Neurophysiologic monitoring

• US 9,392,953 B1
• Filed: 09/19/2011
• Issued: 07/19/2016
• Est. Priority Date: 09/17/2010
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Gharib, James
• Primary Examiner(s): DOUGHERTY, SEAN PATRICK
• Application Number:
  US13/236,600
• Time in Patent Office: 1,765 Days
• Field of Search: 600/554, 600/546, 607/48
• US Class Current: 1/1
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2505/05 Surgical care
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/407 Evaluating the spinal cord A61B5/4896 takes precedence
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61N 1/00 Electrotherapy; Circuits therefor A61N2/00 takes precedence; irradiation apparatus A61N5/00
• CPC Class Codes: A61N 1/36017 with leads or electrodes penetrating the skin

Abstract

The present invention relates generally to a system and methods used for neurophysiologic monitoring, and more particularly to an algorithm capable of discerning between background activity (non-physiologic and physiologic) and evoked neurophysiologic activity.

Claims

1. A system for detecting and monitoring nerves during surgery, comprising:

at least one electrode configured to detect activity from a muscle innervated by a nerve;

a surgical accessory configured to transmit stimulation signals; and

a control unit communicatively linked to said at least one EMG electrode and said accessory, the control unit being configured to perform free-run EMG monitoring by monitoring muscle activity detected by the at least one electrode, the control unit also being configured to perform stimulated EMG monitoring by directing delivery of stimulation signals from the surgical accessory, receiving neuromuscular response data from the at least one electrode, and determining a relationship between the stimulation signal and associated neuromuscular response activity,

wherein the control unit further includes a selectable sensitivity setting for which a voltage sensitivity setting is selected, the selected sensitivity setting representing a minimum amplitude detected by the electrode recognized by the control unit as an event, and wherein the control unit applies a pre-determined differential sensitivity setting that differs from the selected sensitivity setting to activity associated with free-run EMG monitoring and activity associated with stimulated EMG monitoring.

2. The system of claim 1, wherein said neuromuscular responses comprise responses from at least one of static pedicle screw testing, dynamic pedicle screw testing, nerve proximity detection, nerve pathway assessments, manual motor evoked potentials, and automatic motor evoked potentials.

3. The system of claim 1, wherein said selectable sensitivity setting input is selectable through user intervention.

4. The system of claim 3, wherein said selectable sensitivity setting input is selectable based on at least one of background noise and background neurophysiologic activity.

5. The system of claim 1, wherein said sensitivity setting differential is achieved using a fixed increase differential.

6. The system of claim 1, wherein said differential sensitivity setting is achieved using percent increase differential.

7. The system of claim 1, wherein said sensitivity setting differential is achieved using a fixed offset differential.

8. The system of claim 1, wherein said sensitivity setting differential is achieved using a percent offset differential.