A system for accessing a surgical target site, comprising: a dilator system comprising a plurality of sequential dilators deliverable along a lateral, trans-psoas path to a targeted spinal site to create a distraction corridor; a handle assembly including a first pivotable arm member, a second pivotable arm member that pivots relative to said first arm member in response to manual adjustment of a component of the handle assembly, and a translating member adapted to move longitudinally relative to said first and second arm members; a first retractor blade having a generally concave inner-facing surface and being rigidly coupled to said first pivotable arm member prior to introduction toward the targeted spinal site, a second retractor blade having a generally concave inner-facing surface and being rigidly coupled to said second pivotable arm member prior to introduction toward the targeted spinal site, and a third retractor blade rigidly coupled to said translating member prior to introduction toward the targeted spinal site; an intradiscal shim element that releasably mounts to the third retractor blade such that a maximum length of the intradiscal shim element extends generally parallel to a maximum length of the third retractor blade and a distal tip portion of the intradiscal shim element extends distally of the distal end of the third retractor blade, wherein the intradiscal shim element engages with a groove defined by the third retractor blade to penetrate into a spinal disc at the targeted spinal site when the intradiscal shim element is releasably mounted to the third retractor blade; and said handle assembly being configured to simultaneously introduce said first, second and third retractor blades along the lateral, trans-psoas path toward the targeted spinal site in a closed position while the generally concave inner-facing surfaces of said first and second retractor blades engage with an outermost dilator of the dilator system and thereafter opened by pivoting said first and second pivotable arm members relative to one another to create an operative corridor to said surgical target site. view more

The system of claim 1, further comprising a K-wire configured to be advance along the lateral, trans-psoas path to the targeted spinal site and engage an annulus of said spinal disc, the K-wire further configured to extend entirely through a dilator of said dilator system from the annulus of the spinal disc to a position beyond a proximal most end of the dilator system. view more

The system of claim 1, wherein each of the plurality of sequential dilators includes a stimulation electrode at a distal region.

The system of claim 15, further comprising a K-wire configured to be advanced to the targeted spinal site and to engage an annulus of said spinal disc at the targeted spinal site, wherein at least one of the plurality of sequential dilators are deliverable over the K-wire. view more

The system of claim 1, further comprising a shim insertion tool that releasably attaches to the intradiscal shim element during introduction of the intradiscal shim element toward the targeted spinal site.

A system for forming an operating corridor to a lumbar spine, comprising: a distraction assembly to create a tissue distraction corridor in a lateral, trans-psoas path to a lumbar spine, wherein said distraction assembly includes an elongate inner element and a plurality of dilators, the plurality of dilators being configured to sequentially advance along the lateral, trans-psoas path to the lumbar spine, the elongate inner element being positionable in a lumen of an initial dilator of the plurality of dilators, wherein at least one instrument from the group consisting of said elongate inner element and said dilators includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the at least one instrument is positioned in the psoas muscle; a three-bladed retractor tool slidable over an exterior of an outermost sequential dilator of the dilator system toward the targeted spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including: a blade-holder assembly, and a posterior-most retractor blade, a cephalad-most retractor blade, and a caudal-most retractor blade that extend from the blade-holder assembly, wherein the posterior-most, cephalad-most, and caudal-most retractor blades are slidably advanced over the exterior of the outermost sequential dilator while in a first position, wherein the blade-holder assembly is adjustable to move the posterior-most, cephalad-most, and caudal-most retractor blades to a second position in which the cephalad-most and caudal-most retractor blades are spaced apart from the posterior-most retractor blade to define an operative corridor, wherein three-bladed retractor tool is configured to define the operative corridor along the lateral, trans-psoas path to the lumbar spine in which a space extending to the targeted spinal disc between the posterior-most, cephalad-most, and caudal-most refractor blades is dimensioned so as to pass an implant through the operative corridor along the lateral, trans-psoas path to the lumbar spine. view more

The system of claim 1, wherein the elongate inner member is advanced along the lateral, trans-psoas path to the targeted spinal discs such that a distal tip portion of the elongate inner member penetrates into an annulus of the targeted spinal disc.

The system of claim 1, further comprising a fourth retractor blade that couples with the blade-holder assembly only after the blade-holder assembly moves the posterior-most, cephalad-most, and caudal-most retractor blades to the second position.

The system of claim 1, further comprising a fixation element to releasably engage with one of said retractor blades so that at least a portion of the fixation element extends distally into the lumbar spine, wherein the fixation element is configured to releasably engage with the posterior-most retractor blade after the posterior-most retractor blade is advanced along the lateral, trans-psoas path to the lumbar spine. view more

A system for forming an operating corridor along a lateral, trans-psoas path to a lumbar spine, comprising: plurality of dilators of increasing diameters to create a tissue distraction corridor along the selected path through the bodily tissue toward the targeted intervertebral disc of the lumbar spine, the plurality of dilators including at least a first dilator and a second dilator that slidably advances over an exterior of the first dilator and engages the lumbar spine; a three-bladed retractor slidable along a dilator of the plurality of dilators toward the lumbar spine to enlarge the tissue distraction corridor and thereby form an operative corridor along the selected lateral, trans-psoas path through the bodily tissue toward the targeted intervertebral disc of the lumbar spine, the three-bladed retractor tool including:a blade holder coupled to first, second, and third retractor blades, wherein the three-bladed retractor is adjustable from a closed position in which the first, second, and third retractor blades are adjacent to one another and slidable over the outer dilator of the plurality of sequential dilators to an opened position in which the first, second, and third retractor blades are spaced apart from one another to thereby form the operative corridor along the selected path through the bodily tissue toward the targeted intervertebral disc of the lumbar spine,wherein the blade holder includes a first arm with a first connector for coupling the first retractor blade, a second arm with a second connector for coupling the second retractor blade, and a third arm with a third connector for coupling the third retractor blade, wherein the first arm pivots relative to the second arm and the third arm to move the first retractor blade away from the second and third retractor blades, the second arm pivots relative to the first arm and the third arm to move the second retractor blade away from the first and third retractor blades, and the third arm linearly translates relative to the first arm and second arm to move the third retractor blade relative to the first and second retractor blades, wherein the blade holder includes a rotatable actuator that controls translation of the third arm independent of the pivoting of the first arm and the pivoting of the second arm,a first arm extender that releasably couples to the first arm opposite the first connector and a second arm extender that releasably couples to the second arm opposite the second connector,wherein when the three-bladed retractor is adjusted to the opened position to form the operative corridor along the selected path through the bodily tissue toward the targeted intervertebral disc of the lumbar spine, the operative corridor is dimensioned so as to pass an implant through the operative corridor along the selected lateral, trans-psoas path toward the targeted intervertebral disc of the lumbar spine. view more

The surgical access system ofclaim 1, further including a spinal fusion implant sized and shaped to insert through the operative corridor formed between the first, second and third retractor blades along the lateral, transpsoas path.