Surgical access system and related methods
First Claim
1. A method of forming and using an operative corridor through a retroperitoneal space and a psoas muscle during a substantially lateral, retroperitoneal approach to a lumbar spine, the method comprising:
- while a user'"'"'s finger is inserted through a skin incision, moving a tip portion of the user'"'"'s finger through bodily tissue that is generally lateral from a lumbar spine for blunt finger dissection of the bodily tissue proximate to a retroperitoneal space;
advancing the tip portion of the user'"'"'s finger into the retroperitoneal space so as to palpate to a psoas muscle;
advancing an elongate stimulation instrument along a lateral, trans-psoas path through the retroperitoneal space, through the psoas muscle, and to the lumbar spine such that a distal tip portion of the elongate stimulation instrument engages an annulus of a spinal disc of the lumbar spine, the distal tip portion of the elongate stimulation instrument including a stimulation electrode that outputs electrical stimulation for nerve monitoring during advancement of the elongate stimulation instrument through the psoas muscle;
advancing a dilator system along the lateral, trans-psoas path to the lumbar spine to create a distraction corridor, the dilator system comprising at least one dilator that slidably engages an exterior of the elongate stimulation instrument, the at least one dilator being advanced to the spinal disc along the lateral, trans-psoas path to the lumbar spine;
slidably advancing a three-bladed retractor assembly over the dilator system toward the spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including a posterior-most retractor blade, a caudal-most retractor blade, and a cephalad-most retractor blade that extend generally perpendicularly relative to arm members of a blade holder apparatus, wherein the three-bladed retractor assembly is slidably advanced over the dilator system when in a first position in which the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade are positioned to simultaneously advance over the dilator system;
adjusting the blade holder apparatus to shift the three-bladed retractor assembly to a second position in which the caudal-most retractor blade and the cephalad-most retractor blade are spaced apart from the posterior-most retractor blade to enlarge the distraction corridor and form an operative corridor along the lateral, trans-psoas path to the lumbar spine;
inserting an implant that is releasably secured to an inserter tool through the operative corridor formed by the three-bladed retractor assembly along the lateral, trans-psoas path to the lumbar spine;
releasing the implant from the inserter tool when the implant is positioned in a disc space of the lumbar spine.
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0 Petitions
Accused Products
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. Some embodiments of the surgical access system may be particularly suited for establishing an operative corridor to a surgical target site in the spine. Such an operative corridor may be established through the retroperitoneal space and the psoas muscle during a direct lateral, retroperitoneal approach to the spine.
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Citations
36 Claims
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1. A method of forming and using an operative corridor through a retroperitoneal space and a psoas muscle during a substantially lateral, retroperitoneal approach to a lumbar spine, the method comprising:
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while a user'"'"'s finger is inserted through a skin incision, moving a tip portion of the user'"'"'s finger through bodily tissue that is generally lateral from a lumbar spine for blunt finger dissection of the bodily tissue proximate to a retroperitoneal space; advancing the tip portion of the user'"'"'s finger into the retroperitoneal space so as to palpate to a psoas muscle; advancing an elongate stimulation instrument along a lateral, trans-psoas path through the retroperitoneal space, through the psoas muscle, and to the lumbar spine such that a distal tip portion of the elongate stimulation instrument engages an annulus of a spinal disc of the lumbar spine, the distal tip portion of the elongate stimulation instrument including a stimulation electrode that outputs electrical stimulation for nerve monitoring during advancement of the elongate stimulation instrument through the psoas muscle; advancing a dilator system along the lateral, trans-psoas path to the lumbar spine to create a distraction corridor, the dilator system comprising at least one dilator that slidably engages an exterior of the elongate stimulation instrument, the at least one dilator being advanced to the spinal disc along the lateral, trans-psoas path to the lumbar spine; slidably advancing a three-bladed retractor assembly over the dilator system toward the spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including a posterior-most retractor blade, a caudal-most retractor blade, and a cephalad-most retractor blade that extend generally perpendicularly relative to arm members of a blade holder apparatus, wherein the three-bladed retractor assembly is slidably advanced over the dilator system when in a first position in which the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade are positioned to simultaneously advance over the dilator system; adjusting the blade holder apparatus to shift the three-bladed retractor assembly to a second position in which the caudal-most retractor blade and the cephalad-most retractor blade are spaced apart from the posterior-most retractor blade to enlarge the distraction corridor and form an operative corridor along the lateral, trans-psoas path to the lumbar spine; inserting an implant that is releasably secured to an inserter tool through the operative corridor formed by the three-bladed retractor assembly along the lateral, trans-psoas path to the lumbar spine; releasing the implant from the inserter tool when the implant is positioned in a disc space of the lumbar spine. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
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21. A method of forming and using an operative corridor through a retroperitoneal space and a psoas muscle during a substantially lateral, retroperitoneal approach to a lumbar spine, the method comprising:
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while a user'"'"'s finger is inserted through a skin incision, moving a tip portion of the user'"'"'s finger through bodily tissue in a retroperitoneal space that is generally lateral from a lumbar spine and advancing the tip portion of the user'"'"'s finger to palpate to a psoas muscle that is generally lateral from a lumbar spine; advancing a dilator system along the lateral, trans-psoas path to the lumbar spine to create a distraction corridor, the dilator system comprising;
an initial dilator that is advanced through the psoas muscle to a spinal disc of the lumbar spine, a first supplemental dilator that slidably advances along the lateral, trans-psoas path over an exterior of the initial dilator, and a second supplemental dilator that slidably advances along the lateral, trans-psoas path over an exterior of the first supplemental dilator, wherein at least the initial dilator includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the initial dilator is positioned in the psoas muscle;slidably advancing a three-bladed retractor assembly over an exterior of an outermost dilator of the dilator system toward the spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including a posterior-most retractor blade, a caudal-most retractor blade, and a cephalad-most retractor blade that extend from a blade-holder apparatus, wherein the three-bladed retractor assembly is slidably advanced over the dilator system when in a first position in which the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade are positioned to simultaneously advance over the outermost dilator of the dilator system; adjusting the blade-holder apparatus of the three-bladed retractor assembly so as to shift the three-bladed retractor assembly to a second position in which the caudal-most retractor blade and the cephalad-most retractor blade are spaced away from the posterior-most retractor blade to enlarge the distraction corridor and form an operative corridor along the lateral, trans-psoas path to the lumbar spine; inserting an implant that is releasably secured to an inserter tool through the operative corridor formed by the three-bladed retractor assembly along the lateral, trans-psoas path to the lumbar spine; and releasing the implant from the inserter tool when the implant is positioned in a disc space of the lumbar spine. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36)
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Specification