Systems, devices and methods are provided for neuromonitoring, particularly neuromonitoring to reduce the risks of contacting or damaging nerves or causing patient discomfort during and after surgical procedures, including spinal surgeries. The neuromonitoring procedures include monitoring for the presence of or damage to sensory nerves, and optionally includes additional monitoring for motor nerves. In some systems, including systems that monitor for both sensory and motor nerves, components of the monitoring systems (e.g., stimulating electrodes and response sensors), may be combined with one or more surgical instruments. The systems, devices, and methods provide for pre-surgical assessment of neural anatomy and surgical planning, intraoperative monitoring of nerve condition, and post-operative assessment of nerve position and health.

Systems, devices and methods are provided for neuromonitoring, particularly neuromonitoring to reduce the risks of contacting or damaging nerves or causing patient discomfort during and after surgical procedures, including spinal surgeries. The neuromonitoring procedures include monitoring for the presence of or damage to sensory nerves, and optionally includes additional monitoring for motor nerves. In some systems, including systems that monitor for both sensory and motor nerves, components of the monitoring systems (e.g., stimulating electrodes and response sensors), may be combined with one or more surgical instruments. The systems, devices, and methods provide for pre-surgical assessment of neural anatomy and surgical planning, intraoperative monitoring of nerve condition, and post-operative assessment of nerve position and health.

An automated method of controlling neural stimulation. A neural stimulus is applied to a neural pathway in order to give rise to an evoked action potential on the neural pathway, and the stimulus is defined by at least one stimulus parameter. A neural compound action potential response evoked by the stimulus is measured. From the measured evoked response a feedback variable such as observed ECAP voltage (V) is derived. A feedback loop is completed by using the feedback variable to control the at least one stimulus parameter value for a future stimulus. The method adaptively compensates for changes in a gain of the feedback loop caused by electrode movement relative to the neural pathway. A compensating transfer function is applied to the feedback variable, the compensating transfer function being configured to compensate for both (i) a distance-dependent transfer function of stimulation, and (ii) a distance dependent transfer function of measurement which is distinct from (i).

An automated method of controlling neural stimulation. A neural stimulus is applied to a neural pathway in order to give rise to an evoked action potential on the neural pathway, and the stimulus is defined by at least one stimulus parameter. A neural compound action potential response evoked by the stimulus is measured. From the measured evoked response a feedback variable such as observed ECAP voltage (V) is derived. A feedback loop is completed by using the feedback variable to control the at least one stimulus parameter value for a future stimulus. The method adaptively compensates for changes in a gain of the feedback loop caused by electrode movement relative to the neural pathway. A compensating transfer function is applied to the feedback variable, the compensating transfer function being configured to compensate for both (i) a distance-dependent transfer function of stimulation, and (ii) a distance dependent transfer function of measurement which is distinct from (i).

A system comprises a neuromonitoring system configured to generate nerve data regarding a state of a nerve of a patient during a surgical procedure on the patient. The system includes a robotic system configured to receive or generate, for the surgical procedure, location data that identifies a location of the nerve of the patient. The robotic system may cause the neuromonitoring system to be in either an active state or an inactive state based on the location data, where the active state is a state in which the neuromonitoring system provides the nerve data to the robotic system, while the inactive state is a state in which the neuromonitoring system does not provide the nerve data to the robotic system. The robotic system may further generate at least one control signal that implements one or more safeguards for the surgical procedure.

A system comprises a neuromonitoring system configured to generate nerve data regarding a state of a nerve of a patient during a surgical procedure on the patient. The system includes a robotic system configured to receive or generate, for the surgical procedure, location data that identifies a location of the nerve of the patient. The robotic system may cause the neuromonitoring system to be in either an active state or an inactive state based on the location data, where the active state is a state in which the neuromonitoring system provides the nerve data to the robotic system, while the inactive state is a state in which the neuromonitoring system does not provide the nerve data to the robotic system. The robotic system may further generate at least one control signal that implements one or more safeguards for the surgical procedure.

Systems, devices, methods, and kits for monitoring one or more physiologic and/or physical signals from a subject are disclosed. A system including patches and corresponding modules for wirelessly monitoring physiologic and/or physical signals is disclosed. A service system for managing the collection of physiologic data from a customer is disclosed. An isolating patch for providing a barrier between a handheld monitoring device with a plurality of contact pads and a subject is disclosed.

Systems, devices, methods, and kits for monitoring one or more physiologic and/or physical signals from a subject are disclosed. A system including patches and corresponding modules for wirelessly monitoring physiologic and/or physical signals is disclosed. A service system for managing the collection of physiologic data from a customer is disclosed. An isolating patch for providing a barrier between a handheld monitoring device with a plurality of contact pads and a subject is disclosed.

A method of surgically positioning an electrode array at a desired implantation location relative to a nerve. A temporary probe electrode is temporarily positioned adjacent to the nerve and at a location which is caudorostrally separate to the desired implantation location of the electrode array. The implanted position of the probe electrode is temporarily fixed relative to the nerve. During implantation of the electrode array, electrical stimuli are applied from one of the temporarily fixed probe electrode and the electrode array, to evoke compound action potentials on the nerve. Compound action potentials evoked by the stimuli are sensed from at least one electrode of the other of the temporarily fixed probe electrode and the electrode array. From the sensed compound action potentials a position of the electrode array relative to the nerve is determined.

A method of surgically positioning an electrode array at a desired implantation location relative to a nerve. A temporary probe electrode is temporarily positioned adjacent to the nerve and at a location which is caudorostrally separate to the desired implantation location of the electrode array. The implanted position of the probe electrode is temporarily fixed relative to the nerve. During implantation of the electrode array, electrical stimuli are applied from one of the temporarily fixed probe electrode and the electrode array, to evoke compound action potentials on the nerve. Compound action potentials evoked by the stimuli are sensed from at least one electrode of the other of the temporarily fixed probe electrode and the electrode array. From the sensed compound action potentials a position of the electrode array relative to the nerve is determined.