Electromyography system

Abstract

A method of determining relative neuro-muscular response onset value thresholds for a plurality of spinal nerves, comprising: depolarizing a portion of the patient's cauda equina; and measuring the current intensity level at which a neuro-muscular response to the depolarization of the cauda equina is detected in each of the plurality of spinal nerves. A method for detecting the presence of a nerve adjacent the distal end of at least one probe, comprising: determining relative neuro-muscular response onset values for a plurality of spinal nerves; emitting a stimulus pulse from a probe or surgical tool; detecting neuro-muscular responses to the stimulus pulse in each of the plurality of spinal nerves; and concluding that the electrode disposed on the distal end of the at least one probe is positioned adjacent to a first spinal nerve when the neuro-muscular response detected in the first spinal nerve is detected as a current intensity level less than or equal to a corresponding neuro-muscular response onset value of the first spinal nerve.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS [0001] The present application claims priority under 35 U.S.C. § 120 from the commonly owned and co-pending U.S. patent application Ser. No. 09 / 722,070 filed Nov. 24, 2000, the complete disclosure of which is hereby incorporated herein by reference in its entirety for all purposes. Additionally, the present application claims benefit under 35 U.S.C. § 119(e) from U.S. Provisional Application Ser. No. 60 / 167,416 filed Nov. 24, 1999, the entire contents of which are hereby expressly incorporated by reference into this disclosure as if set forth fully herein.TECHNICAL FIELD [0002] The present invention relates to electromyography (EMG) and to systems for detecting the presence of nerves during surgical procedures. BACKGROUND OF THE INVENTION [0003] It is important to avoid unintentionally contacting a patient's nerves when performing surgical procedures, especially when using surgical tools and procedures that involve cutting or boring through t...

AI Technical Summary

Benefits of technology

[0021] In an additional aspect of the invention, the relative neuro-muscular response onset values can be repeatedly re-determined (at automatic intervals or at intervals determined by the operator) so as to account for any changes to the response onset values caused by the surgical procedure itself. Accordingly, a further advantage of the present invention is that it permits automatic re-assessment of the nerve status, with the relative neuro-muscular response onset values for each of the plurality of spinal nerves being re-determined before, during and after the surgical procedure, or repeatedly determined again and again during the surgical procedure. This optional aspect is advantageous during spinal surgery as the surgery itself may change the relative neuro-muscular response onset values for each of the plurality of nerves, such as would be caused by reducing the pressure on an exiting spinal nerve positioned between two adjacent vertebrae. This periodic re-determination of the onset values can be carried out concurrently with the nerve sensing function.

[0022] Accordingly, an advantageous feature of the present invention is that it can simultaneously indicate to an operator both: (1) nerve detection (i.e.: whether the surgical tool / probe is near a nerve); and (2) nerve status changes (i.e.: the change in each nerve's neuro-muscular response onset values over time). The surgeon is thus able to better interpret the accuracy of nerve detection warnings by simultaneously viewing changes in the various onset levels. For example, should the surgeon note that a particular onset value (i.e.: the current level of a stimulus pulse required to elicit an EMG response for a particular nerve) is increasing, this would tend to show that this nerve pathway is becoming less sensitive. Accordingly, a “low” warning may be interpreted to more accurately correspond to a “medium” likelihood of nerve contact; or a “medium” warning may be interpreted to more accurately correspond to a “high” likelihood of nerve contact.

[0023] Optionally, such re-assessment of the nerve status can be used to automatically re-calibrate the present nerve detection system. This can be accomplished by continually updating the onset values that are then used in the nerve detection function.

[0024] In preferred aspects, the neuro-muscular response onset values for each of the plurality of spinal nerves are measured at each of the spaced-apart myotome locations, and are visually indicated to an operator (for example, by way of an LED scale). Most preferably, the measuring of each of the various neuro-muscular response onset values is repeatedly carried out with the present and previously measured onset value levels being simultaneously visually indicated to an operator such as by way of the LED scale.

[0025] Accordingly, in one preferred aspect, for example, different LED lights can be used to indicate whether the value of each of the various neuro-muscular response onset values is remaining constant over time, increasing or decreasing. An advantage of this optional feature of the invention is that a surgeon operating the device can be quickly alerted to the fact that a neuro-muscular response onset value of one or more of the spinal nerves has changed. Should the onset value decrease for a particular nerve, this may indicate that the nerve was previously compressed or impaired, but become uncompressed or no longer impaired.

[0026] In a particular preferred embodiment, example, a blue LED can be emitted at a baseline value (i.e.: when the neuro-muscular response onset value remains the same as previously measured); and a yellow light can be emitted when the neuro-muscular response onset value has increased from that previously measured; and a green light being emitted when the neuro-muscular response onset value has decreased from that previously measured.

Problems solved by technology

However, avoiding inadvertent contact with these nerves is especially difficult due to the high nerve density in the region of the spine and cauda equina.

Unfortunately, a downside of such minimally invasive surgical procedures is that they tend to offer a somewhat reduced visibility of the patient's tissues during the surgery.

Accordingly, the danger of inadvertently contacting and / or severing a patient's nerves can be increased.

However, such systems cannot be used when initially penetrating into the tissue.

Moreover, such optical viewing systems cannot reliably be used to detect the location of small diameter peripheral nerves.

A disadvantage of such systems is that they rely on a visual indication, being seen as a “twitch” in the patient's body.

During precision minimally invasive surgery, uncontrollable patient movement caused by patient twitching, is not at all desirable, since such movement may itself be injurious.

Accordingly, such systems are quite limited, and are not particularly well adapted for use in minimally invasive surgery.

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