Surgical access system and related methods
A surgical access system including a tissue distraction assembly and a tissue refraction assembly, 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.
1. A system for accessing a lateral aspect of a lumbar spine, comprising:
an elongate member deliverable to a spinal disc along a lateral, trans-psoas path to the lumbar spine such that a distal tip portion of the elongate member engages with an annulus of the spinal disc;
a dilator system comprising a plurality of dilators to sequentially advance along the lateral, trans-psoas path to the lumbar spine to create a distraction corridor, the dilator system comprising at least one dilator that is sized to slidably receive an exterior of the elongate member, wherein at least one of the elongate member and the sequential dilators includes a stimulation electrode that outputs electrical stimulation for nerve monitoring when said at least one of the elongate member and the sequential dilators is positioned in the lateral, trans-psoas path;
a multi-bladed refractor assembly to slidably engage with an outer dilator of the dilator system while the multi-bladed retractor assembly is advanced toward the spinal disc along the lateral, trans-psoas path, the multi-bladed retractor assembly including a caudal-most retractor blade and a cephalad-most refractor blade that extend generally perpendicularly relative to respective arm members of a blade holder assembly, wherein the caudal-most retractor blade and the cephalad-most retractor blade are pivotable relative to one another in response to movement of the respective arm members, wherein blade holder assembly comprises a shaft member extending between said respective arm members and having a first side with an exterior ridge pattern and a second side that is substantially flat, wherein the multi-bladed retractor assembly is slidably advanceable over the outer dilator of the dilator system when in a first position in which the caudal-most refractor blade and the cephalad-most retractor blade are generally side-by-side to one another, and wherein the blade holder assembly is configured to adjust the multi-bladed retractor assembly to a second position in which the caudal-most retractor blade and the cephalad-most retractor blade are moved away from one another to enlarge the distraction corridor and form an operative corridor along the lateral, trans-psoas path to the lumbar spine.
2. The system of claim 1 , wherein the shaft member extending between said respective arm members comprises a locking shaft.
3. The system of claim 2 , wherein the exterior ridge pattern along the first side of the shaft member comprises a thread pattern.
4. The system of claim 1 , wherein the multi-bladed retractor assembly includes a posterior-most retractor blade.
5. The system of claim 1 , wherein the multi-bladed retractor assembly is slidably advanceable over the outer dilator of the dilator system when in said first position in which the posterior-most retractor blade, the caudal-most retractor blade, and the cephalad-most retractor blade are generally adjacent to one another.
6. The system of claim 1 , further comprising a fixation element that is releasably engageable with one of said blades of the multi-bladed refractor assembly so that at least a portion of the fixation element extends distally from said one of said blades and anchors into the spine.
7. The system of claim 1 , wherein the blade holder assembly is configured to adjust the multi-bladed refractor assembly to the second position by squeezing proximal gripper portions of the blade holder assembly so that the caudal-most retractor blade and the cephalad-most retractor blade are simultaneously moved away from one another.
8. The system of claim 1 , wherein the caudal-most refractor blade and the cephalad-most retractor blade are pivotable relative to one another about a pivot axis define by the blade holder assembly.
9. The system of claim 1 , wherein said respective arm members of the blade holder assembly comprise: a first pivotable arm member arranged between a first gripper portion and the caudal-most retractor blade, and a second pivotable arm member arranged between a second gripper portion and the cephalad-most retractor blade.
10. The system of claim 9 , wherein the blade holder assembly further comprises a translating arm member coupled to a posterior-most retractor blade of the multi-bladed retractor assembly.
11. The system of claim 1 , wherein the elongate member is deliverable to the spinal disc together with said at least one dilator.
12. The system of claim 1 , wherein when the multi-bladed retractor assembly is adjusted to the second position, the caudal-most retractor blade and the cephalad-most retractor blade are spaced apart and configured to be maintained generally parallel to one another.
13. The system of claim 1 , wherein when the multi-bladed retractor assembly is in the first position, the caudal-most retractor blade and the cephalad-most retractor blade generally abut with one another.
14. The system of claim 1 , wherein the elongate member comprises a K-wire.
15. The system of claim 1 , further comprising a nerve monitoring system to deliver an electrical stimulation signal to the stimulation electrode of at least one of the elongate member and the dilator tool when at least one of the elongate member and the dilator tool is positioned in the lateral, trans-psoas path, the nerve monitoring system being configured to detect electromyographic activity via a set of sensor electrodes in leg muscle myotomes associated with nerves in the vicinity of the spinal disc, and the nerve monitoring system comprising a video display device that displays information regarding electromyographic activity in at least one of said leg muscle myotomes.
16. The system of claim 15 , wherein the nerve monitoring system comprises a control unit having the video display device, a patient module connected to the control unit via a data cable, an EMG sensor harness having the set of sensor electrodes connected to the patient module.
17. The system of claim 16 , wherein the control unit receives signals from the patient module and processes EMG responses output from the sensor electrodes to extract characteristic information for each of said leg muscle myotomes.