Surgical access system and related methods
First Claim
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1. A system for accessing a lateral aspect of 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 portion of the elongate member engages with an annulus of the spinal disc;
a dilator system comprising a plurality of dilators to sequentially advance along the lateral, trans-psoas path to the lumbar spine to create a distraction corridor, the dilator system comprising at least one dilator that is sized to slidably receive an exterior of the elongate member, wherein at least one of the elongate member and the sequential dilators includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when said at least one of the elongate member and the sequential dilators is positioned in the lateral, trans-psoas path;
a multi-bladed refractor assembly to slidably engage with an outer dilator of the dilator system while the multi-bladed retractor assembly is advanced toward the spinal disc along the lateral, trans-psoas path, the multi-bladed retractor assembly including a caudal-most retractor blade and a cephalad-most refractor blade that extend generally perpendicularly relative to respective arm members of a blade holder assembly, wherein the caudal-most retractor blade and the cephalad-most retractor blade are pivotable relative to one another in response to movement of the respective arm members, wherein blade holder assembly comprises a shaft member extending between said respective arm members and having a first side with an exterior ridge pattern and a second side that is substantially flat, wherein the multi-bladed retractor assembly is slidably advanceable over the outer dilator of the dilator system when in a first position in which the caudal-most refractor blade and the cephalad-most retractor blade are generally side-by-side to one another, and wherein the blade holder assembly is configured to adjust the multi-bladed retractor assembly to a second position in which the caudal-most retractor blade and the cephalad-most retractor blade are moved away from one another to enlarge the distraction corridor and form an 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.
312 Citations
17 Claims
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1. A system for accessing a lateral aspect of 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 portion of the elongate member engages with an annulus of the spinal disc; a dilator system comprising a plurality of dilators to sequentially advance along the lateral, trans-psoas path to the lumbar spine to create a distraction corridor, the dilator system comprising at least one dilator that is sized to slidably receive an exterior of the elongate member, wherein at least one of the elongate member and the sequential dilators includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when said at least one of the elongate member and the sequential dilators is positioned in the lateral, trans-psoas path; a multi-bladed refractor assembly to slidably engage with an outer dilator of the dilator system while the multi-bladed retractor assembly is advanced toward the spinal disc along the lateral, trans-psoas path, the multi-bladed retractor assembly including a caudal-most retractor blade and a cephalad-most refractor blade that extend generally perpendicularly relative to respective arm members of a blade holder assembly, wherein the caudal-most retractor blade and the cephalad-most retractor blade are pivotable relative to one another in response to movement of the respective arm members, wherein blade holder assembly comprises a shaft member extending between said respective arm members and having a first side with an exterior ridge pattern and a second side that is substantially flat, wherein the multi-bladed retractor assembly is slidably advanceable over the outer dilator of the dilator system when in a first position in which the caudal-most refractor blade and the cephalad-most retractor blade are generally side-by-side to one another, and wherein the blade holder assembly is configured to adjust the multi-bladed retractor assembly to a second position in which the caudal-most retractor blade and the cephalad-most retractor blade are moved away from one another to enlarge the distraction corridor and form an 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, 12, 13, 14, 15, 16, 17)
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Specification