Method and apparatus for implantation between two vertebral bodies

• US 7,567,834 B2
• Filed: 05/03/2004
• Issued: 07/28/2009
• Est. Priority Date: 05/03/2004
• Status: Active Grant

• Current Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Navigation Incorporated (Medtronic Plc)
• Inventors: Clayton, John B, Rampersaud, Y. Raja
• Primary Examiner(s): Winakur; Eric F
• Assistant Examiner(s): Rozanski; Michael T
• Application Number:
  US10/837,997
• Publication Number:
  US 20050245817A1
• Time in Patent Office: 1,912 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. An apparatus to determine a position for implanting a prosthesis in an anatomy, comprising:

an instrument including a sensor;

a system operable to navigate a procedure, including a tracking system that tracks the sensor to determine a position of the instrument relative to the anatomy, the tracking system spaced apart from the instrument;

an imaging device to obtain image data of the anatomy;

a display that displays the image data;

a user input device that enables a user to select a plurality of points on the image data displayed on the display;

wherein said system is configured to determine a first anatomical definition based substantially only on the plurality of points, the first anatomical definition including at least a midline plane of a spinal column;

wherein said first anatomical definition is substantially independent of the orientation of the image data; and

wherein an icon that represents the prosthesis is displayed on the display relative to the image data, and the icon changes when the prosthesis is on the midline plane.

2. The apparatus of claim 1, wherein said imaging device is selected from a group consisting of a fluoroscopic imaging device, a CT imaging device, a MRI imaging device, a PET imaging device, an ultrasound imaging device, and combinations thereof.

3. The apparatus of claim 1, wherein said image data obtained by said imaging device may be substantially two dimensional image data or three dimensional image data of the anatomy.

4. The apparatus of claim 1, wherein said system further includes a processor operable to manipulate said image data for display on the display, including displaying said plurality of points and determining said first anatomical definition.

5. The apparatus of claim 1, wherein the system further comprises:

a second sensor trackable by said tracking system positioned relative to the prosthesis;

wherein said icon is displayed on said display for tracking the position of the prosthesis relative to said first anatomical definition.

6. The apparatus of claim 5, wherein said prosthesis is displayable on said display relative to the image data or substantially only with the anatomical definitions alone.

7. The apparatus of claim 5, wherein said sensor is selected from a the group consisting of:

an acoustic sensor, an electromagnetic sensor, an optical sensor, a radiation sensor, and combinations thereof.

8. The apparatus of claim 1, wherein said first anatomical definition further includes at least one of a mid-sagittal plane, a depth plane, or combinations thereof.

9. The apparatus of claim 8, wherein said midline plane is substantially a true midline of a spinal column.

10. The apparatus of claim 9, wherein said depth plane is operable with said midline plane to navigate a positioning of the prosthesis in a spinal portion of the anatomy.

11. The apparatus of claim 1, wherein said system includes:

a processor;

wherein said processor is operable to determine cues for display on said display for use by a user when positioning the prosthesis.

12. The apparatus of claim 11, wherein said cues include a distance to a destination, a distance from a selected orientation or anatomical definition and an angular orientation relative to a selected anatomical definition.

13. The apparatus of claim 12, wherein said tracking system is operable to track the prosthesis during an implantation, and said cues are operable by a user to determine the position of the prosthesis relative to a selected portion of the anatomy.

14. The apparatus of claim 1, wherein said system is substantially a pre-operative system wherein the image data obtained by said imaging device is used in conjunction with said system to define a plurality of points such that said system is operable to determine an anatomical definition for planning the implantation.

15. The apparatus of claim 1, wherein said tracking system includes:

a tracking array to track said sensor during an operative procedure, the tracking array spaced apart from said sensor;

wherein said tracking array can track said sensor during a procedure to determine a position of said sensor and a relative location of a portion interconnected with said sensor;

wherein said imaging device is operable to confirm a location of a member interconnected with said sensor.

16. The apparatus of claim 1, wherein said system substantially automatically determines the first anatomical definition based on substantially only the plurality of points.

17. The system of claim 1, further comprising:

a user input to identify at least one of spinous process points, symmetrical lateral portions on a vertebra, a first lateral transverse process point, a second lateral transverse process point, or combinations thereof.

18. 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 two substantially adjacent vertebrae;

displaying the image data viewable by a user;

defining a plurality of points on the displayed image data that includes a posterior point on a spinous process, a lateral point on a transverse process of a vertebra, a lateral point on a vertebral body of a vertebra, or combinations thereof;

determining an anatomical definition in part due to the defining of the plurality of points;

defining a second plurality of points on the displayed image data relative to at least one of the adjacent vertebrae;

determining a depth plane for the insertion of the prosthesis based on the second plurality of points;

tracking a sensor coupled to an instrument;

determining a position of the instrument relative to at least one of the anatomical definition and the depth plane during the procedure based on tracking of the sensor; and

navigating a surgical procedure relative to the determined anatomical definitions.

19. The method of claim 18, wherein obtaining the image data includes obtaining a substantially two dimensional image data or a substantially three dimensional image data of the anatomy.

20. The method of claim 18, wherein obtaining the image data includes using an image device selected from the group consisting of a fluoroscope, an X-ray device, a CT device, a MRI device, a PET device, an ultrasound device, and combinations thereof.

21. The method of claim 18, wherein defining a plurality of points includes defining the plurality of points relative to the image data;

and

storing the plurality of points relative to the image data in a storage device.

22. The method of claim 18, wherein defining the plurality of points further includes defining the lateral most points of the transverse bodies of a vertebrae, the most posterior point of a spinous process, the two lateral most points of a vertebral body of a vertebrae, or combinations thereof.

23. The method of claim 18, wherein determining an anatomical definition includes determining a midline.

24. The method of claim 23, further comprising:

navigating the position of the prosthesis relative to the determined anatomical definitions;

wherein said navigating substantially assists in positioning the prosthesis in a selected position.

25. The method of claim 18, wherein determining an anatomical definition includes:

processing at least a first selected point and a second selected point to determine a line that substantially interconnects the first point and the second point;

wherein said processing is performed by a processor performing a set of instructions.

26. The method of claim 18, further comprising:

navigating a position of the prosthesis relative to the anatomical definitions; and

displaying a representative position of the prosthesis relative to the determined anatomical definitions to assist in positioning the prosthesis.

27. The method of claim 18, further comprising displaying navigational information of a procedure relative to the image data of the anatomy.

28. The method of claim 27, wherein said navigation information further 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.

29. The method of claim 18, wherein determining an anatomical definition further includes defining at least one of a mid-point, a midline, or combinations thereof of the vertebra.

30. The method of claim 29, wherein determining an anatomical definition includes substantially defining a true midline of a spine by defining at least one of a line, a plane, or combinations thereof between a plurality of midlines of vertebrae.

31. The method of claim 18, further comprising:

displaying cues for a user to assist in positioning the prosthesis relative to the determined anatomical definitions.

32. The method of claim 18, wherein obtaining image data further includes obtaining anterior to posterior image data, lateral image data, axial image data, and combinations thereof.

33. The method of claim 18, further comprising:

implanting a prosthetic selected from the group comprising a disc, a nucleous, a fusion apparatus, and combinations thereof between at least two vertebrae.

34. The method of claim 18, wherein determining an anatomical definition includes accessing an atlas model that includes points that are already determined on the atlas model.

35. The method of claim 18, wherein determining an anatomical definition includes a midline of the spine or a substantially weight bearing midline.

36. The method of claim 18, wherein determining

an anatomical definition includes:

determining the orientation of the acquired image data;

determining a substantially precise spinal midline; and

illustrating the determined spinal midline obliquely relative to the acquired image data.

37. The method of claim 36, wherein the illustrated determined midline is a substantially true midline for performing a procedure.

38. The method of claim 36, wherein defining a plurality of points on the displayed image data includes:

manipulating a user input to select the points on the displayed image data.

39. The method of claim 36, wherein determining the orientation of the acquired image data includes determining that the acquired image data is within a determined plane and determining the anatomical definition relative to the determined plane.

40. The method of claim 18, wherein obtaining image data includes acquiring a x-ray image of the anatomy.

41. The method of claim 40, wherein the acquired image data is acquired relative to the anatomy along an axis or plane other than a true anterior-to-posterior axis or mid-sagittal plane.

42. The method of claim 18, further comprising:

determining the anatomical definition independent of an orientation of the image data;

wherein the image data is obtained with the anatomy positioned in at least one orientation.

43. The method of claim 42, further comprising:

executing instructions with a processor to determine the anatomical definition;

wherein the anatomical definition is based on the defined plurality of points.

44. A surgical system operable to allow for defining an anatomical definition and navigating a procedure relative to an anatomy, comprising:

a prosthesis including a sensor, the prosthesis selected from the group consisting of a nucleous replacement, a disc replacement, a disc fusion apparatus, and combinations thereof;

a tracking array to track a position of the sensor;

an imaging device operable to obtain image data of the anatomy;

a display to display the image data and a position of the prosthesis relative to the anatomy during the procedure;

a user input device that allows a user to input a first anatomical definition and at least one depth point for the prosthesis based on the image data;

a processor that determines a second anatomical definition based on the first anatomical definition and determines an insertion depth for the prosthesis within the anatomy based on the least one depth point;

wherein said first anatomical definition, said second anatomical definition and said insertion depth assist in navigating the procedure; and

wherein said display displays an indicator that illustrates whether the prosthesis has reached said insertion depth.

45. The surgical system of claim 44, wherein said tracking array is selected from the group consisting of an electromagnetic tracking array, an acoustic tracking array, an optical tracking array, a radiation tracking array, and combinations thereof.

46. The surgical system of claim 45, wherein said sensor includes an electromagnetic sensor, an acoustic sensor, an optical sensor, a radiation sensor, and combinations thereof.

47. The surgical system of claim 44, wherein said imaging device is selected from the group consisting of a fluoroscope, a MRI, a PET, a CT device, an ultrasound and combinations thereof.

48. The surgical system of claim 44, wherein said imaging device is operable to obtain image data that is substantially two dimensional or three dimensional of the anatomy.

49. The surgical system of claim 48, wherein said display is operable to display at least one of the two dimensional image data, the three dimensional image data, and combinations thereof.

50. The surgical system of claim 44, wherein said user input is operable to input the first anatomical definition relative to said image data to be displayed on said display.

51. The surgical system of claim 44, wherein said first anatomical definition input by said user input is stored in a storage system for use by said processor.

52. The surgical system of claim 44, wherein said tracking array is operable to track said sensor relative to said prosthesis to display a location of said prosthesis relative to at least one of said first anatomical definition and said second anatomical definition.

53. The surgical system of claim 44, wherein said first anatomical definition and said second anatomical definition substantially define a planning portion of a procedure;

wherein said processor is operable to determine said second anatomical definition for positioning the prosthesis relative to the anatomy.

54. The surgical system of claim 44, wherein said second anatomical definition determined by said processor includes at least one of a true midline of a spine, a depth for a position of the prosthesis in a spine, and combinations thereof.

55. The surgical system of claim 44, wherein said display is operable to display an orientation of the prosthesis relative to said second anatomical definition to assist a user in positioning the prosthesis relative to the anatomy in a selected position.

56. The surgical system of claim 55, further comprising an implantation cue:

wherein said implantation cue is displayable on said display to notify a user of a position of the prosthesis relative to the second anatomical definition.

57. The surgical system of claim 44, further comprising:

a dynamic reference frame operable to be interconnected with the anatomy such that said dynamic reference frame is movable with the anatomy;

wherein said tracking array is operable to track said dynamic reference frame during a procedure.

58. The surgical system of claim 57 wherein said tracking of said dynamic reference frame with said tracking array is operable with said processor to substantially assure that said first anatomical definition and said second anatomical definition are properly displayed on said display relative to the anatomy in the patient space.

59. The surgical system of claim 57, wherein said dynamic reference frame is operable with said processor to substantially assure that said first anatomical definition and said second anatomical definition are properly oriented with the anatomy;

such that the navigation and display of the prosthesis is substantially accurate for implantation of said prosthesis.

60. The surgical system of claim 44, wherein said image data is selected from the group consisting of anterior to posterior image data, lateral image data, axial image data, and combinations thereof.

61. The surgical system of claim 60, wherein the image data is image data regarding the spine.

62. The surgical system of claim 44, wherein said first anatomical definition includes points selected on an anatomy.

63. The surgical system of claim 62, wherein said points include lateral points of a vertebral body, lateral points of a transverse process, a posterior point of a spinous process, and combinations thereof.