Surgical access system and related methods
First Claim
Patent Images
1. A system for forming an operating corridor to a lumbar spine, comprising:
- plurality of sequential dilators of increasing diameters to create a tissue distraction corridor along a lateral, trans-psoas path through bodily tissue to a targeted intervertebral disc of a lumbar spine, at least one of the sequential dilators comprising a stimulation electrode along a distal region to deliver electrical stimulation for nerve monitoring when the sequential dilator is positioned in the lateral, trans-psoas path, said at least one of the sequential dilators comprising a proximal connector portion for releasable electrical connection with a nerve monitoring system;
a bladed retractor assembly comprising a plurality of retractor blades that are simultaneously slidable over an outermost dilator of the plurality of sequential dilators along the lateral, trans-psoas path to enlarge the tissue distraction corridor and thereby form an operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine, wherein the bladed retractor assembly is adjustable from a first position in which the plurality of retractor blades are positioned to slide over the outermost dilator of the plurality of sequential dilators to a second position in which the plurality of retractor blades are spaced apart from one another to enlarge the tissue distraction corridor,wherein when the bladed retractor assembly forms the operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine, the operative corridor is dimensioned so as to pass an implant through the operative corridor along the lateral, trans-psoas path toward the targeted intervertebral disc of the lumbar spine.
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Abstract
A surgical access system including a tissue distraction assembly and a tissue refraction 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.
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Citations
33 Claims
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1. A system for forming an operating corridor to a lumbar spine, comprising:
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plurality of sequential dilators of increasing diameters to create a tissue distraction corridor along a lateral, trans-psoas path through bodily tissue to a targeted intervertebral disc of a lumbar spine, at least one of the sequential dilators comprising a stimulation electrode along a distal region to deliver electrical stimulation for nerve monitoring when the sequential dilator is positioned in the lateral, trans-psoas path, said at least one of the sequential dilators comprising a proximal connector portion for releasable electrical connection with a nerve monitoring system; a bladed retractor assembly comprising a plurality of retractor blades that are simultaneously slidable over an outermost dilator of the plurality of sequential dilators along the lateral, trans-psoas path to enlarge the tissue distraction corridor and thereby form an operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine, wherein the bladed retractor assembly is adjustable from a first position in which the plurality of retractor blades are positioned to slide over the outermost dilator of the plurality of sequential dilators to a second position in which the plurality of retractor blades are spaced apart from one another to enlarge the tissue distraction corridor, wherein when the bladed retractor assembly forms the operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine, the operative corridor is dimensioned so as to pass an implant through the operative corridor along the lateral, trans-psoas path toward the targeted intervertebral disc of the lumbar spine. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A system for forming an operating corridor to a lumbar spine, comprising:
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plurality of sequential dilators of increasing diameters to create a tissue distraction corridor along a lateral, trans-psoas path through bodily tissue to a targeted intervertebral disc of a lumbar spine, each of the sequential dilators comprising a stimulation electrode along a distal region to deliver electrical stimulation for nerve monitoring during advancement of the sequential dilator along the lateral, trans-psoas path through the bodily tissue to the targeted intervertebral disc of the lumbar spine, each of the sequential dilators comprising a proximal connector portion for electrical connection with a nerve monitoring system; the nerve monitoring system delivering an electrical stimulation signal to the stimulation electrode of each of the sequential dilators during advancement of the sequential dilator along the lateral, trans-psoas path through the bodily tissue to the targeted intervertebral disc of the lumbar spine, the nerve monitoring system monitoring electromyographic (EMG) activity detected by a set of sensor electrodes in communication with leg muscle myotomes associated with nerves in the vicinity of the targeted intervertebral disc, and the nerve monitoring system displaying to a user a numeric stimulation current threshold required to obtain the detected EMG activity in at least one of said leg muscle myotomes; a bladed retractor assembly comprising a plurality of retractor blades that are simultaneously slidable over an outermost dilator of the plurality of sequential dilators along the lateral, trans-psoas path to enlarge the tissue distraction corridor and thereby form an operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine, wherein the bladed retractor assembly is adjustable from a closed position in which the plurality of retractor blades are adjacent to one another and slidable over the outermost dilator of the plurality of sequential dilators to an opened position in which the plurality of retractor blades are spaced apart from one another, wherein when the bladed retractor assembly forms the operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine, the operative corridor is dimensioned so as to pass an implant through the operative corridor along the lateral, trans-psoas path toward the targeted intervertebral disc of the lumbar spine. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22)
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23. A method of forming an operating corridor to a lumbar spine, comprising:
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inserting a first sequential dilator of a plurality of sequential dilators along a lateral, trans-psoas path through bodily tissue to a targeted intervertebral disc of a lumbar spine, wherein a first stimulation electrode at a distal region of the first sequential dilator is configured to deliver electrical stimulation for nerve monitoring when the first sequential dilator is positioned in the lateral, trans-psoas path, the first sequential dilator comprising a first proximal connector portion for electrical connection with a nerve monitoring system; slidably 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, wherein a second stimulation electrode at a distal region of the second sequential dilator is configured to deliver electrical stimulation for nerve monitoring when the second sequential dilator is positioned in the lateral, trans-psoas path, the second sequential dilator comprising a second proximal connector portion for electrical connection with the nerve monitoring system, wherein the plurality of sequential dilators create a tissue distraction corridor along the lateral, trans-psoas path through the bodily tissue to the targeted intervertebral disc of the lumbar spine; simultaneously delivering a plurality of retractor blades of a retractor assembly over an outermost dilator of the plurality of sequential dilators along the lateral, trans-psoas path to enlarge the tissue distraction corridor and thereby form an operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine, wherein the retractor assembly is adjustable from a first position in which the plurality of retractor blades are positioned to slide over the outermost dilator of the plurality of sequential dilators to a second position in which the plurality of retractor blades are spaced apart from one another; and after the retractor assembly forms the operative corridor along the lateral, trans-psoas path to the targeted intervertebral disc of the lumbar spine, passing an implant through the operative corridor along the lateral, trans-psoas path toward the targeted intervertebral disc of the lumbar spine. - View Dependent Claims (24, 25, 26, 27, 28, 29, 30, 31, 32, 33)
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Specification