while the description of the dilator system of this invention will be discussed primarily in relation to spinal surgery , it should be understood that the system will find use in other areas of surgery in which a surgeon wishes to gain access to an internal cavity by cutting the skin and enlarging an incision in a body wall so that surgical instruments can be inserted to perform a desired surgical procedure . for example , the dilator system may be used to create an incision to provide access to the posterior spine through which pedicle screws may be percutaneously installed in one or more selected vertebra . alternatively , the dilator system may be used to create an incision to access an invertebral disc space for performance of a minimally invasive discectomy procedure and / or spinal fusion procedure including the implantation of one or more intervertebral or interspinous process implants . implants are inserted between adjacent spinous processes to distract the spine segments and maintain them in a position to relieve symptoms of spinal stenosis and other conditions that cause pain which is associated with the back . such implants have a spacer which remains in place between the adjacent spinous processes . an opening is created in the supraspinous and / or interspinous ligament so that the implant can be inserted . the dilators of the present invention are used to step dilate or gradually dilate body tissue , in particular , the supraspinous and / or interspinous ligament . the dilator system of the present invention includes one or more dilators configured to work independently or in conjunction with one another . when used in conjunction with one another a first dilator is generally smaller in outer diameter or cross - sectional area than that of a second dilator which typically is also cannulated so that the second dilator fits over the first dilator to dilate tissue . it should be noted that the second dilator , in one variation , is not cannulated but is sized larger than the first dilator . in such a variation , the first dilator is removed and the second dilator is inserted to expand body tissue . in another variation , the first dilator is cannulated to be placed over a guide wire that is first positioned in the patient . in any of the variations disclosed herein , the first dilator may also be cannulated . although in some cases two dilators are discussed it should be noted that more than two dilators may be employed in any of the variations disclosed herein . furthermore , some of the distal ends of the dilators of the present invention are sufficiently sharp or manufactured with integrated knife points to cut tissue without a need for a separate instrument such as a scalpel to create an initial incision in the skin or ligament which is then expanded with the dilators , whereas other dilators of the present invention have a distal end that is too blunt and a separate instrument such as a scalpel is employed to create the first incision in the tissue or ligament . with reference to fig1 a , there is shown a dilator 10 according to the present invention . the dilator 10 has an elongated body 12 , a proximal end 14 and a distal end 16 . the dilator 10 includes a pair of channels 18 shown in fig1 b , 1 c and 1 e that are oppositely located from each other and run parallel to the longitudinal axis of the dilator 10 . the distal end 20 of the channel 18 commences in the distal end 16 and the proximal end 22 of the channel 18 ends in the body 12 portion of the dilator 10 . in one variation , the channel 18 has a flat base between two sidewalls . when inserted in a patient and aligned with the adjacent spinous processes , the channels 18 are advantageous for distracting the spinous processes apart as well as for keeping the dilator 10 in position between the spinous processes while being inserted especially in a “ kissing ” condition of the spine where the posterior tips of adjacent spinous processes are in close proximity , touch or “ kiss ”. in one variation , the channels 18 are absent from the dilator 10 . the distal end 16 of the dilator 10 is a tapered portion where the diameter or cross - sectional area is less than the diameter or cross - sectional area of the body portion 12 . in the embodiment shown in fig1 a - 1 e , the distal end 16 portion has a cone shape shown in fig1 c . an end view of the distal end 16 is shown in fig1 d illustrating the tip or point 24 of the cone or bore 24 in a cannulated version of the dilator . when a cross - section of the distal end 16 is taken at a location distal to the channels 18 and perpendicular to the longitudinal axis of the dilator 10 as shown in fig1 e , the cross - sectional area 26 of the distal end 16 is circular in shape . the cone - shaped dilator of fig1 a - 1 e is generally employed as a first dilator 10 and may be cannulated for passing over a guide wire or if used as a subsequent dilator for passing over a previous dilator . the cone - shaped dilator 10 shown in fig1 punctures ligament and passes through soft tissue easily and therefore , it can be used as a first dilator in a minimally invasive percutaneous procedure without the need to first create a cut with a separate sharp edge such as a scalpel . a sharper tip formed by a distal end 16 with a more acute angle θ ( see fig1 b ) will prevent the tip 24 from slipping off to the sides of the ligament . turning now to fig2 a - 2 e , there is shown another variation of a dilator 10 according to the present invention wherein like reference numbers are used to describe like parts . referring first to fig2 a , the dilator 10 has an elongated body 12 , a proximal end 14 and a distal end 16 . the dilator 10 includes a pair of channels 18 shown in fig2 b , 2 c and 2 e that are oppositely located from each other and run parallel to the longitudinal axis of the dilator 10 . the distal end 20 of the channel 18 commences in the distal end 16 and the proximal end 22 of the channel 18 ends in the body 12 portion of the dilator 10 . when inserted in a patient and aligned with the adjacent spinous processes , the channels 18 are advantageous for distracting the spinous processes apart as well as for keeping the dilator 10 in position between adjacent spinous processes while being inserted especially in a “ kissing ” condition of the spine where the posterior tips of adjacent spinous processes are in close proximity , touch or “ kiss ”. in one variation , the channels 18 are absent from the dilator 10 . the distal end 16 of the dilator 10 is a tapered portion where the diameter or cross - sectional area is less than the diameter or cross - sectional area of the body portion 12 and decreases toward the distal end 16 . in the embodiment shown in fig2 a - 2 e , the distal end 16 portion has a wedge shape formed by two substantially flat faces 28 that angle towards each other at the distal end 16 and form a line or rectangular tip 24 shown in fig2 d . an end view of the distal end 16 is shown in fig2 d illustrating the line or rectangular tip 24 of the wedge . a cannulated variation of the dilator 10 is not shown but is within the scope of the present invention . when a cross - section of the distal end 16 is taken at a location distal to the channels 18 and perpendicular to the longitudinal axis of the dilator 10 as shown in fig2 e , the cross - sectional area 26 of the distal end 16 is rectangular in shape . the wedge - shaped dilator of fig2 a - 2 e is generally employed as a first dilator 10 and may be cannulated for passing over a guide wire or if used as a subsequent dilator for passing over a previous dilator . the distal end 16 is positioned in the patient such that the length of the tip 24 is aligned along the cephalad - caudal direction when puncturing the supraspinous ligament or otherwise aligned substantially parallel to the fibrous strands of the ligament . the wedge - shaped dilator 10 shown in fig2 a - 2 e does not puncture ligament as readily as the dilator 10 of fig1 a - 1 e and hence , is typically used in conjunction with a scalpel or other sharp edge , for example , to create a small opening in the ligament prior to insertion of the dilator 10 of fig2 a - 2 e which then splits the ligament to create a larger opening as it is inserted . for these reasons , the dilator of fig2 a - 2 e is generally used as a first dilator in a mini - open or open procedure in which direct visual access is gained and a sharp edge is used to first create a cut . the line or rectangular shaped point 24 is centered as seen in fig2 d and 2 e and therefore advantageously assists in centering the location of the splitting on the ligament . it should be noted that a sharper tip may be formed by a distal end 16 with a more acute angle θ ( see fig2 b ) thereby , creating or a approaching a knife - like edge that can pierce the ligament without first using a sharp edge and therefore well suited for truly percutaneous procedures . turning now to fig3 a - 3 e , there is shown another variation of a dilator 10 according to the present invention wherein like reference numbers are used to describe like parts . referring first to fig3 a , the dilator 10 has an elongated body 12 , a proximal end 14 and a distal end 16 . the dilator 10 includes a pair of channels 18 shown in fig3 b , 3 c , 3 d and 3 e that are oppositely located from each other and run parallel to the longitudinal axis of the dilator 10 . the distal end 20 of the channel 18 commences in the distal end 16 and the proximal end 22 of the channel 18 ends in the body 12 portion of the dilator 10 . when inserted in a patient and aligned with the adjacent spinous processes , the channels 18 are advantageous for distracting the spinous processes apart as well as for keeping the dilator 10 in position between the spinous processes while being inserted especially in a “ kissing ” condition of the spine where the posterior tips of adjacent spinous processes are in close proximity , touch or “ kiss ”. in one variation , the channels 18 are absent from the dilator 10 . the distal end 16 of the dilator 10 is a tapered portion where the diameter or cross - sectional area is less than the diameter or cross - sectional area of the body portion 12 and decreases towards the distal end 16 . in the embodiment shown in fig3 a - 3 e , the distal end 16 portion has a pyramid shape formed by four substantially flat faces 28 that angle towards each other at the distal end 16 and meet at a tip 24 shown in fig3 c and 3 d . an end view of the distal end 16 is shown in fig3 d illustrating the tip 24 of the pyramid - shaped distal end 16 . a cannulated variation of the dilator 10 is not shown but is within the scope of the present invention wherein the tip 24 would include an opening . when a cross - section of the distal end 16 is taken at a location distal to the channels 18 and perpendicular to the longitudinal axis of the dilator 10 as shown in fig3 e , the cross - sectional area 26 of the distal end 16 is substantially square in shape . the pyramid - shaped dilator of fig3 a - 3 e is generally employed as a first dilator 10 and may be cannulated for passing over a guide wire or if used as a subsequent dilator for passing over a previous dilator . the pyramid - shaped dilator 10 shown in fig3 a - 3 e can puncture ligament and pass through soft tissue and hence , is generally used as a first dilator in a minimally invasive percutaneous procedure without the need to first create a cut with a separate sharp edge such as a scalpel . a sharper tip formed by a distal end 16 with a more acute angle θ ( see fig3 b ) will prevent the tip 24 from slipping off to the sides of the ligament . turning now to fig4 a - 4 e , there is shown another variation of a dilator 10 according to the present invention wherein like reference numbers are used to describe like parts . referring first to fig4 a , the dilator 10 has an elongated body 12 , a proximal end 14 and a distal end 16 . the dilator 10 includes a pair of channels 18 shown in fig4 b , 4 c , 4 d and 4 e that are oppositely located from each other and run parallel to the longitudinal axis of the dilator 10 . the distal end 20 of the channel 18 commences in the distal end 16 and the proximal end 22 of the channel 18 ends in the body 12 portion of the dilator 10 . when inserted in a patient and aligned with the adjacent spinous processes , the channels 18 are advantageous for distracting the spinous processes apart as well as for keeping the dilator 10 in position between the spinous processes while being inserted especially in a “ kissing ” condition of the spine where the posterior tips of adjacent spinous processes are in close proximity , touch or “ kiss ”. in one variation , the channels 18 are absent from the dilator 10 . the distal end 16 of the dilator 10 is a tapered portion where the diameter or cross - sectional area is less than the diameter or cross - sectional area of the body portion 12 and decreases toward the distal end 16 . in the embodiment shown in fig4 a - 4 e , the distal end 16 portion has a pyramid shape formed by four substantially flat faces 28 that angle towards each other at the distal end 16 and form a tip 24 shown in fig4 d . an end view of the distal end 16 is shown in fig4 d illustrating the tip 24 of the pyramid . a cannulated variation of the dilator 10 is not shown but is within the scope of the present invention wherein the tip 24 would include an opening . when a cross - section of the distal end 16 is taken at a location distal to the channels 18 and perpendicular to the longitudinal axis of the dilator 10 as shown in fig4 e , the cross - sectional area 26 of the distal end 16 is a quadrilateral and , in the variation shown in fig4 e , the quadrilateral is a rhombus in which one of the diagonals 30 or the longest diagonal 30 is aligned with the channels 18 as opposed to the variation of fig3 a - 3 e in which none of the diagonals are aligned with the channels 18 . it is the intersection of two faces 28 that align with one channel 18 and the intersection of opposite two faces 28 that align with the other channel 18 . in a variation in which no channels 18 are included , the difference between the dilator of fig3 a - 3 e is in the shape of the quadrilateral . the pyramid - shaped dilator of fig4 a - 4 e is generally employed as a first dilator 10 and may be cannulated for passing over a guide wire or if used as a subsequent dilator for passing over a previous dilator . the distal end 16 is positioned in the patient such that one of the diagonals or longest diagonal 30 is aligned along the cephalad - caudal direction when puncturing the supraspinous ligament or otherwise aligned substantially parallel to the fibrous strands of the ligament such that the intersection of faces 28 form an edge along which ligament is split . the pyramid - shaped dilator 10 shown in fig4 a - 4 e in either the channeled or non - channeled variations , splits ligament more readily than either of the channeled or non - channeled variations of the dilator 10 of fig3 a - 3 e where the intersections of faces 28 are not aligned with the channels 18 or does not have a diagonal 30 that is longer relative to the other diagonal 30 which can be aligned with the fibrous ligament strands for easier splitting . the variation of fig4 a - 4 e can be used with or without a scalpel or other sharp edge , for example , to create a small opening in the ligament prior to insertion of the dilator 10 of fig4 a - 4 e which then splits the ligament to create a larger opening as it is inserted . the intersection of faces 28 or diagonal 30 , when aligned substantially parallel to the ligament strands , assist in centering the location of the splitting on the ligament . it should be noted that a sharper tip , intersection or diagonal may be formed by a distal end 16 with a more acute angle θ ( see fig4 b ) thereby , creating or a approaching a knife - like edge that can pierce the ligament without first using a sharp edge and therefore well suited for percutaneous procedures . turning now to fig5 a - 5 e , there is shown another variation of a dilator 10 according to the present invention wherein like reference numbers are used to describe like parts . referring first to fig5 a , the dilator 10 has an elongated body 12 , a proximal end 14 and a distal end 16 . the dilator 10 includes a pair of channels 18 shown in fig5 b , 5 c , 5 d and 5 e that are oppositely located from each other and run parallel to the longitudinal axis of the dilator 10 . the distal end 20 of the channel 18 commences in the distal end 16 and the proximal end 22 of the channel 18 ends in the body 12 portion of the dilator 10 . when inserted in a patient and aligned with the adjacent spinous processes , the channels 18 are advantageous for distracting the spinous processes apart as well as for keeping the dilator 10 in position between the spinous processes while being inserted especially in a “ kissing ” condition of the spine where the posterior tips of adjacent spinous processes are in close proximity , touch or “ kiss ”. in one variation , the channels 18 are absent from the dilator 10 . the distal end 16 of the dilator 10 is a tapered portion where the diameter or cross - sectional area is less than the diameter or cross - sectional area of the body portion 12 and decreases toward the distal end 16 . in the embodiment shown in fig5 a - 5 e , the distal end 16 portion has two curved faces 28 that angle towards each other at the distal end 16 and form a tip 24 shown in fig5 d . an end view of the distal end 16 is shown in fig5 d illustrating the tip 24 . a cannulated variation of the dilator 10 is not shown but is within the scope of the present invention wherein the tip 24 would include an opening . in yet another variation , the tip 24 includes an opening to a blade housing through which a blade may extend . the blade ( not shown ) may also be retractable . when a cross - section of the distal end 16 is taken at a location distal to the channels 18 and perpendicular to the longitudinal axis of the dilator 10 as shown in fig5 e , the cross - sectional area 26 of the distal end 16 is comprised of an area bounded by two curved lines in which the length is aligned with the channels 18 . it is the intersections of two faces 28 that align with one channel 18 . in a variation in which no channels 18 are included , the length is aligned with the length of the ligament . the dilator 10 of fig5 a - 5 e is generally employed as a first dilator 10 and may be cannulated for passing over a guide wire or if used as a subsequent dilator for passing over a previous dilator . the distal end 16 is positioned in the patient such that the length of the tip 24 is aligned along the cephalad - caudal direction when puncturing the supraspinous ligament or otherwise aligned substantially parallel to the fibrous strands of the ligament or to the ligament itself such that the intersections of faces 28 form an edge along which ligament is split . the variation of fig5 a - 5 e can be used with or without a scalpel or other sharp edge , for example , to create a small opening in the ligament prior to insertion of the dilator 10 of fig5 a - 5 e which then splits the ligament to create a larger opening as it is inserted . the intersection of faces 28 when aligned substantially parallel to the ligament strands , assist in centering the location of the splitting on the ligament . it should be noted that a sharper tip , intersection or diagonal may be formed by a distal end 16 with a more acute angle θ ( see fig5 b ) thereby , creating or a approaching a knife - like edge that can pierce the ligament without first using a sharp edge and therefore well suited for percutaneous procedures . turning now to fig6 a - 6 d , there is shown another variation of a dilator 10 according to the present invention wherein like reference numbers are used to describe like parts . referring first to fig6 a , the dilator 10 has an elongated body 12 , a proximal end 14 and a distal end 16 . the dilator 10 includes a pair of channels 18 shown in fig6 b , 6 c and 6 d that are oppositely located from each other and run parallel to the longitudinal axis of the dilator 10 . the distal end 20 of the channel 18 commences in the distal end 16 and the proximal end 22 of the channel 18 ends in the body 12 portion of the dilator 10 . when inserted in a patient and aligned with the adjacent spinous processes , the channels 18 are advantageous for distracting the spinous processes apart as well as for keeping the dilator 10 in position between the spinous processes while being inserted especially in a “ kissing ” condition of the spine where the posterior tips of adjacent spinous processes are in close proximity , touch or “ kiss ”. in one variation , the channels 18 are absent from the dilator 10 . the distal end 16 of the dilator 10 is a tapered portion where the diameter or cross - sectional area is less than the diameter or cross - sectional area of the body portion 12 and decreases toward the distal end 16 . in the embodiment shown in fig6 a - 6 d , the distal end 16 portion has a surface 28 , that may also be curved that angles toward the distal end 16 and forms an opening 32 at tip 24 shown in fig6 c and 6 d . an end view of the distal end 16 is shown in fig6 d illustrating the opening 32 that forms distal end of the cannulation or bore 34 running along at least part of the length of the dilator 10 . because of the central bore 34 is sized to received therein a smaller dilator 10 such as any of the dilators described above in fig1 - 5 , the dilator 10 of fig6 a - 6 d is generally employed as a second dilator 10 or dilator 10 subsequent for passing over a previous dilator . the distal end 16 is positioned over a previous dilator 10 in the patient such that the channels 18 are aligned generally perpendicular to the cephalad - caudal direction when puncturing the supraspinous ligament or otherwise aligned substantially perpendicular to the fibrous strands of the ligament or to the ligament itself . when inserted , the cannula of fig6 a - 6 d continues to distract the spinous processes as they ride in the channels 18 with the channels 18 helping with maintaining the proper orientation of the dilators 10 between the spinous processes . in one variation , the channels 18 are ramped or angled towards the distal end to improve upon the distraction action provided by the dilator . turning now to fig7 a - 7 d , there is shown another variation of a dilator 10 according to the present invention wherein like reference numbers are used to describe like parts . referring first to fig7 a , the dilator 10 has an elongated body 12 , a proximal end 14 and a distal end 16 . the dilator 10 includes a pair of channels 18 shown in fig7 b , 7 c and 7 d that are oppositely located from each other and run parallel to the longitudinal axis of the dilator 10 . the distal end 20 of the channel 18 commences in the distal end 16 and the proximal end 22 of the channel 18 ends in the body 12 portion of the dilator 10 . in one variation , the channel 18 includes a flat base between two sidewalls . when inserted in a patient and aligned with the adjacent spinous processes , the channels 18 are advantageous for distracting the spinous processes apart as well as for keeping the dilator 10 in position between the spinous processes while being inserted especially in a “ kissing ” condition of the spine where the posterior tips of adjacent spinous process are in close proximity , touch or “ kiss ”. in one variation , the channels 18 are absent from the dilator 10 . the distal end 16 of the dilator 10 is a tapered portion where the diameter or cross - sectional area is less than the diameter or cross - sectional area of the body portion 12 and decreases toward the distal end 16 . in the embodiment shown in fig7 a - 7 d , the distal end 16 portion has a surface 28 that may also be curved that angles toward the distal end 16 and forms an opening 32 at tip 24 shown in fig7 c and 7 d . an end view of the distal end 16 is shown in fig7 d illustrating the opening 32 that forms distal end of the cannulation or bore 34 running along at least part of the length of the dilator 10 . because of the central bore 34 is sized to received therein a smaller dilator 10 such as any of the dilators described above in fig1 - 5 , the dilator 10 of fig7 a - 7 d is generally employed as a second dilator 10 or dilator 10 subsequent for passing over a previous dilator . the distal end 16 is positioned over a previous dilator 10 in the patient such that the channels 18 are aligned generally perpendicular to the cephalad - caudal direction when puncturing the supraspinous ligament or otherwise aligned substantially perpendicular to the fibrous strands of the ligament or to the ligament itself . the dilator of fig7 a - 7 d further includes a pair of oppositely located flats 36 that are aligned with the channels 18 . at least part of the channel 18 is formed in the flats 36 and in one variation , the flat 36 is substantially parallel to the flat base of the channel 18 . the flats 36 create a lower profile for the dilator 10 which is advantageous for insertion between closely spaced spinous processes . when inserted , the cannula of fig7 a - 7 d continues to distract the spinous processes as they ride in the channels 18 with the channels 18 helping with maintaining the proper orientation of the dilators 10 between the spinous processes . an entry point is selected on the patient &# 39 ; s skin to obtain access to the targeted surgical site , and an incision of appropriate length is made through the dermal layers of a patient &# 39 ; s body at the entry point . the length and depth of the incision may be larger depending on whether the clinician is using an open , mini - open , or minimally invasive , percutaneous approach . if a guide wire is used , the tip of the guide wire is then positioned within the incision and guided toward the spine using a cannulated t - handled trocar . if a ligament such as the supraspinous or interspinous ligament is to be punctured with a sharp edge other than with the dilator , the sharp edge or scalpel is used to create a small cut in the ligament . one of the first dilators , such as any one of the dilators 10 described above in reference to fig1 - 5 , is then inserted ( over the guidewire if one is used ) into the incision and into the cut in the ligament ( if the ligament is pre - cut with a scalpel or other sharp edge ). the first dilator is properly oriented ( such that diagonal or edges are aligned with ligamentous strands as described above ) and further inserted to spread apart body tissue and / or pierce and / or split and / or cut the ligament . after the first dilator is inserted a second dilator , such as any one of the dilators 10 described above in reference to fig6 - 7 , is then passed over the proximal end 14 of the first dilator and further passed over the first dilator into the incision to further spread apart tissue and / or split the ligament . any number of additional dilators , that are preferably cannulated for passing over the one or more previous dilators , are then inserted . a dilator with a channel 18 is oriented such that one of the adjacent spinous processes is positioned inside the channel 18 and in one variation , the other of the adjacent spinous processes is tracked inside the oppositely located channel 18 . such placement of the dilator with respect to the spinous processes stabilizes the dilator with respect to the spine . advancement of the dilator relative to the adjacent spinous processes , ramps the adjacent spinous processes first at the tip of the distal portion and then inside the channel 18 if one is employed to distract the adjacent spinous processes . subsequent dilators placed over the previous dilator may further distract the spinous processes . in one variation , the channels 18 themselves may be flat or further ramped to further distract the adjacent spinous processes . after the desired amount of dilation with dilators is achieved , a cannula 40 of the type shown in fig8 a - 8 b is passed over the last dilator 10 such that the dilators 10 are received in the cannula bore 42 . the cannula 40 may further include oppositely located channels 44 for receiving the adjacent spinous processes , stabilizing the spinous processes with respect to the dilator and for further distraction of the adjacent spinous processes . the channels 44 are formed by four wings 46 extending outwardly from the surface . with the cannula 40 in place , the dilators 10 inside the cannula bore 42 are removed leaving an open cannula bore 42 through which surgery can be performed or an implant be inserted . all publications mentioned anywhere herein are incorporated herein by reference as part of the detailed description of the present invention to disclose and describe the methods and / or materials in connection with which the publications are cited or in connection with the present invention . the publications discussed herein are provided solely for their disclosure prior to the filing date of the present application . nothing herein is to be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention . further , the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed . the preceding merely illustrates the principles of the invention . it will be appreciated that those skilled in the art will be able to devise various arrangements which , although not explicitly described or shown herein , embody the principles of the invention and are included within its spirit and scope .
a dilator that facilitates implantation of an interspinous spacer is provided . the dilator includes a proximal portion and a tapered distal portion interconnected by an elongated body portion . the tapered distal portion is ideally suited for splitting ligamentous tissue for creating a posterior midline pathway through the supraspinous ligament as well as for distracting the adjacent spinous processes . two oppositely located and longitudinally extending channels or grooves are formed in the outer surface of the dilator for stabilizing the dilator with respect to the spinous processes . an accompanying cannula together with the dilator form a system for the distraction of the adjacent spinous processes , stabilization of the spinous processes with respect to the system and creation of a working channel for the implantation of an interspinous spacer .