Methods of implanting electrode leads for use with implantable neuromuscular electrical stimulator
Electrode leads for providing neuromuscular stimulation of the spinal muscles, and methods of implantation of electrode leads, are provided that reduce injury to target muscles, and avoid extended recuperation period, by enabling a clinician to visualize and confirm the implantation site of the electrode leads during an implantation procedure.
1. A method of implanting an electrode lead for use in neuromuscular electrical stimulation to improve muscle tone, strength or endurance, comprising:
providing an electrode lead having a distal end including at least first and second electrodes, the electrode lead configured to be implanted with a trajectory that includes one or more multifidus fascicles;
providing a tool for implanting the electrode lead comprising a cannula having a lumen and a tip configured for blunt dissection, the lumen configured to permit the electrode lead to extend therethrough for implantation in a vicinity of a medial branch of a dorsal ramus nerve;
separating a multifidus muscle from a longissimus thoracis muscle along naturally occurring tissue planes therebetween using the tip of the tool to provide a path to the one or more multifidus fascicles associated with the lumbar spine; and
implanting the distal end of the electrode lead through the lumen of the cannula in the vicinity of the medial branch of the dorsal ramus nerve.
2. The method of implanting an electrode lead of claim 1 , wherein the electrode lead further comprises a fixation element.
3. The method of implanting an electrode lead of claim 1 , wherein implanting the distal end of the electrode lead comprises implanting the distal end of the electrode lead with the first and second electrodes in a crossing orientation relative to the medial branch of the dorsal ramus nerve.
4. The method of implanting an electrode lead of claim 1 , wherein implanting the distal end of the electrode lead further comprises implanting the distal end of the electrode lead with the first and second electrodes in an adjacent orientation relative to the medial branch of the dorsal ramus nerve.
5. The method of implanting an electrode lead of claim 1 , further comprising boring an opening in a spinous process, wherein implanting the distal end of the electrode lead further comprises implanting the distal end of the electrode lead with a trans-spinous orientation relative to the medial branch of the dorsal ramus nerve.
6. A method of implanting an electrode lead for use in neuromuscular electrical stimulation of nerves innervating spinal muscles to improve muscle tone, strength or endurance, comprising:
providing an electrode lead having a distal end including a fixation element, the electrode lead configured to be implanted with a trajectory that includes one or more multifidus fascicles;
providing a tool for implanting the electrode lead comprising a cannula having a lumen and a tip configured for blunt dissection, the lumen configured to permit the electrode lead to extend therethrough for implantation in a vicinity of a medial branch of a dorsal ramus nerve;
separating muscles overlying the one or more multifidus fascicles along naturally occurring tissue planes using the tip of the tool to provide a path to a preselected portion of the medial branch of the dorsal ramus nerve;
implanting the distal end of the electrode lead with a desired relationship relative to the preselected portion through the lumen of cannula; and
deploying the fixation element to retain the distal end of the electrode lead in a vicinity of the preselected portion without penetrating the muscles overlying the one or more multifidus fascicles other than along the naturally occurring tissue planes.
7. The method of implanting an electrode lead of claim 6 , wherein the overlying muscles comprise a group consisting of a transverse abdominus, interspinales, longissimus, ileocostalis, intertransversus, or quadratus muscle.
8. The method of implanting an electrode lead of claim 6 , wherein the fixation element brackets the preselected portion.
9. The method of implanting an electrode lead of claim 6 , wherein implanting the distal end of the electrode lead further comprises implanting the distal end of the electrode lead with a crossing orientation relative to the preselected portion.
10. The method of implanting an electrode lead of claim 6 , wherein implanting the distal end of the electrode lead further comprises implanting the distal end of the electrode lead with an adjacent orientation relative to the preselected portion.
11. The method of implanting an electrode lead of claim 6 , further comprising boring an opening in a spinous process, wherein implanting the distal end of the electrode lead further comprises implanting the distal end of the electrode lead with a trans-spinous orientation relative to the preselected portion.