JP3213655U - Spinal and neurosurgical instruments and systems - Google Patents

Abstract

An instrument and a system for facilitating a surgical operation by separating muscles and adipose tissue around the nerve from the nerve more safely and reliably. An instrument A for monitoring the proximity of a nerve during a spinal surgery of a patient, wherein the instrument is a finger attachment part 1, a connection part 2 connectable to a nerve monitoring system, the connection part and the finger. A cable 3 for connecting the mounting portion and an electrode 4 formed on the finger mounting portion are provided. [Selection] Figure 1

Description

  The present invention relates to a spinal cord / neurosurgical instrument and system, and more particularly, for spinal cord / nerve surgery for securing a passage for inserting a spinal surgical tool by avoiding adipose tissue and muscle around the nerve extending from the spine with fingers. It relates to instruments and systems.

  Various surgical procedures require a passage for the surgical tool to access the target site. Such a passage may be in the vicinity of a nerve. For example, in spinal surgery such as an intervertebral disc, it is necessary to secure a passage for a surgical tool by avoiding adipose tissue around the nerve and the iliopsoas muscle. is there.

  Patent Document 1 discloses a configuration in which a bar-shaped surgical tool having a sensor for detecting a distance from a nerve is inserted from an incision site of a skin toward a spine, and the spine is operated using the surgical tool.

  Although the position of the surgical tool and the spine can be monitored by fluoroscopic images, a skillful doctor has been required to perform spine surgery without damaging the nerve.

Special table 2006-512983

  An object of the present invention is to provide an instrument and a system for facilitating a surgical operation by safely and reliably separating muscles and adipose tissue around the nerve from the nerve.

The present invention provides the following instruments and systems.
Item 1. An instrument for monitoring the proximity of a nerve during a spinal surgery of a patient, the instrument comprising a finger attachment part, a connection part connectable to a nerve monitoring system, a cable connecting the connection part and the finger attachment part, a finger An instrument comprising an electrode formed on the mounting portion.
Item 2. Item 2. The instrument according to Item 1, wherein the finger mounting portion is made of flexible silicone rubber or plastic.
Item 3. Item 3. The device according to Item 1 or 2, which is made of a sterilizable material.
Item 4. Item 4. The instrument or body according to any one of Items 1 to 3, comprising a finger attachment unit, a connection unit connectable to a nerve monitoring system, a cable connecting the connection unit and the finger attachment unit, and an electrode formed on the finger attachment unit. Nerve position detection system for surgical operation with surface electrode and nerve monitoring system, measuring electromyogram (EMG) between body surface electrode placed on muscle of lower limb and electrode of finger wearing part Then, the nerve position detection system is characterized in that the nerve position is detected by determining a current threshold value to which the muscle reacts.

  According to the present invention, it is possible to perform a surgical operation without damaging the nerve by reliably checking the position of the nerve with a finger and damaging the adipose tissue and muscles around the surgical site, and skilled in using the finger. Surgery can be performed smoothly even with no doctor.

1 shows a schematic view of an instrument of the present invention. The figure which mounted | wore the finger | toe with the instrument of this invention is shown.

  One embodiment of the present application is shown in FIGS.

  The device A of the present invention includes a finger mounting part 1, a connection part 2 connectable to a nerve monitoring system, a cable 3 connecting the connection part and the finger mounting part, and an electrode 4 formed on the finger mounting part. A finger sack is exemplified as the finger mounting part 1, and it is firmly attached so that it does not come out even if the finger is moved in a state where tissues such as fat and muscle, blood, and tissue fluid are in the surroundings, and the position of the electrode does not move Put on the finger. An electrode 4 is formed on the finger mounting portion 1. The electrode 4 measures the EMG (electromyogram) between the body surface electrode (not shown) placed on each muscle of the lower limbs and the finger wearing part 1 to measure a threshold value (current at which the muscle reacts above a certain current). Value) is displayed on the monitor of the nerve monitoring system. If the electromyogram measurement threshold is low, the distance between the electrode 4 and the nerve is close, and if the threshold is high, the distance between the electrode 4 and the nerve is long. The threshold can be measured if the electrode 4 when worn on the finger is facing the direction of the nerve, but the threshold cannot be measured if the electrode 4 is not facing the direction of the nerve. Thereby, the direction of the nerve from the finger can be confirmed. The electrode 4 can stimulate the nerve with, for example, a current pulse. If the direction of the electrode is changed by rotating the finger, the nerve can be detected or cannot be detected, so that the surgeon can confirm the direction of the nerve. Further, since the threshold current value changes when the position of the electrode is moved together with the finger, the surgeon can check the distance between the nerve and the finger. Since the distance and direction of the nerve that can be detected vary depending on the threshold current amount, the position information of the nerve can be obtained in the distance and direction within the range necessary for the operation by setting an appropriate amount of current pulse.

  The device of the present invention can be finely adjusted by the movement of the finger compared to the case where it is operated remotely using a monitor and a device for wearing on a finger, and fat around the nerve without damaging the nerve. The position of tissue and muscle tissue can be easily moved, and spinal cord surgery can be performed smoothly.

  Examples of spinal cord / neural surgery include a lateral approach to the spine, and specifically include excision of an intervertebral disc and insertion of a plate. Although a spinal lateral approach is preferred, the devices and systems of the present invention may also be used in anterior or posterior approaches of the spine.

  The neurological monitoring system has a control unit, display device, impedance meter, body surface electrode, electromyogram (EMG) stimulation shaft and grip, MEP / EMG lead, and the electromyogram measurement threshold is determined by the control unit And display on the display unit according to the distance from the nerve. The display means of the display unit includes display by image, sound / sound, light, vibration, etc. Specifically, when displaying by image, a speaker when displaying by sound such as a display, sound or warning sound. And a sound source chip (for example, a sound source such as a CPU). A light source is used for display by light, and a vibration source is used for display by vibration. For example, two or three types such as an image and sound / sound light may be combined to make it clear to the surgeon that the distance from the nerve is close.

  When displaying by voice / sound, light, heat, vibration, etc., the closer the nerve is, the louder sound, strong light, strong vibration, heat, etc. may be generated and displayed. Further, when the image is displayed, the color may be displayed in a red color when the nerve is near, yellow, blue, or the like as the nerve is far away. When the distance between the nerve and the electrode 4 is less than a predetermined value, it can be set by the control unit so that it is not displayed.

  The finger mounting portion 1 is mounted such that the electrode 4 is positioned on the palm side of the finger and the cable 3 is on the fingernail side, for example. Since the cable 3 and the finger mounting portion 1 are made of a flexible material, it does not hinder the movement of the finger. Since the cable 3 and the finger attachment part 1 are inserted into the body, the cable and the finger attachment part 1 can be made disposable if the cable is detachably connected to the connection part. Further, since the size of the finger varies depending on the doctor, the finger mounting unit 1 of an appropriate size for the surgeon can be obtained by making the cable 3 and the connection unit 2 detachable, or by making the finger mounting unit 1 detachable. Can be selected.

  When the finger attachment unit 1 is attached to a finger of a doctor who performs surgery to avoid adipose tissue, muscles (muscular psoas), etc. around the spine, if the nerve is close in the direction of the electrode 4, the threshold current amount becomes small. In the range where there is a possibility of damaging the nerve, the operation at the time of surgery can be appropriately performed by alerting the doctor by an image, a warning sound, flashing red light, or the like.

  The insertion of the finger of the doctor wearing the finger attachment unit 1 can be performed, for example, from the skin incision on the side of the upper body toward the spine. Using the instrument of the present invention, a device for cutting a part of the intervertebral disc with the adipose tissue and psoas muscles aside can be inserted into the body through the incision, and discectomy and plate insertion can be performed. As a device used for discectomy, New Basijaban Coroent system titanium cage X / X Plus, CoRoent XLIF surgical machine, Maxcess surgical machine set, XLP spinal plate system, and the like can be used.

  Each nerve, including the periphery of the spine, has a characteristic threshold current level, and subthreshold current stimulation at the electrodes does not elicit a significant neural response. Once this stimulation threshold (ITThreshold) is reached, the evoked response is reproducible and increases with increasing stimulation until saturation is reached. The current pulse at the electrode is set to a predetermined value within a range that causes each neural response.

DESCRIPTION OF SYMBOLS 1 Finger mounting part 2 Connection part 3 Cable 4 Electrode A Instrument

Claims (4)

An instrument for monitoring the proximity of a nerve during a spinal surgery of a patient, the instrument comprising a finger attachment part, a connection part connectable to a nerve monitoring system, a cable connecting the connection part and the finger attachment part, a finger An instrument comprising an electrode formed on the mounting portion. The instrument according to claim 1, wherein the finger mounting portion is made of flexible silicone rubber or plastic. The instrument according to claim 1 or 2, which is made of a sterilizable material. The instrument according to any one of claims 1 to 3, comprising a finger attachment part, a connection part connectable to a nerve monitoring system, a cable connecting the connection part and the finger attachment part, and an electrode formed on the finger attachment part, A nerve position detection system for surgical operation equipped with a body surface electrode and a nerve monitoring system, and an electromyogram (EMG) between the body surface electrode placed on the muscle of the lower limb and the electrode of the finger wearing part. A nerve position detection system characterized by detecting a nerve position by measuring and determining a current threshold value to which a muscle reacts.

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