior annulus fibrosus;
wherein the electrical impulses are configured to relieve the pain in the patient in a Step A followed by a Step B, wherein;
Step A comprises electrical stimulation of the one or more nerves, wherein no significant heat damage is generated in any tissue of the patient;
wherein some of the one or more nerves are stimulated reversibly and/or are subjected to non-thermal irreversible electroporation; and
wherein a determination is made that the patient finds that said stimulation without significant heat damage does not substantially relieve said pain;
and Step B comprises irreversible electrical stimulation of the one or more nerves that generates significant joule heating and/or dielectric heating of proteins;
wherein all nerves within a thecal sac neighboring the anterior epidural space are substantially shielded thermally from said joule heating and/or dielectric heating; and
wherein the position of the plurality of electrodes is substantially the same during Step B as the position of the plurality of electrodes during Step A.
0 Assignments
0 Petitions
Accused Products
Abstract
Disclosed methods and devices treat lower back pain from degenerated or injured intervertebral discs. Electrodes connected to a pulse generator deliver electrical impulses to nerves located within the posterior longitudinal ligament and posterior annulus fibrosus of lumbar intervertebral discs. Percutaneous and paddle leads containing the electrodes are disclosed. The percutaneous lead, designed to prevent inappropriate stimulation of the thecal sac, is inserted in the anterior epidural space using a special cannula and lead blank. Paddle leads are configured individually for implantation in each patient. The electrical stimulation may reduce back pain reversibly, with or without the simultaneous use of non-thermal irreversible electroporation. If such stimulation is unsuccessful, nerves in the ligament or annulus fibrosus may then be injured therapeutically without repositioning the lead, using impulses that result in heating, wherein a thermal insulator covers the thecal sac, thereby shielding nerves within the thecal sac from potential heat damage.
48 Citations
43 Claims
-
1. A method for relieving a 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 a vicinity of one or more nerves in said posterior longitudinal ligament and/or posterior annulus fibrosus; wherein the electrical impulses are configured to relieve the pain in the patient in a Step A followed by a Step B, wherein; Step A comprises electrical stimulation of the one or more nerves, wherein no significant heat damage is generated in any tissue of the patient;
wherein some of the one or more nerves are stimulated reversibly and/or are subjected to non-thermal irreversible electroporation; and
wherein a determination is made that the patient finds that said stimulation without significant heat damage does not substantially relieve said pain;and Step B comprises irreversible electrical stimulation of the one or more nerves that generates significant joule heating and/or dielectric heating of proteins;
wherein all nerves within a thecal sac neighboring the anterior epidural space are substantially shielded thermally from said joule heating and/or dielectric heating; and
wherein the position of the plurality of electrodes is substantially the same during Step B as the position of the plurality of electrodes during Step A. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24)
-
-
25. A device for relieving a discogenic lumbar back pain in a patient comprising:
a plurality of electrodes that is coupled to an electrical pulse generator; and
a thermal insulator;
wherein the plurality of electrodes and the thermal insulator are 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;
wherein the electrical impulses may be configured to relieve the pain in the patient through;
(A) electrical stimulation of one or more nerves within the posterior longitudinal ligament and/or the posterior annulus fibrosus, wherein some of the one or more nerves are stimulated reversibly and/or are subjected to non-thermal irreversible electroporation; and
wherein no significant heat damage is generated in any tissue of the patient; and
in an alternate selectable configuration of the electrical impulses, through;
(B) irreversible electrical stimulation of the one or more nerves that generates significant joule heating and/or dielectric heating of proteins;
wherein the thermal insulator is configured to cover a thecal sac such that all nerves within said thecal sac are substantially shielded from said joule and/or dielectric heating; and
wherein electrical impulse configurations (A) and (B) are configured for use when the plurality of electrodes resides in a stationary position within the anterior epidural space of the patient.- View Dependent Claims (26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42)
-
43. A device for relieving a discogenic lumbar back pain in a patient comprising:
a plurality of electrodes that is coupled to an electrical pulse generator; and
a thermal insulator;
wherein the plurality of electrodes and the thermal insulator are configured to be implanted within an anterior epidural space of the patient at a fixed 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;
wherein said electrical impulses are configured to relieve the pain in the patient through electrical stimulation in the vicinity of one or more nerves in said posterior longitudinal ligament and/or said posterior annulus fibrosus;
wherein said electrical impulses generate therapeutically significant joule heating and/or dielectric heating of proteins;
wherein a selectable electrode among the plurality of electrodes may be configured to be an active electrode, and wherein a return or dispersive electrode may be configured to comprise one or more electrodes selected from among the plurality of electrodes excluding the active electrode; and
wherein the thermal insulator is configured to cover a thecal sac such that all nerves within said thecal sac are shielded to prevent an iatrogenesis that would arise from heating of said thecal sac.
Specification