Surgical access system and related methods

• US 20060069315A1
• Filed: 05/25/2005
• Published: 03/30/2006
• Est. Priority Date: 09/25/2003
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Martinelli, Scot, Finley, Eric, Miles, Patrick
• Granted Patent: US 7,207,949 B2
• Time in Patent Office: Days
• US Class Current: 600/219
• CPC Class Codes: A61B 1/06 with illuminating arrangements
• 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 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• CPC Class Codes: A61B 2017/00473 Distal part, e.g. tip or head A61B2017/00464 takes precedence
• 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 2505/05 Surgical care
• CPC Class Codes: A61B 2560/045 with a separable interface unit, e.g. for communication
• CPC Class Codes: A61B 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/1104 induced by stimuli or drugs; A61B5/1102 takes precedence; investigating medicinal preparations G01N33/15
• CPC Class Codes: A61B 5/296 for electromyography [EMG]
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: Y10S 606/909 Bone

Abstract

A surgical access system including a tissue distraction 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 before, during, and after the establishment of an operative corridor to a surgical target site.

Claims

1. A system for accessing a surgical target site, comprising the steps of:

a rector assembly having a plurality of blades releasably coupled to a handle assembly, said plurality of blades capable of being advanced simultaneously to said surgical target site while in a closed position and thereafter selectively opened to create a customized operative corridor to said surgical target site.

2. The system of claim 1, including a distraction assembly for creating a distraction corridor to said surgical target site prior to advancing said retractor blades to said surgical target site.

3. The system of claim 2, wherein said distraction assembly includes an initial distraction assembly including a K-wire and at least one dilator capable of being slideably passed over said K-wire to perform said initial distraction.

4. The system of claim 3, including a secondary distraction assembly for distracting said initial distraction corridor to a secondary distraction corridor, said retractor blades being advanced through said secondary distraction corridor to said surgical target site.

5. The system of claim 1 or 2, wherein at least one of said distraction assembly and at least one of said retractor blades includes at least one stimulation electrode.

6. The system of claim 5, or comprising a control unit capable of electrically stimulating said at least one stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining a direction from at least one of said distraction system and at least one of said retractor blades to the nerve based upon the sensed response, and communicating said direction to a user.

7. The system of claim 6, further comprising an electrode configured to sense a neuromuscular response of a muscle coupled to said depolarized nerve, the electrode being operable to send the response to the control unit.

8. The system of claim 3, wherein said K-wire has a first stimulation electrode at a distal tip of the K-wire.

9. The system of claim 1, wherein said system for establishing an operative corridor to a surgical target site is configured to access a spinal target site.

10. The system of claim 1, wherein said system for establishing an operative corridor to a surgical target site is configure to establish said operative corridor via a lateral, trans-psoas approach.

11. The system of claim 6, further comprising a handle coupled to at least one of said initial distraction assembly and one of said retractor blades, the handle having at least one button for initiating the electrical stimulation from said control unit to said at least one stimulation electrode.

12. The system of claim 6, wherein the control unit comprises a display operable to display an electromyographic (EMG) response of the muscle.

14. The system of claim 6, wherein the stimulation electrodes are positioned near a distal end of at least one of the distraction on assembly and at least one of said retractor blades.

13. The system of clam 6, wherein control unit comprises a touch-screen display operable to receive commands from a user.

15. A method of accessing a surgical target site, comprising the steps of:

simultaneously introducing a plurality of retractor blades to a surgical target site while in a generally closed position; and

selectively moving said retractor blades to create a customized operative corridor to said surgical target site.

16. The method of claim 15, further comprising the step of creating an initial distraction corridor via the use of a K-wire and at least one dilator capable of being slideably passed over said K-wire.

17. The method of claim 15, further comprising the step of distracting said initial distraction corridor via the use of a secondary distraction assembly to create a secondary distraction corridor.

18. The method of claim 17, wherein said step of performing secondary distraction system is accomplished via sequential dilation using successively larger cannulae.

19. The method of claim 15, further comprising the step of providing a control unit capable of electrically stimulating said at least one stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining a direction from a surgical accessory to the nerve based upon the sensed response, and communicating said direction to a user.