A new 3-dimensional method for measuring precision in surgical navigation and methods to optimize navigation accuracy

Kleck, Christopher; Cullilmore, Ian; LaFleur, Matthew; Lindley, Emily M.; Rentschler, Mark E.; Burger, Evalina L.; Cain, Christopher M.; Patel, Vikas V.

doi:10.1007/s00586-015-4235-0

Cited by 36 publications

(26 citation statements)

References 48 publications

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“…In our study, we saw a malposition and need for correction in only 1.9% of pedicle approaches (3/154). 98.1% of accurate pedicle approaches is an excellent result of our series compared to the previous studies with rates ranging from 78 to 100% in open and MIS surgical procedures [14,[24][25][26][27][29][30][31]. The fact that an additional haptic control of intrapedicular course of the implant is not possible in MIS surgery did not have any effect on accuracy in our series.…”

Section: Discussionsupporting

confidence: 55%

“…Miekisiak et al found an accuracy of 79% in free-hand administered pedicle screws in a series leading to 2 revisions in 85 cases [28]. Kleck et al published an accuracy of 94% in a CT-based navigation series using the O-arm CTguided navigation technique distributed by Medtronic [29]. Kraus et al saw an accuracy of 90.3% (< 2 mm breaching) in fluoroscopy navigation-guided pedicle screws compared to 94.6% in the standard technique pedicle screws in the thoracic and lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

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A minimally invasive, 3D-fluoroscopy-navigation-guided, 3D-controlled pedicle approach in spine surgery: first reliable results and impact on patient safety

Saman

Meier

Marzi

2020

Eur J Trauma Emerg Surg

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Purpose Safe pedicle screw placement is a daily challenge to every spine surgeon. Introduction of minimally invasive approaches in spinal surgery led to an impaired facility of inspection of the surgical field increasing the importance of intraoperative imaging and navigation. During the past years, we established a minimally invasive, navigated approach in our clinical setting. Methods We retrospectively reviewed the accuracy of pedicle approaches in patients treated due to traumatic or osteoporotic fractures, spondylitis/discitis, and tumoral lesions. Guide wires for pedicle screws or kyphoplasty cannulas were inserted in a 3D-navigation-guided, minimally invasive technique. Positioning of the guide wires was verified via 3D-scan, and pedicle screws/kyphoplasty cannulas were then visualized via a.p./lateral radiographs. Accuracy data were compared to a standard navigated open approach control group with indications similar to the MIS-group. Results 23 MIS patients were included in this study (25-84 years, mean 70 years) with a total of 154 placed guide wires. Handling of the navigated Jamshidi needle was easy and secure. The guide wires showed correct placement in 151/154 cases. Three wires (1.9%) needed correction of placement after control scan. There were no vascular or neurologic complications due to wire misplacement. In the open-surgery control group, 7/181 screws (3.9%) needed intraoperative correction presenting no significant difference compared to the correction rate of the MIS-group (p = 0.35). Conclusion Our study shows the feasibility and reliability of a navigation-guided, minimally invasive pedicle approach in the clinical setting. Therefore, reduced morbidity due to minimized approaches can be combined with higher accuracy of navigated pedicle screw/kyphoplasty cannula placement improving patient safety.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

A minimally invasive, 3D-fluoroscopy-navigation-guided, 3D-controlled pedicle approach in spine surgery: first reliable results and impact on patient safety

Saman

Meier

Marzi

2020

Eur J Trauma Emerg Surg

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“…The position of the inserted screws relative to the planned path was measured on postoperative 3D scans to assess technical accuracy. 8 , 9 The angular deviation was measured in the axial as well as in the sagittal plane. 9 – 11 Figure 3 depicts the technical accuracy and angular deviation measurements.…”

Section: Methodsmentioning

confidence: 99%

Feasibility and Accuracy of Thoracolumbar Minimally Invasive Pedicle Screw Placement With Augmented Reality Navigation Technology

Elmi-Terander

Nachabé

Skúlason

et al. 2018

Spine

111

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Study Design.Cadaveric laboratory study.Objective.To assess the feasibility and accuracy of minimally invasive thoracolumbar pedicle screw placement using augmented reality (AR) surgical navigation.Summary of Background Data.Minimally invasive spine (MIS) surgery has increasingly become the method of choice for a wide variety of spine pathologies. Navigation technology based on AR has been shown to be feasible, accurate, and safe in open procedures. AR technology may also be used for MIS surgery.Methods.The AR surgical navigation was installed in a hybrid operating room (OR). The hybrid OR includes a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D imaging capabilities, integrated optical cameras for AR navigation, and patient motion tracking using optical markers on the skin. Navigation and screw placement was without any x-ray guidance. Two neurosurgeons placed 66 Jamshidi needles (two cadavers) and 18 cannulated pedicle screws (one cadaver) in the thoracolumbar spine. Technical accuracy was evaluated by measuring the distance between the tip of the actual needle position and the corresponding planned path as well as the angles between the needle and the desired path. Time needed for navigation along the virtual planned path was measured. An independent reviewer assessed the postoperative scans for the pedicle screws’ clinical accuracy.Results.Navigation time per insertion was 90 ± 53 seconds with an accuracy of 2.2 ± 1.3 mm. Accuracy was not dependent on operator. There was no correlation between navigation time and accuracy. The mean error angle between the Jamshidi needles and planned paths was 0.9° ± 0.8°. No screw was misplaced outside the pedicle. Two screws breached 2 to 4 mm yielding an overall accuracy of 89% (16/18).Conclusion.MIS screw placement directed by AR with intraoperative 3D imaging in a hybrid OR is accurate and efficient, without any fluoroscopy or x-ray imaging during the procedure.Level of Evidence: N/A

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“…The accuracy of this study is higher than the accuracy of other studies, and the stability of the system is excellent. As early as 2016, Kleck et al [37] employed the O-arm and StealthStation to evaluate the accuracy of the three-dimensional navigation of the pedicle screw. The obtained navigation accuracy is approximately 5.9 ± 3.5 mm.…”

Section: Comparison Of Spine Surgery Without Robotic Assistance Basedmentioning

confidence: 99%

Optimization of virtual and real registration technology based on augmented reality in a surgical navigation system

et al. 2020

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Background: The traditional navigation interface was intended only for two-dimensional observation by doctors; thus, this interface does not display the total spatial information for the lesion area. Surgical navigation systems have become essential tools that enable for doctors to accurately and safely perform complex operations. The image navigation interface is separated from the operating area, and the doctor needs to switch the field of vision between the screen and the patient's lesion area. In this paper, augmented reality (AR) technology was applied to spinal surgery to provide more intuitive information to surgeons. The accuracy of virtual and real registration was improved via research on AR technology. During the operation, the doctor could observe the AR image and the true shape of the internal spine through the skin. Methods: To improve the accuracy of virtual and real registration, a virtual and real registration technique based on an improved identification method and robotassisted method was proposed. The experimental method was optimized by using the improved identification method. X-ray images were used to verify the effectiveness of the puncture performed by the robot. Results: The final experimental results show that the average accuracy of the virtual and real registration based on the general identification method was 9.73 ± 0.46 mm (range 8.90-10.23 mm). The average accuracy of the virtual and real registration based on the improved identification method was 3.54 ± 0.13 mm (range 3.36-3.73 mm). Compared with the virtual and real registration based on the general identification method, the accuracy was improved by approximately 65%. The highest accuracy of the virtual and real registration based on the robot-assisted method was 2.39 mm. The accuracy was improved by approximately 28.5% based on the improved identification method. Conclusion: The experimental results show that the two optimized methods are highly very effective. The proposed AR navigation system has high accuracy and stability. This system may have value in future spinal surgeries.

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A new 3-dimensional method for measuring precision in surgical navigation and methods to optimize navigation accuracy

Cited by 36 publications

References 48 publications

A minimally invasive, 3D-fluoroscopy-navigation-guided, 3D-controlled pedicle approach in spine surgery: first reliable results and impact on patient safety

A minimally invasive, 3D-fluoroscopy-navigation-guided, 3D-controlled pedicle approach in spine surgery: first reliable results and impact on patient safety

Feasibility and Accuracy of Thoracolumbar Minimally Invasive Pedicle Screw Placement With Augmented Reality Navigation Technology

Optimization of virtual and real registration technology based on augmented reality in a surgical navigation system

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