JP2010540196A - 拡張システム及びその使用方法 - Google Patents
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- 238000000034 method Methods 0.000 title claims abstract description 28
- 230000000638 stimulation Effects 0.000 claims abstract description 102
- 239000000523 sample Substances 0.000 claims abstract description 73
- 210000003205 muscle Anatomy 0.000 claims abstract description 42
- 210000005036 nerve Anatomy 0.000 claims abstract description 37
- 230000010339 dilation Effects 0.000 claims description 11
- 210000003484 anatomy Anatomy 0.000 claims description 3
- 238000002594 fluoroscopy Methods 0.000 claims description 2
- 210000001519 tissue Anatomy 0.000 abstract description 17
- 230000001537 neural effect Effects 0.000 abstract description 13
- 238000001356 surgical procedure Methods 0.000 description 5
- 210000004705 lumbosacral region Anatomy 0.000 description 4
- 238000000926 separation method Methods 0.000 description 4
- 238000013459 approach Methods 0.000 description 3
- 230000001960 triggered effect Effects 0.000 description 3
- 238000003780 insertion Methods 0.000 description 2
- 230000037431 insertion Effects 0.000 description 2
- 239000000463 material Substances 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- 230000004936 stimulating effect Effects 0.000 description 2
- 230000000451 tissue damage Effects 0.000 description 2
- 231100000827 tissue damage Toxicity 0.000 description 2
- 238000007792 addition Methods 0.000 description 1
- 235000014510 cooky Nutrition 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 230000007613 environmental effect Effects 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 210000002988 lumbosacral plexus Anatomy 0.000 description 1
- 238000012978 minimally invasive surgical procedure Methods 0.000 description 1
- 230000000399 orthopedic effect Effects 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
- 210000000115 thoracic cavity Anatomy 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
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- A61B17/025—Joint distractors
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Abstract
【選択図】 図3
Description
Claims (15)
- 患者の解剖学的構造における神経から遠ざけて拡張させる方向性順次拡張システムであって、この方向性順次拡張システムが、
プローブ軸線を有する刺激プローブと、
第1の方向性拡張装置であって、第1の長手軸線と、近位端から遠位端へ延びた第1のボアと、第1のボアと連通している第1の通路とを具備し、第1のボアは第1のボア軸線を有し、第1の長手軸線が第1のボア軸線からオフセットしている、上記第1の方向性拡張装置と、
第2の方向性拡張装置であって、第2の長手軸線と、第2の方向性拡張装置における近位端から遠位端へ延びた第2のボアと、第2のボアと連通している第2の通路とを具備し、第2のボアは第2のボア軸線を有し、第2の長手軸線は第2のボア軸線からオフセットしており、刺激プローブは第1のボアの中に着脱可能に受け入れられ、第1の方向性拡張装置は第2のボアの中に着脱可能に受け入れられる、上記第2の方向性拡張装置と、
を備えていることを特徴とする方向性順次拡張システム。 - プローブ軸線は、組み立てられた状態において、第1のボア軸線と同軸的になっていることを特徴とする請求項1に記載の方向性順次拡張システム。
- 第1の長手軸線は、組み立てられた状態において、第2のボア軸線と同軸的になっていることを特徴とする請求項1に記載の方向性順次拡張システム。
- 前記システムが、さらに、
第1の方向性拡張装置の遠位端に配置された第1の先端部であって、第1の長手軸線が第1の先端部を通過している、上記第1の先端部と、
第2の方向性拡張装置の遠位端に配置された第2の先端部であって、第2の長手軸線が第2の先端部を通過している、上記第2の先端部と、
とを備えていることを特徴とする請求項1に記載の方向性順次拡張システム。 - 前記方向性順次拡張システムが、さらに、
複数の第1の深さ指示器であって、第1の方向性拡張装置における第1の外面に配置され、複数の第1の深さ指示器は、第1の長手軸線に対して略垂直である第1の外面上にそれぞれ延び、複数の第1の深さ指示器は、第1の先端部と複数の第1の深さ指示器との間に、それぞれ複数の第1の距離を形成する、上記複数の第1の深さ指示器と、
複数の第2の深さ指示器であって、第2の方向性拡張装置における第2の外面に配置され、複数の第2の深さ指示器は、第2の長手軸線に対して略垂直である第2の外面上にそれぞれ延び、複数の第2の深さ指示器は、第2の先端部と複数の第2の深さ指示器との間に、それぞれ複数の第1の距離を形成する、上記第2の深さ指示器と、
を備えていることを特徴とする請求項4に記載の方向性順次拡張システム。 - 第1及び第2の拡張装置は、それぞれそれらの近位端に配置された、第1及び第2の把持部を具備していることを特徴とする請求項1に記載の方向性順次拡張システム。
- 第1の方向性拡張装置は第1の長さを有し、第2の方向性拡張装置は第2の長さを有し、第1の長さは、第2の長さに比べて長くなっていることを特徴とする請求項1に記載の方向性順次拡張システム。
- 刺激プローブは、プローブ長さを有し、プローブ長さは、第1の長さ及び第2の長さに比べて長くなっていることを特徴とする請求項7に記載の方向性順次拡張システム。
- 第1の方向性拡張装置は第1の直径を有し、第2の方向性拡張装置は第2の直径を有し、第2の直径は、第1の直径に比べて大きくなっていることを特徴とする請求項1に記載の方向性順次拡張システム。
- 神経を避けるために、刺激プローブと第1の方向性拡張装置と第2の方向性拡張装置とを有する方向性順次拡張システムを用いて、腰部筋肉を通して患者の脊椎へのアクセス開口部を形成する方法であって、第1及び第2の方向性拡張装置が、第1及び第2のボアを有し、第1及び第2のボア軸線が第1及び第2の長手軸線からそれぞれオフセットしており、この方法が、
(a) 腰部筋肉の中へ刺激プローブを横方向に挿入する段階と、
(b) 腰部筋肉における安全領域に配置させるために、刺激プローブに、EMGを介して電気パルスを伝達する段階と、
(c) プローブ先端部が患者の脊椎に近接するように、腰部筋肉を通して刺激プローブを横方向に挿入する段階と、
(d) 第1の方向性拡張装置を腰部筋肉に通して患者の脊椎に向けて挿入し、第1のボアを備えた刺激プローブの摺動係合によって案内し、第1のボア軸線を第1の長手軸線に比べて神経の近くに配置する段階と、
(e) 第2の方向性拡張装置を腰部筋肉に通して患者の脊椎に向けて挿入し、第2のボアを備えた第1の方向性拡張装置の摺動係合によって案内し、第2のボア軸線を第2の長手軸線に比べて神経の近くに配置する段階と、
を備えていることを特徴とする方法。 - 前記方法が、さらに、
(f) 第2の方向性拡張装置にかぶせて開創器を挿入する段階、
を備えていることを特徴とする請求項10に記載の方法。 - 前記方法が、さらに、
(f) 段階(c)の前に、安全領域の位置を術中X線透視を介して確認する段階、
を備えていることを特徴とする請求項10に記載の方法。 - 神経を避けるために、刺激プローブとEMGと第1の刺激通路及び第2の刺激通路を備えてなる刺激拡張装置とを有するブラント刺激拡張システムを用いて、腰部筋肉を通して患者の脊椎へのアクセス開口部を形成する方法であって、この方法が、
(a) 腰部筋肉の中へ刺激拡張装置を横方向に挿入する段階と、
(b) 患者の腰部筋肉における安全領域に配置させるために、刺激拡張装置に、EMGを介して電気パルスを伝達する段階と、
(c) 腰部筋肉を通して、患者の脊椎に向けて刺激拡張装置を横方向に挿入する段階と、
(d) 刺激通路の中へ刺激プローブを挿入する段階と、
を備えていることを特徴とする方法。 - 前記方法がさらに、EMGを使用しつつ刺激拡張装置及び刺激プローブを回転させて、神経の位置を確認する段階(e)を備えていることを特徴とする請求項13に記載の方法。
- 前記方法が、さらに、
(e) 通路から刺激プローブを取り外す段階と、
(f) 第2の刺激通路の中へ刺激プローブを再挿入する段階と、
を備えていることを特徴とする請求項13に記載の方法。
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Application Number | Priority Date | Filing Date | Title |
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US97788207P | 2007-10-05 | 2007-10-05 | |
US60/977,882 | 2007-10-05 | ||
PCT/US2008/078927 WO2009046414A1 (en) | 2007-10-05 | 2008-10-06 | Dilation system and method of using the same |
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JP2010540196A true JP2010540196A (ja) | 2010-12-24 |
JP2010540196A5 JP2010540196A5 (ja) | 2011-11-24 |
JP5250632B2 JP5250632B2 (ja) | 2013-07-31 |
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US (6) | US9387009B2 (ja) |
EP (1) | EP2205171B1 (ja) |
JP (1) | JP5250632B2 (ja) |
KR (1) | KR20100080529A (ja) |
CN (1) | CN101815475B (ja) |
AU (1) | AU2008308426A1 (ja) |
BR (1) | BRPI0818608A2 (ja) |
CA (1) | CA2701504A1 (ja) |
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JP2014517710A (ja) * | 2011-03-10 | 2014-07-24 | インターヴェンショナル スパイン、インコーポレイテッド | 椎間インプラントを低侵襲で挿入する方法および装置 |
JP2015037564A (ja) * | 2010-08-23 | 2015-02-26 | ニューヴェイジヴ,インコーポレイテッド | 外科的アクセスシステムおよび関連する方法 |
JP2017500980A (ja) * | 2014-01-03 | 2017-01-12 | デピュイ・シンセス・プロダクツ・インコーポレイテッド | 拡張システム及び方法 |
US10182842B2 (en) | 2011-03-10 | 2019-01-22 | DePuy Synthes Products, Inc. | Method and apparatus for minimally invasive insertion of intervertebral implants |
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KR20100080529A (ko) | 2007-10-05 | 2010-07-08 | 신세스 게엠바하 | 팽창 시스템 및 이를 이용한 방법 |
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US8876851B1 (en) | 2008-10-15 | 2014-11-04 | Nuvasive, Inc. | Systems and methods for performing spinal fusion surgery |
US20100114147A1 (en) * | 2008-10-30 | 2010-05-06 | The University Of Toledo | Directional soft tissue dilator and docking pin with integrated light source for optimization of retractor placement in minimally invasive spine surgery |
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US20110144687A1 (en) * | 2009-12-10 | 2011-06-16 | Kleiner Jeffrey | Lateral Based Retractor System |
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KR20100080529A (ko) | 2010-07-08 |
EP2205171A1 (en) | 2010-07-14 |
AU2008308426A1 (en) | 2009-04-09 |
BRPI0818608A2 (pt) | 2015-04-22 |
US20110208226A1 (en) | 2011-08-25 |
EP2205171B1 (en) | 2016-03-23 |
US20190167245A1 (en) | 2019-06-06 |
US20180242963A1 (en) | 2018-08-30 |
JP5250632B2 (ja) | 2013-07-31 |
US9974533B2 (en) | 2018-05-22 |
US20170340317A1 (en) | 2017-11-30 |
US9387009B2 (en) | 2016-07-12 |
WO2009046414A1 (en) | 2009-04-09 |
US20160310123A1 (en) | 2016-10-27 |
CN101815475B (zh) | 2012-11-28 |
US10194895B2 (en) | 2019-02-05 |
US20210169461A1 (en) | 2021-06-10 |
US11737743B2 (en) | 2023-08-29 |
US9737290B2 (en) | 2017-08-22 |
CO6270292A2 (es) | 2011-04-20 |
CN101815475A (zh) | 2010-08-25 |
CA2701504A1 (en) | 2009-04-09 |
US10925594B2 (en) | 2021-02-23 |
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