Method and apparatus for implantation between two vertebral bodies

• US 7,953,471 B2
• Filed: 07/27/2009
• Issued: 05/31/2011
• Est. Priority Date: 05/03/2004
• Status: Active Grant

• Current Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Inventors: Rempersaud, Y. Raja, Clayton, John B.
• Primary Examiner(s): Le; Long V
• Assistant Examiner(s): Rozanski; Michael T
• Application Number:
  US12/509,868
• Publication Number:
  US 20090299477A1
• Time in Patent Office: 673 Days
• Field of Search: 600/407, 600/424, 600/427, 128/920
• US Class Current: 600/424
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/4504 Bones A61B5/4547 takes precedence
• CPC Class Codes: A61B 5/4514 Cartilage
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence

Abstract

A method and system to assist in a planning and navigation of procedure. Generally, the system allows for image acquisition of a selected area of the anatomy. The images may then be used to mark various points to determine true anatomical definitions and planes. The definitions may assist in positioning a prosthesis.

Claims

1. A method of selecting a position for a prosthesis to be implanted in an anatomy, comprising:

obtaining image data of the anatomy that includes at least a portion of a spine having at least two substantially adjacent vertebrae;

displaying the obtained image data on an image device viewable by a user;

defining a plurality of points on the displayed image data corresponding at least to each of a first vertebra and a second vertebra of the at least two substantially adjacent vertebrae, the plurality of defined points including a posterior point on a spinous process, a lateral point on a transverse process, a lateral point on a vertebral body, or combinations thereof;

determining a midline of the first vertebra and the second vertebra based at least on the defined plurality of points;

determining a midline of the portion of the spine based on the determined midline of the first vertebra and the determined midline of the second vertebra;

displaying the determined spinal midline on the displayed image data relative to at least the portion of the spine;

tracking a sensor coupled to an instrument;

determining a position of the instrument relative to at least one of the defined plurality of points of the first and second vertebrae and the determined spinal midline based on tracking of the sensor;

determining an incision point relative to at least one of the defined plurality of points of the first and second vertebrae and the determined spinal midline;

navigating a surgical procedure through an incision and relative to the defined plurality of points and the determined spinal midline; and

navigating the prosthesis through the incision and relative to at least the determined spinal midline to the selected position, wherein said prosthesis navigation substantially assists in positioning the prosthesis in the selected position.

2. The method of claim 1, wherein defining a plurality of defined points includes defining the plurality of points relative to the displayed image data, and storing the plurality of points relative to the image data in a storage device.

3. The method of claim 1, wherein defining a plurality of points on the displayed image data includes manipulating a user input on an image device to select certain points on the displayed image data.

4. The method of claim 1, wherein defining a plurality of points of the first and second vertebrae further includes defining lateral most points of the transverse process, defining a posterior most point of the spinous process, defining two lateral most points of the vertebral body, or combinations thereof.

5. The method of claim 1, wherein determining a midline of the portion of the spine further includes:

determining an orientation of the obtained image data; and

displaying the determined spinal midline obliquely relative to the obtained image data.

6. The method of claim 1, wherein the determined spinal midline includes a substantially weight bearing spinal midline.

7. The method of claim 1, further comprising displaying a representative position of the prosthesis relative to at least one of the defined plurality of points, the determined midlines of the first and second vertebrae, or the determined spinal midline.

8. The method of claim 7, further comprising displaying cues for a user to assist in positioning the prosthesis.

9. The method of claim 8, wherein the cues include icons, the icons arranged to change based on the representative position of the prosthesis moving closer to the determined spinal midline.

10. The method of claim 7, further comprising tracking a position of the prosthesis with a sensor coupled to the prosthesis.

11. The method of claim 7, further comprising:

implanting the prosthesis selected from the group including a disc, a nucleous, a fusion apparatus, a bladder implant, or combinations thereof between the first and second vertebrae; and

verifying a position of the implanted prosthesis corresponds to the selected position of the prosthesis.

12. The method of claim 1, further comprising:

removably coupling the instrument to the prosthesis;

tracking a position of the prosthesis with the sensor; and

displaying a representative position of the prosthesis relative to the displayed image data and the displayed spinal midline;

wherein navigating the prosthesis includes navigating the prosthesis with the instrument.

13. The method of claim 1, wherein the prosthesis is an expandable prosthesis and includes at least one trackable sensor, the prosthesis being positioned relative to at least the determined spinal midline and the defined plurality of points, and wherein expansion of the expandable prosthesis is tracked via the trackable sensor.

14. The method of claim 13, wherein the expandable prosthesis includes a bladder implant.

15. A method of selecting a position for a prosthesis to be implanted in an anatomy, comprising:

obtaining image data of the anatomy that includes at least a portion of a spine having at least two substantially adjacent vertebrae, and displaying the obtained image data to be viewable by a user;

positioning a dynamic reference frame relative to at least one of a first vertebra or a second vertebra of the two substantially adjacent vertebrae such that the dynamic reference frame is moveable with the at least one of the first and second vertebrae;

defining a plurality of points on the displayed image data corresponding at least to each of the first and second vertebrae;

determining a midline of the first vertebra and the second vertebra on the displayed image data based at least on the defined plurality of points;

determining a midline of the portion of the spine on the displayed image data based at least on the determined midlines of the first and second vertebrae;

tracking a sensor coupled to an instrument;

determining a position of the instrument relative to at least one of the defined plurality of points of the first and second vertebrae and the determined spinal midline based on tracking of the sensor;

navigating a surgical procedure relative to the defined plurality of points and the determined spinal midline, including manipulating a position of at least one of the first or second vertebrae;

positioning a prosthesis template relative to the first and second vertebrae and displaying an image of the template relative to the first and second vertebrae on the displayed image data; and

updating the displayed image data using at least the dynamic reference frame to reflect the manipulated position of the at least one of the first or second vertebrae relative to the instrument and the determined spinal midline.

16. The method of claim 15, further comprising using the template to select an appropriate prosthesis and to determine an appropriate amount of resection.

17. The method of claim 16, further comprising using the template for determining a selected position for the prosthesis based in part on the displayed image data of the template relative to the first and second vertebrae.

18. The method of claim 15, further comprising:

providing the prosthesis with a sensor arrangement such that a real-time position of the prosthesis can be tracked and displayed relative to the obtained image data of the anatomy and the determined spinal midline to assist in navigating the prosthesis to the selected position;

implanting the prosthesis selected from the group including a disc, a nucleous, a fusion apparatus, a bladder implant, or combinations thereof between the first and second vertebrae; and

verifying an implanted position of the prosthesis corresponds to the selected position of the prosthesis.

19. The method of claim 18, wherein the sensor arrangement is removably connected to the prosthesis, and wherein the sensor arrangement is removed after implantation and verification of the implanted position of the prosthesis.

20. The method of claim 15, wherein the dynamic reference frame is operable in connection with a processor to generate an alert based on movement of the dynamic reference frame relative to a previously known or selected location.

21. The method of claim 15, wherein the dynamic reference frame includes a first dynamic reference frame associated with the first vertebra and a second dynamic reference frame associated with the second vertebra, and

wherein the first and second dynamic reference frames are operable in connection with a processor to update and display any real-time movement of the respective first and second vertebrae relative to at least the obtained image data and the defined plurality of points on the displayed image data.

22. The method of claim 21, wherein manipulating a position of at least one of the first and second vertebrae includes distracting the first and second vertebrae to a distracted position to assist in a resection of the spine, and

wherein the first and second dynamic reference frames are operable in connection with a processor and an image device to update and display the distracted position of the first and second vertebrae relative to each other, the obtained image data, the instrument and the determined spinal midline.

23. The method of claim 15, further comprising displaying navigational information of the surgical procedure relative to the obtained image data of the anatomy;

wherein the navigational information includes displaying at least one of a distance from a selected plane, an angle relative to a selected plane, a distance to a selected plane or point, and combinations thereof.

24. The method of claim 15, wherein defining a plurality of points includes defining the plurality of points relative to the displayed image data, and storing the defined plurality of points relative to the image data in a storage device.

25. The method of claim 15, wherein defining a plurality of points on the displayed image data includes manipulating a user input on an image device to select certain points on the displayed image data.

26. The method of claim 15, wherein determining a midline of the portion of the spine further includes:

determining an orientation of the obtained image data; and

displaying the determined spinal midline obliquely relative to the obtained image data.

27. The method of claim 15, wherein the determined spinal midline includes a substantially weight bearing spinal midline.

28. A method of selecting a position for a prosthesis to be implanted in an anatomy, comprising:

obtaining image data of the anatomy that includes at least a portion of a spine having at least two substantially adjacent vertebrae, and displaying the obtained image data to be viewable by a user;

positioning a first dynamic reference frame relative to a first vertebra of the substantially two adjacent vertebrae and a second dynamic reference frame relative to a second vertebra of the substantially two adjacent vertebra such that such that the first and second dynamic reference frames are each moveable with the respective first and second vertebrae;

defining a plurality of points on the displayed image corresponding at least to each of the first or second vertebrae;

determining a midline of the first vertebra and the second vertebra on the displayed image data based at least on the defined plurality of points;

determining a midline of the portion of the spine on the displayed image data based at least on the determined midlines of the first and second vertebrae;

navigating a surgical procedure relative to the defined plurality of points and the determined spinal midline, including distracting the first and second vertebrae to a distracted position;

updating the displayed image data using at least the first and second dynamic reference frames to reflect the distracted position of the first and second vertebrae relative to the determined spinal midline and the defined plurality of points;

tracking a sensor associated with the prosthesis; and

positioning the prosthesis relative to the distracted first and second vertebrae.

29. The method of claim 28, further comprising determining a depth plane relative to the determined spinal midline and based on the obtained image data and the defined plurality of points.

30. The method of claim 29, further comprising positioning the prosthesis relative to the determined spinal midline and the depth plane, and wherein the sensor is coupled to the prosthesis.

31. The method of claim 29, further comprising:

coupling an instrument to the prosthesis, the instrument including the sensor;

tracking the prosthesis via the sensor relative to the determined spinal midline, the defined plurality of points, the depth plane, or combinations thereof; and

positioning the prosthesis relative to the determined spinal midline and depth plane.

32. A method of selecting a position for a prosthesis to be implanted in an anatomy, comprising:

obtaining image data of the anatomy that includes at least a portion of a spine having at least two substantially adjacent vertebrae;

displaying the obtained image data on an image device viewable by a user;

defining a plurality of points on the displayed image data corresponding at least to each of a first vertebra and a second vertebra of the at least two substantially adjacent vertebrae, the plurality of defined points including a posterior point on a spinous process, a lateral point on a transverse process, a lateral point on a vertebral body, or combinations thereof;

determining a midline of the first vertebra and the second vertebra based at least on the defined plurality of points;

determining a midline of the portion of the spine based on the determined midline of the first vertebra and the determined midline of the second vertebra;

displaying the determined spinal midline on the displayed image data relative to at least the portion of the spine; and

navigating the prosthesis relative to at least the determined spinal midline to the selected position, wherein said prosthesis navigation substantially assists in positioning the prosthesis in the selected position.

33. A method of selecting a position for a prosthesis to be implanted in an anatomy, comprising:

obtaining image data of the anatomy that includes at least a portion of a spine having at least two substantially adjacent vertebrae, and displaying the obtained image data to be viewable by a user;

positioning a dynamic reference frame relative to at least one of a first vertebra or a second vertebra of the two substantially adjacent vertebrae such that the dynamic reference frame is moveable with the at least one of the first and second vertebrae;

defining a plurality of points on the displayed image data corresponding at least to each of the first and second vertebrae;

determining a midline of the first vertebra and the second vertebra on the displayed image data based at least on the defined plurality of points;

determining a midline of the portion of the spine on the displayed image data based at least on the determined midlines of the first and second vertebrae;

navigating the prosthesis relative to the defined plurality of points and the determined spinal midline, including manipulating a position of at least one of the first or second vertebrae; and

updating the displayed image data using at least the dynamic reference frame to reflect the manipulated position of the at least one of the first or second vertebrae relative to the determined spinal midline.