Directional Sequential Dilation System for Spinal Surgery
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Solution Overview
Problem
Current methods for neuro monitoring and incision dilation in spinal surgery involve the use of right-cylinder dilation tubes that dilate circumferentially, making it difficult for surgeons to maintain the position of the working channel relative to the nerve, as the tubes grow in all directions, potentially damaging nerves during the procedure.
Innovation Solution
A system and method utilizing an assembly of nesting tubes, where each dilation tube is configured to provide directional and sequential incision dilation by increasing in size and angle from an initial neuro-monitoring insertion point, using elliptical tubes with off-centered channels or notches to allow for controlled migration away from the initial insertion point, ensuring precise nerve positioning and safe dilation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If right-cylinder dilation tubes are used to dilate the incision, then the incision can be dilated to gain access to the surgical area, but the dilation occurs circumferentially in all directions which causes the working channel position to shift relative to the nerve, requiring continual neuro monitoring and adjustment
Solution Approach 1:
The dilation process is segmented into multiple sequential steps using a series of dilation tubes with progressively larger diameters. Each tube is inserted through the previous one, allowing controlled incremental dilation rather than simultaneous expansion in all directions. This segmentation enables the surgeon to maintain better control over the working channel position relative to the nerve throughout the dilation process.
Solution Approach 2:
The dilation tubes are designed to nest within one another, with each subsequent larger tube inserted through the previous smaller tube. This nesting arrangement allows the dilation to proceed in a controlled sequence while maintaining a stable reference point for neuro monitoring. The initial dilation tube with the neuro-monitor remains in place as subsequent tubes are nested around it, preserving the relationship between the monitoring point and the working channel.
2Productivity
If circumferential dilation is performed with right-cylinder tubes, then the incision is adequately dilated, but the center point of the initial dilation tube and the main working channel remain the same which increases the risk of nerve damage as dilation grows towards and away from the nerve position
Solution Approach 1:
Neuro monitoring is performed preliminarily before dilation begins, with the initial dilation tube positioned and the neuro-monitor in place to identify nerve locations. This preliminary neuro monitoring allows the surgeon to plan the dilation path to avoid nerves. Additionally, the system allows for preliminary adjustment of the working channel position before subsequent dilation tubes are inserted, ensuring the channel is positioned safely relative to identified nerves.
Solution Approach 2:
The neuro-monitor provides continuous feedback during the dilation process, allowing the surgeon to detect nerve proximity in real-time. This feedback mechanism enables immediate adjustment of the dilation path or working channel position if nerve damage is anticipated. The system transforms the potentially harmful circumferential dilation into a controlled process where nerve safety is continuously monitored and maintained.
Data Source
AI summary
A system for providing access to a surgical site includes a first dilator; a second dilator slidably couplable to a first side of the first dilator and including a first interface portion; a plurality of additional dilators slidably couplable to a second side of the first dilator in a nested manner; and at least one retractor member including a second interface portion removably couplable to the first interface portion. When the first interface portion is coupled to the second interface portion, and the second dilator and the plurality of additional dilators are coupled to the first dilator, the second dilator and the at least one retractor member form a retractor wall extending about the first dilator and the plurality of additional dilators.