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 introducer needles configured and arranged for concurrently implanting multiple electrical stimulation leads into a patient, as well as methods of making and using the introducer needles, leads, and electrical stimulation systems.
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.
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.
In one embodiment, a multi-lead introducer for facilitating implantation of at least one electrical stimulation lead includes a needle assembly configured and arranged to concurrently implant a plurality of leads into a patient. The needle assembly includes a first needle having a first end, an opposing second end, and a longitudinal length. The first needle defines a first needle lumen extending along the longitudinal length of the first needle from the first end to the second end. The first needle lumen is configured and arranged to receive a first lead of the plurality of leads. A first sharpened tip is disposed along the first end of the first needle. The first sharpened tip is configured and arranged to pierce patient tissue. A second needle has a first end, an opposing second end, and a longitudinal length. The second needle defines a second needle lumen extending along the longitudinal length of the second needle from the first end to the second end. The second needle lumen is configured and arranged to receive a second lead of the plurality of leads. A second sharpened tip is disposed along the first end of the second needle. The second sharpened tip is configured and arranged to pierce patient tissue. A hub is coupled to both the second end of the first needle and the second end of the second needle. The hub defines at least one hub lumen that is in communication with both the first needle lumen and the second needle lumen. The at least one hub lumen is configured and arranged to concurrently receive both the first lead and the second lead.
In another embodiment, a multi-lead introducer for facilitating implantation of at least one electrical stimulation lead includes a needle assembly configured and arranged to concurrently implant a plurality of leads into a patient. The needle assembly includes a single needle having a first end, an opposing second end, and a longitudinal length. The single needle defines a single needle lumen extending along the longitudinal length of the single needle from the first end to the opposing second end. The single needle lumen is configured and arranged to concurrently receive both a first lead and a second lead of the plurality of leads. A sharpened tip is disposed along the first end of the single needle. The sharpened tip is configured and arranged to pierce patient tissue. A hub is coupled to the second end of the single needle. The hub defines at least one hub lumen that is in communication with the single needle lumen. The at least one hub lumen is configured and arranged to concurrently receive both the first lead and the second lead.
In yet another embodiment, a multi-lead introducer for facilitating implantation of at least one electrical stimulation lead includes a needle assembly configured and arranged to concurrently implant a plurality of leads into a patient. The needle assembly includes a single needle having a first end, an opposing second end, and a longitudinal length. The single needle defines a first needle lumen and a second needle lumen. Each of the first needle lumen and the second needle lumen extends along the longitudinal length of the single needle from the first end to the second end. The first needle lumen is configured and arranged to receive a first lead the plurality of leads. The second needle lumen is configured and arranged to receive a second lead the plurality of leads. A sharpened tip is disposed along the first end of the single needle. The sharpened tip is configured and arranged to pierce patient tissue. A hub is coupled to the second end of the single needle. The hub defines at least one hub lumen that is in communication with each of the first needle lumen and the second needle lumen. The at least one hub lumen is configured and arranged to concurrently receive both the first lead and the second lead.
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 introducer needles configured and arranged for concurrently implanting multiple electrical stimulation leads into a patient, as well as methods of making and using the introducer needles, leads, and electrical stimulation systems.
Suitable implantable electrical stimulation systems include, but are not limited to, a least one lead with one or more electrodes disposed on a distal end of the lead and one or more terminals disposed on 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; 7,244,150; 7,672,734; 7,761,165; 7,949,395; 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.
The control module 102 typically includes an electronic subassembly 110 and an optional power source 120 disposed in a sealed housing 114. The control module 102 typically includes a connector 144 (
The electrical stimulation system or components of the electrical stimulation system, including 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, 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. The number of electrodes 134 in each array 133 may vary. For example, there can be two, four, six, eight, ten, twelve, fourteen, sixteen, or more electrodes 134. As will be recognized, other numbers of electrodes 134 may also be used.
The electrodes of 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 lead bodies 106 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 end of the one or more lead bodies 106 to the proximal end of each of the one or more lead bodies 106.
Terminals (e.g., 210 in
The conductor wires 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 wire. In other embodiments, two or more conductor wires may extend through a lumen. There may also be one or more lumens (not shown) that open at, or near, the proximal end of the lead body 106, for example, for inserting a stylet wire to facilitate placement of the lead body 106 within a body of a patient. Additionally, there may also be one or more lumens (not shown) that open at, or near, the distal end of the lead body 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 may be flushed continually, or on a regular basis, with saline, epidural fluid, or the like. In at least some embodiments, the one or more lumens can be permanently or removably sealable at the distal end.
In at least some embodiments, leads are coupled to connectors disposed on control modules. In
In
In at least some embodiments, the proximal end of a lead extension is similarly configured and arranged as a proximal end of a lead. The lead extension 224 may include a plurality of conductive wires (not shown) that electrically couple the conductive contacts 240 to a proximal end 248 of the lead extension 224 that is opposite to the distal end 226. In at least some embodiments, the conductive wires disposed in the lead extension 224 can be electrically coupled to a plurality of terminals (not shown) disposed on the proximal end 248 of the lead extension 224. In at least some embodiments, the proximal end 248 of the lead extension 224 is configured and arranged for insertion into a connector disposed in another lead extension. In other embodiments, the proximal end 248 of the lead extension 224 is configured and arranged for insertion into a connector disposed in a control module. As an example, in
In at least some situations, it may be advantageous to implant two or more leads into the patient to expand stimulation coverage from what might be achievable using a single lead. For example, in at least some instances it may be desirable to stimulate a patient along two or more regions in proximity to one another, or along a single region that is larger than might be stimulated using a single lead.
In the case of implantation of multiple percutaneous leads, when a conventional lead introducer needle is used to individually implant each of the multiple leads patient skin may be separately pierced by the introducer needle during each individual lead implantation, thereby potentially causing extended pain and anxiety for the patient. Additionally, once each of the individual leads is inserted into the patient, significant time and effort may be spent aligning the leads with one another into a desired stimulation arrangement (e.g., side-by-side, end-to-end, or the like).
As herein described, a multi-lead introducer enables concurrent implantation of multiple percutaneous leads into the patient using a single lead introducer. In at least some embodiments, the multi-lead introducer enables implantation of multiple percutaneous leads using only a single patient skin pierce. In at least some embodiments, the multi-lead introducer enables implantation of two or more leads, where each of the two or more leads is aligned side-by-side with one another when the leads are inserted. In which case, post-insertion alignment of the leads may be easier when the leads are implanted using the multi-lead introducer than when the leads are individually implanted using a conventional introducer needle.
Turning to
The multi-lead introducer 300 includes a needle assembly 301 having a proximal end 304 and a distal end 306. A hub 320 is coupled to the proximal end 304 of the needle assembly 301. In
In at least some embodiments, the needles 312a and 312b are positioned in a side-by-side arrangement. In at least some embodiments, the needles 312a and 312b are in physical contact with one another along at least a portion of the longitudinal length of the needle assembly 301, while in at least some other embodiments the needles 312a. and 312b are positioned with a gap between the needles 312a and 312b such that the needles 312a and 312b do not physically touch one another along the entire longitudinal length of the needle assembly 301. It will be understood that, although the needles may or may not physically contact one another along the longitudinal length of the needle assembly 301, the needles 312a and 312b are each physically coupled to the hub 320 at the proximal end 304 of the needle assembly.
The needles 312a and 312b can be formed from any material suitable for implantation including, for example, one or more metals (e.g., stainless steel, Nitinol™, titanium, or the like), one or more alloys, one or more plastic resins, or the like. Each of the needles of the needle assembly 301 defines one or more needle lumens extending from the proximal end 304 to the distal end 306. In
The needles 312a and 312b have any selected bore size suitable for receiving a lead (see e.g., 103 in
Any suitable huh 320 may be coupled to the needle assembly 301. In
The hub 320 is configured and arranged to simultaneously receive multiple leads so that each different lead of the multiple leads can be simultaneously extended through the hub 320 and inserted into the one or more needle lumens. In at least some embodiments, the hub 320 defines a single hub lumen configured to concurrently receive multiple leads (see e.g., 890 in
The hub 320 can be formed from any material suitable for implantation including, for example, one or more metals (e.g., stainless steel, Nitinol™, titanium, or the like), one or more alloys, one or more plastic resins, or the like. Other molding or formation techniques can also be used. The hub 320 can be coupled to the one or more needles in any suitable manner including, for example, welding, bonding, brazing, insert molding (e.g., using an insert molded thermoplastic), or the like or combinations thereof.
In at least some embodiments, the hub 320 includes a mating male Luer tip syringe configured and arranged for injecting or withdrawing fluid or air during insertion of the multi-lead introducer. For example, during insertion of the multi-lead introducer, fluid (e.g., saline solution, air, or the like) may be introduced or removed through the luer hub 320 to check for positioning of the multi-lead introducer 300 (e.g., in an epidural space of the patient).
Optionally, the multi-lead introducer includes one or more stylets 330 (
In
The stylet 330 can be formed from any material suitable for implantation including, for example, one or more metals (e.g., stainless steel, Nitinol™, titanium, or the like), one or more alloys, one or more plastic resins, or the like.
The stylet handle (or handles) 334 can be formed from any material suitable for implantation including, for example, one or more metals (e.g., stainless steel, Nitinol™, titanium, or the like), one or more alloys, one or more plastic resins, or the like. In at least some embodiments, the stylet handle 334 is insert molded onto a metal stylet(s) using an insert molded thermoplastic.
The multi-lead introducer can be inserted into the patient in proximity to a target stimulation location (e.g., the epidural space of the patient). Optionally, the stylet(s) are inserted into the needle assembly to reduce the risk of tissue coring. The needle assembly and stylet(s) are inserted into the patient and guided into proximity of the target stimulation location.
Once the needle assembly and stylet(s) are in proximity to a target stimulation location, the positioning of the needle assembly may be checked. The positioning of the needle assembly may be checked in any suitable manner, such as by introducing or removing fluid through the luer hub 320 (e.g., performing a loss of resistance test), imaging (e.g., via fluoroscopy, magnetic resonance imaging, or the like) the patient with or without introducing one or more contrast agents into the patient, or using the electrodes of the lead (or another insertable stimulation device) to stimulate surrounding patient tissue.
Once the needle assembly and stylet(s) are in proximity to the target stimulation location, the stylet(s) 330 are removed and the leads are advanced along the needle assembly. The leads can be advanced along the needle assembly either sequentially or concurrently. It may be advantageous for the leads to be physically separated from one another when the leads are advanced out from the distal end of the needle assembly and into the patient so that the leads can be moved independently of one another when positioning the leads within the patient.
Turning to
In at least some embodiments the multi-lead introducer includes one or more needle couplers disposed over the needles to modulate physical coupling between the individual needles, along the longitudinal lengths of the needles. In at least some embodiments, the needle coupler 402 is configured and arranged to prevent, or hinder, the distal tips of the needles from spreading away from each other during handling/insertion.
In at least some embodiments, the needle coupler 402 is disposed over a portion of the distal end 306 of the needle assembly 301 such that the needle coupler 402 is coupled to each of the needles of the needle assembly. In at least some alternate embodiments, the needle coupler 402 is coupled to less than all of the needles of the needle assembly. The needle coupler 402 can be coupled to the needle assembly in any suitable manner. In at least some embodiments, the needle coupler 402 is press-fit over the needle assembly.
In at least some embodiments, the needle couple 402 is configured and arranged to slidably move along the longitudinal length of the needle assembly 301. In at least some embodiments, the needle coupler 402 is initially positioned at the distal end 306 of the needle assembly 301 to maintain the needles 312a, 312b in close proximity to one another during insertion, and moves proximally during insertion by the pressure exerted on the needle coupler 402 by the patient's skin.
The needle coupler 402 can be formed from any suitable material including, for example, an elastomer (e.g., rubber, silicone, plastic resin, stamped metal, a wire spring element, or the like or combinations thereof). In at least some embodiments, the needle coupler 402 maintains attachment to the needle assembly 301, while also being slidably moveable along the longitudinal length of the needle assembly 301 during insertion into the patient.
Turning to
The distal tip insert 502 can be formed from any hard material that is suitable for tissue cutting/dissection. In at least some embodiments, the distal tip insert 502 is formed from a metal that is capable of being joined (e.g., welded) to the needles. Such a configuration may improve manufacture by simplifying manufacture, or reducing the cost of manufacture, or both.
The distal tip insert 502 can be either temporary or permanent. The distal tip insert 502 can be coupled to the distal tips of the individual needles in any suitable manner including, for example, friction fit, adhesive, welding, brazing, or the like or combinations thereof.
Turning to
Turning to
Additionally, the needle lumen 714 is also configured and arranged to receive the stylet rod 732. For example, during an implantation procedure the needle 702 may be inserted into the patient while the stylet rod 732 is disposed in the needle lumen 714.
In at least some embodiments, the transverse shape of the stylet rod 732 is similar to the transverse shape of the needle lumen 714. In
Turning to
As discussed above, in at least some embodiments the divider 852 is configured and arranged to be removable so that the divider 852 is disposed in the needle assembly 701 when the leads are disposed in the needle assembly 701 to physically separate the leads from one another, but not present in the needle assembly 701 when the stylet rod 832 is disposed in the needle assembly 701.
Turning to
It will be understood that, in alternate embodiments of the retention assembly 866 the tabs are disposed in needle lumen 814 and the slots are defined along the divider 852, or the stylet rod 832, or both. In at least some other embodiments, the needle lumen 814 and at least one of the divider 852 or the stylet rod 832 includes both at least one slot and at least one tab.
In at least some embodiments, the retention assembly includes apertures and protrusions configured to mate with the apertures.
In
In at least some embodiments, the element of the retention assembly 866 disposed along the needle assembly 701 is disposed, either partially or entirely, along the hub of the needle assembly.
In embodiments where the needle lumen 814 does not include slots (as is shown in
It will be understood that, in alternate embodiments, the tabs are disposed in the hub lumen 890 and the slots are defined along the divider 852. In at least some other embodiments, each of the hub lumen 890 and the divider 852 includes both at least one slot and at least one tab.
In at least some embodiments, the element of the retention assembly 866 disposed along the needle assembly 701 is disposed, either partially or entirely, external to the needle assembly.
In
Optionally, in at least some embodiments the needle assembly includes one or more bends.
The bend 902 is configured and arranged to alter the approach angle of the needle assembly 701 during lead implantation. In at least some embodiments, altering the approach angle of the needle assembly 701 facilitates lead implantation. The bend 902 can be any suitable angle. In at least some embodiments, the bend 902 is at least 5°. In at least some embodiments, the bend 902 is no greater than 20°. In at least some embodiments, the bend 902 is at least 5° and no greater than 15°, it will be understood that the bend 902 can be formed along any of the disclosed embodiments of the needle assembly. It will also be understood that the needle assembly may include additional bends, as desired.
Some of the components (for example, power source 1012, antenna 1018, receiver 1002, and processor 1004) 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 1012 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 1018 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 1012 is a rechargeable battery, the battery may be recharged using the optional antenna 1018, if desired. Power can be provided to the battery for recharging by inductively coupling the battery through the antenna to a recharging unit 1016 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. A processor 1004 is generally included to control the timing and electrical characteristics of the electrical stimulation system. For example, the processor 1004 can, if desired, control one or more of the timing, frequency, strength, duration, and waveform of the pulses. In addition, the processor 1004 can select which electrodes can be used to provide stimulation, if desired. In some embodiments, the processor 1004 may select which electrode(s) are cathodes and which electrode(s) are anodes. In some embodiments, the processor 1004 may be 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 1508 that, for example, allows modification of pulse characteristics. In the illustrated embodiment, the processor 1004 is coupled to a receiver 1002 which, in turn, is coupled to the optional antenna 1018. This allows the processor 1004 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 1018 is capable of receiving signals (e.g., RF signals) from an external telemetry unit 1006 which is programmed by a programming unit 1008. The programming unit 1008 can be external to, or part of, the telemetry unit 1006. The telemetry unit 1006 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 1006 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 1008 can be any unit that can provide information to the telemetry unit 1006 for transmission to the electrical stimulation system 1000. The programming unit 1008 can be part of the telemetry unit 1006 or can provide signals or information to the telemetry unit 1006 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 1006.
The signals sent to the processor 1004 via the antenna 1018 and receiver 1002 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 1000 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 an antenna 1018 or receiver 1002 and the processor 1004 operates as programmed.
Optionally, the electrical stimulation system 1000 may include a transmitter (not shown) coupled to the processor 1004 and the antenna 1018 for transmitting signals back to the telemetry unit 1006 or another unit capable of receiving the signals. For example, the electrical stimulation system 1000 may transmit signals indicating whether the electrical stimulation system 1000 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 1004 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, examples and data provide a description of the manufacture and use of the composition 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 claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 61/679,620 filed on Aug. 3, 2012, which is incorporated herein by reference.
Number | Date | Country | |
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61679620 | Aug 2012 | US |