The present invention is directed to the area of implantable electrical stimulation systems and methods of making and using the systems. The present invention is also directed to a biased lead connector for an operating room cable assembly for use with an implantable electrical stimulation system, as well as methods of making and using the operating room cable assembly.
Implantable electrical stimulation systems have proven therapeutic in a variety of diseases and disorders. For example, spinal cord stimulation systems have been used as a therapeutic modality for the treatment of chronic pain syndromes. Peripheral nerve stimulation has been used to treat chronic pain syndrome and incontinence, with a number of other applications under investigation. Functional electrical stimulation systems have been applied to restore some functionality to paralyzed extremities in spinal cord injury patients. Stimulation of the brain, such as deep brain stimulation, can be used to treat a variety of diseases or disorders.
Stimulators have been developed to provide therapy for a variety of treatments. A stimulator can include a control module (with a pulse generator), one or more leads, and an array of stimulator electrodes on each lead. The stimulator electrodes are in contact with or near the nerves, muscles, or other tissue to be stimulated. The pulse generator in the control module generates electrical pulses that are delivered by the electrodes to body tissue.
One embodiment is an operating room cable assembly for an electrical stimulation system that includes a lead connector having a housing, a lead lumen extending inwardly from a first opening in the housing and configured and arranged to receive a portion of a lead or lead extension, and a contact assembly disposed within the housing and configured and arranged to move relative to the housing. The contact assembly is configured and arranged to move to a load position and is biased to return to a lock position. The contact assembly includes of contacts that are configured and arranged to engage a portion of any lead or lead extension within the lead lumen when the contact assembly is in the lock position and to disengage from the portion of the lead or lead extension within the lead lumen when the contact assembly is in the load position.
In at least some embodiments, the operating room cable assembly further includes a button coupled to the contact assembly, disposed within the housing, and movable relative to the housing, wherein the button is configured and arranged to move the contact assembly to the load position when the button is pushed and to return the contact assembly to the lock position when the button is released. In at least some embodiments, the button includes a carriage and the contact assembly is fastened to the carriage. In at least some embodiments, the carriage includes a lead engagement portion that is configured and arranged to engage the portion of the lead or lead extension in the lead lumen when the contact assembly is in the lock position to facilitate retention of the lead or lead extension.
In at least some embodiments, the operating room cable assembly further includes an elongated body coupled to, and extending from, the lead connector and including conductors with each of the conductors coupled to at least one of the contacts of the contact assembly of the lead connector. In at least some embodiments, the operating room cable assembly further includes a trial stimulator connector coupled to the elongated body and including at least one contact coupled to the conductors of the elongated body.
In at least some embodiments, the operating room cable assembly further includes at least one spring disposed between the contact assembly and the housing and configured and arranged to bias the contact assembly to the lock position. In at least some embodiments, the operating room cable assembly further includes a lead lumen housing disposed within the housing and defining at least a portion of the lead lumen. In at least some embodiments, the lead lumen housing further defines a plurality of contact openings that intersect the lead lumen and through which the contacts of the contact assembly can move between the load position and the lock position.
In at least some embodiments, the operating room cable assembly further includes a stylet lumen inwardly extending from a second opening in the housing opposite the lead lumen and intersecting the lead lumen. In at least some embodiments, the operating room cable assembly further includes a visually distinctive marking disposed on the housing around the first opening. In at least some embodiments, the contacts are “M” shaped pins. In at least some embodiments, the contact assembly includes a base with the contacts attached to the base. In at least some embodiments, the button includes a carriage and the base is part of the carriage.
Another embodiment is a trial stimulation system that includes a trial stimulator; and any of the operating room cable assemblies described above and coupleable, or coupled, to the trial stimulator. The trial stimulation system optionally includes a lead coupleable to the lead connector of the operating room cable assembly. The trial stimulation system optionally includes a lead extension coupleable to the lead and the lead connector of the operating room cable assembly.
A further embodiment is an insertion kit that includes any of the operating room cable assemblies described above and at least one electrical stimulation lead, each electrical stimulation lead having a distal end portion and a proximal end portion and including electrodes disposed along the distal end portion of the electrical stimulation lead, terminals disposed along the proximal end portion of the electrical stimulation lead, and conductors coupling the electrodes to the terminals, where the proximal end portion of the electrical stimulation lead is insertable into the lead connector of the operating room cable assembly.
Yet another embodiment is a method for performing a trial stimulation on a patient. The method includes providing any of the operating room cable assemblies described above; advancing a distal end portion of an electrical stimulation lead into the patient with a proximal end portion of the electrical stimulation lead extending outward from the patient, wherein the distal end portion of the electrical stimulation lead is advanced to a position where a plurality of electrodes disposed along the distal end portion of the electrical stimulation lead are in proximity to a target stimulation location; placing the proximal end portion of the electrical stimulation lead into the lead connector of the operating room cable assembly while the contact assembly is in the load position; and allowing the contact assembly to return to the lock position to lock the proximal end portion of the lead in the lead connector.
Another embodiment is a method for performing a trial stimulation on a patient. The method includes providing any of the operating room cable assemblies described above; advancing a distal end portion of an electrical stimulation lead into the patient with a proximal end portion of the electrical stimulation lead extending outward from the patient, wherein the distal end portion of the electrical stimulation lead is advanced to a position where a plurality of electrodes disposed along the distal end portion of the electrical stimulation lead are in proximity to a target stimulation location; coupling the lead to a lead extension; placing a proximal end portion of the lead extension into the lead connector of the operating room cable assembly while the contact assembly is in the load position; and allowing the contact assembly to return to the lock position to lock the proximal end portion of the lead extension in the lead connector.
Non-limiting and non-exhaustive embodiments of the present invention are described with reference to the following drawings. In the drawings, like reference numerals refer to like parts throughout the various figures unless otherwise specified.
For a better understanding of the present invention, reference will be made to the following Detailed Description, which is to be read in association with the accompanying drawings, wherein:
The present invention is directed to the area of implantable electrical stimulation systems and methods of making and using the systems. The present invention is also directed to a push-button lead connector for an operating room cable assembly for use with an implantable electrical stimulation system, as well as methods of making and using the operating room cable assembly.
Suitable implantable electrical stimulation systems include, but are not limited to, a least one lead with one or more electrodes disposed along a distal end of the lead and one or more terminals disposed along the one or more proximal ends of the lead. Leads include, for example, percutaneous leads, paddle leads, and cuff leads. Examples of electrical stimulation systems with leads are found in, for example, U.S. Pat. Nos. 6,181,969; 6,516,227; 6,609,029; 6,609,032; 6,741,892; 7,949,395; 7,244,150; 7,672,734; 7,761,165; 7,974,706; 8,175,710; 8,224,450; and 8,364,278; and U.S. Patent Application Publication No. 2007/0150036, all of which are incorporated by reference.
It will be understood that the electrical stimulation system can include more, fewer, or different components and can have a variety of different configurations including those configurations disclosed in the electrical stimulation system references cited herein. For example, instead of a paddle body, the electrodes can be disposed in an array at or near the distal end of a lead body forming a percutaneous lead.
The lead 103 can be coupled to the control module 102 in any suitable manner. In
In
With reference to
The electrical stimulation system or components of the electrical stimulation system, including the paddle body 104, the one or more of the lead bodies 106, and the control module 102, are typically implanted into the body of a patient. The electrical stimulation system can be used for a variety of applications including, but not limited to deep brain stimulation, neural stimulation, spinal cord stimulation, muscle stimulation, and the like.
The electrodes 134 can be formed using any conductive, biocompatible material. Examples of suitable materials include metals, alloys, conductive polymers, conductive carbon, and the like, as well as combinations thereof. In at least some embodiments, one or more of the electrodes 134 are formed from one or more of: platinum, platinum iridium, palladium, palladium rhodium, or titanium.
Any suitable number of electrodes 134 can be disposed on the lead including, for example, four, five, six, seven, eight, nine, ten, eleven, twelve, fourteen, sixteen, twenty-four, thirty-two, or more electrodes 134. In the case of paddle leads, the electrodes 134 can be disposed on the paddle body 104 in any suitable arrangement. In
The electrodes of the paddle body 104 (or one or more lead bodies 106) are typically disposed in, or separated by, a non-conductive, biocompatible material such as, for example, silicone, polyurethane, polyetheretherketone (“PEEK”), epoxy, and the like or combinations thereof. The one or more lead bodies 106 and, if applicable, the paddle body 104 may be formed in the desired shape by any process including, for example, molding (including injection molding), casting, and the like. The non-conductive material typically extends from the distal ends of the one or more lead bodies 106 to the proximal end of each of the one or more lead bodies 106.
In the case of paddle leads, the non-conductive material typically extends from the paddle body 104 to the proximal end of each of the one or more lead bodies 106. Additionally, the non-conductive, biocompatible material of the paddle body 104 and the one or more lead bodies 106 may be the same or different. Moreover, the paddle body 104 and the one or more lead bodies 106 may be a unitary structure or can be formed as two separate structures that are permanently or detachably coupled together.
Terminals (e.g., 310 in
The electrically conductive wires (“conductors”) may be embedded in the non-conductive material of the lead body 106 or can be disposed in one or more lumens (not shown) extending along the lead body 106. In some embodiments, there is an individual lumen for each conductor. In other embodiments, two or more conductors extend through a lumen. There may also be one or more lumens (not shown) that open at, or near, the proximal end of the one or more lead bodies 106, for example, for inserting a stylet to facilitate placement of the one or more lead bodies 106 within a body of a patient. Additionally, there may be one or more lumens (not shown) that open at, or near, the distal end of the one or more lead bodies 106, for example, for infusion of drugs or medication into the site of implantation of the one or more lead bodies 106. In at least one embodiment, the one or more lumens are flushed continually, or on a regular basis, with saline, epidural fluid, or the like. In at least some embodiments, the one or more lumens are permanently or removably sealable at the distal end.
The control module connector 144 defines at least one port into which a proximal end of the elongated device 300 can be inserted, as shown by directional arrows 312a and 312b. In
The control module connector 144 also includes a plurality of connector contacts, such as connector contact 314, disposed within each port 304a and 304b. When the elongated device 300 is inserted into the ports 304a and 304b, the connector contacts 314 can be aligned with a plurality of terminals 310 disposed along the proximal end(s) of the elongated device(s) 300 to electrically couple the control module 102 to the electrodes (134 of
A lead extension connector 322 is disposed on the lead extension 324. In
In at least some embodiments, the proximal end of the lead extension 324 is similarly configured and arranged as a proximal end of the lead 103 (or other elongated device 300). The lead extension 324 may include a plurality of electrically conductive wires (not shown) that electrically couple the connector contacts 340 to a proximal end 348 of the lead extension 324 that is opposite to the distal end 326. In at least some embodiments, the conductive wires disposed in the lead extension 324 can be electrically coupled to a plurality of terminals (not shown) disposed along the proximal end 348 of the lead extension 324. In at least some embodiments, the proximal end 348 of the lead extension 324 is configured and arranged for insertion into a connector disposed in another lead extension (or another intermediate device). In other embodiments (and as shown in
Turning to
In some embodiments, the trial stimulations can continue for two, four, six, eight, twelve, or more hours or for one, two, three, four, five or more days. In these instances, the patient may be in a hospital or other care facility. In some embodiments, the trial stimulations may continue for an extended period (e.g., 2-10 days or more) where the patient is sent home with the lead, cable, and trial stimulator to assess the effectiveness of the therapy to determine if a permanent implanted system will be effective in treating the medical condition. During the trial stimulations, the lead can be electrically coupled to the trial stimulator by electrically coupling the proximal end portion of the lead (or lead extension) to an operating room cable (“cable”) which, in turn, is electrically coupled to the trial stimulator. In some cases, when multiple leads are implanted into a patient, multiple leads (or lead extensions) may be coupled to the cable.
During operation, the electrodes 434 are disposed internal to the patient, while the terminals 410 remain external to the patient, as shown in
The operating room cable assembly 450 includes an elongated body 458 having a first end portion 454 and an opposing second end portion 456, a lead connector 452 with connector contacts, and an optional trial stimulator connector 460 optionally with terminals (a trial stimulator connector and terminals are not needed if the operating room cable assembly is permanently wired, or otherwise permanently attached, to the trial stimulator). Conductors (not shown) extend from the connector contacts of the lead connector to the terminals of the trial stimulator connector. The lead connector 452 is disposed along the first end portion 454 of the operating room cable assembly 450 and the connector contacts within the lead connector are coupleable to the terminals 434 of the lead 403 (or lead extension). The trial stimulator connector 460 is disposed along the second end portion 456 of the operating room cable assembly 450 and is coupleable to the trial stimulator 448, either directly or via one or more operating room cable extensions. Any suitable terminals can be used in the operating room cable assembly including rings, c-shaped contacts, plate contacts, pogo pins, and the like. Examples of terminals can be found in, for example, U.S. Pat. Nos. 7,539,542 and 8,849,396; U.S. Patent Application Publication No. 2013/0098678; and U.S. patent application Ser. No. 14/330,330, all of which are incorporated herein by reference.
Conventionally, the lead connectors of the operating room cable assembly are relatively large, bulky, and heavy. In some instances, conventional lead connectors may require two hands to operate. In some instances, it may not be clear to surgical personnel how to load a lead into the lead connector or how to “lock” the lead within the lead connector.
In the description below, leads will be referred to in connection with the lead connector. It will be understood, however, that a lead extension can be used in place of any of the leads for coupling to the lead connector with a lead coupled, in turn, to the lead extension.
A lead connector for use with an operating room cable assembly (or as a lead connector on a lead extension) can include a simpler, quicker, and easier locking-unlocking mechanism. One embodiment of an operating room cable assembly 550 with an elongated body 558, a lead connector 552, and trial stimulator connector 560 is illustrated in
The lead connector 552, illustrated in close-up views in
The contact assembly 580 includes a base 590 and multiple contacts 592 attached to the base. The contact assembly 580 is movable relative to the housing 570 and can be moved to a load position for receiving the lead. The contact assembly 580 is biased to a lock position in which the contact assembly the engages a portion of a lead or lead extension within the lead lumen to hold or lock the portion of the lead or lead extension within the lead connector 552.
The base 590 of the contact assembly 580 can be made of any suitable non-conductive material such as, for example, polyimide, epoxy, other printed circuit board materials, flex circuit materials, other plastics, or the like or combinations thereof. The contacts 592 are made of metal or other conductive material and are positioned to engage the terminals of a lead (or lead extension) when the proximal portion of the lead (or lead extension) is properly and fully inserted in the lead connector 570 and the button 572 is in the lock position. As explained further below, the contact assembly 580 is coupled to the button 572 and moves with the button 572 to engage the lead (or lead extension) in the lock position or disengage from the lead (or lead extension) in the load position. Optionally, in the lock position, the contacts 580 may compress or otherwise engage the terminals of the lead to resist removal of the proximal portion of the lead from the lead connector 570.
In the illustrated embodiment, the contacts 592 are “M” shaped pins, but any other suitably shaped contact can be used. Each contact 592 is individually electrically coupled (for example, directly coupled or coupled through a wire) to one of multiple conductors 594 (
As best illustrated in
The button 572 includes a carriage 588 to which the contact assembly 580 is attached. Any suitable method of attachment can be used including, but not limited to, screws 594, other fasteners, adhesive, or the like or the carriage 584 and the base 590 of the contact assembly 580 can be formed (e.g., molded) together with, for example, the contacts inserted or otherwise disposed in the combined arrangement. In some embodiments, the button 572 and carriage 588, instead of being a single, integral piece as illustrated in
In at least some embodiments, the springs 584 (
Optionally, the carriage 588 includes a lead engagement portion 589 that passes through an opening 577 in the lead lumen housing 582 to engage, or press against, a lead present within the lead lumen 586 to facilitate locking the lead within the lead lumen. The illustrated embodiment has a single lead engagement portion 589, but it will be understood that additional lead engagement portions can be used and may be part of the contact assembly 580 instead of the carriage 588.
Some of the components (for example, a power source 712, an antenna 718, a receiver 702, and a processor 704) of the electrical stimulation system can be positioned on one or more circuit boards or similar carriers within a sealed housing of an implantable pulse generator, if desired. Any power source 712 can be used including, for example, a battery such as a primary battery or a rechargeable battery. Examples of other power sources include super capacitors, nuclear or atomic batteries, mechanical resonators, infrared collectors, thermally-powered energy sources, flexural powered energy sources, bioenergy power sources, fuel cells, bioelectric cells, osmotic pressure pumps, and the like including the power sources described in U.S. Pat. No. 7,437,193, incorporated herein by reference.
As another alternative, power can be supplied by an external power source through inductive coupling via the optional antenna 718 or a secondary antenna. The external power source can be in a device that is mounted on the skin of the user or in a unit that is provided near the user on a permanent or periodic basis.
If the power source 712 is a rechargeable battery, the battery may be recharged using the optional antenna 718, if desired. Power can be provided to the battery for recharging by inductively coupling the battery through the antenna to a recharging unit 716 external to the user. Examples of such arrangements can be found in the references identified above.
In one embodiment, electrical current is emitted by the electrodes 134 on the paddle or lead body to stimulate nerve fibers, muscle fibers, or other body tissues near the electrical stimulation system. The processor 704 is generally included to control the timing and electrical characteristics of the electrical stimulation system. For example, the processor 704 can, if desired, control one or more of the timing, frequency, strength, duration, and waveform of the pulses. In addition, the processor 704 can select which electrodes can be used to provide stimulation, if desired. In some embodiments, the processor 704 selects which electrode(s) are cathodes and which electrode(s) are anodes. In some embodiments, the processor 704 is used to identify which electrodes provide the most useful stimulation of the desired tissue.
Any processor can be used and can be as simple as an electronic device that, for example, produces pulses at a regular interval or the processor can be capable of receiving and interpreting instructions from an external programming unit 708 that, for example, allows modification of pulse characteristics. In the illustrated embodiment, the processor 704 is coupled to a receiver 702 which, in turn, is coupled to the optional antenna 718. This allows the processor 704 to receive instructions from an external source to, for example, direct the pulse characteristics and the selection of electrodes, if desired.
In one embodiment, the antenna 718 is capable of receiving signals (e.g., RF signals) from an external telemetry unit 706 which is programmed by the programming unit 708. The programming unit 708 can be external to, or part of, the telemetry unit 706. The telemetry unit 706 can be a device that is worn on the skin of the user or can be carried by the user and can have a form similar to a pager, cellular phone, or remote control, if desired. As another alternative, the telemetry unit 706 may not be worn or carried by the user but may only be available at a home station or at a clinician's office. The programming unit 708 can be any unit that can provide information to the telemetry unit 706 for transmission to the electrical stimulation system 700. The programming unit 708 can be part of the telemetry unit 706 or can provide signals or information to the telemetry unit 706 via a wireless or wired connection. One example of a suitable programming unit is a computer operated by the user or clinician to send signals to the telemetry unit 706.
The signals sent to the processor 704 via the antenna 718 and the receiver 702 can be used to modify or otherwise direct the operation of the electrical stimulation system. For example, the signals may be used to modify the pulses of the electrical stimulation system such as modifying one or more of pulse duration, pulse frequency, pulse waveform, and pulse strength. The signals may also direct the electrical stimulation system 700 to cease operation, to start operation, to start charging the battery, or to stop charging the battery. In other embodiments, the stimulation system does not include the antenna 718 or receiver 702 and the processor 704 operates as programmed.
Optionally, the electrical stimulation system 700 may include a transmitter (not shown) coupled to the processor 704 and the antenna 718 for transmitting signals back to the telemetry unit 706 or another unit capable of receiving the signals. For example, the electrical stimulation system 700 may transmit signals indicating whether the electrical stimulation system 700 is operating properly or not or indicating when the battery needs to be charged or the level of charge remaining in the battery. The processor 704 may also be capable of transmitting information about the pulse characteristics so that a user or clinician can determine or verify the characteristics.
The above specification provides a description of the manufacture and use of the invention. Since many embodiments of the invention can be made without departing from the spirit and scope of the invention, the invention also resides in the claims hereinafter appended.
This application is a continuation of U.S. patent application Ser. No. 16/132,018, filed Sep. 14, 2018, which issued as U.S. Pat. No. 11,045,656, which claims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Patent Application Ser. No. 62/559,195, filed Sep. 15, 2017, both of which are incorporated herein by reference.
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Number | Date | Country | |
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20210299454 A1 | Sep 2021 | US |
Number | Date | Country | |
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62559195 | Sep 2017 | US |
Number | Date | Country | |
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Parent | 16132018 | Sep 2018 | US |
Child | 17343559 | US |