METHOD, SYSTEM AND APPARATUS FOR NEURAL LOCALIZATION
Described herein are devices, systems and methods for determining if a nerve is nearby a device or a region of a device. In general, a device for determining if a nerve is nearby a device includes an elongate body having an outer surface with one or more bipole pairs arranged on the outer surface. Bipole pairs may also be referred to as tight bipoles. The bipole pairs may be arranged as a bipole network, and may include a cathode and an anode that are spaced relatively close together to form a limited broadcast field. In general, the broadcast filed is a controlled or “tight” broadcast field that extends from the bipole pair(s). Methods of using these devices and system are also described.
1 . A method of detecting if a nerve is above or below a region of a device in a tissue, the method comprising:
positioning a flexible elongate device within the tissue, so that an upper region of the device faces the dorsal side of a patient and a lower region of the device faces the ventral side of the patient;
determining a threshold amount of energy required to stimulate a response in the patient while the upper region faces the dorsal side of the patient by applying increasing levels of energy from the upper region to determine the first stimulation level at which the nerve responds;
repositioning the device within the tissue so that the lower region faces the dorsal side of the patient and the upper region faces the ventral side of the patient;
determining a threshold amount of energy required to stimulate a response in the patient while the upper region faces the ventral side by applying increasing levels of energy from upper region to determine the first stimulation level at which the nerve responds;
confirming that the nerve is ventral to the device by comparing the threshold amounts.
2 . The method of claim 1 , further comprising positioning a guidewire after confirming that the nerve is ventral to the device.
3 . The method of claim 2 , further comprising removing the device from the patient with the guidewire in position.
4 . The method of claim 3 , further comprising using the guidewire to position a surgical device.
5 . A method of detecting if a nerve is above or below a region of a device in a tissue, the method comprising:
positioning a device within the tissue, wherein the device comprises a flexible elongate body having a first plurality of anodes and cathodes on a stimulation region of the device;
determining a threshold amount of energy required to stimulate a response in the patient from the stimulation region by applying increasing levels of energy to form a substantially continuous broadcast field in a first direction from the stimulation region to determine the first stimulation level at which the nerve responds;
determining a threshold amount of energy required to stimulate a response in the patient from the stimulation region by applying increasing levels of energy to form a substantially continuous broadcast field in a second direction from the stimulation region to determine the second stimulation level at which the nerve responds; and
determining if the nerve is in the first direction from the device or in the second direction from the device by comparing the threshold amounts.
6 . The method of claim 5 , further comprising positioning a guidewire after confirming that the nerve is ventral to the device.
7 . The method of claim 6 , further comprising removing the device from the patient with the guidewire in position.
8 . The method of claim 7 , further comprising using the guidewire to position a surgical device.