METHODS AND SYSTEMS FOR USE IN GUIDING IMPLANTATION OF A NEUROMODULATION LEAD
Methods and systems for use in guiding implantation of a neuromodulation lead during an implant procedure are disclosed herein. Certain methods and system are for use in guiding implantation of a lead toward an implant position where at least one electrode of the lead is located near a target dorsal root ganglion (DRG). Such methods can involve inserting a distal end of the lead into an epidural space of a spinal column within which is located the target DRG, and using one or more electrodes of the lead to obtain a sensed signal indicative of proximity of at least one electrode of the lead relative to the target DRG. Additionally, the sensed signal is used to guide placement of at least one electrode of the lead toward the implant position near the target DRG.
1 . A method for use in guiding implantation of a lead toward an implant position where at least one electrode of the lead is located near a target dorsal root ganglion (DRG), the method comprising:
(a) inserting a distal end of the lead into an epidural space of a spinal column within which is located the target DRG;
(b) using at least one electrode of the lead to obtain a sensed signal indicative of proximity of the at least one electrode relative to the target DRG; and
(c) using the sensed signal to guide placement of at least one electrode of the lead toward an implant position near the target DRG.
2 . The method of claim 1 , wherein step (c) includes:
producing an audio indicator in dependence on the sensed signal, wherein changes in at least one of an amplitude, a frequency or a repetition rate of the audio indicator are indicative of changes in proximity of at least one electrode of the lead relative to the target DRG.
3 . The method of claim 1 , wherein step (c) includes:
producing a visual indicator in dependence on the sensed signal, wherein changes in the visual indicator are indicative of changes in proximity of at least one electrode of the lead relative to the target DRG.
4 . The method of claim 1 , wherein step (c) includes:
producing a tactile indicator in dependence on the sensed signal, wherein changes in the tactile indicator are indicative of changes in proximity of at least one electrode of the lead relative to the target DRG.
5 . The method of claim 1 , wherein the signal that is sensed at step (b), and is used to guide placement of at least one electrode of the lead at step (c), comprises an intrinsic signal.
6 . The method of claim 1 , wherein the signal that is sensed at step (b), and is used to guide placement of at least one electrode of the lead at step (c), comprises an evoked response signal.
7 . The method of claim 6 , wherein the lead is for use in stimulating the target DRG to treat pain in a targeted body region that is remote from the target DRG, and wherein the method further comprises:
delivering a physical or electrical stimulation to the targeted body region to induce the evoked response signal that is sensed at step (b) and is used to guide placement of at least one electrode of the lead at step (c).
8 . The method of claim 1 , wherein
the sensed signal is indicative of a potential difference between an electrode of the lead and a further electrode.
9 . The method of claim 8 , wherein step (c) includes:
(c.1) interpreting an increase in the sensed signal as an indication that at least one electrode of the lead moved closer to the target DRG; and
(c.2) interpreting a decrease in the sensed signal as an indication that at least one electrode of the lead moved away from the target DRG.
10 . The method of claim 8 , wherein step (c) includes:
(c.1) determining a signal-to-noise ratio (SNR) of the sensed signal;
(c.2) interpreting an increase in the SNR as an indication that at least one electrode of the lead, used to obtain the sensed signal, moved closer to the target DRG; and (c.3) interpreting a decrease in the SNR as an indication that at least one electrode of the lead, used to obtain the sensed signal, moved away from the target DRG.
11 . The method of claim 1 , wherein the sensed signal is indicative of an impedance between an electrode of the lead and a further electrode.
12 . The method of claim 9 , wherein step (c) includes interpreting an increase in the sensed signal as an indication that the electrode moved closer to the target DRG.
13 . A system for use in guiding implantation of a lead toward an implant position where an electrode of the lead is located near a target dorsal root ganglion (DRG), the system comprising:
circuitry to obtain a sensed signal from a lead after a distal end of the lead has been inserted into an epidural space of a spinal column within which is located the target DRG; and
a transducer that produces an indicator in dependence on the sensed signal, wherein changes in the indicator are indicative of changes in proximity of at least one electrode of the lead relative to the target DRG.
14 . The system of claim 13 , further comprising:
a controller to interpret changes in the sensed signal and adjust the indicator so that changes in the indicator are indicative of changes in proximity of at least one electrode of the lead relative to the target DRG.
15 . The system of claim 14 , wherein:
the transducer comprises an audio transducer that produces an audio indicator; and
the controller controls the audio transducer to change at least one of an amplitude, a frequency or a repetition rate of the audio indicator to indicate changes in proximity of at least one electrode of the lead relative to the target DRG.
16 . The system of claim 14 , wherein:
the transducer comprises a visual transducer that produces a visual indicator; and
the controller controls the visual transducer to change the visual indicator to indicate changes in proximity of at least one electrode of the lead relative to the target DRG.
17 . The system of claim 14 , wherein:
the transducer comprises a tactile transducer that produces a tactile indicator; and
the controller controls the tactile transducer to change the tactile indicator to indicate changes in proximity of at least one electrode of the lead relative to the target DRG.
18 . The system of claim 14 , wherein:
the circuitry to obtain a sensed signal comprises voltage sense circuitry to obtain a sensed signal indicative of a potential difference between an electrode of the lead and a further electrode; and
the controller interprets an increase in the sensed signal as an indication that at least one electrode of the lead, which that was used to obtain the sensed signal, moved closer to the target DRG;
the controller interprets a decrease in the sensed signal as an indication that at least one electrode of the lead, which was used to obtain the sensed signal, moved away from the target DRG; and
the controller adjusts the indicator produced by the transducer in dependence on changes in the sensed signal.
19 . The system of claim 14 , wherein:
the circuitry to obtain a sensed signal comprises voltage sense circuitry to obtain a sensed signal indicative of a potential difference between an electrode of the lead and a further electrode; and
the controller determines a signal-to-noise ratio (SNR) of the sensed signal;
the controller interprets an increase in the SNR as an indication that at least one electrode of the lead, which was used to obtain the sensed signal, moved closer to the target DRG;
the controller interprets a decrease in the SNR as an indication that at least one electrode of the lead, which was used to obtain the sensed signal, moved away from the target DRG; and
the controller adjusts the indicator produced by the transducer in dependence on changes in the SNR.
20 . The system of claim 14 , wherein:
the circuitry to obtain a sensed signal comprises impedance measurement circuitry to obtain a sensed signal indicative of an impedance between an electrode of the lead and a further electrode; and
the controller interprets an increase in the sensed impedance signal as an indication that at least one electrode of the lead, which was used to obtain the sensed signal, moved closer to the target DRG; and
the controller adjusts the indicator produced by the transducer in dependence on changes in the sensed signal.
21 . A method for use in guiding of a lead toward a position where a sense element of the lead or of a sheath covering at least a portion of the lead is located near a target dorsal root ganglion (DRG), the method comprising:
(a) inserting a distal end of the lead and a distal end of the sheath covering at least a portion of the lead into an epidural space of a spinal column within which is located the target DRG;
(b) using the sense element to obtain a sensed signal indicative of proximity of the sense element relative to the target DRG; and
(c) using the sensed signal to guide positioning of the sense element toward a position near the target dorsal root ganglion (DRG).
22 . The method of claim 21 , wherein the sense element comprises at least one of an electrode or a chemical sensor.