A novel cost-effective computer-assisted imaging technology for accurate placement of thoracic pedicle screws

2011 ◽  
Vol 15 (5) ◽  
pp. 479-485 ◽  
Author(s):  
Yuichiro Abe ◽  
Manabu Ito ◽  
Kuniyoshi Abumi ◽  
Yoshihisa Kotani ◽  
Hideki Sudo ◽  
...  
Keyword(s):  
Preoperative Planning ◽  
Pedicle Screws ◽  
Entry Point ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Special Equipment ◽  
Operating Theater ◽  
Thoracic Pedicle Screws ◽  
Intraoperative Guidance ◽  
The Ideal

Object Use of computer-assisted spine surgery (CASS) technologies, such as navigation systems, to improve the accuracy of pedicle screw (PS) placement is increasingly popular. Despite of their benefits, previous CASS systems are too expensive to be ubiquitously employed, and more affordable and portable systems are desirable. The aim of this study was to introduce a novel and affordable computer-assisted technique that 3-dimensionally visualizes anatomical features of the pedicles and assists in PS insertion. The authors have termed this the 3D-visual guidance technique for inserting pedicle screws (3D-VG TIPS). Methods The 3D-VG technique for placing PSs requires only a consumer-class computer with an inexpensive 3D DICOM viewer; other special equipment is unnecessary. Preoperative CT data of the spine were collected for each patient using the 3D-VG TIPS. In this technique, the anatomical axis of each pedicle can be analyzed by volume-rendered 3D models, as with existing navigation systems, and both the ideal entry point and the trajectory of each PS can be visualized on the surface of 3D-rendered images. Intraoperative guidance slides are made from these images and displayed on a TV monitor in the operating room. The surgeon can insert PSs according to these guidance slides. The authors enrolled 30 patients with adolescent idiopathic scoliosis (AIS) who underwent posterior fusion with segmental screw fixation for validation of this technique. Results The novel technique allowed surgeons, from office or home, to evaluate the precise anatomy of each pedicle and the risks of screw misplacement, and to perform 3D preoperative planning for screw placement on their own computer. Looking at both 3D guidance images on a TV monitor and the bony structures of the posterior elements in each patient in the operating theater, surgeons were able to determine the best entry point for each PS with ease and confidence. Using the current technique, the screw malposition rate was 4.5% in the thoracic region in corrective surgery for AIS. Conclusions The authors found that 3D-VG TIPS worked on a consumer-class computer and easily visualized the ideal entry point and trajectory of PSs in any operating theater without costly special equipment. This new technique is suitable for preoperative planning and intraoperative guidance when performing reconstructive surgery with PSs.

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

scholarly journals Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis

2011 ◽  
Vol 21 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Peiqiang Su ◽  
Wentong Zhang ◽  
Yan Peng ◽  
Anjing Liang ◽  
Kaili Du ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Tomographic Reconstruction ◽  
Pedicle Screws ◽  
Entry Point ◽  
Computed Tomographic ◽  
The Ideal

Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging

2011 ◽  
Vol 14 (4) ◽  
pp. 532-536 ◽  
Author(s):  
Matthias F. Oertel ◽  
Juliane Hobart ◽  
Marco Stein ◽  
Vanessa Schreiber ◽  
Wolfram Scharbrodt
Keyword(s):  
Imaging System ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Radiographic Imaging ◽  
Spinal Navigation ◽  
Multidimensional Imaging ◽  
The Difference ◽  
Navigated Spine Surgery ◽  
Traditional Image

Object In recent years, the importance of intraoperative navigation in neurosurgery has been increasing. Multiple studies have proven the advantages and safety of computer-assisted spinal neurosurgery. The use of intraoperative 3D radiographic imaging to acquire image information for navigational purposes has several advantages and should increase the accuracy and safety of screw guidance with navigation. The aim of this study was to evaluate the clinical and methodological precision of navigated spine surgery in combination with the O-arm multidimensional imaging system. Methods Thoracic, lumbar, and sacral pedicle screws that were placed with the help of the combination of the O-arm and StealthStation TREON plus navigation systems were analyzed. To evaluate clinical precision, 278 polyaxial pedicle screws in 139 vertebrae were reviewed for medial or caudal perforations on coronal projection. For the evaluation of the methodological accuracy, virtual and intraoperative images were compared, and the angulation of the pedicle screw to the midsagittal line was measured. Results Pedicle perforations were recorded in 3.2% of pedicle screws. None of the perforated pedicle screws damaged a nerve root. The difference in angulation between the actual and virtual pedicle screws was 2.8° ± 1.9°. Conclusions The use of the StealthStation TREON plus navigation system in combination with the O-arm system showed the highest accuracy for spinal navigation compared with other studies that used traditional image acquisition and registration for navigation.

scholarly journals Določanje velikosti in vstavitvene trajektorije pedikularnih vijakov v računalniškotomografskih (CT) slikah deformacij prsne hrbtenice: primerjava ročnega in računalniško podprtega predoperacijskega načrtovanja

2017 ◽  
Vol 85 (11-12) ◽  
Author(s):  
Dejan Knez ◽  
Janez Mohar ◽  
Robert Janez Cirman ◽  
Boštjan Likar ◽  
Franjo Pernuš ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Preoperative Planning ◽  
Sagittal Plane ◽  
Pedicle Screws ◽  
Ct Images ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Pull Out ◽  
Significant Difference

Background: Vertebral fixation by pedicle screw placement is the most frequently applied fixation technique in spinal surgery. In this retrospective study we present a comparison of manual and computer-assisted preoperative planning of pedicle screw placement in three-dimensional (3D) computed tomography (CT) images of deformities in the thoracic spine.Methods: Manual planning of the pedicle screw size and trajectory was performed by two orthopedic surgeons using a dedicated software for preoperative planning of surgical procedures, while computer-assisted planning was performed by automated image processing and analysis techniques through the optimization of screw fastening strength. The size (diameter and length) and trajectory (pedicle crossing point, inclination in the sagittal plane, inclination in the axial plane) were obtained for 316 pedicle screws from 3D CT images of 17 patients with thoracic spinal deformities.Results: the analysis of pedicle screw parameters, obtained by two manual and one computer-assisted planning, indicated a statistically significant difference in the screw size (p < 0.05) and trajectory (p < 0.001). Computer-assisted planning proposed wider (p < 0.05) and longer (p < 0.001) screws with a higher (p < 0.001) normalized fastening strength.Conclusions: The comparison revealed consistency between manual and computer-assisted planning of the pedicle screw size and trajectory, except for the screw inclination in the sagittal plane, as manual planning followed more the straight-forward while computer-assisted planning followed more the anatomical insertion technique. While being faster, more repeatable and more reliable than manual planning, computer-assisted planning was also linked with a higher screw fastening strength and consequently a higher screw pull-out strength.

scholarly journals Freehand thoracic pedicle screw technique using a uniform entry point and sagittal trajectory for all levels: preliminary clinical experience

2014 ◽  
Vol 21 (5) ◽  
pp. 778-784 ◽  
Author(s):  
Vernard S. Fennell ◽  
Sheri Palejwala ◽  
Jesse Skoch ◽  
David A. Stidd ◽  
Ali A. Baaj
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Transverse Process ◽  
Pedicle Screw Fixation ◽  
Entry Point ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Thoracic Pedicle Screw ◽  
Thoracic Pedicle Screws ◽  
Screw Diameter

Object Experience with freehand thoracic pedicle screw placement is well described in the literature. Published techniques rely on various starting points and trajectories for each level or segment of the thoracic spine. Furthermore, few studies provide specific guidance on sagittal and axial trajectories. The goal of this study was to propose a uniform entry point and sagittal trajectory for all thoracic levels during freehand pedicle screw placement and determine the accuracy of this technique. Methods The authors retrospectively reviewed postoperative CT scans of 33 consecutive patients who underwent open, freehand thoracic pedicle-screw fixation using a uniform entry point and sagittal trajectory for all levels. The same entry point for each level was defined as a point 3 mm caudal to the junction of the transverse process and the lateral margin of the superior articulating process, and the sagittal trajectory was always orthogonal to the dorsal curvature of the spine at that level. The medial angulation (axial trajectory) was approximately 30° at T-1 and T-2, and 20° from T-3 to T-12. Breach was defined as greater than 25% of the screw diameter residing outside of the pedicle or vertebral body. Results A total of 219 thoracic pedicle screws were placed with a 96% accuracy rate. There were no medial breaches and 9 minor lateral breaches (4.1%). None of the screws had to be repositioned postoperatively, and there were no neurovascular complications associated with the breaches. Conclusions It is feasible to place freehand thoracic pedicle screws using a uniform entry point and sagittal trajectory for all levels. The entry point does not have to be adjusted for each level as reported in existing studies, although this technique was not tested in severe scoliotic spines. While other techniques are effective and widely used, this particular method provides more specific parameters and may be easier to learn, teach, and adopt.

scholarly journals Computer-assisted surgery navigation of pedicle screw insertion by standardized trainees

2019 ◽  
Author(s):  
Ming Yong Liu
Keyword(s):  
Ct Scan ◽  
Pedicle Screw ◽  
Navigation System ◽  
Pedicle Screws ◽  
Computer Assisted Surgery ◽  
Control Group ◽  
Computer Assisted ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Thoracic Pedicle Screws

Objective: To assess the precision and efficiency computer-assisted surgery navigation of pedicle screw insertion by standardized trainees. Methods: From September 2013 to June 2016, 360 thoracic pedicle screws were inserted into 100 patients by standardized trainees (n = 30). Screws on the left side were inserted by hands (control group), while the other side were inserted under the guidance of computer-assistant navigation system (guided group). The insertion time and volume of blood lost by each screw were retrospectively analyzed. The precision ratio was assessed by computerized tomography (CT) scan after operation. Results: The time consumed in screw insertion was significantly shorter in the guided group than that in the control group. The blood lost volume was lesser in the guided group. Post-operation CT scan revealed higher precision in the guided group than that in the control group. Conclusion: Computer-assistant navigation system facilitates the learning of standardized trainees, and reduces the time-consuming and bleeding in thoracic pedicle screw insertion.

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