Predicting postoperative global sagittal alignment based on a whole-body musculoskeletal model and posture optimization

Abstract

To provide a system for surgical planning and assessment of spinal pathology or spinal deformity correction in a subject.SOLUTION: A system comprises a control unit configured to align one or more vertebral bodies of a biomechanical model to one or more vertebral bodies of a radiograph. The control unit is configured to receive one or more pieces of spinal correction input. The control unit is configured to, on the basis of the received one or more pieces of spinal correction input, simulate the biomechanical model in a predetermined posture. The control unit is configured to provide display of one or more characteristics of the simulated biomechanical model.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62 / 792,349, filed January 14, 2019, the entire disclosure of which is expressly incorporated herein by reference.

[0002] The present disclosure describes prediction of post-operative sagittal alignment based on simulation of a biomechanical model. [Background technology]

[0003] The ability to maintain an upright body posture and horizontal gaze requires proper standing balance and normal spino-pelvic sagittal alignment. Several studies have demonstrated a relationship between malalignment and reduced health-related quality of life, highlighting the importance of considering sagittal balance when planning spine surgery. This is true not only in cases of deformity but also in cases of degeneration, as even localized malalignment can distort optimal global balance and lead to pain and disability. Summary of the Invention

[0004] In one embodiment, a system for surgical planning and assessment of spinal pathology or spinal deformity correction in a subject includes a control unit, an input device, and a display device. The control unit is configured to align one or more vertebral bodies of a biomechanical model with one or more vertebral bodies of a radiograph. The control unit is also configured to receive one or more spinal correction inputs. The control unit is also configured to simulate the biomechanical model in a predetermined posture based on the received one or more spinal correction inputs. The control unit is also configured to provide an indication of one or more characteristics of the simulated biomechanical model.

[0005] In another embodiment, a method for surgical planning and assessment of spinal deformity correction in a subject includes aligning one or more vertebral bodies of a biomechanical model to one or more vertebral bodies of an x-ray. The method also includes receiving one or more spinal correction inputs. The method also includes simulating the biomechanical model in a predetermined posture based on the received one or more spinal correction inputs. The method also includes displaying one or more properties of the simulated biomechanical model. [Brief description of the drawings]

[0006] Many advantages of the present invention will become apparent to those skilled in the art from a reading of this specification in conjunction with the accompanying drawings, in which like reference numerals refer to like elements and in which:

[0007] [Figure 1] 1 illustrates an exemplary system for performing a surgical procedure, according to one embodiment of the present disclosure.

[0008] [Diagram 2] 1 shows an exemplary diagram of a biomechanical model, according to one embodiment of the present disclosure.

[0009] [Diagram 3] 1 shows an exemplary view of two vertebral bodies according to one embodiment of the present disclosure.

[0010] [Figure 4] 1 illustrates another exemplary view of two vertebral bodies, according to an embodiment of the present disclosure.

[0011] [Diagram 5] 1 shows an exemplary diagram of two vertebral bodies and an implant according to one embodiment of the present disclosure.

[0012] [Figure 6] 1 illustrates an exemplary workflow according to one embodiment of the present disclosure.

[0013] [Figure 7] 1 illustrates an exemplary flow diagram according to one embodiment of the present disclosure.

[0014] [Figure 8] 1 illustrates an exemplary computer-readable medium according to one embodiment of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0015] Exemplary embodiments of the present invention are described below. For clarity, not all features of an actual implementation are described in this specification. Of course, in the development of such an actual embodiment, numerous implementation-specific decisions must be made to activate the developer's particular goals, such as compliance with system-related and business-related constraints. It is further recognized that such development efforts are complex and time-consuming, but are nevertheless a routine undertaking for those of ordinary skill in the art having the benefit of this disclosure. Moreover, it should be readily understood that the systems and methods of the present invention, while discussed below primarily in the context of spinal surgery, may be used in any number of anatomical settings to provide access to any number of different surgical target sites throughout the body.

[0016] 1 is a diagram of an exemplary system 100 for performing a surgical procedure. The exemplary system 100 includes a base unit 102 that supports a C-arm imaging device 103. The C-arm 103 includes a radiation source 104 that is positioned below a patient P and directs a radiation beam upward toward a receiver 105. The receiver 105 of the C-arm 103 transmits image data to a control unit 122. The control unit 122 is in communication with a tracking device 130 to obtain position and orientation information of various instruments (e.g., instrument T) used during the surgical procedure.

[0017] The base unit 102 includes a control panel 110 through which a user can control the position of the C-arm 103 and radiation exposure. The control panel 110 thus enables a radiologist to acquire images of the surgical site at the direction of the surgeon, control the radiation dose, and initiate radiation pulse images.

[0018] The C-arm 103 may be rotated about an axis parallel to the patient P for different viewing angles of the surgical site. In some cases, an implant or instrument T may be located at the surgical site, which requires changing the viewing angle to view the site unobstructed. Thus, the position of the receiver relative to the patient P, and more specifically relative to the surgical site of interest, may change during the procedure required by the surgeon or radiologist. Thus, the receiver 105 may include a tracking target 106 attached thereto that allows tracking of the position of the C-arm 103 using the tracking device 130. By way of example only, the tracking target 106 may include multiple infrared (IR) reflectors or emitters spaced around the target, while the tracking device 130 is configured to triangulate the position of the receiver 105 from IR signals reflected or emitted by the tracking target 106.

[0019] The control unit 122 may include a digital memory associated therewith and a processor for executing digital and software instructions. The control unit 122 may also incorporate a frame grabber that uses frame grabber technology to generate digital images for projection as displays 123 and 124 on a display device 126. The displays 123 and 124 are positioned for interactive viewing by the surgeon during the procedure. The two displays 123 and 124 may be used to show images from two views, such as lateral and anterior / posterior (A / P), or may show a baseline scan and a current scan of the surgical site, or a current scan and a "merged" scan based on a previous baseline scan and a low radiation current scan. An input device 125, such as a keyboard or touch screen, allows the surgeon to select and manipulate images on the screen. It is understood that the input device may incorporate an array of keys or touch screen icons corresponding to various tasks and features implemented by the control unit 122. The control unit 122 includes a processor that converts image data obtained from the receiver 105 into a digital format. In one example, the control unit 122 is configured to receive x-ray data, computed tomography imaging data, magnetic resonance imaging data, or bi-plane x-ray data from the subject. In some cases, the C-arm 103 may operate in a cinematic exposure mode, producing many images per second. In these cases, multiple images may be averaged into one image over a short period of time to reduce motion artifacts and noise.

[0020] In one example, the control unit 122 is configured to determine digitized positions of one or more vertebral bodies of the subject. The vertebral bodies may be, for example, cervical, thoracic, lumbar, sacrum, or coccyx. In one example, the control unit 122 includes software configured to receive, collect, and / or determine one or more digitized positions corresponding to any number of positions for one or more vertebral bodies, respectively. In another example, the control unit 122 may collect digitized positions from any data source of the subject that depicts the vertebral bodies in sufficient detail, including, but not limited to, X-ray images, computed tomography images, magnetic resonance imaging images, or bi-plane X-ray images of the subject. In one example, the control unit 122 may include image recognition software whereby the control unit 122 digitizes provided data, such as X-ray images, computed tomography images, magnetic resonance imaging images, bi-plane X-ray images, of the subject, and the control unit 122 may select the digitized positions based on the output from the image recognition software. The image recognition software may, for example, process the image and identify and transmit positions, such as corners of one or more vertebral bodies. In some embodiments, this processing and identification is automatic, while in other embodiments, a user manually selects or verifies the locations from data provided to the control unit 122, such that the control unit 122 receives the digitized locations from the user. In yet another embodiment, the digitized locations are received digitally from a digital imaging component, such as a digital radiography system.

[0021] The tracking device 130 may include sensors for determining position data associated with various elements (e.g., infrared reflectors or emitters) used in a surgical procedure. In one example, the sensors may be charge-coupled device (CCD) image sensors. In another example, the sensors may be complementary metal oxide semiconductor (COMS) image sensors. It is also contemplated that a different number of other image sensors may be used to achieve the described functions.

[0022] Although the control unit 122 is shown in FIG. 1 in association with a surgical system in an operating room or surgical theatre, it is contemplated that the control unit 122 may be utilized without the remaining components of the system shown in FIG. 1 for surgical planning using the input device 125 and the display device 126.

[0023] 2 is an example diagram of a general biomechanical model 200 of a whole body. The biomechanical model 200 includes muscles 202, 204, 206, 208, 210, 212, and 224 connected to one or more rigid segments 214, 216, 218, 220, and 222. As shown, the biomechanical model 200 is in a standing position. In another example, the biomechanical model 200 is in a different predefined position, such as a sitting position. It is envisioned that the predefined position may include other positions not described herein.

[0024] In one example, the biomechanical model 200 is a musculoskeletal model of a human subject. In one example, the musculoskeletal model includes several elements, such as bones (e.g., rigid bodies), joints (e.g., mobilizers, constraints and forces), contact elements (e.g., rigid constraints and compliant forces), and ligament and muscle actuators (e.g., forces). In one example, the elements of the musculoskeletal model are based on user-defined functions. For example, the user-defined functions may be associated with constraints, such as a maximum angle between two vertebral bodies. In one example, muscles extending from joints are connected to bones via tendons and ligaments. For example, muscles can generate forces and movements. In another example, the musculoskeletal model includes one or more spine-pelvis parameters, ligament parameters, muscle parameters, and joint kinematics.

[0025] According to one embodiment, the biomechanical model 200 is customized to represent patient-specific parameters. For example, the patient-specific parameters including weight and height, muscle strength, and spino-pelvic parameters such as pelvic incidence angle, sacral inclination angle, and pelvic tilt are used to determine the sagittal curvature of the patient's spine. In another example, the spino-pelvic parameters may include lumbar lordosis, thoracic kyphosis, and sagittal translation of the C7 plumbline. In another example, the spino-pelvic parameters may include the relative positions and angles of the vertebral bodies. In one example, the ligament parameters may include approximated slack length and force-length relationship coefficients.

[0026] In one example, joint kinematics includes the relative motion between two consecutive segments of a musculoskeletal model. In one example, analysis of two consecutive segments (e.g., rigid bodies) requires knowledge of scalar quantities to define the relative motion of the involved links. For example, the scalar quantities may be described in terms of three rotations and three translations with respect to the human anatomy. In one example, to analyze the range of motion of a joint, joint kinematics may consider characterization of the range of motion in one or more planes, such as the sagittal plane (i.e., longitudinal plane), the transverse plane (i.e., axial or horizontal plane), and the coronal plane (i.e., coronal plane).

[0027] Figure 3 shows an example diagram 300 of a patient-specific biomechanical model of two vertebral bodies 302, 304 generated from applying patient-specific parameters to the generic biomechanical model 200 of Figure 2. As shown, the two vertebral bodies 302, 304 are at a given angle 306 relative to each other and a given distance 308 from each other.

[0028] According to an exemplary embodiment, an x-ray of the patient is taken preoperatively. The x-ray may be taken while the patient is in an upright position. Alternatively, the x-ray may be taken while the patient is in a non-upright position, such as prone or supine. During surgical planning, the x-ray is transmitted to a control unit, which is configured to align one or more vertebral bodies shown in the biomechanical model 200 with one or more vertebral bodies of the patient's preoperative x-ray to create a patient-specific biomechanical model 200. In one example, aligning the one or more vertebral bodies may include modifying the biomechanical model 200 to represent the patient's specific spino-pelvic sagittal alignment, vertebral body morphometry, weight and height, and muscle strength (e.g., maximum allowed active force). Based on pre-operative x-rays and input of additional patient-specific parameters, the individual vertebrae shown in the patient-specific model 200 can be morphed to reflect the curvature of the spine in the sagittal plane, for example, as shown in FIG.

[0029] According to yet another example, x-rays of the patient may be taken intraoperatively using a system such as the system shown in Figure 1. According to this exemplary embodiment, the control unit 122 communicates with an imaging system, such as a C-arm, to receive x-rays of the subject acquired by the imaging system immediately prior to or during surgery. The intraoperative imaging may be used to create a patient-specific biomechanical model 200 or to update an existing patient-specific biomechanical model 200 that was created preoperatively.

[0030] FIG. 4 illustrates an exemplary diagram 400 of two vertebral bodies 302, 304 represented by the patient-specific biomechanical model 200, generated from the generic biomechanical model 200 of FIG. 3 morphed according to the corresponding vertebral bodies of the patient's preoperative x-ray. As shown in FIG. 4, a given angle 406 between the two vertebral bodies 302, 304 of the real patient is smaller than the given angle 306 between the two vertebral bodies 302, 304 of the generic biomechanical model 200 shown in FIG. 3. Furthermore, a given distance 408 between the two vertebral bodies 302, 304 of the real patient of FIG. 4 is smaller than the given height 308 between the two vertebral bodies 302, 304 of the generic biomechanical model 200 of FIG. 3. In one example, the height or angle mismatch between the vertebral bodies of the real patient and the more typical spine represented by the generic biomechanical model 200 may be the result of a medical condition such as spondylosis.

[0031] In one example, the control unit 122 may be configured to predict or determine how the simulated surgical correction will affect the patient's posture after surgery. Figure 5 shows an exemplary diagram 500 of the patient-specific biomechanical model 200 showing two vertebral bodies 302, 304 with an implant 510 disposed between the two vertebral bodies 302, 304. As shown in Figure 5, upon insertion of the implant 510, a given angle 506 between the vertebral bodies 302, 304 is greater than a given angle 406 (Figure 4) between the vertebral bodies 302, 304 before insertion of the implant 510. Furthermore, a given distance 508 between the two vertebral bodies 302, 304 is greater than a given distance 408 between the two vertebral bodies 302, 304 before insertion of the implant 510. Although the exemplary embodiments are described using intervertebral implants as the surgical correction, it is contemplated that other surgical corrections using other types of implants and / or alterations (including removal of all or part of bone) or manipulation of the patient's spine may also be simulated using the biomechanical model.

[0032] 5, based on one or more received spinal correction inputs (e.g., simulating the insertion of an implant 510) to two vertebral bodies 302, 304, the control unit 122 is configured to simulate the biomechanical model 200 in a predetermined pose. In one example, a stiff constraint is applied to the fused or fixed segment (e.g., vertebral bodies 302, 304 with an implant 510 implanted between them), which does not allow movement in a given plane but allows full force and moment transfer.

[0033] In one example, the control unit 122 is configured to simulate the patient's predicted global posture taking into account the surgical correction inputs. As an example, standing body posture is modeled by controlling the horizontal position of the body's center of gravity over the ankle joint. In this example, the global rotation of the skull is constrained to model horizontal gaze. Knee flexion, pelvic tilt, lumbar and thoracic correction angles may be changed during posture optimization. In one example, changes to lumbar and thoracic curvature are distributed among the individual segments using the ratio of relative segmental mobility.

[0034] Inverse dynamics is the estimation of unknown forces from known displacements by solving Newton's equations of motion inversely for a given mechanical system. In terms of musculoskeletal modeling, some of the forces of interest are the internal muscle and joint reaction forces that are responsible for supporting the body's posture or movement. Due to the large number of muscles, the equations of motion do not have a unique solution based on an infinite number of combinations of muscle activations to generate the simulated body kinematics. In one example, muscle recruitment criterion is based on the summation of cubed muscle activities. The summation of cubed muscle activities may minimize muscle activities based on the interaction of various muscle groups within a subject.

[0035] In one example, posture prediction can be determined by using an inverse-inverse dynamics approach, as shown in the example workflow 600 of FIG. 6. In the inverse-inverse dynamics approach, an additional optimization loop is added to iteratively adjust the kinematics (e.g., posture) based on the output of the inverse dynamics simulation. In one example, the simulation-predicted muscle effort can be used as an objective function to be minimized to find the optimal posture. As an example, the selection of the minimum muscle expenditure as the posture optimality criterion may correspond to the principle of cone of economy (i.e., ideal spinal alignment allows standing posture with minimum muscle energy). In one example, during posture optimization, the thoracic and lumbar compensation angles, pelvic tilt, and known flexion in the non-fused segments are simultaneously optimized until a solution is found. In one example, the control unit 122 is configured to implement an inverse-inverse dynamics approach, as shown in workflow 600.

[0036] 6, as indicated by block 602, the control unit 122 is configured to receive a patient-customized biomechanical model (e.g., biomechanical model 200) as described herein. In one example, a user may select to apply one or more logical parameters such that the biomechanical model maintains a center of mass over the ankles, maintains a constant horizontal gaze, stands in a posture where postural muscle energy is minimized, has an arm position that matches the patient being imaged, has no coronal plane deformation, or any combination of these logical parameters.

[0037] As indicated by block 604, the control unit 122 is configured to perform kinematic analysis. In one example, the kinematic analysis includes simulating the positions, velocities, and accelerations of whole body segments for typical activities of the patient (e.g., sitting, standing, walking, etc.) and basic human body movements. In one example, the control unit is configured to simulate a surgical correction (e.g., insertion of an implant 510 between the vertebral bodies 302, 304) using the patient's anatomical characteristics. By way of example, the patient's anatomical characteristics may include the size and shape of the vertebral bodies, muscle attachment sites, and the location of the joint center of rotation.

[0038] As indicated by block 606, the control unit 122 is configured to determine one or more equations of motion. In one example, the one or more equations of motion may be directed to determining one or more of positions, velocities, and accelerations of various elements of the biomechanical model 200. In another example, the one or more equations of motion may be directed to determining one or more of forces and torques acting on various elements of the biomechanical model 200.

[0039] As shown in block 608, the control unit 122 is configured to solve a muscle recruitment problem. In one example, the muscle recruitment problem may include optimizing muscle force data or muscle activation data corresponding to one or more postures of a subject.

[0040] As shown in block 610, the control unit 122 is configured to output the muscle and joint forces determined in the previous step of the workflow 600. As shown by block 612, the control unit 122 is configured to determine whether a postural optimality criterion is met. If the postural optimality criterion is met, the workflow 600 ends at block 618. Otherwise, the control unit 122 proceeds to block 614 of the workflow 600. For example, the postural optimality criterion may include one or more of a minimum muscle effort, a minimum sagittal imbalance, and a minimum load on one or more vertebral bodies.

[0041] As indicated by block 614, the control unit 122 is configured to update the optimized variables. In one example, the optimized variables may include spinal-pelvic parameters, lumbar offset, thoracic offset, cervical offset, pelvic tilt, hip flexion, knee flexion, ankle flexion, or a position of the body's center of gravity.

[0042] As indicated by block 616, the control unit is configured to determine one or more posture measurements. For example, the posture measurements may include one or more of thoracic offset, lumbar offset, pelvic tilt, and knee flexion.

[0043] 7 is a flow diagram of an exemplary method during a surgical procedure, according to at least one or more embodiments described herein. Although the blocks in each diagram are shown in sequence, the blocks may in some instances be performed in parallel and / or in a different order than that described therein. Also, various blocks may be combined into fewer blocks, divided into additional blocks, and / or removed based on the desired implementation.

[0044] Further, the flow diagram of FIG. 7 illustrates the functionality and operation of a possible embodiment of the present invention. In this regard, each block may represent a module, segment, or portion of program code, including one or more instructions executable by a processor to implement a particular logical function or step in a process. The program code may be stored in any type of computer-readable medium, such as a storage device, including, for example, a disk or a hard drive. The computer-readable medium may include a non-transitory computer-readable medium that stores short-term data, such as a register memory, a processor cache, or a random access memory (RAM), and / or a persistent long-term storage device, such as, for example, a read-only memory (ROM), an optical or magnetic disk, or a compact disk read-only memory (CD-ROM). The computer-readable medium may be or include any other volatile or non-volatile storage system. The computer-readable medium may be considered, for example, a computer-readable storage medium, a tangible storage device, or other article of manufacture.

[0045] Alternatively, each block in FIG. 7 may represent a circuit that is hardwired to perform a particular logical function in a process. The exemplary method as illustrated in FIG. 7 may be performed, in whole or in part, by the cloud and / or one or more components in the system 100 of FIG. 1. However, it should be understood that the exemplary method may alternatively be performed by other entities or combinations of entities (i.e., other computing devices and / or computer devices) without departing from the scope of the present invention. For example, the functions of the method in FIG. 7 may be performed entirely by a computing device (or a component of a computing device, such as one or more processors), or may be distributed across multiple components of a computing device, across multiple computing devices (e.g., the control unit 122 of FIG. 1), and / or across servers.

[0046] 7, an exemplary method 700 during a surgical procedure may include one or more operations, functions, or actions, as depicted by blocks 702-708. In one embodiment, the method 700 is implemented in whole or in part by the system 100 of FIG. 1. According to another embodiment, the method 700 is implemented in whole or in part by a computing device in a surgical room that may be in communication with one or more components of the system 100 of FIG. 1. According to yet another embodiment, the method 700 is performed in whole or in part by a computing device outside of a surgical room or surgical site, such as, for example, in a surgeon's office or anywhere where surgical planning is performed.

[0047] As indicated by block 702, the method 700 includes aligning one or more vertebral bodies of the biomechanical model to one or more vertebral bodies of the actual patient's x-ray. In one example, the biomechanical model includes a musculoskeletal model of the subject. In one example, the musculoskeletal model includes one or more of spinal-pelvic parameters, ligament parameters, and joint kinematics. In one example, the processing of the musculoskeletal model includes inverse-inverse dynamics modeling. In another example, the method also includes generating a sagittal curvature profile based on the one or more vertebral bodies of the x-ray. In one example, aligning the one or more vertebral bodies of the biomechanical model includes modifying the biomechanical model to match the sagittal curvature profile. As an example, modifying the biomechanical model may include one or more of scaling the one or more vertebral bodies, adjusting the position of the one or more vertebral bodies, and morphing the anatomy of the simulated subject.

[0048] As indicated by block 704, the method 700 includes receiving one or more spinal correction inputs. In one example, the one or more spinal correction inputs include one or more changes in intervertebral height and angle between one or more vertebral bodies. In one example, the one or more spinal correction inputs include simulating one or more spinal implants between the one or more vertebral bodies. In another example, the one or more spinal correction inputs include simulating the removal of one or more discs between the multiple vertebral bodies.

[0049] As indicated by block 706, the method 700 includes simulating the biomechanical model in a predetermined posture based on the received one or more spinal correction inputs. In one example, the predetermined posture is a standing posture. In one example, the standing posture is determined according to a location of a center of mass in the biomechanical model. In another example, the predetermined posture is a sitting posture.

[0050] As indicated by block 708, the method 700 includes providing an indication of one or more characteristics of the simulated biomechanical model. In one example, the characteristics of the simulated biomechanical model may include any combination of muscle activation values, lordosis values, kyphosis values, and Cobb angle values ​​in the patient. In another example, the one or more characteristics may include one or more values ​​corresponding to minimal muscle effort, minimal sagittal imbalance, and minimal load on one or more vertebral bodies.

[0051] 8 illustrates an exemplary computer-readable medium configured in accordance with an exemplary embodiment. In an exemplary embodiment, an exemplary system may include one or more processors, one or more types of memory, one or more input devices / interfaces, one or more output devices / interfaces, and machine-readable instructions that, when executed by the one or more processors, cause the system to perform various functions, tasks, capabilities, etc. described above.

[0052] As mentioned above, in some embodiments, the disclosed techniques may be implemented by computer program instructions encoded in a machine-readable format on a computer-readable storage medium or other medium or article of manufacture. Figure 8 is a schematic diagram illustrating a conceptual partial view of an exemplary computer program product including a computer program for executing a computer process on a computing device, configured in accordance with at least some embodiments disclosed herein.

[0053] In one embodiment, the exemplary computer program product 800 is provided using a signal bearing medium 802. The signal bearing medium 802 may include one or more programming instructions 804 that, when executed by one or more processors, may provide the functionality or a portion of the functionality described above with respect to FIGS. 1-7. In some examples, the signal bearing medium 802 may be a computer readable medium 806, such as, but not limited to, a hard disk drive, a compact disc (CD), a digital video disc (DVD), digital tape, memory, and the like. In some implementations, the signal bearing medium 802 may be a computer recordable medium 808, such as, but not limited to, a memory, a read / write (R / W) CD, a R / W DVD, and the like. In some implementations, the signal bearing medium 802 may be a communication medium 810 (e.g., fiber optic cable, a wave guide, a wired communication link, and the like). Thus, for example, the signal bearing medium 802 may be conveyed by a wireless form of the communication medium 810.

[0054] The one or more programming instructions 804 may be, for example, computer-executable instructions and / or logic-implemented instructions. In some examples, a computing device may be configured to provide various operations, functions, or actions in response to the programming instructions 804 communicated to the computing device by one or more of the computer-readable medium 806, the computer-recordable medium 808, and / or the communication medium 810.

[0055] The computer-readable medium 806 may also be distributed among multiple data storage elements that may be located remotely from each other. The computing device that executes some or all of the stored instructions may be an external computer or a mobile computing platform such as a smartphone, tablet device, personal computer, wearable device, etc. Alternatively, the computing device that executes some or all of the stored instructions may be a remotely located computer system such as a server.

[0056] It should be understood that the configurations described herein are for illustrative purposes only. Thus, those skilled in the art will understand that other configurations and other elements (e.g., machines, interfaces, functions, instructions, and groupings of functions, etc.) can be used instead, and that some elements may be omitted entirely according to the desired results. Furthermore, many of the described elements are functional entities that may be implemented as separate or distributed components, or with other components, in any suitable combination and location, or other structural elements described as independent structures may be combined.

Claims

1. 1. A system for surgical planning and assessment of spinal pathology or spinal deformity correction in a subject, the system comprising: One or more processors: creating a musculoskeletal model having one or more vertebral bodies based on an x-ray of the subject; receiving one or more spinal correction inputs; modifying a musculoskeletal model based on the one or more spinal correction inputs; updating the musculoskeletal model based on an output of an inverse dynamics simulation for the musculoskeletal model by predicting a minimum muscle effort to maintain the musculoskeletal model until a posture optimality criterion is met; providing an indication of one or more properties of the updated musculoskeletal model after the posture optimality criterion is met. having one or more processors; system.

2. the one or more spinal correction inputs include one or more changes in intervertebral height and angle between the one or more vertebral bodies; The system of claim 1 .

3. Updating the musculoskeletal model based on the output of the inverse dynamics simulation for the musculoskeletal model includes: updating one or more variables of the musculoskeletal model, the one or more variables including variables selected from the group consisting of: spinal-pelvic parameters, lumbar compensation variables, thoracic compensation variables, cervical compensation variables, pelvic tilt variables, hip flexion variables, knee flexion variables, ankle flexion variables, and variables representing the position of the center of gravity of the body; The system of claim 1 .

4. The musculoskeletal model includes one or more ligament parameters and joint kinematics. The system of claim 1 .

5. the one or more processors are further configured to generate a sagittal plane curvature of the musculoskeletal model based on a position of the one or more vertebral bodies in the x-ray. The system of claim 1 .

6. creating the musculoskeletal model includes modifying an existing musculoskeletal model to correspond to the anatomy of the target by one or more of: scaling the one or more vertebral bodies, adjusting the position of the one or more vertebral bodies, and morphing the anatomy of a simulated target; The system of claim 1 .

7. The one or more processors further comprise: configured to simulate the updated musculoskeletal model based on a predetermined posture, including a standing posture; The system of claim 1 .

8. the standing posture is determined according to a location of a center of mass within the updated musculoskeletal model. The system of claim 7.

9. The predetermined posture includes a sitting posture. The system of claim 7.

10. 1. A method for surgical planning and evaluation of spinal deformity correction in a subject, the method comprising: creating a musculoskeletal model based on an x-ray of the subject; applying one or more spinal correction inputs to the musculoskeletal model; simulating the musculoskeletal model in a predetermined posture, said simulating including performing inverse dynamics modeling; updating the musculoskeletal model based on an output of an inverse dynamics simulation for the musculoskeletal model until a posture optimality criterion is met by predicting a minimum muscle effort to maintain the musculoskeletal model; providing an indication of one or more properties of the simulated and updated musculoskeletal model after the postural optimality criteria have been met; method.

11. the one or more spinal correction inputs include one or more changes in intervertebral height and angle between one or more vertebral bodies; The method of claim 10.

12. The musculoskeletal model includes spine-pelvis parameters, ligament parameters, and joint kinematics. The method of claim 10.

13. generating a sagittal plane curvature profile based on the one or more vertebral bodies of the x-ray; aligning the one or more vertebral bodies of the musculoskeletal model including modifying the musculoskeletal model to match the sagittal plane curvature profile; modifying the musculoskeletal model including one or more of: scaling the one or more vertebral bodies, adjusting the position of the one or more vertebral bodies, and morphing anatomy of a simulated subject; Further comprising: The method of claim 10.

14. Updating the musculoskeletal model based on the output of the inverse dynamics simulation for the musculoskeletal model further includes: updating one or more variables of the musculoskeletal model, the one or more variables including variables selected from the group consisting of: spinal-pelvic parameters, lumbar compensation variables, thoracic compensation variables, cervical compensation variables, pelvic tilt variables, hip flexion variables, knee flexion variables, ankle flexion variables, and variables representing the position of the center of gravity of the body; The method of claim 10.

15. Updating the musculoskeletal model based on the output of the inverse dynamics simulation for the musculoskeletal model further comprises: (i) maintaining a center of mass over the ankle; (ii) maintaining a constant horizontal gaze; (iii) standing in a posture where postural muscle energy is minimized; (iv) positioning arms to match the subject during imaging; (v) removing coronal plane deformations; or (vi) applying one or more logical parameters including any one of any combination of (i)-(v). The method of claim 10.

16. A non-transitory computer readable medium containing instructions that, when executed, perform: creating a musculoskeletal model having one or more vertebral bodies based on an x-ray of the subject; receiving one or more spinal correction inputs; modifying a musculoskeletal model based on the one or more spinal correction inputs; updating the musculoskeletal model based on an output of an inverse dynamics simulation for the musculoskeletal model by predicting a minimum muscle effort to maintain the musculoskeletal model until a posture optimality criterion is met; providing an indication of one or more properties of the updated musculoskeletal model after the posture optimality criterion is met. Non-transitory computer-readable medium.

17. The instructions, when executed, further include: generating a sagittal curvature profile of the musculoskeletal model based on the position of the one or more vertebral bodies on the x-ray; aligning the one or more vertebral bodies of the musculoskeletal model, including modifying the musculoskeletal model to match the sagittal plane curvature profile; modifying the musculoskeletal model including one or more of: scaling the one or more vertebral bodies, adjusting the position of the one or more vertebral bodies, and morphing anatomy of a simulated subject; It is configured as follows:

20. The non-transitory computer-readable medium of claim 16.

18. The instructions, when executed, further include: configured to simulate the updated musculoskeletal model based on a predetermined posture.

20. The non-transitory computer-readable medium of claim 16.

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