Surgical retractor

Abstract

To provide a surgical retractor for accessing a surgical site, such as a portion of a patient's spine.SOLUTION: A retractor blade includes a base part slidably engaged with two or more retractor arms, and at least one of the retractor arms releasably secures the retractor blade configured to be anchored to a bone anchor. The retractor blade includes an elongated blade part, a retractor engagement portion is disposed at a proximal end of the elongated blade part and an anchor mechanism is disposed at a distal end of the elongated blade part. The anchor mechanism includes a first jaw and a second jaw configured to engage a bone implant. When it is closed around or anchored to the bone implant (which may be the shank of a modular screw system), components of a modular screw can be assembled to the shank without adjusting, loosening, or opening the anchor mechanism.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present disclosure relates to a surgical retractor configured to provide access to a surgical site, such as a portion of a patient's spine. [Background technology]

[0002] Also disclosed herein are methods of using such surgical retractors in surgical procedures, such as spinal surgery. Summary of the Invention

[0003] Disclosed herein are modular surgical retractors, some of which utilize anchored retractor blades, including an elongated blade portion, a retractor engagement portion disposed at a proximal end of the elongated blade portion, first and second jaws disposed at a distal end of the elongated blade portion and configured to engage a bone implant and configured to occupy closed and open configurations, and a control assembly configured to transition the first and second jaws between the open and closed configurations.

[0004] According to some embodiments, the elongated blade portion lies substantially in a first plane, and first portions of the first and second jaws lies in a second plane when in the closed configuration, the first and second planes intersect with each other at an angle of about 65° to about 120°. According to some embodiments, at least a portion of the retractor engagement portion lies in a third plane, and the first and third planes intersect with each other at an angle of about 65° to about 120°. The second and third planes can be substantially parallel. In some embodiments, second portions of the first and second jaws lies in the first plane when in the closed configuration.

[0005] According to some embodiments, the first jaw pivots about a first axis and the second jaw pivots about a second axis. The first and second axes may lie in a first plane and may intersect each other such that an angle between the first and second axes is between about 55° and about 115°. The first and second axes may be symmetrical about the elongated blade portion.

[0006] According to some embodiments, the first and / or second jaw includes a base portion and an arcuate portion. The base portion pivotally engages with the distal end of the elongated blade portion. The arcuate portion is designed and shaped to engage with a bone implant when the first and second jaws are in a closed configuration. The arcuate portion may be sized and shaped to engage with a head of a pedicle screw. The first and second jaws may be configured to allow assembly of a modular tulip onto the head of the pedicle screw when the first and second jaws are in a closed configuration.

[0007] According to some embodiments, the control assembly is disposed on the rear surface of the elongated blade portion. The control assembly may include a tool engaging portion, a movable block for engaging the first and second jaws and transitioning them between the open and closed configurations, and a connecting rod mechanically connecting the tool engaging portion and the movable block and configured to translate rotation of the tool engaging portion into movement of the block in either a distal or proximal direction along the elongated blade portion. The tool engaging portion may be disposed at the proximal end of the elongated blade portion. In some embodiments, the movable block applies equal forces to both the first and second jaws to move them in unison between the open and closed configurations.

[0008] According to some embodiments, the retractor-engaging portion includes a spherical portion configured to be received by the retractor assembly and may include a pair of lateral extensions configured to allow the anchoring blade to rotate relative to the retractor assembly only in a single plane.

[0009] Some embodiments disclosed herein are directed to a surgical retractor system including a retractor assembly, a support engagement portion, and at least one anchoring blade. The retractor assembly may have a first retractor arm and a second retractor arm, each retractor arm configured to releasably engage a retractor blade. The support engagement portion may releasably engage a support structure. The at least one anchoring blade may be any one of the anchoring blade embodiments disclosed herein that releasably engages with the first retractor arm. Some embodiments further include a second anchoring blade that may be any one of the anchoring blade embodiments disclosed herein that releasably engages with the second retractor arm. Some embodiments further include an inner blade engagement portion configured to releasably engage with an inner retractor blade. Such embodiments may also include an inner retractor blade that releasably engages with the inner blade engagement portion of the retractor assembly. The support structure may be secured to a surgical table or a surgical frame. The support structure may be an A-arm.

[0010] Some embodiments disclosed herein relate to a method of securing an anchoring blade to a first bone implant. Such a method includes first positioning a first anchoring blade, which may be any one of those disclosed herein, such that at least a portion of the first and second jaws of the anchoring blade are disposed below an upper surface of the first bone implant, and second actuating a control assembly of the first anchoring blade to transition the first and second jaws from an open configuration to a closed configuration, thereby anchoring the first anchoring blade to the first bone implant. Some methods further include first positioning a second anchoring blade, which may be any one of those disclosed herein, such that at least a portion of the first and second jaws of the second anchoring blade are disposed below an upper surface of a second bone implant, and second actuating a control assembly of the second anchoring blade to transition the first and second jaws from an open configuration to a closed configuration, thereby anchoring the second anchoring blade to the second bone implant.

[0011] In some embodiments, the first bone implant is secured to the first vertebra before the first anchoring blade is secured to the first bone implant, and / or the second bone implant is secured to the second vertebra before the second anchoring blade is secured to the second bone implant. In some embodiments, the first bone implant is secured to the first vertebra after the first anchoring blade is secured to the first bone implant, and / or the second bone implant is secured to the second vertebra after the second anchoring blade is secured to the second bone implant. In some embodiments, a driver is secured to the first bone anchor or the second bone anchor before securing the first or second bone anchor to the first or second vertebra. The first bone implant and / or the second bone implant may be a pedicle screw having a threaded shank portion and a head portion. The head portion may be at least partially spherical in shape. The pedicle screw may be a component of a modular screw assembly. Some methods further include assembling the modular screw assembly after the first and / or second anchoring blades are anchored to the first and / or second bone implants, respectively. Some methods disclosed herein form part of a transforaminal lumbar interbody fusion procedure.

[0012] Also described herein is a base portion having first and second extensions and one or more engagement portions. Various embodiments of an anchored surgical retractor are disclosed, including a first retractor arm, a first retractor arm, and a second retractor arm. The first retractor arm has a proximal end and a distal end, a third receiving area at the proximal end configured to slidably receive the first extension of the base portion, and a fourth receiving area at the distal end configured to releasably engage a portion of the first retractor blade. The second retractor arm has a proximal end and a distal end, a fifth receiving area at the proximal end configured to slidably receive the second extension of the base portion, and a sixth receiving area at the distal end configured to releasably engage a portion of the second retractor blade. In some embodiments, the inner, first, and second retractor blades together form an adjustable surgical corridor, while in some embodiments, only two of the three retractor blades are used to form the adjustable surgical corridor.

[0013] According to some embodiments, the first and / or second retractor blades include an elongated blade portion having a proximal end and a distal end, a retractor engagement portion disposed at the proximal end of the elongated blade portion, and an anchor mechanism disposed at the distal end of the elongated blade portion. In some embodiments, the anchor mechanism includes a first jaw and a second jaw configured to engage a bone implant, the first and second jaws configured to transition between a closed configuration and an open configuration. In the open configuration, a portion of the bone implant can pass through the first and second jaws.

[0014] According to some embodiments, the first and second retractor blades include a control assembly configured to transition the first and second jaws between an open configuration and a closed configuration. In some cases, the base portion further includes a first receiving area, and the retractor assembly further includes an inner retractor arm having a proximal end and a distal end. The inner retractor arm can have a second receiving area at its distal end designed and configured to releasably engage a portion of the inner retractor blade. The proximal end can be configured to be slidably received in the first receiving area of ​​the base portion.

[0015] Some embodiments of the retractor assembly further include an outer retractor arm having a proximal end and a distal end, the proximal end having a seventh receiving area configured to releasably engage an outer arm engagement portion disposed on one of the first retractor arm or the second retractor arm, and the distal end may include an eighth receiving area configured to releasably engage a portion of the outer retractor blade.

[0016] In some embodiments, the first and / or second retractor blades are as described elsewhere herein. In some embodiments, both the first and second retractor blades are as described elsewhere herein.

[0017] These and other features are disclosed in more detail in the accompanying drawings and the detailed description that follows. [Brief explanation of the drawings]

[0018] The embodiments set forth in the drawings are illustrative and exemplary in nature and are not intended to limit the subject matter defined by the claims. The following detailed description of exemplary embodiments can be better understood when read in conjunction with the following drawings, in which like structure is designated with like reference numerals and in which:

[0019] [Figure 1]1 is a perspective view of a surgical retractor in accordance with the present disclosure; [Figure 2] FIG. 2 is an enlarged perspective view of the embodiment shown in FIG. [Figure 3] 2 is a perspective view of a retractor base portion that is a component of the surgical retractor shown in FIG. 1. FIG. [Figure 4] 2 is a perspective view of a first retractor arm that is a component of the surgical retractor shown in FIG. 1. FIG. [Figure 5] 2 is a perspective view of a second retractor arm that is a component of the surgical retractor shown in FIG. 1. FIG. [Figure 6] 5 is an enlarged view of the underside of a portion of the first retractor arm shown in FIG. 4. [Figure 7] FIG. 10 is a perspective view of an anchoring blade for use with a retractor assembly according to the present disclosure; [Figure 8A] FIG. 8 is a partial front plan view of the anchoring blade of FIG. 7 with the anchoring assembly in a closed configuration. [Figure 8B] FIG. 8 is a partial front plan view of the anchoring blade of FIG. 7 with the anchoring assembly in an open configuration. [Figure 9] FIG. 8 is a side view of the anchoring blade of FIG. 7. [Figure 10A] FIG. 8 is a rear view of the anchoring blade of FIG. 7. [Figure 10B] FIG. 8 is a rear view of the anchoring blade of FIG. 7. [Figure 11] FIG. 8 is a top view of the proximal end of the anchoring blade of FIG. 7. [Figure 12] FIG. 2 is a perspective view of an inner retractor arm that is a component of the surgical retractor shown in FIG. 1. [Figure 13] FIG. 13 is a front view of the distal end of the inner retractor arm shown in FIG. 12. [Figure 14] FIG. 13 is a perspective view of one element of the locking member of the inner retractor arm shown in FIG. 12. [Figure 15] FIG. 13 is a perspective view of an inner retractor blade that can be used with the inner retractor arm shown in FIG. 12. [Figure 16]FIG. 16 is a close-up view of the proximal end of the inner retractor blade shown in FIG. 15. [Figure 17] FIG. 2 is a perspective view of an outer retractor arm that may be used with the surgical retractor shown in FIG. 1. DETAILED DESCRIPTION OF THE INVENTION

[0020] The present disclosure relates to surgical retractors, particularly retractors configured for use in spinal surgery. The retractor assemblies disclosed herein offer the advantages that retractor blades are easily attached to and detached from the retractor arms of the assembly, some embodiments use at least four retractor blades, while some embodiments may use two or fewer retractor blades, at least one and / or two retractor blades can be anchored to fixation elements, and modular screws can be assembled even when the screws serve as anchors for the anchored retractor. These and other advantages will be apparent to those skilled in the art based on this disclosure.

[0021] FIG. 1 illustrates one embodiment of a surgical retractor 1000. In this illustrated embodiment, the retractor 1000 includes a base portion 100 having two lateral extensions 100a and 100b. The extensions 100a and 100b are shown extending in opposite directions to form a substantially straight line. In some embodiments, the extensions 100a and 100b are positioned relative to one another to form an angle, which may be acute or obtuse. Variations in such orientation may facilitate certain procedures or approaches.

[0022] The base portion 100 further includes an engagement portion 120 disposed rearward of the base portion 100. In the illustrated embodiment, the engagement portion 120 includes two engagement extensions 120a and 120b configured to attach to a support structure, such as an A-arm (not shown). The presence of the two engagement extensions allows the user to control the position of the retractor 1000 relative to the support structure, and and / or the position of the support structure relative to the retractor 1000 and / or relative to the surgical site may be changed.

[0023] 1, retractor 1000 includes three retractor arms: inner retractor arm 200 and two retractor arms 300 and 400, each having an anchored retractor blade 310 and 410 attached thereto. Inner arm 200 has an inner blade 210 attached thereto. As described in more detail below, each of these blades can be easily attached to base portion 100 during a surgical procedure and easily detached from its respective retractor arm during the procedure. Additionally, each retractor arm can be detached from base portion 100 to allow for maximum customizability.

[0024] Each of the anchoring retractor blades 310 and 410 is configured to engage or be anchored to an anchor 500, such as a bone screw or pedicle screw. In some embodiments, the anchor is a modular pedicle screw, and one or both of the anchoring retractor blades 310 and 410 are configured to allow assembly of the modular pedicle screw, which may include placing a tulip onto the modular pedicle screw. Such assembly of the tulip to the modular pedicle screw may be accomplished without making any adjustments to the anchoring retractor blades 310 and 410. For example, the tulip may be secured to the head of the modular pedicle screw without having to remove, much less loosen, the anchoring retractor blades 310 and 410 from the head of the modular pedicle screw.

[0025] According to some embodiments, a method of using the retractor 1000 includes a first step of placing one or more bone anchors, such as pedicle screws, in a patient space. The one or more bone anchors may be modular screws, including only the shank portion of the screw during this first step. The first retractor blade 310 is then advanced toward the first bone anchor, advancing the anchor portion of the blade 310 over the proximal end of the screw. The anchor portion is then closed around the screw. If a second bone anchor is used, the retractor blade 410 is advanced toward and anchored onto the second bone anchor in a manner similar to the first retractor blade 310. Each retractor blade is then secured to the retractor assembly 1000, which includes the base portion 100 and retractor arms 300 and 400. The arms can then be manipulated to enlarge an opening that allows access to the patient's spine, particularly the intervertebral space. Once sufficient access is obtained, the surgeon may perform a variety of procedures, such as a laminectomy, or a disc fusion, which requires the total or partial removal of the patient's disc and an interbody graft between each vertebra.

[0026] During or after the procedure, the retractor 1000 can be manipulated to open the disc space and / or adjust the configuration of the disc space by adjusting the position and / or angle of the retractor blades 310 and 410.

[0027] The opening formed by the retractor 1000 may be further enhanced through the use of inner retractor blades 310 or outer retractor blades, described further below.

[0028] In some embodiments, the retractor 1000 includes only one anchored retractor blade 310 or 410 and one inner blade 210. In some embodiments, the retractor 1000 includes anchored retractor blades 310 and 410 but does not include an inner blade 210.

[0029] FIG. 2 highlights the engagement of the retractor arm 300 with the extension 100a of the base 100. Shown in an enlarged view of retractor 1000, this engagement is achieved by inserting extension 100a through a receiving portion, i.e., window 320, of retractor arm 300. Similarly, retractor arm 400 engages extension 100b by receiving extension 100b through window 420 of retractor arm 400. In contrast, inner arm 200 engages base 100 by being inserted into a receiving portion on base 100, i.e., window 130.

[0030] Extensions 100a and 100b each include two sets of linear gear teeth. One set of gear teeth on each extension engages with a pinion gear on each retractor arm to form a rack-and-pinion mechanism that allows for linear translational control of retractor arms 300 and 400 along extensions 100a and 100b, respectively. Rotation of the respective pinion gears is accomplished by rotating extension mechanisms 330 and / or 430, respectively. In this illustrated embodiment, rotation of either extension mechanism can only be performed in one direction, i.e., the direction of extension away from inner retractor blade 210, also referred to herein as the midline. This is because each rack-and-pinion mechanism is coupled to catches 340 and 440, respectively, which engage the other set of linear gear teeth on each extension. As each extension mechanism rotates, each pinion gear rotates and engages its respective set of linear gear teeth, translating its respective retractor arm away from the midline. As each retractor arm advances, catch 340 and / or catch 440 (each spring-loaded to maintain engagement with the second set of linear gear teeth) allows each retractor arm to translate away from the midline but prevents either retractor arm from translating toward the midline. To achieve translation toward the midline, catch 340 and / or catch 440 must be pivoted away from the linear gear teeth, thereby allowing each retractor arm to freely translate along extension 100a and / or 100b.

[0031] In some embodiments, no such catch is used, and translation away from and toward the midline is achieved simply by rotating the expansion mechanism 330 and / or 430, which in some embodiments is modified to require more torque to achieve translation. Requiring more torque may prevent the expansion mechanism from being unintentionally rotated solely by the force applied to the retractor arms 300 and / or 400.

[0032] 2 also shows that inner retractor arm 200 includes a set of linear gear teeth 220 configured to engage with adjustment mechanism 140 (which is a worm gear in this embodiment) on base portion 100. Depending on the direction it is rotated, rotation of adjustment mechanism 140 causes linear translation of inner retractor arm 200 either away from or toward the surgical channel formed between anchored retractor blades 310 and 410 and inner retractor blade 210.

[0033] FIG. 3 shows the base portion 100 without the retractor arms attached. This view clearly shows the respective sets of linear gear teeth on extensions 100a and 100b. Also clearly shown are the respective engagement extensions 120a and 120b that form engagement portion 120. While this embodiment of retractor 1000 includes both engagement extensions 120a and 120b, some embodiments of retractor 1000 may include only one engagement extension. When using retractor 1000, a user can secure retractor 1000 to the operating table by attaching an A-arm or similar device to either or both engagement extensions 120a and 120b. The presence of two engagement extensions allows the user to select from a variety of engagement orientations. For example, from one side of the patient, the user can engage the patient's spine. When approaching the patient's spine from the opposite side, however, the other engagement extension may allow the surgeon to mirror the orientation achieved on the patient's first side. Alternatively, in some cases, a different fixation point may prove more beneficial if the surgeon is left-handed, or vice versa.

[0034] 4 is a perspective view of the retractor arm 300 without the base portion 100 or retractor blade 310. This view clearly shows the receiving portion 320, which in this illustrated embodiment includes a raised or keyed portion 350 that engages with a corresponding channel on the underside of the extension 100a (not shown), ensuring a secure engagement between the retractor arm 300 and the extension 100a.

[0035] The retractor arm 300 also includes an auxiliary mounting portion 360 configured to serve as an attachment point for an auxiliary or outer retractor arm, which will be described below with reference to FIG.

[0036] The retractor arm 300 further includes a distraction mechanism 370 that, when rotated, causes the distal ends of the retractor blades 310 to project outward, thereby enabling or causing distraction of the vertebrae to which the retractor 1000 is attached or anchored.

[0037] At its distal end, the retractor arm 300 includes a retractor blade engagement portion 380 configured to releasably secure the proximal end of the retractor blade 310, as described below with reference to Figures 6 and 7. The retractor blade engagement portion 380 includes a release button 380a that, when pressed, can release the proximal end of the retractor blade 310 from the retractor blade engagement portion 380. However, engagement of the retractor blade 310 with the retractor blade engagement portion 380 does not require depression of the button 380a, because the mechanism (described in more detail with respect to Figure 6) is a passive mechanism that allows for easy attachment of the retractor blade 310 with minimal effort. Engagement of the blade 310 with the arm 300 requires only pressing the proximal end of the blade 310 into the blade engagement portion 380.

[0038] 5 is a perspective view of the retractor arm 400 without the base portion 100 or retractor blade 410. This view clearly shows the receiving portion 420, which in this illustrated embodiment includes a raised or keyed portion 450 that engages with a corresponding channel on the underside of the extension 100b (not shown), ensuring a secure engagement between the retractor arm 400 and the extension 100b.

[0039] The retractor arm 400 also includes an auxiliary mounting portion 460 configured to serve as an attachment point for an auxiliary or outer retractor arm, which is a mirror image of the embodiment shown in FIG.

[0040] The retractor arm 400 further includes a distraction mechanism 470 that, when rotated, causes the distal ends of the retractor blades 410 to project outward, thereby enabling or causing distraction of the vertebrae to which the retractor 1000 is attached or anchored.

[0041] Retractor arm 400 includes, at its distal end, a retractor blade engagement portion 480 configured to releasably secure the proximal end of retractor blade 410. Retractor blade engagement portion 480 includes a release button 480a that, when pressed, can release the proximal end of retractor blade 410 from retractor blade engagement portion 480. However, depression of button 480a is not required to engage retractor blade 410 with retractor blade engagement portion 480 because the mechanism is such that This is because it is a passive mechanism that allows for easy installation of the retractor blade 410 with minimal effort.

[0042] 6 is a close-up view of the underside of engagement portion 380 of retractor arm 300. This view shows that engagement portion 380 includes a receiving area 380b that includes a slot 380c, in addition to release button 380a. Within receiving area 380b is locking mechanism 380d that is releasably held in a locked position by biasing element 380e. Although not shown, release button 380a includes a notched portion that aligns with locking mechanism 380d when release button 380a is pressed, allowing locking mechanism 380d to pivot to an unlocked position.

[0043] 7 is a perspective view of retractor blade 310, the illustrated embodiment of retractor blade 410 is substantially identical. Thus, this description of retractor blade 310 applies equally to retractor blade 410. Likewise, the manner in which retractor blade 310 engages with retractor arm 300 is substantially identical to the manner in which retractor blade 410 engages with retractor arm 400.

[0044] FIG. 7 illustrates one such embodiment of an anchored retractor blade 310, defined as an elongated blade portion 5 having a proximal end 10 and a distal end 15. Disposed at the distal end 15 of the blade portion 5 is an anchor assembly 20 including two jaw members 20A, 20B configured to be secured to a bone implant (not shown), such as a pedicle screw. The jaw members 20A, 20B may be "mirror image" components or may each have a distinct design to facilitate attachment to the appropriate anchor. The blade portion 5 has both a front surface 25 and an opposing rear surface 30. As seen in FIG. 7, in this embodiment, the blade portion 5 is slightly curved such that the sides of the blade portion 5 curve toward the front surface 25.

[0045] Disposed in the front surface 25 is a channel 35 extending from the proximal end 10 toward the distal end 15. The channel 35 is configured to facilitate the passage of instruments downward from the proximal end 10 toward the distal end 15. Such instruments may include an illumination strip used to facilitate visualization of the surgical path formed by the anchoring blade 310. Along the channel 35 are multiple indentations that may serve as instrument anchoring points for securing instruments at various depths along the blade portion 5. These channels may also facilitate cleaning of the anchoring blade 310.

[0046] The proximal end 10 of the blade portion 5 includes a retractor-engaging portion 40 that includes a substantially horizontal member 45 and a spherical head portion 50 having a pair of lateral extensions 55. The engagement portion 40 is configured to releasably engage a retractor assembly, such as the retractor 1000. The spherical head portion 50, in conjunction with the lateral extensions 55, is configured such that the anchored blade 310, when engaged or secured to the retractor assembly, can rotate along a single plane of rotation to a desired position with the lateral extensions forming an axis of rotation.

[0047] Also visible in FIG. 7 is a tool engaging portion 60A which is part of a control assembly 60 which will be described in more detail with reference to FIGS.

[0048] 8A shows anchor assembly 20 in a closed configuration, and FIG. 8B shows anchor assembly 20 in an open configuration. FIGS. 8A and 8B further illustrate that first jaw member 20A pivots about a first axis 65A and second jaw member 20B pivots about a second axis 65B. In this illustrated embodiment, first axis 65A and second axis 65B lie substantially in the same plane as elongated blade portion 5, or at least in a plane parallel to the plane of elongated blade portion 5. However, despite being in the same plane as each other, first axis 65A and second axis 65B may be different from each other. 65A and second axis 65B intersect each other at an angle 65C.

[0049] Angle 65C can be any suitable angle, such as about 60° to about 70°, about 65° to about 75°, about 70° to about 80°, about 75° to about 85°, about 80° to about 90°, about 85° to about 95°, about 90° to about 100°, about 95° to about 105°, about 100° to about 110°, about 65° to about 105°, or about 75° to about 95°. It should be appreciated that in some embodiments, the openings in anchoring assembly 20 should allow for easy anchoring onto and / or removal from a bone implant while performing surgery within the limited confines of a surgical corridor. Thus, in some embodiments, angle 65C is selected not only to open and close anchoring assembly 20 around a portion of the bone implant, but also to facilitate upward or downward movement of anchoring blade 310 as it is lowered into or removed from the surgical corridor.

[0050] Angle 65C is shown with its centerline substantially coincident with the centerline of elongated blade portion 5. This means that first axis 65A and second axis 65B are substantially symmetrical. However, in some embodiments, the two axes are not symmetrical, such that the centerline of angle 65C does not coincide with the centerline of elongated blade portion 5. In such embodiments, it may be desirable to have the first and second jaw members open and close in an asymmetrical manner, or, in some cases, to have one jaw member move in a more vertical or more horizontal line. For example, in some embodiments, the centerline of angle 65C is about 1° to about 4°, about 3° to about 6°, about 5° to about 8°, about 7° to about 10°, about 9° to about 12°, about 11° to about 14°, or about 13° to about 16° away from the centerline of elongated blade portion 5.

[0051] Although anchoring assembly 20 is shown as including first and second jaw members 20A, 20B that can cooperate with one another, in some embodiments, only one jaw member pivots while the other jaw member remains in the closed configuration. In some embodiments, control assembly 60 (described in more detail below) achieves the open configuration by equally positively engaging both jaw members when in the closed configuration while allowing each jaw member to pivot freely, so that first and second jaw members 20A, 20B may or may not pivot in cooperation.

[0052] FIG. 9 is a side view of the anchoring blade 310, illustrating many features, such as the substantially orthogonal orientation of the anchoring assembly 20 relative to the elongated blade portion 5 and the orthogonal orientation of the elongated blade portion 5 relative to the horizontal member 45 of the retractor engagement portion 40, when in the closed configuration. In this illustrated embodiment, the elongated blade portion 5 can be said to define a first plane, a portion of the anchoring assembly 20 can be said to define a second plane, and the horizontal member 45 can be said to define a third plane. In some embodiments, when the anchoring assembly 20 is in the closed configuration, the second and third planes are substantially parallel to each other and substantially orthogonal to the first plane. In some embodiments, one of the second and third planes is substantially orthogonal to the first plane, but the second and third planes are not parallel to each other. In some embodiments, neither the second plane nor the third plane is orthogonal to the first plane, and they may or may not be parallel to each other. 9 further illustrates that at least a portion of anchoring assembly 20 lies substantially in a first plane or in a plane parallel to the first plane when in the closed configuration. This portion of the anchoring assembly may be referred to as a base portion of both the first and second jaw members.

[0053] In some embodiments, the first and second planes are at an angle between about 70° and about 85°, between about 80° and about 95°, between about 90° and about 105°, between about 100° and about 115°, between about 70° and about 115°, between about They intersect each other at an angle of about 80° to about 100°, or about 85° to about 95°. In some embodiments, the first and third planes intersect each other at an angle of about 70° to about 85°, about 80° to about 95°, about 90° to about 105°, about 100° to about 115°, about 70° to about 115°, about 80° to about 100°, or about 85° to about 95°.

[0054] 9 illustrates the front face 25 and rear face 30 of elongated blade portion 5 and the fact that control assembly 60 is located on rear face 30, control assembly 60 including tool engaging portion 60A (shown in FIGS. 7 and 11), connecting rod 60C housed within connecting rod housing 60B, and movable block 60D. In this embodiment, rotation of tool engaging portion 60A rotates connecting rod 60C, which in turn translates movable block 60D in a distal or proximal direction. In some embodiments, the control assembly is located on front face 25, such as in channel 35.

[0055] 10A and 10B, distal translation of movable block 60D pushes first and second jaw members 20A, 20B of anchor assembly 20 distally or downwardly, thereby pivoting first and second jaw members 20A, 20B to assume and maintain the closed configuration as shown in FIG. 10A. The open configuration is achieved by proximal translation of movable block 60D (caused by rotating tool engaging portion 60A), as shown in FIG. 10B. As movable block 60D translates proximally, the pressure applied to first and second jaw members 20A, 20B is reduced and removed, but the jaw members may not automatically transition from the closed configuration. In other words, first and second jaw members 20A, 20B may passively remain in the closed configuration. When the anchoring assembly 20 is anchored to a bone implant, opening the first and second jaw members 20A, 20B may require pulling the anchoring blade 310 proximally to disengage the anchoring assembly 20 from the bone implant. However, when the anchoring assembly 20 is not anchored to a bone implant and there is no tissue or other object in contact with it, translating the movable block 60D allows the first and second jaw members to be pulled downward or distally by gravity to achieve the open configuration.

[0056] In some embodiments, distal translation of movable block 60D automatically transitions anchoring assembly 20 to the open configuration without the need to move anchoring blade 310. In some embodiments, either first jaw member 20A or second jaw member 20B is mechanically engaged to movable block 60D such that proximal translation of movable block 60D transitions the associated jaw member to the open configuration while the other jaw member passively remains in the closed configuration.

[0057] In the illustrated embodiment, a connecting rod 60C is housed within connecting rod housing 60B, which mechanically transfers rotation of tool engaging portion 60A to translation of movable block 60D. In some embodiments, connecting rod 60C is not housed within a housing. In some embodiments, connecting rod 60C is shorter so that tool engaging portion 60A is not located on or near retractor engaging portion 40. For example, tool engaging portion 60A may be located more distally along rear surface 30 of elongated blade portion 5. In some embodiments, connecting rod 60C is not included at all, such that tool engaging portion 60A is directly connected to block 60D.

[0058] In some embodiments, part or all of the control assembly 60 is located on the front face 25 of the elongated blade portion 5. In some such embodiments, it may be desirable to maintain as much working space as possible toward the proximal end of the anchored blade 310. Accordingly, the control assembly 60 is configured such that the tool engaging portion 60A is positioned on the movable block 310. The connecting rod may be absent so that the adjustment tool is positioned directly above or proximal to the movable block 60D, and the adjustment tool must extend the length of the elongated blade portion 5 along the front face 25 to engage and rotate the tool engagement portion 60A.

[0059] 9 and 10 also show lateral protrusions 55 on the spherical head portion 50 of the retractor engagement portion 40. In the illustrated embodiment, the lateral protrusions 55 define an axis that causes rotation of the anchoring blade 310 in a plane of rotation that is generally perpendicular to the plane defined by the elongated blade portion 5. However, in some embodiments, rotation in a different plane may be desirable, in which case the lateral protrusions 55 can be appropriately positioned on the spherical head portion 50 to achieve rotation in the desired plane. Furthermore, in some embodiments, the lateral protrusions 55 are eliminated entirely to allow the anchoring blade 310 to rotate in multiple planes.

[0060] FIG. 11 is a top view of the proximal end of anchoring blade 310. While this perspective view illustrates the structural relationships of many of the elements of anchoring blade 310 discussed above with respect to other figures, FIG. 11 also illustrates the distal or arcuate portions of first and second jaw members 20A, 20B. When the first and second jaw members 20A, 20B abut one another in a closed configuration, they form an opening 70 configured to anchor and retain a portion of a bone implant, such as a bone screw or pedicle screw. In this illustrated embodiment, opening 70 is substantially circular; however, in some embodiments, opening 70 has other shapes, such as oval, square, rectangular, etc. In this illustrated embodiment, the circular shape of opening 70 is achieved by two semicircular aspects of the first and second jaw members 20A, 20B. In some embodiments, one or both of the first and second jaw members form fewer than two semicircles. In the illustrated embodiment, the two semicircles of the first and second jaw members 20A, 20B are shown to substantially abut one another at each end of the semicircles. Such a configuration may provide greater stability or engagement of the anchoring blade 310, as well as greater tactile response to a user engaging the anchoring blade 310 with a bone implant. However, in some embodiments, only one end of one semicircle (or other suitable shape) abuts a corresponding end of the other semicircle (or other suitable shape). In some embodiments, neither end of a semicircle (or other suitable shape) abuts a corresponding end of the other semicircle (or other suitable shape).

[0061] The shape of the opening 70 may be determined by the shape of the portion of the bone implant to which the anchoring assembly 20 is to be anchored. For example, if the bone implant is a pedicle screw and the portion to be anchored has a partially or completely spherical head, the shape of the opening 70 is ideally circular, and the edges of the arcuate arms of the first and second jaw members 20A, 20B may further include beveled or rounded surfaces to accommodate or engage the spherical head of the pedicle screw. In some embodiments, the shape and sides of the opening 70 may be configured to attach to the shank portion of the pedicle screw, thereby providing access to the top or head portion of the pedicle screw if the pedicle screw is a modular pedicle screw, allowing for assembly of a tulip to the head.

[0062] In some embodiments, the closed configuration of anchoring assembly 20 is understood to be achieved when at least a portion of first jaw member 20A contacts and maintains contact with at least a portion of second jaw member 20B. In some embodiments, the closed configuration is understood to be achieved when movable block 60D is translated distally a sufficient distance to apply a force to first and second jaw members 20A, 20B to allow anchoring assembly 20 to engage and anchor to a bone implant or other suitable anchoring point, even when no portion of first jaw member 20A contacts any portion of second jaw member 20B.

[0063] In some embodiments, the open configuration of the anchoring assembly 20 is understood to be achieved when the movable block 60D is translated proximally sufficiently to open the first and second jaw members 20A, 20B of the anchoring assembly 20, thereby allowing a portion of the bone implant (or other suitable anchoring point) to enter and exit the opening 70.

[0064] The anchored retractor blades disclosed herein are configured for use with a retractor assembly, such as retractor 1000. Such an assembly may have one or more retractor arms, each configured to have a retractor blade attached thereto (releasably or non-releasably), at least one of which is an anchored retractor blade according to the present disclosure. In some embodiments of the retractor assembly, two anchored blades are positioned opposite each other within the retractor assembly. Some embodiments include inner and / or outer blades positioned on either side of the space formed by the two opposing anchored blades.

[0065] A suitable retractor assembly may also include a support engagement portion such that the retractor assembly may be releasably secured and held in a fixed position and orientation relative to the operating table. In such a configuration, an A-arm may be utilized to secure the retractor assembly to the operating table.

[0066] The anchoring retractor blades discussed herein can be used in methods for anchoring a surgical retractor to a bone implant or other suitable anchor. Such methods may include placing a first anchoring blade according to this disclosure in a surgical corridor such that at least a portion of the first and second jaws of the anchoring blade are positioned below an upper surface of the first bone implant. Once in place, a user actuates a control assembly of the first anchoring blade to transition the first and second jaws from an open configuration to a closed configuration, anchoring the first anchoring blade to the first bone implant. Some methods further include placing a second anchoring blade according to this disclosure in a surgical corridor such that at least a portion of the first and second jaws of the second anchoring blade are positioned below an upper surface of the second bone implant. Once in position, the user actuates the control assembly of the second anchoring blade to transition the first and second jaws from an open configuration to a closed configuration, anchoring the second anchoring blade to the second bone implant.

[0067] The above methods illustrate how anchoring blades can be secured to bone implants already placed at or near the surgical site. In alternative embodiments, one or both anchoring blades are secured to bone anchors before the resulting construct is inserted into the patient's body near the surgical site. In such a configuration, the blade / implant combination is advanced toward the surgical or anchor site, and once properly positioned, a bone implant (e.g., a pedicle screw) is advanced into the bone, thereby also securing the anchoring blades in place. The same steps can be performed with the other anchoring blade, placing both anchoring blades in place and securing them to the retractor assembly to establish a stable surgical path. In some embodiments, a driver is secured to the blade / implant combination to achieve the blade / implant / driver combination and then advanced toward the surgical or anchor site, so that once the combination is properly positioned, the driver can be immediately used to advance the implant into the bone without the need for additional instruments or steps.

[0068] If the bone implant is a modular pedicle screw, some methods involve The method further includes installing a tulip on the head portion of the anchored retractor blade. Some methods utilizing an anchored retractor blade as disclosed herein are part of a transforaminal lumbar interbody fusion procedure. Some methods are part of a posterior lumbar interbody fusion procedure. Some methods are part of a lateral lumbar interbody fusion procedure.

[0069] 12 shows an inner retractor arm 200 including an elongated portion 215 having an upper surface with linear gear teeth 220 configured to mate with an adjustment mechanism 140. As described above, rotation of the adjustment mechanism 140 causes the inner retractor arm 200 to linearly translate relative to the base portion 100, expanding or contracting the inner portion of the surgical corridor formed by two or more retractor blades / arms. The inner retractor arm 200 includes an inner blade engagement portion 225 at its distal end that is pivotable relative to the elongated portion 215 by a distraction mechanism 230 that, when rotated, pivots the engagement portion 225 downward, meaning below the plane defined by the elongated portion 215. Such pivoting can be useful to expand surgical access and / or combat tissue intrusion into the surgical corridor.

[0070] Engagement portion 225 includes a receiving window 235 configured to receive an engagement extension of inner retractor blade 210, which is described in more detail below with reference to Figures 15 and 16. Engagement portion 225 further includes a release / lock mechanism 240 that includes a locking portion 245 (described in more detail below with reference to Figures 13 and 14) and a button portion 250 that, in the illustrated embodiment, extends above the top surface of engagement portion 225.

[0071] 13 is a front view of engagement portion 225, showing distraction mechanism 230, receiving window 235, and release / lock mechanism 240. Although not shown, a biasing element, such as a spring, is located below release / lock mechanism 240 to maintain the release / lock mechanism in a locked position, which is achieved when a majority of the frusto-conical section of lock portion 245 is visible through receiving window 235. Depressing button portion 250 compresses the biasing element, allowing lock portion 245 to drop below receiving window 235, thereby releasing the inner blade engagement portion.

[0072] 14 shows the release / lock mechanism 240 in isolation, highlighting the rear section that includes two notches 255 behind the frustoconical section that are configured to receive at least a portion of the inner blade engagement portion, as described below. Some embodiments include only a single notch 255. Some embodiments include differently shaped notches, but generally the shape of the notch corresponds to the shape of the extension of the inner blade engagement portion.

[0073] FIG. 15 is a perspective view of inner retractor blade 210, showing that inner retractor blade 210 includes an engagement portion 260 at its proximal end and an extendable portion 265 at its distal end. Between the proximal and distal ends is blade body 255. Extendable portion 265 is shown having a curved tip at its distal end. This configuration allows inner retractor blade 210 to better hold or restrain tissue from a surgical channel formed by two or more retractor blades secured to surgical retractor 1000. Extendable portion 265 can be translated into or out of blade body 255 depending on the depth of the surgical channel and the needs of the surgical procedure.

[0074] The engagement portion 260 includes an extension, or a pair of extensions 270, which are configured to engage the release / lock mechanism 240 when inserted into the receiving window 235, as shown. FIG. 15 shows that in this embodiment, the extension 270 has a hook or arch 275. This structural feature is configured to fit the frustoconical shape of the lock portion 245 of the release / lock mechanism 240. Adjacent to the arched region 275 The angled surface 280 is configured to depress the locking portion 245 when the engagement portion 260 is pressed into the receiving window 235, thereby depressing the locking portion 245 and compressing the biasing element therebelow, allowing the extension 270 to at least partially pass through the locking portion 245. When the extension 270 is fully inserted into the engagement portion 225 of the inner retractor arm 200, the arched region 275 allows the release / locking mechanism 240 to return to the locked position by receiving the locking portion 245 into the arched region 275. Furthermore, the generally rectangular outer shape of the extension 270 corresponds to the generally rectangular inner surface of the receiving window 235, thereby resisting rotational movement of the engagement portion, and therefore, inner retractor blade 210.

[0075] The features described above are designed to allow passive locking of the inner blade 210 by the inner arm 200 without the need for an active lockstep, actuation of other components, pressing of components or buttons, etc.

[0076] Disengagement of inner retractor blade 210 from inner retractor arm 200 is achieved by pressing button portion 250, which moves locking portion 245 downward and allows extension 270 to be pulled over locking portion 245 and out of receiving window 235.

[0077] FIG. 16 further illustrates that inner retractor blade 210 may include channel 285 that, in this embodiment, is configured to operate in a manner similar to channel 35 of anchored retractor blades 310 and / or 410.

[0078] 17 shows an auxiliary or outer retractor arm 500. While this illustrated outer retractor arm 500 is configured to attach to retractor arm 300, in some embodiments, outer retractor arm 500 can be configured to attach to retractor arm 400. This is accomplished by simply reversing the orientation of various features of outer retractor arm 500, which are described below.

[0079] The outer retractor arm 500 includes an arm engagement portion 505 at its proximal end and an outer blade engagement portion 510 at its distal end. Between the distal and proximal ends are a distraction mechanism 515 and an outer adjustment mechanism 520, which in this illustrated embodiment comprises a worm gear. Rotation of the adjustment mechanism 520 expands or contracts the outer retractor arm 500, thereby increasing or decreasing the size of the surgical passageway when attached to the retractor 1000. When rotated, the distraction mechanism 515 protrudes or angles the outer retractor blade secured to the outer blade engagement portion 510 outward. The outer blade (not shown) may be similar in design to the inner retractor blade 210. In this illustrated embodiment, the outer blade engagement portion 510 operates similarly to the inner blade engagement portion 225 in that it releasably secures the retractor blade against twisting or rotation.

[0080] To achieve a proper surgical passageway, the surgical retractors disclosed herein can include as few as two retractor blades, and as many as three retractor blades, using any combination of two anchored retractor blades, one inner retractor blade, and one outer retractor blade, with the outer retractor blade secured to one of two retractor arms via an outer retractor arm. For example, some configurations include only two anchored retractor blades facing each other. Some configurations include only two retractor blades and an inner retractor blade, and some of these configurations further include an outer retractor blade attached to one of two retractor arms via an outer retractor arm. Some embodiments include an inner retractor blade. The retractor blade may include a main arm or outer retractor, or both an inner retractor blade and an outer retractor blade, and only one anchored retractor blade.

[0081] Embodiment

[0082] The following embodiments are provided merely as examples of specific configurations, materials, arrangements, etc. contemplated by the authors of this disclosure. Embodiment 1. a base portion including first and second extensions, a first receiving area, and one or more engagement portions; an inner retractor arm having a proximal end and a distal end, the inner retractor arm having a second receiving area at the distal end configured to releasably engage a portion of the inner retractor blade, the proximal end configured to be slidably received in the first receiving area of ​​the base portion; a first retractor arm having a proximal end and a distal end, the first retractor arm having a third receiving area at the proximal end configured to slidably receive the first extension of the base portion and a fourth receiving area at the distal end configured to releasably engage a portion of the first retractor blade; a second retractor arm having a proximal end and a distal end, the second retractor arm having a fifth receiving area at the proximal end configured to slidably receive the second extension of the base portion and a sixth receiving area at the distal end configured to releasably engage a portion of the second retractor blade; Equipped with The inner, first, and second retractor blades together form an adjustable surgical corridor; Surgical retractors. Embodiment 2. 2. The surgical retractor of embodiment 1, wherein one or both of the first and second retractor arms further comprises an outer arm engagement portion. Embodiment 3. 3. A surgical retractor as described in embodiment 2, further comprising an outer retractor arm having a proximal end and a distal end, the proximal end comprising a seventh receiving area configured to releasably engage with the outer arm engagement portion of the first or second retractor arm, and the distal end comprising an eighth receiving area configured to releasably engage with a portion of the outer retractor blade. Embodiment 4. A surgical retractor as described in embodiment 2 or 3, wherein at least one of the second and eighth receiving areas comprises a housing configured to receive and maintain a portion of the inner or outer retractor blade in a fixed orientation. Embodiment 5. A surgical retractor as described in embodiment 2, 3, or 4, wherein at least one of the second and eighth receiving areas includes a first passive locking mechanism configured to receive and passively lock a portion of the inner or outer retractor blade in position. Embodiment 6. 6. A surgical retractor as described in embodiment 5, wherein the first passive locking mechanism comprises a spring-loaded column having a frusto-conical base portion with one or more notches facing away from the surgical corridor. Embodiment 7. A surgical retractor as described in embodiment 6, wherein the portion of the inner blade received by the second and / or eighth receiving area has a pair of extensions spaced apart to fit the width of the spring-loaded column, each extension having a distally extending protrusion configured to be received by a respective notch in the frustum body. Embodiment 8. 8. A surgical retractor according to embodiment 3, 4, 5, 6, or 7, wherein the outer retractor arm further comprises an outer adjustment mechanism disposed between the proximal end and the distal end. Embodiment 9. 9. A surgical retractor according to embodiment 1, 2, 3, 4, 5, 6, 7, or 8, wherein the first receiving area comprises an internal adjustment mechanism configured to engage with and adjust the position of the internal retractor arm. Embodiment 10. 10. The surgical retractor of embodiment 8 or 9, wherein at least one of the outer adjustment mechanism and the inner adjustment mechanism is a worm gear. Embodiment 11. A surgical retractor as described in embodiment 2, 3, 4, 5, 6, 7, 8, 9, or 10, wherein at least one of the first, second, inner, and outer retractor arms further comprises a distraction adjustment mechanism disposed between the proximal end and the distal end. Embodiment 12. A surgical retractor according to embodiment 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11, wherein at least one of the fourth and sixth receiving areas comprises a housing including a second passive locking mechanism configured to receive and passively lock in place a portion of the first or second retractor blade. Embodiment 13. 13. A surgical retractor as described in embodiment 12, wherein the housing is configured to allow a portion of the first or second retractor blade to pivot on a plane that intersects the surgical corridor. Embodiment 14. A surgical retractor as described in embodiment 12 or 13, wherein the passive locking mechanism includes a spring-loaded blocker that is passively maintained in a first position, the blocker pivoting about a first axis and rotating to a second position when a portion of the first or second retractor blade is pushed into the fourth or sixth receiving area, but is configured to automatically rotate back to the first position when a portion of the first or second retractor blade is sufficiently advanced into the fourth or sixth receiving area. Embodiment 15. 15. A surgical retractor as described in embodiment 14, wherein the passive locking mechanism includes a spring-loaded button that, when pressed, allows the blocker to rotate to a third position that releases a portion of the first or second retractor blade from the housing of the first or second retractor blade. Embodiment 16. 16. A surgical retractor according to embodiment 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15, wherein the one or more engagement portions of the base portion comprise two engagement portions. Embodiment 17. 17. A surgical retractor according to embodiment 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or 16, wherein a portion of the first and / or second retractor blade comprises a spherical shape with two lateral protrusions. Embodiment 18. 18. The surgical retractor of embodiment 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, or 17, wherein at least one of the first and second retractor blades is an anchored retractor blade. Embodiment 19. 19. A surgical retractor as described in embodiment 18, wherein the anchored retractor blade is configured to be releasably anchored to the pedicle screw. Embodiment 20. 19. The surgical retractor of claim 19, wherein the anchored retractor blade is an anchored blade as described in embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, or 49. Embodiment 21. 21. The surgical retractor of embodiment 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20, wherein at least one of the second and third receiving areas comprises a ratchet mechanism configured to lock the first or second retractor arm in position along the first or second extension when the first or second retractor arm advances along the first or second extension away from the inner retractor arm. Embodiment 22. 22. A surgical retractor as described in embodiment 21, wherein the ratchet mechanism includes a release lever that, when pulled, disengages the ratchet mechanism from the first or second extension portion, allowing free movement of the first or second retractor arm along the first or second extension portion. Embodiment 23. 23. A surgical retractor according to claim 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, or 22, wherein at least one of the second and third receiving areas comprises an advancement mechanism that, when rotated, advances the first or second retractor arm away from the inner retractor arm. Embodiment 24. A surgical retractor as described in embodiment 21, 22, or 23, wherein at least one of the first and second extensions includes ratchet teeth arranged on a first side and a second side (opposite the first side) of the first or second extension. Embodiment 25. 1. A method of using an anchored surgical retractor, comprising: inserting first and second retractor blades through an opening in a patient near a spine of the patient, the first and second retractor blades comprising: an elongated blade portion having a proximal end and a distal end; a retractor engagement portion disposed at the proximal end of the elongated blade portion; an anchor mechanism disposed at the distal end of the elongated blade portion, the anchor mechanism configured to engage a bone implant, the anchor mechanism comprising first and second jaws configured to assume closed and open configurations, wherein in the open configuration a portion of the bone implant can pass through the first and second jaws; and a control assembly configured to transition the first and second jaws between the open and closed configurations; advancing first and second retractor blades toward respective first and second bone anchors secured to the patient's spine; Positioning a portion of each of the first and second bone anchors between first and second jaws of the first and second retractor blades, respectively; manipulating each control assembly such that each set of first and second jaws is held in a closed position about a respective portion of the first and second bone anchors; releasably securing the first and second retractor blades to a surgical retractor assembly including a base portion, a first retractor arm that releasably receives a portion of the retractor engagement portion of the first retractor blade, and a second retractor arm that releasably receives a portion of the retractor engagement portion of the second retractor blade; manipulating one or both of the first and second retractor arms to form and / or widen a surgical corridor formed between the first and second retractor blades; A method comprising: Embodiment 26. 26. The method of embodiment 25, wherein the base portion further comprises one or more engagement portions, and the method further comprises fixing a stabilizing device to one of the one or more engagement portions of the base portion, the stabilizing device being fixed to the operating table so as to fix the position of the base portion relative to the operating table. Embodiment 27. 27. The method of embodiment 26, wherein the stabilization device is an A-arm. Embodiment 28. inserting an inner retractor blade, the inner retractor blade comprising an elongated blade portion having a proximal end and a distal end and a retractor engagement portion disposed at the proximal end of the elongated blade portion, through the opening and advancing the inner retractor blade toward the patient's spine; releasably securing the inner retractor blade to a retractor assembly further comprising an inner retractor arm disposed in the opening in the base portion and movable relative to the base portion, the inner retractor arm having a blade engagement portion at a distal end configured to releasably receive a portion of the retractor engagement portion of the inner retractor blade; adjusting the position of the inner retractor arm relative to the base portion to maintain and / or enlarge the surgical corridor; 28. The method of embodiment 25, 26, or 27, further comprising: Embodiment 29. inserting an outer retractor blade, the outer retractor blade comprising an elongated blade portion having a proximal end and a distal end and a retractor engagement portion disposed at the proximal end of the elongated blade portion, through the opening and advancing the outer retractor blade toward the patient's spine; releasably securing the outer retractor blade to a retractor assembly further comprising an outer retractor arm releasably secured to either the first or second retractor arm, the outer retractor arm having a blade engagement portion at a distal end configured to releasably receive a portion of the retractor engagement portion of the outer retractor blade; adjusting the position of the outer retractor arm relative to the first or second retractor arm to maintain and / or enlarge the surgical corridor; 29. The method of embodiment 25, 26, 27, or 28, further comprising: Embodiment 30. The method of embodiment 25, 26, 27, 28, or 29, wherein the first and second retractor arms further comprise a distraction mechanism configured to adjust the angular orientation of the first and second retractor blades relative to the first and second retractor arms, respectively, and the method further comprises utilizing one or both distraction mechanisms to distract the vertebrae when the first and second retractor blades are anchored to first and second bone anchors, respectively, fixed to separate vertebrae. Embodiment 31. The method of embodiment 25, 26, 27, 28, 29, or 30, wherein the anchored surgical retractor is the surgical retractor of any one of embodiments 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, or 24. Embodiment 32. 1. An anchoring blade for use with a surgical retractor, comprising: an elongated blade portion having a proximal end, a distal end, a front surface configured to face the surgical corridor, a rear surface opposite the front surface, and at least one channel extending along the front surface from the proximal end toward the distal end; a retractor engagement portion disposed at a proximal end of the elongated blade portion; a first jaw and a second jaw disposed at a distal end of the elongated blade portion and configured to engage a bone implant, the first jaw and the second jaw configured to assume a closed configuration and an open configuration, wherein when in the open configuration a portion of the bone implant can pass through the first and second jaws; a control assembly configured to transition the first and second jaws between an open configuration and a closed configuration; An anchored blade comprising: Embodiment 33. 33. The anchored blade of embodiment 32, wherein the elongated blade portion lies substantially in a first plane and, when in the closed configuration, first portions of the first and second jaws lies in a second plane, and the first and second planes intersect with each other at an angle of about 70° to about 85°, about 80° to about 95°, about 90° to about 105°, about 100° to about 115°, about 70° to about 115°, about 80° to about 100°, or about 85° to about 95°. Embodiment 34. An anchoring blade as described in embodiment 32 or 33, wherein at least a portion of the retractor engagement portion lies in a third plane and the first and third planes intersect each other at an angle of about 70° to about 85°, about 80° to about 95°, about 90° to about 105°, about 100° to about 115°, about 70° to about 115°, about 80° to about 100°, or about 85° to about 95°. Embodiment 35. 35. The anchored blade of embodiment 34, wherein the second and third planes are substantially parallel. Embodiment 36. 36. The anchored blade of embodiment 32, 33, 34 or 35, wherein the second portions of the first and second jaws reside in a first plane when in the closed configuration. Embodiment 37. An anchored blade as described in embodiment 32, 33, 34, 35, or 36, wherein the first jaw is configured to pivot about a first axis and the second jaw is configured to pivot about a second axis. Embodiment 38. 38. The anchored blade of embodiment 37, wherein the first and second axes lie in a first plane and intersect with each other such that the angle between the first and second axes is about 60° to about 70°, about 65° to about 75°, about 70° to about 80°, about 75° to about 85°, about 80° to about 90°, about 85° to about 95°, about 90° to about 100°, about 95° to about 105°, about 100° to about 110°, about 65° to about 105°, or about 75° to about 95°. Embodiment 39. 39. The anchored blade of embodiment 38, wherein the first and second axes are symmetrical about the elongated blade portion. Embodiment 40. The first and / or second jaws are a base portion configured to pivotally engage a distal end of the elongated blade portion; an arcuate portion configured to engage the bone implant when the first and second jaws are in a closed configuration; 40. The anchoring blade of embodiment 32, 33, 34, 35, 36, 37, 38, or 39, comprising: Embodiment 41. 41. An anchoring blade as described in embodiment 40, wherein the arcuate portion has a size and shape to engage with the head of a pedicle screw. Embodiment 42. An anchoring blade as described in embodiment 41, wherein the first and second jaws are configured to enable assembly of a modular tulip onto the head of the pedicle screw when the first and second jaws are in a closed configuration. Embodiment 43. 43. An anchored blade according to embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, or 42, wherein the front surface of the elongated blade portion has a curved portion such that the sides of the front surface bulge toward the surgical corridor. Embodiment 44. 44. The anchoring of embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, or 43, wherein the control assembly is disposed on the rear surface of the elongated blade portion. blade. Embodiment 45. The control assembly a tool engaging portion; a movable block configured to engage the first and second jaws to transition them between an open configuration and a closed configuration; a connecting rod mechanically connecting the tool engaging portion and the movable block and configured to translate rotation of the tool engaging portion into movement of the block in either a distal or proximal direction along the elongated blade portion; 45. The anchoring blade of embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, or 44, comprising: Embodiment 46. 46. ​​An anchored blade as described in embodiment 45, wherein the tool engagement portion is located at the proximal end of the elongated blade portion. Embodiment 47. 47. An anchored blade as described in embodiment 45 or 46, wherein the movable block is configured to apply equal force to both the first and second jaws to move them in unison between the open and closed configurations. Embodiment 48. 48. The anchoring blade of embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, or 47, wherein the retractor engagement portion comprises a spherical portion configured to be received by a retractor assembly. Embodiment 49. An anchoring blade as described in embodiment 48, wherein the spherical portion has a pair of lateral extensions configured to allow the anchoring blade to rotate relative to the retractor assembly only in a single plane. Embodiment 50. a retractor assembly including a first retractor arm and a second retractor arm, each retractor arm configured to releasably engage a retractor blade; a support engagement portion configured to releasably engage the support structure; a first anchoring blade comprising the anchoring blade of embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, or 49 releasably engaged with the first retractor arm; and A surgical retractor system comprising: Embodiment 51. 51. The surgical retractor system of embodiment 50, further comprising a second anchoring blade comprising an anchoring blade of embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, or 49 releasably engaged with the second retractor arm. Embodiment 52. 52. A surgical retractor system according to embodiment 50 or 51, wherein the retractor assembly further comprises an inner blade engagement portion configured to releasably engage with the inner retractor blade. Embodiment 53. 53. A surgical retractor system as described in embodiment 52, further comprising an inner retractor blade that releasably engages with the inner blade engagement portion of the retractor assembly. Embodiment 54. A surgical retractor system according to embodiment 50, 51, 52, or 53, wherein the support structure is fixed to an operating table or a surgical frame. Embodiment 55. 55. A surgical retractor system according to embodiment 50, 51, 52, 53, or 54, wherein the support structure is an A-arm. Embodiment 56. 1. A method of securing an anchoring blade to a first bone implant, comprising: Positioning a first anchoring blade comprising an anchoring blade according to embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 or 49 such that at least a portion of the first and second jaws of the anchoring blade are positioned below an upper surface of the first bone implant; actuating a control assembly of the first anchoring blade to transition the first and second jaws from an open configuration to a closed configuration to anchor the first anchoring blade to the first bone implant; A method comprising: Embodiment 57. Positioning a second anchoring blade comprising an anchoring blade according to embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 or 49 such that at least a portion of the first and second jaws of the second anchoring blade are positioned below an upper surface of the second bone implant; actuating a control assembly of the second anchoring blade to transition the first and second jaws from an open configuration to a closed configuration to anchor the second anchoring blade to the second bone implant; 57. The method of embodiment 56, further comprising: Embodiment 58. 58. The method of embodiment 56 or 57, wherein the first bone implant is fixed to the first vertebra before the first anchoring blade is fixed to the first bone implant, and / or the second bone implant is fixed to the second vertebra before the second anchoring blade is fixed to the second bone implant. Embodiment 59. 58. The method of embodiment 56 or 57, wherein the first anchoring blade is fixed to the first bone implant, and then the first bone implant is fixed to the first vertebra, and / or the second anchoring blade is fixed to the second bone implant, and then the second bone implant is fixed to the second vertebra. Embodiment 60. 29. The method of embodiment 28, wherein a driver is secured to the first or second bone anchor before securing the first or second bone anchor to the first or second vertebra. Embodiment 61. 30. The method according to embodiment 25, 26, 27, 28 or 29, wherein the first bone implant and / or the second bone implant is a pedicle screw having a threaded shank portion and a head portion. Embodiment 62. 31. The method of embodiment 30, wherein the head portion is at least partially spherical in shape. Embodiment 63. The method of embodiment 30 or 31, wherein the pedicle screw is a component of a modular screw assembly. Embodiment 64. 33. The method of embodiment 32, further comprising assembling the modular screw assembly after the first and / or second anchoring blades are anchored to the first and / or second bone implants, respectively. Embodiment 65. 34. The method of embodiment 25, 26, 27, 28, 29, 30, 31, 32, or 33, wherein the method forms part of a transforaminal lumbar interbody fusion procedure. Embodiment 66. a base portion comprising first and second extensions and one or more engagement portions; a first retractor arm having a proximal end and a distal end, the first retractor arm having a third receiving area at the proximal end configured to slidably receive the first extension of the base portion and a fourth receiving area at the distal end configured to releasably engage a portion of the first retractor blade; a second retractor arm having a proximal end and a distal end, the second retractor arm having a fifth receiving area at the proximal end configured to slidably receive the second extension of the base portion and a sixth receiving area at the distal end configured to releasably engage a portion of the second retractor blade; Equipped with The inner, first, and second retractor blades together define an adjustable surgical passageway, and the first and second retractor blades are an elongated blade portion having a proximal end and a distal end; a retractor engagement portion disposed at a proximal end of the elongated blade portion; a first jaw and a second jaw disposed at a distal end of the elongated blade portion and configured to engage a bone implant, the first and second jaws being configured to assume a closed configuration and an open configuration, such that when in the open configuration a portion of the bone implant can pass through the first and second jaws; 1. An anchored surgical retractor assembly comprising: Embodiment 67. 67. A retractor assembly as described in embodiment 66, wherein the first and second retractor blades further include a control assembly configured to transition the first and second jaws between an open configuration and a closed configuration. Embodiment 68. A retractor assembly as described in embodiment 66 or 67, wherein the base portion further comprises a first receiving area, and the retractor assembly further comprises an inner retractor arm having a proximal end and a distal end, the inner retractor arm having a second receiving area at the distal end configured to releasably engage with a portion of the inner retractor blade, and the proximal end configured to be slidably received in the first receiving area of ​​the base portion. Embodiment 69. A retractor assembly as described in embodiment 66, 67, or 68, further comprising an outer retractor arm having a proximal end and a distal end, the proximal end comprising a seventh receiving area configured to releasably engage with an outer arm engagement portion located on one of the first or second retractor arms, and the distal end comprising an eighth receiving area configured to releasably engage with a portion of the outer retractor blade. Embodiment 70. A retractor assembly as described in embodiment 66, 67, 68, or 69, wherein at least one of the first and second retractor blades is an anchoring blade as described in embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, or 49. Embodiment 71. 70. A retractor assembly according to embodiment 66, 67, 68, or 69, wherein the first and second retractor blades are each anchoring blades according to embodiment 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, or 49.

[0083] While particular embodiments have been illustrated and described herein, it should be understood that various other changes and modifications can be made without departing from the spirit and scope of the claimed subject matter. It should also be noted that while some of the embodiments disclosed herein may be disclosed in connection with a particular approach (e.g., lateral or transforaminal), other approaches (e.g., anterior, posterior, etc.) are also contemplated.

[0084] Unless otherwise indicated, all numbers used in the specification and claims expressing quantities of ingredients, properties such as molecular weight, reaction conditions, and the like, should be understood to be modified in all instances by the term "about." Accordingly, unless otherwise indicated, the numerical parameters set forth in the specification and appended claims are approximations that may vary depending on the desired properties sought to be obtained by the embodiments of the present disclosure. At the very least, and not as a limitation on the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should be construed in light of, at least, the number of reported significant digits and by applying ordinary rounding techniques. Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the present disclosure are approximations, the numerical values ​​set forth in the specific examples are reported as precisely as possible. However, any numerical value inherently contains certain errors necessarily resulting from the standard deviation found in its respective testing measurements. In one embodiment, the terms "about" and "approximately" refer to a numerical parameter within 10% of the stated range.

[0085] As used in the context of describing embodiments of the present disclosure (particularly in the context of the claims below), the terms “a,” “an,” “the,” and similar referents should be construed to include both the singular and the plural unless otherwise indicated herein or clearly contradicted by context. The recitation of ranges of values ​​herein is merely intended to serve as a shorthand method of individually referring to each separate value falling within the range. Unless otherwise indicated herein, each separate value is incorporated herein as if individually set forth herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or clearly contradicted by context. The use of any examples or exemplary language (e.g., “etc.”) provided herein is solely for the purpose of providing a better understanding of embodiments of the present disclosure and does not pose a limitation on the scope of the disclosure. No language herein should be construed as indicating any non-claimed element essential to the practice of embodiments of the present disclosure.

[0086] Groupings of alternative elements or embodiments disclosed herein are not to be construed as limitations. Each group member may be referenced and claimed individually or in any combination with other members of the group or other elements described herein. It is anticipated that one or more members of a group may be included in, or deleted from, a group for reasons of convenience and / or patentability. When such inclusion or deletion is made, the specification is deemed to include the group as modified, and therefore satisfies the written description of all Markush groups used in the appended claims.

[0087] Certain embodiments are described herein, including the best mode known to the author(s) of the present disclosure for carrying out the embodiments disclosed herein. Of course, variations on these described embodiments will become apparent to those skilled in the art upon reading the foregoing description. The author(s) expect that those skilled in the art will adopt such variations as appropriate, and the author(s) intend for the embodiments of the present disclosure to be practiced otherwise than as specifically described herein. Accordingly, this disclosure includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, this disclosure encompasses any combination of the above-described elements in all possible variations thereof unless otherwise indicated herein or clearly contradicted by context.

[0088] Certain embodiments disclosed herein may be further limited in the claims using the language "consisting of" or "consisting essentially of." When used in a claim, whether submitted or added by amendment, the transitional term "consisting of" excludes any element, step, or ingredient not specified in the claim. The transitional term "consisting essentially of" limits the claim to certain materials or steps and those that do not materially affect the basic and novel characteristic(s). Embodiments of the disclosure so claimed are essentially or expressly described and embodied herein.

[0089] Additionally, where any references are made throughout this disclosure to patents and printed publications, each of these references and printed publications is herein individually incorporated by reference in its entirety.

[0090] Finally, it is to be understood that the embodiments disclosed herein are illustrative of the principles of the present disclosure. Other modifications that may be employed are within the scope of this disclosure. Thus, by way of example, and not of limitation, alternative configurations of the embodiments of the present disclosure may be utilized in accordance with the teachings herein. Accordingly, the present disclosure is not limited to that precisely as shown and described.

[0091] This application claims priority to U.S. Provisional Application No. 63 / 123,394, filed December 9, 2020, the entire contents of which are incorporated herein by reference.

Claims

1. a base portion including first and second extensions, a first receiving area, and one or more engagement portions; an inner retractor arm having a proximal end and a distal end, the inner retractor arm having a second receiving area at the distal end configured to releasably engage an engagement portion of the inner retractor blade, the proximal end configured to be slidably received in the first receiving area of ​​the base portion; a first retractor arm having a proximal end and a distal end, the first retractor arm having a third receiving area at the proximal end configured to slidably receive the first extension of the base portion and a fourth receiving area at the distal end configured to releasably engage an engagement portion of a first retractor blade; a second retractor arm having a proximal end and a distal end, the second retractor arm having a fifth receiving area at the proximal end configured to slidably receive a second extension of the base portion and a sixth receiving area at the distal end configured to releasably engage an engagement portion of a second retractor blade; Equipped with the inner, first, and second retractor blades together define an adjustable surgical corridor; the fourth and sixth receiving areas comprise housings including first passive locking mechanisms configured to receive and passively lock in place an engagement portion of the first or second retractor blade; the housing is configured to allow an engagement portion of the first or second retractor blade to pivot in a plane intersecting the respective engagement portions of the first and second retractor blades received in the housing; Surgical retractors.

2. 2. The surgical retractor of claim 1, wherein the first passive locking mechanism comprises a spring-loaded blocker passively maintained in a first position, the blocker configured to pivot about a first axis, rotate to a second position when an engagement portion of the first or second retractor blade is pressed into the fourth or sixth receiving area, but automatically rotate back to the first position when the engagement portion of the first or second retractor blade is sufficiently advanced into the fourth or sixth receiving area.

3. 3. The surgical retractor of claim 2, wherein the first passive locking mechanism includes a spring-loaded button that, when pressed, enables the blocker to rotate to a third position that releases an engagement portion of the first or second retractor blade from a housing of the first or second retractor blade.

4. The surgical retractor of claim 1 , wherein one or both of the first and second retractor arms further comprises an outer arm engagement portion.

5. 3. The surgical retractor of claim 2, further comprising an outer retractor arm having a proximal end and a distal end, the proximal end comprising a seventh receiving area configured to releasably engage an outer arm engagement portion of the first or second retractor arm, and the distal end comprising an eighth receiving area configured to releasably engage an engagement portion of an outer retractor blade.

6. The surgical retractor of claim 2 , wherein at least one of the second and eighth receiving areas comprises a housing configured to receive and maintain an engaging portion of an inner or outer retractor blade in a fixed orientation.

7. 5. The surgical retractor of claim 4, wherein at least one of the second and eighth receiving areas comprises a second passive locking mechanism configured to receive and passively lock in place an engagement portion of an inner or outer retractor blade.

8. The surgical retractor of claim 7, wherein the second passive locking mechanism comprises a spring-loaded column having a frusto-conical base portion with one or more notches facing away from the operating corridor.

9. 9. The surgical retractor of claim 8, wherein the engaging portion of the inner blade received by the second and / or eighth receiving area comprises a pair of extensions spaced apart to fit the width of the spring-loaded column, each extension having a distally extending protrusion configured to be received by a respective notch in the frustum body.

10. The surgical retractor of claim 1 , wherein the engagement portion of the first and / or second retractor blade comprises a spherical shape with two lateral protrusions.

11. The surgical retractor of claim 1 , wherein at least one of the first and second retractor blades is an anchored retractor blade configured to be releasably anchored to a bone screw.

12. the anchored retractor blade an elongated blade portion having a proximal end, a distal end, a front surface configured to face a surgical corridor, a rear surface opposite the front surface, and at least one channel extending along the front surface from the proximal end toward the distal end; an engagement portion disposed at a proximal end of the elongated blade portion; a first jaw and a second jaw disposed at a distal end of the elongated blade portion and configured to engage the bone screw, the first jaw and the second jaw configured to assume a closed configuration and an open configuration, wherein when in the open configuration a portion of the bone screw can pass through the first and second jaws; a control assembly configured to transition the first and second jaws between an open configuration and a closed configuration; The surgical retractor of claim 11 , comprising:

13. 13. The surgical retractor of claim 12, wherein the elongated blade portion lies substantially in a first plane and, when in a closed configuration, first portions of the first and second jaws lies in a second plane that is substantially perpendicular to the first plane.

14. The surgical retractor of claim 12, wherein the first jaw is configured to pivot about a first axis and the second jaw is configured to pivot about a second axis.

15. 15. The surgical retractor of claim 14, wherein the first and second axes lie in the first plane and intersect one another such that an angle between the first and second axes is between about 75 degrees and about 95 degrees.

16. The surgical retractor of claim 12, wherein the control assembly is disposed on a rear surface of the elongated blade portion.

17. the control assembly a tool engaging portion; a movable block configured to engage the first and second jaws to transition them between an open configuration and a closed configuration; a connecting rod mechanically connecting the tool engaging portion and the movable block and configured to translate rotation of the tool engaging portion into movement of the block in either a distal or proximal direction along the elongated blade portion; 17. The surgical retractor of claim 16, comprising:

18. The surgical retractor of claim 17, wherein the tool engaging portion is disposed at a proximal end of an elongated blade portion.

19. The surgical retractor of claim 17, wherein the movable block is configured to apply equal forces to both the first and second jaws to move them in unison between the open and closed configurations.

Images