Surgical access system and related methods

• US 8,747,307 B2
• Filed: 09/04/2013
• Issued: 06/10/2014
• Est. Priority Date: 01/16/2003
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Miles, Patrick, Martinelli, Scot, Finley, Eric, Gharib, James E., Farquhar, Allen, Kaula, Norbert F., Blewett, Jeffrey J.
• Primary Examiner(s): Hammond, Ellen C
• Application Number:
  US14/018,209
• Publication Number:
  US 20140012089A1
• Time in Patent Office: 279 Days
• Field of Search: 600201-246, 606/279
• US Class Current: 600/202
• 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 17/0206 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 2017/00473 Distal part, e.g. tip or head A61B2017/00464 takes precedence
• CPC Class Codes: A61B 2017/0262 with a provision for protecting nerves
• CPC Class Codes: A61B 5/4893 Nerves

Abstract

A surgical access system and method for accessing a surgical target site in order to perform surgical procedures, and particularly suited for establishing an operative corridor to an intervertebral target.

Claims

1. A method for accessing a spinal disc space of a lumbar spine of a patient, comprising:

sequentially inserting a plurality of sequentially larger diameter dilators into a patient along a lateral, trans-psoas path to create a distraction corridor along said lateral, trans-psoas path toward a targeted spinal disc of a lumbar spine, wherein at least one of said plurality of sequentially larger diameter dilators is configured to receive an elongate member, wherein at least one instrument from a group consisting of the elongate member and the sequentially larger diameter dilators comprises;

a stimulation electrode along a distal region, and a proximal connector region for releasable electrical connection with a nerve monitoring system;

outputting electrical stimulation from said stimulation electrode of said at least one instrument from the group consisting of the elongate member and the sequentially larger diameter dilators for nerve monitoring when said stimulation electrode is positioned in said lateral, trans-psoas path;

simultaneously advancing a plurality of retractor blades of a bladed retractor assembly along said lateral, trans-psoas path and over an exterior of an outermost dilator of said plurality of sequentially larger diameter dilators, wherein the bladed retractor assembly is adjustable from a first position in which the plurality of retractor blades are positioned to slide over the outermost dilator of the plurality of sequential dilators to a second position in which the plurality of retractor blades are moved apart from one another;

removing said plurality of sequentially larger diameter dilators from said patient after said plurality of 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 plurality of retractor blades; and

maintaining said operative corridor along said lateral, trans-psoas path using said bladed retractor tool while delivering a spinal implant through said operative corridor to a disc space of the targeted spinal disc of the lumbar spine.

2. The method of claim 1, further comprising adjusting the bladed retractor assembly from the first position to the second position to create said operative corridor along said lateral, trans-psoas path to said targeted spinal disc, wherein said operative corridor is dimensioned so as to pass the spinal implant through said operative corridor along said lateral, trans-psoas path to said targeted spinal disc.

3. The method of claim 2, wherein the bladed refractor assembly comprises a blade holder apparatus and said plurality of retractor blades are attached to said blade holder apparatus, the method further comprising adjusting the blade holder apparatus so as to move the retractor blades away from one another while said retractor blades are positioned along said lateral, trans-psoas path to said targeted spinal disc.

4. The method of claim 3, wherein said blade holder apparatus is adjustable to move at least one of the retractor blades away from a neighboring retractor blade of the retractor blades while the neighboring retractor blade remains in a generally stationary position relative to the targeted spinal disc.

5. The method of claim 2, wherein said plurality of sequentially larger diameter dilators are removed from said patient after said step of adjusting the bladed retractor assembly from the first position to the second position.

6. The method of claim 1, further comprising activating a light emitting device to direct light through said operative corridor toward the targeted spinal disc, the light emitting device being coupled to one of the plurality of retractor blades.

7. The method of claim 1, further comprising advancing said elongate inner member along said lateral, trans-psoas path and penetrating said elongate inner member into the disc space.

8. The method of claim 1, wherein said elongate inner member includes the stimulation electrode along its distal region.

9. The method of claim 8, wherein the elongate member comprises a K-wire.

10. The method of claim 1, further comprising, after said removing said plurality of sequentially larger diameter dilators from said patient, releasably attaching a fixation element with one of the refractor blades so that at least a portion of the fixation element extends distally from the one of the retractor blades to penetrate into the lumbar spine.

11. The method of claim 10, wherein the fixation element comprises a shim member that at least partially extends distally from the one of the retractor blades to anchor into the targeted intervertebral disc.

12. The method of claim 1, wherein each of said plurality of sequentially larger diameter dilators comprises a distal end on which a respective stimulation electrode is situated, said distal end being angled relative to a longitudinal axis of said dilator such that said stimulation electrode is angled relative to said longitudinal axis.

13. The method of claim 1, wherein said bladed retractor assembly comprises a three-bladed retractor tool.

14. The method of claim 13, wherein said plurality of retractor blades comprises a posterior-most retractor blade, a cephalad-most retractor blade, and a caudal-most retractor blade.

15. The method of claim 1, further comprising:

activating the nerve monitoring system that delivers an electrical stimulation signal to the stimulation electrode of said at least one instrument from the group consisting of the elongate member and the sequentially larger diameter dilators when said stimulation electrode is positioned in said lateral, trans-psoas path, the nerve monitoring system detecting neuromuscular responses via a set of sensors in leg muscle myotomes associated with nerves in the vicinity of the spinal disc; and

during advancement of said at least one instrument from the group consisting of the elongate member and the sequentially larger diameter dilators through the psoas muscle, viewing a video display device of the nerve monitoring system that displays a numeric stimulation threshold value in units of milliAmps which varies in response to the detection of said neuromuscular responses via said set of sensor in said leg muscle myotomes.

16. The method of claim 15, wherein the nerve monitoring system delivers the electrical stimulation signal to the stimulation electrode, monitors electrical activity detected by a set of sensor electrodes in communication with leg muscle myotomes associated with nerves in the vicinity of the targeted intervertebral disc, and displays on the video display device the numeric stimulation current threshold required to obtain a threshold value of the detected electrical activity in at least one of said leg muscle myotomes.

17. The method of claim 1, wherein the elongate member and said at least one of said plurality of sequentially larger diameter dilators are simultaneously inserted into the patient along the lateral, trans-psoas path.

18. The method of claim 1, wherein the stimulation electrode is positioned the elongate member.