Retractor assembly

Abstract

Disclosed herein are retractor assemblies and methods of using the same in anterior cervical approach procedures. The retractor assembly can minimize damage or strain to a patient by allowing for the independent application of force to a skin incision and a longitudinal muscle of a patient. The retractor assembly can include a support, a pair of skin retractors, and a pair of deep retractors. The pair of skin retractors and the pair of deep retractors can be coupled to the support such that distraction of at least one of the pair of skin retractors and at least one of the pair of deep retractors enlarges the incision and moves the longitudinal muscle to facilitate accessing a portion of a patient spine.

Description

RETRACTOR ASSEMBLYCROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No. 63 / 568,228 filed March 21, 2024, which is expressly incorporated herein by reference. TECHNICAL FIELD

[0002] The present application is directed to a device for use in orthopaedic or neurosurgical spine surgery, particularly for procedural exposure for an anterior cervical spine operation.BACKGROUND

[0003] Anterior cervical approaches to the spine are among the most common operations performed in the US and worldwide, and include both anterior cervical discectomy and fusion (ACDF) and anterior cervical discectomy and arthroplasty (artificial disc replacement).

[0004] Existing solutions for anterior cervical exposure include retractor systems composed of two soft tissue blades that are placed into the cervical wound by handheld attachments and then distract apart by an external mechanism. The two soft tissue blades perform two functions: to open the skin incision superficially to allow the surgeon to visualize the deep spinal anatomy and to distract the longus colli muscles attached to the cervical bodies to expose the disc.

[0005] Accordingly, there remains a need for improvements to the devices, systems, and methods of surgical anterior cervical approaches, for example by increasing the efficiency of the procedure or reducing the risks or likelihood of damage or strain to patient physiology.SUMMARY

[0006] Aspects of the present retractor assembly minimize damage or strain to patient physiology by decoupling the application of force to the skin incision and longitudinal muscles of a patient during approaches to the anterior cervical spine. Aspects can reduce unwanted motion of the retractor assembly during procedures. Additional aspects can reduce the required skin incision size for the approach, therefore reducing theinvasiveness of the procedure. Additional aspects can increase the visibility of the surgical site. Additional aspects can increase the positional stability of the retractor assembly. Furthermore, certain implementations can reduce the required time for a procedure or reduce the number of personnel required to complete the procedure, therefore reducing patient costs.

[0007] An implementation of the present disclosure provides a retractor assembly with a support, a pair of deep retractors, and a pair of skin retractors, where the pair of skin retractors and the pair of deep retractors are coupled to the support such that distraction of the skin retractors enlarges a skin incision and distraction of the deep retractors moves a longitudinal muscle of a patient.

[0008] An example of the present disclosure provides a retractor assembly for exposing a portion of a spine through an incision in a skin and adjacent at least one longitudinal muscle of a patient, the retractor assembly including: a support configured to be coupled to a vertebra of the spine; a pair of skin retractors including elongate surfaces configured to extend into the skin incision through a surface level adjacent to the skin of the patient; and a pair of deep retractors including elongate surfaces configured to extend through the skin incision and into a subcutaneous level having an adjacent relationship with the longitudinal muscle of the patient and below the surface level; wherein the pair of skin retractors and the pair of deep retractors are coupled to the support such that distraction of at least one of the pair of skin retractors and at least one of the pair of deep retractors enlarges the incision and moves the longitudinal muscle to facilitate accessing the portion of the spine.

[0009] A further example of the present disclosure provides a retractor assembly for exposing a portion of a spine through an incision in a skin and adjacent a longitudinal muscle of a patient, the retractor assembly including: a support configured to be coupled to a vertebra of the spine; a pair of deep retractor arms extending from the support in a superior-inferior direction; a pair of deep retractors extending from the deep retractor arms in a proximal-distal direction, including elongate surfaces configured to extend through the skin incision and into a subcutaneous level having an adjacent relationship with the longitudinal muscle of the patient and distal to the surface level; wherein each of the pair of deep retractors translate in a superior-inferior direction via a sliding mount on each of the deep retractor arms; wherein each of the pair of deep retractor arms at leastpartially connects a corresponding one of the pair of deep retractors to the support via an adjuster mechanism configured to allow medial-distal translation of each of the deep retractors; a pair of skin retractors including elongate surfaces extending in a proximal- distal direction configured to extend into the skin incision through a surface level adjacent to the skin of the patient; wherein each one of the pair of skin retractors is at least partially coupled to a corresponding one of the deep retractors at a location proximal the surface level; wherein each of the pair of skin retractors further includes longitudinal beams extending in a medial-lateral direction; a supplemental brace extending from the pair of longitudinal beams on the pair of skin retractors proximal the surface level; wherein each of the pair of skin retractors translate in a medial-lateral direction via a sliding mount on each of the longitudinal beams that at least partially couple the pair of longitudinal beams to the supplemental brace; wherein the supplemental brace is configured to be coupled to an operating table.BRIEF DESCRIPTION OF DRAWINGS

[0010] FIG. 1 is a rear, right-side perspective view of an exemplary retractor assembly.

[0011] FIG. 2 is a rear, right-side perspective view of the retractor assembly of FIG. 1 with a schematic representation of a surface level and a subcutaneous level.

[0012] FIG. 3 is a front view of the retractor assembly of FIG. 1 with a schematic representation of a surface level and a subcutaneous level.

[0013] FIG. 4 is a rear, right-side perspective view of an exemplary retractor assembly.

[0014] FIG. 5 is a left-side view of the support and deep retractor arms of the retractor assembly of FIG. 4.

[0015] FIG. 6 is a front view of the support, deep retractor arms, and deep retractors of the retractor assembly of FIG. 4.

[0016] FIG. 7A is a front perspective view of the support, adjuster mechanism, and deep retractor arms of the retractor assembly of FIG. 4 depicting the deep retractor arms in a first position.

[0017] FIG. 7B is a front perspective view of the support, adjuster mechanism, and deep retractor arms of FIG. 7A depicting the first of the deep retractor arms in a second position, translated in a medial-lateral direction.

[0018] FIG. 7C is a front perspective view of the support, adjuster mechanism, and deep retractor arms of FIG. 7A depicting the second of the deep retractor arms in a second position, translated in a medial-lateral direction.

[0019] FIG. 8 is a right-side view of the retractor assembly of FIG. 4.

[0020] FIG. 9 is a front, right-side perspective view of one of the deep retractor arms, a corresponding one of the deep retractors, and a corresponding one of the skin retractors of the retractor assembly of FIG. 4.

[0021] FIG. 10 is a rear, right-side perspective view of the retractor assembly of FIG. 4.

[0022] FIG. 11 is atop view of the retractor assembly of FIG. 4.

[0023] FIG. 12 is a top view of the retractor assembly of FIG. 4. depicting the retractor assembly positioned over vertebral bodies of a spine.DETAILED DESCRIPTION

[0024] The following description of certain examples of the inventive concepts should not be used to limit the scope of the claims. Other examples, features, aspects, implementations, and advantages will become apparent to those skilled in the art from the following description. As will be realized, the device and / or methods are capable of other different and obvious aspects, all without departing from the spirit of the inventive concepts. Accordingly, the drawings and descriptions should be regarded as illustrative in nature and not restrictive.

[0025] For purposes of this description, certain aspects, advantages, and novel features of the aspects of this disclosure are described herein. The described methods, systems, and apparatus should not be construed as limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed aspects, alone and in various combinations and sub-combinations with one another. The disclosed methods, systems, and apparatus are not limited to any specific aspect, feature, or combination thereof, nor do the disclosed methods, systems, and apparatus require that any one or more specific advantages be present or problems be solved.

[0026] Features, integers, characteristics, compounds, chemical moieties, or groups described in conjunction with a particular aspect or example of the present disclosure are to be understood to be applicable to any other aspect or example described herein unless incompatible therewith. All of the features disclosed in this specification (including any accompanying claims, abstract, and drawings), and / or all of the steps of any method orprocess so disclosed, may be combined in any combination, except combinations where at least some of such features and / or steps are mutually exclusive. The present disclosure is not restricted to the details of any foregoing aspects. The present disclosure extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims, abstract, and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed.

[0027] As used in the specification and the appended claims, the singular forms "a." "an" and "the" include plural referents unless the context clearly dictates otherwise.

[0028] The terms “proximal” and “distal” as used herein refer to positions, features, components, or motion of a retractor assembly according to the disclosure herein. “Proximal” generally means closer to the operator and / or further from the patient body, while “distal” generally means further from the operator and / or closer to the patient body.

[0029] The terms “medial” and “lateral” as used herein refer to positions, features, components, or motion of a retractor assembly according to the disclosure herein. “Medial” generally means toward the midline of the patient body. “Lateral” generally means away from the midline of the patient body.

[0030] The terms “superior” and “inferior” as used herein refer to positions, features, components, or motion of a retractor assembly according to the disclosure herein. “Superior” generally means toward the head end of the patient body. “Inferior” generally means away from the head of the patient body.

[0031] Throughout the description and claims of this specification, the word "comprise" and variations of the word, such as "comprising" and "comprises," means "including but not limited to," and is not intended to exclude, for example, other additives, components, integers or steps. "Exemplary" means "an example of' and is not intended to convey an indication of a preferred or ideal aspect. "Such as" is not used in a restrictive sense, but for explanatory purposes.

[0032] An example retractor assembly 10, as shown in FIG. 1, can include a support 100, a pair of skin retractors 200, and a pair of deep retractors 300. The support 100 can be configured to be coupled to a vertebra of the spine. The pair of skin retractors 200 can include elongate surfaces that can extend into a skin incision (not shown) through a surface level 20 adjacent to the skin of the patient. The pair of deep retractors 300 can include elongate surfaces configured to extend through the skin incision and into asubcutaneous level 40 having an adjacent relationship with a longitudinal muscle (not shown) of the patient and below the surface level 20. The pair of skin retractors 200 and the pair of deep retractors 300 can be coupled to the support 100 such that distraction of at least one skin retractor 200 of the pair of skin retractors 200 and at least one deep retractor 300 of the pair of deep retractors 300 enlarges the incision and moves the longitudinal muscle to facilitate accessing the portion of the spine.

[0033] The retractor assembly and related componentry described herein can be used for exposing a portion of a spine through an incision in a skin and adjacent at least one longitudinal muscle of a patient. Disclosed aspects of the retractor assembly can minimize trauma to the patient by reducing the required incision size for a procedure, for example, an orthopaedic or neurosurgical spine surgery such as an anterior cervical approach. Disclosed aspects of the retractor assembly can minimize trauma to the patient by allowing for more precise application of force to the skin and the longitudinal muscle of a patient during a procedure. Disclosed aspects of the retractor assembly can address asymmetric resistance that can be encountered during procedures, for example arising from the reduced lateral resistance where the carotid artery and jugular vein are located anatomically. Tn addition, disclosed aspects can reduce the influence of tension that can be caused by the size of the skin incision and the location of the operative disc in relation to the skin opening. Disclosed aspects of the retractor assembly can reduce or minimize the risk of blade dislodgment, for example, dislodgment from the undersurface of the longus colli muscle. In addition, disclosed aspects can minimize risks associated with mid-procedure adjustments to the retractor, for example when multiple discs are being addressed in a single procedure. In addition, disclosed aspects of the retractor assemblycan minimize trauma to the patient by providing greater visibility and / or surgical access to the portion of a spine while reducing the risk of dislodging or disturbing the retractor assembly. Disclosed aspects of the retractor assembly can minimize trauma to the patient by reducing the risk of injury- to the patient, for example, by reducing the risk of excessive pressure medially near the groove between the trachea and esophagus, which can be associated with a higher risk of postoperative dysphagia and injury to the recurrent laryngeal nerve.

[0034] The term surface level 20 as used herein refers to a layer with thickness that encompasses or is adjacent to the skin surface of the patient, as show n in the exampleretractor assembly depicted in FIGS. 2-3. The term subcutaneous level 40 as used herein refers to a layer with thickness that passes through the longitudinal muscle and the anterior surfaces of the cervical spine. When operating in the subcutaneous level 40, the retractor assembly 10 can adjust and retract / distract the longitudinal muscles relative to the spine independent of the adjusting and retracting / distracting of the skin incision at the surface level 20.

[0035] The support 100 can be any body with sufficient rigidity to serve as an anchor connecting the retractor assembly 10 to a part of the patient’s anatomy, such as a bone of the patient (e.g., a cervical vertebral body). In one implementation, the support, as shown in FIGS. 4 and 5, can comprise an angled block. The support can have a rectangular base 102, four vertical sidewalls 104 and 106 forming a generally rectangular configuration and a first angled superior surface 108 that connects one of the vertical sidewalls 106 to the top surface 110. The vertical sidewalls 106 are the superior / inferior walls that extend vertically. The vertical sidewalls 104 are the medial / lateral walls that extend vertically and are generally longer than the vertical sidewalls 106. The top surface 110 can define an opening 112 in the top surface 110 that extends distally towards the rectangular base 102, where the opening 1 12 is defined by the profiles of the first angled superior surface 108, the vertical sidewalls 104, and the vertical sidewalls 106.

[0036] The support 100 can have a second angled superior surface 114 extending from the opposite side of the top surface 110, as shown in FIG. 5. The support can have an opening 116 located between the second angled superior surface 114 and the vertical sidewall 106. The support 100 can have cutouts 122 and 124 in a respective one of the vertical sidewalls 104 extending into the opening 112. The cutouts 122 and 124 can be generally or approximately parallel to the first angled superior surface 108. The cutout 122 can be located inferior to the cutout 124 in the support 100 or vice versa. The cutouts 122 and 124 can also be in the same superior-inferior location. The cutouts 122 and 124 can include a first rectangular section extending in the superior-inferior and proximal- distal direction of the vertical sidewalls 104 and a second rectangular section extending in the superior-inferior direction of the vertical sidewalls 104, as shown in FIG. 5.

[0037] As shown in FIG. 5, the support 100 can include internal mounts 126 and 128 in the opening 112. The internal mounts 126 and 128 can extend from one of the inner surfaces of the rectangular base 102, vertical sidewalls 104, vertical sidewalls 106, firstangled superior surface 108, top surface 110, or second angled superior surface 114 within the opening 112. The internal mounts 126 and 128 can include a threaded interface 127 and 129, respectively, for receiving a corresponding threaded component.

[0038] As shown in FIG. 5, the support 100 can additionally have a fastening interface configured for attaching the support to a vertebra of a patient. The fastening interface can include, for example, a flange 118 extending from the vertical sidewall 106 at a location proximate the rectangular base 102. The flange 118 can define an opening 120, through which a fastener can be inserted to affix the support 100 and the retractor 10 to a part of the patient’s anatomy (e.g., a vertebral body). The opening 120 can be a threaded opening, a clearance hole, a through-hole, or any other slot or opening suitable for securing the movement of the support 100 or the retractor 10 in at least one direction. For example, as shown in FIG. 5, the opening 120 can be a clearance hole that provides access for a fastener 121, such as a screw or bolt. In some examples, the fastener 121 can be a vertebral body screw', such as the kind used routinely for the purpose of distracting the disc space. The fastening interface allows for increased stability of the retractor assembly 10 and further minimizes unwanted displacement of the deep retractors 300 from their desired position. The fastening interface can also comprise a latching mechanism, clamping mechanism, or other mechanical fixation mechanisms suitable for securing the movement of the support 100 or the retractor 10 in at least one direction.

[0039] The retractor assembly 10 can include an adjuster mechanism 700, as shown in FIGS 6-8. The adjuster mechanism 700 can be housed within the opening 1 12 of the support 100, as shown in FIG. 6.

[0040] As shown in FIGS. 7A-7C, the retractor assembly 10 can include an adjuster mechanism 700 including a first lower wedge 702 and a mating first upper wedge 722 and a second lower wedge 712 with a mating second upper wedge 732. The wedges 702. 722, 712, and 732 can, in one configuration, be located within the opening 112 of the support 100, as shown in FIG. 7A.

[0041] The first lower wedge 702 can have an incline surface 704 that defines a slot 706, which extends distally into the first lower wedge 702. The mating first upper wedge 722 can include a decline surface 724 and an opening 726 that extends through mating first upper wedge 722 distally, as shown in FIG. 7B. The opening 726 can be configured to receive a fastener. The opening 726 can be a threaded hole for accepting a threadedfastener 727. The opening 726 can share an axis with threaded interface 127 such that a threaded fastener can be accepted through opening 726 and into threaded interface 127. as shown in FIG. 5. The first lower wedge 702 and mating first upper wedge 722 can be oriented within the support 100 such that the incline surface 704 is either directly or indirectly in contact w ith the decline surface 724. Rotation of the threaded fastener 727 causes relative motion of first lower wedge 702 with respect to mating first upper wedge 722. As shown in FIGS. 7A-7B, rotation of the threaded fastener 727 causes the mating first upper wedge 722 to translate axially along the axis of threaded fastener 727. As the mating first upper wedge 722 translates axially along the axis of threaded fastener 727, the first low er w edge 702 slides along the interface of incline surface 704 and decline surface 724, causing the first lower wedge 702 to translate in a medial-lateral direction.

[0042] Similarly, the second lower wedge 712 can have an incline surface 714 that defines a slot 716, which extends distally into the second lower wedge 712. The mating second upper wedge 732 can include a decline surface 734 and an opening 736 that extends through mating second upper wedge 732. The opening 736 can be configured to receive a fastener. As shown in FIG. 7C. the opening 736 can be a threaded hole for accepting a threaded fastener 737. The opening 736 can share an axis with threaded interface 129 such that a threaded fastener can be accepted through opening 736 and into threaded interface 129, as shown in FIG. 5. The second lower wedge 712 and mating second upper wedge 732 can be oriented within the support 100 such that the incline surface 714 is either directly or indirectly in contact with the decline surface 734. Rotation of the threaded fastener 737 causes relative motion of second lower wedge 712 with respect to mating second upper wedge 732. As shown in FIGS. 7B-7C, rotation of the threaded fastener 737 causes the mating second upper wedge 732 to translate axially along the axis of threaded fastener 737. As the mating second upper wedge 732 translates axially along the axis of threaded fastener 737, the second low er wedge 712 slides along the interface of incline surface 714 and decline surface 734, causing the second lower wedge 712 to translate in a medial-lateral direction.

[0043] In some examples, the threaded fasteners 727, 737 can include one or more tool interface geometries, such as a hex, torx, or similar suitable tool interface geometries. In some examples, as show n in FIGS. 5 and 8, a central axis of the threaded fasteners 727, 737 can be inclined at an angle between a coronal plane, a plane running from side toside that divides the patient body into anterior and posterior portions, and a transverse plane, a plane that divides the patient body or any of its parts into upper and lower parts, of the patient. As a result of this incline, the tool interface geometry can, in some examples, be more readily accessed, reducing the size of skin-incision required for a patient procedure. This incline allows the operator to expand the retractor arms with a tool that can be inserted in a non-orthogonal direction relative to the surface level 20 or subcutaneous level 40, which can reduce the need for the adjuster mechanism 700 or support 100 to be positioned directly beneath the skin incision, therefore reducing the necessary skin incision size and increasing the efficiency of multi-level procedures. According to the disclosure herein, the support 100 and adjuster mechanism 700 of the retractor assembly 10 can be positioned about or adjacent the subcutaneous level 40 or at least partially within a skin incision of a patient.

[0044] As shown in FIGS. 8-10, the retractor assembly 10 can include a pair of deep retractor arms 400. The deep retractor arms connect a corresponding one of the pair of deep retractors 300 to the support 100. Each of the pair of deep retractors can connect to the support 100 either directly or indirectly through the adjuster mechanism 700. Each of the pair of deep retractor arms 400 can include a longitudinal member 402 extending in the superior-inferior direction and an angled protrusion 404 extending in the superiorinferior direction and distally from the longitudinal member 402, as shown in FIG. 8. In one example, as shown in FIGS. 7A-7C, each of the deep retractor arms 400 can include one of the lower wedges (702, 712, respectively) integrally formed into each one of the deep retractor arms 400 in the angled protrusion 404. As a result, medial-lateral motion of the first lower wedge 702 or second lower wedge 712 can cause corresponding medial- lateral motion of a respective one of the deep retractor arms 400. In some examples, the angled protrusion 404 is at least partially coupled to at least one component of the adjuster mechanism 700, such that translation of one of the first lower wedge 702 or second low er wedge 712 causes a corresponding translation of one of the deep retractor arms 400.

[0045] In some examples, as shown in FIG. 9. the longitudinal member 402 can include a sliding mount 406 such that each of the deep retractors 300 is connected to a corresponding deep retractor arm 400 via the sliding mount 406. The sliding mount 406 can. for example, include a plurality of slots or cutouts 408, as shown in FIG. 9, forlocating one of the deep retractors 300 on the longitudinal member 402 of the deep retractor arm 400 at set increments along the length of the longitudinal member 402 in the superior-inferior direction. The deep retractor arms 400 can also include a mechanism, such as an adjustable locking mechanism, for translating and / or releasably constraining at least one degree of translation of at least one of the deep retractors 300 along the sliding mount 406. For example, the locking mechanism can comprise a camlock mechanism, set-screw mechanism, a channel-lock mechanism, or other locking mechanisms suitable for translating and / or constraining translation of one of the deep retractors 300 relative to the deep retractor arms 400.

[0046] As shown in FIGS. 4, 6, 9, and 10 the retractor assembly 10 can include a pair of deep retractors 300 extending in a proximal-distal direction configured to extend through a skin incision into a subcutaneous level adjacent with a patient’s longitudinal muscle. As shown in FIG. 9, each of the deep retractors 300 can comprise an elongated rectangular inner surface 302 extending between a proximal end 304 and a distal end 306. The deep retractors 300 can be oriented such that the inner surface 302 of one of the deep retractors 300 faces the other’s inner surface 302. The deep retractors 300 can each include sidewalls 308 extending from the inner surface 302 extending in the medial -lateral direction. The sidewalls 308 can define a rectangular outer surface 310 and a protrusion 312 extending betw een the sidew alls 308. The protrusion 312 can be located proximate the distal end 306 of the inner surface 302. The protrusion 312 can include an opening 309 extending therethrough in a superior-inferior direction for receiving a longitudinal member 402 of one of the deep retractor arms 400. As a result, each of the deep retractors 300 receives a respective one of the deep retractor arms 400 via the openings 309. The deep retractors 300 can include a locating protrusion 311 within the opening 309 to be received within one or more of the cutouts 408 of the deep retractor arms 400. The locating protrusion 311 can be fixed or spring-loaded within the deep retractor 300 such that it extends into one of the cutouts 408 of the deep retractor arms 400 at set positions as the deep retractor 300 is translated axially along the deep retractor arm 400, adjustably locating the deep retractor 300 along the length of the longitudinal member 402 of the deep retractor arm 400. The deep retractors 300 can further include a mechanism, such as an adjustable locking mechanism, for translating and / or constraining translation of the deep retractors 300 relative to the deep retractor arms 400. For example, the deepretractors 300 can include a cam-lock mechanism, set-screw mechanism, a channel-lock mechanism, or other locking mechanisms suitable for translating and / or constraining motion of one of the deep retractors 300 relative to the deep retractor arms 400. The opening 309 generally defines corresponding slot geometry to that of the profile of the longitudinal member 402 and sliding mount 406 of the deep retractor arm 400, such that insertion of the longitudinal member 402 into a respective one of the deep retractors 300 at least partially constrains deep retractor motion in the medial-lateral direction and the proximal-distal direction.

[0047] Each of the deep retractors 300 can include a blade 320 extending from the distal end 306 in a distal and medial-lateral directions. In some examples, as shown in FIGS. 4 and 9, the blade defines an arc profile such that it extends distally into the patient and laterally towards the outermost extremities of the patient. The blade 320 can be configured to accept a longitudinal muscle of a patient such that, as the deep retractors 300 are retracted or distracted via the medial-lateral translation of the deep retractor arms 400, at least a portion of the longitudinal muscle of the patient is translated in at least one direction relative to the patient. In some examples, the distal tip of the blades 320 can be positioned underneath a longitudinal muscle (e.g., longus colli muscle) of a patient. The positioning of the deep retractors 300 adjacent to the spine allows the forces necessary to move the blade 320 beneath the longitudinal muscle not to be compromised by tension at the surface level 20 of the retractor assembly 10 and remain orthogonal to the accessed disc space.

[0048] In some examples, the blade 320 can be removably attached to one of the deep retractors 300. For example, the blade 320 can define a protrusion extending from its proximal end that is received in a corresponding slot in the deep retractors 300.

[0049] The proximal end 304 of each of the deep retractors 300 can also include a sliding mount 330 extending in a proximal direction therefrom for receiving one of the skin retractors 200, as shown in FIG. 9. The sliding mount 330 can include a channel 332 extending in the medial-lateral direction for receiving a portion of a respective one of the skin retractors 200.

[0050] As shown in FIGS. 4, 9 and 10, The retractor assembly 10 can include a pair of skin retractors 200. In some examples, as show n in FIG. 9, each of the skin retractors 200 can include a longitudinal beam 220, a pair of blade supports 210, and a pair of blades230. The longitudinal beam 220 can have a medial end 202 and a lateral end 204. The longitudinal beam 220 can include a protrusion 222 extending along the length of longitudinal beam 220 between the medial end 202 and lateral end 204. The protrusion 222 can extend from a distal surface of the longitudinal beam 220. The protrusion 222 can generally define corresponding geometry' for the channel 332 of the sliding mount 330 of one of the deep retractors 300, as shown in FIG. 9. As a result, the protrusion 222 can be received within the channel 332 of the sliding mount 330 of one of the deep retractors 300. In this way, each one of the skin retractors 200 can be supported by a corresponding one of the deep retractors 300, while allowing for medial-lateral translation of each of the skin retractors 200 relative to each one of the deep retractors 300. The longitudinal beam 220 can also include a plurality of slots or cutouts 228 on the sides, as shown in FIG. 9.

[0051] The first of the blade supports 210 can include a rectangular base 211 extending in a superior direction from the medial end 202 of the longitudinal beam 220 and a support arm 212 extending distally from the superior end of the rectangular base 211. The second of the pair of blade supports 210 can include a rectangular base 211 extending in an inferior direction from the longitudinal beam 220 at its medial end 202 and a support arm 212 extending distally from the inferior end of the rectangular base 211. The blades 230 extend distally and laterally from the distal end of a corresponding one of the support arms 212. As shown in FIG. 8, a superior-inferior distance between the rectangular bases 211 and / or the support arms 212 can each of the skin retractors 200 to slide along a respective channel 332 of each of the deep retractors 300 without interference between the skin retractors 200 and the deep retractors 300. As a result, each of the pair of blades 230 and / or pair of blade supports 210 can, in some examples, be positioned medially relative to a respective one of the deep retractors 300.

[0052] The retractor assembly 10 can include a supplemental brace 500 about or adjacent the surface level 20 connecting the first of the skin retractors 200 to the second of the skin retractors 200. As shown in FIGS. 10-11, the supplemental brace 500 can include a frame 502 and a pair of adjusters 550. The adjusters 550 extend in a superior-inferior direction from a respective one of the longitudinal beam 220 of the skin retractors 200. The adjusters 550 can include an opening 552 extending in a medial-lateral direction through the adjusters 550. The openings 552 generally define a corresponding receivinggeometry for the longitudinal beam 220 portion (including the protrusion 222) of the skin retractors 200. The adjusters 550 can also include a mechanism, such as an adjustable locking mechanism, for changing and / or locking the position of a respective one of the skin retractors 200 relative to the adjusters 550. The mechanism can include, for example, a ratcheting mechanism, a cam-lock mechanism, a channel lock, a set screw, or other suitable mechanisms for translating and / or constraining translation, in at least one degree, the skin retractors 200 relative to the supplemental brace 500.

[0053] As shown in FIGS. 10-11, the adjusters 550 can include a cam-lock mechanism. The cam-lock mechanism can include a rotational element 554 with a tool interface such as a hex, torx, or otherwise for engaging or disengaging the cam-lock mechanism. The rotational element 554 can drive a cam disposed within the adjuster 550. In some examples, the cam can include a plurality of protrusions to be received in one or more of the cutouts 228 on the longitudinal beam 220 of each of the skin retractors 200. As a result, rotation of a rotational element 554 along its axis can cause a respective one of the skin retractors 200 to translate in a medial-lateral direction. In some examples, the cam can be connected to one or more of the cutouts 228 on the longitudinal beam 220 indirectly. The adjusters 550 can include a locking element 556 for selectively preventing rotation of the rotational element 554 and / or the cam in at least one direction. As a result, the locking element 556 can be engaged or disengaged to selectively permit or constrain motion of a respective one of the skin retractors 200 relative to the adjusters 550. The locking element 556 can be selectively disengaged to allow free rotation of the rotational element 554 and cam in both directions, thereby allowing for linear translation of a corresponding skin retractor 200 in both the medial and lateral direction. Through operation of the adjusters 550 via the rotational element 554, each of the skin retractors 200 may be translated through a corresponding adjuster 550 (and along the channel 332 of one of the deep retractors 300), changing the position of the skin retractor 200 with respect to the supplemental brace 500 and / or deep retractors 300.

[0054] In some examples, the adjusters 550 can include a lockable ratcheting mechanism. The ratcheting mechanism can include a rotational element 554 with a tool interface such as a hex, torx, or otherwise for engaging or disengaging the ratcheting mechanism. The rotational element 554 can include a ratchet wheel disposed within each of the adjusters 550. In some examples, the ratchet wheel can include a plurality of protrusions to bereceived in one or more of the cutouts 228 on the longitudinal beam 220 of each of the skin retractors 200. As a result, rotation of a rotational element 554 along its axis can cause a respective one of the skin retractors 200 to translate in a medial-lateral direction. In some examples, the ratchet wheel can be connected to one or more of the cutouts 228 on the longitudinal beam 220 indirectly. The adjusters 550 can include a locking element 556, such as, for example, a spring-loaded retaining mechanism. The spring-loaded retaining mechanism can include, for example, a pawl, for selectively preventing rotation of the rotational element 554 in at least one direction. The locking element 556 can be selectively disengaged to allow free rotation of the rotational element 554 and ratchet wheel in both directions, thereby allowing for linear translation of a corresponding skin retractor 200 in both the medial and lateral direction. Through operation of the adjusters 550, each of the skin retractors 200 may be slid through a corresponding adjuster 550 (and along the channel 332 of one of the deep retractors 300), changing the position of the skin retractor 200 with respect to the supplemental brace 500 and / or deep retractors 300.

[0055] In some examples, the adjusters 550 can include a rotational element 554 with a tool interface such as a hex, torx, or otherwise, for locking the position of a respective one of the skin retractors 200 relative to the supplemental brace 500 in at least one direction. For example, the rotational element 554 can lock the position of the skin retractor 200 relative to the supplemental brace 500 by applying force directly to the skin retractor 200 (e.g., as a set-screw), or by preventing the disengagement of a separate retaining mechanism. The supplemental brace 500 can include a locking element 556, which can include a spring-loaded protrusion to be received in at least one of the cutouts 228 of the skin retractors 200. Activating one of the locking elements 556 retracts the spring-loaded protrusion within the respective adjuster 550 of the supplemental brace 500 such that, with the locking element 556 and rotational element 554 disengaged, a skin retractor 200 may be slid through the adjuster 550 (and along the channel 332 of one of the deep retractors 300), changing the position of the skin retractor 200 with respect to the supplemental brace 500 and / or deep retractors 300.

[0056] The frame 502 can extend from each of the adjusters 550 proximate the surface level 20 and connect the first of the adjusters 550 to the second of the adjusters 550. As shown in FIGS. 10-11, the frame 502 can include a portion extending in a superior-inferior direction from each of the adjusters 550 and a portion that extends in a medial- lateral direction to join the two adjusters 550.

[0057] As shown in FIGS. 10-11, the supplemental brace 500 can include a table attachment interface 520. The table attachment interface 520 can constrain the translation and / or rotation of the retractor assembly 10 in at least one degree / direction. The table attachment interface 520 can include an opening 522 extending through the table attachment interface 520 in the proximal-distal direction. As shown in FIG. 11, the opening 522 can be a hexagonal opening extending through the table attachment interface 520 in the proximal-distal direction. The table attachment interface 520 can comprise corresponding geometry7to attach to a retractor arm (not shown). The retractor arm connects the attachment interface 520 of the supplemental brace 500 to an operating table (not shown). The table attachment interface 520 can include corresponding geometry for mounting the supplemental brace 500 directly to the operating table. In some embodiments, the table attachment interface 520 can include a clamp, a fastener (such as, for example, a threaded fastener), or any other suitable mechanism for constraining the translation and / or rotation of the supplemental brace 500 in at least one degree / direction.

[0058] In FIG. 12, the retractor assembly 10 is shown positioned over vertebral bodies of a spine. In the example shown and as described herein, the retractor assembly 10 can provide access to a surgical site, including the exposure of at least a portion of vertebral bodies 50 (for example, vertebral bodies C3 and C4) and intervertebral disc 60 disposed therebetween.

[0059] According to the disclosure herein, an example retractor assembly 10 can be removably attached to a patient via the support 100 and removably attached to an operating table via the supplemental brace 500. Each of the deep retractors 300, which can be connected to the support 100 via the pair of deep retractor arms 400. can independently translate in a medial-lateral direction through operation of the adjuster mechanism 700, as described. Each of the deep retractors 300 can also translate in a superior-inferior direction along a respective one of the deep retractor arms 400 via the sliding mount. As a result, each of the deep retractor arms 400 can be independently moved in both a medial-lateral and superior-inferior direction relative to the other deep retractor arm 400. Each of the skin retractors 200 can be coupled to a respective one of the pair of deep retractors 300. Each of the skin retractors 200 can be slidably mounted toa respective one of the deep retractors 300. As a result, each of the pair of skin retractors 200 can translate in a medial-lateral direction independently of the other of the pair of skin retractors 200. The supplemental brace 500, through operation of each of the adjusters 550, can individually lock or adjust the medial-lateral position of each of the skin retractors 200.

[0060] As a result, each one of the pair of skin retractors 200 and each one of the pair of deep retractors 300 can be moved independently in a medial-lateral direction. This can permit the operator to retract the skin and move the longitudinal muscle independently of one another. In addition, this can permit the operator to apply skin retraction or distraction force asymmetrically. This can also permit the operator to apply longitudinal muscle retraction or distraction force asymmetrically.

[0061] The superior-inferior translation of the skin retractors 200 and deep retractors 300 can be coupled such that superior-inferior translation of one of the deep retractors 300, for example along the length of one of the deep retractor arms 400, can cause a corresponding superior-inferior translation of one of the pair of skin retractors 200. Each of the pair of deep retractors 300 can, in some examples, be translated in a superiorinferior direction independently of the other deep retractor 300. As a result, a first of the pair of skin retractors 200 and a first of the pair of deep retractors 300 can be in a first superior-inferior position, while the second of the pair of skin retractors 200 and the second of the pair of deep retractors 300 can be in a second, different superior-inferior position. In some examples, a pair of blades 230 of one of the skin retractors 200 can be in substantially the same superior-inferior position as the blade 320 of the corresponding deep retractor 300 and the pair of blades 230 of the other skin retractor 200 can be in substantially the same superior-inferior position as the blade 320 of the other corresponding deep retractor 300.

[0062] The retractor assembly 10 as described herein can increase positional stability while also providing increased adjustability. The direct spinal fixation of the retractor assembly 10 can provide for increased stability, in conjunction with or independently of a table attachment feature. In addition, the independent or decoupled retraction / distraction motion of the skin retractors 200 relative to the deep retractors 300 can allow for more precise application of force, as necessary. The retraction or distraction of the skin can be completed independently from the retraction or distraction of the longitudinal muscle ofthe patient (e.g., longus colli), which can reduce the size of skin incision required for a procedure and reduce risks of damage or strain to surrounding physiology (e.g.. reducing the risk of postoperative dysphagia or injury to the recurrent laryngeal nerve). In addition, the forces necessary to move the deep retractors 300 at the subcutaneous level can be less subject to being compromised by tension at the surface level and can remain orthogonal to the disc space. Furthermore, independent retraction / distraction motion of each of the skin retractors 200 and each of the deep retractors 300 can permit force to be applied selectively or unilaterally, in the event that increased access to one side of the spine is required or otherwise advantageous because of particular patient anatomy.

[0063] Exemplary' Aspects

[0064] In view of the disclosure, hereinbelow are described certain more particular aspects. These particularly recited aspects should not, however, be interpreted to have any limiting effect on any different claims containing different or more general teachings described herein, or that “particular” aspects are somehow limited in some way other than the inherent meanings of the language and formulas literally used therein.

[0065] Example 1 : A retractor assembly for exposing a portion of a spine through an incision in a skin and adjacent at least one longitudinal muscle of a patient, the retractor assembly comprising: a support configured to be coupled to a vertebra of the spine; a pair of skin retractors including elongate surfaces configured to extend into the skin incision through a surface level adjacent to the skin of the patient; and a pair of deep retractors including elongate surfaces configured to extend through the skin incision and into a subcutaneous level having an adjacent relationship with the longitudinal muscle of the patient and below the surface level; wherein the pair of skin retractors and the pair of deep retractors are coupled to the support such that distraction of at least one of the pair of skin retractors and at least one of the pair of deep retractors enlarges the incision and moves the longitudinal muscle to facilitate accessing the portion of the spine.

[0066] Example 2: The retractor assembly according to any example herein, particularly example 1, wherein one of the pair of skin retractors is at least partially coupled to one of the pair of deep retractors.

[0067] Example 3: The retractor assembly according to any example herein, particularly example 2, wherein the coupled skin and deep retractors comprise a shared sliding mount allowing at least one degree of translation by the coupled skin and deep retractors.

[0068] Example 4: The retractor assembly according to any example herein, particularly example 3, wherein the at least one degree of translation includes inferior-superior translation.

[0069] Example 5: The retractor assembly according to any example herein, particularly examples 1-4, further comprising a pair of deep retractor arms, wherein each of the pair of deep retractor arms connect a corresponding one of the pair of deep retractors to the support.

[0070] Example 6: The retractor assembly according to any example herein, particularly example 5, further comprising a pair of sliding mounts, wherein the pair of deep retractors are connected to the pair of deep retractor arms via the pair of sliding mounts.

[0071] Example 7: The retractor assembly according to any example herein, particularly examples 5-6, wherein the pair of deep retractor arms further comprise at least one locking mechanism, wherein the locking mechanism is configured to constrain at least one degree of translation of at least one of the deep retractors relative to at least one of the deep retractor arms.

[0072] Example 8: The retractor assembly according to any example herein, particularly claim 7, wherein the at least one degree of translation includes superior-inferior translation.

[0073] Example 9: The retractor assembly according to any example herein, particularly examples 7-8, wherein the locking mechanism comprises a cam-lock mechanism.

[0074] Example 10: The retractor assembly according to any example herein, particularly examples 5-9, further comprising an adjuster mechanism, wherein the pair of deep retractor arms are connected to the support via the adjuster mechanism.

[0075] Example 11 : The retractor assembly according to any example herein, particularly example 10, wherein the adjuster mechanism comprises at least one pair of wedges and at least one screw coupled to one of the wedges, wherein one of the pair of wedges is at least partially coupled to one of the pair of deep retractor arms, wherein one of the pair of wedges defines a decline surface and the other wedge defines a mating incline surface, wherein the pair of wedges are oriented such that the incline surface and decline surface are directly or indirectly in contact, and wherein rotation of the screw causes relative motion of the pair of wedges via sliding of at least one of the pair of wedges along the incline surface or decline surface.

[0076] Example 12: The retractor assembly according to any example herein, particularly example 11, wherein rotation of the screw causes translation of one of the wedges along a central axis of the screw and an orthogonal translation of the other wedge.

[0077] Example 13: The retractor assembly according to any example herein, particularly examples 11-12, wherein the screw central axis is inclined at a tool interface angle, wherein the tool interface angle is between a coronal plane and a transverse plane of the patient.

[0078] Example 14: The retractor assembly according to any example herein, particularly examples 11-13, wherein the orthogonal translation includes medial-lateral translation.

[0079] Example 15: The retractor assembly according to any example herein, particularly examples 1-14, further comprising a supplemental brace adjacent the surface level, wherein the supplemental brace connects the first of the pair of skin retractors to the second of the pair of skin retractors.

[0080] Example 16: The retractor assembly according to any example herein, particularly example 15, wherein the supplemental brace further comprises a pair of sliding mounts, wherein each of the skin retractors is connected to the supplemental brace via one of the pair of sliding mounts.

[0081] Example 17: The retractor assembly according to any example herein, particularly examples 15-16, further comprising at least one locking mechanism, wherein the locking mechanism is configured to constrain at least one degree of translation of at least one of the deep retractors relative to at least one of the deep retractor arms.

[0082] Example 18: The retractor assembly according to any example herein, particularly example 17, wherein the at least one degree of translation includes medial -lateral translation.

[0083] Example 19: The retractor assembly according to any example herein, particularly examples 17-18, wherein the locking mechanism comprises a cam-lock mechanism.

[0084] Example 20: The retractor assembly according to any example herein, particularly examples 15-19, wherein the supplemental brace further comprises a table attachment interface configured to constrain at least one degree of translation or rotation of the retractor assembly.

[0085] Example 21: The retractor assembly according to any example herein, particularly example 20, wherein the table attachment interface comprises an opening through the supplemental brace.

[0086] Example 22: The retractor assembly according to any example herein, particularly example 21, wherein the at least one degree of translation or rotation comprises superiorinferior translation.

[0087] Example 23: The retractor assembly according to any example herein, particularly examples 1-22, wherein the support further comprises at least one fastening interface, wherein the support is coupled to the vertebra via the fastening interface.

[0088] Example 24: The retractor assembly according to any example herein, particularly example 23, wherein the fastening interface comprises an opening in the support and a fastener, wherein the fastener extends through the opening into the vertebra.

[0089] Example 25: The retractor assembly according to any example herein, particularly example 24, wherein the fastener is a screw.

[0090] Example 26: The retractor assembly according to any example herein, particularly examples 1-25. wherein the support comprises an angled block.

[0091] Example 27: The retractor assembly according to any example herein, particularly examples 1 -26, wherein the pair of skin retractors translate in at least one degree independent of the pair of deep retractors.

[0092] Example 28: The retractor assembly according to any example herein, particularly example 27, wherein the at least one degree includes medial-lateral translation.

[0093] Example 29: The retractor assembly according to any example herein, particularly examples 1-28, wherein the first skin retractor translates at least one degree independent of the second skin retractor.

[0094] Example 30: The retractor assembly according to any example herein, particularly example 29, wherein the at least one degree includes medial-lateral translation.

[0095] Example 31 : The retractor assembly according to any example herein, particularly examples 1-30, wherein the first deep retractor translates in at least one degree independent of second deep retractor.

[0096] Example 32: The retractor assembly according to any example herein, particularly example 31, wherein the at least one degree includes medial-lateral translation.

[0097] Example 33: The retractor assembly according to any example herein, particularly examples 1-32, wherein each of the pair of skin retractors translate in at least one degree independent of each of the pair of deep retractors.

[0098] Example 34: The retractor assembly according to any example herein, particularly example 33, wherein the at least one degree includes medial-lateral translation.

[0099] Example 35: The retractor assembly according to any example herein, particularly examples 1-34, wherein each of the pair of skin retractors translate in a medial-later direction and in a medial-distal direction.

[0100] Example 36: The retractor assembly according to any example herein, particularly examples 1-35, wherein each of the pair of deep retractors translate in a superior-inferior direction and in a medial-distal direction.

[0101] Example 37: The retractor assembly according to any example herein, particularly examples 1-36, wherein the pair of deep retractors further comprises removable blades configured to receive a longus colli muscle.

[0102] Example 38: The retractor assembly according to any example herein, particularly examples 1-37. wherein the pair of skin retractors further comprises removable blades configured to receive a portion of the skin.

[0103] Example 39: A retractor assembly for exposing a portion of a spine through an incision in a skin and adjacent a longitudinal muscle of a patient, the retractor assembly comprising: a support configured to be coupled to a vertebra of the spine; a pair of deep retractor arms extending from the support in a superior-inferior direction; a pair of deep retractors extending from the deep retractor arms in a proximal-distal direction, including elongate surfaces configured to extend through the skin incision and into a subcutaneous level having an adjacent relationship with the longitudinal muscle of the patient and distal to the surface level; wherein each of the pair of deep retractors translate in a superiorinferior direction via a sliding mount on each of the deep retractor arms; wherein each of the pair of deep retractor arms at least partially connects a corresponding one of the pair of deep retractors to the support via an adjuster mechanism configured to allow medial- distal translation of each of the deep retractors; a pair of skin retractors comprising elongate surfaces extending in a proximal-distal direction configured to extend into the skin incision through a surface level adj acent to the skin of the patient; wherein each one of the pair of skin retractors is at least partially coupled to a corresponding one of thedeep retractors at a location adjacent the surface level; wherein each of the pair of skin retractors further comprises longitudinal beams extending in a medial-lateral direction; a supplemental brace extending from the pair of longitudinal beams on the pair of skin retractors adjacent the surface level; wherein each of the pair of skin retractors translate in a medial-lateral direction via a sliding mount on each of the longitudinal beams that at least partially couple the pair of longitudinal beams to the supplemental brace; wherein the supplemental brace is configured to be coupled to an operating table.

Claims

ClaimsWhat is claimed is:

1. A retractor assembly for exposing a portion of a spine through an incision in a skin and adjacent at least one longitudinal muscle of a patient, the retractor assembly comprising: a support configured to be coupled to a vertebra of the spine; a pair of skin retractors including elongate surfaces configured to extend into the skin incision through a surface level adjacent to the skin of the patient; and a pair of deep retractors including elongate surfaces configured to extend through the skin incision and into a subcutaneous level having an adjacent relationship with the longitudinal muscle of the patient and below the surface level; wherein the pair of skin retractors and the pair of deep retractors are coupled to the support such that distraction of at least one of the pair of skin retractors and at least one of the pair of deep retractors enlarges the incision and moves the longitudinal muscle to facilitate accessing the portion of the spine.

2. The retractor assembly of claim 1, wherein one of the pair of skin retractors is at least partially coupled to one of the pair of deep retractors.

3. The retractor assembly of claim 2, wherein the coupled skin and deep retractors comprise a shared sliding mount allowing at least one degree of translation by the coupled skin and deep retractors.

4. The retractor assembly of claim 3, wherein the at least one degree of translation includes inferior-superior translation.

5. The retractor assembly of any one of claims 1-4, further comprising a pair of deep retractor arms, wherein each of the pair of deep retractor arms connect a corresponding one of the pair of deep retractors to the support.

6. The retractor assembly of claim 5, further comprising a pair of sliding mounts, wherein the pair of deep retractors are connected to the pair of deep retractor arms via the pair of sliding mounts.

7. The retractor assembly of any one of claims 5-6, wherein the pair of deep retractor arms further comprise at least one locking mechanism, wherein the locking mechanism is configured to constrain at least one degree of translation of at least one of the deep retractors relative to at least one of the deep retractor arms.

8. The retractor assembly of claim 7, wherein the at least one degree of translation includes superior-inferior translation.

9. The retractor assembly of any one of claims 7-8. wherein the locking mechanism comprises a cam-lock mechanism.

10. The retractor assembly of any one of claims 5-9, further comprising an adjuster mechanism, wherein the pair of deep retractor arms are connected to the support via the adjuster mechanism.

11. The retractor assembly of claim 10, wherein the adjuster mechanism comprises at least one pair of wedges and at least one screw coupled to one of the wedges, wherein one of the pair of wedges is at least partially coupled to one of the pair of deep retractor arms, wherein one of the pair of wedges defines a decline surface and the other wedge defines a mating incline surface, wherein the pair of wedges are oriented such that the incline surface and decline surface are directly or indirectly in contact, and wherein rotation of the screw causes relative motion of the pair of wedges via sliding of at least one of the pair of wedges along the incline surface or decline surface.

12. The retractor assembly of claim 11, wherein rotation of the screw causes translation of one of the wedges along a central axis of the screw and an orthogonal translation of the other wedge.

13. The retractor assembly of any one of claims 11-12, wherein the screw central axis is inclined at a tool interface angle, wherein the tool interface angle is between a coronal plane and a transverse plane of the patient.

14. The retractor assembly of any one of claims 11-13, wherein the orthogonal translation includes medial-lateral translation.

15. The retractor assembly of any one of claims 1-14, further comprising a supplemental brace, wherein the supplemental brace connects the first of the pair of skin retractors to the second of the pair of skin retractors.

16. The retractor assembly of claim 15, wherein the supplemental brace further comprises a pair of sliding mounts, wherein each of the skin retractors is connected to the supplemental brace via one of the pair of sliding mounts.

17. The retractor assembly of claim 15, further comprising at least one lockingmechanism, wherein the locking mechanism is configured to constrain at least one degree of translation of at least one of the deep retractors relative to at least one of the deep retractor arms.

18. The retractor assembly of claim 17, wherein the at least one degree of translation includes medial-lateral translation.

19. The retractor assembly of any one of claims 17-18, wherein the locking mechanism comprises a cam-lock mechanism.

20. The retractor assembly of any one of claims 15-19, wherein the supplemental brace further comprises a table attachment interface configured to constrain at least one degree of translation or rotation of the retractor assembly.

21. The retractor assembly of claim 20, wherein the table attachment interface comprises an opening through the supplemental brace.

22. The retractor assembly of claim 20, wherein the at least one degree of translation or rotation comprises superior-inferior translation.

23. The retractor assembly of any one of claims 1-22, wherein the support further comprises at least one fastening interface, wherein the support is coupled to the vertebra via the fastening interface.

24. The retractor assembly of claim 23, wherein the fastening interface comprises an opening in the support and a fastener, wherein the fastener extends through the opening into the vertebra.

25. The retractor assembly of claim 24, wherein the fastener is a screw.

26. The retractor assembly of any one of claims 1-25, wherein the support comprises an angled block.

27. The retractor assembly of any one of claims 1-26, wherein the pair of skin retractors translate in at least one degree independent of the pair of deep retractors.

28. The retractor assembly of claim 27, wherein the at least one degree includes medial-lateral translation.

29. The retractor assembly of any one of claims 1-28, wherein the first skin retractor translates in at least one degree independent of the second skin retractor.

30. The retractor assembly of claim 29, wherein the at least one degree includes medial-lateral translation.

31. The retractor assembly of any one of claims 1-30, wherein the first deep retractor translates in at least one degree independent of second deep retractor.

32. The retractor assembly of claim 31, wherein the at least one degree includes medial-lateral translation.

33. The retractor assembly of any one of claims 1-32, wherein each of the pair of skin retractors translate in at least one degree independent of each of the pair of deep retractors.

34. The retractor assembly of claim 33, wherein the at least one degree includes medial-lateral translation.

35. The retractor assembly of any one of claims 1-34, wherein each of the pair of skin retractors translate in a medial-later direction and in a medial-distal direction.

36. The retractor assembly of any one of claims 1-35, wherein each of the pair of deep retractors translate in a superior-inferior direction and in a medial-distal direction.

37. The retractor assembly of any one of claims 1-36, wherein the pair of deep retractors further comprises removable blades configured to receive a longus colli muscle.

38. The retractor assembly of any one of claims 1-37, wherein the pair of skin retractors further comprises removable blades configured to receive a portion of the skin.

39. A retractor assembly for exposing a portion of a spine through an incision in a skin and adjacent a longitudinal muscle of a patient, the retractor assembly comprising: a support configured to be coupled to a vertebra of the spine; a pair of deep retractor arms extending from the support in a superior-inferior direction; a pair of deep retractors extending from the deep retractor arms in a proximal-distal direction, including elongate surfaces configured to extend through the skin incision and into a subcutaneous level having an adjacent relationship with the longitudinal muscle of the patient and distal to the surface level; wherein each of the pair of deep retractors translate in a superior-inferior direction via a sliding mount on each of the deep retractor arms; wherein each of the pair of deep retractor arms at least partially connects a corresponding one of the pair of deep retractors to the support via an adjuster mechanism configured to allow medial-distal translation of each of the deep retractors; a pair of skin retractors comprising elongate surfaces extending in a proximal-distal direction configured to extend into the skin incision through a surface level adjacent to the skin of the patient;wherein each one of the pair of skin retractors is at least partially coupled to a corresponding one of the deep retractors at a location adjacent the surface level; wherein each of the pair of skin retractors further comprises longitudinal beams extending in a medial-lateral direction; a supplemental brace extending from the pair of longitudinal beams on the pair of skin retractors adjacent the surface level; wherein each of the pair of skin retractors translate in a medial -lateral direction via a sliding mount on each of the longitudinal beams that at least partially couple the pair of longitudinal beams to the supplemental brace; wherein the supplemental brace is configured to be coupled to an operating table.

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