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WO2010121291A1 - Ensemble pour chirurgie spinale comprenant une lame d'écarteur tubulaire - Google Patents

Ensemble pour chirurgie spinale comprenant une lame d'écarteur tubulaire Download PDF

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Publication number
WO2010121291A1
WO2010121291A1 PCT/AU2010/000431 AU2010000431W WO2010121291A1 WO 2010121291 A1 WO2010121291 A1 WO 2010121291A1 AU 2010000431 W AU2010000431 W AU 2010000431W WO 2010121291 A1 WO2010121291 A1 WO 2010121291A1
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WO
WIPO (PCT)
Prior art keywords
blade
retractor
anchor
channel
retractor blade
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/AU2010/000431
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English (en)
Inventor
Kevin Seex
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from AU2009901671A external-priority patent/AU2009901671A0/en
Application filed by Individual filed Critical Individual
Publication of WO2010121291A1 publication Critical patent/WO2010121291A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/0293—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors with ring member to support retractor elements

Definitions

  • the present invention relates to retraction assemblies used in surgery, For retracting soft tissue particularly though not exclusively in spinal surgery.
  • the invention further relates to a retracting blade having a geometry which enables more convenient engagement of the blade to an anchor.
  • the invention further provides a retraction blade having a formation which enables engagement of an anchorage fastener, before or after the fastener has been set in bone.
  • the invention further- relates to a retractor plate which has an open channel which enables the blade to detachably receive an anchorage fastener once the fastener has been set in vertebral bone.
  • the invention further relates to a retractor blade usable with an anchor and including at least one cannulated region each capable of engagement with an anchor pin before or after insertion of the pin in bone, the blade allowing retraction of veins and arteries during surgery.
  • a retractor blade usable with an anchor and including at least one cannulated region each capable of engagement with an anchor pin before or after insertion of the pin in bone, the blade allowing retraction of veins and arteries during surgery.
  • retractor blades which engage bone during such retraction.
  • retractor blades which retract soft tissue during, spinal surgery.
  • Such retractor blades are maintained at a setting to allow a surgeon access to a spinal disc space and vertebrae in cervical and lumbar spinal disc surgery.
  • Retractors are sometimes used in conjunction with distraction assemblies.
  • the process of separating bones is termed distraction. This involves insertion of a spreading type instrument into an excised disc space which engages the upper and lower vertebral bodies and when applied, separates them. This is known as intervertebral distraction.
  • non - intervertebral distraction in which long screws are inserted into the upper and lower vertebral bodies.
  • retractors Surrounding soft tissues must be held apart by retractors. Once retracted, there is a natural elastic recoil of the stretched tissues so it is essential to employ retractors which effectively restrain soft tissues and without loosing the requisite retraction.
  • Anterior, lumbar surgery can be performed for a number of reasons, but most commonly this is for excision of degenerate intervertebral disc after which a fusion procedure or lumbar disc arthroplasty is performed.
  • spinal surgeons it is recognized that the most difficult and dangerous part of the surgery on the anterior lumbar disc spaces is dissection, mobilization and maintenance of retraction of the vessels, and in particular the left common iliac vein.
  • this vein In the usual left retroperitoneal approach to the spine, this vein has to be retracted from left to right and inferiorly to expose the inferior right hand corner of the 45 disc space.
  • Whatever level of surgery is being performed, there is an initial approach requiring some degree of vascular dissection.
  • the approach and surgery generally requires the use of handheld retractors, at least initially, which may then be replaced with fixed retractors to maintain retraction for the rest of the procedure.
  • Fixed retractors require either internal fixation to spinal vertebra or external fixation using a table mounted system.
  • Retractors are usually positioned to hold tissues away from the surgical field both laterally (side to side) and longitudinally (up and down) relative to a spine.
  • Existing retractors may be internally or externally fixed. Internal fixation of retractors is utilized to hold the left common iliac vein or other tissues in a retracted position. There is a danger that veins may be punctured or squeezed. Due to. the difficulty and dangers of moving and keeping the blood vessels retracted during anterior lumbar surgery, stability of the retractors is particularly important.
  • the most stable retractors are those embedded in the bone e.g. Steinma ⁇ pins and Hohmann retractors. Steinman pins are long pins impacted into the bone while Hohmann retractors are conventional retractor blades with a curved pointed end which can be impacted into the bone for stability. Some limited movement of the Hohmann blade is possible by bending.
  • Also known arc standard retractor blades that have a through passage which allows separate introduction of sharp pins through the passage into the vertebral body thus securing the blade to the spine. It is lateral as distinct from longitudinal retraction that represents the greatest difficulty as the soft tissues naturally want to return to their normal anatomical location. Typically the soft tissues when displaced or retracted by a retractor blade, will attempt to locate to their normal position by migrating under a distal end of the blade which would normally be in engagement with vertebral bone.
  • I O lateral retraction are in contact with the bone along the side of the body i.e. in contact with the spine along a superior inferior plane. To remain stable they rely on a solid immobile connection to the operating table through various linkages and if in contact with the bone, a force is directed along the edge of the blade (the lip) parallel to this radius of the body. Many conventional blades just sit beside the bone with a
  • the edge of the blades can be pushed down onto the anterior surface of the vertebral bodies where they are lying across llie spine and perpendicular to the main radius. This gives them much greater relative stability. The stability is also enhanced because the anterior surface of the spine is less curved anteriorly than laterally.
  • One of the limitations of many existing retraction systems is I he tendency for the vessels, in particular the left common iliac vein, to bulge around the retractor, which can expose the vein to injury and impede the surgeon.
  • Various techniques can be employed to keep the vein safe, either by placing the lateral retractors as far laterally as possible displacing the vein laterally while retracting the vein infcriorly away from the disc space with another retractor. This technique risks over stretching the vein
  • Another technique is to fill the 'difficult corner' between the side to side and inferior blades with a swab or other protective material.
  • Another approach is to displace the vein away with hand held retractors and insert a Steinman pin at the apex of the corner to maintain retraction.
  • retractor blades exist for use in surgery of various shapes and geometry.
  • One retractor blade is known with two surfaces at right angles to each other over the length of the blade.
  • This is a handheld retractor for use posteriorly in the lumbar spine to retract muscle to aid in implantation of pedicle screws. This does not have any function to retract blood vessels.
  • the end is shaped for bone contact on or close to the transverse processes of the spine or the sacrum without adapting to the anatomical shape of the bones and the bone contact is in one plane only.
  • US patent number 6,692,434 discloses a method and device for retractor for microsurgical intermuscular lumbar arthrodesis
  • the lenglh of the pin is also critical to avoid over insertion and penetration of critical structures on the opposition side of the bone and also to prevent under penetration which could lead to pin breakage. Maintaining the optimal blade and pin angles to optimize retraction against soft tissue forces while at the same time trying to locate a safe entry point for safe insertion of the pin can be difficult and hazardous.
  • the present invention addresses the problems associated with the known retraction blades and seeks to eliminate the aforesaid disadvantages of existing prior art retractor systems by providing a retractor blade having an open recess which receives an anchor before or after insertion of the anchor in bone.
  • the present invention provides retraction assemblies used in surgery, for retracting soft tissue particularly though not exclusively in spinal surgery, and comprising a retracting blade which has an open channel which enables the blade to dctachably receive an anchorage fastener once the fastener has been set in vertebral bone.
  • the invention further provides a retraction blade having a formation which enables engagement of an anchorage fastener before or after the fastener has been set in bone.
  • the invention further provides a retractor blade usable with an anchor and including at least one cannulated region each capable of engagement with an anchor pin before or after insertion of the pin in bone, the blade providing retraction of soft tissues including veins and arteries during surgery.
  • the retractor blade in addition to the cannulation includes a distal end geometry which conforms at least in part to vertebral bone contours to facilitate stability and more effective and efficient soft tissue retraction during blade insertion.
  • This retractor seeks to improve the installation and stability of an anchor blade and pin assembly during an operation such as anterior lumbar surgery.
  • the invention provides an alternative blade shape and configuration including a recess which allows an alternative means of coupling of the blade and anchor to avoid the dangers described earlier of selecting positioning for the anchor point.
  • the principles of the invention have application throughout the spine and elsewhere where bone is available for load distribution.
  • the anterior surface of all the vertebral bodies forms an approximate arc of a circle which is .slightly flattened in the middle.
  • the vertebral body diameter however varies. It is narrowest in the mid body and then expands circumferentially adjacent to the disc spaces between adjacent vertebra. When viewed in coronal section this produces a modest, hour glass shape. In the axial plane the anterior oval vertebral shape is relatively constant with the discs and the endplatcs forming slightly larger diameter circles than in the mid body.
  • the present invention comprises; a retractor blade for retracting soft tissues during surgery, ihe blade comprising: a blade body having first and second ends, the first end providing means to allow connection of the blade body to a support member, the second end having a contour adapted to engage bone; and located between said first and second ends a generally elongated open longitudinal channel defining a recess, the channel extending at least part of the distance between said first and second ends and enabling the blade to be coupled and uncoupled to an anchor member before or after the anchor member is engaged to bone.
  • the present invention comprises: a retractor blade for retracting soft tissues during surgery, the blade comprising: a blade body having first and second ends, the first end providing means to allow connection of the blade body to a support member, the second end having a contour adapted to engage bone; and located between said first and second ' ends a generally elongated open channel defining a longitudinal recess, the channel extending at least part of the distance between said first and second ends and enabling the blade to be coupled to an anchor member while the anchor member is engaged to bone.
  • the blade comprises a first part disposed in a first plane and a second part disposed in a second plane normal to the first plane forming an L shape.
  • the open channel is disposed at or near the junction of the first and second parts.
  • the blade includes a formation at an edge at least part of which is capable of transmission of load applied Io the retractor to spinal vertebrae to resist unwanted movement of the retractor.
  • the ideal form of recess is a generally circular channel having a longitudinal opening, it will be appreciated by persons skilled in the art that alternative channel configurations arc feasible provided they accept an anchor by at least lateral, rotational or lateral and rotational engagement
  • the present invention comprises:
  • a retractor blade comprising; a blade body having first and second ends, a first part disposed in a first plane and a second part disposed in a second plane, wherein at least one of said first and second parts terminates in an edge at least part of which includes a contour which generally conforms to a contour of a spinal vertebrae; at or near a junction of the first and second parts an open channel defining a longitudinal recess which follows the channel; the recess allowing the blade to be coupled to a corresponding anchor body even where the anchor is in engagement with bone.
  • the blade is V or L shaped and the channel is located along the iunction of the legs of the L or V.
  • the channel according to one embodiment passes along the full length of the blade.
  • the channel comprises channel sections which pass at least part way along the length of the blade. The channel or channel section is arranged so that the blade can be urged towards a shaft body of an anchor so that when the blade is coupled the anchor is engage with bone.
  • the present invention comprises:
  • a retractor blade for retraction of soft tissue
  • the blade comprising: a generally elongated blade body having first and second ends, the first end providing means for connection of the blade body to a support member, the second end comprising a first part disposed in a first plane and a second part connected to the first part and disposed in a second plane, wherein at least one of said first and second parts terminates in an edge at least part of which includes a contour which transmits load to a contour of a spinal vertebrae; characterised in that the blade includes an open longitudinal channel which passes along at least part of the length of the blade so that the blade allows mutual engagement with an anchorage in addition to axially, from a direction at angle to a longitudinal axis of the channel.
  • the first part in the first plane is essentially parallel to a longitudinal axis of the spine.
  • the second part in the second plane is normal to the first plane.
  • the contour of said edge of the second part defines an arc which generally conforms to a mid body circumferential surface of a lumbar vertebrae. According to a preferred embodiment, said edges of the first and second parts engage vertebral bone when an axial load is applied to the retractor.
  • the present invention comprises:
  • a surgical retractor blade for retraction of soft tissue during anterior approach spinal surgery, the blade comprising: a generally elongated blade body having first and second ends, the first end providing means for connection of the blade body to a support member, the second end comprising a first part disposed in a first plane and a second part connected norma] to the (list part and disposed in a second plane, wherein each of said first and second parts terminate in respective continuous edges at least part of which include a concave contour which generally conforms to at least part of a contour of a spinal vertebrae, the second part further providing a load bearing edge which transmits loads applied to the blade to said vertebrae; characterised in that tho blade includes an open longitudinal channel which passes along al least part of the length of the blade so that the blade allows mutual engagement with an anchorage in addition to axially, from a direction at angle to a longitudinal axis of the channel.
  • the angle of engagement between blade and anchor can be normal to the longitudinal axis of the channel .
  • This form of engagement is alternative to axial engagement by passing the anchor through a closed passage ( cannulated) once the blade is located on the bone at a location which will correctly position the anchor.
  • the present invention provides an alternative to the known prior art and the shortcomings identified. The foregoing and other objects and advantages will appeal" from the description to follow. In the description reference is made Lo the accompanying representations, which forms a part hereof, and in which is
  • Figure 1 shows a perspective exploded view of a retraction blade including abbreviated channel formations according to one embodiment.
  • Figures 2 shows the blade of figure 1 with anchor pin inserted in channel formations.
  • Figure 3 shows a perspective view of a retraction blade including open abbreviated channels according to an alternative embodiment.
  • Figure 4 shows the blade of figure 3 with pin inserted in channel formations.
  • Figure 5 shows a perspective view of a retractor assembly with retractor blades of the type shown in figures I and 3 fitted
  • Figure 6 shows according to a preferred embodiment, a side elevation of the handle assembly of figure 5 supporting a cannulated blade.
  • Figure 7 shows a rear perspective elevation of the support assembly of figure 6 engaged with blade.
  • Figure 8 shows an opposite perspective view of slide assembly detached from the support assembly of figure 7
  • Figure 9 shows an exploded perspective view of a retractor blade prior to engagement with an anchor pin at least partially inserted in a spinal vertebrae.
  • Figure 10 shows the retractor blade of figure 9 rotated into engagement with the anchor pin.
  • Figure 11 shows the retractor blade of figure 9 engaged with an anchor pin but prior to full insertion of the pm.
  • Figure 12 shows the retractor blade of figure 9 with the anchor pin rotated into locking engagement with the pin.
  • the design objective with retraction blades are primarily, optimal stability and safe and efficient retraction of soft tissue.
  • Contact and pressure on the blade against the bone improves stability of a retractor blade.
  • Most conventional blades however rely only on their external fixation for stability. These ' blades effectively "float" with a free end.
  • the contact is at the side of the vertebral body usually at or above the ⁇ equator of the vertebrae where the bone is curving posterolateral Iy.
  • the blade relies primarily on a solid immobile connection to the operating table through various linkages.
  • the required stability can be easily achieved by manual engagement of the blade but to a lesser extent when attached to an external frame such as assembly I because of the long moment arm from the end of the retractor blade to anchorage.
  • Such lateral retractors tend to move and slip causing soft tissues and blood vessels to slip under or around the retractor blades.
  • Blade 1 shows a front perspective view of a retractor blade 1 according to a preferred embodiment.
  • the blade to be described below according to its various embodiments, is capable of adaption to various retraction assemblies.
  • Blade 1 comprises: a generally elongated blade body 2 having first end 3 and second end 4.
  • First end 3 is coniiectable to a blade support assembly (not shown).
  • Body 2 comprises a first part 5 disposed in a first plane and a second part 6 connected to the first part 5 and disposed in a second plane, the first and second • parts generally forming an L shape.
  • the first part 5 terminates in an edge 7 at least part of which includes a contour which generally conforms to a contour of a spinal vertebrae at a point of contact with the vertebra when in situ.
  • First part 5 in the first plane is essentially parallel to a longitudinal axis (not shown) of a spine.
  • the second part 6 in the second plane is normal to the first plane and is preferably normal to the first part 5.
  • the contour of an edge 8 of the second part 6 defines an arc which generally conforms to a mid vertebral body circumferential surface.
  • the radius of this arc in the lumbar spine is approximately 45 mm +/- 10mm.
  • Edges 7 & 8 engage vertebral bone during insertion and when an axial load is applied to the retractor.
  • the blade 1 is formed as one piece.
  • Retractor 1 is preferably configured to maximize contact with the surface of the vertebral bone with first and second edges 7 and 8 of retractor 1 contoured to approximate the curvature of the vertebra, provide stability and Io maximise point of contact.
  • blade I includes formations 9 and 10. Formation 9 comprises an open channel 11 defined by a wall 12 . Formation IO comprises an open channel 13 defined by a wall 14.
  • Formations 9 and 10 are shown as ⁇ abbreviated in that they doe not travel the full length of the retractor blade I .
  • the blade can include one abbreviated formation.
  • the formation can extend the full length or approximately the full length ofthe blade.
  • Figure 1 also shows an anchor pin 15 which is exploded from formations 9 and 10.
  • the open channels 1 1 and 13 allows the surgeon to engage the retractor blade 1 by an alternative to axial insertion of pin 15. Since channels 1 1 and 13 are open, pin 15 can be inserted into channels 1 1 and 13 laterally in the direction of arrow 16 or by mutual rotation of blade 1 and anchor pin 15 or by rotation of blade 1 relative to pin 15 or pin 15 relative to blade I .
  • Blade 1 also includes graduated openings 17 which enable engagement of the blade with a retraction support assembly ( as shown in figure 5).
  • Figures 2 shows the 10 blade 1 of figure 1 with anchor pin 15 inserted in open channels 1 1 and 13.
  • Figure 3 shows a perspective view of a retraction blade 20 according to an alternative embodiment including formations 21 and 22.
  • Retractor 20 would typically be used at would extremities of a surgical wound.
  • Blade 1 would •
  • Formation 15 normally be used at lateral margins of a surgical wound.
  • Formation 21 comprises an open channel 23 defined by a wall 24 .
  • Formation 22 comprises an open channel 25 defined by a wall 26. Formations 21 and 22 arc shown as abbreviated in that they do not travel the full length of the retractor blade 20. In an alternative embodiment, the blade can include one abbreviated formation.
  • Blade 20 In a further embodiment the formation can extend the full length or approximately the full length of the blade.
  • Blade 20 also includes graduated openings 27 which enable engagement of the blade with a retraction support assembly ( as shown in figure 5).
  • Figure 4 shows the blade 1 of figure I and blade 20 of figure 3 with pins 15 and 28 respectively inserted in channel formations in each blade-
  • Figure 5 shows a perspective view of a retractor assembly 30 with retractor blades 1 and 20 of the type shown in figures 1 and 3 fitted.
  • '30 31 is included which opposes blade 1 and has a mirror image geometry to blade
  • Assembly 30 includes a hoop 32 which receives supporting arms 33 and 34 via adjustable fasteners 35 and 36. Connectors 37 and 38 allow vertical adjustment of retractor blades 1 and 31. Once blades 1 and 20 are located in position with respective anchor pins 15, 28 and 39 the retraction assembly can be attached. 5
  • Figure 6 shows according to a preferred embodiment, a side elevation of the support assembly 50 of figure 5 which receives and retains cannulated blade 20.
  • Support assembly 50 includes a detachable handle 51 and press button release 52 which allows quick release of handle 51 from sleeve 53.
  • Sleeve 53 engages I O articulated coupling 54 which engages retractor blade 20.
  • S.leeve 53 includes a press button release 55 which enables sleeve 53 to be released from shaft 56 ( see figure 7).
  • Figure 7 shows a rear perspective elevation of the support assembly 50 of 15 figure 6 engaged with blade 20. Shaft 56 is shown released from sleeve 53.
  • Coupling member 54 includes a slide assembly 57 which engages runner 58.
  • Slide assembly 57 is capable of sliding adjustment along runner 58.
  • Figure 8 shows an opposite perspective view of slide assembly 57 detached from support assembly 50 which includes a substantially U shaped boss defining a channel 590 which receives and retains therein runner 58.
  • Runner 58 includes a series of openings which receive a locking pin 60 which is actuated by lever 61.
  • FIG. 9 shows an exploded perspective view of a retractor blade assembly 70 prior to engagement between retractor blade 71 and anchor pin 72.
  • retractor blade 71 according to the embodiment shown is substantially L shaped and . includes a proximal end 73 and distal end 74.
  • Al proximal end 73 there is provided an abbreviated channel portion or cannulation 89 in which walls 750 define an internal passage 76.
  • a runner 77 which receives a sliding connector similar to that shown in figure 7.
  • a second abbreviated cannulation 78 is also included at proximal end 73 in which walls 79 define an internal passage 80.
  • Blade 71 also comprises at distal end 74 a first curved region 81 relative to the plane of leg 82 and a second curved region 83 relative to the plane of leg 84. Curved regions 81 and 83 allow retractor blade 71 to conform to the general shape of spinal vertebra.
  • Assembly 70 further comprises anchor pin 72 which has a threaded distal end 85 and a tool engaging formation 90 on its proximal end 86. Located intermediate ends 85 and 86 is a retaining boss 87 which holds blade 71 in position by engagement with internal passage 88.
  • Figure 10 shows the retractor blade 71 of figure 9 rotated into engagement with the anchor pin 72. Upon engagement pin 72 locates in passages 80 and 88 respectively of cannulatio ⁇ s 89 and 78.
  • Retaining boss 87 is shown sitting proud of passage 80 so in that state, blade 71 is free to rotate away from pin 72. Once blade 71 is in engagement with pin 71 , the surgeon using a suitable tool which engages tool engaging formation 90 completes final rotation of pin 72 sufficient to facilitate engagement between retaining boss 87 and passage or channel 88.
  • Figure 11 shows the assembly 70 with corresponding numbering with pin 72 rotated in the direction of arrow 91 and further advanced distally into vertebra! bone but prior to full insertion.
  • Figure 12 shows the pin 72 fully anchored into vertebra 92 with blade 71 attached.
  • Pin 72 is advanced distally so that retaining boss 87 has engaged channel 88. This prevents release of blade 71 until anchor pin 72 is unscrewed to release boss 87 from channel 88.
  • pin 72 is unscrewed and axially displaced to release boss 87 from channel 88.
  • the blades described herein may be a combination of the features of the present invention in all its embodiments and features of known retractor blade assemblies.
  • a blade according to the invention described may be detachable or malleable, rotating and other variable engagements are envisaged. Blades may also be attached without handle 51 to allow fixation of the blade at various angles.
  • Various materials may be used for the retractor blade including metals and plastics and malleable and radiolucent materials. Various sizes and 5 shapes arc envisaged.
  • Variations in the retractor may be made to accommodate different variation in engagement to vertebrae.
  • the length, width and relative heights of horizontal and vertical sections may vary to accommodate, different locations in the spine and different types of procedures.
  • corners of the device may I O be radiused and in the lumbar spine build up sections over the corners added in order to retract blood vessels.
  • This invention provides an improved method of inserting an anchor pin in exactly the correct position.
  • the method and cannulated blades also provide5 greater visibility of the sharp point of the pin as it engages the bone or surface of the bone covered with ligament which improves blade position.
  • As there are major vessels close to the anchor points of the cannulated blades and ability to engage anchor pins by rotation improves safety but without compromise to current blade and pin engagement techniques i.e. stability of position through0 pin fixation and downward pressure.
  • the invention achieves increased safety by allowing the pins to be initially engaged in the bone in an ideal position , without requiring initial perfect positioning of the blade.
  • the pin itself can then be used to act as a lever5 helping to position the blade and pin and move the soft tissues away until the correct angle of pin entry and blade angulation is achieved. Having already engaged the bone the risk of unwanted soft tissue entrapment by the pin is reduced.
  • the blade then engages accurately with the pin and after this initial engagement, as the pin is further inserted in into the bone it becomes securely0 engaged in the cannulated blade preventing disengagement and finally at a controlled distance is able to apply downward pressure to the blade further securing the blade and pin.
  • an insertion ofthe cannulated blade in the anterior lumbar spine are as follows *
  • the retractor blade After exposure, the retractor blade should be positioned close to final position but outside allowing good exposure of the critical entry point so as to be available to engage the pin as mentioned below. 4 The retractor blade holds the tissues out the way allowing the surgeon a good view ofthe entry point.
  • the pin tip is positioned (on the inside of the blade) on- its correct entry point without the need to be inserted through the cannulation as in the prior art retractor blades.
  • the pin may and need not be in contact with the blade at this point. This allows an easier angle for tip positioning without the pin being displaced by the tissue forces acting on the retractor blade.
  • the screw and the blade have matching configurations that allow this engagement and as the screw advances it becomes securely held by the slot preventing disengagement plus these configurations further allow a compressive force downwards to be applied to the blade as the screw reaches its correct depth in to the bone.

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Abstract

L'invention concerne une lame d'écarteur pour écarter des tissus mous pendant une chirurgie. Ladite lame comprend : un corps de lame doté d'une première et d'une seconde extrémité, la première extrémité étant pourvue de moyens permettant la liaison du corps de lame avec un élément de support, la seconde extrémité présentant un contour conçu pour venir en contact avec un os ; et un canal longitudinal ouvert généralement allongé définissant un évidement situé entre les première et seconde extrémités, ledit canal s'étendant au moins partiellement sur une partie de la distance entre la première et la seconde extrémité et permettant le couplage et le découplage de la lame avec un élément d'ancrage, ce dernier étant en contact avec l'os.
PCT/AU2010/000431 2009-04-19 2010-04-19 Ensemble pour chirurgie spinale comprenant une lame d'écarteur tubulaire Ceased WO2010121291A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AU2009901671 2009-04-19
AU2009901671A AU2009901671A0 (en) 2009-04-19 Cannulated retractor blade and assembly for spinal surgery

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Publication Number Publication Date
WO2010121291A1 true WO2010121291A1 (fr) 2010-10-28

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Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103690205A (zh) * 2012-09-06 2014-04-02 梅达塔国际股份有限公司 最小侵入性脊柱融合术的手术设备和包括其的手术系统
US9066701B1 (en) 2012-02-06 2015-06-30 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
EP2898836A1 (fr) * 2013-12-13 2015-07-29 Stryker European Holdings I, LLC Rétraction tissulaire et dispositifs, systèmes et procédés de déplacement vertébral pour fusion spinale postérieure
US9486133B2 (en) 2010-08-23 2016-11-08 Nuvasive, Inc. Surgical access system and related methods
US9655505B1 (en) 2012-02-06 2017-05-23 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
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US9795367B1 (en) 2003-10-17 2017-10-24 Nuvasive, Inc. Surgical access system and related methods
US10980525B2 (en) 2010-08-23 2021-04-20 Nuvasive, Inc. Surgical access system and related methods
US9486133B2 (en) 2010-08-23 2016-11-08 Nuvasive, Inc. Surgical access system and related methods
US12426866B2 (en) 2010-08-23 2025-09-30 Nuvasive, Inc. Surgical access system and related methods
US9924859B2 (en) 2010-08-23 2018-03-27 Nuvasive, Inc. Surgical access system and related methods
US10172515B2 (en) 2010-08-23 2019-01-08 Nuvasive, Inc. Surgical access system and related methods
US11457907B2 (en) 2010-08-23 2022-10-04 Nuvasive, Inc. Surgical access system and related methods
US9655505B1 (en) 2012-02-06 2017-05-23 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9066701B1 (en) 2012-02-06 2015-06-30 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
CN103690205A (zh) * 2012-09-06 2014-04-02 梅达塔国际股份有限公司 最小侵入性脊柱融合术的手术设备和包括其的手术系统
US9757067B1 (en) 2012-11-09 2017-09-12 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US11622793B2 (en) 2013-12-13 2023-04-11 Stryker European Operations Holdings Llc Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion
US10507046B2 (en) 2013-12-13 2019-12-17 Stryker European Holdings I, Llc Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion
US9622795B2 (en) 2013-12-13 2017-04-18 Stryker European Holdings I, Llc Tissue retraction and vertebral displacement devices, systems, and methods for posterior spinal fusion
EP2898836A1 (fr) * 2013-12-13 2015-07-29 Stryker European Holdings I, LLC Rétraction tissulaire et dispositifs, systèmes et procédés de déplacement vertébral pour fusion spinale postérieure
US12349945B2 (en) 2017-09-22 2025-07-08 Medos International Sàrl Patient-mounted surgical support
US11559372B2 (en) 2017-09-22 2023-01-24 Medos International Sarl Patient-mounted surgical retractor
US11723697B2 (en) 2017-09-22 2023-08-15 Medos International Sarl Patient-mounted surgical support
US10945773B2 (en) 2017-09-22 2021-03-16 Medos International Sarl Patient-mounted surgical support
US11413029B2 (en) 2018-10-24 2022-08-16 Stryker European Operations Holdings Llc Anterior to psoas instrumentation
US12256917B2 (en) 2018-10-24 2025-03-25 Stryker European Operations Holdings Llc Anterior to psoas instrumentation
US20200253657A1 (en) * 2019-02-13 2020-08-13 Loubert S. Suddaby Anterior and lateral spinal retractor system with pivotable k-wire
US10898253B2 (en) * 2019-02-13 2021-01-26 Loubert S. Suddaby Anterior and lateral spinal retractor system with pivotable k-wire
US11204060B2 (en) 2019-11-27 2021-12-21 Medos International Sari Selectively lockable ball and socket joint
US11668340B2 (en) 2019-11-27 2023-06-06 Medos International Sarl Selectively lockable ball and socket joint
US12392370B2 (en) 2019-11-27 2025-08-19 Medos International Sàrl Selectively lockable ball and socket joint
US12038041B2 (en) 2019-11-27 2024-07-16 Medos International Sarl Selectively lockable ball and socket joint
US11229464B2 (en) 2019-12-04 2022-01-25 Medos International Sarl Apparatus for driver-specific backout prevention
US11931085B2 (en) 2019-12-04 2024-03-19 Medos International Sàrl Apparatus for driver-specific backout prevention
ES2959541A1 (es) * 2022-07-29 2024-02-26 Univ Rey Juan Carlos Dispositivo retractor de tejidos para cirugía de cuello

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