Surgical access system and related methods

• US 9,848,861 B2
• Filed: 06/05/2014
• Issued: 12/26/2017
• Est. Priority Date: 06/26/2002
• 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): WOODALL, NICHOLAS W
• Application Number:
  US14/297,438
• Publication Number:
  US 20140288375A1
• Time in Patent Office: 1,300 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 of accessing a surgical target site within a patient, the patient having an anterior aspect, a posterior aspect, and two lateral aspects, the method comprising the steps of:

creating an operative corridor through tissue extending between an incision point on one of the two lateral aspects of the patient and a lateral aspect of a spinal surgical target site via a distraction assembly and a retraction assembly, wherein said operative corridor is established to the spinal target site via a lateral, trans-psoas approach 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 and extends through a region of a psoas muscle containing nerves, wherein said distraction assembly comprises an initial assembly including an elongate inner element and at least one dilator, said distraction assembly further comprises a secondary instrument advanceable to said spinal target site along said at least one dilator of said initial assembly, and wherein at least one of said distraction assembly and retraction assembly includes at least one stimulation electrode;

electrically stimulating said at least one stimulation electrode;

sensing a response of a nerve in the region of the psoas muscle depolarized by said stimulation;

determining at least one of nerve proximity and nerve direction of said nerve relative to at least one of said distraction assembly and said retraction assembly based upon the sensed response for negotiating past the nerves in the region of the psoas muscle and avoiding direct contact with the nerves; and

communicating indicia to a user representing at least one of said determined nerve proximity and said determined nerve direction.

2. The method of claim 1, wherein the operative corridor is created using said distraction assembly which creates a tissue distraction corridor along the lateral, trans-psoas path to the spinal target site and said retraction assembly which comprises first and second retractor blades that are advanced along the lateral, trans-psoas path to the spinal target site only after the distraction assembly creates said tissue distraction corridor.

3. The method of claim 1, wherein the step of communicating indicia comprises communicating numeric indicia of a stimulation current threshold level representing at least one of said determined nerve proximity and said determined nerve direction.

4. The method of claim 1, wherein the retraction assembly comprises first and second retractor blades that are releasably lockable to an external assembly having handle arms, and the first and second retractor blades of the retraction assembly create said operative corridor by increasing a size of a tissue distraction corridor formed by the distraction assembly and thereafter maintaining said increased size such that surgical instruments are passable through said operative corridor along the lateral, trans-psoas path to the surgical spinal target site.

5. The method of claim 4, wherein the step of creating the operative corridor comprises adjusting a position of the second retractor blade relative to the first retractor blade after the first retractor blade is advanced along the lateral, trans-psoas path to the spinal target site.

6. The method of claim 5, further comprising releasably engaging a first locking member within a passageway of the first retractor blade such that a distal region of the first locking member penetrates laterally into the lumbar spine to secure the distal end of the first retractor blade relative to the lumbar spine.

7. The method of claim 6, wherein the first retractor blade has a first main body element that is shaped identically to a second main body element of the second retractor blade, wherein the first main body element of the first retractor blade comprises a generally concave inner face and a generally convex exterior face, and the second main body element of the second retractor blade comprises a generally concave inner face and a generally convex exterior face.

8. The method of claim 1, wherein said secondary instrument comprises a set of sequentially insertable dilators.

9. The method of claim 1, wherein the elongate inner element comprises a K-wire.

10. The method of claim 1, wherein said secondary instrument comprises a speculum assembly.