System and methods for determining nerve proximity, direction and pathology during surgery

摘要

The present invention involves systems and methods for determining nerve proximity, nerve direction, and pathology relative to a surgical instrument based on an identified relationship between neuromuscular responses and the stimulation signal that caused the neuromuscular responses.

主权项

1. A system for establishing an operative corridor for spinal surgery, comprising:
a plurality of sequential dilator cannulas deliverable through bodily tissue having neural structures in a selected path toward a targeted intervertebral disc of a spine, the plurality of sequential dilator cannulas including at least an inner dilator cannula and an outer dilator cannula configured to be guided over the previously delivered inner dilator cannula, at least the inner dilator cannula of the plurality of sequential dilator cannulas having a stimulation electrode positioned along a distal tip region to deliver a stimulation signal to the bodily tissue when the inner dilator cannula is positioned in the selected path toward the targeted intervertebral disc of the spine; a nerve monitoring system comprising a control unit and a plurality of leg muscle sensor electrodes, the nerve monitoring system being configured to deliver an electrical stimulation signal to the stimulation electrode when said inner dilator cannula is positioned along the selected path toward the targeted intervertebral disc of the spine, the nerve monitoring system being configured to monitor electrical activity detected by the plurality of leg muscle sensor electrodes in response to the electrical stimulation signal output from the stimulation electrode of said inner dilator cannula, and the control unit of the nerve monitoring system comprising a display device that simultaneously displays both: a numeric stimulation current threshold in units of milliAmps that changes in response to the detected electrical activity at one or more of said leg muscle sensor electrodes, and a graphic representation of human legs showing locations of leg muscle myotomes monitored by said leg muscle sensor electrodes; and a working corridor instrument deliverable over the outer dilator cannula of the plurality of sequential dilator cannulas toward the targeted intervertebral disc of the spine, wherein the working corridor instrument is configured to establish an operative corridor to the targeted intervertebral disc of the spine.