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:
- a distraction assembly to create a tissue distraction corridor in a lateral, trans-psoas path to a lumbar spine, wherein said distraction assembly includes an elongate inner element and a plurality of dilators, the plurality of dilators being configured to sequentially advance along the lateral, trans-psoas path to the lumbar spine, the elongate inner element being positionable in a lumen of an initial dilator of the plurality of dilators, wherein at least one instrument from the group consisting of said elongate inner element and said dilators includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the at least one instrument is positioned in the psoas muscle;
a three-bladed retractor tool slidable over an exterior of an outermost sequential dilator of the dilator system toward the targeted spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including;
a blade-holder assembly, anda posterior-most retractor blade, a cephalad-most retractor blade, and a caudal-most retractor blade that extend from the blade-holder assembly, wherein the posterior-most, cephalad-most, and caudal-most retractor blades are slidably advanced over the exterior of the outermost sequential dilator while in a first position, wherein the blade-holder assembly is adjustable to move the posterior-most, cephalad-most, and caudal-most retractor blades to a second position in which the cephalad-most and caudal-most retractor blades are spaced apart from the posterior-most retractor blade to define an operative corridor,wherein three-bladed retractor tool is configured to define the operative corridor along the lateral, trans-psoas path to the lumbar spine in which a space extending to the targeted spinal disc between the posterior-most, cephalad-most, and caudal-most refractor blades is dimensioned so as to pass an implant through the operative corridor along the lateral, trans-psoas path to 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.
296 Citations
20 Claims
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1. A system for forming an operating corridor to a lumbar spine, comprising:
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a distraction assembly to create a tissue distraction corridor in a lateral, trans-psoas path to a lumbar spine, wherein said distraction assembly includes an elongate inner element and a plurality of dilators, the plurality of dilators being configured to sequentially advance along the lateral, trans-psoas path to the lumbar spine, the elongate inner element being positionable in a lumen of an initial dilator of the plurality of dilators, wherein at least one instrument from the group consisting of said elongate inner element and said dilators includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the at least one instrument is positioned in the psoas muscle; a three-bladed retractor tool slidable over an exterior of an outermost sequential dilator of the dilator system toward the targeted spinal disc along the lateral, trans-psoas path, the three-bladed retractor assembly including; a blade-holder assembly, and a posterior-most retractor blade, a cephalad-most retractor blade, and a caudal-most retractor blade that extend from the blade-holder assembly, wherein the posterior-most, cephalad-most, and caudal-most retractor blades are slidably advanced over the exterior of the outermost sequential dilator while in a first position, wherein the blade-holder assembly is adjustable to move the posterior-most, cephalad-most, and caudal-most retractor blades to a second position in which the cephalad-most and caudal-most retractor blades are spaced apart from the posterior-most retractor blade to define an operative corridor, wherein three-bladed retractor tool is configured to define the operative corridor along the lateral, trans-psoas path to the lumbar spine in which a space extending to the targeted spinal disc between the posterior-most, cephalad-most, and caudal-most refractor blades is dimensioned so as to pass an implant through the operative corridor along the lateral, trans-psoas path to the lumbar spine. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A method for accessing a spinal disc of a lumbar spine of a patient, comprising:
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sequentially inserting a plurality of sequentially larger diameter dilators into said patient along a lateral, trans-psoas path to create a distraction corridor along said lateral, trans-psoas path toward a targeted spinal disc, wherein an initial dilator of said plurality of sequentially larger diameter dilators is configured to receive an elongate inner element, wherein at least one of said elongate inner element and said sequential dilators comprises a stimulation electrode; outputting electrical stimulation from said stimulation electrode of said at least one of said elongate inner element and said sequential dilators for nerve monitoring when said stimulation electrode is positioned in said lateral, trans-psoas path; simultaneously advancing a posterior-most retractor blade, a cephalad-most retractor blade, and a caudal-most retractor blade of a three-bladed retractor tool along said lateral, trans-psoas path and over an exterior of an outermost dilator of said plurality of sequentially larger diameter dilators, said three-bladed refractor tool comprising a blade holder assembly and said posterior-most, cephalad-most, and caudal-most refractor blades attached to said blade holder assembly; removing said plurality of sequentially larger diameter dilators from said patient after said posterior-most, cephalad-most, and caudal-most retractor blades are advanced through the psoas muscle, wherein an operative corridor along the lateral, trans-psoas path to the targeted spinal disc is at least partially defined by said posterior-most, cephalad-most, and caudal-most retractor blades; and maintaining said operative corridor along said lateral, trans-psoas path using said three-bladed retractor tool while delivering a spinal implant to a disc space of the targeted spinal disc. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19, 20)
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Specification