Percutaneous registration apparatus and method for use in computer-assisted surgical navigation

Abstract

An apparatus and procedures for percutaneous placement of surgical implants and instruments such as, for example, screws, rods, wires and plates into various body parts using image guided surgery. The invention includes an apparatus for use with a surgical navigation system, an attaching device rigidly connected to a body part, such as the spinous process of a vertebrae, with an identification superstructure rigidly but removably connected to the attaching device. This identification superstructure, for example, is a reference arc and fiducial array which accomplishes the function of identifying the location of the superstructure, and, therefore, the body part to which it is fixed, during imaging by CAT scan or MRI, and later during medical procedures.

1. An apparatus for facilitating percutaneous placement of surgical instruments into the spine, adapted for use with a surgical navigation system employing an energy-detecting array in communication with a surgical navigation computer to track positions of instruments in three dimensional space relative to a known reference point, said apparatus comprising:
 a connector adapted to be rigidly attached to a portion of the spine;    at least one central post connected to said connector;    a position identification structure rigidly and removably connected to said central post at a predetermined position on said central post and adapted to be reconnected at the same said predetermined position, said identification structure being further adapted to allow a patient to be scanned with the structure connected to the central post, said structure including an assembly for communicating positioning information with respect to said assembly to the energy detecting array and surgical navigation computer; and    a connector assembly for said reconnecting of said structure substantially to said predetermined position on said central post.    
     
     
       2. The apparatus of  claim 1 , wherein the connector is a clamp having teeth adapted for biting into a spinous process. 
     
     
       3. The apparatus of  claim 1 , wherein the connector includes an elongated fixture with a central axis and a threaded end adapted to be inserted into the spinous process and a substantially rigid wire connected to the fixture with the central axis of the wire adapted to be implanted into the spinous process at an angle to elongated fixture to prevent the fixture from rotating. 
     
     
       4. The apparatus of  claim 1 , wherein said assembly for communication positioning information is a substantially H-shaped frame. 
     
     
       5. The apparatus of  claim 1 , wherein said assembly for communicating positioning information is a substantially W-shaped frame. 
     
     
       6. The apparatus of  claim 1 , wherein said assembly for communicating positioning information is a substantially U-shaped frame. 
     
     
       7. The apparatus of  claim 1 , wherein said assembly for communicating positioning information is a substantially X-shaped frame. 
     
     
       8. The apparatus of  claim 1 , wherein said assembly for communicating positioning information comprises:
 a fiducial array for registering the location of a spinal element with rigidly connected fiducials; and    a reference arc for signaling the position of a spinal element, said arc further comprising rigidly connected emitters.    
     
     
       9. The apparatus of  claim 1 , wherein said reference point is on the spine. 
     
     
       10. A method for monitoring the location of an instrument, surgical implant and various portions of the body, to be operated on, using a surgical navigation system with a surgical navigation computer and a digitizer array for monitoring the location of instruments in three-dimensional space relative to a known reference point, said method comprising the steps of:
 attaching a fixture having a central post to a portion of the spine;    removably attaching an identification structure including a fiducial array and a reference arc to said central post;    providing a scanned three-dimensional image of a patient including said fiducial array rigidly attached to said central post of said fixture, said fixture being rigidly attached to the patient to identify the position of said fixture and said fiducial array on the scanned image;    using an image-guided system, by touching an image guided surgical pointer to one or more fiducials on the fiducial array to register the location of a spinal element fixed to said array; and    emitting a signal from said reference arc to indicate changes in position of the spinal element during a surgical procedure.    
     
     
       11. The method of  claim 10 , further comprising:
 performing a surgical procedure percutaneously on a patient using an instrument and implant locatable relative to the spinal element and said structure in known positions identified in the surgical navigation system.    
     
     
       12. The method of  claim 10 , further comprising:
 inserting a threaded fixture having a substantially rigid wire into a spinal element; and    touching an image guided pointer to said threaded fixture and wire to positively register the location of said fixture and wire in a surgical navigation computer.    
     
     
       13. The method of  claim 10 , further comprising:
 implanting imageable devices into spinal elements to identify the location of the spinal elements in the surgical navigation computer.    
     
     
       14. The method of  claim 10 , further comprising:
 implanting imageable devices into a plurality of spinal elements; and    manipulating the patient's spine by viewing the location of the implanted devices, as communicated to the surgical navigation computer by touching an instrument with a tracking emitter to said implanted imageable devices to align the actual position of the spinal elements with the previously scanned image.    
     
     
       15. The method of  claim 10  further comprising:
 percutaneously implanting screws into spinal elements; and  
 locating the position of said screws using image guided surgical navigation techniques.  
 
     
     
       16. The method of  claim 15  further comprising:
 manipulating the orientation of the screw heads percutaneously using a head-positioning probe for communicating location containing an emitter, said probe communicating to the surgical navigation computer the orientation of the screw heads; and  
 using a head positioning tool for manipulating implants having an end portion that mates with the heads of the screws and rotating the screws to receive a connecting implant.  
 
     
     
       17. The method of  claim 16  further comprising:
 tracking the location and position of the connecting implant by means of an instrument affixed to the implant having emitters capable of communicating orientation and location to the surgical navigation computer.  
 
     
     
       18. A system for use in performing the percutaneous placement of surgical implants and instruments into the spine using image guided surgery and a surgical navigation computer and energy detecting array, said system comprising:
 means for attaching a fixture to a portion of the spine;    means for communicating position information to the surgical navigation computer and energy detecting array said means rigidly and removably connected to said means for attaching a fixture;    means for providing location information of said spinal portion to the surgical navigation system adapted to be connected to spinal elements;    means for indicating screw-head position said means electrically connected to the surgical navigation system and adapted to mate with the head of a screw implanted in one or more of said spinal elements.    
     
     
       19. The system of  claim 18  further comprising:
 an elongated implant adapted to be inserted into said implanted screws;  
 means for indicating the position of said elongated implant electrically connected to the surgical navigation system and adapted to mate with the elongated implant.  
 
     
     
       20. The system of  claim 18 , wherein said implanted screws have heads and the elongated implant is a rod adapted to be guided through holes in said implanted screw heads. 
     
     
       21. A method of positioning an implant in an anatomy, including a first implant portion and a second implant portion with a surgical navigation system, comprising:
   positioning the first implant portion through an opening in a soft tissue of the anatomy;        tracking a position of the first implant portion;        interconnecting an implant inserter with the second implant portion;        determining a location of the second implant portion; and        moving the second implant portion relative to the first implant portion via determining a location of the second implant portion.     
     
     
       22. The method of  claim 21 , wherein positioning a first implant portion through an opening in a soft tissue, moving the second implant portion relative to the first implant portion, or combinations thereof includes positioning the first implant portion, the second implant portion, or combinations thereof percutaneously. 
     
     
       23. The method of  claim 22 , wherein tracking a position of the first implant portion includes;
   interconnecting a tracking apparatus with the first implant portion; and        tracking the tracking apparatus interconnected to the first implant portion.     
     
     
       24. The method of  claim 23 , further comprising:
   determining a position of the portion of the first implant portion;        wherein moving the second implant portion relative to the first implant portion includes determining a location of a second implant portion relative to the first implant portion.     
     
     
       25. The method of  claim 24 , further comprising:
   displaying the determined position of the first implant portion and the position of the second implant portion.     
     
     
       26. The method of  claim 21 , further comprising:
   configuring the second implant portion based upon a tracked position of the first implant portion, a determined location of the second implant portion, or combinations thereof.     
     
     
       27. The method of  claim 21 , further comprising:
   interconnecting a reference frame with the anatomy.     
     
     
       28. The method of  claim 27 , further comprising:
   displaying a determined position of the second implant portion on a display relative to a registered image of the anatomy.     
     
     
       29. The method of  claim 21 , further comprising:
   interconnecting a tracking apparatus with the implant inserter; and        tracking the tracking apparatus.     
     
     
       30. The method of  claim 29 , wherein the tracking apparatus includes a sensor. 
     
     
       31. The method of  claim 30 , further comprising:
   selecting a sensor to include at least one of a light emitter, an infrared light emitter, an electromagnet, a magnet, a radiation emitter, an acoustic emitter, or combinations thereof.     
     
     
       32. The method of  claim 21 , wherein determining a location of the second implant further includes tracking the tracking apparatus. 
     
     
       33. The method of  claim 21 , further comprising:
   imaging the anatomy while at least one of tracking the position of the first implant, tracking the tracking apparatus, determining a location of a portion of the second implant portion, or combinations thereof.     
     
     
       34. The method of  claim 33 , wherein imaging the anatomy includes imaging the anatomy with an ultrasound system. 
     
     
       35. The method of  claim 21 , further comprising:
   positioning a third implant portion through an opening in a soft tissue; and        interconnecting the first implant portion and the third implant portion with the second implant portion by moving the second implant portion relative to the first implant portion and the third implant portion.     
     
     
       36. The method of  claim 21 , wherein said first implant portion is a slot in a screw head;
   wherein said second implant portion is a rod;        wherein moving the second implant portion includes aligning the rod with the slot.     
     
     
       37. The method of  claim 36 , further comprising:
   fixing the first implant portion to a vertebrae.     
     
     
       38. The method of  claim 21 , wherein tracking a position includes tracking with an acoustic tracking system, optical tracking system, electromagnetic tracking system, micropulsed radar, or combinations thereof. 
     
     
       39. A method of performing a spinal procedure in an anatomy with a surgical navigation system, comprising:
   positioning a first screw implant in a vertebrae percutaneously through an opening in a soft tissue of the anatomy;        tracking a position of the first screw implant with a screw tracking apparatus;        orientating the first screw implant in a selected orientation at least in part via tracking the position of the first screw implant;        interconnecting an implant inserter with a rod;        determining a position of a portion of the rod; and        moving the rod relative to the first screw implant via determining a location of the rod to interconnect the screw with rod.     
     
     
       40. The method of  claim 39 , further comprising:
   interconnecting a second tracking apparatus with the implant inserter.     
     
     
       41. The method of  claim 39 , wherein orientating said first screw implant includes orientating a slot defined by the screw. 
     
     
       42. The method of  claim 41 , wherein tracking a position of the first screw implant includes interconnecting the screw tracking apparatus with the first screw implant. 
     
     
       43. The method of  claim 42 , wherein interconnecting the screw tracking apparatus includes selecting a sensor. 
     
     
       44. The method of  claim 43 , wherein selecting the sensor includes selecting a light emitting diode, a light reflector, an infrared emitter, a magnet, an electromagnet, an acoustic emitter, an infrared reflector, or combinations thereof. 
     
     
       45. The method of  claim 42 , wherein interconnecting the screw tracking apparatus with the first screw implant includes positioning the screw tracking apparatus percutaneously. 
     
     
       46. The method of  claim 42 , wherein tracking the tracking apparatus includes at least triangulating a position of the tracking apparatus with the surgical navigational system. 
     
     
       47. The method of  claim 46 , wherein the surgical navigation system includes an acoustic tracking system, or electromagnetic tracking system, an optical tracking system, a micropulsed radar, or combinations thereof. 
     
     
       48. The method of  claim 41 , wherein orientating the first screw implant includes orientating the slot relative to the anatomy. 
     
     
       49. The method of  claim 48 , further comprising:
   positioning a second screw implant in a vertebrae percutaneously; and        orientating the second screw implant;        wherein orientating the second screw implant includes orientating second screw implant relative to the first screw implant.     
     
     
       50. The method of  claim 49 , wherein moving the rod relative to the first screw implant includes moving the rod relative to both the first screw implant and the second screw implant. 
     
     
       51. The method of  claim 50 , further comprising:
   manipulating the rod to achieve an interconnection of the first screw implant and the second screw implant.     
     
     
       52. The method of  claim 48 , wherein interconnecting the implant inserter with the rod includes interconnecting the implant inserter near a first end of the rod, a second end of the rod, a portion intermediate between the first end and the second end, or combinations thereof. 
     
     
       53. The method of  claim 48 , wherein interconnecting an implant inserter with a rod includes rigidly interconnecting an implant inserter with the rod. 
     
     
       54. The method of  claim 53 , further comprising:
   interconnecting a tracking apparatus with the implant inserter that includes rigidly interconnecting the tracking apparatus with the implant inserter.     
     
     
       55. The method of  claim 48 , wherein interconnecting an implant inserter with a rod includes releasably interconnecting the implant inserter with the rod. 
     
     
       56. The method of  claim 48 , further comprising:
   interconnecting a tracking apparatus with the implant inserter that includes positioning an emitter on the tracking apparatus.     
     
     
       57. The method of  claim 56 , wherein interconnecting a sensor with the tracking apparatus includes selecting at least one of a light emitting a diode, a light reflecting portion, an infrared light emitting portion, an infrared light reflecting portion, an acoustic emitter, an electromagnet, a magnet, or combinations thereof. 
     
     
       58. The method of  claim 48 , further comprising:
   imaging a portion of the anatomy.     
     
     
       59. The method of  claim 58 , wherein imaging an portion of the anatomy includes obtaining an MRI scan, a CT scan, an x- ray image, an ultrasound image, or combinations thereof.   
     
     
       60. The method of  claim 48 , further comprising:
   displaying an image of the anatomy; and        displaying a position of the portion of the screw on the display relative to the image of the anatomy, and displaying a determined position of the rod relative to the image of the anatomy.     
     
     
       61. The method of  claim 60 , wherein moving the rod relative to the screw includes displaying on the display the portion of the rod relative to the position of the head of the screw. 
     
     
       62. The method of  claim 61 , further comprising:
   manipulating the rod to achieve a selected interconnection of the rod and the screw implant.     
     
     
       63. The method of  claim 62 , wherein manipulating the rod includes bending the rod. 
     
     
       64. The method of  claim 63 , further comprising:
   positioning a second screw implant in a vertebrae percutaneously; and        moving the rod relative to the screw implant and the second screw implant.     
     
     
       65. The method of  claim 48 , wherein moving the rod relative to the screw includes moving the rod substantially percutaneously. 
     
     
       66. The method of  claim 65 , wherein moving the rod substantially percutaneously includes inserting the rod through a substantially single opening in a soft tissue of the anatomy and moving the rod based upon a tracked position of the rod. 
     
     
       67. The method of  claim 66 , wherein tracking a position of the portion of the screw and determining a position of a portion of the rod is substantially percutaneous. 
     
     
       68. The method of  claim 48 , wherein tracking the position of the first screw implant includes tracking a position of a slot defined by the screw. 
     
     
       69. The method of  claim 68 , wherein moving the rod relative to the first screw implant includes moving the rod percutaneously through the slot. 
     
     
       70. The method of  claim 69 , further comprising:
   positioning a second screw implant in a vertebrae percutaneously through an opening in a soft tissue of the anatomy;        tracking a position of the second screw implant; and        orientating the second screw implant in a selected orientation at least in part via tracking the position of the second screw implant.     
     
     
       71. The method of  claim 70 , wherein orientating the second screw implant includes aligning a second slot defined by the second screw implant with a first slot defined by the first screw implant at least in part by tracking the position of the first screw implant, tracking the position of the first screw implant, or combinations thereof;
   wherein moving the rod includes moving the rod through the first slot and the second slot.     
     
     
       72. The method of  claim 71 , further comprising:
   fixing the rod to the first screw implant and the second screw implant.     
     
     
       73. The method of  claim 39 , wherein orientating the first screw implant includes selecting an orientation of a head of the screw relative to a portion of the anatomy.