SPINAL ORIENTATION SYSTEM
The invention involves a system and method for confirming the orientation of the spine around and along the longitudinal axis of the spine to provide additional accuracy with pedicle screw placement when the pedicle screw placement is by hand or with a robot. The system utilizes a CT scan of the patient which is overlain with a real time fluoroscopic image to confirm the proper orientation and positioning. Optical or electromagnetic markers can then be utilized to monitor for movement of the spine during the procedure.
1 . A spinal orientation system for determining the rotational orientation of the spine about and along the longitudinal axis comprising:
a computer, said computer including a processor and sufficient memory to store and display at least one image of a spine, a monitor in electric communication with said computer for display of said at least one image of a spine, a keyboard in electric communication with said computer for input of commands to said computer for display of said at least one image of a spine, a C-arm in electric communication with said computer, said C-arm including an x-ray source positioned at a first end of said C-arm and an x-ray detector positioned at a second end of said C-arm to take a fluoroscopic image of a spine for input of said fluoroscopic image to said computer and display of said fluoroscopic image on said monitor, said computer memory having a stored file including a computer tomography image stored thereon for recall onto the monitor for viewing via said keyboard, said system constructed and arranged so that said computer tomography image can be overlaid onto said fluoroscopic image on said monitor whereby both images are simultaneously viewable, said computer tomography image moveably positionable to align with said fluoroscopic image.
2 . The spinal orientation system of claim 1 wherein said computer tomographic image is aligned with a predetermined plane of said fluoroscopic image.
3 . The spinal orientation system of claim 2 wherein said computer tomographic image is aligned with a sagittal plane of said fluoroscopic image.
4 . The spinal orientation system of claim 1 wherein said computer tomographic image is a magnetic resonance image.
5 . The spinal orientation system of claim 4 wherein said fluoroscopic image is overlaid onto said computer tomographic image.
6 . The spinal orientation system of claim 1 wherein said spinal orientation system further includes an optical monitoring system for monitoring for spinal movement, said optical monitoring system in electrical communication with said computer for providing a visible alert to detected movement on said monitor to indicate to the surgeon that a portion of a spine has rotated or translated with respect to said predetermined or said sagittal plane.
7 . The spinal orientation system of claim 6 wherein said visible alert is a colored indicator.
8 . The spinal orientation system of claim 6 wherein said visible alert is a reference line indicating the area of movement.
9 . The spinal orientation system of claim 6 wherein said optical monitoring system includes at least one optical sensor securable to a bone.
10 . The spinal orientation system of claim 9 wherein said optical monitoring system includes one or more optical monitoring cameras constructed and arranged to monitor movement of said at least one optical sensor.
11 . The spinal orientation system of claim 1 wherein said alignment of said computer tomographic image provides a rotation angle of said fluoroscopic image with respect to said computer tomographic image.
12 . The spinal orientation system of claim 11 wherein said rotation angle adds to or subtracts from about 30 degrees at the T1 level and from about 15 degrees at the T3 level, and from a sagittal angle from T4 downward.
13 . The spinal orientation system of claim 1 wherein said alignment of said computer tomographic image provides a translation distance of said fluoroscopic image with respect to said computer tomographic image for use as a pedicle screw entry point.
14 . The spinal orientation system of claim 13 wherein said entry point is defined as the confluence of any of four reference lines, including the pars interarticularis, the mammillary process, the lateral border of the superior articular facet, and the mid transverse process.
15 . The spinal orientation system of claim 13 wherein said entry point into a lower thoracic segment is generally determined by a mid portion of a facet joint and a superior edge of a transverse process.