Rack based tissue retractor

Abstract

A retractor system includes a retractor body, a first arm configured to support a first blade and a second arm configured to support a second blade. A first rack-based distraction mechanism is coupled to a first actuator and is configured to independently move the first arm upon rotation of the first actuator. A second rack-based distraction mechanism is coupled to a second actuator and is configured to independently move the second arm upon rotation of the second actuator. A third rack- based distraction mechanism is coupled to a third actuator and is configured to simultaneously move the first arm and the second arm. Some embodiments include a third arm supporting a third blade. Some embodiments include a fourth rack-based distraction mechanism for independently adjusting the third arm and a fifth rack-based distraction mechanism for simultaneously adjusting the first arm, the second arm, and the third arm.

Description

Attorney Docket No. A0013240W001RACK BASED TISSUE RETRACTOR

[0001] This application claims the benefit of U.S. Provisional Patent Application Serial No.63 / 760,154, filed 19 February 2025, the entire content of which is incorporated herein by reference.FIELD

[0002] The present technology is generally related to medical devices to assist a surgeon during treatment of musculoskeletal disorders, and more particularly to a surgical system and method for accessing a surgical site to facilitate treatment. More particularly, the present disclosure is directed to a rack based surgical retractor system configured for various approaches to the spine, including for example, anterior, lateral, and oblique surgical techniques.BACKGROUND

[0003] Spinal disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including pain, nerve damage, and partial or complete loss of mobility.

[0004] Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes fusion, fixation, discectomy, laminectomy and implantable prosthetics.Surgical retractors may be employed during a surgical treatment to provide access and visualization of a surgical site. Such retractors space apart and support tissue and / or other anatomical structures to expose anatomical structures at the surgical site and / or provide a surgical pathway for the surgeon to the surgical site. To optimize surgical outcomes, it is crucial to adjust the surgical pathway to accommodate the unique anatomy of each patient and the requirements of the procedure, often necessitating a retractor system that allows for flexible and precise adjustments.SUMMARY

[0005] In one aspect of the disclosed technology, a retractor system for enabling access to a surgical site is disclosed. The retractor system may include a central retractor body; a first arm extending from a first side of the central retractor body and being configured to support a first blade coupled to a distalAttorney Docket No. A0013240W001end thereof; and a second arm extending from a second side of the central retractor body opposite the first side and having a second blade coupled to a distal end thereof.

[0006] In another aspect of the disclosed technology, the retractor system may also include a first rack-based distraction mechanism including a first rack and a first actuator, the first rack-based distraction mechanism being configured to independently move the first arm along the first rack along a first path of motion when the first actuator is rotated.

[0007] In another aspect of the disclosed technology, the retractor system may also include a second rack-based distraction mechanism including a second rack and a second actuator, the second rackbased distraction mechanism being configured to independently move the second arm along the second rack along a second path of motion when the second actuator is rotated.

[0008] The retractor system may also include a third rack-based distraction mechanism including a third rack, a fourth rack, and a third actuator, the third rack-based distraction mechanism being configured to simultaneously move the first arm and the second arm along the first and second paths of motion, respectively, when the third actuator is rotated.

[0009] In another aspect of the disclosed technology, a method of using a retractor system includes preparing a retractor system; inserting a first dilator and a second dilator into a surgical site; inserting the first blade and the second blade over the first dilator and the second dilator into the surgical site; independently adjusting at least one of the first blade and the second blade; and simultaneously adjusting the first and second blades.

[0010] In another aspect of the disclosed technology, a method of using a retractor system includes the following: inserting a first dilator and a second dilator into a surgical site, inserting a first blade, a second blade and a third blade over the first and the second dilator into a surgical site, independently adjusting the first blade by moving a first arm along a first rack by operating a first rack-based distraction mechanism including a first rack and a first actuator and simultaneously adjusting the first blade and a second blade by simultaneously moving the first blade and the second blade along the first rack and a second rack, respectively, by operating a second rack-based distraction mechanism including a third rack, a fourth rack and a third actuator.

[0011] In another aspect of the disclosed technology, the method of using a retractor system includes simultaneously adjusting the first blade, the second blade and a third blade by moving the first blade, the second blade and the third blade along the first rack, the second rack and a fifth rack, respectively,Attorney Docket No. A0013240W001by operating a third rack-based distraction mechanism including the third rack, the fourth rack and a third actuator.

[0012] The details of one or more aspects of the disclosure are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the techniques described in this disclosure will be apparent from the description and drawings, and from the claims.BRIEF DESCRIPTION OF THE DRAWINGS

[0013] FIG. 1 depicts a perspective view of an example embodiment of a retractor system in accordance with the principles of the disclosure;

[0014] FIG. 2A depicts a top-down view of an example embodiment of a retractor system with a central axis overlayed in accordance with the principles of the disclosure;

[0015] FIG. 2B depicts a top-down view of a central body with a central axis overlayed in accordance with the principles of the disclosure;

[0016] FIG. 3 depicts an alternative top-down view of an example embodiment of a retractor system in accordance with the principles of the disclosure;

[0017] FIG. 4 depicts a top-down view of the retractor system of FIG. 3 with the top cover removed to show the central body in accordance with the principles of the disclosure;

[0018] FIG. 5A depicts an example embodiment of a first arm of a retractor system in accordance with the principles of the disclosure;

[0019] FIG. 5B depicts an alternative view of the first arm of FIG. 5 A in accordance with the principles of the disclosure;

[0020] FIG. 6A depicts an alternative view of the first arm of FIG. 5 A in accordance with the principles of the disclosure;

[0021] FIG. 6B depicts an alternative view of the first arm of FIG. 5 A in accordance with the principles of the disclosure;

[0022] FIG. 7A depicts an example embodiment of a second arm of a retractor system in accordance with the principles of the disclosure;

[0023] FIG. 7B depicts an alternative view of the first arm of FIG. 7A in accordance with the principles of the disclosure;

[0024] FIG. 8A depicts an alternative view of the first arm of FIG. 7A in accordance with the principles of the disclosure;Attorney Docket No. A0013240W001

[0025] FIG. 8B depicts an alternative view of the first arm of FIG. 7A in accordance with the principles of the disclosure;

[0026] FIG. 9A depicts a zoomed in view of an example embodiment of a ratcheting feature of a retractor system in accordance with the principles of the disclosure;

[0027] FIG. 9B depicts the internal components of the ratcheting feature of FIG. 9A in accordance with the principles of the disclosure;

[0028] FIG. 10A depicts an example embodiment of a posterior arm of a retractor system in accordance with the principles of the disclosure;

[0029] FIG. 10B depicts an alternative view of the posterior arm of FIG. 10A in accordance with the principles of the disclosure;

[0030] FIG. 11 depicts an alternative view of the posterior arm of FIG. 10A in accordance with the principles of the disclosure;

[0031] FIG 12 depicts a zoomed in view of the posterior arm of FIGS. 10A-B and FIG 11 and an example embodiment of a release mechanism in accordance with the principles of the disclosure;

[0032] FIG. 13 depicts an alternative view of the central body of FIG. 2B in accordance with the principles of the disclosure;

[0033] FIG. 14 depicts an alternative view of the central body of FIG. 13 in accordance with the principles of the disclosure;

[0034] FIG. 15 depicts an alternative view of the central body of FIG. 13 in accordance with the principles of the disclosure;

[0035] FIG. 16A depicts an example embodiment of a central body with internal components removed in accordance with the principles of the disclosure;

[0036] FIG. 16B depicts an alternative view of the central body of FIG. 16A in accordance with the principles of the disclosure;

[0037] FIG. 17 depicts internal components of an example embodiment of a central body in accordance with the principles of the disclosure;

[0038] FIG. 18 depicts an alternative view of the internal components of FIG. 17 in accordance with the principles of the disclosure;

[0039] FIG. 19 depicts an alternative view of some of the internal components of FIGS. 17 and 18 in accordance with the principles of the disclosure;Attorney Docket No. A0013240W001

[0040] FIG. 20A depicts an alternative view of the internal components of FIG. 19 with a pinion assembly in a first position in accordance with the principles of the disclosure;

[0041] FIG. 20B depicts the internal components of FIG. 20 with the pinion assembly in a second position in accordance with the principles of the disclosure;

[0042] FIG. 21 depicts an example embodiment of a blade support and supplemental blade in accordance with the principles of the disclosure;

[0043] FIG. 22 depicts an alternative view of the supplemental blade of FIG. 21 in accordance with the principles of the disclosure;

[0044] FIG. 23 depicts an example embodiment of a curved arm connector in accordance with the principles of the disclosure;

[0045] FIG. 24 depicts an example embodiment of a table fixation device in accordance with the principles of the disclosure;

[0046] FIG. 25A depicts a first view of an embodiment of a curved arm for connection of the table fixation device to the retractor system in accordance with the principles of the disclosure;

[0047] FIG. 25B depict a second view of the embodiment in FIG. 25A in accordance with the principles of the disclosure;

[0048] FIG. 26 depicts an example embodiment of a screw for use with the curved arm of FIGS. 25 A and 25B in accordance with the principles of the disclosure;

[0049] FIG. 27A depicts an embodiment of a mounting point for connection of the curved arm of FIG.26 to the retractor system in accordance with the principles of the disclosure;

[0050] FIG. 27B depicts an embodiment of a mounting point for connection of the curved arm of FIG.26 to the retractor system in accordance with the principles of the disclosure;

[0051] FIG. 28A depicts an example embodiment of a first blade for use with the retractor system in accordance with the principles of the disclosure;

[0052] FIG. 28B depicts an example embodiment of a first blade for use with the retractor system in accordance with the principles of the disclosure;

[0053] FIG. 29 depicts an example embodiment of a first blade for use with the retractor system in accordance with the principles of the disclosure;

[0054] FIG. 30A depicts an example embodiment of a second blade for use with the retractor system in accordance with the principles of the disclosure;Attorney Docket No. A0013240W001

[0055] FIG. 3 OB depicts an example embodiment of a second blade for use with the retractor system in accordance with the principles of the disclosure;

[0056] FIG. 31 depicts an example embodiment of a second blade for use with the retractor system in accordance with the principles of the disclosure;

[0057] FIG. 32A depict an example embodiment of a third blade for use with the retractor system in accordance with the principles of the disclosure;

[0058] FIG. 32B depicts an example embodiment of a third blade for use with the retractor system in accordance with the principles of the disclosure;

[0059] FIG. 33 A depicts an example embodiment of a third blade for use with the retractor system in accordance with the principles of the disclosure;

[0060] FIG. 33B depicts an example embodiment of a third blade for use with the retractor system in accordance with the principles of the disclosure;

[0061] FIG. 34A depicts an example embodiment of a retractor system with blades in a first position in accordance with the principles of the disclosure;

[0062] FIG. 34B depicts an example embodiment of a retractor system with blades in a second position in accordance with the principles of the disclosure;

[0063] FIG. 35 depicts an example embodiment of a retractor system with blades in a third position in accordance with the principles of the disclosure;

[0064] FIG. 36 depicts an example embodiment of one or more dilators of varying diameters or use with the retractor system in accordance with the principes of the disclosure;

[0065] FIG. 37 depicts the dilators of FIG. 36 between the blades of the retractor system in accordance with the principles of the disclosure;

[0066] FIG. 38 depicts an example embodiment of an alternative dilator for use with the retractor system in accordance with the principles of the disclosure;

[0067] FIG. 39 depicts the dilator of FIG. 38 between one or more blades for use with the retractor system in accordance with the principles of the disclosure; and

[0068] FIG. 40 is an example method of using a retractor system in accordance with the principles of the disclosure.DETAILED DESCRIPTION

[0069] In one aspect, example embodiments describe a retractor system 100 for use with anterior, lateral, and oblique surgical techniques. At least one use of retractor system 100 is to prepare a surgicalAttorney Docket No. A0013240W001site for access to a patient’s spine. Blades of retractor system 100 may be used to retract muscles and tissue in order to access the disc space between vertebrae.

[0070] The retractor system 100 includes three arms. In addition, the retractor system 100 includes mechanisms for simultaneous movement of two arms and simultaneous movement of three arms. The retractor system 100 also includes mechanisms for independent movement of each of the three arms. The retractor system 100 is rack-based, i.e., movement of the arms is effectuated by mechanisms including racks. The retractor system 100 includes rack-based mechanisms to effectuate independent movement of the arms and rack-based mechanisms to effectuate simultaneous movement of the arms. The retractor system is also highly customizable with the ability to hold varying numbers of blades, e.g., two blades, three blades. The retractor system 100 may be used in conjunction with different types of dilators and with various dilator configurations, e.g., nested dilator assemblies with varying numbers of dilators. The retractor system 100 may also be used with various auxiliary components, e.g., a table fixation device, a supplemental blade.

[0071] As used herein, the term “actuator” shall be interpreted in a broad sense according to its ordinary technical understanding. As explained in more detail below, the term “actuator” can include, for example and without limitation, a knob such as knobs 106a, 106b and 118, push buttons 314 and 316, or handles and tools that are used in conjunction with these components.

[0072] Referring generally to FIGS. 1-3, an example embodiment of retractor system 100 is shown. As seen in FIGS. 2A-2B, retractor system 100 includes a central axis 197 that bisects retractor system 100. Central axis 197 extends through central body 200 and between lateral racks 202a and 202b so that lateral racks 202a and 202b are disposed symmetrically on opposite sides of central axis 197. Stated another way, central axis is positioned equidistant from lateral racks 202a and 202b and extends in a perpendicular direction to lateral racks 202a and 202b as shown in FIGS. 2A and 2B.

[0073] Retractor system 100 includes first and second arms 102a and 102b located on opposing sides of central axis 197. Retractor system 100 also includes third arm 108 which may be referred to as a third arm 108. In some embodiments, arms 102a and 102b may be symmetrically disposed about central axis 197. Attached to arms 102a, 102b, and 108 are blades 10, 20 and 30, respectively. First arm 102a and second arm 102b are moveable relative to central axis 197 along lateral racks 202a and 202b, respectively. Blades 10 and 20 are attached to first arm 102a and second arm 102b respectively, and, therefore, movement of arms 102a and 102b effectuates movement of blades 10 and 20 relative to central axis 197. As illustrated in FIG. 2A, first arm 102a is moveable relative to central axis 197 inAttorney Docket No. A0013240W001directions dia and dib. Second arm 102b is moveable relative to central axis 197 in directions d2a and d2b- Third arm 108 is moveable in a direction that approximates central axis 197. For example, posterior arm 198 moves forward and backward along a path that intersects and approximates central axis 197 but is not necessarily identically coextensive with the linear path defined by central axis 197. Attached to third arm 108 is blade 30, and, therefore, movement of third arm 108 effectuates movement of blade 30 along directions ds and d4. Movement of blades 10, 20, and 30 may enable a user to retract tissue and obtain access to the spine as discussed above.

[0074] FIG. 4 shows the retractor system 100 with the top cover 113a (see FIG. 3) removed for ease of understanding. Enclosed between top cover 113a and bottom cover 113b is central body 200. Retractor system 100 includes mechanisms for independent and simultaneous movement of first arm 102a, second arm 102b and third arm 108. Central body 200 houses the components for movement of third arm 108 and for simultaneous movement of first arm 102a, second arm 102b, and third arm 108.Located at various locations of retractor system 100, such as on lateral racks 202a and 202b, first arm 102a and second arm 102b, third arm 108, and central body 200 are mounting points 120 for attaching a table fixation device 600. For example, lateral racks 202a and 202b each terminate at the outermost ends thereof in a mounting point 120, which are attached via apertures 203 (see FIGS. 14-15). Central body 200 and associated mechanisms are further discussed below in relation to FIGS. 13-19. The structure of first arm 102a and second arm 102b and the mechanisms underlying their independent movement are further discussed in detail in the forthcoming paragraphs.

[0075] Top cover 113a (see FIG. 3) and bottom cover 113b (see FIG. 4) enclose internal components of retractor system 100. Top cover 113a and bottom cover 113b may include plastic or an elastic material. Other components of retractor system 100 such as first arm 102a, second arm 102b and central body 200 may include metal alloys, plastic or a combination of both. For example, these components may include titanium alloy, stainless steel or aluminum alloy. The alloys included in these components, if any, may be anodized or include coatings for durability and biocompatibility. The use of materials such as titanium alloys and plastics in combination ensures that retractor system 100 is both lightweight, strong, and durable.

[0076] Referring now to FIGS. 5A-5B, 6A-6B, 7A-7B and 8A-8B, first arm 102a and second arm 102b are shown. FIG. 5 A shows a top-down view of first arm 102a and FIG. 5B shows a side profile view of first arm 102a. FIG. 6A shows a bottom up view and FIG. 6B shows a side profile from an opposite perspective of FIG. 5B. FIG. 7A shows a top down view of second arm 102b and FIG. 7BAttorney Docket No. A0013240W001shows a side profile view of second arm 102b. FIG. 8A shows a bottom up view and FIG. 8B shows a side profile view from an opposite perspective of FIG. 7B. The structure and functionality are described in detail with respect to first arm 102a for convenience, however, the structure and functionality is equally applicable to second arm 102b and should be understood to extend to the second arm 102b accordingly (unless the context clearly indicates otherwise). Like numbering with respect to first arm 102a is preserved with respect to second arm 102b. First arm 102a comprises a curved section or elbow 101, a first side 136a and a second side 136b. First side 136a bows outward at elbow 101, while second side 136b bows inward at elbow 101. An extension 109 extends from side 136b perpendicularly or substantially perpendicularly to the longitudinal direction of each of arms 102a and 102b. A hollow aperture 103 (see FIG. 5B) extends transversely through extension 109 of the first arm 102a from side 136a to side 136b. Disposed on an extension 109 is a knob 106a that is connected to pinion 107a. In addition, a ratcheting feature 112 is situated on extension 109 (discussed in more detail in relation to FIGS. 9A-B). Also, on first side 136a is a protrusion 105 configured to interface with central body 200. On a distal end of first arm 102a is a blade attachment mechanism 122c for removably attaching and locking in place a corresponding blade. As seen in FIG. 5Aa locking mechanism 110 is located on extension 109 and may be rotated with a suitable tool to prevent first arm 102a from moving along lateral rack 202a. Locking mechanism 110 may be configured as a screw and include a recess which may be configured to mate with a tool such as a wrench or driver. A user may rotate locking mechanism 110, such as with a tool, to lock the position of first arm 102a on rack 202a. Locking mechanism 110 may also prevent pawl 112a (see FIGS. 9A and 9B) from moving along lateral rack 202a and / or stop pinion 107a from moving along lateral rack 202a.

[0077] Second arm 102b has the same or substantially the same structure and functionality as first arm 102a. Second arm 102b is shown in FIGS. 7A-8B. Second arm 102b may be a mirror image of first arm 102a from the perspective of central axis 197 as shown in FIG. 2A-B. Second arm includes knob 106b attached to pinion 107b, which may have the same or similar functionality as knob 106a and pinion 107a, respectively. Second arm 102b also includes blade attachment mechanism 123c, which has the same or similar functionality to blade attachment mechanism 122c. In addition, second arm 102b includes a relief 145 to provide clearance for secondary lateral rack 308a on first arm 102a. This clearance is helpful because, as best seen in FIG. 4, second arm 102b is longer than first arm 102b in this embodiment. This additional length is helpful such that secondary lateral racks 308a and 308bAttorney Docket No. A0013240W001may both be accommodated in central body 200, i.e., secondary lateral racks 308a and 308b do not interfere with one another.

[0078] It should be noted that first arm 102a and second arm 102b may vary in thickness between end 144a and end 144b. In the example embodiment, first arm 102a and second arm 102b are thicker in the transverse direction (from side 136a to side 136b) near elbow 101 than at ends 144a or 144b. This variation in thickness is to account for greater torsional forces in the vicinity of elbow 101 when the retractor system 100 is in operation.

[0079] First arm 102a and second arm 102b may each include a corresponding secondary lateral rack 308a and 308b, respectively, that is disposed on an opposite end of the corresponding arm from the blade attachment mechanism 122c, 122b. The secondary lateral racks 308a and 308b extend from a first end 144a of their corresponding arm towards central body 200 and are housed at least partially within central body 200 in apertures 209 (see FIGS. 14 and 15). At a second end 144b (see FIGS. 7A and 7B) are pivoting members 122a and 123a on first arm 102a and second arm 102b, respectively. In the embodiment shown in FIGS. 5A-5B, 6A-6B, 7A-7B and 8A-8B, secondary lateral racks 308a and 308b extend from their corresponding arm in a perpendicular or substantially perpendicular manner.

[0080] Still referring to FIGS. 5A-8B, pivoting members 122a and 123a will now be discussed in more detail. In various embodiments, the first and second arms 102a and 102b may be coupled to first and second pivoting members 122a and 123b at a second end 144b thereof, respectively. The first and second pivoting members 122a, 123b may be configured to operably couple to first and second blades, 10, 20, respectively, by a corresponding blade attachment mechanism 122c, 123 c as will be explained in more detail below. In the example embodiment, a first actuator 122b and a second actuator 123 b, which may also be referred to as angular actuators 122b, 123b, are configured to adjust the angulation of first blade 10 and second blade 10, respectively. For example, the first actuator 122b may be configured to actuate the first pivoting member 122a to adjust the angulation of first blade 10 with respect to the first arm 102a. Similarly, the second actuator 123b may be configured to actuate the second pivoting member 123a to adjust the angulation of second blade 20 with respect to second arm 102b. In the example embodiment, the first pivoting member 122a may be configured to independently adjust the angulation of first blade 10 with respect to the first arm 102a upon actuation of the first actuator 122b. Similarly, the second pivoting member 123a may be configured to independently adjust the angulation of the second blade 20 with respect to the second arm 102b upon actuation of the second actuator 123 b. In disclosed embodiments, the first and second pivotingAttorney Docket No. A0013240W001members 122a, 123a may each include a corresponding pin and socket mechanism enabling the pivoting members to pivot on a pin aperture 199 (see FIG. 35).

[0081] The pivoting members 122a, 123a may each include the same or similar components and features. For example, pivoting members 122a, 123a may each include a corresponding pin and socket mechanism. The pin and socket mechanism of pivoting members 122a, 123a may be adjustable by way of actuators 122b, 123 b such that an inclination of pivoting members 122a, 123 a may be independently adjustable with respect to arms 102a, 102b, respectively. In some embodiments, translation of actuators 122b, 123b may cause a corresponding element, such as an internal pin, set screw or the like, to urge pivoting members 122a, 123a to pivot outwards on a corresponding pin within a corresponding socket thereby enabling travel of pivoting members 122a, 123a inwards and outwards with respect to arms 102a, 102b, respectively. In some embodiments, pivoting members 122a, 123a may pivot outwards, for example, within a range of 0-25 degrees, and more particularly within a range of 0-15 degrees with respect to arms 102a, 102b.

[0082] The blade attachment mechanisms 122c, 123 c, may each include a groove portion or groove 143 having a geometry that facilitates secure engagement with a corresponding engagement feature lOe of one of blades 10, 20. In the embodiment shown, the grooves 143 of blade attachment mechanisms 122c and 123 c have a rectangular or substantially rectangular geometry. The blade attachment mechanisms 122c and 123 c, may have an indent portion on an inside surface thereof facilitating secure engagement with an outdent portion disposed on an outside surface of blades 10 and 20 respectively. In some embodiments, the grooves 143 of the blade attachment mechanisms 122c and 123 c, are tapered, and may for example be conically tapered, from one end to the other end to further securely retain blades 10 and 20. In other embodiments, the blade attachment mechanisms 122c and 123 c, may take alternate shapes, and have varying configurations provided that the shape thereof can securely engage with a corresponding one of blades 10, 20. For example, an indent such as a dovetail, square channel, hexagonal channel, or the like dimensioned to match to a corresponding outdent. Additionally, the blade attachment mechanisms 122c, 123 c may have an outdent portion (rather than an indent portion as illustrated) and blades 10, 20 may have an indent portion (rather than an outdent portion as illustrated).

[0083] First arm 102a and second arm 102b are configured to move linearly along the length of a corresponding lateral racks 202a and 202b (see FIGS. 2B, and 13-15) received within corresponding hollow apertures 103 of first arm 102a and second arm 102b, respectively. First arm 102a and secondAttorney Docket No. A0013240W001arm 102b are configured for both simultaneous movement and independent movement, as discussed further below. Each lateral rack 202a and 202b may include toothed portions 204 and 206 extending linearly on opposite transverse sides of lateral racks 202a and 202b. As seen in FIG. 13, toothed portion 206 may extend along an outside side surface and toothed portion 204 may extend along an interior surface so that each may mate with a corresponding and different pinion. In this way, each lateral rack 202a and 202b may include a first toothed rack portion and a second rack portion, e.g. 206, 204. As best seen in FIGS. 4B and 6B, respective hollow apertures 103 of first and second arms 102a and 102b are aligned along the length of first and second arms 102a and 102b with pinions 107a and 107b. Teeth of pinions 107a and 107b mesh with toothed portion 204 of lateral racks 202a and 202b. Pinions 107a and 107b are connected to knobs 106a and 106b and may be rotated by knobs 106a and 106b, respectively.

[0084] Independent movement of first arm 102a and second arm 102b will now be discussed. The mechanisms governing independent movement of arms 102a and 102b may be referred to as a first distraction mechanism (governing movement of first arm 102a) and a second distraction mechanism (governing movement of second arm 102b). First distraction mechanism may include lateral rack 202a, knob 106a and pinion 107a. Likewise, second distraction mechanism may include lateral rack 202b, knob 106b, and pinion 107b.

[0085] Lateral rack 202b may operate in the same, similar or substantially the same way as lateral rack 202a to effectuate movement of second arm 102b and blade 20. Accordingly, this description should be understood to apply to second arm 102b and its corresponding components. Teeth of pinion 107a may mesh with toothed portion 204 of lateral rack 102a. Rotation of pinion 107a causes first arm 102a to move along lateral rack 202a towards and away from central axis 197. For example, rotation of pinion 107a in a first direction, e.g., clockwise direction may cause first arm 102a, to move away from central axis 197 in direction dia(see FIG. 2A) within hollow aperture 103. Likewise, counterclockwise rotation of pinion 107a may cause first arm 102a to move towards central axis 197 in direction d2a (see FIG. 2A) within hollow aperture 103. In some embodiments clockwise rotation of pinion 107a may effectuate movement of first arm 102a towards central axis 197 in direction d2a and counterclockwise rotation of pinion 107a may effectuate movement of first arm 102a away from central axis 197 in direction dia. Motion of first arm 102a relative to central axis 197 causes blade 10 to move relative to central axis 197. This allows a user to adjust the width of the operative corridor formed by blades 10, 20. Pinion 107a may be rotated independently to adjust arm 201a independently of arms 102b and armAttorney Docket No. A0013240W001108. In some embodiments, one or more supplemental pinions 137 (see FIGS. 5A-5B, 6A-6B) may engage lateral rack 202a. The one or more supplemental pinions 137, which may be configured as rollers, pinions, sprockets, gears or other rotary mechanism, may reduce friction experienced by the lateral rack 202a during operation, e.g., friction between lateral rack 202a and pinion 107a may facilitate even distribution of the loads experienced by the lateral rack 102a during operation and minimize play of the blade 10.

[0086] Likewise, second arm 102b may be moved along lateral rack 202b away from central axis 197 in direction dib towards central axis 197 in direction d2b- This movement is accomplished via rotation of pinion 107b via knob 106b in the same or similar manner to that described above for first arm 102a.

[0087] In some embodiments, toothed portion 204 and pinions 107a and 107b may be configured so that precise adjustments in the positioning of first arm 102a and second arm 102b may be made by rotating their respective knobs 106a and 106b. For example, the tooth spacing or pitch of racks 202a and 202b may range from about 1mm to about 2mm. Additionally, the number of teeth on pinions 107a and 107b may be about 12 teeth to about 16 teeth.

[0088] In addition, because first arm 102a and second arm 102b are configured for independent movement finer adjustments of the operative corridor can be made. For example, one of the arms can be locked via its corresponding locking mechanism 110 (see FIG. 7A) while the other arm is independently adjusted. Once the desired position of one arm and its corresponding blade is achieved there is less of a risk of the arm and corresponding blade being moved out of its position due to a need to adjust the position of one of the other arms and blades. The level of precision and independent operation that can be achieved with making adjustments with the disclosed embodiments speeds up surgical workflows. First and second arms 102a and 102b are also capable of simultaneous movement, discussed later in relation to FIGS. 13-19 and 20A-20B.

[0089] Referring now to FIGS . 9A-9B, ratcheting features 112 of first arm 102a and second arm 102b will now be discussed in more detail. First arm 102a and second arm 102b each include a corresponding ratcheting feature 112. This feature will be discussed in relation to first arm 102a and it should be understood that this description also applies to second arm 102b. As illustrated, ratcheting feature 112 includes a pawl 112a that slides over (e.g., in and out) the teeth of toothed portion 206 as first arm 102a moves away from central axis 197. When pawl 112a is engaged with toothed portion 206 movement of first arm 102a towards central axis 197 is prevented because the pawl 112a is locked against one of the teeth of toothed portion 206. The ratcheting feature prevents inadvertent movementAttorney Docket No. A0013240W001of first arm 102a towards central axis 197 and it also resists the tendency for patient tissue to push against the blades and close the operative corridor. A biasing mechanism 112b, depicted in FIG. 9B, is housed inside of ratcheting feature 112. Biasing mechanism 112b includes a spring 112d and when spring 112d is in the biased or default position biasing mechanism 112b biases pawl 112a into contact with toothed portion 206. A user may apply a force to pawl 112a, such as by pulling lever 112c in direction di, to compress spring 112d of biasing mechanism 112b so that pawl 112a is moved out of contact with toothed portion 206. When pawl 112a is out of contact with toothed portion 206 arm 102a can move freely along rack 202a both towards and away from central axis 197 as opposed to movement being restricted to one direction, e.g., movement is naturally allowed away from central axis 197 but is restricted towards central axis 197. When a user releases the force on pawl 112a, spring 112d urges biasing mechanism 112b back into contact with toothed portion 206. Stated another way, in the neutral position pawl 112a allows expansion of the operative corridor but prevents contraction of the operative corridor and only allows contraction of the operative corridor with pawl 112a is moved out of contact with toothed portion 206.

[0090] The teeth of toothed portion 206 may be spur teeth (the teeth extend perpendicularly to the longitudinal direction of lateral rack 202a) or the teeth may be angled or helical (the teeth extend at an angle to the longitudinal direction of rack 202a). Pawl 112a may have an angle or shape so that it may slide over the teeth of toothed portion 206 when moving away for central axis 197 along the longitudinal length of lateral rack 202a and lock against the teeth of toothed portion 206 when moving towards central axis 197 along lateral rack 202a, for example.

[0091] Referring nowto FIGS. 10A-10B and FIG. 11, third arm 108 is shown. Third arm 108 is slightly curved and extends lengthwise between a first end 138 and a second end 139. Third arm 108 curves when extending in the lengthwise direction between first end 138 and second end 139. First side 136a is concave and a second side 136b is convex. A toothed integrated rack 115 extends along first side 136a. A slot 114 extends between first side 136a and second side 136b and runs partially concurrently with integrated rack 115. During operation of retractor system 100, third arm 108 is received in passageway 212 of central body 200 and slot 114 receives plate 213. In turn, plate 213 supports one or more screws 213a to stabilize third arm 108 within central body 200.

[0092] Plate 213 remains stationary when third arm 108 moves during operation of retractor system 100. The length of integrated rack 115 and slot 114 allow for third arm 108 to have a range of motion sufficient to move third arm 108 to a position along central axis 197 within passageway 212 withoutAttorney Docket No. A0013240W001interference from plate 213. In addition, slot 114 and integrated rack 115 are sufficiently sized so that blade 30 may be positioned as needed for various surgical procedures. In addition, third arm 108 may be moved so that third arm 108 is out of the way of first arm 102a and second arm 102b. This is particularly useful in spinal surgical procedures in which two blades are used as opposed to three blades. Two blade procedures may include procedures such as a prone trans psoas lateral interbody fusion and direct lateral inter body fusion (DLIF). Furthermore, the positioning marker 125 of third arm 108 can be used to position the retractor system 100 in two blade procedures as well as three blade procedures without obstructing the operative corridor when the third blade 30 is not in use.

[0093] A blade attachment mechanism 124c, is attached to first end 138. Third arm 108 has a positioning marker 125 configured as a cutout extending between top surface 131 and bottom surface 132 so as to form an aperture. Positioning marker 125 has a geometry (e.g., triangular) corresponding to and aligning with a cutout on blade attachment mechanism 124c. The positioning marker 125 is discussed in more detail below. On first end 138 upstream of blade attachment mechanism 124c is a mounting point 120. Mounting point 120 may be configured to attach table fixation device 600 (discussed in more detail in relation to FIG. 24) or other accessory component of the retractor system 100. For example, mounting point 120 may be outfitted with a screw 410 as shown in FIG. 26 configured to connect to a corresponding mounting point 120 on table fixation device 600. In the illustrated embodiment, mounting point 120 may be shaped like a circular washer with teeth.

[0094] Pivoting member 124a may include the same or similar structure as pivoting members 122a and 123 a, however, pivoting member 124a may have a slightly different shape or arrangement of its respective components compared to pivoting members 122a and 123 a. Pivoting member 124a may function in the same or similar manner as pivoting members 122a and 123a. For example, pivoting members 124a may include a corresponding pin and socket mechanism adjustable by way of angulator actuators 124b such that an inclination of pivoting member 124a may be independently adjustable with respect to arm 108. In some embodiments, translation of actuators 124b may cause a corresponding element, such as an internal pin, set screw or the like, to urge pivoting member 124a to pivot outwards on a corresponding pin 198 (see FIGS. 10A-B and 11) within a corresponding socket thereby effectuating the same or similar movement as pivoting members 122a and 123a.

[0095] In addition to the embodiments described above, there are various embodiments of blades and pivoting members known to those of skill in the art, such as those described in U.S. Patent Application Publication No. 2022 / 0387013 Al, which is hereby incorporated by reference in its entirety.Attorney Docket No. A0013240W001

[0096] Independent movement of third arm 108 will now be discussed. Mechanisms governing independent movement of third arm 108 may also be referred to as a third distraction mechanism. Third distraction mechanism may include integrated rack 115, knob 118, pinion 304a and pinion 304b. Pinion 304a and pinion 304b are shown in FIGS. 17-19 and 20A and 20B.

[0097] Pinion 304a is situated near integrated rack 115 and is housed within central body 200 so that it may contact or engage integrated rack 115. Knob 118 (shown in FIG. 2) is connected to pinion 304a by shaft 304b. Teeth of pinion 304a mesh with teeth of integrated rack 115 to move third arm 108 relative to central axis 197 when knob 118 is rotated. Rotation of knob 118 in a first direction moves third arm 108 and subsequently third blade 30 along central axis 197 in direction ds (away from first blade 10 and second blade 20). Rotation of knob 118 in a second direction moves third arm 108 and subsequently third blade 30 along central axis in direction d4 (towards first blade 10 and second blade 20). In some embodiments, the first direction of rotation of knob 118 is clockwise and the second direction is counterclockwise. In other embodiments the first and second directions may be counterclockwise and clockwise, respectively.

[0098] Integrated rack 115 and pinion 304a may be configured for precise movements of third arm 108. For example, integrated rack 115 may have a tooth spacing or pitch ranging from about 1 mm to about 2 mm. In addition, pinion 304a may have about 12 to about 16 teeth having a pitch of corresponding size to rack 115.

[0099] It should be noted that due to the curvature of third arm 108 and the curvature of passageway 212, third arm 108 moves within curved passageway 212 relative to central axis 197 but the trajectory of third arm 108 does not necessarily coincide entirely with central axis 197.

[0100] Referring now to FIG. 12, release mechanism 147 is shown. Release mechanism 147 is housed within central body 200. Release mechanism includes a tab 147a that is able to be manipulated by a user to engage and disengage pawl 146, e.g., by grasping, sliding over, depressing, or other actuation type movement. Situated near release mechanism 147 is pawl 146 and biasing mechanism 147b.Biasing mechanism 147b contacts pawl 146 and biases pawl 146 into contact with integrated rack 115. When pawl 146 is in contact with integrated rack, pawl 146 may freely slide over or in and out of the teeth of integrated rack 115 when third arm 108 moves in one direction relative to central axis 197, for example in direction d4 in FIG 2A as third arm 108 is distracted. Conversely, pawl 146 may lock against the teeth of integrated rack 115 when third arm 108 moves in another direction relative central axis 197, for example, in direction ds in FIG. 2A. This allows pawl to freely allow the movement ofAttorney Docket No. A0013240W001the third arm when performing a distraction type movement and to prevent the pressure applied by patient tissue from inadvertently closing the operative corridor. Teeth of integrated rack 115 may be spur teeth or helical teeth. When a user moves tab 146 in direction d2 biasing mechanism 147b moves into relief 141 (shown in FIG. 14) so that pawl 146 may be moved out of contact with integrated rack 115. When pawl 146 is out of contact with integrated rack 115, third arm 108 may move freely in both directions in relation to central axis 197 within passageway 212, as opposed to movement of third arm 108 being restricted to one direction when pawl 146 is engaged. Biasing mechanism 147b may include a spring (not shown) that biases pawl 146 back into contact with integrated rack 115 after a user has moved it out of contact.

[0101] Protruding upwardly from pawl 146 is an oblong extension 146a and a cylindrical extension 146b. Extension 146a and 146b are secured in apertures 256 and 257 of central body 200, respectively (see FIG. 16Aand 16B). Additionally, extension 146a secures tab 147a to pawl 146. Tab 147a sits outside of central body 200 under top cover 113a and extends partially outside of top cover 113a through an aperture or opening in top cover 113a.

[0102] Referring generally to FIGS. 13-19 and 20A-B, central body 200 and associated components will now be discussed. FIG. 13 illustrates how central body 200 houses a first push button 314 and a second push button 316 secured to central body via plate 230. First push button 314 and second push button 316 are coupled to pinion assemblies 301 and 302, respectively. First pinion assembly 301 includes pinion 301a and shaft 301b. Pinion 301a is coaxially aligned with shaft 301b and situated on top of shaft 301b. Second pinion assembly 302 includes pinion 320a and pinion 302b. Pinion 302a is coaxially aligned with pinion 302b and located on top of pinion 302b.

[0103] The first push button 314 and second push button 316 can each be toggled between an “engaged position” and an “disengaged position” to allow for simultaneous movement of arms 102a, 102b and 108 Regarding push button 314, when push button 314 is in the “engaged position,” pinion 301a aligns with toothed portions 309a-309b of secondary lateral racks 308a and 308b while shaft 304b is out of alignment with secondary racks 308a and 308b. When push button 314 is in the “disengaged position,” pinion 301a is out of alignment with toothed portions 309a-309b and shaft 304b is aligned with toothed portions 309a-309b. Regarding push button 316, when push 316 is in the “engaged position,” pinion 302a is aligned with toothed portions 309a-b of secondary lateral racks 308a and 308b and pinion 302b is aligned with pinion 303. When push button 316 is in the “disengaged position” pinion 302a is out of alignment with toothed portions 309a-b and pinion 302b isAttorney Docket No. A0013240W001in alignment with toothed portions 309a-b. In the “disengaged position,” pinion assembly 302 is out of contact with pinion 303. As explained in further detail below, pinions can move in and out of engagement at least partly because they are moveable up and down vertically and are biased by a spring.

[0104] First push button 314 allows for simultaneous movement of arms 102a and 102b independent of arm 108. Second push button 316 allows for simultaneous movement of all three arms 102a, 102b and 108 when it is engaged. The push buttons 314 and 316 include a corresponding recess 314a and 316a, respectively. The interior surfaces of recesses 314a and 316a, interior surfaces 314b and 316b, respectively, form a socket having a size and shape configured to mate with a tool such as a wrench. For example, interior surfaces 314b and 316b may form a hexagonal socket.

[0105] A user can toggle one of the push buttons 314 and 316 into the “engaged position” and then insert a corresponding tool (not shown) into one of recesses 314a and 316a to rotate one of pinion assemblies and 301 and 302 (discussed in more detail later herein) housed within central body 200 to simultaneously move two or three of the blades 10, 20, and 30 as discussed above. Central body 200 also includes a knob 118. Knob 118 is connected to a pinion 304a housed within central body 200 and allows for independent movement of third blade 30. Central body 200 also includes locking mechanism 111 which is configured to prevent third blade 30 from moving. Locking mechanism 111 may be configured as a set screw which may be configured to mate with a tool such as a wrench or driver. A user may rotate locking mechanism 111 to exert a force on third arm 108 sufficient to prevent movement of third arm 108 and subsequently blade 30. Therefore, third arm 108 may also be positioned and subsequently locked so that its position is not disturbed by the need to adjust blades 10 or 20.

[0106] Central body 200 incudes a passageway 212 for receiving third arm 108. Passageway 212 opens on a first end 211a of central body 200 and terminates at a second end 211b of central body. Passageway 212 may have an arcuate or curved shape that may correspond to an arcuate or curved shape of third arm 108.

[0107] Central body 200 also includes release mechanism 147 (discussed in relation to FIG. 12). As discussed previously, release mechanism also includes a tab 147a and a biasing mechanism 147b and a pawl 146 (shown in FIG. 12). Tab 147a extends outside of central body 200 via aperture 256 so that a user may grasp tab 147a. Central body 200 also includes a relief 141 for biasing mechanism 147b.Attorney Docket No. A0013240W001

[0108] Referring now to FIGS. 16A and 16B central body 200 is shown with various components removed for clarity and ease of understanding of the remaining components. FIG. 16A is a front perspective view of central body 200 and FIG. 16B is a back perspective view of central body 200. A first aperture 251 and a second aperture 252 for housing push buttons 314 and 316 and their associated pinion assemblies 301 and 302 are located on front face 253. First aperture 251 and second aperture 252 have a first diameter at their respective openings on front face 253. First aperture 251 and second aperture 252 have a second diameter that is smaller than the first diameter at their respective openings on back face 254. Also on front face 253 are holes 255 for receiving screws or fasteners to secure plate 213. Additionally, on front face 253 are apertures 256 and 257 for securing pawl 146 via extension 146a and extension 146b, respectively. Aperture 258 secures locking mechanism 111. Furthermore, there is extending through central body 200 aperture 265 for receiving shaft 304b of knob 118.

[0109] Apertures 209, which house secondary lateral racks 308a and 308b extend between sides 259 and 260. Passageway 212 extends through back face 254 from end 211a to end 211b. As illustrated, passageway 212 does not extend through front face 253. Near end 211a are cutouts 261 for plate 213 and holes 262 for receiving screws 213a. As illustrated, a mounting point 120 is integrated on side 211b of central body 200. Adjacent passageway 212 is cutout 263 for housing components of release mechanism 147. Additionally, extending partially through central body 200 from back face 254 are apertures 264 and 265 for accommodating pinion 303 and 304a, respectively. Aperture 264 includes an integrated axle 264a, which extends through the center of pinion 303. It is also seen that aperture 258 for locking mechanism opens on back face 254 as well as front face 253.

[0110] Each of the arms 102a and 102b includes a protrusion configured to interface with a corresponding slot 210 on central body 200. This interfacing of the protrusions 105 and the slots 210 ensures a secure mechanical fit, facilitating accurate alignment and secure structural engagement between the arms 102a and 102b and central body 200. The interfacing also minimizes play and undesired movement of the retractor system 100 during operation because the interface provides stability to the retractor system 100 as forces are experienced by various components of retractor system 100, such as central body 200, lateral rack 202a and lateral rack 202b when the knobs 106a, 106b and 118 are rotated and the blades 10, 20 and 30 are moved. Another advantage of the interface between the protrusions 105 and the slots 210 is that they enable the edges of blades 10, 20, and 30 to directly contact one another so that there are no gaps between the edges of the blades 10, 20, and 30Attorney Docket No. A0013240W001when the blades are in a “closed position” (see FIG. 34A) which also minimizes play and instability of the blades 10, 20 and 30 during insertion.

[0111] The mechanisms governing the simultaneous movement of first arm 102a and second arm 102b will now be discussed. These mechanisms may also be referred to collectively as a fourth distraction mechanism. Fourth distraction mechanism may include components such as secondary lateral racks 308a and 308b and pinion assembly 301.

[0112] A user enables simultaneous movement of first arm 102a and second arm 102b by toggling push button 314 into the “engaged position.” Push button 314 is coupled and coaxially aligned with pinion assembly 301. Pinion assembly 301 includes pinion 301a, which has teeth that engage first and secondary lateral racks 308a and 308b. Pinion assembly 301 also includes shaft 301b, which does not have teeth and is otherwise configured to not mesh with toothed portions 309a-b of secondary lateral racks 308a and 308b. Pinion assembly 301 is arranged so that when push button 314 is in the “engaged position” teeth of pinion 301a engage secondary lateral racks 308a and 308b. When push button 314 is in the “disengaged position” pinion 301a is biased out of engagement with first secondary lateral racks 308a and 308b. In the “disengaged position,” shaft 301b may sit between secondary lateral racks 308a and 308b while pinion 301a sits above shaft 301b. Because shaft 301b lacks teeth secondary lateral racks may move past pinion assembly 301 when push button 314 is in the “disengaged position” without simultaneous movement of first arm 102a and second arm 102b being effectuated upon rotation of pinion assembly 301, i.e., when individual movement is desired (through rotation of knobs 106a or 106b). When push button 314 is in the “engaged position” teeth of pinion 301a engage toothed portions 309a-b of secondary lateral racks 308a and 308b of first arm 102a and second arm 102b, respectively.

[0113] As shown in FIGS. 14-18 teeth on diametrically opposed sides of pinion 301a simultaneously engage toothed portions 309a-309b. A user may rotate pinion 301a by inserting a corresponding tool into recess 314a of push button 314 and the rotation of pinion 302a causes secondary lateral racks 308a and 308b to simultaneously move inward or outward of central body 200 relative to central axis 197. Because secondary lateral racks are connected to first arm 102a and second arm 102b, simultaneous movement of first arm 102a and second arm 102b and corresponding blades 10 and 20 is effectuated by rotation of pinion 301a. Pinion 301a may be rotated in a first direction to cause simultaneous movement of first arm 102a and second arm 102b away from central axis 197 and in a second direction to cause simultaneous movement of first arm 102a and second arm 102b towardsAttorney Docket No. A0013240W001central axis 197. In some embodiments the first direction may be clockwise and the second direction counterclockwise or vice versa.

[0114] A coil spring 305 (shown in FIGS. 19, 20A and 20B) is axially aligned with pinion 301a so that spring 305 is compressed and decompressed or biased when push button 314 is toggled between the “engaged position” and “disengaged position.” In some embodiments, when push button 314 is toggled into the “engaged position” spring 305 is compressed and pinion 301a moves so that the teeth of pinion 301a engage with secondary racks 308a and 308b. For example, pinion 301a may move linearly or vertically in a direction that is coaxially aligned with its central rotation axis. When push button 314 is toggled into the “disengaged position” spring 305 may bias pinion 301a so that its teeth are out of engagement with secondary lateral racks 308a and 308b thereby un-enabling the simultaneous movement capability of arms 102a and 102b At the time push button 314 is in the “engaged position,” push button 316 may be in the “disengaged position” so that teeth of pinion 302b engage secondary lateral racks 308a and 308b. Additionally, when push button 316 is in the “disengaged position,” teeth of pinion 302a may be out of engagement with secondary lateral racks 308a and 308b thereby preventing movement of third arm 108 simultaneously with first arm 102a and second arm 102b. In other embodiments, push button 314 may be configured so that spring 305 may cause teeth of pinion 301a to engage secondary lateral racks 308a and 308b when spring 305 biases pinion 301a and for teeth of pinion 301a to disengage from secondary lateral racks 308a and 308b when spring 305 is compressed.

[0115] Secondary lateral racks 308a and 308b and pinions 301a and 302a may be configured to allow precise simultaneous adjustments of first arm 102a and second arm 102b. For example, toothed portions 309a-309b of secondary lateral racks may have a tooth spacing or pitch ranging from about 1 mm to about 2 mm. In addition, pinions 301a and 301b may have about 12 to about 16 teeth.Additionally, simultaneous movement of the first arm 102a and second arm 102b is symmetrical and equidistant, i.e., upon movement of secondary lateral racks 308a and 308b via pinions 301a and / or 301b, first arm 102a and second arm 102b are adjusted in equal increments.

[0116] The mechanisms governing the simultaneous movement of arms 102a, 102b and 108 will now be discussed. These mechanisms may be referred to as fifth distraction mechanism, which may include secondary lateral racks 308a and 308b, pinion assembly 302, pinion 303, and pinion 304a.

[0117] Push button 316 is coaxially aligned with a spring 305 and may be toggled between an “engaged position” and an “disengaged position” in the same, similar or substantially the same mannerAttorney Docket No. A0013240W001as push buton 314. In addition, push buton 316 is connected to a pinion 302a of pinion assembly 302. A user enables simultaneous movement of arms 102a, 102b and 108 by toggling push button 316 into the “engaged position.” When push button 316 is in the “engaged position” teeth of pinion 302a engage toothed portions 309a-309b of secondary lateral racks 308a and 308b. While pinion 302a is engaged with secondary lateral racks 308a and 308b, teeth of pinion 302b engage with teeth of pinion 303. Teeth of pinion 303 engage teeth of pinion 304a, which engages integrated rack 115. A user may use a tool to rotate pinion 302a by way of recess 316a of push button 316 to move secondary lateral racks 308a and 308b (along with first arm 102a and second arm 102b) and third arm 108 so as to move blades 10 and 20 towards and away from central axis 197 and to move blades 30 forward and backward along central axis 197. When push buton 316 is in the “disengaged position” pinion 302b is situated out of engagement with pinion 303 so movement of third arm 108 is not effectuated upon rotation of pinion assembly 302. When push buton 316 is in the “disengaged position” pinion 302b may be engaged with secondary lateral racks 308a and 308b while pinion 302a is out of engagement with secondary lateral racks 308a and 308b.

[0118] The ability to adjust multiple blades of retractor system 100 simultaneously offers several advantages. It speeds up surgical workflows by reducing the time needed to reposition each blade individually, thereby enhancing efficiency during critical procedures. This synchronized adjustment also ensures more precise and uniform retraction, minimizing tissue trauma and improving the surgeon's visibility and access to the operative site. Additionally, it reduces manual effort, allowing the surgical team to focus on more critical aspects of the procedure.

[0119] Referring back to FIGS. 5A-8B, 10A-10B and 11, positioning features or markers of retractor system 100 will now be discussed. On each of the first and second arms 102a and 102b are one or more positioning markers 130 that can be used by a user, such as a surgeon to align the retractor system 100. For example, two positioning markers 130 can be used to ensure retractor system 100 and blades 10, 20, and 30 are properly oriented in and around the target surgical site. The positioning markers 130 may be configured as protrusions extending from first and second arms 102a and 102b. In the embodiment shown in FIGS. 5A-8B the positioning markers are configured as having one or more triangular faces i.e., are configured to have a pyramidal geometry.

[0120] There is also a positioning marker 125 (see FIGS 10A-B and 11) on blade attachment mechanism 124c of third arm 108. Positioning marker 125 is configured as a cutout in a surface of third arm 108. In the embodiment shown positioning marker 125 is a cutout extending through thirdAttorney Docket No. A0013240W001arm 108 from top surface 131 to bottom surface 132 so that a user may see through the positioning marker 125 when the retractor system 100 is positioned properly, e.g., flat or level. This configuration makes positioning marker 125 suitable as a level marker as well as a positioning marker. If the retractor system 100 is level the user or surgeon can see through positioning marker 125 and if retractor system 100 is not level the user or surgeons view through positioning marker 125 may appear obstructed. In alternative embodiments, positioning marker 125 can be on blade attachment mechanisms 122c and 123 c in addition to blade attachment mechanism 124c.

[0121] The one or more positioning markers 125 and 130 may be used in conjunction with an imaging system (not shown). Images of patient anatomy rendered by the imaging system can be used to align the one or more positioning markers with the patient anatomy, e.g., the posterior aspect of the spine.

[0122] There may also be one or more bubble markers, level markers, aerated indicator or gas-filled indicators (not shown) on retractor system 100, e.g., on the first and second arms 102a and 102b or central body to allow a user or surgeon to ensure the retractor system 100 is level.

[0123] Proper alignment of the retractor system 100 ensures the blades 10, 20 and 30 are aligned correctly with patient anatomy, e.g., the third blade 30 is properly aligned with the posterior element of the spine.

[0124] FIGS. 21 and 22 depict an embodiment of a supplemental blade support 500. Support 500 includes an elongate body 503 having a first slot 501 and a second slot 502. In the embodiment shown in FIG. 21, first slot 501 and second slot 502 are of different geometries. In alternative embodiments, first slot 501 and second slot 502 may be of identical geometries or the respective geometries of each of first and second slot may be the reverse of what is illustrated. First slot 501 and second slot 502 at least partially circumscribe blade release button 133a and second blade release button 133b (see FIG.1), respectively. In this manner support 500 is supported on retractor system 100. Attached to support 500 in between first slot 501 and second slot 502 is blade support 505. Support 500 also includes an extension 506 having a first portion 506a and a second portion 506b. First portion 506a extends perpendicularly or substantially perpendicularly to elongate body 503. Second portion 506b extends from first portion in a direction parallel or substantially parallel to elongate body 503. Extension 506 may stabilize support 500 when supported on retractor system 100 and / or facilitate handling of support 500. Support 500 may maintain the relative positioning of blade 10 and blade 20.

[0125] Blade support 505 is configured to receive supplemental blade 504. Supplemental blade 504 can be secured to blade support 505 by fitting prongs 507a and 507b of supplemental blade 504 intoAttorney Docket No. A0013240W001grooves 508a and 508b of blade support 505. Prongs 507a-b and grooves 508a-508b may interlock via friction fit, clearance fit or interference fit, for example. When in position on blade support 505 the supplemental blade 504 can be inserted into the operative corridor formed by blades 10, 20 and 30 wherever it is desired. Supplemental blade 504 may be particularly advantageous for preventing and / or addressing tissue creep.

[0126] Blade support 505 and supplemental blade 504 have the potential to speed up surgical workflows. Due to the configuration and interchangeability of the components an additional blade can be added to the retractor system 100 quickly. In addition, securing blade 504 to blade support 505 does not require any additional tools such as fasteners or a wrench and, therefore, further promotes speed and simplicity.

[0127] Referring now to FIG. 23, curved support 700 is shown. Curved support 700 may be used in addition to or in place of support 500 to support supplemental blade 504 on retractor system 100. Curved support 700 includes a curved arm 707 having a ridged portion 706 and a slot 705. Attachment 703 is configured to move longitudinally along ridged portion 706 within slot 705. Attachment 703 is configured to receive blade support 505 (see FIGS. 21 and 22) in slot 704 and to securely hold blade support 505 and supplemental blade 504 when supplemental blade 504 is attached to blade support 505, as described previously. A user can slide attachment 703 along ridged portion 706 to adjust the relative position of supplemental blade 504 relative to blades 10, 20, and 30. Knob 702 is located on curved arm 707 at connecting end 701 and may be rotated to attach curved support 700 to retractor system 100. Connecting end 701 may be aligned and attached with any of slots 104. The curved geometry of curved arm 707 allows attachment 703 to support supplemental blade 504 between blades 10 and 20, for example, while curved arm 707 does not obstruct the operative corridor formed by blades 10, 20, and 30.

[0128] Referring now to FIG. 24, a table fixation device 600 is shown. The table fixation device may connect to any one of the mounting points 120 described previously and to a surgical table, e.g., by clamping, in order to secure the retractor system 100 to the surgical table. The mounting points 120 on retractor system 100 may be configured as apertures having threads, e.g., on an interior surface corresponding to screw 410. An example of a table fixation device 600 is shown in FIG. 20. Table fixation device 600 is described only for illustrative purposes. Other types of table fixation devices known to a person of skill in the art are contemplated. Accordingly, table fixation device 600 will only be briefly described. Table fixation device extends between a first end 603 and a second end 610.Attorney Docket No. A0013240W001Table fixation device 600 includes coupling device 601, first link 604, second link 607, and third link 609. On first end 603 is coupling device 601. Coupling device 601 adjoins a first link 604 via ball and socket joint 602. Ajuncture 606 joins first link 604 to second link 607. Second link 607 adjoins third link 609 via a ball and socket joint 608. Third link 609 terminates in second end 610. A clamping device 611 is located on third link 609 at second end 610. Clamping device 611 clamps to a surgical table so that retractor system 100 may be secured to a surgical table. On coupling device 601 and juncture 606 are one or more knobs 605 for adjusting components of the table fixation device 600.

[0129] As is seen in FIG. 25 A and 25B, a curved arm 400 connects the table fixation device to the mounting points 120. Curved arm 400 has a mounting point 409 on a first end 403 that is configured to make a secure or hard connection with any of the mounting points 120 on retractor system 100. For example, mounting point 409 of curved arm 400 may be welded to screw 410 and screw 410 may be threaded into mounting points 120 on retractor system 100. In alternative embodiments, screw 410 may be connected threadedly to both mounting point 120 on curved arm 400 and any one of the mounting points 120 on retractor system 100. In other embodiments, the mounting points 120 on retractor system 100 and mounting point 409 on curved arm 400 may be connected via a fastener other than a screw and thread mechanism.

[0130] Curved arm includes a connector 411 on second end 403. Connector 411 has an elongate portion 402, which may be cylindrical or barrel shaped and a conical portion 401, which may be cone shaped or tapered. The geometry of connector 411 is configured to mate with a corresponding aperture on a coupling device 601 of table fixation device 600 and to form a secure connection with table fixation device 600. For example, connector 411 and coupling device 601 may be connected via friction fit, threading, a detent and indent mechanism or any other suitable means.

[0131] As shown in FIG. 26, screw 410 may have a first threaded end 412a and a second threaded end 412b separated by a neck 413. Neck 413 may have a smaller diameter than first end 412a and second end 412b. A pin hole 408 allows a pin 414 to be inserted in mounting point 120 adjacent screw 410 in order to stabilize screw 410. Pin 414 may fit inside neck 413 in order to stabilize screw 410.

[0132] Referring now to FIGS. 27A-27B a mounting point 120 is shown. Mounting point 120 has a first ridged surface 134a and a second ridged surface 134b. On an interior mounting point 120 also has a threaded surface 135, which may engage with a screw or other fastener e.g., screw 410. The mounting points 120 and curved arm 400 provide the user flexibility in connection of the curved arm 400 to the retractor system 100. For example, the user can connect the curved arm 400 to an inferiorAttorney Docket No. A0013240W001side of retractor system 100 or to a superior side of retractor system 100. This flexibility in connection also enables a user to connect the table fixation device to various portions of a surgical table, such as to a top surface of the surgical table or to a bottom surface the surgical table as may be needed depending on the circumstances.

[0133] Referring to FIGS. 28A-28B and 29, an example first blade 10 and second blade 20 are illustrated. It shall be understood that the foregoing description is described with respect to first blade 10 but the characteristics of first blade 10 may apply to second blade 20. Moreover, although first blade 10 is illustrated as a relatively long and narrow curved blade it can take any shape suitable for any particular type of surgical application. Indeed, it is contemplated that retractor system 100 is suitable for a multitude of different blades having different lengths, widths, and cross-sectional shapes thereof that can couple and uncouple to secondary blades, tools, horizontally extending shims and vertically extending shims. For example, relatively shorter and wider blades having generally planar surfaces are contemplated. Furthermore, first blade 10 may feature any number or type of secondary coupling members where shims, for example, may couple thereto. In at least one embodiment, blade 10 may have a relatively narrow portion at one end and fan out to a relatively wider portion at the opposite end, i.e., the blade 10 may have a width that increases along the length thereof from one end to the other end. Additionally, blade 10 may include channels, grooves, indents, outdents, etc. for fixation of secondary members such as shims, light fixtures other diagnostic tools such as endoscopes, electrodes, temperature sensors, suction devices, and etc.

[0134] In the example embodiment, blade 10 has a proximal side 10a, a distal side 10b opposite the proximal side 10a, an exterior surface 10c and an inside surface lOd opposite the exterior surface 10c. The proximal side 10a may be operably coupled to a distal end of pivoting member 122a via an engagement feature lOe disposed on the exterior surface 10c of blade 10, for example. Running from proximal side 10a to distal side 10b on opposite sides of interior surface lOd are edges 10g and lOh. In some embodiments, blade 10 may include an elastic material allowing it to deflect at least partially. Additionally, in some embodiments a blade removal instrument may be required to install and / or remove blade 10 from a blade attachment mechanism.

[0135] In the disclosed embodiment, engagement feature lOe is the outdent portion of a groove, i.e., the dovetail. In other embodiments, engagement feature lOe may be a lap joint, tongue and groove type joint, a doweled butt joint, etc. Blade 10 may have an aperture lOf for running a diagnostic tool such as an electrode or endoscope therethrough. In some embodiments, blade 10 may be conductiveAttorney Docket No. A0013240W001such that it may communicate with an external diagnostic tool (not illustrated). In some embodiments the aperture lOf may retain a pin or probe (not shown). In at least one embodiment, the pin or probe may securely attach to a vertebra of a patient’s spine by socketing into the vertebrae or screwing into the vertebrae or docking with the disc space. In some embodiments, the pin may be a conductive pin having a sensor at a distal end thereof or pin may be a hollow pin that houses electrical components and wiring therein. In other embodiments the pin is purely mechanical in nature. For example, blades may include a conductive material such as a metal like copper and be conductive and / or have terminals for electrical conduction between conductive pads placed external to retractor system 100. In some embodiments, blade 10 may include partially conductive features, e.g., a semiconductor and / or other passive electrical devices such as resisters, diodes, and etc. In other embodiments, blade 10 may be an insulator such that it does not interfere with electrical signal processing of the aforementioned electrical devices.

[0136] Referring to FIGS. 30A-30B and 31, blade 20 is a mirror image of blade 10 from the perspective of either edge 10g and / or lOh. Therefore, the blade 20 should be understood to have the same or substantially the same components as blade 10. Blade 20 has a proximal side 10a and a distal side 20b. Exterior surface 20c and interior surface 20d correspond to exterior surface 10c and interior surface lOd, respectively. An engagement feature 20e is on proximal side 20a and corresponds to engagement feature 1 Oe. Aperture 20f corresponds to aperture 1 Of. Edges 20g and 20h correspond to edges 10g and lOh, respectively.

[0137] Referring now to FIGS. 32A-32B and 33A-33B, an example embodiment of a blade 30 is shown. Blade 30 includes a proximate side 30a, a distal side 30b opposite the proximate side, an exterior surface 30c and an inside surface 30d opposite the exterior surface 30c. The proximate side 30a may be operably coupled to a distal end of pivoting member 124a, for example, by disposing engagement feature 30e into groove 151 (see FIGS. 10A-B and 11). In some embodiments, blade 30 may include an elastic material allowing it to deflect at least partially. Additionally, in some embodiments a blade removal instrument may be required to install and / or remove blade 30 from a blade attachment mechanism.

[0138] As is seen best in FIG. 33A, blade 30 includes a shim 32 housed inside blade 30 along interior surface 30d. Shim 32 may be secured to blade 30 by fitting into one or more slots or grooves on interior surface 30d. Shim 32 extends beyond distal side 30b. Shim 32 may be a discal shim and may be pre-loaded on blade 30 or inserted into blade 30 at the time of a surgical procedure. It should beAttorney Docket No. A0013240W001noted that blades 10 and 20 may include the same or similar shims. Shims and associated procedures are disclosed in U.S. Provisional Patent Application No. 63 / 557,124, which is hereby incorporated by reference in its entirety.

[0139] Blade 30 may have an aperture 30f for running a diagnostic tool such as an electrode, endoscope, pin or probe (not shown) there through, like those discussed in relation to blades 10 and 20. In some embodiments, blade 30 may be conductive such that it may communicate with an external diagnostic tool (not illustrated).

[0140] Located on interior surface 30d is aperture 35. Aperture 35 may extend through one or more of interior surface 30d and exterior surface 30c. In the embodiment shown aperture 35 extends from interior surface 30d through engagement feature 30e. Aperture 35 can be said to open on both interior surface 34d and exterior surface 30c. Also, on interior surface 30d at distal side 30b is aperture 34. Aperture 34 may extend through one or more of interior surface 30d and exterior surface 30c. In the embodiment shown, aperture 34 extends through exterior surface 30c but does not extend through interior surface 30d i.e., aperture 34 opens on exterior surface 30c but not interior surface 30d.

[0141] Blade 30 includes an aperture 30f, which may be the same or similar to aperture lOf on blades 10 and 20. Aperture 30f may receive a probe or pin (not shown). Aperture 30f may form a slot 33 in communication with aperture 35 on interior surface 30d and / or aperture 34 on exterior surface 30c. One or more portions of a probe may be exposed to the interior or exterior of blade 30. For example, a conductive tip of a probe can align with aperture 34 when received in aperture 3 Of.

[0142] Referring to FIGS. 34A-34B and FIG. 35 various orientations of blades 10, 20, and 30 that may be adopted by moving arms 102a, 102b, and 108 are shown. FIG 34A depicts blades 10, 20, and 30 in a “closed position,” i.e., blades 10, 20, and 30 form a closed perimeter circumscribing the operative corridor. The closed perimeter may be defined entirely by the blades 10, 20, and 30 or by the blades 10, 20, and 30. Alternatively, the closed perimeter may be defined by blades 10, 20, and 30 and other components of retractor system 100, e.g., dilator 91. FIG. 34B shows blades 10, 20, and 30 in an “open position,” i.e., spaced apart from one another. FIG. 35 shows blades 10, 20, and 30 at relative angles to one another by operating actuators 122b, 123b, and 124b, as discussed previously. The depicted configurations are examples.

[0143] Referring generally to FIGS. 36-39 various dilators for use with retractor system 100 are illustrated. FIG. 36 is a perspective view of a plurality of nested dilators in a non-nested configuration. In the example embodiment, two dilators are illustrated having progressively increasing sizing.Attorney Docket No. A0013240W001Dilators 81 and 82 are depicted as having circular cross-sections. However, cross-sections of different shapes are contemplated, such as oval or elliptical. A first dilator 81 may have an outside perimeter having a circular shape and a relatively narrow diameter for initiating a dilation process. As shown in FIG. 36, dilator 81 has a cylindrical outer surface 81a. An outside perimeter of the second dilator 82 may also have a circular and a cylindrical outer surface 82a, or, alternatively it may have an oval or elliptical shape. An inside diameter of second dilator 82 may have a circular-like shape or other shape corresponding to the shape of the outer diameter of first dilator 81.

[0144] FIG. 37 is a top view of the plurality of nested dilators in a nested configuration within the operative corridor formed by blades 10, 20 and 30. Two dilators are illustrated in the nested configuration, however, more or fewer dilators are contemplated. Blades 10, 20 and 30 are in the “closed position”. Edges lOh and 10g of blades 10, 20 and 30 may contact, nearly contact or abut one another when the dilators 81 and 82 are in place in the operative corridor. Interior surfaces lOd, 20d and 30d may correspond to outer surface 82a of dilator 82 so as to contact or nearly contact outer surface 82a. Protrusions 105 on arms 102a and 102b and slots 210 on central body 200 facilitate the edges of blades 10, 20 and 30 contacting, nearly contacting or abutting one another. In various embodiments, the dilators may be successively nested within one another to dilate a patient tissue before use of retractor system 100.

[0145] FIG. 38 shows a perspective view of another embodiment of a dilator, dilator 91. It is seen that the outside circumferential surface of dilator 91 has a plurality of ribs or rail portions 92 that extend down its length in a proximal to distal direction. The embodiment of dilator 91 shown has two rail portions disposed at different locations around the circumference of dilator 91. Rail portions 92 may begin at a point along the length of dilator 91 e.g., one third down the length of dilator 91 in the proximal to distal direction. The rail portions 92 may be a prism formed of cross sections. For example, rail portions 92 in the embodiment shown are formed from cross sections 92a, 92b, 92c and 92d, which extend from dilator 91. In the embodiment shown, cross sections 92a and 92b taper in the proximal to distal direction. Rail portions 92 may be configured so as to accommodate one of the blades disclosed herein. For example, cross sections 92a, 92b, 92c and 92d may be configured so that edges 21 h and 21g of blade 30 he flush with cross sections 92a and 92b so that the interfaces between edges 21h and 21g and cross section 92a and 92b are free of gaps.

[0146] In addition to the embodiments disclosed herein, there are various embodiments of dilators known to those of skill in the art, such as those described in U.S. Patent Application Publication No.Attorney Docket No. A0013240W0012022 / 0387013 Al and U.S. Patent Application Publication No. 2024 / 0065680 Al and which are hereby incorporated by reference in their entirety.

[0147] FIG. 40 depicts an example method 1000 of use of a retractor system 100. Although retractor system 100 may be used to perform the method 1000, the method of operation is not limited to retractor system 100. Furthermore, the following steps need not be performed in sequence and can be performed in any alternate sequence with or without all of the disclosed method steps.

[0148] In a first step 1001, a surgeon or user may prepare retractor system 100. This may include sterilizing retractor system 100 and associated components, positioning and orienting retractor system 100 relative to a patient, attaching one or more blades or other associated components to retractor system 100 and securing retractor system 100 to a surgical table. For example, the retractor system 100 may be oriented in a plane parallel to the surgical table, such as during DLIF or other procedures in which the patient is in the lateral decubitus position. Alternatively, the surgeon may orient the retractor system 100 in a plane perpendicular to the surgical table, such as during procedures in which the patient is in the prone lateral position.

[0149] In a second step 1002, a surgeon may insert an initial dilator or pin, e.g., dilator 81 into the surgical site. In some embodiments, and depending on the particular surgical approach dilator 81 may be inserted into a patient from a lateral, anterior, or trans psoas approach. Once the dilator 81 is inserted in the surgical site of the patient, in a third step 1003, a dilator having a relatively wider size may be inserted over the dilator 81, e.g., dilator 82. After dilator 82 is slipped over initial dilator 81, any number of successive and iteratively increasing in size dilators may be slipped over one another in this process. The outermost or last inserted dilator may have one or more rail portions 92 (see dilator 91 in FIG. 38).

[0150] In a fourth step 1004, a surgeon may position retractor system 100 over the outermost dilator. For example, a surgeon may install a first blade and a second blade to arms 102a and 102b, respectively. In some procedures, a surgeon may attach a third blade to third arm 108. Alternatively, in two-blade procedures, a surgeon may refrain from attaching a third blade to third arm 108 and move third arm 108 away from blades the first blade and second blade to the extent slot 114 and integrated rack 115 will allow. The blades may be placed in a “closed position” (see FIG. 34Afor three blades and FIG. 39 for two blades) such that edge portions contact one another and a circular void space is formed by the interior surfaces of the blades. Next, the surgeon may slip the blades over the outermost dilator as shown in FIG. 37 or FIG. 38, for example, such that the blades slide down along the lengthAttorney Docket No. A0013240W001of outermost dilator and into the surgical site to form an operative corridor. At step 1005, once the surgeon has moved the blades into the surgical site, and the blades are supporting adjacent tissue, the surgeon may remove the outermost dilator. After the outermost dilator has been removed, the surgeon can freely manipulate any one of the blades in any manner or relative movement as previously explained to enlarge the operative corridor. For example, the surgeon may manipulate one or more of the blades independently by rotating knobs 106a, 106b and 118. The surgeon may also manipulate two or three blades simultaneously by rotating push button 314 and / or push button 316.

[0151] It should be understood that various aspects disclosed herein may be combined in different combinations than the combinations specifically presented in the description and accompanying drawings. For example, features, functionality, and components from one embodiment may be combined with another embodiment and vice versa unless the context clearly indicates otherwise. Similarly, features, functionality, and components may be omitted unless the context clearly indicates otherwise. It should also be understood that, depending on the example, certain acts or events of any of the processes or methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques).

[0152] Unless otherwise specifically defined herein, all terms are to be given their broadest possible interpretation including meanings implied from the specification as well as meanings understood by those skilled in the art and / or as defined in dictionaries, treatises, etc. It must also be noted that, as used in the specification and the appended claims, the singular forms "a," "an" and "the" include plural referents unless otherwise specified, and that the terms "comprises" and / or "comprising," when used in this specification, specify the presence of stated features, elements, and / or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and / or groups thereof.

[0153] Terms such as “same,” “equal,” “planar,” “coplanar,” “parallel,” “perpendicular,” etc. as used herein are intended to encompass a meaning of exactly the same while also including variations that may occur, for example, due to manufacturing processes. The term “substantially” may be used herein to emphasize this meaning, particularly when the described embodiment has the same or nearly the same functionality or characteristic, unless the context or other statements clearly indicate otherwise. Additionally, it shall be understood that the term “about” encompasses a variation of at least + / - 10% from the example values provide herein.Attorney Docket No. A0013240W001

[0154] The various embodiments described above are provided by way of illustration only and should not be construed to limit the claims attached hereto. Those skilled in the art will readily recognize various modifications and changes that may be made without following the embodiments and applications illustrated and described herein, and without departing from the true spirit and scope of the claims.

[0155] The techniques of this disclosure may also be described in the following examples.

[0156] Example 1 : A retractor system for enabling access to a surgical site, comprising: a central retractor body; a first arm extending from a first side of the central retractor body and being configured to support a first blade coupled to a distal end thereof; a second arm extending from a second side of the central retractor body opposite the first side and having a second blade coupled to a distal end thereof; a first rack-based distraction mechanism including a first rack and a first actuator, the first rack-based distraction mechanism being configured to independently move the first arm along the first rack along a first path of motion when the first actuator is rotated; a second rack-based distraction mechanism including a second rack and a second actuator, the second rack-based distraction mechanism being configured to independently move the second arm along the second rack along a second path of motion when the second actuator is rotated; and a third rack-based distraction mechanism including a third rack, a fourth rack, and a third actuator, the third rack-based distraction mechanism being configured to simultaneously move the first arm and the second arm along the first path of motion and the second path of motion, respectively, when the third actuator is rotated.

[0157] Example 2: The retractor system of example 1, wherein: the first rack-based distraction mechanism further comprises a first pinion coupled to the first actuator, wherein teeth of the first pinion mesh with the first rack; the second rack-based distraction mechanism further comprises a second pinion coupled to the second actuator, wherein teeth of the second pinion mesh with second rack; and the third rack-based distraction mechanism further comprises a third pinion coupled to the third actuator, wherein the third rack-based distraction mechanism is configured to independently move between an engaged position and a disengaged position, and wherein when in the engaged position, the teeth of the third pinion mesh with the third rack and fourth rack.

[0158] Example 3: The retractor system of any one of examples 1 through 2, further comprising: a third arm extending through the central retractor body between the first arm and the second arm, the third arm being configured to support a third blade coupled to a distal end thereof; a fourth rack-based distraction mechanism including a fifth rack and a fourth actuator, the fourth rack-based distractionAttorney Docket No. A0013240W001mechanism being configured to independently move the third arm along a third path of motion when the fourth actuator is rotated; and a fifth rack-based distraction mechanism including a fifth actuator slidably engagable to the third rack, the fourth rack, and the fifth rack, the fifth rack-based distraction mechanism being configured to simultaneously move the first arm, the second arm, and the third arm along the first path of motion, the second path of motion, and the third path of motion, respectively, when the fifth actuator is engaged and rotated.

[0159] Example 4: The retractor system of example 3, further comprising a dilator received within a blade perimeter, the blade perimeter defined by the first blade, the second blade and the third blade, the dilator having an outer surface corresponding to a corresponding inner surface of each of the first blade, the second blade, and the third blade so that when the retractor is in a closed position, the first blade, the second blade, and the third blade form a contiguous perimeter.

[0160] Example 5: The retractor system of any one of examples 3 through 4, wherein the fifth rack is integrally formed with the third arm and the third path of motion of the third arm is an arcuate path of motion.

[0161] Example 6: The retractor system of any one of examples 3 through 5, wherein: the first rackbased distraction mechanism further comprises a first pinion fixed to the first actuator, wherein teeth of the first pinion mesh with the first rack; the second rack-based distraction mechanism further comprises a second pinion fixed to the second actuator, wherein teeth of the second pinion mesh with second rack; the third rack-based distraction mechanism further comprises a third pinion fixed to the third actuator, wherein the third rack-based distraction mechanism is configured to independently move between an engaged position and a disengaged position, and wherein when in the engaged position, the teeth of the third pinion mesh with the third rack and the fourth rack; the fourth rackbased distraction mechanism further comprises a fourth pinion fixed to the fourth actuator, wherein teeth of the fourth pinion mesh with the fifth rack; and the fifth rack-based distraction mechanism further comprises a fifth pinion fixed to the fifth actuator, wherein the fifth rack-based distraction mechanism is configured to independently move between an engaged position and a disengaged position, and wherein when in the engaged position, the teeth of the fifth pinion mesh with the third rack and fourth rack.

[0162] Example 7: The retractor of example 6, wherein the fifth rack- based distraction mechanism further comprises a sixth pinion disposed proximate to the fifth pinion; and wherein the fourth rackbased distraction mechanism further comprises a seventh pinion engaged with the fourth pinion,Attorney Docket No. A0013240W001wherein when the fifth rack-based distraction mechanism is in the engaged position, the teeth of the sixth pinion mesh with the teeth of the seventh pinion to thereby couple the fifth rack-based distraction mechanism to the fifth rack.

[0163] Example 8: The retractor system of any one of examples 1 through 7, further comprising one or more rollers engaged with each of the first rack and the second rack, the one or more rollers being configured to stabilize movement of the first arm and the second arm along the first path of motion and second path of motion, respectively.

[0164] Example 9: The retractor system of any one of examples 1 through 8, further comprising a first protrusion on the first arm and a second protrusion on the second arm, wherein the first protrusion and the second protrusion are configured to mate with a first slot and a second slot on the central retractor body, respectively, to stabilize one or more components of the retractor system upon movement of at least one of the first arm and the second arm.

[0165] Example 10: The retractor system of any one of examples 1 through 9, further comprising one or more locking mechanisms on at least one of the first arm and the second arm and being configured to restrict movement of at least one of the first arm and the second arm.

[0166] Example 11: The retractor system of any one of examples 1 through 10, further comprising one or more mounting points on one or more components of the retractor system, the one or more mounting points comprising a threaded surface and configured to engage with a fastener of an accessory component to the retractor system.

[0167] Example 12: The retractor system of example 11, wherein the one or more mounting points are configured to couple the accessory component to a top or a bottom side of the retractor system.

[0168] Example 13: The retractor system of any one of examples 1 through 12, wherein the first blade and the second blade are each configured to be coupled to the first arm and the second arm, respectively, by way of a corresponding pivoting member and wherein each of the corresponding pivoting members include a corresponding angular actuator configured to adjust an angulation of the corresponding pivoting member by rotating the corresponding pivoting member about a corresponding pivot point.

[0169] Example 14: The retractor system of example 13, further comprising a supplemental blade support coupled to at least one of the first arm and the second arm and configured to hold a supplemental blade.Attorney Docket No. A0013240W001

[0170] Example 15: The retractor system of example 14, wherein the supplemental blade support is coupled to at least one of the first arm and the second arm by way of the corresponding pivoting members attached thereto.

[0171] Example 16: The retractor system of any one of examples 14 through 15, wherein the supplemental blade support further comprises a curved arm having a groove portion and an attachment, wherein the attachment includes a slot configured to receive the supplemental blade and wherein the curved arm is configured to be coupled to at least one of the first arm and the second arm.

[0172] Example 17: The retractor system of any one of examples 1 through 16, further comprising a dilator received within a blade perimeter defined by the first blade and the second blade, the dilator having an outer surface corresponding to a corresponding inner surface of the first blade and the second blade and one or more ribs, wherein the first blade and the second blade and the one or more ribs of the dilator form a closed perimeter when the retractor system is in a closed position.

[0173] Example 18: The retractor system of any one of examples 1 through 17, further comprising a probe having a conductive tip, wherein the probe extends in a longitudinal direction beyond the distal end of at least one of the first blade and the second blade.

[0174] Example 19: A method of using a retractor system, the method comprising: preparing the retractor system of clause 1 ; inserting a first dilator and a second dilator into a surgical site; inserting the a first blade and the second blade over the first dilator and the second dilator into the surgical site; independently adjusting at least one of the first blade and the second blade by moving a first arm along a first rack; and simultaneously adjusting the first blade and a second blades by moving the first arm and a second arm along the first rack and a second rack, respectively.

[0175] Example 20: The method of example 19, further comprising simultaneously adjusting the first blade, the second blade and a third blade by moving the first arm, the second arm and a third arm along the first rack, the second rack and a third rack, respectively.

Claims

Attorney Docket No. A0013240W001WHAT IS CLAIMED IS:

1. A retractor system (100) for enabling access to a surgical site, comprising:a central retractor body (200);a first arm (102a) extending from a first side of the central retractor body and being configured to support a first blade (10) coupled to a distal end thereof;a second arm (102b) extending from a second side of the central retractor body opposite the first side and having a second blade (20) coupled to a distal end thereof;a first rack-based distraction mechanism including a first rack (202a) and a first actuator (106a), the first rack-based distraction mechanism being configured to independently move the first arm along the first rack along a first path of motion when the first actuator is rotated;a second rack-based distraction mechanism including a second rack (202b) and a second actuator (106b), the second rack-based distraction mechanism being configured to independently move the second arm along the second rack along a second path of motion when the second actuator is rotated; anda third rack-based distraction mechanism including a third rack (308a), a fourth rack (308b), and a third actuator (314a), the third rack-based distraction mechanism being configured to simultaneously move the first arm and the second arm along the first path of motion and the second path of motion, respectively, when the third actuator is rotated.

2. The retractor system of claim 1 , wherein:the first rack-based distraction mechanism further comprises a first pinion (107a) coupled to the first actuator (106a), wherein teeth of the first pinion mesh with the first rack;the second rack-based distraction mechanism further comprises a second pinion (107b) coupled to the second actuator (106b), wherein teeth of the second pinion mesh with second rack; and the third rack-based distraction mechanism further comprises a third pinion (301a) coupled to the third actuator (314a), wherein the third rack-based distraction mechanism is configured to independently move between an engaged position and a disengaged position, and wherein when in the engaged position, the teeth of the third pinion mesh with the third rack and fourth rack.Attorney Docket No. A0013240W0013. The retractor system of any one of claims 1 through 2, further comprising:a third arm (108) extending through the central retractor body between the first arm and the second arm, the third arm being configured to support a third blade (30) coupled to a distal end thereof; a fourth rack-based distraction mechanism including a fifth rack (115) and a fourth actuator (118), the fourth rack-based distraction mechanism being configured to independently move the third arm along a third path of motion when the fourth actuator is rotated; anda fifth rack-based distraction mechanism including a fifth actuator (314b) slidably engagable to the third rack, the fourth rack, and the fifth rack, the fifth rack-based distraction mechanism being configured to simultaneously move the first arm, the second arm, and the third arm along the first path of motion, the second path of motion, and the third path of motion, respectively, when the fifth actuator is engaged and rotated.

4. The retractor system of claim 3, further comprising a dilator (82) received within a blade perimeter, the blade perimeter defined by the first blade, the second blade and the third blade, the dilator having an outer surface corresponding to a corresponding inner surface (lOd, 20d, 30d) of each of the first blade, the second blade, and the third blade so that when the retractor is in a closed position, the first blade, the second blade, and the third blade form a contiguous perimeter.

5. The retractor system of any one of claims 3 through 4, wherein the fifth rack is integrally formed with the third arm and the third path of motion of the third arm is an arcuate path of motion.

6. The retractor system of any one of claims 3 through 5, wherein:the first rack-based distraction mechanism further comprises a first pinion (107a) fixed to the first actuator, wherein teeth of the first pinion mesh with the first rack;the second rack-based distraction mechanism further comprises a second pinion (107b) fixed to the second actuator, wherein teeth of the second pinion mesh with second rack;the third rack-based distraction mechanism further comprises a third pinion (301a) fixed to the third actuator, wherein the third rack-based distraction mechanism is configured to independently move between an engaged position and a disengaged position, and wherein when in the engaged position, the teeth of the third pinion mesh with the third rack and the fourth rack;Attorney Docket No. A0013240W001the fourth rack-based distraction mechanism further comprises a fourth pinion (304a) fixed to the fourth actuator, wherein teeth of the fourth pinion mesh with the fifth rack; andthe fifth rack-based distraction mechanism further comprises a fifth pinion (302a) fixed to the fifth actuator, wherein the fifth rack-based distraction mechanism is configured to independently move between an engaged position and a disengaged position, and wherein when in the engaged position, the teeth of the fifth pinion mesh with the third rack and the fourth rack.

7. The retractor of claim 6, wherein the fifth rack-based distraction mechanism further comprises a sixth pinion (302b) disposed proximate to the fifth pinion; and wherein the fourth rackbased distraction mechanism further comprises a seventh pinion (303) engaged with the fourth pinion, wherein when the fifth rack-based distraction mechanism is in the engaged position, the teeth of the sixth pinion mesh with the teeth of the seventh pinion to thereby couple the fifth rack-based distraction mechanism to the fifth rack.

8. The retractor system of any one of claims 1 through 7, further comprising one or more rollers (137) engaged with each of the first rack and the second rack, the one or more rollers being configured to stabilize movement of the first arm and the second arm along the first path of motion and second path of motion, respectively.

9. The retractor system of any one of claims 1 through 8, further comprising a first protrusion on the first arm and a second protrusion on the second arm, wherein the first protrusion and the second protrusion are configured to mate with a first slot (210) and a second slot (210) on the central retractor body, respectively, to stabilize one or more components of the retractor system upon movement of at least one of the first arm and the second arm.

10. The retractor system of any one of claims 1 through 9, further comprising one or more locking mechanisms (110) on at least one of the first arm and the second arm and being configured to restrict movement of at least one of the first arm and the second arm.

11. The retractor system of any one of claims 1 through 10, further comprising one or more mounting points (120) on one or more components of the retractor system, the one or more mountingAttorney Docket No. A0013240W001points comprising a threaded surface (135) and configured to engage with a fastener (410) of an accessory component (400) to the retractor system.

12. The retractor system of any one of claims 1 through 11, further comprising a dilator (82) received within a blade perimeter defined by the first blade and the second blade, the dilator having an outer surface corresponding to a corresponding inner surface (lOd, 20d) of the first blade and the second blade and one or more ribs (92), wherein the first blade and the second blade and the one or more ribs of the dilator form a closed perimeter when the retractor system is in a closed position.

13. The retractor system of any one of claims 1 through 12, further comprising a probe having a conductive tip, wherein the probe extends in a longitudinal direction beyond the distal end of at least one of the first blade and second blade.

14. A method of using a retractor system, the method comprising:inserting a first dilator (82) and a second dilator (81) into a surgical site;inserting a first blade (10) and a second blade (20) over the first dilator and the second dilator into the surgical site;independently adjusting the first blade by moving a first arm (102a) along a first rack (202a), by operating a first rack-based distraction mechanism including the first rack and a first actuator (106a); andsimultaneously adjusting the first blade and a second blade (20) by moving the first arm and a second arm (102b) along the first rack and a second rack (202b), respectively, by operating a second rackbased distraction mechanism including a third rack (308a), a fourth rack (308b) and a second actuator (314a).

15. The method of claim 14, further comprising simultaneously adjusting the first blade, the second blade and a third blade (30) by moving the first arm, the second arm and a third arm (108) along the first rack, the second rack and a fifth rack (115), respectively, by operating a third rack-based distraction mechanism including the third rack, the fourth rack and a third actuator (316a).

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