System and methods for performing surgical procedures and assessments

摘要

The present invention involves systems and related methods for performing surgical procedures and assessments, including the use of neurophysiology-based monitoring to: (a) determine nerve proximity and nerve direction to surgical instruments employed in accessing a surgical target site; (b) assess the pathology (health or status) of a nerve or nerve root before, during, or after a surgical procedure; and/or (c) assess pedicle integrity before, during or after pedicle screw placement, all in an automated, easy to use, and easy to interpret fashion so as to provide a surgeon-driven system.

主权项

1. A surgical system for forming an operative corridor in a trans-psoas approach to a spine, comprising:
a plurality of sequential dilators to form a lateral, trans-psoas path between a skin surface and a lateral aspect of a targeted spinal disc, the plurality of sequential dilators comprising an outer dilator fitting over another of the sequential dilators when advanced in the lateral, trans-psoas path toward the lateral aspect of the targeted spinal disc, wherein at least one of the sequential dilators comprises a stimulation electrode positioned on a tapered distal tip region of said at least one of the sequential dilators to deliver a stimulation signal for nerve monitoring when the tapered distal tip region is positioned in the lateral, trans-psoas path, the stimulation electrode being positioned on the tapered distal tip region at a fixed orientation relative to a longitudinal axis of said at least one of the sequential dilators such that the stimulation electrode is oriented at an angle relative to the longitudinal axis, wherein the stimulation electrode has a shape comprising at least three edges, and wherein said at least one of the sequential dilators includes a reference mark proximate a proximal end of the at least one dilating cannula that is indicative of the radial position of the stimulation electrode on said at least one of the sequential dilators; and a working corridor instrument slidable over the outer dilator of the plurality of sequential dilators along in the lateral, trans-psoas path toward the lateral aspect of the targeted spinal disc, wherein the working corridor instrument is configured to establish a trans-psoas operative corridor to the lateral aspect of the targeted spinal disc.