MEMS-Based Intraoperative Monitoring System for Improved Safety
Transcription
MEMS-Based Intraoperative Monitoring System for Improved Safety
IEEE SENSORS JOURNAL, VOL. 13, NO. 5, MAY 2013 1541 MEMS-Based Intraoperative Monitoring System for Improved Safety in Lumbar Surgery Xing Liu, Hui Chen, Qing-An Huang, Senior Member, IEEE, and Darrin J. Young, Member, IEEE Abstract— This paper presents the design and characterization of a microelectromechanical system (MEMS)-based intraoperative monitoring system for improving lumbar surgery safety. A MEMS pressure-sensing module is designed and incorporated into a nerve root retractor tip to directly monitor pressure exerted on a nerve root during a lumbar surgery. Animal experiments are conducted for intraoperative pressure monitoring to investigate effects of nerve root retraction during a surgery. Amplitude and latency of electrophysiological response of a nerve root are measured during different time intervals after retraction under various retraction magnitude and duration conditions. Correlation between exerted pressure on a retracted nerve root and its electrophysiological response is investigated. The relationship between intraoperative pressure and alteration of neural tissue structure is analyzed by morphological observation. Experimental results indicate that a nerve root injury is strongly related to the magnitude and duration of its retraction. The prototype MEMS-based intraoperative monitoring system can potentially alert surgeons about risk factors associated with nerve root injury during a lumbar surgery as well as provide critical surgical guidelines. The system can also serve as a basis for implementing an intelligent robotically controlled closed-loop lumbar surgical operating system in the future. Index Terms— Iatrogenic nerve root injury, intraoperative monitoring system, intraoperative pressure monitoring, lumbar surgery, silicon pressure sensor. I. I NTRODUCTION A LARGE population suffers from chronic low back pain due to various medical reasons. With rapid development of medical technology, an increasing number of patients, who are unaided by the conservative therapies alone, have begun to resort to lumbar surgery for a rapid effective resolution of symptoms [1]. However, this type of surgery has associated potential risks of iatrogenic neurological damage due to the surgical site being too close to the nerve root [2], [3]. Manuscript received September 17, 2012; revised December 1, 2012; accepted January 21, 2013. Date of publication March 20, 2013; date of current version March 27, 2013. This work was supported in part by the Foundation of Science and Technology Commission of Nanjing, China under Grant 201001093, and the National Natural Science Foundation of China under Grant 61136006. The associate editor coordinating the review of this paper and approving it for publication was Prof. Paul C.-P. Chao. X. Liu and Q.-A. Huang are with the Key Laboratory of MEMS of Ministry of Education, Southeast University, Nanjing 210096, China (e-mail: hqa@seu.edu.cn). H. Chen is with the Medical College, Southeast University, Nanjing 210009, China. D. J. Young is with the Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112 USA. Color versions of one or more of the figures in this paper are available online at http://ieeexplore.ieee.org. Digital Object Identifier 10.1109/JSEN.2013.2243141 Fig. 1. Schematic of nerve root retraction during a lumbar surgery. Keeping away from an inadvertent contact or damage by surgical instruments, the nerve root would typically be pulled outside the surgical corridor by using a nerve root retractor as depicted in Fig. 1. The degree of a nerve root retraction typically depends on a surgeon’s manual manipulation. An excessive nerve root retraction can cause neurological injury, thus resulting in a postoperative symptom [4]–[6]. Electrophysiological monitoring is introduced into the surgery for avoiding iatrogenic neurological injury [7]–[9]. To reveal the physiological integrity of the nerve root during operation, the surgical procedure has to be interrupted and the electrical stimulation is applied on the nerve root to obtain electromyography (EMG) signals. The measurement would be repeated multiple times during a surgery to alert the surgeon to any deterioration before irreversible neural injury of the nerve root occurs. The electrophysiological monitoring can significantly increase treatment cost and operation time. In most lumbar surgeries, such monitoring procedures are not warranted [7], [10]. It is, therefore, highly desirable to develop an effective, low cost and user-friendly intraoperative monitoring system to address aforementioned concerns. MEMS technology has been widely employed for medical applications [11]–[16], greatly improving the functionality and performance of surgical devices, lowering risk to improve surgical outcomes, and providing real-time feedback on the operations [17]–[19]. In this paper, a MEMS-based intraoperative monitoring system design, implementation, and characterization for improving lumbar surgery safety is presented. The MEMS-based intraoperative monitoring would be beneficial for monitoring neural function integrity of the nerve root without interrupting the surgical procedure. A MEMS pressure sensing module is designed and incorporated into a prototype nerve root retractor to directly monitor pressure exerted on a nerve root during a lumbar surgery. Animal experiments have been conducted for intraoperative pressure monitoring to investigate effects of nerve root retraction during a surgery. 1530-437X/$31.00 © 2013 IEEE 1542 IEEE SENSORS JOURNAL, VOL. 13, NO. 5, MAY 2013 Fig. 2. Fig. 3. Schematic of intraoperative monitoring system. Prototype of nerve root retractor with embedded pressure sensor. (a) The prototype system can potentially alert surgeons about risk factors associated with nerve root injury during a lumbar surgery, provide critical surgical guidelines, and serve as a basis for implementing an intelligent robotically controlled closed-loop lumbar surgical operating system in the future. II. I NTRAOPERATIVE M ONITORING S YSTEM D ESIGN The components of intraoperative monitoring system are shown in Fig. 2. The MEMS pressure sensor is installed inside the nerve root retractor, which measures the retraction pressure and sends the output signal in the millivolts (mV) range to an interface electronic system. The interface electronic system further amplifies the signal within a range of 5 V. The signal is then sent to a digital display unit, which displays the measured pressure values converted from the voltage signals. Finally, the data acquisition computer receives the signal by RS-232 interface, which saves and processes the collected data. Fig. 3 presents an overview of prototype nerve root retractor design. The retractor structure is made of stainless steel exhibiting a lateral length of 166 mm and a height of 100 mm, which is typical and convenient for a lumbar surgical operation. The tip of the nerve root retractor is designed with an embedded MEMS pressure sensing module covered by a cambered thin silicone sensing membrane, which can effectively couple the exerted pressure on a nerve root to a MEMS pressure sensor underneath [20]. The pressure sensing region exhibits a height of 2.3 mm, length of 7.5 mm, and width of 6.7 mm. Fig. 4 presents a detailed schematic view of the pressure sensing module design with respect to the retractor structure and a nerve root. The deformation of a nerve root before and after retraction is also depicted for an illustration purpose. Exerted force on the nerve root causing structural deformation is responsible for its neurological injury as will be discussed in Section IV. (b) Fig. 4. Schematic view of intraoperative pressure monitoring module design. (a) Before retraction. (b) After retraction. A MEMS piezoresistive pressure sensor is attached over a thin flexible printed circuit board (PCB) and covered by a silicone layer for surface protection, forming a pressure sensing module. Electrical connections are formed by bonded wires and soldered wires, which can be channeled through the hallow retractor handle to interface with an external data acquisition unit. The piezoresistive sensing scheme is chosen due to its straight forward electronic interface and a nearly constant operating temperature for the targeted application. Silicon-silicon-structure-based absolute pressure sensor is used for retraction pressure measurement. The membrane is fabricated by anisotropic etching. The vacuum chamber is formed between the membrane and the silicon substrate by silicon-onsilicon bonding technology. The piezoresistors, made by boron implantation into n-type silicon membrane, placed on the membrane form a full bridge and provide the voltage output according to the induced strain from the external pressure. The sensing module is housed inside the retractor tip and further encapsulated by a thin silicone membrane as shown in Fig. 4. The silicone sensing membrane is shaped to exhibit a cambered surface for achieving an intimate contact with a nerve root under retraction, thus a more sensitive pressure coupling for the measurement. A low retractor tip profile is critical for lumbar surgery because it determines the minimum displacement of a nerve root before applying any retraction. In our prototype design, a 1 mm × 1 mm × 0.6 mm MEMS piezoresistive pressure sensor is chosen along with a 0.4 mm-thick flexible PCB to achieve a small tip height of 2.3 mm. Further minimizing the sensor and PCB thickness will be considered in the future to reduce the tip height. A typical nerve root exhibits a diameter around 4 mm. Surgical retraction can flatten the nerve root as depicted in LIU et al.: MEMS-BASED INTRAOPERATIVE MONITORING SYSTEM Fig. 5. 1543 Schematic of calibration process for the MEMS sensor. Fig. 7. Animal experimental research model. retracted nerve root contacts the silicone sensing membrane is less than 1 K. In the future, capacitive MEMS pressure sensors will be considered for the system design due to their zero DC power dissipation. The obtained performance is adequate for the proposed intraoperative pressure monitoring application. III. A NIMAL E XPERIMENTAL M ODEL AND P ROCEDURE Fig. 6. Measured sensor cyclic load response. Fig. 3, resulting in an enlarged nerve root width around 6 mm. Therefore, the pressure sensing region is designed with a length of 7.5 mm to ensure a reliable contact with the nerve root. The width of the retractor tip is chosen to be 6.7 mm for readily installing the pressure sensing module. A maximum pressure load of 100 kPa was chosen as the worst-case pressure exerted on a nerve root based on previous surgical data. The excitation voltage of the MEMS sensor at the retractor tip is 5 V. This sensor employs a differential Wheatstone bridge architecture and exhibits a nominal resistance of 5 k. The calibration process for the MEMS sensor with the components of gas cylinder, digital pressure calibrator, pressure test fixture and digital multimeter is shown in Fig. 5. The accuracy of the pressure calibrator is 0.02%. A special pressure test fixture is used to limit the gas flow loading to the retractor tip, where MEMS pressure sensor is located. Three sensor cyclic load processes are conducted for calibration with gas pressure set by the calibrator equidistantly among the measurement range and the output voltage signal measured by the multimeter. The measured cyclic load response is plotted in Fig. 6, indicating a repeatability and hysteresis of 0.06% full-scale (FS) and 0.10% FS, respectively. The device nonlinearity and sensitivity are as a function of an applied pressure. The worstcase nonlinearity is 0.13% FS and an average sensitivity is 59.74 μV/V/kPa. The power consumption of the MEMS sensor is 4.73 × 10−3 W. The resulting heat distribution from the MEMS sensor is insignificant, thus would not cause damage to the nerve root. The temperature rise at the surface where the The intraoperative pressure information can be effectively used to investigate potential neurological injury occurred in a retracted nerve root. The research results can be used to alert surgeons about potential risk factors associated with nerve root injury as well as provide critical surgical guidelines. Animal experiments were first conducted to characterize the effectiveness of our prototype monitoring system and obtain correlation between intraoperative pressure and alteration of neural tissue structure and related injury. An experimental research model was established as shown in Fig. 7. Pressure exerted on a nerve root is monitored by the MEMS pressure sensing module incorporated in the tip of a nerve root retractor and is recorded by an external data acquisition unit. Electrophysiological monitoring and morphological observation are standard medical procedures for characterizing nerve root injury [21], [22]. Electrophysiological analysis based on EMG signals is effective for detecting nerve root injury, thus employed for the prototype development and research. EMG parameters can be measured after each nerve root retraction, revealing its functional integrity. A needle electrode is inserted in an appropriate muscle group innervated by the selected nerve root. An electrical stimulation is then applied to the nerve root followed by EMG monitoring. EMG abnormalities such as a reduction in amplitude and/or an increase in latency [21], corresponding to a particular surgical manipulation, are used to correlate with the measured intraoperative pressure. In addition to the electrophysiological response, morphological observation of the nerve root is also conducted after retractions. Through optical microscopy, pathological sections of a nerve root can be inspected. Morphological alteration of distorted nerve fibers and deformation of nervous tissues and cells can reflect how neural structure of a nerve root is damaged, thus confirming injury occurrence. Intraoperative pressure monitoring experiments were performed under nerve root retractions on laboratory goats 1544 IEEE SENSORS JOURNAL, VOL. 13, NO. 5, MAY 2013 Fig. 10. Fig. 8. Fig. 9. Pressure and output voltage in a retraction process. Nerve root retraction experiment conducted in laboratory goat. Measured electrophysiological response-based EMG signal. weighting about 20 kg as shown in Fig. 8. A laboratory goat was placed prone and a midline longitudinal incision was made, followed by bilaterally retracting the paravertebral muscle. A lamina was partially resected to explore the lumbar nerve root. Two groups of lumbar nerve root were retracted under different magnitude and duration while the exerted pressure was monitored by the pressure monitoring module installed at a retractor tip. A nerve root was retracted for a short period of time around one minute and then released for a few minutes to let it recover followed by repeating the same procedure, thus emulating a real-time surgical environment and effects. After each retraction, the nerve root was electrically stimulated at three different time intervals to monitor the corresponding EMG amplitude and latency. The exerted retraction pressure and cumulative retraction pressure, which is the sum of the exerted pressure during a retraction period, were then related to the electrophysiological response to investigate potential neurological damage. Neural structural alternations after multiple retraction cycles were investigated by morphological observation. Pathological sections of retracted and nonretracted nerve roots were viewed by optical microscopy for comparison, indicating that effects of nerve root retraction and associated injury can be revealed in the nerve root morphological structures, thus serving an effective procedure to confirm neurological injury. IV. M EASUREMENT R ESULTS AND D ISCUSSION A. Effects of Retraction Magnitude on Nerve Root Two groups of nerve root were retracted under different amount of pressure to investigate the effect of retraction magnitude. The pressure sensing module incorporated in the retractor tip monitored the exerted pressure. The nerve root electrophysiological test was then conducted at one minute, three minutes and five minutes after a retraction. The amplitude and latency of the EMG response were recorded. Fig. 9 shows a measured EMG signal after an electrical stimulation was applied to a nerve root, illustrating the response amplitude and latency. The retraction style in animal experiments is the same as the one in operation, to retract the nerve root by hand for a short time and then release it. As shown in Fig. 10, the pressure at the figures following Fig. 10 in this section is the weighted average value of original pressures in a retraction process. The weighted average for the retraction process in Fig. 10 is 15.3 kPa, which is the first pressure data point presented in Fig. 11(a). S1 nerve root and adjacent L5 nerve root are usually involved in lumbar surgery. They exhibit similar properties for retraction. In the following figures shown in this section, Group I presents S1 nerve roots of goats and Group II presents L5 nerve roots of goats. Fig. 11 presents the measured EMG amplitude versus the exerted pressure. The amplitude is normalized to a baseline value, which is the EMG amplitude obtained prior to any retraction applied to the nerve root. The measurement results reveal that an increased pressure exerted on a nerve root causes a reduced EMG amplitude response, indicating an increased degree of injury to the nerve root. At each retraction pressure, the measured EMG amplitude response increases with a prolonged delay time from one minute to five minutes. This increased amplitude response is associated with an inherent nerve root recovery process. Note that the experiments were performed under a limited pressure range to avoid a permanent injury to the nerve root. Latency of the electrophysiological response was also measured after each retraction. Fig. 12 presents the measured EMG latency versus the exerted pressure. The latency is also normalized to its baseline value. Pressure exerted on a nerve root causes a prolonged latency, relating to an increased degree of injury to the nerve root. At each retraction pressure, it is found that the latency decreases with a prolonged measurement delay time from one minute to five minutes. The reduced latency is associated with an inherent nerve root recovery process. Through the retraction LIU et al.: MEMS-BASED INTRAOPERATIVE MONITORING SYSTEM 1545 (a) (a) (b) (b) Fig. 11. Measured EMG amplitude versus exerted pressure with different measurement delay times. (a) Group I presents S1 nerve roots of goats. (b) Group II presents L5 nerve roots of goats. Fig. 12. Measured EMG latency versus exerted pressure with different measurement delay times. (a) Group I presents S1 nerve roots of goats. (b) Group II presents L5 nerve roots of goats. experiments, the exerted pressure is correlated with the electrophysiological response, which relates to a neural functional injury of the nerve root. Nerve root retraction experiments over an extensive pressure range or retraction distance were performed to illustrate a pronounced resulting injury. Fig. 14 shows the measured intraoperative pressure versus retraction distance for a selected nerve root. During the first cycle of retraction, the nerve root was pulled to 3 mm, 6 mm, and 9 mm with a measured exerted pressure of 20 kPa, 42 kPa, and 69 kPa, respectively, noting that 69 kPa exerted pressure or 9 mm retraction distance is considered substantial in lumbar surgery. The nerve root contains certain structures to resist the effect of retraction. Neural tissues were extended to absorb the extra energy from the retraction. The same retraction procedure was repeated for the second cycle. The resulting response at retraction distances of 3 mm and 6 mm was slightly lower than that obtained during the first cycle due to nerve root viscoelastic behavior [23] and possible occurred injury. However, a significant reduction in response was observed at 9 mm retraction distance, which indicates the second-cycle 9 mm retraction went beyond mechanical tolerance of the nerve root causing a severe neural tissue structural breakdown and a permanent neurological damage [23], [24]. The neural structure alternation due to retraction can be revealed through morphological observation. After multiple retraction cycles, longitudinal sections of retracted and nonretracted nerve root were observed by optical microscopy for comparison as shown in Fig. 15. B. Effects of Accumulative Pressure on Nerve Root Besides retraction magnitude, retraction duration can have a significant impact on a nerve root’s neurological condition. The cumulative pressure, which is the sum of an exerted pressure on a nerve root over a retraction duration, was recorded and investigated for its related nerve root injury. Fig. 13 presents the measurement data obtained from the two selected groups of nerve roots under study. Fig. 13(a) shows the exerted pressure along with the corresponding retraction duration versus measured EMG response amplitude for Group I nerve root. The plot consists of four retraction conditions with different exerted pressure and duration. The cumulative pressure was then determined and plotted against the EMG response amplitude as shown in Fig. 13(b), where the amplitude is presented as a normalized quantity with respect to the corresponding baseline amplitude. Fig. 13(c) shows the EMG response latency versus the cumulative pressure. It is evident that a large cumulative pressure causes a more severe injury to the nerve root, thus a degraded neural function with a decreased EMG response amplitude and an increased latency. The measurement data obtained from Group II nerve root are presented in Fig. 13(d)–(f), revealing a similar behavior. 1546 IEEE SENSORS JOURNAL, VOL. 13, NO. 5, MAY 2013 (a) Fig. 14. Nerve root response under multiple large retractions. (b) (c) (d) (e) (f) Fig. 13. Cumulative retraction effects on nerve root electrophysiological response. (a) Pressure and retraction duration versus measured amplitude for S1 nerve root. (b) Cumulative pressure versus measured amplitude for S1 nerve root. (c) Cumulative pressure versus measured latency for S1 nerve root. (d) Pressure and retraction duration versus measured amplitude for L5 nerve root. (e) Cumulative pressure versus measured amplitude for L5 nerve root. (f) Cumulative pressure versus measured latency for S1 nerve root. Irregular arrangement of nerve fibers, accumulation of inflammatory cells in the vicinity of nerve fibers and necrotic nervous tissues were clearly observed in the retracted nerve Fig. 15. Optical micrographs showing the histology of nerve roots. (a) Retracted nerve root. (b) Nonretracted nerve root. Hematoxylin-eosin staining of the longitudinal section of the samples. Arrow: Irregular arrangement of nerve fibers. : Inflammatory cells. NNT: necrotic nervous tissues. root compared to the nonretracted nerve root. The structural alternations can impair the nerve conduction and affect its neurological function. It is expected that human nerve root injury is related to the magnitude and duration of retraction in a similar manner. Therefore, the obtained animal experimental results and experiences can serves as a starting point for human trials in the future. The collected clinic data can provide a general guideline for human lumbar surgery. V. C ONCLUSION A MEMS-based intraoperative monitoring system for improving lumbar surgery safety has been demonstrated. Animal experiments reveal that a nerve root injury is strongly related to the magnitude and duration of its retraction. It is expected that a similar correlation exists for human nerve roots. The prototype monitoring system can potentially alert surgeons about risk factors associated with nerve root injury during a lumbar surgery as well as provide critical surgical guidelines. It can also serve as a basis for implementing an intelligent robotically controlled closed-loop lumbar surgical operating system in the future. R EFERENCES [1] M. Sutter, A. Eggspuehler, D. Grob, D. Jeszenszky, A. Benini, F. Porchet, A. Mueller, and J. Dvorak, “The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: A prospective study of 1,017 patients,” Eur Spine J., vol. 16, no. 2, pp. 162–170, Nov. 2007. [2] H. Matsui, H. Kitagawa, Y. Kawaguchi, and H. Tsuji, “Physiologic changes of nerve root during posterior lumbar discectomy,” Spine, vol. 20, no. 6, pp. 654–659, Mar. 1995. LIU et al.: MEMS-BASED INTRAOPERATIVE MONITORING SYSTEM [3] C. Feltes, K. Fountas, R. Davydov, V. Dimopoulos, and J. S. Robinson, “Effects of nerve root retraction in lumbar discectomy,” Neurosurg. Focus, vol. 13, no. 2, pp. 1–2, Aug. 2002. [4] R. Nagayama, H. Nakamura, Y. Yamano, T. Yamamoto, Y. Minato, M. Seki, and S. Konishi, “An experimental study of the effects of nerve root retraction on the posterior ramus,” Spine, vol. 25, no. 4, pp. 418–424, Feb. 2000. [5] Y. R. Rampersaud, E. R. P. Moro, M. A. Neary, K. White, S. J. Lewis, E. M. Massicotte, and M. G. Fehlings, “Intraoperative adverse events and related postoperative complications in spine surgery: Implications for enhancing patient safety founded on evidence-based protocols,” Spine, vol. 31, no. 13, pp. 1503–1510, Jun. 2006. [6] R. Kraemer, A. Wild, H. Haak, J. Herdmann, R. Krauspe, and J. Kraemer, “Classification and management of early complications in open lumbar microdiscectomy,” Eur. Spine J., vol. 12, no. 3, pp. 239–246, Jun. 2003. [7] N. R. Malhotra and C. I. Shaffrey, “Intraoperative electrophysiological monitoring in spine surgery,” Spine, vol. 35, no. 25, pp. 2167–2179, Dec. 2010. [8] R. Bošnjak and M. Makovec, “Neurophysiological monitoring of S1 root function during microsurgical posterior discectomy using H-Reflex and spinal nerve root potentials,” Spine, vol. 35, no. 4, pp. 423–429, Feb. 2010. [9] B. Bose, L. R. Wierzbowski, and A. K. Sestokas, “Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar spine surgery,” Spine, vol. 27, no. 13, pp. 1444–1450, Jul. 2002. [10] J. H. Owen, “The application of intraoperative monitoring during surgery for spinal deformity,” Spine, vol. 24, no. 24, pp. 2649–2662, Dec. 1999. [11] X. Chen and A. Lal, “Integrated pressure and flow sensor in siliconbased ultrasonic surgical actuator,” in Proc. IEEE Ultrason. Symp., 2001, pp. 1373–1376. [12] K. J. Rebello, “Applications of MEMS in surgery,” Proc. IEEE, vol. 92, no. 1, pp. 43–55, Jan. 2004. [13] S. Sokhanvar, M. Packirisamy, and J. Dargahi, “MEMS endoscopic tactile sensor: Toward in-situ and in-vivo and tissue softness characterization,” IEEE Sensors J., vol. 9, no. 12, pp. 1679–1687, Dec. 2009. [14] P. Peng and R. Rajamani, “Handheld microtactile sensor for elasticity measurement,” IEEE Sensors J., vol. 11, no. 9, pp. 1935–1942, Sep. 2011. [15] R. Ahmadi, M. Packirisamy, J. Dargahi, and R. Cecere, “Discretely loaded beam-type optical fiber tactile sensor for tissue manipulation and palpation in minimally invasive robotic surgery,” IEEE Sensors J., vol. 12, no. 1, pp. 22–32, Jan. 2012. [16] X. Liu, Q. Huang, M. Qin, H. Chen, and D. Young, “Animal experimental study on the nerve root retraction with a silicon pressure sensor,” in Proc. IEEE 16th Int. Solid-State Sensors, Actuat. Microsyst. Conf., Jun. 2011, pp. 1220–1223. [17] A. Menciassi, G. Scalari, A. Eisinberg, C. Anticoli, P. Francabandiera, M. C. Carrozza, and P. Dario, “An instrumented probe for mechanical characterization of soft tissues,” Biomed. Microdevices, vol. 3, no. 2, pp. 149–156, Jun. 2001. [18] A. Pedrocchi, S. Hoen, G. Ferrigno, and A. Pedotti, “Perspectives on MEMS in bioengineering: A novel capacitive position microsensor,” IEEE Trans. Biomed. Eng., vol. 47, no. 1, pp. 8–11, Jan. 2000. [19] J. Rosen, B. Hannaford, M. P. MacFarlane, and M. N. Sinanan, “Force controlled and teleoperated endoscopic grasper for minimally invasive surgery-experimental performance evaluation,” IEEE Trans. Biomed. Eng., vol. 46, no. 10, pp. 1212–1221, Oct. 1999. [20] P. Cong, W. H. Ko, and D. J. Young, “Wireless batteryless implantable blood pressure monitoring microsystem for small laboratory animals,” IEEE Sensors J., vol. 10, no. 2, pp. 243–254, Feb. 2010. [21] J. Meulstee and F. G. A. van der Meche, “Electrodiagnostic criteria for polyneuropathy and demyelination: Application in 135 patients with Guillain-Barré syndrome,” J. Neurol. Neurosurg. Psychiatry, vol. 59, no. 5, pp. 482–486, Nov. 1995. [22] R. Jancalek and P. Dubovy, “An experimental animal model of spinal root compression syndrome: An analysis of morphological changes of myelinated axons during compression radiculopathy and after decompression,” Exp. Brain Res., vol. 179, no. 1, pp. 111–119, May 2007. [23] A. Singh, Y. Lu, C. Chen, and J. M. Cavanaugh, “Mechanical properties of spinal nerve roots subjected to a tension at different strain rates,” J. Biomech., vol. 39, no. 9, pp. 1669–1676, 2006. [24] A. Singh, S. Kallakuri, C. Chen, and J. M. Cavanaugh, “Structural and functional changes in nerve roots due to tension at various strains and strain rates: An in-vivo study,” J. Neurotrauma, vol. 26, no. 4, pp. 627–640, Apr. 2009. 1547 Xing Liu received the B.S. degree from Huazhong University of Science and Technology, Wuhan, China, in 2004 and the M.S. degree from Tsinghua University, Beijing, China, in 2007. She is currently pursuing the Ph.D. degree at Southeast University, Nanjing, China. Her research focuses on biomedical sensor design and application. Hui Chen received the B.S.M. degree and the M.S.M degree from Southeast University, School of medicine, Nanjing, China, in 1982 and 2004, respectively. He joined the Department of Orthopaedics, Zhongda Hospital, affiliated hospital of Southeast University, Nanjing, China, as a resident in 1987 and became an attending doctor in 1993. He has been the associate chief surgeon from 2003 and ViceChief of the Department of Orthopaedics at Zhongda Hospital. Moreover, he is Associate Professor of the Department of Orthopaedics at Southeast University. He specializes in orthopaedic injuries and complex fracture, including spine injury, pelvis fractures, femoral neck fractures and supracondylar femur fractures. His research focuses on the mechanism of orthopedic trauma and novel medical devices for clinical application. Dr. Chen is the member of the Specialty Committee of Orthopaedic Trauma, Chinese Medical Association, Branch of Jiangsu Province. He has also been the member of the Specialty Committee of Reparative and Reconstructive Surgery, Chinese Association of Rehabilitation Medicine, Branch of Jiangsu Province since 2009. Qing-An Huang (S’89–M’91–SM’95) received the B.S. degree from Hefei University of Technology, Hefei, China, in 1983, the M.S. degree from Xidian University, Xi’an, China, in 1987, and the Ph.D. degree from Southeast University, Nanjing, China, in 1991, all in electronic engineering. His Ph.D. research focused on micromachined GaAs piezoelectric sensors. After graduation, he joined the faculty of the Department of Electronic Engineering, Southeast University, where he became a Full Professor in 1996, and was appointed to Chair Professor for the Chang-Jiang Scholar by the Ministry of Education in 2004. He is currently the Founding Director of the Key Laboratory of MEMS of the Ministry of Education, Southeast University. He has authored a book entitled Silicon Micromachining Technology (Science Press, 1996), and published over 150 peer-reviewed international journals/conference papers. He is the holder of 30 Chinese patents. Dr. Huang has currently served as Editor-in-Chief of the Chinese Journal of Sensors and Actuators and Editorial Board member of the Journal of Micromechanics and Microengineering. He was a Conference Cochair for the SPIE-Microfabrication and Micromachining Process Technology and Devices (Proc.SPIE, vol.4601, 2001), TPC Co-chair of the 7th IEEE NEMS(Kyoto, 2012) and the 6th Asia-Pacific Conference of Transducers and Micro/Nano Technologies (Nanjing,2012), TPC Member of TRANSDUCERS’09 &’11&’13 and IEEE Sensors Conference through 2002 to 2012. Dr. Huang has served as the Founding Chairman of IEEE ED-SSC Nanjing Chapter. He received the National Outstanding Youth Science Foundation Award of China in 2003. 1548 Darrin J. Young (S’93–M’99) received his B.S., M.S., and Ph.D. degrees from the Department of Electrical Engineering and Computer Sciences at University of California at Berkeley in 1991, 1993, and 1999, respectively. Between 1991 and 1993, he worked at HewlettPackard Laboratories in Palo Alto, California, where he designed a shared memory system for a DSPbased multiprocessor architecture. Between 1997 and 1998, he worked at Rockwell Semiconductor Systems in Newport Beach, California, where he designed silicon bipolar RF analog circuits for cellular telephony applications. During this time period he was also at Lawrence Livermore National Laboratory, working on the design and fabrication of three-dimensional RF MEMS coil inductors for wireless communications. Dr. Young joined the Department of Electrical Engineering and Computer Science at Case Western Reserve University in 1999 as an assistant professor. In 2009 he joined the Electrical and Computer Engineering Department at the University of Utah as an USTAR associate professor. Dr. Young pioneered the research work in MEMS-based, high-Q, tunable capacitors and on-chip 3-D coil inductors for low-phase noise RF voltagecontrolled oscillator design for wireless communication applications. His interests include micro-electro-mechanical systems design, fabrication, and integrated circuits design for wireless sensing, biomedical implant, communication and general industrial applications as well as commercialization of wireless microsystems. He has published many technical papers in journals and conferences, and served as a technical program committee member and session chair for a number of international conferences. Dr. Young was an associate editor of the IEEE Journal of Solid-State Circuits from 2006 to 2011 and currently serves as the chair of the IEEE Electron Devices Society MEMS Committee. IEEE SENSORS JOURNAL, VOL. 13, NO. 5, MAY 2013