Zone for surgical procedures and method and system for implant planning

Abstract

A system and method for mapping a zone for monitoring the position of a surgical instrument during a procedure from a model vertebra to a 3D image of a patient's vertebra. A model vertebra in a first coordinate system is received, the model vertebra including a plurality of model features localized in the first coordinate system and the pose of a model zone in the first coordinate system. A 3D image of a first and a second vertebra of the patient in a second coordinate system is also received. The model vertebra including the model zone is mapped to the first vertebra, thereby generating a zone for the first vertebra. An input indicating a revised pose of the zone for the first vertebra is received, and based on the revised pose of the zone for the first vertebra, a zone for the second vertebra is generated.

Description

Technical Field

[0001] Cross - Reference to Related Applications This application claims the benefit and priority of U.S. Provisional Patent Application No. 63 / 367,550, filed on July 1, 2022, which is hereby incorporated by reference in its entirety.

Background Art

[0002] In modern surgery, one of the most important instruments available to medical practitioners is powered surgical instruments such as cordless drills, saws, wire drivers, high - speed drills, ultrasonic handpieces, etc. In many cases, these surgical instruments include a motor and / or a processor within the handpiece or housing. The surgical instrument can include attachment features configured to receive a cutting attachment designed to be applied to the surgical site to perform a particular medical procedure. For example, a surgical drill can utilize a cutting attachment such as a drill bit, borer, or reamer to create a hole in tissue or selectively remove tissue such as bone. Enabling the use of powered surgical instruments on patients reduces the physical strain on medical practitioners when performing medical procedures. Further, compared to existing manual equivalents, the use of powered surgical instruments allows most surgical procedures to be performed more quickly and accurately.

[0003] A surgical navigation system can assist medical personnel regarding the navigation of surgical instruments during surgery. One or more 2D or 3D images of a patient's spine can be acquired before or during a spinal surgery procedure, and the surgical navigation system can access those images. A warning zone plan for a spinal surgery procedure involves establishing zones for 2D or 3D images to define areas surrounding important anatomical structures of the spine, such as vertebrae or the spinal cord, to be avoided during spinal surgery. These warning zones can be used to control the operation of surgical instruments to avoid accidental collisions with important anatomical structures. Existing surgical navigation systems can automatically generate warning zones, and then medical personnel can be provided with the ability to manually edit one or more of the automatically generated warning zones. However, when a surgical procedure involves multiple vertebrae (which is often the case), typically medical personnel must edit the warning zones for each vertebra on which the surgery is to be performed. As a result, the warning zone planning of existing surgical navigation systems can be very cumbersome.

[0004] Similarly, existing surgical navigation systems can propose an initial implant posture, but typically medical personnel must adjust the implant posture from the initial posture for each vertebra on which the surgery is to be performed and further manually edit the warning zones and implants in a similar manner among similar patients according to their own medical preferences and considerations regarding medicine. Therefore, it is desirable to optimize warning zone and implant planning for medical personnel.

[0005] The description of the background art provided herein is for the purpose of schematically presenting the content of the present disclosure. Within the scope described in this background art section, the work of the inventors named in this specification, as well as aspects of this description that would not ordinarily be considered prior art as of the filing date of the application, are not expressly or implicitly admitted as prior art to the present disclosure.

Summary of the Invention

[0006] A system consisting of one or more computers can be configured to perform a particular operation or action by having software, firmware, hardware, or a combination thereof installed in the system and causing the system to perform such actions during operation. One or more computer programs can be configured to perform a particular operation or action by including instructions that cause the apparatus to perform an action when executed by a data processing apparatus.

[0007] One general aspect includes a method of mapping zones of an anatomical model to a three-dimensional (3D) image of a patient's anatomical structure, and describes zones for monitoring the position of a surgical instrument relative to the patient's anatomical structure corresponding to the anatomical model during a surgical procedure. The method includes receiving a 3D anatomical model in a first coordinate system, the 3D model including a plurality of model features localized in the first coordinate system and the pose of a model zone in the first coordinate system. The method also includes receiving a 3D image of the patient's anatomical structure corresponding to the anatomical model. The method also includes mapping the 3D anatomical model including the model zone to the patient's anatomical structure based on the plurality of model features localized in the first coordinate system, thereby generating a zone relative to the patient's anatomical structure in a second coordinate system. The method also includes receiving input from a healthcare provider, the input indicating a revised pose of the zone relative to the patient's anatomical structure in the second coordinate system. The method also includes generating a zone relative to another anatomical structure of the patient that can similarly correspond to the anatomical model and / or can be shown within the 3D image, based on the revised pose of the zone relative to the patient's anatomical structure, and / or adjusting the pose of the model zone based on the revised pose of the zone relative to the patient's anatomical structure, for example, mapping an adjusted zone model to a further 3D image of the patient's anatomical structure corresponding to the anatomical model and / or a 3D image of another anatomical structure of the patient corresponding to the anatomical model. In some implementations, the anatomical model can be a vertebral model and the patient's anatomical structure can be the patient's vertebrae. Other examples of this aspect include a corresponding computer system, apparatus, and computer program recorded on one or more computer storage devices, each configured to perform the acts of the method.

[0008] One general aspect is described as including a method of mapping zones to a three-dimensional medical image to control a surgical instrument. The method includes retrieving a three-dimensional vertebra model in a first coordinate system, the three-dimensional vertebra model including (i) a plurality of model features localized in the first coordinate system, and (ii) the orientation of a model zone with respect to an important structure for a surgical instrument in the first coordinate system. The method also includes retrieving a three-dimensional image in a second coordinate system, the three-dimensional image representing a first vertebra and a second vertebra. The method also includes mapping a three-dimensional vertebra model including the model zone to the first vertebra based on the plurality of model features localized in the first coordinate system, thereby generating a zone for the first vertebra. The method also includes receiving an input from a healthcare provider, the input indicating a revised orientation of the zone of the first vertebra in the second coordinate system. The method also includes generating a zone for the second vertebra based on the revised orientation of the zone of the first vertebra. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the acts of the method, respectively.

[0009] One general aspect is described as including a method of mapping zones for a surgical instrument to a three-dimensional medical image. The method includes retrieving a three-dimensional vertebra model in a first coordinate system, the three-dimensional vertebra model including a plurality of model features localized in the first coordinate system and the pose of a model zone for a surgical instrument in the first coordinate system. The method also includes retrieving a three-dimensional image having a first vertebra and a second vertebra in a second coordinate system. The method also includes mapping the three-dimensional vertebra model including the model zone to the first vertebra to generate a zone for the first vertebra and a zone for the second vertebra. The method also includes receiving an input from a healthcare provider, the input indicating a revised pose for the model zone of the three-dimensional vertebra model in the first coordinate system. The method also includes applying the revised pose for the model zone to at least one of the zone for the first vertebra and the zone for the second vertebra. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the acts of the method, respectively.

[0010] One general aspect is described as including a method of mapping zones for a surgical instrument to a three-dimensional image. The method includes retrieving a three-dimensional vertebra model in a first coordinate system, the three-dimensional vertebra model including (i) a plurality of model features localized in the first coordinate system, and (ii) the pose of a model zone for a surgical instrument in the first coordinate system. The method also includes retrieving a three-dimensional image of a first patient having at least one vertebra in a second coordinate system. The method also includes mapping the three-dimensional vertebra model including the model zone to the at least one vertebra to generate a zone for the at least one vertebra. The method also includes receiving an input regarding a revised pose of the zone for the at least one vertebra. The method also includes revising the pose of the model zone based on the revised pose of the zone for the at least one vertebra. The method also includes retrieving a three-dimensional image of a second patient having at least one vertebra in a third coordinate system. The method also includes mapping the three-dimensional vertebra model including the revised pose of the model zone to the at least one vertebra of the second patient to generate a zone for the at least one vertebra of the second patient. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the actions of the method, respectively.

[0011] One general aspect is described as including a method of adjusting zones for a three-dimensional image according to a healthcare provider's preference history. The method also includes retrieving a three-dimensional image having at least one vertebra in a first coordinate system. The method also includes receiving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including a pose of a model zone with respect to a surgical instrument in the second coordinate system and a plurality of model features localized in the second coordinate system. The method also includes mapping a three-dimensional vertebra model including the model zone to at least one vertebra based on the plurality of model features localized in the second coordinate system, thereby generating a zone for the at least one vertebra. The method also includes receiving input from a healthcare provider regarding a revised pose of the zone for the at least one vertebra. The method also includes determining one or more transformations based on the pose of the model zone of the three-dimensional vertebra model and the revised pose of the zone for the at least one vertebra in the first coordinate system. The method also includes storing one or more transformations based on the pose of the model zone of the three-dimensional vertebra model in the first coordinate system and the revised pose of the zone for the at least one vertebra in the first coordinate system in a database including transformation data for a plurality of patients. The method also includes determining correction data based on the transformation data for the plurality of patients. The method also includes retrieving a three-dimensional image having at least one vertebra of a second patient in a third coordinate system. The method also includes mapping a three-dimensional vertebra model including the model zone to at least one vertebra of the second patient based on the plurality of model features localized in the third coordinate system and the correction data, thereby generating a zone for the at least one vertebra of the second patient. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the acts of the method.

[0012] One general aspect is described as including a method for adjusting zones for a three-dimensional image in accordance with a healthcare provider's preference history. The method includes receiving a three-dimensional image having at least one vertebra in a first coordinate system. The method also includes receiving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the pose of a model zone with respect to a surgical instrument in the second coordinate system and a plurality of model features localized in the second coordinate system. The method also includes mapping a three-dimensional vertebra model including the model zone to at least one vertebra based on a plurality of model features localized in the second coordinate system, thereby generating a zone for the at least one vertebra. The method also includes receiving input from a healthcare provider regarding a revised pose of the zone for the at least one vertebra. The method also includes determining one or more transformations based on the pose of the model zone of the three-dimensional vertebra model and the revised pose of the zone for the at least one vertebra in the first coordinate system. The method also includes storing one or more transformations based on the pose of the model zone of the three-dimensional vertebra model and the revised pose of the zone for the at least one vertebra in the first coordinate system in a database including transformation data for a plurality of patients. The method also includes determining correction data based on the transformation data for the plurality of patients. The method also includes selectively adjusting the pose of the model zone of the three-dimensional vertebra model based on the correction data. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the acts of the method.

[0013] One general aspect is described as including a method of adjusting zones for a 3D image according to a medical practitioner's preference history. The method includes retrieving a 3D image having at least one vertebra in a first coordinate system. The method also includes retrieving a 3D vertebra model in a second coordinate system, the 3D vertebra model including the pose of a model zone relative to a surgical instrument in the second coordinate system. The method also includes mapping an initial pose of a zone for at least one vertebra of the 3D image based on the pose of the model zone of the 3D vertebra model. The method also includes receiving input from a medical practitioner regarding a revised pose of the zone for at least one vertebra. The method also includes comparing the revised pose of the zone for at least one vertebra to the initial pose of the zone for at least one vertebra. The method also includes storing in a zone correction database a comparison of the revised pose of the zone for at least one vertebra to the initial pose of the zone for at least one vertebra. The method also includes learning a zone preference for the medical practitioner based on the zone correction database. The method also includes adjusting the pose of a zone for at least one vertebra of a second patient based on the learned zone preference. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the acts of the method.

[0014] One general aspect is described as including a method for adjusting a planned implant based on the preference history of a healthcare provider. The method includes retrieving a three-dimensional image of a first patient, the three-dimensional image including at least one vertebra in a first coordinate system. The method also includes retrieving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the pose of a model implant in the second coordinate system. The method also includes mapping the three-dimensional vertebra model, including the pose of the model implant, to at least one vertebra to generate an initial pose of the planned implant relative to the at least one vertebra of the three-dimensional image. The method also includes receiving input from a healthcare provider indicating a correction to the planned implant, the correction including a revised pose for the planned implant. The method also includes determining one or more transformations based on the initial pose of the planned implant and the revised pose of the planned implant. The method also includes storing one or more transformations based on the initial pose of the planned implant and the revised pose of the planned implant relative to at least one vertebra in a database including implant transformation data for a plurality of patients. The method also includes determining correction data based on the implant transformation data for a plurality of patients. The method also includes selectively adjusting the pose of the model implant relative to the three-dimensional vertebra model based on the correction data. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the acts of the method.

[0015] One general aspect is described as including a method of adjusting the posture of an implant planned based on the preference history of a healthcare provider. The method includes retrieving a three-dimensional image of a first patient, the three-dimensional image including at least one vertebra in a first coordinate system. The method also includes retrieving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the posture of a model implant in the second coordinate system. The method also includes mapping the three-dimensional vertebra model including the posture of the model implant to at least one vertebra to generate an initial posture of the planned implant. The method also includes receiving input from a healthcare provider indicating a correction to a revised posture of the planned implant. The method also includes determining one or more transformations based on the initial posture of the planned implant and the revised posture of the planned implant. The method also includes storing one or more transformations based on the initial and revised postures of the planned implant in a database including implant transformation data for a plurality of patients. The method also includes determining correction data based on the implant transformation data for a plurality of patients. The method also includes storing the correction data in an implant correction database. The method also includes retrieving a three-dimensional image of a second patient, the three-dimensional image including at least one vertebra in a third coordinate system. The method also includes mapping the three-dimensional vertebra model including the posture of the model implant to at least one vertebra of the three-dimensional image of the second patient to generate the posture of the planned implant for at least one vertebra of the three-dimensional image of the second patient. The method also includes selectively adjusting the posture of the planned implant based on the correction data. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the acts of the method.

[0016] One exemplary aspect is described as including a method of adjusting zones based on a healthcare provider's preference history. The method includes retrieving a three-dimensional image of a first patient, the three-dimensional image including at least one vertebra in a first coordinate system. The method also includes retrieving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including a plurality of poses for a plurality of model zones in the second coordinate system. The method also includes retrieving one or more preferences associated with previous procedures performed by a healthcare provider. The method also includes mapping, based on the one or more preferences associated with the previous procedures, a three-dimensional vertebra model including at least one pose of the plurality of model zones to at least one vertebra, thereby generating at least one zone for the at least one vertebra. Other examples of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices configured to perform the acts of the method.

[0017] Further areas of applicability of the present disclosure will become apparent from the detailed description, the claims, and the drawings. The detailed description and specific examples are intended for illustration only and are not intended to limit the scope of the present disclosure.

[0018] The present disclosure will be more fully understood from the detailed description and the accompanying drawings.

Brief Description of the Drawings

[0019]

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[0020] In the drawings, reference numbers may be repeated to identify similar and / or identical elements.

[0021] Referring to FIG. 1, an exemplary configuration of an operating room or surgical suite for performing a medical procedure on a patient 20 using a surgical system 10 is shown. The surgical navigation system 100 can include a navigation computer 140, a user input device 130, a display unit 120, and a tracking unit 110. The navigation computer 140 can include a central processing unit (CPU) and / or other processors, a memory (not shown), and a storage (not shown). The navigation computer 140 can be a personal computer, a laptop computer, a tablet computer, or any other suitable computing device. The navigation computer 140 can include surgical navigation software including one or more modules and / or operating instructions related to the operation of the surgical navigation system 100 to implement various routines, functions, or methods disclosed herein.

[0022] The display unit 120 is configured to display various graphical user interfaces (GUIs) 150 and patient images (e.g., preoperative patient images or intraoperative patient images). The preoperative images can be uploaded to the surgical navigation system 100 prior to the surgical procedure. Medical personnel can interact with the various GUIs 150 via the user input device 130 or touch input. In particular, the various GUIs 150 will be discussed in more detail with respect to FIGS. 4-11. The display unit 120 of the surgical navigation system 100 can be configured to display various prompts or data entry boxes. For example, the display unit 120 can be configured to display a text box or prompt that allows a medical professional to manually enter or select the type of surgical procedure to be performed.

[0023] The display unit 120 can be further configured to display a surgical plan for a medical procedure superimposed on a patient image. The surgical plan can include a surgical path for performing the medical procedure, or a planned trajectory or orientation for a medical instrument during the medical procedure. The surgical plan can also include the pose of an implant or medical device inserted during the medical procedure superimposed on the patient data or image. It is contemplated that the surgical navigation system 100 can be configured to display and / or project a holographic image of a surgical path for performing the medical procedure or a planned trajectory or orientation for a medical instrument during the medical procedure. This can include projecting the surgical path onto the patient 20 or other surface in the operating room. This can also include projecting the surgical path onto a head unit worn by a healthcare provider, such as the lens, shield, or glasses of the head unit. An exemplary configuration of the surgical navigation system 100 including a display unit worn by a healthcare provider to display a target trajectory and / or target location is disclosed in International Application No. WO2018 / 203304A1, which is hereby incorporated by reference in its entirety.

[0024] The GUI 150 can be configured to enable a healthcare provider to input or enter patient data or modify a surgical plan. The patient data can include, in addition to patient images, the type of medical procedure being performed, the patient's anatomical features, the patient's specific symptoms, and / or additional information related to the surgical settings for the surgical navigation settings. For example, when performing a spinal fixation procedure, the healthcare provider can enter information related to specific vertebrae or the vertebrae on which the medical procedure is being performed via the user input device 130 and / or the GUI 150. The healthcare provider can also input various anatomical dimensions related to the vertebrae and / or the size and shape of the medical device or implant to be inserted during the medical procedure. The user input device 130 and / or the GUI 150 can also be configured to enable a healthcare provider to select, edit, or manipulate patient data. For example, the healthcare provider can identify and / or select anatomical features from the patient data. This can include selecting the surgical site, for example, selecting the vertebrae on which the medical procedure is to be performed and / or a specific area on the vertebrae.

[0025] The surgical navigation system 100 can be configured to utilize segmentation to facilitate the generation of an interest warning zone around important anatomical features. These important anatomical features can include cortical walls, nerves, blood vessels, or similar important anatomical structures. The warning zone can be defined by one or more virtual boundaries. In addition to those proposed by the navigation computer 140, medical personnel can also provide input to the user input device 130 or the GUI 150 to identify additional important anatomical features and / or warning zones, or can desire to edit the warning zones and / or virtual boundaries generated by the navigation computer 140. Medical personnel can also provide input to the user input device 130 or the GUI 150 to select and / or input target locations, target trajectories, target depths, or similar features of a surgical path to assist in guiding the medical personnel during the performance of a medical procedure.

[0026] Input to the user input device 130 or the GUI 150 can be provided to select the surgical instrument to be used, to select the device and / or implant to be inserted, to select the planned orientation in which the device or implant is to be placed within the patient, and to enable selection of parameters of the implant to be inserted, such as the length and / or diameter of the screw to be inserted by the medical personnel, as discussed in more detail below.

[0027] The surgical system 10 can also include an imaging system 500 and a surgical navigation system 100. The imaging system 500, such as a CT or MRI imaging device, can perform intraoperative imaging. The imaging system 500 can include a scanner 510 and a display unit 520. The scanner 510 can be used to acquire an image of the surgical site 30 of the patient 20 and display it on the display unit 520. For example, the scanner 510 can include a C-arm configured to rotate around the patient 20 to create a plurality of images of the surgical site 30. The imaging system 500 can also include a processor (not shown) including software capable of acquiring a plurality of images captured by the scanner 510 and creating a 2D image and / or 3D model of the surgical site 30. The display unit 520 can be configured to display the resulting 2D image and / or 3D model.

[0028] The imaging system 500 can also communicate with the navigation computer 140 of the surgical navigation system 100. The imaging system 500 can be configured to communicate with the navigation computer 140 via a wired and / or wireless connection. For example, the imaging system 500 can be configured to provide preoperative and / or intraoperative image data, such as the resulting 2D image and / or 3D model of the surgical site 30, to the navigation computer 140 and provide the resulting 2D image and / or 3D model to the display unit 120.

[0029] The surgical system 10 also includes at least one of the surgical instrument assemblies 200 that communicate directly or indirectly, wired or wirelessly, with the navigation computer 140. Only the first surgical instrument assembly 200 is shown in FIG. 1, but this is merely an exemplary configuration of the surgical system 10, and it is contemplated that any number of surgical instrument assemblies 200, 300, 400 (described in more detail with respect to FIG. 2) can be placed in the operating room. The first surgical instrument assembly 200 includes a first surgical instrument 220 that includes an end effector 240 and a tracking device 230. The tracking device 230 includes a plurality of markers 235 that can be identified and / or tracked by the surgical navigation system 100. To follow the planned surgical path and / or avoid important anatomical structures, it is most important to accurately track the surgical instrument during the performance of the surgical procedure. Further, it is equally important to provide feedback and / or notify the medical personnel performing the procedure when the position of the surgical instrument and the surgical path deviate and / or there is a risk of collision with important anatomical structures. Referring further to FIG. 3, the surgical instrument 220 can be coupled to a drill chuck 240A, a tap 240B for creating threads on the inner surface of a hole or opening, or a driver 240C for driving or inserting a screw into a bone perforation or opening.

[0030] The tracking unit 110 can include one or more sensors 115 for tracking the tracking device 230 of the surgical instrument assembly 200. The sensors can include cameras such as CCD cameras, CMOS cameras, and / or optical image cameras, magnetic sensors, radio frequency sensors, or any other sensors adapted to detect and / or sense the position of the tracking device 230 of the surgical instrument assembly 200. A description of suitable tracking units and the various localizers that such tracking units can utilize can be found in U.S. Patent Publication No. 2017 / 0333137, which is hereby incorporated by reference in its entirety.

[0031] Referring to FIG. 2, in addition to the surgical instrument assembly 200, various other surgical instrument assemblies 300, 400 that communicate with the surgical navigation system 100 are shown. Each of the various exemplary surgical instrument assemblies 200, 300, 400 will be described in more detail below. The surgical instrument assemblies 200, 300, 400 can be configured to communicate with the surgical navigation system 100 either wired and / or wirelessly. Further, each of the surgical instrument assemblies 200, 300, 400 can have a plurality of similar components capable of performing similar functions and / or operations. Similar components among the various surgical instrument assemblies 200, 300, 400 include the same two-digit code together with a leading 2, 3, or 4 so as to reflect the associated surgical instrument assemblies 200, 300, 400. For example, each of the surgical instrument assemblies 200, 300, 400 can include a surgical instrument 220.

[0032] The first surgical instrument assembly 200 is communicating with the surgical navigation system 100. As already discussed, the first surgical instrument assembly 200 can be configured as a first surgical instrument 220, such as a surgical drill or driver, including a handpiece 225. The handpiece 225 can include a housing 210 configured to house the components of the first surgical instrument 220. The handpiece 225 can be shaped to define a handle or gripping portion for a medical practitioner to hold during the performance of a medical procedure. Suitable handpieces are described in U.S. Patent No. 5,747,953, which is incorporated herein by reference in its entirety.

[0033] The first surgical instrument 220 can further include a first instrument processor 215 and a motor 245. Each of the first instrument processor 215 and the motor 245 can be disposed within the handpiece 225 of the first surgical instrument 220. The first instrument processor 215 and the motor 245 can communicate with each other, and the first instrument processor 215 can be configured to control the operation of the motor 245 and the first surgical instrument 220 as its extension. For example, the first surgical instrument 220 can include an end effector 240 such as a drill bit for making a hole or a driver for inserting a screw. The end effector 240 can be coupled to the handpiece 225 of the first surgical instrument 220, and thus the motor 245 can be operably coupled to the end effector 240. For example, the motor 245 can be configured to rotate the drill bit 240 to make a hole and / or to remove biological tissue. The first instrument processor 215 can communicate with the motor 245 and can be configured to control the operation of the motor 245 and the drill bit 240 as its extension. The first instrument processor 215 can also communicate with the navigation computer 140 and can be configured to transmit and receive data related to the position and / or orientation of the first surgical instrument 220, as well as data related to the operation of the first surgical instrument 220. For example, the first instrument processor 215 and the navigation computer 140 can be configured to communicate with each other data related to the operation of the first surgical instrument 220 based on the position and / or orientation of the first surgical instrument 220 detected by the surgical navigation system 100.

[0034] The first surgical instrument assembly 200 can also include a power source 260. The power source 260 can be removably coupled to the handpiece 225 of the surgical drill 220. For example, the power source 260 can include a removable battery pack. It is also contemplated that the power source 260 can be formed as part of the handpiece 225 of the first surgical instrument 220 or disposed within the handpiece 225 of the first surgical instrument 220. The power source 260 can be in electrical communication with the first instrument processor 215 and / or the motor 245 and can be configured to selectively provide power to the motor 245 to rotate the end effector 240. The power source 260 can also be a surgical console that provides power to the first surgical instrument 220 by a cord.

[0035] In cases where the power source 260 takes the form of a removable battery pack, the power source 260 can further include a processor 265. The processor 265 can communicate with the first instrument processor 215 via a power signal and / or a data signal. The processor 265 and the first instrument processor 215 can be configured to communicate with each other to control the operation of the motor 245 and the first surgical instrument 220 as an extension thereof. For example, the processor 265 within the power source 260 can be configured to identify when the power source 260 drops below a threshold charge level and is unable to continue operating the motor 245 at a minimum threshold for drilling holes or cutting biological tissue by the power source 260. The processor 265 can be configured to cut off all power to the first instrument processor 215 and / or the motor 245 to prevent the operation of the end effector 240 until the power source 260 has a charge level sufficient to operate the motor 245 at a speed above the minimum threshold for drilling holes or cutting biological tissue. The processor 265 within the power source 260 can also communicate wirelessly with the navigation computer 140. The power source 260 can include a transceiver configured to transmit and receive signals between the power source 260 and the surgical navigation system 100 and / or the instrument processor 215.

[0036] The processor 265 and the navigation computer 140 can be configured to communicate with each other data related to the operation of the first surgical instrument 220 based on the position and / or orientation of the first surgical instrument 220 detected by the surgical navigation system 100. For example, the surgical navigation system 100 can be configured to communicate to the processor 265 data including instructions to the processor 265 to interrupt providing energy to the first instrument processor 215 and / or the motor 245 based on the position and / or orientation of the first surgical instrument 220 detected by the surgical navigation system 100. The surgical navigation system 100 can also be configured to communicate to the processor 265 data including instructions to the processor 265 to continue and / or resume providing energy to the first instrument processor 215 and / or the motor 245 based on the position and / or orientation of the first surgical instrument 220 detected by the surgical navigation system 100.

[0037] The first surgical instrument assembly 200 can also include a switch 250, such as a trigger or a button or a lever, operably coupled to the first instrument processor 215. The switch 250 can be configured to be operable by a medical practitioner to control the energization of the variable speed motor 245. For example, the switch 250 can be made operable between a first position that is an off state and a second position that is an on state. The first surgical instrument assembly 200 can also include a switch sensor configured to detect the position of the switch 250, generate a signal indicative of the position of the switch 250, and / or communicate it to the first instrument processor 215 based on the operation of the switch 250 by a user to control the operation of the first surgical instrument 220. For example, the switch 250 can include a first position, a second position, and a plurality of intermediate positions between the first position and the second position.

[0038] The first position can be configured as an off position. Thus, when the first instrument processor 215 receives a signal from the switch sensor detecting that the switch 250 is in the first position, the first instrument processor 215 prevents the flow of energy from the power supply 260 to the motor 245 and prevents the operation of the first surgical instrument 220. Or, when the first instrument processor 215 receives a signal from the switch sensor detecting that the switch 250 is in the second position, the first instrument processor 215 can be configured to allow the maximum flow of energy from the power supply 260 to the motor 245, enabling the first surgical instrument 220 to operate at a maximum piercing or cutting speed.

[0039] When the first instrument processor 215 receives a signal from the switch sensor detecting that the switch 250 is in one of the intermediate positions, the first instrument processor 215 can be configured to allow the flow of energy from the power supply 260 to the motor 245 at a level corresponding to the position of the switch 250 between the first and second positions, enabling the first surgical instrument 220 to operate at an intermediate piercing or cutting speed. For example, when the first instrument processor 215 receives a signal from the switch sensor detecting that the switch 250 is positioned at the midpoint (50%) between the first and second positions, the first instrument processor 215 can be configured to allow the flow of energy from the power supply 260 to the motor 245 at a level that enables the first surgical instrument 220 to operate at 50% of the maximum piercing or driving speed. Alternatively, the first instrument processor 215 can be configured to allow the maximum flow of energy from the power supply 260 to the motor 245 whenever the switch 250 is in a position other than the first position, enabling the first surgical instrument 220 to operate at the maximum piercing or cutting speed whenever the switch 250 is in either the second or an intermediate position. An exemplary switch sensor can be found in U.S. Patent No. 9,295,476, which is hereby incorporated by reference in its entirety.

[0040] The first surgical instrument assembly 200 can also include a first warning device 255. In an exemplary configuration, the first warning device 255 is disposed to contact a healthcare provider and can include any one of a variety of devices such as a vibration device configured to vibrate to notify the healthcare provider of a particular condition or provide an alert, an audible device such as a speaker configured to provide an audible warning to notify the healthcare provider of a particular condition or provide an alert, or a visually perceptible device or indicator such as a visual device configured to provide a visual indication to notify the healthcare provider of a particular condition or provide an alert. An exemplary first warning device can be found in International Application No. WO2021 / 062373A2, which is hereby incorporated by reference in its entirety.

[0041] The first warning device 255 can be configured to communicate with the first instrument processor 215 or the processor of the power supply 260. The first instrument processor 215 or other processor can transmit a signal to activate (start up) the first warning device 255 and can be configured to provide an alarm or notification based on pre-programmed conditions or settings. For example, as described above, a medical practitioner can input defined conditions and / or settings into the surgical navigation system 100, for example, select cortical walls, nerves, blood vessels, or similar anatomical structures that the medical practitioner wishes to avoid, and establish warning zones surrounding those anatomical structures. The first instrument processor 215 can be configured to transmit a signal to activate the first warning device 255 when the end effector 240 of the first surgical instrument 220 enters one of the warning zones defined by the medical practitioner based on the data provided by the navigation computer 140. The first instrument processor 215 or other processor can also be configured to transmit a signal to activate the first warning device 255 when the end effector 240 of the first surgical instrument 220 deviates from its trajectory and / or when the end effector 240 reaches the target location, based on the data provided by the navigation computer 140.

[0042] The first warning device 255 is shown as being coupled to or in proximity to the switch 250 of the first surgical instrument assembly 200, although it is contemplated that the first warning device 255 can also be coupled and / or positioned at alternative locations. For example, when the first warning device 255 includes a tactile device, the first warning device 255 can be configured as a vibration member removably attached to a healthcare provider. The first warning device 255 can be configured as a wearable device such as a bracelet worn on a healthcare provider's wrist or arm, such that the healthcare provider can feel the first warning device 255 vibrating when a defined condition occurs. Or, when the first warning device 255 includes an audible device, the first warning device 255 can be configured as a speaker removably attached to a healthcare provider. The first warning device 255 can be configured as a Bluetooth (registered trademark) speaker or earphone worn on a healthcare provider's head or positioned in a healthcare provider's ear, such that the healthcare provider can hear the noise generated by the first warning device 255 when a defined condition occurs.

[0043] Although not required, positioning the first warning device 255 remotely from the first surgical instrument 220 has several advantages. For example, one advantage of positioning the first warning device 255 remotely from the first surgical instrument 220 is that it can reduce the size of the first surgical instrument 220. This allows the first surgical instrument 220 to be stored in a smaller space. The smaller first surgical instrument 220 can also provide a view for the medical practitioner that does not overly obstruct the surgical site. Another advantage of positioning the first warning device 255 remotely from the first surgical instrument 220 is that, particularly in the case of a tactile device, the first warning device 255 can still provide a warning or notification to the medical practitioner without vibrating the first surgical instrument 220 or affecting the movement of the first surgical instrument 220. During a technically advanced procedure, a warning that vibrates the first surgical instrument 220 can, unexpectedly as a result of the first warning device 255, and / or as a result of the vibration causing an undesirable movement of the first surgical instrument 220, cause the medical practitioner to move the first surgical instrument 220 to an undesirable position.

[0044] The first surgical instrument assembly 200 can also include a tracking device 230. The tracking device 230 can be coupled to the handpiece 225 of the first surgical instrument 220. The tracking device 230 can include a plurality of markers 235 that can be identified by the tracking unit 110 of the surgical navigation system 100. The markers 235 can include passive tracking elements (e.g., reflectors) for transmitting an optical signal to the sensor 115 (e.g., reflecting light emitted from the tracking unit 110). In other configurations, the markers 235 can be configured as active tracking markers. It is also contemplated that the markers 235 can include a combination of active and passive arrangements.

[0045] The marker 235 can be arranged at a defined or known position and orientation relative to other markers 235, whereby the surgical navigation system 100 can determine the position and orientation (posture) of the surgical instrument 220. For example, the marker 235 can be associated with the first surgical instrument 220, whereby the surgical navigation system 100 can determine the position and / or orientation of the end effector 240 or the cutting portion of the first surgical instrument 220 within a defined space such as the surgical field. In one exemplary configuration, the surgical navigation system 100 can be configured to determine the position and / or orientation of the end effector 240 or the cutting portion of the second surgical instrument 220, or the position and / or orientation relative to the target trajectory and / or target location of the planned surgical path. In another exemplary configuration, the surgical navigation system 100 can also be configured to determine the position and / or orientation of the end effector 240 or the cutting portion of the second surgical instrument 220, or the position and / or orientation relative to important anatomical structures within the patient's body, as well as relative to virtual boundaries and / or warning zones.

[0046] As an alternative, the surgical system 10 can include a second surgical instrument assembly 300 for use with the surgical navigation system 100. For example, the second surgical instrument assembly 300 can include a second surgical instrument 320 such as a surgical high-speed drill or a surgical ultrasonic handpiece that includes a handpiece 325. The handpiece 325 can be coupled to a console 310 configured to control the operation of various components of the second surgical instrument 320. The handpiece 325 can be shaped to define a handle or gripping portion for a healthcare provider to hold during the performance of a medical procedure. Exemplary second surgical instruments that connect to the console can be found in U.S. Patent No. 10,016,209 and U.S. Patent Publication No. 2019 / 0117322, each of which is incorporated herein by reference in its entirety.

[0047] The second surgical instrument 320 can further include a second instrument processor 315 and a motor 345. The second instrument processor 315 can be disposed within the console 310 of the second surgical instrument assembly 300. The motor 345 can be disposed within the handpiece 325 of the second surgical instrument 320. The second instrument processor 315 and the motor 345 can communicate with each other, and the second instrument processor 315 can be configured to control the operation of the motor 345 and, as its extension, the second surgical instrument 320. For example, the second surgical instrument 320 can be coupled to the console 310 by a cord connecting the second instrument processor 315 to the motor 345, and the communication between the second instrument processor 315 and the motor 345 enables the operation of the motor 345 to be controlled. The second instrument processor 315 can also include an end effector 340 such as a high-speed cutting bur or an ultrasonic tip. The end effector 340 can be coupled to the handpiece 325 of the second surgical instrument 320, and thus the motor 345 can be operably coupled to the end effector 340. For example, the motor 345 can be configured to operate the high-speed cutting bur 340 to grind and / or remove biological tissue from the surgical site or to vibrate the ultrasonic tip. The second instrument processor 315 can communicate with the motor 345 and can be configured to control the operation of the motor 345 and, as its extension, the high-speed cutting bur 340.

[0048] The second surgical instrument assembly 300 can also include a tracking device 330. The tracking device 330 can be coupled to the handpiece 325 of the second surgical instrument 320. The tracking device 330 can be similar to that described above with respect to the first surgical instrument assembly 200. For example, the tracking device 330 can include a plurality of markers 335 that can be identified by the tracking unit 110 of the surgical navigation system 100, and each of the markers 335 can be arranged at a defined or known position and orientation relative to the other markers 335, whereby the surgical navigation system 100 can determine the position and orientation (posture) of the second surgical instrument 320. The second instrument processor 315 can also communicate with the navigation computer 140 and can be configured to exchange data related to the position and / or orientation of the second surgical instrument 320, as well as data related to the operation of the second surgical instrument 320. For example, the second instrument processor 315 and the navigation computer 140 can be configured to communicate with each other data related to the operation of the second surgical instrument 320 based on the position and / or orientation of the second surgical instrument 320 detected by the surgical navigation system 100. It is also contemplated that additional surgical instruments can be coupled to the console 310 and / or that additional surgical instruments can communicate with the second instrument processor 315 disposed within the console 310.

[0049] The second surgical instrument assembly 300 can also include a power source (not shown). The power source can be coupled to the console 310 of the second surgical instrument assembly 300 and configured to provide energy to the motor 345 of the second surgical instrument 320 to operate the end effector 340. It is also contemplated that the console 310 can include a cord configured to be plugged into an outlet connected to a power grid to supply energy to the second surgical instrument assembly 300. The power source can communicate electrically with the second instrument processor 315 and / or the motor 345 and can be configured to selectively provide power to the motor 345 to operate the end effector 340.

[0050] The second surgical instrument assembly 300 can also include a switch 350, such as a foot switch, trigger, or button, operably coupled to the second instrument processor 315. The switch 350 can be configured to generate a signal and / or communicate it to the second instrument processor 315 based on a user input for controlling the operation of the second surgical instrument 320. Although not shown in the figures, it is contemplated that multiple surgical instruments 320 can be coupled to the console 310 and controlled by a foot switch. A switch 350, such as a foot switch, can be configured to control each of the multiple surgical instruments 320. For example, a single foot switch can include multiple buttons, and each of the multiple buttons can be assigned to one of the multiple surgical instruments 320. An exemplary surgical system including a switch connected to a console for controlling multiple surgical instruments is disclosed in U.S. Patent No. 10,820,912, which is incorporated by reference in its entirety.

[0051] The second surgical instrument assembly 300 can also include a second warning device 355 similar to the first warning device 255. The second warning device 355 can include one of an audible, tactile, and / or visually perceivable device, as discussed with respect to the first warning device 255. The second warning device 355 can be configured to communicate with the second instrument processor 315 or to communicate directly with the navigation processor. The second instrument processor 315 or the navigation processor can be configured to send a signal to activate the second warning device 355 and provide an alarm or notification based on pre-programmed conditions or settings. Although the second warning device 355 is shown as being coupled to the switch 350 of the second surgical instrument assembly 300, it is contemplated that the second warning device 355 can also be coupled and / or positioned at an alternative location.

[0052] The surgical system 10 can include a third surgical instrument assembly 400 that communicates with the surgical navigation system 100. For example, the third surgical instrument assembly 400 can include a third surgical instrument 420, such as an ultrasonic instrument that includes a handpiece 425. The handpiece 425 can be coupled to a console 410 configured to control the operation of various components of the third surgical instrument 420. The handpiece 425 can be shaped to include a handle or gripping portion for a medical practitioner to hold during the performance of a medical procedure.

[0053] The third surgical instrument 420 can further include a third instrument processor 415 and a motor 445. The third instrument processor 415 can be disposed within the console 410 of the third surgical instrument assembly 400. The motor 445 can be disposed within the handpiece 425 of the third surgical instrument 420. The third instrument processor 415 and the motor 445 can communicate with each other. The motor 445 can include a piezoelectric element, which is configured to expand and contract when an electric current is applied to the piezoelectric element. The piezoelectric element can include a plurality of disc-shaped piezoelectric elements arranged with ends connected and stacked. The third instrument processor 415 can be configured to control the operation of the motor 445 and, as its extension, the third surgical instrument 420. For example, the third surgical instrument 420 can include an end effector 440 such as an ultrasonic tip assembly.

[0054] The end effector 440 can include an ultrasonic tip assembly including a horn, and the ultrasonic tip portion thereof vibrates at ultrasonic speed when the piezoelectric element expands and contracts. The ultrasonic tip assembly can also include an outer sheath disposed at least partially over the horn except for the ultrasonic tip portion. The end effector 440 can be coupled to the handpiece 425 of the third surgical instrument 420, and thus the motor 445 can be operably coupled to the end effector 440. For example, the motor 445 can be configured to operate the ultrasonic tip assembly to grind and / or remove biological tissue from the surgical site. The third instrument processor 415 can communicate with the motor 445 and can be configured to control the flow of current to the piezoelectric element to control the operation of the motor 445 and, as its extension, the ultrasonic tip assembly.

[0055] The third surgical instrument assembly 400 can also include a tracking device 430. The tracking device 430 can be coupled to the handpiece 425 of the third surgical instrument 420. The tracking device 430 can be similar to that defined above with respect to other instrument assemblies. For example, the tracking device 430 can include a plurality of markers 435 that can be identified by the tracking unit 110 of the surgical navigation system 100, and each marker 435 can be arranged at a defined or known position and orientation relative to the other markers 435, whereby the surgical navigation system 100 can determine the position and orientation (posture) of the third surgical instrument 420. The third instrument processor 415 can also communicate with the navigation computer 140 and can be configured to transmit and receive data related to the position and / or orientation of the third surgical instrument 420, as well as data related to the operation of the third surgical instrument 420. For example, the third instrument processor 415 and the navigation computer 140 can be configured to communicate data related to the operation of the third surgical instrument 420 between each other based on the position and / or orientation of the third surgical instrument 420 detected by the surgical navigation system 100.

[0056] The third surgical instrument assembly 400 can also include a power source (not shown). The power source can be coupled to the console 410 of the third surgical instrument assembly 400 and can be configured to provide energy to the motor 445 of the third surgical instrument 420 to operate the end effector 440. For example, the power source can include a removable battery pack. It is also contemplated that the console 410 can include a cord configured to be plugged into a receptacle connected to a power grid to supply energy to the third surgical instrument assembly 400. The power source can be electrically communicable with the third instrument processor 415 and / or the motor 445 and can be configured to selectively provide power to the motor 445 to operate the end effector 440.

[0057] The third surgical instrument assembly 400 can also include a switch 450, such as a footswitch, pedal, or button, operably coupled to the third instrument processor 415. The switch 450 can be configured to generate a signal and / or communicate it to the third instrument processor 415 based on a user input for controlling the operation of the third surgical instrument 420.

[0058] The third surgical instrument assembly 400 can also include a third warning device 455 similar to the first warning device 255 and the second warning device 355. The third warning device 455 can include one of an audible, tactile, and / or visually perceivable device, as discussed with respect to the first warning device 255. The third warning device 455 can be configured to communicate with the third instrument processor 415. The third instrument processor 415 can be configured to send a signal to activate the third warning device 455 and provide an alarm or notification based on a pre-programmed condition or setting.

[0059] The surgical instrument assemblies 200, 300, 400 described above are intended to be exemplary instruments and / or configurations within the surgical system 10 and are not intended to be limiting. Other types and forms of surgical instrument assemblies are contemplated. Although multiple exemplary surgical instrument assemblies 200, 300, 400 are described as being part of the surgical system 10 and communicating with the surgical navigation system 100, it is also contemplated that the surgical system 10 may include only a single surgical instrument assembly 200, 300, 400. Further, although the surgical system 10 shown in FIG. 2 includes three surgical instrument assemblies 200, 300, 400 and a single surgical navigation system 100, it is contemplated that the surgical system 10 may be configured to include any combination of surgical instrument assemblies 200, 300, 400 and / or surgical navigation systems 100. For example, the surgical system 10 may include a single surgical instrument assembly 200, 300, 400 and multiple surgical navigation systems 100.

[0060] Referring to FIG. 4, an exemplary configuration of the GUI 150A of the surgical navigation system 100 is shown. The GUI 150A can be configured as a touch screen on the display unit 120 of the surgical navigation system 100. As shown in FIG. 4, the GUI 150A can be referred to as a segmentation interface. The GUI 150A can include an area selection button 141 for selecting an area to be segmented and a segment button 142 that a medical practitioner selects to segment the selected area.

[0061] The surgical navigation system 100 can be configured to facilitate warning zone planning for generating warnings or controlling the parameters of surgical instruments based on the posture of the tracked surgical instruments by utilizing segmentation, as will be described in more detail below. When the surgery targets the lumbar spine, a medical practitioner can provide an input to the user input device 130 by selecting the region selection button 141 of the graphical user interface (GUI) 150A to define an area of interest such as the lumbar region 153 of the patient image, and thus limit the segmentation of the patient image to the lumbar region 153. After the medical practitioner selects an area of interest such as the lumbar region 153, the medical practitioner can select the segment button 142 to segment the lumbar region 153.

[0062] Segmentation can be performed automatically, semi-automatically, or manually. One automatic segmentation that the surgical navigation system 100 can be configured to perform is an atlas image mapping process for mapping a three-dimensional vertebra model to each of the vertebrae in the lumbar region 153. The three-dimensional vertebra model can be overlaid on each vertebra in the lumbar region 153, and then the vertebra model can be deformed automatically, manually, or semi-automatically until the three-dimensional vertebra model fits each vertebra in the lumbar region 153.

[0063] In one example of the automatic segmentation process, the surgical navigation system 100 can be configured to perform segmentation of the lumbar region 153 using a model fitting algorithm. The model can represent, for example, the variations within a set of images of the structure represented in the first image and can be adapted to the first image based on the characteristics of the image. The adaptation can include applying an adaptation technique selected from the group consisting of rigid registration, non-rigid registration, active shape modeling, and active appearance modeling. The adaptation technique can be similar to that described by International Application No. WO2011 / 098752A2, which is incorporated herein by reference. In practice, the adaptation can include any suitable adaptation technique. Although examples are provided where automatic segmentation can be performed based on a model fitting algorithm, the system can also be configured to perform automatic or semi-automatic segmentation using another suitable algorithm.

[0064] In the semi-automatic segmentation process, it can be required to provide some input to a medical practitioner during the segmentation process in order to identify anatomical landmarks. The surgical navigation system 100 can be configured to implement one of the semi-automatic segmentation methods for segmenting the lumbar region 153 based on one of the methods described in U.S. Patent No. 8,698,795 (the title of the invention is "Interactive Image Segmentation"), the content of which is incorporated herein by reference.

[0065] The surgical navigation system 100 can also be configured to perform segmentation of the lumbar region 153 using a combination of manual, semi-automatic, and automatic segmentation algorithms. For example, the surgical navigation system 100 can perform an initial segmentation using a first algorithm such as the model fitting algorithm described above, and then use a second segmentation algorithm such as a graph cut algorithm to refine the initial segmentation of one or more vertebrae in the lumbar region 153. A method of segmenting a medical image based on the first segmentation algorithm and the second segmentation algorithm is described in U.S. Patent Publication No. 2021 / 0192743(A1), which is incorporated herein by reference in its entirety.

[0066] During or after the segmentation of the lumbar region 153, the surgical navigation system 100 can map one or more virtual implants, a plurality of warning zones, and / or a plurality of virtual boundaries to each vertebra in the lumbar region 153 based on the three-dimensional vertebra model. Referring to FIG. 5, the graphical user interface 150B shows various views of the vertebra model 145, including an implant view showing a top view of the vertebra model 145 with the model implants 275A-M, 275B-M in an optimal orientation, a model warning zone view of the vertebra model 145 in which a plurality of model warning zones (zones 1-6) are defined by a plurality of model virtual boundaries (boundaries 1-13) and the plurality of model warning zones and virtual boundaries are shown in the top view, and a simple model view of the vertebra model 145 showing a model without the model implant or the model warning zones. The vertebra model 145 can be defined in a second coordinate system (i.e., the vertebral body coordinate system). The optimal orientation for the model implants 275A-M, 275B-M is defined in the second coordinate system with respect to various landmarks or anatomical features of the vertebra model 145.

[0067] Referring to FIG. 5, in the model warning zone diagram, the pose of each of the plurality of model warning zones and / or virtual boundaries is shown relative to the vertebral model 145 and is defined in a second coordinate system. The plurality of model warning zones includes a first model warning zone (zone 1), a second model warning zone (zone 2), a third model warning zone (zone 3), a fourth model warning zone (zone 4), a fifth model warning zone (zone 5), and a sixth model warning zone (zone 6). Model warning zone 1 can be defined relative to the spinal cord. For example, model warning zone 1 can be defined as the volume between a first virtual boundary (boundary 1) and a second virtual boundary (boundary 2). Boundary 1 can be defined relative to the outer periphery of the spinal cord. Boundary 2 can be arranged at a default distance from boundary 1 based on the surgical procedure that is at least partially performed. For example, boundary 2 can be shifted 2 millimeters from boundary 1.

[0068] Model warning zone 2 can be defined at a second distance from important anatomical structures, and thus the second distance is greater than the first distance. Model warning zone 2 can be defined as the volume between boundary 2 and boundary 3 which is a third virtual boundary. Boundary 3 can be arranged at a default distance from boundary 2 based on the surgical procedure that is at least partially performed. Model warning zone 3 can be defined at the boundary of important anatomical structures and / or can be defined to include important anatomical structures. For example, boundary 3 can define the outer periphery of model warning zone 3. Boundary 8 which is an eighth boundary and boundary 9 which is a ninth boundary define the outer periphery of the vertebra. Model warning zone 4 can be defined relative to the outer periphery of the vertebra. Model warning zone 4 can be demarcated by boundary 14 which is a fourteenth virtual boundary and boundary 9 which is a ninth virtual boundary. Boundary 14 can be shifted from boundary 9 which can be defined on the outer periphery of the vertebra.

[0069] The model warning zone 5 can be defined such that a contour is drawn around an important anatomical structure (the central hole within the vertebra) to warn medical personnel to prevent contact with the important anatomical structure when the end effector 240 of the first surgical instrument 220 approaches the important anatomical structure. The model warning zone 5 can be defined by a tenth virtual boundary, boundary 10, and an eleventh virtual boundary, boundary 11. Boundary 10 can contact or be directly adjacent to boundary 3, and boundary 11 is disposed at a default distance from boundary 10.

[0070] The model warning zone 6 is shown around the outer periphery of the pedicle to warn medical personnel to prevent them from breaking through the outer periphery of the pedicle when the end effector 240 of the first surgical instrument 220 approaches the outer periphery of the vertebra. The model warning zone 6 can be defined by a twelfth virtual boundary, boundary 12, and boundary 8. Boundary 12 can be offset from the outer boundary of the pedicle region of the vertebra, and boundary 8 can be defined on the outer periphery of the pedicle region of the vertebra.

[0071] It is also contemplated that the surgical navigation system 100 can be configured to define virtual boundaries (boundaries 1-13) and / or model warning zones (zones 1-6) based on information selected or input by medical personnel. For example, the surgical navigation system 100 can be configured to define a model warning zone (zones 1-6) based on one or more of the following items input by medical personnel: the type of procedure to be performed, the location of the patient's treatment, the type of implant 275 to be used, the type of surgical instruments 220, 320, 420 to be used, and / or the type of end effectors 240, 340, 440. At this time, medical personnel can use the user input device 130 and / or the GUI 150 to obtain the opportunity to modify or change the virtual boundaries (boundaries 1-13) and / or the model warning zones (zones 1-6) of the three-dimensional vertebra model.

[0072] In addition to the plurality of model warning zones (zones 1-6) and virtual boundaries (boundaries 1-13), the vertebral model 145 can include a plurality of features or regions defined with respect to a second coordinate system. The plurality of features or regions can include, for example, superior articular facets, spinous processes, mammillary processes, accessory processes, pedicles, vertebral foramina, superior articular processes, vertebral arches, superior vertebral notches, vertebral bodies, and the like.

[0073] The vertebral model 145 can include virtual boundaries of a plurality of planes that can be used to indicate a plurality of target depths (e.g., three target depths) so that separate instruments can be used in a single procedure. For example, a fifth virtual boundary (model boundary 5) representing the target depth for a drill to create a hole, a sixth virtual boundary (model boundary 6) representing the target depth for a tap, and a seventh virtual boundary (model boundary 7) representing the target depth for a driver to insert a screw are shown in FIG. 5 and will be described in more detail below with respect to FIG. 7.

[0074] During or after segmentation, the model implants 275A-M, 275B-M, the model warning zones (zones 1-6), and the model virtual boundaries (boundaries 1-12) of the vertebral model 145 can be mapped to the vertebrae in the lumbar region 153, and as a result, a patient-specific surgical plan is generated according to the vertebral model. For example, after the L3 vertebra in the lumbar region 153 is segmented and mapped with respect to the implant, warning zones, and virtual boundaries, each vertebra has a planned orientation of one or more implants 275A, 275B, a plurality of warning zones (zones 1-6), and a plurality of virtual boundaries (1-12). A healthcare provider can adjust one or more of the plurality of warning zones (zones 1-6), virtual boundaries (boundaries 1-12), and the planned implant orientations 275A, 275B, as described in more detail below.

[0075] The virtual boundaries (boundaries 1-12) and warning zones (zones 1-6) can be one-dimensional (1D), two-dimensional (2D), or three-dimensional (3D), and can include points, lines, axes, trajectories, planes (infinite planes, or plane segments bounded by anatomical structures or other virtual boundaries), volumes, or other shapes including complex geometries. The virtual boundaries (boundaries 1-12) and warning zones (zones 1-6) can be represented by pixels, point clouds, voxels, triangular meshes, other 2D or 3D models, combinations thereof, etc., as disclosed by U.S. Patent Publication No. 2018 / 0333207 and U.S. Patent No. 8,898,043, which are incorporated by reference.

[0076] As discussed in more detail below, the virtual boundaries and / or warning zones can be used in a variety of ways. For example, the navigation computer 140 can control certain operations / functions of the surgical instrument 220 (e.g., space, speed, etc.) based on the relationship of the surgical instrument 220 to one or more virtual boundaries and / or warning zones. Other uses of the virtual boundaries are contemplated. The plurality of warning zones (zones 1-6) can be made active / inactive one at a time by the navigation computer 140, as described in more detail with respect to the warning interface.

[0077] When the surgical navigation system 100 determines that one or more of the surgical instruments 220, 320, 420 are located at and / or adjacent to one or more of the virtual boundaries, or have entered one of the defined warning zones, the surgical navigation system 100 can be programmed and / or configured to manipulate the speeds of the motors 245, 345, 445 of the surgical instruments 220, 320, 420 and / or activate the warning devices 255, 355, 455. For example, when the surgical navigation system 100 detects that the first end effector 240A is coupled to the handpiece 225, the surgical navigation system 100 can transmit a signal to the instrument processors 215, 315, 415 of the surgical instrument 220 to configure the motors 245, 345, 445 to be in an inactive state when the first end effector 240A is adjacent to and / or distal from the boundary 5.

[0078] Referring to FIG. 6, GUI 150C shows the lumbar region 153 segmented according to one of the segmentation methods described above. GUI 150C includes a sagittal view, an axial view, and a model or perspective view of the lumbar region 153, and GUI 150C focuses on the L3 vertebra. GUI 150C can include one or more buttons such as a segmentation acceptance button 165, a segmentation manual editing button 167, a segmentation automatic editing button 177, and a setting button 179. When selected by a medical practitioner, the setting button can show a notification setting interface, as discussed in more detail with respect to FIG. 7. GUI 150C can include one or more labels 174 that identify the vertebrae displayed on GUI 150C. As shown in FIG. 6, three labels 174A, 174B, 174C are shown on GUI 150C, where the first label 174A identifies the L3 vertebra, the second label 174B identifies the L2 vertebra adjacent to the L3 vertebra, and the third label 174C identifies the L1 vertebra adjacent to the L2 vertebra. GUI 150C can be configured so that a user can operate GUI 150C to navigate between various vertebrae such as the L3 vertebra, the L2 vertebra, and the L1 vertebra. The navigation computer 140 can be configured to display the L3 vertebra at the center of GUI 150C when the label corresponding to L3 is selected. Alternatively, a medical practitioner can select the second label 174B, and the navigation computer 140 can identify the L2 vertebra adjacent to the second label 174B as the primary anatomical structure and be configured to position the L2 vertebra and the second label 174B at the center of GUI 150C. Although only three labels are shown in FIG. 6, GUI 150C can be configured to include any number of labels 174.

[0079] When the medical staff selects the apply (propagate) button 197, the navigation computer 140 can be configured to apply (propagate) the warning zone editing to all vertebrae associated with the level label 174 set to the first lighting state. Therefore, the medical staff can exclude a certain vertebra from the application of the warning zone editing made for a specific vertebra by releasing the level label 174 before selecting the apply button 197. In FIG. 11, all the level labels 174 are selected, and thus the navigation computer 140 expands and sets the warning zone editing made for the L3 vertebra to the L1 vertebra and the L2 vertebra. However, for example, if the medical staff releases the level label 174C associated with the L1 vertebra, the navigation computer applies the warning zone editing only to the L2 vertebra.

[0080] Referring to the GUI150C, the lumbar region 153 after segmentation has been performed on the L3 vertebra displayed by the GUI150C is shown, and various virtual boundaries (1, 8, 9) defining the segmentation of the L3 vertebra are included. If the medical staff is not satisfied with this segmentation, the medical staff can select the segmentation manual editing button 167, as disclosed by U.S. Patent Publication No. 2021 / 0192743 (A1) which has already been incorporated by reference as a whole, and then change the position of one or more of the virtual boundaries to the desired position, or select the segmentation automatic editing button 177, and then select the region of the L3 vertebra for improved segmentation by a second segmentation algorithm.

[0081] By operating the slide bars 169A, 169B, a medical practitioner can navigate the selected lumbar region 153 so as to move the focus of the GUI150C within the selected lumbar region 153. After the medical practitioner has confirmed a segmented vertebra such as the segmented L3, the medical practitioner can choose to select the segmentation acceptance button 165 and send a signal to the navigation computer 140 that the medical practitioner is satisfied with the segmentation of the L3 vertebra, and then can confirm the other remaining segmented vertebrae within the lumbar region 153 for accuracy.

[0082] Referring to FIG. 7, an exemplary configuration of the GUI150F of the surgical navigation system 100 called the notification interface 151 is shown. The GUI150F can include a plurality of buttons 156, 162, 164, 169 configured to receive input by a medical practitioner to control or modify or adjust various settings for providing warnings during the execution of a medical procedure, as discussed in more detail below.

[0083] The notification interface 151 can include tool selection buttons 152A, 152B. The tool selection buttons 152A, 152B can enable a medical practitioner to select the surgical instrument assemblies 200, 300, 400 from a pre-set list of surgical instruments, or can enable the medical practitioner to input specific surgical instrument assemblies 200, 300, 400 to be used during a surgical procedure. For example, the tool selection buttons 152A, 152B can enable a medical practitioner to select a second surgical instrument 320 including a high-speed cutting tool. Thereby, a specific surgical instrument 320 is identified to the navigation computer 140, and the navigation computer 140 can add various virtual boundaries and / or warning zones to be used for the identified instrument to the list. The tool selection buttons 152A, 152B can also be configured to enable a medical practitioner to select one or more end effectors 240, 340, 440 that can be coupled to the surgical instrument assemblies 200, 300, 400, as well as the surgical instruments 220, 320, 420. For example, a medical practitioner can select a first surgical instrument 220 and further select one or more of the end effectors 240A, 240B, 240C to be used during the procedure, enabling the navigation system to add various virtual boundaries and / or warning zones for each of the various end effectors 240A, 240B, 240C to the list.

[0084] The notification interface 151 can also include one or more warning buttons 156A, 156B, 156C, 156D that are used to operate (adjust) the various warnings described above. The first warning button 156A can be configured to enable a medical practitioner to activate or deactivate a warning related to the rotational speed of the end effectors 240, 340, 440. For example, as described above, the navigation computer 140 and / or the instrument processors 215, 315, 415 can be configured to adjust the rotational speed (RPM) of the end effectors 240, 340, 440 based on the position of the end effectors 240, 340, 440 relative to at least one of the virtual boundaries and / or at least one of the warning zones. The second warning button 156B can be configured to enable a medical practitioner to activate or deactivate a tactile warning. For example, a medical practitioner can operate the second warning button 156B to activate one of the tactile warnings described above. This can include the navigation computer 140 being configured to send a signal to the surgical instrument assemblies 200, 300, 400 to activate the warning devices 255, 355, 455 configured to provide a tactile warning to the medical practitioner based on the position of the end effectors 240, 340, 440 relative to at least one of the virtual boundaries and / or at least one of the warning zones.

[0085] The third warning button 156C can be configured to enable a medical practitioner to activate or deactivate a visual warning. For example, the medical practitioner can operate the third warning button 156C to activate one of the visual warnings. This can include the navigation computer 140 being configured to send a signal to the surgical instrument assemblies 200, 300, 400 to activate warning devices 255, 355, 455 configured to provide a visual warning to the medical practitioner based on the position of the end effectors 240, 340, 440 relative to at least one of the virtual boundaries and / or at least one of the warning zones. The fourth warning button 156D can be configured to enable a medical practitioner to activate or deactivate one of the audible warnings described above. For example, the medical practitioner can operate the fourth warning button 156D to activate the audible warning, and the navigation computer 140 can send a signal to the surgical instrument assemblies 200, 300, 400 to activate warning devices 255, 355, 455 configured to provide an audible warning to the medical practitioner based on the position of the end effectors 240, 340, 440 relative to at least one of the virtual boundaries and / or at least one of the warning zones.

[0086] The notification interface 151 of the GUI 150D can also include one or more warning graphics 158A, 158B. The warning graphics 158A, 158B can be specific to a particular surgical instrument and / or end effector and can be configured to provide a schematic and / or visual representation of the locations of various virtual boundaries and / or warning zones, which will be described in more detail below. The first warning graphic 158A can include a visual representation of the surgical area and any implant or device inserted during a medical procedure to assist a healthcare provider in identifying the location of the procedure and setting various warnings. For example, as shown in FIG. 7, the first warning graphic includes a diagram of a vertebral body, with the outline of the area where the procedure is to be performed drawn in dotted lines. The first warning graphic 158A can also include a diagram of a pedicle screw inserted during the procedure.

[0087] The second warning graphic 158B can be configured to provide a visual representation of an implant or device inserted during a procedure, along with markers indicating various virtual boundaries (boundaries 5, 6, 7) for the implant or device, to assist a healthcare provider in adjusting or modifying the locations where warnings assigned to each of the various virtual boundaries and / or warning zones should be activated. For example, as shown in FIG. 7, the second warning graphic 158B includes a visual representation of a pedicle screw being inserted and markers along the pedicle screw indicating the locations of various virtual boundaries (boundaries 5, 6, 7) for the pedicle screw that activate various warnings during the procedure.

[0088] The notification interface 151 of the GUI 150D can also include warning zones or virtual boundary setting interfaces 160A, 160B. The warning zone or boundary setting interfaces 160A, 160B can include one or more prompts or buttons 162A, 162B, 162C, 162D, 162E for setting and / or adjusting when the virtual boundary activates one or more of the various warnings described above. The first warning zone or boundary setting interface 160A can include a first set of buttons 162A configured to identify the implant and / or device inserted during the procedure. Thereby, the surgical navigation system 100 can determine which and how many virtual boundaries and / or warning zones to provide. For example, when a medical practitioner operates the lamina button of the first set of buttons 162A indicating that a laminectomy is to be performed, the surgical navigation system 100 knows that this involves resection of various parts of one or more vertebrae, and the surgical navigation system 100 identifies and provides various warning zones around the important structures of the target vertebrae to assist the medical practitioner in performing the procedure. When a medical practitioner operates the pedicle button of the first set of buttons 162A indicating that a pedicle screw procedure is to be performed, the surgical navigation system 100 identifies and provides the various virtual boundaries required to assist the medical practitioner in perforating, tapping, and placing the pedicle screw.

[0089] The second button 162B of the warning zone or virtual boundary setting interface 160A can correspond to the depth button. The depth button can be configured to enable a medical practitioner to select the depth of the warning zone for an excision procedure such as a laminectomy. For example, as shown in FIG. 7, the first warning zone or virtual boundary setting interface 160A indicates that the medical practitioner is setting a warning for a laminectomy based on the operation of the first button 162A. Based on this selection by the medical practitioner, the second button 162B provides an operable button configured to enable the medical practitioner to select the depth of the warning zone utilized by the surgical navigation system 100 to activate one or more of the various warnings.

[0090] The second warning zone or virtual boundary setting interface 160B of the notification interface 151 can include additional buttons 162C, 162D, 162E related to the configuration of various virtual boundaries and / or warning zones for implants such as screws, and can activate warnings related to the implant during a medical procedure. For example, the second warning zone or virtual boundary setting interface 160B can be configured to provide buttons 162C, 162D, 162E for manipulating the setting of warnings for a procedure of inserting a pedicle screw.

[0091] The third button 162C of the second warning zone or virtual boundary setting interface 160B can be configured to set the distance or depth to a reference location for positioning a virtual boundary such as boundary 5 along a target trajectory. For example, as shown in FIG. 7, the third button 162C includes a toggle to enable a medical practitioner to set the depth before a warning for inserting the first end effector (i.e., the drill) is activated. In this example, the medical practitioner has set the third button 162C to 30 mm, which indicates that when the first end effector reaches a depth of 30 mm, the surgical navigation system 100 activates a warning for the first end effector.

[0092] The second warning zone or virtual boundary setting interface 160B can include additional buttons 162D, 162E for operating and / or adjusting when warnings for a second end effector (i.e., a tap) and / or a third end effector (i.e., a driver) for inserting a screw should be activated. As described above, the surgical navigation system 100 can be configured such that the fourth and fifth buttons 162D, 162E for adjusting the warnings of the second and third end effectors can adjust the location of the virtual boundary for activating the warning based on the virtual boundary for activating the warning for the first end effector. For example, as indicated by the fourth button 162D, the virtual boundary for activating the warning for the second end effector (i.e., a tap) is moved 0 millimeters (0 mm) relative to the virtual boundary for activating the warning for the first end effector. However, if necessary, the fourth button 162D can be operated to move the virtual boundary for activating the warning for the second end effector. Similarly, the fifth button 162E can be operated to modify or adjust the virtual boundary for activating the warning for the third end effector.

[0093] The notification interface 151 of the graphical user interface (GUI) 150D can also include warning test buttons 164A, 164B. The warning test buttons 164A, 164B can be configured to test and / or verify that the selected warnings are active and functioning properly. For example, during operation, after a healthcare provider has selected or entered all of the various pieces of information related to a medical procedure into the notification interface 151, the healthcare provider can select the warning test buttons 164A, 164B to verify that the selected warnings are active. For example, if a healthcare provider selects to activate a first warning button 156A that targets a motor speed warning, the healthcare provider can activate the surgical instruments 220, 320, 420 and press the warning test buttons 164A, 164B. By pressing the warning test buttons 164A, 164B, the navigation system is instructed to send a test signal to the instrument processors 215, 315, 415 to activate the warning associated with the first warning button 156A, such as to reduce the speed of the motor and, by extension, the rotational speed of the end effectors 240, 340, 440. When the user selects the warning test buttons 164A, 164B, each of the various warnings that have been activated based on the operation of the warning buttons 156A, 156B, 156C, 156D should be triggered. If there are any active warnings that were not triggered when the warning test buttons 164A, 164B were selected, they are further evaluated by the healthcare provider to verify that they are actually functioning properly before the medical procedure is started.

[0094] Referring to FIG. 8, after the medical staff is satisfied with the segmentation of the lumbar region 153 and enters various preferences into the notification interface 151, the medical staff can proceed to the implant planning step. An exemplary GUI 150E for facilitating implant planning is shown in FIG. 7. The GUI 150E can be configured to display a visual representation of the surgical plan including the planned postures of the implants 275A, 275B within the image coordinate system (i.e., the first coordinate system). The medical staff can input the planned postures of the implants 275A, 275B, or in some cases such as when the medical staff selects the implant proposal button 190, the surgical navigation system 100 can propose the planned postures for the implants 275A, 275B obtained from the vertebral model 145. The GUI 150E can also include a preference adjustment button 191 that allows the medical staff to select to apply the preference history of corrections in previous similar procedures, and an application button 197 that allows the medical staff to select to apply the corrections made to a specific vertebra such as the L3 vertebra to another vertebra, as will be discussed in more detail below.

[0095] As shown, the implants 275A, 275B can define the target axes Axis-T1, Axis-T2. The surgical navigation system 100 can provide virtual boundaries (boundaries 5, 6, 7) representing the target depths for each of the various end effectors 240A, 240B, 240C used during the execution of the procedure along the target axes Axis-T1, Axis-T2. As shown in FIG. 8, a fifth boundary (boundaries 5A, 5B) is shown along the target axes Axis-T1, Axis-T2 for each of the implants 275A, 275B. The navigation computer 140 can be configured to define the fifth boundary (boundaries 5A, 5B) based on the target depth set for the tip of the first end effector 240A, such as a drill for making a hole for placing the screws 275A, 275B, and the vertebral model 145.

[0096] The surgical navigation system 100 can be further configured to define a sixth virtual boundary (boundaries 6A, 6B) based on a target depth for a second end effector 240C, such as a tap for cutting threads in a hole. It is contemplated that the surgical navigation system 100 can define a sixth virtual boundary (boundaries 6A, 6B) relative to a fifth virtual boundary (boundaries 5A, 5B) based at least in part on the selected implants 275A, 275B, their orientation, and the vertebral model 145. For example, the surgical navigation system 100 can define a fifth virtual boundary (boundaries 5A, 5B) along target axes Axis-T1, Axis-T2 in a first coordinate system. Then, based on the selected implants 275A, 275B, the surgical navigation system 100 can be configured to define a sixth virtual boundary (boundaries 6A, 6B) at a distance from the fifth virtual boundary (boundaries 5A, 5B) based on the selected implants 275A, 275B. The navigation computer 140 can be further configured to define a seventh virtual boundary (boundaries 7A, 7B) based on a target depth for a third end effector 240C, such as a driver for placing screws 275A, 275B into a hole.

[0097] The surgical navigation system 100 is contemplated to be able to at least partially define a seventh virtual boundary (boundaries 7A, 7B) with respect to a fifth virtual boundary (boundaries 5A, 5B) based on the selected implants 275A, 275B, their orientation, and the vertebral model 145. For example, the surgical navigation system 100 can define a fifth virtual boundary (boundaries 5A, 5B) along the target axes Axis-T1, Axis-T2 in the patient's first coordinate system. Then, based on the selected implants 275A, 275B, the navigation system can be configured to define a seventh virtual boundary (boundaries 7A, 7B) at a distance from the fifth virtual boundary (boundaries 5A, 5B) based on the selected implants 275A, 275B. For example, the navigation computer 140 can be configured such that based on the depth of the fifth virtual boundary (boundaries 5A, 5B), the known lengths of the selected implants 275A, 275B, and the vertebral model 145, the navigation computer 140 can determine that the seventh virtual boundary (boundaries 7A, 7B) should be spaced 30 millimeters (30 mm) from the fifth virtual boundary (boundaries 5A, 5B) along the target axes Axis-T1, Axis-T2.

[0098] Only the fifth virtual boundary (boundaries 5A, 5B), the sixth virtual boundary (boundaries 6A, 6B), and the seventh virtual boundary (boundaries 7A, 7B) are shown in FIG. 8, but additional virtual boundaries are contemplated. The navigation computer 140 can be configured to define and assign virtual boundaries for each of the end effectors 240A, 240B, 240C. The location of these virtual boundaries and / or the conditions under which these virtual boundaries are configured to trigger one of the various warnings described above can be controlled and / or adjusted according to the desires of the medical personnel.

[0099] The GUI 150D of FIG. 8 can also include a planning interface 166A that is operable by a healthcare provider to modify or adapt the placement of the implants 275A, 275B. For example, the planning interface 166A can include one or more diameter buttons 168A that are operable by a healthcare provider to modify the planned diameter of the screw. The planning interface 166A can also include one or more length buttons 168B that are operable by a healthcare provider to modify the length of the planned screws 275A, 275B. The planning interface 166A can also enable a healthcare provider to change the position of the planned screws 275A, 275B by changing the posture (i.e., position and / or orientation) of the screws with respect to the L3 vertebra. The GUI 150D can also display various virtual buttons 186, 188 proximate to Axis-T1, along with the planning interface 166A, to facilitate adjustment of the posture of the implants 275A, 275B.

[0100] Referring further to FIG. 9, the planned interface 166A of the GUI 150D of FIG. 8 can also include a warning button 170. The GUI 150D can be configured such that selection of the warning button 170 by a healthcare provider can open the boundary setting interface 160C, and thus the healthcare provider can activate, modify, and / or deactivate one or more of the various warnings described above, similar to the virtual boundary setting interface 160B described with respect to FIG. 7. The virtual boundary setting interface 160C can include additional buttons and / or prompts that can be operable by a healthcare provider to modify or adjust virtual boundaries and / or warning zones configured to activate one or more of the warnings. The warning indicator 172 can be positioned proximate to one or more specific virtual boundaries such as the virtual boundaries (5, 6, 7), and can be configured to identify for the healthcare provider whether a warning assigned to one of the specific virtual boundaries (5, 6, 7) is in an active state, an inactive state, and / or a snooze state. For example, among the warning indicators 172, 172A shown proximate to boundary 6B and having a bell with a strike-through indicates that the nearest virtual boundary is in an inactive state. A bell warning indicator 172 without a strike-through, such as 172A, indicates that the warning for the nearest virtual boundary is in an active state. Although not specifically shown, a bell warning indicator 172 with a dashed strike-through can indicate that the warning indicator is in a snooze state. The warning indicator 172 can also be made selectable and / or operable by a healthcare provider to make the warning assigned to a specific virtual boundary (5, 6, 7) active or inactive.

[0101] The GUI 150E shows a virtual boundary setting interface 160C for the implants 275A, 275B that can be visually recognized by medical staff when the warning button 170 is selected. For example, when the user selects the warning button 170 of the planning interface 166A from the GUI 150E in FIG. 8, the GUI 150E can open the virtual boundary setting interface 160C so that it can be visually recognized on the navigation display 120. The virtual boundary setting interface 160C can include warning buttons 156D configured to allow medical staff to activate or deactivate various warnings. The virtual boundary setting interface 160C can also include three virtual boundary operation buttons 162C, 162D, 162E for each of the various end effectors 240A, 240B, 240C, respectively.

[0102] As described above, a medical staff member can select one of the buttons 162C, 162D, 162E to activate a warning for each of the various end effectors 240A, 240B, 240C. In other words, when a medical staff member provides an input to one of the buttons 162C, 162D, 162E, based on that input, the corresponding virtual boundaries (5, 6, 7) are moved. Based on the values input by the medical staff member using the buttons 162C, 162D, 162E, various locations of the virtual boundaries are updated within the scope of the surgical plan used to navigate the system so as to activate a warning based on the positions of the various end effectors 240A, 240B, 240C with respect to one or more virtual boundaries during the procedure.

[0103] When the navigation computer 140 proposes an orientation for implants 275A, 275B, since the navigation computer 140 is only proposing based on the vertebral model 145, medical personnel may need to correct or improve the orientation. Thus, medical personnel can operate one or more buttons 186, 188 positioned proximal to the target Axis-T1 or target Axis-T2 to change the position of implants 275A, 275B. As shown in FIG. 9, medical personnel are adjusting the orientation of implant 275A, and thus the implant is being moved away from the outer wall of the pedicle of the L3 vertebra and toward the outer virtual boundary into the vertebral foramen.

[0104] After medical personnel are satisfied with the desired positioning of implants 275A, 275B, medical personnel may desire to apply the corrections made to implants 275A, 275B in the L3 vertebra to other vertebrae within the lumbar region 153. Medical personnel can select the application button 197 such that the navigation computer 140 applies those corrections to the remaining vertebrae within the lumbar region 153. In other words, the navigation computer 140 can update the proposed orientations of the implants for the L1 and L2 vertebrae based on the revised orientations of implants 275A, 275B in the L3 vertebra.

[0105] The navigation computer 140 can disable the navigation function discussed above with respect to label 174 when medical personnel select the application button 197. The navigation computer 140 can be configured to prompt medical personnel to select one or more labels 174 associated with one or more desired vertebrae from the lumbar region 153 in order to apply (apply) the revised orientation for implants 275A, 275B when medical personnel select the application button 197. In this way, the navigation computer 140 can exclude specific vertebrae of the lumbar region 153 from the application of implant corrections.

[0106] By selecting the L3 vertebra approval button 194, a healthcare provider can choose to defer the application of corrections to the remaining vertebrae and thereby proceed to the implant plan for the remaining vertebrae in the lumbar region 153. When the healthcare provider selects the L3 vertebra approval button without it, the default position for the planned implant corresponds to the mapped posture for those implants based on the vertebra model 145.

[0107] The navigation computer 140 can include an implant correction database that stores implant correction data and related patient data. The implant correction data can include spatial information such as one or more transformations that describe how the implant was corrected relative to the posture for the initially proposed implants 275A, 275B, or spatial information that describes how the implant was corrected relative to the model implants 275A, 275B. The implant correction data can also include implant parameters such as screw diameter, screw length, warning zones, and preference for virtual boundaries (e.g., the distance between virtual boundaries 5, 6, and 7).

[0108] The navigation computer 140 can access the implant correction database and update the postures of the implants 275A-M and 275B-M of the vertebral model 145, or can propose implant postures for future patients while taking into account previous corrections to the implant postures and the preferences of medical personnel. For example, the navigation computer 140 can be configured to determine one or more transformations between the initial posture of the implant 275A with respect to the first coordinate system and the revised posture of the implant 275A. The navigation computer 140 can be configured to store the transformation data in an implant correction database that includes transformation data of other patients previously operated on by the medical personnel. Based on the transformation data stored in the implant correction database, the navigation computer 140 can periodically (for example, when a new patient case entered into the implant correction database reaches a threshold) retrieve the transformation data for the patient from the implant correction database. The navigation computer 140 can determine the average transformation of all the transformation data stored in the implant correction database based on the retrieved transformation data. The navigation computer 140 can update the model postures of the implants 275A-M and 275B-M to reflect the average transformation data or other statistical analysis parameters. For example, when the number of patients reaches a threshold (for example, 100 patients) and the average transformation data indicates that medical personnel prefer a larger gap between the implant and the vertebral foramen, the navigation computer 140 can update the postures of the model implants 275A-M and 275A-B to reflect the preferences of the medical personnel. The navigation computer can optionally edit the proposed implants such as 275A and 275B based on the implant correction database.In another example, if the data stored in the implant correction database indicates a clear trend that smaller diameter screws are preferred, the navigation computer 140 can update the model implants 275A-M, 275B-M to reflect the preferences of the medical staff. The medical staff can select the preference adjustment button 191 to update the L3 vertebra based on the preferences of the medical staff determined based on the implant correction database as described above.

[0109] The navigation computer 140 can include a machine learning module, and the machine learning module can be configured to implement a machine learning algorithm for training a machine learning model based on the implant correction database so as to provide proposed postures of the implants 275A, 275B. For example, the machine learning module can train the machine learning model based on corrections, preferences, or settings selected by the medical staff during previous surgical procedures and the patient outcomes. The machine learning module can train the machine learning model according to one of the algorithms described in U.S. Patent Publication No. 2021 / 0378752(A1), the content of which is hereby incorporated by reference in its entirety. The navigation computer 140 can be configured to process the image data and other relevant patient data for each vertebra in the lumbar region 153 by the machine learning model to provide the proposed postures for the implants 275A, 275B.

[0110] Referring to FIG. 10, an exemplary GUI 150F having a plurality of views of the L3 vertebra is shown, with selected virtual boundaries (1, 2, 8, and 9) and warning zone 1 shown. For simplicity of the figure, virtual boundaries (3 - 6, 7, and 10 - 12) and warning zones (zones 2 - 6) are omitted. However, it will be understood that the teachings of the present disclosure applicable to zone 1 are applicable to any of the other zones such as zones (2 - 6) and virtual boundaries (boundaries 3 - 6, 7, and 10 - 12). The plurality of views shown in the GUI 150 of the L3 vertebra include a sagittal view, an axial view, and a planar view, which will be described in more detail below.

[0111] The GUI 150E can include a planning interface 166B that includes one or more buttons, such as warning button 156D, configured to place one or more of the various warnings in an active and / or non - active state. The planning interface 166B can also include planning buttons 168C configured to enable a healthcare provider to manipulate the various virtual boundaries (1, 2, 8, 9) to adjust the various warnings, such as warning zone 1, and to activate one or more of the various warnings. For example, the planning buttons 168C of the planning interface 166B can be configured to receive user input to adjust the distance between one or more of the virtual boundaries (1, 2) that define at least a portion of warning zone 1, thereby increasing or decreasing the depth of one or more of the various warning zones, such as zone 1.

[0112] The planning button 168C includes a pair of virtual touch buttons for a healthcare provider to increase or decrease the depth of one or more of various warning zones such as zone 1. The virtual boundaries (1, 2, 8, 9) can be provided as selectable objects that a healthcare provider can manipulate when desired. For example, a healthcare provider can provide an input (via a touch screen or user input device) to the GUI 150F and manually manipulate the virtual boundaries (1, 2) to move one or more of the virtual boundaries (1, 2), thereby adjusting the size (e.g., depth) of various warning zones such as zone 1. For example, a healthcare provider can move virtual boundary 2 away from virtual boundary 1 to expand zone 1, or move virtual boundary 2 inward toward virtual boundary 1 to be adjacent to zone 1. In another example, a healthcare provider can adjust a portion of virtual boundary 1 or virtual boundary 2 to exclude or include a particular anatomical feature.

[0113] The GUI 150F can also include a warning indicator 172 positioned within the display of the L3 vertebrae relative to various virtual boundaries (1, 2, 8, 9) and / or zone 1. Similar to what was described with respect to FIGS. 8 and 9, the warning indicator 172 can be positioned proximate to specific virtual boundaries such as the virtual boundaries (1, 2, 8, 9) and / or various warning zones such as zone 1, and configured for a medical practitioner to identify whether a warning assigned to one of the specific virtual boundaries (1, 2, 8, 9) and / or zone 1 proximate to the warning button is in an active, inactive, and / or snooze state. For example, a warning indicator showing a bell with a strike-through line such as 172A shown proximate to the virtual boundaries (boundaries 8, 9) indicates that the nearest virtual boundary is in an inactive state. A warning indicator without a strike-through line on the bell such as 172B indicates that the warning for the nearest virtual boundary is in an active state. Although not specifically shown, a warning indicator 172 with a dashed strike-through line on the bell can indicate that the warning indicator is in a snooze state. The warning indicator 172 can also be made selectable and / or operable by a medical practitioner to activate or deactivate a warning assigned to a specific virtual boundary such as the virtual boundaries (boundaries 1, 2, 8, 9) and / or zone 1.

[0114] Referring to FIG. 11, in the GUI 150F, the locations of the virtual boundaries (boundaries 1, 2) after the user inputs to the plan button 168C to adjust the depth from 2 mm to 3 mm as shown in FIG. 10 are shown in a revised posture. The virtual boundaries (boundaries 7, 8) remain unchanged from FIG. 10 to FIG. 11. Additionally, the medical practitioner has selected a warning button 156D configured to activate various warnings such as 172B.

[0115] After the medical staff is satisfied with the appearance of Zone 1 and / or the virtual boundaries (Boundaries 1, 2, 8, 9), the medical staff can click on the warning zone application virtual button on the GUI150F shown in FIG. 11. By clicking on the warning zone application virtual button, the surgical navigation system 100 can apply various virtual warning zones applied to the L3 vertebra to the remaining vertebrae of the lumbar region 153.

[0116] Similar to what was discussed regarding the application of implant correction, the navigation computer 140 can disable the navigation function discussed above with respect to the label 174 when the medical staff selects the application button 197 of the GUI150F. The navigation computer 140 can be configured to prompt the medical staff to select one or more labels 174 associated with one or more desired vertebrae from the lumbar region 153 in order to apply Zone 1 when the medical staff selects the application button 197. In this way, the navigation computer 140 can exclude specific vertebrae of the lumbar region 153 from the application of implant correction.

[0117] The medical staff can choose to defer the application of the warning zone correction to the remaining vertebrae by selecting the L3 vertebra approval button 194, thereby proceeding to the warning zone plan for the remaining vertebrae of the lumbar region 153. When the medical staff selects the L3 vertebra approval button, the default posture for the warning zone corresponds to the mapped posture for those warning zones based on the vertebra model 145.

[0118] The navigation computer 140 can include a warning zone correction database that stores warning zone and virtual boundary correction data (hereinafter collectively referred to as warning zone correction data) and related patient data. The warning zone correction data can include spatial information such as one or more transformations that describe how the warning zone and / or virtual boundary have been corrected relative to the initially proposed orientation for the warning zone and / or virtual boundary, or spatial information that describes how the warning zone and / or virtual boundary have been corrected relative to the model warning zone and / or model virtual boundary. The warning zone correction data can also include warning preferences and depth preferences for each warning zone.

[0119] The navigation computer 140 can access the warning zone correction database and update the orientation of the model warning zone and / or virtual boundary of the vertebral model, or propose warning zones and / or virtual boundaries for future patients while taking into account previous corrections made by medical personnel. For example, the navigation computer 140 can be configured to determine one or more transformations between the initially mapped warning zone and / or virtual boundary for the L3 vertebra in a first coordinate system and the revised orientation of the mapped warning zone and / or virtual boundary of the L3 vertebra. In another example, the navigation computer 140 can store depth adjustments made to each warning zone, such as when a medical professional changes the depth setting (e.g., from 2 mm as shown in FIG. 10) to another depth setting (e.g., a depth of 3 mm as shown in FIG. 11). The navigation computer 140 can be configured to store the transformation data in a warning zone correction database that includes warning zone transformation data for other patients previously operated on by that medical professional.

[0120] Based on the warning zone correction data stored in the warning zone correction database, the navigation computer 140 can periodically retrieve the warning zone correction data for a patient from the warning zone correction database, such as when a new patient case entered into the warning zone correction database reaches a threshold. The navigation computer 140 can determine the average warning zone conversion for all the warning zone conversion data stored in the warning zone correction database based on the retrieved warning zone correction data. For example, the navigation computer 140 determines the average warning zone conversion for warning zones (zones 1 to 6). The navigation computer 140 can update the vertebral model 145 to reflect the average zone conversion. For example, when the number of patients reaches a threshold (e.g., 100 patients) and the average conversion data indicates that medical staff prefer a greater depth for zone 1 (i.e., a greater distance between virtual boundary 1 and virtual boundary 2), the navigation computer 140 can update the posture of the model warning zone 1 of the vertebral model to reflect the preference of the medical staff for the greater depth.

[0121] The navigation computer 140 can optionally edit the proposed warning zone and / or virtual boundary based on the warning zone correction database. For example, after the navigation computer maps the model warning zone to the L3 vertebra as shown in FIG. 10, the medical staff can select the preference adjustment button 191 to update the L3 vertebra based on the preference from the medical staff determined based on the warning zone correction database.

[0122] The machine learning module can be configured to train a machine learning model based on warning zone correction databases to provide proposed warning zones. For example, the machine learning module can train a machine learning model based on warning zones and / or virtual boundary corrections, warning settings, and depth preferences during previous surgical procedures, as well as patient outcomes. The navigation computer 140 can process image data and other relevant patient data for each vertebra within the lumbar region 153 by the machine learning model and be configured to provide a proposed warning zone based on the preference history.

[0123] With reference to FIGS. 12-19, a flowchart illustrating a method according to the teachings of the present disclosure will be described. As will be appreciated from the following subsequent description, these methods represent only exemplary and non-limiting flowcharts illustrating particular ways of implementing the teachings of the present disclosure. This method can be implemented by the surgical navigation system 100 described above. This method is in no way intended to represent a complete or comprehensive way of implementing the various teachings discussed above.

[0124] Referring to FIG. 12, method 1200 will be described. At 1204, method 1200 retrieves a three-dimensional vertebral model in a first coordinate system, the three-dimensional vertebral model including (i) a plurality of model features localized in the first coordinate system, and (ii) the orientation of a model zone with respect to important structures for a surgical instrument in the first coordinate system. At 1208, method 1200 retrieves a three-dimensional medical image in a second coordinate system, the three-dimensional image representing a first vertebra and a second vertebra. At 1212, method 1200 maps a vertebral model including a model zone to the first vertebra based on the plurality of model features localized in the first coordinate system, thereby generating a zone for the first vertebra. For example, without limitation, the methods described in U.S. Patent Publication No. 2009 / 0089034 (A1), and U.S. Provisional Patent Application No. 63 / 505,466, filed on June 1, 2023 and published as PCT Patent Publication No. ____________, each of which is incorporated herein by reference in its entirety, can be used to map a vertebral model including a model zone to a vertebra. At 1216, method 1200 receives an input from a healthcare provider, the input indicating a revised orientation of a zone of the first vertebra in the second coordinate system. At 1220, method 1200 generates a zone for the second vertebra based on the revised orientation of the first vertebra.

[0125] In some implementations, the three-dimensional vertebral model can include the orientations of a plurality of model zones, each model zone having a different orientation in the coordinate system of the vertebral model. Assuming three-dimensional images of multiple patient vertebrae, each model zone can be mapped to one of the patient vertebrae based on a plurality of model features localized in the coordinate system of the model, thereby generating a zone for one vertebra in the coordinate system of the vertebra for each of the model zones, each zone having a different orientation. Then, in response to receiving an input indicating a revised orientation of any of the zones for one vertebra in the coordinate system of that one vertebra, a zone for a different one of the patient vertebrae can be generated based on the revised orientation of the zone for the previous vertebra.

[0126] Referring to FIG. 13, method 1300 will be described. At 1304, method 1300 extracts a three-dimensional vertebral model in a first coordinate system. The three-dimensional vertebral model includes a plurality of model features localized in the first coordinate system and the posture of a model zone with respect to a surgical instrument in the first coordinate system. At 1308, method 1300 extracts a three-dimensional medical image having a first vertebra and a second vertebra in a second coordinate system. At 1312, method 1300 maps the vertebral model including the model zone to the first vertebra to generate a zone for the first vertebra and a zone for the second vertebra. At 1316, method 1300 receives an input from a healthcare provider, the input indicating a revised posture with respect to the model zone of the three-dimensional vertebral model in the first coordinate system. At 1320, method 1300 applies the revised posture with respect to the model zone to at least one of the zone for the first vertebra and the zone for the second vertebra.

[0127] Referring to FIG. 14, method 1400 will be described. At 1404, method 1400 retrieves a three-dimensional medical image having at least one vertebra in a first coordinate system. At 1408, method 900 receives a three-dimensional vertebra model in a second coordinate system. The three-dimensional vertebra model includes the pose of a model zone with respect to a surgical instrument in the second coordinate system. At 1412, method 900 maps a vertebra model including the model zone to the first vertebra based on a plurality of model features localized in the second coordinate system, thereby generating a zone for the first vertebra. At 1416, method 900 receives input from a medical practitioner regarding a revised pose of the zone for at least one vertebra. At 1420, method 900 determines one or more transformations based on the pose of the model zone of the three-dimensional vertebra model and the revised pose of the zone for at least one vertebra in the first coordinate system. At 1424, method 1400 stores one or more transformations in a database including transformation data for a plurality of patients based on the pose of the model zone of the three-dimensional vertebra model in the first coordinate system and the revised pose of the zone for at least one vertebra in the first coordinate system. At 1428, method 1400 determines correction data based on the transformation data for a plurality of patients. At 1432, method 1400 retrieves a three-dimensional medical image having at least one vertebra of a second patient in a third coordinate system. At 1436, method 1400 maps a three-dimensional vertebra model including the model zone to the second vertebra based on a plurality of model features localized in the third coordinate system and the correction data, thereby generating a zone for the second vertebra.

[0128] Referring to FIG. 15, method 1500 will be described. At 1504, method 1500 receives a three-dimensional medical image having at least one vertebra in a first coordinate system. At 1508, method 1500 receives a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the pose of a model zone relative to a surgical instrument in the second coordinate system. At 1512, method 1500 maps the vertebra model including the model zone to the first vertebra based on a plurality of model features localized in the second coordinate system, thereby generating a zone for the first vertebra. At 1516, method 1500 receives input from a medical practitioner regarding a revised pose of the zone for at least one vertebra. At 1520, method 1500 determines one or more transformations based on the pose of the model zone of the three-dimensional vertebra model and the revised pose of the zone for at least one vertebra in the first coordinate system. At 1524, method 1500 stores one or more transformations in a database including transformation data for a plurality of patients based on the pose of the model zone of the three-dimensional vertebra model in the first coordinate system and the revised pose of the zone for at least one vertebra in the first coordinate system. At 1528, method 1500 determines correction data based on the transformation data for the plurality of patients. At 1532, method 1500 selectively adjusts the pose of the model zone of the three-dimensional vertebra model based on the correction data and then uses this to generate and / or adjust a zone for a patient vertebra at a later time. For example, in response to receiving a further three-dimensional image of at least one vertebra in a third coordinate system, such as that of another patient, a three-dimensional vertebra model including the adjusted pose of the model zone can be mapped to the at least one vertebra in the third coordinate system, thereby generating a zone for the at least one vertebra of the further three-dimensional image.

[0129] Optionally, selectively adjusting the posture of the model zone of the three-dimensional vertebral model can be performed based on the number of a plurality of patients from whom correction data has been obtained. More specifically, this number can be compared with a predetermined threshold, and the posture of the model zone of the three-dimensional vertebral model can be adjusted based on the correction data, which is executed in response to the number of a plurality of patients exceeding the threshold.

[0130] Optionally, the three-dimensional vertebral model can include the posture of each of a plurality of model zones for monitoring the position of a surgical instrument during a surgical procedure. Generally, given a three-dimensional image of at least one vertebra of a patient, the posture of the plurality of model zones of the three-dimensional vertebral model can be defined to generate zones in which the posture of each model zone mapped to at least one vertebra has different coordinates in the coordinate system of at least one vertebra of the patient. Further, the posture of each model zone of the three-dimensional vertebral model can be selectively adjusted individually in response to receiving an input indicating a revised posture of the zone relative to at least one vertebra of the patient corresponding to that model zone. In other words, as described above, in response to an input indicating a revised posture of the zone generated for at least one patient vertebra corresponding to any one of the model zones, one or more conversions based on the posture of that model zone in the coordinate system of the three-dimensional vertebral model and the revised posture of the zone in the coordinate system of the three-dimensional image of the patient can be determined and stored in a database. Then, correction data based on the conversion data for a plurality of patients corresponding to that particular model zone can be determined and used to selectively adjust the posture of that model zone of the three-dimensional vertebral model.

[0131] Referring to FIG. 16, method 1600 will be described. At 1604, method 1600 retrieves a three-dimensional medical image having at least one vertebra in a first coordinate system. At 1608, method 1600 retrieves a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the pose of a model zone with respect to a surgical instrument in the second coordinate system. At 1610, method 1600 maps an initial pose of a zone with respect to at least one vertebra of the three-dimensional medical image based on the pose of the model zone of the three-dimensional vertebra model. At 1612, method 1600 receives input from a healthcare provider regarding a revised pose of the zone with respect to at least one vertebra. At 1616, method 1600 analyzes the revised pose of the zone for at least one vertebra with respect to the initial pose of the zone for at least one vertebra. At 1620, method 1600 stores the analysis of the revised pose of the zone for at least one vertebra with respect to the initial pose of the zone for at least one vertebra in a zone correction database. At 1624, method 1600 learns the zone preference of the healthcare provider based on the zone correction database.

[0132] Referring to FIG. 17, method 1700 will be described. At 1704, method 1700 retrieves a three-dimensional medical image of a first patient, the three-dimensional medical image including at least one vertebra in a first coordinate system. At 1708, method 1700 retrieves a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the posture of a model implant in the second coordinate system. At 1712, method 1700 maps the three-dimensional vertebra model including the posture of the model implant to at least one vertebra to generate an initial posture of a planned implant with respect to at least one vertebra of the three-dimensional medical image. At 1716, method 1700 receives input from a medical practitioner indicating a correction regarding the implant, the correction including a revised posture for the implant. At 1720, method 1700 determines one or more transformations based on the initial posture of the planned implant and the revised posture of the planned implant. At 1724, method 1700 stores one or more transformations based on the initial posture of the planned implant and the revised posture of the planned implant with respect to at least one vertebra in a database including implant transformation data for a plurality of patients. At 1728, method 1700 determines correction data based on the implant transformation data for a plurality of patients. At 1732, method 1700 selectively adjusts the posture of the model implant with respect to the three-dimensional vertebra model based on the correction data.

[0133] Referring to FIG. 18, method 1800 will be described. At 1804, method 1800 retrieves a three-dimensional medical image of a first patient, the three-dimensional medical image including at least one vertebra in a first coordinate system. At 1808, method 1800 retrieves a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the pose of a model implant in the second coordinate system. At 1812, method 1800 maps the three-dimensional vertebra model including the pose of the model implant to at least one vertebra to generate the pose of a planned implant. At 1816, method 1800 receives input from a medical practitioner indicating a correction regarding the planned implant. At 1820, method 1800 determines one or more transformations based on the initial pose of the planned implant and the revised pose of the planned implant. At 1824, method 1800 stores one or more transformations in a database including implant transformation data for a plurality of patients based on the initial pose and the revised pose of the planned implant. At 1828, method 1800 determines correction data based on the implant transformation data for a plurality of patients. At 1832, method 1800 stores the correction data in an implant correction database. At 1836, method 1800 retrieves a three-dimensional medical image of a second patient, the three-dimensional medical image including at least one vertebra in a third coordinate system. At 1840, method 1800 maps the three-dimensional vertebra model including the pose of the model implant to at least one vertebra of the three-dimensional medical image of the second patient to generate the pose of a planned implant for at least one vertebra of the three-dimensional medical image of the second patient. At 1844, method 1800 selectively adjusts the pose of the planned implant based on the correction data.

[0134] Referring to FIG. 19, method 1900 will be described. At 1904, method 1900 retrieves a three-dimensional medical image of a first patient, the three-dimensional medical image including at least one vertebra in a first coordinate system. At 1908, method 1900 retrieves a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including a plurality of poses for a plurality of model zones in the second coordinate system. At 1912, method 1900 retrieves one or more preferences associated with a previous procedure performed by a healthcare provider. For example, but not limited to, one or more preferences associated with a previous procedure performed by a healthcare provider can include the selection of one or more model zones from a plurality of model zones during the previous procedure and / or a margin previously selected by the healthcare provider to define a zone used in the previous procedure. At 1916, method 1900 maps a three-dimensional vertebra model including at least one pose of at least one model zone to at least one vertebra based on one or more preferences associated with the previous procedure, thereby generating at least one zone for the at least one vertebra.

[0135] Clause A method of mapping a zone for controlling a surgical instrument to a three-dimensional medical image, the method comprising: retrieving a three-dimensional bone model in a first coordinate system, the three-dimensional bone model including (i) a plurality of model features localized in the first coordinate system and (ii) poses of model zones relative to critical structures for a surgical instrument in the first coordinate system; retrieving a three-dimensional medical image in a second coordinate system, the three-dimensional image representing a first bone region and a second bone region; mapping a bone model including model zones to the first bone region based on the plurality of model features localized in the first coordinate system, thereby generating a zone for the first bone region; receiving an input from a healthcare provider, the input indicating a revised pose of the zone of the first bone region in the second coordinate system; and generating a zone for the second bone region based on the revised pose of the zone of the first bone region.

[0136] Clause 2 - A method of mapping a zone for a surgical instrument onto a three-dimensional medical image, comprising: retrieving a three-dimensional bone model in a first coordinate system, the three-dimensional bone model including a plurality of model features localized in the first coordinate system and the orientation of a model zone for the surgical instrument in the first coordinate system; retrieving a three-dimensional medical image having a first bone region and a second bone region in a second coordinate system; mapping the bone model including the model zone onto the first bone region to generate a zone for the first bone region and a zone for the second bone region; receiving an input from a healthcare provider, the input indicating a revised orientation for the model zone of the three-dimensional bone model in the first coordinate system; and applying the revised orientation for the model zone to at least one of the zone for the first bone region and the zone for the second bone region.

[0137] Clause 3 - A method of mapping a zone for a surgical instrument onto a three-dimensional medical image, comprising: retrieving a three-dimensional bone model in a first coordinate system, the three-dimensional bone model including (i) a plurality of model features localized in the first coordinate system and (ii) a model zone for the surgical instrument in the first coordinate system; retrieving a three-dimensional medical image of a first patient having at least one bone in a second coordinate system; mapping the three-dimensional bone model including the model zone onto the at least one bone to generate a zone for the at least one bone; receiving an input regarding a revised orientation of the zone for the at least one bone; revising the orientation of the model zone based on the revised orientation of the zone for the at least one bone; retrieving a three-dimensional medical image of a second patient having at least one bone in a third coordinate system; and mapping the three-dimensional vertebral model including the revised orientation of the model zone onto the at least one bone of the second patient to generate a zone for the at least one bone of the second patient.

[0138] A method for adjusting zones for three-dimensional medical images according to the preference history of medical personnel, comprising: retrieving a three-dimensional medical image having at least one bone in a first coordinate system; receiving a three-dimensional bone model in a second coordinate system, the three-dimensional bone model including the pose of a model zone with respect to a surgical instrument in the second coordinate system; mapping the bone model including the model zone to the first bone based on a plurality of model features localized in the second coordinate system, thereby generating a zone for the first bone; receiving input from a medical personnel regarding the revised pose of the zone for at least one bone; determining one or more transformations based on the pose of the model zone of the three-dimensional bone model and the revised pose of the zone for at least one bone in the first coordinate system; storing one or more transformations in a database including transformation data for a plurality of patients based on the pose of the model zone of the three-dimensional bone model in the first coordinate system and the revised pose of the zone for at least one bone in the first coordinate system; determining correction data based on the transformation data for a plurality of patients; retrieving a three-dimensional medical image having at least one bone of a second patient in a third coordinate system; and mapping the three-dimensional bone model including the model zone to the second bone based on a plurality of model features localized in the third coordinate system and the correction data, thereby generating a zone for the second bone.

[0139] A method for adjusting zones for a three-dimensional medical image according to the preference history of a medical practitioner, comprising receiving a three-dimensional medical image having at least one bone in a first coordinate system; receiving a three-dimensional bone model in a second coordinate system, the three-dimensional bone model including the pose of a model zone with respect to a surgical instrument in the second coordinate system; mapping the bone model including the model zone to a first bone region based on a plurality of model features localized in the second coordinate system, thereby generating a zone for the first bone region; receiving an input from the medical practitioner regarding a revised pose of the zone with respect to at least one bone; determining one or more transformations based on the pose of the model zone of the three-dimensional bone model and the revised pose of the zone with respect to at least one bone in the first coordinate system; storing one or more transformations in a database including transformation data for a plurality of patients based on the pose of the model zone of the three-dimensional bone model in the first coordinate system and the revised pose of the zone with respect to at least one bone in the first coordinate system; determining correction data based on the transformation data for the plurality of patients; and selectively adjusting the pose of the model zone of the three-dimensional bone model based on the correction data.

[0140] A method for adjusting a zone for a three-dimensional medical image according to the preference history of a medical practitioner, comprising: retrieving a three-dimensional medical image having at least one bone in a first coordinate system; retrieving a three-dimensional bone model in a second coordinate system, the three-dimensional bone model including the posture of a model zone with respect to a surgical instrument in the second coordinate system; mapping an initial posture of a zone with respect to at least one bone of the three-dimensional medical image based on the posture of the model zone of the three-dimensional bone model; receiving an input from the medical practitioner regarding a revised posture of the zone with respect to at least one bone; analyzing the revised posture of the zone for at least one bone with respect to the initial posture of the zone for at least one bone; storing the analysis of the revised posture of the zone for at least one bone with respect to the initial posture of the zone for at least one bone in a zone correction database; learning the zone preference by the medical practitioner based on the zone correction database; and adjusting the posture of the zone with respect to at least one bone of a second patient based on the learned zone preference.

[0141] A method of adjusting an implant planned based on the preference history of a healthcare provider, comprising: retrieving a three-dimensional medical image of a first patient, the three-dimensional medical image including at least one bone in a first coordinate system; retrieving a three-dimensional bone model in a second coordinate system, the three-dimensional bone model including the pose of a model implant in the second coordinate system; mapping the three-dimensional bone model including the pose of the model implant to the at least one bone to generate an initial pose of the planned implant relative to the at least one bone in the three-dimensional medical image; receiving input from a healthcare provider indicating a correction to the implant, the correction including a revised pose for the implant; determining one or more transformations based on the initial pose of the planned implant and the revised pose of the planned implant; storing the one or more transformations in a database including implant transformation data for a plurality of patients based on the initial pose of the planned implant relative to the at least one bone and the revised pose of the planned implant; determining correction data based on the implant transformation data for the plurality of patients; and selectively adjusting the pose of the model implant relative to the three-dimensional bone model based on the correction data.

[0142] A method for adjusting a planned implant position based on the preference history of medical personnel, comprising: retrieving a three-dimensional medical image of a first patient, the three-dimensional medical image including at least one bone in a first coordinate system; retrieving a three-dimensional bone model in a second coordinate system, the three-dimensional bone model including the position of a model implant in the second coordinate system; mapping the three-dimensional bone model including the position of the model implant to at least one bone to generate a planned implant position; receiving input from a medical personnel indicating a correction for the planned implant; determining one or more transformations based on the initial position and the revised position of the planned implant; storing the one or more transformations in a database containing implant transformation data for a plurality of patients based on the initial position and the revised position of the planned implant; determining correction data based on the implant transformation data for the plurality of patients; storing the correction data in an implant correction database; retrieving a three-dimensional medical image of a second patient, the three-dimensional medical image including at least one bone in a third coordinate system; mapping the three-dimensional bone model including the position of the model implant to at least one bone in the three-dimensional medical image of the second patient to generate a planned implant position for at least one bone in the three-dimensional medical image of the second patient; and selectively adjusting the position of the planned implant based on the correction data.

[0143] Article 9 - A method for adjusting zones based on the preference history of medical practitioners, comprising retrieving a three-dimensional medical image of a first patient, the three-dimensional medical image including at least one bone in a first coordinate system; retrieving a three-dimensional bone model in a second coordinate system, the three-dimensional bone model including a plurality of poses for a plurality of model zones in the second coordinate system; retrieving one or more preferences associated with previous procedures performed by a medical practitioner; mapping a three-dimensional vertebral model including at least one pose of at least one model zone to the at least one bone based on the one or more preferences associated with the previous procedures, thereby generating at least one zone for the at least one bone.

[0144] The foregoing description is merely illustrative in nature and is in no way intended to limit the disclosure, its applications, or uses. The broad teachings of the disclosure can be implemented in a variety of forms. Thus, while the disclosure includes specific examples, other modifications will become apparent upon consideration of the drawings, the specification, and the following claims, and the true scope of the disclosure should not be so limited. It should be understood that one or more steps within the scope of a method can be executed in a different order (or simultaneously) without changing the principles of the disclosure. Further, for each example described above as having specific features, any one or more of those features described with respect to any example of the disclosure can be implemented with any of the features of any other example, and / or can be combined with such features even if their combination is not explicitly described, i.e., the examples described are not mutually exclusive, and permutations of one or more examples relative to each other remain within the scope of the disclosure.

[0145] For the spatial and functional relationships between elements (e.g., a controller, a circuit element, a semiconductor layer, etc.), various terms including "connected", "engaged", "coupled", "adjacent", "next to", "on", "above", "below", and "disposed" were used to describe. Unless explicitly stated to be "direct", when describing the relationship between a first element and a second element in the above disclosure, the relationship may be a direct relationship without other intervening elements between the first element and the second element, or an indirect relationship with one or more intervening elements (spatially or functionally) between the first element and the second element.

[0146] In this specification, the phrase "at least one of A, B, and C" should be interpreted to mean the logical OR (A or B or C) using non-exclusive disjunction, and should not be interpreted to mean "at least one of A, at least one of B, and at least one of C". The term subset does not necessarily require a proper subset. In other words, a first subset of a first set can have the same extent (be equal to) the first set.

[0147] In these figures, the direction of the arrow indicated by the tip of the arrow generally represents the flow of information (such as data or instructions) related to that figure. For example, if element A and element B exchange various information, and the information transmitted from element A to element B is relevant to that figure, the arrow can point from element A to element B. This one-way arrow does not imply that no other information is transmitted from element B to element A. Further, with respect to the information transmitted from element A to element B, element B can transmit a request for information or an acknowledgment of its receipt to element A.

[0148] In this specification, which includes the following definitions, the terms "controller" or "module" can be replaced by the term "circuit". The term "controller" can refer to one or more of the following, or a combination of some or all of them, a part of them, or including them: application-specific integrated circuit (ASIC), programmable system-on-chip (PSoC), digital, analog, or analog / digital hybrid discrete circuits, digital, analog, or analog / digital hybrid integrated circuits, combinational logic circuits, field-programmable gate arrays (FPGA), processor circuits (shared, dedicated, or grouped) that execute code, memory circuits (shared, dedicated, or grouped) that store code executed by the processor circuits, other suitable hardware components that provide the described functions, or within a system-on-chip, etc.

[0149] The controller can include one or more interface circuits having one or more transceivers. In some examples, the interface circuit can implement a wired or wireless interface to connect to a local area network (LAN) or a wireless personal area network (WPAN). Examples of LANs include Institute of Electrical and Electronics Engineers (IEEE) Standard 802.11-2016 (also known as the WIFI wireless networking standard), and IEEE Standard 802.3-2015 (also known as the ETHERNET® wired networking standard). Examples of WPANs include the BLUETOOTH® wireless networking standard (Bluetooth Special Interest Group), and IEEE Standard 802.15.4.

[0150] The controller can communicate with other controllers using an interface circuit. Although the controller may be depicted in this disclosure as communicating logically directly with other controllers, in various implementations, the controller can actually communicate via a communication system. The communication system can include physical and / or virtual networking devices such as hubs, switches, routers, gateways, and transceivers. In some implementations, the communication system connects to or traverses a wide area network (WAN) such as the Internet. For example, the communication system can include multiple LANs connected to each other via the Internet or a point-to-point dedicated line using technologies including Multiprotocol Label Switching (MPLS) and virtual private networks (VPNs).

[0151] In various implementations, the functions of the controller can be distributed among multiple controllers connected via a communication system. For example, multiple controllers can implement the same function distributed by a load balancing system. In a further example, the functions of the controller can be split between a server (also known as a remote or cloud) controller and a client (or user) controller.

[0152] Some or all of the hardware features of the controller can be defined using a hardware description language such as IEEE Standard 1364-2005 (commonly referred to as "Verilog" (registered trademark)) and IEEE Standard 1076-2008 (commonly referred to as "VHDL"). A hardware description language can be used to manufacture and / or program a hardware circuit. In some implementations, some or all of the features of the controller can be defined by a language such as IEEE 1666-2005 (commonly referred to as "SystemC" (registered trademark)) that encompasses both the code and hardware descriptions described below.

[0153] The term "code" as used above can include software, firmware, and / or microcode, and can refer to programs, routines, functions, classes, data structures, and / or objects. The term "shared processor circuit" includes a single processor circuit that executes some or all of the code from multiple controllers. The term "group processor circuit" includes a processor circuit that, in combination with additional processor circuits, executes some or all of the code from one or more controllers. References to multiple processor circuits include multiple processor circuits on separate dies, multiple processor circuits on a single die, multiple cores of a single processor circuit, multiple threads of a single processor circuit, or combinations of the above. The term "shared memory circuit" includes a single memory circuit that stores some or all of the code from multiple controllers. The term "group memory circuit" includes a memory circuit that, in combination with additional memory, stores some or all of the code from one or more controllers.

[0154] The term "memory circuit" is a subset of the term "computer-readable medium". As used herein, the term "computer-readable medium" does not include transient electrical or electromagnetic signals propagated through a medium (such as a carrier wave), and thus the term "computer-readable medium" can be considered tangible and non-transitory. Non-limiting examples of non-transitory computer-readable media include non-volatile memory circuits (such as flash memory circuits, erasable programmable read-only memory circuits, or mask read-only memory circuits), volatile memory circuits (such as static random access memory circuits or dynamic random access memory circuits), magnetic storage media (such as analog or digital magnetic tape, or hard disk drives), and optical storage media (such as CDs, DVDs, or Blu-ray Discs).

[0155] The apparatus and method described in this application can be implemented partially or fully by a special-purpose computer created by configuring a general-purpose computer to perform one or more specific functions implemented by a computer program. The functional blocks and flowchart elements described above serve as software specifications, and such software specifications can be converted into a computer program by the typical work of a skilled technician or programmer.

[0156] The computer program includes processor-executable instructions stored in at least one non-transitory computer-readable medium. The computer program can also include stored data or can rely on stored data. The computer program can include a basic input / output system (BIOS) that interacts with the hardware of the special-purpose computer, device drivers that interact with specific devices of the special-purpose computer, one or more operating systems, user applications, background services, background applications, and the like.

[0157] A computer program can include (i) parsed descriptive text such as HTML (Hypertext Markup Language), XML (Extensible Markup Language), or JSON (JavaScript® Object Notation), (ii) assembly code, (iii) object code generated from source code by a compiler, (iv) source code for execution by an interpreter, (v) source code for editing and execution by a just-in-time compiler, and the like. For illustrative purposes only, source code can be written using syntax from languages including C, C++, C#, Objective C, Swift, Haskell, Go, SQL, R, Lisp, Java®, Fortran, Perl, Pascal, Curl, OCaml, JavaScript®, HTML5 (Hypertext Markup Language Revision 5), Ada, ASP (Active Server Pages), PHP (PHP: Hypertext Preprocessor), Scala, Eiffel, Smalltalk, Erlang, Ruby, Flash®, Visual Basic®, Lua, MATLAB®, SIMULINK®, and Python®.

Claims

1. A method of mapping a zone for monitoring the position of a surgical instrument during treatment onto a three-dimensional medical image of a patient's vertebrae, comprising: Receiving a three-dimensional vertebra model in a first coordinate system, the three-dimensional vertebra model including a plurality of model features localized in the first coordinate system and the orientation of a model zone with respect to the surgical instrument in the first coordinate system; Receiving a three-dimensional image in a second coordinate system, the three-dimensional image representing a first vertebra and a second vertebra of a patient; Mapping the three-dimensional vertebra model including the model zone onto the first vertebra based on the plurality of model features localized in the first coordinate system, thereby generating a zone for the first vertebra in the second coordinate system; Receiving an input from a medical practitioner, the input indicating a revised orientation of the zone with respect to the first vertebra in the second coordinate system; Generating a zone for the second vertebra based on the revised orientation of the zone with respect to the first vertebra A method including the above steps.

2. Generating the zone for the second vertebra based on the revised orientation of the zone with respect to the first vertebra includes: Mapping the three-dimensional vertebra model including the model zone onto the second vertebra based on the plurality of model features localized in the first coordinate system, thereby generating the zone for the second vertebra in the second coordinate system; and Editing the zone for the second vertebra based on the revised orientation of the zone with respect to the first vertebra. The method according to claim 1.

3. The zone for the first vertebra and the zone for the second vertebra are defined by a first boundary with respect to a critical structure and a second boundary spaced apart from the first boundary by a first distance, the first boundary and the second boundary defining a volume representing the zone. The method according to claim 1 or 2.

4. The zone for the first vertebra is provided as a user-selectable object, and the input corresponds to an operation of the user-selectable object. The method according to any one of claims 1 to 3.

5. Based on the plurality of model features localized in the first coordinate system, mapping the three-dimensional vertebral model including the model zone to the first vertebra, whereby the zone for the first vertebra is generated in the second coordinate system, which includes segmenting the first vertebra in the three-dimensional image, the method according to claim 4.

6. Tracking the posture of the surgical instrument, Based on the tracked posture of the surgical instrument with respect to the zone for the first vertebra and the zone for the second vertebra, performing at least one of controlling the parameters of the surgical instrument and providing a warning The method according to any one of claims 1 to 5, comprising.

7. The method according to any one of claims 1 to 6, wherein the zone for the first vertebra and the zone for the second vertebra are provided as a mesh.

8. The three-dimensional medical image represents a third vertebra and a fourth vertebra, The method comprises Receiving an input regarding at least one of the third vertebra and the fourth vertebra, In response to the input regarding the at least one of the third vertebra and the fourth vertebra, generating a zone for the third vertebra or a zone for the fourth vertebra based on the revised posture of the zone for the first vertebra, the method according to any one of claims 1 to 7.

9. The model zone is defined as a first model zone, the zone for the first vertebra is defined as a first zone for the first vertebra, the three-dimensional vertebral model in the first coordinate system includes the posture of a second model zone with respect to the surgical instrument in the first coordinate system, the second model zone has a posture different from that of the first model zone in the first coordinate system, The method comprises Based on the plurality of model features localized in the first coordinate system, mapping the second model zone to the first vertebra, whereby a second zone for the first vertebra is generated in the second coordinate system, and the second zone for the first vertebra has a posture different from that of the first zone for the first vertebra, mapping. Receiving an input from the medical practitioner, wherein the input indicates a revised pose of the second zone relative to the first vertebra in the second coordinate system. The method according to any one of claims 1 to 8, comprising generating a second zone for a second vertebra based on the revised pose of the second zone relative to the first vertebra. **Claim 10** The method according to any one of claims 1 to 9, comprising updating the pose of the model zone in the first coordinate system based on the revised pose of the zone relative to the first vertebra. **Claim 11** A method of mapping a zone for monitoring the position of a surgical instrument during a procedure to a three-dimensional medical image of a patient's vertebrae, Receiving a three-dimensional vertebra model in a first coordinate system, the three-dimensional vertebra model including a plurality of model features localized in the first coordinate system and a pose of a model zone relative to the surgical instrument in the first coordinate system. Receiving a three-dimensional image of a first vertebra and a second vertebra of a patient in a second coordinate system. Mapping the three-dimensional vertebra model including the model zone to the first vertebra based on the plurality of model features localized in the first coordinate system to generate a zone for the first vertebra and a zone for the second vertebra in the second coordinate system. Receiving an input from a medical practitioner, the input indicating a revised pose of the model zone of the three-dimensional vertebra model in the first coordinate system. A method comprising applying the revised pose of the model zone to at least one of the zone for the first vertebra and the zone for the second vertebra. **Claim 12** A method of mapping a zone for monitoring the position of a surgical instrument during a procedure to a three-dimensional image of at least one patient vertebra, Receiving a three-dimensional vertebra model in a first coordinate system, the three-dimensional vertebra model including a plurality of model features localized in the first coordinate system and a pose of a model zone relative to the surgical instrument in the first coordinate system. Receiving a three-dimensional image of at least one vertebra of a first patient in a second coordinate system. Based on the plurality of model features localized in the first coordinate system, mapping the three-dimensional vertebral model including the model zone to the at least one vertebra to generate a zone for the at least one vertebra in the second coordinate system; Receiving an input regarding a revised pose of the zone for the at least one vertebra in the second coordinate system; Revising the pose of the model zone in the first coordinate system based on the revised pose of the zone for the at least one vertebra; Receiving a three-dimensional image of at least one vertebra of a second patient in a third coordinate system; Based on the plurality of model features localized in the first coordinate system, mapping the three-dimensional vertebral model including the revised pose of the model zone to the at least one vertebra of the second patient to generate a zone for the at least one vertebra of the second patient in the third coordinate system A method comprising.

13. A method for adjusting a zone for at least one patient vertebra of a three-dimensional image for monitoring the position of a surgical instrument during a procedure according to the preference history of a healthcare provider, Receiving a three-dimensional image having at least one vertebra of a first patient in a first coordinate system; Receiving a three-dimensional vertebral model in a second coordinate system, the three-dimensional vertebral model including a plurality of model features localized in the second coordinate system and a pose of a model zone for the surgical instrument in the second coordinate system; Based on the plurality of model features localized in the second coordinate system, mapping the three-dimensional vertebral model including the model zone to the at least one vertebra, whereby a zone for the at least one vertebra is generated in the first coordinate system; Receiving an input from the healthcare provider regarding a revised pose of the zone for the at least one vertebra in the first coordinate system; Determining one or more transformations based on the pose of the model zone of the three-dimensional vertebral model in the second coordinate system and the revised pose of the zone for the at least one vertebra in the first coordinate system; Storing the one or more transformations in a database containing transformation data for a plurality of patients, based on the posture of the model zone with respect to the three-dimensional vertebral model in the second coordinate system and the revised posture of the zone with respect to the at least one vertebra in the first coordinate system; Determining correction data based on the transformation data for the plurality of patients; Receiving a three-dimensional image of at least one vertebra of a second patient in a third coordinate system; Mapping the three-dimensional vertebral model including the model zone to the at least one vertebra of the second patient based on the plurality of model features localized in the second coordinate system and the correction data, thereby generating a zone for the at least one vertebra of the second patient in the third coordinate system; A method comprising:

14. Determining the correction data includes: Receiving the transformation data for the plurality of patients from the database; The method according to claim 13, further comprising determining an average transformation based on the transformation data.

15. The method according to claim 13 or 14, wherein determining the correction data based on the transformation data is performed by a machine learning algorithm.

16. A method for adjusting a zone for at least one patient vertebra of a three-dimensional image for monitoring the position of a surgical instrument during a procedure according to the preference history of a healthcare provider, the method comprising: Receiving a three-dimensional image of at least one vertebra of a patient in a first coordinate system; Receiving a three-dimensional vertebral model in a second coordinate system, the three-dimensional vertebral model including a plurality of model features localized in the second coordinate system and the posture of a model zone with respect to the surgical instrument in the second coordinate system; Mapping the three-dimensional vertebral model including the model zone to the at least one vertebra based on the plurality of model features localized in the second coordinate system, thereby generating a zone for the at least one vertebra in the first coordinate system; Receiving input from the healthcare provider regarding a revised posture of the zone for the at least one vertebra; Determining one or more transformations based on the posture of the model zone of the three-dimensional vertebral model in the second coordinate system and the revised posture of the zone with respect to the at least one vertebra in the first coordinate system; Storing the one or more transformations in a database containing transformation data for a plurality of patients based on the posture of the model zone with respect to the three-dimensional vertebral model in the second coordinate system and the revised posture of the zone with respect to the at least one vertebra in the first coordinate system; Determining correction data based on the transformation data for the plurality of patients; Selectively adjusting the posture of the model zone of the three-dimensional vertebral model based on the correction data A method comprising.

17. Including comparing the number of the plurality of patients from whom the correction data was obtained with a threshold value, and selectively adjusting the posture of the model zone of the three-dimensional vertebral model based on the correction data is performed in response to the number of the plurality of patients exceeding the threshold value, The method according to claim 16.

18. The three-dimensional image is defined as a first three-dimensional image, The method is Receiving a second three-dimensional image having at least one vertebra in a third coordinate system; Receiving the three-dimensional vertebral model in the second coordinate system, the three-dimensional vertebral model including the adjusted posture of the model zone with respect to the surgical instrument in the second coordinate system; Mapping the three-dimensional vertebral model including the adjusted posture of the model zone to the at least one vertebra in the third coordinate system, thereby generating a zone for the at least one vertebra of the second three-dimensional image The method according to claim 16 or 17, comprising:

19. The transformation data is defined as first transformation data, the correction data is defined as first correction data, the zone for the at least one vertebra of the three-dimensional image is defined as a first zone, and the three-dimensional vertebral model includes the posture of a second model zone with respect to the surgical instrument in the second coordinate system, The method is Map the posture of the second model zone to the at least one vertebra of the three-dimensional image in the first coordinate system, thereby generating a second zone having coordinates different from those of the first zone; Receive an input from the medical practitioner regarding the revised posture of the second zone with respect to the at least one vertebra; Determine second transformation data based on the posture of the second model zone and the revised posture of the second zone with respect to the at least one vertebra; Determine second correction data based on the transformation data with respect to the number of the plurality of patients; Selectively adjust the posture of the second model zone of the three-dimensional vertebra model based on the second correction data The method according to any one of claims 16 to 18, comprising: **Claim 20** The at least one vertebra of the three-dimensional image is defined as a first vertebra, the transformation data is defined as first transformation data, the three-dimensional image includes a second vertebra in the first coordinate system, The method includes: Generate a posture of a second zone with respect to the second vertebra in the first coordinate system of the three-dimensional image based on the posture of the model zone of the three-dimensional vertebra model; Receive an input from the medical practitioner regarding the revised posture of the second zone with respect to the second vertebra; Determine second transformation data based on the posture of the model zone and the revised posture of the second zone with respect to the second vertebra; Determine second correction data based on the second transformation data; Adjust the posture of the zone with respect to at least one vertebra of a second patient based on the second correction data The method according to any one of claims 16 to 19, comprising: **Claim 21** A method for adjusting a zone for at least one patient vertebra of a three-dimensional image for monitoring the position of a surgical instrument during a procedure according to the preference history of a medical practitioner, comprising: Receiving a three-dimensional image having at least one vertebra of a patient in a first coordinate system; Receiving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including a posture of a model zone with respect to the surgical instrument in the second coordinate system Generating an initial pose of a zone for at least one vertebra of the three-dimensional image in the first coordinate system based on the pose of the model zone of the three-dimensional vertebra model; Receiving an input from a healthcare provider regarding a revised pose of the zone for at least one vertebra; Comparing the revised pose of the zone for at least one vertebra with the initial pose of the zone for at least one vertebra; Storing the comparison of the revised pose of the zone for at least one vertebra with the initial pose of the zone for at least one vertebra in a zone correction database; Learning a zone preference for the healthcare provider based on the zone correction database; Adjusting a pose of a zone for at least one vertebra of a second patient based on the learned zone preference A method comprising.

22. A method of adjusting a planned implant based on a preference history of a healthcare provider for at least one vertebra, comprising: Receiving a three-dimensional image of a first patient, the three-dimensional image including at least one vertebra of the patient in a first coordinate system; Receiving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including a pose of a model implant in the second coordinate system; Mapping the three-dimensional vertebra model including the pose of the model implant to the at least one vertebra to generate an initial pose of the planned implant for the at least one vertebra of the three-dimensional image in the first coordinate system; Receiving an input from a healthcare provider indicating a revised pose of the planned implant for the at least one vertebra in the first coordinate system; Determining one or more transformations based on the initial pose and the revised pose of the planned implant for the at least one vertebra; Based on the initial posture of the planned implant for the at least one vertebra and the revised posture of the planned implant, storing one or more conversions in a database containing implant conversion data for a plurality of patients; Determining correction data based on the implant conversion data for the plurality of patients; Selectively adjusting the posture of the model implant for the three-dimensional vertebra model based on the correction data A method comprising.

23. The method according to claim 22, wherein the correction data includes the diameter of the planned implant, the length of the planned implant, and a warning zone or virtual boundary associated with the planned implant.

24. A method of adjusting a planned implant based on the preference history of a medical practitioner for at least one vertebra, comprising: Receiving a three-dimensional image of a first patient, the three-dimensional image including at least one vertebra of the first patient in a first coordinate system; Receiving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the posture of a model implant in the second coordinate system; Mapping the three-dimensional vertebra model including the posture of the model implant to the at least one vertebra to generate an initial posture of a planned implant for the at least one vertebra in the first coordinate system; Receiving an input from the medical practitioner indicating a revised posture of the planned implant for the at least one vertebra in the first coordinate system; Determining one or more conversions based on the initial posture of the planned implant for the at least one vertebra and the revised posture of the planned implant; Storing the one or more conversions in a database containing implant conversion data for a plurality of patients based on the initial posture of the planned implant for the at least one vertebra and the revised posture of the planned implant; Determining correction data based on the implant conversion data for the plurality of patients; Storing the correction data in an implant correction database; Receiving a three-dimensional image of a second patient, the three-dimensional image including at least one vertebra of the second patient in a third coordinate system; Mapping the three-dimensional vertebra model including the posture of the model implant to the at least one vertebra of the second patient to generate a planned implant posture for the at least one vertebra of the second patient in the third coordinate system; Selectively adjusting the planned implant posture for the at least one vertebra of the second patient based on the correction data; A method comprising.

25. Receiving an input from a medical practitioner indicating a desire to adjust the planned implant posture for the at least one vertebra of the second patient based on the medical practitioner's preference history, and selectively adjusting the planned implant posture for the at least one vertebra of the second patient based on the correction data is performed in response to the input by the medical practitioner. The method according to claim 24.

26. A method of adjusting a zone for at least one patient vertebra of a three-dimensional image for monitoring the position of a surgical instrument during a procedure based on the preference history of a medical practitioner, comprising: Receiving a three-dimensional image of a first patient, the three-dimensional image including at least one vertebra of the first patient in a first coordinate system; Receiving a three-dimensional vertebra model in a second coordinate system, the three-dimensional vertebra model including the posture of each of a plurality of model zones for the surgical instrument in the second coordinate system; Receiving one or more preferences associated with previous procedures performed by the medical practitioner; Selecting at least one of the postures of the model zones for the surgical instrument based on the one or more preferences; Mapping the three-dimensional vertebra model to the at least one vertebra based on at least one of the selected postures of the model zones, thereby generating at least one zone for the at least one vertebra in the first coordinate system; A method comprising.

27. The method of claim 26, wherein the one or more preferences associated with the previous procedure includes selection of one or more of the plurality of model zones by the healthcare provider.

28. The method of claim 26 or 27, wherein the one or more preferences associated with the previous procedure includes margins for defining zones relative to critical structures.

29. A surgical navigation system including one or more controllers configured to perform the method of any one of claims 1 to 28.

30. A computer program product comprising a non-transitory computer-readable medium storing computer-executable instructions that, when executed by at least one processor or processing device, cause the at least one processor or processing device to perform the method of any one of claims 1 to 28.

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