Surgical access system and related methods
First Claim
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1. A system for accessing a surgical target site, comprising:
- a tubular distraction member capable of being advanced to said surgical target site;
an elongated inner member dimensioned to be received within said tubular distraction member and advanced to said surgical target site, said elongated inner member having a stimulation electrode;
a retractor assembly having a plurality of blades capable of being advanced to said surgical target site while in a closed position and thereafter opened to create an operative corridor to said surgical target site; and
a monitoring system capable of electrically stimulating said stimulation electrode, monitoring electromyographic activity in muscle myotomes associated with nerves in the vicinity of said surgical target site, and alerting a user of the presence of a nerve near said elongated inner element if said electrical stimulation results in electromyographic activity in at least one of said muscle myotomes.
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Reexamination
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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.
665 Citations
38 Claims
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1. A system for accessing a surgical target site, comprising:
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a tubular distraction member capable of being advanced to said surgical target site; an elongated inner member dimensioned to be received within said tubular distraction member and advanced to said surgical target site, said elongated inner member having a stimulation electrode; a retractor assembly having a plurality of blades capable of being advanced to said surgical target site while in a closed position and thereafter opened to create an operative corridor to said surgical target site; and a monitoring system capable of electrically stimulating said stimulation electrode, monitoring electromyographic activity in muscle myotomes associated with nerves in the vicinity of said surgical target site, and alerting a user of the presence of a nerve near said elongated inner element if said electrical stimulation results in electromyographic activity in at least one of said muscle myotomes. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15)
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16. A method of accessing a spinal target site, comprising the steps of:
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creating an initial distraction corridor to a spinal target site using a tubular distraction member; disposing an elongated inner member within said tubular distraction member at least one of during and after the creation of said initial distraction corridor, said elongated inner member having a stimulation electrode; electrically stimulating said stimulation electrode at least one of during and after the creation of said initial distraction corridor; monitoring electromyographic activity in muscle myotomes associated with nerves in the vicinity of said spinal target site at least one of during and after the creation of said initial distraction corridor; alerting a user to at least one of the presence and absence of a nerve near said elongated inner element based on said monitored electromyographic activity at least one of during and after the creation of said initial distraction corridor; introducing a plurality of retractor blades to said spinal target site while in a generally closed position in the event of an absence of said nerve near said elongated inner element; and moving said retractor blades to create an operative corridor to said spinal target site. - View Dependent Claims (17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38)
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Specification