Integrated surgical navigational and neuromonitoring system having automated surgical assistance and control

• US 8,374,673 B2
• Filed: 01/25/2007
• Issued: 02/12/2013
• Est. Priority Date: 01/25/2007
• Status: Active Grant

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: Adcox, W. Keith, Ryterski, Eric
• Primary Examiner(s): Chen, Tse
• Assistant Examiner(s): REARDON, ROCHELLE D
• Application Number:
  US11/626,942
• Publication Number:
  US 20080183190A1
• Time in Patent Office: 2,210 Days
• Field of Search: 600/407, 600/410, 600/424, 600/425, 600/437, 600/546, 600/594, 600/595, 382/131
• US Class Current: 600/410
• 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:

a hand-held surgical instrument configured to apply an electrostimulation to induce a neurological response for a neural monitoring system wherein the electrostimulation is automatically adjusted based on the real-time positioning of the hand-held surgical instrument;

an integrated system comprising;

an instrument tracking system configured to track a real-time positioning of the hand-held surgical instrument, and the neural monitoring system configured to conduct real-time neuromonitoring during a surgical procedure;

a database containing pre-acquired images of an anatomical structure and technical information regarding the surgical procedure and patient anatomy;

a graphical user interface (GUI);

a computer operatively linked with the instrument tracking system, the neural monitoring system, the surgical instrument, the database, and a display terminal, the computer programmed to;

determine an anticipated trajectory of the hand-held instrument and display the anticipated trajectory on the GUI;

display on the display terminal the pre-acquired images of the anatomical structure, the pre-acquired images of the anatomical structure including an image of a nerve structure;

receive data relating to a measured neurological response of a portion of the nerve structure of the anatomical structure;

determine a predicted structure of the nerve structure based on a measured neurological response of a portion of the nerve structure;

display on the display terminal the predicted structure over the pre-acquired images such that the predicted structure supplements the image of the pre-acquired nerve structure to provide a real-time structural view of the nerve structure in its entirety;

automatically identify and determine based on the positioning of the instrument with respect to the anatomical structure, 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 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 wherein the database further contains anatomical images of the patient anatomy, the anatomical images including a coronal image, a sagittal image, and an axial image, each image in a separate image pane, and wherein the computer is further programmed to display the anticipated trajectory superimposed over the anatomical images of the patient anatomy.

4. The apparatus of claim 1 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.

5. The apparatus of claim 4 wherein the computer is further programmed to cause publication of an indicator if the instrument is approaching a neural structure.

6. The apparatus of claim 1 wherein the computer is further programmed to automatically determine an electrostimulation pattern from the location of the neural structure and control the neuromonitoring system to electrostimulate the neural structure according to the determined electrostimulation pattern.

7. The apparatus of claim 1 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.

8. A method comprising:

displaying a pre-acquired image of an anatomical structure;

applying electrostimulation at a given surgical instrument position within the patient using a hand-held surgical instrument;

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

determining a predicted structure of the neural structure in its entirety based on the neurological response of the portion of the neural structure;

displaying the predicated structure over the pre-acquired image such that the predicted structure supplements the image of the pre-acquired neural structure to provide a structural view of the nerve structure in its entirety;

determining a trajectory of a movement of the hand-held surgical instrument and generating a neural structure map along the trajectory by applying electrostimulation to and measuring the neurological response of neural structures along the trajectory;

developing a visualization of patient anatomy containing the neural structure from a coronal image, a sagittal image, and an axial image of the patient anatomy, each of the images contained in a separate image pane;

displaying the trajectory superimposed on the visualization of patient anatomy containing the neural structure;

varying a direction of electrostimulation based on a movement of the hand-held surgical instrument; and

automatically setting one of the electrostimulation intensity and electrostimulation pattern based on the surgical instrument position.

9. The method of claim 8 further comprising automatically identifying the neural structure from the neurological response.

10. The method of claim 9 further comprising updating the visualization of the neural structure based on its identification.

11. The method of claim 9 further comprising displaying a list of on-demand resources available for review by a surgeon based on the identified neural structure.

12. The method of claim 11 further comprising updating the list as the surgical instrument moves from one identified neural structure to another identified neural structure.

13. An apparatus including an integrated neuromonitoring and surgical navigational system comprising a computer, the computer programmed to:

display a pre-acquired image of an anatomical structure;

determine a real-time location of a hand-held neuromonitoring bone-screwdriver positioned within a patient using the pre-acquired image, the neuromonitoring bone-screwdriver configured to drive a bone screw and to apply an electrostimulation to the patient during a pedicle hole preparation;

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

automatically determine one of electrostimulation intensity and electrostimulation pattern for electrostimulating the neural structure based on the position of the neuromonitoring bone-screwdriver and the neural structure;

apply electrostimulation to a portion of the neural structure by the neuromonitoring bone-screwdriver positioned within the patient during the pedicle hole preparatoin;

determine a predicted structure of the neural structure in its entirety based on a neurological response of the portion of the neural structure to the electrostimulation; and

display the predicted structure over the pre-acquired image such that the predicted structure supplements the pre-acquired image of the neural structure to provide a real-time structural view of the nerve structure in its entirety,

wherein the integrated neuromonitoring and surgical navigational system includes a display configured as a graphical user interface (GUI) showing a visualization of the anatomical framework through a plurality of image panes including a coronal image, a sagittal image, and an axial image, and wherein the computer causes a superimposition of a position marker on the visualization of the anatomical framework indicating the location of the neuromonitoring bone-screwdriver in image panes, and wherein the computer is further programmed to indicate, on the GUI, an anticipated trajectory of a movement of the bone-screwdriver.

14. The apparatus of claim 13 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.

15. A computer programmable to execute non-transitory computer readable storage medium having instructions thereon that when executed by a computer causes the computer to:

access an anatomical visualization of a patient, the visualization of the patient including a pre-acquired image of an anatomical structure;

access real-time neurological information acquired from applying electrostimulation to a portion of the neural structure of the patient a hand-held surgical instrument configured to apply electrostimulation;

instantaneously track a position of the hand-held surgical instrument in the patient using an optical tracking system;

automatically identify an determine a class of neural structure of the patient by accessing the neurological information of the patient and a predicted structure of the neural structure in its entirety based on the neurological information acquired from applying the electrostimulation to a portion of the neural structure;

automatically update the anatomical visualization obtained by movement of the surgical instrument to incorporate the neurological information, and the predicted structure;

integrate the optical tracking system and the pre-acquired image to produce a display;

display the integrated optical tracking system and the predicted structure over the pre-acquired image by automatically refreshing an image pane such that the predicted structure supplements the pre-acquired portion image of the neural structure to provide a real-time structural view of the nerve structure in its entirety and a trajectory of the hand-held surgical instrument; and

automatically adjusts the electrostimulation based on the tracked instantaneous position of the surgical instrument.

16. The computer programmable to execute computer readable storage medium of claim 15 wherein the instructions further cause the computer to color-code the anatomical visualization based on the neurological information.

17. The computer programmable to execute computer readable storage medium of claim 15 wherein the instructions further cause the computer to derive the anatomical visualization from at least one of an anatomical image and an atlas model.