Surgical access system and related methods

Patent metadata

Field	Value
Publication number	US-9622732-B2
Application number	US-66503905-A
Country	US
Kind code	B2
Filing date	Oct 11, 2005
Priority date	Oct 8, 2004
Publication date	Apr 18, 2017
Grant date	Apr 18, 2017

Abstract

A surgical access system including a tissue distraction assembly 40 and a tissue retraction assembly 10 , both of which may be equipped with one or more electrodes 23 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 15 to a surgical target site. The tissue retraction assembly 10 has a plurality of blades 12, 16, 18 which may be introduced while in a closed configuration, after which point they may be opened to create an operation corridor 15 to the surgical target site, including pivoting at least one blade 12, 16, 18 to expand the operative corridor 15 adjacent to the operative site.

First claim

What is claimed is:

1. A system for accessing a spinal surgical target site, comprising: a retractor assembly having first, second, and third blades and a blade holder assembly, the first, second, and third blades being advanceable to said surgical target site while in a first position in which the first blade is immediately adjacent the second and third blades, the second blade is immediately adjacent the first and third blades, and the third blade is immediately adjacent the first and second blades, and adjustable to a second position in which the first, second, and third blades are separated relative to said first position, said blade holder assembly including first arm having a first longitudinal axis and a second arm having a second longitudinal axis, the first and second arms being coupled about a pivot, said first retractor blade being coupled to said first arm distally to said pivot and said second retractor blade being coupled to said second arm distally to said pivot, wherein adjustment from the first position to the second position includes pivoting movement of the first and second arms about said pivot such that said first longitudinal axis and said second longitudinal axis move away from each other distal of said pivot, said first arm having a first rotatable arm section situated distally to a first static arm section, the first retractor blade being rigidly secured to the first rotatable arm section, said first rotatable arm section rotatable relative to said first static arm section and about said first longitudinal axis to translocate a distal end of said first blade relative to a proximal end of the first blade, said second arm having a second rotatable arm section situated distally to a second static arm section, the second retractor blade being rigidly secured to the second rotatable arm section, said second rotatable arm section rotatable relative to said second static arm section and about said second longitudinal axis to translocate a distal end of said second blade relative to a proximal end of the second blade.

2. The system of claim 1 , including a distraction assembly for creating a distraction corridor to said surgical target site prior to advancing said first, second and third blades to said surgical target site.

3. The system of claim 2 , wherein said distraction assembly includes a first dilator having a stimulation electrode on a distal end portion thereof.

4. The system of claim 3 , including a secondary distraction assembly including a plurality of sequentially larger diameter dilators that advance along the first dilator for distracting said initial distraction corridor to a secondary distraction corridor, said first, second and third blades being advanced through said secondary distraction corridor to said surgical target site.

5. The system of claim 4 , wherein each dilator of the plurality of sequentially larger diameter dilators includes a stimulation electrode on a distal end portion.

6. The system of claim 5 , wherein another stimulation electrode is positioned near a distal end of the third retractor blade.

7. The system of claim 3 , further comprising a control unit configured to electrically stimulate said stimulation electrode, sense a response of a nerve depolarized by said stimulation, determine a relative proximity from said first dilator to the nerve based upon the sensed response, and communicate said direction to a user.

8. The system of claim 7 , further comprising an electrode configured to sense a neuromuscular response of a muscle coupled to said depolarized nerve, the electrode being operable to send the response to the control unit.

9. The system of claim 8 , wherein the control unit comprises a display operable to display an electromyographic (EMG) response of the muscle.

10. The system of claim 7 , further comprising a coupling device that provides an electrical connection to said first dilator for delivering an electrical stimulation signal to the first dilator at the direction of said control unit.

11. The system of claim 7 , wherein the control unit comprises a touch-screen display operable to receive commands from a user.

12. The system of claim 3 , wherein said distraction assembly also includes a K-wire configured for disposal within the first dilator.

13. The system of claim 1 , wherein said third retractor blade includes a stimulation electrode.

14. The system of claim 13 , wherein the stimulation electrode is positioned near a distal end of said third blade.

15. The system of claim 13 , further comprising a control unit capable of electrically stimulating said stimulation electrode, sensing a response of a nerve depolarized by said stimulation, determining a relative proximity from said distraction assembly to the nerve based upon the sensed response, and communicating said relative proximity to a user.

16. The system of claim 15 , further comprising an electrode configured to sense a neuromuscular response of a muscle coupled to the depolarized nerve, the electrode being operable to send the response to the control unit.

17. The system of claim 16 , wherein the control unit comprises a display operable to display an electromyographic (EMG) response of the muscle.

18. The system of claim 15 , further comprising a coupling device that provides an electrical connection between said stimulation electrode and said control unit.

19. The system of claim 15 , wherein the control unit comprises a touch-screen display operable to receive commands from a user.

20. The system of claim 1 , wherein said system for accessing a spinal surgical target site is configured to provide said access to the spinal surgical target site via a lateral, trans-psoas approach.

21. The system of claim 1 , wherein at least one of the first, second, and third blades is constructed from a material that is at least partially radiolucent.

22. The system of claim 1 , wherein said first rotatable arm section and said second rotatable arm section are each equipped with a locking mechanism to selectively lock the first and second blades in a selected position.

23. The system of claim 22 , wherein the locking mechanism allows the first and second blades to be locked in any of a variety of predetermined angles.

24. The system of claim 23 , wherein the locking mechanism includes a plurality of pre-selected stops corresponding to said predetermined angles.

25. The system of claim 23 , wherein the predetermined angles include the range of 0 to 20 degrees relative to when the first and second blades are in the first position.

26. The system of claim 1 , further comprising at least one tool for moving the distal ends of the first and second blades relative to the proximal ends thereof, wherein the at least one tool comprises at least one of a wrench and a blade expander.

27. The system of claim 1 , further comprising at least one of a blade extender and a blade shim configured to be releasably coupled to at least one of the three retractor blades.

28. The system of claim 27 , wherein at least one of the blade extender and the blade shim include a lateral extension to increase the width of the blade extender and blade shim.

29. The system of claim 27 , wherein at least one of the blade extender and the blade shim include a distal extension to increase the length of the blade extender and blade shim.

30. A system for acc

Assignees

• Martinelli Scot
• Arambula Jared
• Finley Eric
• Miles Patrick
• Nuvasive Inc

Inventors

• Martinelli Scot
• Arambula Jared
• Finley Eric
• Miles Patrick

Classifications

• A61B2017/00022

  Sensing or detecting at the treatment site · CPC title

• A61B5/742

  using visual displays (displays for heart-related electrical signals, e.g. ECG, A61B5/339) · CPC title

• A61F2/4611

  of spinal prostheses · CPC title

• A61B2017/0262

  with a provision for protecting nerves · CPC title

• A61B17/0218

  for minimally invasive surgery (A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence) · CPC title