WO2025072056A1

WO2025072056A1 - Spinal portal and visualization

Info

Publication number: WO2025072056A1
Application number: PCT/US2024/047719
Authority: WO
Inventors: Nicholas DOMEK; Edward Liou; Christopher U. Phan; Bret Foreman; Christopher D. Summa
Original assignee: Providence Medical Technology Inc
Current assignee: Providence Medical Technology Inc
Priority date: 2023-09-27
Filing date: 2024-09-20
Publication date: 2025-04-03
Anticipated expiration: 2026-03-27

Abstract

Systems and methods related to spinal portal and visualization are provided. A system may include a portal. The portal may include a lumen extending longitudinally through a length of the portal. An illuminator may be selectively coupled to the portal. The illuminator may be configured to produce light to illuminate a surgical site through the portal. The illumination may be provided via the light traveling through at least a portion of the portal. The system may include one or more surgical instruments. The portal may be configured to provide access to a surgical site for the one or more surgical instruments. For example, the lumen may be configured to receive the one or more surgical instruments. Additional systems and associated methods are also provided.

Description

SPINAL PORTAL AND VISUALIZATION

CROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of U.S. Provisional Patent Application No. 63/540,762, filed September 27, 2023. which is incorporated by reference herein in its entirety.

TECHNICAL FIELD

[0002] This disclosure is directed to medical devices, systems and methods. More specifically, this disclosure is directed to devices, systems and methods related to spinal portal and visualization.

BACKGROUND

[0003] Tissue-sparing surgical approaches to posterior spinal fusion require a significant amount of fluoroscopic imaging which exposes the surgeon and operating room staff to harmful radiation. Furthermore, there are known scenarios where fluoroscopy- guided posterior spinal fusion procedures are not ideal, such as at the C6/C7 facet joint where the shoulders often get in the way of lateral x-rays, preventing a clear image of the spine. Unclear imaging can reduce the confidence of surgeons as well as increase the duration of the procedure, leading to greater anesthesia time for the patient.

[0004] Tubular retractor products (or tubular retractors), which are used for surgery in the lumbar spine, can provide a relatively tissue-sparing surgical approach while allowing the surgeon to visualize the surgical site directly by eye, with a surgical loupe, under microscopy, or with an endoscopic camera. Current tubular retractor products come in a wide variety of diameters and lengths for varying anatomy and surgical procedures. They are fairly straightforward products that are essentially a single cannula made from a biocompatible material, most of which are reusable.

[0005] Because of the simple geometry of commercially available tubular retractors, they often are not ideal for certain procedures. Specifically, the geometry of tubular retractors do not w ork well for procedures that require access to the cervical facet joints. In addition, illumination of the surgical site down a tubular retractor is another known issue. Most technologies require a high-powered light generator in the operating room with an optical cable and an attachment mechanism to the tubular retractor. [0006] Accordingly, a need exists for new systems and methods related to spinal portal and visualization.

SUMMARY

[0007] The present disclosure describes devices, systems, and associated methods for spinal portal and visualization. In accordance with embodiments of the present disclosure, a system may include a portal. The portal may include a lumen extending longitudinally through a length of the portal. The system may include an illuminator selectively coupled to the portal. The illuminator may be configured to produce light to illuminate a surgical site through the portal.

[0008] In some examples, the portal may include a threaded attachment for securing the illuminator to the portal. The portal may include an attachment flange defining a secured position of the illuminator on the portal.

[0009] In some examples, the illuminator may include a light source. An engagement of the illuminator with the portal may activate the light source.

[0010] In some examples, the portal may include a tip. The tip may have a marker ring of a radiopaque material.

[0011] In some examples, the illuminator may include an aperture aligned with the lumen. The illuminator may include a light ring window adjacent the aperture.

[0012] In some examples, the portal may include one or more walls defining the lumen. The illumination may be provided via the light travelling through the one or more walls.

[0013] In some examples, the system may include a dilator. The dilator may include an outer diameter compatible with the lumen to receive the dilator through the lumen. The dilator may include a distal tip configured to promote a separation of tissue as the dilator is advanced through the tissue. The dilator may include one or more depth markings along a length of the dilator. The dilator may include a proximal grip.

[0014] In accordance with embodiments of the present disclosure, a system may include one or more surgical instruments, a portal, and an illuminator. The portal may be configured to provide access to a surgical site. The portal may include a lumen extending longitudinally through a length of the portal. The lumen may be configured to receive the one or more surgical instruments. The illuminator may be selectively coupled to the portal. The illuminator may include an aperture aligned with the lumen to receive the one or more surgical instruments. The illuminator may include a light source to produce light to illuminate the surgical site through the portal. The illumination may be provided via the light traveling through at least a portion of the portal.

[0015] In some examples, the illuminator may include a switch. Coupling the illuminator to the portal may engage the switch to turn the light source on. Decoupling the illuminator from the portal may disengage the switch to turn the light source off. The illuminator may threadingly engage the portal to secure the illuminator to the portal.

[0016] In some examples, the portal may include a distal tip. The tip may have a bevel configured to match the joint angle of a facet joint.

[0017] In some examples, the illuminator may include a power source contained within the illuminator.

[0018] In some examples, when the illuminator is coupled to the portal, the light source may be centered on a wall of the portal to transmit light into the material of the wall.

[0019] In some examples, the one or more surgical instruments may include a dilator, a decortication instrument, a guide tube, or an implant delivery device.

[0020] In accordance with embodiments of the present disclosure, a portal for providing access to a surgical site is provided. The portal may include at least one wall defining a lumen extending longitudinally through a length of the portal to a distal end. The at least one wall may be made of a material with a higher refractive index than its surrounding medium that allows for total internal reflection. Rays of light may reflect internally within the material and transmit down the length of the portal until the rays are refracted out the distal end to illuminate the surgical site.

[0021] In some examples, the distal end may include one or more features configured to direct light towards the surgical site. The one or more features may include a counterbore in the distal end. The one or more features may include a textured surface along an inner diameter of the distal end. The one or more features may include a slot defined in the distal end.

[0022] In some examples, the material may include a transparent medium.

[0023] In some examples, a system may include the portal according to any of the aforementioned examples. The system may include an illuminator selectively coupled to the portal. The illuminator may include a light source aligned with the at least one wall to transmit light into the material. The illuminator may include an aperture aligned with the lumen to receive one or more surgical instruments.

[0024] In accordance with some embodiments of the present disclosure, a system may include one or more surgical instruments, and a portal configured to provide access to a surgical site. The portal may include a lumen extending longitudinally through a length of the portal and configured to receive the one or more surgical instruments. The portal may be configured for selective attachment to an illuminator configured to produce light to illuminate a surgical site through the portal.

[0025] In some examples, the system may include the illuminator selectively coupled to the portal. The illuminator may include an aperture aligned with the lumen to receive the one or more surgical instruments. The illuminator may include a light source to produce light to illuminate the surgical site through the portal, wherein the illumination is provided via the light traveling through at least a portion of the portal.

[0026] In some examples, the portal may include a flange configured for engagement with the illuminator.

[0027] In some examples, the portal may be adjustable in length.

[0028] In accordance with some embodiments of the present disclosure, a system may include one or more surgical instruments, and a portal configured to provide access to a surgical site, the portal including a lumen configured to receive the one or more surgical instruments. The portal may be adjustable in length.

[0029] In some examples, the portal may include one or more score lines defining different lengths of the portal.

[0030] In some examples, the one or more surgical instruments may include sequential dilators for sequentially dilating soft tissue at the surgical site. Each dilator of the sequential dilators may include a radiopaque material or additive. Each dilator of the sequential dilators may include a depth marker ring.

[0031] In some examples, the portal may include a U-shaped flange.

[0032] In accordance with some embodiments of the present disclosure, a system may include one or more surgical instruments, and a portal configured to provide access to a surgical site, the portal including a lumen configured to receive the one or more surgical instruments. The portal may include a flange configured for coupling to one or more accessories or devices.

[0033] In some examples, the flange may define a U-shape.

[0034] In some examples, the flange may define a handle.

[0035] In some examples, the flange may be configured to reduce glare from surgical lights. [0036] In accordance with some embodiments of the present disclosure, a method of accessing a spinal surgical site may be implemented using a system and/or device according to any of the aforementioned examples.

BRIEF DESCRIPTION OF THE DRAWINGS

[0037] FIG. 1 illustrates an illuminated portal system in accordance with embodiments of the present disclosure.

[0038] FIG. 2 illustrates a dilator of the system of FIG. 1 in accordance with embodiments of the present disclosure.

[0039] FIGS. 3A-3B illustrate a portal of the system of FIG. 1 in accordance with embodiments of the present disclosure.

[0040] FIGS. 4A-4C illustrate an illuminator of the system of FIG. 1 in accordance with embodiments of the present disclosure.

[0041] FIGS. 5A-5B illustrate a printed circuit board assembly of the illuminator of FIGS. 4A-4C in accordance with embodiments of the present disclosure.

[0042] FIG. 6 illustrates an illuminator circuit in accordance with embodiments of the present disclosure.

[0043] FIG. 7 illustrates use of a dilator to separate or retract tissue at a surgical site in accordance with embodiments of the present disclosure.

[0044] FIG. 8 illustrates advancement of a portal over a dilator in accordance with embodiments of the present disclosure.

[0045] FIG. 9 illustrates an illuminator coupled to a portal to illuminate a surgical site in accordance with embodiments of the present disclosure.

[0046] FIG. 10 illustrates a view down a portal showing direct visualization of a surgical site in accordance with embodiments of the present disclosure.

[0047] FIG. 11 illustrates a coupling of an illuminator to a portal in accordance with embodiments of the present disclosure.

[0048] FIGS. 12A-12B illustrate activation of a switch of an illuminator in accordance with embodiments of the present disclosure.

[0049] FIG. 13 illustrates total internal reflection in a light pipe homogenizing rod in accordance with embodiments of the present disclosure.

[0050] FIG. 14 illustrates total internal reflection in a portal in accordance with embodiments of the present disclosure. [0051] FIGS. 15A-15B illustrate a distal radiopaque marker of a portal in accordance with embodiments of the present disclosure.

[0052] FIGS. 16A-16D illustrate examples of distal light transmission to illuminate a surgical site in accordance with embodiments of the present disclosure.

[0053] FIGS. 17A-17B illustrate facet access through a portal by a decortication instrument in accordance with embodiments of the present disclosure.

[0054] FIG. 18 illustrates facet access through the portal by another decortication instrument in accordance with embodiments of the present disclosure.

[0055] FIG. 19 illustrates facet access through the portal by another decortication instrument in accordance with embodiments of the present disclosure.

[0056] FIG. 20 illustrates facet access through the portal by another decortication instrument in accordance with embodiments of the present disclosure.

[0057] FIG. 21 illustrates facet access through the portal using a guide tube in accordance with embodiments of the present disclosure.

[0058] FIGS. 22A-22B illustrate facet implant placement using the portal in accordance with embodiments of the present disclosure.

[0059] FIGS. 23 A-23B illustrate another portal in accordance with embodiments of the present disclosure.

[0060] FIGS. 24A-24D illustrate another portal in accordance with embodiments of the present disclosure.

[0061]

[0062] FIG. 25 illustrates an exploded view of another illuminated portal system in accordance with embodiments of the present disclosure.

[0063] FIGS. 26A-26C illustrate a coupling of an illuminator to a portal of the system of FIG. 24 in accordance with embodiments of the present disclosure.

[0064] FIGS. 27A-27B illustrate exploded views of another illuminated portal system in accordance with embodiments of the present disclosure.

[0065] FIG. 28 illustrates sectional views of the system of FIGS. 27A-27B when coupled in accordance with embodiments of the present disclosure.

[0066] FIGS. 29A-29B illustrate perspective views of the system of FIG. 28 in accordance with embodiments of the present disclosure.

[0067] FIGS. 30A-30D illustrate use of sequential dilators to achieve a desired tissue dilation in accordance with embodiments of the present disclosure. [0068] FIG. 31 illustrates portal insertion over the sequential dilators of FIGS. 30A-30D in accordance with embodiments of the present disclosure.

[0069] FIG. 32 illustrates a flow diagram of a process of using an illuminated portal system in accordance with embodiments of the present disclosure.

[0070] FIG. 33 illustrates another example system for accessing a surgical site in accordance with embodiments of the present disclosure.

[0071] FIG. 34 illustrates an example use of the system of FIG. 33 in accordance with embodiments of the present disclosure.

DETAILED DESCRIPTION

[0072] The following description of certain embodiments is merely exemplary in nature and is in no way intended to limit the invention or its applications or uses. In the following detailed description of embodiments of the present systems and methods, reference is made to the accompanying drawings which form a part hereof, and which are shown byway of illustration specific embodiments in which the described systems and methods may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice presently disclosed systems and methods, and it is to be understood that other embodiments may be utilized and that structural and logical changes may be made without departing from the spirit and scope of the present system. Moreover, for the purpose of clarity, detailed descriptions of certain features will not be discussed when they would be apparent to those with skill in the art so as not to obscure the description of the present system. The following detailed description is therefore not to be taken in a limiting sense, and the scope of the present system is defined only by the appended claims.

[0073] The terms ’distal ’ and “proximal” are used to refer to a position or direction relative to the treating clinician, such as a surgeon. “Distal” and “distally” refer to a position that is distant from, or in a direction aw ay from, the treating clinician. “Proximal” and “proximally” refer to a position that is near, or in a direction toward, the treating clinician. The terms “posterior” and “anterior” refer to the back and front, respectively, of the body of a subject.

[0074] As used herein, “decortication” refers to the process by which an outer surface of a bone is roughened or removed and the underlying cancellous bone exposed. Relative to the outer bone surface, the cancellous bone more effectively retains deposited graft material, thereby promoting healing and bone growth after surgery. [0075] The terms “device” and “instrument” may be used interchangeably herein. The terms “component,” “member” and “tool” may also be used interchangeably.

[0076] For the following defined terms, certain definitions shall be applied unless a different definition is given elsewhere in this disclosure. The terms “a,” “an,” and “the” are used to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” The term “or” is used to refer to a nonexclusive or. such that “A or B” includes “A but not B,” “B but not A,” and “A and B.” All numeric values are assumed to be modified by the term “about,” whether or not explicitly indicated. The term “about” generally refers to a range of numbers that one of skill in the art would consider equivalent to the recited value (e g., having the same function or result). In many instances, the term “about” can include numbers that are rounded to the nearest significant figure. The recitation of numerical ranges by endpoints includes all numbers and subranges within and bounding that range (e.g., 1 to 4 includes 1, 1.5, 1.75, 2, 2.3, 2.6, 2.9, etc. and 1 to 1.5, 1 to 2, 1 to 3, 2 to 3.5, 2 to 4, 3 to 4, etc ).

[0077] FIG. 1 illustrates an illuminated portal system 100 in accordance with embodiments of the present disclosure. As described herein, the system 100 includes various features that result in bright, even illumination of a surgical site. For example, the system 100 may include various light-transmission elements that allow a light source to transmit light efficiently to a surgical site for spinal surgery, among other surgical sites. As described herein, the system 100 may be simple to operate, such as including a simple attachment mechanism that activates a light source and contributes to the illumination characteristics of the system 100.

[0078] As shown, the system 100 may include an access portal device (or “portal”) 102 and an illumination device (or “illuminator”) 104. In one example, the system 100 also includes one or more surgical instruments, such as a tissue dilation device (or “dilator”) 106. As described herein, the portal 102 is configured to provide access to a surgical site. For instance, the portal 102 may include a body 110 defining a lumen 112 extending longitudinally through a length of the portal 102. The lumen 112 may be configured to receive one or more surgical instruments, such as the dilator 106, among other instruments. In one example, the lumen 112 may be sized and configured to accommodate the receipt and passage of the dilator 106, among other devices, therethrough, such as for the purposes described herein. The illuminator 104 may be selectively coupled to the portal 102 and configured to produce light to illuminate a surgical site through the portal 102, as described more fully below. For instance, light produced by the illuminator 104 may be directed to the surgical site by the portal 102, such as via one or more walls of the portal 102, as detailed below. Additional features and configurations of each of the portal 102, illuminator 104, and dilator 106 will be described in further detail below.

[0079] FIG. 2 illustrates the dilator 106 in accordance with embodiments of the present disclosure. The dilator 106 may be configured to spread apart tissues, such as surrounding or posterior to targeted bones, thereby facilitating access to a surgical site. As shown, the dilator 106 may include a proximal portion 210, a distal portion 212, and a shaft portion 214 therebetween. The proximal portion 210 may include or define a proximal grip 220. The grip 220 may allow manipulation of the dilator 106, such as by a user, a robot, and/or a navigation system. The distal portion 212 may include a distal tip 222 configured to promote a separate of tissue as the dilator 106 is advanced through the tissue. In such examples, the tip 222 may be urged through or between tissues to spread the tissues apart, such as to enable clear access to the adjacent or underlying bony surfaces at the surgical site. In one example, the tip 222 may be angled or tapered to facilitate smooth, gradual penetration and stretching of the tissues.

[0080] The shaft portion 214 may be configured to slide proximally and distally through the lumen 112, such as to allow the portal 102 to slide along the dilator 106. For instance, the dilator 106 may include an outer diameter that is compatible with the lumen 112 to receive the dilator 106 through the lumen 112. In one example, one or more depth markings 226 may be defined along a length of the dilator 106, such as incrementally from the tip 222, to visualize a depth of insertion of the dilator 106 within the tissues.

[0081] FIGS. 3A-3B illustrate the portal 102 in accordance with embodiments of the present disclosure. As shown, the portal 102 may include a proximal head 310 and a tube 312 extending distally from the head 310, the lumen 112 defined through the head 310 and tube 312. In one example, at least one wall 314 (e.g., the wall defining the tube 312) of the portal 102 may define the lumen 112 extending longitudinally through a length of the portal 102 to a distal end 316. The head 310 may define a threaded attachment 318, such as for securing the illuminator 104 to the portal 102, as detailed below. An attachment flange 320 may be defined at the bottom of the threaded attachment 318. such as to define a secured position of the illuminator 104 on the portal 102, as described below. In one example, the attachment flange 320 may extend annularly from the threaded attachment 318, although other configurations are contemplated.

[0082] A tapered region 324 may extend from the attachment flange 320 to the tube 312. In one example, the tapered region 324 may allow for a single illuminator 104 for multiple sized portals. For instance, the tapered region 324 may allow the portal 102 to taper from a standard sized head 310 to tubes of various diameters. In this manner, multiple portals of various tube/lumen sizes may be used with the same illuminator 104. Thus, the illuminator 104 described herein may be selectively coupled to different sized portals.

[0083] As shown, the distal end 316 of the portal 102 may include a tip 332. The tip 332 may be shaped to achieve one or more characteristics. For instance, the tip 332 may have various configurations (e.g., beveled, angled, angular, wavy, flat, etc.) to facilitate insertion of the portal 102 (e.g., tube 312) to the surgical site, such as allowing the portal 102 to be more easily advanced through tissue, among other benefits. In one example, the tip 332 may include a distal radiopaque marker 338 (e.g., a marker ring of a radiopaque material), such as to verify a position of the portal 102 during surgery, as explained below. As shown in FIG. 3B, one or more depth markings 340 may be defined along a length of the portal 102, such as incrementally from the tip 332 along the tube 312, to visualize a depth of insertion of the portal 102 within the surgical site.

[0084] FIGS. 4A-4C illustrate the illuminator 104 in accordance with embodiments of the present disclosure. The illuminator 104 may have a ring or torus-like shape defined by a body 410 and an aperture 412 defined through the body 410. The body 410 may be defined by a 2-piece outer housing 414, including a top housing 414A and a bottom housing 414B. As shown, at least one of the top housing 414A or the bottom housing 414B (e.g., both the top housing 414A and the bottom housing 414B) may include grip features 418 (e.g., notches, divots, knurling, etc.) to increase a user’s grip of the illuminator 104.

[0085] Referring to FIG. 4 A, the top housing 414A may be tapered around the aperture 412. For instance, the edge 422 around the aperture 412 may be beveled, rounded, or chamfered. In some embodiments, the tapered edge 422 may increase a user’s visualization through the aperture 412, such as increasing a viewing window^ through the aperture 412.

[0086] Referring to FIG. 4B. the bottom housing 414B may include a threaded attachment 426 for engagement with the threaded attachment 318 of the portal 102 to secure the illuminator 104 to the portal 102. The threaded attachment 426 may be defined annularly around the aperture 412, such as concentrically aligned with the aperture 412. In some embodiments, the illuminator 104 may include a light ring window 428 for providing illumination to the surgical site. As shown, the light ring window 428 may be positioned adjacent the aperture 412, such as surrounding the aperture 412 at the bottom of the threaded attachment 426. In some embodiments, the bottom housing 414B may include a flat bottom 430, such as for engagement with the attachment flange 320 of the portal 102, as detailed below. As shown, a switch 434 may be positioned on the flat bottom 430, such as protruding from the flat bottom 430. Depending on the application, the switch 434 may be momentary’ switch that remains in an on state only as long as it is being actuated (e.g.. pressed). In one example, one or more fasteners 436 may extend through the bottom housing 414B to secure the top housing 414A to the bottom housing 414B. [0087] FIG. 4C illustrates an exploded view of the illuminator 104. As shown, the illuminator 104 may include a printed circuit board assembly (“PCBA’’) 440 positioned within the outer housing 414, such as between the top housing 414A and the bottom housing 414B. The illuminator 104 may be self-powered, such that the illuminator’s power source is contained within the illuminator 104 itself. For instance, the illuminator 104 may be battery-powered, and in such examples, the PCBA 440 may include one or more battery clips 442. As shown, the PCBA 440 may be ring-shaped having an aperture 444 defined therethrough to accommodate the aperture of the body 410. The PCBA 440 may include the switch 434, and in such examples, the switch 434 may extend, at least partially, through the bottom housing 414B.

[0088] FIGS. 5A-5B illustrate top and bottom views of the PCBA 440, respectively, in accordance with embodiments of the present disclosure. Referring to FIG. 5A, a plurality of battery clips 442 (e g., two battery clips, greater than two battery clips, four battery clips, etc.) may be coupled to a top side 510 of a printed circuit board “PCB” 512. In one example, LED control circuitry 516, among other circuitry components, may be coupled to the top side 510.

[0089] Referring to FIG. 5B, the switch 434 may be coupled to a bottom side 520 of the PCB 512. In one example, the switch 434 may be coupled proximate to the outer periphery of the PCB 512. In one example, one or more light sources 524, such as plurality⁷ of light sources 524, may be coupled to the bottom side 520, such as proximate to the inner periphery of the PCB 512 adjacent the aperture 444. The light sources 524 may be spaced around the aperture 444, such as spaced equidistantly around the aperture 444. In one example, the light source(s) 524 may be light emitting diodes (LEDs), although other light sources are contemplated without intent to limit. For example, the light source(s) 524 may include any configuration operable to produce light to illuminate the surgical site through the portal 102. In one example, the light source(s) 524 may dangle inside or outside the portal 102 to provide light into or through the portal 102.

[0090] FIG. 6 illustrates an illuminator circuit 600 in accordance with embodiments of the present disclosure. As shown, the illuminator circuit 600 includes one or more batteries 610, a switch 612 (e.g., switch 434), a resistor/current control circuitry⁷ 614 (e.g. LED control circuitry 516), and one or more light sources 616 (e.g., light sources 524). Closing the switch 612 may complete the circuit 600 to illuminate the light sources 616. Conversely, opening the switch 612 may sever the circuit 600 to turn off the light sources 616. The switch 612 is shown between the batteries 610 and the resistor/current control circuitry 614; however, the switch 612 may be positioned any where in the circuit 600, such as between the batteries 610 and the light sources 616 or between the resistor/current control circuitry 614 and the light sources 616, among other locations.

[0091] FIG. 7 illustrates an example use of the dilator 106 to separate or retract tissue at a surgical site 700 in accordance with embodiments of the present disclosure. Referring to FIG. 7, an incision may be made over a facet joint 710 (e.g., a cervical facet joint, a lumbar facet joint, a thoracic facet joint, etc.) and the dilator 106 inserted through the incision and down to the entrance of the targeted facet joint 710. As noted above, the tip 222 may promote separation of tissue (e.g., muscle fibers, etc.) as the dilator 106 is advanced through the tissue.

[0092] FIG. 8 illustrates advancement of the portal 102 over the dilator 106 in accordance with embodiments of the present disclosure. Referring to FIG. 8, after the dilator 106 is advanced to the targeted facet joint 710, the portal 102 can be advanced over the dilator 106 until the tip 332 contacts the bony entrance to the facet joint 710. In such example, the bevel on the tip 332 may allow the portal 102 to be more easily advanced through the tissue either with direct downward pressure or with downward pressure while rotating the portal 102. In some examples, the bevel on the tip 332 may match or substantially match the joint angle of the anatomy, allowing the portal 102 to be docked on the bone directly in line with the facet joint 710. In one example, the angle of the bevel may be perpendicular to the angle of the facet joint angle, which may allow the portal 102 to be placed directly aligned with the facet joint 710. Once positioned, the portal 102 may be held in place. For example, the portal 102 may include various features to secure the portal 102 in place at the surgical site. In some examples, the portal 102 may be held in place using various systems or devices, such as fixation devices, attachment systems, or a docking station, among others, whether internal or external. [0093] FIG. 9 illustrates the illuminator 104 coupled to the portal 102 to illuminate the surgical site 700 in accordance with embodiments of the present disclosure. Referring to FIG. 9, after the portal 102 has been advanced to the facet joint 710, the dilator 106 can be removed and the illuminator 104 attached to the portal 102. For instance, as noted above, the illuminator 104 may be attached to the portal 102 via matching threaded features [0094] FIG. 10 illustrates a view down the portal 102 showing direct visualization of the surgical site 700 in accordance with embodiments of the present disclosure. Referring to FIG. 10, the aperture 412 of the illuminator 104 may be aligned with the lumen 112 when the illuminator 104 is coupled to the portal 102. In one example, the aperture 412 may include a diameter greater than the lumen 112, which may further facilitate direct visualization of the surgical site 700 as viewed down the portal 102. In one example, the illuminator 104 may provide even lighting to the entire surgical site 700 when viewed through the portal 102, as detailed below.

[0095] Although a facet joint is illustrated, the system 100 described herein may be used to access and/or illuminate a surgical site anywhere along the spine or at other joints. Thus, the surgical site 700 is not limited to the cervical spine, nor is the system 100 limited for use on the cervical spine. For example, the system 100 may be used on the lumbar or thoracic spine in the same manner as described herein. In such embodiments, the portal 102 may include various configurations based on the surgical site, such as a first configuration for a cervical operation, a second configuration for a lumbar operation, and so on. The various configurations of the portal 102 may include differing docking or securement features to anchor the portal 102 or system 100 in place based on the surgical site.

[0096] FIG. 11 illustrates a coupling of the illuminator 104 to the portal 102 in accordance with embodiments of the present disclosure. In one example, an engagement of the illuminator 104 with the portal 102 may activate the light source(s) 524. For instance, as noted above, the switch 434 of the illuminator 104 may be a momentary switch that protrudes from the bottom of the housing 414. In such examples, as the user applies a torsional force to screw the illuminator 104 onto the portal 102. the illuminator 104 may be actuated downward until the switch 434 contacts the attachment flange 320. The attachment flange 320 may exert a reactionary' force on the switch 434 to compress the switch 434 and complete the circuit 600, illuminating the light source(s) 524. In this manner, an engagement of the illuminator 104 with the attachment flange 320 may activate the light source 524. In some examples, the illuminator 104 may be designed to engage other portions of the portal 102 to activate the light source 524. For example, the illuminator 104 may engage the threads of the portal 102 to activate the light source 524. [0097] After the illuminator 104 is tightened onto the portal 102, frictional forces between the threads of the illuminator 104 and the portal 102 may limit the two components from loosening, and therefore the light source(s) 524 may remain illuminated until the user applies a torsional force in the opposite direction to overcome the frictional forces and release the illuminator 104 from the portal 102.

[0098] FIGS. 12A-12B illustrate activation of the switch 434 in accordance with embodiments of the present disclosure. FIG. 12A illustrates a schematic view of the switch 434 open before the illuminator 104 is coupled to (e.g., threaded on) the portal 102. As shown, the switch 434 protrudes from the bottom of the illuminator 104 at a position between the illuminator 104 and the attachment flange 320. In such examples, coupling the illuminator 104 to the portal 102 may move the illuminator 104 tow ards the attachment flange 320. For instance, the illuminator 104, and specifically the switch 434, may move towards the attachment flange 320 while the illuminator 104 is threaded onto the portal 102 (see arrow' showing movement direction towards the attachment flange 320).

[0099] FIG. 12B illustrates a schematic view of the switch 434 closed when the illuminator 104 is coupled to (e.g., fully threaded on) the portal 102, such that the switch 434 contacts the attachment flange 320. As shown, the switch 434 may be closed when the illuminator 104 is fully threaded on the portal 102, such as the switch 434 abutting the attachment flange 320 to close the switch 434. In this manner, coupling the illuminator 104 to the portal 102 may engage the switch 434 to turn the light source 524 on. Conversely, decoupling the illuminator 104 from the portal 102 may disengage the switch 434 to turn the light source 524 off. In this manner, the light source 524 may remain illuminated as long as the illuminator 104 is coupled to the portal 102. In addition, or alternatively, the switch 434 may form, at least in part, a rotational switch mechanism. For example, the switch 434 may be activated via a rotational movement of the illuminator 104 relative to the portal 102.

[0100] FIG. 13 illustrates total internal reflection (TIR) in a light pipe homogenizing rod (or “light pipes”) 1300 in accordance with embodiments of the present disclosure. In some embodiments, the portal 102 may include one or more light pipes 1300 to transmit light through the portal 102. Much like optical fibers, the light pipe 1300 may utilize TIR to transmit light from an entrance 1310 to an exit 1312 of the light pipe 1300. As shown, TIR may result in a complete reflection of a ray of light (e.g., incident beam 1316) within the light pipe 1300, and such phenomenon may occur if the angle of incidence is greater than a critical angle 0c. In general, TIR takes place at the boundary between two transparent media when a ray of light in a medium of higher index of refraction approaches the other medium at an angle of incidence greater than the critical angle 0c. The substrate’ s refractive index may be the only factor that influences the light pipe's critical angle 0c, which defines the angle of acceptance at which TIR will occur. Since light rays can enter the light pipe 1300 at a variety of incident angles, the number of reflections inside the light pipe 1300 differs from ray to ray. The smallest incident angle, which is equal to the critical angle 0c. will have more reflections than light entering at an incident angle that is many times larger than the critical angle 0c within the light pipe 1300.

[0101] FIG. 14 illustrates TIR in the portal 102 in accordance with embodiments of the present disclosure. Referring the FIG. 14, the one or more walls 314 of the portal 102 may act as a light pipe to transmit light from the illuminator 104. When the illuminator 104 is coupled to the portal 102, the light sources 524 may be placed centered on the wall 314 of the portal 102 to transmit light into the material of the wall 314. For example, the illuminator 104 may be positioned on the portal 102 such that a small or no gap exists between the light source 524 and the portal 102. When the light sources 524 are illuminated, light is transmitted into the material of the portal walls. In one example, the portal 102 may be made of a material (e.g., a transparent medium) with a higher refractive index than the surrounding medium (in this embodiment, air or human soft tissue) that allows for TIR. The geometry of the portal 102 may be designed such that rays of light 1410 will reflect internally within the material and transmit dow n the length of the portal 102 until the rays of light 1410 are refracted out the distal end 316 of the portal 102 to illuminate the surgical site 700. For example, the portal 102 may include geometry with angles less than the critical angle of the material, which is the limiting angle at which light refracts out of the material rather than being reflected internally within the material. In this manner, the illumination of the surgical site 700 may be provided via light traveling through at least a portion of the portal 102. In some embodiments, the edge of the portal 102 where the rays of light 1410 enter may be polished to facilitate the rays of light 1410 entering the portal 102.

[0102] FIGS. 15A-15B illustrate use of the distal radiopaque marker 338 in accordance with embodiments of the present disclosure. The distal radiopaque marker 338 may be used to verify a position of the portal 102 during surgery. For instance, the distal radiopaque marker 338 may be used to verify the depth of the portal 102 under lateral x- ray fluoroscopy or the position in the coronal plane under anterior to posterior (AP) x-ray fluoroscopy. FIG. 15A illustrates the distal radiopaque marker 338 shown on a simulated lateral x-ray. FIG. 15B illustrates the distal radiopaque marker 338 shown on a simulated AP x-ray.

[0103] FIGS. 16A-16D illustrate examples of distal light transmission to illuminate the surgical site 700 in accordance with embodiments of the present disclosure. As noted above, when light reaches the distal end 316 of the portal 102 near the surgical site 700. light exits the portal 102 and illuminates the surgical site 700. FIGS. 16A-16D illustrate various embodiments that can disperse the light (e.g., evenly) to the surgical site 700. In particular, FIGS. 16A-16D are lateral sectional views of the distal end 316, and illustrate one or more features of the distal end 316 configured to direct light towards the surgical site 700.

[0104] Referring to FIG. 16A, the portal 102 may include a straight bore 1610. As shown, the distal end 316 may not have any distal features. In such embodiments, all light may be sent out the far distal end 316 of the portal 102.

[0105] Referring to FIG. 16B, the portal 102 may include a counterbore distal feature, such as a counterbore 1620 in the distal end 316. For example, the counterbore 1620 may have a diameter greater than the adjacent bore 1610 of the portal 102. In such embodiments, the counterbore 1620 may cause light to refract out of the material of the portal 102 towards the surgical site 700. For instance, the dashed lines 1622 shown in FIG. 16B illustrate approximate direction of light rays disperse at the surgical site 700.

[0106] Referring to FIG. 16C, the portal 102 may include a textured distal feature, such as a textured inner diameter at the distal end 316. For example, the distal end 316 may include a textured surface 1630 along the interior of the bore 1610 (as indicated by cross- hatched region in FIG. 16C). The textured surface 1630 may allow light to disperse out of the portal 102 and onto the surgical site 700.

[0107] Referring to FIG. 16D, the portal 102 may include a slotted distal feature, such as a slot 1640 or multiple slots 1640 defined in the distal end 316. Each slot 1640 may allow light to exit the portal 102 and be directed towards the surgical site 700. For instance, the dashed lines 1642 shown in FIG. 16D illustrate approximate direction of light rays disperse at the surgical site 700.

[0108] FIGS. 17A-22B illustrate facet access and surgical instrument (e.g., decortication instrument) compatibility in accordance with embodiments of the present disclosure. For example, once the portal 102 is in position, the portal 102 may allow for access and one or more decortication instruments to be used through the portal 102 while directly visualizing the anatomy. In some embodiments, the illuminator 104 may also allow for access and instrument use. For instance, the aperture of the illuminator 104 may be aligned with the lumen 112 to receive one or more surgical instruments. In such embodiments, the portal 102 and illuminator 104 may receive the one or more surgical instruments while directly visualizing the anatomy through the aperture and lumen 112. [0109] FIGS. 17A-17B illustrate facet access by a first decortication instrument 1710 in accordance with embodiments of the present disclosure. The first decortication instrument 1710 may be an access chisel, which may be inserted or wedged in a facet to guide and anchor a device at the target site. As shown in FIG. 17B, the first decortication instrument 1710 may access the facet joint 710 under direct visualization provided by the portal 102, and in some embodiments, by the portal 102 and illuminator 104.

[0110] Other decortication instruments may be used with the illuminated portal system 100. For example, FIG. 18 illustrates facet access through the portal 102 by a second decortication instrument 1810, FIG. 19 illustrates facet access through the portal 102 by a third decortication instrument 1910, FIG. 20 illustrates facet access through the portal 102 by a fourth decortication instrument 2010, and FIG. 21 illustrates facet access through the portal 102 using a fifth decortication instrument 2110, in accordance with embodiments of the present disclosure. The second decortication instrument 1810 may be a trephine decorticator. The third decortication instrument 1910 may be a rasp decorticator. The fourth decortication instrument 2010 may be rotary decorticator. The firth decortication instrument 2110 may be a guide tube. Similar to the first decortication instrument 1710, each of the second, third, fourth, and fifth decortication instruments 1810, 1910, 2010, 2110 may access the facet joint 710 under direct visualization provided by the portal 102, and in some embodiments, by the portal 102 and illuminator 104.

[OHl] FIGS. 22A-22B illustrate facet implant placement using the portal 102 in accordance with embodiments of the present disclosure. Referring to FIG. 22A, once the portal 102 is in position, the portal 102 may allow for a facet implant 2204 or graft to be placed in the facet joint 710 under direct visualization, such as under illumination provided by the illuminator 104. For example, an implant delivery device 2210 may be positioned through the portal 102 (and illuminator 104) to deliver the facet implant 2204. Referring to FIG. 22B, after the facet implant 2204 is placed, the facet implant 2204 may be visualized through the portal 102 (and illuminator 104). [0112] FIGS. 23A-23B illustrate another portal 2302 in accordance with embodiments of the present disclosure. Except as otherwise noted below, the portal 2302 illustrated in FIGS. 23A-23B may be similar to the portal 102, described above. Referring to FIGS. 23A-23B, the portal 2302 may include an oblong shape that allows direct visualization of at least two facet joints (e.g., a first facet joint 2310A and a second facet joint 2310B). In such examples, the long width of the portal 2302 may be positionable in the cranial-caudal direction, while the short width of the portal 2302 is in the medial -lateral direction. The oblong profile may be used to allow access of more than one level while minimizing the required incision size. FIG. 23A illustrates a side view of the oblong portal 2302 docked on multiple facet joints. FIG. 23B illustrates a view down the oblong portal 2302 showing direct visualization of two facet joints through one portal.

[0113] FIGS. 24A-24D illustrate another portal 2402 in accordance with embodiments of the present disclosure. Except as otherwise noted below, the portal 2402 illustrated in FIGS. 24A-24D may be similar to the portal 102 and/or the portal 2302, described above. Referring to FIGS. 24A-24D. the portal 2402 may include a cannula 2408 and an offset lumen 2412 to directly visualize the adjacent facet joint. For example, the cannula 2408 may be slid over the shaft of an anchoring instrument 2420 that is anchored in a first facet joint 2430A. The lumen 2412 is offset from the cannula 2408 such that when the portal 2402 is advanced to the bone, the lumen 2412 provide direct visualization of an adjacent second facet joint 2430B. A surgical instrument 2440 can then be used to perform surgical procedures on the second facet joint 2430B under direct visualization. FIG. 24A illustrates a side view showing the portal 2402 slid over the anchoring instrument 2420 anchored in the first facet joint 2430A. FIG. 24B illustrates direct visualization of the second facet joint 2430B after the portal 2402 is slid over the anchoring instrument 2420. FIG. 24C is a low-angle view illustrating a position of the portal 2402 in relation to the anchoring instrument 2420. FIG. 24D illustrates the surgical instrument 2440 accessing the second facet joint 2430B under direct visualization once the portal 2402 is advanced down to the bone.

[0114] FIG. 25 illustrates an exploded view of another illuminated portal system 2500 in accordance with embodiments of the present disclosure. Except as otherwise noted below; the system 2500 may be similar to the system 100, described above. For example, the system 2500 includes a portal 2502 and an illuminator 2504. The illuminator 2504 may snap or clip onto the proximal end of the portal 2502 with a wire 2522 that extends down the inside of the portal 2502 to provide a light source 2524 close to the surgical site 700 at the distal end 316 of the portal 2502. For example, the illuminator 2504 may include a clip 2530 that engages the portal 2502. Such embodiments may reduce the amount of light lost by placing the light source 2524 directly near the surgical site 700. In addition, or alternatively, the power switch in this embodiment may be automatically switched on when the illuminator 2504 is clipped onto the portal 2502, providing immediate illumination and eliminating the added step of manually switching on the light source 2524.

[0115] FIGS. 26A-26C illustrate a coupling of the illuminator 2504 to the portal 2502 in accordance with embodiments of the present disclosure. As shown, the illuminator 2504 may clip onto a side of the portal 2502, with the wire 2522 extending along an interior surface of the portal 2502. When clipped, the illuminator 2504 may include a housing 2536 positioned on the outside of the portal 2502, the housing 2536 having one or more compartments for batteries, circuitry, and other features of the illuminator 2504. In this manner, the system 2500 may provide direct visualization through the portal 2502, such as in a manner as described above.

[0116] FIGS. 27A-27B illustrate exploded views of another illuminated portal system 2700 in accordance with embodiments of the present disclosure. FIG. 28 illustrates sectional views of the system 2700 in accordance with embodiments of the present disclosure. FIGS. 29A-29B illustrate perspective views of the system 2700 in accordance with embodiments of the present disclosure. Except as otherwise noted below, the system 2700 may be similar to the system 100 and/or system 2500, described above. For instance, the system 2700 includes a portal 2702 and an illuminator 2704. The portal 2702 may include an external cannula 2710 to receive a fiber optic cable 2712 of the illuminator 2704. A light source 2724 may be located proximally on a battery housing 2736 of the illuminator 2704, with the fiber optic cable 2712 abutting the light source 2724. As best shown in FIG. 28, the fiber optic cable 2712 runs down the external cannula 2710 and exits a hole 2740 near the distal end 316 of the portal 2702. In one example, the hole 2740 may be oriented toward the surgical site 700. Light is carried down the fiber optic cable 2712 and exits at a distal outlet to illuminate the surgical site 700.

[0117] FIGS. 30A-30D illustrate use of sequential dilators in accordance with embodiments of the present disclosure. Instead of a single dilator, multiple dilators may be used to achieve a desired tissue dilation. For instance, a series of dilators 3006 that slide over one another may be used until the tissue is slowly dilated to the appropriate diameter of a portal. Referring to FIG. 30A, a first dilator 3006A may be advanced to the targeted facet joint to dilate the tissue. Referring to FIG. 30B, a second dilator 3006B may slide over the first dilator 3006A and advanced to the targeted facet joint to dilate the tissue greater than the first dilator 3006 A. Referring to FIG. 30C, a third dilator 3006C may slide over the second dilator 3006B and advanced to the targeted facet joint to dilate the tissue greater than the second dilator 3006B. Referring to FIG. 30D, a fourth dilator 3006D may slide over the third dilator 3006C and advanced to the targeted facet joint to dilate the tissue greater than the third dilator 3006C. Although FIGS. 30A-30D illustrate a series of four sequential dilators 3006, more or fewer dilators 3006 may be used as desired.

[0118] FIG. 31 illustrates portal insertion over the sequential dilators 3006 in accordance with embodiments of the present disclosure. After the sequential dilators 3006 dilate the tissue to the appropriate diameter, a portal (e.g., any of portal 102, 2302, 2402, 2502, or 2702) may be inserted over the final sequential dilator (e.g., the fourth dilator 3006D), such as in a manner as described above.

[0119] FIG. 32 illustrates a flow diagram of a method 3200 of using an illuminated portal system (e.g., any of system 100, 2500. or 2700 or other systems described herein) in accordance with embodiments of the present disclosure. For explanatory purposes, the method 3200 is described herein with reference to FIGS. 1-31, although the method 3200 is not limited to the embodiments illustrated therein (e.g., FIGS. 33-34). Note that one or more operations in FIG. 32 may be combined, omitted, and/or performed in a different order, as desired.

[0120] As shown, the method 3200 may begin at block 3210. At block 3220, the method 3200 includes skin incision. For instance, block 3220 may include one or more skin incisions being made over a facet joint, such as over a targeted cervical facet joint.

[0121] At block 3230, the method 3200 includes tissue dilation. For example, block 3230 may include inserting a dilator through the skin incision and down to the entrance of the targeted facet joint. Block 3230 may include using any one of dilator 106, first dilator 3006A, second dilator 3006B, third dilator 3006C, fourth dilator 3006D, or sequential dilators 3006, described above, to perform tissue dilation.

[0122] At block 3240, the method 3200 includes portal placement. For example, block 3240 may include placing any one of portal 102, 2302, 2402, 2502, or 2702 at the targeted facet joint, such as in a manner as described above. For example, block 3240 may include sliding a portal over or along a dilator until the portal is docked on the targeted facet joint, such as in a manner as described above. [0123] At block 3250, the method 3200 includes querying whether a light source is desired for the surgical procedure. If a light source is desired, the method 3200 may proceed to block 3260. If a light source is not desired, the method 3200 may proceed to block 3270.

[0124] At block 3260, the method 3200 includes illuminating the surgical site. In some examples, block 3260 includes attaching an illuminator to the portal. The illuminator may be any of the illuminator 104, 2504, or 2704, described above. In such examples, block 3260 may include attaching the illuminator to the portal in a manner as described above. [0125] At block 3270, the method 3200 includes proceeding with the surgical procedure. At block 3280, the method 3200 may end.

[0126] FIGS. 33-34 illustrate another example system 3300 for accessing a surgical site in accordance with embodiments of the present disclosure. The system 3300 may be similar to any of the other systems described herein (e.g., any of system 100, 2500, or 2700), and vice-versa, and thus descriptions of similar or generally understood features may be omitted in describing the system 3300 of FIG. 33. For example, the system 3300 includes multiple surgical instruments or devices that combine to facilitate surgical site access or operation. As shown, the system 3300 includes a portal 3302 and multiple instruments that engage the portal 3302 (e.g., for surgical site access). For example, the system 3300 may include sequential dilators (e.g., a first dilator 3306A and a second dilator 3306B) designed to sequentially dilate soft tissue at the surgical site, such as over an access chisel 3308 (see FIG. 34). In examples, the system 3300 may be similar to examples described with reference to FIGS. 30A-31, described above.

[0127] The portal 3302 may be similar to portal 102, described above, such as including a body defining a lumen 3312 extending longitudinally through a length of the portal 3302; an angled tip 3332 having a radiopaque marker to match anatomy, ease insertion, and verify positioning of the portal 3302; an attachment flange 3320 for coupling to one or more accessories or devices; among other similar features. For example, the attachment flange 3320 may allow coupling of the portal 3302 to stabilizing arms, a fixture, an illuminator, or other devices. In examples, the attachment flange 3320 may be dark and textured, such as to reduce glare from surgical lights. In examples, the attachment flange 3320 may define a handle, such as a U-shaped handle. The U-shape may be configured to engage other accessories or devices (e.g.. stabilizing arm, fixtures, etc.). In examples, an illuminator (e.g., illuminator 104, 2504, or 2704) may be selectively coupled to the attachment flange 3320, such as to provide light to illuminate a surgical site through the portal, as described herein, although the system 3300 may be used without an illuminator. In examples, the portal 3302 may be adjustable, such as adjustable in length, to configure the portal 3302 based on use or application. For instance, the length of the portal 3302 may be changed to create different lengths, at the surgeon’s discretion. In such examples, the portal 3302 may include one or more score lines (or other areas of local weakening) associated with different lengths.

[0128] The first dilator 3306 A may be a hollow tube configured for insertion through the portal 3302. For example, the first dilator 3306A may have an outer diameter that allows the first dilator 3306A to be inserted through the lumen 3312 of the portal 3302. In examples, the first dilator 3306A may include a radiopaque material or additive, such as to verify the depth of the first dilator 3306A under imaging. The proximal end of the first dilator 3306A may include a marker ring or rings 3340, such as to indicate proper depth for subsequent dilator or final system configuration. The first dilator 3306A may also include depth markings 3326 along a length of the first dilator 3306A (e.g., every' 10mm), such as to assist with positioning or reference. The first dilator 3306A may be longer than the portal 3302. In other aspects, the first dilator 3306A may be similar to dilator 106, described above.

[0129] The second dilator 3306B may be a hollow tube configured for insertion through the first dilator 3306A. For example, the second dilator 3306B may have an outer diameter that allows the second dilator 3306B to be inserted through the lumen of the first dilator 3306A. In examples, the second dilator 3306B may include a radiopaque material or additive, such as to verify the depth of the second dilator 3306B under imaging. The proximal end of the second dilator 3306B may include a marker ring or rings 3342, such as to indicate proper depth for subsequent instruments (access chisel 3308) or final system configuration. The second dilator 3306B may also include depth markings 3328 along a length of the second dilator 3306B (e.g., every 10mm), such as to assist with positioning or reference. The second dilator 3306B may my longer than the first dilator 3306A. In other aspects, the second dilator 3306B may be similar to dilator 106, described above.

[0130] Although described with reference to an illuminated system, in examples, the systems described herein may be used without a light source. For example, the illuminators described herein may be optional. In such examples, the illuminators may be selectively coupled to the portal, when desired or when conditions permit.

[0131] Of course, it is to be appreciated that any one of the examples, embodiments or processes described herein may be combined with one or more other examples, embodiments and/or processes or be separated and/or performed amongst separate devices or device portions in accordance with the present systems, devices and methods.

[0132] Finally, the above-discussion is intended to be merely illustrative of the present system and should not be construed as limiting the appended claims to any particular embodiment or group of embodiments. Thus, while the present system has been described in particular detail with reference to exemplary embodiments, it should also be appreciated that numerous modifications and alternative embodiments may be devised by those having ordinary skill in the art without departing from the broader and intended spirit and scope of the present system as set forth in the claims that follow. Accordingly, the specification and drawings are to be regarded in an illustrative manner and are not intended to limit the scope of the appended claims.

Claims

CLAIMS What is claimed is:

1. A system comprising: a portal comprising a lumen extending longitudinally through a length of the portal; and an illuminator selectively coupled to the portal and configured to produce light to illuminate a surgical site through the portal.

2. The system of claim 1, wherein the portal comprises: a threaded attachment for securing the illuminator to the portal; and an attachment flange defining a secured position of the illuminator on the portal.

3. The system of claim 1 or 2, wherein the illuminator comprises a light source, and wherein an engagement of the illuminator with the portal activates the light source.

4. The system of any of claims 1 -3, wherein the portal comprises a tip having a marker ring of a radiopaque material.

5. The system of any of claims 1 -4, wherein the illuminator comprises an aperture aligned with the lumen.

6. The system of claim 5, wherein the illuminator comprises a light ring window adjacent the aperture.

7. The system of any of claims 1-6, wherein the portal comprises one or more walls defining the lumen, and wherein the illumination is provided via the light travelling through the one or more walls.

8. The system of any of claims 1-7, further comprising a dilator comprising an outer diameter compatible with the lumen to receive the dilator through the lumen.

9. The system of claim 7, wherein the dilator comprises at least one of: a distal tip configured to promote a separation of tissue as the dilator is advanced through the tissue; one or more depth markings along a length of the dilator; and a proximal grip.

10. A system comprising: one or more surgical instruments; a portal configured to provide access to a surgical site, the portal comprising a lumen extending longitudinally through a length of the portal and configured to receive the one or more surgical instruments; and an illuminator selectively coupled to the portal and comprising: an aperture aligned with the lumen to receive the one or more surgical instruments, and a light source to produce light to illuminate the surgical site through the portal, wherein the illumination is provided via the light traveling through at least a portion of the portal.

11. The system of claim 10, wherein: the illuminator comprises a switch; coupling the illuminator to the portal engages the switch to turn the light source on; and decoupling the illuminator from the portal disengages the switch to turn the light source off.

12. The system of claim 11, wherein the illuminator threadingly engages the portal to secure the illuminator to the portal.

13. The system of any of claims 10-12, wherein the portal comprises a distal tip having a bevel configured to match the joint angle of a facet joint.

14. The system of any of claims 10-13, wherein the illuminator comprises a power source contained within the illuminator.

15. The system of any of claims 10-14, wherein when the illuminator is coupled to the portal, the light source is centered on a wall of the portal to transmit light into the material of the wall.

16. The system of any of claims 10-15, wherein the one or more surgical instruments comprises a dilator, a decortication instrument, a guide tube, or an implant delivery device.

17. A portal for providing access to a surgical site, the portal comprising: at least one wall defining a lumen extending longitudinally through a length of the portal to a distal end; wherein the at least one wall is made of a material with a higher refractive index than its surrounding medium that allows for total internal reflection; and wherein rays of light reflect internally within the material and transmit down the length of the portal until the rays are refracted out the distal end to illuminate the surgical site.

18. The portal of claim 17, wherein the distal end comprises one or more features configured to direct light towards the surgical site.

19. The portal of claim 18, wherein the one or more features comprises a counterbore in the distal end.

20. The portal of claim 18 or 19, wherein the one or more features comprises a textured surface along an inner diameter of the distal end.

21. The portal of any of claims 18-20, wherein the one or more features comprises a slot defined in the distal end.

22. The portal of any of claims 17-21, wherein the material comprises a transparent medium.

23. A system comprising the portal of any of claims 17-22. the system further comprising an illuminator selectively coupled to the portal, the illuminator comprising a light source aligned with the at least one wall to transmit light into the material.

24. The system of claim 23, wherein the illuminator comprises an aperture aligned with the lumen to receive one or more surgical instruments.

25. A system comprising: one or more surgical instruments; and a portal configured to provide access to a surgical site, the portal comprising a lumen extending longitudinally through a length of the portal and configured to receive the one or more surgical instruments, wherein the portal is configured for selective attachment to an illuminator configured to produce light to illuminate a surgical site through the portal.

26. The system of claim 25, further comprising the illuminator selectively coupled to the portal.

27. The system of claim 26, wherein the illuminator comprises: an aperture aligned with the lumen to receive the one or more surgical instruments; and a light source to produce light to illuminate the surgical site through the portal, wherein the illumination is provided via the light traveling through at least a portion of the portal.

28. The system of any of claims 25-27, wherein the portal comprises a flange configured for engagement with the illuminator.

29. The system of any of claims 25-28, wherein the portal is adjustable in length.

30. A system comprising: one or more surgical instruments; and a portal configured to provide access to a surgical site, the portal comprising a lumen configured to receive the one or more surgical instruments, wherein the portal is adjustable in length.

31. The system of claim 30, wherein the portal comprises one or more score lines defining different lengths of the portal.

32. The system of claim 30 or 31, wherein the one or more surgical instruments comprises sequential dilators for sequentially dilating soft tissue at the surgical site.

33. The system of claim 32. wherein each dilator of the sequential dilators comprises a radiopaque material or additive.

34. The system of claim 32 or 33, wherein each dilator of the sequential dilators comprises a depth marker ring.

35. The system of any of claims 30-34, wherein the portal comprises a U-shaped flange.

36. A system comprising: one or more surgical instruments; and a portal configured to provide access to a surgical site, the portal comprising a lumen configured to receive the one or more surgical instruments, wherein the portal comprises a flange configured for coupling to one or more accessories or devices.

37. The system of claim 36, wherein the flange defines a U-shape.

38. The system of claim 36 or 37, wherein the flange defines a handle.

39. The system of any of claims 36-38, wherein the flange is configured to reduce glare from surgical lights.

40. A method of accessing a spinal surgical site, the method implemented using a system and/or device according to any one of claims 1-39.