Surgical tracking device and instrument

An image guide includes a member having a first surface and a second surface. The member defines a plane. The member is oriented relative to a sensor to communicate a signal representative of a position of a surgical instrument. At least one marker is connectable with the member and extends relative to the plane from the first surface and the second surface for detectable alignment with the sensor. In some embodiments, surgical systems, surgical instruments, implants and methods are disclosed.

TECHNICAL FIELD

The present disclosure generally relates to medical devices for the treatment of musculoskeletal disorders, and more particularly to a surgical system and a method for treating a spine.

BACKGROUND

Spinal pathologies and disorders such as degenerative disc disease, disc herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvature abnormalities, kyphosis, tumor, and fracture may result from factors including trauma, disease and degenerative conditions caused by injury and aging. Spinal disorders typically result in symptoms including deformity, pain, nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercise can be effective, however, may fail to relieve the symptoms associated with these disorders. Surgical treatment of these spinal disorders includes fusion, fixation, corpectomy, discectomy, laminectomy and implantable prosthetics. For example, fusion and fixation treatments may be performed that employ implants to restore the mechanical support function of vertebrae. Surgical instruments are employed, for example, to prepare tissue surfaces for disposal of the implants. Surgical instruments are also employed to engage implants for disposal with the tissue surfaces at a surgical site. This disclosure describes an improvement over these prior technologies.

SUMMARY

In one embodiment, an image guide is provided. The image guide comprises a member including a first surface and a second surface. The member defines a plane. The member is oriented relative to a sensor to communicate a signal representative of a position of a surgical instrument. At least one marker is connectable with the member and extends relative to the plane from the first surface and the second surface for detectable alignment with the sensor. In some embodiments, surgical systems, surgical instruments, implants and methods are provided.

In one embodiment, the image guide includes a member defining a plane and including a transverse wall. The member is oriented relative to a sensor to communicate a signal representative of a position of a surgical instrument. At least one marker is connectable with the member and extends laterally from the wall in alignment with the plane for detectable alignment with the sensor in a plurality of orientations of the surgical instrument relative to the sensor.

In one embodiment, a surgical system is provided. The surgical system includes a surgical instrument and an image guide including a member having a first surface and a second surface, and defining a plane. The member is oriented relative to a sensor to communicate a signal representative of a position of the surgical instrument. At least one marker is connectable with the member and extends relative to the plane from the first surface and the second surface for detectable alignment with the sensor. A tracking device includes the sensor that receives the signal and communicates with a processor to generate data for display of an image from a monitor. The image represents position of the surgical instrument relative to a body.

DETAILED DESCRIPTION

The exemplary embodiments of a surgical system are discussed in terms of medical devices for the treatment of musculoskeletal disorders and more particularly, in terms of a surgical system for preparing a surgical site, and a method for treating a spine. In some embodiments, the surgical system includes a surgical instrument having an image guide, such as, for example, a surgical navigation tracking device. In some embodiments, the surgical system includes a surgical instrument, such as, for example, an inserter employed with a selected spinal implant, such as, for example, an interbody implant, which is connected to the surgical instrument.

In some embodiments, the present surgical system includes an image guide comprising a multiple directional navigation tracker. In some embodiments, the present surgical system includes an image guide that allows repositioning of a surgical navigation tracker to change orientation of a surgical navigated instrument with respect to a sensor camera during a surgical procedure, for example, changing orientation of the surgical navigated instrument from being pointed from a first orientation to a second orientation, and/or a plurality of alternate orientations, for example, cranially to caudally and/or caudally to cranially. In some embodiments, the image guide allows markers, such as, for example, spherical fiducials to be positioned on either side or on a center plane of a tracker body. As such, the marker is visible and/or detectable from either side of the surgical instrument.

In some embodiments, the present surgical system includes an image guide comprising markers, such as, for example, pins disposed above and below a central plane of a surgical navigation tracker. In some embodiments, the image guide includes markers, such as, for example, spherical fiducials placed on either side of the tracker depending on the surgical instrument orientation and/or the sensor camera position. In some embodiments, the tracker includes markers such that the position of the markers can be changed if the desired instrument orientation is changed. In some embodiments, the image guide includes a tracker body that is machined with features that allow markers, such as, for example, pins with spherical fiducials to be re-positioned as needed enabling the spherical fiducials to be placed either above or below a central plane of the tracker body depending on sensor camera position and surgical instrument orientation. In some embodiments, the image guide includes a tracker body such that the pins lie on the central plane and allow the camera to detect and/or visually align with the spherical fiducials from either side of the surgical instrument. In some embodiments, the image guide allows orientation of the surgical instrument to be changed without having to detach and re-attach, or otherwise re-orient, the tracker.

In some embodiments, the surgical system includes a surgical instrument having one or more image guides, which include one or more fiducial markers. In some embodiments, the fiducial marker includes a single ball-shaped marker. In some embodiments, the image guide is disposed adjacent a proximal end of the surgical instrument. In some embodiments, the image guide provides indicia and/or display of a precise linear position of the image guide on the surgical instrument. In some embodiments, this configuration provides indicia and/or display of an amount of manipulation, movement, translation and/or rotation of the surgical instrument and/or the implant with tissue, such as, for example, an intervertebral space.

In some embodiments, the surgical system includes a surgical instrument having one or more image guides, which include a tracker that provides location of a surgical instrument in three dimensions, and a tracker that provides location of the surgical instrument and/or a spinal implant in two dimensions, such as, for example, a selected plane. In some embodiments, this configuration provides indicia and/or display of surgical instrument and/or implant position corresponding to an amount of manipulation, movement, translation and/or rotation of the surgical instrument and/or the implant with tissue, such as, for example, an intervertebral space. In some embodiments, the surgical system includes a surgical instrument that comprises an inserter employed with a method for delivering an interbody spacer into an intervertebral disc space. In some embodiments, the method includes the step of manipulating, moving, translating and/or rotating the interbody spacer in a precise amount upon selected disposal of the interbody spacer in the intervertebral disc space.

In some embodiments, the surgical system includes a surgical instrument comprising a navigation compatible implant inserter. In some embodiments, the surgical system includes a surgical instrument having one or more image guides, which provide position and rotation indicia and/or display of an implant via a camera sensor and a computer display screen. In some embodiments, the surgical system includes a surgical inserter that has two image guide arrays. In some embodiments, the image guide arrays interact with a navigation enabled camera sensor to provide imaging during insertion and rotation of an implant.

In some embodiments, the surgical instrument includes a surgically navigated instrument, such as, for example, drills, drivers, and taps, which freely rotate about a centerline axis. In some embodiments, the surgical instrument includes a navigation tracker that is optically tracked and requires a line-of-sight view to a sensor, such as, for example, a camera. In some embodiments, the surgical system includes a navigation tracker attached to a surgical instrument and is disposed in a direct line of sight of a sensor, which includes one or more cameras. In some embodiments, the surgical system includes an O-arm medical imaging device that digitally captures images of an anatomy. In some embodiments, the tracker communicates with a surgical navigation system to determine and/or display surgical instrument positioning relative to the anatomy.

In some embodiments, one or all of the components of the surgical system may be disposable, peel pack and/or pre packed sterile devices. One or all of the components of the surgical system may be reusable. The surgical system may be configured as a kit with multiple sized and configured components.

The following discussion includes a description of a surgical system including a surgical instrument, related components and methods of employing the surgical system in accordance with the principles of the present disclosure. Alternate embodiments are disclosed. Reference is made in detail to the exemplary embodiments of the present disclosure, which are illustrated in the accompanying figures. Turning toFIGS. 1 and 2, there are illustrated components of a surgical system10.

Various components of surgical system10may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, biomechanical performance, durability and radiolucency or imaging preference. The components of surgical system10, individually or collectively, may also be fabricated from a heterogeneous material such as a combination of two or more of the above-described materials. The components of surgical system10may be monolithically formed, integrally connected or include fastening elements and/or instruments, as described herein.

Surgical system10is employed, for example, with a fully open surgical procedure, a minimally invasive procedure including percutaneous techniques, and mini-open surgical techniques to deliver and introduce instrumentation and/or a spinal implant to a surgical site of a patient. In some embodiments, the spinal implant can include one or more components of one or more spinal constructs, such as, for example, cages, spacers, vertebral devices, bone fasteners, spinal rods, connectors and/or plates.

Surgical system10comprises a surgical instrument12. Surgical instrument12is configured for connection with an image guide, such as, for example, a navigation component20, as described herein. Navigation component20generates a signal representative of a position of surgical instrument12and/or a spinal implant connected thereto, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10for display on a monitor, as described herein. In some embodiments, navigation component20is configured to generate a signal representative of a position of surgical instrument12as surgical instrument12is manipulated into one or more orientations relative to a sensor array202, as described herein.

Navigation component20maintains communication and/or is configured to maintain detectable alignment with sensor array202. In some embodiments, navigation component20maintains communication and/or detectable alignment with sensor array202during movement of surgical instrument12without having to manipulate, move, translate and/or rotate navigation component20, relative to surgical instrument12. As such, navigation component20is detectable when surgical instrument12is disposed in various orientations relative to sensor array202. In some embodiments, navigation component20is connected with surgical instrument12in fixed position.

In some embodiments, an image guide as described herein, may include one or more components having markers for identification under x-ray, fluoroscopy, CT or other imaging techniques, at least one light emitting diode, a wireless component, a wired component, a near field communication component and/or one or more components that generate acoustic signals, magnetic signals, electromagnetic signals and/or radiologic signals.

Navigation component20is connectable with surgical instrument12via a post18, which defines an axis A1. Navigation component20includes a tracking device having an emitter array22. Emitter array22is disposed along axis A1. In some embodiments, emitter array22may be disposed at various orientations relative to axis A1, such as, for example, parallel, perpendicular, transverse and/or other angular orientations, such as, acute or obtuse. One or more markers40are disposed with emitter array22in detectable alignment with sensor array202, as described herein. Emitter array22is configured for generating a signal to sensor array202, as shown inFIG. 2and described herein, representing a three-dimensional spatial position and/or a trajectory of surgical instrument12and/or a spinal implant connected thereto, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10for display on a monitor, as described herein.

Emitter array22defines a plane P1. Emitter array22includes four spaced apart arms23that extend along plane P1and radially extend from axis A1. In some embodiments, arms23define a substantially X-shape. Emitter array22includes a surface24. Surface24is oriented in a direction, as shown by arrow B inFIG. 1, relative to plane P1. In some embodiments, the direction shown by arrow B can include, such as, for example, a caudal, cranial, lateral, anterior and/or posterior direction and/or orientation. In some embodiments, surface24may include various surface configurations, such as, for example, smooth, grooved, rough, dimpled, polished and/or textured.

Arms23each include a mating surface configured for engagement with markers40, as described herein. Markers40include one or more markers40athat are engageable with a threaded surface26of arm23. Each of arms23define a cavity28configured for disposal of marker40aand include surface26, which is threaded with a surface of marker40ato fix marker40awith arm23. Cavity28is disposed with each of arms23such that marker40aextends from surface24, in the direction shown by arrow B inFIG. 1. Disposal of marker40ain the direction shown by arrow B facilitates maintaining communication and/or detectable alignment of one or more markers40awith sensor array202when surgical instrument12and/or a spinal implant connected thereto is disposed in a three-dimensional spatial position and/or a trajectory, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10. In some embodiments, one or more arms23can include a cavity28.

In some embodiments, one or more markers40aare welded to emitter array22and/or one or more arms23. In some embodiments, one or more markers40aare monolithically formed with emitter array22and/or one or more arms23. In some embodiments, marker40aincludes a mating surface that is forcibly snap-fit to emitter array22and/or one or more arms23, for example, to a snap fit mating surface that defines at least a portion of cavity28. In some embodiments, marker40aincludes a mating surface that is forcibly pop-fit to emitter array22and/or one or more arms23, for example, to a pop-fit mating surface that defines at least a portion of cavity28. In some embodiments, marker40amay be connected with emitter array22and/or one or more arms23in alternate fixation configurations, such as, for example, friction fit, pressure fit, locking protrusion/recess, locking keyway and/or adhesive.

Emitter array22includes a surface30. Surface30is oriented in a direction, as shown by arrow C inFIG. 1, relative to plane P1. Surface30is oriented in an alternative direction relative to the direction shown by arrow B. In some embodiments, surface30is oriented in a direction opposite to the direction shown by arrow B. In some embodiments, surface30is oriented, in a direction transverse and/or at other angular orientations, such as, acute or obtuse, to the direction shown by arrow B. In some embodiments, the direction shown by arrow C can include, such as, for example, a caudal, cranial, lateral, anterior and/or posterior direction and/or orientation. In some embodiments, surface30is disposed parallel to surface24. In some embodiments, surface30may include various surface configurations, such as, for example, smooth, grooved, rough, dimpled, polished and/or textured. Emitter array22includes a wall32that extends laterally thereabout. Surfaces24,30define at least a portion of wall32such that wall32extends therebetween.

Markers40include one or more markers40bthat are engageable with a threaded surface34of arm23. Each of arms23define cavity28, which is configured for disposal of marker40band includes surface34, which is threaded with a surface of marker40bto fix marker40bwith arm23. Cavity28is disposed with each of arms23such that marker40bextends from surface30, in the direction shown by arrow C inFIG. 1. Disposal of marker40bin the direction shown by arrow C facilitates maintaining communication and/or detectable alignment of one or more markers40bwith sensor array202when surgical instrument12and/or a spinal implant connected thereto is disposed in a three-dimensional spatial position and/or a trajectory, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10. In some embodiments, one or more arms23can include a cavity28.

In some embodiments, one or more markers40bare welded to emitter array22and/or one or more arms23. In some embodiments, one or more markers40bare monolithically formed with emitter array22and/or one or more arms23. In some embodiments, marker40bincludes a mating surface that is forcibly snap-fit to emitter array22and/or one or more arms23, for example, to a snap fit mating surface that defines at least a portion of cavity28. In some embodiments, marker40bincludes a mating surface that is forcibly pop-fit to emitter array22and/or one or more arms23, for example, to a pop-fit mating surface that defines at least a portion of cavity28. In some embodiments, marker40bmay be connected with emitter array22and/or one or more arms23in alternate fixation configurations, such as, for example, friction fit, pressure fit, locking protrusion/recess, locking keyway and/or adhesive.

Marker40aincludes a spherical fiducial extending from surface24and marker40bincludes a spherical fiducial extending from surface30. Markers40a,40bextend from surfaces24,30relative to plane P1to facilitate detectable alignment and generating the signal to sensor array202during a surgical procedure, for example, when surgical instrument12and/or a spinal implant connected thereto is disposed in a three-dimensional spatial position and/or a trajectory, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10. In some embodiments, surface26is disposed in a relative co-axial orientation with surface34within cavity28such that markers40a,40bare disposed in a relative co-axial orientation. In some embodiments, surfaces26,34and/or markers40a,40bmay be disposed at alternative relative orientations, such as, for example, transverse and/or other angular orientations, such as, acute or obtuse.

For example, surgical instrument12, which includes markers40aextending from surface24in the direction shown by arrow B and markers40bextending from surface30in the direction shown by arrow C, is initially disposed in a first and/or selected orientation relative to sensor array202. In one example, surgical instrument12and/or a spinal implant connected thereto is disposed in a three-dimensional spatial position and/or a trajectory such that surface24is disposed in a cranial orientation and surface30is disposed in a caudal orientation relative to a patient anatomy. In the first and/or selected orientation relative to sensor array202, markers40aare fixed with surface24and disposed in communication and/or detectable alignment with sensor array202to generate a signal to sensor array202representing the three-dimensional spatial position and/or trajectory of surgical instrument12and/or a spinal implant connected thereto, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10for display on a monitor. Markers40bare fixed with surface30.

During a surgical procedure, surgical instrument12may be manipulated, moved, translated, rotated and/or repositioned to a second and/or selected orientation relative to sensor array202. In one example, surgical instrument12and/or a spinal implant connected thereto is rotated and repositioned to the second and/or selected orientation such that surface24and markers40aare moved out of communication and/or detectable alignment with sensor array202and surface30and markers40bare moved into communication and/or detectable alignment with sensor array202. As such, surface30is disposed in a cranial orientation and surface24is disposed in a caudal orientation relative to a patient anatomy. In the second and/or selected orientation relative to sensor array202, markers40bare fixed with surface30and disposed in communication and/or detectable alignment with sensor array202to generate a signal to sensor array202representing the three-dimensional spatial position and/or trajectory of surgical instrument12and/or a spinal implant connected thereto, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10for display on a monitor. Markers40aare fixed with surface24. In some embodiments, the configuration of emitter array22provides multi-directional detectable alignment with sensor array202, which allows repositioning of surgical instrument12and emitter array22relative to sensor array202during a surgical procedure such that markers40are visible and/or detectable from either side of surgical instrument12. As such, emitter array22allows orientation of surgical instrument12to be changed without having to detach and re-attach, or otherwise re-orient, emitter array22. In some embodiments, one or more markers40can be connected to emitter array22and/or one or more arms23intra-operatively.

Markers40appear in the image produced by a surgical navigation system200for use as a point of reference or a measure. Emitter array22generates signals representing the position of various body reference points of a patient's anatomy. In some embodiments, markers40include at least one light emitting diode. In some embodiments, markers40may include other tracking devices capable of being tracked by sensor array202, such as, for example, a tracking device that actively generates acoustic signals, magnetic signals, electromagnetic signals, radiologic signals. In some embodiments, markers40may be removably attached to emitter array22. In some embodiments, one or more of markers40each include a single ball-shaped marker.

Surgical instrument12is configured for disposal adjacent a surgical site such that navigation component20is oriented relative to sensor array202to maintain communication between navigation component20and sensor array202during a surgical procedure, as described herein. In some embodiments, sensor array202receives signals from navigation component20to provide a three-dimensional spatial position and/or a trajectory of surgical instrument12and/or a spinal implant connected thereto relative to a portion of a patient's anatomy and/or a depth of surgical instrument12within the patient's anatomy for display on a monitor. See, for example, similar surgical navigation components and their use as described in U.S. Pat. Nos. 6,021,343, 6,725,080, 6,796,988, the entire contents of each of these references being incorporated by reference herein.

Surgical navigation system200is configured for acquiring and displaying medical imaging, such as, for example, x-ray images appropriate for a given surgical procedure, as shown inFIG. 2. In some embodiments, pre-acquired images of a patient are collected. In some embodiments, surgical navigation system200can include an O-arm® imaging device204sold by Medtronic Navigation, Inc. having a place of business in Louisville, Colo., USA. Imaging device204may have a generally annular gantry housing that encloses an image capturing portion208.

In some embodiments, image capturing portion208may include an x-ray source or emission portion and an x-ray receiving or image receiving portion located generally or as practically possible 180 degrees from each other and mounted on a rotor (not shown) relative to a track of image capturing portion208. Image capturing portion208can be operable to rotate 360 degrees during image acquisition. Image capturing portion208may rotate around a central point or axis, allowing image data of the patient to be acquired from multiple directions or in multiple planes. Surgical navigation system200can include those disclosed in U.S. Pat. Nos. 8,842,893, 7,188,998; 7,108,421; 7,106,825; 7,001,045; and 6,940,941; the entire contents of each of these references being incorporated by reference herein.

In some embodiments, surgical navigation system200can include C-arm fluoroscopic imaging systems, which can generate three-dimensional views of a patient. The position of image capturing portion208can be precisely known relative to any other portion of imaging device204. In some embodiments, a precise knowledge of the position of image capturing portion208can be used in conjunction with a tracking system210to determine the position of image capturing portion208and the image data relative to the patient.

Tracking system210can include various portions that are associated or included with surgical navigation system200. In some embodiments, tracking system210can also include a plurality of types of tracking systems, such as, for example, an optical tracking system that includes an optical localizer, such as, for example, sensor array202and/or an EM tracking system that can include an EM localizer. Various tracking devices can be tracked with tracking system210and the information can be used by surgical navigation system200to allow for a display of a position of an item, such as, for example, a patient tracking device214, an imaging tracking device216, and/or an instrument tracking device, such as, for example, navigation component20to allow selected portions to be tracked relative to one another with the appropriate tracking system.

In some embodiments, the EM tracking system can include the STEALTHSTATION® AXIEM™ Navigation System, sold by Medtronic Navigation, Inc. having a place of business in Louisville, Colo. Exemplary tracking systems are also disclosed in U.S. Pat. Nos. 8,057,407, 5,913,820, 5,592,939, the entire contents of each of these references being incorporated by reference herein.

Fluoroscopic images taken are transmitted to computer218where they may be forwarded to surgical navigation computer220. Image transfer may be performed over a standard video connection or a digital link including wired and wireless. Computer220provides the ability to display, via monitor222, as well as save, digitally manipulate, or print a hard copy of the received images. In some embodiments, images may also be displayed to the surgeon through a heads-up display.

In some embodiments, surgical navigation system200provides for real-time tracking of surgical instrument12and/or a spinal implant connected thereto. Sensor array202is located in such a manner to provide a clear line of sight with navigation component20, as described herein. In some embodiments, navigation component20communicates with sensor array202via infrared technology. Sensor array202is coupled to computer220, which may be programmed with software modules that analyze signals transmitted by sensor array202to determine the position of each object in a detector space. A processor sends the information to monitor222, which provides a visual representation of the position of surgical instrument12and/or a spinal implant connected thereto relative to the patient's anatomy to allow the medical practitioner to move surgical instrument12to a desired location within the patient's anatomy.

In assembly, operation and use, surgical system10, similar to the systems and methods described herein, is employed with a surgical procedure for treatment of a spinal disorder affecting a section of a spine of a patient, as discussed herein. For example, the components of surgical system10can be used with a surgical procedure for treatment of a condition or injury of an affected section of the spine. In some embodiments, one or all of the components of surgical system10can be delivered or implanted as a pre-assembled device or can be assembled in situ. Surgical system10may be completely or partially revised, removed or replaced.

The components of surgical system10can be employed with a surgical treatment of an applicable condition or injury of an affected section of a spinal column and adjacent areas within a body. In some embodiments, the components of surgical system10may be employed with one or a plurality of vertebra. To treat a selected section of vertebrae, a medical practitioner obtains access to a surgical site in any appropriate manner, such as through incision and retraction of tissues. In some embodiments, the components of surgical system10can be used in any existing surgical method or technique including open surgery, mini-open surgery, minimally invasive surgery and percutaneous surgical implantation, whereby the vertebrae are accessed through a mini-incision, or sleeve that provides a protected passageway to the area. Once access to the surgical site is obtained, the particular surgical procedure can be performed for treating the spine disorder.

An incision is made in the body of a patient and a cutting instrument (not shown) creates a surgical pathway for delivery of components of surgical system10including surgical instrument12having navigation component20, as described herein, adjacent an area within the patient's body. Surgical instrument12may be utilized to prepare tissue surfaces of vertebrae and/or facilitate insertion of a spinal implant. Surgical instrument12, as shown inFIG. 2, includes a distal and/or working end connected with a drill bit for creating one or more pilot holes in tissue for disposal of implants. In some embodiments, surgical instrument12includes a distal and/or working end that includes an implant inserter for disposing a spinal implant with tissue.

Surgical instrument12includes markers40aextending from surface24and markers40bextending from surface30, as described herein. A practitioner manipulates surgical instrument12for creating a pilot hole in vertebral tissue such that surface24is disposed in a cranial orientation, in the direction shown by arrow B inFIG. 2, and surface30is disposed in a caudal orientation, in the direction shown by arrow C inFIG. 2, relative to the patient. Markers40aare fixed with surface24and disposed in communication and/or detectable alignment with sensor array202to generate a signal to sensor array202representing the three-dimensional spatial position of surgical instrument12for display on monitor222, as described herein. Markers40bare fixed with surface30. Surgical navigation system200provides for real-time tracking of surgical instrument12and a visual representation of the position of surgical instrument12relative to the patient's anatomy.

During the surgical procedure, repositioning of surgical instrument12may be performed to facilitate removal of tissue and/or spinal implant placement. Surgical instrument12is rotated and repositioned to a selected orientation such that surface24and markers40aare moved out of communication and/or detectable alignment with sensor array202, and surface30and markers40bare moved into communication and/or detectable alignment with sensor array202. As such, surface30is disposed in a cranial orientation and surface24is disposed in a caudal orientation relative to a patient anatomy. Markers40bare fixed with surface30such that communication and/or detectable alignment of emitter array22with sensor array202is maintained. Markers40bgenerate a signal to sensor array202representing the three-dimensional spatial position of surgical instrument12, as described herein, for display on monitor222. Emitter array22provides multi-directional detectable alignment with sensor array202. Surgical instrument12is repositionable relative to sensor array202during a surgical procedure such that markers40are visible and/or detectable from either side of surgical instrument12. Emitter array22allows orientation of surgical instrument12to be changed without having to detach and re-attach, or otherwise re-orient, emitter array22.

In some embodiments, surgical instrument12includes a distal and/or working end that may comprise various instruments including the configuration of the present disclosure, such as, for example, inserters, extenders, reducers, spreaders, distractors, blades, retractors, clamps, forceps, elevators and drills, which may be alternately sized and dimensioned, and arranged as a kit.

In some embodiments, surgical system10includes an agent, which may be disposed, packed or layered within, on or about the components and/or surfaces of surgical system10. In some embodiments, the agent may include bone growth promoting material, such as, for example, bone graft to enhance fixation with the vertebrae. The components of surgical system10can be made of radiolucent materials such as polymers. Radiomarkers may be included for identification under x-ray, fluoroscopy, CT or other imaging techniques. In some embodiments, the agent may include one or a plurality of therapeutic agents and/or pharmacological agents for release, including sustained release, to treat, for example, pain, inflammation and degeneration. Upon completion of the procedure, the surgical instruments, assemblies and non-implant components of surgical system10are removed from the surgical site and the incision is closed.

In one embodiment, as shown inFIG. 3, surgical system10, similar to the systems and methods described above with regard toFIGS. 1 and 2, includes surgical instrument12, as described herein, configured for connection with an image guide, such as, for example, a navigation component320, similar to navigation component20described herein. Navigation component320is connectable with surgical instrument12via a post318, which defines an axis A2. Navigation component320includes a tracking device having an emitter array322, similar to emitter array22, disposed along axis A2. One or more markers340, similar to markers40described herein, are disposed with emitter array322in detectable alignment with sensor array202, as described herein.

Emitter array322defines a plane P2. Emitter array322includes four spaced apart arms323, similar to arms23described herein, which extend along plane P2and radially extend from axis A2. Emitter array222includes a surface324, similar to surface24described herein. Arms323each include a mating surface configured for engagement with markers340. Markers340are engageable with a threaded surface326of arm323adjacent surface324.

Each of arms323define a cavity328configured for disposal of marker340and include surface326, which is threaded with a surface of marker340to fix marker340with arm323adjacent surface324. Cavity328is disposed with each of arms323and marker340is threaded with surface326such that marker340can be attached with emitter array322to extend from surface324, in the direction shown by arrow D inFIG. 3. Disposal of marker340in the direction shown by arrow D facilitates maintaining communication and/or detectable alignment of one or more markers340with sensor array202when surgical instrument12and/or a spinal implant connected thereto is disposed in a three-dimensional spatial position and/or a trajectory, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10.

Emitter array322includes a surface330, similar to surface30described herein. Markers340are engageable with a threaded surface334of arm323adjacent surface330. Cavity328is configured for disposal of marker340and includes surface334, which is threaded with a surface of marker340to fix marker340with arm323adjacent surface330. Cavity328is disposed with each of arms323such that marker340can be attached with emitter array322to extend from surface330, in the direction shown by arrow E inFIG. 3. Disposal of marker340in the direction shown by arrow E facilitates maintaining communication and/or detectable alignment of one or more markers340with sensor array202when surgical instrument12and/or a spinal implant connected thereto is disposed in a three-dimensional spatial position and/or a trajectory, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10.

Markers340are disposable with cavity328and removably attachable with surfaces326,334such that markers340are extendable from emitter array322in one or a plurality of orientations, for example, in the direction shown by arrows D, E. In some embodiments, markers340are connectable with emitter array322in a plurality of detectable alignments to facilitate generating a signal to a sensor array202. In some embodiments, markers340are intra-operatively attachable, removable and re-attachable with emitter array322such that during a surgical procedure markers340are moveable to facilitate maintaining communication and alignment and to at least one alternative position for detection by sensor array202. In some embodiments, markers340are intra-operatively adjustable with emitter array322such that during a surgical procedure, markers340are moveable to facilitate maintaining communication and alignment and or realignment to at least one alternative position for detection by sensor array202.

For example, surgical instrument12includes markers340threaded with surface326such that markers340are attached with emitter array322to extend from surface324, as described herein. A practitioner manipulates surgical instrument12to prepare tissue surfaces of vertebrae and/or facilitate insertion of a spinal implant such that surface324is disposed in a cranial orientation and surface330is disposed in a caudal orientation relative to the patient. Markers340are fixed with surface324and disposed in communication and/or detectable alignment with sensor array202to generate a signal to sensor array202representing the three-dimensional spatial position of surgical instrument12for display on monitor222, as described herein. During the surgical procedure, repositioning of surgical instrument12may be performed to facilitate removal of tissue and/or spinal implant placement. Surgical instrument12is rotated and repositioned to a selected orientation such that surface324and markers340are moved out of communication and/or detectable alignment with sensor array202. Markers340are removed from surfaces326and re-attached with surface330such that markers340are threaded with surfaces334and maintain communication and/or detectable alignment with sensor array202to generate a signal to sensor array202representing the three-dimensional spatial position of surgical instrument12, as described herein.

In some embodiments, marker340includes a mating surface that is forcibly snap-fit to emitter array322and/or one or more arms323, for example, to a snap fit mating surface that defines at least a portion of cavity328. In some embodiments, marker340includes a mating surface that is forcibly pop-fit to emitter array322and/or one or more arms323, for example, to a pop-fit mating surface that defines at least a portion of cavity328.

In one embodiment, as shown inFIG. 4, surgical system10, similar to the systems and methods described herein, includes surgical instrument12, as described herein, configured for connection with an image guide, such as, for example, a navigation component420, similar to navigation component20described herein. Navigation component420is connectable with surgical instrument12via a post418, which defines an axis A3. Navigation component420includes a tracking device having an emitter array422, similar to emitter array22, disposed along axis A3. One or more markers440, similar to markers40described herein, are disposed with emitter array422in detectable alignment with sensor array202, as described herein.

Emitter array422defines a plane P3. Emitter array422includes four spaced apart arms423, similar to arms23described herein, which extend along plane P3and radially extend from axis A3. Emitter array422includes surfaces424,430, similar to surfaces24,30described herein. Emitter array422includes a wall432that extends laterally thereabout. Surfaces424,430define at least a portion of wall432such that wall432extends therebetween. Arms423each include a mating surface configured for engagement with markers440. Markers440are engageable with a threaded surface426of arm423adjacent wall432.

Each of arms423define a cavity428configured for disposal of marker440and include surface426, which is threaded with a surface of marker440to fix marker440with arm423. Cavity428is disposed with each of arms423such that marker440extends laterally from wall432and transverse relative to axis A3, in the direction shown by arrow F inFIG. 4. Disposal of marker440in the direction shown by arrow F facilitates maintaining communication and/or detectable alignment of one or more markers440with sensor array202when surgical instrument12and/or a spinal implant connected thereto is disposed in a three-dimensional spatial position and/or a trajectory, for example, relative to a portion of a patient's anatomy, a depth within the patient's anatomy and/or one or more components of surgical system10. In some embodiments, one or more arms423can include a cavity428. In some embodiments, marker440may extend from wall432in various orientations relative to axis A3and/or plane P3, such as, for example, parallel, perpendicular, transverse and/or other angular orientations, such as, acute or obtuse, offset and/or staggered.

Markers440are connected with each of arms423in alignment with plane P3and centrally disposed with wall432. Markers440extend laterally from wall432to maintain communication and detectable alignment of markers440with sensor array202as surgical instrument12is manipulated, moved, positioned and/or re-oriented into various orientations, as described herein, relative to sensory array202during a surgical procedure, as described herein.

In some embodiments, one or more markers440are welded to emitter array422and/or one or more arms423. In some embodiments, one or more markers440are monolithically formed with emitter array422and/or one or more arms423. In some embodiments, marker440includes a mating surface that is forcibly snap-fit to emitter array422and/or one or more arms423, for example, to a snap fit mating surface that defines at least a portion of cavity428. In some embodiments, marker440includes a mating surface that is forcibly pop-fit to emitter array422and/or one or more arms423, for example, to a pop-fit mating surface that defines at least a portion of cavity428. In some embodiments, marker440may be connected with emitter array422and/or one or more arms423in alternative fixation configurations, such as, for example, friction fit, pressure fit, locking protrusion/recess, locking keyway and/or adhesive.