UA134741U - METHOD OF INVASIVE ELECTROSTIMULATION OF THE SPINAL CRAIN - Google Patents

Abstract

The method of invasive electrical stimulation of the spinal cord is a method of neurosurgical treatment of patients with spinal cord injuries with complete or partial violation of the physiological conductivity of the spinal cord in acute and remote periods of traumatic spinal cord disease. Patients with spinal cord injuries after anterior decompression of the spinal cord are placed six receiving electrodes in the epidural space on the dura mater above the anterior parts of the spinal cord above the level of its damage. Six stimulating electrodes are placed puncture and epidurally in the area of the posterior columns of the spinal cord below the level of its damage. The indifferent electrode is installed epidurally at a distance of 10-15 cm from the six receiving electrodes. Next, a specially designed device (bypass) for physiological impulses (which can not pass independently through the area of spinal cord injury) consistently conduct electrical stimulation first anterior (efferent conductive pathways), then posterior (afferent conductive pathways), and then simultaneously - posterior and anterior spines brain. Thus, with the help of this device, the biopotentials above the area of spinal cord injury are removed and transmitted to the spinal cord below the area of injury.

Description

The useful model belongs to medicine, in particular to neurosurgery, neurotraumatology, and can be used for the treatment of vertebral-spinal cord injuries with complete disruption of conduction as a result of complicated spinal fractures with compression and/or gross injury (anatomical interruption) of the spinal cord in the acute period of traumatic

B diseases.

An analogue is the method of treating patients with the consequences of damage to the spinal cord (author. St. ZU

Mo. 1512625, AbITM 1/36, dated 07.21.87, publ. in Bull. Mo. 37 of 1989 dated 07.10.89), which includes laminectomy, resection of bone fragments compressing the spinal cord from the back, thereby carrying out posterior decompression, intraoperative introduction of electrodes to the posterior parts of the spinal cord, while the electrodes are placed on the lateral surfaces of the lumbar thickening of the spinal cord brain below the level of its damage, and plates with a diameter of 0.2-0.3 mm and a length corresponding to the size of the segments of the spinal cord that innervate the lower extremities serve as electrodes, while electrical stimulation is started after the sutures are removed on the 9th-12th day. Electrical stimulation of the spinal cord is carried out in the following modes: bell-shaped pulses with a duration of 1-5 ms, a filling frequency of 4-10 kHz, a frequency of 8-12 Hz and a voltage of 13-20 V. The disadvantages of this method are the implementation of electrical stimulation of only the posterior parts of the spinal cord, which does not allows you to effectively and fully influence the efferent pathways and the segmental apparatus of the spinal cord, and the use of electrodes-plates in the subdural space can cause cerebrospinal fluid and the development of meningitis, as well as other purulent complications.

The basis of a useful model is the task of developing such a method of invasive electrostimulation of the spinal cord, which will allow to obtain more opportunities for the rehabilitation of patients with spinal cord injury by normalizing the function of the pelvic organs as a result of improving the coordination of the work of the spinal centers, improving sensitivity and movements below the corresponding zone of spinal cord damage.

The task is solved by the fact that, according to a useful model, in patients with vertebral and spinal cord injuries, after anterior decompression of the spinal cord, six receiving electrodes (1-6) are installed in the epidural space on the dura mater above the anterior parts of the spinal cord above the level of its damage and six stimulating

Of the electrodes (11-16), they are installed puncture- and epidurally in the area of the posterior columns of the spinal cord below the level of its damage, the indifferent electrode (19) is installed epidurally at a distance of 10-15 cm from the six receiving electrodes (1-6), then with a specially designed device ( bypass) for physiological impulses (which cannot pass independently through the spinal cord damage zone) sequentially carry out electrical stimulation first of the front (efferent conduction paths), then the back (afferent conduction paths), and then simultaneously - the back and front sections of the spinal cord, thus, with the help of this device, biopotentials above the zone of spinal cord damage are removed and transferred to the spinal cord below the zone of damage.

The method is performed as follows.

After anterior decompression of the spinal cord, six receiving electrodes (1-6) are placed intraoperatively in the epidural space on the dura mater above the anterior parts of the spinal cord above the level of its damage and are connected through the input switch (7) to the biopotential amplifier (8), and the indifferent electrode (19) are installed epidurally at a distance of 10-15 cm from six receiving electrodes (1-6). Stimulating six electrodes (11-16) coming from the analog-to-digital converter (9) are set below the level of damage to the dura mater, which is stimulated with electrical impulses that are proportional in magnitude to the biopotentials registered from the receiving electrodes (1-6). set above the level of spinal cord injury. Next, with a device specially developed by the authors (bypass) for physiological impulses (which cannot pass independently through the spinal cord damage zone), electrostimulation is carried out sequentially, first of the front (efferent conduction pathways), then of the back (afferent conduction pathways), and then simultaneously - of the posterior and anterior sections spinal cord Thus, with the help of this device, biopotentials above the spinal cord damage zone are removed and transferred to the spinal cord below the damage zone, thanks to which the period of stimulating pulses corresponds to the duration of biopotentials recorded from the electrodes that remove the biopotential.

The course of treatment depends on the degree of damage to the spinal cord: with partial damage, electroimpulse treatment is carried out for 4-8 weeks, with gross damage (complete anatomical interruption) - for life, that is, long-term, chronically, for many months and years.

Thus, the damaged area of the spinal cord below the level of the damage is stimulated with electrical impulses that are proportional to the value of the biopotential registered from each of the receiving electrodes (1-6) installed above the level of the spinal cord damage. Thanks to this, the duration of the biopotentials recorded from six receiving electrodes (1-6) that capture the biopotential are ensured to correspond to the period of the stimulating pulses. Parameters of electroimpulse impact: the lower parts correspond to a current amplitude of 20-25 μA, the frequency of pulses is determined in strict accordance with the registration of biopotentials coming from receiving electrodes (1-6) located on the dura mater above the level of damage. Since when installing stimulating electrodes (11-16) it is impossible to know in advance the degree of damage to neurons below the level of spinal cord damage, the existing problem is solved by sending packets of stimulating impulses to the lower part of the spinal cord, which, in turn, allows to significantly increase stimulation more neurons below the level of spinal cord injury. Installation of electrodes on the dura mater connecting the upper intact part of the spinal cord with the lower damaged part of the spinal cord contributes to the restoration of feedback from the upper parts of the central nervous system to the periphery. The device that generates pulses for electrical stimulation is installed subcutaneously in the area closest to the site of the spinal cord injury.

For more effective electrical stimulation, a device specially developed by the authors is used, which functions as follows. Reception electrodes (1-6) are applied to the dura mater above the level of the spinal cord injury. The input commutator (7) supplies the biopotential amplifier (8) with a signal coming from each of the receiving electrodes (1-6). The amplified signal is fed in the same sequence to the analog-to-digital converter (9). The output voltage from the output switch (10) is transmitted to the stimulating electrodes (11-16), which are placed on the dura mater below the level of the spinal cord injury. The output commutator (10) is connected to the stimulating electrodes (11-16) with a variable frequency from 5 to 40 Hz. The analog-to-digital converter (ADC) (9) ensures the transmission of a wide range of signals from the receiving electrodes (1-6) to the stimulating electrodes (11-16), which ensures the transmission of signals to the spinal cord in a fairly wide frequency range, which in turn ensures stimulating effect on the maximum possible number of neurons located in the area of action of one electrode. In order to carry out continuous operation of the implanted part of the device for the longest possible time, a power supply unit is built into it

Zo (17), consisting of a battery and a converter with a Hall sensor, which allows you to turn on and off the stimulator remotely. Long-term operation of the implanted part of the device is ensured by the possibility of recharging the battery once a month for 30 minutes. Recharging is carried out with the help of a recharging device (18), which the patient can independently place in the place indicated to him above the implanted part of the device. The charger (18) is powered by a battery with a voltage of 4.7 V, so it does not pose any danger to the patient. The sub-charger (18) is charged from the AC mains using a standard 5V charger.

In Fig. 1 shows the block diagram of the device used in the implementation of the proposed method, where: 1-6 - receiving electrodes; 7 - input switch; 8 - amplifier of biopotentials; 9 - ADC; 10 - output switch; 11-16 - stimulating electrodes; 17 - power supply unit with a Hall sensor; 18 - charger; 19 - indifferent electrode.

Figure 2 shows a graphic interpretation of the operation of the device when performing the proposed method, where: a - a graphic interpretation of the passage of information about biopotentials registered from the upper part of the spine; c - the path of movement of information from the receiving electrodes to the transmitting electrodes, which are installed on the lower part of the dura mater; c - the path connecting the lower parts of the spine with the upper electrodes; a - the path connecting the lower parts of the dura mater with the upper parts; e - graphic interpretation of biopotentials coming from the biopotential amplifier;

Ii - a graphic scheme of stimulating impulses going from the ADC to the lower parts of the dura mater.

The proposed method of treatment makes it possible to move to a new level and quality of treatment of patients with vertebral and spinal cord injury with complete disruption of conduction (with complicated spinal fractures, with compression, gross damage and/or rupture (anatomical break) of the spinal cord) in the acute and late period of traumatic diseases due to the use of rational placement schemes of electrodes and potentials, sequences and modes of electrical stimulation.

The medical and social effectiveness of the method consists in improving the quality of life of patients with the consequences of spinal cord injury; by normalizing the function of the pelvic organs as a result of improving the coordination of the work of the spinal centers, improving the sensitivity and movements below the corresponding area of the spinal cord lesion.

In comparison with the analogue, the proposed method has the following advantages: the electric impulse effect is not carried out differentially, but below the level of damage, the frequency of stimulating pulses is set synchronously with the registration of biopotentials by each of the electrodes installed above the level of damage; the technique uses a device that is a kind of bypass (Bu raz5) for physiological impulses that cannot pass through the spinal cord damage zone, that is, one that removes biopotentials above the spinal cord damage zone and transmits them to the spinal cord below the damage zone; in this way, physiological impulses traveling along the spinal cord can bypass the spinal cord injury zone; in this method, electrical impulses are sent to the posterior parts of the spinal cord in packets, the frequency of which corresponds to the speed of the ADC, which corresponds to a 12-bit conversion of information, for example, if the duration of the biopotential registered from the upper part of the spine is 0.3 msec., then it is the duration of the stimulating effect; in this technique, biopotentials from the lower part of the spine are transferred to the upper part, as a response to the stimulating effect on other electrodes: in case of any damage to the spinal cord, stimulation can be continued for a long time, and if necessary, it can be blocked externally, thanks to the use of a rechargeable block in the implanted device feeding.

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Claims (1)

USEFUL MODEL FORMULA The method of invasive electrical stimulation of the spinal cord, which is a method of neurosurgical treatment of patients with spinal cord injuries with complete or partial violation of the physiological conduction of the spinal cord in the acute and remote periods of traumatic spinal cord disease, which differs from that in patients with spinal cord injuries after anterior decompression of the spinal cord, six receiving electrodes (1-6) are placed in the epidural space on the dura mater above the anterior parts of the spinal cord above the level of its damage, and six stimulating electrodes (11-16) are placed punctured and epidurally in the region of the posterior columns of the spinal cord below level of its damage, an indifferent electrode (19) is installed epidurally at a distance of 10-15 cm from six receiving electrodes (1-6), then a specially designed device (bypass) for physiological impulses (which cannot pass independently through the spinal cord damage zone) by electrostimulation is carried out sequentially, first of the front (efferent conductive paths), then of the rear (afferent conductive paths), and then simultaneously - of the posterior and anterior parts of the spinal cord, thus, with the help of this device, biopotentials above the zone of damage to the spinal cord are removed and transferred to the spinal cord below the damage zone.