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. The surgical access system further includes pressure sensing technology to measure the pressure being exerted upon body tissues before, during, and/or after retraction and/or distraction.

主权项

1. A method of accessing a targeted intervertebral disc of the lumbar spine, comprising the steps of:
advancing a sequential dilation system along a lateral, trans-psoas path to a lateral aspect of the targeted intervertebral disc, the sequential dilation system comprising a plurality of dilators of increasing width, wherein at least one of the plurality of dilators includes a stimulation electrode along a distal end 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 three blades of a three-bladed retractor assembly over an outer dilator of the sequential dilation system along the lateral trans-psoas path to the lateral aspect of the targeted intervertebral disc of the lumbar spine, wherein the three blades of the retractor assembly are oriented such that one of the retractor blades is a posterior blade, one is a caudal-most blade, and one is a cephalad-most blade, wherein the posterior blade includes a pressure sensor situated thereon; operating the retractor assembly to move distal ends of the cephalad-most and caudal most retractor blades away from the posterior retractor blade to retract body tissue away from the lateral trans-psoas path and form a lateral trans-psoas operative corridor along the lateral trans-psoas path to lateral aspect of the targeted intervertebral disc of the lumbar spine; and determining the pressure exerted on the body tissue adjacent the posterior retractor blade; and selectively adjusting the size of the lateral trans-psoas operative corridor based on the determined pressure to control the retraction stress applied to the retracted body tissue adjacent the lateral trans-psoas operative corridor.