System and methods for determining nerve proximity, direction and pathology during surgery
First Claim
1. A nerve monitoring system comprising a control unit having a display and a plurality of leg muscle sensor electrodes in communication with the control unit, the nerve monitoring system being configured to (a) deliver a plurality of electrical stimulation signals so that when a surgical access instrument adapted to transmit electrical signals received from the nerve monitoring system through a stimulation electrode on the surgical access instrument is connected to the nerve monitoring system and positioned along a selected path within tissue of a patient that contains one or more motor nerves, the plurality of electrical stimulation signals are delivered to the patient tissue, (b) in response to delivery of each one of the plurality of electrical stimulation signals, receive a plurality of voltage response values detected by the plurality of leg muscle sensors coupled to different leg muscles, (c) determine the amplitude value of an unknown stimulation threshold required to evoke a threshold response from any of the leg muscles, d) enter a monitoring mode in response to determining the value of the unknown stimulation threshold, and e) as the surgical access instrument is advanced along the selected path toward a targeted intervertebral disc detect whether stimulation thresholds are changing by incrementing or decrementing the amplitude of the simulation signal delivered.
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Accused Products
Abstract
The present invention involves systems and methods for determining nerve proximity, nerve direction, and pathology relative to a surgical instrument based on an identified relationship between neuromuscular responses and the stimulation signal that caused the neuromuscular responses.
557 Citations
18 Claims
- 1. A nerve monitoring system comprising a control unit having a display and a plurality of leg muscle sensor electrodes in communication with the control unit, the nerve monitoring system being configured to (a) deliver a plurality of electrical stimulation signals so that when a surgical access instrument adapted to transmit electrical signals received from the nerve monitoring system through a stimulation electrode on the surgical access instrument is connected to the nerve monitoring system and positioned along a selected path within tissue of a patient that contains one or more motor nerves, the plurality of electrical stimulation signals are delivered to the patient tissue, (b) in response to delivery of each one of the plurality of electrical stimulation signals, receive a plurality of voltage response values detected by the plurality of leg muscle sensors coupled to different leg muscles, (c) determine the amplitude value of an unknown stimulation threshold required to evoke a threshold response from any of the leg muscles, d) enter a monitoring mode in response to determining the value of the unknown stimulation threshold, and e) as the surgical access instrument is advanced along the selected path toward a targeted intervertebral disc detect whether stimulation thresholds are changing by incrementing or decrementing the amplitude of the simulation signal delivered.
Specification