Abstract:
A stimulation lead assembly for making a lead includes a lead body defining a central lumen extending along the lead body and multiple conductor lumens disposed circumferentially around the central lumen and extending along the lead body; electrically conductive contacts disposed along an end of the lead body with a portion of each of the conductor lumens disposed radially underneath the conductive contacts conductor wires disposed in the conductor lumens with at least one of the conductor wires electrically connected to each conductive contact; and a solid, non-conductive material disposed, at least in part, radially underneath the conductive contacts within portions of the conductor lumens not occupied by conductor wire.

Description:
This application is a continuation of U.S. patent application Ser.No. 13/013.599 filed Jan. 25, 2011, which is a continuation of U.S. patent application Ser. No. 11/329,907, filed Jan. 11, 2006, now U.S. Pat. No. 7,891,085, which application claims the benefit of U.S. Provisional Patent Application Ser. No. 60/643,093, filed Jan. 11, 2005, which is incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to implantable leads for providing electrical stimulation and, more particularly, relates to leads having multiple electrode contacts and methods of making such leads. 
     BACKGROUND 
     Many types of implantable leads are currently used to treat a variety of maladies. Two common treatment applications use leads having multiple electrode contacts. Cochlear stimulator systems use a multiple electrode contact lead inserted into one of the cochlear chambers to stimulate the cochlear nerve. Another application where a multiple electrode contact lead is used is the treatment of chronic pain through stimulation of the spinal cord. 
     Spinal cord stimulation systems generally have two implantable components: an implantable pulse generator (IPG) and at least one lead connected to one output of the PG. Generally, however, the IPG is a multi-channel device capable of delivering electrical current through the electrode contacts of the lead. The term “lead” used herein will refer to an elongate device having any conductor or conductors, covered with an insulated sheath and having at least one electrode contact attached to the elongate device, usually at the distal portion of the elongate device. The lead can have an inner stylet lumen running through most of the length of the lead and which lumen has an opening at the proximal end of the lead. A stylet may be placed into this stylet lumen during steering and implantation of the lead. The inserted stylet in the lumen can help stiffen the lead so that the stylet/lead combination may be more easily inserted through tissue. 
     There are two types of leads that may be used with the IPG. The first type is a paddle lead, which has a multiplicity of electrode contacts spread out over a flat, paddle-like surface that is attached to one end of the lead. A paddle lead advantageously permits the electrode contacts to be spaced apart to provide wide coverage over a stimulation area. A disadvantage presented with a paddle lead is that it usually requires a laminectomy or laminotomy, which are highly invasive surgical procedures necessary to implant the large, non-isodiametric paddle. 
     A second type of lead that is commonly used is a percutaneous lead, which has multiple electrode contacts positioned along the distal portion of an elongate lead. U.S. Pat. No. 6,205,361 issued to Baudino et al, describes the making of a multi-contact electrode array for a lead. The distal end of the lead may be about the same thickness or diameter as the remainder of the lead. The percutaneous lead is dimensionally configured for tunneling to a target stimulation site. No invasive surgical procedure such as a laminotomy is required; the percutaneous lead may be placed through an epidural type needle reducing surgical trauma. 
     The method of making a multi-contact percutaneous lead can be involved. In general, it is desirable to make the lead efficiently, with the fewest number of process steps, maximize the manufacturing yield, and hence reduce the cost of goods of building the leads. There is thus a continual need to improve the design of a percutaneous lead in order to improve its performance and to improve the method of manufacturing the lead. 
     BRIEF SUMMARY 
     A method of making a lead is provided. In one embodiment of the invention the method comprises: providing a plurality of conductive contacts located at the distal end of the stimulation lead; connecting a conductor wire to each of the conductive contacts; placing spacers between pairs of adjacent conductive contacts; placing monofilament within void spaces not occupied by a conductor wire, wherein the monofilament is the same material as the spacers; placing a heat shrink tubing around the spacers, conductive contacts and monofilament; and heating the spacers and monofilament just below the melting temperature to cause thermal fusion between the monofilament and spacer. 
     The conductive contacts may be connector contacts located at the proximal portion of the lead, which contacts are used to connect to the IPG, or the conductive contacts may be electrode contacts located somewhere on the lead (e.g., usually at the distal end of the lead). 
     In another embodiment of the method of making the lead, the method comprises: providing a plurality of conductive contacts located at the proximal end of the stimulation lead; connecting a conductor wire to each of the conductive contacts; placing spacers between pairs of adjacent conductive contacts; placing monofilament within void spaces not occupied by a conductor wire, wherein the monofilament is a different material than the spacers; placing a heat shrink tubing around the spacers, conductive contacts, and monofilament; and heating the spacers and monofilament to a temperature to cause thermal flow or melting of at least one of the spacers or monofilament. 
     Hence, while the monofilament and spacers may be the same material with the same melting temperatures, that is an optional part of the invention. The monofilament and spacers may actually be different materials, e.g., a type of thermoplastic polyurethane monofilament and another type thermoplastic polyurethane spacer, with different hardness and melting points in order to yield a particular stiffness. 
     In an embodiment of the invention, a lead assembly is provided comprising: a plurality of electrically conductive contacts; spacers placed between each adjacent contacts; a conductor wire connected to each conductive contact; and monofilament placed into void spaces not occupied by conductor wire, wherein the monofilament is made from the same insulative material as the spacer; and wherein the spacer and monofilament are thermally fused from heat applied to the lead assembly, which heat is just below the melting temperature of the spacer and the monofilament material. 
     In yet another embodiment, a lead assembly is provided comprising: a plurality of electrically conductive contacts; spacers placed between each adjacent contacts; a conductor wire connected to each conductive contact; and monofilament placed into void spaces not occupied by conductor wire, wherein the monofilament is made from a different insulative material as the spacer; and wherein the spacer and monofilament are heated to a temperature to cause either the spacer or monofilament material to thermally reflow or melt. 
     The monofilament and spacer may be the same thermoplastic material to have the same melting point and to thereby allow thermal fusion upon heating at a temperature just below the melting temperature of the material or the monofilament and spacer may have different melting points. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above and other aspects of the present invention will be more apparent from the following more particular description thereof, presented in conjunction with the following drawings wherein: 
         FIG. 1  shows a generalized spinal cord stimulation system with a percutaneous lead connected to an implantable pulse generator (“IPG”); 
         FIG. 2  shows an illustration of the percutaneous lead implanted into the epidural space of a human spinal cord; 
         FIG. 3A  shows a side view of the distal end of a percutaneous lead. 
         FIG. 3B  shows a side view of the proximal (connector) end of the percutaneous lead shown in  FIG. 3A ; 
         FIG. 4  shows a view of the proximal end of the lead assembly showing the connector contacts and conductor wires that connect to each connector contact; 
         FIG. 5A  shows a cross-sectional view of the percutaneous lead shown in  FIG. 3A  at line  5 A- 5 A; 
         FIG. 5B  shows a cross-sectional view of the percutaneous lead shown in  FIG. 5A  along line  5 B- 5 B; 
         FIG. 5C  shows a perspective view of the lead body, having a central stylet lumen and surrounding smaller lumens for containing conductor wires; 
         FIG. 6A  shows a close-up, partial, longitudinal view of the lead assembly at the distal portion of the lead; and 
         FIG. 6B  depicts how polyurethane monofilament or a thermoplastic material is used to fill the voids and is incorporated into the lead by applying heat. 
     
    
    
     Corresponding reference characters indicate corresponding components throughout the several views of the drawings. 
     DETAILED DESCRIPTION OF THE INVENTION 
     The following description is of the best mode presently contemplated for carrying out the invention. This description is not to be taken in a limiting sense, but is made merely for the purpose of describing the general principles of the invention. The scope of the invention should be determined with reference to the claims. 
       FIG. 1  shows a generalized stimulation system that may be used in spinal cord stimulation (SCS), as well as other stimulation applications. Such a system typically comprises an implantable pulse generator (“IPG”)  12 , an optional lead extension  14 , a lead  16  and an electrode array  18 . The electrode array  18  includes a plurality of electrode contacts  17 . In a percutaneous lead, the electrode contacts  17  can be arranged in an in-line electrode array  18  at the distal end of the lead  16 . Other electrode array configurations can also be used. The IPG  12  generates stimulation current pulses that are applied to selected electrode contacts  17  within the electrode array  18 . 
     The proximal end of the lead extension  14  can be removably connected to the IPG  12  and a distal end of the lead extension  14  can be removably connected to a proximal end of the lead  16 . The electrode array  18  is formed on a distal end of the lead  16 . The in-series combination of the lead extension  14  and lead  16  conduct the stimulation current from the IPG  12  to electrode contacts  17  of the electrode array  18 . It is noted that the lead extension  14  need not always be used with the neural stimulation system  10 . Instead, the lead extension  14  may be used when the physical distance between the IPG  12  and the electrode array  18  requires its use, or for the purpose of a temporary trial procedure. 
     The IPG  12  contains electrical circuitry, powered by an internal primary (one-time-use-only) or a rechargeable battery, which through the use of electrical circuitry can output current pulses to each stimulation channel. Communication with the IPG can be accomplished using an external programmer (not shown), typically through a radio-frequency (RF) link. 
       FIG. 2  shows a transverse, mid-sagittal view of a spinal cord and a generalized, implantable, spinal cord stimulation system. The stimulation system shown is being used as a spinal cord stimulator (SCS) system. In such an application, the lead  16  and, more particularly, the electrode array  18  are implanted in the epidural space  20  of a patient in close proximity to the spinal cord  19 . Because of the lack of space near the lead exit point  15  where the electrode lead  16  exits the spinal column, the IPG  12  may be implanted in the abdomen or above the buttocks. Use of lead extension  14  facilitates locating the IPG  12  away from the lead exit point  15 . 
       FIG. 3A  shows, in accordance with the invention, a distal portion of a percutaneous stimulating lead  16 . The stimulating lead  16  is used to stimulate neural tissue by delivering electrical stimulus pulses through at least one of the electrode contacts  17 . The electrode contacts  17  can be separated by electrode contact spacers (or an insulative material)  61  that insulate the electrode contacts  17  from each other. A radiopaque marker  30  located at the distal tip of the lead  16  may be optionally included. Alternatively, the tip of the lead may be the same material as the remainder of the lead insulation. The IPG  12  may be configured to permit connection to the two stimulating leads, each having eight electrode contacts  17 . A pair of stimulating leads  16  may be connected to an IPG  12  and an electrical circuit may be created between one electrode contact on the first lead and another electrode contact located on the second lead. The IPG  12 , for example, may have sixteen independently programmable outputs that allow programming of pulse amplitude, pulse width and frequency of the pulse width. The electrode contacts  17  are to be made of a bio-compatible, electrically conductive electrode material such as platinum/iridium alloy, platinum, titanium or the like. 
     As an example, the stimulating lead  16  may have a diameter of between about 0.03 to 0.07 inches for spinal cord stimulation applications. An insertion cannula (not shown), e.g., a 14 gauge insertion needle may be used, while a 0.05 inch diameter stimulating lead is inserted within the cannula to help implant the stimulating lead  16 . The stimulating lead  16  may come in a variety of lengths, e.g., 30, 50, 70 and 90 cm. A practitioner can extend the length of any of the available lead lengths by opting to use an extension lead  14  (shown in  FIG. 1 ). The proximal male end of the extension lead  14  should be configured to be insertable into the lead connector of the IPG and the distal female end of the extension lead should be configured to accept the proximal connector end of the stimulating lead  16 . 
       FIG. 3B  shows, in accordance with the invention, a depiction of the proximal end of the lead  16 . This proximal lead end, including the eight, electrically conductive, connector contacts  40 , and a contact tip element  41 , collectively will be called herein as the proximal lead connector end  42  of the stimulating lead  16 . Connector contact spacers  45  are placed between the connector contacts  40 . The spacers  45  may be made from an implantable grade polyurethane such as Pellethane® 55D thermoplastic material. The contacts  40  may be made from a non-corrosive, electrically conductive material, e.g., platinum/indium alloy or platinum. Contact tip  41 , however, is not electrically connected to any conductor and contact tip  41  may merely serve as a hard surface for a mechanical contact securing device, such as a set screw, which may be used to secure the lead connector end  42  with the connector block of the IPG  12 . Contact tip  41  is optional and does not need to be included as part of the lead. Instead, the contact tip of the lead may be of similar or the same insulation material as the remainder of the lead  16  or lead body  110  ( FIG. 5C ). 
     Preferably the lead  16  is substantially isodiametric, meaning that the diameter along the lead&#39;s entire length is equal or nearly equal. However, the lead  16  does not need to be isodiametric. For example, the connector contacts  40  at the proximal end may be larger (oversized) or smaller in diameter compared to the remainder of the lead  16  or lead body  110  (shown in  FIG. 5C ). Likewise, the electrode contacts  17  may be larger (oversized) or smaller in diameter compared to the remainder of the lead  16  or lead body  110  (shown in  FIG. 5C ). 
       FIG. 4  shows a proximal lead assembly with each of the connector contacts  40  welded to a respective one of conductors  122 . Each of the eight connector contacts  40 , as shown, are connected to a conductor  122  which, in turn, are connected to a respective electrode contact  17  at the distal end of the stimulating lead  16 . The insulating material between the connector contacts  40  and around the conductors  122  is not shown in  FIG. 4  for purposes of better illustrating the connection between each conductor and its respective connector contact. The connection may be a weld. Cylindrical element  46  is optional and is not connected to any conductor. Cylindrical element  46  may be used as a contact element for a mechanical securing device such as a set screw in order to secure the lead  16  to the IPG  12 . Alternatively, or in addition, the cylindrical element  46  may function as a radiopaque element, provided that the material used for element  46  is radiopaque. 
       FIG. 5A  shows a cross-sectional view of the lead of  FIG. 3A  along line  5 A- 5 A. 
       FIG. 5B  shows a partial, cross-sectional view of the lead along the line  5 B- 5 B. 
       FIG. 5C  shows a perspective view of an exemplary lead body  110  of the lead  16 , excluding conductor wires. The lead body is that portion of the lead insulation  112  that is between the distal electrode contact array  18  and the array of connectors contacts  40  ( FIG. 4 ) at the proximal lead connector end  42 . The lead body  110  may be extruded as a one-piece component. Note the central stylet lumen  114  and the surrounding eight conductor lumens  116 . 
       FIGS. 5A and 5B  show an exemplary embodiment of an insulation section  112  of the lead body  110  having eight lumens  116  containing the conductor (wires)  122 , having individual strands  120 . For example 15 or 16 individual conductor strands  120  may be braided or bundled into a single conductor  122 . Also shown is a central lumen  114  that may be used to accept an insertion stylet (not shown) within the lumen to facilitate lead implantation. The opening of the lumen occurs at the proximal end of the lead  16 . The lead body  110  may be a biocompatible, insulating lead material. Preferably the lead body  110  is made from a polyurethane. In particular the material may be Pellethane® thermoplastic material, e.g. 55D, 65D, or other durometer hardness. As previously indicated for  FIG. 5C , the lead body  110  shown in  FIG. 56  may be extruded as one piece. 
       FIG. 6A  shows a partial view of a longitudinal, cross-section at the distal end of the lead, in accordance with an embodiment of the invention.  FIG. 6A  shows a ring-like electrode contact  17  (which may be platinum, for example), multi-stranded conductor  122  and electrode contact spacer  61  or an insulative material). The spacer  61 , which is ring-like in configuration, may be made of polyurethane insulative material, e.g., Pellethane®. Monofilament 60, also may be made of thermoplastic Pellethane® material or other insulation material, e.g., polyester. During manufacture, the monofilament  60  may be inserted into the void spaces that are not filled by the conductor  50 . A heat shrink tube  65  is also shown placed around the electrode contacts  17  and conductor  122  assembly. The heat shrink tube  65  may be PTFE (e.g., Teflon® material) or a polyester heat shrink material. The heat shrink tube can be used during manufacturing and is not part of the stimulation lead. 
       FIG. 6B  shows a two-frame, time-elapsed illustration of a partial view of the distal end of the lead as in  FIG. 6A  showing the conductor  122  connected (e.g., welded) to the electrode contact  17 . The first frame (i) of  FIG. 66  shows the sequence in which the monofilament  60  fills a large part of the void space  70 . The part of the lead assembly shown is then placed into a heat, for example, at 190 degrees Celsius for a period of 30 seconds. The heat that may be used e.g., for polyurethane material (such as Pellethane®), may range from about 140 to 250 degrees Celsius for a period of about between 15 to 120 seconds. However, importantly, the heat applied to the spacer and monofilament material, should be just below the melting temperature of the material. At this just-below-melting temperature, the spacer and monofilament will reflow and thermally fuse together as shown in the second frame (ii). The spacer  61  and the monofilament  60  may be exactly the same material with the same melting temperature in order to facilitate thermal fusion. For example, the material may be the same implantable grade polyurethane such as Pellethane 55D or 75D. 
     Alternatively, however, the monofilament may be of a different material than the spacer to alter the mechanical characteristic of the final lead assembly. The monofilament and spacer may have different melting points or very close melting points. The monofilament and spacers may be the same type of material but with different formulations, e.g., to provide different hardness. For example, the monofilament may be a 55D (durometer hardness) material and the spacer may be a 75D material. The predetermined temperature chosen to heat both the monofilament and spacers should cause at least one of the materials used to thermally reflow or, alternatively to melt, in some cases, the temperature may be chosen that one material melts while the other material thermally ref lows. 
     While  FIGS. 6A and 6B  show the distal end of the lead, the same process of using a monofilament to fill up void spaces may be used at the proximal end of the lead assembly. At the proximal end of the lead assembly, the conductive contacts are not electrode contacts but, are instead, electrically conductive connector contacts  40  that must be in electrical connection with complementary contacts in the IPG connector. The connector contact spacers  45  at the proximal end of the lead (shown in  FIG. 3B ) are placed between adjacent connector contacts  40 . In one embodiment of the invention, the connector contact spacers  45  may be oversized—that is, the spacers may have an initial diameter that is larger than the final lead diameter. The proximal connector end of the lead assembly  42  may then be heated to a temperature (just below melting point of the spacer and monofilament) for a duration of time previously described in order to produce thermal fusion of the connector contact spacer  45  and monofilament  60  to create a continuous reflow of material between the spaces not occupied by the connector contacts  40  and conductor wires  122 . 
     Alternatively, the monofilament  60  and spacer  45  may be different materials with different melting points or about the same melting points. 
     Hence, the method of placing monofilament into void spaces not occupied by the conductor  122 , may be used solely at the distal end of a lead, solely at the proximal end of a lead, or may be employed concurrently at both ends of a lead. If only one end of a lead employs monofilament, the other end of the lead may employ another method to finish the build, e.g., overmolding using a mold or injecting material such as epoxy, e.g., Hysol® into the void spaces between the contacts and conductor wires. 
     EXAMPLE 
     The following steps illustrate one example embodiment of a method for making the lead, in accordance with the invention. Embodiments of the method can include one or more of the following steps (although not necessarily in the order presented). (1) A braided or bundled, insulated, multi-filament conductor, e.g., having 2-200 filaments, can be ablated of insulation at one end to expose the conductor. (2) The exposed end of the conductor can be welded to an electrode contact (located on the distal end lead assembly). (3) Oversized, distal lead spacers may be placed between the electrode contacts. (4) The multi-lumen tube (lead body) may be pro-out with ablated section located at the distal and proximal ends, (5) Each end of the conductor cable can be inserted through the corresponding conductor lumens in the lead body. (6) The oversized spacers can be placed between each ring-like electrode contact at the distal end of the lead assembly; the spacers  61  may be “oversized”, meaning that they may have a diameter greater than the lead body  110  and in addition, the diameter of the electrode contacts  17  may be oversized compared to the diameter of the lead body  110 . (7) The distal end of each conductor cable can be welded to the ring-shaped electrode contact. (8) Polyurethane monofilament may be placed inside the void space as shown in  FIG. 6A , and inside any empty conductor lumens  116 . (9) A heat shrink tube or wrap, preferably, made from PTFE (Teflon) or polyester, can be placed over the distal end of the lead assembly and over the electrode array; this distal end can be placed into a high temperature block, e.g., between about 140-250 degrees Celsius for a period of about 30 to 120 seconds. (10) The distal assembly can be removed from the heat and the shrink tube or wrap can be removed. (10) Optionally, the distal tip of the lead can be formed using an RF welder. 
     Post processing of the lead is not always required. For example, grinding of the distal or proximal ends of the leads is not necessary with this method of manufacturing, although optionally, a centerless grinding process may be used, if desired. 
     The method of making the distal and proximal part of the lead, in accordance with the present invention, eliminates most, if not all tooling, including eliminating the use of molds. 
     The method of making a lead and the resulting multi-contact lead, in accordance with the invention, provides advantages over conventional leads and methods of making a lead. A prior method of making the distal portion of the lead uses epoxy to fill the voids between the spacer  61  and the contacts  17 . This has certain disadvantages. For instance, use of an epoxy requires a curing step, e.g., of up to eight hours, adding to the total time required to build a lead. With use of epoxy, there may also be some variation in stiffness of the final lead assembly post-cure because the epoxy is generally a different material than the insulative body or spacers and because curing may occur unevenly. The use of like materials, e.g., polyurethane lead body, polyurethane spacers and polyurethane monofilament can yield a better bond between these parts. 
     Although the lead and method of making the lead are described in the context of a spinal cord stimulation lead, it will be understood by those skilled in the art that the same lead, albeit with appropriate dimensions for a particular application, and the method of making the lead may be used to make a multi-contact lead suitable for use in other applications, such as deep brain stimulation, cardiac stimulation and peripheral nerve stimulation. 
     While the invention herein disclosed has been described by means of specific embodiments and applications thereof, numerous modifications and variations could be made thereto by those skilled in the art without departing from the scope of the invention set forth in the claims.