Abstract:
A three-blade spinal retractor utilizes adjustable and lockable translating arms with angulating blades to provide triangulated medial/lateral and cephalad/caudal tissue retraction for spinal surgeries via the adjustably lockable translating arms. A medial/lateral translating arm with an angularly adjustable retraction blade co-acts and cooperates with angularly adjacent first and second cephalad/caudal translating arms with angularly adjustable retraction blades for tissue retraction and surgical site access. A plate having a medial/lateral adjustment system adjustably holds the medial/lateral translating arm, a first cephalad/caudal adjustment system adjustably holding the first cephalad/caudal translating arm and a second cephalad/caudal adjustment system adjustably holding the second cephalad/caudal translating arm. The translating arms each have a blade holder that provides angular adjustment of the blade. Angular adjustment of each blade along with medial/lateral and cephalad/caudal adjustment provides improved preciseness and stability in positioning, tissue distraction, and surgical site access.

Description:
RELATED APPLICATIONS 
     This patent application claims the benefit of and/or priority under 35 U.S.C. §119(e) to U.S. Provisional Patent Application Ser. No. 61/577,857 filed Dec. 20, 2011, entitled “Three-Blade Spinal Retractor” the entire contents of which is specifically incorporated herein by this reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to surgical devices for retracting anatomy to provide exposure of an operating site, and more particularly, to retraction apparatus providing improved access to a surgical site for a spine procedure. 
     2. Background 
     Surgical procedures typically require the use of a retractor to hold anatomies and/or tissues out of the way from the incision down to the actual surgical site. In the case of posterior spinal surgery for implanting various spine fixation components and/or other spinal orthopedic devices, it is necessary to retract different tissue types including large and strong paraspinal muscles in order to get to the actual surgical site. In order to accomplish this goal, spinal retractors have been developed that hold back the desired anatomy of a spinal surgical site and is fixed relative to the patient either directly or indirectly. 
     Many different types of spinal retractors are currently available many of which use retractor blades—a part of the distraction mechanism of the spinal retractor that enters the site of the incision and physically holds the anatomy apart. The retractor blades can be attached to a frame at an angle such as about 90 degrees from horizontal (i.e. generally vertical) or as to have a variable angle. However, current spinal retractors have various deficiencies. For instance, fixed angle retractor blade configurations limit flexibility of the spinal retractor, including loss of surgical site precision and overall stabilization. The variable angle retractor blade configurations lack preciseness and flexibility in retractor blade positioning. 
     It is therefore evident from the above that there is a need for an improved spinal retractor that can overcome the deficiencies of current spinal retractors. It is also evident from the above that there is a need for an improved spinal retractor which provides enhanced preciseness and flexibility in retractor blade positioning. It is furthermore evident that there is a need for an improved spinal retractor as aforementioned which also allows for instrument and/or component retention and positioning by the retractor blade assembly. 
     SUMMARY OF THE INVENTION 
     The present invention is a spinal retractor for spinal surgeries providing improved preciseness and stability in positioning, tissue distraction, and surgical site access. The spinal retractor utilizes adjustable and lockable translating arms with angulating blades to provide a stable surgical site finestra and the adjustable retraction of surgical site tissue. 
     The present spinal retractor is a three blade retractor that allows triangulated medial/lateral and cephalad/caudal tissue retraction for spinal surgeries via the adjustably lockable translating arms. A medial/lateral translating arm with an angularly adjustable retraction blade co-acts and cooperates with angularly adjacent first and second cephalad/caudal translating arms with angularly adjustable retraction blades for tissue retraction and surgical site access. 
     The spinal retractor includes a plate having a medial/lateral adjustment system adjustably holding the medial/lateral translating arm, a first cephalad/caudal adjustment system adjustably holding the first cephalad/caudal translating arm, and a second cephalad/caudal adjustment system adjustably holding the second cephalad/caudal translating arm. The translating arms each have a blade holder which provides angular adjustment of the blade. Angular adjustment of each blade along with medial/lateral and cephalad/caudal adjustment provides improved preciseness and stability in positioning, tissue distraction, and surgical site access. 
     Further aspects of the present invention will become apparent from consideration of the drawings and the following description of a preferred embodiment of the invention. A person skilled in the art will realize that other embodiments of the invention are possible and that the details of the invention can be modified in a number of respects without departing from the inventive concept. The following drawings and description are to be regarded as illustrative in nature and not restrictive. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The features of the invention will be better understood by reference to the accompanying drawings which illustrate a presently preferred embodiment of the invention, wherein: 
         FIG. 1  is a topside view of a spinal retractor fashioned in accordance with the present principles, the spinal retractor shown in a closed position; 
         FIG. 2  is an underside view of the spinal retractor of  FIG. 1  shown in a closed position; 
         FIG. 3  is another topside view of the spinal retractor of  FIG. 1  in an open position; 
         FIG. 4  is a top plan view of the spinal retractor of  FIG. 1  in a closed position; and 
         FIG. 5  is an enlarged topside view of a blade assembly on an arm of the spinal retractor of  FIG. 1 . 
     
    
    
     Like reference numbers indicate the same or similar parts throughout the several figures. 
     A description of the features, functions and/or configurations of the components depicted in the various figures will now be presented. It should be appreciated that not all of the features of the components of the figures are necessarily described. Some of these non discussed features as well as discussed features are inherent from the figures. Other non discussed features may be inherent in component geometry and/or configuration. 
     DETAILED DESCRIPTION OF THE INVENTION 
     Reference is now made to  FIGS. 1-5  which depict several views of a spinal retractor  10 , fashioned in accordance with the present principles. The spinal retractor  10  is fashioned for use in anterior, posterior and lateral spinal surgeries or procedures, such as orthopedic implantation, vertebral fixation and vertebral stabilization, but may be used in other surgical procedures and orientations. The spinal retractor  10  is formed of an appropriate surgical material such as titanium, stainless steel, an alloy of same or the like. 
     The spinal retractor  10  has a body  12  characterized by a base, plate, platform or the like  13 , a first translating arm  14  carried by the base  13  on one side thereof, a second translating arm  16  carried by the base  13  on another side thereof, wherein the sides are in the cephalad/caudal direction when the spinal retractor  10  is used, and a middle arm  18  carried by the base between the first and second translating arms  14 ,  16 , wherein the middle arm is in the lateral/medial direction when the spinal retractor  10  is used. The base  13  further has a first side arm or wing  24  extending from a first side of the base  13  and a second side arm or wing  26  extending from a second side of the base  13 . The first and second side arms  24 ,  26  extend generally in opposite directions relative to each other but with a slight inward angle as shown. The first and second side arms  24 ,  26  are in the cephalad/caudal direction when the spinal retractor  10  is used. 
     The spinal retractor  10  is designed to be fixed relative to a surgical site particularly, but not necessarily, to an external frame or the like (not shown) that is fixed relative to the patient. The spinal retractor  10  is also configured for rotation relative to the external frame. As such the base  13  has a boss  22  situated between opposite edges  25 ,  27 , the boss  22  defining a face  23  from which projects a post, shaft, pole, bar, rod, stick or the like (i.e. a projection)  21 . The spinal retractor  10  is connected with the external frame via the projection  21  which is received in or by a clamp, holder, receiver or the like (not shown) of the external frame. The projection  21  has a textured or keyed outer surface for engagement with the external frame, shown in the figures as radially spaced longitudinal grooves. The external surface of the projection  21  aids in positive engagement of the spinal retractor  10  with the external frame in order to fix rotational position of the spinal retractor  10  relative to the external frame. 
     A housing  28  is disposed on the base  13  between the first and second side arms  24 ,  26  and has an opening that receives the arm  18 . The housing  28  cooperates with the arm  18  to provide adjustment of the arm  18  relative to the housing  28 . Particularly, the arm  18  has a plurality of teeth, serrations or the like  51  on an inside edge thereof while the housing  28  includes ratchet components that cooperate with the teeth  51  of the arm  18  to provide ratcheting adjustability/translation of the arm  18  relative to the base  13 . A button  29  is associated with the housing  28  and is coupled to the internal ratchet components thereof in order to allow release of the ratcheted (fixed) position of the arm  18  relative to the housing  28 . In this manner, the arm  18  translates or slides in and out relative to the housing  28 /base  13 . Additionally, since a blade assembly  48 , as described more fully below, is connected to the arm  18 , the blade assembly  48  translates relative to the housing  28 /base  13 . This allows the blade assembly  48  to be positioned relative to the housing  28 /base  13  and to the other blade assemblies  50 ,  52 . Because of its position, the arm  18  and thus the blade assembly  48  translate or move in the medial/lateral directions when the spinal retractor  10  is in use. Position of the blade assembly  48  affects and effects retraction of tissue at the surgical site, particularly in the medial/lateral directions. 
     A housing  30  is disposed on an end of the first side arm  24  and has an opening that receives the first translating arm  14 . The housing  30  cooperates with the first translating arm  14  to provide adjustment of the first translating arm  14  relative to the housing  30 . Particularly, the first translating arm  14  has a plurality of teeth, serrations or the like  41  on an inside edge of an end  39  of the first translating arm  14  while the housing  30  includes ratchet components that cooperate with the teeth  41  of the first translating arm  14  to provide ratcheting adjustability/translation of the first translating arm  14  relative to the first side arm  24 /base  13 . A button  31  is associated with the housing  30  and is coupled to the internal ratchet components thereof in order to allow release of the ratcheted (fixed) position of the first translating arm  14  relative to the housing  30 . In this manner, the first translating arm  14  translates or slides in and out relative to the housing  30 /first side arm  24 . Additionally, since the blade assembly  50 , as described more fully below, is connected to the first translating arm  14 , the blade assembly  50  translates relative to the housing  30 /first side arm  24 . This allows the blade assembly  50  to be positioned relative to the housing  30 /first side arm  24  and to the other blade assemblies  48 ,  52 . 
     Mention is now made to the configuration of the first translating arm  14 . The first translating arm  14  is angled or bent so as to define a “boomerang” shape—i.e. an elbow or bend  38  between arm segments  36  and  39 . Particularly, arm segments  36 ,  39  are bent to have an internal angle of less than ninety degrees (angle&lt;90°) with around seventy degrees (70°) being shown and preferred. Other angles, of course, may be used. A head  37  is provided at an end of the arm segment  36  opposite the bend  38  and is angled so as to project essentially parallel with the arm segment  39 . The head  37  holds the blade assembly  50 . As seen, the first translating arm  14  is angled so that its blade assembly  50  is proximate the blade assembly  48  of the arm  18 . 
     The first translating arm  14  moves in and out relative to the housing  30  and thus the first side arm  24  through ratcheting of the arm segment  39  with its plurality of teeth  41  cooperating with the ratchet components of the housing  30 . Movement of the arm  14  moves the corresponding blade assembly  50  relative to the other blade assemblies  48 ,  52 . Because of its position and connection with the housing  30 , the first translating arm  14  translates or moves in the cephalad/caudal directions so that the blade assembly  50  also moves in the cephalad/caudal directions. Position of the blade assembly  50  affects and effects retraction of tissue at the surgical site, particularly in the cephalad/caudal directions. 
     A housing  32  is disposed on an end of the second side arm  26  and has an opening that receives the second translating arm  16 . The housing  32  cooperates with the second translating arm  16  to provide adjustment of the second translating arm  16  relative to the housing  32 . Particularly, the second translating arm  16  has a plurality of teeth, serrations or the like  47  on an inside edge of an end  45  of the second translating arm  16  while the housing  32  includes ratchet components that cooperate with the teeth  47  of the second translating arm  16  to provide ratcheting adjustability/translation of the second translating arm  16  relative to the second side arm  26 /base  13 . A button  32  is associated with the housing  32  and is coupled to the internal ratchet components thereof in order to allow release of the ratcheted (fixed) position of the second translating arm  16  relative to the housing  32 . In this manner, the second translating arm  16  translates or slides in and out relative to the housing  32 /second side arm  26 . Additionally, since the blade assembly  52 , as described more fully below, is connected to the second translating arm  16 , the blade assembly  52  translates relative to the housing  32 /second side arm  26 . This allows the blade assembly  52  to be positioned relative to the housing  32 /second side arm  26  and to the other blade assemblies  48 ,  50 . 
     Mention is now made to the configuration of the second translating arm  16 . The second translating arm  16  is angled or bent so as to define a “boomerang” shape—i.e. an elbow or bend  44  between arm segments  42  and  45 . Particularly, arm segments  42 ,  45  are bent to have an internal angle of less than ninety degrees (angle&lt;90°) with around seventy degrees (70°) being shown and preferred. Other angles, of course, may be used. A head  43  is provided at an end of the arm segment  42  opposite the bend  44  and is angled so as to project essentially parallel with the arm segment  45 . The head  43  holds the blade assembly  52 . As seen, the second translating arm  16  is angled so that its blade assembly  52  is proximate the blade assembly  48  of the arm  18 . 
     The second translating arm  16  moves in and out relative to the housing  32  and thus the second side arm  26  through ratcheting of the arm segment  45  with its plurality of teeth  47  cooperating with the ratchet components of the housing  32 . Movement of the arm  16  moves the corresponding blade assembly  52  relative to the other blade assemblies  48 ,  50 . Because of its position and connection with the housing  32 , the second translating arm  16  translates or moves in the cephalad/caudal directions so that the blade assembly  52  also moves in the cephalad/caudal directions. Position of the blade assembly  52  affects and effects retraction of tissue at the surgical site, particularly in the cephalad/caudal directions. 
     Ratcheting adjustment of the arm  18  and of the first and second translating arms  14 ,  16  (and thus adjustment of the blade assemblies  48 ,  50 ,  52 ) may be accomplished manually but are preferably adjusted via one or more surgical instruments or tools. As such, the arms  18 ,  24 ,  26  and the base  13  are configured to allow manipulation of the arms  18 ,  24 ,  26  by a surgical instrument or tool (not shown). 
     As best seen in  FIGS. 1 and 4 , the arm  18  has a series of holes  19  that extend along its longitudinal length. The base  13  has a slot  70  that extends through the housing  28  and which is sized to receive the arm  18 . The arm  18  thus translates within the slot  70 . One or more holes  19  of the arm  18  accepts a surgical instrument, tool and/or instrument/tool portion to manually move the arm  18  within the slot  70  and in conjunction/cooperation with the ratcheting housing  28 . As should be appreciated, the ratcheting housing  28  allows incremental locking movement of the arm  18  in one direction while prohibiting movement in an opposite direction without the release thereof. In the case of arm  18 , the arm  18  incrementally locks in a direction toward the base  13  in order to hold tissue by the blade assembly  48  in the medial/lateral direction. This allows the surgeon to incrementally manipulate the blade assembly  48  and thus the amount of tissue retraction by the blade assembly  48 . Release is accomplished by the button/ratchet release system  29  associated with the housing/ratchet system  28 . As best seen in  FIG. 4 , the button  29  extends from the housing  28  into a configured notch or recess  77  in the first side arm  24 . Recessing the button  29  helps to prevent accidental activation and thus release of tissue retraction. 
     As best seen in  FIGS. 1, 3 and 4 , the first translating arm  14  has a series of holes  40  that extend along a length of the end segment  39 . In conjunction therewith, the first side arm  24  of the base  13  has a slot  76  that extends from the configured recess  77  into the housing  30 . The slot  76  is sized both in width and length to fit under the arm segment  39  and particularly under the holes  40 . One or more holes  40  of the first translating arm  14  accepts a surgical instrument, tool and/or instrument/tool portion to manually move the arm  14  over the slot  76  and in conjunction/cooperation with the ratcheting housing  30 . As should be appreciated, the ratcheting housing  30  allows incremental locking movement of the arm  14  in one direction while prohibiting movement in an opposite direction without the release thereof. In the case of the first translating arm  14 , the arm  14  incrementally locks in a direction along the longitudinal length of the first side arm  24  inwardly toward the base  13  in order to hold tissue by the blade assembly  50  in the cephalad/caudal direction. This allows the surgeon to incrementally manipulate the blade assembly  50  and thus the amount of tissue retraction by the blade assembly  50 . Release is accomplished by the button/ratchet release system  31  associated with the housing/ratchet system  30 . The button  31  extends outward from the housing  30  helping to prevent accidental activation and thus release of tissue retraction. 
     As best seen in  FIGS. 1, 3 and 4 , the second translating arm  16  has a series of holes  46  that extend along a length of the end segment  45 . In conjunction therewith, the second side arm  26  of the base  13  has a slot  74  that extends from proximate an end of the second side arm  26  near the base  13  and into the housing  32 . The slot  74  is sized both in width and length to fit under the arm segment  45  and particularly under the holes  46 . One or more holes  46  of the second translating arm  16  accepts a surgical instrument, tool and/or instrument/tool portion to manually move the arm  16  over the slot  74  and in conjunction/cooperation with the ratcheting housing  32 . As should be appreciated, the ratcheting housing  32  allows incremental locking movement of the arm  16  in one direction while prohibiting movement in an opposite direction without the release thereof. In the case of the second translating arm  16 , the arm  16  incrementally locks in a direction along the longitudinal length of the second side arm  26  inwardly toward the base  13  in order to hold tissue by the blade assembly  52  in the cephalad/caudal direction. This allows the surgeon to incrementally manipulate the blade assembly  52  and thus the amount of tissue retraction by the blade assembly  52 . Release is accomplished by the button/ratchet release system  33  associated with the housing/ratchet system  32 . The button  33  extends outward from the housing  32  helping to prevent accidental activation and thus release of tissue retraction. 
     As seen in the figures each arm  18 ,  14  and  16  has a respective blade assembly  48 ,  50 ,  52  for holding and retracting tissue during spinal surgery. The blade assembly  48  includes a head  54  which pivotally retains a blade holder  57  via an angulation system controlled by a set screw  66 , the head  54  holding a blade  60   a . The blade assembly  50  includes the head  37  which pivotally retains a blade holder  56  via an angulation system controlled by a set screw  67 , the head  37  holding a blade  60   b . The blade assembly  52  includes the head  43  which pivotally retains a blade holder  58  via an angulation system controlled by a set screw  68 , the head  43  holding a blade  60   c . The blades  60   a ,  60   b  and  60   c  are preferably, and as shown, identical. While each blade assembly  48 ,  50 ,  52  is identical, one or more blade assembly may be different as desired. However, in the preferred embodiment as shown, the three blade assemblies forming a triangular blade assemblage, are identical and fashioned in accordance with the present principles. Therefore, description of one blade assembly of the blade assemblies  48 ,  50 ,  52  describes the others of the blade assemblies  48 ,  50 ,  52 . Moreover, the description of one blade  60   a ,  60   b ,  60   c  of the blade assemblies  48 ,  50 ,  52  describes the others of the blades  60   a ,  60   b ,  60   c . In general, the blade assemblies  48 ,  50 ,  52  are each designed for up/down or posterior/anterior translation or angulation. In  FIGS. 1, 2 and 4 , the blade assemblies  48 ,  50 ,  52  are in a 0° or non-angulated position as well as in an un-retracted position. In  FIG. 3 , the blade assemblies  48 ,  50 ,  52  are in a downwardly angled position (an angle downwardly from 0°) as well as in a retracted position. 
     With particular reference to  FIG. 5  the details of a blade assembly and blade will be described with reference to blade assembly  50 . As seen, the blade holder  56  is shown in a 0° position wherein the blade  60   b  is in a full upright or vertical position. The blade holder  56  is pivotally coupled to the head  37 . Particularly, an end or tongue  88  of the blade holder  56  is received within a cutout  86  of the head  37  and pivotally connected at sides thereof to arms  84  and  85  of the head  37 . This allows the blade holder  56  to pivot relative to the head  37 . The blade holder  56  and the head  37  are connected via the angulation adjustment system  63  which includes a worm gear system driven by the hex nut  67 . Particularly (and in conjunction with  FIG. 3 ) the hex nut  67  is externally threaded to mesh with screw serrations  80  on an end of the blade holder  56 . As the hex nut  67  is rotated clockwise or counterclockwise the blade holder  56  will angulate or pivot up and down. As the blade holder  56  angulates or pivots downward, the spade portion  61   b  of the blade  60   b  moves outwardly (medially or laterally) to effect splaying of the tissue. As seen in  FIG. 3 , the blade holder  58  includes screw serrations  82  on an end thereof as part of its angulation adjustment system  59 . 
     The blade holder  56  has first and second side arms  90 ,  91  that define a configured notch  94  that is adapted to receive a configured flange  96  of a head  95  of the blade  60   b . The blade holder  56  and the blade  60   b  are configured to allow the blade  60   b  to be positively received and held, removed and replaced. Inwardly projecting ends  92 ,  93  of the first and second side arms  90 ,  91  define a confined slot for receipt and retention of the blade head  96 , the blade flange  96  having lips  97 ,  98  for complementary reception by the ends  92 ,  93 . The blade  60   b  is thus vertically inserted into and removed from the blade holder  56 . 
     The blade holder  56  incorporates a spring loaded detent system  79  which releasably locks the blade  60   b  into the blade holder  56 . The blade  60   b  has a keyed access point  62   b  to allow both insertion of the blade  60   b  into the blade holder  56  as well as actuation of the detent system  79  in order to release the blade  60   b  from the blade holder  56 . 
     The blade  60   b  has a tong, spade, paddle or the like  61   b  that extends transverse from the head  95 . An inner surface  99  of the paddle  61   b  is curved inwardly (i.e. concave relative to the head  95 ). A channel  100  extends from a top of the paddle  61   b  (i.e. the top of the concavity  99 ) to an end of the paddle  61   b . The channel  100  receives a shaft that permits anatomical docking of the blade to bony anatomy and/or a cannula in which lighting may be inserted to aid in intraoperative visualization. Rounded corners permit the finestra formed by the blades  60   a ,  60   b ,  60   c  to maintain the same diameter as the blades are angulated. 
     It should be appreciated that the present spinal retractor  10  provides a table mount connection to secure retractor position relative to the patient via the frame (table). The cephalad/caudal translating arms incrementally lock positions via ratcheting teeth within each ratchet housing and subsequently expand both soft tissue retraction by means of the blades. Each translating arm can be moved independently. The cephalad/caudal translating arms cooperate and co-act with the medial/lateral translating arm to provide a stable finestra and retraction. Thumb actuated depressors release the locked positions of the arms and thus the blades. Adjustable convergence of each translating arm  14 ,  16 ,  18  with respective blades creates an adjustable finestra to the surgical site. 
     While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only a preferred embodiment has been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.