Methods and apparatus for spinal reconstructive surgery and measuring spinal length and intervertebral spacing, tension and rotation
Methods and apparatus are disclosed for performing spinal reconstructive surgery, including measuring spinal length in the Y-axis at the middle column, measuring intervertebral spacing in the Y-axis at the middle column, measuring intervertebral tension applied to the posterior longitudinal ligament, establishing the height of intervertebral spacers along the Y-axis at the middle column based on one or more of such measurements, measuring intervertebral rotation around the Y-axis, and measuring flexion-extension or anterior-posterior rotation around the X-axis.
1. A method of measuring intervertebral spacing length at a middle column of a spine comprising:
positioning a first middle column marker in a first vertebra, wherein the first middle column marker is located at a depth of the middle column of the first vertebra;
positioning a second middle column marker in a second vertebra, wherein the second middle column marker is located at a depth of the middle column of the second vertebra; and
measuring, at the middle column, a distance between the first and second middle column markers to thereby determine the intervertebral spacing length at the middle column,
wherein the measuring comprises:
determining a first line, within a medical image of the spine, along the middle column of the first vertebra at a point at which the first middle column marker passes through the middle column of the first vertebra;
identifying a first point on an edge of the first vertebra where the first line intersects with the edge of the first vertebra;
determining a second line, within a medical image of the spine, along the middle column of the second vertebra at a point at which the second middle column marker passes through the middle column of the second vertebra;
identifying a second point on an edge of the second vertebra where the second line intersects with the edge of the second vertebra; and
measuring a distance between the first point and the second point
wherein the distance between the first point and the second point represents the distance between the first and second middle column markers; and
wherein the middle column comprises a region on the spine, wherein the region is bounded on a first side by a posterior surface of a vertebral body of a vertebra, and wherein the region is bounded on a second side located at a distance between substantially one-third and substantially one-half through the vertebral body from the posterior surface to an anterior surface of the vertebral body.
2. The method of claim 1 , wherein the first middle column marker is provided on a first bone anchor, and the second middle column marker is provided on a second bone anchor.
3. The method of claim 2 , wherein each of the first and second bone anchors comprises a pedicle screw or pin.
4. The method of claim 3 , wherein the first and second middle column markers comprise a detectable feature on the pedicle screw or pin.
5. The method of claim 4 , wherein the detectable feature comprises a shoulder on a shaft of the pedicle screw or pin.
6. The method of claim 2 , further comprising:
attaching a distraction tool to the first and second bone anchors;
distracting the first and second bone anchors away from each other with the distraction tool; and
measuring a distracted intervertebral spacing length at the middle column corresponding to a distracted distance between the first and second middle column markers.
7. The method of claim 6 , further comprising measuring distraction force applied by the distraction tool against the first and second bone anchors.
8. A method of measuring spinal length at a middle column of a spine comprising:
tracing a posterior longitudinal ligament on a medical image of the spine, wherein the posterior longitudinal ligament is located within the middle column;
identifying, on the traced posterior longitudinal ligament, a location of the middle column for individual vertebra along at least a portion of a length of the spine;
performing, on the traced posterior longitudinal ligament, a measurement of the length of each of the vertebrae, the measurement occurring at the middle column;
measuring, on the traced posterior longitudinal ligament, intervertebral lateral offset distances between adjacent vertebrae; and
determining an overall spinal length representing a combination of the measured lengths of the vertebrae at the middle column and the measured intervertebral lateral offset distances,
wherein the middle column comprises a region on the spine, wherein the region is bounded on a first side by a posterior surface of a vertebral body of a vertebra, and wherein the region is bounded on a second side located at a distance between substantially one-third and substantially one-half through the vertebral body from the posterior surface to an anterior surface of the vertebral body.
9. A method of measuring intervertebral tension of a posterior longitudinal ligament of a spine comprising:
positioning a first bone anchor in a first vertebra within a middle column of the spine;
positioning a second bone anchor in a second vertebra within the middle column of the spine;
distracting the first and second vertebrae by applying force against the first and second bone anchors; and
measuring tension of a posterior longitudinal ligament between the first and second vertebrae at different distraction distances,
wherein the middle column comprises a region on the spine, wherein the region is bounded on a first side by a posterior surface of a vertebral body of a vertebra, and wherein the region is bounded on a second side located at a distance between substantially one-third and substantially one-half through the vertebral body from the posterior surface to an anterior surface of the vertebral body.
10. The method of claim 9 , further comprising establishing an intervertebral spacer length based upon the measured tension.
11. A method of spinal reconstructive surgery comprising:
measuring a pre-operative spinal length at a middle column of the spine, the measuring comprising:
tracing a posterior longitudinal ligament on a medical image of the spine, wherein the posterior longitudinal ligament is located within the middle column;
identifying, on the traced posterior longitudinal ligament, a location of the middle column for individual vertebra along at least a portion of a length of the spine;
performing, on the traced posterior longitudinal ligament, a measurement of the length of each of the vertebrae, the measurement occurring at the middle column;
measuring, on the traced posterior longitudinal ligament, intervertebral lateral offset distances between adjacent vertebrae; and
determining an overall spinal length representing a combination of the measured lengths of the vertebrae at the middle column and the measured intervertebral lateral offset distances; and
establishing at least one intervertebral spacing in the spine based on the measured pre-operative spinal length at the middle column,
wherein the middle column comprises a region on the spine, wherein the region is bounded on a first side by a posterior surface of a vertebral body of a vertebra, and wherein the region is bounded on a second side located at a distance between substantially one-third and substantially one-half through the vertebral body from the posterior surface to an anterior surface of the vertebral body.
12. A method for measuring rotational displacement of adjacent vertebrae of a spine comprising:
positioning a middle column marker in at least two vertebrae of the spine within a middle column of the spine;
applying a force between the middle column markers; and
measuring relative angular movement between the middle column markers,
wherein the middle column comprises a region on the spine, wherein the region is bounded on a first side by a posterior surface of a vertebral body of a vertebra, and wherein the region is bounded on a second side located at a distance between substantially one-third and substantially one-half through the vertebral body from the posterior surface to an anterior surface of the vertebral body.
13. The method of claim 12 , where the force is applied by a distraction tool.
14. An apparatus for measuring intervertebral spacing distances between adjacent vertebrae at a middle column of a spine comprising:
a first middle column marker, wherein the first middle column marker is positionable in the spine at a depth of a middle column of a first vertebra;
a second middle column marker, wherein the second middle column marker is postitionable in the spine at a depth of a middle column of a second vertebra; and
a detector capable of measuring a distance between the first and second middle column markers at the middle column to thereby determine the intervertebral spacing length at the middle column,
wherein the middle column comprises a region on the spine, wherein the region is bounded on a first side by a posterior surface of a vertebral body of a vertebra, and wherein the region is bounded on a second side located at a distance between substantially one-third and substantially one-half through the vertebral body from the posterior surface to an anterior surface of the vertebral body.
15. An intervertebral tension measuring apparatus for measuring intervertebral tension and identifying intervertebral spacer lengths comprising:
a distractor engageable with bone anchors installed in adjacent vertebrae within a middle column of a spine;
a tension measurement device structured and arranged to measure amounts of force applied by the distractor against the bone anchors when the vertebrae are separated from each other by the distractor against tension applied by a posterior longitudinal ligament of the spine; and
a distance correlating device structured and arranged to record varying distances between the adjacent vertebrae in the middle column and correlating each of the varying distances with a force measured by the tension measuring device corresponding to the tension applied by the posterior longitudinal ligament,
wherein the middle column comprises a region on the spine, wherein the region is bounded on a first side by a posterior surface of a vertebral body of a vertebra, and wherein the region is bounded on a second side located at a distance between substantially one-third and substantially one-half through the vertebral body from the posterior surface to an anterior surface of the vertebral body.