Precision and accuracy of consumer-grade motion tracking system for pedicle screw placement in pediatric spinal fusion surgery

2017 ◽  
Vol 46 ◽  
pp. 33-43 ◽  
Author(s):  
Andrew Chan ◽  
Janelle Aguillon ◽  
Doug Hill ◽  
Edmond Lou
Keyword(s):  
Spinal Fusion ◽  
Pedicle Screw ◽  
Motion Tracking ◽  
Tracking System ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Precision And Accuracy ◽  
Motion Tracking System

scholarly journals Four Year Experience of Robot-Assisted Pedicle Screw Placement: An Australian Prospective Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jordan Cory ◽  
Mohammed A Awad ◽  
Richard G Bittar
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Intraoperative Radiation ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

Abstract INTRODUCTION Robot-assisted surgery has emerged as an innovative and minimally-invasive technique, touted as superior to the traditional free-hand technique of pedicle screw fixation in spinal fusion surgery. Complications of misplaced pedicle screws include inadequate fixation and surgical failure requiring revision, neural injury, cerebrospinal fluid (CSF) leak, vascular injury, and facet joint trauma with sequela of adjacent segment disease. Literature reports an incidence of pedicle screw misplacement in up to 10% with free-hand technique. Robot-assisted surgery has reported superiority with increased accuracy of pedicle screw placement and reduced complication rates. This prospective multi-institutional single cohort analysis reports the outcomes in robot-assisted spinal fusion surgery in Melbourne, Australia over 4 yr. METHODS Data was prospectively collected from 2015 to 2019 from robot-assisted spinal surgeries performed by 2 surgeons across 2 institutions. Postoperative spinal computed tomography (CT) scan was compared to preoperative CT based planning to determine the accuracy of pedicle screw placement to 0.1 mm. Accurate pedicle screw placement was defined as within 2.0 mm from the target. Intraoperative radiation exposure time, operative time and length of hospital stay were also collected. RESULTS The total number of cases was 164 and the total number of screws placed was 744. Accurate pedicle screw placement was 98.65%. Average intraoperative radiation exposure time was 9.9 s. Average operative time for single-level surgery was 74 min. The average length of hospital stay was 2.4 d. CONCLUSION The authors conclude that robot-assisted pedicle screw placement is a safe and highly accurate adjunct to spinal surgery. While robot-assisted spinal surgery significantly improves patient outcomes with reduced patient morbidity and revision rates, it has limitations in primary capital expenditure, consumable costs and, in training and accreditation. It is the authors’ opinion that the robot-assisted spinal surgery technique requires nuanced patient selection and expertise in the traditional free-hand method is still essential in the event of technological failure.

scholarly journals Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110035
Author(s):  
Brigita De Vega ◽  
Aida Ribera Navarro ◽  
Alexander Gibson ◽  
Deepak M. Kalaskar
Keyword(s):  
Systematic Review ◽  
Spinal Fusion ◽  
Pedicle Screw ◽  
Meta Analysis ◽  
Three Dimensional ◽  
Bias Assessment ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Evidence Quality ◽  
Comprehensive Search

Study Design: Systematic review and meta-analysis. Objective: Various methods of pedicle screw (PS) placement in spinal fusion surgery existed, which can be grouped into conventional freehand (FH), modified freehand (MF), and image-guided methods (including fluoroscopy-based navigation (FL), computed tomography-based navigation (CT-nav), robot-assisted (RA), and ultrasound-guided (UG)). However, the literature showed mixed findings regarding their accuracy and complications. This review aimed to discover which method of PS placement has the highest accuracy and lowest complication rate in pediatric and adolescent spinal fusion surgery. Methods: A comprehensive search in MEDLINE (PubMed), EMBASE (OVID), CENTRAL, and Web of Science was conducted until May 2020 by 2 independent reviewers, followed by bias assessment with ROB 2 and ROBINS-I tools and quantification with meta-analysis. Overall evidence quality was determined with GRADE tool. Results: Four RCTs and 2 quasi-RCTs/CCTs comprising 3,830 PS placed in 291 patients (4-22 years old) were analyzed. The lowest accuracy was found in FH (78.35%) while the highest accuracy was found in MF (95.86%). MF was more accurate than FH (OR 3.34 (95% CI, 2.33-4.79), P < .00 001, I2 = 0%). Three-dimensional printed drill template (as part of MF) was more accurate than FH (OR 3.10 (95% CI, 1.98-4.86), P < .00 001, I2 = 14%). Overall, complications occurred in 5.84% of the patients with 0.34% revision rate. Complication events in MF was lower compared to FH (OR 0.47 (95% CI, 0.10-2.15), P = .33, I2 = 0%). Conclusions: Meta-analysis shows that MF is more accurate than FH in pediatric and adolescent requiring PS placement for spinal fusion surgery.

scholarly journals Usability of Graphical Visualizations on a Tool-Mounted Interface for Spine Surgery

2021 ◽  
Vol 7 (8) ◽  
pp. 159
Author(s):  
Laura Schütz ◽  
Caroline Brendle ◽  
Javier Esteban ◽  
Sandro M. Krieg ◽  
Ulrich Eck ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Navigation Systems ◽  
Pedicle Screw Placement ◽  
Spinal Fusion Surgery ◽  
Positive Effects ◽  
Mental Demand ◽  
Spinal Navigation ◽  
New Research ◽  
Navigation Information

Screw placement in the correct angular trajectory is one of the most intricate tasks during spinal fusion surgery. Due to the crucial role of pedicle screw placement for the outcome of the operation, spinal navigation has been introduced into the clinical routine. Despite its positive effects on the precision and safety of the surgical procedure, local separation of the navigation information and the surgical site, combined with intricate visualizations, limit the benefits of the navigation systems. Instead of a tech-driven design, a focus on usability is required in new research approaches to enable advanced and effective visualizations. This work presents a new tool-mounted interface (TMI) for pedicle screw placement. By fixing a TMI onto the surgical instrument, physical de-coupling of the anatomical target and navigation information is resolved. A total of 18 surgeons participated in a usability study comparing the TMI to the state-of-the-art visualization on an external screen. With the usage of the TMI, significant improvements in system usability (Kruskal–Wallis test p < 0.05) were achieved. A significant reduction in mental demand and overall cognitive load, measured using a NASA-TLX (p < 0.05), were observed. Moreover, a general improvement in performance was shown by means of the surgical task time (one-way ANOVA p < 0.001).

scholarly journals SpineDepth: A Multi-Modal Data Collection Approach for Automatic Labelling and Intraoperative Spinal Shape Reconstruction Based on RGB-D Data

2021 ◽  
Vol 7 (9) ◽  
pp. 164
Author(s):  
Florentin Liebmann ◽  
Dominik Stütz ◽  
Daniel Suter ◽  
Sascha Jecklin ◽  
Jess G. Snedeker ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Pedicle Screw ◽  
Tracking System ◽  
Ground Truth ◽  
Shape Reconstruction ◽  
Optical Tracking ◽  
Data Driven ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Optical Tracking System

Computer aided orthopedic surgery suffers from low clinical adoption, despite increased accuracy and patient safety. This can partly be attributed to cumbersome and often radiation intensive registration methods. Emerging RGB-D sensors combined with artificial intelligence data-driven methods have the potential to streamline these procedures. However, developing such methods requires vast amount of data. To this end, a multi-modal approach that enables acquisition of large clinical data, tailored to pedicle screw placement, using RGB-D sensors and a co-calibrated high-end optical tracking system was developed. The resulting dataset comprises RGB-D recordings of pedicle screw placement along with individually tracked ground truth poses and shapes of spine levels L1–L5 from ten cadaveric specimens. Besides a detailed description of our setup, quantitative and qualitative outcome measures are provided. We found a mean target registration error of 1.5 mm. The median deviation between measured and ground truth bone surface was 2.4 mm. In addition, a surgeon rated the overall alignment based on 10% random samples as 5.8 on a scale from 1 to 6. Generation of labeled RGB-D data for orthopedic interventions with satisfactory accuracy is feasible, and its publication shall promote future development of data-driven artificial intelligence methods for fast and reliable intraoperative registration.

scholarly journals Alternative Pedicle Screw Design via Biomechanical Evaluation

2020 ◽  
Vol 10 (14) ◽  
pp. 4746 ◽  
Author(s):  
Jiwoon Kwon ◽  
Myung Heon Ha ◽  
Moon Gu Lee
Keyword(s):  
Spinal Fusion ◽  
Pedicle Screw ◽  
Bending Strength ◽  
Pedicle Screws ◽  
The Elderly ◽  
Spinal Diseases ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Screw Design ◽  
Experimental Apparatus

With the recent increase in the elderly population, many people suffer from spinal diseases, and, accordingly, spinal fusion surgery using pedicle screws has been widely applied to treat them. However, most research on pedicle screw design has been focused on the test results rather than the behavior of the screws and vertebrae. In this study, a design platform with a series of biomechanical tests and analyses were presented for pedicle screw improvement and evaluation. The platform was then applied to an alternative hybrid screw design with quadruple and double threads. An experimental apparatus was developed to investigate the bending strength of the screw, and several tests were performed based on the ASTM F1717 standard. In the experiments, it was confirmed that the alternative pedicle screw has the highest bending strength. To examine the stress distribution of pedicle screws, finite element models were established, through which it was found that the proposed pedicle screw has sufficient mechanical safety to make it acceptable for spinal fusion treatment. Finally, we conclude that the platform has good potential for the design and evaluation of pedicle screws, and the alternative dual screw design is one of the best options for spinal fusion surgery.

Robotic-assisted pedicle screw placement fails to reduce overall postoperative complications in fusion surgery

2019 ◽  
Vol 19 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Alexander M. Lieber ◽  
Gregory J. Kirchner ◽  
Yehuda E. Kerbel ◽  
Amrit S. Khalsa
Keyword(s):  
Postoperative Complications ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Fusion Surgery ◽  
Robotic Assisted

Navigated Pedicle Screw Placement in Lumbar Spine Fusion Surgery

2007 ◽  
pp. 540-546
Author(s):  
J. Geerling ◽  
D. Kendoff ◽  
M. Citak ◽  
A. Gösling ◽  
T. Gösling ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Spine Fusion ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Fusion Surgery ◽  
Lumbar Spine Fusion

scholarly journals Ultrasound Guided Pedicle Screw Entry Point Identification for Spinal Fusion Surgery

10.29007/chdq ◽  
2019 ◽  
Author(s):  
Xiao Qi ◽  
Michael Vives ◽  
Ilker Hacihaliloglu
Keyword(s):  
Spinal Fusion ◽  
Pedicle Screw ◽  
Identification Accuracy ◽  
Automatic Identification ◽  
Navigation Systems ◽  
Accurate Identification ◽  
Fusion Surgery ◽  
Screw Insertion ◽  
Spinal Fusion Surgery

Accurate identification of the location the vertebra and corresponding pedicle is critical during pedicle screw insertion for percutaneous spinal fusion surgery. Currently, two dimensional (2D) fluoroscopy based navigation systems have extensive usage in spinal fusion surgery. Relying on 2D projection images for screw guidance results in high misplacement rates. Furthermore, fluoroscopy-based guidance exposes the surgical staff and patient to harmful ionizing radiation. Real-time non-radiation-based ultrasound (US) is a potential alternative to intra-operative fluoroscopy. However, accurate interpretation of noisy US data and manual operation of the transducer during data collection remains a challenge. In this work we investigate the potential of using multi-modal deep convolutional neural network (CNN) architectures for fully automatic identification of vertebra level and pedicle from US data. Our proposed network achieves 93.54% vertebra identification accuracy on in vivo US data collected from 27 subjects.

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