Fluoroscopic image guided surgery system with intraoperative registration

• US 8,768,437 B2
• Filed: 10/25/2006
• Issued: 07/01/2014
• Est. Priority Date: 08/20/1998
• Status: Active Grant

• Current Assignee: Sofamor Danek Holdings, Inc
• Original Assignee: Sofamor Danek Holdings, Inc
• Inventors: Barrick, Earl F
• Primary Examiner(s): Jung, Unsu
• Assistant Examiner(s): Santos Rodriguez, Joseph M
• Application Number:
  US11/586,105
• Publication Number:
  US 20070038079A1
• Time in Patent Office: 2,806 Days
• Field of Search: 600/407, 600/429, 606/130, 378205-207
• US Class Current: 600/426
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1721 for applying pins along or parallel to the axis of the femoral neck
• CPC Class Codes: A61B 17/1742 for the hip
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• 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 2090/363 Use of fiducial points
• 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 5/064 using markers A61B5/062 takes precedence
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/4441 the rigid structure being a C-arm or U-arm
• CPC Class Codes: A61B 6/547 involving tracking of position of the device or parts of the device
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for

Abstract

A system and apparatus allows the tracking of a selected body portion, instrument, or both. A tracking device can be interconnected to a body portion at a mounting site. A procedure can be performed at a location remote from the mounting site of the tracking device. The tracking device can be interconnected with the body in a low invasive manner.

Claims

1. A method of performing an image guided surgery on an anatomy, comprising:

obtaining image data of a region of the anatomy including a bone portion and a pelvis of the anatomy, wherein obtaining image data includes obtaining a first fluoroscopic two-dimensional x-ray image and a second fluoroscopic two-dimensional x-ray image that is at an angle to the first fluoroscopic x-ray image;

attaching a reference bar to the pelvis, wherein the pelvis defines a first portion of a joint;

selecting a bone portion separate and different from the pelvis in the anatomy and defining a second portion of the joint, wherein the reference bar is not inserted into the bone portion;

placing only a single registration pin in the selected bone portion;

registering the obtained image data to the selected bone portion with the single registration pin and the outline of the bone portion in the first fluoroscopic two-dimensional x-ray image and the second fluoroscopic two-dimensional x-ray image;

tracking the reference bar to determine a location of the pelvis;

tracking and guiding an instrument with a tracking device to determine a location of the instrument relative to the reference bar attached to the pelvis; and

while tracking and guiding the instrument, performing a procedure with the instrument on the bone portion that is separate and different from the pelvis to which the reference bar is attached, wherein the procedure includes fusing a first segment of the bone portion and a second segment of the bone portion wherein at least one of the first segment or the second segment form the joint with the pelvis;

calculating a plane in which the pelvis lies in relation to the reference bar;

wherein registering the obtained image data to the selected bone portion further includes using a spherical femoral head to increase registration accuracy.

2. The method of claim 1, further comprising:

maintaining the bone portion immobile relative to the pelvis while performing the procedure.

3. The method of claim 2, further comprising:

displaying the determined location of the instrument superimposed on the registered obtained image data to show the location of the instrument relative to a location of the bone portion based upon the tracked position of the instrument and the reference bar.

4. The method of claim 3, wherein tracking the instrument includes tracking a drill driving a bone screw.

5. The method of claim 1, further comprising:

sterilizing an appropriate portion of the anatomy including;

selecting a portion of the anatomy for attachment of the reference bar;

sterilizing the selected portion of the anatomy for attaching the reference bar; and

inserting the reference bar through a small incision to attach the reference bar to the pelvis.

6. The method of claim 1, wherein tracking the reference bar to determine the location of the pelvis and tracking the instrument with the tracking device to determine the location of the instrument includes determining with a system the locations of the reference bar and the instrument in three dimensional space.

7. The method of claim 1, wherein fusing the first segment of the bone portion and the second segment of the bone portion includes internal fixation of an intertrochanteric hip fracture with a screw.

8. The method of claim 7, wherein the first segment and the second segment are both segments of the same bone portion and the hip fracture is a fracture of a femoral neck of the bone portion;

wherein the joint includes a hip joint.

9. The method of claim 8, further comprising:

inserting a guide pin into the femur with the instrument while tracking the instrument; and

driving a cannulated screw over the guide pin once the guide pin is inserted into the femur.

10. The method of claim 9, further comprising:

determining a location of the guide pin based on the obtained image data prior to inserting the guide pin.

11. The method of claim 9, further comprising:

tracking a position of an imaging device with a tracking system relative to the reference bar while obtaining the image data.

12. A method of performing an image guided surgery on an anatomy, comprising:

obtaining image data of a hip joint region of the anatomy including the hip joint defined by a pelvis of the anatomy and a spherical femoral head of a femur of the anatomy, wherein obtaining image data includes obtaining a first fluoroscopic two-dimensional x-ray image and a second fluoroscopic two-dimensional x-ray image that is at an angle to the first fluoroscopic x-ray image;

attaching a reference bar to an ilium of the pelvis;

tracking the reference bar to determine a location of the pelvis and the femur;

registering the obtained image data to the hip joint of the anatomy including the pelvis and the femur using only a single registration pin inserted into the femur and the spherical femoral head to increase registration accuracy; and

tracking a tracking device attached to an instrument to determine a location of the instrument relative to the femur based on tracking the reference bar attached to the pelvis while performing a procedure with the instrument on the femur in the anatomy, wherein performing the procedure includes fusing a first segment of the femur and a second segment of the femur, wherein at least one of the first segment or the second segment form the hip joint with the pelvis;

displaying the determined location of the instrument superimposed on the registered obtained image data to show the location of the instrument relative to the location of the femur based upon the tracked position of the tracking device attached to the instrument that is tracked relative to tracked location of the reference bar;

calculating a plane in which the pelvis lies in relation to the reference bar;

wherein the femur is naturally moveable relative to the pelvis, is separate from the pelvis, and is different from the pelvis;

wherein the reference bar remains unfixed to the femur.

13. The method of claim 12, wherein performing a procedure includes:

inserting a guide pin into the femur with the instrument; and

displaying a determined location of the guide pin to show the location of the guide pin relative to the location of the femur based upon the tracked position of the tracking device attached to the instrument and the reference bar.

14. The method of claim 13, wherein performing the procedure further includes:

passing a cannulated screw over the inserted guide pin into the femur for internal fixation of an intertrochanteric hip fracture.

15. A method of performing an image guided surgery on an anatomy, comprising:

obtaining a first fluoroscopic two-dimensional x-ray image data of a region of the anatomy including a femoral joint between a pelvis of the anatomy and a spherical femoral head of a femur of the anatomy with an imaging device at a first position;

obtaining a second fluoroscopic two-dimensional x-ray image data of the region of the anatomy including the femoral joint between the pelvis of the anatomy and the spherical femoral head of the femur of the anatomy with the imaging device at a second position that is at an angle to the first position;

attaching a reference bar to an illium of the pelvis;

attaching only a single registration pin to the femur at a location away from the illium;

registering the first fluoroscopic two-dimensional x-ray image data and the second fluoroscopic two-dimensional x-ray image data to at least the spherical femoral head of the femur of the anatomy using the single registration pin and an outline of the femur in the first fluoroscopic two-dimensional x-ray image and the second fluoroscopic two-dimensional x-ray image, wherein registering includes using the spherical femoral head to increase registration accuracy;

calculating a plane in which the pelvis lies in relation to the reference bar;

tracking the reference bar to determine a location of the pelvis and the femur; and

tracking an instrument with a tracking device to determine a location of the instrument relative to the reference bar attached to the pelvis while performing a procedure with the instrument on the femur portion in the anatomy, wherein fusing a first segment of the femur and a second segment of the femur, wherein at least one of the first segment or the second segment form the joint with the pelvis;

wherein the femur is naturally moveable relative to the pelvis, is separate from the pelvis, and is different from the pelvis;

wherein the reference bar remains unfixed to the femur.

16. The method of claim 15, further comprising:

driving a guide pin to the spherical femoral head of the femur while tracking the instrument; and

driving a cannulated bone screw over the guide pin for fixation of a fracture of a femoral neck of the femur.

17. The method of claim 16, further comprising:

illustrating a location of the guide pin on a monitor based on tracking the instrument to which the guide pin is coupled.