Surgical access system and related methods
DCFirst Claim
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1. A system for forming an operating corridor to a lumbar spine, comprising:
- an elongate member deliverable to a spinal disc along a lateral, trans-psoas path to the lumbar spine such that a distal tip region of the elongate member penetrates into an annulus of the spinal disc, the distal tip region of the elongate member including a stimulation electrode to deliver electrical stimulation for nerve monitoring when the stimulation electrode is positioned along the lateral, trans-psoas path to the lumbar spine;
a dilator system to create a distraction corridor along the lateral, trans-psoas path to the lumbar spine, the dilator system comprising at least one dilator cannula that slidably engages an exterior of the elongate member, the at least one dilator being deliverable to the spinal disc along the lateral, trans-psoas path to the lumbar spine;
a three-bladed retractor assembly slidable over the dilator system toward the spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including;
a blade holder assembly and first, second, and third retractor blades that extend generally perpendicularly relative to arm members of the blade holder assembly,wherein the three-bladed retractor assembly is adjustable from a first position in which the first, second, and third retractor blades are adjacent to one another and slidable over the dilator system to a second position in which the second and third retractor blades are moved away from the first retractor blade to enlarge the distraction corridor and thereby form an operative corridor along the lateral, trans-psoas path to the lumbar spine,wherein the first retractor blade is linearly movable relative to the second and third retractor blades in response to rotation of a knob element on the blade holder assembly, andwherein the second and third retractor blades are movable relative to the first blade in response to pivoting movement of two of the arm members of the blade holder assembly; and
wherein when the three-bladed retractor assembly is adjusted to the second position to form the operative corridor along the lateral, trans-psoas path to the lumbar spine, the first retractor blade is a posterior-most retractor blade of the first, second, and third retractor blades and the operative corridor is dimensioned so as to pass an implant through the operative corridor and into 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.
308 Citations
29 Claims
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1. A system for forming an operating corridor to a lumbar spine, comprising:
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an elongate member deliverable to a spinal disc along a lateral, trans-psoas path to the lumbar spine such that a distal tip region of the elongate member penetrates into an annulus of the spinal disc, the distal tip region of the elongate member including a stimulation electrode to deliver electrical stimulation for nerve monitoring when the stimulation electrode is positioned along the lateral, trans-psoas path to the lumbar spine; a dilator system to create a distraction corridor along the lateral, trans-psoas path to the lumbar spine, the dilator system comprising at least one dilator cannula that slidably engages an exterior of the elongate member, the at least one dilator being deliverable to the spinal disc along the lateral, trans-psoas path to the lumbar spine; a three-bladed retractor assembly slidable over the dilator system toward the spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including; a blade holder assembly and first, second, and third retractor blades that extend generally perpendicularly relative to arm members of the blade holder assembly, wherein the three-bladed retractor assembly is adjustable from a first position in which the first, second, and third retractor blades are adjacent to one another and slidable over the dilator system to a second position in which the second and third retractor blades are moved away from the first retractor blade to enlarge the distraction corridor and thereby form an operative corridor along the lateral, trans-psoas path to the lumbar spine, wherein the first retractor blade is linearly movable relative to the second and third retractor blades in response to rotation of a knob element on the blade holder assembly, and wherein the second and third retractor blades are movable relative to the first blade in response to pivoting movement of two of the arm members of the blade holder assembly; and wherein when the three-bladed retractor assembly is adjusted to the second position to form the operative corridor along the lateral, trans-psoas path to the lumbar spine, the first retractor blade is a posterior-most retractor blade of the first, second, and third retractor blades and the operative corridor is dimensioned so as to pass an implant through the operative corridor and into the lumbar spine. - View Dependent Claims (2, 3, 4, 5, 6, 7, 13, 14, 15, 16, 17, 18, 19, 20)
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- 8. The system of clam 1, wherein the three-bladed retractor assembly includes a shim element removably engageable with the first refractor blade so that a distal portion of the shim element extends from a distal end of the first retractor blade.
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10. The system of clam 9, wherein the shim element is removably engageable with grooves along an inner-facing of the first retractor blade.
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11. The system of clam 10, wherein the three-bladed retractor assembly includes a first retractor extension member that is removably engageable with the second retractor blade and a second refractor extension member that is removably engageable with the third retractor blade.
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12. The system of clam 11, wherein the first retractor extension member is removably engageable with grooves along an inner-facing of the second retractor blade, and the second retractor extension member is removably engageable with grooves along an inner-facing of the third retractor blade.
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21. A system for forming an operating corridor to a lumbar spine, comprising:
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a dilator system to create a distraction corridor along a lateral, trans-psoas path to the lumbar spine, wherein said dilator system comprises at least two dilators of sequentially larger widths deliverable to a spinal disc along the lateral, trans-psoas path to the lumbar spine, a second dilator of said at least two dilators being slidably engageable with an exterior of a first of said at least two dilators, at least one of the first and second dilators including a stimulation electrode to deliver electrical stimulation for nerve monitoring when the stimulation electrode is positioned along the lateral, trans-psoas path to the lumbar spine; a three-bladed retractor assembly slidable over the dilator system toward the spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including; a blade holder assembly and first, second, and third retractor blades that extend generally perpendicularly relative to arm members of the blade holder assembly, wherein the three-bladed retractor assembly is adjustable from a first position in which the first, second, and third retractor blades are adjacent to one another and slidable over the dilator system to a second position in which the second and third retractor blades are moved away from the first retractor blade to enlarge the distraction corridor and thereby form an operative corridor along the lateral, trans-psoas path to the lumbar spine, wherein the first retractor blade is linearly movable relative to the second and third retractor blades in response to rotation of a knob element on the blade holder assembly, wherein the second refractor blade is movable relative to the first blade in response to pivoting movement of a first pivotable arm member of said arm members which is coupled to the second retractor blade, and wherein the third retractor blade is movable relative to the first blade in response to pivoting movement of a second pivotable arm member of said arm members which is coupled to the third refractor blade; and wherein when the three-bladed retractor assembly is adjusted to the second position to form the operative corridor along the lateral, trans-psoas path to the lumbar spine, the first retractor blade is a posterior-most retractor blade of the first, second, and third retractor blades and the operative corridor is dimensioned so as to pass an implant through the operative corridor and into the lumbar spine. - View Dependent Claims (22, 23, 24, 26, 27, 28, 29)
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25. The system of clam 21, wherein the three-bladed retractor assembly includes an intradiscal shim element having a proximal portion removably engageable with the first retractor blade so that a distal portion of the shim element extends from a distal end of the first retractor blade and is configured to penetrate into the spinal disc, wherein the proximal portion of the shim element is slidably engageable with grooves defined along the first retractor blade.
Specification