Method and apparatus for laterally accessing an intervertebral disc space
A method for laterally accessing a lumbosacral intervertebral disc space of a patient includes positioning the patient laterally and making an incision to provide lateral access to the patient's iliac crest. A bracket ( 24 ) may be placed on the iliac crest and a retractor ( 28 ) may be attached to the bracket such that a distal end of the retractor is positioned over the lumbosacral intervertebral disc space while a proximal end of the retractor provides an entry space for a surgeon to insert at least one tool ( 90 ). The surgeon may perform a surgical procedure on the lumbosacral intervertebral disc space through a channel ( 49 ) defined by the retractor.
1. A surgical kit for laterally accessing a lumbosacral intervertebral disc space by engaging an iliac crest of a patient, the kit comprising:
a bracket including a pair of laterally spaced plates, each of the pair of laterally spaced plates defining an inner surface that faces the inner surface of the other of the pair of laterally spaced plates, the pair of laterally spaced plates defining a receiving space between the inner surfaces, the receiving space sized and configured to receive the iliac crest so as to mount the bracket onto the iliac crest, and each of the pair of laterally spaced plates including a top portion and a bottom portion, wherein the top portions of each of the pair of laterally spaced plates are connected such that the receiving space between the inner surfaces of the top portions is fixed, and the bottom portions are movable relative to one another such that the receiving space between the inner surfaces of the bottom portions is adjustable;
a refractor defining a channel that is elongate in a longitudinal direction, the retractor including a proximal end defining a first opening that is open to the channel, the retractor further including a distal end opposite the proximal end, the distal end defining a second opening that is open to the channel, such that when the retractor is attached to the bracket and the bracket is mounted to the iliac crest, 1) the channel extends toward and is aligned with the lumbrosacral intervertebral disc space along the longitudinal direction such that the second opening faces the lumbosacral disc space, 2) at least one of the pair of laterally spaced plates overlaps at least a portion of the first opening along the longitudinal direction, and 3) the at a least a portion of the first opening is positioned between the at least one of the pair of laterally spaced plates and the second opening with respect to the longitudinal direction;
wherein the retractor defines an inner dimension measured across the channel in a direction perpendicular to the longitudinal direction, and the retractor is movable between a retracted position and a distracted position, whereby the inner dimension is larger when the retractor is in the distracted position than when the retractor is in the retracted position.
2. The kit of claim 1 , wherein the retractor includes a plurality of segments, each of the plurality of segments has a first portion having a longitudinally extending raised flange and a second portion having a longitudinally extending expansion link, and the flange of each of the plurality of segments is received in the expansion link of an adjacent segment of the plurality of segments.
3. The kit of claim 2 , wherein each of the plurality of segments is connected to the adjacent segment of the plurality of segments to create a cylindrical tube.
4. The kit of claim 1 , wherein the bracket includes engagement rails and the retractor includes guides that are slidably engageable with the engagement rails.
5. The kit of claim 1 , wherein the bracket includes bracket guides and the retractor includes engagement rails that are configured to be slidably received within the bracket guides.
6. The kit of claim 5 , wherein each of the bracket guides comprises a body having a pair of spaced walls.
7. The kit of claim 6 , wherein the pair of spaced walls define a vertically elongate U-shaped receptacle.
8. The kit of claim 5 , wherein the bracket guides include a stop plate extending across a lower end of each of the bracket guides.
9. The kit of claim 1 , wherein at least one of the pair of laterally spaced plates comprises flexible fingers.
10. The kit of claim 1 , wherein the retractor comprises an interior, the interior of the retractor being accessible after the retractor has been directly attached to the bracket.
11. The kit of claim 1 , wherein one of the pair of laterally spaced plates includes an adjustable locking fastener.
12. The kit of claim 11 , wherein the adjustable locking fastener is a thumbscrew.
13. The kit of claim 12 , wherein the adjustable locking fastener engages each of the pair of laterally spaced plates, such that when the adjustable locking fastener is tightened the pair of laterally spaced plates are drawn together.
14. The kit of claim 1 , wherein the bracket includes at least one tether hook that when pulled taut applies a force to the bracket and deflects the iliac crest.
15. The kit of claim 1 , wherein the retractor includes a plurality of arc shaped elements, each of the plurality of arc shaped elements having a first portion and a second portion that telescopically receives the first portion.
16. The kit of claim 1 , further comprising one or more fiber optic lights or cameras that are attached to the bracket.
17. The kit of claim 1 , wherein the retractor is attachable directly to the bracket such that the retractor is positioned entirely outside of the receiving space.
18. The kit of claim 1 , wherein the retractor is attachable directly to the top portion of a first of the pair of laterally spaced plates of the bracket.
19. The kit of claim 1 , wherein the retractor defines a retractor length measured from the first opening to the second opening in the longitudinal direction, the kit further comprising at least one tool having an elongated handle and a shaft, the shaft having a shaft length, the shaft length being greater than the retractor length.
20. The kit of claim 1 , further comprising
an annular insert that defines an outer diameter that is smaller than the inner dimension when the retractor is in the distracted position and larger than the inner dimension when the retractor is in the retracted position, wherein the annular insert is configured to be inserted into the channel and advanced in the longitudinal direction to gradually increase the inner dimension of the retractor.
21. The kit of claim 1 , wherein the pair of laterally spaced plates are spaced apart from each other in a lateral direction to define the receiving space, and the at least one of the pair of laterally spaced plates faces the first opening in the lateral direction.
22. A surgical kit for laterally accessing a lumbosacral intervertebral disc space by engaging an iliac crest of a patient, the kit comprising:
a bracket including a pair of laterally spaced plates, each of the pair of laterally spaced plates defining an inner surface that faces the inner surface of the other of the pair of laterally spaced plates, the pair of laterally spaced plates defining a receiving space between the inner surfaces, the receiving space sized and configured to receive the iliac crest so as to mount the bracket onto the iliac crest, and each of the pair of laterally spaced plates including a top portion and a bottom portion, the bracket further including at least one tether hook that when pulled taut applies a force to the bracket and deflects the iliac crest, wherein the top portions of each of the pair of laterally spaced plates are connected such that the receiving space between the inner surfaces of the top portions is fixed, and the bottom portions are movable relative to one another such that the receiving space between the inner surfaces of the bottom portions is adjustable;
a refractor that defines a channel that is elongate in a longitudinal direction, the refractor including a proximal end that defines a first opening that is open to the channel, the retractor further including a distal end opposite the proximal end that defines a second opening that is open to the channel, such that when the retractor is attached to the bracket and the bracket is mounted to the iliac crest, 1) the channel is configured to extend toward and align with the lumbrosacral intervertebral disc space along the longitudinal direction, and 2) at least one of the pair of laterally spaced plates at least partially overlaps the first opening along the longitudinal direction;
wherein the retractor defines an inner dimension measured across the channel in a direction perpendicular to the longitudinal direction, and the retractor is movable between a retracted position and a distracted position, whereby the inner dimension is larger when the retractor is in the distracted position than when the retractor is in the retracted position.
23. The kit of claim 22 , wherein the retractor includes a plurality of segments, each of the plurality of segments has a first portion that includes a longitudinally extending raised flange and a second portion that includes a longitudinally extending expansion link, and the flange of each of the plurality of segments is configured to be received in the expansion link of an adjacent segment of the plurality of segments.
24. The kit of claim 23 , wherein each of the plurality of segments is substantially arc shaped, and the second portion of each of the plurality of segments is configured to telescopically receive the first portion of the respective one of the plurality of segments.
25. The kit of claim 22 , wherein at least one of the pair of laterally spaced plates comprises flexible fingers.
26. A surgical kit for laterally accessing a lumbosacral intervertebral disc space by engaging an iliac crest of a patient, the kit comprising:
a bracket configured to be mounted to the iliac crest; and
a refractor that is attachable to the bracket and elongate in a longitudinal direction, the retractor including a plurality of segments, each of the plurality of segments having a first portion having a longitudinally extending raised flange and a second portion having a longitudinally extending expansion link that is configured to receive the raised flange of an adjacent one of the plurality of segments, each of the plurality of segments defining a respective length measured from the respective longitudinally extending raised flange to the respective longitudinally extending expansion link, each expansion link including a back wall and a pair of side walls that are spaced from each other so as to define a channel that receives the raised flange of the adjacent one of the plurality of segments, and each of the pair of side walls including a projection that extends toward the projection of the other of the pair of side walls, the projections of each of the pair of side walls of each of the plurality of segments being configured to interfere with the received raised flange so as to prevent removal of the received raised flange from the channel,
wherein the first portion of a first of the plurality of segments is movable relative to and at least partially receivable within the second portion of the first of the plurality of segments such that the length of the first of the plurality of segments is adjustable, such that the retractor is movable between a retracted position and a distracted position, whereby the length is larger when the retractor is in the distracted position than when the retractor is in the retracted position.
27. The kit of claim 26 , wherein the retractor defines a retractor length measured along the longitudinal direction, and the kit further comprises at least one tool having an elongated handle and a shaft, the shaft having a shaft length, the shaft length being greater than the retractor length.
28. The kit of claim 26 , wherein the bracket includes a pair of laterally spaced plates, each of the pair of laterally spaced plates defining an inner surface that faces the inner surface of the other of the pair of laterally spaced plates, the pair of laterally spaced plates defining a receiving space between the inner surfaces, the receiving space configured to receive the iliac crest so as to mount the bracket onto the iliac crest.
29. The kit of claim 26 , wherein the bracket includes at least one tether hook that when pulled taut applies a force to the bracket and deflects the iliac crest.
30. The kit of claim 26 , wherein when the raised flange of each of the plurality of segments is received within the expansion link of the adjacent one of the plurality of segments the raised flange of each of the plurality of segments moves toward the projections and away from the back wall of the adjacent one of the plurality of segments when the retractor is moved from the retracted position to the distracted position.
31. The kit of claim 26 , wherein the pair of side walls are generally parallel to each other.