Surgical access system and related methods

Abstract

A system for accessing a surgical target site and related methods, involving an initial distraction system for creating an initial distraction corridor, and an assembly capable of distracting from the initial distraction corridor to a secondary distraction corridor and thereafter sequentially receiving a plurality of retractor blades for retracting from the secondary distraction corridor to thereby create an operative corridor to the surgical target site, both of which may be equipped with one or more electrodes for use in detecting the existence of (and optionally the distance and/or direction to) neural structures before, during, and after the establishment of an operative corridor to a surgical target site.

1 - 20 . (canceled) 
     
     
         21 . A method for creating an operative corridor along a lateral, trans-psoas path to a lumbar spine, comprising:
 delivering a first retractor blade toward a spinal disc along a lateral, trans-psoas path to the lumbar spine, the first retractor blade comprising: at least one mounting arm configured to receive and lock with a blade holder apparatus, a distal blade portion extending perpendicular to the at least one mounting arm of the first retractor blade and including an interior face and an exterior face, an intermediate portion connecting between the distal blade portion and the at least one mounting arm of the first retractor blade, and at least one stimulation electrode disposed along the exterior face of the distal blade portion and oriented oppositely away from the exterior face of the distal blade portion;   delivering a second retractor blade toward the spinal disc along the lateral, trans-psoas path to the lumbar spine at a position opposite from the first retractor blade, the second retractor blade comprising: at least one mounting arm configured to receive and lock with the blade holder apparatus, a distal blade portion having the same shape and size as the distal blade portion of the first retractor blade, extending perpendicular to the at least one mounting arm of the second retractor blade, and including an interior face and an exterior face, and an intermediate portion connecting between the distal blade portion and the at least one mounting arm of the second retractor blade;   delivering an elongate inner member toward the spinal disc along the lateral, trans-psoas path to the lumbar spine;   delivering a first dilator to the spinal disc along the lateral, trans-psoas path to the lumbar spine, the first dilator having a lumen configured to slidably receive the elongate inner member;   causing a control unit to transmit an electrical stimulation signal to the at least one stimulation electrode;   causing the control unit to receive an electromyographic (EMG) sensor signal of a neuromuscular response of a nerve depolarized by the electrical stimulation signal; and   causing the control unit to, at a display device of the control unit, display a graphical user interface with information indicative of nerve proximity and nerve direction in response to the EMG sensor signal.   
     
     
         22 . The method of  claim 21 , wherein the one or more stimulation electrodes of the first retractor blade are positioned proximate to a distal most end of the distal blade portion of the first retractor blade, wherein the second retractor blade further comprises one or more stimulation electrodes disposed along the exterior face of the distal blade portion of the second retractor blade and oriented oppositely away from the exterior face of the distal blade portion of the second retractor blade. 
     
     
         23 . The method of  claim 21 ,
 wherein the distal blade portion of the first retractor blade defines a single tubular passageway fixedly positioned relative to the at least one mounting arm of the first retractor blade;   wherein the method further comprises sliding a first spine penetration member into the single tubular passageway.   
     
     
         24 . The method of  claim 23 ,
 wherein the single tubular passageway includes an upwardly facing opening and a downwardly facing opening   facing the downwardly facing opening toward the lumbar spine while the first and second retractor blades maintain the operative corridor along the lateral, trans-psoas path to the lumbar spine.   
     
     
         25 . The method of  claim 21 ,
 wherein the distal blade portion of the second retractor blade defines a single tubular passageway fixedly positioned relative to the at least one mounting arm of the first retractor blade; and   wherein the method further comprises sliding a first spine penetration member into the single tubular passageway.   
     
     
         26 . The method of  claim 21 , further comprising:
 positioning the one or more stimulation electrodes of the first retractor blade proximate to a distal most end of the distal blade portion of the first retractor blade.   
     
     
         27 . The method of  claim 21 , further comprising:
 mating the mounting arm of the first retractor blade with a blade holder apparatus; and   mating the mounting arm of the second retractor blade with the blade holder apparatus.   
     
     
         28 . The method of  claim 27 , further comprising:
 locking the mounting arm in relation to the blade holder apparatus so as to maintain the operative corridor along the lateral, trans-psoas path to the lumbar spine.   
     
     
         29 . The method of  claim 27 , further comprising:
 adjusting the first retractor blade and the second retractor blade relative to one another so that the first retractor blade is spaced apart from the second retractor blade.   
     
     
         30 . The method of  claim 27 , wherein the at least one mounting arm of the first retractor blade comprises first and second mounting arms. 
     
     
         31 . The method of  claim 21 , wherein at least a portion of the exterior face of the distal blade portion of the first retractor blade and at least a portion of the exterior face of the distal blade portion of the second retractor blade have a cylindrical surface region 
     
     
         32 . The method of  claim 21 , wherein the at least one mounting arm of the second retractor blade comprises first and second mounting arms. 
     
     
         33 . A method for creating an operative corridor along a lateral, trans-psoas path to a lumbar spine, comprising:
 providing a first retractor blade for use;   receiving and locking a mounting arm of the first retractor blade with a blade holder apparatus;   delivering the first retractor blade toward a spinal disc along a lateral, trans-psoas path to the lumbar spine, the first retractor blade comprising: at least one mounting arm, a distal blade portion extending perpendicular to the at least one mounting arm of the first retractor blade and including an interior face and an exterior face, an intermediate portion connecting between the distal blade portion and the at least one mounting arm of the first retractor blade, and at least one stimulation electrode disposed along the exterior face of the distal blade portion and oriented oppositely away from the exterior face of the distal blade portion;   receiving and locking the mounting arm of the first retractor blade with a blade holder apparatus;   delivering a second retractor blade toward the spinal disc along the lateral, trans-psoas path to the lumbar spine at a position opposite from the first retractor blade, the second retractor blade comprising: at least one mounting arm, a distal blade portion having the same shape and size as the distal blade portion of the first retractor blade, extending perpendicular to the at least one mounting arm of the second retractor blade, and including an interior face and an exterior face, and an intermediate portion connecting between the distal blade portion and the at least one mounting arm of the second retractor blade;   receiving and locking the mounting arm of the second retractor blade with the blade holder apparatus;   delivering an elongate inner member toward the spinal disc along the lateral, trans-psoas path to the lumbar spine;   delivering a first dilator to the spinal disc along the lateral, trans-psoas path to the lumbar spine, the first dilator having a lumen configured to slidably receive the elongate inner member;   causing a control unit to transmit an electrical stimulation signal to the at least one stimulation electrode;   causing the control unit to receive an electromyographic (EMG) sensor signal of a neuromuscular response of a nerve depolarized by the stimulation signal; and   causing the control unit to, at a display device of the control unit, display a graphical user interface with information indicative of nerve proximity and nerve direction in response to the EMG sensor signal.   
     
     
         34 . The method of  claim 33 , further comprising
 sliding a first spine penetration member into a tubular passageway of the first or second retractor blade.   
     
     
         35 . The method of  claim 33 , further comprising:
 positioning the one or more stimulation electrodes of the first retractor blade proximate to a distal most end of the distal blade portion of the first retractor blade.   
     
     
         36 . The method of  claim 33 , further comprising:
 mating the mounting arm of the first retractor blade with a blade holder apparatus.   
     
     
         37 . The method of  claim 36 , further comprising:
 mating the mounting arm of the second retractor blade with the blade holder apparatus.   
     
     
         38 . The method of  claim 37 , further comprising:
 locking the mounting arm in relation to the blade holder apparatus so as to maintain the operative corridor along the lateral, trans-psoas path to the lumbar spine.   
     
     
         39 . The method of  claim 33 , further comprising:
 adjusting the first retractor blade and the second retractor blade relative to one another so that the first retractor blade is spaced apart from the second retractor blade.   
     
     
         40 . A method for creating an operative corridor along a lateral, trans-psoas path to a lumbar spine, comprising:
 delivering a first retractor blade toward a spinal disc along a lateral, trans-psoas path to the lumbar spine, the first retractor blade comprising: at least one mounting arm configured to receive and lock with a blade holder apparatus, a distal blade portion extending perpendicular to the at least one mounting arm of the first retractor blade and including an interior face and an exterior face, an intermediate portion connecting between the distal blade portion and the at least one mounting arm of the first retractor blade, and at least one stimulation electrode disposed along the exterior face of the distal blade portion proximate a distal most end of the first retractor blade, wherein the distal blade portion of the first retractor blade defines a single tubular passageway with an upwardly facing opening and a downwardly facing opening, the single tubular passageway fixedly positioned relative to the at least one mounting arm of the first retractor blade;   delivering a second retractor blade toward the spinal disc along the lateral, trans-psoas path to the lumbar spine at a position opposite from the first retractor blade, the second retractor blade comprising: at least one mounting arm configured to receive and lock with the blade holder apparatus, a distal blade portion having the same shape and size as the distal blade portion of the first retractor blade, extending perpendicular to the at least one mounting arm of the second retractor blade, and including an interior face and an exterior face, and an intermediate portion connecting between the distal blade portion and the at least one mounting arm of the second retractor blade, wherein the second retractor blade further comprises at least one stimulation electrode disposed along the exterior face of the distal blade portion of the second retractor blade;   delivering an elongate inner member toward the spinal disc along the lateral, trans-psoas path to the lumbar spine;   delivering a first dilator to the spinal disc along the lateral, trans-psoas path to the lumbar spine, the first dilator having a lumen configured to slidably receive the elongate inner member;   causing a control unit to transmit an electrical stimulation signal to one or more of the stimulation electrodes;   causing the control unit to receive an electromyographic (EMG) sensor signal of a neuromuscular response of a nerve depolarized by the stimulation signal; and   causing the control unit to, at a display device of the control unit, display a graphical user interface with information indicative of nerve proximity and nerve direction in response to the EMG sensor signal.