# US 2018/0021032 A1 · Nir/red light for lateral neuroprotection

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- Number: US 2018/0021032 A1
- Document ID: US20180021032A1
- Status: Published application
- Kind: A1
- Application number: 15/726,418
- Filed: 2017-10-06
- Published: 2018-01-25
- Earliest claimed: 2012-09-26
- Assignees: DePuy Synthes Products, Inc.
- Applicants: Depuy Synthes Products, Inc.
- Inventors: Thomas M. DiMauro; William Horton
- Web page: https://patentgrep.com/patent/US20180021032A1

## CPC

- A61B 17/025: {Joint distractors}
- A61B 5/4893: {Nerves}
- A61B 17/0206: {with antagonistic arms as supports for retractor elements}
- A61B 17/0293: {with ring member to support retractor elements}
- A61N 5/0601: {Apparatus for use inside the body}
- A61N 5/0622: {Optical stimulation for exciting neural tissue}
- A61B 5/746: {Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms}
- A61B 2017/00907: {for light}
- A61B 2017/0262: {with a provision for protecting nerves}
- A61N 2005/063: {comprising light transmitting means, e.g. optical fibres}
- A61N 2005/0651: {Diodes}
- A61N 2005/0659: {infrared}
- A61N 2005/0663: {Coloured light}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)

## Abstract

The use of red or near infrared light upon neurons of the lumbar plexus that are in distress due to retraction-induced ischemia. The surgeon may protect nerves made ischemic in the surgery by: a) making an incision in a patient, b) inserting an access device into the patient through the incision to at least partially create a path to a spine of the patient, and c) irradiating nervous tissue adjacent the path with an amount of NIR or red light effective to provide neuroprotection.

## Claims

### Claim at position 1

1-58. (canceled)

### Claim 59

A retractor system, comprising:
a first component adapted to retract tissue;
a second component adapted to retract tissue, the second component being movable relative to the first component to provide a working channel through tissue, the second component including an electrode in electrical connection with a neuromonitoring system adapted to monitor nerve status or health; and
a light delivery device inserted through the working channel, the light delivery device being connected to an endoscope.

### Claim 60 (depends on 59)

The system of claim 59, further comprising the neuromonitoring system, wherein the neuromonitoring system is configured to provide a warning when it detects a decline in nerve status or health.

### Claim 61 (depends on 59)

The system of claim 59, wherein the light delivery device is connected to a light source disposed outside a patient's body.

### Claim 62 (depends on 59)

The system of claim 59, wherein the second component has an arc-shaped outer wall having the electrode thereon.

### Claim 63 (depends on 59)

The system of claim 59, wherein the light delivery device runs down the length of an inner wall of the first component.

### Claim 64 (depends on 59)

The system of claim 59, wherein the light delivery device is secured within a channel or bore of the first component.

### Claim 65 (depends on 64)

The system of claim 64, wherein the light delivery device is secured within a channel formed in an inner wall of the first component.

### Claim 66 (depends on 59)

The system of claim 59, wherein the light delivery device is removably coupled to the first component.

### Claim 67 (depends on 59)

The system of claim 59, wherein the light delivery device is secured to the first component via a taper-lock configuration.

### Claim 68 (depends on 59)

The system of claim 59, wherein the light delivery device runs along a proximal portion of the first component and terminates in a distal end portion of the first component.

### Claim 69 (depends on 59)

The system of claim 59, wherein the second component is formed from a conductive metal coated with a non-conductive polymer, wherein the electrode is defined by an uncoated portion of the conductive metal.

### Claim 70 (depends on 59)

The system of claim 59, further comprising an extension adapted to dock the retractor system to spinal tissue.

### Claim 71 (depends on 70)

The system of claim 70, wherein the extension is axially adjustable with respect to the first component.

### Claim 72 (depends on 59)

The system of claim 59, further comprising a cable containing a fiber optic extending proximally from the first component.

### Claim 73 (depends on 72)

The system of claim 72, further comprising a receptacle at a proximal end of the first component that receives the cable to secure the cable to the first component.

### Claim 74 (depends on 59)

The system of claim 59, further comprising a connector adapted to receive a fiber optic cable and located on an outer surface of a proximal end of the first component.

### Claim 75 (depends on 59)

The system of claim 59, further comprising a light diffusing panel adapted to spread light emanating from a distal end of the light delivery device.

### Claim 76 (depends on 59)

The system of claim 59, wherein the light delivery device comprises a handheld light source lowered into the working channel.

### Claim 77 (depends on 59)

The system of claim 59, wherein the light delivery device comprises a red/NIR light emitter.

### Claim 78 (depends on 77)

The system of claim 77, wherein the light delivery device emits red light combined with polychrome visible or white light.

### Claim 79

A surgical method, comprising:
making an incision in a patient,
inserting a retractor into the patient through the incision to provide a working channel through tissue of the patient, the retractor being inserted such that first and second components of the retractor are in contact with tissue of the patient, the first and second components being movable with respect to one another,
irradiating nervous tissue of the patient adjacent to the retractor using a light delivery device inserted through the working channel,
visualizing the nervous tissue using an endoscope connected to the light delivery device,
moving the first and second components of the retractor relative to one another to retract the nervous tissue, and
monitoring a heath or status of the nervous tissue using an electrode of the second component, the electrode being in electrical connection with a neuromonitoring system.

### Claim 80 (depends on 79)

The method of claim 79, wherein the working channel leads to an intervertebral disc space.

### Claim 81 (depends on 79)

The method of claim 79, wherein the retractor is inserted using a transforaminal lumbar interbody fusion (TLIF) approach.

### Claim 82 (depends on 79)

The method of claim 79, further comprising inserting an intervertebral fusion cage through the working channel and into an intervertebral disc space of the patient.

### Claim 83 (depends on 79)

The method of claim 79, wherein the nervous tissue comprises a nerve root.

### Claim 84 (depends on 83)

The method of claim 83, wherein the nerve root is a traversing root of a dorsal root ganglion.

### Claim 85 (depends on 79)

The method of claim 79, wherein the nervous tissue is a nerve of the lumbar plexus.

### Claim 86 (depends on 79)

The method of claim 79, wherein the retractor is inserted through a psoas muscle of the patient.

### Claim 87 (depends on 79)

The method of claim 79, further comprising docking the retractor to spinal tissue.

### Claim 88 (depends on 87)

The method of claim 87, wherein the retractor is docked via an extension of the retractor.

### Claim 89 (depends on 88)

The method of claim 88, further comprising axially adjusting the extension with respect to the retractor.

### Claim 90 (depends on 79)

The method of claim 79, further comprising securing the retractor to a rigid arm.