METHOD AND APPARATUS FOR COMPUTERIZED SURGERY

• US 20080058837A1
• Filed: 10/30/2007
• Published: 03/06/2008
• Est. Priority Date: 03/07/1999
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Active Implants Corporation
• Inventors: Steinberg, Amiram
• Granted Patent: US 9,827,109 B2
• Time in Patent Office: Days
• US Class Current: 606/130
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/1631 Special drive shafts, e.g. flexible shafts A61B17/1642, A61B17/164 take precedence
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61B 2034/104 Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/742 Joysticks
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/30 Surgical robots
• CPC Class Codes: A61B 34/70 Manipulators specially adapted for use in surgery
• CPC Class Codes: A61B 6/506 for diagnosis of nerves
• CPC Class Codes: A61B 90/11 with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/14 Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
• CPC Class Codes: A61F 2/08 Muscles; Tendons; Ligaments sutures A61B17/04
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30
• CPC Class Codes: A61F 2/30742 Bellows or hose-like seals; Sealing membranes A61B17/8808 takes precedence; sealing membranes for retaining bone substitute A61F2/2846
• CPC Class Codes: A61F 2/30749 : Fixation appliances for connecting prostheses to the body
• CPC Class Codes: A61F 2/30767 : Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30965 : Reinforcing the prosthesis by embedding particles or fibres during moulding or dipping
• CPC Class Codes: A61F 2/32 : for the hip
• CPC Class Codes: A61F 2/36 : Femoral heads ; Femoral endoprostheses
• CPC Class Codes: A61F 2/3601 : for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices non-prosthetic internal fixation devices for the femoral head or neck A61B17/74
• CPC Class Codes: A61F 2/3662 : Femoral shafts
• CPC Class Codes: A61F 2/38 : for elbows or knees
• CPC Class Codes: A61F 2/44 : for the spine, e.g. vertebrae, spinal discs
• CPC Class Codes: A61F 2/441 : made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
• CPC Class Codes: A61F 2/4455 : for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages intervertebral discs A61F2/442
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2002/2835 : Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30009 : differing in fibre orientations
• CPC Class Codes: A61F 2002/30014 : differing in elasticity, stiffness or compressibility
• CPC Class Codes: A61F 2002/30062 : (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/3007 : Coating or prosthesis-covering structure made of elastic material, e.g. of elastomer
• CPC Class Codes: A61F 2002/30133 : kidney-shaped or bean-shaped
• CPC Class Codes: A61F 2002/30136 : undulated or wavy, e.g. serpentine-shaped or zigzag-shaped
• CPC Class Codes: A61F 2002/30156 : triangular
• CPC Class Codes: A61F 2002/30197 : Omega-shaped
• CPC Class Codes: A61F 2002/30242 : spherical
• CPC Class Codes: A61F 2002/30289 : helically-coiled
• CPC Class Codes: A61F 2002/30354 : Cylindrically-shaped protrusion and recess, e.g. cylinder of circular basis
• CPC Class Codes: A61F 2002/30369 : Limited lateral translation of the protrusion within a larger recess
• CPC Class Codes: A61F 2002/3037 : Translation along the common longitudinal axis, e.g. piston
• CPC Class Codes: A61F 2002/30383 : made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
• CPC Class Codes: A61F 2002/30398 : Sliding
• CPC Class Codes: A61F 2002/30426 : Bayonet coupling
• CPC Class Codes: A61F 2002/30448 : using adhesives
• CPC Class Codes: A61F 2002/305 : Snap connection
• CPC Class Codes: A61F 2002/30515 : using a locking wedge or block
• CPC Class Codes: A61F 2002/30563 : having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
• CPC Class Codes: A61F 2002/30574 : with an integral complete or partial collar or flange
• CPC Class Codes: A61F 2002/30579 : with mechanically expandable devices, e.g. fixation devices
• CPC Class Codes: A61F 2002/30581 : having a pocket filled with fluid, e.g. liquid
• CPC Class Codes: A61F 2002/30593 : hollow
• CPC Class Codes: A61F 2002/30594 : slotted, e.g. radial or meridian slot ending in a polar aperture, non-polar slots, horizontal or arcuate slots
• CPC Class Codes: A61F 2002/30599 : stackable
• CPC Class Codes: A61F 2002/30604 : modular
• CPC Class Codes: A61F 2002/30639 : having rolling elements between both articulating surfaces
• CPC Class Codes: A61F 2002/30642 : having a single rolling (or sliding) ball articulating between two cups
• CPC Class Codes: A61F 2002/30652 : Special cut-outs, e.g. flat or grooved cut-outs
• CPC Class Codes: A61F 2002/30662 : with rotation-limiting means
• CPC Class Codes: A61F 2002/30673 : Lubricating means, e.g. synovial pocket
• CPC Class Codes: A61F 2002/30733 : Inserts placed into an endoprosthetic cavity, e.g. for modifying a material property
• CPC Class Codes: A61F 2002/30777 : Oblong apertures
• CPC Class Codes: A61F 2002/30795 : Blind bores, e.g. of circular cross-section
• CPC Class Codes: A61F 2002/3082 : Grooves
• CPC Class Codes: A61F 2002/30878 : with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
• CPC Class Codes: A61F 2002/30879 : Ribs
• CPC Class Codes: A61F 2002/30884 : Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
• CPC Class Codes: A61F 2002/30919 : Sleeves
• CPC Class Codes: A61F 2002/30934 : Special articulating surfaces
• CPC Class Codes: A61F 2002/30971 : Laminates, i.e. layered products
• CPC Class Codes: A61F 2002/30973 : Two joined adjacent layers having complementary interlocking protrusions and recesses
• CPC Class Codes: A61F 2002/3208 : Bipolar or multipolar joints, e.g. having a femoral head articulating within an intermediate acetabular shell whilst said shell articulates within the natural acetabular socket or within an artificial outer shell
• CPC Class Codes: A61F 2002/3216 : tripolar
• CPC Class Codes: A61F 2002/3412 : with pins or protrusions, e.g. non-sharp pins or protrusions projecting from a shell surface
• CPC Class Codes: A61F 2002/3429 : with an integral peripheral collar or flange, e.g. oriented away from the shell centre line
• CPC Class Codes: A61F 2002/3611 : Heads or epiphyseal parts of femur
• CPC Class Codes: A61F 2002/3613 : with lateral or oblique apertures, holes or openings
• CPC Class Codes: A61F 2002/3631 : with an integral complete or partial peripheral collar or bearing shoulder at its base
• CPC Class Codes: A61F 2002/3652 : Connections of necks to shafts
• CPC Class Codes: A61F 2002/3694 : with longitudinal bores
• CPC Class Codes: A61F 2002/448 : comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants
• CPC Class Codes: A61F 2002/4619 : for extraction
• CPC Class Codes: A61F 2002/4632 : using computer-controlled surgery, e.g. robotic surgery
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2220/0008 : Fixation appliances for connecting prostheses to the body
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2220/005 : using adhesives
• CPC Class Codes: A61F 2230/0004 : Rounded shapes, e.g. with rounded corners
• CPC Class Codes: A61F 2230/0015 : Kidney-shaped, e.g. bean-shaped
• CPC Class Codes: A61F 2230/0023 : triangular
• CPC Class Codes: A61F 2230/0045 : Omega-shaped
• CPC Class Codes: A61F 2230/0071 : spherical
• CPC Class Codes: A61F 2230/0091 : helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
• CPC Class Codes: A61F 2250/0018 : differing in elasticity, stiffness or compressibility
• CPC Class Codes: A61F 2250/0028 : differing in fibre orientations
• CPC Class Codes: A61F 2250/0063 : Nested prosthetic parts
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel

Abstract

An implant for use in spinal surgery comprises a resilient element having an inflatable cavity. It is formed of a biologically compatible material and is arranged for placement between end plates of adjacent vertebra. The implant may also include a wound disc replacement element. A method of performing spinal surgery on a patient comprises securely mounting a patient onto a patient support table; imaging a spinal region of the patient; building up a three-dimensional image file of the spinal region of the patient; storing the image file; and utilizing the image file for planning and carrying out computer controlled spinal surgery on the patient utilizing the implant. A computer-controlled surgical implant system comprises a steerable endosurgical implanting assembly operative to install the implant at a desired location in a patient; and a computerized controlled, which operates the steerable endosurgical implanting assembly.

Claims

1. A computer-controlled surgical implant system comprising:

at least one steerable endosurgical implanting assembly operative to install an implant at a desired location in a patient; and

a computerized controller operating the at least one steerable endosurgical implanting assembly.

2. A computer-controlled surgical implant system according to claim 1 wherein said at least one steerable endosurgical assembly comprises a multi-stage cannula assembly.

3. A computer-controlled surgical implant system according to claim 1 wherein said at least one steerable endosurgical assembly comprises a multi-functional cannula assembly.

4. A computer controlled surgical implant system according to claim 1 also comprising a tracking system for tracking the position of the endosurgical implanting assembly.

5. A computer controlled surgical implant system according to claim 1 wherein said at least one steerable endosurgical implanting assembly provides an anchoring finctionality for anchoring a cannula at a desired location.

6. A computer controlled surgical implant system according to claim 1 also comprising a computer controlled patient support table.

7. A computer controlled surgical implant system according to claim 2 also comprising a computer controlled patient support table.

8. A computer controlled surgical implant system according to claim 6 wherein said computer controlled patient support table comprises:

a chest support portion;

a plurality of intermediate support elements, selectably positionable with respect to a longitudinal axis of said chest support portion to accommodate an existing or desired orientation of the patient; and

a lower body support portion having a longitudinal axis, which is angled with respect to said chest support portion by an angle, selected to accommodate an existing or desired orientation of the patient.

9. A computer controlled surgical implant system according to claim 6 also comprising an equipment support base arranged to be motruted over the back of the patient onto said support table.

10. A computer controlled surgical implant system according to claim 6, also including encoders to enable accurate patient repositioning on said patient support table.

11. A computer controlled surgical implant system according to claim 9 wherein said at least one steerable endosurgical implanting assembly operative to install an implant at a desired location in a patient comprises a multifunctional surgical assembly including:

a universal mounting assembly which is secured to and supported by said equipment support base;

at least two drive assemblies, which are replaceably and modularly mountable onto said universal mounting assembly; and

a multifunctional cannula assembly, operative in association with said universal mounting assembly and with said at least two drive assemblies.

12. A computer controlled surgical implant system according to claim 11 wherein said multifunctional cannula assembly includes at least two different cannula subassemblies which are driven by respective ones of said at least two drive assemblies.

13. A computer controlled surgical implant system according to claim 12 wherein said multifunctional surgical assembly includes a computerized operator interface.

14. A computer controlled surgical implant system according to claim 11, wherein said universal mounting assembly comprises:

first mounting tracks which are removably attached to said equipment support base;

a carriage assembly, defining second mounting tracks and arranged for selectable and fixable positioning on said first mounting tracks;

a platform, arranged for selectable and fixable positioning onto said second mounting tracks; and

a cannula mounting assembly associated with said platform and onto which are mounted said first, second and third drive assemblies.

15. A computer controlled surgical implant system according to claim 14 also comprising a real-time imaging assembly mounted onto said platform.

16. A computer controlled surgical implant system according to claim 14, also comprising an array of RF receiving antennas which are used for sensing the precise orientation and position of elements of said multifunctional cannula subassembly.

17. A computer controlled surgical implant system according to claim 14 wherein said cannula mounting assembly comprises:

a base which is mounted onto said platform, said base including an upstanding portion and a protruding portion;

a spherical bearing mounted onto said protruding portion and including a central aperture through which first, second and third cannula subassemblies, which form palt of said multifunctional cannula assembly, may slidably extend;

a selectably orientatable socket mounted on said spherical bearing for removably and replaceably receiving said first, second and third drive assemblies.

18. A computer controlled surgical implant system according to claim 17 wherein said selectably orientatable socket is selectably positionable in three dimensions by at least two pivotably mounted positioning pistons operated by a hydraulic driving controller.

19. A computer controlled surgical implant system according to claim 18, wherein said at least two pivotably mounted positioning pistons are pivotably mounted onto a portion of said base by means of spherical mounting bearings and are attached to said socket by means of spherical mounting bearings.

20. A computer controlled surgical implant system according to claim 17 also comprising first, second and third drive assemblies, each of which comprises a housing onto which is mounted a linear driving motor controlled by a linear driving controller, and a rotational driving motor controlled by a rotational driving controller.

21. A computer controlled surgical implant system according to claim 20 wherein each linear driving motor is coupled to at least one driving roller, which drivingly engages a cannula subassembly for providing linear driving thereof and wherein each rotational driving motor is coupled to gearing, which drivingly engages said cannula subassembly for providing rotational driving thereof.

22. A computer controlled surgical implant system according to claim 17 also comprising a pressurized fluid source having a plurality of pressurized fluid sockets mounted on said cannula mounting assembly.

23. A computer controlled surgical implant system according to claim 17 also comprising a multifunctional controller which includes a plurality of electric power sockets and a plurality of electric control signal sockets, said multifunctional controller receiving electric control and power inputs from an operator interface.

24. A computer controlled surgical implant system according to claim 23 also comprising a bidirectional information link between said multifunctional controller and various devices controlled thereby, such that at any given time, said controller is aware of the identity and operational status of each of the devices controlled thereby, for optimal control of the operation thereof.

25. A computer controlled surgical implant system according to claim 11 wherein said multifunctional cannula assembly comprises first, second and third cannula subassemblies, which are generally coaxial.

26. A computer controlled surgical implant system according to claim 25 wherein said first cannula subassembly is steerable to a desired location in a patient'"'"'s anatomy.

27. A computer controlled surgical implant system according to claim 25 wherein said first cannula subassembly comprises:

a central flexible core located within a flexible outer tube, said outer tube containing therewithin curvature control tendons which may be tensioned or compressed to effect desired curvature of the first cannula subassembly.

28. A computer controlled surgical implant system according to claim 27 wherein said first cannula subassembly also comprises:

a flexible shaft terminating in a anchor screw; and

at least one fiber optics link.

29. A computer controlled surgical implant system according to claim 25 wherein said first cannula subassembly also comprises a cover for the anchor screw which is formed of a material which is readily absorbed by the human body.

30. A computer controlled surgical implant system according to claim 28 wherein said shaft is rotatably located within a bore formed within said core.

31. A computer controlled surgical implant system according to claim 27 also comprising tendons which are slidably disposed within respective elongate bores formed in said core.

32. A computer controlled surgical implant system according to claim 27 wherein said tendons are each anchored at a location adjacent a forward end of said first cannula subassembly and coupled at an opposite end thereof to a driving structure.

33. A computer controlled surgical implant system according to claim 32 wherein said driving structure is formed with externally facing recesses to enable it to be readily engaged by an external driving member for linear driving thereof in a push-pull manner for applying tension or compression to the tendon fixed thereto.

34. A computer controlled surgical implant system according to claim 33 wherein said driving structure is linearly slidably disposed in a recess formed in said core at a window formed in said outer tube.

35. A computer controlled surgical irrmplant system according to claim 27 also comprising at least one fiber optics link located in a suitable recess or bore formed in said core and extending to at least one optical sensor.

36. A computer controlled surgical implant system according to claim 27 also comprising at least one fiber optics link located in a suitable recess or bore formed in said core and extending from an external light source to an illuminator.

37. A computer controlled surgical implant system according to claim 27 wherein said first cannula subassembly also comprises at least one electrical conductor for supplying electrical power to at least one electrical signal beacon transducers which are sensible by at least one of the elements of a real time imaging assembly, thereby to enable the precise location and orientation of the first cannula subassembly to be ascertained and monitored.

38. A computer controlled surgical implant system according to claim 27 wherein said first cannula subassembly also comprises an elongate low power RF transmitting antenna receiving an electrical signal from a suitable RF signal source such that its precise orientation may be readily sensed by antennas forming part of a real time imaging assembly.

39. A computer controlled surgical implant system according to claim 27 wherein said first cannula subassembly also comprises an elongate recess formed along a majority of the length of the first cannula subassembly, said recess being engageable by a suitable protrusion connected to gearing for rotational driving of the first cannula subassembly.

40. A computer controlled surgical implant system according to claim 25 wherein said second cannula subassembly is anranged to be inserted over said first cannula subassembly and has a larger cross-section than the first cannula subassembly.

41. A computer controlled surgical implant system according to claim 40 wherein said second cannula subassembly comprises a plurality of sub-sub-assemblies, each of larger cross-section than its predecessor.

42. A computer controlled surgical implant system according to claim 40 wherein said second cannula subassembly includes a conditioned easily grippable surface for enhancing ease of manipulation of the second cannula subassembly.

43. A computer controlled surgical implant system according to claim 40 wherein said second cannula subassembly includes fiber optics connectors at the rearward end of the second cannula subassembly for fiber optics communication connections between fiber optics links, which comrnmunicate with optical sensors, and illuminators.

44. A computer controlled surgical implant system according to claim 40 wherein said second cannula subassembly includes, adjacent a rearward end thereof, a slider, having a manual engagement portion, and a generally flat portion, having a forward end, said slider being slidably retained in said second cannula subassembly for longitudinal sliding motion relative thereto, into and out of operative engagement with a flexible engagement member.

45. A computer controlled surgical implant system according to claim 44, wherein said flexible engagement member is formed of a resilient material and includes a mounting portion which is seated in a recess formed in the second cannula subassembly, an elongate portion and an inner facing protrusion portion, said flexible engagement member being mounted such that it is biased inwardly into engagement into a recess in the first cannula subassembly, when not displaced by the slider.

46. A computer controlled surgical implant system according to claim 25 wherein said third cannula subassembly comprises tracks for transport of surgical equipment therealong to a surgical site in the patient'"'"'s anatomy and removal of body materials fiom the surgical site.

47. A computer controlled surgical implant system according to claim 46 wherein said third cannula subassembly comprises:

at least one electrical power link; and

at least one fiber optics link.

48. A computer controlled surgical implant system according to claim 46 wherein said third cannula subassembly comprises piping for liquid transport, vacuum and gas pressure.

49. A computer controlled surgical implant system according to claim 46 wherein said third cannula subassembly also includes a plurality of curvature control tendons.

50. A computer controlled surgical implant system according to claim 26 comprising, in association with said first cannula subassembly, a steering subassembly comprising:

a housing onto which are mounted a drill driving assembly and a tendon tensioning and compressing assembly; and

a base which is mounted on said housing and which supports a fiber optic connector assembly.

51. A computer controlled surgical implant system according to claim 50 wherein said tendon tensioning and compressing assembly comprises a plurality of pistons, corresponding in number to the number of tendons in said first cannula subassembly, each of said pistons operative for selectably tensioning or compressing an individual tendon.

52. A computer controlled surgical implant system according to claim 51 wherein each of said plurality of pistons includes an at least partially flexible toothed shaft which is arranged to operatively engage recesses in driving structures for producing linear displacement thereof in recesses formed in said core for selectably tensioning or compressing individual tendons attached to each of the driving struct ues.

53. A computer controlled surgical implant system according to claim 25 wherein said third cannula subassembly comprises:

an inner portion, and an outer portion, said outer portion being selectably slidable with respect to the inner portion and comprising a generally cylindrical hollow element formed with a plurality of tracks.

54. A computer controlled surgical implant system according to claim 53 wherein said plurality of tracks include a first plurality of inner facing tracks having a first cross-sectional configuration and a second plurality of inner facing tracks, having a cross-sectional configuration different from that of said first plurality of tracks.

55. A computer controlled surgical implant system according to claim 54 wherein said plurality of tracks include a third plurality of inner facing tracks having a cross-sectional configuration different from that of said first and second pluralities of tracks and also having an undercut cross-section.

56. A computer controlled surgical implant system according to claim 53 wherein said outer portion comprises at least one elongate bore having disposed therein an anchoring screw including a tapered thread at a forward end and an engagement head at a rearward end.

57. A computer controlled surgical implant system according to claim 56, wherein said outer portion comprises, disposed in said at least one elongate bore, an elongate eye assembly, said elongate eye assembly including a visual sensor and an illuminator.

58. A computer controlled surgical implant system according to claim 57 wherein said visual sensor is coupled, via a fiber optic link embedded in an elongate eye manipulating support, to utilization circuitry.

59. A computer controlled surgical implant system according to claim 58 wherein said manipulating support is, in turn, operated by a drive assembly mounted on said outer portion, and by an eye directing assembly and is capable of linear displacement and rotation relative to said outer portion as well as directable bending.

60. A computer controlled surgical implant system according to claim 57 also comprising tendons disposed in bores formed in said outer portion, said tendons being employable for providing selectable bendability and directability to the third cannula subassembly.

61. A computer controlled surgical implant system according to claim 53, wherein said inner portion functions principally as a spacer for properly positioning the outer portion with respect to the second cannula subassembly and is designed to be removed prior to carrying out most of the functionality of the outer portion.

62. A computer controlled surgical implant system according to claim 51 wherein fiber optics connectors are provided at the rearward end of the third cannula subassembly for fiber optics communication between fiber optics links which communicate with optical sensors and illuminators.

63. A computer controlled surgical implant system according to claim 53 comprising a slider disposed adjacent a rearward end of the third cannula subassembly, said slider having a manual engagement portion and a generally flat portion, the flat portion having a forward end, the slider being slidably retained in third cannula subassembly for longitudinal sliding motion relative thereto, into and out of operative engagement with a flexible engagement member.

64. A computer controlled surgical implant system according to claim 63 wherein said flexible engagement member is formed of a resilient material and includes a mounting portion which is seated in a recess formed said inner portion, an elongate portion and an inner facing protrusion portion, said flexible engagement member being mounted such that it is biased inwardly into engagement with a recess in the second cannula subassembly, when not displaced by the slider.

65. A computer controlled surgical implant system according to claim 63 also comprising a locking pin, associated with said outer portion, which selectably engages a recess formed in said inner portion for preventing linear motion therebetween prior to intended removal of the inner portion from the outer portion.

66. A computer controlled surgical implant system according to of claim 59 wherein said drive assembly comprises a housing onto which is mounted a linear driving motor which is controlled by a linear driving controller, said driving motor being coupled to at least one driving roller, which drivingly engages eye manipulating support.

67. A computer controlled surgical implant system according to claim 66 wherein said drive assembly also comprises a rotational driving motor, which is controlled by a rotational driving controller, said rotational driving motor being coupled to gearing, which drivingly engages said eye manipulating support for providing rotational driving thereof.

68. A computer controlled surgical implant system according to claim 53 wherein said eye directing assembly comprises a housing onto which is mounted a tendon tensioning and compressing assembly and has an output which is coupled to an operator visualization subsystem.

69. A computer controlled surgical implant system according to claim 57 wherein said elongate eye assembly includes a plurality of visual sensors surrounding an illuminator.

70. A computer controlled surgical implant system according to claim 25, comprising at least one self-propelled surgical vehicle associated with said third cannula subassembly.

71. A computer controlled surgical implant system according to claim 70, wherein said at least one self-propelled surgical vehicle comprises:

a body of generally uniform cross-section having a longitudinal bore and defining forward and rearward faces;

at least two fieely rolling rollers mounted on said body; and

a driving roller, which is powered by an electric motor, disposed within said body.

72. A computer controlled surgical implant system according to claim 70 wherein said at least one self-propelled surgical vehicle comprises a quick connection mounting assembly located at at least one of said fonvard and rearward faces at said bore.

73. A computer controlled surgical implant system according to claim 72 wherein said forward face of the body is formed with a plurality of recesses which are employed for assisting in the mounting of hands onto the vehicle.

74. A computer controlled surgical implant system according to claim 71 wherein said body is formed with a pair of longitudinal recesses which extend along edges of the body in parallel to said bore and in which are disposed said at least two fieely rolling rollers.

75. A computer controlled surgical implant system according to claim 74, wherein said driving roller is disposed in one of said pair of longitudinal recesses.

76. A computer controlled surgical implant system according to claim 71 wherein said at least two freely rotating rollers roll along at least one track formed in said third cannula subassembly and said driving roller drivingly engages cogs formed along at least another track formed in said third cannula subassembly for precision longitudinal positioning of the vehicle along said tracks.

77. A computer controlled surgical implant system according to claim 71 wherein said electric motor is controlled by a multifunctional controller via a control cable which extends through said outer portion of said third cannula subassembly.

78. A computer controlled surgical implant system according to claim 71 wherein said electric motor receives electrical power from said multifunctional controller via a power cable extending from an electric power socket which is removably coupled to a socket formed on said rearward face.

79. A computer controlled surgical implant system according to claim 71 wherein auxiliary electrical power is provided for hands attached to the forward face by means of an auxiliary power cable which is removably coupled to a socket formed on said rearward face and extends through said longitudinal bore.

80. A computer controlled surgical implant system according to claim 71 wherein auxiliary electrical control is provided for hands attached to the forward face by means of an auxiliary control cable which is removably coupled to a socket formed on said rearward face and which extends through said longitudinal bore.

81. A computer controlled surgical implant system according to claim 80 wherein auxiliary electrical control is provided to said socket for said hands attached to said forward face by means of an auxiliary control cable which is removably coupled to a socket formed on said rearward face, extends through the outer portion of the third cannula subassembly and is connected to a control signal socket of a multifunctional controller.

82. A computer controlled surgical implant system according to claim 71 wherein said vehicle has cross-sectional dimensions which do not exceed 20 mm.

83. A computer controlled surgical implant system according to claim 71 wherein said body is formed with a throughgoing bore for accommodating an eye manipulating support.

84. A computer controlled surgical implant system according to claim 71 wherein said body is formed with a pair of longitudinal recesses which extend along edges of the body in parallel to said bore and in which are disposed said at least two freely rolling rollers and a third longitudinal recess along which are disposed at least one freely rolling roller and a driving roller, which is powered by an electric motor disposed within said body.

85. A computer controlled surgical implant system according to claim 84, wherein said third longitudinal recess is formed at its ends with a cross-sectional configuration defining an undercut which maintains operative engagement between said at least one freely rolling roller, said driving roller and said track and thus enables said vehicle to ride on said single track.

88. A computer controlled surgical implant system according to claim 71 wherein said body is formed with a longitudinal recess defining forward and rearward faces onto which are formed quick connectors, peripherally of said recess and wherein at least one freely rolling roller and a driving roller, powered by an electric motor are disposed within said body.

89. A computer controlled surgical implant system according to claim 88, wherein said longitudinal recess is formed at its ends with a cross-sectional configuration defining an undercut which maintains operative engagement between said at least one fieely rolling roller and said diiving roller and said track and thus enables said vehicle to ride on said single track.

90. A computer controlled surgical implant system according to claim 89 wherein said at least one freely rolling roller rolls along said track, while said driving roller drivingly engages cogs on said track for precision longitudinal positioning of the vehicle therealong.

91. A computer controlled surgical implant system according to claim 89 wherein said vehicle has cross-sectional dimensions which do not exceed 10 mm.

92. A computer controlled surgical implant system according to claim 25 comprising at least one non self-propelled surgical vehicle.

93. A computer controlled surgical implant system according to claim 92 wherein said at least one non self-propelled surgical vehicle comprises an elongate flexible element having a forward face and a rearward face and a generally uniform cross-sectional configuration including an undercut which maintains operative engagement between the vehicle and a track on said third cannula subassembly.

94. A computer controlled surgical implant system according to claim 93 wherein said at least one non self-propelled surgical vehicle is translated along tracks of said third cannula subassembly by an electric motor external of said vehicle.

95. A computer controlled surgical implant system according to claim 92 wherein a quick connector is provided on at least one elongate surface of each vehicle for connection thereto of hands.

96. A computer controlled surgical implant system according to claim 58 also comprising a universal hand which is employed in association with said at least one surgical vehicle, said universal hand including:

a base, which is removably coupled to a surgical vehicle;

a first intermediate element rotatable relative to said base about a longitudinal axis in said base by an electric motor;

a second intermediate element rotatable relative to said first intermediate element by an electric motor;

at least one additional intermediate element rotatable relative to said second intermediate element by an electric motor; and

a tool engagement element rotatable relative to said at least one additional intermediate element by an electric motor.

97. A computer controlled surgical implant system according to claim 96 wherein said at least one additional intermediate element comprises at least first and second additional intermediate elements, which are rotatable relative to each other.

98. A computer controlled surgical implant system according to claim 96 wherein a plurality of said vehicles is simultaneously operated with a plurality of hands.

99. A computer controlled surgical implant system according to claim 98 wherein four said vehicles and four hands are simultaneously employed.

100. A computer controlled surgical implant system according to claim 96 comprising at least one tool mounted on said tool engagement element.

101. A computer controlled surgical implant system according to claim 100 wherein said at least one tool is selected fi-om the following tools:

a milling head, a forceps tool, a forceps finger, an fluid dispenser tool, a pick and place tool, an articulated element, an inflation tool, a gauging tool, and a cutting tool.

102. A computer controlled surgical implant system according to claim 25 also comprising a staging assembly employable in setting up and connecting tools and hands together with surgical vehicles, said staging assembly comprising:

a pair of end mounts, which are fixedly joined together by an elongate base element, which defines an inner facing surgical vehicle support track, which is alignable with a track in said third cannula subassembly, said end mounts defining seats for removably and securably receiving respective inner facing surgical vehicle support track defining members which are alignable with tracks in said third cannula subassembly.

103. A computer controlled surgical implant system according to claim 25 also comprising a staging complex comprising a plurality of staging assemblies and being operative for modularly connecting various pieces of surgical equipment together and mounting them onto surgical vehicles.

104. A computer controlled surgical implant system according to claim 103 wherein at least one of said plurality of staging assemblies comprises:

a pai of end mounts, fixedly joined together by an elongate base element which defines an inner facing surgical vehicle support track, which track is alignable with a track in said third cannula subassembly, said end mounts defining seats for removably and securably receiving respective inner facing surgical vehicle support track defining members which are alienable with tracks in said third cannula subassembly.

105. A computer controlled surgical implant system according to claim 102 wherein said end mounts are of generally open octagonal configuration and are fixedly joined together by an elongate base element, which defines an inner facing surgical vehicle support track, which is alignable with a track in the third cannula subassembly.

106. A computer controlled surgical implant system according to claim 102 wherein said end mounts each define seats for removably and securably receiving inner facing surgical vehicle support track defining members.

107. A computer controlled surgical implant system according to claim 102 wherein retaining pins are provided for removable engagement with sockets formed in at least one of said end mounts for engagement with corresponding sockets formed in ends of support track defining members, thereby to retain the track defining members in engagement with their respective seats.

108. A computer controlled surgical implant system according to claim 102 wherein one of said end mounts is provided with an inner socket which is configured to receive a flange of said outer portion of said third cannula subassembly in such a manner that the vehicle support track defining members of the staging assembly are properly aligned with the respective inner facing tracks of said outer portion.

109. A computer controlled surgical implant system according to claim 108 wherein said socket and said corresponding flange are formed to have somewhat angled walls thereby to provide designed mutual mating thereof.

110. A computer controlled surgical implant system according to claim 109 also comprising a retaining pin engaging a socket in an end mount and a corresponding socket in a corresponding flange, thereby to retain the flange in mating engagement with the socket.

111. A computer controlled surgical implant system according to claim 102 wherein surgical vehicles, hands and tools are mounted onto a track defining member prior to attachment of the track defining member onto said end mounts.

112. A computer controlled surgical implant system according to claim 1 wherein said computerized controller also comprises an operator interface comprising:

an operator support seat assembly; and

a plurality of control elements, arranged in an arc so as to be readily engageable by an operator seated on said seat assembly, said pluiality of control elements including visualization rotation control elements;

at least one visualization zoom control element, forward and rearward drive elements and a brake element, usefull for governing operation of first second and third cannula subassemblies, surgical vehicles and hands associated therewith.

113. A computer controlled surgical implant system according to claim 112, wherein said operator interface also comprises:

a display coupled to a computer which contains at least patient imaging data and operation planning data; and

a least one computer input device.

114. A computer controlled surgical implant system according to claim 112 wherein said operator interface also comprises virtual reality apparatus.

115. A computer controlled surgical implant system according to claim 112 wherein said operator interface comprises:

an operator visualization subsystem; and

an operator-controlled driving subsystem, said operator-controlled driving subsystem and said operator visualization subsystem being operative together.

116. A computer controlled surgical implant system according to claim 115 wherein said operator visualization subsystem receives inputs from at least three of the following elements:

a computer, a real time imaging assembly, optical sensors, a keyboard, a mouse, a joystick and a hand interface.

117. A computer controlled surgical implant system according to claim 115 wherein said operator visualization subsystem provides outputs to at least one of illuminators, monitors and virtual reality equipment.

118. A computer controlled surgical implant system according to claim 115 wherein said operator-controlled driving subsystem is operable to interactively interface with said operator visualization subsystem and also to receive inputs from at least one of the following elements:

a computer;

control pedals;

a keyboard;

a mouse;

a joystick;

a hand interface;

audio inputs from a headset and hand and tool identification and orientation inputs from a multifunctional controller.

119. A computer controlled surgical implant system according to claim 115 wherein said operator-controlled driving subsystem provides outputs to controllers.

120. A computer controlled surgical implant system according to claim 115 wherein said operator support seat assembly comprises a fixed base, selectably vertically raisable and lowerable leg portions having leg portions fixedly attached thereto, a back and head support, a seat, which is swivelable in a generally horizontal plane about a vertical axis and adjustably fixable arm supports.

121. A computer controlled surgical implant system according to claim 120 wherein said operator interface also comprises a plurality of foot control pedals which are arranged about a vertical axis so as to be readily engageable by an operator seated on said seat who swivels the seat appropriately, said plurality of foot control pedals including clockwise and counterclockwise visualization rotation control pedals, a visualization zoom control pedal, forward and rearward drive pedals and a brake pedal, said foot control pedals being operative to govern translation of said first, second and third cannula subassemblies, and said surgical vehicles.

122. A computer controlled surgical implant system according to claim 114 wherein said virtual reality apparatus is operable to provide to an operator a sense that his hands are located within a region between adjacent vertebra at which the operation is taking place and are able to accurately manipulate various hands, within that region.

123. A computer controlled surgical implant system according to claim 114 wherein said virtual reality apparatus is operable to provide to an operator a view of the patient'"'"'s spine having no necessary relationship with the actual orientation of the patient'"'"'s spine.

86. A computer controlled surgical implant system according to claim 845 wherein said at least one freely rolling roller rolls along said track, while said driving roller drivingly engages cogs on said track for precision longitudinal positioning of the vehicle therealong.

87. A computer controlled surgical implant system according to claim 86 wherein said vehicle has cross-sectional dimensions which do not exceed 16 mm.