Surgical retractors and methods for using surgical retractors

Abstract

Disclosed herein is a surgical retractor having a base portion and two retractor blades, and a method of using such a surgical retractor. The base portion has (a) two extension portions, each having a receiving area, and (b) one or more engagement portions. Each retractor blade has both a blade portion having a proximal end and a distal end, and an arm portion extending from the proximal end of the blade portion. Each arm portion is received by a respective receiving area.

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. The present disclosure further discloses a method of using such a surgical retractor in a surgical procedure such as spinal surgery.

Summary of the Invention

Means for Solving the Problems

[0002] A surgical retractor having a base portion and two retractor blades, and a method of using such a surgical retractor are disclosed herein. The base portion has (a) two extension portions each having a receiving region, and (b) one or more engagement portions. Each retractor blade has both a blade portion having a proximal end and a distal end, and an arm portion extending from the proximal end of the blade portion. Each arm portion is received by a respective receiving region.

[0003] Each receiving region may have a ratchet mechanism that engages the arm portion to fix the arm portion relative to the base portion. In certain embodiments, the arm portion has ratchet teeth for engaging the ratchet mechanism. In certain embodiments, the receiving region may have an advancement mechanism that rotates to adjust the position of the arm portion relative to the base portion.

[0004] According to certain embodiments, the retractor blade is formed as a single piece. In certain embodiments, the retractor blades are functionally integral. In certain embodiments, the blade portion is orthogonal to the arm portion, each blade portion is parallel to the other blade portion, and the arm portion is parallel to the base portion. In certain embodiments, the retractor is configured to maintain such orthogonality and parallel orientation even when the two retractor blades are adjusted relative to the base portion.

[0005] In some embodiments, an alignment function is included to indicate whether the retractor is properly oriented toward a target site, such as the intervertebral disc cavity of a patient. In some embodiments, the proper orientation is a lateral approach perpendicular to the intervertebral disc cavity. In some embodiments, the alignment function is identifiable by radiography and is located at one or both proximal ends of the blade portion.

[0006] One embodiment of the surgical retractor is configured for use when the patient is in a prone position. Another embodiment allows for use when the patient is in a supine or lateral position.

[0007] According to one embodiment, one or both blade portions have a central channel for securing an optical cable, anchoring mechanism, blade extender, or other useful tool to the blade portion. In one embodiment, at least one transverse channel is included, which may be used in conjunction with a bone anchor.

[0008] In one embodiment, the cross-sections of the two retractor blades together are generally circular. In another embodiment, the cross-sections are generally oval. Whether circular or oval, the retractor blades may be configured to slide over the expander as they advance toward the surgical site.

[0009] Methods of using a surgical retractor are further disclosed herein. In one method, an incision is made in the patient's skin at a lateral position to the patient's spine, the location of the surgical site on the spine is identified, a posterior retractor blade and anterior retractor blade of a two-blade surgical retractor, which may be a surgical retractor according to the present disclosure, is inserted, the surgical retractor is advanced toward the surgical site, the distal end of the posterior retractor blade is positioned posteriorly to the surgical site, the posterior retractor blade is fixed in the posterior position, and the surgical passage is enlarged.

[0010] In one embodiment, when locating the surgical site on the spine, a K-wire is advanced toward the surgical site, the distal end of the K-wire is embedded in the tissue of the surgical site, and at least an internal dilator and at least an external dilator, both of which may have a circular or oval cross-section, are advanced sequentially toward the surgical site on the K-wire. In one embodiment, at least one of the internal and external dilators has at least one electrode, which is configured to provide nerve monitoring, such as nerve plexus mapping, as the internal and external dilators advance toward the surgical site. [Brief explanation of the drawing]

[0011] The embodiments shown in the drawings are illustrative and typical in nature and are not intended to limit the subject matter defined by the claims. The following detailed description of the exemplary embodiments can be better understood when read together with the following drawings, in which similar structures are indicated by the same reference numerals.

[0012] [Figure 1] This is a perspective view showing the surgical retractor related to this disclosure. [Figure 2] This is another perspective view showing the embodiment shown in Figure 1. [Figure 3] Figure 1 is a plan view showing the surgical retractor. [Figure 4] Figure 1 is a side view showing the surgical retractor. [Figure 5] Figure 1 is a perspective view showing the base portion of the surgical retractor, which is one of its components. [Figure 6] Figure 1 is a perspective view showing the surgical arm and blade, which are components of the surgical retractor. [Figure 7] Figure 1 is a perspective view showing the surgical arm and blade, which are components of the surgical retractor. [Figure 8] This is a perspective view showing a surgical retractor according to the present disclosure, equipped with an auxiliary retractor blade. [Figure 9]This is a perspective view showing one embodiment of the auxiliary retractable blade relating to this disclosure. [Figure 10] This is a perspective view showing another embodiment of the auxiliary retractable blade relating to this disclosure. [Figure 11] This is a plan view showing yet another embodiment of the auxiliary retractable blade according to the present disclosure. [Figure 12] This is a perspective view showing yet another embodiment of the auxiliary retractable blade according to the present disclosure. [Figure 13] Figure 8 shows a perspective view of a surgical retractor, including different embodiments of the auxiliary retractor blade relating to this disclosure. [Figure 14] This is a perspective view showing a surgical retractor according to the present disclosure, equipped with an auxiliary retractor blade. [Figure 15] This is a perspective view showing a surgical retractor according to the present disclosure, equipped with two auxiliary retractor blades. [Modes for carrying out the invention]

[0013] This disclosure relates to surgical retractors, and more specifically to retractors configured for use in spinal surgery. The retractors are configured not merely to allow access to the surgical site, but are further configured to address specific problems encountered when accessing these surgical sites. For this purpose, the surgical retractors disclosed herein, and methods for using such surgical retractors, are particularly suited to accessing a patient's spine by a lateral approach. Some embodiments are particularly suited to a lateral approach when the patient is in a prone position. Some embodiments are particularly suited to a lateral approach when the patient is in a lateral position. Some embodiments are particularly suited to a lateral approach when the patient is in a supine position. While some embodiments are suited to a lateral approach, other approaches are also considered, as the superior features of the disclosed retractors may be beneficial for other approaches.

[0014] Figure 1 shows one embodiment of a retractor 100 comprising a base portion 105 having two extensions, a rear retractor arm 110, a rear retractor blade 115, a front retractor arm 120, and a front retractor blade 125. The base portion 105 has two receiving areas 130, 135, with one receiving area provided for each extension. The receiving areas 130, 135 are configured to receive each of the retractor arms. Receiving area 130 is configured to receive the rear retractor arm 110, and receiving area 135 is configured to receive the front retractor arm 120. Each retractor arm 110, 120 may be detachably received by each receiving area 130, 135, or each end may have a pin (or some other retaining means) to prevent the retractor arm from separating from the base portion 105. Detachability may be desirable to have the option to quickly select different retractor blades for the rear and / or front positions. The base portion 105 is shown in detail in Figure 5.

[0015] According to one embodiment, the retractor 100 is positioned for use in lateral access to the lumbar spine while the patient may be in a prone, lateral, or supine position. In one embodiment, the retractor 100 is positioned with retractor blades 115, 125 that form a passage perpendicular to the patient's intervertebral disc cavity, with the posterior blade 115 located posterior to the intervertebral disc cavity and the anterior blade 125 located anterior to the intervertebral disc cavity, in which case the base portion 105 is positioned lateral to the patient and posterior to the intervertebral disc cavity. This arrangement has been shown to limit interference with the surgical passage and provide the desired stability, but other configurations and arrangements are possible.

[0016] Each receiving area has adjustment mechanisms 140, 145 respectively configured to hold each retractor arm in a fixed position relative to the base portion 105 to enable stepwise adjustment of each retractor arm. The adjustment mechanisms 140, 145 are configured to operate independently of each other. In certain embodiments, the two adjustment mechanisms are configured to operate at least partially together by simultaneously adjusting the two retractor arms and / or simultaneously releasing each retractor arm so that the retractor arm is freely movable relative to the base portion 105. The adjustment mechanisms 140, 145 may have any suitable form of mechanism capable of maintaining the position of the retractor arms 110, 120 fixed relative to the base portion 105. In certain embodiments, the adjustment mechanisms 140, 145 are further capable of adjusting the position of the retractor arms 110, 120 fixed relative to the base portion 105. In the illustrated embodiment, the adjustment mechanisms 140, 145 are ratchet mechanisms that engage corresponding ratchet teeth of each retractor arm.

[0017] The base portion 105 further has an engagement portion 150 extending from the base portion 105, and the engagement portion 150 is configured to enable the retractor 100 to be releasably fixed to a support structure such as an A-arm, and the support structure itself is fixed to another support structure such as a bed frame or a patient support structure.

[0018] Each retractor arm and its associated retractor blade may constitute an integral part, may be fixed or attached to each other to functionally realize the integral part, or may be releasably fixed to each other. In this embodiment, each retractor arm and its retractor blade are manufactured to be integral. One advantage of being integral or functionally integral is that additional strength and stability are added. Such stability is necessary to maintain the position of the retractor arm and prevent unwanted movement.

[0019] In the illustrated embodiment, various components are configured to be generally orthogonal or generally parallel to each other. For example, the base portion 105 can be described as having two extension portions along a first plane, and each retractor arm is also disposed in the first plane and configured to be maintained in the first plane parallel to the other retractor arm even when adjusted relative to the base portion. Similarly, the engagement portion 150 extends from the base portion 105 in the first plane. The rear retractor blade 115 and the front retractor blade 125 are orthogonal to the first plane and parallel to each other. Each orientation is maintained even while adjusting or expanding the surgical access, and for this reason, it is necessary to adjust one or both of the retractor blades relative to the base portion 105.

[0020] In the illustrated embodiment, the engagement portion 150 is shown as extending orthogonally from the base portion 105, but in some embodiments, the engagement portion 150 extends obliquely. For example, when the engagement portion 150 defines an axis and the base portion defines a plane, the angle between the axis and the plane is 0° in the illustrated embodiment, but can be any suitable angle from about -45° to about 90°, such as about -30°, about -15°, about 0°, about 15°, about 30°, or about 45°.

[0021] Figure 2 shows the retractor 100 at a slightly different angle to better illustrate the adjustment mechanisms 140, 145, each having a chock 155 configured to engage with a pair of teeth 160 on each retractor arm. Each adjustment mechanism further has a toothed shaft 165 (at least partially visible in Figure 5), which, when rotated clockwise, moves the retractor arm backward (for the rear retractor arm 110) or forward (for the front retractor arm 120). As the retractor arms 110, 120 advance relative to the base portion 105, marks 170 on each retractor arm are visible through the display window 175. In some embodiments, the marks 170 are positioned at increments of 0.5 mm, 1 mm, 2 mm, 3 mm, 4 mm, or some value between these values. Mark 170 is related to the size and spacing of the teeth 160 along the retractor arms 110 and 120, and indicates the displacement of each retractor arm from the "zero" position.

[0022] By advancing the retractor arms 110 and 120, the surgical passage is enlarged. The retractor arms 110 and 120 may be released or returned to their original positions by pressing one or both of the levers 180 that disengage the chocks 155 from the teeth 160, thereby allowing adjustment of the surgical passage or removal of the retractor blades 115 and 125 from the surgical site. By holding one lever (either rearward or frontward) and rotating the toothed shaft in the opposite direction, the user can simultaneously move both the front retractor arm 120 and the rear retractor arm 110 in parallel. This may be desirable when the user wants to move the retractor 100 to improve its positioning but does not want to adjust the surgical support to which the retractor 100 is retained or fixed.

[0023] Figure 3 shows the retractor 100 from above, in other words, along the surgical passage formed by the rear retractor blade 115 and the front retractor blade 125. This figure further shows that the rear retractor arm 110 and the front retractor arm 120 each have an alignment function 185, and the proximal ends of the rear retractor blade 115 and the front retractor blade 125 each have a further alignment function 187. In this embodiment, the alignment function 185 is a triangular hole extending from the top to the bottom surface of each retractor arm. The further alignment function 187 is an angled cut portion on the outer surface of each blade. Both the alignment function 185 and the further alignment function 187 are configured to provide the surgeon with an indicator of the orthogonality of the retractor 100 to the patient's intervertebral disc space. Such orthogonality is achieved by creating an incision in the patient to access the intervertebral disc space via a lateral approach, positioning the retractor 100 in the incision, and then confirming the position of the retractor 100 using an X-ray image of the intervertebral disc space. An indicator of orthogonality is achieved when the alignment function 185 is fully visible in the X-ray image, which is positioned to directly view the intervertebral disc space of the subject along a line of sight orthogonal to the intervertebral disc space of the subject.

[0024] Although the alignment function 185 is shown in a triangular shape, it may be formed using any other suitable shape, such as a circle or a square. Also, although the alignment function 185 in this embodiment is a hole extending from the top to the bottom, a partial hole may have a desired amount of X-ray transparency. Alternatively, if the retractor arms 110, 120 themselves are X-ray transparent to some extent, the alignment function 185 may have an X-ray opaque marker, such as an X-ray opaque material embedded in or applied to the retractor arms 110, 120.

[0025] Figure 3 further shows that the retractor blades 115 and 125 each have a central channel 190 and two transverse channels 195, respectively. In one embodiment, the central channel is configured to receive at least one of the following: an optical cable, a tissue shim, an intradiscal shim, an anchor shim, a blade extender, or any other suitable device. In one embodiment, at least one of the transverse channels 195 is configured to receive an anchor device, such as a bone screw whose head engages with the transverse channel 195, an optical cable, a tissue shim, or an auxiliary retraction device.

[0026] Looking down at the opening formed between the retractor blades 115, 125, the circular shape of the opening is emphasized. However, in some embodiments, the opening has other shapes, such as oval or elliptical. Although not shown, such non-circular shapes are achieved in some embodiments by increasing the width of the retractor blades 115, 125 relative to their depth or thickness.

[0027] In one embodiment, the shape of the opening between the retractor blades 115, 125 may be determined by the shape of the type of implant configured to be surgically implanted in the patient's body. For example, a wider implant may require a wider surgical passage, but using oval-shaped blades reduces trauma to surrounding tissues and nerves by expanding the passage in one direction without requiring a larger passage in all directions, rather than simply expanding the surgical passage in all directions.

[0028] In some embodiments, the shape of the opening is determined by the shape of the dilator used to guide a path to the surgical site and form a surgical passage. For example, when using a cylindrical dilator, optimal engagement may be obtained by using a retractor with circular blades to form a working passage, while with an oval dilator, the use of a retractor in which the blades together form an oval opening or passage may be required or at least suggested.

[0029] Figure 4 is a side view of the retractor 100, showing the desired orthogonality between the retractor arms 110, 120 and the retractor blades 115, 125, which is achieved to some extent by securely maintaining the retractor arms 110, 120 along the base portion 105. Figure 4 further shows that the shape of the retractor blades 115, 125 is generally cylindrical, especially when the blades 115, 125 are arranged to be in contact with each other. However, as illustrated, some embodiments include retractor blades that taper toward the distal end. In some embodiments, such tapering portions are limited to the outer surface of the retractor blade. In other words, the inner surfaces of the retractor blades both maintain a constant cylindrical path along their respective lengths.

[0030] Figure 5 shows the base portion 105 independently. If the retractor arm 110 is not inserted into the receiving area 130, the toothed portion of the toothed shaft 165 can be seen through the display window 175. For ease of use, each end or extension of the base portion is labeled "A" for "anterior" or "P" for "posterior," not only indicating which retractor arm to insert into which receiving area, but also providing advance attention to how to position the retractor 100 relative to the patient, particularly the intervertebral disc cavity being accessed.

[0031] Figure 6 shows the rear retractor arm 110 and the rear retractor blade 115, which in this embodiment are configured to form a single unit. In some embodiments, the retractor arm and the retractor blade constitute a single unit. In some embodiments, the retractor arm and the retractor blade are irreversibly fixed to each other to essentially form a single unit. In some embodiments, the retractor blade and the retractor arm are reversibly attached to each other.

[0032] The central channel 190 is shown to extend substantially the entire length of the rear retractor blade 115, with one opening at the proximal end of the rear retractor blade 115. In one embodiment, the central channel 190 extends the entire length of the rear retractor blade 115, meaning it opens at both the proximal and distal ends of the rear retractor blade 115. In this illustrated embodiment, the central channel 190 has recesses 197 configured to provide various fixation or stopping points for tools inserted into a surgical passage along the central channel 190. For example, when an extension or tab of an intradiscal shim can extend into one of the recesses 197, the intradiscal shim may be fixed in place relative to the rear retractor blade 115. Although not shown in Figure 7, similar recesses may be incorporated into the central channel of the anterior retractor blade 125.

[0033] Figure 7 shows the front retractor arm 120 and front retractor blade 125 as shown to be configured to form a single unit. Similar to the rear retractor arm 110 and rear retractor blade 115, the front retractor arm 120 and front retractor blade 125 may be configured as a single unit, or fixed to form a single unit, or reversibly fixed to each other.

[0034] Methods using the surgical retractor 100 and similar retractors consistent with the present disclosure involve several preparation steps. In one embodiment, such preparation begins with positioning the patient in a prone, lateral, supine, or any other suitable patient position. Subsequent preparations include identifying an incision point to access the desired surgical site, forming the incision, and advancing an instrument guide, such as a guidewire or K-wire, into the surgical site. The instrument guide may advance through at least a portion of the psoas muscle to perform transpsoas procedures.

[0035] Once initial access to the surgical site is established, in one embodiment, this includes advancing one or more sequential dilators along instrument guides through the incision to the surgical site. One or more of the sequential dilators may be configured for nerve monitoring and / or nerve detection. The sequential dilators may have a circular or oval cross-section. In one embodiment, a suitable retractor, such as a surgical retractor 100, advances over the outermost dilators until the distal end of the retractor touches or is sufficiently close to the surgical site or intervertebral disc cavity, after which one or more dilators may be removed so that the retractor 100 forms a surgical passage and accesses the surgical site.

[0036] The retractor 100 may be fixed to a surgical support such as an A-arm, which, once positioned, is fixed to a frame, operating bed, or operating table. In one embodiment, one of the blades of the surgical retractor, such as the posterior blade 115, is positioned posterior to the intervertebral disc space. Such positioning may be achieved by adjusting the surgical support (e.g., the A-arm) or by operating the adjustment mechanism 140 to move the posterior blade 115 posteriorly. Once properly positioned, an anchor shim or intradiscal shim advances into the surgical passage along either the central channel 190 or the transverse channel 195 and is positioned in either the bone or the intradiscal space to fix the posterior blade 115 to the intervertebral disc space.

[0037] Subsequently, the surgeon or user operates one or both of the adjustment mechanisms 140, 145 to move the anterior blade 125 forward until a surgical passage of the desired size is formed at a point where the anterior blade 125 may be fixed using an anchor screw, an intradiscal shim, or any other suitable anchoring mechanism, thereby enlarging the surgical passage.

[0038] Figure 8 shows an embodiment of the surgical retractor 200, which is similar in many respects to the retractor 100, except that the relative positions of the rear retractor blade 215 and the front retractor blade 225 are reversed compared to the rear retractor blade 115 and the front retractor blade 125. In one embodiment, one orientation is preferred over the other. This embodiment is further illustrated with an intradiscal shim 291 positioned within the channel of the rear retractor blade 215. As described elsewhere in this specification, one or more channels of the retractor blade may be configured to receive any number of attachments or accessories, such as tissue shims of various sizes and shapes, intradiscal shims, optical cables, bone anchors, etc.

[0039] Figure 8 further illustrates that surgical retractors according to this disclosure, such as retractor 200, may be configured to receive one or more modular blade assemblies, such as a modular blade assembly 300, which includes a base portion 305, a blade arm 310, and an auxiliary blade 315. The modular blade assembly 300 has many functions provided in retractors 100 and 200, such as an adjustment mechanism 365, which, when rotated, adjusts the position of the auxiliary blade 315 relative to the rear blade 215 and the front blade 225 to increase or decrease the surgical passage formed by the various retractor blades. The modular blade assembly 300 is configured to snap into place on the front blade arm 220 or to be securely attached in other ways. One embodiment of the modular blade assembly, as described in more detail below, is configured to snap into place on the rear blade arm 210 or to be securely attached in other ways.

[0040] The blade arm 310 is movable relative to the base portion 305 and, in some embodiments, may be completely detached from the base portion 805. This modularity allows the use of various base portions with various blades. Various configurations of the base portion and various configurations of the blade are described in further detail below. In some embodiments, a set of fixtures for a modular blade assembly includes (1) one base portion and two or more separate retractor blades, (2) two or more base portions and one retractor blade, or (3) two or more base portions and two or more retractor blades. In some embodiments, it may be advantageous to use various arrangements of the base portion and / or retractor blade in a single procedure because the user's needs change during the procedure.

[0041] The modular blade assembly further includes an alignment function 385. In this embodiment, the alignment function 385 is a triangular through-hole in a base portion 305 that aligns with an alignment function located on the front blade arm 220 (similar to the alignment function 285 of the rear blade arm 210, but not shown). This alignment function is configured so as not to prevent the user from using the alignment function of the retractor 200. In some embodiments, the alignment function 385 is configured to enhance the functionality of the alignment function of the retractor arm. In this illustrated embodiment, the alignment function 385 has substantially the same shape and size as the base alignment function, but in some embodiments, the alignment function 385 has a different shape from the base alignment function and / or is larger or smaller than the base alignment function.

[0042] Figures 9–11 show three different embodiments of modular blade assemblies, each configured to be attached to the front blade arm of a retractor according to the present disclosure. Those skilled in the art will understand that the features of these disclosed embodiments may similarly apply to modular blade assemblies configured to be attached to the rear blade arm.

[0043] Figure 9 shows that the auxiliary blade 315 of the modular blade assembly 300 has both a central channel 390 and two transverse channels 395. In one embodiment, the central channel 390 is configured to receive one of a tissue shim, an intradiscal shim, and / or an optical cable. In one embodiment, the transverse channels 395 are configured to receive at least a portion of a bone anchor to attach or fix the auxiliary blade 315 in place to the surgical site.

[0044] Figure 10 shows an embodiment of a modular blade assembly 400 similar to the modular blade assembly 300, except that the auxiliary blade 415 has only a central channel 490 and no lateral channels. Figure 10 also shows a release mechanism 401 configured to quickly release the blade arm 410. In one embodiment, the release mechanism 401 operates by sliding back and forth. In another embodiment, the release mechanism 401 acts as a push button that is pressed down to release the blade arm 410. When the release mechanism 401 is activated, the blade arm 410 may slide freely relative to the main body portion 405.

[0045] Figure 11 shows an embodiment of a modular blade assembly 500 similar to the modular blade assemblies 300 and 400, but the auxiliary blade 515 has a central channel 590 and only one transverse channel 595 to the left of the central channel 590. In one embodiment, the transverse channel 595 is located to the right of the central channel 590.

[0046] Figure 12 shows an embodiment of modular blade assembly 600 similar to modular blade assemblies 300, 400, and 500, the main difference being that modular blade assembly 600 is configured to be attached to a rear blade arm 210. Figure 12 further shows a receiving area 603 located below the base portion 605. A portion of the rear blade arm 210 is inserted into this receiving area. Modular blade assembly 600 further includes a release mechanism 602 configured to cause detachment from the rear blade arm 210. As shown, the release mechanism 602 is a push-button mechanism, although in some embodiments a toggle mechanism and any number of other suitable mechanisms may be used. This illustrated embodiment further includes a tissue shim 691 located in the central channel 690.

[0047] Figure 13 shows an embodiment of a modular blade assembly 700 fixed to the front blade arm 220 of the retractor 200. The modular blade assembly 700 is similar in many respects to the modular blade assemblies 300, 400, 500, and 600, except for the elongated portion of the base section 705, which is a key difference. Such a configuration allows for the formation of a much larger surgical passage. For example, when the surgery to be performed targets only one intervertebral disc, a smaller surgical passage may be desirable to minimize trauma to surrounding tissues. However, in some surgeries, it may be desirable to access two or more intervertebral disc spaces with a single approach, rather than forming separate surgical passages for each intervertebral disc space. The modular blade assembly 700 is configured for such situations by having an elongated portion that may be of any appropriate length to obtain the desired size of the surgical passage.

[0048] Figure 14 shows an embodiment of the surgical retractor 800 with modular retractor blades 900. The surgical retractor 800 is similar in many respects to the retractors 100 and 200, with the key difference being that both the rear blade 815 and the front blade 825 are oval-shaped rather than circular. Such a change in shape may be advantageous in certain surgical procedures.

[0049] The modular blade assembly 900 is similar in many respects to the modular blade assemblies 300, 400, 500, 600, and 700. In this embodiment, the modular blade assembly 900 has a release mechanism 902, which is a toggle mechanism. The release mechanism 902 maintains the modular blade assembly in a fixed position with the front blade arm 820, but is configured so that when switched, the modular blade assembly 900 can be easily detached from the front blade arm 820. The modular blade assembly is further shown to have tissue shims 991.

[0050] Figure 15 shows an embodiment of the surgical retractor 1000, which includes a front modular retractor blade 1100 and a rear modular retractor blade 1200. The surgical retractor 1000 is similar in many respects to the retractors 100, 200, and 800, with the key difference being that both the rear blade 1015 and the front blade 1025 are somewhat rectangular rather than oval or circular. Such a change in shape may be advantageous in certain surgical procedures.

[0051] The modular blade assembly 900 is similar in many respects to the modular blade assemblies 300, 400, 500, 600, and 700. In this embodiment, the modular blade assembly 900 has a release mechanism 902, which is a toggle mechanism. The release mechanism 902 maintains the modular blade assembly in a fixed position with the front blade arm 820, but is configured so that when switched, the modular blade assembly 900 can be easily detached from the front blade arm 820. The modular blade assembly is further shown to have tissue shims 991.

[0052] The modular blade assemblies 1100 and 1200 are similar in many respects to the modular blade assemblies 300, 400, 500, 600, 700, and 900. The use of both the modular blade assemblies 1100 and 1200 in a single retractor 1000 illustrates how easily the simple configuration of two blades in the retractor 1000 can be modified to establish a surgical passage with four blades, each having one or more channels for accommodating tissue shims such as tissue shims 1191, 1291, intradiscal shims, and optical cables.

[0053] According to one embodiment, it may be desirable to make the type of retractor blade used in the retractor 1000 available for treatment and / or to change during treatment. For example, since access to the surgical site is achieved using one or more expanders, the user may want to be able to determine whether the final surgical passage should be roughly circular, roughly oval, or roughly rectangular and select a retractor blade accordingly.

[0054] Accordingly, a suitable retractor system may comprise (1) one retractor base portion (e.g., one of base portions 105, 205, 805, 1005), (2) two or more types of retractor blades (e.g., one of retractor blades 115, 125, 215, 225, 815, 825, 1015, 1025) in which the retractor blade is integrated with or integral with the blade arm, and (3) optionally one or more of the various modular retractor assemblies disclosed herein (e.g., one of modular retractor blade assemblies 300, 400, 500, 600, 700, 900, 1100, 1200). One embodiment of the retractor system may exhibit additional modularity using retractor blades of different lengths. One embodiment of the retractor system may exhibit further modularity by using retractor blades that are not integrated with the blade arms, so that any suitable or desirable shape / size / length of blade may be attached to or detached from a retractor arm that engages with the retractor base.

[0055] According to this disclosure, an exemplary method using the surgical retractor disclosed herein involves forming an access route to a surgical site through the patient's skin, inserting a pair of retractor blades through the skin, advancing the retractor blades toward the surgical site, separating the retractor blades from each other, and establishing a surgical passage for performing a surgical procedure at the surgical site. Forming the access route may include (a) forming an incision in a desired location in the skin and then advancing a guidewire toward the surgical site, and (b) advancing one or more dilators along the guidewire to sequentially widen the access route. In some embodiments, one or more dilators are electrically connected to a nerve monitoring system configured to detect nerves that may be along or near the access route. In some embodiments, the retractor blades may already be connected to a retractor base or may be connected to a retractor base after advancing toward the surgical site. In some embodiments, the retractor base is then attached to a support structure, such as an A-arm, which is attached to an operating table. The blades may be separated from each other by moving one or both of the blades, which may be done by simply pulling the blades apart or by adjusting the position of one or both blades relative to the retractor base using an adjustment mechanism. In some embodiments, after separating the retractor blades, it may be desirable to further enlarge the surgical passage or to provide an additional barrier to reduce or prevent the intrusion of surrounding tissue into the surgical passage. In such situations, a modular blade assembly may be used by inserting the retractor blade of the modular blade assembly into the surgical passage until the modular blade assembly can be fixed to one of the retractor arms of an existing retractor. If further enlargement or an additional barrier is desired, another modular blade assembly may be used in the same manner as the first modular blade assembly, but fixed to another retractor arm.

[0056] Embodiment The following embodiments are provided only as examples of specific configurations, materials, arrangements, etc., considered by the authors of this disclosure.

[0057] Embodiment 1. A first extension having a first receiving area, a second extension having a second receiving area, and a base having one or more engaging areas, A rear retractor blade having a proximal end and a distal end, the rear retractor blade having a first retractor arm extending from the proximal end and configured to slide and be received by a first receiving area of ​​the base portion, A front retractor blade having a proximal end and a distal end, the front retractor blade having a second retractor arm extending from the proximal end and configured to slide and be received by a second receiving region of the base portion; It is equipped with, The rear and front retractable blades both form adjustable surgical passages. A surgical retractor in which the rear and front retractor blades are independently adjustable relative to the base.

[0058] Embodiment 2. A surgical retractor according to Embodiment 1 or 2, wherein at least one of the first and second receiving regions has a ratchet mechanism configured to fix the first or second retractor arm in a predetermined position relative to the base when the first or second retractor arm moves parallel through the first or second receiving region.

[0059] Embodiment 3. The surgical retractor according to Embodiment 2, wherein the first or second retractor arm has ratchet teeth along its outer surface configured to engage with a ratchet mechanism.

[0060] Embodiment 4. The surgical retractor according to Embodiment 2 or 3, wherein the ratchet mechanism has a release lever, which, when pressed, disengages the ratchet mechanism from the first or second retractor arm, allowing the first or second retractor arm to move freely through the first or second receiving area.

[0061] Embodiment 5. A surgical retractor according to any one of Embodiments 1 to 4, wherein at least one of the first receiving area and the second receiving area has a forward mechanism that rotates to adjust the position of the first retractor arm or the second retractor arm relative to the base portion.

[0062] Embodiment 6. A surgical retractor according to any one of embodiments 1 to 5, wherein at least one of the rear retractor blade and the front retractor blade is integrated with a first retractor arm or a second retractor arm.

[0063] Embodiment 7. A surgical retractor according to any one of embodiments 1 to 6, wherein at least one of the rear retractor blade and the front retractor blade is functionally integrated with a first retractor arm or a second retractor arm, respectively.

[0064] Embodiment 8. A surgical retractor according to any one of Embodiments 1 to 7, wherein at least one of (a) a rear retractor blade and a first retractor arm, and (b) a front retractor blade and a second retractor arm are integrated.

[0065] Embodiment 9. A surgical retractor according to any one of Embodiments 1 to 8, wherein at least one of (a) a rear retractor blade and a first retractor arm, and (b) a front retractor blade and a second retractor arm are formed from a single material.

[0066] Embodiment 10. A surgical retractor according to any one of Embodiments 1 to 9, wherein the rear retractor blade defines an axis substantially perpendicular to the axis defined by the first retractor arm, and the front retractor blade defines an axis substantially perpendicular to the axis defined by the second retractor arm.

[0067] Embodiment 11. The surgical retractor according to Embodiment 10, wherein the axes of the rear retractor blade and the front retractor blade are substantially parallel to each other and remain substantially parallel when the rear retractor blade and the front retractor blade are independently adjusted relative to the base portion to adjust the size of the surgical passage.

[0068] Embodiment 12. The surgical retractor according to Embodiment 10 or 11, wherein the axes of the rear retractor blade and the front retractor blade are substantially parallel to each other and are maintained even when the rear retractor blade and the front retractor blade are adjusted relative to each other.

[0069] Embodiment 13. A surgical retractor according to any one of embodiments 1 to 12, wherein at least one of the rear retractor blade and the front retractor blade has at least one alignment function configured at its proximal end to provide an indicator of the orthogonality of the surgical retractor to the surgical site.

[0070] Embodiment 14. The surgical retractor according to Embodiment 13, wherein the alignment function is identifiable by X-ray imaging.

[0071] Embodiment 15. The surgical retractor according to Embodiment 13 or 14, wherein the alignment function has a through hole at the proximal end of the first or second retractor.

[0072] Embodiment 16. A surgical retractor according to any one of Embodiments 13 to 15, wherein the alignment function has a triangular through-hole at the proximal end of the first or second retractor, the triangle pointing toward the surgical passage.

[0073] Embodiment 17. A surgical retractor according to any one of Embodiments 13 to 16, wherein the surgical site is the intervertebral disc space of the patient's spine.

[0074] Embodiment 18. The surgical retractor according to Embodiment 17, wherein the orthogonality of the surgical retractor to the intervertebral disc space is obtained by a lateral procedure.

[0075] Embodiment 19. The surgical retractor according to Embodiment 18, configured to extend at least partially through a portion of the patient's psoas muscle.

[0076] Embodiment 20. A surgical retractor according to any one of embodiments 1 to 19, wherein at least one of the rear retractor blades and the front retractor blade has a mark to indicate whether it is positioned rearward or forward.

[0077] Embodiment 21. A surgical retractor according to any one of Embodiments 1 to 20, wherein the base portion has one or more marks to indicate which extension portion is positioned rearward or forward.

[0078] Embodiment 22. A surgical retractor according to any one of Embodiments 1 to 21, configured for use when the patient is in a prone position.

[0079] Embodiment 23. A surgical retractor according to any one of Embodiments 1 to 21, configured for use when the patient is in a lateral decubitus position.

[0080] Embodiment 24. A surgical retractor according to any one of Embodiments 1 to 23, wherein the base portion has a front, rear, top, and bottom surface, and the first receiving area and the second receiving area extend from the front to the rear, respectively.

[0081] Embodiment 25. The surgical retractor according to Embodiment 24, wherein one or more engaging portions extend from the rear surface of the base portion.

[0082] Embodiment 26. A surgical retractor according to any one of embodiments 1 to 25, wherein at least one of the first and second retractor arms has an upper surface having a mark for indicating the size of the surgical passage.

[0083] Embodiment 27. The surgical retractor according to Embodiment 26, wherein at least one of the first and second receiving regions has a window for viewing a mark on the first or second retractor arm.

[0084] Embodiment 28. A surgical retractor according to any one of embodiments 1 to 27, wherein at least one of the rear retractor blade and the front retractor blade has a central channel extending from the proximal end to the distal end.

[0085] Embodiment 29. A surgical retractor according to any one of embodiments 1 to 28, wherein at least one of the rear retractor blade and the front retractor blade has at least one transverse channel extending from the proximal end to the distal end.

[0086] Embodiment 30. The surgical retractor according to Embodiment 29, further comprising an anchor having a threaded shaft and a projection configured to be received by at least one transverse channel.

[0087] Embodiment 31. A surgical retractor according to any one of Embodiments 1 to 30, wherein the rear retractor blade and the front retractor blade form a tube together when in contact with each other.

[0088] Embodiment 32. A surgical retractor according to Embodiment 31, wherein the tube substantially encloses a surgical passage.

[0089] Embodiment 33. The surgical retractor according to Embodiment 31 or 32, wherein the tube has a substantially circular cross-section.

[0090] Embodiment 34. The surgical retractor according to Embodiment 31 or 32, wherein the tube has a substantially oval cross-section.

[0091] Embodiment 35. The surgical retractor according to Embodiment 31 or 32, wherein the tube has a substantially rectangular cross-section.

[0092] Embodiment 36. A surgical retractor according to any one of embodiments 1 to 35, wherein the rear retractor blade and the front retractor blade are configured to slide on an expander.

[0093] Embodiment 37. A surgical retractor according to any one of Embodiments 1 to 30, wherein the rear retractor blade and the front retractor blade form a substantially rectangular surgical passage.

[0094] Embodiment 38. A method for using a surgical retractor, An incision is made in the patient's skin at a lateral position on the patient's spine. Identify the location of the surgical site in the spine, Insert the rear retractor blade and the front retractor blade of the surgical retractor described in any one of Embodiments 1 to 37, The surgical retractor is advanced toward the surgical site to form a surgical passage for accessing the surgical site. The distal end of the posterior retractor blade is positioned posterior to the surgical site. The rear retractor blade is fixed in the rear position. A method for widening the surgical passage.

[0095] Embodiment 39. When identifying the location of the surgical site on the spine, The K-wire is advanced toward the surgical site, and the distal end of the K-wire is embedded in the tissue of the surgical site. The method according to embodiment 38, wherein the internal and external dilators are advanced sequentially toward the surgical site on the K-wire.

[0096] Embodiment 40. The method according to Embodiment 39, wherein the K wire is advanced toward the surgical site, crossing at least a portion of the psoas muscle.

[0097] Embodiment 41. The method according to Embodiment 39 or 40, wherein at least one of the internal and external dilators has at least one electrode and is configured to provide nerve monitoring as at least one of the internal and external dilators advances toward the surgical site.

[0098] Embodiment 42. The method according to Embodiment 41, wherein at least one electrode is configured to provide a nerve plexus map.

[0099] Embodiment 43. The method according to any one of Embodiments 39 to 42, wherein the inner expander and the outer expander have a circular cross-section.

[0100] Embodiment 44. The method according to any one of Embodiments 39 to 42, wherein the inner expander and the outer expander have an oval cross-section.

[0101] While specific embodiments are shown and described herein, it should be understood that various other modifications and adjustments may be made without departing from the spirit and scope of the claimed subject matter. Furthermore, while various aspects of the claimed subject matter are described herein, these aspects do not need to be used in combination. Some of the embodiments disclosed herein may be disclosed in relation to a particular approach (e.g., lateral), but it should be further noted that other approaches (e.g., anterior, posterior, transintervertebral, etc.) are also considered.

[0102] Unless otherwise indicated, all numbers used in the specification and claims to represent quantities, properties, etc., such as molecular weight and reaction conditions of the components should be understood to be modified in all examples by the term "approximately". Therefore, unless otherwise indicated, the numerical parameters described in the specification and the attached claims are approximations, which may vary depending on the desired properties sought to be obtained by the embodiments of this disclosure. At the very least, without attempting to limit the application of the principle of equivalents in the claims, each numerical parameter should be interpreted by applying the usual rounding techniques, taking into account the number of significant figures stated. Although the numerical ranges and parameters representing the broad scope of this disclosure are approximations, the numbers described in the specific examples are described as accurately as possible. However, every number inherently contains some error that inevitably arises from the standard deviation obtained in each test measurement. In one embodiment, the terms "approximately" and "about" represent numerical parameters within 10% of the indicated range.

[0103] The terms “a,” “an,” “the,” and “the” and similar references used in relation to describing embodiments of this disclosure (particularly in relation to the following claims) should be construed to encompass both singular and plural unless otherwise specifically indicated herein or unless clearly inconsistent with the context. The enumeration of value ranges herein is merely intended to serve as a simple way to individually refer to each distinct value within that range. Unless otherwise specifically indicated herein, each individual value is incorporated into the specification as if it were individually described herein. All methods described herein may be performed in any appropriate order unless otherwise specifically indicated herein or unless clearly inconsistent with the context. The use of any and all examples or exemplary language (e.g., “etc.”) herein is merely intended to further illustrate embodiments of this disclosure and does not limit the scope of this disclosure. The language herein should not be construed to indicate any unclaimed elements essential to the implementation of embodiments of this disclosure.

[0104] The grouping of alternative elements or embodiments disclosed herein should not be construed as limiting. Each group member may be 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 removed from a group for convenience and / or patentability. In any event of such inclusion or removal, the specification shall be deemed to include a group modified to satisfy the description of all Markush groups used in the appended claims.

[0105] One or more authors of this disclosure describe embodiments herein that include the best known methods for carrying out the embodiments disclosed herein. Needless to say, variations of these described embodiments will be apparent to those skilled in the art by reading the foregoing description. One or more authors anticipate that those skilled in the art will appropriately adopt such variations and intend that the embodiments of this disclosure will be carried out in ways other than those specifically described herein. Accordingly, this disclosure includes all modifications and equivalents of the subject matter described in the claims attached to this application, as permitted by applicable law. Furthermore, any combination of the elements described herein of all possible variations is included herein unless specifically shown herein or is obviously inconsistent with the context.

[0106] The specific embodiments disclosed herein may be further limited in the claims using the phrases “composed of” or “essentially composed of.” When used in the claims, the transitional phrase “composed of,” whether in the original filing or added by amendment, excludes any elements, processes or components not specified in the claims. The transitional phrase “essentially composed of” limits the claims to the specified materials or processes and any materials or processes that do not substantially affect one or more fundamental novel properties. Embodiments of the disclosure thus claimed are essentially or expressly described herein and made possible.

[0107] Furthermore, if any reference is made to patents and publications through this disclosure, each of these references and publications is individually incorporated herein by reference in whole.

[0108] Finally, the embodiments disclosed herein should be understood as examples of the principles of the disclosure. Other modifications that may be adopted are within the scope of the disclosure. Accordingly, alternative configurations of the embodiments of the disclosure may be used in accordance with the teachings herein, without limitation, as examples. Accordingly, the disclosure is not limited to what is shown and described in itself.

[0109] Related applications This application claims priority to U.S. Provisional Application No. 63 / 186008, filed on 7 May 2021, the entirety of which is incorporated herein by reference.

Claims

1. A base portion comprising a first extension having a first receiving area, a second extension having a second receiving area, and one or more engaging areas, wherein the first receiving area is a first passage passing through the base portion, and the second receiving area is a second passage passing through the base portion, A rear retractor blade having a proximal end and a distal end, the rear retractor blade having a first retractor arm extending from the proximal end and configured to slide and be received by a first receiving area of ​​the base portion, A front retractor blade having a proximal end and a distal end, the front retractor blade having a second retractor arm extending from the proximal end and configured to slide and be received by a second receiving region of the base portion; It is equipped with, The rear retractor blade and the front retractor blade together form an adjustable surgical passage. The rear retractor blade and the front retractor blade are independently adjustable relative to the base portion. The rear retractor blade and the front retractor blade are fixed at an angle to the base portion. A surgical retractor wherein the first retractor arm and the second retractor arm are each movable parallel to each other through the first receiving area and the second receiving area, respectively.

2. The surgical retractor according to claim 1, wherein at least one of the first receiving area and the second receiving area has an adjustment mechanism that, when rotated, adjusts the position of the first retractor arm or the second retractor arm relative to the base portion.

3. The surgical retractor according to claim 1 or 2, wherein at least one of the rear retractor blade and the front retractor blade is integrated with the first retractor arm or the second retractor arm.

4. The rear retractor blade has an axis that is substantially perpendicular to the axis determined by the first retractor arm, The front retractor blade has an axis that is substantially perpendicular to the axis determined by the second retractor arm, The surgical retractor according to claim 1 or 2, wherein the axes of the rear retractor blade and the front retractor blade are substantially parallel to each other and remain substantially parallel when the rear retractor blade and the front retractor blade are independently adjusted relative to the base portion to adjust the size of the surgical passage.

5. The surgical retractor according to claim 1 or 2, wherein at least one of the rear retractor blade and the front retractor blade has at least one alignment function at its proximal end to indicate whether at least one of the rear retractor blade and the front retractor blade of the surgical retractor is oriented perpendicular to the surgical site, which is the intervertebral disc space of the patient's spine.

6. The surgical retractor according to claim 5, wherein the alignment function is identifiable by X-ray imaging.

7. The surgical retractor according to claim 5, wherein a through hole is provided in the base of the first retractor arm or the second retractor arm as the alignment function.

8. The surgical retractor according to claim 5, wherein, as the alignment function, a through hole with a triangular opening shape is provided at the base of the first retractor arm or the second retractor arm, and the vertex of the triangle points toward the surgical passage.

9. The surgical retractor according to claim 5, wherein when the surgical retractor enters a lateral position of the patient's spine, at least one of the rear retractor blade and the front retractor blade of the surgical retractor is oriented perpendicular to the intervertebral disc cavity.

10. The surgical retractor according to claim 9, configured to extend at least partially through at least a portion of the patient's psoas muscle.

11. A surgical retractor according to claim 1 or 2, configured for use when the patient is in a prone position.

12. The surgical retractor according to claim 1 or 2, wherein at least one of the first retractor arm and the second retractor arm has an upper surface having a mark for indicating the size of the surgical passage.

13. The surgical retractor according to claim 1 or 2, wherein at least one of the rear retractor blade and the front retractor blade has a central channel extending from the proximal end toward the distal end.

14. The surgical retractor according to claim 1 or 2, wherein at least one of the rear retractor blade and the front retractor blade has at least one transverse channel extending from the proximal end toward the distal end.

15. The surgical retractor according to claim 1 or 2, wherein the rear retractor blade and the front retractor blade together form a tube when they are in contact with each other.

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