초록 ▼

Methods and cannulae for providing access to a surgical location within a patient are described. A cannula (10) receives surgical instruments (120) for performing a surgical procedure on a body (130). The cannula (10) comprises a tube structure (12) defining a passage (16) through which the surgical

Methods and cannulae for providing access to a surgical location within a patient are described. A cannula (10) receives surgical instruments (120) for performing a surgical procedure on a body (130). The cannula (10) comprises a tube structure (12) defining a passage (16) through which the surgical instruments (120) are inserted into the body (130). The tube structure (12) has a proximal end (20) and a distal end (62). The tube structure (12) includes an expandable portion (40) for enabling an increase in the cross-sectional area of the passage (16) at the distal end (62). The expandable portion (40) of the tube structure (12), when expanded, has a conical configuration.

대표청구항 ▼

What is claimed is: 1. A method for providing access to a vertebral location within a patient, the method comprising: providing an elongate body and an outer member, said elongate body having a proximal end, a distal end, an outer surface and an inner surface, said inner surface defining a passage

What is claimed is: 1. A method for providing access to a vertebral location within a patient, the method comprising: providing an elongate body and an outer member, said elongate body having a proximal end, a distal end, an outer surface and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the vertebral location, said outer member at least partially surrounding and contacting said outer surface; inserting said distal end of said elongate body into the patient such that the distal end resides proximate the vertebral location; and configuring said elongate body so that the cross-sectional area of said passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location, wherein configuring said elongate body causes said outer surface to engage body tissue. 2. The method of claim 1, wherein configuring said elongate body comprises expanding said elongate body. 3. The method of claim 1, wherein configuring said elongate body comprises configuring said elongate body as a cone. 4. The method of claim 1, wherein the first location is at a distal end of the elongate body, and the second location is at a proximal end of the elongate body. 5. The method of claim 1, further comprising providing a tubular portion attached to said elongate body, the tubular portion extending proximally therefrom. 6. The method of claim 5, wherein providing said elongate body comprises providing a second tubular portion. 7. The method of claim 6, wherein configuring said elongate body comprises expanding said second tubular body. 8. The method of claim 1, wherein inserting said elongate body into the patient further comprises inserting the elongate body through an incision in the skin to the vertebral location. 9. The method of claim 1, wherein configuring the elongate body further comprises moving the elongate body from a first configuration to a second configuration, wherein when the elongate body is in the second configuration the cross-sectional area of said passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location. 10. The method of claim 1, wherein providing the elongate body further comprises providing an elongate body having a width greater than about 14 mm. 11. The method of claim 1, wherein providing the elongate body further comprises providing an elongate body having a width between about 14 mm and about 36 mm. 12. The method of claim 1, wherein said elongate body comprises rigid material extending around substantially the entire perimeter of the cross-sectional area between the first and second locations. 13. The method of claim 1, wherein inserting further comprises inserting the elongate body into the patient such that the proximal end remains outside the patient. 14. The method of claim 1, wherein the elongate body comprises a first elongate member at least partially defining said inner surface and a second elongate member pivotably coupled with the first elongate member, wherein at least the second elongate member is configured to at least partially reside adjacent the skin of the patient. 15. The method of claim 14, wherein the first elongate member comprises a distally expandable conical structure and the second elongate member comprises a non-expanding proximal portion. 16. A method for providing access to a spinal location within a patient, the method comprising: providing an elongate body having a distal end, a proximal end, an outer surface, an inner surface, a first planar edge, a second planar edge, and a gap extending from the outer surface to the inner surface between the first and second planar edges, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the spinal location, and said first and second planar edges extending to the proximal end and the distal end of said elongate body; inserting the distal end of said elongate body through an incision in the skin of the patient to the spinal location; and expanding said elongate body so that a first distance extending transversely to a longitudinal axis of said elongate body at the distal end of the elongate body is greater than a second distance extending transversely to a longitudinal axis of said elongate body at the proximal end of the elongate body. 17. The method of claim 16, comprising expanding said elongate body so that the cross-sectional area of said passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location. 18. The method of claim 16, wherein the inner surface defines a major axis being the largest distance across said passage, and comprising expanding said elongate body such that the major axis at a first location is greater than the major axis at a second location, wherein the first location is distal to the second location. 19. The method of claim 18, wherein said elongate body has an inner surface defining a minor axis being the smallest distance across said passage, wherein said minor axis and said major axis at a location are about equal. 20. The method of claim 16, wherein inserting further comprises inserting the elongate body such that the proximal end remaining outside the patient. 21. The method of claim 16, wherein expanding said elongate body further comprises moving the first planar edge relative to the second planar edge to increase an exposed area of said gap between said first and second planar edges. 22. The method of claim 16, wherein said elongate body comprises a length of stainless steel sheet stock and said gap is an arcuate slot in said steel sheet stock. 23. The method of claim 22, wherein said gap is configured to define the path of travel of a guide pin attached to the inner surface of the elongate body. 24. The method of claim 23, further comprising providing an outer member at least partially surrounding said elongate body and contacting said outer surface. 25. The method of claim 24, further comprising expanding said elongate body so that the cross-sectional area of the passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location. 26. The method of claim 16, further comprising inserting said elongate body through an incision formed posterior of the spine and laterally of the spinous process. 27. The method of claim 16, further comprising inserting a dilator into the patient. 28. The method of claim 16, further comprising inserting a viewing instrument into the elongate body and directing the viewing instrument toward the distal end of the elongate body. 29. The method of claim 28, wherein the viewing instrument is a camera. 30. The method of claim 28, further comprising inserting a dissector simultaneously with the viewing instrument. 31. The method of claim 16, further comprising performing a discectomy through the elongate body. 32. The method of claim 16, wherein the elongate body comprises a first elongate member at least partially defining said inner surface and a second elongate member pivotably coupled with the first elongate member, wherein at least the second elongate member is configured to at least partially reside adjacent the skin of the patient. 33. The method of claim 32, wherein the first elongate member comprises a distally expandable conical structure and the second elongate member comprises a non-expanding proximal portion. 34. A method for providing access to a spinal location within a patient, the method comprising: providing an elongate body and an outer member, said elongate body having a proximal end, a distal end, an outer surface and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the spinal location, said outer member at least partially surrounding and contacting said outer surface, the elongate body being actuatable between a contracted configuration and an expanded configuration; inserting said distal end of said elongate body into the patient such that the distal end resides proximate the spinal location, said elongate body remaining in its contracted configuration until the distal end resides proximate the spinal location; and actuating said elongate body from its collapsed configuration to its expanded configuration after said distal end is proximate the spinal location. 35. The method of claim 34, said outer member at least partially limiting expansion of said elongate body until said distal end resides proximate the spinal location. 36. The method of claim 34, wherein the outer member comprises a plastic outer tubular layer. 37. The method of claim 34, wherein the outer member restrains at least the proximal end of the elongate body. 38. The method of claim 34, further comprising disengaging the outer member to allow the elongate body to take on the expanded configuration. 39. The method of claim 38, further comprising providing a release device coupled with the outer member that is accessible at the proximal end of the elongate body. 40. The method of claim 39, wherein the release device is accessible at the proximal end of the elongate body. 41. The method of claim 39, wherein the release device is positioned between the outer member and the elongate body. 42. The method of claim 34, wherein the elongate body includes an area of overlap between the inner surface of the elongate body and the outer surface of the elongate body, and wherein expanding the elongate body comprises reducing the amount of overlap between the inner surface of the elongate body and the outer surface of the elongate body. 43. The method of claim 34, wherein inserting further comprises inserting the elongate body such that the proximal end remains outside the patient. 44. The method of claim 34, said elongate body further comprising a first planar edge, a second planar edge, and a gap extending from the outer surface to the inner surface between the first and second planar edges, said first and second planar edges extending to the proximal end and the distal end of said elongate body. 45. The method of claim 34, wherein the elongate body comprises a first elongate member at least partially defining said inner surface and a second elongate member pivotably coupled with the first elongate member, wherein at least the second elongate member is configured to at least partially reside adjacent the skin of the patient. 46. The method of claim 45, wherein the first elongate member comprises a distally expandable conical structure and the second elongate member comprises a non-expanding proximal portion. 47. A method for providing access to a surgical location within a patient, the method comprising: providing an elongate body having a proximal end, a distal end, an outer surface, an inner surface, a first planar edge, a second planar edge, and a gap extending from the outer surface to the inner surface between the first and second planar edges, said inner surface at least partially defining a passage extending through the elongate body and through which surgical instruments can be inserted to the surgical location, said first and second planar edges extending to the distal end of said elongate body, the elongate body being actuatable between a contracted configuration and an expanded configuration; inserting said distal end of said elongate body into the patient such that the distal end resides proximate the surgical location; engaging an expansion tool with the elongate body; rotating the expansion tool while the elongate body is being expanded from its contracted configuration to its expanded configuration; and disengaging the expansion tool from the elongate body. 48. The method of claim 47, wherein the elongate body includes an area of overlap between the inner and outer surfaces, and actuating the expansion tool to expand the elongate body reduces the area of overlap between the inner and outer surfaces. 49. The method of claim 47, wherein the distal end of the elongate body is inserted proximate to a spinal location with the patient. 50. The method of claim 47, wherein expanding the elongate body causes the outer surface to engage tissue. 51. The method of claim 47, wherein inserting said distal end of said elongate body further comprises inserting the elongate body such that the proximal end remaining outside the patient. 52. The method of claim 47, wherein the elongate body comprises a first elongate member at least partially defining said inner surface and a second elongate member pivotably coupled with the first elongate member, wherein at least the second elongate member is configured to at least partially reside adjacent the skin of the patient. 53. The method of claim 52, wherein the first elongate member comprises a distally expandable conical structure and the second elongate member comprises a non-expanding proximal portion. 54. A method for providing access to a spinal location within a patient, the method comprising: providing an elongate body and an outer member, said elongate body having a proximal end, a distal end, an outer surface and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the spinal location, the elongate body being actuatable between a contracted configuration and an expanded configuration, said outer member at least partially surrounding and contacting said outer surface; inserting said distal end of said elongate body into the patient such that the distal end resides proximate the spinal location; and applying a force adjacent a proximal end of an expansion device to rotate a distal portion of the expansion device about a pivot, whereby said elongate body is expanded from its contracted configuration to its expanded configuration. 55. The method of claim 54, wherein the expansion device comprises a first leg extending between the proximal end and the distal portion and a second leg extending between the proximal end and the distal portion, the first and second legs being coupled at the pivot for rotation thereabout. 56. The method of claim 54, wherein when the force is applied adjacent to the proximal end, the distal portion rotates into contact with the inner surface to apply a force to the inner surface. 57. The method of claim 54, wherein the elongate body further comprises a first planar edge, a second planar edge, and a gap extending from the outer surface to the inner surface between the first and second planar edges, said first and second planar edges extending to the proximal end and the distal end of said elongate body.