U.S. patent number 3,738,368 [Application Number 05/097,987] was granted by the patent office on 1973-06-12 for implantable electrodes for the stimulation of the sciatic nerve.
This patent grant is currently assigned to Avery Laboratories, Inc.. Invention is credited to Roger E. Avery, James S. Wepsic.
United States Patent |
3,738,368 |
Avery , et al. |
June 12, 1973 |
IMPLANTABLE ELECTRODES FOR THE STIMULATION OF THE SCIATIC NERVE
Abstract
An electrode for the stimulation of the sciatic nerve is
disclosed, the electrode being comprised of a pair of
physiologically inert plastic strips each of which has a plurality
of contact means fixed thereto. The contact or electrode means
which preferably are formed of platinum comprise a plurality of
buttons positioned on opposite sides the sciatic nerve and are
oriented by the surgeon with respect to each other to achieve
optimum pain inhibition. When properly placed, the two plastic
members are suitably secured to each other. External power means
that are electrically coupled to the contact buttons by conductive
leads provide selective stimulation of the sciatic nerve in order
to relieve pain. The conductive leads for the contact buttons that
are not coupled to the source of electrical power are severed. The
aforementioned abstract is neither intended to define the invention
of the application which, of course, is measured by the claims, nor
is it intended to be limiting as to the scope of the invention in
any way.
Inventors: |
Avery; Roger E. (Melville,
NY), Wepsic; James S. (Jamaica Plains, NY) |
Assignee: |
Avery Laboratories, Inc.
(Farmingdale, NY)
|
Family
ID: |
22266078 |
Appl.
No.: |
05/097,987 |
Filed: |
December 14, 1970 |
Current U.S.
Class: |
607/117 |
Current CPC
Class: |
A61N
1/0553 (20130101) |
Current International
Class: |
A61N
1/05 (20060101); A61n 001/04 () |
Field of
Search: |
;128/2.6E,2.1E,404,411,410,418,419C,DIG.4 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Claims
What we claim as new and desire to secure by Letters Patent is:
1. A device implantable within a living body for the electrical
stimulation of the sciatic nerve, said device comprising the
combination of:
a. a first and second relatively thin strips of flexible,
electrically insulating material that is inert to body fluids and
tissues, each of said strips being defined by a pair of
longitudinally spaced end sections and a central section
therebetween, said central section being in a plane different from
at least one of said end sections, said respective end sections of
said first and said second strips, in use, being secured to each
other and said opposed central sections defining a recess
therebetween having an axis that is substantially perpendicular to
the longitudinal axis of said strips, said recess being adapted to
accommodate the sciatic nerve therein;
b. a plurality of substantially flat, button-like electrically
conductive electrode means secured to said central section of each
of said strips in said recess defined by the combination of said
opposed central sections whereby at least one of said electrode
means of each of said strips is adapted to directly contact the
sciatic nerve when said device is implanted; and
c. a plurality of conductive lead means secured to said central
section of each of said strips, said lead means being electrically
and physically coupled to said electrode means.
2. The device in accordance with claim 1 wherein each said lead
means is comprised of a platinum section secured to said electrode
means and a stainless steel section secured to said platinum
section.
3. The device in accordance with claim 1 wherein said electrode
means are each comprised of a cup-shaped member and means for
securing said cup-shaped member to said strip.
4. The device in accordance with claim 3 wherein said means for
securing said cup-shaped member to said strip comprises a staple
welded to said cup, said staple being crimped to said strip of
insulating material.
5. The device in accordance with claim 4 wherein each said strip
comprises a first layer to which said staple is crimped and a
second layer sealingly covering said first layer and the legs of
said staple, said second layer being remote from said electrode
means, said lead means extending through said first and second
layers for making electrical contact with said staple.
6. The device in accordance with claim 5 wherein said lead means
are encapsulated in an electrically insulating material that is
inert to body fluids and tissues, said encapsulating means
extending through at least said layer that is remote from said
electrode means.
7. The device in accordance with claim 6 further including sealing
means positioned about said encapsulating material in the area at
which said encapsulating material passes through said remote
layer.
8. The device in accordance with claim 1 wherein said electrode
means are rectangular in shape.
9. The device in accordance with claim 8 wherein said electrode
means are oriented with the longer dimension thereof at an angle
with respect to the length dimension of said strips.
10. The device in accordance with claim 1 wherein said strips are
molded with the end sections thereof in a common plane and the
central portion thereof intermediate said end section being in a
different plane.
11. The device in accordance with claim 1 wherein said lead means
are encapsulated in a flexible, electrically insulated material
that is inert to body fluids and tissues.
12. The device in accordance with claim 1 further including color
coding means for said lead means.
13. The device in accordance with claim 1 wherein said lead means
leave said strip at an angle with respect to the length dimension
thereof.
Description
This invention relates generally to an implantable electrode for
use in the human body and more particularly to an improved device
for stimulating the sciatic nerve.
BACKGROUND OF THE INVENTION
There are many different types of therapy that require surgical
procedures wherein electrodes are implanted in the body for
stimulating a selected nerve. Pain inhibition is an example of one
application wherein devices of the type that will be subsequently
described are a particularly advantageous therapeutic tool. A
source of power electrically coupled to the electrode may also be
implanted or an external source of power and a transmitter may be
utilized, together with an implanted receiver. Regardless of the
techniques that are used, it is absolutely essential that the body
be able to tolerate the foreign object for extended periods of
time.
The management of chronic, severe pain has historically been an
elusive and compromising problem for the physician. One example of
such pain is the "phantom pain" in an amputated extremity. Pain of
partial nerve injury due to trauma or vascular disease is also
difficult to deal with using traditional narcotics or
neuro-destructive procedures. Recently, however, researchers have
gained significant insight into the physiology of pain. From their
observation and from recent developments in the field of
neuro-stimulation, the physician now has means for controlling pain
by utilizing the body's own natural inhibiting mechanisms. The new
devices are beneficial in that they provide non-destructive means
for regulating pain without the systematic administration of drugs.
Electrical stimulation for the purpose of regulating or inhibiting
pain is non-destructive and permits great selectivity in relieving
severe pain in the desired region.
One of the problems encountered in developing an electrical
stimulator for the sciatic nerve resides in the fact that there are
really two nerve bundles in one, both of the bundles being covered
by a sheath system. There are also substantial differences in the
connective tissue and the relative positions of the two bundles as
well as the individual fibers within each bundle. For a surgeon
attempting to get at one series of fibers it is virtually
impossible to judge, from one person to the next, where to place
the point electrodes. Attempts made by the prior art structures to
solve this problem were not satisfactory.
The devices used in the past have generally consisted of a flat
strip of plastic material in which two contact buttons were
imbedded with conductive leads extending from the buttons to the
power source. The plastic strip was then wrapped around the sciatic
nerve such that the buttons were in opposition to each other with
the nerve therebetween. However, with the prior art structure there
was very little possibility for the surgeon to reorient the contact
buttons so as to change their relative position since the device
was made in one piece. Frequently, the buttons in the prior art
would be too far to one side or the other.
In the usage of the device comprising the present invention, a
curvilinear incision is made through the gluteus maximus over the
sciatic notch of the ilium. This allows stimulation of the sciatic
nerve at its most proximate point of exit from the pelvis. It is
useful to stimulate proximally to allow inhibition of pain for as
much of the leg as is possible. With the muscles and tissues
retracted the implant is sutured in place and the leads from the
electrode are connected directly to an external signal source to
allow direct stimulation of the nerve. Usually the patient can
tolerate this arrangement for several days allowing the surgeon to
electrically energize different combinations of electrodes to
achieve optimum relief in the proper location of the patient's
pain. When the most effective electrode sites are determined, the
remaining leads connected to the sites not to be stimulated are
severed and receiver means are implanted after connection to the
leads that have been selected for stimulation.
In its broadest aspect, the present invention comprises two
separate sections that are sutured together around the nerve after
they are appropriately aligned, with respect to each other. Each of
the sections comprises a plurality of platinum contact buttons,
each of the buttons having a platinum staple welded thereto. A
separate length of platinum wire is also welded to each staple and
button combination. Preferably, the contact button is concave with
the staple being positioned internally. A stainless steel lead wire
is then coupled to the platinum lead wire.
The present invention avoids dissimilar materials adjacent the
contact button. The platinum staple is secured to a relatively thin
strip of dacron mesh reinforced silicon rubber which is covered
with another layer of the same material, the platinum together with
the stainless steel lead wire, being encased in a plastic tube.
Preferably the leads are color coded so that the surgeon may know
the exact position of each electrode. A colored suture thread
inside the plastic tube is used for this purpose. It should also be
noted that the stainless steel lead wire is remote from the
platinum contact button and is insulated therefrom. Further, it is
to be understood that the term "plastic" in its present context
refers to a medical grade material that is an electrical insulator
and which is physiologically inert to body fluids and tissues.
As noted hereinabove, there are provided two of the aforementioned
assemblies, one on each side of the sciatic nerve, so that the
contact buttons are in opposition to each other. There are provided
in the preferred embodiment a total of eight contact buttons and
eight leads. As opposed to the prior art structure, the present
invention provides that the leads come out of the plastic layers at
an angle to the length thereof. This allows the leads to leave the
site of implantation in the proper plane of the overlying
musculature and to provide a more stable attachment of the
electrode to the nerve. In addition, it prevents stress on the
electrode-lead interface during exercise of the patient. As will be
explained hereinafter in making the implant it is necessary to
reach the site of implant through an opening located from a remote
point and at an angle to the sciatic nerve.
Accordingly, it is a primary object of the present invention to
provide an improved implantable device for stimulating a nerve by
means of electricity, whereby pain being sensed by that nerve is
inhibited.
Another object of this invention is to provide a device as
described above, particularly for use in conjunction with the
sciatic nerve, the device being made in two complimentary halves
that are sutured in place during surgery.
A further object of this invention is to provide an improved
implantable device for stimulating the sciatic nerve as described
above, the device including two halves each having a plurality of
electrodes whereby the electrodes in one of the halves may be
oriented with respect to the electrodes in the other half.
These and other objects, features and advantages of the invention
will, in part, be pointed out with particularity and will, in part,
become obvious from the following more detailed description of the
invention, taken in conjunction with the accompanying drawings,
which forms an integral part thereof.
DESCRIPTION OF THE DRAWING
In the drawing:
FIG. 1A is a pictorial showing of a portion of a human torso
showing in phantom the location of sciatic nerve;
FIG. 1B is a perspective, schematic view illustrating a typical
prior art structure;
FIG. 2 is an exploded, perspective view of a preferred embodiment
of the present invention;
FIG. 3 is a greatly enlarged, sectional elevational view of a
typical button contact and plastic strip assembly comprising the
present invention;
FIG. 4 is a schematic perspective view showing the relationship of
the present invention to a typical sciatic nerve;
FIG. 5A and 5B are cross sectional views showing the difference in
fat and asymmetry of two different sciatic nerves taken in the
buttock area;
FIG. 6 is a plan view of an alternative embodiment of the present
invention; and
FIG. 7 is a schematic view, typical of both embodiments
illustrating the improved selectivity of electrode position made
possible by the present invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT
In FIG. 1A there is shown a portion of the human body showing the
point A at which the curvilinear incision is made and the point B
where electrode connection is made to the sciatic nerve at its most
proximate point of exit from the pelvis. The surgeon performs the
actual implant through a "tunnel" through retracted muscle layers,
about five inches long. This tunnel is oriented at any acute angle
making implantation with the prior art structures used for
connection to peripheral nerves. A typical prior device is shown
schematically and in perspective in FIG. 1B.
The prior art device is comprised of a thin plastic strip 10 that
is adapted to be implanted in a human body. A pair of electrodes 12
are imbedded in the plastic strip 10 such that they, the electrodes
12, will be positioned in opposition to each other when the device
is installed, and adjacent the sciatic nerve designated by the
reference character S. A difficulty encountered with this form of
prior art device is that orientation of the electrodes 12 with
respect to each other and to specific fibers in the sciatic nerve
was virtually impossible because of the one-piece form of
construction. That is, it was necessary to wrap the one-piece
device about the nerve. At best, the surgeon could only compromise
with the optimum position of the device. As a result, the relief
from pain was not as complete as it could be.
There is shown in FIG. 2 and FIG. 3, the preferred embodiment of
the present invention. The implant 14 comprising the present
invention consists of two spacedly opposed strips 16 made of a
relatively thin, inert plastic material such as dacron mesh
reinforced with silicon rubber. A plurality of contact buttons or
electrodes 18 are imbedded in each of the strips 16, in a manner to
be described more fully hereinafter, and lead wires, generally
designated by the reference character 20, are electrically coupled
to the contact buttons. The leads 20 are positioned at an angle to
the length of the strips 16 and are color coded by any suitable
means such as colored suture thread or lumens.
Each of the strips 16 is preferably molded with a central section
16a and two laterally positioned end sections 16b, the central
section 16a being in a plane different from the end sections 16b so
that when the two strips 16 are positioned such as shown in FIG. 2,
there will be a central recess for the nerve, the recess being
defined by the spacedly opposed central sections 16a. The degree of
molded-in curvature will depend upon the thickness of the plastic
and the degree to which it can be made to envelope a portion of the
nerve. While the various sections have been shown as being
relatively flat and joined by angular portions 16c it should be
understood that the various sections may also be gentle curves.
Turning now to FIG. 3, the construction of a typical strip 16 and
the mounting of an electrode button 18 thereon will be described. A
staple 22 is welded at 24 to the inside surface of the cup-shaped
electrode button 18. A platinum lead wire 26 is welded to the
staple 22 as shown by the reference character 28. A stainless steel
lead wire 30 is then secured to the platinum lead wire 26 at
junction 32. A length of plastic 34, preferably medical grade
silicon or the like, encapsulates the combined lead wires 26 and
30.
The legs of the staple 22 are crimped over a first layer of plastic
36 which is the dacron mesh reinforced with silicon rubber
mentioned above, and a second layer 38 made of the same plastic
material, is adhesively secured to the layer 36. Sealing means 40
are positioned about the length of plastic 34 where that member
passes through the layer 38. As shown in FIG. 3, the outer surface
of the electrode button 18 makes a "kissing" contact with the
sciatic nerve that is labeled S.
The difficulties encountered in installing a neuro-stimulator for
the sciatic nerve will be more fully appreciated by reference to
FIGS. 4, 5A and 5B. As shown particularly in FIGS. 5A and 5B, there
are substantial differences in the cross section of the sciatic
nerve, for example as taken in the buttock area. There are
differences as to the connective tissues surrounding the nerve as
well as the asymmetry of the nerve. Accordingly, it was very
difficult for the surgeon to select the most effective location for
opposed electrodes. With the prior art electrodes the surgeon had
very little mechanical leeway in locating the electrode contact
points. By use of the present invention, the surgeon may now
position the two strips 16 on opposite sides of the sciatic nerve
and then move them about relative to each other. It should be noted
that eight leads 20 are shown. When the surgeon has determined the
two or more contacts that will provide a maximum of relief from
pain, the remaining leads may either be severed or connected to a
steerable system such as a transmitter with a switching circuit.
When the optimum position of the contacts has been established by
the temporary expedient described hereinabove and the unused leads
have been severed, the device together with receiver means may be
sutured in place. When using the steerable system, the leads are
brought out through the skin for connection to a suitable source of
electrical energy.
Average dimensions a and b have been established by study of
cadavers at 12.5 millimeters and 5.25 millimeters respectively, for
the sciatic nerve in the area of the buttocks. At mid-thigh, the
same dimensions a and b, on an average, are 11.5 millimeters and
4.5 millimeters respectively. Thus, it may be seen that there is a
wide deviation from patient to patient, and without means for
orienting the opposed electrodes with respect to each other, the
problems encountered by the surgeon for providing maximum relief
from pain are greatly enlarged.
An alternative embodiment of the present invention is shown in FIG.
6. Instead of aligning the contact or electrode buttons 18 as
previously shown in FIG. 2, electrode buttons 50 are positioned
along a line that is at an angle with respect to the longitudinal
axis of each strip 16'. All of the components of the invention
remain the same as described hereinabove. The arrangement as shown
in FIG. 6 provides increased selectivity for the surgeon when he
moves one of the strips 16' in relation to the other strip 16'.
FIG. 7 is used to show the mathematically possible combinations of
electrode pairs that are available to the surgeon. Electrodes c, d,
e and f are on one plastic strip 16 and opposed electrodes c' , d'
, e' and f' are on the other strip 16'. Thus there are 32 possible
combinations of single pairs of electrodes and if pairs are taken
in combination a much greater number of possibilities exists,
whereas in the prior art structure shown in FIG. 1, there is only
one pair of electrodes available. Six further combinations of
electrode pairs are available if both electrodes that are
ultimately connected to the receiver means are on the same plastic
strip. This last mentioned arrangement is a distinct possibility
depending on the nerve fiber to be stimulated and/or the
relationship of the surrounding tissue.
While a specific number of contact buttons or electrodes have been
shown for each of the two embodiments, it should be clearly
understood that the invention is not so limited. Three and four
contacts have been illustrated merely for purposes of convenience.
Further, while the contacts or electrode buttons 18 have been shown
to be rectangular in area, with rounded corners, it should also be
understood that other shapes such as oval, ellipses, etc., may be
employed within the scope of this invention.
There has been disclosed heretofore the best embodiment of the
invention presently contemplated. However, it is to be understood
that various changes and modifications may be made by those skilled
in the art without departing from the spirit of the invention.
* * * * *