Orthopedic Surgical System Including Surgical Access Systems, Distraction Systems, And Methods Of Using Same

TECHNICAL FIELD

The present disclosure relates generally to orthopedic surgical systems, and more particularly, to surgical access systems for separating tissue in a surgical field to increase visualization of the surgical field and surgical distraction systems for separating adjacent vertebral bodies, and methods of using the same.

BACKGROUND

The human spine includes thirty-three vertebrae. The vertebrae interlock with one another to form a spinal column. Each vertebra has a cylindrical bony body (vertebral body), two pedicles extending from the vertebral body, a lamina extending from the pedicles, two wing-like projections extending from the pedicles, a spinous process extending from the lamina, a pars interarticularis, two superior facets extending from the pedicles, and two inferior facets extending from the lamina. The vertebrae are separated and cushioned by thin pads of tough, resilient fiber known as intervertebral discs. Intervertebral discs provide flexibility to the spine and act as shock absorbers during activity. A small opening (foramen) located between each vertebra allows passage of nerves. When the vertebrae are properly aligned, the nerves pass through without a problem. However, when the vertebrae are misaligned or a constriction is formed in the spinal canal, the nerves get compressed and may cause back pain, leg pain, or other neurological disorders.

Disease, the effects of aging, or physical trauma resulting in damage to the spine has been treated in many instances by fixation or stabilization of the effected vertebra. A wide variety of spinal fixation apparatuses have been employed in surgical procedures for correcting spinal injuries and the effects of spinal diseases.

Disorders of the spine that may cause misalignment of the vertebrae or constriction of the spinal canal include spinal injuries, infections, tumor formation, herniation of the intervertebral discs (i.e., slippage or protrusion), arthritic disorders, and scoliosis. In these pathologic circumstances, surgery may be tried to either decompress the neural elements and/or fuse adjacent vertebral segments. Decompression may involve laminectomy, discectomy, or corpectomy. Laminectomy involves the removal of part of the lamina, i.e., the bony roof of the spinal canal. Discectomy involves removal of the intervertebral discs. Corpectomy involves removal of the vertebral body as well as the adjacent intervertebral discs.

The time-honored method of addressing the issues of neural irritation and instability resulting from severe disc damage has largely focused on removal of the damaged disc and fusing the adjacent vertebral elements together. Removal of the disc relieves the mechanical and chemical irritation of neural elements, while osseous union (bone knitting) solves the problem of instability.

After a partial or complete discectomy, the normally occupied space between adjacent vertebral bodies is subject to collapse and/or misalignment due to the absence of all or a part of the intervertebral disc. In such situations, the physician may insert one or more prosthetic spacers between the affected vertebrae to maintain normal disc spacing and/or the normal amount of lordosis in the affected region.

Typically, a prosthetic implant is inserted between the adjacent vertebrae and may include pathways that permit bone growth between the adjacent vertebrae until they are fused together. As is typical, the intervertebral spaces are accessed either anteriorly or posteriorly. It would be desirable to access the intervertebral spaces via an approach that provides greater access to the surgical area while applying the least amount of stress to the surrounding tissue.

Additionally, one of the challenges during surgery is to ensure that the vertebral bodies can maintain parallel distraction so as not to move the spine out of alignment.

Therefore, a need exists for systems and/or devices used in spinal surgery that provides greater access and visualization of a surgical area while applying the least amount of stress to the surrounding tissue and/or maintains alignment and spacing of the vertebral bodies and rigid attachment to the vertebral bodies.

SUMMARY

In accordance with an aspect of the present disclosure, a surgical access system includes a first connector including an arm, a coupling element, a rod, and a ridged slider. The arm includes first and second notched sections disposed in opposed lateral sides of the arm. The coupling element includes a body section defining an opening therethrough, and opposed tabs protruding from the body section that are configured to receive the second notched section of the arm therebetween such that the arm is pivotably coupled to the coupling element. The rod includes a shaft having a plurality of angled grooves defined partially along a length thereof. The rod extends through the opening of the coupling element and the first notched section of the arm. The ridged slider includes a first surface having a plurality of ridges extending along a partial length thereof. The ridged slider extends through the coupling element with the plurality of ridges operably engaged with the plurality of angled grooves of the rod.

The first notched section of the arm of the first connector may include a connecting element and the rod may include a circumferential groove engaged with the connecting element.

In embodiments, the first connector has a closed position in which the arm is adjacent to the coupling element, and an open position in which the arm is angled with respect to the coupling element.

The arm of the first connector may include a cavity having a receiving element disposed therein. The receiving element may include an engaging portion movable between a locked state and an unlocked state.

In embodiments, the surgical access system further includes a first retractor blade having a planar portion including a protruding portion having a grooved defined therein, and a blade portion. The planar and blade portions extend along different planes. In some embodiments, the protruding portion of the first retractor blade is releasably engaged with the engaging portion of the receiving element.

The surgical access device may further include a second connector and a second retractor blade. The surgical access device may further include first and second supports, and a beam. The first retractor blade may be coupled to the first support and the second retractor blade may be coupled to the second support. The first support may be fixed to the beam and the second support may be slidably mounted on the beam.

In embodiments, the surgical access device further includes an extension device having a first extension arm pivotably coupled to a second extension arm. The second extension arm includes a protruding portion having a groove defined therein. In some embodiments, the protruding portion of the extension device is releasably engaged with the engaging portion of the receiving element. In certain embodiments, the extension device includes a channel releasably engaged with the protruding portion of the first retractor blade.

In accordance with another aspect of the present disclosure, a surgical distraction system includes a distractor device including first and second elongated members pivotably coupled together. Each of the first and second elongated members includes a flat portion disposed on a lateral side thereof. The flat portions are substantially parallel to each other and in abutting relationship when the distractor device is in a closed position, and the flat portions are substantially parallel to each other and laterally spaced apart when in an open position.

In embodiments, each of the first and second elongated members of the distractor device includes a partial lumen extending partially along a length thereof substantially perpendicularly from the flat portion.

The surgical distraction system may further include a plurality of pins releasably engaged with the partial lumens of the first and second elongated members of the distractor device. Each pin of the plurality of pins may include at least one protrusion and the partial lumens may include at least one detent configured to receive the at least one protrusion.

In embodiments, the distractor device includes a handle including a biasing mechanism configured to bias the distractor device in the closed position.

In accordance with an aspect of the present disclosure, a method of creating separation between adjacent vertebral bodies includes inserting first and second pins into adjacent vertebral bodies, securing first and second elongated members of a distractor device to the first and second pins, the first and second elongated members pivotably coupled together, and each of the first and second elongated members including a flat portion disposed on a lateral side thereof, the flat portions being substantially parallel to each other and in an abutting relationship when the distractor device is in a closed position, and the flat portions being substantially parallel to each other and laterally spaced apart when the distractor device is in an open position, and manipulating a handle of the distractor device to move the distractor device to the open position to apply a distraction force to the adjacent vertebral bodies.

In embodiments, securing the first and second elongated members of the distractor device to the first and second pins includes positioning the distractor device between the first and second pins, and manipulating the handle of the distractor device to move the first and second elongated members of the distractor device into contact with the first and second pins to releasably secure the first and second elongated members to the first and second pins.

The method may further include inserting first and second retractor blades of a surgical access system into an opening in a patient, and moving at least one of the first and second retractor blades to increase a size of the opening.

In embodiments, the method further includes manipulating the handle of the distractor device to move the distractor device to the closed position to remove the distraction force, and removing the distractor device and the first and second pins from the adjacent vertebral bodies.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiments given below, serve to explain the principles of the disclosure, wherein:

FIG. 1A is a perspective view of a connector in accordance with an embodiment of the present disclosure;

FIG. 1B is an exploded view of the connector of FIG. 1A;

FIG. 2A is a front view of the connector of FIG. 1A in a straight or closed position;

FIG. 2B is a cross-sectional view of the connector of FIG. 2A, taken along line 2B-2B of FIG. 2A;

FIG. 3A is a front view of the connector of FIG. 1A in an angled or open position;

FIG. 3B is a cross-sectional view of the connector of FIG. 3A, taken along line 3B-3B of FIG. 3A;

FIG. 4A is a front view of a straight retractor blade in accordance with an embodiment of the present disclosure;

FIG. 4B is a side view of the straight retractor blade of FIG. 4A;

FIG. 4C is a perspective view of a tapered retractor blade in accordance with another embodiment of the present disclosure;

FIG. 4D is a front view of the tapered retractor blade of FIG. 4C;

FIG. 4E is a side view of the tapered retractor blade of FIGS. 4C and 4D;

FIG. 5A is a perspective view of an angled retractor blade in accordance with yet another embodiment of the present disclosure;

FIG. 5B is a front view of the angled retractor blade of FIG. 5A;

FIG. 5C is a side view of the angled retractor blade of FIGS. 5A and 5B;

FIG. 5D is a front view of a straight retractor blade in accordance with another embodiment of the present disclosure;

FIG. 5E is a side view of the straight retractor blade of FIG. 5D;

FIG. 6A is a perspective view of the arm of the connector of FIG. 1A releasably secured to the tapered retractor blade of FIG. 4C via a receiving element in accordance with an embodiment of the present disclosure;

FIG. 6B is an exploded view of the arm and the receiving element of FIG. 6A, with a portion of the tapered retractor blade of FIG. 4C shown separated from the arm;

FIG. 6C is a top view of the arm of the connector and the tapered retractor blade of FIG. 4C, with the receiving element in a locked state;

FIG. 6D is a cross-sectional view of the arm of the connector and the tapered retractor blade of FIG. 4C, taken along line 6D-6D of FIG. 6C;

FIG. 6E is a top view of the receiving element, in a locked state, and the tapered retractor blade of FIG. 4C, with the arm of the connector removed;

FIG. 6F is a cross-sectional view of the receiving element and the tapered retractor blade of FIG. 4C, taken along line 6F-6F of FIG. 6E;

FIG. 6G is a top view of the arm of the connector and the tapered retractor blade of FIG. 4C, with the receiving element in an unlocked state;

FIG. 6H is a cross-sectional view of the arm of the connector and the tapered retractor blade of FIG. 4C, taken along line 6H-6H of FIG. 6G;

FIG. 6I is a top view of the receiving element, in an unlocked state, and the tapered retractor blade of FIG. 4C, with the arm of the connector removed;

FIG. 6J is a cross-sectional view of the receiving element and the tapered retractor blade of FIG. 4C, taken along line 6J-6J of FIG. 6I;

FIG. 7A is a top view of a surgical access system in accordance with an embodiment of the present disclosure, with connectors in a straight or closed position;

FIG. 7B is a top view of the surgical access system of FIG. 7A, with the connectors in an open or angled position;

FIG. 8A is a top view of the surgical access system of FIG. 7A, with retractor blades coupled thereto;

FIG. 8B is a side view of the surgical access system of FIG. 8A;

FIG. 9A is a top view of the surgical access system of FIG. 8A, with retractor blades coupled thereto and in an angled position;

FIG. 9B is a side view of the surgical access system of FIGS. 7B and 9A;

FIG. 10A is a top view of an extension device in accordance with an embodiment of the present disclosure;

FIG. 10B is a side view of the extension device of FIG. 10A;

FIG. 10C is an exploded view of the extension device of FIGS. 10A and 10B;

FIG. 11 is a top view of a surgical access system in accordance with another embodiment of the present disclosure;

FIG. 12A is a top view of a surgical access system in accordance with yet a further embodiment of the present disclosure;

FIG. 12B is a side view of the surgical access system of FIG. 12A;

FIG. 13 is a top view of a surgical access system in accordance with an alternate embodiment of the present disclosure;

FIG. 14A is a perspective view of a distractor device in accordance with an embodiment of the present disclosure;

FIG. 14B is an enlarged view of the area of detail of the distractor device of FIG. 14A;

FIG. 15 is a front view of a pin in accordance with an embodiment of the present disclosure;

FIG. 16A is a front perspective view of a surgical distraction system with the distractor device of FIG. 14A coupled to pins of FIG. 15 in accordance with an embodiment of the present disclosure;

FIG. 16B is an enlarged view of the area of detail of FIG. 16A showing the pins separated from the distractor device;

FIG. 16C is a front end view of the surgical distraction system of FIG. 16A;

FIG. 16D is a side view of the surgical distraction system of FIG. 16A; and

FIG. 16E is an enlarged side view of the area of detail of FIG. 16D showing a distal portion of the surgical distraction system.

DETAILED DESCRIPTION

Embodiments of the present disclosure are now described in detail with reference to the drawings in which like reference numerals designate identical or corresponding elements in each of the several views. Throughout this description, the term “proximal” refers to a portion of a system, device, or component thereof that is closer to a clinician, and the term “distal” refers to the portion of the system, device, or component thereof that is farther from the clinician.

Referring now to the drawings, FIGS. 1A and 1B illustrate a connector 100 configured and adapted for a minimally invasive surgical procedure to access, for example, the thoracic or lumbar vertebrae, in accordance with an embodiment of the present disclosure. The connector 100 is suitable for use with a retractor or surgical access system 2 (see FIG. 11) as will be described in detail hereinbelow. The connector 100 includes an arm 110, a coupling element 120, a rod 130, and a ridged slider 140. The arm 110 is configured and dimensioned to receive and support the coupling element 120 which, in turn, is configured and dimensioned to receive and support the rod 130 and the ridged slider 140.

The arm 110 extends along a longitudinal axis “X” (FIG. 6C), and includes a first end portion 110a and a second end portion 110b. The first end portion 110a includes a first notched section 112 disposed in a lateral side of the arm 110 that is configured and dimensioned to receive the rod 130, and a second notched section 114 disposed in an opposed lateral side of the arm 110 that is configured to receive a tab 126 of the coupling element 120. The first notched section 112 includes a connecting element 116 that is configured and dimensioned to engage a circumferential groove 131 of the rod 130. In embodiments, the connecting element 116 is a ridge or raised surface that extends from and wraps around an interior wall of the first notched section 112 (see e.g., FIG. 6B), and in some embodiments, the connecting element is substantially “U” or “C” shaped. It is contemplated that other shapes, textures, and/or configurations of the connecting element are possible so long as the connecting element 116 can releasably engage the circumferential groove 131 of the rod 130. The second notched section 114 includes a pair of opposed openings 115 configured to receiving a fixation pin 150 for securing the coupling element 120 to the arm 110. The arm 110 is rotatable about the fixation pin 150.

The second end portion 110b of the arm 110 includes a cavity 111 defined therein that is configured and dimensioned to house a receiving element 160 (see e.g., FIG. 6B), as described in further detail below. The cavity 111 is open at a first opening 111a defined in a proximal surface 118a of the arm 110, a second opening 111b defined in a front surface 118b of the arm 110, and a third opening 111c defined in a back surface 118c of the arm 110.

The coupling element 120 includes a body section 122 and a protruding section 124 integrally formed with and extending from a side surface of the body section 122. The body section 122 includes an opening 123 extending transverse through the body 122 that is configured and dimensioned to receive the rod 130 and the ridged slider 140. The protruding section 124 includes a pair of opposed tabs 126 configured to receive the second notched section 114 of the arm 110 therebetween. Each tab of the pair of opposed tabs 126 includes an opening 127 defined therethrough that is configured to receive the fixation pin 150 for securing the coupling element 120 to the arm 110, as described above. Retaining features 128 extend from a distal surface of the body section 122 of the coupling element 120 for coupling with a support 180 (see e.g., FIG. 7A).

The rod 130 includes a shaft 132 that extends between a first end 130a and a second end 130b of the rod 130. While the rod 130 is shown as substantially circular and having a circumference, it should be understood that the rod may be any shape, such as substantially square or angled. The shaft 132 includes a plurality of angled grooves 134 defined partially along a length of one side of the shaft 132. It should be understood, however, that the plurality of angled grooves 134 may extend around the circumference of the shaft 132.

The plurality of angled grooves 134 are disposed at an angle with respect to the shaft 132 and, in embodiments, the plurality of angled grooves 134 are disposed within a range of about 30° to about 40°. It should be understood that the plurality of angled grooves 134 may be disposed at any angle so long as they are configured to engage a plurality of ridges 142 disposed on the ridged slider 140, as described in further detail below. Additionally or alternatively, the shaft 132 of the rod 130 may include any textured pattern partially along its length and/or around its circumference so long as the textured pattern is configured to engage the ridged slider 140 (i.e., the shaft and the ridged slider have complementary configurations).

The first end 130a of the rod 130 includes a flattened side 136 located on the same side of the rod 130 as the plurality of angled grooves 134. The first end 130a of the rod 130 has a circumference that is greater than the circumference of the shaft 132. The larger circumference of the first end 130a aids in preventing the rod 130 from moving completely through the first opening 123 of the coupling element 120.

A circumferential groove 131 is defined between the second end 130b of the rod 130 and the shaft 132 in longitudinally spaced relation relative to the plurality of angled grooves 134. It should be understood that the circumferential groove 131 may be any shape or form so long as it is configured to engage the connecting element 116 in the first notched section 112 of the arm 110, as discussed above.

The ridged slider 140 includes a first surface 140a having a plurality of ridges 142 extending along a partial length thereof. The plurality of ridges 142 is disposed at an angle with respect to the first surface 140a to engage the plurality of angled grooves 134 of the rod 130, as discussed above. The plurality of ridges 142 may be any shape or form so long as they are configured to engage the plurality of angled grooves 134 of the rod 130. In embodiments, the ridged slider 140 acts as a pawl with the plurality of angled grooves 134 of the rod 130.

The ridged slider 140 includes a beveled surface 140b. The angle of the beveled surface 140b may be shallow (e.g., no bevel) or deep (e.g., almost 90°), or any angle therebetween. The angle of the beveled surface 140b affects the ability to apply a force to the ridged slider 140 by a user.

The ridged slider 140 is connected to the coupling element 120 with at least one connection pin 152 such that the first surface 140a of the ridged slider 140 is adjacent to the rod 130. The ridged slider 140 is operably coupled to a biasing member 154, such as a spring, disposed between the ridged slider 140 and an inner surface of the coupling element 120 to bias the ridged slider 140 towards engagement with the rod 130 thereby defining a locked state.

Referring now to FIGS. 2A and 2B, the connector 100 is shown in a straight or closed position. The arm 110 is coupled to the coupling element 120 via fixation pin 150. The rod 130 extends through the opening 123 (FIG. 1B) in the coupling element 120 and the circumferential groove 131 of the rod 130 is engaged with the connecting element 116 of the first notched section 112 of the arm 110. The ridged slider 140 also extends through the opening 123 of the coupling element 120 and is operatively engaged with the biasing member 154 so that the ridged slider 140 is biased towards the locked state. In the locked state, the plurality of ridges 142 on the first surface 140a of the ridged slider 140 is engaged with the plurality of angled grooves 134 of the rod 130.

The arm 110 of the connector 100 can move from the straight or closed position (FIGS. 2A and 2B) to an angled or open position, as shown in FIGS. 3A and 3B. A user applies a force to the first end 130a of the rod 130 thereby causing the plurality of angled grooves 134 to disengage from the plurality of ridges 142 of the ridged slider 140. Because the circumferential groove 131 of the rod 130 is engaged with the connecting element 116 of the arm 110, the arm 110 rotates about the fixation pin 150 to the angled or open position. Once the force is removed, the plurality of ridges 142 of the ridged slider 140 engages the plurality of angled grooves 134 of the rod 130 along a portion closer to the first end 130a of the rod 130 thereby retaining the connector 100 in the angled or open position. It should be noted that the rod 130 can continue to move upon an application of a force thereto so long as the plurality of ridges 142 of the ridged slider 140 is engaged with the plurality of angled grooves 134 of the rod 130. It should be understood that the rod 130 may only move in one direction due to the angle of the plurality of grooves 134 when the plurality of ridges 142 of the ridged slider 140 are engaged with the plurality of angled grooves 134. As discussed below, the rod 130 may be moved in two directions when the ridged slider 140 is in an unlocked state and the plurality of ridges 142 are disengaged from the plurality of angled grooves 134.

The arm 110 may also move from an angled or open position to a straight or closed position, e.g., from the angled or open position of FIGS. 3A and 3B to the straight or closed position of FIGS. 2A and 2B. A user applies a force to the beveled surface 140b of the ridged slider 140 which, in turn, causes the ridged slider 140 to engage the biasing member 154 thereby moving the ridged slider 140 from a locked state to an unlocked state, and away from the rod 130. In the unlocked state, the ridged slider 140 actively engages the biasing member 154 and the plurality of ridges 142 of the ridged slider 140 disengages from the plurality of angled grooves 134 of the rod 130. The arm 110 can then be rotated around the fixation pin 150 to the straight or closed position. Once the force is removed from the beveled surface 140b of the ridged slider 140, the biasing member 154 is disengaged and the ridged slider 140 returns to the locked state. Specifically, the ridged slider 140 slides back towards the rod 130 so that the plurality of ridges 142 engage the plurality of angled grooves 134 to retain the arm 110 in the straight or closed position.

The cavity 111 of the arm 110 is configured and dimensioned to releasably secure a protruding portion of a retractor blade or a protruding portion of an extension device thereto. Exemplary retractor blades are shown in FIGS. 4A-5E, and an exemplary extension device is shown in FIGS. 10A-10C.

Referring now to FIGS. 4A and 4B, a straight retractor blade 200 includes a planar portion 210 and a blade portion 212 extending, in a different plane, than the planar portion 210. The planar blade portions 210, 212 extend along transverse planes such that the planar and blade portions 210, 212 are substantially orthogonal to each other. The planar portion 210 is configured and dimensioned to engage the back surface 118c (FIG. 1A) of the arm 110, such as in a superposed relationship. The planar portion 210 includes a protruding portion 214 configured and dimensioned to extend into the cavity 111 (FIG. 1A) of the arm 110 through the third opening 111c defined in the back surface 118c of the arm 110. As described in further detail below, the protruding portion 210 includes a groove 216 configured and dimensioned to releasably engage an engaging portion 162 (see e.g., FIG. 6D) of a receiving element 160 of the arm 110. The blade portion 212 includes a distal end 212a having a curvature “C,” and defining a recess 213 therein.

As shown in FIGS. 4C-4E, a tapered retractor blade 201 is shown. The tapered retractor blade 201 is substantially similar to the straight retractor blade 200 of FIGS. 4A and 4B, and includes a planar portion 210 including a protruding portion 214 having a groove 216 defined therein, and a blade portion 212′ including a distal end 212a′ having a curvature “C,” and defining a recess 213′ therein. The blade portion 212′ of the tapered retractor blade 201, however, tapers towards the planar portion 210. While the blade portion 212′ is shown as being angled relative to the planar portion 210, it should be understood that the blade portion 212′ may be substantially orthogonal to the planar portion 210 as described above with regard to the straight retractor blade 200 of FIGS. 4A and 4B.

FIGS. 5A-5C show an angled retractor blade 202 in accordance with another embodiment of the present disclosure. The angled retractor blade 202 is substantially similar the retractor blades 200, 201 described above with regard to FIGS. 4A-4E. The angled retractor blade 202 includes a planar portion 210″ including a protruding portion 214″ having a groove 216″, and a blade portion 212″ including a distal end 212a″ having a curvature “C.” The blade portion 212″ of the angled retractor blade 202 extends along a plane that is angled, but not orthogonal, with respect to the plane along which the planar portion 210″ extends. Additionally, the protruding portion 214″ is offset at an angle relative to the plane of the planar portion 210″. In embodiments, the protruding portion 214″ may be disposed at a 30° with respect to the planar portion 210″. One of ordinary skill in the art will readily understand that once the protruding portion 214″ of the angled retractor blade 202 is engaged with the cavity 111 (see e.g. FIG. 1A) of an arm 110, the blade portion 212″ is offset at the angle of the protruding portion 214″ relative to a length of the arm 110.

FIGS. 5D and 5E show a straight retractor blade 203 in accordance with yet another embodiment of the present disclosure. The straight retractor blade 203 is substantially similar the angled retractor blade 202 described above with regard to FIGS. 5A-5C, except that the planar portion 210″ and the blade portion 212′″ extend along transverse planes that are orthogonal to each other, the protruding portion 214″ is aligned with the planar portion 210″, and a recess 213″ is defined in a distal end 212a′″ of the blade portion 212′″.

As described above, the arm of a connector is configured and dimensioned to receive and support a protruding portion of a retractor blade. As shown, for example, in FIG. 6A, the protruding portion 214 of the retractor blade 201 is received and supported in the 111 cavity, via the third opening 111c (FIG. 6B), of the arm 110 to releasably secure the retractor blade 201 to the arm 110. While the retractor blade shown coupled to the connector is a tapered retractor blade, it should be understood that the retractor blade may be a straight, tapered, or angled retractor blade, such as those shown and described above, among other retractor blades within the purview of those skilled in the art.

As shown in FIG. 6B, the cavity 111 of the arm 110 houses a receiving element 160. The receiving element 160 includes an engaging portion or first cavity 162 defined in a forked portion between opposed forks 164. The engaging portion 162 is configured and dimensioned to engage the groove 216 of the protruding portion 214 of the retractor blade 201. In embodiments, the engaging portion 162 includes a beveled edge. The engaging portion 162 can slidably engage the groove 216 defined in the protruding portion 214 to releasably secure the protruding portion 214 of the retractor blade 201 to the arm 110.

The receiving element 160 includes a second cavity 166 configured and dimensioned to engage a spring 156 and a stop 158. The receiving element 160 is biased towards a locked state by the spring 156. In the locked state, the length of the spring 156 is increased, e.g., at its longest length, and the engaging portion 162 is engaged with the groove 216 of the protruding portion 214 of the retractor blade 201. The receiving element 160 includes a third cavity 168 disposed between the first and second cavities 162, 166 that is configured and dimensioned to receive a post 170. The post 170 includes a body 172 and a head 174. The body 172 of the post 170 is configured and dimensioned to extend through the second opening 111b of the arm 110 and into the third cavity 168 of the receiving element 160 such that the head 174 of the post 170 is adjacent the front surface 118b of the arm 110.

FIGS. 6C and 6D show the protruding portion 214 of the retractor blade 201 engaged with the engaging portion 162 of the arm 110. The spring 156 is positioned between the stop 158 and an inner wall 166a of the second cavity 166. The engaging portion 162 is engaged with the groove 216 of the protruding portion 214 of the retractor blade 201. As shown in FIGS. 6E and 6F, in both of which the arm 110 has been removed for clear viewing of the receiving element 160, the forked portion of the receiving element 160 (i.e., the space between forks 164) surrounds the protruding portion 214 of the retractor blade 201 on two sides with the engaging portion 162 of the receiving element 160 engaged with the groove 216 of the retractor blade 201. The post 170 is in close proximity to the protruding portion 214 of the retractor blade 201 because the spring 156 biases the receiving element 160 towards the locked state (i.e., spring 156 extends towards its maximum length).

FIGS. 6G and 6H show the engaging portion 162 of the receiving element 160 disengaged from the protruding portion 214 of the retractor blade 201. The post 170 is spaced from the protruding portion 214 of the retractor blade 201 by a distance greater than the distance therebetween when the engaging portion 162 of the receiving element 160 is engaged with the protruding portion 214 of the retractor blade 201 (see e.g. FIG. 6D). A user applies a force to the post 170, which causes the receiving element 160 to compress the spring 156 (i.e., spring compresses towards its minimum length) and receiving element 160 moves towards an unlocked state. With the receiving element 160 in the unlocked state, the length of the spring 156 is shortened relative to the length of the spring 156 when the receiving element 160 is in the locked state because the post 170 acts on the spring 156, and the engaging portion 162 of the receiving element 160 is not engaged with the groove 216 of the protruding portion 214 of the retractor blade 201. As shown in FIGS. 6I and 6J, in both of which the arm 110 has been removed for clear viewing of the receiving element 160, the forked portion of the receiving element 160 surrounds the protruding portion 214 of the retractor blade 201 on two side with the engaging portion 162 of the receiving element 160 disengaged from the groove 216 of the retractor blade 201. The post 170 is separated by a distance from the protruding portion 214 because the spring 156 is compressed and the receiving element is in the unlocked state.

In a method of releasably coupling the retractor blade 201 with the arm 110, the protruding portion 214 of the retractor blade 201 is pushed into the cavity 111 of the arm 110 through the third opening 111c defined in the back surface 118c of the arm 110. The protruding portion 214 forces the engaging portion 162 of the receiving element 160 into an unlocked state (i.e., compressing spring 156) until the protruding portion 214 extends out the cavity 111 through the second opening 111b defined in the front surface 118b of the arm 110. At that moment, the engaging portion 162 enters the locked state (i.e., extending spring 156) thereby releasably securing the protruding portion 214 of the retractor blade 201 within the cavity 111 of the arm 110.

Referring now to FIGS. 7A and 7B, there is shown a retractor or surgical access system 1 in accordance with an embodiment of the present disclosure. The surgical access system 1 includes a plurality of connectors 100 (designated first and second connectors 100a, 100b), a plurality of supports 180 (designated first and second supports 180a, 180b), and a beam 190. An arm 110 of the first connector 100a is coupled to the first support 180a via a coupling element 120 of the first connector 100a, and an arm 110 of the second connector 100b is coupled to the second support 180b via a coupling element 120 of the second connector 100b. The first support 180a is coupled to the beam 190 and the second support 180b is slidably mounted on the beam 190 such that the second support 180b, and thus the arm 110 of the second connector 100b, can be secured in a plurality of locations relative to the first arm 110 of the first connector 100a which is coupled to the first support 180a.

In embodiments, the first and second connectors 100a, 100b are mirror opposite of each other. For example as shown in FIG. 7A, the coupling element 120, the rod 130, and the ridged slider 140 of the first connector 100a are reversed in location, i.e., mirror opposites, of the coupling element 120, the rod 130, and the ridged slider 140 of the second connector 100b. Such a configuration places the fixation pins 150 (see e.g., FIG. 2B) of the first and second connectors 100a, 100b on lateral sides of the surgical access system 1 allowing the arms 110 of the first and/or second connectors 100a 100b to be rotate about the fixation pins 150 between a closed or straight position as shown in FIG. 7A (see also, e.g., FIGS. 2A and 2B), and an open or angled position as shown in FIG. 7B (see also, e.g., FIGS. 3A and 3B), or at any angle therebetween.

Retractor blades 200 (designated herein as first and second retractor blades 200a and 200b) may be releasably secured to the arms 110 of the first and/or second connectors 100a, 100b of the surgical access system 1 as shown, for example, in FIGS. 8A-9B. While the retractor blades shown coupled to the connectors are straight retractor blades, it should be understood that the retractor blades may be a straight, tapered, or angled retractor blade, such as those shown and described above, and combinations thereof.

The first and second retractor blades 200a, 200b are releasably coupled to the arms 110 of the first and second connectors 100a, 100b, respectively, by engaging the protruding portion 214 of the first and second retractor blades 200a, 200b with the cavities 111 (FIGS. 7A and 7B) of the arms 110, as described above. In FIGS. 8A and 8B, the first and second connectors 100a, 100b are disposed in a straight or closed position such that the planar portions 210 of the first and second retractor blades 200a, 200b are aligned along the same plane and the blade portions 212 are substantially parallel to one another and substantially perpendicular to the beam 190. In FIGS. 9A and 9B, the first and second connectors 100a, 100b are disposed in an opened or angled position. In this configuration, the first and second retractor blades 200a, 200b are separated from one another by an angled distance. In order to open or angle the arms 110 of the first and/or second connectors 100a, 100b, and the attached first and second retractor blades 200a, 200b, a force is applied to the rods 130 of the first and second connectors 100a 100b, as described above, to rotate the arms 110 about the respective fixation pins 150 of the first and second connectors, 100a, 100b. Additionally or alternatively, the arm(s) 110 may be grasped by a user and manually rotated. As seen in FIG. 8B, the first ends 130a of the rods 130 are visible when the connectors 100a, 100b are in the closed position and as seen in FIG. 9B, the second ends 130b of the rods 130 are visible when the connectors 100a, 100b are in the open position. The arms 100, therefore, have been rotated about the fixation pins 150.

Also contemplated for use with the connector 100 and/or surgical access system 1 of the present disclosure is an extension device 300, as shown in FIGS. 10A-10C. The extension device 300 includes a first extension arm 302 having a plurality of projections 304 extending laterally therefrom in spaced relation relative to each other, and a second extension arm 306 also having a plurality of projections 304 extending therefrom. Each projection 304 defines a lumen 305 therethrough that extends perpendicular to the projection 304.

The second extension arm 306 includes first and second ends 306a, 306a each having a protruding portion 308 extending therefrom. Each protruding portion 308 includes a groove 310 defined therein that engages with the engaging portion 162 of the receiving element 160 of the arm 110 of the connector 100. Accordingly, it should be understood that the protruding portions 308 of the extension device 300 is configured to slidingly engage the cavity 111 of the arm 110 and be releasably secured thereto in substantially the same manner as discussed above with regard to the protruding portion of a retractor blade.

The first extension arm 302 is connected to the second extension arm 306 with a plurality of fixation pins 312 and a plurality of torsional springs 314 along the length of the first and second extension arms 302, 306. Each of the plurality of projections 304 of the first extension arm 302 is paired with a projection 304 of the second extension arm 306 to align the lumens 305 of the projections 304. A torsional spring of the plurality of torsional springs 314 is positioned between the paired projections 304 and a fixation pin of the plurality of fixation pins 312 is positioned through paired projections 304 and the torsional spring 314.

Once the first and second extension arms 302306 are coupled together, a channel 316 is defined therebetween. The second extension arm 306 includes a receiving element 318 extending along the length thereof that is disposed within the channel 316. The channel 316 is configured and dimensioned to releasably secure a plurality of retractor blades thereto, and the receiving element 318 is configured to engage the groove(s) of the protruding portion(s) of the retractor blade(s). It should be understood that the plurality of retractor blades may be straight, tapered, angled, or combinations thereof, as described above.

The extension device 300 may be disposed in a closed position or an open position. The torsional springs 314 bias the extension device 300 to the closed position as shown in FIG. 10A. To open the extension device 300 to the open position, a user applies a force to one or more of the plurality of projections 304 to force the first and second extension arms 302, 306 to rotate about the fixation pins 312 to the open position. Once the extension device 300 is open, the protruding portion(s) of the retractor blade(s) can engage the channel 316.

Referring now to FIG. 11, a retractor or surgical access system 2 is shown including a plurality of extension devices 300 (designated first and second extension devices 300a, 300b). The first and second extension devices 300a, 300b are parallel to one another such that they are a mirror opposite of each other. The surgical access system 2 also includes a plurality of retractor blades, including straight and angled retractor blades 200, 202. It should be understood that any number and combination of retractor blades may be used with the extension devices.

The angled retractor blades 202 are coupled to the first and second ends 306a, 306b of the first and second extension devices 300a, 300b, and the straight retractor blades 200 are coupled to the first and second extension device 300a, 300b between the angled retractor blades 202 about a central portion of the first and second extension devices 300a, 300b. The area defined between the planar portions 210, 210″ of the straight and angled retractor blades 200, 202 is substantially oval in shape which can increase the visualization of the surgical field, and minimize stress on the ends of an incision through which the retractor blades 200, 202 of the surgical access system 2 is introduced and placed.

FIGS. 12A and 12B show a retractor or surgical access system 3 in accordance with another embodiment of the present disclosure. The surgical access system 3 is substantially similar to the surgical access system 2 of FIG. 11, but further includes a plurality of connectors 100 (designated first and second connectors 100a, 100b), a plurality of supports 180 (designated first and second supports 180a, 180b), and a beam 190.

The second end 306b of the first and second extension devices 300a, 300b are releasably coupled to the first and second connectors 100a, 100b, respectively, by inserting the protruding portion 308 of each of the first and second extension devices 300a 300b into the respective cavity 111 of the arms 110 of each of the first and second connectors 100a, 100b. The engaging portions 162 (see e.g., FIG. 6D) of the respective receiving element 160 of each of the arms 110 then engages with a groove 310 on the respective protruding portion 308 of the first and second extension devices 300a 300b, respectively. The first and second connectors 100a, 100b are coupled to the first and second supports 180a, 180b, respectively, with the first support 180a fixed to the beam 190 and the second support 180b slidably coupled to the beam 190 such that the second support 180b can be secured in a plurality of locations relative to the first support 180a.

It is within the scope of the present disclosure that the plurality of retractor blades 200, 202 are shown in a straight or closed position because the first ends 130a of the rods 130 of the first and second connectors 100a, 100b are visible and accordingly, the arms 110 of the first and second connectors 100a, 100b have not been rotated about their respective fixation pins 150 (see e.g. FIG. 8B).

FIG. 13 shows a retractor or surgical access system 4 in accordance with yet another embodiment of the present disclosure. The surgical access system 4 is substantially similar to the surgical access system 3 of FIGS. 12A and 12B, but further includes third and fourth connectors 100c, 100d, third and fourth supports 180c, 180d, and first and second beams 190a, 190b.

The first ends 306a of the first and second extension devices 300a, 300b are releasably coupled to the third and fourth connectors 100c, 100d, respectively, by inserting the protruding portion 308 of each of the first and second extension devices 300a 300b into the respective cavity 111 of the arms 110 of each of the third and fourth connectors 100c, 100d. The engaging portions 162 (see e.g., FIG. 6D) of the respective receiving element 160 of each of the arms 110 then engages with a groove 310 on the respective protruding portion 308 of the first and second extension devices 300a 300b, respectively. The third and fourth connectors 100c, 100d are coupled to the third and fourth supports 180c, 180d, respectively, with the fourth support 180d fixed to the second beam 190b and the third support 180c slidably coupled to the second beam 190b such that the third support 180c can be secured in a plurality of locations relative to the fourth support 180d.

In embodiments, a user positions the straight and angled retractor blades 200, 202 within an incision of a surgical field. The user releasably secures the protruding portion 214 of each retractor blade 200, 202 into the channels 316 of the first or second extension device 300a, 300b. In particular, the groove 216 of the protruding portion 214 of each retractor blade 200, 202 engages the receiving element 318 of the first or second extension device 300a.

The protruding portions 308 of each of the first and second extension devices 300a, 300b is then releasably secured to the arms 110 of respective first, second, third, and fourth connectors 100a-100d. The user applies a force to insert the protruding portions 308 into the cavity 111 of the arms 110. As described above, the engaging portion 162 of the receiving elements 160 of each of the respective arms 110 engages the groove 310 of the protruding portion 308 of each of the respective first and second extension devices 300a, 300b.

Each arm 110 of the first, second, third, and fourth connectors 100a-100d is connected to first, second, third, and fourth supports 180a-180d, respectively, via the coupling element 120 of each of the first, second, third, and fourth connectors 100a-100d, as described above. The first and fourth supports 180a, 180d are fixed to the first and second beams 190a, 190b, respectively, and the second and third supports 180b, 180c are slidably mounted on the first and second beams 190a, 190b, respectively.

It is contemplated that the extension devices and the secured retractor blades can be moved into an open or angled position when a user applies a force to the rods of the connectors in a manner previously discussed. Additionally, it is contemplated that the extension devices and the secured retractor blades can also be moved into a closed or straight position when a user applies a force to the ridged sliders of the connectors in a manner as also previously discussed.

Turning now to FIGS. 14A and 14B, a distractor device 400 is shown. The distractor device 400 includes first and second elongated members 410, 420 connected together via a connection pin 430. The distractor device 400 includes a proximal portion 400a which forms a handle 440 of the distractor device 400. The handle 440 is configured to allow a user to effect movement of at least one of the first and second elongated members 410, 420 relative to the other. In use, a force may be applied to the handle 440 to cause the first and second elongated members 410, 420 to move from a closed position, as shown in FIG. 14A, to an open position, as discussed in further detail below. The handle 440 may include a biasing mechanism 442 positioned between the first and second elongated members 412, 422 in the proximal portion of the distractor device 400 which biases the first and second elongated members 410, 420 to the open or closed positions.

The distractor device 400 includes a central portion 400b and that extends along a longitudinal axis “X” (FIG. 16A) of the distractor device 400, and a distal portion 400c pivotably connected to the central portion 400b.

Each of the first and second elongated members 410, 420 includes a flat portion 412, 422 on lateral sides of the distal portion 400c, and a partial lumen 413, 423 extending substantially perpendicularly from the flat portions 412422. The flat portions 412, 422 are substantially parallel to each other and abut each other when the distractor device 400 is in a closed position. The partial lumens 413, 423 extend at least partially along a length of its corresponding first or second elongated member 410, 420.

While only the partial lumen 423 of the second elongated member 420 is shown in FIGS. 14A and 14B, it should be understood that the partial lumen 413 of the first elongated member 410 is identical thereto. The partial lumens 413, 423 include a plurality of detents 414, 424 extending from an inner wall 416, 426 of the partial lumens 413, 423, respectively, in spaced relation relative to each other. In embodiments, the partial lumens 413, 423 include one or more detents 414, 424, in some embodiments, the partial lumens 413, 423 include two or more detents 414, 424, and in certain embodiments, the partial lumens 413, 423 include three or more detents 414, 424. Each detent of the plurality of detents 414, 424 is configured and dimensioned to releasably secure a protrusion 516 (see e.g., FIG. 15) of a pin 500, as described in further detail below.

The detents 414, 424 are separated from each other by a ledge 418, 428 extending along the inner wall 416, 426 of the partial lumens 413, 423. It should be understood that any number of detents 414, 424 and ledges 418, 428 may be disposed in the partial lumens 413, 423 so long as they are in an alternating pattern of, for example, detent, ledge, detent, ledge, and detent. In embodiments, the ledge 418, 428 is continuous along the inner wall 416, 426 of the partial lumens 413, 423. In some embodiments, the ledge 418, 428 is non-continuous along the inner wall 416, 426 of the partial lumens 413, 423.

The height of each detent 414, 424 from one ledge 418, 428 to another ledge 418, 428 is variable and is based, in part, upon the height of each protrusion 516 (see e.g., FIG. 15) of a pin 500. At a minimum, the height of a detent 414, 424 from one ledge 418, 428 to another ledge 418, 428 is the same as the height of a protrusion 516 of a pin 500. The distance of a detent 414, 424 from one ledge 418, 428 to another ledge 418, 428 should be at least sufficient to releasably secure the protrusion 516 of the pin 500, and optionally a gap 517, which is disposed above and/or below the protrusion 516. As specifically shown in FIG. 16E, the gap 517 of the pin 500 should be enough to ensure the protrusion 516 is releasably secured within the detent 414, 424 of the first or second extensions arms 410, 420, and provide some additional space for small movements of the distractor device 400. However, the gap 517 should not be so great as to allow the protrusion 517 to become dislodged or separated from the detent 414, 424 and/or allow for large vertical movements of the distractor device 400 during use.

In embodiments, the distractor device 400, in its natural or biased state, is in the closed position. In the closed position, each of the flat portions 412, 422 of the first and second elongate members 410, 420 are substantially parallel to, and abut, each other. When a force is applied to the handle 440 (i.e., handle portions move towards each other), the first and second elongated members 410, 420 move from the closed position to the open position (i.e., away from each other). In the open position, the flat portions 412, 422 of the first and second elongate members 410420 remain parallel to each other but are separated by a lateral distance. The separated distance can be increased by increasing the force on the handle 440 of the distractor device 400. When the force on the handle 440 is released, the first and second elongated members 410, 420 move toward each other to reduce the separated distance until the first and second elongate members 410, 420 return to the closed position, such as via the biasing mechanism 442 which can force each of the first and second elongated members 410, 420 towards each other (i.e., forces the first and second elongated members 410, 420 to the closed position).

An exemplary pin 500 for use with the distractor device 400 is shown in FIG. 15. The pin 500 includes a proximal section 500a, an intermediate section 500b, and a distal section 500c. The proximal section 500a includes a shaft 510 at least partially cut with hexagonal facets 512 along its length. The hexagonal facets 512 terminate at a circumferential groove 514. The circumferential 514 is located near a proximal end 500d of the pin 500. The hexagon facets 512 and/or the circumferential groove 514 can increase a friction fit with a device to insert the pin 500 into a vertebral body.

The proximal and distal sections 500a, 500c are separated by the intermediate section 500b. The intermediate section 500b includes a plurality of protrusions 516 disposed in spaced relation relative to each other. In embodiments, the intermediate section 500b includes one or more protrusions 516, in some embodiments, the intermediate section 500b includes two or more protrusions 516, and in certain embodiments, the intermediate section 500b includes three or more protrusions 516. In embodiments, each protrusion of the plurality of protrusions 516 is continuous around the circumference of the pin 500. In some embodiments, the plurality of protrusions 516 are non-continuous around the circumference of the pin 500.

The protrusions 516 are separated from each other by an interval 515. One of ordinary skill in the art can appreciate that any number of protrusions 516 and intervals 515 can be configured so long as they are in an alternating pattern of, for example, protrusion, interval, and protrusion.

Each protrusion of the plurality of protrusions 516 is configured and dimensioned to releasably engage a detent 414, 424 on the distractor device 400 (FIGS. 1A, 1B). It should be understand that the plurality of protrusions 516 can be any shape or in any pattern so long as they are configured to releasably secure the pin 500 to the plurality of detents 414, 424 (FIG. 1A, 1B) of the distractor device 400.

The height of a protrusion 516 can vary and be based, in part, upon the height of each detent 414, 424 of a distractor device 400. At a maximum, the height of a protrusion 516 is less than the height of a detent 414, 424 so that the protrusion and the detent 414, 424 are snugly releasably secured together. As shown in FIG. 16E, the height of the protrusion 516 should be at least sufficient to releasably secure the protrusion 516, and optionally a gap 517 disposed above and/or below the protrusion 516. The gap 517 ensures the protrusion 516 is releasably secured within the detent 414, 424 and provide some additional space for small movement of the distractor device 400. The gap(s) 517, however, should not be so great as to allow the protrusion 516 to become unsecured from the detent 414, 424 and/or allow for large vertical movements of the distractor device 400 during use.

The distal section 500c of the pin 500 includes a first threaded portion 518a and a second threaded section 518b longitudinally spaced from each other and separated by a non-threaded gap 519. The second threaded section 518b terminates at a threaded tapered distal end 500e. The gap 519 may be a visual marker for a user to measure the depth of insertion of the pin 500 into a vertebral body. In embodiments, the visual marker may be in the form of a color, change of material, or change in pattern. In embodiments, the pin 500 includes a plurality of visual markers. In some embodiments, each visual marker may be in the form of a color or a pattern. For example, a first pre-determined color may indicate that the pin 500 is at a first depth into the vertebral body, a second pre-determined color can indicate that the pin 500 is at a second depth into the vertebral body, and so on.

The pin 500 may have a length of from about 3 inches to about 4 inches. In embodiments, the pin 500 has a length from about 3.2 inches to about 3.8 inches. In some embodiments, the pin 500 has a length of from about 3.4 inches to about 3.6 inches, and in certain embodiments, the pin 500 has a length of about 3.5 inches.

As shown in FIGS. 16A-16E, a surgical distraction system 5 includes a distractor device 400 and a plurality of pins 500. In a method of use, the pins 500 are placed in adjacent vertebral bodies, and the distractor device 400 is positioned between the pins 500, as shown in FIG. 16A. The plurality of detents 414, 424 of the first and second elongate members 410, 420 are brought into contact with the plurality of protrusions 516 of the pins 500 to releasably secure the distractor device 400 to the pins 500, as shown in FIGS. 16B-16E. A force can be applied to the handle 440 of the distractor device 400 to move the first and second elongated members 410, 420 of the distractor device 400 from a closed position to an open position to assist in releasably securing the plurality of detents 414, 424 to the plurality of protrusions 516 of the pins 500.

After attaching the pins 500 to the distractor device 400, the pins 500 are substantially parallel to one another and the distractor device 400 is disposed in the closed position. The handle 440 of the distractor device 400 may then be manipulated (e.g., by squeezing the first and second elongated members 410, 420 towards each other) to create a separation between the first and second adjacent vertebral bodies. Squeezing the handle 440 applies a distraction force to the adjacent vertebral bodies by moving the pins 500, which remain substantially parallel to each other when in an open position, and thus the vertebral bodies away from each other and creating a space, or separation, between the adjacent vertebral bodies. One or ordinary skill in the art will readily understand the need for the pins 500 to remain substantially parallel to each other in a method for separating vertebral bodies.

An intervertebral disc located between the adjacent vertebral bodies may then be removed. Once the intervertebral disc is removed, an implant can be inserted. Thereafter, the handle 440 may be further manipulated to remove the distraction force, and the distractor device 400 may be removed with the pins 500 from the adjacent vertebral bodies.

Persons skilled in the art will understand that the structures and methods specifically described herein and shown in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely as exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, the elements and features shown and described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of the present disclosure, and that such modifications and variation are also included within the scope of the present disclosure.

Accordingly, the subject matter of the present disclosure is not limited by what has been particularly shown and described.

	Number	Date	Country
	62204386	Aug 2015	US
	62204384	Aug 2015	US

	Number	Date	Country
Parent	15234174	Aug 2016	US
Child	16203750		US

	Number	Date	Country
Parent	16203750	Nov 2018	US
Child	17322083		US

Orthopedic Surgical System Including Surgical Access Systems, Distraction Systems, And Methods Of Using Same

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