Abstract: A bone plate assembly is disclosed which includes at least one plate segment having at least one aperture extending therethrough for receiving a head portion of a bone screw, and a structure supported by the plate segment and intersecting the aperture for retaining the head portion of the bone screw with respect to the plate segment.

Abstract: An adaptable spinal facet joint prosthesis, including a pedicle fixation element; a laminar fixation element; and a facet joint bearing surface having a location adaptable with respect at least one of the pedicle fixation element and the laminar fixation element. The invention also includes a method of implanting an adaptable spinal facet joint prosthesis including the steps of determining a desired position for a facet joint bearing surface; and attaching a prosthesis comprising a facet joint bearing surface to a pedicle portion of a vertebra and a lamina portion of a vertebra to place the facet joint bearing surface in the desired position. The invention also provides a facet joint prosthesis implant tool including a tool guide adapted to guide a vertebra cutting tool; and first and second fixation hole alignment elements extending from the saw guide.

Abstract: Methods, systems, and apparatuses are disclosed for spinal fixation.

Abstract: The invention relates to a connection system (3, 12, 13) between two longitudinal cylindrical spinal support rods (4), said connection system comprising at least one transverse elongate element (6, 14) having, on each end thereof, a head (7, 8; 17, 18; 43) for attaching onto a corresponding rod. At least one of said attachment heads (7, 8; 17, 18) includes a semi-cylindrical recess (19) for clipping with the rod (4), said recess having an upper lip (20, 21), covering the bottom of the rod, and a lower lip (22, 23), that is radially opposite said upper lip, and the head comprises a means (11, 24) for bending said lower lip (22, 23) between a position for connecting and a position for locking onto the rod.

Abstract: Methods, systems, and apparatuses are disclosed for spinal fixation.

Abstract: Methods, systems, and apparatuses are disclosed for spinal fixation.

Abstract: A device intended for the treatment of spinal stenosis. This device is an inter-spinous spacer that is introduced through a single posterior incision. It uses a single piece insertion technique with a unilateral approach. The surgeon does not need to access the opposite side of the spinous process. It allows the user infinite adjustability in distraction height with a single locking mechanism.

Abstract: A bone-anchored surgical mesh has slot-like anchoring members that allow for the variable placement of screws and other bone fasteners. This permits the surgeon discretion in the placement of bone fasteners used to attach the mesh to the patient's bone. The elongate openings of the anchoring members allow for a sliding motion between the bone fasteners and the anchoring members, and facilitates positioning and articulation of the mesh. The anchoring members may include bushings to aid the sliding motion of the anchoring member on the bone fastener. In one embodiment, the mesh consists of shorter modular strips that overlap each other such that a single bone fastener is passed through two overlapping anchoring members to lock the two modular mesh strips together. Additional modular mesh strips can be added on at either end, as desired, to provide the desired length of dural coverage.

Abstract: The longitudinal implant is fastened to bones on either side of a damaged area through a connecting device. Said implant is comprised of a filament or fiber composite material and said connecting device is made of a material harder than said longitudinal implant. The longitudinal implant is preferably made of a carbon filament composite material, wherein the filament are encapsulated in a polymer matrix.

Abstract: Bone screws, such as polyaxial bone screws, with dilations located between the screw head and the threaded portion of the screw, for use in preserving polyaxial functionality of the screw head and/or to which crosslinks may be coupled.

Abstract: A reversible bone coupling device including a first component having a first elongated stem portion for insertion from a first end longitudinally into a surface of a first bone piece, and a second component having a second elongated stem portion for insertion from a second end longitudinally into a surface of a second bone piece, and a connector extending from a second top for coupling with the first component and reversibly locking therein.

Abstract: An assembly and method for attaching a medical device, or other structure, to a bone, according to which two projections are formed on one end of a driver that extend in two corresponding recesses, respectively, formed in the head of the screw to drivingly engage the driver and the screw.

Abstract: A receiving part for connecting a shank of a bone anchoring element to a rod. The receiving part has a first end, a second end and a recess having a substantially U-shaped cross section. The recess extends from the first end in a direction of the second end forming two legs open at the first end. The recess defines a channel to receive the rod. The channel has a longitudinal axis. The legs have an inner thread to receive a securing element having an outer thread cooperating with the inner thread. The legs are provided with stiffening structures. In one embodiment, the stiffening structures are formed by the wall thickness of the outer edges of the legs being larger than the wall thickness of the legs at a location closest to the central axis of the receiving part.

Abstract: A medical guide wire comprising a guide wire hollowed sleeve member and a retention member provided through a hollowed central portion of the sleeve member. The sleeve member includes at least one retention member operational port allowing the retention arm to laterally extend therethrough and retract therein as desired. The functional end of the locking member can be of any reasonable shape and may include one or multiple extending retention arms. A solid penetrating head is integrated into the hollowed sleeve member or the retention member allowing for direct insertion during use. The operational port may be located through either a sidewall or the distal end of the sleeve member. The medical guide wire can be functionally reversed using a feature of a central actuating member to retain the retention arms of a respective hollowed sleeve member in a retracted, insertion configuration and release the retention arms for deployment.

Abstract: A bone wedge is provided for fixing tissue to bone. The bone wedge comprises an elongate body with a proximal end a distal end and a longitudinal axis (A) which extends between said proximal end and said distal end. The elongate body comprises at least two opposed sidewall portions between the proximal and distal ends, wherein the bone wedge is configured to be inserted into a wedge shaped cavity in the bone, said wedge shaped cavity having a smaller diameter at its portion proximal to the bone surface than at its distal portion, and wherein said two opposed sidewall portions are configured to clamp the tissue against the inner walls of said cavity.

Abstract: In one embodiment, a fixation system includes an anchor adapted to be implanted within a first bone, a washer adapted to be associated with a second bone that is to be secured to the first bone, and a suture that is fixedly attached at one end to the anchor and that extends between the anchor and the washer in multiple passes, the suture being adapted to extend through a passage formed in the first and second bones.

Abstract: Techniques for morphologic discrimination between beats of a tachyarrhythmia episode are described for selecting delivery of appropriate therapy. An exemplary method comprises nonordered binning of digitized amplitude values of signals associated with cardiac depolarizations. Monomorphic VT is discriminated from polymorphic VT without signal alignment. One exemplary method involves sensing electrical signals associated with depolarizations of a patient's heart during a tachyarrhythmia episode. The sensed electrical signals are converted to digital values and stored. The stored digital values are normalized and binned. At most, 5 pairs of beats or depolarizations are compared for morphologic similarity by determining the similarity between the binned values associated with each pair. The result of the comparison is used to select and deliver therapy to the patient.

Abstract: A system in combination with a stimulator system and an electrophysiology recorder system in delivering a stimulator signal to a subject's heart is provided. The electrophysiology recorder system can be generally operable to acquire an electrocardiogram from the subject's heart. The system can include an electrical couple in electrical connection between the simulator system and the electrophysiology recorder. The electrical couple can be configured to communicate the stimulator signal without loading an impedance of the electrophysiology recorder system on the stimulator system.

Abstract: Cardiac pacing methods for an implantable single chamber pacing system, establish an offset rate for pacing at a predetermined decrement from either a baseline rate (i.e. dictated by a rate response sensor), or an intrinsic rate. Pacing maintains the offset rate until x of y successive events are paced events, at which time the offset rate is switched to the baseline rate for pacing over a predetermined period of time. Following the period, if an intrinsic event is not immediately detected, within the interval of the offset rate, the rate is switched back to baseline for pacing over an increased period of time. Some methods establish a preference rate, between the offset and baseline rates, wherein an additional criterion, for switching from the offset rate to the baseline rate, is established with respect to the preference rate.

Abstract: A medical device system and associated method predict a patient response to a cardiac therapy. The system includes for delivering cardiac pacing pulses to a patient's heart coupled to a cardiac sensing module and a cardiac pacing module for generating cardiac pacing pulses and controlling delivery of the pacing pulses at multiple pace parameter settings. An acoustical sensor obtains heart sound signals. A processor is enabled to receive the heart sound signals, derive a plurality of heart sound signal parameters from the heart sound signals, and determine a trend of each of the plurality of heart sound signal parameters with respect to the plurality of pace parameter settings. An external display is configured to present the trend of at least one heart sound parameter with respect to the plurality of pace parameter settings.

Abstract: A cardiac rhythm management system selects one of multiple electrodes associated with a particular heart chamber based on a relative timing between detection of a depolarization fiducial point at the multiple electrodes, or based on a delay between detection of a depolarization fiducial point at the multiple electrodes and detection of a reference depolarization fiducial point at another electrode associated with the same or a different heart chamber. Subsequent contraction-evoking stimulation therapy is delivered from the selected electrode.

Abstract: Methods and/or devices for modifying the sampling rate for measuring a patient's intrinsic AV conduction time during cardiac therapy. For example, the sampling rate for measuring a patient's intrinsic AV conduction time may be modified (e.g., decrease or increased) based on one or more monitored physiological parameters, such as activity level and/or heart rate.

Abstract: Described herein are implantable systems and devices, and methods for use therewith, that can be used to increase compliance with a predetermined preferred ventricular electrical activation pattern. Such implantable systems preferably includes a first lead having at least one electrode implantable in a right ventricular (RV) chamber, and a second lead having at least two electrodes implantable in a left ventricular (LV) chamber. A plurality of different sensing vectors are used to obtain a plurality of IEGMs that collectively enable electrical activations to be detected in at least the RV chamber and at at least two separate regions of the LV chamber. The IEGMs can be obtained while the patient's LV chamber is not being paced, or during bi-ventricular (BiV) pacing that includes pacing at only a single site within the LV chamber. An actual ventricular electrical activation pattern is determined based on the plurality of IEGMs.

Abstract: Medical devices and methods for providing breathing therapy (e.g., for treating heart failure, hypertension, etc.) may determine at least the inspiration phase of one or more breathing cycles based on the monitored physiological parameters and control delivery of a plurality of breathing therapy sessions (e.g., each of the breathing therapy sessions may be provided during a defined time period). Further, each of the plurality of breathing therapy sessions may include delivering stimulation after the start of the inspiration phase of each of a plurality of breathing cycles to prolong diaphragm contraction during the breathing cycle.

Abstract: Methods and/or devices for sampling a patient's intrinsic AV conduction time during cardiac therapy that may, e.g., change the AV delays to values based on the AV delays themselves, previously-sampled intrinsic AV conduction times, and/or one or more other parameters directly related to AV delays to provide a time period during which to measure the patient's intrinsic AV conduction time.

Abstract: Methods, systems, and/or devices for selecting spinal cord stimulation (SCS) electrode array configurations to provide effective cardiac therapy. Physiological parameters related to the heart may be monitored and analyzed during the delivery of SCS using various SCS electrode array configurations to determine an effect SCS electrode array configuration.

Abstract: An implantable device and associated method discriminate between cathodal and anodal capture during electrical stimulation. A control response to a pacing pulse delivered using a candidate cathode electrode and a universal anode and responses to bipolar pacing pulses delivered using candidate bipoles including the candidate cathode are measured. Responsive to the control response meeting a threshold response, the control response is classified as normal and each of the responses for the candidate bipoles are compared to the control response. The responses for the candidate bipoles are each classified based on the comparison.

Abstract: An implantable device and associated method detect anodal capture during electrical stimulation. A first pacing pulse is delivered using a first cathode and a first anode. A second pacing pulse is delivered using the first cathode and a second anode. A first response to the first pacing pulse and a second response to the second pacing pulse are measured. Anodal capture of the first pacing pulse at the first anode is detected in response to a first difference between the first response and the second response.

Abstract: According to some methods, for example, preprogrammed in a microprocessor element of an implantable cardiac pacing system, at least one of a number of periodic pacing threshold searches includes steps to reduce an evoked response amplitude threshold for evoked response signal detection. The reduction may be to a minimum value measurable above zero, for example, as determined by establishing a ‘noise floor’. Alternately, amplitudes of test pacing pulses and corresponding post pulse signals are collected and reviewed to search for a break, to determine a lower value to which the evoked response threshold may be adjusted without detecting noise. Subsequent to reducing the threshold, if no evoked response signal is detected for a test pulse applied at or above a predetermined maximum desirable pulse energy, an operational pacing pulse energy is set to greater than or equal to the maximum desirable in conjunction with a reduction in pacing rate.

Abstract: Devices, systems, and methods are disclosed for relaying information from a cardiac pacemaker to an external device. Logic on the pacemaker modulates a heartbeat clock of the pacemaker to encode information onto a blood pressure sequence. This is accomplished by adding or subtracting a small subinterval to or from a pulse repetition interval of the pacemaker. A muscle stimulator beats the heart according to the modulated sequence. A monitoring device external to the body monitors the blood pressure to retrieve the encoded information, or message. The encoded information is then decoded to determine the information in the message. This information may concern the pacemaker as well as other devices within the body that are in communication with the pacemaker such as blood monitors, etc. Since the message is conveyed via simple modulation of the heart beat intervals, no separate transmitter is required in the pacemaker which would otherwise increase cost and decrease battery life.

Abstract: A medical device and associated method detect ischemia using stimulation delivered to induce respiration. A spontaneous breathing response to the stimulation-induced respiration is determined. Ischemia is detected in response to the spontaneous breathing response. The spontaneous breathing response is measured as a response to adjusting a parameter controlling the stimulation.

Abstract: A system and method for delivering a nerve stimulation therapy determines whether a cardiac EGM signal can be sensed by a bipolar pair of electrodes selected from a number of electrodes positioned for stimulating a nerve. In response to not being able to sense a cardiac signal using the bipolar pair, stimulation of the nerve using a selected pair of the electrodes is enabled.

Abstract: A system and associated method deliver a respiration therapy. Stimulation pulse trains are delivered to activate a first portion of a patient's diaphragm at an established intended induced respiration rate during a time interval. Stimulation pulse trains are delivered to activate a second portion of a patient's diaphragm at a second rate during the time interval, the second rate being different than the first rate.

Abstract: A system and associated method deliver a respiration therapy. Stimulation pulses are delivered to activate a right portion of a patient's diaphragm and to activate a left portion of a patient's diaphragm. A control processor determines dyssynchrony of a respiratory response to the stimulation pulses and adjusts a stimulation control parameter controlling the delivering of the stimulation pulses in response to dyssynchrony of the respiratory response.

Abstract: Due to the lack of internal anatomic detail with traditional magnetic resonance imaging, preoperative stereotactic planning for the treatment of tremor usually relies on indirect targeting based on atlas-derived coordinates. To overcome such disadvantages, a method is provided that allows for deep brain stimulation targeting based on brain connectivity. For example, probabilistic tractography-based thalamic segmentation for deep brain stimulator (DBS) targeting is suitable for the treatment of tremor.

Abstract: A method and a control system (20) are provided for determining a relation between stimulation settings for a brain stimulation probe (10) and a corresponding V-field. The brain stimulation probe (10) comprises multiple stimulation electrodes (11). The V-field is an electrical field in brain tissue surrounding the stimulation electrodes (11).

Abstract: In some embodiments, a paddle lead is implanted within a patient such that the electrodes are positioned within the cervical or thoracic spinal levels. An electrode combination on a first row of electrodes can be determined that is effective for a first pain location with minimal effects on other regions of the body. The first pain location can be addressed by stimulating a first dorsal column fiber due to the relatively fine electrical field resolution achievable by the multiple columns. Then, another electrode combination on a second row of electrodes can be determined for a second pain location with minimal effects on other regions. The second pain location could be addressed by stimulating a second dorsal column fiber. After the determination of the appropriate electrodes for stimulation, the patient's IPG can be programmed to deliver pulses using the first and second rows according to the determined electrode combinations.

Abstract: Embodiments disclosed herein are directed to systems configured to power at least one device disposed in a living subject, apparatuses configured to be disposed in a living subject and export power stored in an energy-storage device, and related methods of powering at least one device disposed in the living subject.

Abstract: Apparatus (18) for treating a human patient, which includes one or more electrode contact surfaces (100), which are configured to be applied to a fundus (22) of the patient. A control unit (90) is configured to drive the one or more electrode contact surfaces (100) to apply an electrical signal to the fundus (22) that chronically improves a blood glucose level of the patient, in order to treat the patient, without calculating an impedance of tissue of the fundus (22) based on a sensed parameter that varies in response to the electrical signal, for detecting eating by the patient or a characteristic of food eaten by the patient. Other embodiments are also described.

Abstract: A method and apparatus for selecting neural stimulation electrode configuration is provided. One aspect of this disclosure relates to an implantable medical device including a neural stimulator adapted to generate neural stimulation signals and an electrode configuration tester for testing a first electrode configuration for stimulating a desired neural target. The device includes a controller to control the neural stimulator to selectively provide a first neural stimulation signal with appropriate signal characteristics to stimulate the desired neural target using the first electrical configuration and a second neural stimulation signal with appropriate signal characteristics to stimulate the desired neural target using a second electrode configuration, and adapted to communicate with the electrode configuration tester and to respond to an indication that an efficacy of the first electrode configuration is lower than a threshold by providing the neural stimulation using the second neural stimulation signal.

Abstract: A laser device for treating skin is provided which includes a handholdable housing; a laser member arranged within the housing emitting an output beam; a printed circuit board mounted on a support block within the housing; and a flexible electrically conductive connector having forward and rear ends, the forward end electrically communicating with the laser member, the rear end electrically communicating with the printed circuit board and an area between the ends allowing the connector to bend through an angle range of 0 to 360°.

Abstract: A laser device for treating skin is provided which includes a handholdable housing; a continuous wave laser member arranged within the housing emitting an output beam; a user activated output switch system including a power activating button for arming the device and a power setting button to fire a single first pulse of output beam and after a pause in succession a second pulse of output beam, the second pulse being automatically programmed to fire after the first pulse and pause; and a lens array for receiving the output beam and transmitting the beam through a prism splitting the beam into multiple beamlets, each beamlet targeting a specific spot on the skin, and wherein beamlets from the first and second pulses successively strike the specific spot reinforcing energy applied to the specific spot.

Abstract: A device is presented for use in treatment of tissues inside a body cavity. The device comprises a probe member having at least a portion thereof carrying a plurality of light sources, at least said portion of the probe member having dimensions and shape suitable for insertion into a certain body cavity and for arranging within the surface thereof a three-dimensional array of said light sources, the light sources being configured and operable to irradiate optical energy outwardly from said probe member.

Abstract: An electrode array attached to neural tissue, such as the retina, necessarily has graded pressure exerted on the tissue, with higher pressure near the attachment point. Greater pressure improves contact between the electrodes and neural tissue while too much pressure may damage neural tissue. Hence it is advantageous to obtain equal pressure across the array field. In the present invention a central attachment point in the electrode field applies the most even pressure. Further, multiple and selective attachment points may be additionally provided on an electrode array allowing a surgeon to select the attachment points providing the best electrode tissue contact.

Abstract: Disclosed herein is an implantable medical lead configured to receive a stylet. The lead may include a tubular body and a structure. The tubular body may include a distal end and a proximal end. The body may be configured to receive the stylet. The structure longitudinally may extend through the body between the distal end and the proximal end. The structure may be anchored within the body such that a tensile force arising within the body by the stylet being extended through the body causes the tensile force to be substantially carried by the structure.

Abstract: A neural prosthetic device is provided that includes one or more ion-selective membranes enabled by electrically-controlled local modulation of ion concentrations around a nerve so as to achieve different excitability states of the nerve for electrical stimulation or inhibition of nerve signal propagation. The local modulation is achieved by positioning the nerve in a bipolar perpendicular arrangement so as to modulate the ion concentrations of the one or more ion-selective membranes in situ to change the nerve excitability locally at the site of electrical stimulation or along the nerve for on-demand suppression of nerve propagation.

Abstract: Lead electrode assemblies for use with an implantable cardioverter-defibrillator subcutaneously implanted outside the ribcage between the third and twelfth ribs comprising the electrode. Example assemblies include appendages of various types for use during implantation including fins, pinholes, loops, tubes, openings and other means for attachment to an implant tool. Several embodiments include first and second faces on the electrodes such that a first face is configured to be implanted facing the ribcage of the patient and the second face has the appendage.

Abstract: A coronary sinus lead is disclosed that includes a lead body having opposed proximal and distal end portions, and an open-ended cavity formed in the distal end portion of the lead body for temporarily receiving an angioplasty balloon. The lead is configured for connection with a pacing device. A method of implanting the lead is also disclosed, which includes passing a coronary angioplasty balloon catheter over a length of guide wire extending through the coronary sinus, coronary veins, and collaterals so that the balloon is externalized. The method further includes inserting the balloon into an open cavity of the lead, inflating the balloon within the open cavity to temporarily engage a distal end portion of the lead to the catheter, and pulling the distal end portion of the lead though the coronary sinus and into a coronary vein by at least partially withdrawing the catheter from the coronary sinus.

Abstract: An ostial stent for use in improving vessel patency includes a manually-expanding tube section that presents a distal opening of the ostial stent and a pre-shaped self-expanding SMA tube that presents a proximal opening of the ostial stent. The tubes are attached end-to-end to define a passage extending continuously between the openings. The tubes have a generally cylindrical shape in a radially contracted condition so that the tubes can be inserted into the patient. The self-expanding SMA tube is self-expandable from the radially contracted condition to a memory flared condition.

Abstract: A stent graft delivery device (1) has an elongated extension piece (20) extending from its proximal end of the introducer portion (3). The elongate extension piece is selectively separable from the introducer portion. A plurality of auxiliary guide wires (50) extend from through the stent graft delivery device and through the elongate extension piece. The auxiliary guide wires can cross over at the proximal end of the extension piece and return. The stent graft delivery device can be introduced into a patient via a femoral artery and the elongated extension piece can extend out an artery of the thoracic arch whereby to extend the auxiliary guide wires out of such an artery to give through and through guide wires. Catheterization of pararenal arteries is then possible via a brachial route.