Methods and apparatus for performing spine surgery
Systems and methods are described for correcting sagittal imbalance in a spine including instruments for performing the controlled release of the anterior longitudinal ligament through a lateral access corridor and hyper-lordotic lateral implants.
1. A method for correcting sagittal imbalance of a lumbar spine, comprising the steps of:
inserting an access system along a lateral, trans-psoas path to a target site on the lumbar spine to create an operative corridor to the target site;
preparing the intervertebral space between first and second vertebra of the lumbar spine for receipt of an intervertebral implant, the intervertebral space being at least partially defined by an anterior aspect, a posterior aspect, and opposing first and second lateral aspects;
advancing a tissue retractor through the operative corridor along the lateral, trans-psoas path to a protective position in which a protective head of the tissue retractor is positioned between the Anterior Longitudinal Ligament (ALL) and the anterior vasculature, the tissue retractor protective head including an inner surface that faces the ALL and an outer surface that that faces the anterior vasculature when the tissue retractor is in the protective position, a distal end of the protective head being curved such that the distal end curves around the anterior aspect of the target site,
advancing a cutting blade along the inner surface of the tissue retractor protective head and severing the Anterior Longitudinal Ligament (ALL) with the cutting blade; and
advancing an intervertebral implant through the operative corridor along the lateral, trans-psoas path and depositing the intervertebral implant into the intervertebral disc space.
2. The method of claim 1 , wherein the intervertebral implant includes an upper surface that contacts the first vertebra and a lower surface that contacts the second vertebra, a distal wall, a proximal wall, an anterior sidewall that faces anteriorly, and a posterior sidewall that faces posteriorly, an anterior height extending from the upper surface to the lower surface at the anterior sidewall and a posterior height extending from the upper surface to the lower surface at the posterior sidewall, the anterior height being greater than the posterior height such that the upper and lower surfaces increase in slope from the posterior sidewall to the anterior sidewall forming an angle that is at least 20 degrees.
3. The method of claim 2 , wherein the intervertebral implant has a maximum longitudinal length extending from a proximal end of the proximal wall to a distal end of the distal wall, a width extending from the anterior end of the anterior sidewall to the posterior end of the posterior sidewall, the maximum longitudinal length being at least 40 mm.
4. The method of claim 3 , comprising the additional step of anchoring the implant to at least one of the first vertebra and the second vertebra.
5. The method of claim 4 , wherein the intervertebral implant proximal end includes an extension tab that abuts a lateral aspect of at least one of the first vertebra and second vertebra, the extension tab including at least one aperture that receives a fixation anchor therethrough, wherein the step of anchoring the implant comprises advancing an anchor through the at least one aperture into one of the first and second vertebra.
6. The method of claim 5 , wherein the extension tab includes an upper portion including a first aperture that abuts a lateral aspect of first vertebra and a lower portion including a second aperture that abuts a lateral aspect of the second vertebra, and wherein the step of anchoring the implant comprises advancing an anchor through the first aperture into the first vertebra and advancing a second anchor through the second aperture into second vertebra.
7. The method of claim 6 , wherein the intervertebral implant is a fusion implant and includes at least one fusion aperture opening in the upper surface and lower surface to permit bone growth between the first vertebra and second vertebra.
8. The method of claim 7 , comprising the additional step of depositing bone growth promoting substances within the at least one fusion aperture at least one of before, during, and after advancing the implant into the intervertebral disc space.
9. The method of claim 1 , wherein the tissue retractor includes a shaft extending from the protective head and a handle extending from the shaft.
10. The method of claim 9 , wherein the shaft is hollow and the cutting blade travels through the hollow shaft.
11. The method of claim 1 , wherein the cutting blade is situated on the distal end of an extender.
12. The method of claim 11 , wherein the cutting blade is disposable and the extender is reusable.
13. The method of claim 11 , wherein the cutting blade is disposable and the extender is disposable.
14. The method of claim 11 , wherein the cutting blade is reusable and the extender is reusable.
15. The method of claim 11 , wherein the tissue retractor includes a guide along which the cutting blade is advanced.
16. The method of claim 15 , wherein the tissue retractor includes a shaft extending from the protective head and a handle extending from the shaft.
17. The method of claim 16 , wherein the guide comprises a lumen extending through the tissue retractor shaft.
18. The method of claim 1 , wherein the access system comprises at least one dilator and a retractor that slides over the at least one dilator in a first configuration, and there after adjusts to a second configuration to enlarge the operative corridor.
19. The method claim 18 , wherein at least the at least one dilator of the access system includes a stimulation electrode and is advanced through the psoas muscle with stimulation signals being emitted from the stimulation electrode to detect nerves located in the psoas muscle.