Reliable navigation registration in cranial and spine surgery based on intraoperative computed tomography

Carl, Barbara; Bopp, Miriam; Saß, Benjamin; Pojskić, Mirza; Gjorgjevski, Marko; Voellger, Benjamin; Nimsky, Christopher

doi:10.3171/2019.8.focus19621

Cited by 49 publications

(50 citation statements)

References 33 publications

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“…ED for the control scan was 4.51 ± 2.48 mSv. Segmentation of the implant and its visualization with updated AR allowed the checking of patient accuracy and patient registration, image registration, and AR calibration [ 20 ]. In this series, no revision surgeries were needed following control iCT.…”

Section: Resultsmentioning

confidence: 99%

“…However, this strategy is not applicable to the lateral approach to the spine because it can be implemented only in posterior open surgery. In spine procedures, fiducial-based registration is an option only when intraoperative imaging is available, because flexibility of the spine precludes the vertebra alignment during the preoperative scan being identical to the intraoperative alignment [ 20 , 22 ]. User-independent registration can be achieved by intraoperative imaging, which, regarding spinal surgery, has the additional advantage that the positioning of the patient and vertebral alignment during imaging correspond to the real intraoperative situation.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

et al. 2021

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Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

et al. 2021

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“…In this workflow, the Dynamic Reference Frame is fixated intra-operatively, and during acquisition of a Cone-Beam CT (CBCT) the DRF is tracked with the optical camera 7,10,12,30 . This method yields an accurate registration, even if low-dose scan protocols are used, but may lead to an increase in operation time and pose logistical challenges intra-operatively 10,12 . A compatible intra-operative scanner is required, and currently, this method is only available for optical tracking.…”

Section: Discussionmentioning

confidence: 99%

Registration-Free Workflow for Electromagnetic and Optical Navigation in Orbital and Craniofacial Surgery

Schreurs

Baan

Klop

et al. 2020

Preprint

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The accuracy of intra-operative navigation is largely dependent on the intra-operative registration procedure. Next to accuracy, important factors to consider for the registration procedure are invasiveness, time consumption, logistical demands, user-dependency, compatibility and radiation exposure. In this study, a workflow is presented that eliminates the need for a registration procedure altogether: registration-free navigation. In the workflow, the maxillary dental model is fused to the pre-operative imaging data using commercially available virtual planning software. A virtual Dynamic Reference Frame on a splint is designed on the patient’s fused maxillary dentition: during surgery, the splint containing the reference frame is positioned on the patient’s dentition. This alleviates the need for any registration procedure, since the position of the reference frame is known from the design. The accuracy of the workflow was evaluated in a cadaver set-up, and compared to bone-anchored fiducial, virtual splint and surface-based registration. The results showed that accuracy of the workflow was greatly dependent on tracking technique used: the workflow was the most accurate with electromagnetic tracking, but the least accurate with optical tracking. Although this method offers a time-efficient, non-invasive, radiation-free automatic alternative for registration, clinical implementation is hampered by the unexplained differences in accuracy between tracking techniques.

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“…The same authors showed that the techniques currently employed in cranial surgery for HUD can be applied to spine tumor surgery (35). In a separate publication, they demonstrated that intraoperative CT can be used with a low-dose protocol for AR registration in spine cases with registration errors of less than 1 cm and 70% decrease in overall radiation exposure, which can further facilitate AR usage in spine surgery (36). Müller et al explored the use of 3D intraoperative fluoroscopy for AR registration (37).…”

Section: Workflows For Registrationmentioning

confidence: 99%

Current innovation in virtual and augmented reality in spine surgery

Yuk

Maragkos

Sato³

et al. 2021

Ann Transl Med

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In spinal surgery, outcomes are directly related both to patient and procedure selection, as well as the accuracy and precision of instrumentation placed. Poorly placed instrumentation can lead to spinal cord, nerve root or vascular injury. Traditionally, spine surgery was performed by open methods and placement of instrumentation under direct visualization. However, minimally invasive surgery (MIS) has seen substantial advances in spine, with an ever-increasing range of indications and procedures. For these reasons, novel methods to visualize anatomy and precisely guide surgery, such as intraoperative navigation, are extremely useful in this field. In this review, we present the recent advances and innovations utilizing simulation methods in spine surgery. The application of these techniques is still relatively new, however quickly being integrated in and outside the operating room. These include virtual reality (VR) (where the entire simulation is virtual), mixed reality (MR) (a combination of virtual and physical components), and augmented reality (AR) (the superimposition of a virtual component onto physical reality). VR and MR have primarily found applications in a teaching and preparatory role, while AR is mainly applied in hands-on surgical settings. The present review attempts to provide an overview of the latest advances and applications of these methods in the neurosurgical spine setting.

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Reliable navigation registration in cranial and spine surgery based on intraoperative computed tomography

Cited by 49 publications

References 33 publications

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

Registration-Free Workflow for Electromagnetic and Optical Navigation in Orbital and Craniofacial Surgery

Current innovation in virtual and augmented reality in spine surgery

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