US 2014/0180016 A1 · SURGICAL ACCESS SYSTEM AND RELATED METHODS

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.

Claims21

Dependent claims

(canceled)

A surgical system for providing a lateral, trans-psoas operative corridor to a lumbar spine, comprising:

an first cannula configured to advance to a targeted spinal disc along a lateral, trans-psoas path to the lumbar spine, an elongate inner member advanceable through an inner lumen of the first cannula and having a tip configured to engage with a lateral aspect of a targeted spinal disc along the lateral, trans-psoas path to the lumbar spine, and a plurality of sequential dilators of sequentially larger diameter deliverable to the targeted spinal disc along the lateral, trans-psoas path to the lumbar spine, wherein at least one instrument from a group consisting of the first cannula, and the elongate inner member, and the sequential dilators includes a stimulation electrode at distal tip region to deliver electrical stimulation for nerve monitoring when the stimulation electrode is positioned in the lateral, trans-psoas path, wherein the elongate inner member has a longitudinal length that is greater than a longitudinal length of the first cannula, and wherein one or more dilators of the plurality of sequential dilators have an outer diameter that is greater than an outer diameter of the first cannula;
and
a trans-psoas retractor assembly comprising a blade holder apparatus and a plurality of retractor blades configured to mate with and mount onto said blade holder apparatus, wherein the plurality of retractor blades of the trans-psoas retractor assembly are configured to maintain a trans-psoas operative corridor along the lateral, trans-psoas path to the lumbar spine after advancement of the plurality of sequential dilators along the lateral, trans-psoas path to the lumbar spine, wherein at least two retractor blades of the plurality of retractor blades are mountable to the blade holder apparatus so as to be caudal-most and cephalad-most retractor blades when the plurality of retractor blades maintain a trans-psoas operative corridor along the lateral, trans-psoas path, and
wherein the blade holder apparatus is configured to retain the plurality of retractor blades in a selected position so that the trans-psoas operative corridor is so dimensioned to pass an implant through the trans-psoas operative corridor along the lateral, trans-psoas path to the lumbar spine.

1 more element

A surgical system for providing a lateral, trans-psoas operative corridor to a lumbar spine, comprising:

an first cannula configured to advance to a targeted spinal disc along a lateral, trans-psoas path to the lumbar spine, an elongate inner member advanceable through an inner lumen of the first cannula and being configured to penetrate into a lateral aspect of a targeted spinal disc along the lateral, trans-psoas path to the lumbar spine, and a plurality of sequential dilators of sequentially larger diameter deliverable to the targeted spinal disc along the lateral, trans-psoas path to the lumbar spine, wherein at least one instrument from a group consisting of the first cannula and the elongate inner member includes a stimulation electrode at distal tip region to deliver electrical stimulation for nerve monitoring when the stimulation electrode is positioned in the lateral, trans-psoas path, wherein each of the sequential dilators includes one or more stimulation electrodes at distal tip regions to deliver electrical stimulation for nerve monitoring when the stimulation electrodes are positioned in the lateral, trans-psoas path, wherein the elongate inner member has a longitudinal length that is greater than a longitudinal length of the first cannula, and wherein one or more dilators of the plurality of sequential dilators have an outer diameter that is greater than an outer diameter of the first cannula;
and
a trans-psoas retractor assembly comprising a blade holder apparatus and a plurality of retractor blades coupled to said blade holder apparatus, wherein at least two retractor blades of the plurality of retractor blades are releasably attachable to said blade holder apparatus, wherein the plurality of retractor blades of the trans-psoas retractor assembly are configured to maintain a trans-psoas operative corridor along the lateral, trans-psoas path to the lumbar spine after advancement of the plurality of sequential dilators along the lateral, trans-psoas path to the lumbar spine, wherein a first retractor blade of the plurality of retractor blades is movable away from a second retractor blade of the plurality of retractor blades while in the lateral, trans-psoas path, and
wherein the blade holder apparatus is configured to retain the plurality of retractor blades in a selected position so that the trans-psoas operative corridor is so dimensioned to pass an implant through the trans-psoas operative corridor along the lateral, trans-psoas path to the lumbar spine.

1 more element

A surgical system for providing a lateral, trans-psoas operative corridor to a lumbar spine, comprising:

an first cannula configured to advance to a targeted spinal disc along a lateral, trans-psoas path to the lumbar spine, an elongate inner member advanceable through an inner lumen of the first cannula and being configured to is penetrate into a lateral aspect of a targeted spinal disc along the lateral, trans-psoas path to the lumbar spine, and a plurality of sequential dilators of sequentially larger diameter deliverable to the targeted spinal disc along the lateral, trans-psoas path to the lumbar spine, wherein at least one instrument from a group consisting of the first cannula and the elongate inner member includes a stimulation electrode at distal tip region to deliver electrical stimulation for nerve monitoring when the stimulation electrode is positioned in the lateral, trans-psoas path, wherein each of the sequential dilators includes one or more stimulation electrodes at distal tip regions to deliver electrical stimulation for nerve monitoring when the stimulation electrodes are positioned in the lateral, trans-psoas path, wherein the elongate inner member has a longitudinal length that is greater than a longitudinal length of the first cannula, and wherein one or more dilators of the plurality of sequential dilators have an outer diameter that is greater than an outer diameter of the first cannula;
and
a trans-psoas retractor assembly comprising a blade holder apparatus and a plurality of retractor blades configured to releasably lock onto said blade holder apparatus, wherein all of the retractor blades of the trans-psoas retractor assembly have a distal portion shaped to safely advanced along the lateral, trans-psoas path to the lumbar spine, wherein a first retractor blade of the plurality of retractor blades is movable away from a second retractor blade of the plurality of retractor blades while in the lateral, trans-psoas path, wherein the plurality of retractor blades of the trans-psoas retractor assembly are shaped and operable to safely maintain a trans-psoas operative corridor along the lateral, trans-psoas path to the lumbar spine after advancement of the plurality of sequential dilators along the lateral, trans-psoas path to the lumbar spine, and
wherein the blade holder apparatus is configured to retain the plurality of retractor blades in a selected position so that the trans-psoas operative corridor is so dimensioned to pass an implant through the trans-psoas operative corridor along the lateral, trans-psoas path to the lumbar spine.

1 more element

Dependencies are inferred from the claim text.

Facts

Application

14/195,227Filed 3 Mar 2014

Priority

8 Oct 2002

Published

26 Jun 2014

Term ends

Not estimatedThe source records don’t support an estimate.

Classification13 codes

A61B 17/025
For holding wounds open, e.g. retractors; Tractors: joint distractors
A61B 1/32
Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g.…:…
A61B 5/395
Electromyography [EMG]: details of stimulation, e.g. nerve stimulation to elicit EMG response
A61B 17/0218
For holding wounds open, e.g. retractors; Tractors: for minimally invasive surgery

Family

Application60/417,235Us provisional application · filed 8 Oct 2002

Application10/682,568Continuation · filed 8 Oct 2003

Application12/650,271Continuation · filed 30 Dec 2009

Application13/486,093Continuation · filed 1 Jun 2012

Application13/756,908Continuation · filed 1 Feb 2013

Application14/018,173Continuation · filed 4 Sep 2013

Application14/195,227Continuation

US 2008/0058606 A1Published application

US 2010/0174146 A1Published application

US 2012/0238822 A1Published application

US 2013/0150676 A1Published application