Surgical access system and related methods

• US 9,610,071 B2
• Filed: 01/15/2015
• Issued: 04/04/2017
• 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): BOCKELMAN, MARK
• Application Number:
  US14/598,043
• Publication Number:
  US 20150133734A1
• Time in Patent Office: 810 Days
• 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 accessing a surgical target site, the system comprising:

a trans-psoas dilator system, which includes at least a first dilator cannula, to create a tissue distraction corridor along the lateral, trans-psoas path through bodily tissue to the targeted intervertebral disc of the lumbar spine;

a three-bladed tissue retraction assembly to maintain the tissue distraction corridor along the lateral, trans-psoas path through bodily tissue to the targeted intervertebral disc of the lumbar spine, the three-bladed retractor comprising;

a caudal-most retractor blade connectable at a proximal end of the caudal-most retractor blade;

a cephalad-most retractor blade connectable at a proximal end of the cephalad-most retractor blade;

a posterior-most retractor blade connectable at a proximal end of the posterior-most retractor blade;

a handle assembly comprising;

means for connecting to the proximal end of the caudal-most retractor blade,

means for connecting to the proximal end of the cephalad-most retractor blade,

means for causing the cephalad-most retractor blade connecting means and the posterior-most retractor blade connecting means to retract in a hinged motion away from one another,

means for connecting to the proximal end of the posterior-most retractor blade, and

means for causing the posterior-most retractor blade to retract in a translating motion away from the cephalad-most retractor blade and the caudal-most retractor blade independently of the hinged motion; and

a spinal fusion implant sized and shaped to insert between the retractor blades along the trans-psoas path and into the targeted intervertebral disc of the lumbar spine while the retractor blades maintain the tissue-distraction corridor along the trans-psoas path.

2. The system of claim 1, wherein the means for connecting to the proximal end of the posterior-most retractor blade moves linearly in a direction that intersects with and is perpendicular to the common axis.

3. The system of claim 1, further comprising one or more light emitting devices to couple with one or more of 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 tissue retraction assembly maintains the tissue distraction corridor.

4. The system of claim 1, wherein the three-bladed tissue retraction assembly further includes a shim having a width and a thickness with its width being greater than its thickness and that releasably engages with the posterior-most retractor blade so that a distal portion of the spine penetration element extends distally from the posterior-most retractor blade to anchor the posterior-most retractor blade in fixed relation relative the lumbar spine.

5. The system of claim 4, wherein the spine penetration element includes a tapered tip for penetrating the lumbar spine and includes a proximal connection portion extending from a side of the shim to mate with the posterior-most retractor blade.

6. The system of claim 1, wherein when the three-bladed tissue retraction assembly is in a closed position, the distal-most retractor blade, the caudal-most retractor blade and the cephalad-most retractor blade abut one another.

7. The system of claim 1, wherein the caudal-most retractor blade, the cephalad-most retractor blade and the posterior-most retractor blade define a tissue-distracting corridor having a cross-sectional shape that is not circular.

8. The system of claim 1, wherein the spinal fusion implant further comprises bone products or bone morphogenic protein.

9. The system of claim 1, wherein the trans-psoas dilator system comprises:

an initial dilator and at least one supplemental dilator that slidably advances over an exterior of the initial dilator and engages the lumbar spine.

10. The system of claim 1, wherein the means for causing the posterior-most retractor blade to retract in a translating motion away from the cephalad-most retractor blade and the caudal-most retractor blade comprises a rotatable actuator, wherein the rotatable actuator interacts with teeth on a rack of the means for connecting to the proximal end of the posterior-most retractor blade to linearly adjust the position of the posterior-most retractor blade relative to the caudal-most retractor blade and the cephalad-most retractor blade.

11. The system of claim 1, and further comprising:

nerve monitoring means for delivering an electrical stimulation signal to a stimulation electrode positioned within the psoas muscle, for monitoring electromyographic activity detected in leg muscle myotomes associated with nerves in the vicinity of the spinal disc, and for displaying;

a numeric stimulation threshold that changes in response to the electromyographic activity detected in said leg muscle myotomes, a graphical representation of a patient, and myotomes levels being monitored.