Navigation Using Fluoro-CT Technology

Abstract

Background: The mobile SIREMOBIL® Iso-C 3D C-arm is a device that permits the intraoperative three-dimensional (3-D) representation of bony structures (multiplanar reconstructions). Linking to navigation makes it possible to transfer the generated 3-D data directly to the navigation system. The advantages of CT-based navigation with 3-D representation of bone structures are therefore combined with the advantages of inherent navigation with intraoperative imaging. The surgical instrument is immediately displayed in the image, i.e., without any complex manual registration procedure. Patients and Methods: Inherent navigation in 3-D images from the Iso-C 3D was successfully used for the first time in this study in a larger group of patients. 39 patients who intraoperatively underwent successful navigation in Iso-C 3D images were included in the study. Results: 143 drilling procedures were performed in the 39 patients. Pedicle instrumentations took place in 24 of the 39 patients. Eight patients underwent screw placements on the pelvic ring (sacroiliac joint screw placement, placement of anterior column screw, acetabulum osteosynthesis). Four patients underwent retrograde perforation of a talus cyst and filling with autologous cancellous bone, while one patient underwent screw osteosynthesis on the neck of the femur, and two patients underwent placement of an external fixator with a hinge at the elbow joint. One pedicle screw was found to be 2 mm out of position in the spinal group. All other screws/drillings were placed correctly. Additionally, in three patients intraoperative navigation had to be aborted due to hard-or software problems. In these cases, surgery was finished in conventional ways. Conclusion:The results herein for the extremities, spine, and pelvis are very encouraging and portend an advance in safety and quality in the operating room (OR). As compared to the conventional approach and other computer-assisted procedures (CT-based navigation, C-arm-based 2-D navigation), the lowest rate of incorrect placements and the lowest average fluoroscopy time were achieved during the placement of pedicle screws on the spine with Iso-C 3D navigation at a comparable average OR duration. Iso-C 3D navigation supports standardized work procedures in the OR.

Assessment of spline‐based 2D–3D registration for image‐guided spine surgery

“…Recently, intra-operative 3D fluoroscopy-based computerized tomography has been introduced as an image modality for image-guided spine surgery (24,25). The availability of 3D imaging in the operating room provides full information about the current anatomical setting.…”

Computer assisted orthopaedic surgery: Past, present and future

“…This last technique allows the reduction of radiation dose during surgery because after completing registration and matching it is not necessary to take any further image intensifier shots during the surgical procedure. [19] This last modality is mainly used in spine and trauma surgery.…”

Computer-Assisted Orthopedic Surgery: Current State and Future Perspective

“…It consists of a motorized, iso-centric C-arm that acquires series of 50–100, 2-D projections and reconstructs from them 13 cm × 13 cm × 13 cm volumetric datasets that are comparable to CT scans. Being initially advocated primarily for surgery at the extremities, this “fluoro-CT” has been adopted for usage with a navigation system and has been applied to several anatomical areas already ( 13 , 14 ). As a major advantage, the device combines the availability of 3-D imaging with the intra-operative data acquisition.…”

“…Efforts to apply it to total hip replacement ( 66 ) and the treatment of long bone fractures ( 67 ) have been commercially less successful. The intra-operative 3-D fluoroscopy or O-arm has been explored intensively ( 13 – 16 ). It is expected that with the advent of the flat panel technology, the use of fluoro-CT as a virtual object generator will significantly grow ( 16 ).…”