Surgical access system and related methods
First Claim
1. A method of forming an operative corridor through a psoas muscle along a substantially lateral, trans-psoas path for insertion of a spinal implant in a targeted spinal disc space, 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 psoas muscle and a targeted spinal disc space and advancing the tip portion of the user'"'"'s finger to contact the psoas muscle;
advancing a dilator system along a substantially lateral, trans-psoas path to the targeted spinal disc space, the dilator system comprising;
a first cannulated dilator that is advanced laterally through the psoas muscle to the targeted spinal disc space, one or more sequential dilators that are advanced along the substantially 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 said first cannulated dilator, said one or more sequential dilators, and said elongate inner member includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the stimulation electrode is positioned in the substantially lateral, trans-psoas path;
slidably advancing a multi-blade retractor assembly over an outermost dilator of the dilator system toward the targeted spinal disc space along the substantially 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 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 at least a portion of the dilator system after the multi-blade retractor assembly is advanced through the psoas muscle, wherein a trans-psoas operative corridor along the substantially lateral, trans-psoas path to the targeted spinal disc space is at least partially defined by the plurality of retractor blades;
inserting a spinal implant that is releasably secured to an inserter tool through the trans-psoas operative corridor maintained by the multi-blade refractor assembly along the substantially lateral, trans-psoas path to the targeted spinal disc space; and
releasing the spinal implant from the inserter tool when the spinal implant is positioned in the targeted spinal disc space.
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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.
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Citations
19 Claims
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1. A method of forming an operative corridor through a psoas muscle along a substantially lateral, trans-psoas path for insertion of a spinal implant in a targeted spinal disc space, 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 psoas muscle and a targeted spinal disc space and advancing the tip portion of the user'"'"'s finger to contact the psoas muscle; advancing a dilator system along a substantially lateral, trans-psoas path to the targeted spinal disc space, the dilator system comprising;
a first cannulated dilator that is advanced laterally through the psoas muscle to the targeted spinal disc space, one or more sequential dilators that are advanced along the substantially 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 said first cannulated dilator, said one or more sequential dilators, and said elongate inner member includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when the stimulation electrode is positioned in the substantially lateral, trans-psoas path;slidably advancing a multi-blade retractor assembly over an outermost dilator of the dilator system toward the targeted spinal disc space along the substantially 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 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 at least a portion of the dilator system after the multi-blade retractor assembly is advanced through the psoas muscle, wherein a trans-psoas operative corridor along the substantially lateral, trans-psoas path to the targeted spinal disc space is at least partially defined by the plurality of retractor blades; inserting a spinal implant that is releasably secured to an inserter tool through the trans-psoas operative corridor maintained by the multi-blade refractor assembly along the substantially lateral, trans-psoas path to the targeted spinal disc space; and releasing the spinal implant from the inserter tool when the spinal implant is positioned in the targeted spinal disc space. - 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