Systems and methods for performing neurophysiologic monitoring during spine surgery
First Claim
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1. A method for determining at least one of the depth, proximity, health, and status of the femoral nerve during lateral lumbar spine surgery, comprising:
- establishing a lateral, trans-psoas operative corridor to a surgical target site in the lumbar spine using a retractor assembly including a retractor body and a plurality of retractor blades extending generally perpendicularly to the retractor body, the retractor body being operable to separate the plurality of retractor blades relative to each to retract tissue away from the interior of the retractor blades when the tissue retractor is advanced to the surgical target site and the retractor blades are separated to thereby form an operative corridor to the surgical target site, wherein at least one of the plurality of retractor blades includes at least two electrode members associated with the at least one retractor blade, the at least two electrode contacts configured to at least one of transmit an electrical stimulation signal to tissue adjacent the distal portion of the at least one retractor blade and record an evoked neurophysiologic response received by the at least one retractor blade;
placing at least one stimulation electrode in position to stimulate the inguinal ligament ipsilateral to the operative corridor;
providing a stimulation current to the stimulation electrode;
calculating a first IThresh value at a first recording electrode positioned within the operative corridor adjacent to an inferior aspect of the at least one retractor blade;
calculating a second IThresh value at a second recording electrode positioned within the operative corridor adjacent to a superior aspect of the at least one retractor blade; and
comparing the first and second IThresh values to determine at least one of the depth, proximity, health, and status of the femoral nerve.
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Abstract
A surgical access system comprising a tissue retraction assembly equipped with two or more electrodes for use in monitoring the status of nearby neural structures, including the localized depth of neural structures relative to one or more components of the tissue retraction assembly. Additional neurological testing may be performed to monitor the health and status of the neural structures during the portions of the surgical procedure in which the tissue retraction assembly is used to maintain the operative corridor.
258 Citations
9 Claims
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1. A method for determining at least one of the depth, proximity, health, and status of the femoral nerve during lateral lumbar spine surgery, comprising:
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establishing a lateral, trans-psoas operative corridor to a surgical target site in the lumbar spine using a retractor assembly including a retractor body and a plurality of retractor blades extending generally perpendicularly to the retractor body, the retractor body being operable to separate the plurality of retractor blades relative to each to retract tissue away from the interior of the retractor blades when the tissue retractor is advanced to the surgical target site and the retractor blades are separated to thereby form an operative corridor to the surgical target site, wherein at least one of the plurality of retractor blades includes at least two electrode members associated with the at least one retractor blade, the at least two electrode contacts configured to at least one of transmit an electrical stimulation signal to tissue adjacent the distal portion of the at least one retractor blade and record an evoked neurophysiologic response received by the at least one retractor blade; placing at least one stimulation electrode in position to stimulate the inguinal ligament ipsilateral to the operative corridor; providing a stimulation current to the stimulation electrode; calculating a first IThresh value at a first recording electrode positioned within the operative corridor adjacent to an inferior aspect of the at least one retractor blade; calculating a second IThresh value at a second recording electrode positioned within the operative corridor adjacent to a superior aspect of the at least one retractor blade; and comparing the first and second IThresh values to determine at least one of the depth, proximity, health, and status of the femoral nerve. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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Specification