Surgical access system and related methods
First Claim
1. A system for forming an operating corridor to a lumbar spine of a patient, the patient having an anterior aspect, a posterior aspect and two lateral aspects, the system comprising:
- a plurality of dilators including a first dilator having a first diameter and a second dilator having a second diameter, the first diameter being smaller than the second diameter, the first and second dilators being configured to be sequentially inserted into the patient from one of the two lateral aspects of the patient along a lateral, trans-psoas path to a lateral aspect of a target intervertebral disc of the lumbar spine, the lateral, trans-psoas path having a path axis that extends from one of the two lateral aspects of the patient to the other of the two lateral aspects of the patient, and to create a tissue distraction corridor along the lateral, trans-psoas path through a region of a psoas muscle containing nerves to the target intervertebral disc, the tissue distraction corridor negotiating around the nerves of the psoas muscle;
a stimulation electrode along a distal region of the first dilator or the second dilator, the stimulation electrode being configured to deliver electrical stimulation to the nerves of the psoas muscle for monitoring a nerve response while the first dilator or the second dilator is advanced along the lateral, trans-psoas path to avoid directly contacting the nerves of the psoas muscle; and
a bladed retractor assembly comprising a plurality of retractor blades, the bladed retractor assembly being configured to be movable along the lateral, trans-psoas path to form an operative corridor along the lateral, trans-psoas path,wherein the bladed retractor assembly is adjustable from a first configuration comprising the plurality of retractor blades in a first position to a second configuration comprising the plurality of retractor blades in a second position to form the operative corridor along the lateral, trans-psoas path, the plurality of retractor blades being separated from one another along the length of the operative corridor in the second configuration, the operative corridor negotiating around the nerves of the psoas muscle and being dimensioned to pass an implant therethrough along the lateral, trans-psoas path toward the target intervertebral disc of the lumbar spine.
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Accused Products
Abstract
A system for accessing a surgical target site and related methods, involving an initial distraction system for creating an initial distraction corridor, and an assembly capable of distracting from the initial distraction corridor to a secondary distraction corridor and thereafter sequentially receiving a plurality of retractor blades for retracting from the secondary distraction corridor to thereby create an operative corridor to the surgical target site, 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.
557 Citations
30 Claims
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1. A system for forming an operating corridor to a lumbar spine of a patient, the patient having an anterior aspect, a posterior aspect and two lateral aspects, the system comprising:
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a plurality of dilators including a first dilator having a first diameter and a second dilator having a second diameter, the first diameter being smaller than the second diameter, the first and second dilators being configured to be sequentially inserted into the patient from one of the two lateral aspects of the patient along a lateral, trans-psoas path to a lateral aspect of a target intervertebral disc of the lumbar spine, the lateral, trans-psoas path having a path axis that extends from one of the two lateral aspects of the patient to the other of the two lateral aspects of the patient, and to create a tissue distraction corridor along the lateral, trans-psoas path through a region of a psoas muscle containing nerves to the target intervertebral disc, the tissue distraction corridor negotiating around the nerves of the psoas muscle; a stimulation electrode along a distal region of the first dilator or the second dilator, the stimulation electrode being configured to deliver electrical stimulation to the nerves of the psoas muscle for monitoring a nerve response while the first dilator or the second dilator is advanced along the lateral, trans-psoas path to avoid directly contacting the nerves of the psoas muscle; and a bladed retractor assembly comprising a plurality of retractor blades, the bladed retractor assembly being configured to be movable along the lateral, trans-psoas path to form an operative corridor along the lateral, trans-psoas path, wherein the bladed retractor assembly is adjustable from a first configuration comprising the plurality of retractor blades in a first position to a second configuration comprising the plurality of retractor blades in a second position to form the operative corridor along the lateral, trans-psoas path, the plurality of retractor blades being separated from one another along the length of the operative corridor in the second configuration, the operative corridor negotiating around the nerves of the psoas muscle and being dimensioned to pass an implant therethrough along the lateral, trans-psoas path toward the target intervertebral disc of the lumbar spine. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15)
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16. A system for forming an operating corridor to a lumbar spine of a patient, the system comprising:
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a plurality of dilators including a first dilator having a first diameter and a second dilator having a second diameter, the first diameter being smaller than the second diameter, the first and second dilators being configured to be inserted into one of two anatomically lateral aspects of the patient and advanced along a lateral, trans-psoas path to a lateral aspect of a target intervertebral disc of the lumbar spine, the trajectory of the lateral, trans-psoas path exiting the patient at the other of the two anatomically lateral aspects of the patient, the first and second dilators creating a tissue distraction corridor to the target intervertebral disc along the lateral, trans-psoas path, the lateral, trans-psoas path extending through a region of a psoas muscle containing nerves and negotiating around the nerves; a stimulation electrode along a distal region of the first dilator or the second dilator, the stimulation electrode being configured to deliver electrical stimulation to the nerves of the psoas muscle for monitoring a nerve response while advancing the first dilator or the second dilator along the lateral, trans-psoas path to avoid impairment of the nerves of the psoas muscle; and a bladed retractor assembly comprising a plurality of retractor blades, the bladed retractor assembly being configured to be movable over one of the plurality of dilators along the lateral, trans-psoas path to form an operative corridor along the lateral, trans-psoas path, the operative corridor being dimensioned to pass an implant therethrough along the lateral, trans-psoas path toward the target intervertebral disc of the lumbar spine. - View Dependent Claims (17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30)
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Specification