Surgical access system and related methods
A system for accessing a surgical target site and related methods, involving an initial distraction system for creating an initial distraction corridor, and an assembly capable of distracting from the initial distraction corridor to a secondary distraction corridor and thereafter sequentially receiving a plurality of retractor blades for retracting from the secondary distraction corridor to thereby create an operative corridor to the surgical target site, 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 creating an operative corridor along a lateral, trans-psoas path to a lumbar spine, comprising:
a first retractor blade configured to be delivered toward a spinal disc along a lateral, trans-psoas path to the lumbar spine, the first retractor blade comprising: at least one mounting arm configured to receive and lock with a blade holder apparatus, a distal blade portion extending perpendicular to the at least one mounting arm of the first retractor blade and including an interior face and an exterior face, an intermediate portion connecting between the distal blade portion and the at least one mounting arm of the first retractor blade, and one or more stimulation electrodes disposed along the exterior face of the distal blade portion and oriented oppositely away from the exterior face of the distal blade portion;
a second retractor blade configured to be delivered toward the spinal disc along the lateral, trans-psoas path to the lumbar spine and positioned oppositely from the first retractor blade, the second retractor blade comprising: at least one mounting arm configured to receive and lock with the blade holder apparatus, a distal blade portion having a same shape and size as the distal blade portion of the first retractor blade, extending perpendicular to the at least one mounting arm of the second retractor blade, and including an interior face and an exterior face, and an intermediate portion connecting between the distal blade portion and the at least one mounting arm of the second retractor blade;
an elongate inner member configured to be delivered toward the spinal disc along the lateral, trans-psoas path to the lumbar spine, and a first dilator configured to be delivered to the spinal disc along the lateral, trans-psoas path to the lumbar spine, the first dilator having a lumen configured to slidably receive the elongate inner member, wherein the first dilator includes a stimulation electrode to deliver electrical stimulation for nerve monitoring; and
a control unit to transmit an electrical stimulation signal to said one or more stimulation electrode and to receive an electromyographic (EMG) sensor signal of a neuromuscular response of a nerve depolarized by said electrical stimulation signal, the control unit including a display device with a graphical user interface that displays information indicative of nerve proximity and nerve direction in response to the EMG sensor signal.
2. The system of claim 1 , wherein the distal blade portion of the first retractor blade defines a single tubular passageway fixedly positioned relative to the at least one mounting arm of the first retractor blade and configured to slidably receive a first spine penetration member.
3. The system of claim 2 , wherein the single tubular passageway includes an upwardly facing opening, and a downwardly facing opening configured to face toward the lumbar spine when the first and second retractor blades maintain the operative corridor along the lateral, trans-psoas path to the lumbar spine.
4. The system of claim 1 , wherein the distal blade portion of the second retractor blade defines a single tubular passageway fixedly positioned relative to the at least one mounting arm of the first retractor blade and configured to slidably receive a first spine penetration member.
5. The system of claim 1 , wherein the one or more stimulation electrodes of the first retractor blade are positioned proximate to a distal most end of the distal blade portion of the first retractor blade.
6. The system of claim 1 , wherein the at least one mounting arm of the first retractor blade and the at least one mounting arm of the second retractor blade are configured to mate with a same blade holder apparatus.
7. The system of claim 6 , wherein the at least one mounting arm of the first retractor blade and the at least one mounting arm of the second retractor blade are configured to be locked in relation to the said blade holder apparatus so as to maintain the operative corridor along the lateral, trans-psoas path to the lumbar spine.
8. The system of claim 6 , wherein the first retractor blade and the second retractor blade are adjustable relative to one another so that the first retractor blade is configured to be spaced apart from the second retractor blade.
9. The system of claim 1 , wherein at least a portion of the exterior face of the distal blade portion of the first retractor blade and at least a portion of the exterior face of the distal blade portion of the second retractor blade have a cylindrical surface region.
10. The system of claim 1 , wherein said at least one mounting arm of the first retractor blade comprises first and second mounting arms.
11. The system of claim 1 , wherein said at least one mounting arm of the second retractor blade comprises first and second mounting arms.
12. The system of claim 1 , wherein the one or more stimulation electrodes of the first retractor blade are positioned proximate to a distal most end of the distal blade portion of the first retractor blade, wherein the second retractor blade further comprises one or more stimulation electrodes disposed along the exterior face of the distal blade portion of the second retractor blade and oriented oppositely away from the exterior face of the distal blade portion of the second retractor blade.