Surgical access system and related methods

摘要

A surgical access system including a tissue distraction assembly and a tissue retraction 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. The tissue retraction assembly has a plurality of blades which may be introduced while in a closed configuration, after which point they may be opened to create an operation corridor to the surgical target site, including pivoting at least one blade to expand the operative corridor adjacent to the operative site.

主权项

1. A method of performing a revision surgery of an interbody total disc replacement implant having a first endplate contacting a first vertebra adjacent one side of a lumbar intervertebral disc space and a second endplate contacting a second vertebra adjacent the opposite side of the lumbar intervertebral disc space, the total disc replacement implant having been inserted into the lumbar intervertebral space during a first surgery:
advancing an elongate dilator along a lateral trans-psoas path to the intervertebral space, the elongate dilator comprising a stimulation electrode along a distal region, and wherein an electrical stimulation is delivered to the stimulation electrode when the stimulation electrode is positioned in the lateral, trans-psoas path to detect the proximity of one or more nerves relative to the stimulation electrode; advancing at least one additional dilator of larger diameter over the elongate dilator along the lateral trans-psoas path to the intervertebral space; advancing a plurality of retractor blades over an outermost of the at least one additional dilator along the trans-psoas path to the intervertebral space; moving at least one of the plurality of retractor blades away from at least one other of the plurality of retractor blades to retract body tissue away from the lateral trans-psoas path and create an operative corridor along the lateral trans-psoas path to the intervertebral space; maintaining the operative corridor along the lateral trans-psoas path to the intervertebral space with the plurality of retractor blades; completely removing the interbody total disc replacement implant through the operative corridor, the complete removal of the interbody total disc replacement implant including inserting a wedge between the first endplate and the first vertebra and levering the first endplate free from the first vertebra and inserting a wedge between the second endplate and the second vertebra and levering the second endplate free from the second vertebra; and inserting a spinal fusion implant through the operative corridor and into the intervertebral space previously occupied by a motion preservation implant.