WO2000067645A1 - Rotating surgical instrument - Google Patents
Rotating surgical instrument Download PDFInfo
- Publication number
- WO2000067645A1 WO2000067645A1 PCT/EP2000/002253 EP0002253W WO0067645A1 WO 2000067645 A1 WO2000067645 A1 WO 2000067645A1 EP 0002253 W EP0002253 W EP 0002253W WO 0067645 A1 WO0067645 A1 WO 0067645A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- tool
- tool according
- bone
- receiving device
- ultrasonic transducer
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
- A61B17/7092—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for checking pedicle hole has correct depth or has an intact wall
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1637—Hollow drills or saws producing a curved cut, e.g. cylindrical
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
- A61B2090/3782—Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument
- A61B2090/3784—Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument both receiver and transmitter being in the instrument or receiver being also transmitter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0875—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of bone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
- A61C1/02—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design characterised by the drive of the dental tools
- A61C1/07—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design characterised by the drive of the dental tools with vibratory drive, e.g. ultrasonic
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0089—Implanting tools or instruments
Definitions
- the invention relates to a rotating surgical tool for producing a recess in bone material.
- a wide variety of rotating tools are known for producing depressions in bone material, for example drills, milling cutters, reamers, etc. All these tools have in common that they can be used to introduce depressions in various forms into the bone material, for example receiving bores for bone screws. It is of the utmost importance that these bores and depressions are placed in the bone in the desired manner, since in many cases there is only little bone material available for fixing bone screws and other implant parts. For example, it is extremely difficult to place pedicle screws in the vertebral body in the area of the spine in such a way that on the one hand they are fixed in the desired manner in the vertebral body and on the other hand they do not cause any injuries.
- This object is achieved according to the invention in a rotating surgical tool of the type described in the introduction in that an ultrasound transducer is arranged in it which can transmit and receive ultrasound waves, and in that the ultrasound transducer can be connected to an ultrasound generator and a receiving device which depends on the strength of the Ultrasound radiation received by the ultrasound transducer and the time period between the emission of the ultrasound radiation and the reception of reflected ultrasound radiation generates signals which are a measure of the nature of the bone material in the radiation direction.
- the ultrasound radiation emitted by the transducer in the rotating tool penetrates into the surrounding bone structures and is reflected there, in particular on the surfaces of the bone material and on inhomogeneities in the bone material, for example on surfaces on which the structure of the bone material changes.
- the reflected ultrasound radiation is captured by the transducer, and from the strength of the received signal and the time that has passed since the ultrasound radiation was emitted, information can be given about the nature of the bone material adjacent to the tool, in particular about the layer thickness of the bone material and possibly also about changes in the structure of the bone material. The surgeon can use this information to check the position of the tool in the bone and thus the position of the depression created by the tool.
- separate transducers can be provided for the transmission and for the reception of the ultrasound radiation, but it is also possible to emit the ultrasound radiation with the same transducer and then to take up the reflected radiation again. This can be done, for example, with a so-called pulse-echo method.
- the ultrasound transducer is arranged in the area of the distal end of the tool, so that the area in front of the distal end of the tool is "seen” by the ultrasound radiation emitted by the tool. The surgeon is thus provided with information about how the bone material is made in the machining direction, and is therefore given the opportunity to control the feed direction of the tool accordingly.
- a particularly favorable embodiment results if the ultrasound transducer is arranged in the tool in such a way that its direction of transmission and reception for the ultrasound waves is inclined with respect to the axis of rotation, for example with an angle of inclination between 30 and 60 °, in particular in the order of magnitude of approximately 45 °.
- the ultrasound radiation is emitted on a conical jacket that opens in the distal direction, and in this way the surgeon receives information not only exactly in the direction of advance of the rotating tool, but about the entire angle of rotation of the tool in a region that is distal Direction in front of the tool. This results in an optimal orientation over the bone areas still to be processed.
- the tool has an inner receiving space for the ultrasound transducer, which is connected to a channel running in the tool up to its proximal end. Connection lines for the ultrasound transducer can run through this channel.
- the tool is a drilling tool with a conical cutting surface and the ultrasound transducer is arranged in the region of the conical cutting surface.
- the tool comprises a sensor for its angular position and if the sensor feeds a signal corresponding to the angular position to the receiving device, which thus generates the signals for the condition of the bone as a function of the angular position of the tool.
- the ultrasound transducer forms, as it were, a camera arranged on a rotatable carrier, which covers the entire area in front of the tool in all directions.
- the receiving device is assigned an optical display device which displays the signals generated by the receiving device for the bone quality. Such a display device can therefore be used to directly read how the bone is made in the direction of radiation of the ultrasound radiation, what bone wall thickness is available here and which structural changes may occur.
- cross sections through the tool and the adjacent bone material can be displayed on the optical display device, the nature of the bone material being determined by the signals generated by the receiving device.
- These cross sections simultaneously show the signals generated by the receiving device, which result from different angular positions of the tool, so that information about the condition of the bones is obtained simultaneously over the entire angular range.
- the cross-sectional area shown is a conical surface, the axis of which coincides with the axis of rotation of the tool and which opens in the distal direction.
- Cross sections of implants that show in can also be shown on the optical display device how certain implants should be placed in the bone after implantation.
- the surgeon thus has the possibility, with knowledge of the implant shape and the desired position of the implant, to set depressions, for example boreholes, in such a way that their position corresponds to the shape and position of the implant.
- the image of the implant can be generated from a data memory in which the display data for this implant are stored. From this data, the image of the image that results from the ultrasound signals can be superimposed.
- the receiving device can also be assigned, for example, an optically or acoustically operating warning device which warns the operator that the wall thickness of the bone material in the area to be processed is below a certain value, so that there is a risk of breakthrough.
- Figure 1 is a schematic view of a drilling tool attached to a vertebral body with an ultrasound monitoring device with an optical display and
- Figure 2 is an enlarged sectional view in area A in Figure 1 with a drilling tool equipped with an ultrasonic transducer.
- the invention is discussed below using the example of a drilling tool, but in principle the invention can also be used in other rotating machining tools, for example in milling cutters, reamers, trephines, etc., by means of which the bone material is machined by rotary movement, in particular for the production of Holes and other recesses.
- a surgical hand drill 1 is equipped with a twist drill 2 which is rotated about its longitudinal axis by a drive inside the hand drill 1 and which produces a bore 5 with its tip 3 in a bone 4, in the exemplary embodiment shown in a vertebral bone in the pedicle area.
- this twist drill 2 is provided with an inner channel 6 which extends from the proximal end to the distal end region and which ends in a receiving space 7 which in turn is located directly behind the conical cutting surface 8 of the twist drill 2.
- An ultrasound transducer 9 is arranged in this receiving space 7, which can radiate ultrasound radiation essentially perpendicular to the cutting surface 8 and can absorb ultrasound radiation impinging on it from this direction. This can be a single ultrasound transducer 9 or two separate ultrasound transducers, each of which is designed to emit or receive ultrasound radiation.
- the ultrasound transducer is connected via a line (not shown in the drawing) which leads through the inner channel 6 to a line 10 which, starting from the hand drill 1, ends at a transmitting and receiving device 11, which in turn has a line 12 with a display device 13 connected is.
- the transmitting and receiving device 11 can work, for example, as a so-called pulse-echo system and generate and record ultrasound radiation with frequencies in the order of 15 MHz.
- This ultrasound radiation is emitted in the form of a pulse by the ultrasound transducer 9 into the surrounding bone 4 and is reflected there at inhomogeneities and at interfaces, for example at the interface 14 with the medullary cavity 15 of the vertebral bone.
- the reflected radiation then hits the ultrasonic transducer 9 again and is converted there into an electrical signal, which is fed to the transmitting and receiving device 11.
- the size of the signal corresponding to the reflected radiation depends on the strength of the reflection of the inhomogeneity, the time between the emission of the pulse and the reception of the reflected radiation depends on the thickness of the bone material to an interface and the nature of the bone material, because of this nature affects the speed of propagation of ultrasound radiation.
- the reflection signals supplied to the transmitting and receiving device 11 are thus a measure of the bone quality and the thickness of the bone material on this conical jacket, that is to say in an area which is distally in front of the twist drill 2 and into which the twist drill 2 will enter during further processing.
- the signals picked up by the transmitting and receiving device 11 can be displayed on the display device 13 in such a way that, starting from the position of the twist drill 2, the area of the bone swept by the ultrasound radiation around the twist drill 2 is displayed, so that the operator can perform one receives an optical display of how the bone material around the twist drill 2 is made in a region lying distally in front of the twist drill, for example how large the distance is to the next cavity or to an interface of the bone.
- This enables the surgeon to direct the twist drill 2 so that when it penetrates further into the bone 4 it is always centered as precisely as possible in the bone material and maintains a sufficient distance from the interfaces of the bone. It is also possible in this way to direct the drill bit into areas of particularly strong bone material, since the reflected ultrasound signals le also provide information about the nature of the bone material, for example the speed of propagation of the ultrasound waves in the bone tissue changes with differently structured bone tissue.
- An ultrasound camera with a receiving device is thus installed in the tip of the twist drill 2, which observes the area which is arranged in front of the tip of the twist drill 2 and which thus provides the operator with information about which bone areas the twist drill 2 will get into upon further penetration.
Abstract
Description
Claims
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP00912604A EP1115338B1 (en) | 1999-05-07 | 2000-03-15 | Rotating surgical instrument |
JP2000616678A JP3662851B2 (en) | 1999-05-07 | 2000-03-15 | Rotary surgical tool |
US10/004,274 US6719692B2 (en) | 1999-05-07 | 2001-10-23 | Rotating surgical tool |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE19921279.1 | 1999-05-07 | ||
DE29908259U DE29908259U1 (en) | 1999-05-07 | 1999-05-07 | Rotating surgical tool |
DE19921279A DE19921279C1 (en) | 1999-05-07 | 1999-05-07 | Rotating surgical tool |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/004,274 Continuation US6719692B2 (en) | 1999-05-07 | 2001-10-23 | Rotating surgical tool |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2000067645A1 true WO2000067645A1 (en) | 2000-11-16 |
Family
ID=26053277
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/EP2000/002253 WO2000067645A1 (en) | 1999-05-07 | 2000-03-15 | Rotating surgical instrument |
Country Status (2)
Country | Link |
---|---|
DE (2) | DE19921279C1 (en) |
WO (1) | WO2000067645A1 (en) |
Cited By (26)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP1443859A1 (en) * | 2001-10-24 | 2004-08-11 | Cutting Edge Surgical Inc. | Intraosteal ultrasound during surgical implantation |
DE102010042012A1 (en) | 2010-10-05 | 2012-04-05 | Aces Gmbh | Instrument for implantation of pedicle during spinal column surgery, has ultrasound probe for measuring distance between instrument and cortical outer zone of pedicle |
DE102011083360A1 (en) | 2011-09-23 | 2013-03-28 | Aces Gmbh | Pedicle awl used during implantation of pedicle screw for spine treatment, has ultrasonic probe that is adapted to measure distance between cortical pedicle and outer layer of pedicles |
US8870960B2 (en) | 2005-07-28 | 2014-10-28 | Nuvasive, Inc. | Total disc replacement system and related methods |
US8915846B2 (en) | 2002-06-26 | 2014-12-23 | Nuvasive, Inc. | Surgical access system and related methods |
US8920500B1 (en) | 2009-04-16 | 2014-12-30 | Nuvasive, Inc. | Methods and apparatus for performing spine surgery |
US8942801B2 (en) | 2003-09-25 | 2015-01-27 | Nuvasive, Inc. | Surgical access system and related methods |
US8956283B2 (en) | 2002-10-08 | 2015-02-17 | Nuvasive, Inc. | Surgical access system and related methods |
US8977352B2 (en) | 2001-09-25 | 2015-03-10 | Nuvasive, Inc. | Systems and methods for performing surgical procedures and assessments |
US9014776B2 (en) | 1998-12-23 | 2015-04-21 | Nuvasive, Inc. | Surgical access and nerve surveillance |
US9037250B2 (en) | 2001-07-11 | 2015-05-19 | Nuvasive, Inc. | System and methods for determining nerve proximity, direction and pathology during surgery |
US9198765B1 (en) | 2011-10-31 | 2015-12-01 | Nuvasive, Inc. | Expandable spinal fusion implants and related methods |
US9301743B2 (en) | 2003-01-16 | 2016-04-05 | Nuvasive, Inc. | Surgical access system and related methods |
US9314152B2 (en) | 2003-09-25 | 2016-04-19 | Nuvasive, Inc. | Surgical access system and related methods |
US9351845B1 (en) | 2009-04-16 | 2016-05-31 | Nuvasive, Inc. | Method and apparatus for performing spine surgery |
US9468405B2 (en) | 2003-02-27 | 2016-10-18 | Nuvasive, Inc. | Surgical access system and related methods |
US9622732B2 (en) | 2004-10-08 | 2017-04-18 | Nuvasive, Inc. | Surgical access system and related methods |
US9743853B2 (en) | 1999-11-24 | 2017-08-29 | Nuvasive, Inc. | Electromyography system |
US9827109B2 (en) | 1999-03-07 | 2017-11-28 | Nuvasive, Inc. | Methods and apparatus for performing spine surgery |
US9949840B1 (en) | 2011-04-01 | 2018-04-24 | William D. Smith | Systems and methods for performing spine surgery |
US10245043B2 (en) | 2013-07-09 | 2019-04-02 | Stryker Corporation | Surgical drill having a brake that, upon the drill bit penetrating through bone, prevents further insertion of the drill |
US10299756B1 (en) | 2005-09-27 | 2019-05-28 | Nuvasive, Inc. | System and methods for nerve monitoring |
US10441183B2 (en) | 2005-09-22 | 2019-10-15 | Nuvasive, Inc. | Multi-channel stimulation threshold detection algorithm for use with neurophysiology monitoring systems |
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DE19921279C1 (en) * | 1999-05-07 | 2000-11-30 | Aesculap Ag & Co Kg | Rotating surgical tool |
EP1115338B1 (en) | 1999-05-07 | 2006-08-16 | Aesculap AG & Co. KG | Rotating surgical instrument |
WO2001087154A1 (en) | 2000-05-18 | 2001-11-22 | Nuvasive, Inc. | Tissue discrimination and applications in medical procedures |
US6620101B2 (en) * | 2001-07-26 | 2003-09-16 | Dentosonic Ltd. | Bone measurement device |
DE10250006A1 (en) * | 2002-10-25 | 2004-05-19 | Sirona Dental Systems Gmbh | Process for the correct production of a cavity, in particular a bone cavity, and instrument therefor |
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US7285093B2 (en) | 2003-10-10 | 2007-10-23 | Imadent Ltd. | systems for ultrasonic imaging of a jaw, methods of use thereof and coupling cushions suited for use in the mouth |
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US8715292B2 (en) | 2004-09-15 | 2014-05-06 | Paul Andrew Glazer | Hand held integrated pedicle screw placement device |
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US20060178594A1 (en) * | 2005-02-07 | 2006-08-10 | Neubardt Seth L | Apparatus and method for locating defects in bone tissue |
US8740783B2 (en) | 2005-07-20 | 2014-06-03 | Nuvasive, Inc. | System and methods for performing neurophysiologic assessments with pressure monitoring |
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FR2938748B1 (en) * | 2008-11-26 | 2011-08-26 | Hassan Razian | DEVICE FOR DETERMINING A DRILLING AXIS IN A LIVING ENVIRONMENT |
DE102010016448A1 (en) | 2010-04-14 | 2011-10-20 | Aesculap Ag | Orthopedic fixation system and target device for such a fixation system |
US10098585B2 (en) | 2013-03-15 | 2018-10-16 | Cadwell Laboratories, Inc. | Neuromonitoring systems and methods |
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US9935395B1 (en) | 2017-01-23 | 2018-04-03 | Cadwell Laboratories, Inc. | Mass connection plate for electrical connectors |
US11253182B2 (en) | 2018-05-04 | 2022-02-22 | Cadwell Laboratories, Inc. | Apparatus and method for polyphasic multi-output constant-current and constant-voltage neurophysiological stimulation |
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EP1443859A1 (en) * | 2001-10-24 | 2004-08-11 | Cutting Edge Surgical Inc. | Intraosteal ultrasound during surgical implantation |
EP1443859A4 (en) * | 2001-10-24 | 2006-03-22 | Cutting Edge Surgical Inc | Intraosteal ultrasound during surgical implantation |
US10470707B2 (en) | 2001-10-30 | 2019-11-12 | Nuvasive, Inc. | System and methods for performing percutaneous pedicle integrity assessments |
US10251633B2 (en) | 2002-06-26 | 2019-04-09 | Nuvasive, Inc. | Surgical access system and related methods |
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DE19921279C1 (en) | 2000-11-30 |
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