Get Rid of Shoulder and Scapulae Pain by Flossing the Spinal Accessory Nerve
This application claims the benefit of priority of U. Provisional Application No. The present invention relates generally to devices and methods for treating damaged or compromised spinal cord tissue using sub-atmospheric pressure and more particularly, but not exclusively, to devices and methods Spine Behandlung in Kirov treating spinal cord tissue that have experienced a recoverable or non-recoverable injury.
The anatomy, physiology, and pathologic processes that involve the spinal cord pose special concerns for the treatment of damaged or compromised spinal cord tissue. The preservation of both the three-dimensional structural anatomy and the microanatomical relationships of neurons whose function depends on specific spacial relationships with other neurons and other supporting cellsas well as the maintenance of properly oxygenated blood flow and the homogeneous ground substance matrix in which the neurons survive, are vital to the survival and function of spinal cord tissues.
Moreover, the inability of spinal cord cells to regenerate emphasizes the need to maximize survival of every possible neuron. For reasons such as these, treatment of both open and closed space pathology in the spinal cord poses special concerns. Among the clinical problems that threaten survival of spinal cord tissue, the control of spinal cord edema, infection, and blood supply are central.
The spinal cord responds to trauma and injury by collecting a significant amount of interstitial edema. Because the spinal cord is enclosed in a closed space dura and the spinal canaledema results in compression and compromise of the blood flow and nutritional performance of the spinal Spine Behandlung in Kirov, which greatly impairs physiological recovery of the spinal cord and often of itself results in progression of compromise and death of the spinal cord.
Currently available treatments for reducing edema include pharmacologic agents, such as glucocorticoids Dexamethasone, Prednisone, Methyl Prednisolonediuretics, and extensive surgical decompression. However, disadvantages to these treatments include irregular and unpredictable results, complications of the drugs, infection, and surgical complications. The need for rapid and effective treatment is also vital due to the disastrous consequences and high likelihood of rapid propagation of infection and edema in the spinal cord.
At present there are few successful methods available to treat pathologies affecting the intraspinal space, spinal cord parenchyma, and the surrounding structures.
Where tissues elsewhere in the body can be treated with dressing changes, the spinal cord is not amenable to this type of treatment because of its precarious structure, propensity for infection, Spine Behandlung in Kirov potential for progression of injury. There is evidence that inflammation and immunological response to spinal cord trauma and other pathology are of equal or greater long term consequences than the initial trauma or insult. These injuries contribute to the neuropathological sequella, which greatly contribute to the adverse Spine Behandlung in Kirov of spinal injury.
In addition, the spinal cord requires a continuous supply of oxygenated blood to function and survive. Within a few minutes of complete interruption of blood flow to the spinal cord, irreversible spinal cord damage results. The spinal cord can, however, remain viable and recover from reduced blood flow for more prolonged periods. There is evidence that focal areas of the spinal cord can remain ischemic and relatively functionless for days and still recover.
This finding has led to the concept of an ischemic zone, termed the penumbra or halo zone, that surrounds an area of irreversible injury. A secondary phenomena in the ischemic zone is the release of Spine Behandlung in Kirov that are released locally by injured neurons, alterations in focal blood flow, and edema.
Vascular pathology of the spine may be a result of: inadequate blood flow to the spinal Spine Behandlung in Kirov cells from decreased perfusion pressure, rupture of a Spine Behandlung in Kirov vessel resulting in direct injury to the local spinal cord area, or by compression of adjacent tissue; intrinsic disease of the spinal cord blood vessels such as atherosclerosis, aneurysm, inflammation, etc. In cases of intraspinal hemorrhage, the hemorrhage usually begins as a small mass that grows in volume by pressure dissection and results in displacement and compression of adjacent spinal cord tissue.
Edema in the adjacent compressed tissue around the hemorrhage may lead Spine Behandlung in Kirov a mass effect and a worsening of the clinical condition by compromising a larger area of spinal cord tissue. Edema in the adjacent spinal cord may cause progressive deterioration usually seen over 12 to 72 hours. The occurrence of Spine Behandlung in Kirov in the week following the intraspinal hemorrhage often worsens the prognosis, particularly in the elderly.
The tissue surrounding the hematoma is displaced and compressed but is not necessarily fatally Spine Behandlung in Kirov. Improvement can result as the hematoma is resorbed, adjacent edema decreased, and the involved tissue regains function.
Treatment of these conditions has been disappointing. Surgical decompression Spine Behandlung in Kirov the spinal cord can be helpful in some cases to prevent irreversible compression. Agents such as mannitol and some other osmotic agents Spine Behandlung in Kirov reduce intraspinal pressure caused by edema. Steroids are of uncertain value in these cases, and recently hyperbaric oxygen has been proposed. Thus, though the application of negative or sub-atmospheric pressure therapy to wounded cutaneous and subcutaneous tissue demonstrates an increased rate of healing compared to traditional methods as set forth in U.
The present invention provides devices and methods that use sub-atmospheric or negative pressure to treat damaged spinal cord tissue, such as spinal tissue damaged by disease, infection, or trauma, for example, which may Spine Behandlung in Kirov to the presence of swelling, compression, and compromised blood flow secondary to interstitial edema. For instance, the spinal cord may be damaged by blunt trauma resulting in a recoverable or non-recoverable injury.
In one of its aspects the present invention provides a method for treating damaged spinal cord tissue using sub-atmospheric pressure.
The method comprises locating a porous material proximate the damaged spinal cord tissue to provide gaseous communication between one or more pores of the porous material and the damaged spinal cord tissue. The porous material may be sealed in situ proximate the damaged spinal cord tissue to provide a region about the damaged spinal cord tissue for maintaining sub-atmospheric pressure at the damaged spinal cord tissue.
The porous material may be operably connected with a vacuum system for producing sub-atmospheric pressure at the damaged spinal cord tissue, and the vacuum Spine Behandlung in Kirov activated to provide sub-atmospheric pressure at the damaged spinal cord tissue. The sub-atmospheric pressure may be maintained at the damaged spinal cord tissue for a time sufficient to decrease edema Spine Behandlung in Kirov the spinal cord.
For example, the sub-atmospheric pressure may be maintained at about 25 mm Hg below atmospheric pressure. The method may also include locating a cover over damaged Spine Behandlung in Kirov cord tissue and sealing the cover to tissue proximate the damaged spinal cord tissue for maintaining sub-atmospheric pressure at the damaged spinal cord tissue. The cover may be provided in the form of a self-adhesive sheet which may be located over the damaged spinal cord tissue.
In such a case, the step of sealing the cover may include adhesively sealing Spine Behandlung in Kirov adhering the self-adhesive sheet to tissue surrounding the damaged spinal cord tissue to form a seal between the sheet and tissue Spine Behandlung in Kirov the damaged spinal cord tissue. In another of its aspects the present invention provides an apparatus for treating damaged spinal cord tissue. The apparatus may include a porous bio-incorporable material, such as an open-cell collagen, having pore structure configured to permit gaseous communication between one or more pores of Spine Behandlung in Kirov porous material and the spinal cord tissue to be treated.
The bio-incorporable nature of the porous material can obviate the need for a second procedure to remove the porous material. The apparatus also includes a vacuum source for producing sub-atmospheric pressure; the vacuum source may be disposed in gaseous communication with the porous material for distributing the sub-atmospheric pressure to the spinal cord tissue.
The porous material may have, at least at a selected surface of the porous material, pores sufficiently small to prevent the growth of tissue therein. In addition, the porous material may have, at least at a selected surface of the porous material, a pore Spine Behandlung in Kirov smaller than the size Spine Behandlung in Kirov fibroblasts and spinal cord cells, and may have a pore size at a Spine Behandlung in Kirov other than the selected surface Spine Behandlung in Kirov is larger than that of fibroblasts and spinal cord cells.
The pore size of the porous material may be large enough to allow movement of proteins the size of albumin therethrough. Also, the porous bio-incorporable material may include at least one Spine Behandlung in Kirov that is sealed to prevent the transmission of sub-atmospheric pressure therethrough. The apparatus may Spine Behandlung in Kirov include a cover configured to cover the damaged spinal cord tissue to maintain sub-atmospheric pressure under the cover at the damaged spinal cord tissue.
Thus, the present invention provides devices and methods for minimizing the progression of pathologic processes, minimizing the disruption of physiological spinal cord integrity, and minimizing the interference with spinal cord blood flow and nutrition. By decreasing spinal cord edema and intraspinal pressure the risk of spinal cord herniation and Spine Behandlung in Kirov may be minimized.
In addition, the present invention facilitates the removal of mediators, degradation products, and toxins that enhance the inflammatory and neuropathological response of tissues in the spinal cord. The foregoing summary and the following detailed description of the preferred embodiments of the present invention will be best understood when read in conjunction with the appended drawings, in which:.
An exemplary configuration of a sub-atmospheric spinal cord treatment device of the present invention Spine Behandlung in Kirov include a vacuum Spine Behandlung in Kirov 30 for supplying sub-atmospheric pressure via a tube 20 to a porous material 10 disposed proximate the spinal cord 7FIGS.
In this regard, the porous material 10 may be structured to deliver and distribute sub-atmospheric pressure to the spinal cord 7.
The spinal cord treatment device may be applied to a Spine Behandlung in Kirov by locating a porous material 10 proximate the damaged Spine Behandlung in Kirov cord tissue 7 to provide gaseous communication between one or more pores of the porous material 10 and the damaged spinal cord tissue 7.
A tube 20 may be connected to the porous material 10 at a distal end 22 of the tube 20and the porous material 10 may be sealed in situ by sutures 8 in the skin and subcutaneous tissues 2 to provide a region about the damaged spinal cord tissue 7 for maintaining sub-atmospheric pressure. The proximal end 24 of the tube 20 may Spine Behandlung in Kirov attached to a vacuum source 30 to operably connect the porous material Spine Behandlung in Kirov to the vacuum system 30 for producing sub-atmospheric pressure at the damaged spinal cord tissue 7 upon activation of the vacuum system Turning to FIG.
The tissues illustrated include the skin and Spine Behandlung in Kirov tissue 2muscle tissue, such as the trapezius 3 and erector spinae 4vertebrae 5transverse process 6and the Spine Behandlung in Kirov cord 7. To provide access to the spinal cord 7a portion of the vertebrae 5 may be missing. For instance, the spinous process may be absent due to surgical dissection, disease, or injury. A porous material 10such as an open-cell collagen material, may be placed in the subcutaneous space proximate the spinal cord tissue 7 to be treated with sub-atmospheric pressure to decrease edema in the parenchymal tissues and improve physiologic function, for example.
Such materials include a solution of chitosan 1. The material may be cross-linked by 2. Additionally, the porous material 10 may be made by casting polycaprolactone PCL. Polycaprolactone may be mixed with sodium chloride 1 part caprolactone to 10 parts sodium chloride and placed in a sufficient volume of chloroform to dissolve the components. For example, 8 ml of the solution may be poured into an appropriately sized and shaped contained and allowed to dry for twelve hours.
The sodium chloride may then be leached out in water for 24 hours. It is also possible to use electrospun materials for the porous material For electrospinning, the solution containing the collagen:CS:POC mixture was placed in a 3 ml syringe fitted to an 18 Ga needle. FL and was applied between the needle anode and the grounded collector cathode with a distance of cm.
An additional method for creating porous materials 10 is to use thermal inkjet printing technologies. A mixture of Type I collagen 2.
Louis Mo. Hardware from a Hewlett Packard c printer, including the stepper motors and carriage for the cartridges, can be mounted to a platform. The height of the hardware above the platform can then be adjusted for printing in layers. The porous material 10 may comprise pores sufficiently small at the interface between the porous material 10 and Spine Behandlung in Kirov spinal cord 7 to prevent the growth of tissue therein, e.
In addition, the pore size at the interface between the porous material 10 and the spinal cord 7 may be sufficiently small so as to avoid the excessive production of granulation or scar tissue at the spinal cord 7 which may interfere with the physiologic function of the spinal cord 7. At the same time, the pore size of the porous material 10 may be large enough to allow movement of proteins the size of albumin therethrough to permit undesirable compounds to be removed, such as mediators, degradation products, and toxins.
The porous material 10 may, however, have a larger pore size e. For example, the porous material may comprise a multi-layer structure with a non-ingrowth layer having a sufficiently small pore size to prevent the growth of tissue therein for placement at the spinal cord, and may have an additional layer of a different material that has a relatively larger pore size in contact with the non-ingrowth layer At a location away from the interface with the spinal cord 7the porous material 10 may have a pore size sufficiently large to promote the formation of granulation tissue at other tissues in the spaces surrounding the spinal cord 7such as promotion of granulation tissue in areas where spinal cord disruption has occurred.
In addition, the porous material 10 may have a configuration in which one or Spine Behandlung in Kirov sides or surfaces of the porous material 10 are sealed to prevent the transmission of sub-atmospheric pressure through such a sealed surface, while at the same time having at least one surface through which sub-atmospheric pressure may be transmitted.
Such a configuration of the porous material 10 can present preferential treatment of tissue on one side of the porous material 10 while not treating the other side. For instance, the parenchyma of the spinal cord 7 could be treated with the non-sealed interface on one side of the porous material The porous material 10 may be comprised of a material that needs to be removed after sub-atmospheric therapy is given, which could require a second surgery.
Alternatively, the porous material 10 may be comprised of a material that is bioabsorbable or degrades harmlessly over time to avoid a second surgery, such Spine Behandlung in Kirov collagen. In addition, the porous material 10 may comprise a non-metallic material so that an MRI can be performed while the porous material 10 is in situ.
The porous material 10 may also comprise a material that is sufficiently compliant so that if it presses against the spinal cord 7 the porous material 10 does not interfere with spinal cord function. To deliver sub-atmospheric pressure to the porous material 10 for distribution to the spinal cord 7a tube 20 may be connected directly or indirectly in gaseous communication with the porous material 10 at the distal end 22 of the tube For example, the distal end 22 of the tube 20 may be embedded in the porous material 10 or may be placed over the porous material The distal Spine Behandlung in Kirov 22 of the tube 20 may also include one or more fenestrations to assist in delivering the sub-atmospheric pressure to the porous material 10 and the spinal cord 7.