Surgical access and nerve surveillance

• US 8,165,653 B2
• Filed: 06/14/2011
• Issued: 04/24/2012
• Est. Priority Date: 12/23/1998
• Status: Expired due to Term

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Marino, James F., Stone, Corbett W., Christopher, Troy K., Blewett, Jeffrey J., Kelleher, Brian S.
• Primary Examiner(s): Peffley, Michael
• Assistant Examiner(s): HUPCZEY, JR, RONALD JAMES
• Application Number:
  US13/160,477
• Publication Number:
  US 20110245843A1
• Time in Patent Office: 315 Days
• Field of Search: 600373-374, 600546-548, 600/554, 600/557, 128/898, 607115-118, 606 32- 52, 604 21- 22, 604/27, 604/500, 604/912
• US Class Current: 600/373
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1487 Trocar-like, i.e. devices producing an enlarged transcutaneous opening
• CPC Class Codes: A61B 2017/3484 Anchoring means, e.g. spreading-out umbrella-like structure
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2018/00595 Cauterization
• CPC Class Codes: A61B 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/296 for electromyography [EMG]
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/4029 for evaluating the peripheral nervous systems A61B5/24 takes precedence
• CPC Class Codes: A61B 5/4041 Evaluating nerves condition
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes

Abstract

An expandable tip cannula system, comprising: a hollow cannula shaft having a proximal end and a distal end; and an expandable tip mounted at the distal end of the hollow cannula shaft, the expandable tip comprising a plurality of generally-triangular shaped petals held together in a radially-inwardly tapered arrangement between adjacent petals, each petal comprising a nerve sensing electrode disposed therein.

Claims

1. A method of performing spine surgery, comprising:

minimally invasively advancing a nerve surveillance instrument and a surgical access instrument towards a spinal target site, wherein the nerve surveillance instrument is dimensioned to be slidably received within the surgical access instrument and the surgical access instrument defines a passageway through which an implant can be passed for introduction into said spinal target site, the nerve surveillance instrument having at least one nerve stimulation electrode disposed proximate a distal end thereof;

energizing at least one nerve stimulation electrode disposed proximate a distal end of the nerve surveillance instrument while advancing the nerve surveillance instrument towards the surgical target site to detect the presence of nerves adjacent said nerve surveillance instrument;

removing said nerve surveillance instrument from said passageway after said surgical access instrument has been advanced to said spinal target site;

separating tissue displacement members of said surgical access instrument; and

introducing said implant into said spinal target site through said separated tissue displacement members.

2. The method of claim 1, wherein said at least one nerve stimulation electrode comprises a plurality of nerve stimulation electrodes and wherein the step of advancing comprises the further sub-step of sensing the presence of said nerves in a radial direction relative to a central axis of said surgical access instrument through the use of the plurality of nerve stimulation electrodes which are radially disposed around said distal end of said nerve surveillance instrument.

3. The method of claim 1, wherein said step of introducing said implant includes using at least one of a bone decorticator, a camera, an articulating forcep and an intervertebral positioning system.

4. The method of claim 1, wherein said tissue displacement members comprise a plurality of petals, each of said plurality of petals having at least one nerve stimulation electrode disposed therein.

5. The method of claim 1, wherein said tissue displacement members are expandable from a first position to a second position.

6. The method of claim 5, wherein said tissue displacement members are provided in said first position and held together by breakable seals.

7. The method of claim 1, wherein said surgical access instrument is a cannula.

8. A method of performing spine surgery, comprising:

minimally invasively advancing a nerve surveillance instrument and a surgical access instrument towards a spinal target site, wherein the nerve surveillance instrument is dimensioned to be slidably received within the surgical access instrument;

delivering energy through at least one nerve stimulation electrode located proximate a distal end of said nerve surveillance instrument while advancing said nerve surveillance instrument and detecting electromyographic activity evoked by said delivered energy to detect the presence of nerves adjacent said nerve surveillance instrument;

removing said nerve surveillance instrument from said surgical access instrument after said surgical access instrument has been advanced to said spinal target site;

opening said surgical access instrument to create a passageway configured to pass an implant into said spinal target site; and

introducing an implant through said passageway and into said spinal target site.

9. The method of claim 8, wherein said step of opening said surgical access instrument involves moving a first portion of said surgical access instrument away from a second portion of said surgical access instrument.

10. The method of claim 9, wherein a distal end of said surgical access instrument comprises a plurality of tissue displacement members, each of said plurality of tissue displacement members having at least one nerve stimulation electrode disposed therein, said tissue displacement members being movable from a first position to a second position.

11. The method of claim 10, wherein said tissue displacement members are provided in said first position and held together by breakable seals.

12. The method of claim 8, wherein said surgical access instrument is a cannula.