Minimally invasive intervertebral rod insertion
A system and method for the minimally invasive insertion of an intervertebral rod into the vertebrae of a subject, according to a preoperative surgical plan also defining positions for the insertion of rod clamping screws into the vertebrae. The rod shape for connecting the heads of the screws is calculated, and a path planning algorithm used to determine whether the distal end of the rod can be threaded through the screw heads by longitudinal and rotational manipulation of the proximal end of the rod. If so, instructions are provided for forming that rod shape and for the robotic insertion of the screw holes and the rod. If not, either or both of the screw positions and the rod shape are adjusted, to moderate the bends in the rods, until insertion becomes possible. The insertion can be performed robotically, or, if a navigation tracking system is added, manually.
1. A method of planning an intervertebral rod insertion procedure, comprising:
using a preoperative surgical plan to define positions and orientations for inserting screws into vertebrae of a subject, each of the screws having a head,
calculating a shape of a rod that will connect the heads of the screws;
determining, using a path planning algorithm, whether manipulation of a proximal end of the rod having the calculated shape enables a distal end of the rod to pass sequentially through the heads of the screws;
when the distal end of the rod can be passed sequentially through the heads of the screws:
providing instructions for insertion of the screws in the defined positions and orientations,
providing information for forming the rod having the shape, and
providing instructions for insertion of the rod; or
when the distal end of the rod cannot be passed through the heads of the screws:
adjusting in the plan, at least one of the position and orientation of at least one of the screws in order to moderate bends in a path between the heads of the screws, and recalculating the shape of the rod to match any adjusted position and orientation of the at least one screw;
using the path planning algorithm on the rod having moderated bends to determine whether the rod can be passed through the heads of the screws; and
repeating the steps of adjusting the screw positions, and recalculating the rod shape, until the rod acquires a planned shape that enables it to be inserted between the heads of the screws by longitudinal manipulation of the rod from its proximal end.
2. A method according to claim 1 , wherein the step of determining whether manipulation of the proximal end of the rod having the calculated shape enables the distal end of the rod to be passed through the heads of the screws, includes broadening a range of rod shape which can be passed through the heads of the screws by enabling adjustment of a position or orientation of at least one of the vertebrae.
3. A method according to claim 1 , wherein a criterion of enabling the distal end of the rod to be passed through the heads of the screws includes possibility of proposing adjustment of a position or orientation of at least one of the vertebrae.
4. A method according to claim 1 , wherein the plan further includes an optional use of osteotomies on selected vertebrae to enable the moderating of bends in the rod.
5. A method according to claim 4 , further comprising selecting at least some of a number, position, and parameters of the osteotomies to reduce a diversity of bend directions in the rod.
6. A method according to claim 1 , wherein the moderating of bends in the rod comprises reducing at least one of an extent and a diversity of direction of the bends.
7. A method according to claim 1 , further comprising the step of providing instructions to a robot control to manipulate is the proximal end of the rod, such that the rod can be inserted robotically.
8. A method according to claim 1 , further comprising the step of providing instructions to manipulate the proximal end of the rod manually using information from X-ray fluoroscopy images to enable defining a position of the rod during insertion.
9. A method according to claim 1 , further comprising using a navigational tracking system adapted to enable determination of the a position and orientation of the proximal end of the rod during insertion.
10. A method according to claim 1 , wherein if the distal end of the rod can be passed through the heads of the screws, the method further comprises determining whether the step of inserting the rod involves motions of the rod within a predetermined threshold of acceptable insertion motion procedures.
11. A method according to claim 1 , further comprising the step of determining maximum lateral forces which the insertion procedure would exert on the subject's tissues.
12. A system for minimally invasive insertion of an intervertebral rod, comprising:
a robot whose position is known relative to a subject's vertebrae; and
a control system adapted to receive information about a position of a head of each of a plurality of rod-clamping screws, each screw to be inserted at a defined position and orientation into a subject's vertebrae according to a preoperative surgical plan, and information about a shape of a rod calculated using the preoperative surgical plan, the calculated shape being such that the rod can pass through the heads of the screws, the control system being further adapted to:
utilize a path planning algorithm to determine whether manipulating a proximal end of the rod having the calculated shape, enables the distal end of the rod to be passed sequentially through the heads of the screws;
when the distal end of the rod can be passed through the heads of the screws, instructing the screws to be inserted in the defined positions and orientations, and instructing the robot to insert the rod by longitudinal manipulation of the rod from its proximal end; and
when the distal end of the rod cannot be passed through the heads of the screws, adjusting at least one of the position and an orientation of at least one of the screws in order to moderate bends in a path through the heads of the screws.
13. A system according to claim 12 , wherein when the distal end of the rod cannot be passed through the heads of the screws, the control system is further adapted to:
adjust the information about the rod shape to include an updated shape based on the adjusted position and orientation of the screws;
use the path planning algorithm to determine whether, with the updated shape, the rod can be passed through the heads of the screws; and
repeat the steps of adjusting at least one of the position and orientation of at least one of the screw, and adjusting the information about the rod shape, until the updated shape enables the robot to insert the rod through the heads of the screws by longitudinal manipulation of a proximal end of the rod.
14. A system according to claim 12 , wherein at least one of the subject's vertebrae incorporates a tower adjustment device to enable adjustment of a position or an orientation of the at least one of the subject's vertebrae, such that the control system also enables the broadening of a range of rod shapes which can be passed through the heads of the one or more screws.
15. A system according to claim 12 , wherein the moderating of bends in the path comprises reducing at least one of an extent and a diversity of direction of the bends.
16. A system according to claim 12 , further comprising a navigational tracking system adapted to enable determination of a position and orientation of the proximal end of the rod during insertion of the rod.
17. A system according to claim 16 , wherein the rod comprises at least one marker attached with a predetermined pose on the proximal end of the rod, the marker being such that its pose can be tracked by the navigational tracking system during insertion of the rod.
18. A system according to claim 12 , wherein the control system is adapted to receive information about a position of the rod during insertion of the rod using X-ray fluoroscopy images.