System and methods for performing percutaneous pedicle integrity assessments

Patent metadata

Field	Value
Publication number	US-10470707-B2
Application number	US-42761209-A
Country	US
Kind code	B2
Filing date	Apr 21, 2009
Priority date	Oct 30, 2001
Publication date	Nov 12, 2019
Grant date	Nov 12, 2019

Abstract

The present invention involves systems and related methods for performing percutaneous pedicle integrity assessments involving the use of neurophysiology.

First claim

What is claimed is:

1. A system for performing percutaneous pedicle integrity during spine surgery, comprising:
a stimulation element comprising a tubular insulation member with a longitudinal lumen therethrough, which is configured for percutaneous introduction to a pedicle target site within a patient and a K-wire which is disposed through the lumen of the insulation member, and having a stimulation region at a distal end which extends from a distal end of the insulation member and which is configured for contacting at least one of a pilot hole formed in said pedicle and a screw implanted in said pedicle; and
a control unit in electrical communication with said stimulation element, said control unit configured for selectively applying a stimulation signal to said stimulation element, providing an assessment of whether nerves adjacent said pedicle target site innervate as a result of applying said stimulation signal to said element, and communicating the assessment to a user, wherein selectively applying the stimulation signal to said stimulation element comprises identifying a minimum stimulation current capable of evoking a predetermined peak-to-peak voltage associated with a neuromuscular response, wherein providing the assessment also includes determining a relationship between the identified minimum stimulation current and the predetermined peak-to-peak voltage associated with the neuromuscular response to indicate a pedicle integrity based on contact of the distal end of the K-wire at the at least one of a pilot hole formed in said pedicle and a screw implanted in said pedicle.

2. The system of claim 1 and further, wherein said insulation member includes an electrical coupling mechanism for establishing electrical contact between said stimulation source and said stimulation element.

3. The system of claim 2 and further, wherein said electrical coupling mechanism is a clip that attaches directly to an uninsulated portion near a proximal end of said K-wire.

4. The system of claim 1 and further, wherein said control unit comprises an EMG monitoring system for assessing whether nerves adjacent said pedicle target site innervate as a result of applying said stimulation signal to said stimulation element.

5. The system of claim 4 and further, wherein said EMG monitoring system displays at least one of alpha-numeric and graphical information to a user regarding whether nerves adjacent said pedicle target site innervate as a result of applying said stimulation signal to said stimulation element.

6. A system for performing percutaneous pedicle integrity assessments during spine surgery, comprising:
a stimulation element comprising a tubular insulation member with a longitudinal lumen therethrough, positionable within a patient and configured for percutaneous introduction to and contact with one of a fully inserted pedicle screw and an interior of a pedicle screw pilot hole in said patient, said lumen dimensioned to receive and pass through a pedicle preparation tool having an uninsulated stimulation region at a distal end; and
a control unit in electrical communication with said stimulation region, said control unit configured for selectively applying a stimulation signal to said stimulation region, providing an assessment of whether nerves adjacent said pedicle target site innervate as a result of applying said stimulation signal to said stimulation region, and communicating said assessment to a user, wherein selectively applying the stimulation signal to said stimulation element comprises identifying a minimum stimulation current capable of evoking a predetermined peak-to-peak voltage associated with a neuromuscular response, wherein providing the assessment also includes determining a relationship between the identified minimum stimulation current and the predetermined peak-to-peak voltage associated with the neuromuscular response to indicate a pedicle integrity based on contact of the distal end of the stimulation element at the at least one of a pilot hole formed in said pedicle and a screw implanted in said pedicle.

7. The system of claim 6 and further, wherein said pedicle preparation tool is a tap.

8. The system of claim 6 and further, wherein said insulation member is a universal insulating unit.

9. The system of claim 6 and further, wherein said insulation member includes an electrical coupling mechanism for establishing electrical contact between said stimulation source and said stimulation element.

10. The system of claim 9 and further, wherein said electrical coupling mechanism is a clip that attaches directly to an uninsulated portion near a proximal end of said pedicle preparation tool.

11. The system of claim 6 and further, wherein said control unit comprises an EMG monitoring system for assessing whether nerves adjacent said pedicle target site innervate as a result of applying said stimulation signal to said preparation tool.

12. The system of claim 11 and further, wherein said EMG monitoring system displays at least one of alpha-numeric and graphical information to a user regarding whether nerves adjacent said pedicle target site innervate as a result of applying said stimulation signal to said stimulation region.

Assignees

• Miles Patrick
• Martinelli Scot
• Finley Eric
• Elbanna Jamil
• Gharib James
• Farquhar Allen
• Kaula Norbert
• Blewett Jeffrey
• Medeiros Goretti
• Nuvasive Inc

Inventors

• Miles Patrick
• Martinelli Scot
• Finley Eric
• Elbanna Jamil
• Gharib James
• Farquhar Allen
• Kaula Norbert
• Blewett Jeffrey

Classifications

• A61B5/1104

  induced by stimuli or drugs (A61B5/1102 takes precedence) · CPC title

• A61B5/1106

  to assess neuromuscular blockade, e.g. to estimate depth of anaesthesia · CPC title

• A61B5/4893 Primary

  Nerves · CPC title

• A61B17/1757

  for the spine · CPC title

• A61B17/1671

  for the spine · CPC title