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US 2021/0267531 A1Published application
System and Methods for Performing Neurophysiologic Assessments During Spine Surgery
AssigneeNuVasive, Inc.
InventorsJames E. Gharib, Allen Farquhar, Doug Layman
Life of this patent
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Abstract
A system and methods for performing neurophysiologic assessments during surgery, such as assessing the health of the spinal cord via at least one of MEP and SSEP monitoring and assessing bone integrity, nerve proximity, neuromuscular pathway, and nerve pathology during spine surgery.
Claims20
A method comprising:
- causing transmission of a first set of electrical stimulation signals and a second set of electrical stimulation signals to the motor cortex of a patient via a stimulator, each of the first and second sets of electrical stimulation signals including stimulation signals having different electrical current amplitude;
- receiving evoked motor evoked potential response data relating to at least one motor evoked potential response evoked by the first and second sets of electrical stimulation signals;
- determining a first stimulation current amplitude for a first channel from the first set of electrical stimulation signals that evokes a motor evoked potential response greater than a threshold level;
- determining a second stimulation current amplitude for a second channel from the second set of electrical stimulation signals that evokes a motor evoked potential response greater than said threshold level wherein determining the second stimulation current amplitude is based at least in part on:
- the lowest stimulation signal amplitude of the first set of electrical stimulation signals that recruited on the second channel;
- and
- the highest stimulation signal amplitude of the first set of electrical stimulation signals that did not recruit on the second channel;
- and
- providing an assessment of a spinal cord health status based on at least one of (i) the first stimulation current amplitude and (ii) the second stimulation current amplitude.
6 more elements
A method comprising:
- transmitting a first set of electrical stimulation signals to the motor cortex of a patient;
- transmitting a second set of electrical stimulation signals to the motor cortex of the patient;
- transmitting a third set of electrical stimulation signals to one or more peripheral nerves of the patient;
- receiving data from a plurality of sensors configured to detect one or more responses to the first, second, and third sets of electrical stimulation signals;
- determining a first stimulation current amplitude from the first set of electrical stimulation signals that evokes a motor evoked potential response greater than a first threshold level;
- determining a lowest stimulation signal amplitude of the first set of stimulation signals that recruited;
- determining a highest stimulation signal amplitude of the first set of stimulation signals that did not recruit;
- determining a second stimulation current amplitude from the second set of electrical stimulation signals that evokes a neuromuscular response greater than a second threshold level, wherein determining the second lowest stimulation current amplitude is based at least in part on the lowest stimulation signal amplitude of the first set of stimulation signals that recruited and the highest signal amplitude of the first set of electrical stimulation signals that did not recruit;
- determining a third stimulation current amplitude from the third set of electrical stimulation signals delivered that evokes a neuromuscular response greater than a third threshold level;
- providing a spinal cord health status based on (i) the first stimulation current amplitude or (ii) the second lowest stimulation current amplitude;
- and
- providing an assessment of nerve direction, nerve pathology, r neuromuscular pathway integrity status based on the third stimulation current amplitude.
9 more elements
An apparatus comprising:
- a first sensor;
- a second sensor;
- a display;
- and
- a control unit configured to:
- cause a signal to transmit a first set of electrical stimulation signals and a second set of electrical stimulation signals to the motor cortex of a patient, each of said first and second sets of electrical stimulation signals including stimulation signals having different electrical current amplitude;
- receive evoked motor evoked potential response data evoked by the first and second sets of electrical stimulation signals;
- determine a first stimulation current amplitude for a first channel associated with the first sensor from the first set of electrical stimulation signals that evokes a motor evoked potential response greater than a threshold level;
- determine a lowest stimulation signal amplitude of the first set of stimulation signals that recruited on a second channel associated with the second sensor;
- determine a highest stimulation signal amplitude of the first set of stimulation signals that did not recruit on the second channel
- determine a second stimulation current amplitude for a second channel from the second set of electrical stimulation signals that evokes a motor evoked potential response greater than said threshold level wherein determining the second lowest stimulation current amplitude is based at least in part on the lowest stimulation signal amplitude of the first set of stimulation signals that recruited on the second channel and the highest stimulation signal amplitude of the first set of stimulation signals that did not recruit on the second channel;
- and
- provide at the display an onscreen assessment of a spinal cord health status based on (i) the determination of the first lowest stimulation current amplitude or (ii) the determination of the second lowest stimulation current amplitude.
10 more elements
Dependencies are inferred from the claim text.