Surgical access system and related methods

• US 10,172,515 B2
• Filed: 03/23/2018
• Issued: 01/08/2019
• Est. Priority Date: 08/23/2010
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Lee, James Coleman, Verhage, Benjamin, Serra, Michael, Woolley, Troy B., Snider, Brian, Schwartz, Matthew
• Primary Examiner(s): Waggle, Jr., Larry E
• Application Number:
  US15/934,748
• Publication Number:
  US 20180206715A1
• Time in Patent Office: 291 Days
• CPC Class Codes: A61B 1/32 Devices for opening or enlarging the visual field, e.g. of a tube of the body dilators A61M29/00
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• CPC Class Codes: A61B 2017/00407 Ratchet means
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable for prosthetic joint-implanting tools A61F2/4603
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/00725 Calibration or performance testing
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/0262 with a provision for protecting nerves
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 5/6886 Monitoring or controlling distance between sensor and tissue
• CPC Class Codes: A61B 90/30 Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36017 with leads or electrodes penetrating the skin
• CPC Class Codes: A61N 1/37241 providing test stimulations
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

A surgical access system comprising a tissue dilation assembly and a tissue retraction assembly, both of which may be equipped with one or more electrodes for use in detecting the existence of (and optionally the distance and/or direction to) neural structures.

Claims

1. A retractor assembly for creating an operative corridor to a spinal surgical target site, the retractor assembly comprising:

a retractor body and a plurality retractor blades extending generally perpendicularly to the retractor body, the retractor body including a first arm having a first longitudinal axis and a second arm having a second longitudinal axis, a first retractor blade of the plurality of retractor blades being rigidly coupled to a distal end of the first arm and a second retractor blade of the plurality of retractor blades being rigidly coupled to a distal end of the second arm, the first and second arms being movable apart relative to one another to separate the plurality of retractor blades and retract tissue away from an interior of the retractor blades to thereby form the operative corridor to the surgical target site, the first arm being coupled to a first lead screw driven rack and pinion gear operable to splay the first retractor blade such that a distal end of the first retractor blade extends wider than a proximal end of the first retractor blade, the first arm including a first static arm portion and a first rotating arm portion, the first lead screw driven rack and pinion gear including a first translating rack gear housed within the first static arm portion and threadedly engaged about a first lead screw and a first pinion gear engaged with the first translating rack gear and mechanically linked to the first rotating arm portion, wherein the first pinion gear rotates about the first longitudinal axis causing the first rotating arm portion and the first retractor blade rigidly coupled to the first rotating arm portion to rotate about the first longitudinal axis, and wherein the second arm is coupled to a second lead screw driven rack and pinion gear operable to splay the second retractor blade such that a distal end of the second retractor blade extends wider than a proximal end of the second retractor blade, the second arm including a second static arm portion and a second rotating arm portion, the second lead screw driven rack and pinion gear including a second translating rack gear housed within the second static arm portion and threadedly engaged about a second lead screw and a second pinion gear engaged with the second translating rack gear and mechanically linked to the second rotating arm portion, wherein the second pinion gear rotates about the second longitudinal axis causing the second rotating arm portion and the second retractor blade rigidly coupled to the second rotating arm portion to rotate about the second longitudinal axis.

2. The retractor assembly of claim 1, wherein the first arm includes a restrictor to limit a range of angulation through which the first retractor blade can travel.

3. The retractor assembly of claim 2, wherein the second arm includes a restrictor to limit a range of angulation through which the second retractor blade can travel.

4. The retractor assembly of claim 3, wherein the range of angulation through which the first and second retractor blades can travel is between 0 and 20 degrees for each of the first and second retractor blades.

5. The retractor assembly of claim 2, wherein the restrictor comprises an extension of a first width situated at a distal end of the first static arm portion disposed within a recess of a second width greater than the first width situated at a proximal end of the rotating arm portion.

6. The retractor assembly of claim 1, wherein the first arm and the second arm are coupled to each other about a pivot.

7. The retractor assembly of claim 1, wherein the plurality of retractor blades includes a third retractor blade.

8. The retractor assembly of claim 7, wherein the third retractor blade does not splay.

9. The retractor assembly of claim 8, wherein the retractor assembly includes a third arm and the third retractor blade is rigidly coupled to the third arm.

10. The retractor assembly of claim 9, wherein the third arm is a translating arm that translates relative to a pivot about which the first and second arms are coupled.

11. The retractor assembly of claim 7, wherein the third retractor blade includes a stimulation electrode.

12. The retractor assembly of claim 11, wherein the stimulation electrode is a disposable electrode and the third retractor blade is an electrode blade configured to couple to receive the disposable electrode.

13. The retractor assembly of claim 12, wherein the electrode blade has an elongate interior slot extending longitudinally therethrough.

14. The retractor assembly of claim 13, wherein the disposable electrode is configured to be slideably received within the elongate slot of the electrode blade, the disposable electrode comprising a nonconductive material having a conductive trace extending the length thereof between a proximal exposed area and a distal exposed area.

15. The retractor assembly of claim 14, wherein the proximal exposed area is configured to be in electrical communication with a nerve monitoring system.

16. The retractor assembly of claim 15, wherein the electrode blade further comprises an aperture connecting to the elongate slot near a distal end of the electrode blade.

17. The retractor assembly of claim 16, wherein the distal exposed area of the elongate electrode is configured to align with the aperture of the electrode blade.

18. The retractor assembly of any of claim 13, wherein the electrode blade includes a second slot extending longitudinally along an anterior surface and configured to slideably receive a blade accessory while the disposable electrode is coupled to the electrode blade.

19. The retractor assembly of claim 18, wherein the blade accessory is an intradiscal shim.

20. The retractor assembly of claim 1, wherein the retractor assembly includes a supplemental blade assembly attachable to at least two retractor blades of the plurality of retractor blades.

21. The retractor assembly of claim 20, wherein the supplemental retractor blade assembly includes an elongated supplemental retractor blade and a crossbar connector, the crossbar connector configured to be attached to said at least two retractor blades while engaging the supplemental retractor blade.

22. The retractor assembly of claim 21, wherein the crossbar connector extends from a first end to a second end and has an elongated slot opening in the first end and configured to slidably receive elements of the at least two retractor blades to slidably attach said crossbar connector to said at least two retractor blades.

23. The retractor assembly of claim 22, wherein the elements slidably receivable within the elongated slot includes a post extending from each of the at least two retractor blades, each post extending generally perpendicularly relative to said respective retractor blades, the posts being dimensioned to be received in the elongated slot through an opening, the posts further including enlarged ends that are larger than a height of the slot to prevent disengagement of the crossbar connector from the at least two retractor blades.

24. The retractor assembly of claim 22, wherein the crossbar connector further includes a rear face configured to interlock with a series of grooves on the supplemental retractor blade to maintain a desired depth of the supplemental retractor blade relative to the crossbar connector.

25. The retractor assembly of claim 22, wherein the plurality of retractor blades includes at least three retractor blades, the at least three retractor blades comprising a caudal blade, a cephalad blade, and a center blade, and wherein the crossbar connector engages the caudal blade and the cephalad blade.