US20200085420A1 - Surgical retractor and method of use - Google Patents

Abstract

A surgical retractor includes a first member defining a longitudinal axis. The first member includes a blade disposed in spaced apart relation relative to the longitudinal axis and a grip surface. A second member has a blade disposed in spaced apart relation relative to the longitudinal axis and a grip surface. The grip surfaces are configured to be drawn together along the longitudinal axis such that the blades are engageable with tissue and connected with the grip surfaces such that the grip surfaces provide a tactile feedback of the tissue engagement. Systems and methods of use are disclosed.

Description

TECHNICAL FIELD
• The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system and method for accessing a surgical site to facilitate treatment.
BACKGROUND
• 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.
• 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 adjacent the surgical site and/or provide a surgical pathway to the surgical site. This disclosure describes an improvement over these prior art technologies.
SUMMARY
• Accordingly, a surgical system and method are provided for accessing a surgical site, which may include, for example, a portion of a spine to facilitate treatment thereof. It is contemplated that the surgical system and method may be employed for exposing and providing a surgical pathway to a surgical site.
• In one embodiment, in accordance with the principles of the present disclosure, a surgical retractor is provided. The retractor includes a first member defining a longitudinal axis. The first member includes a blade disposed in spaced apart relation relative to the longitudinal axis and a grip surface. A second member has a blade disposed in spaced apart relation relative to the longitudinal axis and a grip surface. The grip surfaces are configured to be drawn together along the longitudinal axis such that the blades are engageable with tissue and connected with the grip surfaces such that the grip surfaces provide a tactile feedback of the tissue engagement.
• In one embodiment, a method of treating a spine is provided. The method comprises the steps of providing a surgical retractor comprising a first member defining a longitudinal axis and including a blade disposed in spaced apart relation relative to the longitudinal axis and a grip surface and a second member including a blade disposed in spaced apart relation relative to the longitudinal axis and a grip surface, wherein the grip surface of the second member includes a first portion and a second portion spaced apart from the first portion; disposing a first finger into engagement with the first portion and a second finger into engagement with the second portion; disposing a third finger into engagement with the grip surface of the first member; and compressing the grip surfaces to draw the grip surfaces together such that the blades space apart to engage tissue and the grip surfaces provide tactile feedback to the fingers of the tissue engagement.
BRIEF DESCRIPTION OF THE DRAWINGS
• The present disclosure will become more readily apparent from the specific description accompanied by the following drawings, in which:
• FIG. 1 is a perspective view of one embodiment of components of a system in accordance with the principles of the present disclosure;
• FIG. 2 is a perspective view of components of the system shown inFIG. 1;
• FIG. 3 is a perspective view of components of the system shown inFIG. 1;
• FIG. 4 is a top view of components of the system shown inFIG. 1;
• FIG. 5 is a side view of components of the system shown inFIG. 1;
• FIG. 6 is a side view of components of the system shown inFIG. 1; and
• FIG. 7 is a perspective view of one embodiment of components of a system in accordance with the principles of the present disclosure.
• Like reference numerals indicate similar parts throughout the figures.
DETAILED DESCRIPTION
• The exemplary embodiments of the surgical system and related methods of use disclosed are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system for accessing a spine to facilitate treatment thereof and a method for treating a spine. One or all of the system components may be reusable or disposable. The surgical system may be configured as a kit with multiple sized and configured components.
• In one embodiment, the system includes a surgical retractor for tissue retraction from a midline approach for surgery of a spine, including minimally invasive applications. In one embodiment, the surgical retractor includes one or a plurality of blades to create access through soft tissue. In one embodiment, the surgical retractor includes a blade rotation mechanism for creating access to a surgical site.
• In one embodiment, the surgical retractor includes a shaft, such as, for example, a hand actuated locking rack, which provides translation of the rack to a selected position. In one embodiment, a first surface includes protrusions on a translating arm of the surgical retractor having finger grips for a practitioner and a second surface disposed on a stationary arm that allows for pressure applied by a practitioner's palm. It is contemplated that the practitioner moves fingers in an axial direction towards the practitioner, in a gripping motion, to actuate the rack. This motion ergonomically conforms to natural human hand strength and provides a 1:1 input to output force ratio such that a tactile feedback including the force the practitioner feels in the palm is a direct output force applied to the tissue during retraction of the tissue. This configuration provides an accurate tactile feedback.
• In one embodiment, the surgical retractor has a blade interface, which includes locking tips to provide rotation in 7.5 degree increments. In one embodiment, the surgical retractor includes a latching or toothed rack mechanism that includes wings, which can be positioned for locking blades in an initial position and unlocking the blades for rotation in situ.
• In one embodiment, the surgical retractor includes a top mounted rack with an increased cross section. In one embodiment, the surgical retractor includes a top mounted, low-profile latch with a locking feature. The latch facilitates a range of 30 degrees of rotation with an indexing feature that includes rotation of 7.5 degree increments. In one embodiment, the surgical retractor includes a main shaft with a blade paddle interface having an increased surface area and ball detent retention surface. In one embodiment, the surgical retractor includes ergonomic gripping surfaces for one-handed operation.
• In one embodiment, the surgical retractor includes an opposing grip configuration distraction mechanism. The configuration enables a practitioner to open blades by pushing the rack forward with a thumb while applying counter pressure with an index/middle finger. In one embodiment, the practitioner can employ two hands.
• It is envisioned that the present disclosure may be employed to treat spinal disorders such as, for example, degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor and fractures. It is contemplated that the present disclosure may be employed with other osteal and bone related applications, including those associated with diagnostics and therapeutics. It is further contemplated that the disclosed surgical system and methods may be alternatively employed in a surgical treatment with a patient in a prone or supine position, and/or employ various surgical approaches to the spine, including anterior, posterior, posterior mid-line, lateral, postero-lateral, and/or antero-lateral approaches, and in other body regions. The present disclosure may also be alternatively employed with procedures for treating the lumbar, cervical, thoracic and pelvic regions of a spinal column. The system and methods of the present disclosure may also be used on animals, bone models and other non-living substrates, such as, for example, in training, testing and demonstration.
• The present disclosure may be understood more readily by reference to the following detailed description taken in connection with the accompanying drawing figures, which form a part of this disclosure. It is to be understood that this disclosure is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed disclosure. Also, as used in the specification and including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure. For example, the references “upper” and “lower” are relative and used only in the context to the other, and are not necessarily “superior” and “inferior”.
• Further, as used in the specification and including the appended claims, “treating” or “treatment” of a disease or condition refers to performing a procedure that may include administering one or more drugs to a patient (human, normal or otherwise or other mammal), in an effort to alleviate signs or symptoms of the disease or condition. Alleviation can occur prior to signs or symptoms of the disease or condition appearing, as well as after their appearance. Thus, treating or treatment includes preventing or prevention of disease or undesirable condition (e.g., preventing the disease from occurring in a patient, who may be predisposed to the disease but has not yet been diagnosed as having it). In addition, treating or treatment does not require complete alleviation of signs or symptoms, does not require a cure, and specifically includes procedures that have only a marginal effect on the patient. Treatment can include inhibiting the disease, e.g., arresting its development, or relieving the disease, e.g., causing regression of the disease. For example, treatment can include reducing acute or chronic inflammation; alleviating pain and mitigating and inducing re-growth of new ligament, bone and other tissues; as an adjunct in surgery; and/or any repair procedure. Also, as used in the specification and including the appended claims, the term “tissue” includes soft tissue, ligaments, tendons, cartilage and/or bone unless specifically referred to otherwise.
• The following discussion includes a description of a surgical system and related methods of employing the surgical system in accordance with the principles of the present disclosure. Alternate embodiments are also disclosed. Reference will now be made in detail to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning now toFIGS. 1-6, there is illustrated components of asurgical system5 including a retractor for accessing a spine to facilitate treatment thereof in accordance with the principles of the present disclosure.
• The components ofsurgical system5 can be fabricated from biologically acceptable materials suitable for medical applications, including metals, synthetic polymers, ceramics and/or their composites, depending on the particular application and/or preference of a medical practitioner. For example, the components ofsurgical system5, individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys,Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, stainless steel alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL® manufactured by Toyota Material Incorporated of Japan), thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO₄polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers, polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigid materials, elastomers, rubbers, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, composites of PEEK and calcium based ceramics, and composites of PEEK with resorbable polymers. Various components ofsurgical system5 may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components ofsurgical system5, individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components ofsurgical system5 may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein.
• Surgical system5, is employed, for example, with minimally invasive, mini-open and/or open procedures for supporting tissue and/or anatomical structures to expose tissue and/or anatomical structures to create a surgical pathway and provide access to a surgical site, which includes, for example, a spine to facilitate treatment.
• Surgical system5 includes aretractor assembly10 having a first member, such as, for example, ashaft12.Shaft12 defines a longitudinal axis L1 and anouter surface14.Outer surface14 includes arack16.Rack16 includes a plurality ofteeth18 configured to engage a second member, as described, for selective positioning of retractor blades.Rack16 extends between a first end and a second end in a configuration to provide a range of spacing and/or distraction of retractor blades for selective spacing of tissue at a surgical site.Shaft12 includes an increased cross section relative to its height such thatrack16 has a wide surface area relative to the height. It is contemplated that all or only a portion ofouter surface14 includes various surface configurations, such as, for example, smooth, rough, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. In one embodiment,retractor assembly10 may be employed with a free hand surgical technique or with a base connected to a frame (not shown).
• Shaft12 extends between afirst end20 and asecond end22.End20 includes agrip surface24.Grip surface24 includes afirst portion26 and asecond portion28.Portion26 extends laterally outward in a first direction fromouter surface14 and transverse to axis L1.Portion28 extends laterally outward in a second direction, opposite to the first direction ofportion26, and transverse to axis L1. It is envisioned thatportion26 and/orportion28 may extend fromouter surface14 in various orientations, relative to axis L1, such as, for example, co-axial, angularly offset, offset and/or staggered relative to axis L1. It is contemplated thatportions26,28 are monolithically formed withshaft12. It is contemplated thatportions26,28 are separate elements attached toshaft12. It is contemplated thatportions26,28 can be moveably connected toshaft12.
• Portions26,28 define a substantiallyplanar surface30 that is configured for engagement with the hand of a practitioner, such as, for example, a finger, which can include a thumb.Portions26,28 define a continuousouter surface32 including a substantially planarupper side34 and a substantially planarlower side36. It is contemplated thatsurface30,side34 and/orside36 may include alternative surface configurations, which can be, for example, smooth, rough, mesh, porous, semi-porous, dimpled, arcuate, undulating, pointed and/or textured according to the requirements of a particular application.
• End22 includes afirst arm38 extending along a first axis A1 transverse to axis L1.Arm38 extends in a perpendicular orientation fromshaft12 along the same plane. It is envisioned thatarm38 may be oriented along axis A1 in alternate configurations, such as, for example, parallel, co-axial, angularly offset, offset and/or staggered relative to axis L1.Arm38 extends fromend40 to anend42.End42 includes an interface configuration that mates with afirst blade assembly50.
• End42 includes amating shaft44 that is cylindrical and includes anouter surface46 having a spline configuration.Outer surface46 comprisessplines48 disposed in an axial orientation along axis A1.Splines48 include a plurality of individual spline members that extend in parallel relation about circumferentialouter surface42. The spline configuration provides a mounting and alignment configuration for providing a snap fit betweenblade assembly50 andarm38.
• It is envisioned thatmating shaft44 may have alternate cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. It is further envisioned that all or only a portion ofsurface46 may have alternate surface configurations, such as, for example, rough, threaded for connection with other instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured according to the requirements of a particular application.
• Blade assembly50 comprises a wall, such as, for example, abarrel52.Barrel52 has a circumferential configuration to define an elongated tubular cavity, such as, for example, a bore (not shown) that is disposed along axis A1 and is configured to receiveshaft44. The bore provides a mounting and alignment configuration formating blade assembly50 witharm38.
• Barrel52 includes an inner surface (not shown) that defines a spline configuration, similar to the spline configuration ofshaft44. The inner surface comprises splines disposed in an axial orientation along axis A1. The splines include a plurality of individual spline members that extend in parallel relation about circumferential the inner surface. The spline configuration provides a mounting and alignment configuration, described above, formating blade assembly50 witharm38.
• The splines ofbarrel52 mate withsplines48 along axis A1 to align and mountblade assembly50 witharm38 such that axis A1 intersects axis L1. The mounting and alignment configuration provides facile assembly ofblade assembly50 witharm38.
• Outer surface46 includes aflange60 engageable with alever62 to facilitate rotation ofarm38.Arm38 includes a tubular portion that is separate and rotatable relative toshaft12 viaindexing lever62 such thatblade assembly50 is rotatable about axis A1 and relative toarm38.Lever62 has a flip-up configuration and facilitates rotation ofarm38 upon fixation ofblade assembly50 witharm38, as described. In an upright orientation,lever62 can be manipulated to rotatearm38 in the opposing directions shown by arrows A inFIG. 3, which corresponds to rotation of retractor blades, as described below.
• Blade assembly50 includes a paddle and/orblade64 for indexed rotation about axis A1 relative toshaft12 in angular increments to engage and/or distract tissue.Lever62 rotatesblade64 through an angle α and can be indexed in selected angular increments. It is envisioned that angle α may include a range of 0-85 degrees, for example, 30 degrees. It is further envisioned that the angular increments may include a range of 0-15 degrees, for example, 7.5 degrees.
• Blade64 has a substantially flat and/or substantially planar configuration and extends between aproximal end66 and a distal end68.Blade64 includes a plurality offeet70 disposed adjacent distal end68.Feet70 extend outwardly from distal end68 to engage and/or distract tissue. It is envisioned that the blade(s) may be oriented in alternate configurations, such as, for example, perpendicular, parallel, co-axial, angularly offset, offset and/or staggered relative to axis L1 and/or axis A1. It is contemplated thatblade64 may include alternative surface configurations, which can be, for example, smooth, rough, mesh, porous, semi-porous, dimpled, arcuate, undulating, pointed and/or textured according to the requirements of a particular application.Blade64 is configured to retract, support and/or space apart tissue from the surgical site.
• A second member, such as, for example, ahousing72 extends along axis L1 between afirst end74 and asecond end76.Housing72 includes anouter surface78 and aninner surface80.Inner surface80 defines aninterior cavity82 configured for movement alongshaft12. In one embodiment,cavity82 has an oval cross section configuration. It is envisioned that all or only a portion ofhousing72 may have alternate cross section configurations, such as, for example, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered.
• Housing72 includes a lock, such as, for example, alatch84 that is releasably engageable withshaft12 to selectively distract and/or space apart the retractor blades in a fixed orientation.Latch84 includes alever86 that extends between a first end and a second end. The first end oflever86 includes a knurled surface to facilitate engagement and/or gripping by a practitioner. The second end oflever86 includes a protrusion (not shown) configured to engageteeth18 to fixshaft12 relative tohousing72.Lever86 is mounted tohousing72 via a fulcrum and configured for pivotal movement relative tohousing72 andrack16.
• Lever86 is engageable for pivotable movement between a non-locking configuration such that the protrusion is released from engagement withteeth18 andshaft12 is freely slidable relative tohousing72 to selectively position the retractor blades, and a locking configuration such thatlever86 is released from manipulative engagement such that the protrusion engagesteeth18 andshaft12 is fixed relative tohousing72. In the locking configuration oflever86, the retractor blades are selectively distracted to space apart tissue according to the requirements of a particular application.Latch84 includes aspring88 thatresiliently biases lever86 to the locked configuration.
• End74 ofhousing72 includes a second grip surface, such as, for example, finger grips90. Finger grips90 include afirst portion92 and asecond portion94.Portion92 extends laterally fromouter surface78.Portion92 is configured for engagement with a hand of a practitioner, such as, for example, a first finger.Portion94 extends laterally fromouter surface78 in an opposite direction fromportion92.Portion94 is configured for engagement with a hand of a practitioner, such as, for example, a second finger. In one embodiment, a third finger can be utilized withgrip surface24 and/orgrip surface90. In one embodiment, two hands can be utilized such that a thumb is engaged with each side ofsurface30 and an index finger is engaged with each side of finger grips90.
• It is contemplated that finger grips90 include various surface configurations, such as, for example, smooth, rough, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application. It is envisioned thatportion92 andportion94 may be oriented in alternate configurations, such as, for example, co-axial, angularly offset, offset and/or staggered relative to axis L1. It is contemplated that finger grips90 are monolithically formed withhousing72. It is contemplated that finger grips90 are separate elements attached tohousing72. It is contemplated, that finger grips90 can be moveably connected tohousing72.
• End76 includes anarm96 extending along a second axis A2 transverse to axis L1.Arm96 extends in a perpendicular orientation fromhousing72 along the same plane. It is envisioned thatarm96 may be oriented along axis A2 in alternate configurations, such as, for example, parallel, co-axial, angularly offset, offset and/or staggered relative to axis L1.Arm96 extends fromend98 to anend100.End100 includes a blade interface configuration that mates with asecond blade assembly102.
• End100 includes amating shaft104 that is cylindrical and includes anouter surface106 having a spline configuration.Outer surface106 comprisessplines108 disposed in an axial orientation along axis A2.Splines108 include a plurality of individual spline members that extend in parallel relation about circumferentialouter surface106. The spline configuration provides a mounting and alignment configuration formating blade assembly102 witharm96.
• It is envisioned thatshaft104 may have alternate cross section configurations, such as, for example, oval, oblong, triangular, rectangular, square, polygonal, irregular, uniform, non-uniform, variable and/or tapered. It is further envisioned that all or only a portion ofsurface106 may have alternate surface configurations, such as, for example, rough, threaded for connection with other instruments, arcuate, undulating, porous, semi-porous, dimpled, polished and/or textured according to the requirements of a particular application.
• Blade assembly102 comprises a wall, such as, for example, abarrel110.Barrel110 has a circumferential configuration to define an elongated tubular cavity, such as, for example, a bore (not shown) that is disposed along axis A2 and is configured to receiveshaft104. The bore provides a mounting and alignment configuration formating blade assembly102 witharm96.
• Barrel110 includes an inner surface (not shown) that defines a spline configuration, similar toshaft104. The inner surface comprises splines (not shown) disposed in an axial orientation along axis A2. The splines include a plurality of individual spline members that extend in parallel relation about the circumferential inner surface. The spline configuration provides a mounting and alignment configuration, described above, formating blade assembly102 witharm96.
• The splines ofbarrel110 mate withsplines108 along axis A2 to align and mountblade assembly102 witharm96 such that axis A2 intersects axis L1. The mounting and alignment configuration provides facile assembly ofblade assembly102 witharm96.Outer surface106 includes aflange118 engageable to facilitate rotation of alever120 andarm96.Arm96 includes a tubular portion that is separate and rotatable relative tohousing72 viaindexing lever120 such thatblade assembly102 is rotatable about axis A2 and relative tohousing72.Lever120 has a flip-up configuration and facilitates rotation ofarm96 upon fixation ofblade assembly102 witharm96, as described. In an upright orientation,lever120 can be manipulated to rotatearm96 in the direction shown by arrows B inFIG. 3, which corresponds to rotation of retractor blades described below.
• Blade assembly102 includes a paddle and/orblade122 for indexed rotation about axis A2 relative tohousing72 in angular increments to engage and/or distract tissue.Lever120 rotatesblade assembly102 through an angle β and can be indexed is selected angular increments. It is envisioned that angle β may include a range of 0-85 degrees, for example, 30 degrees. It is further envisioned that the angular increments may include a range of 0-15 degrees, for example, 7.5 degrees.
• Blade122 has a substantially flat and/or substantially planar configuration and extends between aproximal end124 and adistal end126.Blade122 includes a plurality offeet128 disposed adjacentdistal end126.Feet128 extend outwardly fromdistal end126 to engage and/or distract tissue. It is envisioned thatblade122 may be oriented in alternate configurations, such as, for example, perpendicular, parallel, co-axial, angularly offset, offset and/or staggered relative to axis L1 and/or axis A2.Blade122 is configured to retract, support and/or space tissue from the surgical site. It is contemplated thatblade122 engages tissue to separate tissue adjacent the surgical site and/or prevent tissue from entering the passageway or portal at the surgical site and/or prevent tissue creep at the surgical site. It is contemplated thatblade122 may include alternative surface configurations, which can be, for example, smooth, rough, mesh, porous, semi-porous, dimpled, arcuate, undulating, pointed and/or textured according to the requirements of a particular application.
• In assembly, operation and use,surgical system5, similar to that described, is employed, for example, with a minimally invasive surgical procedure for spinal and neurosurgical applications with a patient. For example, during spine surgery, a surgeon will make an incision in the skin of a patient's back over vertebrae to be treated. One or more dilators may be employed to gradually separate the muscles and create a portal through which the surgery may be performed.
• Retractor assembly10 is positioned adjacent the surgical site over the small incision.Blades64,122 are passed through the incision to create a passageway or portal to the surgical site.Blade assemblies50,102 are disposed at the surgical site in spaced apart relation relative to axis L1.Blade64 is disposed along axis A1 andblade122 is disposed along axis A2.
• Blades64,122 may be selectively distracted and/or rotated to a selected angle about the axes, such as, for example, opening and closing to create access and/or a surgical pathway to a surgical site. For example, to openblades64,122 and create access and/or a surgical pathway, a practitioner engages a finger, such as, for example, a thumb withsurface30 ofgrip surface24 and fingers, such as, for example, an index finger and a middle finger with finger grips90. In one embodiment,teeth18 ofrack16 include a one way locking configuration such thatlever86 is disposed in a non-locking configuration asshaft12 is translated relative tohousing72 via engagement with the grip surfaces and the blades are distracted for opening, andlever86 is disposed in a locking configuration to prevent closing of the blades. In one embodiment, the practitioner engageslever86 for pivotable movement from the locking configuration, described above, to the non-locking configuration such that the protrusion is released from engagement withteeth18 andshaft12 is freely slidable relative tohousing72 to selectively position the retractor blades. It is contemplated that the practitioner may employ separate hands to engagelever86 and the grip surfaces.
• The thumb applies a force to gripsurface24 in the direction shown by arrow C inFIG. 1. The index and middle fingers apply a force to fingergrips90 in the direction shown by arrow D. The fingers together apply a compressive force to the grip surfaces in a configuration such thatshaft12 andhousing72 are drawn together to actuateshaft12 and distractblade assemblies50,102. The grip surfaces are manipulated to selectively distract and/or space apart tissue at the surgical site to create access and/or a surgical pathway.
• Lever62 rotatesblade64, as shown by arrows E inFIG. 3, through an angle α to a selected angular increment about axis A1 relative toshaft12 to engage and/or distract tissue, according to the requirements of a particular application.Lever120 rotatesblade122, as shown by arrows F, through an angle β to a selected angular increment about axis A2 relative toshaft12 to engage and/or distract tissue, according to the requirements of a particular application.
• Grip surfaces24,90 are disposed in a configuration to conform to natural hand strength and provide tactile feedback of a 1:1 input to force ratio applied toshaft12 andhousing72. The thumb applies a force to gripsurface24 andshaft12 while the index and middle fingers apply counter pressure tohousing72 and finger grips90.Blades64,122 engage tissue and are connected with grip surfaces24,90 such that grip surfaces24,90 provide tactile feedback of the tissue engagement to the practitioner.
• Upon selected distraction of tissue,shaft12 andhousing72 are disposed in a locking configuration such thatlever86 is released from manipulative engagement and the protrusion engagesteeth18.Shaft12 is fixed relative tohousing72. In the locking configuration oflever86,blades64,122 are selectively distracted to space apart tissue according to the requirements of a particular application. When the surgical procedure is completed,retractor assembly10 can be unlocked and disengaged from tissue and removed.
• It is envisioned that the use of microsurgical and image guided technologies may be employed to access, view and repair spinal deterioration or damage, with the aid ofretractor assembly10. It is contemplated that a surgical procedure may employ other instruments that can be mounted withretractor assembly10, such as, for example, nerve root retractors, tissue retractors, forceps, cutter, drills, scrapers, reamers, separators, rongeurs, taps, cauterization instruments, irrigation and/or aspiration instruments, illumination instruments and/or inserter instruments.
• Retractor assembly10 may be employed for performing spinal surgeries, such as, for example, discectomy, laminectomy, fusion, laminotomy, laminectomy, nerve root retraction, foramenotomy, facetectomy, decompression, spinal nucleus or disc replacement and bone graft and implantable prosthetics including plates, rods, and bone engaging fasteners.
• In one embodiment,retractor assembly10 ofsystem5, as shown inFIG. 7, similar to the systems and methods described above with regard toFIGS. 1-6, includesend20 ofshaft12, as described, having agrip surface224.Grip surface224 includes afirst portion226 and asecond portion228.Portion226 extends laterally outward in a first direction fromouter surface14 and transverse to axis L1.Portion228 extends laterally outward in a second direction, opposite to the first direction ofportion226, and transverse to axis L1. It is envisioned thatportion226 and/orportion228 may extend fromouter surface14 in various orientations, relative to axis L1, such as, for example, co-axial, angularly offset, offset and/or staggered relative to axis L1. It is contemplated thatportions226,228 are monolithically formed withshaft12. It is contemplated thatportions226,228 are separate elements attached toshaft12. It is contemplated thatportions226,228 can be moveably connected toshaft12.
• Portions226,228 define aconcave surface230 that is configured for engagement with the hand of a practitioner, such as, for example, a finger, which can include a thumb.Portions226,228 define a continuousouter surface232 including an undulatingupper side234 and a substantially planarlower side236. It is contemplated thatconcave surface230 includes various surface configurations, such as, for example, smooth, rough, mesh, porous, semi-porous, dimpled and/or textured according to the requirements of a particular application.
• Arm38 extends fromend40 to end42, as described above.End42 includes an interface configuration that mates with afirst blade assembly252.End42 includes anouter surface244 that defineskey slots246 disposed in opposing portions ofsurface244.End42 includes apost248 having adetent250. In one embodiment,detent250 is resiliently biased for locking engagement withblade assembly252.
• Arm38 includesblade assembly252 for mating engagement withend42.Blade assembly252 includes anend254 including anouter surface256.Outer surface256 defineskeys258 disposed on opposing portions ofsurface256.Keys258 are configured to fit and mate withslots246.End254 includes aninner surface260 that defines acavity262 configured to receive and mate withpost248.Surface256 includes a pair ofrecesses263 that engagedetents250 for releasable fixation therewith.
• Keys258 engageslots246,post248 is disposable withcavity262 anddetents250 to engagesurface256 such thatblade assembly252 is releasably locked witharm38.Outer surface246 includes alatch264 engageable to releaseblade assembly252 fromarm38.Arm38 includes a tubular portion that is separate and rotatable relative toshaft12 viaindexing lever266 such thatblade assembly252 is rotatable about axis A1 and relative toshaft12, as described above.
• Blade assembly252 includes a paddle and/orblade268 for indexed rotation about axis A1 relative toshaft12 in angular increments to engage and/or distract tissue, similar to that described.Blade268 has a substantially flat and/or substantially planar configuration and extends between aproximal end270 and adistal end272.Blade268 includes a plurality offeet274 disposed adjacentdistal end272.Feet274 extend outwardly fromdistal end272 to engage and/or distract tissue. It is envisioned that the blade(s) may be oriented in alternate configurations, such as, for example, perpendicular, parallel, co-axial, angularly offset, offset and/or staggered relative to axis L1 and/or axis A1.Blade268 is configured to retract, support and/or space apart tissue from the surgical site.
• End76 ofhousing74 includes finger grips276, similar to grips90 described above. Finger grips276 include afirst portion278 and asecond portion280.Portion278 extends laterally fromouter surface78.Portion278 is configured for engagement with a hand of a practitioner, such as, for example, a first finger.Portion280 extends laterally fromouter surface78 in an opposite direction fromportion278.Portion280 is configured for engagement with a hand of a practitioner, such as, for example, a second finger.
• Arm96, described above, extends fromend98 to end100.End100 includesouter surface282 and a blade interface configuration that mates withblade assembly284.Arm96 includesblade assembly284 for mating engagement withend100, similar toblade assembly252.Outer surface282 includes alatch286 engageable to releaseblade assembly284 fromarm96.Arm96 includes a tubular portion that is separate and rotatable relative tohousing72 viaindexing lever288 such thatblade assembly284 is rotatable about axis A2 and relative tohousing72.Blade assembly284 includes a paddle and/orblade290 for indexed rotation about axis A2 relative tohousing72 in angular increments to engage and/or distract tissue.
• Blade290 has a substantially flat and/or substantially planar configuration and extends between aproximal end292 and adistal end294.Blade290 includes a plurality offeet296 disposed adjacentdistal end294.Feet296 extend outwardly fromdistal end294 to engage and/or distract tissue.
• It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplification of the various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims (20)

1-18. (canceled)

19. A method of treating a spine, the method comprising the steps of:

providing a surgical retractor comprising a first member defining a longitudinal axis and including a blade disposed in spaced apart relation relative to the longitudinal axis and a grip surface; and a second member including a blade disposed in spaced apart relation relative to the longitudinal axis and a grip surface, wherein the grip surface of the second member includes a first portion and a second portion spaced apart from the first portion;

disposing a first finger into engagement with the first portion and a second finger into engagement with the second portion;

disposing a third finger into engagement with the grip surface of the first member; and

compressing the grip surfaces to draw the grip surfaces together such that the blades space apart to engage tissue, wherein the grip surfaces provide tactile feedback to the fingers of the tissue engagement.

20. A method as recited inclaim 19, further comprising the step of rotating at least one of the blades about an axis transverse to the longitudinal axis in selected angular increments.

21. A method as recited inclaim 19, wherein compressing the grip surfaces comprises the third finger applying a first force in a first direction and the first and second fingers applying a second force in an opposite second direction.

22. A method as recited inclaim 19, wherein compressing the grip surfaces comprises the third finger applying a force to the grip surface of the first member and the first and second fingers applying a counter pressure to the grip surface of the second member.

23. A method as recited inclaim 19, wherein compressing the grip surfaces comprises moving the first and second fingers toward the third finger.

24. A method as recited inclaim 19, wherein drawing the grip surfaces together moving the grip surfaces toward one another such that the grip surface of the first member directly engages the grip surface of the second member.

25. A method as recited inclaim 19, wherein the grip surfaces are disposed in a configuration to conform to natural hand strength.

26. A method as recited inclaim 19, wherein the first, second and third fingers are part of a first hand.

27. A method as recited inclaim 26, further comprising pivoting a lever of the surgical retractor from a locking configuration to a non-locking configuration using a second hand prior to compressing the grip surfaces, wherein a shaft of the first member is fixed relative to a housing of the second member when the surgical retractor is in the locking configuration and the shaft is movable relative to the housing when the surgical retractor is in the non-locking configuration.

28. A method as recited inclaim 27, wherein the grip surface of the second member comprises a gap between the first portion and the second portion, a portion of the lever being positioned in the gap when the surgical retractor is in the locking configuration.

29. A method as recited inclaim 26, further comprising pivoting a lever of the surgical retractor from a non-locking configuration to a locking configuration using a second hand after compressing the grip surfaces, wherein a shaft of the first member is movable relative to a housing of the second member when the surgical retractor is in the non-locking configuration and the shaft is fixed relative to the housing when the surgical retractor is in the locking configuration.

30. A method as recited inclaim 29, wherein the grip surface of the second member comprises a gap between the first portion and the second portion, a portion of the lever being positioned in the gap when the surgical retractor is in the non-locking configuration.

31. A method as recited inclaim 19, wherein the first member comprises a first arm that defines a first axis and the second member comprises a second arm that defines a second axis, the blade of the first member being coupled to the first arm and the blade of the second member being coupled to the second arm, the method further comprising:

rotating the first arm about the first axis to rotate the blade of the first member; and

rotating the second arm about the second axis to rotate the blade of the second member.

32. A method as recited inclaim 19, wherein the first member comprises a shaft that extends through the grip surface of the second member.

33. A method as recited inclaim 19, wherein the first member comprises a shaft that extends through the grip surface of the second member and a housing of the second member, the second member including an arm comprising a shaft that is fixed to the housing and a tubular portion that is rotatable relative to the shaft of the second member, the blade of the second member being coupled to the tubular portion such that the blade of the second member is rotatable relative to the shaft of the second member about an axis defined by the shaft of the second member.

34. A method as recited inclaim 19, wherein the grip surface of the second member is fixed to the housing.

35. A method as recited inclaim 19, wherein the first portion comprises a first hole extending through a thickness of the grip surface of the second member and the second portion comprises a second hole extending through the thickness of the grip surface of the second member.

36. A surgical method comprising:

engaging spaced apart first and second blades of a surgical retractor with tissue;

disposing a first finger of a hand into engagement with a first portion of a first grip surface and a second finger of the hand into engagement with a second portion of the first grip surface;

disposing a third finger of the hand into engagement with a second grip surface that is spaced apart from the first grip surface; and

compressing the grip surfaces to draw the grip surfaces together such that the first grip surface directly engages the second grip surface and the blades space apart tissue to create a surgical pathway to a surgical site.

37. A surgical method comprising:

pivoting a lever of a surgical retractor from a locking configuration to a non-locking configuration using a first hand;

engaging spaced apart first and second blades of the surgical retractor with tissue;

disposing a first finger of a second hand into engagement with a first portion of a first grip surface and a second finger of the second hand into engagement with a second portion of the first grip surface;

disposing a third finger of the second hand into engagement with a second grip surface that is spaced apart from the first grip surface; and

compressing the grip surfaces to draw the grip surfaces together such that the first grip surface directly engages the second grip surface and the blades space apart tissue to create a surgical pathway to a surgical site

pivoting the lever from the non-locking configuration to the locking configuration using the first hand,

wherein the first blade is coupled to a shaft and the second blade is coupled to a housing, the shaft being relative to the housing when the surgical retractor is in the locking configuration and the shaft is movable relative to the housing when the surgical retractor is in the non-locking configuration.

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