Abstract: A robotic system for performing minimally invasive spinal stabilization, using two screws inserted in oblique trajectories from an inferior vertebra pedicle into the adjacent superior vertebra body. The procedure is less traumatic than such procedures performed using open back surgery, by virtue of the robot used to guide the surgeon along a safe trajectory, avoiding damage to nerves surrounding the vertebrae. The robot arm is advantageous since no access is provided in a minimally invasive procedure for direct viewing of the operation site, and the accuracy required for oblique entry can readily be achieved only using robotic control. This robotic system also obviates the need for a large number of fluoroscope images to check drill insertion position relative to the surrounding nerves. Disc cleaning tools with flexible wire heads are also described. The drilling trajectory is determined by comparing fluoroscope images to preoperative images showing the planned path.

Abstract: A robotic surgical system incorporating a surgical robot attached to a patient's bone by an attachment member, such that motion of the bone induces corresponding motion of the robot, maintaining the robot/bone positional relationship. The robot is supported on a mechanical mounting member attached through a controlled joint to a bed-mounted base element. The controlled joint can alternatively enable the mechanical mounting member to move freely relative to the base element, or its position can be controlled by signal inputs adapted to prevent excessive force being applied in the system. Two modes of operation are available (i) free motion in which the control system is decoupled from the mounting member, which rides freely with patient bone motion, and (ii) servo-controlled motion, in which drive mechanisms control the joint motion to prevent application of excessive force on the patient bone or attachment member.

Abstract: A robotic system for performing minimally invasive spinal stabilization, using two screws inserted in oblique trajectories from an inferior vertebra pedicle into the adjacent superior vertebra body. The procedure is less traumatic than such procedures performed using open back surgery, by virtue of the robot used to guide the surgeon along a safe trajectory, avoiding damage to nerves surrounding the vertebrae. The robot arm is advantageous since no access is provided in a minimally invasive procedure for direct viewing of the operation site, and the accuracy required for oblique entry can readily be achieved only using robotic control. This robotic system also obviates the need for a large number of fluoroscope images to check drill insertion position relative to the surrounding nerves. Disc cleaning tools with flexible wire heads are also described. The drilling trajectory is determined by comparing fluoroscope images to preoperative images showing the planned path.

Abstract: A method verifying the position of a surgically inserted orthopedic insert. A preoperative three dimensional image data set of the surgical site is generated, showing the bone into which the insert is to be inserted. During the insertion procedure, a series of intraoperative two-dimensional fluoroscope images are generated, each at a known pose relative to the bone, showing the insert during or after insertion into the bone. The 3-D position of the insert is determined in an intraoperative three dimensional image data set reconstructed from the series of intraoperative 2-D fluoroscope images. The reconstructed intraoperative 3-D image data set is registered with the preoperative three dimensional image data set, such as by comparison of imaged anatomical features. Once this registration is achieved, the determined 3-D position of the insert is used to implant a virtual image of the insert into the preoperative three dimensional image data set.

Abstract: A novel image-guided system for precise automatic targeting in minimally invasive keyhole neurosurgery. The system consists of a miniature robot fitted with a mechanical guide for needle, probe, or catheter insertion. Intraoperative, the robot is directly affixed to a head clamp or to the patient skull. It automatically positions itself with respect to predefined entry points and targets in a preoperative CT/MRI image following an anatomical registration with an intraoperative 3D surface scan of the patient facial features and a registration jig. The registration procedure is a novel three-way scheme, in which the intraoperative surface scan including the registration jig is matched to a model generated from the preoperative CT/MRI image, the robot position is known in relation to the registration jig, and the entry and target points are known from the preoperative CT/MRI image, such that the robot position can be related to the entry and target points.

Abstract: Systems and methods for performing robotic endoscopic surgical procedures, according to a surgical plan prepared on a preoperative set of three dimensional images. The system comprises a surgical robot whose coordinate system is related to that of fluoroscope images generated intraoperatively, by using a three dimensional target having radio-opaque markers, attached in a predetermined manner to the robot or to another element to which the robot is attached, such as the spinal bridge or an attachment clamp. The robot is mounted directly or indirectly on a bone of the patient, thereby nullifying movement of the bone, or a bone tracking system may be utilized. The coordinate system of the intraoperative fluoroscope images may be related to the preoperative images, by comparing anatomical features between both image sets. This system and method enables the endoscope to be directed by the robot along the exact planned path, as determined by the surgeon.

Abstract: Methods and apparatus for detecting or predicting surgical tool-bone skiving are disclosed. In some embodiments, the surgical tool is movably and/or snugly disposed within a guide-sleeve. In some embodiments, a magnitude of a lateral force between the surgical tool and the guide-sleeve is measured (e.g. by a force sensor or strain sensor). The present or future skiving may be detected or predicted according to the magnitude of the lateral force. In some embodiments, an alert signal is generated in response to the detecting or predicting of the skiving.

Abstract: A robotic system for performing minimally invasive spinal stabilization, using two screws inserted in oblique trajectories from an inferior vertebra pedicle into the adjacent superior vertebra body. The procedure is less traumatic than such procedures performed using open back surgery, by virtue of the robot used to guide the surgeon along a safe trajectory, avoiding damage to nerves surrounding the vertebrae. The robot arm is advantageous since no access is provided in a minimally invasive procedure for direct viewing of the operation site, and the accuracy required for oblique entry can readily be achieved only using robotic control. This robotic system also obviates the need for a large number of fluoroscope images to check drill insertion position relative to the surrounding nerves. Disc cleaning tools with flexible wire heads are also described. The drilling trajectory is determined by comparing fluoroscope images to preoperative images showing the planned path.

Abstract: A spinal intervertebral support implant, for fusion or for dynamic stabilization purposes. A rod, preferably in the form of a screw, is inserted obliquely from the pedicle of an inferior vertebra into the body of a neighboring superior vertebra, through the disc space. The rod can be anchored into the body of the superior vertebra by means of a force fit or a screw thread. A pile of elements is disposed on the rod in the disc space like a pile of washers, so that the compression load between vertebrae is carried partly by these elements. These elements can be inserted through the bore through which the rod was inserted in a tightly folded configuration, and deployed into their washer-like form only when in position in the intervertebral space, such that there is no need for any additional incisions.

Abstract: A method verifying the position of a surgically inserted orthopedic insert. A preoperative three dimensional image data set of the surgical site is generated, showing the bone into which the insert is to be inserted. During the insertion procedure, a series of intraoperative two-dimensional fluoroscope images are generated, each at a known pose relative to the bone, showing the insert during or after insertion into the bone. The 3-D position of the insert is determined in an intraoperative three dimensional image data set reconstructed from the series of intraoperative 2-D fluoroscope images. The reconstructed intraoperative 3-D image data set is registered with the preoperative three dimensional image data set, such as by comparison of imaged anatomical features. Once this registration is achieved, the determined 3-D position of the insert is used to implant a virtual image of the insert into the preoperative three dimensional image data set.

Abstract: A system and method for generating CT-type three dimensional imaging information from a conventional C-arm fluoroscope system. This enables the adaptation of widely used C-arm installations to provide CT-type information. The system uses a three dimensional target disposing in a fixed position relative to the subject, and obtains a sequence of video images of a region of interest of a subject while the C-arm is moved manually or by a scanning motor. Images from the video sequence are analyzed to determine the pose of the C-arm relative to the subject by analysis of the image patterns of the target. Images are selected from the video sequence according to predetermined criteria. A set of two-dimensional image data with associated positional data is obtained, which is used to reconstruct a three dimensional volumetric set of imaging data of the region of interest of the subject.

Abstract: A robotic system for performing minimally invasive spinal stabilization, using two screws inserted in oblique trajectories from an inferior vertebra pedicle into the adjacent superior vertebra body. The procedure is less traumatic than such procedures performed using open back surgery, by virtue of the robot used to guide the surgeon along a safe trajectory, avoiding damage to nerves surrounding the vertebrae. The robot arm is advantageous since no access is provided in a minimally invasive procedure for direct viewing of the operation site, and the accuracy required for oblique entry can readily be achieved only using robotic control. This robotic system also obviates the need for a large number of fluoroscope images to check drill insertion position relative to the surrounding nerves. Disc cleaning tools with flexible wire heads are also described. The drilling trajectory is determined by comparing fluoroscope images to preoperative images showing the planned path.

Abstract: A robotic surgical system incorporating a surgical robot attached to a patient's bone by an attachment member, such that motion of the bone induces corresponding motion of the robot, maintaining the robot/bone positional relationship. The robot is supported on a mechanical mounting member attached through a controlled joint to a bed-mounted base element. The controlled joint can alternatively enable the mechanical mounting member to move freely relative to the base element, or its position can be controlled by signal inputs adapted to prevent excessive force being applied in the system. Two modes of operation are available (i) free motion in which the control system is decoupled from the mounting member, which rides freely with patient bone motion, and (ii) servo-controlled motion, in which drive mechanisms control the joint motion to prevent application of excessive force on the patient bone or attachment member.

Abstract: Systems and methods for performing robotic endoscopic surgical procedures, according to a surgical plan prepared on a preoperative set of three dimensional images. The system comprises a surgical robot whose coordinate system is related to that of fluoroscope images generated intraoperatively, by using a three dimensional target having radio-opaque markers, attached in a predetermined manner to the robot or to another element to which the robot is attached, such as the spinal bridge or an attachment clamp. The robot is mounted directly or indirectly on a bone of the patient, thereby nullifying movement of the bone, or a bone tracking system may be utilized. The coordinate system of the intraoperative fluoroscope images may be related to the preoperative images, by comparing anatomical features between both image sets. This system and method enables the endoscope to be directed by the robot along the exact planned path, as determined by the surgeon.

Abstract: A tracking and positioning system and method to enable the precise positioning of an object or tool relative to its surgical surroundings, and in accordance with preoperative CT images of the operating site. When used for artificial spinal disc positioning, the system comprises a computing system incorporating in memory the preoperative CT data showing the two vertebrae and the predetermined disc position between them; a 3-D target having radio-opaque markers for attaching to one of the vertebrae to define the position of the vertebra in an intra-operative fluoroscope image of the spine; a tool for intra-operative insertion of the artificial disc, and a registration system for relating the intra-operative fluoroscope image to the preoperative CT data, such that the predetermined disc position is displayed in the fluoroscope image of the subject, thereby enabling the surgeon to place the artificial disc accurately in its intended position.

Abstract: A system and method for generating three dimensional CT-type information from a conventional C-arm fluoroscope imaging system. A small number of fluoroscope images are used, taken from angles whose pose is determined by means of a three-dimensional target attached to the region of interest, aided by the participation of the surgeon or an image processing routine to pinpoint known anatomical features in the region of interest of the patient. This procedure enables the reconstruction of virtual images in any desired plane, even in planes other than those accessible by the C-arm imaging process, such as the axial plane of a vertebra. Use of this system and method of marking of the feature to be treated in a small number of angularly dissimilar images, enables the generation of CT-type information which can be used to accurately align a robotically guided surgical tool with the anatomical feature.

Abstract: A spinal intervertebral support implant, for fusion or for dynamic stabilization purposes. A rod, preferably in the form of a screw, is inserted obliquely from the pedicle of an inferior vertebra into the body of a neighboring superior vertebra, through the disc space. The rod can be anchored into the body of the superior vertebra by means of a force fit or a screw thread. A pile of elements is disposed on the rod in the disc space like a pile of washers, so that the compression load between vertebrae is carried partly by these elements. These elements can be inserted through the bore through which the rod was inserted in a tightly folded configuration, and deployed into their washer-like form only when in position in the intervertebral space, such that there is no need for any additional incisions.

Abstract: An orthopedic screw having a thread with two parts, a distal and a proximal part, each having a different thread configuration. The distal section has a thread with outer dimension and pitch suitable for entry into cancellous bone, while the proximal section has a composite thread comprising (i) a first thread of the same or slightly larger outer diameter as the cancellous thread in the distal section, having the same pitch thereof, and lying on the same helix, and (ii) another thread having a smaller outer diameter but the same pitch as the first thread, but disposed on a helix displaced from that of the first thread, such that it lies between the crests of the first thread. This screw enables optimum fixation strength in a bone or bones having a harder cortical outer section and a softer cancellous inner section. The screw may have an unthreaded central section.

Abstract: A spinal intervertebral support implant, for fusion or for dynamic stabilization purposes. A rod, preferably in the form of a screw, is inserted obliquely from the pedicle of an inferior vertebra into the body of a neighboring superior vertebra, through the disc space. The rod can be anchored into the body of the superior vertebra by means of a force fit or a screw thread. A pile of elements is disposed on the rod in the disc space like a pile of washers, so that the compression load between vertebrae is carried partly by these elements. These elements can be inserted through the bore through which the rod was inserted in a tightly folded configuration, and deployed into their washer-like form only when in position in the intervertebral space, such that there is no need for any additional incisions.

Abstract: A system and method for generating CT-type three dimensional imaging information from a conventional C-arm fluoroscope system. This enables the adaptation of widely used C-arm installations to provide CT-type information. The system uses a three dimensional target disposing in a fixed position relative to the subject, and obtains a sequence of video images of a region of interest of a subject while the C-arm is moved manually or by a scanning motor. Images from the video sequence are analyzed to determine the pose of the C-arm relative to the subject by analysis of the image patterns of the target. Images are selected from the video sequence according to predetermined criteria. A set of two-dimensional image data with associated positional data is obtained, which is used to reconstruct a three dimensional volumetric set of imaging data of the region of interest of the subject.