System and method for placing and determining an appropriately sized surgical implant

• US 7,996,064 B2
• Filed: 10/19/2009
• Issued: 08/09/2011
• Est. Priority Date: 03/23/1999
• Status: Expired due to Term

• Current Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Inventors: Smith, Kurt R., Foley, Kevin T., Simon, David A.
• Primary Examiner(s): Chen; Tse
• Assistant Examiner(s): Cheng; Jacqueline
• Application Number:
  US12/581,487
• Publication Number:
  US 20100041985A1
• Time in Patent Office: 659 Days
• Field of Search: 600/426, 600/424, 600/425, 600/427, 606/248, 606/279, 606/246, 623/16.11, 623/17.11
• US Class Current: 600/427
• 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 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• 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 2090/376 using X-rays, e.g. fluoroscopy
• 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 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/463 characterised by displaying multiple images or images and diagnostic data on one display
• CPC Class Codes: A61B 6/547 involving tracking of position of the device or parts of the device
• CPC Class Codes: A61M 2025/0166 Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
• CPC Class Codes: A61M 25/0105 Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

Images taken before a surgical procedure by an imager are displayed by a computer and overlaid with graphical representations of instruments and/or surgical implants. The graphical representations can be used to determined appropriate sizes of the surgical implants and trajectories for placement. Also, the images can be used in the operating room. The graphical representations can be updated in real-time to correspond to movement of the instruments in the operating room.

Claims

1. A system for placing a surgical implant into a patient comprising:

a computer processor;

an input system to input dimensions of the surgical implant;

a tracking sensor for sensing three-dimensional position information of a surgical instrument to which the surgical implant is removably coupled, the tracking sensor transmitting the position information to the computer processor;

a display in communication with the computer processor and operable to display an image;

a memory in communication with the computer processor, the memory including computer instructions that when executed by the computer processor cause the computer processor to;

overlay a graphical representation of the surgical implant on the image prior to moving the surgical implant into the patient to ensure appropriate dimensions of the surgical implant;

generate an icon representing the surgical instrument and the mounted surgical implant; and

overlay the icon on the image to represent the real-time position of at least one of the surgical instrument or the surgical implant relative to the image and the patient;

generate a first and a second two-dimensional digitally reconstructed radiograph (DRR) image from a three-dimensional image of an anatomy of the patient;

generate a two-dimensional representation of the appropriate size of the surgical implant for display relative to the first and the second digital reconstructed radiograph image; and

wherein the overlay of the icon is used to determine an appropriately sized surgical implant based upon the two-dimensional representation relative to both the first and second digital reconstructed radiograph image.

2. The system of claim 1, wherein the image is further a two-dimensional x-ray image.

3. The system of claim 1, wherein the input system to input dimensions includes an input display communicating with the computer processor for displaying a three-dimensional image of anatomy of the patient through which a physician may select an appropriate size and placement for the surgical implant.

4. The system of claim 1, wherein the memory in communication with the computer processor further includes computer instructions that when executed by the computer processor cause the computer processor to generate a two-dimensional representation of the appropriate size of the surgical implant for display relative to a direct two-dimensional image of the patient;

wherein the determining an appropriately sized surgical implant is a manual determination of whether the surgical implant is appropriately sized based upon a display of the generated two-dimensional representation of the appropriate size of the surgical implant for display relative to the first and second digital reconstructed radiograph image or the generated two-dimensional representation of the appropriate size of the surgical implant for display relative to the direct two-dimensional image of the patient.

5. The system of claim 4, wherein the surgical implant is a spinal fusion cage and the generated two-dimensional representation of the appropriate size of the surgical implant for display relative to the first and second digital reconstructed radiograph image is a display of a graphical overlay of the spinal fusion cage on an image of a vertebrae of the patient.

6. A method for placing a surgical implant into a patient comprising:

displaying a three-dimensional image of an anatomy of the patient through which an appropriately dimensioned implant is selected to be passed;

selecting the surgical implant, wherein the surgical implant is operable to be detachably mounted to a surgical instrument;

tracking three-dimensional position information of the surgical instrument on which the surgical implant is mounted; and

generating an icon representing the surgical instrument and the mounted surgical implant and superimposing the icon on an image, the icon of the surgical instrument representing the real-time position of the surgical instrument projected into the image and the icon corresponding to the appropriately sized implant;

viewing a graphical overlay of the surgical implant relative to a first image of the patient and a second image of the patient;

wherein selecting the surgical implant includes determining the appropriately sized surgical implant based on the dimensions of the graphical overlay relative to both the first image of the patient and the second image of the patient.

7. The method of claim 6, further comprising:

generating a two-dimensional digitally reconstructed radiograph (DRR) image from the three-dimensional image of the anatomy of the patient, the digitally reconstructed radiograph including a two-dimensional representation of the appropriate size and placement of the implant.

8. The method of claim 7, further comprising:

specifying a desired trajectory icon of the surgical instrument to be superimposed on the image;

wherein generating the desired trajectory icon during a surgical navigation process allows alignment of the icon representing the real-time location of the surgical instrument with the desired trajectory icon representing a planned trajectory.

9. The method of claim 8, wherein the two-dimensional representation of the appropriate size and placement of the implant is included with the specified desired trajectory icon.

10. The method of claim 9, wherein specifying the desired trajectory icon includes illustrating a virtual look-ahead projection of the surgical instrument and directing the computer processor to freeze the virtual look-ahead projection.

11. The method of claim 6, wherein at least one of the first image of the patient and the second image of the patient is a section of a three-dimensional image of the patient.

12. The method of claim 11, wherein the section of a three-dimensional image of the patient includes generating a two-dimensional digitally reconstructed radiograph (DRR) image from the three-dimensional image of the anatomy of the patient.

13. The method of claim 12, further comprising:

mounting the selected surgical implant to the surgical instrument; and

determining the location of the surgical implant by sensing three-dimensional position information of the surgical instrument.

14. The method of claim 13, wherein the surgical implant is a spinal fusion cage.

15. A method for placing a spinal fusion cage into a patient comprising:

displaying a three-dimensional image of an anatomy of the patient through which the spinal fusion cage is to be passed;

viewing a graphical overlay of the spinal fusion cage relative to a first image of the patient and a second image of the patient to view dimensions and a proposed implanted position of the spinal fusion cage relative to the patient;

selecting the spinal fusion cage to include an appropriate dimension that is within an exterior dimension of a bone of the patient, wherein the appropriate dimension is determined by viewing the graphical overlay of the spinal fusion cage relative to the first image of the patient and the second image of the patient;

mounting the selected spinal fusion cage to a surgical instrument;

tracking three-dimensional position information of the surgical instrument on which the spinal fusion cage is mounted;

determining a location of the spinal fusion cage by tracking three-dimensional position information of the surgical instrument;

generating an icon during a navigation procedure representing the determined real-time position of the spinal fusion cage with the appropriate dimensions of the appropriately sized spinal fusion cage relative to the image; and

displaying the icon superimposed on the image.

16. The method of claim 15, further comprising:

generating a two-dimensional digitally reconstructed radiograph image from the three-dimensional image of the anatomy of the patient, wherein the first image is the two-dimensional digitally reconstructed radiograph image from the three-dimensional image and the second image is a two-dimensional image of the patient.

17. The method of claim 16, further comprising:

specifying a desired trajectory icon illustrating a selected trajectory for implanting the spinal fusion cage;

wherein the specifying the desired traiectory icon during the navigation procedure allows alignment of the icon representing the real-time location of the spinal fusion cage with the desired trajectory icon representing a planned trajectory.

18. The method of claim 17, wherein the icon representing the determined real-time position of the spinal fusion cage with the appropriate dimensions of the appropriately sized spinal fusion cage is included with the specified desired trajectory icon.

19. The method of claim 18, wherein specifying the desired trajectory icon includes illustrating a virtual look-ahead projection of the surgical instrument and directing a computer processor to freeze the virtual look-ahead projection.

20. A system for placing a surgical implant into a patient comprising:

a computer processor;

an input system to input modeled dimensions of the surgical implant;

a tracking system including a first portion operably associated with the surgical implant and a second portion remote from the first portion, wherein at least one of the first portion or the second portion is operable to sense three-dimensional position information of a surgical instrument to which the surgical implant is removably coupled and transmitting the position information to the computer processor;

a display in communication with the computer processor and operable to display at least a first image and a second image;

a memory in communication with the computer processor, the memory including computer instructions that when executed by the computer processor cause the computer processor to;

overlay a graphical representation of the surgical implant on the at least the first image and the second image prior to moving the surgical implant into the patient to ensure appropriate dimensions of the surgical implant;

generate an icon representing the surgical instrument and the mounted surgical implant;

overlay the icon on the at least the first image and the second image to represent the real-time position of at least one of the surgical instrument or the surgical implant relative to the image and the patient to determine an appropriately sized surgical implant based upon the graphical representation of the surgical implant relative to both the at least the first and the second image.

21. The system of claim 20, wherein the first portion is at least one of an emitter, a reflector, a magnetic field sensor, a sonic emissions sensor, or a radio waves sensor.

22. The system of claim 21, wherein the memory in communication with the computer processor further includes computer instructions that when executed by the computer processor cause the computer processor to:

generate a two-dimensional digitally reconstructed radiograph (DRR) image from a three-dimensional image of an anatomy of the patient; and

generate a two-dimensional representation of the appropriate size of the surgical implant for display relative to the digital reconstructed radiograph image; and

generate a two-dimensional representation of the appropriate size of the surgical implant for display relative to a direct two-dimensional image of the patient;

wherein the determining an appropriately sized surgical implant is a manual determination of whether the surgical implant is appropriately sized based upon a display of the generated two-dimensional representation of the appropriate size of the surgical implant for display relative to the digital reconstructed radiograph image or the generated two-dimensional representation of the appropriate size of the surgical implant for display relative to the direct two-dimensional image of the patient.