System and methods for performing surgical procedures and assessments
First Claim
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1. A system for inserting a spinal implant through a trans-psoas operative corridor to an intervertebral disc, comprising:
- an elongate stimulation instrument to advance in a trans-psoas path through bodily tissue toward a lateral aspect of the targeted intervertebral disc of the lumbar spine, the elongate stimulation instrument comprising;
an elongate body, a distal tip portion configured to engage an annulus of the targeted intervertebral disc, and a stimulation electrode exposed along the distal tip portion to emit an electrical stimulation signal to the bodily tissue for nerve monitoring while the elongate stimulation instrument is positioned in the trans-psoas path through the bodily tissue;
a plurality of trans-psoas dilators of increasing diameters to dilate the trans-psoas path through the bodily tissue toward the lateral aspect of the targeted intervertebral disc of the lumbar spine, the plurality of dilators comprising;
an first dilator to slidably engage with an exterior of the elongate stimulation instrument and having a first length,a second dilator to slidably engage with an exterior of the initial dilator and having a second length less than the first length of the initial dilator, wherein the second dilator comprises;
a proximal connector region configured to releasably mate with an electrical cable of a nerve monitoring system, and a stimulation electrode exposed along a tapered distal tip region of the second dilator to emit an electrical stimulation signal to the bodily tissue for nerve monitoring while the second dilator is positioned in the trans-psoas path, anda third dilator to slidably engage with an exterior of the second dilator and having a third length less than the second length of the second dilator, wherein the third dilator comprises;
a proximal connector region configured to releasably mate with the electrical cable of a nerve monitoring system, and a stimulation electrode exposed along a tapered distal tip region of the third dilator to emit an electrical stimulation signal to the bodily tissue for nerve monitoring while the third dilator is positioned in the trans-psoas path;
a working corridor instrument slidable over an outermost of the plurality of trans-psoas dilators along the trans-psoas path through the bodily tissue to the lateral aspect of the targeted intervertebral disc of the lumbar spine, the working corridor instrument being configured to enlarge the trans-psoas path through the bodily tissue and define a trans-psoas operative corridor along the trans-psoas path through the bodily tissue toward the lateral aspect of the targeted intervertebral disc of the lumbar spine, wherein the trans-psoas operative corridor defined by the working corridor instrument is dimensioned so as to pass a spinal fusion implant through the trans-psoas operative corridor to the targeted intervertebral disc of the lumbar spine.
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Abstract
The present invention involves systems and related methods for performing surgical procedures and assessments, including the use of neurophysiology-based monitoring to: (a) determine nerve proximity and nerve direction to surgical instruments employed in accessing a surgical target site; (b) assess the pathology (health or status) of a nerve or nerve root before, during, or after a surgical procedure; and/or (c) assess pedicle integrity before, during or after pedicle screw placement, all in an automated, easy to use, and easy to interpret fashion so as to provide a surgeon-driven system.
309 Citations
13 Claims
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1. A system for inserting a spinal implant through a trans-psoas operative corridor to an intervertebral disc, comprising:
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an elongate stimulation instrument to advance in a trans-psoas path through bodily tissue toward a lateral aspect of the targeted intervertebral disc of the lumbar spine, the elongate stimulation instrument comprising;
an elongate body, a distal tip portion configured to engage an annulus of the targeted intervertebral disc, and a stimulation electrode exposed along the distal tip portion to emit an electrical stimulation signal to the bodily tissue for nerve monitoring while the elongate stimulation instrument is positioned in the trans-psoas path through the bodily tissue;a plurality of trans-psoas dilators of increasing diameters to dilate the trans-psoas path through the bodily tissue toward the lateral aspect of the targeted intervertebral disc of the lumbar spine, the plurality of dilators comprising; an first dilator to slidably engage with an exterior of the elongate stimulation instrument and having a first length, a second dilator to slidably engage with an exterior of the initial dilator and having a second length less than the first length of the initial dilator, wherein the second dilator comprises;
a proximal connector region configured to releasably mate with an electrical cable of a nerve monitoring system, and a stimulation electrode exposed along a tapered distal tip region of the second dilator to emit an electrical stimulation signal to the bodily tissue for nerve monitoring while the second dilator is positioned in the trans-psoas path, anda third dilator to slidably engage with an exterior of the second dilator and having a third length less than the second length of the second dilator, wherein the third dilator comprises;
a proximal connector region configured to releasably mate with the electrical cable of a nerve monitoring system, and a stimulation electrode exposed along a tapered distal tip region of the third dilator to emit an electrical stimulation signal to the bodily tissue for nerve monitoring while the third dilator is positioned in the trans-psoas path;a working corridor instrument slidable over an outermost of the plurality of trans-psoas dilators along the trans-psoas path through the bodily tissue to the lateral aspect of the targeted intervertebral disc of the lumbar spine, the working corridor instrument being configured to enlarge the trans-psoas path through the bodily tissue and define a trans-psoas operative corridor along the trans-psoas path through the bodily tissue toward the lateral aspect of the targeted intervertebral disc of the lumbar spine, wherein the trans-psoas operative corridor defined by the working corridor instrument is dimensioned so as to pass a spinal fusion implant through the trans-psoas operative corridor to 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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Specification