Patent Application
20170042620
The present disclosure generally relates to devices and methods to temporarily mount an apparatus to bone. For example, these temporary mounts may be suitable for attaching an apparatus, such as a trackable reference array, to a bony structure in a patient's body to provide a reference point during surgical navigation.
During surgery, it may be necessary to temporarily mount an apparatus to exposed bone. For example, when using surgical navigation, it may be necessary to attach a tracker, such as a trackable reference array of optical markers, to the patient for accurately tracking the position of tools relative to the surgical site. If bone is the surgical target, such as when inserting a bone screw or the like, then attaching the reference array to bone provides better accuracy than attaching the reference array to surrounding soft tissues and more accurately tracks the position of the surgical tools relative to the bone. After the surgical procedure is completed (e.g., installing bone screws, rods, implants, and the like), the mounted tracker is typically removed.
Current methods for temporarily attaching trackers, reference arrays, or other devices to bone may include one or more of the following: screw-based mounting devices, in which one or more screws are inserted to hold the device to bone; clamp-based mounting devices, in which teeth and jaws of a clamp or clamps are tightened around bony prominences; or spike-based devices, in which one or more spikes are driven into bone with a mallet. These devices, however, may only provide for a single point of fixation to the bone, thereby providing a weak attachment to the bone and potentially compromising the accuracy of the tracker. In addition, traditional devices may be accidentally advanced too far into the bony structure, which can damage the bone or surrounding areas or make it difficult to remove the temporary mounting device, which is embedded too deeply into the bone, after the procedure is completed.
To meet this and other needs, devices, systems, kits, and methods for temporarily mounting an apparatus, such as a tracker, to bony structures are provided. In particular, the temporary devices may provide for multiple points of fixation to the bone, thereby providing a strong attachment to the bone and improving the accuracy of an attached apparatus, such as a tracker for surgical navigation. The temporary mounting devices may also include features, such as stops including protrusions and arched regions, for example, which prevent the temporary mounting device from accidentally being advanced too far into the bony structure. The design of the temporary mounts can help to protect the bone and surrounding areas and can be easier to remove from the bone when the surgical navigation and/or surgical procedure are completed.
According to one embodiment, a mount for temporarily affixing a surgical apparatus to a bony structure (e.g., one or more vertebrae of a spine) includes a base member having a top face configured to be impacted by an insertion device, and a plurality of elongated prongs extending downwardly from the base member and configured to engage a bony structure. Each of the plurality of prongs are separated a distance from one another. The prongs may be configured to move inwardly toward one another when driven downward into the bony structure by the insertion device. The mount has multiple points of fixation with the bony structure to provide a strong and reliable attachment to the bone. For example, the plurality of prongs may include two or more, three or more, or four or more prongs extending from the base member. The prongs may be elongated in the form of legs, tines, spikes, pins, or the like.
The temporary mount may include one or more of the following features, for example. Each of the plurality of prongs may include a protrusion extending therefrom configured to act as a stop to prevent over-insertion of the mount in the bony structure. The protrusions may be in the form of hill-shaped prominences positioned along the length of the prong (e.g., spaced apart from a distal most end). The plurality of elongated prongs may extend a length greater than a length of the base member (e.g., the prongs are longer than the base member portion of the mount such that the height of the device is primarily due to the height of the prongs). The plurality of elongated prongs may be in the form of a first prong and a second prong, and a transition from the first prong to the second prong may be arched or curved to act as an ultimate stop to prevent over-insertion of the mount in the bony structure. An arched stop may be provided between each prong. The plurality of elongated prongs may include a first prong, a second prong, a third prong, and a fourth prong, where a first arched portion between the first prong and the second prong has a first distance from the top face, and a second arched portion from the second prong to the third prong has a second distance from the top face, the second distance being different from than the first distance. In particular, the second distance may be greater than the first distance or vice versa. The arched portions on opposite sides of the device may be the same or substantially equivalent. In some embodiments, the mount may also include an outer sleeve having a hollow interior configured to engage an outer surface of the base member and/or a portion of one or more outer surfaces of the prongs. The outer sleeve may be configured to slide or rotate, for example, in order to compress the prongs inwardly toward one another. Each of the plurality of prongs may have a textured inner surface configured to resist extraction from the bone. Each of the plurality of prongs may have a sharpened distal-most tip configured to penetrate the bony structure. When the base member is impacted by the insertion device, the temporary mount may provide an audible sound, as each of the prongs is driven downward, and the frequency of the audible sound may change indicating the relative position of the mount in the bone (e.g., when the mount is fully seated in the bone structure). The mount is configured to hold and engage a portion of a trackable reference array, which may assist in surgical navigation, for example, with a surgical robot.
According to another embodiment, a kit may include a plurality of temporary mounts of different sizes and different configurations. In addition, the kit may include one or more devices suitable for surgical navigation, for example, including a trackable array, and configured to be attachable to the temporary mounts; one or more central shafts configured to guide the mount through soft tissue and into contact with bone; one or more driving sleeves configured to apply a force to the driving sleeve to cause the temporary mount to advance into the bone; one or more insertion devices, such as impact drivers, mallets, or the like, configured to engage the mounts, the central shafts, and/or the driving sleeves; one or more removal devices, such as slap hammers, slide hammers, or the like, configured to retrieve and extract the temporary mounts from the bone; and other tools and devices, which may be suitable for surgery.
According to another embodiment, a system for temporarily affixing a surgical apparatus to a bony structure includes at least one temporary mount and a least one tracking device, such as a trackable reference array for surgical navigation. The temporary mount includes a base member having a top face configured to be impacted by an insertion device, and a plurality of elongated prongs extending downwardly from the base member and configured to engage a bony structure, wherein each of the plurality of prongs are separated a distance from one another, and wherein the prongs are configured to move inwardly toward one another, for example, when driven downward into the bony structure. The trackable reference array is connected to the base member of the temporary mount, for example, at an opening in the top face of the base member.
According to yet another embodiment, a method of temporarily affixing a surgical apparatus to a bony structure includes (a) inserting a central shaft through soft tissue and into contact with bone; (b) inserting a cannulated temporary mount over the central shaft and moving the temporary mount downwardly and into contact with the bone, the cannulated temporary mount having a first end configured to be engaged by an insertion tool and a second end terminating as a plurality of elongated prongs configured to engage bone, wherein each of the plurality of prongs are separated a distance from one another, and wherein the prongs are configured to move inwardly toward one another when driven downward into the bony structure; (c) optionally, positioning a driving sleeve over the central shaft and into contact with the first end of the temporary mount; (d) applying a force to the temporary mount to advance at least a portion of the prongs into the bone, optionally, by applying a force to the driving sleeve; and (e) optionally, removing the driving sleeve and the central shaft to leave the temporary mount embedded in the bone. In one embodiment, the temporary mount further includes an outer sleeve, and the method additionally comprises (f) optionally, rotating the outer sleeve in order to compress the prongs inwardly toward one another to further secure the mount to the bone. The method may also include (g) attaching a portion of a trackable reference array for surgical navigation to the temporary mount and/or (h) removing the temporary mount from the bone after the surgical navigation is complete.
A more complete understanding of the present invention, and the attendant advantages and features thereof, will be more readily understood by reference to the following detailed description when considered in conjunction with the accompanying drawings wherein:
Embodiments of the disclosure are generally directed to devices, systems, kits, and methods for temporarily mounting an apparatus, such as a tracker for surgical navigation, to bony structures. Specifically, the temporary mounts may include a plurality of prongs, legs, spikes, tines, or the like, extending from a base member, which provide for multiple points of fixation to the bony structure. The bony structure may include any bones, bony segments, bony portions, bone joints, or the like of a patient. For example, the bony structure may include areas from a bone from the spine, such as a vertebra, a hip bone, such as an ilium, a leg bone, such as a femur, or a bone from an arm, such as a distal forearm bone or a proximal humerus, or any other bone in a mammal. In an exemplary embodiment, the bony structure or bone includes one or more vertebrae in the spinal column of a human patient. Providing for multiple points of fixation allows for a stronger attachment to the bone and may maintain or improve the positional accuracy of an attached apparatus, such as a tracker for surgical navigation.
The temporary mounting devices may also include features, such as stops, for example, to prevent or minimize the occurrence of the temporary mounting device from being advanced too far into the bony structure. One or more features on the temporary mounting devices can also help to protect the bone and surrounding areas and may make it easier for the surgeon to remove the temporary mounting device from the bone when the surgical navigation has been completed.
The embodiments of the disclosure and the various features and advantageous details thereof are explained more fully with reference to the non-limiting embodiments and examples that are described and/or illustrated in the accompanying drawings and detailed in the following description. The features of one embodiment may be employed with other embodiments as the skilled artisan would recognize, even if not explicitly stated herein. Descriptions of well-known components and processing techniques may be omitted so as to not unnecessarily obscure the embodiments of the disclosure. The examples used herein are intended merely to facilitate an understanding of ways in which the disclosure may be practiced and to further enable those of skill in the art to practice the embodiments of the disclosure. Accordingly, the examples and embodiments herein should not be construed as limiting the scope of the disclosure, which is defined solely by the appended claims and applicable law. Moreover, it is noted that like reference numerals represent similar features and structures throughout the several views of the drawings.
According to a first embodiment, a spike-based device may include multiple prongs or tines extending from a rigid base. For example, a mount for temporarily affixing a surgical apparatus to a bony structure (e.g., vertebrae of a spine) includes a base member having a top face configured to be impacted by an insertion device, and a plurality of elongated prongs extending downwardly from the base member and configured to engage a bony structure. Each of the plurality of prongs are separated a distance from one another. The prongs may be configured to move inwardly toward one another, for example, when driven downward into the bony structure or thereafter. The mount has multiple points of fixation with the bony structure to provide a strong and reliable attachment to the bone. This device has several unique features that give it advantages when used to temporarily attach a reference array or other device to bone.
Referring now to the drawing,
The base member 12 may have a top face 14 configured to receive impaction forces from an insertion tool, such as an impact driver, mallet, or the like. The top face 14 may be substantially flat, curved, angled, for example, or of other suitable shape or contour. In an exemplary embodiment, the top face 14 of the device 10 is flat and can be a suitable surface to strike the device 10 with an impact driver or mallet, for example. The top face 14 of the base member 12 may include an opening or aperture 16. The aperture 16 extends partially or completely through the base member 12. When extending completely therethrough, the aperture 16 may provide for a cannulated device 10. The aperture 16 may be sized and dimensioned to receive, for example, a guide wire, post, or central shaft, discussed in more detail herein, to insert the device 10 in a minimally invasive surgical procedure. For example, a post can be previously mounted to the spike 10, extending upward therefrom, before the device 10 is driven into bone 18. The device 10 can be driven by striking this post, which may be easier than striking the flat part shown, especially when driving the spike 10 down through regions surrounded by thick tissues.
After the mount 10 is in place seated in bone 18, attachments can be mounted to a portion of the device 10 in various ways. In particular, the hole or aperture 16 may also be sized and dimensioned to removably connect a portion of a tracker (not shown), such as a trackable reference array of optical markers, for surgical navigation and/or robotic systems. Surgical navigation systems and trackable markers are described in more detail in U.S. Pat. Nos. 8,010,181, 8,219,177, 8,219,178, 9,078,685, and U.S. Publication Nos. 2013/0345718, 2014/0275955, 2014/0378999, 2015/0032164, which are incorporated by reference herein in their entireties for all purposes. The aperture 16 may be non-threaded, partially threaded, or fully threaded along its length, for example. If the aperture 16 is threaded, a separate device mounted to or having a bolt or shaft can be attached. Alternately, a keyed slot, snap-on attachment, clamp, or other means can be used to attach other devices, such as the reference array, to the device 10.
As shown in
In one embodiment, four separate prongs 20 may be projecting from each corner of a cubic base member 12 and extending generally away from the top face 14. With continued reference to
With further reference to
The device 10 may be constructed from a single piece of suitably strong and rigid material. The material is preferably biocompatible. For example, the material may include metals, such as stainless steel, titanium, or titanium alloys. Dimensions of the device 10 may be about 10 mm×15 mm×60 mm but could be smaller or larger as needed depending on the bone and application.
As best seen in the side view in
Another feature of the 4-prong spike 10 is that the narrow and elongated prongs 20 tend to ring musically. In other words, when device 10 is struck by the impact driver or mallet, the device emits a frequency or audible sound wave. The audible sensation of a frequency is commonly referred to as the pitch of a sound. A high pitch sound corresponds to a high frequency sound wave and a low pitch sound corresponds to a low frequency sound wave. Most people are capable of detecting a difference in frequency between two separate sounds, and thus, different pitches. As each prong 20 is driven downward and becomes encased more and more in the bone 18, the frequency of the ringing noise, as the device 10 is struck with the mallet, for example, changes. For example, as the device begins to enter the bone 18, the frequency may provide a lower pitch. As the device 10 becomes more encased in the bone 18, however, the frequency changes to provide a higher pitch. This ringing quality can act as a feedback mechanism to let the surgeon know the position or depth of the device 10 in the bone 18. Moreover, a higher pitch may let the surgeon know that the device 10 is fully and rigidly seated in the bone 18.
As best seen in the close up view of the prong 20 (e.g., representing each of the tines 22, 24, 26, 28) in
These prominences or protrusions 30 are configured, at least in part, to act as a stop to prevent over-insertion of the device 10 into the bone 18. As the device 10 is driven downward and when bone 18 reaches these prominences or protrusions 30, the device 10 stops or slows. While it is still possible to drive the device 10 beyond this point, more effort is needed. Making these prominences or protrusions 30 as small hills instead of flat buttresses allows one or more of the prongs 20 to continue to be advanced if there is an irregularity of the bony surface 18. Additionally, as the device 10 is driven downward, the wedging action of these prominences 30 against bone 18 increase the rigidity and holding strength.
As shown in the close up perspective view of the base member 12 in
When driven far enough to reach these stops or transitions 32, 34, further advancement of the device 10 is halted and device 10 cannot be driven farther without considerable effort. These stops can be designed to be positioned to act as safety stops to prevent the user from driving the device 10 into unsafe regions, such as nerves or the spinal canal. The transitional regions of the device 10 are formed as arches instead of corners because this design allows the prongs 20 to spread or squeeze horizontally (e.g., away from or toward one another) as the device 10 is driven downward. Horizontal squeezing of the prongs 20 against the elastic resistance of the bending metal creates a compressive force on the bone 18 between the prongs 20, thereby improving the rigidity of the device 10 and attachment to the bone 18. These transition portions 32, 34 of the device 10 also can act as a prying point when the surgeon is ready to remove the device 10. That is, a removal tool, such as a screwdriver or similar tool, can be forced under these arched regions 32, 34 and used to pry the device 10 upward to dislodge it from the bone 18.
As best seen in
According to another embodiment,
According to yet another embodiment,
The top face 214 of the base member 212 may include an opening or aperture 216, which extends partially or completely through the base member 212. Thus, the device 200 may be fully cannulated. The aperture 16 may be sized and dimensioned to receive, for example, a guide wire, post, or central shaft for guiding the device 200 and/or may be sized and dimensioned to removably connect to a portion of a tracker, such as a trackable reference array, for a surgical navigation system.
Similar to devices 10 and 100, the device 200 could initially be malleted into place. Subsequently, the outer sleeve 238 would be activated, for example by sliding or rotating the outer sleeve 238, to move the outer sleeve 238 in a first direction toward the prongs 20, in order to compress the prongs 220 inwardly toward one another. When the temporary mounting apparatus 200 is to be removed, the outer sleeve 238 could be slid or rotated to move the outer sleeve 238 in a second direction, opposite the first direction and away from the prongs, in order to release the prongs 220. Such a mechanism might be especially useful if the prongs 220 are forced down over a bony prominence, such as the spinous process, and then need to be secured further by compressing and clamping the bone 18 between the prongs 220. As can be seen in
Similar to device 200,
Another embodiment, depicted in
The first step may be to position the central shaft 400 next to bone 18. An example of such a central shaft 400 is shown in
One benefit of using the central shaft 400 as the initial penetrator of soft tissue is that it can be used to gauge the size of the device 10, 100, 200, 300 that will ultimately be needed. As shown in
As depicted in
As shown in step (a1), once the distal tip of the shaft 400 is in place against bone 18, the proximal end of the central shaft 400 could be held in one of the surgeon's hands, left in place by friction, or held by an assistant or robot. As shown in step (b1) the cannulated temporary mount 10 is advanced over the central shaft 400. As shown in step (c1), the pronged mount 10 comes down into contact with the bone 18. The central shaft 400 and mount 10 can be designed so that the prongs 20 hug the shaft 400, preventing soft tissue from getting snagged between the prongs 20 and the shaft 400.
If the cannulated device 10 is longer than the central shaft 400, then striking the cannulated device 10 with a mallet would drive it into the bone 18 as described above for the device 10. After the device 10 is in place the central shaft 400 could be left in place or retrieved with a tool such as a threaded rod that is threaded into a socket in the central shaft 400 (not shown). It may not be desirable to leave the central shaft 400 in place. When left in place while striking the cannulated device 10, there would be a risk that once the device 10 advanced past the point of the end of the central shaft 400, further malleting could undesirably force the central shaft 400 into the bone 18. Instead, the dimensions of the device 10 may be such that the central shaft 400 is longer than the device 10.
Alternatively, a sleeve member 406 could be used in order to drive the device 10 down over the central shaft 400. The sleeve member 406 may optionally include a head portion. In the design of the driving sleeve 406, the enlarged head may be larger in diameter than the rest of the shaft to serve as a larger surface area for striking the piece. As can be seen in alternative step (a2), the shaft 400 is positioned with the device 10 in contact with the bone 18. In step (b2), the sleeve member 406 is positioned over the central shaft 400 and into contact with the device 10. In step (c2), the surgeon would mallet the sleeve member 406, causing advancement of the spike 10. Then, the sleeve member 400 would be removed as shown in step (d2). Subsequently, in step (e2), the central shaft 400 would be removed, and the device 10 would be left embedded in the bone 18. These components may be added and removed one-by-one or together. The desired attachment such as a navigation array could then be placed on and attached to the device 10 using suitable techniques known in the art.
After navigation is complete and/or after the surgical operation is complete, but before the patient is closed, the device 10, 100, 200, 300 can be removed, for example, by pulling it out, prying it out, or using a slap-hammer attached to the aperture 16, 216 or a threaded socket on the device 10, 100, 200, 300. The device 10, 100, 200, 300 can be sterilized for re-use. Alternately, the device 10, 100, 200, and 300 may be used as a disposable part.
The designs for the mounts 10, 100, 200, 300 described herein have advantages over the existing methods of using a single nail or spearhead shaped device. In particular, there are multiple points of fixation (e.g., four points of fixation) through cortical and into cancellous bone instead of just a single point found in traditional nails and the like. This plurality of fixation points provides for strong attachment to the bone 18 and improved accuracy of an attached apparatus, such as a tracker for surgical navigation. The prongs 20, 120, 220, 320 are also designed to be delicate enough that they deform while they are driven into bone 18 to improve the rigidity of fixation. The temporary mounting devices 10, 100, 200, 300 may also include one or more stops such that there is less of a chance of accidentally advancing the device 10, 100, 200, 300 too far into the bone than often occurs with a single nail or spearhead. Thus, the design of the temporary mounts 10, 100, 200, 300 can help to protect the bone 18 and surrounding areas and can be easier to remove from the bone 18 when the surgical navigation and/or surgical procedure are completed.
Although the invention has been described in detail and with reference to specific embodiments, it will be apparent to one skilled in the art that various changes and modifications can be made without departing from the spirit and scope of the invention. Thus, it is intended that the invention covers the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents. It is expressly intended, for example, that all ranges broadly recited in this document include within their scope all narrower ranges which fall within the broader ranges. It is also intended that the components of the various devices disclosed above may be combined or modified in any suitable configuration.
