EP1482846A1 - Method of viewing and controlling balance of the vertebral column - Google Patents

Method of viewing and controlling balance of the vertebral column

Info

Publication number
EP1482846A1
EP1482846A1 EP03727566A EP03727566A EP1482846A1 EP 1482846 A1 EP1482846 A1 EP 1482846A1 EP 03727566 A EP03727566 A EP 03727566A EP 03727566 A EP03727566 A EP 03727566A EP 1482846 A1 EP1482846 A1 EP 1482846A1
Authority
EP
European Patent Office
Prior art keywords
vli
limit
vertebrae
vls
radiographs
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP03727566A
Other languages
German (de)
French (fr)
Inventor
Guy Viart
Emeric Gallard
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Surgiview SA
Original Assignee
Eurosurgical SA
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Eurosurgical SA filed Critical Eurosurgical SA
Publication of EP1482846A1 publication Critical patent/EP1482846A1/en
Withdrawn legal-status Critical Current

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Classifications

    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T7/00—Image analysis
    • G06T7/0002—Inspection of images, e.g. flaw detection
    • G06T7/0012—Biomedical image inspection
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/63—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for local operation
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16Z—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS, NOT OTHERWISE PROVIDED FOR
    • G16Z99/00—Subject matter not provided for in other main groups of this subclass
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564—Methods for bone or joint treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T2207/00—Indexing scheme for image analysis or image enhancement
    • G06T2207/30—Subject of image; Context of image processing
    • G06T2207/30004—Biomedical image processing
    • G06T2207/30008—Bone

Definitions

  • the present invention relates to a method for viewing and controlling the balance of the spine of a patient.
  • the visualization and control method according to the present invention is more particularly intended for visualizing and controlling the balance of the spine of a patient during an operation relating to a spinal segment corrected by means of known spinal instrumentation in itself.
  • the osteosynthesis instrumentations or materials known to date consist generally of bone anchoring screws, connectors fixed by the screws on the vertebral bodies of each vertebra and connecting rods connecting the connectors together. Sometimes, the connecting rods are deformed by the surgeon to be able to restore the curvatures of the spinal segment to be corrected.
  • the frontal balance of the patient's spine is obtained from the moment when the first thoracic vertebra (T1) is centered relative to the sacrum.
  • T1 first thoracic vertebra
  • the sagittal equilibrium it can be considered that it is obtained from the moment when the external auditory canals are located vertically from the femoral heads.
  • the surgeon's objective is obviously firstly to reduce the curvatures of the spine in the case of a spinal deformation and / or to fix an area which will be called instrumented.
  • the surgeon must ensure that the instrumented area allows the patient to find or regain his balance after the operation, when he adopts the standing position.
  • surgeons therefore seek during the operation to assess a possible balance or imbalance post-operation in the patient.
  • Radiographic means two X-rays face + profile
  • the problem is that the patient is lying on the operating table, and only the vertebrae that will be fused are released by a conventional posterior approach.
  • VLS instrumented limit vertebra
  • VLI lower instrumented limit vertebra
  • VLS first instrumented vertebra
  • VLI last instrumented vertebra
  • the object of the process according to the present invention is to determine the balance of the spine by looking at the two extreme vertebrae of the instrumentation (VLS and VLI).
  • the method according to the present invention makes it possible to see on a control screen the virtual column of the patient in a standing position after operation.
  • VLS and VLI instrumented limit vertebrae
  • the present invention provides a process for visualizing and controlling the balance of the spine, a spinal segment of which is corrected by means of spinal instrumentation known per se, characterized in that it consists:
  • VLS upper
  • VLI lower
  • VLS upper
  • VLI lower
  • the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment is obtained from a first reconstruction in a three-dimensional visual space of the geometry of the 'envelope or external contour of the upper (VLS) and lower (VLI) limit vertebrae and of a second reconstruction in a three-dimensional visual space of the posterior arch surface of the upper (VLS) and lower (VLI) limit vertebrae.
  • the first and second stages of reconstruction in a three-dimensional visual space make it possible to determine, in a three-dimensional visual space, the relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the segment. spinal column corrected.
  • the visualization and control method consists in that the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment are projected onto the front and profile radiographs of the patient. treat.
  • the visualization and control method consists in that the front and profile projection of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment makes it possible to determine the position on the front and profile radiographs of the spinal segments above and below the corrected spinal segment, and to visualize on the front and profile radiographs the appearance of the reconstructed spine.
  • the visualization and control method consists in identifying or digitizing for each vertebra of the spinal column, at least four points delimiting a rectangle reproducing the vertebral body.
  • the visualization and control method consists in identifying or digitizing the points which correspond to the radiological landmarks used, to define the balance of the patient's head relative to the pelvis.
  • the display and control method consists in identifying or digitizing for the head at least ten points making it possible to identify the external contour of the head.
  • the display and control method consists in identifying or digitizing for the pelvis at least the anatomical points defining the center of each femoral head and the sacred plateau.
  • the display and control method consists in identifying or digitizing for the pelvis, at least five points, one of which for the femoral head and at least three for the sacrum, in order to form a triangle.
  • the display and control method consists in embedding digital points on the patient's radiographs.
  • the visualization and control method consists, from sagittal and frontal radiographs of the patient, in reconstructing in three dimensions the geometric shape of the upper (VLS) and lower (VLI) limit vertebrae.
  • the visualization and control method consists in determining the linear and angular geometric position of the lower limit vertebra (VLI), reconstructed with respect to the front and profile radiographs.
  • the visualization and control method consists in projecting the upper limit (VLS) and lower limit (VLI) vertebrae on the front and profile radiographs.
  • the visualization and control method consists in embedding in radiographs, the projection of the upper (VLS) and lower (VLI) limit vertebrae relative to each other, by performing a registration of the projection of the lower limit vertebra (VLI).
  • Figure 1 shows a sagittal x-ray of a standing patient, on which anatomical points are digitized to identify the pelvis and the femoral heads.
  • FIG. 2 illustrates a sagittal radiography of a patient standing in cervical flexion, on which anatomical points are digitized to identify the head, the vertebrae overlying the instrumentation and the instrumented upper limit vertebra (VLS).
  • VLS instrumented upper limit vertebra
  • Figure 3 shows a sagittal radiograph of a standing patient in cervical extension, on which anatomical points are digitized to identify the head, the vertebrae overlying the instrumentation and the instrumented upper limit vertebra (VLS).
  • FIG. 4 represents a sagittal radiography of a patient seated in lumbar flexion, on which anatomical points are digitized to identify the pelvis, the vertebrae underlying the instrumentation and the instrumented lower limit vertebra (VLI).
  • VLI instrumented lower limit vertebra
  • FIG. 5 represents a sagittal radiography of a patient seated in lumbar extension, on which anatomical points are digitized to identify the pelvis, the vertebrae underlying the instrumentation and the instrumented lower limit vertebra (VLI).
  • VLI instrumented lower limit vertebra
  • Figure 6 illustrates a frontal x-ray of a standing patient, on which anatomical points are digitized to identify the pelvis and the femoral heads.
  • Figure 7 shows a frontal x-ray of a patient lying in a lateral inflection to the left, on which anatomical points are digitized to identify the head, the vertebrae above and below the instrumentation, the upper limit (VLS) and lower vertebrae (VLI) instrumented, pelvis and femoral heads.
  • VLS upper limit
  • VLI lower vertebrae
  • FIG. 8 represents a frontal X-ray of a patient lying in lateral inflexion on the right, on which anatomical points are digitized to identify the head, the vertebrae above and below the instrumentation, the upper limit (VLS) and lower vertebrae (VLI) instrumented, pelvis and femoral heads.
  • VLS upper limit
  • VLI lower vertebrae
  • FIG. 9 illustrates the radiography of FIG. 1 in which the digitalized anatomical points have been embedded in the radiographs of FIGS. 4 and 5, this after matching the scales and adjustment relative to the pelvis.
  • FIG. 10 shows the radiograph of FIG. 6 in which the anatomical points digitized in the radiographs of FIGS. 7 and 8 have been embedded (only those representing the pelvis, the vertebrae underlying the instrumentation, and the lower limit vertebra ( VLI) (instrumented), this after matching scales and adjusting to the pelvis.
  • VLI lower limit vertebra
  • FIG. 11 illustrates the radiography of FIG. 9 in which the projection of the upper (VLS) and lower (VLI) limit vertebrae has been embedded by performing a registration of the instrumented lower limit vertebra (VLI).
  • FIG. 12 shows the radiography of FIG. 10 in which the projection of the upper (VLS) and lower (VLI) limit vertebrae has been embedded by performing a registration of the instrumented lower limit vertebra (VLI).
  • FIG. 13 represents the radiography of FIG. 11 in which the digitalized points have been embedded on the radiography of FIGS. 2 and 3 (head, overlying vertebrae and instrumented upper limit vertebrae (VLS)), by performing a registration of the limit vertebra instrumented upper (VLS).
  • FIG. 14 illustrates the radiography of FIG. 12 in which the digitized points have been embedded on the radiography of FIGS. 7 and 8 (head, overlying vertebrae and instrumented upper limit vertebrae (VLS)), by performing a registration of the limit vertebra instrumented upper (VLS).
  • the first step of the process consists in identifying or digitizing anatomical points or contours on the radiographs of the patient to be treated. So for each vertebra 2 of the spine 1, it is necessary to identify at least four points. The latter delimit a rectangle reproducing the vertebral body. For head 3, it is necessary to identify the anatomical points which usually correspond to the radiological landmarks used to define the balance of the patient's head 3 in relation to his pelvis 4.
  • the head 3 it may be necessary to identify, but not limited to, at least ten points which make it possible to identify the external contour of the head.
  • the second step of the process consists of embedding the digital points on the radiographs of Figures 4 and 5 in the radiography of Figure 1.
  • the digital points are encrusted on the radiographs of FIGS. 7 and 8 in the radiography of FIG. 6.
  • the digital points or contours relate more particularly to those representing the pelvis 4, the vertebrae 2 underlying the instrumentation, and the lower limit vertebra (VLI) instrumented. Provision is made in this step of the method for the scales to be matched and for the points or contour to be adjusted or readjusted relative to the basin 4 (FIG. 10).
  • This step consists, from the sagittal ( Figure 1) and frontal radiographs ( Figure 6), in a three-dimensional reconstruction of the geometric shape of the vertebrae 2 and more particularly of the instrumented limit vertebrae, namely:
  • VLS the upper limit vertebra
  • This step also consists in determining the linear and angular geometrical position of the reconstructed lower limit vertebra (VLI) with respect to the front and profile radiographs (positioning of the patient relative to the films (Rx) when taking radiographic images).
  • VLS upper limit vertebra
  • VLI upper limit vertebra
  • a two-dimensional coordinate system is associated with the projection of the geometric shape of the upper limit vertebra (VLI) on the profile radiography ( Figure 1).
  • a two-dimensional coordinate system is associated with the projection of the geometric shape of the upper limit vertebra (VLI) on the face radiography ( Figure 6).
  • This stage consists in reconstructing in a three-dimensional visual space the geometry of the envelope or the external contour of the upper (VLS) and lower (VLI) limit vertebrae.
  • a second reconstruction is planned in a three-dimensional visual space of the posterior arch surface of the upper (VLS) and lower (VLI) limit vertebrae.
  • This step consists in projecting the upper (VLS) and lower (VLI) limit vertebrae on the front and profile radiographs thanks to the relationships established between the three-dimensional and two-dimensional landmarks defined during the third step.
  • This step also consists in embedding in the radiographs of FIGS. 9 and 10 the projection of the upper (VLS) and lower (VLI) limit vertebrae relative to one another by performing a registration of the projection of the lower limit vertebra ( VLI) on the two positions occupied by this vertebra in the radiographs of Figures 9 and 10.
  • FIG. 11 and 12 illustrate this step.
  • This step consists of embedding in the radiography of FIG. 11 the points or contours digitized on the radiographs of FIGS. 2 and 3 by adjusting the scale between the radiographs and performing a registration with respect to the limit vertebra. higher (VLS).
  • VLS limit vertebra
  • FIG. 13 and 14 illustrate this step.
  • VLS upper
  • VLI lower
  • the latter can be, for example, carried out using a three-dimensional transmitter / sensor provided with a feeler pen allowing reconstruction in a three-dimensional visual space of the external contour and of the surface. of the posterior arch of the upper (VLS) and lower (VLI) limit vertebrae.
  • This implementation is carried out from an image processing system to allow the visualization of the results and the relative position in front and profile projection of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the segment. spinal correction through spinal instrumentation.

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Abstract

The invention relates to a method of viewing and controlling the balance of a vertebral column of which one spinal segment is corrected by means of conventional spinal instrumentation. The inventive method consists in: determining and calculating the relative three-dimensional position of the upper (UEV) and lower (LEV) end instrumented vertebrae of the corrected spinal segment; determining and calculating the position of the spinal segments which are located above and below the spinal segment corrected by the spinal instrumentation, according to the relative three-dimensional position of the upper (UEV) and lower (LEV) end instrumented vertebrae; and viewing the front and side projection of the balance or imbalance of the vertebral column.

Description

PROCEDE DE VISUALISATION ET DE VISUALIZATION AND
CONTROLE DE L'EQUILIBRE D'UNECONTROL OF THE BALANCE OF A
COLONNE VERTEBRALESPINE
La présente invention est relative à un procédé de visualisation et de contrôle de l'équilibre de la colonne vertébrale d'un patient. Le procédé de visualisation et de contrôle suivant la présente invention est plus particulièrement destiné à la visualisation et au contrôle de l'équilibre de la colonne vertébrale d'un patient pendant une opération portant sur un segment rachidien corrigé au moyen d'une instrumentation rachidienne connue en soi. Les instrumentations ou matériels d'ostéosynthèse connus à ce jour sont généralement constitués de vis d'ancrage osseux, de connecteurs fixés par les -vis sur les corps vertébraux de chaque vertèbre et de tiges de liaison reliant les connecteurs entre eux. Parfois, les tiges de liaison sont déformées par le chirurgien pour pouvoir rétablir les courbures du segment rachidien à corriger.The present invention relates to a method for viewing and controlling the balance of the spine of a patient. The visualization and control method according to the present invention is more particularly intended for visualizing and controlling the balance of the spine of a patient during an operation relating to a spinal segment corrected by means of known spinal instrumentation in itself. The osteosynthesis instrumentations or materials known to date consist generally of bone anchoring screws, connectors fixed by the screws on the vertebral bodies of each vertebra and connecting rods connecting the connectors together. Sometimes, the connecting rods are deformed by the surgeon to be able to restore the curvatures of the spinal segment to be corrected.
La notion d'équilibre de la colonne vertébrale est assez complexe et est caractérisée par différents paramètres suivant les approches cliniques.The notion of balance in the spine is quite complex and is characterized by different parameters depending on clinical approaches.
La plupart du temps les chirurgiens évaluent l'équilibre rachidien à la fois cliniquement et par prises de vues radiologiques.Most of the time surgeons assess the spinal balance both clinically and by radiological images.
Dans ce dernier cas, deux clichés radiographiques de grande taille (30cm x 90cm) sont effectués, l'un permettant de visualiser le profil de la colonne vertébrale du patient et l'autre la face.In the latter case, two large radiographic images (30cm x 90cm) are taken, one showing the profile of the patient's spine and the other showing the face.
Globalement, on considère que l'équilibre frontal de la colonne vertébrale du patient est obtenu à partir du moment où la première vertèbre thoracique (T1 ) est centrée par rapport au sacrum. Quant à l'équilibre sagittal, on peut considérer qu'il est obtenu à partir du moment où les conduits auditifs externes se situent à la verticale des têtes fémorales.Overall, it is considered that the frontal balance of the patient's spine is obtained from the moment when the first thoracic vertebra (T1) is centered relative to the sacrum. As for the sagittal equilibrium, it can be considered that it is obtained from the moment when the external auditory canals are located vertically from the femoral heads.
Lorsque l'intervention chirurgicale sur la colonne vertébrale est nécessaire, le simple fait de fusionner des vertèbres entre-elles par l'intermédiaire d'une instrumentation peut engendrer chez le patient des troubles de l'équilibre postopératoires.When surgical intervention on the spine is necessary, the simple fact of fusing vertebrae between them by means of instrumentation can cause postoperative balance disorders in the patient.
L'objectif du chirurgien est bien évidemment dans un premier temps de réduire les courbures du rachis dans le cas d'une déformation rachidienne et/ou de fixer une zone qui sera dite instrumentée. Dans un deuxième temps, le chirurgien doit faire en sorte que la zone instrumentée permette au patient de trouver ou retrouver son équilibre après l'opération, lorsque qu'il adoptera la position debout.The surgeon's objective is obviously firstly to reduce the curvatures of the spine in the case of a spinal deformation and / or to fix an area which will be called instrumented. In a second step, the surgeon must ensure that the instrumented area allows the patient to find or regain his balance after the operation, when he adopts the standing position.
Les chirurgiens cherchent donc pendant l'opération à évaluer un éventuel équilibre ou déséquilibre post-opératoire chez le patient.The surgeons therefore seek during the operation to assess a possible balance or imbalance post-operation in the patient.
Actuellement, les chirurgiens ne disposent pas de systèmes leur permettant de savoir si le niveau instrumenté va permettre l'équilibre post-opératoire du patient.Currently, surgeons do not have systems allowing them to know if the instrumented level will allow the post-operative balance of the patient.
Les chirurgiens recourent donc à la seule appréciation visuelle du segment instrumenté dans le champ opératoire. Certains utilisent un moyen radiographique (deux clichés Rx face + profil) leur permettant de visualiser de façon plus " large " la colonne vertébrale (des têtes fémorales jusqu'aux vertèbres cervicales).Surgeons therefore resort only to visual assessment of the instrumented segment in the operating field. Some use radiographic means (two X-rays face + profile) allowing them to visualize the spine in a "wider" way (from the femoral heads to the cervical vertebrae).
Les chirurgiens peuvent alors apprécier non seulement le segment instrumenté mais également les segments sus et sous-jacents à l'instrumentation, et ce dans les plans frontaux et sagittaux. Malheureusement, ces radiographies sont effectuées sur le patient en position couchée, sur la table d'opération, et par conséquent ne peuvent prédire de façon systématique le comportement de la colonne vertébrale opérée lorsque le patient retrouvera la position debout post-opératoire.Surgeons can then assess not only the instrumented segment but also the segments above and below the instrumentation, in the frontal and sagittal planes. Unfortunately, these x-rays are taken on the patient in the supine position on the operating table, and therefore cannot systematically predict the behavior of the operated spine when the patient returns to the postoperative standing position.
Le problème consiste en ce que le patient est allongé sur la table d'opération, et seules les vertèbres qui seront fusionnées sont dégagées par une voie d'abord classique postérieure.The problem is that the patient is lying on the operating table, and only the vertebrae that will be fused are released by a conventional posterior approach.
Le chirurgien instrumente ces vertèbres, les fusionne mais ne peut apprécier la conséquence de cet acte chirurgical sur les segments sus et sous jacents qui bien évidemment s'adaptent à la nouvelle géométrie que le chirurgien donne au segment qu'il instrumente.The surgeon instruments these vertebrae, fuses them but cannot appreciate the consequence of this surgical act on the above and underlying segments which obviously adapt to the new geometry that the surgeon gives to the segment which he instruments.
On constate que dans chaque instrumentation, il existe une vertèbre limite instrumentée supérieure (VLS) et une vertèbre limite instrumentée inférieure (VLI) qui sont respectivement liées naturellement aux vertèbres de la colonne vertébrale non instrumentée, qui se trouvent au dessus et au dessous de l'instrumentation.It can be seen that in each instrumentation, there is an upper instrumented limit vertebra (VLS) and a lower instrumented limit vertebra (VLI) which are respectively naturally linked to the vertebrae of the non-instrumented spine, which are above and below the 'instrumentation.
C'est l'orientation du plateau supérieur de la première vertèbre instrumentée (VLS) par rapport au plateau inférieur de la dernière vertèbre instrumentée (VLI) qui va définir le comportement d'adaptation du segment sus-jacent et du segment sous-jacent. C'est par conséquent la position relative des deux vertèbres limites instrumentées qui va conditionner la géométrie des segments sus et sous-jacent. Le segment instrumenté se transforme en une grande vertèbre dont les "frontières" détermineront le comportement d'adaptation des segments sus et sous-jacents et donc conditionneront l'équilibre ou le déséquilibre post-opératoire du patient en position debout.It is the orientation of the upper plateau of the first instrumented vertebra (VLS) relative to the lower plateau of the last instrumented vertebra (VLI) which will define the adaptation behavior of the overlying segment and the underlying segment. It is therefore the relative position of the two instrumented limit vertebrae that will condition the geometry of the above and underlying segments. The instrumented segment is transformed into a large vertebra whose "borders" will determine the adaptive behavior of the above and underlying segments and therefore will condition the patient's post-operative balance or imbalance when standing.
Le procédé suivant la présente invention a pour objet de déterminer l'équilibre de la colonne vertébrale en s'intéressant aux deux vertèbres extrêmes de l'instrumentation (VLS et VLI).The object of the process according to the present invention is to determine the balance of the spine by looking at the two extreme vertebrae of the instrumentation (VLS and VLI).
Le procédé suivant la présente invention permet de voir sur un écran de contrôle la colonne virtuelle du patient en position debout après opération.The method according to the present invention makes it possible to see on a control screen the virtual column of the patient in a standing position after operation.
Pour cela, il faut effectuer des mesures sur les vertèbres limites instrumentées (VLS et VLI).For this, measurements must be made on the instrumented limit vertebrae (VLS and VLI).
Les mesures effectuées uniquement sur ces vertèbres permettront de limiter le temps de mesure, toujours trop long dans ces opérations souvent fastidieuses.Measurements made only on these vertebrae will limit the measurement time, which is always too long in these often tedious operations.
A partir des mesures effectuées sur les vertèbres limites instrumentées, des algorithmes de calcul permettent de projeter sur les radiographies préopératoires du patient les possibilités d'équilibre du patient debout en post-opératoire.From the measurements carried out on the instrumented limit vertebrae, calculation algorithms make it possible to project onto the patient's preoperative radiographs the possibilities of equilibrium of the patient standing in postoperative.
Ainsi, la présente invention prévoit un procédé de visualisation et de contrôle de l'équilibre de la colonne vertébrale dont un segment rachidien est corrigé par l'intermédiaire d'une instrumentation rachidienne connue en soi, caractérisé en ce qu'il consiste :Thus, the present invention provides a process for visualizing and controlling the balance of the spine, a spinal segment of which is corrected by means of spinal instrumentation known per se, characterized in that it consists:
- à déterminer et calculer la position relative tridimensionnelle des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé par l'intermédiaire de points ou contours anatomiques identifiés ou digitalisés sur les radiographies du patient à traiter,- to determine and calculate the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the spinal segment corrected by means of anatomical points or contours identified or digitized on the radiographs of the patient to be treated,
- à déterminer et calculer en fonction de la position relative tridimensionnelle des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI), la position des segments rachidiens se trouvant au dessus et au dessous du segment rachidien corrigé par l'instrumentation rachidienne, par l'intermédiaire de points ou contours anatomiques identifiés ou digitalisés sur les radiographies du patient à traiter,- to determine and calculate as a function of the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae, the position of the spinal segments located above and below the spinal segment corrected by the spinal instrumentation, by l '' of anatomical points or contours identified or digitized on the radiographs of the patient to be treated,
- et à visualiser l'équilibre ou le déséquilibre de la colonne vertébrale (1 ) en position verticale et en projection de face et de profil.- and to visualize the balance or imbalance of the spine (1) in a vertical position and in front and profile projection.
Selon un mode de réalisation de la présente invention, la position relative tridimensionnelle des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé est obtenue à partir d'une première reconstruction dans un espace visuel tridimensionnel de la géométrie de l'enveloppe ou le contour externe des vertèbres limites supérieures (VLS) et inférieures (VLI) et d'une seconde reconstruction dans un espace visuel tridimensionnel de la surface de l'arc postérieur des vertèbres limites supérieures (VLS) et inférieures (VLI). Selon un mode de réalisation de la présente invention, les premières et secondes étapes de reconstruction dans un espace visuel tridimensionnel permettent de déterminer, dans un espace visuel tridimensionnel, la position relative des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé.According to an embodiment of the present invention, the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment is obtained from a first reconstruction in a three-dimensional visual space of the geometry of the 'envelope or external contour of the upper (VLS) and lower (VLI) limit vertebrae and of a second reconstruction in a three-dimensional visual space of the posterior arch surface of the upper (VLS) and lower (VLI) limit vertebrae. According to an embodiment of the present invention, the first and second stages of reconstruction in a three-dimensional visual space make it possible to determine, in a three-dimensional visual space, the relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the segment. spinal column corrected.
Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste en ce que les vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé sont projetées sur les radiographies de face et de profil du patient à traiter.According to one embodiment of the present invention, the visualization and control method consists in that the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment are projected onto the front and profile radiographs of the patient. treat.
Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste en ce que la projection de face et de profil des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé permet de déterminer la position sur les radiographies de face et de profil des segments rachidiens se trouvant au dessus et au dessous du segment rachidien corrigé, et de visualiser sur les radiographies de face et de profil l'allure de la colonne vertébrale reconstituée. Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à identifier ou digitaliser pour chaque vertèbre de la colonne vertébrale, au moins quatre points délimitant un rectangle reproduisant le corps vertébral. Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à identifier ou digitaliser les points qui correspondent aux repères radiologiques utilisés, pour définir l'équilibre de la tête du patient par rapport au bassin. Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à identifier ou digitaliser pour la tête au moins, dix points permettant de repérer le contour externe de la tête.According to an embodiment of the present invention, the visualization and control method consists in that the front and profile projection of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment makes it possible to determine the position on the front and profile radiographs of the spinal segments above and below the corrected spinal segment, and to visualize on the front and profile radiographs the appearance of the reconstructed spine. According to an embodiment of the present invention, the visualization and control method consists in identifying or digitizing for each vertebra of the spinal column, at least four points delimiting a rectangle reproducing the vertebral body. According to an embodiment of the present invention, the visualization and control method consists in identifying or digitizing the points which correspond to the radiological landmarks used, to define the balance of the patient's head relative to the pelvis. According to an embodiment of the present invention, the display and control method consists in identifying or digitizing for the head at least ten points making it possible to identify the external contour of the head.
Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à identifier ou digitaliser pour le bassin au moins les points anatomiques définissant le centre de chaque tête fémorale et le plateau sacré.According to an embodiment of the present invention, the display and control method consists in identifying or digitizing for the pelvis at least the anatomical points defining the center of each femoral head and the sacred plateau.
Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à identifier ou digitaliser pour le bassin, au moins cinq points dont un pour la tête fémorale et au moins trois pour le sacrum, afin de former un triangle.According to an embodiment of the present invention, the display and control method consists in identifying or digitizing for the pelvis, at least five points, one of which for the femoral head and at least three for the sacrum, in order to form a triangle.
Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à incruster des points digitalisés sur les radiographies du patient. Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste, à partir des radiographies sagittales et frontales du patient, à reconstruire en trois dimensions la forme géométrique des vertèbres limites supérieures (VLS) et inférieures (VLI).According to an embodiment of the present invention, the display and control method consists in embedding digital points on the patient's radiographs. According to an embodiment of the present invention, the visualization and control method consists, from sagittal and frontal radiographs of the patient, in reconstructing in three dimensions the geometric shape of the upper (VLS) and lower (VLI) limit vertebrae.
Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à déterminer la position géométrique linéaire et angulaire de la vertèbre limite inférieure (VLI), reconstruite par rapport aux radiographies de face et de profil.According to an embodiment of the present invention, the visualization and control method consists in determining the linear and angular geometric position of the lower limit vertebra (VLI), reconstructed with respect to the front and profile radiographs.
Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à projeter les vertèbres limites supérieures (VLS) et inférieures (VLI) sur les radiographies de face et de profil. Selon un mode de réalisation de la présente invention, le procédé de visualisation et de contrôle consiste à incruster dans les radiographies, la projection des vertèbres limites supérieures (VLS) et inférieures (VLI) l'une par rapport à l'autre, en effectuant un recalage de la projection de la vertèbre limite inférieure (VLI). Les caractéristiques et avantages de la présente invention seront exposés en détail dans la description suivant des modes de réalisation particuliers faits à titre non limitatif en relation avec les figures annexées.According to an embodiment of the present invention, the visualization and control method consists in projecting the upper limit (VLS) and lower limit (VLI) vertebrae on the front and profile radiographs. According to an embodiment of the present invention, the visualization and control method consists in embedding in radiographs, the projection of the upper (VLS) and lower (VLI) limit vertebrae relative to each other, by performing a registration of the projection of the lower limit vertebra (VLI). The characteristics and advantages of the present invention will be explained in detail in the following description of particular embodiments made without implied limitation in relation to the appended figures.
La figure 1 représente une radiographie sagittale d'un patient debout, sur laquelle des points anatomiques sont digitalisés pour identifier le bassin et les têtes fémorales.Figure 1 shows a sagittal x-ray of a standing patient, on which anatomical points are digitized to identify the pelvis and the femoral heads.
La figure 2 illustre une radiographie sagittale d'un patient debout en flexion cervicale, sur laquelle des points anatomiques sont digitalisés pour identifier la tête, les vertèbres sus jacentes à l'instrumentation et la vertèbre limite supérieure instrumentée (VLS).FIG. 2 illustrates a sagittal radiography of a patient standing in cervical flexion, on which anatomical points are digitized to identify the head, the vertebrae overlying the instrumentation and the instrumented upper limit vertebra (VLS).
La figure 3 montre une radiographie sagittale d'un patient debout en extension cervicale, sur laquelle des points anatomiques sont digitalisés pour identifier la tête, les vertèbres sus jacentes à l'instrumentation et la vertèbre limite supérieure instrumentée (VLS).Figure 3 shows a sagittal radiograph of a standing patient in cervical extension, on which anatomical points are digitized to identify the head, the vertebrae overlying the instrumentation and the instrumented upper limit vertebra (VLS).
La figure 4 représente une radiographie sagittale d'un patient assis en flexion lombaire, sur laquelle des points anatomiques sont digitalisés pour identifier le bassin, les vertèbres sous jacentes à l'instrumentation et la vertèbre limite inférieure (VLI) instrumentée.FIG. 4 represents a sagittal radiography of a patient seated in lumbar flexion, on which anatomical points are digitized to identify the pelvis, the vertebrae underlying the instrumentation and the instrumented lower limit vertebra (VLI).
La figure 5 représente une radiographie sagittale d'un patient assis en extension lombaire, sur laquelle des points anatomiques sont digitalisés pour identifier le bassin, les vertèbres sous jacentes à l'instrumentation et la vertèbre limite inférieure (VLI) instrumentée.FIG. 5 represents a sagittal radiography of a patient seated in lumbar extension, on which anatomical points are digitized to identify the pelvis, the vertebrae underlying the instrumentation and the instrumented lower limit vertebra (VLI).
La figure 6 illustre une radiographie frontale d'un patient debout, sur laquelle des points anatomiques sont digitalisés pour identifier le bassin et les têtes fémorales. La figure 7 montre une radiographie frontale d'un patient couché en inflexion latérale à gauche, sur laquelle des points anatomiques sont digitalisés pour identifier la tête, les vertèbres sus et sous jacentes à l'instrumentation, les vertèbres limites supérieures (VLS) et inférieures (VLI) instrumentées, le bassin et les têtes fémorales.Figure 6 illustrates a frontal x-ray of a standing patient, on which anatomical points are digitized to identify the pelvis and the femoral heads. Figure 7 shows a frontal x-ray of a patient lying in a lateral inflection to the left, on which anatomical points are digitized to identify the head, the vertebrae above and below the instrumentation, the upper limit (VLS) and lower vertebrae (VLI) instrumented, pelvis and femoral heads.
La figure 8 représente une radiographie frontale d'un patient couché en inflexion latérale à droite, sur laquelle des points anatomiques sont digitalisés pour identifier la tête, les vertèbres sus et sous jacentes à l'instrumentation, les vertèbres limites supérieures (VLS) et inférieures (VLI) instrumentées, le bassin et les têtes fémorales.FIG. 8 represents a frontal X-ray of a patient lying in lateral inflexion on the right, on which anatomical points are digitized to identify the head, the vertebrae above and below the instrumentation, the upper limit (VLS) and lower vertebrae (VLI) instrumented, pelvis and femoral heads.
La figure 9 illustre la radiographie de la figure 1 dans laquelle ont été incrustés les points anatomiques digitalisés dans les radiographies des figures 4 et 5, ceci après mise en correspondance des échelles et ajustement par rapport au bassin.FIG. 9 illustrates the radiography of FIG. 1 in which the digitalized anatomical points have been embedded in the radiographs of FIGS. 4 and 5, this after matching the scales and adjustment relative to the pelvis.
La figure 10 montre la radiographie de la figure 6 dans laquelle ont été incrustés les points anatomiques digitalisés dans les radiographies des figures 7 et 8, (uniquement ceux représentant le bassin, les vertèbres sous jacentes à l'instrumentation, et la vertèbre limite inférieure (VLI) instrumentée), ceci après mise en correspondance des échelles et ajustement par rapport au bassin.FIG. 10 shows the radiograph of FIG. 6 in which the anatomical points digitized in the radiographs of FIGS. 7 and 8 have been embedded (only those representing the pelvis, the vertebrae underlying the instrumentation, and the lower limit vertebra ( VLI) (instrumented), this after matching scales and adjusting to the pelvis.
La figure 11 illustre la radiographie de la figure 9 dans laquelle a été incrustée la projection des vertèbres limites supérieures (VLS) et inférieures (VLI) en effectuant un recalage de la vertèbre limite inférieure (VLI) instrumentée.FIG. 11 illustrates the radiography of FIG. 9 in which the projection of the upper (VLS) and lower (VLI) limit vertebrae has been embedded by performing a registration of the instrumented lower limit vertebra (VLI).
La figure 12 montre la radiographie de la figure 10 dans laquelle a été incrustée la projection des vertèbres limites supérieures (VLS) et inférieures (VLI) en effectuant un recalage de la vertèbre limite inférieure (VLI) instrumentée.FIG. 12 shows the radiography of FIG. 10 in which the projection of the upper (VLS) and lower (VLI) limit vertebrae has been embedded by performing a registration of the instrumented lower limit vertebra (VLI).
La figure 13 représente la radiographie de la figure 11 dans laquelle ont été incrustés les points digitalisés sur la radiographie des figures 2 et 3 (tête, vertèbres sus jacentes et vertèbres limites supérieures (VLS) instrumentées), en effectuant un recalage de la vertèbre limite supérieure (VLS) instrumentée.FIG. 13 represents the radiography of FIG. 11 in which the digitalized points have been embedded on the radiography of FIGS. 2 and 3 (head, overlying vertebrae and instrumented upper limit vertebrae (VLS)), by performing a registration of the limit vertebra instrumented upper (VLS).
La figure 14 illustre la radiographie de la figure 12 dans laquelle ont été incrustés les points digitalisés sur la radiographie des figures 7 et 8 (tête, vertèbres sus jacentes et vertèbres limites supérieures (VLS) instrumentées), en effectuant un recalage de la vertèbre limite supérieure (VLS) instrumentée.FIG. 14 illustrates the radiography of FIG. 12 in which the digitized points have been embedded on the radiography of FIGS. 7 and 8 (head, overlying vertebrae and instrumented upper limit vertebrae (VLS)), by performing a registration of the limit vertebra instrumented upper (VLS).
* PREMIERE ETAPE DU PROCEDE La première étape du procédé consiste à identifier ou digitaliser des points ou contours anatomiques sur les radiographies du patient à traiter. Ainsi pour chaque vertèbre 2 de la colonne vertébrale 1 , il est nécessaire d'identifier au moins quatre points. Ces derniers délimitent un rectangle reproduisant le corps vertébral. Pour la tête 3, il est nécessaire d'identifier les points anatomiques qui correspondent habituellement aux repères radiologiques utilisés pour définir l'équilibre de la tête 3 du patient par rapport à son bassin 4.* FIRST STEP OF THE PROCESS The first step of the process consists in identifying or digitizing anatomical points or contours on the radiographs of the patient to be treated. So for each vertebra 2 of the spine 1, it is necessary to identify at least four points. The latter delimit a rectangle reproducing the vertebral body. For head 3, it is necessary to identify the anatomical points which usually correspond to the radiological landmarks used to define the balance of the patient's head 3 in relation to his pelvis 4.
Pour la tête 3, il peut être nécessaire d'identifier, mais de manière non limitative, au moins dix points qui permettent de repérer le contour externe de la tête.For the head 3, it may be necessary to identify, but not limited to, at least ten points which make it possible to identify the external contour of the head.
Pour le bassin 4, il est nécessaire d'identifier au moins les points anatomiques définissant le centre de chaque tête fémorale 5 et le sacrum 6. Pour le bassin 4, il est nécessaire d'identifier au moins cinq points dont un par tête fémorale 5 et au moins trois pour le sacrum 6 afin de former un triangle.For the pelvis 4, it is necessary to identify at least the anatomical points defining the center of each femoral head 5 and the sacrum 6. For the pelvis 4, it is necessary to identify at least five points, one of which per femoral head 5 and at least three for sacrum 6 to form a triangle.
On note que les coordonnées en deux dimensions (x, y) de chaque point sont connues dans le repère lié à la radiographie numérisée.It is noted that the coordinates in two dimensions (x, y) of each point are known in the coordinate system linked to the digitized radiography.
Cette première étape est illustrée sur chacune des figures 1 à 8.This first step is illustrated in each of Figures 1 to 8.
* DEUXIEME ETAPE DU PROCEDE La seconde étape du procédé consiste à incruster les points digitalisés sur les radiographies des figures 4 et 5 dans la radiographie de la figure 1.* SECOND STEP OF THE PROCESS The second step of the process consists of embedding the digital points on the radiographs of Figures 4 and 5 in the radiography of Figure 1.
Lors de cette incrustation des points ou contours digitalisés, il est nécessaire d'ajuster l'échelle entre les radiographies et de superposer les points définissant le bassin 4 par recalage (figure 9).During this encryption of the digital points or contours, it is necessary to adjust the scale between the radiographs and to superimpose the points defining the pelvis 4 by registration (Figure 9).
Egalement, il est procédé à l'incrustation des points digitalisés sur les radiographies des figures 7 et 8 dans la radiographie de la figure 6. Les points ou contours digitalisés concernent plus particulièrement ceux représentant le bassin 4, les vertèbres 2 sous jacentes à l'instrumentation, et la vertèbre limite inférieure (VLI) instrumentée. Il est prévu dans cette étape du procédé une mise en correspondance des échelles et un ajustement ou recalage des points ou contour par rapport au bassin 4 (figure 10).Also, the digital points are encrusted on the radiographs of FIGS. 7 and 8 in the radiography of FIG. 6. The digital points or contours relate more particularly to those representing the pelvis 4, the vertebrae 2 underlying the instrumentation, and the lower limit vertebra (VLI) instrumented. Provision is made in this step of the method for the scales to be matched and for the points or contour to be adjusted or readjusted relative to the basin 4 (FIG. 10).
TROISIEME ETAPE DU PROCEDETHIRD STEP OF THE PROCESS
Cette étape consiste, à partir des radiographies sagittales (figure 1 ) et frontales (figure 6), en une reconstruction en trois dimensions de la forme géométrique des vertèbres 2 et plus particulièrement des vertèbres limites instrumentées à savoir :This step consists, from the sagittal (Figure 1) and frontal radiographs (Figure 6), in a three-dimensional reconstruction of the geometric shape of the vertebrae 2 and more particularly of the instrumented limit vertebrae, namely:
- la vertèbre limite supérieure (VLS),- the upper limit vertebra (VLS),
- et la vertèbre limite inférieure(VLI). Cette étape consiste également à déterminer la position géométrique linéaire et angulaire de la vertèbre limite inférieure (VLI) reconstruite par rapport aux radiographies de face et de profil (positionnement du patient par rapport aux films (Rx) lors de la prise des clichés radiographiques).- and the lower limit vertebra (VLI). This step also consists in determining the linear and angular geometrical position of the reconstructed lower limit vertebra (VLI) with respect to the front and profile radiographs (positioning of the patient relative to the films (Rx) when taking radiographic images).
Lors de cette étape il est nécessaire de matérialiser des repères géométriques à savoir :During this step it is necessary to materialize geometric markers, namely:
- un repère trois dimensions est associé à la géométrie trois dimensions de la vertèbre limite supérieure (VLS).- a three-dimensional coordinate system is associated with the three-dimensional geometry of the upper limit vertebra (VLS).
- un repère trois dimensions est associé à la géométrie trois dimensions de la vertèbre limite supérieure (VLI).- a three-dimensional coordinate system is associated with the three-dimensional geometry of the upper limit vertebra (VLI).
- un repère deux dimensions est associé à la projection de la forme géométrique de la vertèbre limite supérieure (VLI) sur la radiographie de profil (figure 1 ). - un repère deux dimensions est associé à la projection de la forme géométrique de la vertèbre limite supérieure (VLI) sur la radiographie de face (figure 6).- a two-dimensional coordinate system is associated with the projection of the geometric shape of the upper limit vertebra (VLI) on the profile radiography (Figure 1). - a two-dimensional coordinate system is associated with the projection of the geometric shape of the upper limit vertebra (VLI) on the face radiography (Figure 6).
* QUATRIEME ETAPE DU PROCEDE Cette étape consiste à reconstruire dans un espace visuel tridimensionnel la géométrie de l'enveloppe ou le contour externe des vertèbres limites supérieures (VLS) et inférieures (VLI).* FOURTH STAGE OF THE PROCESS This stage consists in reconstructing in a three-dimensional visual space the geometry of the envelope or the external contour of the upper (VLS) and lower (VLI) limit vertebrae.
Lors de cette étape, il est prévu une seconde reconstruction dans un espace visuel tridimensionnel de la surface de l'arc postérieur des vertèbres limites supérieures (VLS) et inférieures (VLI).During this step, a second reconstruction is planned in a three-dimensional visual space of the posterior arch surface of the upper (VLS) and lower (VLI) limit vertebrae.
* CINQUIEME ETAPE DU PROCEDE Cette étape consiste à projeter les vertèbres limites supérieures (VLS) et inférieures (VLI) sur les radiographies de face et de profil grâce aux relations établies entre les repères trois dimensions et deux dimensions définis lors de la troisième étape. Cette étape consiste également à incruster dans les radiographies des figures 9 et 10 la projection des vertèbres limites supérieures (VLS) et inférieures (VLI) l'une par rapport à l'autre en effectuant un recalage de la projection de la vertèbre limite inférieure (VLI) sur les deux positions qu'occupe cette vertèbre dans les radiographies des figures 9 et 10.* FIFTH STEP OF THE PROCEDURE This step consists in projecting the upper (VLS) and lower (VLI) limit vertebrae on the front and profile radiographs thanks to the relationships established between the three-dimensional and two-dimensional landmarks defined during the third step. This step also consists in embedding in the radiographs of FIGS. 9 and 10 the projection of the upper (VLS) and lower (VLI) limit vertebrae relative to one another by performing a registration of the projection of the lower limit vertebra ( VLI) on the two positions occupied by this vertebra in the radiographs of Figures 9 and 10.
Les figures 11 et 12 illustrent cette étape.Figures 11 and 12 illustrate this step.
*> SIXIEME ETAPE DU PROCEDE Cette étape consiste à incruster dans la radiographie de la figure 11 les points ou contours digitalisés sur les radiographies des figures 2 et 3 en ajustant l'échelle entre les radiographies et en effectuant un recalage par rapport à la vertèbre limite supérieure (VLS). De la même manière, les points ou contours digitalisés sur les radiographies des figures 7 et 8 sont incrustés dans la radiographie de la figure 12, en ajustant l'échelle entre les radiographies et en effectuant un recalage par rapport à la vertèbre limite supérieure (VLS).*> SIXTH STEP OF THE PROCEDURE This step consists of embedding in the radiography of FIG. 11 the points or contours digitized on the radiographs of FIGS. 2 and 3 by adjusting the scale between the radiographs and performing a registration with respect to the limit vertebra. higher (VLS). In the same way, the points or contours digitized on the radiographs of figures 7 and 8 are embedded in the radiography of figure 12, by adjusting the scale between the radiographs and by performing a registration with respect to the upper limit vertebra (VLS ).
Les figures 13 et 14 illustrent cette étape.Figures 13 and 14 illustrate this step.
SEPTIEME ETAPE DU PROCEDE Cette étape consiste, à partir des résultats obtenus lors des étapes précédentes :SEVENTH STEP OF THE PROCESS This step consists, from the results obtained in the previous steps:
- à déterminer et calculer la position relative tridimensionnelle des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé ,- to determine and calculate the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment,
- à déterminer et calculer en fonction de la position relative tridimensionnelle des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) la position des segments rachidiens se trouvant au dessus et au dessous du segment rachidien corrigé par l'instrumentation rachidienne,- to determine and calculate as a function of the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae the position of the spinal segments located above and below the spinal segment corrected by the spinal instrumentation,
- et à visualiser l'équilibre ou le déséquilibre de la colonne vertébrale 1 en projection de face et de profil.- and to visualize the balance or imbalance of the vertebral column 1 in front and profile projection.
On note que pour la réalisation de la quatrième étape, cette dernière peut être, par exemple, réalisée à partir d'émetteur / capteur trois dimensions pourvus d'un stylo palpeur permettant la reconstruction dans un espace visuel tridimensionnel du contour externe et de la surface de l'arc postérieur des vertèbres limites supérieures (VLS) et inférieures (VLI).It is noted that for the realization of the fourth step, the latter can be, for example, carried out using a three-dimensional transmitter / sensor provided with a feeler pen allowing reconstruction in a three-dimensional visual space of the external contour and of the surface. of the posterior arch of the upper (VLS) and lower (VLI) limit vertebrae.
En outre, la mise en œuvre du procédé de l'invention fait appel à des techniques de traitement numérique d'images dont la réalisation pratique est à la portée de l'homme du métier.In addition, the implementation of the method of the invention calls upon digital image processing techniques, the practical realization of which is within the reach of those skilled in the art.
Cette mise en oeuvre est réalisée à partir d'un système de traitement d'images pour permettre la visualisation des résultats et de la position relative en projection de face et de profil des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé par l'intermédiaire de l'instrumentation rachidienne. This implementation is carried out from an image processing system to allow the visualization of the results and the relative position in front and profile projection of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the segment. spinal correction through spinal instrumentation.

Claims

REVENDICATIONS
1. Procédé de visualisation et de contrôle de l'équilibre de la colonne vertébrale dont un segment rachidien est corrigé par l'intermédiaire d'une instrumentation rachidienne connue en soi, caractérisé en ce qu'il consiste :1. Method for visualizing and controlling the balance of the spine, a spinal segment of which is corrected by means of spinal instrumentation known per se, characterized in that it consists:
- à déterminer et calculer la position relative tridimensionnelle des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé par l'intermédiaire de points ou contours anatomiques identifiés ou digitalisés sur les radiographies du patient à traiter,- to determine and calculate the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the spinal segment corrected by means of anatomical points or contours identified or digitized on the radiographs of the patient to be treated,
- à déterminer et calculer en fonction de la position relative tridimensionnelle des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI), la position des segments rachidiens se trouvant au dessus et au dessous du segment rachidien corrigé par l'instrumentation rachidienne, par l'intermédiaire de points ou contours anatomiques identifiés ou digitalisés sur les radiographies du patient à traiter,- to determine and calculate as a function of the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae, the position of the spinal segments located above and below the spinal segment corrected by the spinal instrumentation, by l '' of anatomical points or contours identified or digitized on the radiographs of the patient to be treated,
- et à visualiser l'équilibre ou le déséquilibre de la colonne vertébrale (1) en position verticale et en projection de face et de profil.- and to visualize the balance or imbalance of the spine (1) in a vertical position and in front and profile projection.
2. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce que la position relative tridimensionnelle des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé est obtenue à partir d'une première reconstruction dans un espace visuel tridimensionnel de la géométrie de l'enveloppe ou le contour externe des vertèbres limites supérieures (VLS) et inférieures (VLI) et d'une seconde reconstruction dans un espace visuel tridimensionnel de la surface de l'arc postérieur des vertèbres limites supérieures (VLS) et inférieures (VLI).2. Visualization and control method according to claim 1, characterized in that the three-dimensional relative position of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment is obtained from a first reconstruction in a space three-dimensional visual representation of the geometry of the envelope or the external contour of the upper (VLS) and lower (VLI) limit vertebrae and of a second reconstruction in three-dimensional visual space of the surface of the posterior arch of the upper (VLS) limit vertebrae ) and below (VLI).
3. Procédé de visualisation et de contrôle suivant la revendication 2, caractérisé en ce que les premières et secondes étapes de reconstruction dans un espace visuel tridimensionnel permettent de déterminer dans un espace visuel tridimensionnel la position relative des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé.3. Visualization and control method according to claim 2, characterized in that the first and second stages of reconstruction in a three-dimensional visual space make it possible to determine in a three-dimensional visual space the relative position of the upper (VLS) and lower instrumented limit vertebrae (VLI) of the corrected spinal segment.
Procédé de visualisation et de contrôle suivant la revendication 3, caractérisé en ce que les vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé sont projetées sur les radiographies de face et de profil du patient à traiter.Visualization and control method according to claim 3, characterized in that the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment are projected on the front and profile radiographs of the patient to be treated.
5. Procédé de visualisation et de contrôle suivant la revendication 3, caractérisé en ce que la projection de face et de profil des vertèbres limites instrumentées supérieures (VLS) et inférieures (VLI) du segment rachidien corrigé permet de déterminer la position sur les radiographies de face et de profil des segments rachidiens se trouvant au dessus et au dessous du segment rachidien corrigé, et de visualiser sur les radiographies de face et de profil l'allure de la colonne vertébrale reconstituée. 5. Method of visualization and control according to claim 3, characterized in that the front and profile projection of the upper (VLS) and lower (VLI) instrumented limit vertebrae of the corrected spinal segment makes it possible to determine the position on the radiographs of face and profile of the spinal segments located above and below the corrected spinal segment, and visualize on the face and profile radiographs the appearance of the reconstructed spine.
6. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce qu'il consiste à identifier ou digitaliser pour chaque vertèbre de la colonne vertébrale, au moins quatre points délimitant un rectangle reproduisant le corps vertébral.6. A method of visualization and control according to claim 1, characterized in that it consists in identifying or digitizing for each vertebra of the vertebral column, at least four points delimiting a rectangle reproducing the vertebral body.
7. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce qu'il consiste à identifier ou digitaliser les points qui correspondent aux repères radiologiques utilisés pour définir l'équilibre de la tête du patient par rapport au bassin.7. A display and control method according to claim 1, characterized in that it consists in identifying or digitizing the points which correspond to the radiological landmarks used to define the balance of the patient's head relative to the pelvis.
8. Procédé de visualisation et de contrôle suivant la revendication 7, caractérisé en ce qu'il consiste à identifier ou digitaliser pour la tête au moins dix points permettant de repérer le contour externe de la tête. 8. A display and control method according to claim 7, characterized in that it consists in identifying or digitizing for the head at least ten points making it possible to identify the external contour of the head.
9. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce qu'il consiste à identifier ou digitaliser pour le bassin au moins les points anatomiques définissant le centre de chaque tête fémorale et le plateau sacré.9. Visualization and control method according to claim 1, characterized in that it consists in identifying or digitizing for the pelvis at least the anatomical points defining the center of each femoral head and the sacred plateau.
10. Procédé de visualisation et de contrôle suivant la revendication 9, caractérisé en ce qu'il consiste à identifier ou digitaliser pour le bassin, au moins cinq points dont un par tête fémorale et au moins trois pour le sacrum afin de former un triangle.10. A display and control method according to claim 9, characterized in that it consists in identifying or digitizing for the pelvis, at least five points including one per femoral head and at least three for the sacrum in order to form a triangle.
11. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce qu'il consiste à incruster des points digitalisés sur les radiographies du patient.11. Visualization and control method according to claim 1, characterized in that it consists in encrusting digital points on the patient's radiographs.
12. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce qu'il consiste, à partir des radiographies sagittales et frontales du patient, à reconstruire en trois dimensions la forme géométrique des vertèbres limites supérieures (VLS) et inférieures (VLI).12. Visualization and control method according to claim 1, characterized in that it consists, from sagittal and frontal radiographs of the patient, in reconstructing in three dimensions the geometric shape of the upper (VLS) and lower (VLI) limit vertebrae ).
13. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce qu'il consiste à déterminer la position géométrique linéaire et angulaire de la vertèbre limite inférieure (VLI) reconstruite par rapport aux radiographies de face et de profil.13. Visualization and control method according to claim 1, characterized in that it consists in determining the linear and angular geometric position of the lower limit vertebra (VLI) reconstructed with respect to the front and profile radiographs.
14. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce qu'il consiste à projeter les vertèbres limites supérieures (VLS) et inférieures (VLI) sur les radiographies de face et de profil.14. A method of visualization and control according to claim 1, characterized in that it consists in projecting the upper (VLS) and lower (VLI) limit vertebrae on the front and profile radiographs.
15. Procédé de visualisation et de contrôle suivant la revendication 1 , caractérisé en ce qu'il consiste à incruster dans les radiographies la projection des vertèbres limites supérieures (VLS) et inférieures (VLI) l'une par rapport à l'autre en effectuant un recalage de la projection de la vertèbre limite inférieure15. Visualization and control method according to claim 1, characterized in that it consists in embedding in radiographs the projection of the upper (VLS) and lower (VLI) limit vertebrae relative to one another by performing a registration of the projection of the lower limit vertebra
(VLI). (VLI).
EP03727566A 2002-03-05 2003-03-04 Method of viewing and controlling balance of the vertebral column Withdrawn EP1482846A1 (en)

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FR0202754A FR2836818B1 (en) 2002-03-05 2002-03-05 PROCESS FOR VISUALIZING AND CHECKING THE BALANCE OF A SPINE COLUMN
FR0202754 2002-03-05
PCT/FR2003/000694 WO2003073946A1 (en) 2002-03-05 2003-03-04 Method of viewing and controlling balance of the vertebral column

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FR2836818A1 (en) 2003-09-12

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