Systems and methods for enhanced implantation of electrode leads between tissue layers
Systems and methods for enhanced implantation of an electrode lead for neuromuscular electrical stimulation of tissue associated with control of the lumbar spine for treatment of back pain, in a midline-to-lateral manner are provided. The implanted lead may be secured within the patient and used to restore muscle function of local segmental muscles associated with the lumbar spine stabilization system without disruption of the electrode lead post-implantation due to anatomical structures.
1. A kit for implanting a lead for restoring muscle function to a lumbar spine, the kit consisting essentially of:
a guide needle configured for percutaneous insertion at a first insertion site, the guide needle having a distal tip and a longitudinal axis, the distal tip beveled to facilitate introduction to a location proximal to a tissue associated with control of the lumbar spine;
a delivery needle configured for percutaneous insertion at a second insertion site such that a longitudinal axis of the delivery needle is angled relative to the longitudinal axis of the guide needle, the delivery needle having a distal tip, a lumen extending therethrough, and a length such that, in use, the distal tip of the delivery needle extends from the second insertion site to a distance beyond the distal tip of the guide needle when the distal tip of the guide needle is positioned to be visualized at or near an edge of an outline of a neural foramen of a target vertebrae;
a guidewire configured to be inserted through the lumen of the delivery needle;
an introducer assembly having a distal tip and a lumen extending therethrough configured to receive the guidewire; and
the lead having one or more electrodes disposed at a distal region of the lead, the lead configured for implantation through the lumen of the introducer assembly to position the one or more electrodes in or adjacent to the tissue associated with control of the lumbar spine.
2. The kit of claim 1 , wherein the one or more electrodes are configured to be coupled to an implantable pulse generator via the lead.
3. The kit of claim 1 , wherein the delivery needle is further configured to traverse naturally occurring fascicle planes.
4. The kit of claim 1 , wherein the introducer assembly comprises a dilator having the lumen of the introducer assembly extending therethrough configured to receive the guidewire, and an introducer sheath having a lumen extending therethrough configured to receive the dilator and the lead.
5. The kit of claim 1 , wherein the lead comprises one or more fixation elements disposed in proximity to at least one of the one or more electrodes, the one or more fixation elements configured to transition from a delivery state, wherein the one or more fixation elements are positioned adjacent to the at least one of the one or more electrodes, to a deployed state, wherein the one or more fixation elements are spaced apart from the at least one of the one or more electrodes and positioned to anchor the lead to an anchor site.
6. The kit of claim 5 , wherein the one or more fixation elements are configured to transition from the delivery state to the deployed state upon retraction of the introducer assembly.
7. The kit of claim 5 , wherein the one or more fixation elements are spaced apart a distance between 2 mm and 10 mm.
8. The kit of claim 5 , wherein the one or more fixation elements comprise a length between 1.5 mm to 4 mm.
9. The kit of claim 5 , wherein the one or more fixation elements are radially offset from each other.
10. The kit of claim 5 , wherein the lead further comprises a strain relief portion configured to reduce strain on the lead and the one or more fixation elements, thereby reducing risk of lead dislodgement, fatigue fracture, and injury to the tissue associated with control of the lumbar spine.
11. The kit of claim 1 , wherein the first insertion site is located at a lateral distance from a midline of the target vertebrae.
12. The kit of claim 11 , wherein the first insertion site is located at a cranial edge of a transverse process of the target vertebrae and proximately lateral to a base of a superior articular process of the target vertebrae.
13. The kit of claim 11 , wherein the distal tip of the delivery needle is further configured to be visualized within the outline of the neural foramen of the target vertebrae.
14. The kit of claim 11 , wherein the distal tip of the introducer assembly is configured to be visualized within the outline of the neural foramen of the target vertebrae to confirm placement of the introducer assembly within a plane of an intertransversarii.
15. The kit of claim 1 , wherein the distal tip of the guide needle is further configured to measure a depth, wherein the second insertion site is located a distance from the first insertion site approximately equal to the depth.
16. The kit of claim 1 , wherein the second insertion site is located above an L4 spinous process.
17. The kit of claim 1 , wherein the lead is configured for implantation through the lumen of the introducer assembly to position the one or more electrodes in or adjacent to a dorsal ramus nerve or fascicles thereof.
18. The kit of claim 1 , wherein the longitudinal axis of the delivery needle is approximately angled 45 degrees relative to the longitudinal axis of the guide needle.
19. The kit of claim 1 , wherein the distal tip of the delivery needle is further configured to penetrate an intertransversarii.
20. The kit of claim 1 , wherein the guide needle is further configured to be inserted percutaneously at the second insertion site.
21. The kit of claim 1 , wherein the length of the delivery needle is such that the distal tip of the delivery needle extends 3-5 mm beyond the distal tip of the guide needle.