Device, method and system for screw planning during surgery

Abstract

A device includes at least one processor and a memory, wherein the memory contains instructions that, when executed by the at least one processor, cause the at least one processor to: generate a set of possible screw postures based on at least one image of a spine within a body for implanting at least one screw into the spine during a surgical procedure; evaluate each possible screw posture based on at least one consideration associated with the surgical procedure; select at least one screw posture from the set of possible screw postures based on the evaluation; and output an indication of the selected at least one screw posture to a user interface.

Description

Technical Field

[0001] The disclosed technology generally relates to devices, systems, and methods for screw planning in surgeries such as spinal surgery. Background Art

[0002] A surgical robot may assist a surgeon or other medical provider in performing a surgical procedure, or may autonomously complete one or more surgical procedures. Some surgeries (eg, spinal fusion surgery) involve placing one or more screws into the bony structure of the anatomy. Summary of the invention

[0003] Example aspects of the present disclosure include:

[0004] A device according to at least one embodiment of the present disclosure includes at least one processor and a memory, wherein the memory contains instructions that, when executed by the at least one processor, cause the at least one processor to perform the following operations: generate a set of possible screw postures based on at least one image of a spine within a body, for implanting at least one screw into the spine during a surgical procedure; evaluate each possible screw posture based on at least one consideration associated with the surgical procedure; select at least one screw posture from the set of possible screw postures based on the evaluation; and output an indication of the selected at least one screw posture to a user interface.

[0005] In any of the aspects herein, wherein the instructions comprise instructions that, when executed by the at least one processor, cause the at least one processor to control a robotic arm based on the selected at least one screw pose.

[0006] In any of the aspects herein, wherein the instructions comprise instructions that, when executed by the at least one processor, cause the at least one processor to generate the at least one image by segmenting at least one three-dimensional image of the spine.

[0007] In any of the aspects herein, wherein the at least one consideration comprises one or more considerations related to the safety of the surgical procedure.

[0008] In any aspect of the present invention, the at least one consideration includes one or more of: scraping avoidance considerations, damage avoidance considerations, soft tissue pressure considerations, collision avoidance considerations regarding possible collision of the surgical tool with at least one anatomical element in the body, accessibility, implant proudness, and / or incision size considerations.

[0009] In any of the aspects herein, wherein the at least one consideration comprises one or more considerations not related to the safety of the surgical procedure.

[0010] In any of the aspects herein, wherein the one or more considerations include at least one surgical preference of a surgeon performing the surgical procedure.

[0011] In any of the aspects herein, wherein the at least one screw comprises a plurality of screws, and wherein the selected at least one screw posture comprises a selected screw posture of each screw of the plurality of screws.

[0012] In any of the aspects herein, wherein the at least one consideration relates to alignment of a rod with at least two of the plurality of screws, wherein the at least two screws are mechanically coupled to the rod.

[0013] In any of the aspects herein, wherein the evaluating comprises scoring each of the possible screw postures based on the at least one consideration, and wherein the selected at least one screw posture is selected based on the scoring.

[0014] In any aspect herein, the at least one consideration comprises a plurality of considerations relating to at least one of the safety of the surgical procedure, the preference of a surgeon performing the surgical procedure, or a desired alignment of the rod with the at least one screw.

[0015] In any of the aspects herein, wherein at least one of the plurality of considerations is weighted.

[0016] In accordance with at least one embodiment of the present disclosure, a system includes a user interface; at least one processor; and a memory containing instructions that, when executed by the at least one processor, cause the at least one processor to perform the following operations: generate a set of possible screw postures based on at least one image of a spine within a body for implanting at least one screw into the spine during a surgical procedure; evaluate each possible screw posture based on at least one consideration associated with the surgical procedure; select at least one first screw posture from the set of possible screw postures based on the evaluation; and output an indication of at least one selected screw posture to the user interface.

[0017] In any of the aspects herein, wherein the instructions include instructions to cause the at least one processor to adjust the selected at least one first screw pose based on the received input.

[0018] In any of the aspects herein, wherein the received input comprises surgical preferences for performing the surgical procedure.

[0019] In any aspect of the present invention, the instructions include instructions causing the at least one processor to: in response to input received from a surgeon, abandon the selected at least one first screw posture; in response to abandoning the at least one first screw posture, automatically select at least one second screw posture from the set of possible screw postures; and output an indication of the selected at least one second screw posture to the user interface.

[0020] In any aspect of the present invention, further comprising: a robotic arm, wherein the instructions include instructions that cause the at least one processor to perform the following operations: receive an indication that the selected at least one second screw posture is acceptable; and control the robotic arm based on the selected at least one second screw posture.

[0021] In any of the aspects herein, wherein the robotic arm is controlled to implant the at least one screw into the spine according to the selected at least one second screw posture.

[0022] In any of the aspects herein, wherein the at least one consideration includes a consideration related to at least one of: safety of the surgical procedure, preference of a surgeon performing the surgical procedure, or desired alignment of a rod with the at least one screw.

[0023] A method according to at least one embodiment of the present disclosure includes: generating a set of possible screw postures based on at least one segmented image of a spine in a body for implanting at least one screw into the spine during a surgical procedure; evaluating each possible screw posture based on at least one consideration associated with the surgical procedure; selecting at least one first screw posture from the set of possible screw postures based on the evaluation; and outputting an indication of at least one selected screw posture to a user interface.

[0024] Any aspect may be combined with any one or more other aspects.

[0025] Any one or more features disclosed herein.

[0026] Essentially any one or more features disclosed herein.

[0027] Any one or more features substantially disclosed herein may be combined with any one or more other features substantially disclosed herein.

[0028] Any of the aspects / features / embodiments may be combined with any one or more of the other aspects / features / embodiments.

[0029] Use any one or more of the aspects or features disclosed herein.

[0030] It should be understood that any feature described herein may be claimed in combination with any other feature as described herein, regardless of whether the features are from the same described embodiment.

[0031] The details of one or more aspects of the disclosure are set forth below in the accompanying drawings and the specification. Other features, objects, and advantages described in the disclosure will be apparent from the description and drawings and from the claims.

[0032] The phrases "at least one", "one or more", and "and / or" are open-ended expressions that have both connective and disjunctive properties in operation. For example, each of the expressions "at least one of A, B, and C", "at least one of A, B, or C", "one or more of A, B, and C", "one or more of A, B, or C", and "A, B, and / or C" means only A, only B, only C, A and B together, A and C together, B and C together, or A, B, and C together. When each of A, B, and C in the above expressions refers to an element, such as X, Y, and Z, or for example X1-X n 、Y1-Y m and Z1-Z o When the phrase refers to a class of elements such as X, Y, and Z, a single element selected from X, Y, and Z, a combination of elements selected from the same class (e.g., X1 and X2), and elements selected from two or more classes (e.g., Y1 and Z o ) combination.

[0033] The term "a" or "an" entity refers to one or more of the entities. Therefore, the terms "a" (or "an"), "one or more" and "at least one" can be used interchangeably herein. It should also be noted that the terms "including", "comprising", and "having" can be used interchangeably.

[0034] The foregoing is a simplified overview of the present disclosure to provide an understanding of some aspects of the present disclosure. This overview is not a broad or detailed overview of the present disclosure and its various aspects, embodiments, and configurations. Its purpose is neither to identify the key or important elements of the present disclosure nor to describe the scope of the present disclosure, but to present the selected concepts of the present disclosure in a simplified form as an introduction to the more detailed description presented below. As should be understood, other aspects, embodiments, and configurations of the present disclosure may use one or more of the features set forth above or described in detail below, either alone or in combination.

[0035] Numerous additional features and advantages of the present invention will become apparent to those skilled in the art after considering the description of the embodiments provided below. BRIEF DESCRIPTION OF THE DRAWINGS

[0036] In order to illustrate several examples of the present disclosure, the accompanying drawings are incorporated into the specification and form part of the specification. These drawings, together with the specification, explain the principles of the present disclosure. The accompanying drawings simply illustrate how to obtain and use the preferred and alternative examples of the present disclosure, and should not be interpreted as limiting the present disclosure to only the examples shown and described. As shown in the drawings cited below, further features and advantages will become apparent through the following more detailed description of various aspects, embodiments and configurations of the present disclosure.

[0037] Figure 1 is a block diagram of a system according to at least one embodiment of the present disclosure;

[0038] Figure 2 is a flowchart according to at least one embodiment of the present disclosure; and

[0039] Figure 3 is a flow chart according to at least one embodiment of the present disclosure. DETAILED DESCRIPTION

[0040] It should be understood that the various aspects disclosed herein may be combined in combinations different from those specifically presented in the specification and drawings. It should also be understood that, depending on the examples or embodiments, certain actions or events of any process or method described herein may be performed in a different order, and / or may be added, merged, or omitted entirely (e.g., according to different embodiments of the present disclosure, not all described actions or events may be required to perform the disclosed technology). In addition, for the purpose of clarity, although certain aspects of the present disclosure are described as being performed by a single module or unit, it should be understood that the technology of the present disclosure may be performed by a combination of units or modules associated with, for example, a computing device and / or a medical device.

[0041] In one or more examples, the described methods, processes, and techniques may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored in the form of one or more instructions or codes on a computer-readable medium and may be performed by a hardware-based processing unit. A computer-readable medium may include a non-transitory computer-readable medium, which corresponds to a tangible medium, such as a data storage medium (e.g., RAM, ROM, EEPROM, flash memory, or any other medium that can be used to store desired program code in the form of instructions or data structures and can be accessed by a computer).

[0042] The instructions may be executed by one or more processors, such as one or more digital signal processors (DSPs), general-purpose microprocessors (e.g., Intel Core i3, i5, i7, or i9 processors; Intel Celeron processors; Intel Xeon processors; Intel Pentium processors; AMD Ryzen processors; AMD Athlon processors; AMD Phenom processors; Apple A10 or 10X Fusion processors; Apple A11, A12, A12X, A12Z, or A13 Bionic processors; or any other general-purpose microprocessors), graphics processing units (e.g., Nvidia GeForce RTX 2000 series processors, Nvidia GeForce RTX 3000 series processors, AMD Radeon RX 5000 series processors, AMD Radeon RX 6000 series processors, or any other graphics processing unit), application-specific integrated circuits (ASICs), field-programmable logic arrays (FPGAs), or other equivalent integrated or discrete logic circuits. Thus, the term "processor" as used herein may refer to any of the foregoing structures or any other physical structure suitable for implementation of the described techniques. Furthermore, the described techniques may be fully implemented in one or more circuits or logic elements.

[0043] Before explaining any embodiment of the present disclosure in detail, it should be understood that the present disclosure is not limited to the construction details and component arrangements set forth in the following description or shown in the accompanying drawings in terms of its application. The present disclosure can have other embodiments and can be practiced or executed in various ways. Moreover, it should be understood that the wording and terminology used herein are for the purpose of description and should not be considered as restrictive. "Including" and "including" or "having" and its variants are used herein to intend to cover the items listed thereafter and their equivalents and additional items. In addition, the present disclosure can use examples to illustrate one or more aspects thereof. Unless otherwise clearly stated, it is not intended and does not limit the scope of the present disclosure to use or list one or more examples (which can be represented by "for example", "by way of example", "for example (eg)", "for example (such as)" or similar language).

[0044] The robotic insertion of spinal screws may be sensitive to several parameters or considerations that affect the repeatability and / or safety of the procedure. These parameters or considerations include, for example, the possibility of scraping, the possibility of screws damaging sensitive areas of the spine, the impact of soft tissue pressure within the anatomical structure, possible anatomical structure / tool ​​collision during surgery, accessibility, implant protrusion, and / or the size of the skin incision used for surgery. The embodiments of the present disclosure provide technical solutions to problems associated with implanting screws within anatomical structures in a safe and predictable manner, wherein such implantation is performed with or without robotic assistance. For example, the inventive concept relates to improving or optimizing screw planning for surgical procedures, which can reduce or minimize the learning curve of robotic surgery, increase the predictability of the procedure, limit clinical complications, and / or improve surgical outcomes. In at least one example embodiment, one or more images of the anatomical structure in which the screw is implanted are segmented, and possible screw postures are determined based on the segmented images, the considerations mentioned above, and / or the preferences of the surgeon performing or supervising the surgical procedure. In some cases, the surgeon is able to adjust the planned screw posture, in which case the system provides immediate feedback on the potential impact of the adjustment.

[0045] In at least one example embodiment, one or more 3D images of the spine are subjected to bone segmentation processing to produce a 3D segmented image that identifies and labels the various bones of the spine, which can be used to determine possible screw postures for implanting screws into the spine. As described above and below, each possible screw posture can be evaluated based on one or more considerations or parameters, which may include the possibility of scraping, the possibility of the screw damaging sensitive areas of the spine, the impact of soft tissue pressure within the anatomical structure, possible anatomical structure / tool ​​collision during surgery, accessibility, implant protrusion, and / or the size of the skin incision used for surgery.

[0046] In view of the present disclosure, it should be understood that at least one example embodiment relates to a system that imports a computed tomography (CT) image of a patient's spine and performs a bone segmentation algorithm on the CT image. If the segmentation is unsuccessful, the method disables the screw planning function and ends. However, if the segmentation is successful, the method can continue to generate an initial screw posture suggestion for each pedicle. Then, before finding possible solutions for each pedicle, the user's or surgeon's preferences can be applied to the initial screw posture suggestion. After obtaining possible solutions for each pedicle, the method can perform a pass / fail check on each solution to remove invalid solutions (wherein invalid solutions include solutions that do not meet a minimum threshold or violate one or more rules of the surgical procedure) from the list of possible solutions. Thereafter, the method can include prioritizing or scoring all valid solutions for each screw, where a valid solution is a solution determined to be 'passed'. After prioritization, the method can select the best solution for each screw, which may include considerations about the curvature of the rod mechanically connected to the screw. Finally, the method can include displaying the solution for each screw for user review and / or approval.

[0047] First turn Figure 1 , a block diagram of a system 100 according to at least one embodiment of the present disclosure is shown. The system 100 can be used to assist in planning a screw posture for implantation into an anatomical structure and / or perform one or more other aspects of one or more methods disclosed herein. The system 100 includes a computing device 102, one or more imaging devices 112, a robot 114, a navigation system 118, a database 130, and / or a cloud or other network 134. Systems according to other embodiments of the present disclosure may include more or fewer components than the system 100. For example, the system 100 may not include the imaging device 112, the robot 114, the navigation system 118, one or more components in the computing device 102, the database 130, and / or the cloud 134.

[0048] Computing device 102 includes processor 104, memory 106, communication interface 108, and user interface 110. Computing devices according to other embodiments of the present disclosure may include more or fewer components than computing device 102.

[0049] The processor 104 of the computing device 102 may be any processor described herein or any similar processor. The processor 104 may be configured to execute instructions stored in the memory 106, which may cause the processor 104 to perform one or more computing steps using or based on data received from the imaging device 112, the robot 114, the navigation system 118, the database 130, and / or the cloud 134.

[0050] The memory 106 may be or include RAM, DRAM, SDRAM, other solid-state memory, any memory described herein, or any other tangible, non-transitory memory for storing computer-readable data and / or instructions. The memory 106 may store information or data for completing any of the steps of, for example, the methods 200 and 300 described herein or any other method. The memory 106 may store, for example, one or more image processing algorithms 120, one or more segmentation algorithms 122, one or more transformation algorithms 124, one or more registration algorithms 128, and / or one or more screw planning algorithms 132 (e.g., see Figure 2 and 3 In some embodiments, such instructions or algorithms may be organized into one or more applications, modules, packages, layers, or engines. The algorithms and / or instructions may cause the processor 104 to manipulate data stored in the memory 106 and / or received from or via the imaging device 112, the robot 114, the database 130, and / or the cloud 134.

[0051] The computing device 102 may also include a communication interface 108. The communication interface 108 may be used to receive data or information from an external source (e.g., an imaging device 112, a robot 114, a navigation system 118, a database 130, a cloud 134, and / or any other system or component that is not part of the system 100) and / or to transmit instructions, images, or other information to an external system or device (e.g., another computing device 102, an imaging device 112, a robot 114, a navigation system 118, a database 130, a cloud 134, and / or any other system or component that is not part of the system 100). The communication interface 108 may include one or more wired interfaces (e.g., a USB port, an Ethernet port, a FireWire port) and / or one or more wireless transceivers or interfaces (configured to transmit and / or receive information, e.g., via one or more wireless communication protocols such as 802.11a / b / g / n, Bluetooth, NFC, ZigBee, etc.). In some embodiments, the communication interface 108 may be used to enable the device 102 to communicate with one or more other processors 104 or computing devices 102, whether to reduce the time required to complete a computer-intensive task or for any other reason.

[0052] The computing device 102 may also include one or more user interfaces 110. The user interface 110 may be or include a keyboard, a mouse, a trackball, a monitor, a television, a screen, a touch screen, and / or any other device for receiving information from a user and / or for providing information to a user. The user interface 110 may be used, for example, to receive user selections or other user inputs about any step of any method described herein. Nevertheless, any required inputs for any step of any method described herein may be automatically generated by the system 100 (e.g., by the processor 104 or another component of the system 100) or received by the system 100 from a source external to the system 100. In some embodiments, the user interface 110 may be used to allow a surgeon or other user to modify instructions to be executed by the processor 104 according to one or more embodiments of the present disclosure, and / or to modify or adjust settings of other information displayed on or corresponding to the user interface 110.

[0053] Although user interface 110 is shown as part of computing device 102, in some embodiments, computing device 102 may use user interface 110 that is housed separately from one or more remaining components of computing device 102. In some embodiments, user interface 110 may be located near one or more other components of computing device 102, while in other embodiments, user interface 110 may be located remotely from one or more other components of computing device 102.

[0054] The imaging device 112 can be used to image anatomical features (e.g., bones, veins, tissues, etc.) and / or other aspects of the patient's anatomy to generate image data (e.g., image data depicting or corresponding to bones, veins, tissues, etc.). As used herein, "image data" refers to data generated or captured by the imaging device 112, including data in machine-readable form, graphical / visual form, and in any other form. In different examples, the image data may include data corresponding to the patient's anatomical features or a portion thereof. The image data may be or include pre-operative images, intraoperative images, post-operative images, or images taken independently of any surgical procedure. In some embodiments, the first imaging device 112 can be used to obtain first image data (e.g., a first image) at a first time, and the second imaging device 112 can be used to obtain second image data (e.g., a second image) at a second time after the first time. The imaging device 112 is capable of taking 2D images or 3D images to generate image data. The imaging device 112 may be or include, for example, an ultrasound scanner (which may include, for example, physically separate transducers and receivers, or a single ultrasound transceiver), an O-arm, C-arm, G-arm, or any other device that uses X-ray based imaging (e.g., a fluoroscope, a CT scanner or other X-ray machine), a magnetic resonance imaging (MRI) scanner, an optical coherence tomography (OCT) scanner, an endoscope, a microscope, an optical camera, a thermal imaging camera (e.g., an infrared camera), a radar system (which may include, for example, a transmitter, a receiver, a processor, and one or more antennas), or any other imaging device 112 suitable for obtaining images of anatomical features of a patient. The imaging device 112 may be entirely contained within a single housing, or may include a transmitter / emitter and a receiver / detector that are in separate housings or otherwise physically separated.

[0055] In some embodiments, the imaging device 112 may include more than one imaging device 112. For example, the first imaging device 112 may provide first image data and / or a first image, and the second imaging device 112 may provide second image data and / or a second image. In yet other embodiments, the same imaging device may be used to provide both the first image data and the second image data and / or any other image data described herein. The imaging device 112 may be used to generate an image data stream. For example, the imaging device 112 may be configured to operate with an open shutter, or with a shutter that continuously alternates between open and closed, in order to capture continuous images. For purposes of this disclosure, unless otherwise specified, if the image data represents two or more frames per second, the image data may be considered continuous and / or provided as an image data stream.

[0056] Navigation system 118 can provide navigation for the surgeon and / or surgical robot during the operation. Navigation system 118 can be any known or future developed navigation system, including, for example, Medtronic StealthStation TM S8 surgical navigation system or any subsequent system thereof. The navigation system 118 may include one or more cameras or other sensors for tracking one or more reference markers, navigation trackers, or other objects in the operating room or other rooms where part or all of the system 100 is located. The one or more cameras may be optical cameras, infrared cameras, or other cameras. In some embodiments, the navigation system may include one or more electromagnetic sensors. In various embodiments, the navigation system 118 may be used to track the position and orientation (i.e., posture) of the imaging device 112, the robot 114, and / or the robotic arm 116, and / or one or more surgical tools (or more specifically, for tracking the posture of the navigation tracker attached directly or indirectly, related to one or more of the foregoing). The navigation system 118 may include a display for displaying one or more images from an external source (e.g., a computing device 102, an imaging device 112, or other source) or for displaying images and / or video streams from one or more cameras or other sensors of the navigation system 118. In some embodiments, the system 100 may operate without the use of the navigation system 118. The navigation system 118 can be configured to provide guidance to a surgeon or other user of the system 100 or a component thereof, to the robot 114 or any other element of the system 100, regarding, for example, the pose of one or more anatomical elements, whether a tool is in an appropriate trajectory, and / or how to move a tool into an appropriate trajectory to perform a surgical task based on preoperative or other surgical planning.

[0057] The robot 114 may be any surgical robot or surgical robot system. The robot 114 may be or include, for example, a Mazor X TMStealth version of the robotic guidance system. The robot 114 can be configured to position the imaging device 112 at one or more precise positions and orientations, and / or return the imaging device 112 to the same position and orientation at a later point in time. The robot 114 can be additionally or alternatively configured to manipulate surgical tools (whether or not based on guidance from the navigation system 118) to complete or assist in surgical tasks. In some embodiments, the robot 114 can be configured to hold and / or manipulate anatomical elements during or in conjunction with a surgical procedure. The robot 114 can include one or more robotic arms 116. In some embodiments, the robotic arm 116 can include a first robotic arm and a second robotic arm, but the robot 114 can include more than two robotic arms. In some embodiments, one or more of the robotic arms 116 can be used to hold and / or manipulate the imaging device 112. In embodiments where the imaging device 112 includes two or more physically separate components (e.g., a transmitter and a receiver), one robotic arm 116 can hold one such component, and another robotic arm 116 can hold another such component. Each robotic arm 116 can be positioned independently of the other robotic arms. The robotic arms can be controlled in a single shared coordinate space or in separate coordinate spaces.

[0058] The robot 114, together with the robotic arm 116, can have, for example, one, two, three, four, five, six, seven or more degrees of freedom. In addition, the robotic arm 116 can be positioned or positionable in any posture, plane and / or focus. The posture includes position and orientation. As a result, the imaging device 112, surgical tool or other object held by the robot 114 (or more specifically, held by the robotic arm 116) can be precisely positioned in one or more desired and specific positions and orientations.

[0059] The robotic arm 116 may include one or more sensors that enable the processor 104 (or a processor of the robot 114) to determine the precise pose of the robotic arm (and any object or element held by or secured to the robotic arm) in space.

[0060] In some embodiments, reference markers (i.e., navigation markers) may be placed on the robot 114 (including, for example, on the robotic arm 116), the imaging device 112, or any other object in the surgical space. The reference markers may be tracked by the navigation system 118, and the results of the tracking may be used by the robot 114 and / or by an operator of the system 100 or any component thereof. In some embodiments, the navigation system 118 may be used to track other components of the system (e.g., the imaging device 112), and the system may be operated without the use of the robot 114 (e.g., the surgeon manually manipulates the imaging device 112 and / or one or more surgical tools, e.g., based on information and / or instructions generated by the navigation system 118).

[0061] The system 100 or a similar system may be used, for example, to perform one or more aspects of any of the methods 200 and 300 described herein. The system 100 or a similar system may also be used for other purposes.

[0062] Figure 2 A method 200 is depicted that may be used, for example, to assist in planning the implantation of a screw in an anatomical structure such as the spine.

[0063] The method 200 (and / or one or more steps thereof) may be performed, for example, by at least one processor or otherwise. The at least one processor may be the same or similar to the processor 104 of the computing device 102 described above. The at least one processor may be part of a robot (e.g., robot 114) or part of a navigation system (e.g., navigation system 118). A processor other than any processor described herein may also be used to perform the method 200. The at least one processor may perform the method 200 by executing instructions stored in a memory such as memory 106. The instructions may correspond to one or more steps of the method 200 described below. The instructions may cause the processor to execute one or more algorithms, such as an image processing algorithm 120, a segmentation algorithm 122, a conversion algorithm 124, a registration algorithm 128, and / or a screw planning algorithm 132.

[0064] Method 200 includes generating at least one image by segmenting at least one three-dimensional image of a spine in a body (step 204). For example, operation 204 includes subjecting one or more 3D images of a spine acquired in an MRI scan and / or a CT scan to suitable bone segmentation processing. The resulting segmented image may be further analyzed to identify and label portions of the spine and / or other anatomical structures and / or derive one or more features about portions of the spine or other anatomical structures, such as bone and / or tissue density, bone size, relative bone size, bone position, relative bone position, bone geometry, etc. The resulting segmented image may be displayed on user interface 110 along with the information described above.

[0065] Method 200 also includes generating a group of possible screw postures based on at least one image of the spine for implanting at least one screw into the spine during the surgical procedure (step 208). At least one screw may include a cortical screw, a pedicle screw and / or other suitable screws or mechanical fixation devices (e.g., staples, pins, etc.). Screw posture refers to the position and orientation of the screw when the screw is implanted into a bone or another anatomical element. Position and orientation or posture can be expressed with reference to a Cartesian coordinate system and a spherical coordinate system. Appropriate screw posture helps to reduce or avoid collateral damage to the anatomical structure part when implanting the screw and / or achieve the desired result of the surgical procedure (e.g., by properly fixing the screw to the bone, properly aligning and connecting to a rod, etc.). Step 208 may determine a group of possible screw postures based at least in part on real-time input and / or preprogrammed input from a surgeon, which real-time input and / or preprogrammed input indicate which parts of the spine (e.g., which vertebra or vertebrae) are implanted with screws during the surgical procedure.

[0066] In some embodiments, the surgeon or other user may propose a first screw pose or multiple screw poses, after which a set of possible screw poses may be determined based on the first screw pose or multiple screw poses. In other embodiments, the first screw pose may be automatically generated based on, for example, the segmented image produced from step 204 and / or one or more pre-programmed data points about possible screw poses.

[0067] A set of possible screw postures can be generated based on the information generally known to be required for successful screw implantation, which information can include information about the generally acceptable angle range for implantation, the generally acceptable position for screw implantation, the type and size of screws commonly used, and / or other general knowledge suitable for the surgical procedure. In at least one example embodiment, a set of possible screw postures can be generated based on knowledge obtained from previous similar surgical procedures performed on the same spine or on one or more different spines (e.g., the spines of other patients). For example, one or more machine learning algorithms that have been trained with training data can be executed with the aid of artificial intelligence to generate a set of possible screw postures, wherein the training data includes data from previous surgeries on other parts of the spine or anatomical structure. In some cases, the posture of one screw may affect the posture of one or more other screws (e.g., when two or more screws should be aligned and mechanically connected to a rod). Therefore, each possible screw posture of a specific screw can be determined based on one or more possible screw postures of other screws.

[0068] Step 208 can generate any number of possible screw postures for each screw planned to be implanted. Therefore, the number of possible screw postures for each screw may be too large to be effectively analyzed. For example, a group of possible screw postures may include dozens, hundreds or thousands of possibilities. Therefore, method 200 includes evaluating each possible screw posture based on at least one consideration associated with the surgical procedure (step 212) and selecting at least one screw posture from a group of possible screw postures based on the evaluation (step 216). Steps 212 and 216 can occur automatically after step 208, and can be used to automatically reduce the number of possible screw postures generated in step 208 to a more manageable number by using an evaluation to reject possible screw postures that are not feasible (e.g., fail to meet a predetermined threshold) according to at least one consideration. As discussed in more detail below, evaluating a group of possible screw postures can include scoring each possible screw posture based on at least one consideration and can select the screw posture with the highest score. In an embodiment where at least one consideration includes multiple considerations, scoring can involve weighting one or more considerations in the multiple considerations. Additionally, in some embodiments, one or more of the at least one consideration can be or include a binary determination (e.g., whether the posture results in the screw penetrating the vertebral endplate), while other of the one or more considerations can be scored along a numerical or other scale. The screw posture selected in operation 216 can be the optimal screw posture for a set of considerations and / or surgeon preference.

[0069] In at least one example embodiment, at least one consideration on which the evaluation in step 212 is based includes: scraping avoidance considerations, damage avoidance considerations, soft tissue pressure considerations, collision avoidance considerations regarding possible collision of the surgical tool with at least one anatomical element in the body, accessibility, implant protrusion, and / or incision size considerations. These considerations will be discussed in more detail below.

[0070] Scraping refers to a situation in which a tool such as a drill bit used to implant a screw slides or otherwise moves away from a target implantation location on the bone structure of the spine (e.g., a target location on a vertebra) during operation, thereby causing a risk to safety and / or the overall success of the operation. Sliding may be due to the contour of the target implantation location. Ideally, the surface contour of the target location forms an angle of substantially 90 degrees with the tip of a drill bit or other tool used to implant the screw to avoid scraping during screw implantation. However, the contour of the target implantation location may not allow the drill bit or other tool to form an ideal angle with the surface of the target location, thereby introducing the possibility of scraping. Therefore, evaluating a set of possible screw postures based on considerations to avoid scraping can reduce the risk of scraping by, for example, preventing the selection of a screw posture with an unacceptably high risk of scraping (or providing a warning about it).

[0071] For example, using the segmented image from operation 204, method 200 can determine whether a drill bit used to drill a hole to accommodate a particular screw posture will form an unacceptable angle with the surface contour of the target implant location, and use the determination to rank the particular screw postures in a manner that affects the likelihood of selection in step 216. Typically, the risk of scraping increases when the angle between the tool and the surface contour of the target implant location moves away from 90 degrees. Therefore, the range of acceptable angles and unacceptable angles can be a set of design parameters based on empirical evidence and / or preferences. In the event that scraping cannot be avoided for a set of possible screw postures, method 200 can include outputting an indication to user interface 110 to notify the surgeon that scraping may occur, which the surgeon can use to prepare for surgery by equipping tools to flatten the target implant location and / or by being aware of possible scraping during surgery.

[0072] Damage refers to a situation where a screw damages or breaks away from the vertebral body or other parts of the anatomical structure that receives the screw. Such damage may have the risk of damaging nerves and / or other anatomical elements near the damaged portion of the screw. Parameters that affect whether a screw damages include screw length, screw width, screw implantation angle, screw implantation depth, vertebral geometry (where the screw is implanted in the vertebra), etc. Therefore, evaluating a set of possible screw postures based on avoidance of damage considerations can reduce the risk of screw damage by, for example, preventing the selection of a screw posture with an unacceptably high risk of damage or providing a warning about it.

[0073] Soft tissue pressure can refer to the pressure caused by the surrounding soft tissue on the screw (and / or on the tool used to prepare the screw for implantation). During surgery, soft tissue is often moved aside by a retractor. However, soft pressure may affect various parameters of screw implantation, such as the implantation angle of the screw, stimulation of the soft tissue after the screw is implanted, etc. More retraction may increase the risk of some parts of the soft tissue contacting the upper part of the screw (for example, after the screw is implanted), thereby affecting the angle or implantation state of the screw. Generally, a smaller axial angle of screw implantation is associated with a lower likelihood that the screw angle is affected by soft tissue pressure. Soft tissue pressure information can be derived from images obtained with an MRI scan. Therefore, in at least one example embodiment, method 200 includes co-registering images from a CT scan (for bone segmentation) with images from an MRI scan to collect information about soft tissue pressure for a set of possible screw postures, and using the information in the evaluation of step 212.

[0074] As may be appreciated, surgery, whether robotically assisted or not, involves navigating or otherwise moving one or more tools to a target site within a larger anatomical structure. Therefore, there is a possibility of collision between a tool and another tool or between a tool and one or more anatomical elements (e.g., spinous processes) that are not part of the target site. Evaluating a set of possible screw postures in light of collision avoidance considerations can reduce the risk of undesired collisions between tools or between tools and portions of the anatomical structure, thereby increasing the safety of the surgical procedure and / or improving the effectiveness of the surgery.

[0075] At least one consideration may include a reachability consideration, which method 200 may use to determine the difficulty of a tool reaching a particular target implant location to prepare for implantation and / or implant a screw. Portions of the anatomical structure surrounding the target implant location may have a negative impact on reachability. In other words, reachability may be an assessment of the degree to which one or more portions of the anatomical structure proximate to the target implant location interfere with screw implantation. Assessing the screw posture in light of reachability can reduce the time spent in the surgical procedure because unreachable screw postures can be excluded from selection in step 216.

[0076] Implant protrusion can refer to the amount that the screw protrudes from the implant site and / or the depth of the screw at the implant site. For example, if the screw is embedded too deep into the pedicle, the movement of the screw's tulip may be hindered or prevented. On the other hand, a screw that protrudes too far from the pedicle may interfere with the alignment of the rod, suffer from soft tissue pressure issues, and / or irritate surrounding portions of the anatomy. Therefore, evaluating a set of possible screw postures based on implant protrusion considerations can avoid problems caused by screws being implanted too deep or too shallow at the implant site.

[0077] Incision size considerations may refer to considerations based on the size (e.g., length) of one or more incisions formed in a patient's body in order to implant a screw into a portion of an anatomical structure (e.g., a spine). In some cases, multiple screws may be inserted and implanted through the same incision. Thus, evaluating a set of possible screw postures based on incision size considerations may reduce the size of a single incision and / or reduce the number of incisions, thereby avoiding unnecessary scarring for the patient.

[0078] In at least one example embodiment, at least one consideration relates to the alignment of the rod with at least two screws (e.g., the heads of at least two screws). For example, a spinal fusion procedure involves aligning the screws and implanting the screws on different pedicles and mechanically coupling the screws to the rod. Therefore, evaluating a set of possible screw postures in view of the desired alignment between two or more screws that will be mechanically coupled to the same rod may be useful to increase the overall success of the surgery. Alignment considerations may also take into account the desired curvature of the rod, where the desired curvature refers to the curvature of the rod after being mechanically coupled to the screws.

[0079] In view of the above, it should be understood that at least one consideration may include one or more considerations related to the safety of the surgical procedure (e.g., avoidance of damage considerations, avoidance of collision considerations, etc.) to reduce the risk of damage to parts of the spine and / or other anatomical structures during the surgical procedure. Additionally or alternatively, at least one consideration includes one or more considerations that are not related to the safety of the surgical procedure. Considerations unrelated to the safety of the surgical procedure may include one or more preferences of the surgeon, wherein such preferences have no substantial effect on the risk of damage to other parts of the spine or anatomical structures. Such preferences may include preferences related to screw type and / or size, implantation angle (assuming that the angle will not cause damage to other parts of the spine or anatomical structures), implantation position (assuming that the position will not cause damage to other parts of the spine or anatomical structures), and / or any other suitable preferences that do not involve substantial risks of damage to patient safety or patient anatomical structures during the surgical procedure. Although the surgeon's preferences are described above as being unrelated to the safety of the surgical procedure, it should be understood that the surgeon's preferences may be additionally or alternatively related to the safety of the surgical procedure.

[0080] The surgeon may have a subset of preferences within each category of the above considerations (e.g., avoidance of scraping considerations, avoidance of damage considerations, soft tissue pressure considerations, avoidance of collision considerations regarding possible collisions of surgical tools with at least one anatomical element in the body, accessibility, implant protrusion, and / or incision size considerations). In at least one example embodiment, the surgeon's preferences within some categories are not allowed to violate or exceed certain baseline settings or default standards, while the surgeon's preferences within other categories are allowed to violate or exceed baseline settings or default standards. For example, if it is believed that avoiding damage is important for maintaining safety and / or achieving the desired results of the operation, the avoidance of damage considerations may include a baseline setting that does not allow method 200 to select a screw posture that will cause damage (e.g., medial damage), even if the surgeon's preference requires that damage be allowed to occur. In addition, the surgeon may be prevented from overriding this setting with a preference. For example, the surgeon does not have the option of selecting a screw posture and / or is not allowed to change the selected screw posture that will or may cause damage.

[0081] On the other hand, the incision size considerations may include default settings that, in the absence of surgeon preference or external input to the contrary, generally prevent step 216 from selecting a screw posture that results in an incision size greater than a default maximum size. However, in some cases, incision size is a more flexible surgical procedure parameter than, for example, avoiding damage. Therefore, if the surgeon's preferences include a preference for exceeding the default maximum incision size, the method 200 may perform the evaluation step 212 and the selection step 216 by taking this preference into account. In other words, if the surgeon's preferences indicate that the default maximum incision size can be exceeded, the method 200 may allow the selection of a screw posture that exceeds the default maximum incision size.

[0082] As described above, step 212 may include scoring a set of possible screw postures based on a suitable scale. In this case, one or more of the above considerations may be weighted according to the expected impact on the selection step 216. For example, in step 212, considerations that are closely related to the safety and / or effectiveness of the surgical procedure may be weighted more heavily than considerations that are loosely related to safety and / or effectiveness, so that step 216 selects a screw posture that is more likely to achieve a safe and / or effective outcome.

[0083] During the evaluation, the weights of one or more considerations may be applied equally to a set of possible screw postures. However, example embodiments are not limited thereto, and the weights of one or more considerations may be applied differently for a particular screw posture. For example, a target implantation location for a screw may be known to have or suspected of having a different risk or potential problem than another target implantation location for another screw. In this case, the considerations for each target implantation location may be weighted differently to account for the different risks or potential problems for each target implantation location.

[0084] In at least one example embodiment, method 200 generates a screw posture distribution, wherein each distribution contains the screw postures of a plurality of screws planned for implantation. Then, step 212 can score and sort each screw posture distribution based on the weighted and / or non-weighted considerations described above. For example, the score of each screw posture in the screw posture distribution is added to provide an overall score for the distribution. Step 216 can include selecting the screw posture distribution with the highest score.

[0085] Method 200 may include outputting an indication of at least one selected screw posture to a user interface (step 220). For example, step 220 outputs an audio and / or visual indication of at least one selected screw posture to user interface 110. The visual indication of the selected screw posture may include simulating implanting the screw into a target implantation position on the segmented image generated in step 204. The visual indication may also include additional information about the selected screw posture, such as implantation angle, recommended screw type and size, and any other suitable information that may be useful for the user to evaluate the selected screw posture. The user (e.g., a surgeon) may use the visual indication of the selected screw posture and other information to evaluate whether the selected screw posture should be applied during the surgical procedure.

[0086] At this stage, the surgeon may have the opportunity to approve the selected screw posture, reject the selected screw posture, and / or change the selected screw posture based on other surgeon preferences or other factors (see Figure 3214. For more details on screw posture rejection and / or modification). If the surgeon changes the selected screw posture, the method 200 may further include re-evaluating the modified screw posture in step 212 to determine whether the modified screw posture creates a potential problem that will cause the modified screw posture to be removed from the selection process in step 216. If so, the method 200 may include outputting a warning message or other indication of the problem to the user interface 110 to notify the surgeon of the potential problem and any relevant information associated with the potential problem (e.g., the modified screw posture increases the risk of collision between the tool and a portion of the anatomical structure). The surgeon can then decide to continue using the modified screw posture or reject the selected screw posture and / or the modified screw posture to prompt the system to output an indication of another screw posture from a set of possible screw postures.

[0087] In addition to providing the surgeon with the ability to accept, reject, or change a selected screw posture, method 200 may also include providing the surgeon with an updated screw posture that conforms to the surgeon's preferences and / or the surgeon's proposed changes to the initially selected screw posture. For example, if the surgeon prefers a wider screw than the initially proposed selected screw posture to improve screw grip, method 200 may include regenerating possible screw postures based on the wider screw, and re-evaluating those possible screw postures to provide another selected screw posture that takes the wider screw into account. Method 200 may then regenerate, re-evaluate, and re-select the screw postures of one or more other screws to be implanted during the same surgical procedure (e.g., to maintain rod fit and skin incision alignment).

[0088] The method 200 further includes controlling the robotic arm based on the selected at least one screw posture (step 224). For example, the surgeon can determine that the selected screw posture from step 220 (whether or not modified by the surgeon) is an acceptable screw posture for the surgical procedure, and provide input on the user interface 110 to apply the selected screw posture during the surgical procedure. For a robotic-assisted surgical procedure, the robotic arm 116 can be controlled to assist in implanting the screw according to the selected screw posture. Such control can include controlling the activation and positioning of tools used to prepare for implanting the screw (e.g., one or more scalpels, retractors, dilators, drills, taps) and tools used to implant the screw itself (e.g., screwdrivers).

[0089] The present disclosure encompasses embodiments of method 200 that include more or fewer steps than those described above, and / or one or more steps that differ from the steps described above. For example, steps 204, 220, and / or 224 may be omitted from method 200 if, for example, these steps are performed by a device external to system 100. In addition, it should be appreciated that the screw posture selected in step 216 may be stored in memory 106 and accessed at a later time for presentation on a user interface.

[0090] Figure 3 A method 300 is depicted that may be used, for example, to assist in planning implantation of a screw in an anatomical structure such as the spine. Method 300 may be performed in addition to method 200, for example, as a continuation of method 200.

[0091] Method 300 (and / or one or more steps thereof) can be performed, for example, by at least one processor or otherwise. The at least one processor can be the same or similar to the processor 104 of the computing device 102 described above. The at least one processor can be part of a robot (e.g., robot 114) or part of a navigation system (e.g., navigation system 118). A processor other than any processor described herein can also be used to perform method 300. At least one processor can perform method 300 by executing instructions stored in a memory such as memory 106. The instructions can correspond to one or more steps of method 300 described below. The instructions can cause the processor to execute one or more algorithms, such as image processing algorithm 120, segmentation algorithm 122, conversion algorithm 124, registration algorithm 128, and / or screw planning algorithm 132.

[0092] As mentioned above Figure 2 As described in the description of, the selected at least one screw posture can be one of many possible screw postures that can be selected. For example, when it is determined that the selected at least one first screw posture is unacceptable, the inventive concept can continue to select and present at least one second screw posture different from the selected at least one first screw posture.

[0093] Thus, the method 300 includes, for example, in response to input received from a surgeon, abandoning at least one first screw posture (step 304). Abandoning at least one first screw posture may include removing at least one first screw posture from a display on the user interface 110, deleting at least one first screw posture from a memory, etc. The input may be received on the user interface 110, and an indication is provided to the system 100 that the screw posture output in step 220 is unacceptable to the surgeon. In this case, the method 300 may include automatically selecting at least one second screw posture from a set of possible screw postures in response to abandoning at least one first screw posture (step 308). For example, if the first screw posture is selected because it has the highest score in the set of possible screw postures, then in step 308, the step 308 may automatically select the screw posture with the next highest score as the selected second screw posture. In at least one example embodiment, step 304 includes receiving additional input from the surgeon or user to guide the method 300 to make another selection of the screw posture. Such additional input may include a surgeon or user preference to select another screw posture, an indication of why a previously selected screw posture was unacceptable, and / or other suitable input useful to increase the likelihood that the selected second screw posture is approved for use during the surgical procedure.

[0094] Method 300 also includes outputting an indication of the selected at least one second screw posture to the user interface (step 312). For example, step 312 outputs an audio and / or visual indication of the selected at least one second screw posture to the user interface 110 in the same or similar manner as described above with reference to operation 220.

[0095] The method 300 includes receiving an indication that the selected at least one second screw posture is acceptable (step 316). For example, the surgeon or user indicates on the user interface 110 that the selected at least one second screw posture is acceptable for use during the surgical procedure. Step 316 can also include allowing the surgeon to adjust the selected at least one second screw posture before indicating that the selected at least one second screw posture is acceptable for use during the surgical procedure.

[0096] The method 300 further includes controlling the robotic arm based on the selected at least one second screw posture (step 320). Step 320 can be performed in the same or similar manner as step 226 described above. For example, the robotic arm is controlled to implant at least one screw into the spine according to the selected at least one second screw posture.

[0097] The method 300 may be repeated until the selected screw posture is acceptable to the surgeon. Here, it should be appreciated that one or more steps of the method 300 may be performed automatically (e.g., without manual intervention). For example, steps 308, 312, and 320 may be performed in response to completion of the immediately preceding step without manual prompting.

[0098] The present disclosure encompasses embodiments of method 300 that include more or fewer steps than those described above, and / or one or more steps that are different than those described above. For example, steps 312, 316, and 320 may be omitted from method 300 if, for example, these steps are performed by a device external to system 100. In addition, it should be appreciated that the screw posture selected in step 308 may be stored in memory 106 and accessed at a later time to be presented on a user interface to perform additional steps, such as steps 312, 316, and / or 320.

[0099] As mentioned above, the present disclosure covers Figure 2 and 3 A method comprising all steps less than the steps identified in (and the corresponding descriptions of methods 200 and 300), and a method comprising more than Figure 2 and 3 The present disclosure also encompasses methods that include one or more steps from one method described herein and one or more steps from another method described herein. Any correlation described herein may be or include registration or any other correlation.

[0100] Although the exemplary embodiments have been shown and described with reference to screw planning for spinal surgery, it should be understood that the exemplary embodiments may also encompass screw planning in other types of surgery. In addition, the exemplary embodiments are also related to the planning postures of surgical fixation devices other than screws, which may include staples, pins, rods, plates, sutures, etc.

[0101] The foregoing is not intended to limit the present disclosure to one or more forms disclosed herein. In the aforementioned specific embodiments, for example, for the purpose of simplifying the present disclosure, the various features of the present disclosure may be grouped together in one or more aspects, embodiments and / or configurations. The features of the aspects, embodiments and / or configurations of the present disclosure may be combined in alternative aspects, embodiments and / or configurations other than those discussed above. This method of disclosure should not be interpreted as reflecting the following intention: the claims require more features than those explicitly stated in each claim. On the contrary, as reflected in the following claims, aspects of the present invention do not lie in all the features of the aforementioned single disclosed aspects, embodiments and / or configurations. Therefore, the attached claims are hereby incorporated into the specific embodiments, and each technical solution itself serves as a separate preferred embodiment of the present disclosure.

[0102] In addition, although the foregoing has included descriptions of one or more aspects, embodiments and / or configurations and certain variations and modifications, other variations, combinations and modifications are within the scope of the present disclosure, for example, within the skill and knowledge of those skilled in the art after understanding the present disclosure. It is expected to obtain the right to include alternative aspects, embodiments and / or configurations within the scope of the permission, including the required alternative, replaceable and / or equivalent structure, function, range or step, regardless of whether these alternative, replaceable and / or equivalent structure, function, range or step are disclosed herein, and it is not expected to be disclosed for any patentable subject matter.

Claims

1. A device comprising: at least one processor; as well as A memory comprising instructions that, when executed by the at least one processor, cause the at least one processor to: generating a set of possible screw poses based on at least one image of a spine within the body for implanting at least one screw into the spine during a surgical procedure; evaluating each possible screw posture based on at least one consideration associated with the surgical procedure; selecting at least one screw pose from the set of possible screw poses based on the evaluating; and An indication of the selected at least one screw pose is output to a user interface.

2. The apparatus of claim 1 , wherein the instructions comprise instructions that, when executed by the at least one processor, cause the at least one processor to: The robotic arm is controlled based on the selected at least one screw posture.

3. The apparatus of claim 1 , wherein the instructions comprise instructions that, when executed by the at least one processor, cause the at least one processor to: The at least one image is generated by segmenting at least one three-dimensional image of the spine.

4. The apparatus of claim 1, wherein the at least one consideration comprises one or more considerations related to the safety of the surgical procedure.

5. A device according to claim 1, wherein the at least one consideration includes one or more of the following: scraping avoidance considerations, damage avoidance considerations, soft tissue pressure considerations, collision avoidance considerations regarding possible collision of the surgical tool with at least one anatomical element in the body, accessibility, implant protrusion, and / or incision size considerations.

6. The apparatus of claim 1, wherein the at least one consideration comprises one or more considerations not related to the safety of the surgical procedure.

7. The apparatus of claim 1, wherein the one or more considerations include at least one surgical preference of a surgeon performing the surgical procedure.

8. The apparatus of claim 1, wherein the at least one screw comprises a plurality of screws, and wherein the selected at least one screw posture comprises a selected screw posture of each screw of the plurality of screws.

9. The apparatus of claim 8, wherein the at least one consideration relates to alignment of a rod with at least two of the plurality of screws, wherein the at least two screws are mechanically coupled to the rod.

10. The apparatus of claim 1, wherein the evaluating comprises scoring each of the possible screw postures based on the at least one consideration, and wherein the selected at least one screw posture is selected based on the scoring.

11. The device of claim 10, wherein the at least one consideration comprises a plurality of considerations relating to at least one of: safety of the surgical procedure, preference of a surgeon performing the surgical procedure, or desired alignment of a rod with the at least one screw. The apparatus of claim 11 , wherein at least one of the plurality of considerations is weighted.

13. A system comprising: user interface; at least one processor; as well as A memory comprising instructions that, when executed by the at least one processor, cause the at least one processor to: generating a set of possible screw poses based on at least one image of a spine within the body for implanting at least one screw into the spine during a surgical procedure; evaluating each possible screw posture based on at least one consideration associated with the surgical procedure; selecting at least one first screw pose from the set of possible screw poses based on the evaluating; and An indication of the selected at least one screw posture is output to the user interface.

14. The system of claim 13, wherein the instructions include instructions to cause the at least one processor to: The selected at least one first screw pose is adjusted based on the received input.

15. The system of claim 14, wherein the received input includes surgical preferences for performing the surgical procedure.

16. The system of claim 13, wherein the instructions include instructions to cause the at least one processor to: in response to input received from a surgeon, abandoning the selected at least one first screw posture; In response to discarding the at least one first screw posture, automatically selecting at least one second screw posture from the set of possible screw postures; and An indication of the selected at least one second screw posture is output to the user interface.

17. The system of claim 16, further comprising: The robot arm, wherein the instructions include instructions to cause the at least one processor to: receiving an indication that the selected at least one second screw posture is acceptable; and The robotic arm is controlled based on the selected at least one second screw posture.

18. The system of claim 17, wherein the robotic arm is controlled to implant the at least one screw into the spine according to the selected at least one second screw posture.

19. The system of claim 13, wherein the at least one consideration comprises a consideration related to at least one of: safety of the surgical procedure, preference of a surgeon performing the surgical procedure, or desired alignment of a rod with the at least one screw.

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