Spinal intraoperative three-dimensional navigation: correlation between clinical and absolute engineering accuracy

Guha, Daipayan; Jakubovic, Raphael; Gupta, Shaurya; Alotaibi, Naif M.; Cadotte, David W.; Costa, Leodante B. da; George, Rajeesh; Heyn, Chris; Howard, Peter; Kapadia, Anish; Klostranec, Jesse M.; Phan, Nicolas; Tan, Gamaliel; Mainprize, Todd G.; Yee, Albert; Yang, Victor X. D.

doi:10.1016/j.spinee.2016.10.020

Cited by 32 publications

(30 citation statements)

References 39 publications

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“…The true engineering accuracy of the experimental navigation system is therefore underestimated. Clinical grading of screws, using the established Heary grading system 27 , was performed independently by two neuroradiologists (CH, PH), three neurosurgeons (DWC, NP, & LC) and two orthopedic spine surgeons (RG, GT) (Table 2 ). A mean clinical major breach (Heary III–IV) rate of 5.7% for all navigated screws was reported, with strong intraclass correlation (ICC: 0.725; p < 0.001) and fair inter-rater agreement (Fleiss’ Kappa (95% CI): 0.248 (0.243–0.254); p < 0.0001).…”

Section: Resultsmentioning

confidence: 99%

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High Speed, High Density Intraoperative 3D Optical Topographical Imaging with Efficient Registration to MRI and CT for Craniospinal Surgical Navigation

Jakubovic

Guha

Gupta

et al. 2018

Sci Rep

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Intraoperative image-guided surgical navigation for craniospinal procedures has significantly improved accuracy by providing an avenue for the surgeon to visualize underlying internal structures corresponding to the exposed surface anatomy. Despite the obvious benefits of surgical navigation, surgeon adoption remains relatively low due to long setup and registration times, steep learning curves, and workflow disruptions. We introduce an experimental navigation system utilizing optical topographical imaging (OTI) to acquire the 3D surface anatomy of the surgical cavity, enabling visualization of internal structures relative to exposed surface anatomy from registered preoperative images. Our OTI approach includes near instantaneous and accurate optical measurement of >250,000 surface points, computed at >52,000 points-per-second for considerably faster patient registration than commercially available benchmark systems without compromising spatial accuracy. Our experience of 171 human craniospinal surgical procedures, demonstrated significant workflow improvement (41 s vs. 258 s and 794 s, p < 0.05) relative to benchmark navigation systems without compromising surgical accuracy. Our advancements provide the cornerstone for widespread adoption of image guidance technologies for faster and safer surgeries without intraoperative CT or MRI scans. This work represents a major workflow improvement for navigated craniospinal procedures with possible extension to other image-guided applications.

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Section: Resultsmentioning

confidence: 99%

“…6 ). The accuracy measured in this study is the total surgical application accuracy, stacking the navigation system’s accuracy with the surgeon’s ability to utilize 3D navigation data in placing pedicle screws, where surgeon’s experience and anatomical knowledge also contribute 27 .…”

Section: Discussionmentioning

confidence: 99%

High Speed, High Density Intraoperative 3D Optical Topographical Imaging with Efficient Registration to MRI and CT for Craniospinal Surgical Navigation

Jakubovic

Guha

Gupta

et al. 2018

Sci Rep

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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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“…www.nature.com/scientificreports www.nature.com/scientificreports/ caudo-cranial direction) deviations as highlighted in Fig. 2b, or as the compound 2D distance 16,24,25 . Likewise, the angular deviation was measured in the axial and sagittal planes 15,[25][26][27] .…”

Section: Technical and Clinical Accuracy Evaluation To Reduce Metal mentioning

confidence: 99%

Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

Burström

Balicki

Patriciu

et al. 2020

Sci Rep

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Adrian elmi-terander 1,2 the combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory. The goal of this study was to examine the feasibility, accuracy and efficacy of a new robot-guided system for semi-automated, minimally invasive, pedicle screw placement. A custom robotic arm was integrated into a hybrid operating room (OR) equipped with an augmented reality surgical navigation system (ARSN). The robot was mounted on the OR-table and used to assist in placing Jamshidi needles in 113 pedicles in four cadavers. The ARSN system was used for planning screw paths and directing the robot. the robot arm autonomously aligned with the planned screw trajectory, and the surgeon inserted the Jamshidi needle into the pedicle. Accuracy measurements were performed on verification cone beam computed tomographies with the planned paths superimposed. To provide a clinical grading according to the Gertzbein scale, pedicle screw diameters were simulated on the placed Jamshidi needles. A technical accuracy at bone entry point of 0.48 ± 0.44 mm and 0.68 ± 0.58 mm was achieved in the axial and sagittal views, respectively. The corresponding angular errors were 0.94 ± 0.83° and 0.87 ± 0.82°. The accuracy was statistically superior (p < 0.001) to ARSN without robotic assistance. Simulated pedicle screw grading resulted in a clinical accuracy of 100%. This study demonstrates that the use of a semi-automated surgical robot for pedicle screw placement provides an accuracy well above what is clinically acceptable. The insertion of pedicle screws remains one of the critical steps in spine surgeries involving thoracolumbar posterior fixation. The procedure poses risks for complications, as both neural and vascular structures are in close proximity to the pedicles. A meta-analysis by Gelalis et al. reported that 1-6.5% of pedicle screws placed using free-hand technique had a cortical violation >4 mm 1. Meanwhile, minimally invasive spine (MIS) surgery is increasingly preferred due to reductions in blood loss, length of hospital stay, and surgical site infections 2. Accuracy and complication rates, however, are not different 3,4. When relying only on fluoroscopy in MIS, the pedicle perforation rate has been reported to be in the range of 12.5-13.5% 5-7. Since MIS reduces anatomical feedback to the surgeon, it can be argued that image guidance, and perhaps also robotic guidance, has a natural role in this kind of surgery 8. The promises of increased accuracy, decreased complication rates, and reduced radiation exposure to the surgical team has led to an increasing use of robots in MIS surgery 9. There are currently several navigated robotic systems available on the market employing various strategies for 3D planning using pre-or intraoperative fluoroscopy or CT. The most frequently reported ones in the literature are the Mazor robots (MAZOR Robotics Ltd., Caesarea, Israel) and the ROSA Spine system (Medtech S.A., Montpellier, France). The Mazor robot...

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Spinal intraoperative three-dimensional navigation: correlation between clinical and absolute engineering accuracy

Cited by 32 publications

References 39 publications

High Speed, High Density Intraoperative 3D Optical Topographical Imaging with Efficient Registration to MRI and CT for Craniospinal Surgical Navigation

High Speed, High Density Intraoperative 3D Optical Topographical Imaging with Efficient Registration to MRI and CT for Craniospinal Surgical Navigation

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

Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

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