System and methods for diagnosis and treatment of discogenic lower back pain
First Claim
1. A method of treating 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 one or more nerves in said posterior longitudinal ligament and/or said posterior annulus fibrosus;
wherein the electrical impulses are sufficient to cause one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus to inhibit an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus;
wherein the electrical impulses promote the release of one or more molecules of norepinephrine from the sympathetic nerves, thereby promoting a binding of the norepinephrine molecules to an alpha-2 adrenoreceptor in the nociceptive nerves, whereby the initiation and/or the transmission of the action potential in the nociceptive nerves is inhibited; and
wherein the electrical impulses at least partially relieve the pain without producing irreversible damage in any tissue of the patient.
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Abstract
Methods and devices to treat discogenic lumbar back pain are disclosed. Electrodes are implanted within the anterior epidural space of the patient. A pulse generator that is connected to the electrodes delivers electrical impulses to sympathetic nerves located within the posterior longitudinal ligament (PLL) of the lumbar spine and outer posterior annulus fibrosus of the intervertebral disc. In alternate embodiments, energy directed to nerves in the PLL may be from light or mechanical vibrations, or the nerves may be cooled. The electrodes may also be used diagnostically to correlate spontaneous nerve activity with spinal movement, fluctuations in autonomic tone and the patient'"'"'s experience of pain. The electrodes may also be used to generate diagnostic evoked potentials. The diagnostic data are used to devise parameters for the therapeutic nerve stimulation. Automatic analysis of the data may be incorporated into a closed-loop system that performs the nerve stimulation automatically.
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Citations
28 Claims
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1. A method of treating 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 one or more nerves in said posterior longitudinal ligament and/or said posterior annulus fibrosus;
wherein the electrical impulses are sufficient to cause one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus to inhibit an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus;
wherein the electrical impulses promote the release of one or more molecules of norepinephrine from the sympathetic nerves, thereby promoting a binding of the norepinephrine molecules to an alpha-2 adrenoreceptor in the nociceptive nerves, whereby the initiation and/or the transmission of the action potential in the nociceptive nerves is inhibited; and
wherein the electrical impulses at least partially relieve the pain without producing irreversible damage in any tissue of the patient. - View Dependent Claims (2, 3)
- 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;
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4. A method of treating 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 one or more nerves in said posterior longitudinal ligament and/or said posterior annulus fibrosus;
wherein the electrical impulses are sufficient to inhibit one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus from promoting an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus;
wherein the electrical impulses inhibit the release of one or more molecules of norepinephrine from the sympathetic nerves, thereby inhibiting a binding of the norepinephrine molecules to an alpha-1 adrenoreceptor in the nociceptive nerves, whereby the initiation and/or the transmission of the action potential in the nociceptive nerves is inhibited; and
wherein the electrical impulses at least partially relieve the pain without producing irreversible damage in any tissue of the patient. - View Dependent Claims (5, 6)
- 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;
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7. A device for treating discogenic lumbar back pain in a patient comprising:
- a plurality of electrodes that is coupled to an electrical pulse generator;
wherein the plurality of electrodes is 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 to at least partially relieve the pain without producing irreversible damage in any tissue of the patient; and
wherein the electrical impulses exhibit at least two alternate, selectable waveform configurations, comprising at least a Waveform Configuration A and an alternate Waveform Configuration B;
wherein when Waveform Configuration A is selected, the electrical impulses cause one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus to inhibit an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus;
wherein when Waveform Configuration A is selected, the electrical impulses promote the release of one or more molecules of norepinephrine from the sympathetic nerves, thereby promoting a binding of the norepinephrine molecules to an alpha-2 adrenoreceptor in the nociceptive nerves, whereby the initiation and/or the transmission of the action potential in the nociceptive nerves is inhibited; and
wherein when Waveform Configuration B is selected, the electrical impulses inhibit one or more sympathetic nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus from promoting an initiation and/or a transmission of an action potential in one or more nociceptive nerves in the posterior longitudinal ligament and/or in the posterior annulus fibrosus;
wherein when Waveform Configuration B is selected, the electrical impulses inhibit the release of one or more molecules of norepinephrine from the sympathetic nerves, thereby inhibiting a binding of the norepinephrine molecules to an alpha-1 adrenoreceptor in the nociceptive nerves, whereby the initiation and/or the transmission of the action potential in the nociceptive nerves is inhibited. - View Dependent Claims (8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28)
- a plurality of electrodes that is coupled to an electrical pulse generator;
Specification