Surgical access system and related methods

• US 20080058606A1
• Filed: 10/08/2003
• Published: 03/06/2008
• Est. Priority Date: 10/08/2002
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Blewett, Jeffrey, Martinelli, Scot, Finley, Eric, Miles, Patrick, Kaula, Norbert, Gharib, James, Farquhar, Allen
• Granted Patent: US 8,137,284 B2
• Time in Patent Office: Days
• US Class Current: 600/214
• 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 17/0218 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 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 2017/00261 Discectomy
• 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 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/395 Details of stimulation, e.g. nerve stimulation to elicit EMG response
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61M 29/02 Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

A system for accessing a surgical target site and related methods, involving an initial distraction system for creating an initial distraction corridor, and an assembly capable of distracting from the initial distraction corridor to a secondary distraction corridor and thereafter sequentially receiving a plurality of retractor blades for retracting from the secondary distraction corridor to thereby create an operative corridor to the surgical target site, 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

1-15. -15. (canceled)

16. A method of accessing a spinal target site via a lateral, trans-psoas surgical approach, comprising the steps of:

affixing a first retractor blade introduced to said spinal target site via a lateral, trans-psoas approach such that said first retractor blade is positioned along a posterior aspect of said spinal target site and fixed relative to said spinal target site; and

moving a second retractor blade introduced to said spinal target site via a lateral, trans-psoas approach relative to said affixed first retractor blade such that an operative corridor is established between said first and second retractor blades to said spinal target site.

17. The method of claim 16, wherein said first retractor blade is introduced to said spinal target site before said second retractor blade is introduced to said spinal target site.

18. The method of claim 16, wherein said step of moving said second retractor blade relative to said affixed first retractor blade is accomplished by using a distraction system.

19. The method of claim 18, wherein said distraction system comprises a sequential dilation system disposed in between said first and second retractor blades to sequentially move said first and second retractor blades apart from one another.

20. The method of claim 16, further comprising the step of establishing an initial distraction corridor via a lateral, trans-psoas surgical approach to said spinal target site prior to the introduction of said first retractor blade through the use of an initial distraction assembly.

21. The method of claim 16, further comprising the step of performing neuromonitoring at least one of during and after said lateral, trans-psoas surgical approach to the spinal target site.

22. The method of claim 20, wherein said initial distraction assembly includes a dilating cannula, at least two dilator members disposed within said dilating cannula, and a K-wire, wherein said at least two dilator members and said dilating cannula are capable of being slideably passed over said K-wire.

23. The method of claim 16, wherein said step of affixing said first retractor blade is accomplished through the use of extension dimensioned to extend past said first retractor blade into the spinal target site.

24. The method of claim 21, wherein said step of performing neuromonitoring involves equipping said first retractor blade with at least one stimulation electrode, stimulating said at least one stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining at least one of nerve proximity and nerve direction based on said sensed response, and communicating said at least one nerve proximity and nerve direction to a surgeon performing said surgery.

25. The method of claim 21, wherein said step of performing neuromonitoring is accomplished by using a neuromonitoring system including a control unit capable of stimulating at least one stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining at least one of nerve proximity and nerve direction based on said sensed response, and communicating said at least one nerve proximity and nerve direction to a surgeon performing said surgery.

26. The method of claim 25, wherein said sensing of said depolarized nerve is accomplished through the use of a recording electrode configured to sense a neuromuscular response of a muscle coupled to said depolarized nerve, the recording electrode being communicatively linked to the control unit.

27. The method of claim 16, wherein said second retractor blade is affixed to said spinal target site after being moved relative to said first retractor blade.

28. The method of claim 25, wherein said communication of said at least one of nerve proximity and nerve direction is accomplished through the use of a display communicatively linked to said control unit and operable to display an electromyographic (EMG) response of a muscle coupled to said nerve depolarized by said stimulation.

29. The method of claim 28, wherein said display comprises a touch-screen display operable to receive commands from a user.

30. The method of claim 24, wherein said at least one stimulation electrode is positioned on a posteriorly facing surface of said first retractor blade as said first retractor blade is affixed along the posterior aspect of said spinal target site.

31. A method of accessing a spinal target site via a lateral, trans-psoas surgical approach, comprising the steps of:

introducing a first retractor blade and a second retractor blade to said spinal target site via a lateral, trans-psoas surgical approach such that said first retractor blade is positioned along a posterior aspect of said spinal target site;

affixing said first retractor blade relative to said spinal target site through the use of an extension element extending from said first retractor blade into said spinal target site; and

moving said second retractor blade relative to said affixed first retractor blade such that an operative corridor is established between said first and second retractor blades to said spinal target site.

32. The method of claim 31, wherein said first retractor blade is introduced to said spinal target site before said second retractor blade is introduced to said spinal target site.

33. The method of claim 31, wherein said step of moving said second retractor blade relative to said affixed first retractor blade is accomplished by using a distraction system.

34. The method of claim 33, wherein said distraction system comprises a sequential dilation system disposed in between said first and second retractor blades to sequentially move said first and second retractor blades apart from one another.

35. The method of claim 31, further comprising the step of establishing an initial distraction corridor via a lateral, trans-psoas surgical approach to said spinal target site prior to the introduction of said first retractor blade through the use of an initial distraction assembly.

36. The method of claim 31, further comprising the step of performing neuromonitoring at least one of during and after said lateral, trans-psoas surgical approach to the spinal target site.

37. The method of claim 35, wherein said initial distraction assembly includes a dilating cannula, at least two dilator members disposed within said dilating cannula, and a K-wire, wherein said at least two dilator members and said dilating cannula are capable of being slideably passed over said K-wire.

38. The method of claim 31, wherein said extension element comprises a shim member slidably engaged to said first retractor blade.

39. The method of claim 36, wherein said step of performing neuromonitoring involves equipping said first retractor blade with at least one stimulation electrode, stimulating said at least one stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining at least one of nerve proximity and nerve direction based on said sensed response, and communicating said at least one nerve proximity and nerve direction to a surgeon performing said surgery.

40. The method of claim 36, wherein said step of performing neuromonitoring is accomplished by using a neuromonitoring system including a control unit capable of stimulating at least one stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining at least one of nerve proximity and nerve direction based on said sensed response, and communicating said at least one nerve proximity and nerve direction to a surgeon performing said surgery.

41. The method of claim 40, wherein said sensing of said depolarized nerve is accomplished through the use of a recording electrode configured to sense a neuromuscular response of a muscle coupled to said depolarized nerve, the recording electrode being communicatively linked to the control unit.

42. The method of claim 31, wherein said second retractor blade is positioned angularly relative to said first retractor blade before being affixed to said spinal target site.

43. The method of claim 40, wherein said communication of said at least one of nerve proximity and nerve direction is accomplished through the use of a display communicatively linked to said control unit and operable to display an electromyographic (EMG) response of a muscle coupled to said nerve depolarized by said stimulation.

44. The method of claim 43, wherein said display comprises a touch-screen display operable to receive commands from a user.

45. The method of claim 39, wherein said at least one stimulation electrode is positioned on a posteriorly facing surface of said first retractor blade as said first retractor blade is affixed along the posterior aspect of said spinal target site.

46. A method of accessing a spinal target site via a lateral, trans-psoas surgical approach, comprising the steps of:

introducing a first retractor blade to said spinal target site via a lateral, trans-psoas surgical approach such that said first retractor blade is positioned along a posterior aspect of said spinal target site;

affixing said first retractor blade relative to said spinal target site through the use of a first extension element extending from said first retractor blade into said spinal target site;

moving said second retractor blade relative to said affixed first retractor blade such that an operative corridor is established between said first and second retractor blades to said spinal target site; and

affixing said second retractor blade relative to said spinal target site through the use of a second extension element extending from said second retractor blade into said spinal target site.

47. The method of claim 46, wherein said first retractor blade is introduced to said spinal target site before said second retractor blade is introduced to said spinal target site.

48. The method of claim 46, wherein said step of moving said second retractor blade relative to said affixed first retractor blade is accomplished by using a distraction system.

49. The method of claim 48, wherein said distraction system comprises a sequential dilation system disposed in between said first and second retractor blades to sequentially move said first and second retractor blades apart from one another.

50. The method of claim 46, further comprising the step of establishing an initial distraction corridor via a lateral, trans-psoas surgical approach to said spinal target site prior to the introduction of said first retractor blade through the use of an initial distraction assembly.

51. The method of claim 46, further comprising the step of performing neuromonitoring at least one of during and after said lateral, trans-psoas surgical approach to the spinal target site.

52. The method of claim 50, wherein said initial distraction assembly includes a dilating cannula, at least two dilator members disposed within said dilating cannula, and a K-wire, wherein said at least two dilator members and said dilating cannula are capable of being slideably passed over said K-wire.

53. The method of claim 46, wherein said first extension element comprises a shim member slidably engaged to said first retractor blade and said second extension element comprises a shim member slidably engaged to said second retractor blade.

54. The method of claim 51, wherein said step of performing neuromonitoring involves equipping said first retractor blade with at least one stimulation electrode, stimulating said at least one stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining at least one of nerve proximity and nerve direction based on said sensed response, and communicating said at least one nerve proximity and nerve direction to a surgeon performing said surgery.

55. The method of claim 51, wherein said step of performing neuromonitoring is accomplished by using a neuromonitoring system including a control unit capable of stimulating at least one stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining at least one of nerve proximity and nerve direction based on said sensed response, and communicating said at least one nerve proximity and nerve direction to a surgeon performing said surgery.

56. The method of claim 55, wherein said sensing of said depolarized nerve is accomplished through the use of a recording electrode configured to sense a neuromuscular response of a muscle coupled to said depolarized nerve, the recording electrode being communicatively linked to the control unit.

57. The method of claim 46, wherein said second retractor blade is positioned angularly relative to said first retractor blade before being affixed to said spinal target site.

58. The method of claim 55, wherein said communication of said at least one of nerve proximity and nerve direction is accomplished through the use of a display communicatively linked to said control unit and operable to display an electromyographic (EMG) response of a muscle coupled to said nerve depolarized by said stimulation.

59. The method of claim 58, wherein said display comprises a touch-screen display operable to receive commands from a user.

60. The method of claim 46, wherein said at least one stimulation electrode is positioned on a posteriorly facing surface of said first retractor blade as said first retractor blade is affixed along the posterior aspect of said spinal target site.