scholarly journals P.088 Spinal computer-assisted intra-operative three-dimensional navigation in Canada: a population-based time trend study

2017 ◽  
Vol 44 (S2) ◽  
pp. S35-S36 ◽  
Author(s):  
D Guha ◽  
A Moghaddamjou ◽  
NM Alotaibi ◽  
A Yee ◽  
VX Yang
Keyword(s):  
Temporal Trends ◽  
Three Dimensional ◽  
Population Based ◽  
Learning Curves ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Diagnostic Codes ◽  
Orthopedic Surgeons ◽  
Spinal Fusions ◽  
Univariate Analyses

Background: Spinal computer-assisted navigation (CAN) is proven to increase instrumentation accuracy. Adoption remains limited by workflow restrictions, learning curves and costs. Here, we assess spinal CAN usage among Ontario surgeons to identify gaps in application, and temporal trends of usage. Methods: A prospectively-collected database of provincial insurance billables and diagnostic codes was reviewed retrospectively, from 2002-2014. Patients undergoing instrumented spinal fusions or percutaneous vertebroplasty/kyphoplasty were identified. Fee and diagnostic codes were applied to distinguish surgical indication and approach. The use of intra-operative navigation was determined for each case. Results: We identified 4607 instrumented spinal fusions in our cohort. Most cases were performed by orthopedic surgeons (63.2%) and the remainder by neurosurgeons. Of 2239 cases with identifiable etiology, CAN was utilized in 8.8%, predominantly for trauma and degenerative pathologies rather than deformity. In univariate analyses, CAN was used more often by neurosurgeons (21.0% vs. 12.4%, p<0.001), in academic institutions (15.9% vs. 12.3%, p<0.001), and when performed in/after 2010 (18.9% vs. 8.9%, p<0.001). Differences by specialty and year remained significant in multiple logistic regression. Conclusions: Spinal CAN has proven benefit for instrumentation accuracy, but is used preferentially by academic neurosurgeons. Significant gains must be made in cost and usability to improve access across disciplines and institutions.

scholarly journals Utilization of Spinal Intra-operative Three-dimensional Navigation by Canadian Surgeons and Trainees: A Population-based Time Trend Study

2019 ◽  
Vol 46 (1) ◽  
pp. 87-95 ◽  
Author(s):  
Daipayan Guha ◽  
Ali Moghaddamjou ◽  
Zaneen H. Jiwani ◽  
Naif M. Alotaibi ◽  
Michael G. Fehlings ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Population Based ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Capital Costs ◽  
Orthopedic Surgeons ◽  
Surgical Trainees ◽  
Single Payer ◽  
The Impact

AbstractBackgroundComputer-assisted navigation (CAN) improves the accuracy of spinal instrumentation in vertebral fractures and degenerative spine disease; however, it is not widely adopted because of lack of training, high capital costs, workflow hindrances, and accuracy concerns. We characterize shifts in the use of spinal CAN over time and across disciplines in a single-payer health system, and assess the impact of intra-operative CAN on trainee proficiency across Canada.MethodsA prospectively maintained Ontario database of patients undergoing spinal instrumentation from 2005 to 2014 was reviewed retrospectively. Data were collected on treated pathology, spine region, surgical approach, institution type, and surgeon specialty. Trainee proficiency with CAN was assessed using an electronic questionnaire distributed across 15 Canadian orthopedic surgical and neurosurgical programs.ResultsIn our provincial cohort, 16.8% of instrumented fusions were CAN-guided. Navigation was used more frequently in academic institutions (15.9% vs. 12.3%, p<0.001) and by neurosurgeons than orthopedic surgeons (21.0% vs. 12.4%, p<0.001). Of residents and fellows 34.1% were fully comfortable using spinal CAN, greater for neurosurgical than orthopedic surgical trainees (48.1% vs. 11.8%, p=0.008). The use of CAN increased self-reported proficiency in thoracic instrumentation for all trainees by 11.0% (p=0.036), and in atlantoaxial instrumentation for orthopedic trainees by 18.0% (p=0.014).ConclusionsSpinal CAN is used most frequently by neurosurgeons and in academic centers. Most spine surgical trainees are not fully comfortable with the use of CAN, but report an increase in technical comfort with CAN guidance particularly for thoracic instrumentation. Increased education in spinal CAN for trainees, particularly at the fellowship stage and, specifically, for orthopedic surgery, may improve adoption.

CLINICAL VALIDATION OF A NOVEL SPRING LOADED TENSIONING DEVICE AND COMPUTER ASSISTED NAVIGATION

2006 ◽  
Vol 06 (01) ◽  
pp. 13-18
Author(s):  
S. BIGNOZZI ◽  
S. ZAFFAGNINI ◽  
S. MARTELLI ◽  
M. MARCACCI
Keyword(s):  
Randomized Study ◽  
Computer Software ◽  
Constant Load ◽  
Computer Assisted ◽  
Data Sets ◽  
Clinical Validation ◽  
Qualitative Comparison ◽  
Assisted Navigation ◽  
Orthopedic Surgeons ◽  
Ligament Tension

This study presents the validation of the tensioning device that applies a constant load to the medial and lateral compartments of knee joint separately, which can collapse or expand on each side independently, and that should be able to provide a better evaluation of ligament tension and allow the computer software to better plan the appropriate bone cuts or ligament release, and reports the first phase of the clinical validation of the tensioning device, including first qualitative comparison with standard navigated technique and consideration on the use of the device. A randomized study, involving five experienced orthopedic surgeons with 58 complete data sets, revealed that there is no statistical difference between the gaps obtained with standard navigated technique and tensioning device in extension, while in flexion there is an average difference 1.4 mm.

scholarly journals Application of a new percutaneous multi-function pedicle locator in minimally invasive spine surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaojian Liu ◽  
Hairun Liu ◽  
Yushan Wang
Keyword(s):  
Minimally Invasive ◽  
Spine Surgery ◽  
Three Dimensional ◽  
Operation Time ◽  
Minimally Invasive Spine Surgery ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Number Of Patients ◽  
Potential Benefits ◽  
Minimally Invasive Spine

AbstractIn this study, a new percutaneous multi-function pedicle locator was designed for personalized three-dimensional positioning of a pedicle in minimally invasive spine surgery (MISS) without computer-assisted navigation technology. The proposed locator was used in a number of patients during MISS, and its advantages were analyzed. Based on the position of a pedicle determined by computed tomography (CT) and fluoroscopic images of a patient, 6 lines and 2 distances were used to determine the puncture point of a pedicle screw on skin, while 2 angles were used to indicate the direction of insertion of a pedicle guide needle from the patient's body surface. The results of the proposed locator were compared with those of the conventional freehand technique in MISS. The potential benefits of using the locator included enhanced surgical accuracy, reduced operation time, alleviation of the harmful intra-operative radiation exposure, lower costs, and shortened learning curve for young orthopedists.

scholarly journals Robot Assisted Transforaminal Percutaneous Endoscopic Lumbar Discectomy

10.29007/34nd ◽  
2018 ◽  
Author(s):  
Han Wang ◽  
Yajun Liu ◽  
Mingxing Fan ◽  
Jile Jiang ◽  
Wei Tian
Keyword(s):  
Clinical Results ◽  
Needle Insertion ◽  
Lumbar Discectomy ◽  
Learning Curves ◽  
Computer Assisted ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Assisted Navigation ◽  
Endoscopic Spine Surgery ◽  
Transforaminal Approach ◽  
Endoscopic Lumbar Discectomy

Percutaneous endoscopic spine surgery is popular in recent years because of its minimally invasive manner. After transforaminal approach presented by Kambin in the late 1980s, many specific methods were described to establish an accurate and feasible approach to the target disc. Among them, the techniques of Yeung[1], Hoogland[2] and Ruetten[3] are the most famous ones and each has different design and indications. However, no consensus have been made because of the debated clinical results, steep learning curves, and pitfalls that exist in each approach. Guide needle insertion and subsequent working channel building remain a challenging procedure. Poor accuracy may lead to poor safety as the nerve root and dura are at risk. Many surgeons attempted to optimize the procedure, but few researches have integrated computer-assisted navigation with tPELD (transforaminal percutaneous endoscopic lumbar discectomy). It is time to bring our surgical robot into the field.

scholarly journals Present and Future Spinal Robotic and Enabling Technologies

2021 ◽  
Vol 21 (Supplement_1) ◽  
pp. S48-S56
Author(s):  
Siri Sahib S Khalsa ◽  
Praveen V Mummaneni ◽  
Dean Chou ◽  
Paul Park
Keyword(s):  
Intraoperative Imaging ◽  
Three Dimensional ◽  
Robotic Systems ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Planning Software ◽  
Enabling Technologies ◽  
Advanced Planning ◽  
Spinal Navigation

Abstract Enabling technologies include surgical planning software, computer-assisted navigation, intraoperative three-dimensional (3D) imaging, and robotic systems. Presently, these technologies are in various stages of refinement. Spinal robots in particular are currently limited to the positioning of an alignment guide for pedicle screw placement. Current generation spinal robots, therefore, play a more limited role in spinal surgery. In contrast to spinal robots, intraoperative imaging technology has been developed further, to a stage that allows accurate 3D spinal image acquisition that can be readily utilized for spinal navigation. The integration of these various technologies has the potential to maximize the safety, consistency, reliability, and efficacy of surgical procedures. To that end, the trend for manufacturers is to incorporate various enabling technologies into the spinal robotic systems. In the near-term, it is expected that integration of more advanced planning software and navigation will result in wider applicability and value. In the long-term, there are a variety of enabling technologies such as augmented reality that may be a component of spinal robots. This article reviews the features of currently available spinal robots and discusses the likely future advancements of robotic platforms in the near- and long-term.

scholarly journals Efficacy of a simple intraoperative stem-anteversion measuring device in total hip arthroplasty

2020 ◽  
Author(s):  
Kentaro Iwakiri ◽  
Yoichi Ohta ◽  
Yohei Ohyama ◽  
Yukihide Minoda ◽  
Akio Kobayashi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Measuring Device ◽  
Correction Angle ◽  
Assisted Navigation ◽  
Total Hip ◽  
Flexion Extension

Abstract Background Background: Stem anteversion is important in reducing postoperative complications in total hip arthroplasty (THA). THA utilizing the combined-anteversion theory requires stem anteversion angle (SAA) measurement intraoperatively; however, intraoperative SAA estimation is difficult for surgeons without computer-assisted navigation system. We evaluated the accuracy of the SAA measured intraoperatively using a newly developed device by comparing the three-dimensional measurements using postoperative computed tomography (CT).Materials & Methods In 127 hips in 127 patients who underwent unilateral THA at our hospital, we used our newly developed device that can be easily attached to rasping broach handles for measuring the SAA intraoperatively, which required the addition of the correction angle obtained in the preoperative epicondylar view. Postoperative SAA and its discrepancies from the measured intraoperative SAA with or without adding the correction angle were compared between the groups to evaluate the usefulness of the device.Results The intraoperative SAA measured by the device was 17.93 ± 7.53°. The true SAA measured on postoperative CT was 26.40 ± 9.73°. The discrepancy between the intraoperative SAA and true SAA was 8.94 ± 5.44° (without the correction angle), and 4.93 ± 3.85° (with the correction angle). Accuracy with a discrepancy of <5 degrees was achieved in 77 (60.6%) and <10 degrees was achieved in 113 (89.0%). The accuracy was unaffected by the stem placement angle (varus/valgus, or flexion/extension), or ipsilateral knee osteoarthritis.Conclusion The SAA measuring device, easily attachable to various rasping handles, is useful to measure the intraoperative SAA in a simple, economical, and noninvasive manner during THA.Level of Evidence Therapeutic Level IV.

scholarly journals Application of computer-assisted navigation in mandibular angle osteotomy

2019 ◽  
Vol 47 (7) ◽  
pp. 3160-3170 ◽  
Author(s):  
Liqin Lin ◽  
Bokai Fan ◽  
Zheyuan Yu ◽  
Liang Xu ◽  
Jie Yuan ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Approach ◽  
Mandibular Angle ◽  
Traditional Group ◽  
Assisted Navigation ◽  
Surgical Safety ◽  
Traditional Technique ◽  
Computed Tomography Images ◽  
Navigation Group

Objective To compare the effectiveness, accuracy, and surgical safety of a navigation technique with those of a traditional technique for intraoperative mandibular angle osteotomy. Methods Forty-three postsurgical patients with mandibular angle hypertrophy who were admitted to our Department from June 2014 to June 2017 were retrospectively reviewed. Of these patients, 23 underwent mandibular angle osteotomy using computer-assisted navigation (navigation group), and 20 underwent osteotomy using a traditional technique (traditional group). Postoperative computed tomography images were analyzed by three-dimensional software. Each patient’s facial proportion indices were measured using Mimics 19.0 software, and statistical comparisons and analyses were performed preoperatively and postoperatively. Results The postoperative facial contour morphology and facial proportion were improved in both groups; the navigation group showed greater improvement. The difference between the predicted and postoperative values was smaller in the navigation group than traditional group. The postoperative shape of the mandibular angle sample was similar to the preoperative predicted shape in the navigation group. No complications occurred in the navigation group, but paresthesia occurred in 17% of patients in the traditional group. Conclusions Mandibular angle osteotomy aided with computer-assisted navigation is more effective, accurate, and safe than the traditional technique and represents a promising clinical approach.

scholarly journals GP.01 Quantification of computational geometric congruence in surface-based registration for spinal intra-operative three-dimensional navigation

2017 ◽  
Vol 44 (S2) ◽  
pp. S7-S7
Author(s):  
D Guha ◽  
R Jakubovic ◽  
VX Yang
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Thoracolumbar Spine ◽  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Computational Modelling ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Subaxial Cervical Spine ◽  
Geometric Symmetry

Background: Computer-assisted navigation (CAN) may guide spinal instrumentation, and requires alignment of patient anatomy to imaging. Iterative-Closest-Point algorithms register anatomical and imaging datasets, which may fail in the presence of significant geometric congruence leading to inaccurate navigation. We computationally quantify geometric congruence in posterior spinal exposures, and identify predictors of potential navigation inaccuracy. Methods: Midline posterior exposures were performed from C1-S1 in four human cadavers. An optically-based CAN generated surface maps of the posterior elements at each level. Maps were reconstructed to include bilateral hemilamina, or unilateral hemilamina with/without the base of the spinous process. Maps were fitted to symmetrical geometries (cylindrical/spherical/planar) using computational modelling, and the degree of model fit quantified. Results: Increased cylindrical/spherical/planar symmetry was seen in the subaxial cervical spine relative to the high-cervical and thoracolumbar spine (p<0.001). Inclusion of the base of the spinous process decreased symmetry independent of spinal level (p<0.001). Registration with bilateral vs. unilateral hemilamina did not significantly reduce geometric symmetry. Conclusions: Geometric congruence is most evident at C1 and the subaxial cervical spine, warranting greater vigilance in navigation accuracy verification. At all levels, inclusion of the base of the spinous process in unilateral registration decreases the likelihood of geometric symmetry and navigation error.

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