Patent Description:
The present disclosure relates to surgical retractors configured to provide access to a surgical site, such as a portion of a patient's spine. Also disclosed herein are methods of using such surgical retractors in surgical procedures, such as a spinal surgery. <CIT> discloses one type of spinal retractor and a method of using the retractor. In particular, it discloses a retractor blade having an elongate blade portion with an engagement portion and two jaws configured to be opened and closed.

The invention is recited in the claims. Disclosed herein are modular surgical retractors, some of which utilize anchored retractor blades. Such anchored blades include an elongate blade portion, a retractor engagement portion positioned at the proximal end of the elongate blade portion, a first jaw and second jaw positioned at the distal end of the elongate blade portion and configured to engage a bone implant, the first and second jaws configured to occupy a closed configuration and an open configuration, a control assembly configured to transition the first and second jaws between the open configuration and the closed configuration.

According to some embodiments, the elongate blade portion lies substantially in a first plane and a first portion of the first and second jaws-when in the closed configuration-lies in a second plane, the first and second planes transecting each other at an angle of about <NUM>° to about <NUM>°. According to some embodiments, at least a portion of the retractor engagement portion lies in a third plane, the first and third planes transecting each other at an angle of about <NUM>° to about <NUM>. The second and third planes can be substantially parallel. In some embodiments, a second portion of the first and second jaws - when in the closed configuration - lies in the first plane. According to some embodiments, the first jaw pivots about a first axis and the second jaw pivots about a second axis. The first and second axes may he in the first plane and may transect each other such that an angle between the first and second axes is from about <NUM>° to about <NUM>°. The first and second axes may be symmetrical relative to the elongate blade portion. According to some embodiments, the first and/ or second jaw includes a base portion and an arcuate portion. The base portion pivotally engages the distal end of the elongate blade portion. The arcuate portion is designed and shaped to engage the bone implant when the first and second jaws are in the closed configuration. The arcuate portion may be sized and shaped to engage a head of a pedicle screw. The first and second jaws may be configured to allow for the assembly of a modular tulip on the head of the pedicle screw when the first and second jaws are in the closed configuration.

According to some embodiments, the control assembly is positioned on the rear face of the elongate blade portion. The control assembly may include a tool engagement portion, a movable block to engage the first and second jaws so as to transition them between the open and closed configurations, and a connection rod mechanically connecting the tool engagement portion and the movable block and configured to translate rotation of the tool engagement portion into movement of the block either distally or proximally along the elongate blade portion. The tool engagement portion may be positioned at the proximal end of the elongate blade portion. In some embodiments, the movable block applies an equal force to both the first and second jaws so as to cause them to move in unison between the open and closed configurations.

According to some embodiments, the retractor engagement portion includes a spherical portion configured to be received by a retractor assembly. The spherical portion may include a pair of lateral extensions configured to allow the anchored blade to rotate relative to a retractor assembly in only a single plane.

Some embodiments disclosed herein are for surgical retractor systems that include a retractor assembly, a support engagement portion, and at least one anchored blade. The retractor assemblies may have a first retractor arm and a second retractor arm, each retractor arm configured to releasably engage a retractor blade. The support engagement portion may be releasably engaged with a support structure. The at least one anchored blade may be any one of the anchored blade embodiments disclosed herein that is releasably engaged with the first retractor arm. Some embodiments further include a second anchored blade that may be any one of the anchored blade embodiments disclosed herein that is releasably engaged with the second retractor arm. Some embodiments further include a medial blade engagement portion configured to releasably engage a medial retractor blade. Such embodiments may also include a medial retractor blade releasably engaged with the medial blade engagement portion of the retractor assembly. The support structure may be secured to a surgical bed or a surgical frame. The support structure may be an A-arm.

Some embodiments disclosed herein relate to methods of securing an anchored blade to a first bone implant. Such methods include, first, positioning a first anchored blade that may be any one of those disclosed herein so that at least a portion of the first and second jaws of the anchored blade is positioned below a top surface of the first bone implant and, second, activating the control assembly of the first anchored blade to transition the first and second jaws from the open configuration to the closed configuration to anchor the first anchored blade to the first bone implant. Some methods further include, first, positioning a second anchored blade that may be any one of those disclosed herein so that at least a portion of the first and second jaws of the second anchored blade is positioned below a top surface of a second bone implant, and, second, activating the control assembly of the second anchored blade to transition the first and second jaws from the open configuration to the closed configuration to anchor the second anchored blade to the second bone implant.

In some embodiments, the first bone implant is secured to a first vertebra prior to the first anchored blade is secured to the first bone implant and/or the second bone implant is secured to a second vertebra prior to the second anchored blade is secured to the second bone implant. In some embodiments, the first bone implant is secured to a first vertebra after the first anchored blade is secured to the first bone implant and/or the second bone implant is secured to a second vertebra after the second anchored blade is secured to the second bone implant. In some embodiments, a driver is secured to the first bone anchor or second bone anchor prior to securing the first or second bone anchor to the first or second vertebra. The first bone implant and/or the second bone implant may be a pedicle screw having a threaded shank portion and a head portion. The head portion may be at least partially spherical in shape. The pedicle screw may be a component of a modular screw assembly. Some methods further include assembling the modular screw assembly after the first and/or second anchored blades have been anchored to the first and/or second bone implants, respectively. Some methods disclosed herein form part of a procedure for transforaminal lumbar interbody fixation.

Also disclosed herein are various embodiments of anchored surgical retractors that include a base portion having first and second extensions and one or more engagement portions, a first retractor arm, a second retractor arm. The first retractor arm has proximal and distal ends and a third receiving area at the proximal end configured to slidably receive the first extension of the base portion and a fourth receiving area at the distal end configured to releasably engage a portion of a first retractor blade. The second retractor arm has proximal and distal ends and a fifth receiving area at the proximal end configured to slidably receive the second extension of the base portion and a sixth receiving area at the distal end configured to releasably engage a portion of a second retractor blade. In some embodiments, the medial, first, and second retractor blades together create an adjustable surgical corridor, though, in some embodiments, only two of the three retractor blades are used to create the adjustable surgical corridor.

According to some embodiments, the first and/or second retractor blades include an elongate blade portion having a proximal end and a distal end, a retractor engagement portion positioned at the proximal end of the elongate blade portion, and an anchor mechanism positioned at the distal end of the elongate blade portion. In some embodiments, the anchor mechanism includes a first jaw and a second jaw configured to engage a bone implant-the first and second jaws configured to transition between a closed configuration and an open configuration. In the open configuration, a portion of the bone implant is able to pass through the first and second jaws.

According to some embodiments, the first and second retractor blades include a control assembly configured to transition the first and second jaws between the open configuration and the closed configuration. In some cases, the base portion further comprises a first receiving area and the retractor assembly further comprises a medial retractor arm with proximal and distal ends. The medial retractor arm may have a second receiving area at the distal end designed and configured to releasably engage a portion of a medial retractor blade. The proximal end may be configured to be slidably received in the first receiving area of the base portion.

Some embodiments of a retractor assembly further include a lateral retractor arm having a proximal end and a distal end with the proximal end having a seventh receiving area configured to releasably engage a lateral arm engagement portion located on one of the first retractor arm or second retractor arm. The distal end may include an eighth receiving area configured to releasably engage a portion of a lateral retractor blade.

In some embodiments, the first and/or second retractor blade is as described elsewhere herein. In some embodiments, both the first and second retractor blades is as described elsewhere herein.

These and other features are disclosed in greater detail in the accompanying figures and the Detailed Description below.

The following detailed description of the illustrative embodiments can be better understood when read in conjunction with the following drawings wherein like structure is indicated with like reference numerals and in which:.

The present disclosure relates to surgical retractors and specifically to retractors configured for use in spinal surgery. The retractor assemblies disclosed herein benefit from retractor blades that are easily attached to and removed from the retractor arms of the assembly, the ability to use no more than two retractor blades in some embodiments while using at least four retractor blades in some embodiments, the ability to anchor at least one and/or two retractor blades to a fixation element, and the ability to assemble a modular screw even as that same screw serves as an anchor for the anchored retractor. These and other benefits will be apparent to a skilled artisan based on the present disclosure.

<FIG> illustrates one embodiment of a surgical retractor <NUM>. In this illustrated embodiment, retractor <NUM> includes a base portion <NUM> having two lateral extensions 110a and <NUM>10b. Extensions 110a and 110b are illustrated as extending in opposite directions so as to form a substantially straight line. In some embodiments, extensions 110a and 110b are positioned relative to each other to form an angle that may be acute or obtuse. Such variations in the orientation may facilitate certain procedures or approaches.

Base portion <NUM> further includes an engagement portion <NUM> positioned posteriorly on base portion <NUM>. In this illustrated embodiment, engagement portion <NUM> includes two engagement extensions 120a and 120b configured for attachment to a support structure, such as an A-arm (not illustrated). The presence of two engagement extensions allows a user to vary the position of retractor <NUM> relative to the support structure and/or the position of the support structure relative to retractor <NUM> and/or relative to the surgical site.

In the illustrated embodiment of <FIG>, retractor <NUM> includes three retractor arms-medial retractor arm <NUM> and two retractor arms <NUM> and <NUM> that have attached to them anchored retractor blades <NUM> and <NUM>, respectively. Medial arm <NUM> has attached to it medial blade <NUM>. As will be discussed in greater detail below, each of these blades are easily attached to base portion <NUM> during a surgical procedure and may be easily removed from their respective retractor arms during the procedure. Further, each retractor arm may be removed from base portion <NUM> to allow for maximum customizability.

Anchored retractor blades <NUM> and <NUM> are each configured to engage or to be anchored to an anchor <NUM>, such as a bone screw or a pedicle screw. In some embodiments, the anchor is a modular pedicle screw, and one or both of anchored retractor blades <NUM> and <NUM> is configured to allow for assembly of the modular pedicle screw, which may include the placement of a tulip onto the modular pedicle screw. Such assembly of the tulip onto the modular pedicle screw may be achieved without making any adjustments to anchored retractor blades <NUM> and <NUM>. For example, anchored retractor blades <NUM> and <NUM> need not be removed from the head of the modular pedicle screw let alone loosened from the head to allow for the tulip to be secured to the head of the modular pedicle screw.

According to some embodiments, a method of using retractor <NUM> includes a first step of placing one or more bone anchors, such as pedicle screws, in a patient's space. The one or more bone anchors may be modular screws that, during this first step, include just the shank portion of the screw. First retractor blade <NUM> is then advanced toward a first bone anchor, and the anchor portion of the blade <NUM> is advanced over a proximal end of the screw. The anchor portion is then closed around the screw. If a second bone anchor is used, retractor blade <NUM> is advanced toward and anchored onto the second bone anchor in a similar manner as the first retractor blade <NUM>. The respective retractor blades are then secured to a retractor assembly <NUM> that includes base portion <NUM> and retractor arms <NUM> and <NUM>. The arms may then be manipulated to enlarge an opening that allows access to the patient's spine and, in particular, to an intervertebral space. When sufficient access is achieved, a surgeon may perform any number of procedures, such as a laminectomy or an intervertebral fusion that requires the whole or partial removal of the patient's intervertebral disc and the implantation of an interbody between respective vertebrae.

During or after the above procedures, retractor <NUM> may be manipulated to open and/or adjust the configuration of the intervertebral disc space by adjusting the position and/or angulation of retractor blades <NUM> and <NUM>.

The opening created by retractor <NUM> may be further enhanced by the use of medial retractor blade <NUM> or a lateral retractor blade that is discussed further below.

In some embodiments, retractor <NUM> includes only one anchored retractor blade <NUM> or <NUM> and one medial blade <NUM>. In some embodiments, retractor <NUM> includes anchored retractor blades <NUM> and <NUM> and no medial blade <NUM>.

<FIG> illustrates an enlarged view of retractor <NUM> highlighting the engagement of retractor arm <NUM> with extension 110a of base <NUM>, which is achieved by inserting extension 110a through receiving portion or window <NUM> of retractor arm <NUM>. Similarly, retractor arm <NUM> engages with extension 110b by receiving extension 110b through window <NUM> of retractor arm <NUM>. In contrast, medial arm <NUM> engages with base <NUM> by being inserted into a receiving portion on base <NUM>, which is window <NUM>.

Extensions 110a and 110b each include two sets of linear gear teeth. One set of gear teeth on each extension engages with a pinion gear found in each retractor arm to form a rack and pinion mechanism that allows for controlled translation of retractor arms <NUM> and <NUM> linearly along extensions 110a and 110b, respectively. Rotation of each respective pinion gear is achieved by rotating expansion mechanisms <NUM> and/or <NUM>, respectively. In this illustrated embodiment, rotation of either expansion mechanism may be performed only in one direction, the direction of expansion, which is away from medial retractor blade <NUM>, also referred to herein as the midline. This is because each rack and pinion mechanism is coupled with a catch <NUM> and <NUM>, respectively, that engages the other set of linear gear teeth on each extension. As each expansion mechanism is rotated, each pinion gear rotates and engages with its respective set of linear gear teeth to translate each respective retractor arm away from the midline. As each retractor arm advances, catch <NUM> and/or catch <NUM>-each of which is spring loaded to maintain engagement with the second set of linear gear teeth-allows each retractor arm to translate away from the midline but prevents either retractor arm from translating back toward the midline. To achieve translation toward the midline, catch <NUM> and/or catch <NUM> must be pivoted away from the linear gear teeth thereby allowing the respective retractor arm to translate freely along extension 110a and/or 110b.

In some embodiments, no such catch is used, and translation away from and toward the midline is achieved simply by rotating expansion mechanisms <NUM> and/or <NUM>, which in some embodiments are modified to require more torque to achieve translation. Requiring higher torque may prevent the expansion mechanisms from being unintentionally rotated by just the forces applied to retractor arms <NUM> and/or <NUM>.

<FIG> also illustrates that medial retractor arm <NUM> includes a set of linear gear teeth <NUM> that are configured to engage an adjustment mechanism <NUM>, which in this embodiment is a worm gear, on base portion <NUM>. Depending on the direction it is rotated, rotation of adjustment mechanism <NUM> causes linear translation of medial retractor arm <NUM> either away from or toward the surgical corridor created between anchored retractor blades <NUM> and <NUM> and medial retractor blade <NUM>.

<FIG> illustrates base portion <NUM> without any retractor arms attached. This view clearly illustrates the respective sets of linear gear teeth on each of extension 110a and extension <NUM>10b. Also clearly illustrated are the respective engagement extensions 120a and 120b that form engagement portion <NUM>. This embodiment of retractor <NUM> includes both engagement extensions 120a and 120b, some embodiments of retractor <NUM> may include only one engagement extension. When using retractor <NUM>, a user may secure retractor <NUM> to a surgical table by attaching an A-arm or similar device to either engagement extension 120a or 120b or both. The presence of two engagement extensions provides the user with a variety of engagement orientations to choose from. For example, when approaching a patient's spine from one side of the patient, a particular engagement extension may be the more desirable point of fixation for an A-arm. However, when approaching the patient's spine from the other side, the other engagement extension allows the surgeon to achieve a mirror image of the orientation achieved on the first side of the patient. Or is some cases, a different point of fixation may prove more beneficial if a surgeon is left-handed or vice versa.

<FIG> is a perspective view of retractor arm <NUM> without base portion <NUM> or retractor blade <NUM>. This view clearly illustrates receiving portion <NUM>, which, in this illustrated embodiment, includes a raised or keyed portion <NUM> that engages with a corresponding channel on the underside of extension 110a (not illustrated) to ensure a solid engagement between retractor arm <NUM> and extension 110a.

Retractor arm <NUM> also includes auxiliary attachment portion <NUM> that is configured to serve as a point of attachment for an auxiliary or lateral retractor arm, which is discussed below with reference to <FIG>.

Retractor arm <NUM> further includes a distraction mechanism <NUM> that, when rotated, toes out the distal end of retractor blade <NUM>, thereby allowing for or causing distraction of the vertebrae to which retractor <NUM> is attached or anchored.

At its distal end, retractor arm <NUM> includes a retractor blade engagement portion <NUM> that is configured to releasably secure a proximal end of retractor blade <NUM> as discussed below with reference to <FIG> and <FIG>. Retractor blade engagement portion <NUM> includes a release button 380a that when depressed, allows the proximal end of retractor blade <NUM> to be released from retractor blade engagement portion <NUM>. However, engaging retractor blade <NUM> with retractor blade engagement portion <NUM> does not require the depression of button 380a because the mechanism-discussed in greater detail with respect to <FIG>-is a passive mechanism that allows for the easy attachment of retractor blade <NUM> with minimal effort. Engagement of blade <NUM> with arm <NUM> simply requires pushing the proximal end of blade <NUM> into blade engagement portion <NUM>.

<FIG> is a perspective view of retractor arm <NUM> without base portion <NUM> or retractor blade <NUM>. This view clearly illustrates receiving portion <NUM>, which, in this illustrated embodiment, includes a raised or keyed portion <NUM> that mates with a corresponding channel on the underside of extension 110b (not illustrated) to ensure a solid engagement between retractor arm <NUM> and extension 110b.

Retractor arm <NUM> also includes auxiliary attachment portion <NUM> that is configured to serve as a point of attachment for an auxiliary or lateral retractor arm, which is the mirror image of the embodiment shown in <FIG>.

At its distal end, retractor arm <NUM> includes a retractor blade engagement portion <NUM> that is configured to releasably secure a proximal end of retractor blade <NUM>. Retractor blade engagement portion <NUM> includes a release button 480a that when depressed, allows the proximal end of retractor blade <NUM> to be released from retractor blade engagement portion <NUM>. However, engaging retractor blade <NUM> with retractor blade engagement portion <NUM> does not require the depression of button 480a because the mechanism is a passive mechanism that allows for the easy attachment of retractor blade <NUM> with minimal effort.

<FIG> is an enlarged view of the underside of engagement portion <NUM> of retractor arm <NUM>. This view illustrates that engagement portion <NUM> includes, in addition to release button 380a, a receiving area 380b that includes slots 380c. Within receiving area 380b is a locking mechanism 380d that is releasably held in a locked position by biasing element 380e. Although not illustrated, release button 380a includes a cut out portion that, when release button 380a is depressed, aligns with locking mechanism <NUM> allowing it to pivot to an unlocked position.

<FIG> is a perspective view of retractor blade <NUM>, though the illustrated embodiment of retractor blade <NUM> is substantially identical. Thus, this discussion of retractor blade <NUM> applies equally to retractor blade <NUM>. Similarly, the manner in which retractor blade <NUM> engages with retractor arm <NUM> is substantially identical to the manner in which retractor blade <NUM> engages with retractor arm <NUM>.

<FIG> illustrates one such embodiment of an anchored retractor blade <NUM> defined as an elongate blade portion <NUM> having a proximal end <NUM> and a distal end <NUM>. Located at the distal end <NUM> of blade portion <NUM> is an anchor assembly <NUM> that includes two jaw members 20A, 20B configured to be secured onto a bone implant (not illustrated), such as a pedicle screw. Jaw members 20A, 20B may be "mirrored" components, or they may each have a distinct design to facilitate attachment to a suitable anchor. Blade portion <NUM> has both a front face <NUM> and an opposing rear face <NUM>. Visible in <FIG> is the fact that in this embodiment, blade portion <NUM> is slightly curved such that the lateral sides of blade portion <NUM> are curved toward front face <NUM>.

Positioned on front face <NUM> is a channel <NUM> that extends from proximal end <NUM> toward distal end <NUM>. Channel <NUM> is configured to facilitate the passage of instrumentation from proximal end <NUM> down toward distal end <NUM>. Such instrumentation may include lighting strips used to facilitate visualization of the surgical corridor created by anchored blade <NUM>. Along channel <NUM> are a number of depressions that may serve as points of fixation for the instrumentation so as to secure the instrumentation at various depths along blade portion <NUM>. These channels may also facilitate cleaning of anchored blade <NUM>.

Proximal end <NUM> of blade portion <NUM> includes a retractor engagement portion <NUM> that includes a substantially horizontal member <NUM> and a spherical head portion <NUM> with a pair of lateral extensions <NUM>. Engagement portion <NUM> is configured for releasable engagement with a retractor assembly, such as retractor <NUM>. Spherical head portion <NUM> in conjunction with lateral extensions <NUM> are configured to allow anchored blade <NUM>-when engaged with or secured to a retractor assembly-to be rotated to a desirable position along a single plane of rotation with lateral extensions creating the axis of rotation.

Also visible in <FIG> is a tool engagement portion 60A that is part of a control assembly <NUM> that will be discussed in greater detail with reference to <FIG> and <FIG>.

<FIG> illustrates anchor assembly <NUM> in a closed configuration, and <FIG> illustrates anchor assembly <NUM> in an open configuration. <FIG> further illustrate that first jaw member 20A pivots about a first axis 65A and that second jaw member 20B pivots about a second axis 65B. In this illustrated embodiment, first axis 65A and second axis 65B lie in substantially the same plane as elongate blade portion <NUM> or at least in a plane parallel to the plane of elongate blade portion <NUM>. However, despite lying in the same plane as each other, first axis 65A and second axis 65B transect each other at an angle 65C.

Angle 65C can be any suitable angle such as about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, or about <NUM>° to about <NUM>°. It should be appreciated that the opening of anchoring assembly <NUM> should, in some embodiments, allow for easy anchoring onto and/or removal from a bone implant all while operating within the limited confines of the surgical corridor. Thus, in some embodiments, angle 65C is selected so as to not only open or close anchoring assembly <NUM> around a portion of the bone implant but also to facilitate the upward or downward movement of anchored blade <NUM> as it is either lowered into or taken out of the surgical corridor.

Angle 65C is illustrated as having its midpoint substantially in line with the center of elongate blade portion <NUM>. This means that first axis 65A and second axis 65B are substantially symmetrical. However, in some embodiments, the two axes are not symmetrical such that the midpoint of angle 65C is not in line with the center of elongate blade portion <NUM>. In such embodiments, it may be desirable to have first and second jaw members open and close in a non-symmetrical manner or to have one jaw member move in a more vertical line or a more horizontal line, as the case may be. For example, in some embodiments the midpoint of angle 65C is about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>° away from the center of elongate blade portion <NUM>.

Anchoring assembly <NUM> is illustrated as including first jaw member 20A and second jaw member 20B that may move in concert with each other; however, in some embodiments, only one jaw member may pivot while the other jaw member remains in the closed configuration. In some embodiments, control assembly <NUM> (discussed in greater detail below) proactively engages both jaw members equally when in the closed configuration while achieving the open configuration by allowing each jaw member to pivot freely, such that first and second jaw members 20A, 20B may or may not pivot in concert.

<FIG> is a side view of anchored blade <NUM> illustrating a number of features such as the substantially orthogonal orientation of anchoring assembly <NUM> relative to elongate blade portion <NUM>-when in the closed configuration-as well as the orthogonal orientation of elongate blade portion <NUM> relative to horizontal member <NUM> of retractor engagement portion <NUM>. In this illustrated embodiment, elongate blade portion <NUM> can be said to define a first plane, a portion of anchoring assembly <NUM> can be said to define a second plane, and horizontal member <NUM> can be said to define a third plane. In some embodiments, the second and third planes are substantially parallel to each other and substantially orthogonal to the first plane-when anchoring assembly <NUM> is in the closed configuration. In some embodiments, one of the second plane and the third plane is substantial orthogonal to the first plane but the second and third planes are not parallel to each other. In some embodiments, neither the second plane nor the third plane is orthogonal to the first plane, and they may or may not be parallel to each other. <FIG> further illustrates that at least a portion of anchoring assembly <NUM>-when in the closed configuration-lies substantially in the first plane or in a plane parallel to the first plane. This portion of anchoring assembly may be referred to as the base portion of both the first and second jaw members.

In some embodiments, the first and second planes transect each other at an angle of about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, or about <NUM>° to about <NUM>°. In some embodiments, the first and third planes transect each other at an angle of about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, or about <NUM>° to about <NUM>°.

<FIG> illustrates front face <NUM> and rear face <NUM> of elongate blade portion <NUM> and the fact that positioned on rear face <NUM> is a control assembly <NUM>, which mechanism includes tool engagement portion 60A (illustrated in <FIG> and <FIG>), a connection rod 60C contained within connection rod housing 60B, and a movable block 60D. In this embodiment, rotation of tool engagement portion 60A rotates connection rod 60C, which in turn causes movable block 60D to translate distally or proximally. In some embodiments, control assembly is located on front face <NUM>, such as in channel <NUM>.

Referring now to <FIG> and <FIG>, distal translation of movable block 60D pushes distally or downward against first and second jaw members 20A, 20B of anchor assembly <NUM>, thereby causing first and second jaw members 20A, 20B to pivot into and be maintained in the closed configuration as illustrated in <FIG>. The open configuration is achieved by proximally translating movable block 60D (which is caused by rotating tool engagement portion 60D), as illustrated in <FIG>. When movable clock 60D translates proximally, the pressure applied to first and second jaw members 20A, 20B is reduced and removed; however, the jaw members may not automatically transition out of the closed configuration. In other words, first and second jaw members 20A, 20B may remain in the closed configuration passively. If anchoring assembly <NUM> is anchored to a bone implant, opening of first and second jaw members 20A, 20B may require anchored blade <NUM> to be pulled proximally to disengage anchoring assembly <NUM> from the bone implant. However, if anchoring assembly <NUM> is not anchored to a bone implant and there is no tissue or other object touching it, translating moveable block 60D will allow first and second jaw members to be pulled by gravity downward or distally to achieve the open configuration.

In some embodiments, distal translation of moveable block 60D causes anchoring assembly <NUM> to transition to the open configuration automatically without any need to move anchored blade <NUM>. In some embodiments, either first jaw member 20A or second jaw member 20B is mechanically engaged with moveable block 60D such that proximal translation of moveable block 60D causes the relevant jaw member to transition into the open configuration while the other jaw member remains passively in the closed configuration.

In the illustrated embodiment, connection rod 60C that mechanically communicates rotation of tool engagement portion 60A to translation of moveable block 60D is contained within connection rod housing 60B. In some embodiments, connection rod 60C is not contained within a housing. In some embodiments, connection rod 60C is shorter such that tool engagement portion 60D is not located on or near retractor engagement portion <NUM>. For example, tool engagement portion 60A may be located more distally along rear face <NUM> of elongate blade portion <NUM>. Some embodiments do not include connection rod 60C at all such that tool engagement portion 60D is directly connected to block 60D.

In some embodiments, some or all of control assembly <NUM> is positioned on front face <NUM> of elongate blade portion <NUM>. In some such embodiments, it may be desirable to maintain as much working space as possible toward the proximal end of anchored blade <NUM>. Accordingly, control assembly <NUM> may lack any connection rod, such that tool engagement portion 60A is positioned just above or proximal to moveable block 60D, and an adjustment tool must extend down the length of elongate blade portion <NUM> along front face <NUM> to engage and rotate tool engagement portion 60A.

<FIG> and <FIG> also illustrate lateral projections <NUM> on spherical head portion <NUM> of retractor engagement portion <NUM>. In this illustrated embodiment, lateral projections <NUM> define an axis that produces rotation of anchored blade <NUM> in a plane of rotation that is roughly orthogonal to the plane defined by elongate blade portion <NUM>. However, in some embodiments, a rotation in a different plane may be desired, in which case lateral projections <NUM> can be positioned accordingly on spherical head portion <NUM> to achieve rotation in the desired plane. Additionally, in some embodiments, lateral projections <NUM> are removed altogether to allow anchored blade <NUM> to rotate in multiple planes.

<FIG> is a top view of the proximal end of anchored blade <NUM>. This perspective illustrates the structural relationships of many of the elements of anchored blade <NUM> as discussed above with respect to the other figures; however, <FIG> further illustrates the distal or arcuate portions of first and second jaw members 20A, 20B. When abutting each other in the closed configuration, first and second jaw members 20A, 20B form an opening <NUM> configured to anchor onto and retain a portion of a bone implant, such as a bone screw or a pedicle screw. In this illustrated embodiment, opening <NUM> is substantially circular; however, in some embodiments, opening <NUM> has other shapes, such as an oval, a square, a rectangle, etc. In this illustrated embodiment, the circular shape of opening <NUM> is achieved by the two half-circle aspects of first and second jaw members 20A, 20B. In some embodiments, one or both of first and second jaw members form less than two half circles. In the illustrated embodiment, the two half circles of first and second jaw members 20A, 20B are shown as substantially abutting each other at each end of the half circle. Such a configuration may not only provide greater stability or engagement for anchored blade <NUM> but also may provide greater tactile response for a user who engages anchored blade <NUM> with a bone implant. However, in some embodiments, only one end of one half circle (or other suitable shape) abuts the corresponding end of the other half circle (or other suitable shape). In some embodiments, neither end of the half circle (or other suitable shape) abuts the corresponding end of the other half circle (or other suitable shape).

The shape of opening <NUM> may be determined by the shape of the portion of the bone implant to which anchoring assembly <NUM> is to be anchored. For example, where the bone implant is a pedicle screw and the portion to be anchored to is a partially or fully spherical head, opening <NUM> is ideally circular in shape, and the edges of the arcuate arms of first and second jaw members 20A, 20B may further include sloped or rounded surface to accommodate or engage the spherical head of the pedicle screw. In some embodiments, the shape and side of opening <NUM> may be configured for attachment to the shank portion of a pedicle screw so as to allow the upper or head portion of the pedicle screw to be accessible for assembly of a tulip onto the head wherein the pedicle screw is a modular pedicle screw.

In some embodiments, the closed configuration of anchoring assembly <NUM> is understood to be achieved when at least a portion of first jaw member 20A is brought into and maintained in contact with at least a portion of second jaw member 20B. In some embodiments, the closed configuration is understood to be achieved when moveable block 60D is translated distally far enough to apply a force to first and second jaw members 20A, 20B to allow anchoring assembly <NUM> to be engaged with and anchored onto a bone implant or other suitable anchoring point even if no portion of first jaw member 20A is in contact with any portion of second jaw member 20B.

In some embodiments, the open configuration of anchoring assembly <NUM> is understood to be achieved when moveable block 60D is translated proximally far enough to allow first and second jaw members 20A, 20B of anchoring assembly <NUM> to open thereby allowing a portion of a bone implant (or other suitable anchoring point) to pass in or out of opening <NUM>.

The anchored retractor blades disclosed herein are configured for use with retractor assemblies, such as retractor <NUM>. Such assemblies may have one or more retractor arms, each arm configured to have attached to it (releasably or in a non-releasable manner) a retractor blade, at least one of which blades will be an anchored retractor blade according to the present disclosure. In some embodiments of retractor assemblies, two anchored blades are positioned opposite each other in the retractor assembly. Some embodiments include a medial and/or lateral blade positioned to the side of the space created by the two opposite anchored blades.

Suitable retractor assemblies may also include a support engagement portion so that the retractor assembly may be releasably secured to and held in a fixed position and orientation relative to a surgical bed. Such configurations may utilize an A-arm to secure the retractor assembly to the surgical bed.

The anchored retractor blades discussed herein can be used in methods of anchoring a surgical retractor to a bone implant or other suitable anchor. Such methods may include positioning a first anchored blade according to this disclosure within a surgical corridor so that at least a portion of the first and second jaws of the anchored blade is positioned below a top surface of a first bone implant. Once in position, a user activates the control assembly of the first anchored blade to transition the first and second jaws from the open configuration to the closed configuration to anchor the first anchored blade to the first bone implant. Some methods further include positioning a second anchored blade according to this disclosure within the surgical corridor so that at least a portion of the first and second jaws of the second anchored blade is positioned below a top surface of a second bone implant. Once in position, the user activates the control assembly of the second anchored blade to transition the first and second jaws from the open configuration to the closed configuration to anchor the second anchored blade to the second bone implant.

The above methods illustrate how the anchored blades can be secured to bone implants that have already been placed at or near the surgical site. In alternative embodiments, one or both anchored blades are secured to the bone anchors prior to the resulting construct being inserted into a patient's body near the surgical site. In such configurations, the blade/implant combination is advanced toward the surgical or anchor site and, when properly positioned, the bone implant (e.g., a pedicle screw) is advanced into bone thereby securing the anchored blade in place as well. The same steps may be followed for the other anchored blade, and with both anchored blades in position, they may be secured to a retractor assembly to establish a stable surgical corridor. In some embodiments, a driver is secured to the blade/implant combination to achieve a blade/implant/driver combination that is then advanced toward the surgical or anchor site, such that when the combination is positioned properly, the driver can be used immediately to advance the implant into bone without requiring any additional instruments or steps.

When the bone implant is a modular pedicle screw, some methods further include the step of installing a tulip on the head portion of the pedicle screw. Some methods that utilize an anchored retractor blade as disclosed herein will be part of a procedure for transforaminal lumbar interbody fixation. Some methods will be part of a procedure for a posterior lumbar interbody fixation. Some methods will be part of a procedure for a lateral lumbar interbody fixation.

<FIG> illustrates medial retractor arm <NUM>, which includes an elongate portion <NUM> having a top surface comprised of linear gear teeth <NUM> configured to mate with adjustment mechanism <NUM>. As discussed above, rotation of adjustment mechanism <NUM> causes medial retractor arm <NUM> to translate linearly relative to base portion <NUM> as to expand or contract a medial portion of the surgical corridor created by the two or more retractor blades/arms. Medial retractor arm <NUM> includes at its distal end a medial blade engagement portion <NUM> that is pivotable relative to elongate portion <NUM> by virtue of a distraction mechanism <NUM> that, when rotated, causes engagement portion <NUM> to pivot downward, which means below a plane defined by elongate portion <NUM>. Such pivoting may be useful to enlarge surgical access and/or combat tissue creep into the surgical corridor.

Engagement portion <NUM> includes a receiving window <NUM> configured to receive an engagement extension of medial retractor blade <NUM>, which is discussed in greater detail below with respect to <FIG> and <FIG>. Engagement portion <NUM> further includes a release/locking mechanism <NUM> comprising a locking portion <NUM> (discussed in greater detail below with respect to <FIG> and <FIG>) and a button portion <NUM> that, in this illustrated embodiment, extends above a top surface of engagement portion <NUM>.

<FIG> is an elevation view of engagement portion <NUM> in which is visible distraction mechanism <NUM>, receiving window <NUM>, and release/locking mechanism <NUM>. Not illustrated is a biasing element, such as a spring, located beneath release/locking mechanism <NUM> that maintains release/locking mechanism in a locked position, which is achieved when the majority of the frustoconical section of locking portion <NUM> is visible through receiving window <NUM>. Pressing down on button portion <NUM> compresses the biasing element and allows locking portion <NUM> to drop below receiving window <NUM> so as to release the medial blade engagement portion.

<FIG> illustrates release/locking mechanism <NUM> in isolation and highlights the rear sections that include behind the frustoconical section two cutouts <NUM> configured to receive at least a portion of the medial blade engagement portion as discussed below. Some embodiments include only a single cutout <NUM>. Some embodiments include cutouts of different shapes, though generally the shape of the cutout corresponds to the shape of an extension of the medial blade engagement portion.

<FIG> is a perspective view of medial retractor blade <NUM> illustrating that it includes at its proximal end an engagement portion <NUM> and at its distal end an extendable portion <NUM>. Between the proximal and distal ends is a blade body <NUM>. Extendable portion <NUM> is illustrated as having, at its distal end, a curved tip. This configuration may allow medial retractor blade <NUM> to better retain or hold back tissue from the surgical corridor created by two or more retractor blades secured to surgical retractor <NUM>. Extendable portion <NUM> may be translated into or out of blade body <NUM> depending on the depth of the surgical corridor and the needs of the surgical procedure.

Engagement portion <NUM> includes an extension or, as is illustrated, a pair of extensions <NUM> configured to engage release/locking mechanism <NUM> when extensions <NUM> are inserted into receiving window <NUM>. <FIG> illustrates that in this embodiment of extensions <NUM>, they have a hook or arch <NUM> to them. This structural feature is configured to accommodate the frustoconical shape of locking portion <NUM> of release/locking mechanism <NUM>. The sloped surfaces <NUM> that are adjacent to arched area <NUM> are configured to press down on locking portion <NUM> as engagement portion <NUM> is pressed into receiving window <NUM>, thereby pressing down on locking portion <NUM>, compressing the biasing element beneath it and allowing extensions <NUM> to at least partially pass over locking portion <NUM>. When extensions <NUM> are sufficiently inserted into engagement portion <NUM> of medial retractor arm <NUM>, arched area <NUM> allows release/locking mechanism <NUM> to move back into the locked position by accommodating locking portion <NUM> in arched area <NUM>. Furthermore, the generally rectangular outer shape of extensions <NUM> correspond to the generally rectangular inner surface of receiving window <NUM>, thereby resisting rotational movement of engagement portion and, by association, rotational movement of medial retractor blade <NUM>.

The above-explained features are designed to allow for the passive locking of medial blade <NUM> with medial arm <NUM> without requiring any active locking steps, the activation of any other components, depressing any components or buttons, etc..

Disengaging medial retractor blade <NUM> from medial retractor arm <NUM> is achieved by depressing button portion <NUM>, which moves locking portion <NUM> downward allowing extensions <NUM> to be pulled past lacking portion <NUM> and out of receiving window <NUM>.

<FIG> further illustrates that medial retractor blade <NUM> may include a channel <NUM> that, in this embodiment, is configured to operate in a similar manner to channel <NUM> of anchored retractor blade <NUM> and/or <NUM>.

<FIG> illustrates an auxiliary or lateral retractor arm <NUM>. This illustrated lateral retractor arm <NUM> is configured for attachment to retractor arm <NUM>; however, in some embodiments, lateral retractor arm <NUM> may be configured for attachment to retractor arm <NUM>. This is achieved by simply reversing the orientation of the various features of lateral retractor arm <NUM> discussed below.

Lateral retractor arm <NUM> includes at its proximal end an arm engagement portion <NUM> and at its distal end a lateral blade engagement portion <NUM>. Between the distal and proximal ends is a distraction mechanism <NUM> as well as a lateral adjustment mechanism <NUM>, which in this illustrated embodiment comprises a worm gear. Rotation of adjustment mechanism <NUM> causes expansion or contraction of lateral retractor arm <NUM>, which when attached to retractor <NUM>, enlarges or diminishes the size of the surgical corridor. Distraction mechanism <NUM>, when rotated, toes out or angles a lateral retractor blade secured to lateral blade engagement portion <NUM>. The lateral blade (not shown) may be similar in design to medial retractor blade <NUM>. Lateral blade engagement portion <NUM>, in this illustrated embodiment, operates similarly to medial blade engagement portion <NUM> in that it releasably secures a retractor blade preventing it from twisting or rotating.

To achieve a suitable surgical corridor, the surgical retractor disclosed herein may include as few as two retractor blades and as many as three retractor blades using any combination of two anchored retractor blades, one medial retractor blade, and one lateral retractor blade with the lateral retractor blade secured via a lateral retractor arm to either of the two retractor arms. For example, some configurations will include only the two anchored retractor blades opposite each other. Some configurations will include the two retractor blades and only the medial retractor blade with some of these configurations further including the lateral retractor blade attached via the lateral retractor arm to either of the two retractor arms. Some embodiments will include just one anchored retractor blade with the medial retractor arm or the lateral retractor or both the medial retractor blade and the lateral retractor blade.

While particular embodiments have been illustrated and described herein, it should be understood that various other changes and modifications may be made without departing from the scope of the claimed subject matter Moreover, although various aspects of the claimed subject matter have been described herein, such aspects need not be utilized in combination. It should also be noted that some of the embodiments disclosed herein may have been disclosed in relation to a particular approach (e.g., lateral or transforaminal); however, other approaches (e.g., anterior, posterior, etc.) are also contemplated.

Unless otherwise indicated, all numbers expressing quantities of ingredients, properties such as molecular weight, reaction conditions, and so forth used in the specification and claims are to be understood as being modified in all instances by the term "about. " Accordingly, unless indicated to the contrary, the numerical parameters set forth in the specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained by the embodiments of the present disclosure. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the present disclosure are approximations, the numerical values set forth in the specific examples are reported as precisely as possible. Any numerical value, however, inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements. In one embodiment, the terms "about" and "approximately" refer to numerical parameters within <NUM>% of the indicated range.

The terms "a," "an," "the," and similar referents used in the context of describing the embodiments of the present disclosure (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. Recitation of ranges of values herein is merely intended to serve as a shorthand method of referring individually to each separate value falling within the range. Unless otherwise indicated herein, each individual value is incorporated into the specification as if it were individually recited herein. The use of any and all examples, or exemplary language (e.g., "such as") provided herein is intended merely to better illuminate the embodiments of the present disclosure and does not pose a limitation on the scope of the present disclosure. No language in the specification should be construed as indicating any non-claimed element essential to the practice of the embodiments of the present disclosure.

Groupings of alternative elements or embodiments disclosed herein are not to be construed as limitations. Each group member may be referred to and claimed individually or in any combination with other members of the group or other elements found herein. It is anticipated that one or more members of a group may be included in, or deleted from, a group for reasons of convenience and/or patentability. When any such inclusion or deletion occurs, the specification is deemed to contain the group as modified thus fulfilling the written description of all Markush groups used in the appended claims.

Certain embodiments are described herein, including the best mode known to the author(s) of this disclosure for carrying out the embodiments disclosed herein. Of course, variations on these described embodiments will become apparent to those of ordinary skill in the art upon reading the foregoing description. The author(s) expects skilled artisans to employ such variations as appropriate, and the author(s) intends for the embodiments of the present disclosure to be practiced otherwise than specifically described herein. Accordingly, this disclosure includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the present disclosure unless otherwise indicated herein or otherwise clearly contradicted by context.

Specific embodiments disclosed herein may be further limited in the claims using consisting of or consisting essentially of language. When used in the claims, whether as filed or added per amendment, the transition term "consisting of" excludes any element, step, or ingredient not specified in the claims. The transition term "consisting essentially of" limits the scope of a claim to the specified materials or steps and those that do not materially affect the basic and novel characteristic(s). Embodiments of this disclosure so claimed are inherently or expressly described and enabled herein.

Claim 1:
An anchored blade (<NUM>) for use with a surgical retractor (<NUM>), the blade comprising:
an elongate blade portion (<NUM>) having a proximal end (<NUM>), a distal end (<NUM>), a front face (<NUM>) configured to face a surgical corridor, a rear face (<NUM>) opposite the front face, and at least one channel (<NUM>) extending from the proximal end toward the distal end along the front face;
a retractor engagement portion (<NUM>) positioned at the proximal end of the elongate blade portion;
a first jaw (20A) and second jaw (20B) positioned at the distal end of the elongate blade portion and configured to engage a bone implant, the first jaw configured to pivot about a first axis (65A) and the second jaw configured to pivot about a second axis (65B), the first and second jaws configured to occupy a closed configuration and an open configuration, wherein, when in the open configuration, a portion of the bone implant is able to pass through the first and second jaws;
a control assembly (<NUM>) configured to transition the first and second jaws between the open configuration and the closed configuration.