Method and apparatus for surgical navigation

• US 20060084867A1
• Filed: 09/30/2005
• Published: 04/20/2006
• Est. Priority Date: 10/17/2003
• Status: Active Grant

• Current Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Inventors: Hunter, Mark W., Martens, Todd, Larocque, Brandon D., Tremblay, Brian M.
• Granted Patent: US 7,840,253 B2
• Time in Patent Office: Days
• US Class Current: 600/434
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• CPC Class Codes: A61B 17/72 Intramedullary pins, nails or other devices A61B17/744 takes precedence
• CPC Class Codes: A61B 17/921 for intramedullary devices
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2068 using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2034/207 Divots for calibration
• CPC Class Codes: A61B 2034/256 having a database of accessory information, e.g. including context sensitive help or scientific articles
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3916 Bone tissue
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• CPC Class Codes: A61B 2090/3987 Applicators for implanting markers
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

A surgical navigation system for tracking a procedure relative to a patient is disclosed. The system can track a portion of the patient, an instrument, both, and both or either relative to image data, a coordinate system, an atlas, a morphed atlas, or combinations thereof. The system can include a minimally or non-invasive dynamic reference frame and/or fiducial marker, sensor tipped instruments, and isolator circuits.

Claims

1. A system and apparatus for tracking a portion of a patient, an instrument, registering an image, or combinations thereof;

the system comprising;

a tracking system;

a tracking sensor operable to be tracked by the tracking system;

a body operable to surround at least portion of the tracking sensor;

an anchor to hold the body relative to the portion of the patient at a first location; and

an attachment portion to hold the body relative to the patient at a second location;

wherein the body has a dimension to allow percutaneous placement of the body.

2. The system and apparatus of claim 1, wherein the dimension is less than about 50 mm.

3. The system and apparatus of claim 1, wherein the dimension is less than about 20 mm.

4. The system and apparatus of claim 1, wherein the dimension is a height of the body.

5. The system and apparatus of claim 1, wherein the body is annular.

6. The dimension and apparatus of claim 1, wherein the body includes a lower body portion and an upper body portion;

wherein said upper body portion includes an upper fixation portion and said lower body portion includes a lower fixation portion to allow for holding the upper body portion and the lower body portion relative to one another.

7. The system and apparatus of claim 1, wherein the upper fixation portion and the lower fixation portion include friction fit portions.

8. The system and apparatus of claim 7, wherein one of the upper fixation portion or the lower fixation portion define a groove and the other of the upper fixation portion or the lower fixation portion define a projection;

wherein the projection is operable to fit within the groove to hold the respective portions relative to one another.

9. The system and apparatus of claim 6, wherein the upper fixation portion and lower fixation portion define complementary tapers, complementary threads, adhesives, or combinations thereof.

10. The system and apparatus of claim 1, further comprising:

a tube defining a throughbore; and

wherein the body is operable to pass through the cannula.

11. The system and apparatus of claim 10, wherein the tube is operable to be positioned relative to the patient so that the body can pass through the tube and through a selected portion of the patient to be positioned relative to the portion of the patient.

12. The system and apparatus of claim 1, further comprising:

a tool; and

wherein the tool is operable to engage the anchor.

13. The system and apparatus of claim 12, wherein the tool selectively engages the anchor to manipulate the anchor relative to the patient.

14. The system and apparatus of claim 13, wherein the engagement of the tool and the anchor includes a friction engagement, an adhesive engagement, a threaded engagement, a taper engagement, or combinations thereof.

15. The system and apparatus of claim 1, wherein the anchor includes a screw, a polyaxial screw, a staple, a rivet, a pin, or combinations thereof.

16. The system and apparatus of claim 15, wherein the polyaxial screw defines an axis:

wherein the body defines an axis; and

wherein the axis of the polyaxial screw is operable to be positioned at a selected angle relative to the axis of the body.

17. The system and apparatus of claim 1, wherein the attachment portion includes a screw, a pin, a staple, a rivet, a spike, a projection, or combinations thereof.

18. The system and apparatus of claim 1, further comprising an attachment portion, protector, wherein said protector limits contact of the attachment portion with at least one of the patient, a user, or combinations thereof.

19. The system and apparatus of claim 1, wherein the attachment portion engages the patient at the second position to substantially resist rotation of the body.

20. The system and apparatus of claim 1, wherein the at least two of the tracking sensor, the body, the anchor, the attachment portion, or combinations thereof are formed a single member.

21. The system and apparatus of claim 20, wherein the tracking sensors are positioned within the body prior to an operative procedure.

22. The system and apparatus of claim 1, wherein at least one of the anchor, the second attachment portion, or combinations thereof are selectable intra-operatively.

23. The system and apparatus of claim 1, wherein the tracking system is at least one of an optical tracking system, an acoustic tracking system, electromagnetic tracking system, a radiation tracking system, an infrared tracking system, or combinations thereof.

24. The system and apparatus of claim 1, wherein the tracking sensor is selected from one of an electromagnetic tracking sensor, an acoustic tracking sensor, an optical tracking sensor, a radiation tracking sensor, or combinations thereof.

25. The system and apparatus of claim 1, wherein the dimension is operable to allow for the movement of the portion of the patient to which the body is fixed while substantially not disturbing soft tissue positioned relative to the portion of the patient.

26. The system and apparatus of claim 1, further comprising an imaging system including at least one of an X-ray imager, a computer aided tomography imager, a magnetic resonance imager, a two dimensional imager, a three dimensional imager, ultrasound imager, acoustic imager, microwave imager, radiowave imager, or combinations thereof.

37. The system of claim 25, further comprising:

a protective member, wherein the protective member limits contact of the second anchor with at least one of the anatomy, a user, or combinations thereof.

27. A system for tracking a portion of the anatomy, comprising:

a body having a dimension operable to be positioned percutaneously relative to the anatomy;

an anchor member to be fixed to the portion of the anatomy to hold the body relative to the anatomy; and

a sensor positioned within the body to be held relative to the anatomy.

28. The system of claim 27, wherein said body includes a dimension about 1 mm to about 50 mm.

29. The system of claim 28, wherein the body has a dimension of less than about 20 mm.

30. The system of claim 27, wherein the dimension is the height of the body.

31. The system of claim 30, wherein the height of the body allows movement of the body with a portion of the anatomy while leaving soft tissue relative to the portion of the anatomy substantially undisturbed.

32. The system of claim 27, wherein the body includes a geometry that is substantially annular.

33. The system of claim 27, wherein the anchor is selected from at least one of a screw, a polyaxial screw, a staple, a pin, a rivet, or combinations thereof.

34. The system of claim 33, wherein the polyaxial screw defines an axis:

wherein the body defines an axis; and

wherein the axis of the polyaxial screw is operable to be positioned at a selected angle relative to the axis of the body.

35. The system of claim 27, further comprising:

a second anchor member extending from the body to engage the portion of the anatomy at a position that is a distance from the fixation point of the anchor member.

36. The system of claim 35, wherein the second anchor member includes at least one of a screw, a staple, a pin, a rivet, a spike, a projection, or combinations thereof.

38. The system of claim 27, wherein the anchor defines a throughbore:

wherein a member is operable to be passed through the throughbore to engage the portion of the anatomy to substantially resist rotation of the anchor member.

39. The system of claim 38, wherein the anchor member defines a key passage and the member defines a complementary key to substantially resist rotation of the anchor member.

40. The system of claim 27, wherein a sensor is selected from at least one of an electromagnetic sensor, an acoustic sensor, an optical sensor, an infrared sensor, a radiation sensor, or combinations thereof.

41. The system of claim 38, further comprising a tool to engage the anchor member to move the anchor member relative to the portion of the anatomy and to drive the anchor member into the portion of the anatomy.

42. The system of claim 41, wherein the anchor member, the body, and the sensor are interconnected with the tool to position the body, the anchor member, and the sensor relative to the portion of the anatomy substantially simultaneously.

43. The system of claim 41, wherein the interconnection of the tool and the anchor allows for substantially single-handed positioning of the anchor member.

44. The system of claim 27, further comprising a cannula:

wherein at least one of the anchor member, the body, the sensor or combinations thereof are able to pass through the cannula relative to the portion of the anatomy.

45. The system of claim 27, further comprising:

a tracking system operable to track the sensor.

46. The system of claim 45, wherein the tracking system further includes a display:

wherein the display displays image data of the anatomy and a sensed position of the sensor.

47. A method of tracking a portion of an anatomy with a tracking sensor, comprising:

forming a passage through a soft tissue of the anatomy;

passing a tracking sensor system through the passage formed in the soft tissue;

fixing the tracking sensor system relative to the selected portion of the anatomy;

tracking the tracking sensor system;

moving the selected portion of the anatomy; and

moving the tracking sensor system under soft tissue.

48. The method of claim 47 further comprising:

positioning a tube having a throughbore relative to the anatomy.

49. The method of claim 48, further comprising:

forming the passage with the tube through the soft tissue of the anatomy.

50. The method of claim 49, wherein passing a tracking sensor through the passage formed in the soft tissue includes passing the tracking sensor through the tube.

51. The method of claim 48, wherein fixing the tracking sensor relative to the selected portion of the anatomy includes passing an anchor through the tube with the tracking sensor and fixing the tracking sensor to the anatomy.

52. The method of claim 51, further comprising:

fixing the tracking sensor to the selected portion of the anatomy at a second point;

wherein fixing the tracking sensor to the selected portion of the anatomy at the second point substantially resists rotation of the tracking sensor.

53. The method of claim 47, further comprising:

moving the tracking sensor under the soft tissue of the anatomy while moving the selected portion of the anatomy.

54. The method of claim 53, further comprising:

positioning a second tracking sensor relative to a second selected portion of the anatomy;

tracking the position of the tracking sensor relative to the position of the second tracking sensor to determine the position of the selected portion of the anatomy relative to the second selected portion of the anatomy.

55. The method of claim 47, wherein forming a passage includes forming an incision in the soft tissue.

56. The method of claim 55, wherein forming the incision includes forming an incision of less than about 1 cm.

57. The method of claim 47, wherein fixing the tracking sensor includes fixing the tracking sensor to a femur, a tibia, a pelvis, a humerus, a vertebrae, a bony portion, a patella, an ulna, a skull, or combinations thereof.

58. The method of claim 57, further comprising:

fixing a first tracking sensor to a pelvis and fixing a second tracking sensor to a femur; and

tracking the position of the first tracking sensor relative to the second tracking sensor to determine a position of the femur relative to the pelvis.

59. The method of claim 58, further comprising:

inserting a prosthesis relative to at least one of the femur, the pelvis, or combinations thereof.

60. The method of claim 59, further comprising:

determining an appropriate position of the prosthesis positioned relative to the at least one of the femur, the pelvis, or combinations thereof by tracking the position of the femur relative to the pelvis.

61. The method of claim 47, further comprising;

displaying image data of the anatomy on their display;

displaying a representation of the tracking sensor on the display;

wherein the display can display a real-time image of the selected portion of the anatomy.

62. The method of claim 61, wherein the anatomy is registered to the images displayed on the display.

63. The method of claim 47, further comprising providing a tool;

interconnecting the tool with an anchor;

wherein fixing the tracking sensor relative to the selected portion of the anatomy includes fixing the anchor to the selected portion of the anatomy.

64. The method of claim 63, further comprising:

manipulating the anchor with a single hand via the interconnection of the tool with the anchor.

65. The method of claim 64, wherein fixing the tracking sensor relative to the selected portion of the anatomy includes manipulating the tracking sensor assembly with a single hand via the tool.

66. The method of claim 47, wherein moving the tracking sensor under soft tissue includes minimally engaging the soft tissue during movement of the tracking sensor relative to the soft tissue.

67. The method of claim 47, further comprising:

providing a body of the tracking sensor;

providing a tracking sensor positioned within the body;

providing a first anchor to assist in fixing the tracking sensor system to the selected portion of the anatomy;

providing a second anchor to assist in resisting rotation of the tracking sensor system relative to the selected portion of the anatomy.

68. The method of claim 67, further comprising:

providing a sleeve; and

wherein fixing the tracking sensor system relative to the selected portion of the anatomy includes fixing the sleeve relative to the selected portion of the anatomy and fixing the body to the sleeve.

69. The method of claim 47, wherein fixing the tracking sensor system relative to the selected portion of the anatomy includes anchoring the tracking sensor system to the selected portion of the anatomy.

70. The method of claim 69, wherein anchoring the tracking sensor system to the selected portion of the anatomy includes passing an anchor relative to a body defining a portion of the tracking sensor system at an angle relative to the tracking sensor system.

71. The method of claim 70, wherein the body defines a body central axis, the anchor defines an anchor central axis, and the anchor central axis is positioned at an angle relative to the body central axis.

72. The method of claim 71, wherein the angle between the body central axis and the anchor central axis is about 1°

to about 90°

.

73. The method of claim 47, wherein fixing the tracking sensor system relative to the selected portion of the anatomy includes selecting an angle to pass an anchor relative to a portion of the tracking system to engage substantially only a selected portion of the anatomy.

74. The method of claim 73, wherein selecting the angle includes selecting an angle to allow fixing the tracking sensor system relative to the selected portion of anatomy without allowing a portion of the anchor to engage at an intramedullary canal.

75. The method of claim 47, further comprising:

fixing the tracking sensor system relative to the selected portion of the anatomy at a second location with a second fixation member.

76. The method of claim 75, further comprising:

protecting at least one of the anatomy, a user, or combinations thereof from the second fixation member until the second fixation member is selected to be driven into a selected portion of the anatomy.

77. The method of claim 76, wherein protecting the anatomy includes providing a crushable sleeve, providing a removable cover, providing a retractable sleeve, providing a biased sleeve, or combinations thereof.