System and methods for nerve monitoring

Patent metadata

Field	Value
Publication number	US-11617562-B2
Application number	US-202016875018-A
Country	US
Kind code	B2
Filing date	May 15, 2020
Priority date	Sep 27, 2005
Publication date	Apr 4, 2023
Grant date	Apr 4, 2023

Abstract

A system and related methods for performing nerve detection during surgical access using ultrasound testing during surgery.

First claim

What is claimed is:

1. A system for identifying an anatomical structure proximate a surgical target site, the system comprising:
a medical accessory having a distal end;
a stimulation device operatively coupled to the medical accessory for providing stimulation signals proximate the surgical target site via the medical accessory, wherein the stimulation device includes:
a stimulation handpiece having at least one stimulation button thereon; and
a coupling member for operatively coupling the stimulation handpiece to the medical accessory,
wherein the coupling member includes a stimulation clip having an endplate and a plunger, the plunger for engaging a portion of the medical accessory and maintaining the portion of the medical accessory between the plunger and the endplate;

an ultrasound transducer proximate the distal end of the medical accessory and configured to emit ultrasound signals;
a control unit in communication with the ultrasound transducer, the control unit directing signals to the ultrasound transducer; and
a processor configured to process ultrasound signal data generated from the ultrasound transducer into viewable images for viewing on a display, wherein the anatomical structure identified includes nerve tissue, and
wherein the processor is configured to identify the nerve tissue by analyzing the ultrasound signal data and distinguish the nerve tissue identified from other structure in the viewable images.

2. The system of claim 1 , wherein the ultrasound transducer includes an array of transducer elements disposed at a distal end of the medical accessory.

3. The system of claim 2 , wherein the ultrasound transducer is configured to emit sound waves in a circumferential direction about the distal end of the medical accessory as the medical accessory is advanced to the surgical target site.

4. The system of claim 1 , wherein the ultrasound transducer is located on a portion of the distal end of the medical accessory and the medical accessory is configured to rotate about a longitudinal axis of the medical accessory to perform an ultrasound scan.

5. The system of claim 1 , wherein the ultrasound transducer is disposed within the medical accessory at the distal end.

6. The system of claim 1 , wherein the anatomical structure comprises vasculature and the nerve tissue.

7. The system of claim 1 , wherein the medical accessory includes a surgical access instrument configured to create an access corridor to the surgical target site from an incision on a patient.

8. The system of claim 7 , wherein the access corridor to the surgical target site from the incision is through a lateral, trans-psoas path.

9. The system of claim 7 , wherein the medical accessory is at least one of a screw test probe, a tap member, a bone awl, a dilating cannula, and a retractor assembly.

10. The system of claim 1 , wherein the display is configured to display a location of the medical accessory relative to the anatomical structure.

11. The system of claim 1 , wherein to distinguish the nerve tissue from the other structure in the viewable image, the display is configured to display the nerve tissue in a first color or first shade of color distinct from a second color or second shade of color used to designate surrounding tissue.

12. The system of claim 1 , wherein the ultrasound transducer is configured to emit ultrasound signals having a frequency in a range of 2 MHz to 16 MHz.

13. The of claim 1 , wherein the ultrasound transducer is configured to emit ultrasound signals in a range of 2 MHz to 16 MHz and the processor is configured to identify nerve tissue by analyzing ultrasound signal data generated by emitting the ultrasound signals in the range of 2 MHz to 16 MHz.

14. A system for identifying an anatomical structure proximate a surgical target site, the system comprising:
a surgical instrument for creating a surgical access corridor to the surgical target site;
means for providing stimulation signals proximate the distal end of the surgical instrument, wherein the means for providing stimulation signals includes:
a stimulation handpiece having at least one stimulation button thereon; and
a coupling member for operatively coupling the stimulation handpiece to the surgical instrument,
wherein the coupling member includes a stimulation clip having an endplate and a plunger, the plunger for engaging a portion of the surgical instrument and maintaining the portion of the surgical instrument between the plunger and the endplate;

means for emitting ultrasound signals proximate a distal end of the surgical instrument;
a controller in communication with the means for emitting ultrasound signals, the controller directing signals to the means for emitting ultrasound signals; and
a processor configured to process ultrasound signal data generated from the means for emitting ultrasound signals into viewable images for viewing on a display, wherein the anatomical structure comprises nerve tissue, and
wherein the processor is configured to identify the nerve tissue by analyzing the ultrasound signal data and distinguish the nerve tissue identified from other structure in the viewable images.

15. The system of claim 14 , wherein the means for emitting ultrasound signals includes an array of transducer elements disposed at the distal end of the surgical instrument.

16. The system of claim 14 , wherein the means for emitting ultrasound signals is configured to emit sound waves in a circumferential direction about the distal end of the surgical instrument as the surgical instrument is advanced to the surgical target site.

17. The system of claim 14 , wherein the means for emitting ultrasound signals is located on a portion of the distal end of the surgical instrument and the surgical instrument is configured to rotate about a longitudinal axis of the surgical instrument to perform an ultrasound scan.

18. The system of claim 14 , wherein the means for emitting ultrasound signals is disposed within the surgical instrument at the distal end.

19. The system of claim 14 , wherein the anatomical structure comprises vasculature and the nerve tissue.

20. The system of claim 14 , wherein the surgical instrument is at least one of a screw test probe, a tap member, a bone awl, a dilating cannula, and a retractor assembly.

21. The system of claim 14 , wherein the display is configured to display a location of the surgical instrument relative to the anatomical structure.

22. The system of claim 14 , wherein to distinguish the nerve tissue from the other structure in the viewable image, the display is configured to display the nerve tissue in a first color or first shade of color distinct from a second color or second shade of color used to designate surrounding tissue.

23. The system of claim 14 , wherein the means for emitting ultrasound signals is configured to emit ultrasound signals having a frequency in a range of 2 MHz to 16 MHz.

24. The system of claim 13 , wherein the processor is configured to distinguish the nerve tissue from other structure in the viewable images by causing the nerve tissue to have a different color in the viewable images than the other structure.

25. A system for identifying an anatomical structure proximate a surgical target site, the system comprising:
a medical accessory having a distal end;
an ultrasound transducer proximate the distal end of the medical accessory and configured to emit ultrasound signals;

Assignees

• Nuvasive Inc

Inventors

• Gharib James E
• Pothier Albert

Classifications

• A61B5/395

  Details of stimulation, e.g. nerve stimulation to elicit EMG response · CPC title

• A61B8/4488

  the transducer being a phased array · CPC title

• A61B8/463

  characterised by displaying multiple images or images and diagnostic data on one display · CPC title

• A61B5/4893

  Nerves · CPC title

• A61B8/0841

  for locating instruments · CPC title