Method and Devices for a Sub-Splenius/Supra-Levator Scapulae Surgical Access Technique
A novel posterolateral inter-muscular approach has been developed to access the cervical spine. The approach includes elevating the splenius capitis and trapezios muscles dorsally to create a window for deep spine access, wherein the window comprises: i) an anterior superior border of the trapezius muscle; ii) an anterior inferior border of the splenius capitis muscle, and iii) a posterior superior border of the levator scapulae muscle. Preferably, a device such as an implant or an instrument is then passed through the window to manipulate the spine.
1 .- 90 . (canceled)
91 . A surgical instrument, comprising:
a retractor configured for insertion into a cavity within a patient, the retractor having a through-hole formed therein;
a camera coupled to the retractor; and
a support configured to anchor the retractor from inside the cavity.
92 . The instrument of claim 91 , wherein the support includes a telescopic tube.
93 . The instrument of claim 91 , further comprising a light source coupled to the retractor.
94 . The instrument of claim 93 , further comprising a thread configured to transmit light from the light source to an inner surface of the retractor.
95 . The instrument of claim 91 , wherein the retractor is formed from a polymer.
96 . The instrument of claim 91 , further comprising a wing disposed within the through-hole and extending therefrom;
wherein the wing is configured to retract soft tissue.
97 . The instrument of claim 96 ,
wherein the wing includes a distal head and a proximal end portion; and
wherein the distal head extends from a first end of the retractor and the proximal end portion extends from a second end of the retractor opposite the first end.
98 . The instrument of claim 96 , wherein an inner rim of the through-hole includes one or more features that provide for angular adjustment and securement of the wing relative to the retractor.
99 . The instrument of claim 91 , wherein an outer surface of the retractor is convex.
100 . The instrument of claim 91 , further comprising an irrigation tube having an irrigation port that passes through the retractor.
101 . The instrument of claim 91 , further comprising a suction tube having a suction port that passes through the retractor.
102 . The instrument of claim 91 , further comprising an electrical cable that passes through the retractor.
103 . The instrument of claim 91 , further comprising a neuromonitoring feature coupled to the retractor.
104 . The instrument of claim 103 , wherein the neuromonitoring feature includes an electrode.
105 . The instrument of claim 104 , wherein the neuromonitoring feature further includes an electrical cable coupled to the electrode.
106 . A surgical method, comprising:
forming an incision in the skin of a patient to access the spine;
passing a retractor through the incision and into a cavity within a patient to increase an access window to the spine;
capturing an image of the cavity with a camera; and
supporting a position of the retractor from within the cavity.
107 . The method of claim 106 , further comprising irradiating the cavity with light from a light source.
108 . The method of claim 106 , further comprising:
passing a wing through a through-hole formed in the retractor; and
positioning the wing to retract soft tissue.
109 . The method of claim 108 , wherein passing the wing through a through-hole formed in the retractor includes disposing the wing such that a distal head thereof extends from a first end of the retractor and a proximal end portion thereof extends from a second end of the retractor opposite the first end.
110 . The method of claim 108 , further comprising securing the wing to the retractor using one or more features formed on an inner rim of the through-hole that provide for angular adjustment and securement of the wing relative to the retractor.
111 . The method of claim 106 , further comprising detecting nervous tissue in the vicinity of the cavity using an electrode.
112 . The method of claim 106 , further comprising inserting an implant into the cavity.
113 . The method of claim 112 , wherein the implant is a fusion cage.
114 . The method of claim 106 , further comprising providing at least one of irrigation and suction into the cavity.
115 . The method of claim 106 , wherein supporting the position of the retractor from within the cavity includes sliding apart telescoping tube portions to achieve a desired length.
116 . The method of claim 106 , wherein the incision is formed in the posteriolateral corridor.
117 . The method of claim 106 , wherein at least one step of the method is performed by a surgical robot.