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Surgical access system and related methods

  • US 10,357,238 B2
  • Filed: 10/24/2017
  • Issued: 07/23/2019
  • Est. Priority Date: 01/16/2003
  • Status: Active Grant
First Claim
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1. A method of forming an operating corridor to a lumbar spine of a patient, the patient having an anterior aspect, a posterior aspect and two lateral aspects, the method comprising:

  • inserting a first sequential dilator of a plurality of sequential dilators into the patient at an insertion position on one of the two lateral aspects of the patient and advancing the first sequential dilator to a lateral aspect of a target intervertebral disc of the lumbar spine, a lateral, trans-psoas path having a path axis that extends from the insertion position on the one of the two lateral aspects to the other of the two lateral aspects of the patient, wherein a first stimulation electrode at a distal region of the first sequential dilator is configured to deliver electrical stimulation for nerve monitoring, the first sequential dilator comprising a first proximal connector portion for electrical connection with a nerve monitoring system;

    delivering electrical stimulation signals from the first stimulation electrode while the first sequential dilator is advanced along the lateral, trans-psoas path to detect and avoid directly contacting the nerves in the psoas muscle, advancing an elongate penetration member extending through the first sequential dilator into the target intervertebral disc, advancing a second sequential dilator of the plurality of sequential dilators over the first sequential dilator along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine;

    simultaneously delivering three retractor blades of a retractor assembly over an outermost dilator of the plurality of sequential dilators along the lateral, trans-psoas path, wherein the three retractor blades slide over the outermost dilator of the plurality of dilators in a closed position in which the three retractor blades are adjacent one another to form an enclosed corridor along the lateral trans-psoas path to the target intervertebral disc;

    positioning the retractor assembly such that the three retractor blades comprise a posterior retractor blade, a caudal retractor blade, and a cephalad retractor blade;

    removing the plurality of sequential dilators from the lateral aspect of the target intervertebral disc of the lumbar spine after the three retractor blades are positioned along the lateral, trans-psoas path;

    advancing a shim device along the posterior retractor blade to a position in which a portion of the shim device extends from the posterior retractor blade and into the target intervertebral disc; and

    adjusting the retractor assembly to move the caudal retractor blade and the cephalad retractor blade away from the posterior retractor blade to an open position such that the three retractor blades form a non-enclosed operating corridor to the target intervertebral disc of the lumbar spine that is dimensioned to pass an implant; and

    after adjusting the retractor assembly to form the operating corridor, passing an implant through the operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine.

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