Systems and methods for performing spine surgery
First Claim
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1. A method for accessing the L5/S1 disc of the lumbosacral junction, comprising the steps of:
- preoperatively assessing a patient image to determine the size of a safe zone bordered posteriorly by the L5/S1 nerve root and anteriorly by the iliac vein,advancing a dilator through the ilium to the L5/S1 disc space and directing the dilator to pass just anterior to the L5/S1 nerve root through the safe zone without contacting the L5/S1 nerve root, an electrical signal being delivered from a stimulation electrode on the distal end of the dilator to provide an indication of the proximity of the distal end of the dilator to the L5/S1 nerve root;
advancing to the L5/S1 disc space over the dilator at least one supplemental dilator; and
removing at least one inner dilator and not removing an outermost supplemental dilator.
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Abstract
Systems and methods are described for accessing and operating on an intervertebral disc at the lumbosacral junction via a trans-iliac approach. The instruments and methods described employ nerve monitoring to direct passage of the instruments through a safe zone between the L5 nerve root lying posterior to the trans-iliac path and the iliac vein (and iliac artery) lying anterior to the trans-iliac path.
549 Citations
20 Claims
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1. A method for accessing the L5/S1 disc of the lumbosacral junction, comprising the steps of:
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preoperatively assessing a patient image to determine the size of a safe zone bordered posteriorly by the L5/S1 nerve root and anteriorly by the iliac vein, advancing a dilator through the ilium to the L5/S1 disc space and directing the dilator to pass just anterior to the L5/S1 nerve root through the safe zone without contacting the L5/S1 nerve root, an electrical signal being delivered from a stimulation electrode on the distal end of the dilator to provide an indication of the proximity of the distal end of the dilator to the L5/S1 nerve root; advancing to the L5/S1 disc space over the dilator at least one supplemental dilator; and removing at least one inner dilator and not removing an outermost supplemental dilator. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)
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Specification