Surgical access system and related methods

• US 9,833,227 B2
• Filed: 03/02/2017
• Issued: 12/05/2017
• Est. Priority Date: 06/26/2002
• Status: Expired due to Term

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Miles, Patrick, Martinelli, Scot, Finley, Eric, Gharib, James, Farquhar, Allen, Kaula, Norbert F., Blewett, Jeffrey J.
• Primary Examiner(s): BECCIA, CHRISTOPHER J
• Application Number:
  US15/448,395
• Publication Number:
  US 20170172558A1
• Time in Patent Office: 278 Days
• 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 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• 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 5/296 for electromyography [EMG]
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 5/7405 using sound
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence

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.

Claims

1. A method 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 method comprising:

inserting a plurality of dilators into the patient at an insertion position on one of the two lateral aspects of the patient, the plurality of dilators comprising a first dilator having a first diameter and a second dilator having a second diameter, the first diameter being smaller than the second diameter;

advancing the plurality of dilators 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 the insertion position on the one of the two lateral aspects to the other of the two lateral aspects of the patient, 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 past the nerves of the psoas muscle;

electrically stimulating, using a stimulation electrode along a distal region of a dilator of the plurality of dilators, the nerves of the psoas muscle for monitoring a nerve response, and advancing the dilator along the lateral, trans-psoas path, based on the monitoring, to avoid directly contacting the nerves of the psoas muscle;

moving a plurality of retractor blades along the lateral, trans-psoas path to form an operative corridor along the lateral, trans-psoas path; and

adjusting the plurality of retractor blades 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 in which the plurality of retractor blades are spaced further apart from one another to form the operative corridor along the lateral, trans-psoas path, the operative corridor negotiating past the nerves of the psoas muscle without damaging the nerves and being dimensioned to pass an implant therethrough along the lateral, trans-psoas path toward the target intervertebral disc of the lumbar spine.

2. The method of claim 1, wherein moving the plurality of retractor blades comprises moving a posterior retractor blade.

3. The method of claim 2, further comprising:

using a locking member, the locking member comprising a main body and a distal region;

positioning at least a portion of the main body of the locking member in a passageway at a distal region of the posterior retractor blade; and

engaging the distal region of the locking member between two vertebrae adjacent to the target intervertebral disc.

4. The method of claim 2, wherein moving the plurality of retractor blades comprises moving an anterior retractor blade.

5. The method of claim 4, further comprising using a posterior blade guard member on the posterior retractor blade and an anterior blade guard member on the anterior retractor blade to prevent tissue from entering the operative corridor, the posterior blade guard member and the anterior blade guard member each comprising a curvature, and the posterior blade guard member and the anterior blade guard member each extending from respective distal ends of the posterior retractor blade and the anterior retractor blade toward the target intervertebral disc.

6. The method of claim 2, wherein moving the plurality of retractor blades further comprises moving a caudal retractor blade and a cephalad retractor blade.

7. The method of claim 5, wherein electrically stimulating the nerves comprises electrically stimulating the nerves using another stimulation electrode disposed on at least one of the posterior blade guard member and the anterior blade guard member.

8. The method of claim 1, further comprising coupling a pivot linkage assembly to at least one of the plurality of retractor blades via a locking assembly, the pivot linkage assembly comprising a first pivot arm, a second pivot arm, and an arm assembly, wherein the first pivot arm and the second pivot arm are oriented perpendicularly relative to the arm assembly and are configured to extend towards the target intervertebral disc while positioned in the lateral, trans-psoas path, and wherein the locking assembly is coupled to the first pivot arm or the second pivot arm.

9. The method of claim 8, further comprising sliding a speculum instrument between one of the plurality of dilators and the plurality of retractor blades.

10. The method of claim 9, wherein sliding the speculum instrument comprises sliding a first speculum blade and a second speculum blade.

11. The method of claim 10, further comprising sliding the first pivot arm and the second pivot arm over the first speculum blade and the second speculum blade.

12. The method of claim 10, further comprising activating the handle assembly to move the first pivot arm and the second pivot arm relative to one another to move the first speculum blade and the second speculum blade away from one another.

13. The method of claim 1, wherein electrically stimulating the nerves comprises electrically stimulating the nerves using a respective stimulation electrode along a distal region of each of the first dilator and the second dilator.

14. The method of claim 13, wherein each of the respective stimulation electrodes are oriented at an angle of 15°

to 75°

relative to corresponding longitudinal axes of the first dilator and the second dilator.

15. The method of claim 1, wherein moving the plurality of retractor blades comprises moving the plurality of retractor blades over at least one of the plurality of dilators.

16. A method for forming an operating corridor to a lumbar spine of a patient, the method comprising:

inserting a plurality of dilators into the patient at an insertion position on one of two anatomically lateral aspects of the patient, the plurality of dilators comprising a first dilator having a first diameter and a second dilator having a second diameter, the first diameter being smaller than the second diameter;

advancing the plurality of dilators along a lateral, trans-psoas path from the insertion position on the one of two anatomically lateral aspects of the patient 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, to create 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 past the nerves;

electrically stimulating, using a stimulation electrode along a distal region of the first dilator or the second dilator, the nerves of the psoas muscle for monitoring a nerve response and advancing the first dilator or the second dilator, based on the monitoring, along the lateral, trans-psoas path to avoid impairment of the nerves of the psoas muscle; and

moving a plurality of retractor blades over at least 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.

17. The method of claim 16, wherein moving the plurality of retractor blades comprises moving a posterior retractor blade.

18. The method of claim 17, further comprising:

using a locking member, the locking member comprising a main body and a distal region,

positioning at least a portion of the main body of the locking member in a passageway at a distal region of the posterior retractor blade; and

engaging the distal region of the locking member between two vertebrae adjacent to the target intervertebral disc.

19. The method of claim 17, wherein moving the plurality of retractor blades comprises moving an anterior retractor blade.

20. The method of claim 19, further comprising using a posterior blade guard member on the posterior retractor blade and an anterior blade guard member on the anterior retractor blade to prevent tissue from entering the operative corridor, the posterior blade guard member and the anterior blade guard member each comprising a curvature, and the posterior blade guard member and the anterior blade guard member each extending from respective distal ends of the posterior retractor blade and the anterior retractor blade toward the target intervertebral disc.

21. The method of claim 20, wherein electrically stimulating the nerves comprises electrically stimulating the nerves using another stimulation electrode disposed on at least one of the posterior blade guard member and the anterior blade guard member.

22. The method of claim 17, wherein moving the plurality of retractor blades further comprises moving a caudal retractor blade and a cephalad retractor blade.

23. The method of claim 16, further comprising coupling a pivot linkage assembly to at least one of the plurality of retractor blades via a locking assembly, the pivot linkage assembly comprising a first pivot arm, a second pivot arm, and an arm assembly, wherein the first pivot arm and the second pivot arm are oriented perpendicularly relative to the arm assembly and are configured to extend towards the target intervertebral disc while positioned in the lateral, trans-psoas path, and wherein the locking assembly is coupled to the first pivot arm or the second pivot arm.

24. The method of claim 23, further comprising sliding a speculum instrument between one of the plurality of dilators and the plurality of retractor blades.

25. The method of claim 24, wherein sliding the speculum instrument comprises sliding a first speculum blade and a second speculum blade.

26. The method of claim 25, further comprising sliding the first pivot arm and the second pivot arm over the first speculum blade and the second speculum blade.

27. The method of claim 25, further comprising activating the handle assembly to move the first pivot arm and the second pivot arm relative to one another to move the first speculum blade and the second speculum blade away from one another.

28. The method of claim 16, wherein electrically stimulating the nerves comprises electrically stimulating the nerves using a respective stimulation electrode along a distal region of each of the first dilator and the second dilator.

29. The method of claim 28, wherein each of the respective stimulation electrodes are oriented at an angle of 15°

to 75°

relative to corresponding longitudinal axes of the first dilator and the second dilator.

30. The method of claim 16, wherein moving the plurality of retractor blades comprises moving at least one of the plurality of retractor blades coupled to a fiber optic cable for delivering light to the target intervertebral disc.