Surgical access system and related methods

• US 8,500,634 B2
• Filed: 01/17/2013
• Issued: 08/06/2013
• Est. Priority Date: 09/25/2003
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Miles, Patrick, Martinelli, Scot, Finley, Eric
• Primary Examiner(s): BOLES, SAMEH RAAFAT
• Application Number:
  US13/743,673
• Publication Number:
  US 20130137931A1
• Time in Patent Office: 201 Days
• Field of Search: 606/104, 600201-210, 600213-217, 600221-226, 600228-235
• US Class Current: 600/224
• CPC Class Codes: A61B 1/06 with illuminating arrangements
• CPC Class Codes: A61B 1/32 Devices for opening or enlarging the visual field, e.g. of a tube of the body dilators A61M29/00
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• CPC Class Codes: A61B 2017/00473 Distal part, e.g. tip or head A61B2017/00464 takes precedence
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/0262 with a provision for protecting nerves
• CPC Class Codes: A61B 2505/05 Surgical care
• CPC Class Codes: A61B 2560/045 with a separable interface unit, e.g. for communication
• CPC Class Codes: A61B 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/1104 induced by stimuli or drugs; A61B5/1102 takes precedence; investigating medicinal preparations G01N33/15
• CPC Class Codes: A61B 5/296 for electromyography [EMG]
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: Y10S 606/909 Bone

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.

Claims

1. A system for forming a trans-psoas operative corridor to a lumbar spine, comprising:

a three-bladed psoas retractor tool to create an operative corridor along a lateral, trans-psoas path through bodily tissue toward a targeted intervertebral disc of a lumbar spine, the three-bladed psoas retractor tool including;

a first retractor blade is configured to be a posterior-most retractor blade when the three-bladed psoas retractor tool creates the operative corridor along the lateral, trans-psoas path;

a second retractor blade is configured to be a caudal-most retractor blade when the three-bladed psoas retractor tool creates the operative corridor along the lateral, trans-psoas path;

a third retractor blade is configured to be a cephalad-most retractor blade when the three-bladed psoas retractor tool creates the operative corridor along the lateral, trans-psoas path; and

a blade holder assembly comprising adjustable arm members that are pivotable with respect to one another, wherein the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade extend generally perpendicularly relative to the arm members of the blade holder assembly, wherein the three-bladed psoas retractor tool is adjustable from 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 along the lateral, trans-psoas path to a second position in which the posterior-most retractor blade, the caudal-most retractor blade, and

the cephalad-most retractor blade are spaced further apart from one another, the blade holder assembly comprising;

a rotatable actuator that causes linear adjustment of a position of the posterior-most retractor blade relative to the caudal-most retractor blade and the cephalad-most retractor blade in response to rotation of the rotatable actuator, wherein the position of the posterior-most retractor blade is linearly adjustable relative to the caudal-most retractor blade and the cephalad-most retractor blade while the caudal-most retractor blade and the cephalad-most retractor blade remain generally stationary relative to one another,

wherein when the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade of the three-bladed psoas retractor tool maintain the operative corridor along the lateral, trans-psoas path through the bodily tissue toward 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.

2. The system of claim 1, wherein the rotatable actuator of the blade holder assembly linearly adjusts a translating arm portion of the blade holder assembly that is coupled to the posterior-most retractor blade.

3. The system of claim 2, wherein the rotatable actuator of the blade holder assembly interacts with teeth on a rack of the translating arm portion to linearly adjust the position of the posterior-most retractor blade relative to the caudal-most retractor blade and the cephalad-most retractor blade.

4. The system of claim 3, wherein the blade holder assembly comprises a first pivotable arm portion to pivotably adjust the cephalad-most retractor blade relative to the posterior-most retractor blade, and a second pivotable arm portion to pivotably adjust the caudal-most retractor blade relative to the posterior-most retractor blade.

5. The system of claim 4, wherein the translating arm portion is arranged between the first and second pivotable arm portions of the blade holder assembly.

6. The system of claim 1, further comprising a plurality of sequential dilators of increasing diameters to create a tissue distraction corridor along the lateral, trans-psoas path through the bodily tissue toward the targeted intervertebral disc of the lumbar spine, the plurality of dilators comprising:

an initial dilator and at least a second dilator that slidably advances over an exterior of the initial dilator and engages the lumbar spine, wherein at least one dilator of the plurality of sequential dilators includes markings indicative of a depth distance between a distal end of the at least one dilator and a skin location.

7. The system of claim 6, further comprising an elongate inner member being positionable in a lumen of the initial dilator of the plurality of sequential dilators, wherein at least one instrument selected from the group consisting of said elongate inner member and said plurality of sequential dilators includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the instrument is positioned in the lateral, trans-psoas path.

8. The system of claim 7, further comprising a monitoring system that delivers an electrical stimulation sign to the stimulation electrode of the at least one instrument selected from the group consisting of said elongate inner member and said plurality of sequential dilators, monitors electromyographic activity detected by a set of sensor electrodes in leg muscle myotomes associated with nerves in the vicinity of the spinal disc, and displays to a user:

a numeric stimulation threshold required to obtain the electromyographic activity in said leg muscle myotomes, a graphical representation of a patient, and myotomes levels being monitored.

9. The system of claim 8, wherein the monitoring system comprises a control unit having a video display device, a patient module connected to the control unit via a data cable, an EMG sensor harness having the set of sensor electrodes connected to the patient module.

10. The system of claim 6, wherein the elongate inner member is advanceable together with the initial dilator along the lateral, trans-psoas path.

11. The system of claim 6, wherein when the three-bladed psoas retractor tool is in the first position, the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade are positioned to simultaneously slide over an outer dilator of the plurality of sequential dilators toward the lumbar spine to enlarge the tissue distraction corridor.

12. The system of claim 1, further comprising one or more light emitting devices to couple with one or more of the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade and emit light toward the targeted intervertebral disc of the lumbar spine when the three-bladed psoas retractor tool forms the operative corridor.

13. The system of claim 1, wherein the three-bladed psoas retractor tool further includes an anchor member to releasably engage the posterior-most retractor blade so that a distal portion of the anchor member extends distally from the posterior-most retractor blade to secure the posterior-most retractor blade in fixed relation relative the lumbar spine.

14. The system of claim 13, wherein the anchor member is removably engageable with receiving tracks formed along inner facings of the posterior-most refractor blade.

15. The system of claim 1, wherein when the three-bladed psoas retractor tool is in the first position, the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade are in abutting relation with one another.

16. The system of claim 1, further comprising a plurality of retractor blade extenders that are removably engageable with one or more of the caudal-most retractor blade and the cephalad-most retractor blade.

17. The system of claim 1, wherein when the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade maintain the operative corridor along the lateral, trans-psoas path, the operative corridor is dimensioned so as to pass the implant through the operative corridor along the lateral, trans-psoas path, the implant comprising a lateral approach fusion implant carrying bone products or bone morphogenic protein.