INTEGRATED SURGICAL NAVIGATIONAL AND NEUROMONITORING SYSTEM HAVING AUTOMATED SURGICAL ASSISTANCE AND CONTROL

• US 20080183190A1
• Filed: 01/25/2007
• Published: 07/31/2008
• Est. Priority Date: 01/25/2007
• Status: Active Grant

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: Ryterski, Eric, Adcox, W. Keith
• Granted Patent: US 8,374,673 B2
• Time in Patent Office: Days
• US Class Current: 606/130
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/1655 for tapping
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/8875 Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• CPC Class Codes: A61B 2017/00734 battery operated
• 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 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/252 indicating steps of a surgical procedure
• CPC Class Codes: A61B 2034/254 being adapted depending on the stage of the surgical procedure
• 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 2090/067 for measuring angles
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• 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 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: G16H 20/30 : relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 30/40 : for processing medical images, e.g. editing
• CPC Class Codes: G16H 40/63 : for local operation

Abstract

The invention relates to an integrated surgical navigational and neuromonitoring system having automated surgical assistance and control. The integrated system provides real-time introperative assistance to a surgeon or other user. The integrated system can also automatically control neuromonitoring based on a position of a neuromonitoring probe.

Claims

1. An apparatus comprising:

an instrument tracking system configured to track movement of an instrument;

a database containing technical information regarding a surgical procedure and patient anatomy; and

a computer operatively linked with the instrument tracking system and the database, and programmed to;

determine an anatomical structure proximate the instrument;

determine a portion of the technical information contained on the database that relates to the anatomical structure; and

generate and display identifiers for the portion of the technical information in a user-selectable manner to allow a user to selectively obtain technical information relating to one of the surgical procedure and the anatomical structure.

2. The apparatus of claim 1 wherein the technical information includes one of videos, articles, presentations, publications, and maps contained in electronic format on the database.

3. The apparatus of claim 1 further comprising a GUI, and wherein the computer is further programmed to determine an anticipated trajectory of the instrument and display the anticipated trajectory on the GUI.

4. The apparatus of claim 3 wherein the database further contains anatomical images of the patient anatomy, and wherein the computer is further programmed to display the anticipated trajectory superimposed over an anatomical image of the patient anatomy.

5. The apparatus of claim 1 further comprising a neuromonitoring system configured to induce and measure neurological response, and wherein the computer is further programmed to determine a location of a neural structure relative to the instrument.

6. The apparatus of claim 5 wherein the instrument is capable of applying an electrostimulation, and wherein the computer is further programmed to control the neuromonitoring system and application of electrostimulation by the instrument such that electrostimulation is applied forward of a movement of the instrument.

7. The apparatus of claim 6 wherein the computer is further programmed to cause publication of an indicator if the instrument is approaching a neural structure.

8. The apparatus of claim 5 wherein the computer is further programmed to automatically determine an electrostimuation pattern from the location of the neural structure and control the neuromonitoring system to electrostimulate the neural structure according to the determined electrostimulation pattern.

9. The apparatus of claim 5 wherein the computer is further programmed to predict the neurological response of the neural structure from the location of the neural structure and compare a measured neurological response with the predicted neurological response and determine an integrity of the neural structure from the comparison.

10. A method comprising:

tracking a surgical instrument;

applying electrostimulation at a given surgical instrument position; and

determining a location of a neural structure relative to the surgical instrument position from a neurological response of the neural structure to the electrostimulation.

11. The method of claim 10 further comprising determining a trajectory of surgical instrument movement and generating a neural structure map along the trajectory by applying electrostimulation to and measuring neurological response of neural structures along the trajectory.

12. The method of claim 11 further comprising displaying the trajectory superimposed on a visualization of patient anatomy containing the neural structures.

13. The method of claim 12 further comprising developing the visualization of patient anatomy from an anatomical atlas.

14. The method of claim 12 further comprising developing the visualization of patient anatomy from an image of the patient anatomy.

15. The method of claim 10 further comprising automatically setting one of electrostimulation intensity and electrostimulation pattern based on the surgical instrument position.

16. The method of claim 10 further comprising automatically identifying the neural structure from the neurological response.

17. The method of claim 16 further comprising updating a visualization of the neural structure based on its identification.

18. The method of claim 16 further comprising displaying a list of on-demand resources available for review by a surgeon based on the identified neural structure.

19. The method of claim 18 further comprising updating the list as the surgical instrument moves from one identified neural structure to another identified neural structure.

20. The method of claim 10 further comprising varying a direction of electrostimulation based on movement of the surgical instrument.

21. An apparatus comprising a computer programmed to:

determine a location of a neuromonitoring probe designed to apply electrostimulation to a patient;

compare the determined location to an anatomical framework of the patient, the anatomical framework providing a general localization of a neural structure; and

automatically determine one of electrostimulation intensity and electrostimulation pattern for electrostimulating the neural structure based on the position of the neuromonitoring probe and the neural structure.

22. The apparatus of claim 21 comprising a technical resource library of on-demand technical resources and contained on a database, and wherein the computer is further programmed to generate a list of on-demand resources available for review by a surgeon based on the position of the neuromonitoring probe.

23. The apparatus of claim 21 including an integrated neuromonitoring and surgical navigational system comprising the computer.

24. The apparatus of claim 23 wherein the integrated neuromonitoring and surgical navigational system includes a display designed to display a GUI showing a visualization of the anatomical framework and wherein the computer causes a superimposition of a position marker on the visualization of the anatomical framework indicating the location of the neuromonitoring probe.

25. The apparatus of claim 24 wherein the computer is further programmed to indicate, on the GUI, an anticipated trajectory of surgical instrument movement.

26. A computer readable storage medium having instructions thereon that when executed by a computer causes the computer to:

access an anatomical visualization of a patient;

access neurological information acquired from the patient; and

update the anatomical visualization to incorporate the neurological information.

27. The computer readable storage medium of claim 26 wherein the instructions further cause the computer to color-code the anatomical visualization based on the neurological information.

28. The computer readable storage medium of claim 26 wherein the instructions further cause the computer to derive the anatomical visualization from at least one of an anatomical image and an atlas model.

29. The computer readable storage medium of claim 26 wherein the instructions further cause the computer to update the anatomical visualization in real-time during acquisition of neurological information.

30. A surgical method comprising:

translating a surgical tool relative to patient anatomy containing a neural structure;

applying an electrical stimulus to the neural structure with the surgical tool; and

determining a position of the neural structure relative to other anatomical structures of the patient anatomy through inspection of a GUI displaying a visualization of the patient anatomy and the surgical tool.