Classifications

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  • A61B5/4538—Evaluating a particular part of the muscoloskeletal system or a particular medical condition
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  • A61B17/17—Guides or aligning means for drills, mills, pins or wires
  • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
  • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
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  • 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
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  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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  • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
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  • A61B5/068—Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe using impedance sensors
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  • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
  • A61B5/1071—Measuring physical dimensions, e.g. size of the entire body or parts thereof measuring angles, e.g. using goniometers
• • A—HUMAN NECESSITIES
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  • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb
  • A61B5/1121—Determining geometric values, e.g. centre of rotation or angular range of movement
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  • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb
  • A61B5/1126—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb using a particular sensing technique
  • A61B5/1127—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb using a particular sensing technique using markers
• • A—HUMAN NECESSITIES
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  • A61B6/46—Apparatus for radiation diagnosis, e.g. combined with radiation therapy equipment with special arrangements for interfacing with the operator or the patient
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  • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
  • A61B6/5217—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data extracting a diagnostic or physiological parameter from medical diagnostic data
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• • 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
  • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
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  • 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
  • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B2562/17—Comprising radiolucent components

Definitions

• the invention relates to measuring the movements of a spine. State of the art
• x-ray images are used to evaluate the curvature of a patient's spine.
• the curvature of the column can be modified to reduce natural deformities or that have appeared as a result of trauma.
• the surgeon makes two radiographic images, one of face and one of profile, before the operation to determine the deformation, and two radiographic images after the operation to check the reduction of the deformation.
• the surgeon visually evaluates the correction of the curvature, but he does not have means to control the movements of the vertebrae of the column in real time.
• US Patent Application US20050096535 discloses a method for recording two-dimensional images of digital markers obtained during knee surgery, comprising the steps of:
• the navigation system can calculate a plane that passes through the center of the tibia, the medial malleolus and the medial malleolus of the ankle, to determine an axis of interest of the tibia.
• the image imported from the patient and the image of the recorded axis are displayed on the left corner of the screen.
• the navigation system is not adapted to a measurement of vertebral displacement of a spine, because it requires access to the femoral surface, which is not necessarily the case during a surgical operation. the spine where access to the surface of a vertebra is not possible.
• US patent application US20130268007 discloses a method for measuring an angle of a spinal implant, in particular a rod for binding vertebrae, comprising using a probe configured to measure an angle in a measurement plane (a sagittal plane).
• the probe may include an accelerometer or magnetic sensors to measure the angle.
• the probe is placed on the implant, the probe having an end configured to adapt to the shape of the implant. But the system measures angles of the implant, it does not measure the movement of the body of a vertebra. There is no control in real time.
• International application WO03073946 discloses a method of controlling the balance of a spine, wherein:
• the three-dimensional relative position of the vertebrae is determined by means of digital anatomical points on X-rays; the position of the spinal segments is determined;
• each vertebra at least four points are identified to reproduce the vertebral body, at least three points for the sacrum to form a triangle. Then the scanned points are embedded in the X-ray images. For example, a probe with a location marker is used to reconstruct a virtual space of the outer contour and the surface of the posterior arch of the vertebrae. But it provides information only in two dimensions, which is not accurate enough for a spine operation. In addition, it does not make it possible to determine the movement of the body of the vertebrae in real time.
• United States Patent Application US20030130576 discloses a surgical imaging system for displaying an image containing an indication of position of an instrument, and an image of a patient, and which includes a processor for displaying the two images for navigation. during a surgical operation.
• the system uses an X-ray apparatus, such as a fluoroscope, and a marker attached to a surgical tool, for example a probe.
• X-ray apparatus such as a fluoroscope
• a marker attached to a surgical tool for example a probe.
• International application WO2005084131 discloses an apparatus for measuring the inclination of an object, such as an inclinometer.
• the inclination of the vertebral column is detected by an electromagnetic field probe which detects the spinal process of each vertebra.
• Handling involves holding the meter with one hand and holding it perpendicular to the patient's back.
• a semi-circular arch of the apparatus is positioned above the spinal process of the seventh cervical vertebra.
• the probe makes an acquisition of several images per vertebra.
• a tracker connected to the probe can also be used, and the probe measures the position and inclination of the tracker that is moved along the spine.
• the apparatus may include markers that cooperate with an optical three-dimensional navigation system to identify and calculate vertebrae tilt angles.
• the measuring device does not make it possible to determine the deformation of the column in real time, because it is necessary to move the apparatus along the column to make the measurements of inclination of the vertebrae.
• US patent application US20080208055 discloses a method for aligning fragments of a fractured bone. The method uses an ultrasound apparatus equipped with a location marker and location markers positioned on each of the fragments. The ultrasound apparatus makes it possible to detect characteristic landmarks on the circumference of the bone fragments. In this method, a spatial position and / or an orientation of each marker is determined, and an alignment is determined from the determined positions with respect to a given criterion. But ultrasound imaging is not very precise and does not allow to define a precise profile of an anatomical structure.
• US Pat. No. 6,190,320 discloses an image processing method, comprising: an acquisition, using an ultrasound transducer coupled to an ultrasound apparatus, of a digital ultrasound image of a non-ultrasonic transparent structure;
• US Pat. No. 6,519,319 discloses a reticle for an image detector, comprising a radiolucent plane portion, a pair of first indicia disposed on the surface of the planar portion, and a second indicia disposed on the surface of the planar portion. to indicate the center of the reticle.
• the reticle aligns the detector with an intervertebral plane of the patient's column.
• the reticle guides a surgical instrument.
• An object of the invention is to overcome the disadvantages mentioned above, and in particular to provide a method for measuring the movements of the vertebrae of a spine.
• a method for measuring movements of a spinal column having a segment comprising at least one vertebra, each vertebra of the segment having a body delimited by an upper vertebral plateau and a vertebral body. lower vertebral plateau, and each vertebra of the segment having an associated location marker attached thereto and providing an orientation of the location marker in a global repository of a location system.
• the method includes:
• an initial step, for each vertebra of the segment comprising:
• o a detection, in the global reference system, of an initial orientation of the location marker associated with the vertebra of the segment, o a determination, in the global reference system, of an initial orientation of a vertebral plane parallel to at least one plateau the vertebra of the segment, and
• a step of measuring a displacement of at least one vertebra of the segment comprising: o detecting, in the global repository, the current orientation of the location marker associated with said at least one vertebra of the segment, and
• the method may comprise, after the initial step, an identification step comprising:
• the method may comprise, after the measurement step, a step in which:
• an angle is calculated between the current orientation of the vertebral plane and the current orientation of another vertebral plane, and
• the method may further comprise, after the measuring step:
• angles can be displayed between the vertebral planes which constitute relevant anatomical information relating to the orientation of the vertebral trays.
• This anatomical information can be used later to correct the balance of the spine.
• these values can be displayed in real time, for example during a surgical procedure on the spine.
• the method comprises an instrument provided with a location marker providing a vector for orienting a portion of the instrument to the location system, and wherein the determining step comprises:
• the initial orientation of the vertebral plane of the vertebra of the segment being determined from the first and second vectors provided.
• the portion of the instrument may include an X-ray opaque shaft, and the orientation vector determines a longitudinal direction of the shaft, the method comprising an X-ray emitter and a detector for generating X-ray image of the vertebrae. of the segment and the rod, the determining step comprising:
• the opaque rod is positioned so that it is represented by a line in the x-ray radiographic image parallel to the line representing the said at least one plate.
• the determining step may include:
• the method may include an instrument with a location marker providing an orientation vector perpendicular to a portion of the instrument to the location system, and wherein the determining step comprises :
• the initial orientation of the vertebral plane of the vertebra of the segment is determined from the orientation vector provided.
• the part of the instrument can be a plate.
• the plate may be X-ray opaque
• the method comprising an X-ray emitter and a detector for generating an X-ray X-ray image of the vertebrae of the segment and the plate, and the determining step comprises:
• the instrument may comprise at least one sensor, each sensor being capable of detecting a tissue and differentiating bone tissue with intervertebral tissue, and at least one positioning of the portion of the instrument in the vertebral plane is performed such that said at least one sensor detects an intervertebral tissue.
• the instrument may also be provided with at least one set of at least two sensors, each sensor being capable of detecting tissue and differentiating bone tissue with intervertebral tissue, the instrument being provided with a locator marker providing, to the location system, an orientation vector perpendicular to a detection plane formed by said at least two sensors, and wherein the determining step comprises:
• the initial orientation of the vertebral plane of the vertebra of the segment is determined from the orientation vector provided.
• the instrument may further include a first set of at least two sensors, and a second set of at least two sensors, the provided orientation vector being perpendicular to the detection planes respectively formed by the first and second sets, and the positioning of the instrument comprises a positioning of the sets so that said sets respectively detect two different tissues.
• the determining step may further include displaying a registration line grid in the X-ray image, the registration lines being displayed parallel to each other and to the opaque rod of the X-ray image. the instrument.
• a registration line grid in the X-ray image, the registration lines being displayed parallel to each other and to the opaque rod of the X-ray image. the instrument.
• At least one of the positions of the portion of the instrument may include a positioning of the rod against the detector.
• the method comprises an instrument having an X-ray opaque portion, an X-ray emitter and a detector for generating X-ray radiographic image of the vertebrae of the segment and the opaque portion.
• the opaque portion being movably mounted on the detector, and the instrument being further provided with a locator marker providing an orientation vector of the opaque portion and an orientation of a plane of the detector to the location system; determining step comprising:
• the determining step may further include image processing for calculating an orientation of the line representing said at least one platen, an orientation of the line representing the rod, and an angle between said line orientations.
• the method may further include a step of displaying the angle between said line orientations.
• the initial orientation of the vertebral plane of the vertebra of the segment can be corrected from the angle between said orientations of the lines.
• the portion of the instrument is opaque to X-rays
• the method comprising an X-ray emitter and a detector for generating an X-ray radiographic image of the vertebrae of the segment and the opaque portion, the determining step comprising:
• At least one positioning of the part of the instrument comprising a positioning of the opaque part so that it is represented by a line in the X-ray radiographic image
• image processing making it possible to calculate an orientation of the line representing said at least one plate, an orientation of the line representing the opaque part, and an angle between said orientations of the lines,
• a system for measuring the movements of a spinal column the vertebral column having a segment comprising at least one vertebra, each vertebra of the segment having a body delimited by an upper vertebral plateau and a lower vertebral plateau, the measurement system comprising:
• location markers respectively fixed on the vertebrae of the segment to which they are associated and each providing an orientation of the location marker in a global repository of the location system
• the locating system detecting, in the global reference frame and for each vertebra of the segment, an initial orientation and a current orientation, the location marker associated with the vertebra of the segment, and determining, in the global reference frame and for each vertebra of the segment; an initial orientation of a vertebral plane parallel to at least one plateau of the vertebra of the segment,
• calculating means for calculating, for each vertebra of the segment, a geometric transformation associated with the vertebra of the segment correlating the initial orientation of the vertebral plane of the vertebra of the segment with the initial orientation of the associated location marker, and for calculating , in the global reference frame and for at least one vertebra of the segment, a current orientation of the vertebral plane of said at least one vertebra of the segment from the current orientation of the associated location marker and the geometric transformation associated with said at least one vertebra of the segment. a vertebra.
• the measurement system may include identification means for:
• the locating system comprising a processing unit calculating, for each vertebra of the segment, an angle between the vertebral plane of the vertebra of the segment and the said at least one reference plane, and
• the measurement system comprising a screen for displaying the calculated angles.
• the locating system may comprise a processing unit calculating, for each current orientation of a vertebral plane, an angle between the current orientation of the vertebral plane and the current orientation of another vertebral plane, the measurement system comprising a screen to display the calculated angles.
• the measurement system may include identification means for:
• the location system comprising a calculating processing unit, angles between the projected current orientations, and
• the measurement system comprising a screen for displaying the calculated angles.
• the measurement system may include an instrument with a location marker providing a vector for orienting a portion of the instrument to the location system, and wherein the location system includes a locator receiving, for each vertebra of the segment:
• the initial orientation of the vertebral plane of the vertebra of the segment being determined from the first and second vectors provided.
• the portion of the instrument may include an X-ray opaque shaft, and the orientation vector is a longitudinal direction of the shaft, the measurement system includes an X-ray emitter, a detector for generating a ray radiographic image.
• X of the vertebrae of the segment and the stem and a screen for displaying an X-ray image of the vertebrae of the segment and of the stem, the X-ray emitter and the detector being positioned perpendicular to the segment so that at least a plate of each vertebra of the segment is represented by a line in the X-ray radiographic image, and at each positioning of the part of the instrument, the opaque rod is positioned to be represented by a line in the x-ray radiographic image parallel to the line representing the at least one plate.
• the measurement system may include an instrument with a location marker providing a vector for orienting a portion of the instrument to the location system, and wherein the location system includes a locator receiving, for each vertebra of the segment:
• a second orientation vector comprised in a plane perpendicular to the vertebral plane of the vertebra of the segment, provided by a second positioning of the part of the instrument in said perpendicular plane, the initial orientation of the vertebral plane of the vertebra of the segment being determined from the perpendicular plane and the first orientation vector provided.
• the measurement system may include an instrument with a location marker providing an orientation vector perpendicular to a portion of the instrument to the location system, and wherein the location system includes a locator receiving, for each vertebra of the segment:
• the portion of the instrument may be an X-ray opaque plate
• the measurement system includes an X-ray emitter and a detector for generating an X-ray X-ray image of the vertebrae of the segment and plate, a display for displaying an x-ray X-ray image of the vertebrae of the segment and the plate, the X-ray emitter and the detector being positioned perpendicular to the segment such that at least one plate of each vertebra of the segment is represented by a line in the X-ray radiographic image, and the plate is positioned to be represented by a line in the x-ray radiographic image parallel to the line representing said at least one plate.
• the instrument may comprise at least one sensor, each sensor being capable of detecting a tissue and differentiating bone tissue with intervertebral tissue, and at least one positioning of the portion of the instrument in the vertebral plane is performed such that said at least one sensor detects an intervertebral tissue.
• the instrument may comprise at least one sensor, each sensor being capable of detecting tissue and differentiating bone tissue with intervertebral tissue, and positioning of the portion of the instrument in the vertebral plane is performed such that least one sensor detects an intervertebral tissue.
• the measurement system may include an instrument having at least one set of at least two sensors, each sensor being capable of detecting tissue and differentiating bone tissue with intervertebral tissue, the instrument being provided with a marker locating device providing, to the locating system, an orientation vector perpendicular to a detection plane formed by the at least two sensors, the instrument being positioned whereby said at least two sensors detect an intervertebral tissue, and the initial orientation of the vertebral plane of the vertebra of the segment is determined from the provided orientation vector.
• the instrument may include a first set of at least two sensors, and a second set of at least two sensors, the provided orientation vector being perpendicular to the detection planes respectively formed by the first and second sets, and the sets of the instrument being positioned so that said sets respectively detect two different tissues.
• the screen can display, in the X-ray radiographic image, a grid of alignment lines parallel to each other and to the opaque rod of the instrument. At least one of the positions of the part of the instrument can be made so that the rod is against the detector.
• the measurement system may include an instrument having an X-ray opaque portion, an X-ray emitter and a detector for generating an X-ray X-ray image of the vertebrae of the segment and the opaque portion, the opaque portion being movably mounted on the detector, and the instrument is further provided with a location marker providing an orientation vector of the opaque portion and an orientation of a plane of the detector to the location system, the X-ray emitter and the detector being positioned perpendicularly to the segment so that at least one plate of each vertebra of the segment is represented by a line in the X-ray radiographic image, and the opaque portion of the instrument is positioned so that it is shown by at least one line in the x-ray radiographic image parallel to the line representing said at least one plate, and the initial orientation of the vertebral plane being determined from the orientation of the plane of the detector and the orientation vector of the opaque portion.
• the locating system may comprise a processing unit calculating, for each vertebra of the segment, an orientation of the line representing said at least one plate, and an orientation of the line representing the rod, the measurement system further comprising means for calculate an angle between said orientations of the lines.
• the screen can display the angle between said lines orientations.
• the locating system may include a processing unit determining, for each vertebra of the segment, the initial orientation of the vertebral plane of the vertebra of the segment directly from the angle between said orientations of the lines.
• the portion of the instrument may be X-ray opaque
• the measurement system includes an X-ray emitter and detector for generating an X-ray X-ray image of the vertebrae of the segment and the opaque portion, and a display for displaying an X-ray radiographic image of the vertebrae of the segment and the opaque portion, the X-ray emitter and the detector being positioned perpendicularly to the segment such that at least one plate of each vertebra of the segment is represented by a line in the X-ray image, at least one positioning of the portion of the instrument comprising positioning the opaque portion so that it is represented by a line in the X-ray image, the location system comprising a calculating processing unit, for each vertebra of the segment, an orientation of the line representing said at least one tray, an orientation of the line representing the opaque portion, the measurement system further comprising means for calculating an angle between said orientations of the lines, and the processing unit determining, for each vertebra of the segment, the initial orientation of the vertebral plane of the vertebra of the
• FIGS. 1 and 2 schematically illustrate the main steps of a method for measuring the movements of a spine according to the invention
• FIGS. 3 and 4 schematically illustrate variants of a first mode of implementation of the measurement method
• FIG. 5 schematically illustrates a mode of implementation of a means for guiding the positioning of an instrument
• FIGS. 6 to 8 schematically illustrate variants of a second mode of implementation of the measurement method.
• FIGS. 1 and 2 show the main steps of a method for measuring the movements of a vertebral column 1.
• the spine 1 has several vertebrae V1 to V5.
• the method consists, in particular, to follow the movements of the vertebrae which comprise at least one vertebral plateau.
• a segment 2 of the vertebral column 1 comprising at least one vertebra V2 to V4, each vertebra of the segment having a body A1 to A5 delimited by an upper vertebral plateau PS and a lower vertebral plateau Pl.
• a vertebral plane P2 to P4 that is to say a plane associated with a vertebra of the segment.
• the vertebral plane of a vertebra of segment 2 is a plane parallel to at least one plateau of the vertebra of segment 2, for example the upper plateau PS.
• the vertebral plateau PS, PI of a vertebra of the segment 2 corresponds to a face of the body A2 to A4 of the vertebra.
• the vertebral plane associated with the vertebra of the segment it corresponds to a virtual plane used to measure the movements of the vertebra of the segment.
• FIG. 1 diagrammatically shows a section of the spinal column 1 comprising five consecutive vertebrae V1 to V5.
• Segment 2 comprises, meanwhile, three consecutive vertebrae V2 to V4 corresponding to the vertebrae which one wishes to follow the movements, especially during a surgical operation.
• the segment 2 of vertebrae may comprise a single vertebra V2 or several vertebrae V2 to V4, consecutive or not, as for example the sacrum.
• the segment 2 may comprise a single lumbar vertebra, located in the lower part of the column.
• the segment 2 comprises a cervical vertebra, located in the upper part of the column, and a thoracic vertebra located in the intermediate part of the column.
• the segment 2 may comprise five consecutive thoracic vertebrae.
• each vertebra V2 to V4 of the segment 2 has an associated location marker M2 to M4 which is fixed on the vertebra V2 to V4. In other words, each marker M2 to M4 is mechanically connected to the vertebra V2 to V4 with which it is associated.
• M2 markers at M4 can be connected directly to the vertebrae of segment 2, for example on the body A2 to A4 of the vertebrae.
• screws 3 to 5 are attached to the vertebrae of the segment 2, and connecting elements 6, 7 can connect the screws 3 to 5 between them.
• the screws 3 to 5 and the connecting elements 6, 7 serve to modify the curvature of the spine 1, and therefore the position and orientation of the vertebrae V2 to V4 of the segment 2.
• the markers M2 to M4 can also be fixed to the screws 3 to 5, as shown in Figure 1. They can also be attached to the connecting elements 6, 7, if the latter are rigidly attached to the screws 3 to 5.
• Each vertebra of the segment, for which it is desired to determine a vertebral plane P2 to P4, is equipped with a marker of associated location M2 to M4, we also note these vertebrae, the vertebrae instrumented.
• the method comprises an initial step S1, in which for each vertebra of the segment, an initial orientation of the vertebral vertebral plane is determined relative to that of the associated location marker, and then a measurement step S2 of the displacements.
• vertebrae of the segment in particular movements of at least one vertebra of the segment, following the movements of the location markers.
• orientation of a plane is meant a vector normal to the plane.
• the orientation of a location marker is also understood to mean a rotation transformation associated with the marker.
• a location system 8 is used which makes it possible to determine the position and orientation of an object in space.
• An instrument 9 having at least one location marker 10 is also used to provide an orientation of a part of the instrument 11 to the location system 8.
• the location markers M2 to M4 and 10 each comprise at least three position sensors.
• the location system 8 can detect the position and orientation provided by each location marker M2 to M4 associated with the vertebrae of the segment and by the location marker 10 of the instrument 9.
• location 8 comprises a locator 12 which can be for example optical or magnetic, and which receives, by a 13 wire connection or not, the information provided by the location markers M2 to M4 and by the location marker 10 of the instrument 9
• the locator 12 can monitor in real time the position and orientation of each of the location markers M2 to M4 associated with the vertebrae and the position and orientation of the location marker 10 of the instrument 9.
• each location marker M1 to M3 associated with a vertebra of the segment 2, as well as that of the instrument 9, provides at least one orientation of the location marker in a global reference system of the location system 8. That is, that the location system 8 serves as a global reference for all the measurements of the orientation marker orientations M2 to M3, 10.
• the location system 8 may be an optical camera and the s location markers M2 to M4 and 10 are retro-reflective pellets or marks having a specific color, or shape, adapted to be located by the camera.
• Location markers M 2 to M 4 and 10 may also include light-emitting diodes detectable by the camera.
• the initial step S1 comprises, for each vertebra V2 to V4 of the segment 2:
• a calculation S13 of a geometric transformation associated with the vertebra of the segment correlating the initial orientation of the vertebral plane of the vertebra of the segment with the initial orientation of the associated location marker.
• the geometric transformation associated with a vertebra makes it possible to connect the orientation of the vertebral plane of the vertebra with that of the associated location marker.
• the geometric transformation includes transformations of rotation and translation. In other words, the geometric transformation makes it possible to calculate the relative orientation of the vertebral plane with respect to that of the associated location marker.
• S21 is then detected the new orientation of a location marker M2 to M4, following the displacement of the vertebra with which it is associated, and S22 is calculated the new orientation 02 to 04 vertebral vertebral plane from the transformation calculated geometry and the new orientation of the location marker.
• the new orientations of location markers M2 to M4 and vertebral planes P2 to P4 are also noted as current orientations.
• the calculation step S22 of the measurement step makes it possible to follow in time the orientations 02 to 04 of the vertebral planes of the instrumented vertebrae.
• the method may comprise, after the initial step S1, an identification step S3 during which one or more reference planes are identified, and the respective angles between the current orientations of the vertebral planes and the respective angles are calculated. current orientation of at least one identified reference plane.
• the angles between the projections obtained are determined in each of the reference planes.
• the angle between two planes is the angle between two vectors respectively normal to the planes.
• the angles between the vertebral planes also correspond to the angles between the vertebral endplates of the segment vertebrae.
• the calculation of the angles between vertebral planes gives in particular the true angles between the vertebral trays of the vertebrae.
• the angles between the projections of the current orientations obtained in each reference plane having an anatomical interest in real time can be displayed.
• the identification step S3 can comprise:
• the locating system 8 may comprise a processing unit 14, for example a microprocessor, for calculating an angle between a vertebral plane and each reference plane, as well as the angles between the vertebral planes, or the angles between the vertebral planes. projections of the current orientations of the vertebral planes.
• the locating system 8 may be connected to a screen 15 to display the orientations 02 to 04 of the vertebral planes P2 to P4.
• a first mode of implementation illustrated in FIGS. 3 and 4
• the instrument 9 equipped with the location marker 10 providing a vector for orienting the part 1 1 of the instrument to the location system 8 is used.
• the instrument 9 can be a navigation pointer, and the part of the instrument is a rod.
• the navigation pointer 9 makes it possible to locate particular anatomical points of the column, and in particular to provide a vector for orienting the rod 11 to the locating system 8, this orientation of the rod being established during the manufacture of the rod. instrument, or by calibration with respect to the position and orientation of the location marker position sensors 10.
• the rod 1 1 is placed in a first position 20 located in the vertebral plane P4 of the vertebra of the segment.
• an acquisition is made of the vector of orientation of the rod 1 1, triggered for example from the instrument 9, which provides a first orientation included in the vertebral plane P4 to the tracking system 8.
• the rod 1 1 in a second position 21 also located in the vertebral plane P4, and triggers a second acquisition to provide a second orientation vector included in the vertebral plane P4.
• the location system 8, more particularly the processing unit 14 determines the initial orientation of the vertebral plane from the two orientation vectors provided by the navigation pointer 9.
• the rod 11 is placed in abutment against the body of an instrumented vertebra V4, so that the rod January 1 is located in the vertebral plane.
• the first positioning 20 can be made by placing the rod 1 1 parallel to one of the trays PI, PS, the instrumented vertebra V4.
• the positioning of the rod 1 1 can also be improved by means of guidance described below.
• the rod 1 1 is pivoted in the second position 21 included in the vertebral plane P4, for example by keeping a contact of the end of the rod bearing against the instrumented vertebra V4, and a second acquisition is triggered to provide a second orientation vector included in the vertebral plane P4 to the locating system 8.
• the processing unit 14 determines the initial orientation of the vertebral plane of the instrumented vertebra V4 from the two vectors of orientations provided.
• the processing unit 14 determines the vector normal to the two vectors provided, corresponding to the initial orientation of the vertebral plane P4.
• the rod 1 1 is approached from the column 1 by an operator, and when the end of the rod 1 1 comes into contact with the instrumented vertebra, the location marker 10 of the pointer 9 transmits information of the orientation from the rod 1 1 to the locator 12.
• the contact of the end of the rod 1 1 can be direct in contact with the bone of the vertebra, or a screw 3 to 5, or an element link 6, 7, or the location marker associated with the instrumented vertebra V4.
• the contact can also be indirect percutaneous on the skin at a point located at the level of the vertebra.
• the acquisition of the orientation of the rod 1 1 of the pointer 9 can also be performed without contact, as the rod 1 1 is parallel to at least one vertebral plate.
• the navigation pointer 9 can be used to determine the orientation of the reference planes, sagittal, frontal and axial, during the identification step S3.
• the determination of an orientation of a vertebral plane may include a determination of the vertebral plane, and then a determination of a normal vector at the vertebral plane determined.
• the normal vector corresponds to the orientation of the vertebral plane.
• the determination of a vertebral plane can comprise an acquisition of the position of a vertebral plane point and an acquisition of the orientation of a vertebral plane vector, or the acquisition of the three-point position of the vertebral plane, or, as described above, the acquisition of the orientation of two vectors of the vertebral plane.
• the rod 11 of the navigation pointer 9 is an X-ray opaque rod 11.
• the orientation vector provided by the locating marker 10 corresponds to a longitudinal direction of the rod 11.
• the transmitter 17 and the receiver 18 are used to generate an X-ray image of the vertebrae of the segment and the opaque rod 11.
• the determination step comprises, for each vertebra of the segment 2:
• the opaque rod 1 1 is positioned so that it is represented by a line in the x-ray radiographic image parallel to the line 19 representing said at least one plate.
• the line 19 representing at least one plate serves as a guide means to facilitate the positioning of the rod of the instrument in the vertebral plane.
• a line 19 appears in the image when the transmitter 17 and the detector 18 are located in a particular position, said perpendicular to the segment 2 of vertebrae. In this perpendicular position, at least one plate of the instrumented vertebra is represented in the image as a line 19.
• This line 19 is virtual.
• the two-dimensional images of the bodies of the instrumented vertebrae are displayed, and at least one PS, PI plate of an instrumented vertebra V2 to V4 is displayed in the form of a generally linear curve corresponding to the guide line.
• the instrumented vertebrae plateau appears in the image in the form of a surface and not a generally linear curve, which does not allow not to spot in the image the plateau of a vertebra in the form of a line.
• the rod 1 1 of the navigation pointer 12 is placed on an instrumented vertebra V4 in the first position 20 and the position of the rod 1 1 is displayed on the screen 15. in the picture.
• the operator adjusts the position of the rod 1 1 so that on the screen 15 the pointer rod 9 appears as a line 22 parallel to the guide line 19. In the first position 20, the first orientation of the rod 1 1.
• the operator moves the rod 1 1 of the navigation pointer 12 in the second position 21, so that on the screen 15 the rod of the pointer appears as a line 23, shown here in dashed lines, parallel to the guide line 19.
• the imager 16 which identifies the guide line 19 in the image, to guide the different positions of the rod 1 1 of the navigation pointer 9 so that the rod is located in the vertebral plane P4 of the instrumented vertebra V4.
• the display of the images of the segment 2 of the spine is performed during the determination step S12 of the initial orientations of the vertebral planes.
• Imager 16, including the transmitter 15 and the detector 16, makes it possible to control the position of the instrument 9 with respect to the vertebral plates.
• the operator can correct the positioning of the instrument with respect to the guide line 19.
• the first positioning of the opaque rod 1 1 of the navigation pointer 12 comprises a positioning of the opaque rod against the detector 16.
• the operator who manipulates the pointer can bear against the detector 18.
• the operator pivots the rod 1 1, bearing against the detector, it that is to say by keeping the end of the rod 1 1 in contact with the detector 18, and brings the rod into the second position 21, that is to say in the vertebral plane P4, to provide the second orientation 8.
• the determining step comprises:
• the initial orientation of the vertebral plane of the vertebra of the segment being determined from the perpendicular plane and the first orientation vector provided.
• the rod 1 1 is placed against the detector in a second position 24 distinct from the first one, in particular in a position which is not in alignment with the first orientation of the rod. 1 1.
• the two orientations provided are located in a plane perpendicular to the vertebral plane because the detector is previously located in a plane perpendicular to the vertebral plane.
• the initial orientation of the vertebral plane corresponds to the vector normal to the plane which is perpendicular to the plane formed by the two vectors provided and which comprises the first vector of orientation provided.
• FIG. 5 shows another means for guiding the positioning of the opaque rod 11 of the navigation pointer 9.
• the means comprises a grid 25 of alignment lines parallel to one another.
• the grid 25 is calculated by the processing unit 14 and then displayed in the X-ray radiographic image so that the registration lines are parallel to the opaque rod 11.
• the processing unit 14 also changes the direction of the registration lines on the screen 15.
• This other means is at least one sensor for detecting a type of fabric.
• Each detection sensor is included in the instrument 9, and is configured to detect and differentiate bone tissue and intervertebral tissue.
• the bone tissue corresponds to that of the body of a vertebra
• the intervertebral tissue corresponds to the specific tissue located between two consecutive vertebrae of the column.
• the portion 11 of the instrument 9 is positioned in a vertebral plane so that the sensor of the instrument 9 detects an intervertebral tissue, more particularly the intervertebral tissue situated against the plateau of the instrumented vertebra. Sensing sensors help guide the operator to improve the accuracy of the Positioning of the instrument 9.
• the instrument 9, and in particular the portion of the instrument 1 is generally located in the vertebral plane.
• it is still possible to specify the positioning of the instrument by equipping the instrument with at least two detection sensors.
• the portion of the instrument 11 is located in the vertebral plane with greater precision.
• the two detection sensors then both detect bone tissue.
• FIGS. 6 and 7 show two embodiments of a second mode of implementation of the method.
• the location marker 10 of the instrument 9 provides an orientation vector perpendicular to a part of the instrument to the location system 8.
• the determination step S12 comprises:
• the initial orientation of the vertebral plane of the vertebra of the segment is determined from the orientation vector provided.
• the initial orientation of the vertebral plane is obtained directly because it corresponds to the orientation vector supplied by the location marker 10 of the instrument 9. It is then possible to perform a single positioning of the instrument to obtain the orientation of the instrument. a vertebral plane, which simplifies the method.
• FIG. 6 shows a first embodiment of the second mode of implementation, in which the instrument 9 comprises a plate 31.
• the location marker 10 of the instrument 9 provides a vector of orientation perpendicular to the plane of the plate 31.
• the determination step S12 comprises a positioning of the plate 30 in the vertebral plane of the vertebra of the segment.
• the plate 31 furthermore makes it possible to guide the operator to position the plate 31 in view in the vertebral plane of the instrumented vertebra.
• Figure 6 there is shown, for simplification purposes, the plate 31 in the plane of the sheet, that is to say in a plane perpendicular to a vertebral plane of a vertebra of the segment.
• the operator pivots the instrument 9 to bring the plate 31 in a plane parallel to at least one plate of a vertebra V2 to V4 of the segment 2, that is to say in the vertebral plane of vertebra V2 to V4.
• the plate 31 may be X-ray opaque and the imager 16 may be used to guide the positioning of the plate in the vertebral plane.
• the positioning of the portion of the instrument comprises a positioning of the plate 31 so that it is represented by a line in an X-ray radiographic image parallel to the line 19 representing said at least one plate. We can then use the guide means described above to improve the positioning of the plate 31 in the vertebral plane.
• the instrument includes a first set 32 of at least two detection sensors 34.
• Each sensor is capable of detecting a tissue and differentiate bone tissue with intervertebral tissue.
• each detection sensor detects a type of tissue to a specific depth specific to the characteristics of the sensor.
• the determined depth corresponds to a maximum thickness of the spine.
• the instrument 9 may be an ultrasonic probe, or an electric impedance probe or a Terahertz probe.
• the positioning of the part 1 1 of the instrument comprises a positioning the first set 32 of at least two sensors so that the assembly detects an intervertebral tissue.
• the instrument 9 is positioned between the vertebra V4 of the segment 2 and an adjacent vertebra V5 so that the instrument 9 detects the intervertebral tissue located between said adjacent vertebrae.
• This detection has been illustrated in FIG. 7 by the sensors 34 represented as empty circles.
• the instrument 9 includes a location marker 10 providing, to the location system 8, an orientation vector perpendicular to a detection plane formed by said at least two sensors.
• the detection plane corresponds to the plane in which the detection signals of the sensors are propagated which make it possible to detect the types of tissue.
• the detection plane is parallel to at least one plate of an instrumented vertebra.
• the detection plane is perpendicular to the plane of the sheet, it is represented by the dotted line X.
• the latter may comprise a second set 33 of at least two sensors 35, and the location marker 10 provides a vector of orientation perpendicular to the detection planes respectively formed by the first and second sets. More particularly, the detection plans of the sensor assemblies are parallel to each other.
• the positioning of the instrument 9, to provide an orientation vector perpendicular to the vertebral plane of an instrumented vertebra is performed so that the sensor assemblies 32, 33 respectively detect two different tissues.
• the first set 32 of sensors 34 detects an intervertebral tissue
• the detection of the intervertebral tissue is illustrated by the sensors 34 represented as empty circles
• the second set 33 of sensors 35 detects a bone tissue
• the detection of the bone tissue is illustrated by the sensors 35 represented as circles in which dots are inscribed.
• FIG. 8 shows yet another embodiment of the determination step S12 of the initial orientations of the vertebral planes P2 to P4.
• the instrument 9 is provided with an X-ray opaque portion 11, and an X-ray imager 16 is used to generate an x-ray X-ray image of the vertebrae of the segment and the X-ray image. opaque part.
• the opaque portion 11 is movably mounted on the detector 18.
• the instrument 9 is also provided with a location marker providing an orientation vector of the opaque portion and an orientation of a plane of the detector to the system. 8.
• the instrument may be any system calibrated to provide an orientation vector of the opaque portion and a direction of a plane of the detector to the location system 8.
• the opaque portion 1 1 is a rod fixed at a point 41 of the detector 18 and pivotable about this point 41.
• the opaque portion 1 1 is a plate, shown hatched in Figure 8, which is slidable in a slideway movable in translation on the detector 18.
• the determination step S12 comprises:
• the initial orientation of the vertebral plane being determined from the orientation of the plane of the detector and the orientation vector of the opaque part.
• the operator can adjust the positioning thereof with respect to the line 19 representing said at least one tray.
• the line representing the opaque portion is parallel to the line 19 representing said at least one plate
• the plane of the detector is perpendicular to the vertebral plane
• the orientation vector of the opaque portion is located in the vertebral plane of the instrumented vertebra .
• the initial orientation of the vertebral plane corresponds to the vector perpendicular to the orientation vector of the opaque portion and to the orientation of the detector plane.
• the determination step S12 may comprise an image processing step, carried out by the processing unit 14, to calculate, from the X-ray radiographic image of the vertebrae of the segment, the orientations of the lines representing said at least one plateau of the vertebrae V2 to V4 of the segment 2.
• the image processing step is also performed to calculate the orientations of the line representing the opaque portion 1 1 of the instrument 9. Then it is calculated, for each vertebra of the segment, the angle a between said orientations of the lines. This angle corresponds to a parallelism defect between the positioning of the opaque part of the instrument and the line 19 representing the vertebral plateau of the segment. When the angle ⁇ is zero, the opaque portion is parallel to the guide line 19.
• the processing unit determines the initial orientation of the vertebral plane directly from the calculated angle.

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• 2014
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