Navigation-assisted surgery for tumors of the spine

Bandiera, Stefano; Ghermandi, Riccardo; Gasbarrini, A.; Bròdano, Giovanni Barbanti; Colangeli, Simone; Boriani, Stefano

doi:10.1007/s00586-013-3032-x

Cited by 35 publications

(19 citation statements)

References 23 publications

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“…Previous published reports have described the use of IGS in other areas of the spine. 2,3,5 Two published reports describe the use of IGS in a total of 4 patients with aggressive sacral tumors-1 patient with Ewing's sarcoma 1 and 3 patients with sacral chordoma. 22 In both reports, IGS was found to be a useful adjunct to the surgeon's anatomical knowledge and to decrease the likelihood of injury to vital adjacent structures.…”

Section: Introductionmentioning

confidence: 99%

Image-guided resection of aggressive sacral tumors

Drazin¹,

Bhamb

Al-Khouja³

et al. 2017

FOC

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OBJECTIVE The aim of this study was to identify and discuss operative nuances utilizing image guidance in the surgical management of aggressive sacral tumors. METHODS The authors report on their single-institution, multi-surgeon, retrospective case series involving patients with pathology-proven aggressive sacral tumors treated between 2009 and 2016. They also reviewed the literature to identify articles related to aggressive sacral tumors, their diagnosis, and their surgical treatment and discuss the results together with their own experience. Information, including background, imaging, treatment, and surgical pearls, is organized by tumor type. RESULTS Review of the institutional records identified 6 patients with sacral tumors who underwent surgery between 2009 and 2016. All 6 patients were treated with image-guided surgery using cone-beam CT technology (O-arm). The surgical technique used is described in detail, and 2 illustrative cases are presented. From the literature, the authors compiled information about chordomas, chondrosarcomas, giant cell tumors, and osteosarcomas and organized it by tumor type, providing a detailed discussion of background, imaging, and treatment as well as surgical pearls for each tumor type. CONCLUSIONS Aggressive sacral tumors can be an extremely difficult challenge for both the patient and the treating physician. The selected surgical intervention varies depending on the type of tumor, size, and location. Surgery can have profound risks including neural compression, lumbopelvic instability, and suboptimal oncological resection. Focusing on the operative nuances for each type can help prevent many of these complications. Anecdotal evidence is provided that utilization of image-guided surgery to aid in tumor resection at our institution has helped reduce blood loss and the local recurrence rate while preserving function in both malignant and aggressive benign tumors affecting the sacrum.

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Section: Introductionmentioning

confidence: 99%

Image-guided resection of aggressive sacral tumors

Drazin¹,

Bhamb

Al-Khouja³

et al. 2017

FOC

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“…How to master this technique quickly, accurately and is a thorny problem facing in the clinical physician training. We found that computer-assisted navigation technology can significantly shorten the operation period, reduce the amount of blood loss and reduce the error during implantation of screws [5][6][7][8] . It is suggested that intraoperative navigation can significantly shorten the learning curve, reduce the time of screw implantation, reduce the amount of bleeding, improve the accuracy of pedicle screw implantation and avoid the risk of culture.…”

Section: Discussionmentioning

confidence: 99%

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

Liu¹,

Zhang²,

Zhao³

et al. 2017

Adv Emerg Med

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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. ConclusionComputer-assistant navigation system facilitates the learning of standardized trainees, and reduces the time-consuming and bleeding in thoracic pedicle screw insertion.Orthodontics training is the most important low-grade physician training in the orthopedic department 1,2 . Due to the complexity of spinal anatomy, professional required and high risk of spinal surgery, thoracic pedicle screw implantation has become a very demanding technique. Furthermore, the spine surgery learning is not conducive to the trainees. Since 2013, our department started to use the computer-assisted three-dimensional navigation technology to guide the implantation of screws 3 . We found that the computer-assisted navigation technology has greater advantage when compared with the traditional hand-implanted technology.

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“…Such spinal diseases are treatable by surgery; however, the complexity of spinal structure and function can challenge safe and accurate intervention. Especially for minimally invasive surgical approaches, image guidance improves the localization of target anatomy (e.g., vertebral levels and tumors) and critical structures (e.g., nervous and vascular systems) and has been shown to improve surgical accuracy and outcomes in pedicle screw placement [5], [6], correction of spinal deformities [5], [6], trauma surgery [7], percutaneous vertebroplasty [8], and resection of tumors [9]. …”

Section: Introductionmentioning

confidence: 99%

MIND Demons: Symmetric Diffeomorphic Deformable Registration of MR and CT for Image-Guided Spine Surgery

Reaungamornrat

Silva

Uneri

et al. 2016

IEEE Trans. Med. Imaging

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Intraoperative localization of target anatomy and critical structures defined in preoperative MR/CT images can be achieved through the use of multimodality deformable registration. We propose a symmetric diffeomorphic deformable registration algorithm incorporating a modality-independent neighborhood descriptor (MIND) and a robust Huber metric for MR-to-CT registration. The method, called MIND Demons, finds a deformation field between two images by optimizing an energy functional that incorporates both the forward and inverse deformations, smoothness on the integrated velocity fields, a modality-insensitive similarity function suitable to multimodality images, and smoothness on the diffeomorphisms themselves. Direct optimization without relying on the exponential map and stationary velocity field approximation used in conventional diffeomorphic Demons is carried out using a Gauss-Newton method for fast convergence. Registration performance and sensitivity to registration parameters were analyzed in simulation, phantom experiments, and clinical studies emulating application in image-guided spine surgery, and results were compared to mutual information (MI) free-form deformation (FFD), local MI (LMI) FFD, normalized MI (NMI) Demons, and MIND with a diffusion-based registration method (MIND-elastic). The method yielded sub-voxel invertibility (0.008 mm) and nonzero-positive Jacobian determinants. It also showed improved registration accuracy in comparison to the reference methods, with mean target registration error (TRE) of 1.7 mm compared to 11.3, 3.1, 5.6, and 2.4 mm for MI FFD, LMI FFD, NMI Demons, and MIND-elastic methods, respectively. Validation in clinical studies demonstrated realistic deformations with sub-voxel TRE in cases of cervical, thoracic, and lumbar spine.

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Navigation-assisted surgery for tumors of the spine

Abstract: Navigation system can improve surgical accuracy in screws placement and tumor localization and excision. Learning curve and technical aspects must be considered to avoid potential serious mistakes.

Cited by 35 publications

References 23 publications

Image-guided resection of aggressive sacral tumors

Image-guided resection of aggressive sacral tumors

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

MIND Demons: Symmetric Diffeomorphic Deformable Registration of MR and CT for Image-Guided Spine Surgery

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