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 surgical target site, the system comprising:
a trans-psoas dilator system, which includes at least a first dilator cannula, to create a tissue distraction corridor along the lateral, trans-psoas path through bodily tissue to the targeted intervertebral disc of the lumbar spine;
a three-bladed tissue retraction assembly to maintain the tissue distraction corridor along the lateral, trans-psoas path through bodily tissue to the targeted intervertebral disc of the lumbar spine, the three-bladed retractor comprising:
a caudal-most retractor blade connectable at a proximal end of the caudal-most retractor blade;
a cephalad-most retractor blade connectable at a proximal end of the cephalad-most retractor blade;
a posterior-most retractor blade connectable at a proximal end of the posterior-most retractor blade;
a handle assembly comprising:
means for connecting to the proximal end of the caudal-most retractor blade,
means for connecting to the proximal end of the cephalad-most retractor blade,
means for causing the cephalad-most retractor blade connecting means and the posterior-most retractor blade connecting means to retract in a hinged motion away from one another,
means for connecting to the proximal end of the posterior-most retractor blade, and
means for causing the posterior-most retractor blade to retract in a translating motion away from the cephalad-most retractor blade and the caudal-most retractor blade independently of the hinged motion; and
a spinal fusion implant sized and shaped to insert between the retractor blades along the trans-psoas path and into the targeted intervertebral disc of the lumbar spine while the retractor blades maintain the tissue-distraction corridor along the trans-psoas path.
2. The system of claim 1 , wherein the means for connecting to the proximal end of the posterior-most retractor blade moves linearly in a direction that intersects with and is perpendicular to the common axis.
3. The system of claim 1 , further comprising one or more light emitting devices to couple with one or more of the caudal-most retractor blade and the cephalad-most retractor blade and emit light toward the targeted intervertebral disc of the lumbar spine when the three-bladed tissue retraction assembly maintains the tissue distraction corridor.
4. The system of claim 1 , wherein the three-bladed tissue retraction assembly further includes a shim having a width and a thickness with its width being greater than its thickness and that releasably engages with the posterior-most retractor blade so that a distal portion of the spine penetration element extends distally from the posterior-most retractor blade to anchor the posterior-most retractor blade in fixed relation relative the lumbar spine.
5. The system of claim 4 , wherein the spine penetration element includes a tapered tip for penetrating the lumbar spine and includes a proximal connection portion extending from a side of the shim to mate with the posterior-most retractor blade.
6. The system of claim 1 , wherein when the three-bladed tissue retraction assembly is in a closed position, the distal-most retractor blade, the caudal-most retractor blade and the cephalad-most retractor blade abut one another.
7. The system of claim 1 , wherein the caudal-most retractor blade, the cephalad-most retractor blade and the posterior-most retractor blade define a tissue-distracting corridor having a cross-sectional shape that is not circular.
8. The system of claim 1 , wherein the spinal fusion implant further comprises bone products or bone morphogenic protein.
9. The system of claim 1 , wherein the trans-psoas dilator system comprises: an initial dilator and at least one supplemental dilator that slidably advances over an exterior of the initial dilator and engages the lumbar spine.
10. The system of claim 1 , wherein the means for causing the posterior-most retractor blade to retract in a translating motion away from the cephalad-most retractor blade and the caudal-most retractor blade comprises a rotatable actuator, wherein the rotatable actuator interacts with teeth on a rack of the means for connecting to the proximal end of the posterior-most retractor blade to linearly adjust the position of the posterior-most retractor blade relative to the caudal-most retractor blade and the cephalad-most retractor blade.
11. The system of claim 1 , and further comprising:
nerve monitoring means for delivering an electrical stimulation signal to a stimulation electrode positioned within the psoas muscle, for monitoring electromyographic activity detected in leg muscle myotomes associated with nerves in the vicinity of the spinal disc, and for displaying: a numeric stimulation threshold that changes in response to the electromyographic activity detected in said leg muscle myotomes, a graphical representation of a patient, and myotomes levels being monitored.