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 targeted spinal disc, 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 in a retroperitoneal space that is generally lateral from a targeted spinal disc and advancing the tip portion of the user'"'"'s finger space to palpate to a psoas muscle that is generally lateral from the targeted spinal disc;
advancing a dilator system along the lateral, trans-psoas path to the targeted spinal disc to create a distraction corridor, the dilator system comprising;
a first cannulated dilator that is advanced laterally through the psoas muscle to the targeted spinal disc, a plurality of supplemental dilators that are sequentially advanced along the lateral, trans-psoas path, wherein the first cannulated dilator comprises a central lumen configured to receive an elongate inner member, and wherein one or more of the a first cannulated dilator, the plurality of supplemental dilators, and the elongate inner member includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the stimulation electrode is positioned in the lateral, trans-psoas path;
slidably advancing a multi-blade retractor assembly over an exterior of an outermost dilator of the dilator system toward the targeted spinal disc along the lateral, trans-psoas path, the multi-blade retractor assembly including a blade adjuster apparatus and a plurality of retractor blades extending from the blade adjuster apparatus, wherein the plurality of retractor blades are slidably advanced over the exterior of the outermost dilator while in a first position in which the plurality of retractor blades are configured to simultaneously slide over the outermost dilator of the dilator system, wherein the blade adjuster apparatus is operable to adjust the plurality of retractor blades to a second position in which a first retractor blade is moved away from a second retractor blade;
removing the dilator system after the multi-blade retractor assembly is 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 the plurality of retractor blades;
inserting an implant that is releasably secured to an inserter tool through the operative corridor formed by the multi-blade retractor assembly along the lateral, trans-psoas path to the targeted spinal disc; and
releasing the implant from the inserter tool when the implant is positioned in a disc space of the targeted spinal disc.
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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.
308 Citations
19 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 targeted spinal disc, 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 targeted spinal disc and advancing the tip portion of the user'"'"'s finger space to palpate to a psoas muscle that is generally lateral from the targeted spinal disc; advancing a dilator system along the lateral, trans-psoas path to the targeted spinal disc to create a distraction corridor, the dilator system comprising;
a first cannulated dilator that is advanced laterally through the psoas muscle to the targeted spinal disc, a plurality of supplemental dilators that are sequentially advanced along the lateral, trans-psoas path, wherein the first cannulated dilator comprises a central lumen configured to receive an elongate inner member, and wherein one or more of the a first cannulated dilator, the plurality of supplemental dilators, and the elongate inner member includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the stimulation electrode is positioned in the lateral, trans-psoas path;slidably advancing a multi-blade retractor assembly over an exterior of an outermost dilator of the dilator system toward the targeted spinal disc along the lateral, trans-psoas path, the multi-blade retractor assembly including a blade adjuster apparatus and a plurality of retractor blades extending from the blade adjuster apparatus, wherein the plurality of retractor blades are slidably advanced over the exterior of the outermost dilator while in a first position in which the plurality of retractor blades are configured to simultaneously slide over the outermost dilator of the dilator system, wherein the blade adjuster apparatus is operable to adjust the plurality of retractor blades to a second position in which a first retractor blade is moved away from a second retractor blade; removing the dilator system after the multi-blade retractor assembly is 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 the plurality of retractor blades; inserting an implant that is releasably secured to an inserter tool through the operative corridor formed by the multi-blade retractor assembly along the lateral, trans-psoas path to the targeted spinal disc; and releasing the implant from the inserter tool when the implant is positioned in a disc space of the targeted spinal disc. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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Specification