1
|
Sakhrekar R, Shkumat N, Ertl-Wagner B, Lewis S, Lebel D, McVey MJ, Camp M. Pedicle screw accuracy placed with assistance of machine vision technology in patients with neuromuscular scoliosis. Spine Deform 2024; 12:739-746. [PMID: 38413472 DOI: 10.1007/s43390-024-00830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 01/13/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Pedicle screws are the primary method of vertebral fixation in scoliosis surgery, but there are lingering concerns over potential malposition. The rates of pedicle screw malposition in pediatric spine surgery vary from 10% to 21%. Malpositioned screws can lead to potentially catastrophic neurological, vascular, and visceral complications. Pedicle screw positioning in patients with neuromuscular scoliosis is challenging due to a combination of large curves, complex pelvic anatomy, and osteopenia. This study aimed to determine the rate of pedicle screw malposition, associated complications, and subsequent revision from screws placed with the assistance of machine vision navigation technology in patients with neuromuscular scoliosis undergoing posterior instrumentation and fusion. METHOD A retrospective analysis of the records of patients with neuromuscular scoliosis who underwent thoracolumbar pedicle screw insertion with the assistance of machine-vision image guidance navigation was performed. Screws were inserted by either a staff surgeon, orthopaedic fellow, or orthopaedic resident. Post-operative ultra-low dose CT scans were used to assess pedicle screw accuracy. The Gertzbein classification was used to grade any pedicle breaches (grade 0, no breach; grade 1, <2 mm; grade 2, 2-4 mm; grade 3, >4 mm). A screw was deemed accurate if no breach was identified (grade 0). RESULTS 25 patients were included in the analysis, with a mean age of 13.6 years (range 11 to 18 years; 13/25 (52.0%) were female. The average pre-operative supine Cobb angle was 90.0 degrees (48-120 degrees). A total of 687 screws from 25 patients were analyzed (402 thoracic, 241 lumbosacral, 44 S2 alar-iliac (S2AI) screws). Surgical trainees (fellows and orthopaedic residents) inserted 46.6% (320/687) of screws with 98.8% (4/320) accuracy. The overall accuracy of pedicle screw insertion was 98.0% (Grade 0, no breach). All 13 breaches that occurred in the thoracic and lumbar screws were Grade 1. Of the 44 S2AI screws placed, one screw had a Grade 3 breach (2.3%) noted on intra-operative radiographs following rod placement and correction. This screw was subsequently revised. None of the breaches resulted in neuromonitoring changes, vessel, or visceral injuries. CONCLUSION Machine vision navigation technology combined with careful free-hand pedicle screw insertion techniques demonstrated high levels of pedicle screw insertion accuracy, even in patients with challenging anatomy.
Collapse
Affiliation(s)
- Rajendra Sakhrekar
- Division of Orthopaedic Surgery, University of Toronto, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Nicholas Shkumat
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Stephen Lewis
- Division of Orthopaedic Surgery, University of Toronto, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - David Lebel
- Division of Orthopaedic Surgery, University of Toronto, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - M J McVey
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Mark Camp
- Division of Orthopaedic Surgery, University of Toronto, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| |
Collapse
|
2
|
Takahashi Y, Higashiguchi T, Wakayama T. Calibration for endoscopic 3D shape measurement with cone beam projection. APPLIED OPTICS 2024; 63:3058-3068. [PMID: 38856449 DOI: 10.1364/ao.516747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/17/2024] [Indexed: 06/11/2024]
Abstract
We demonstrate a calibration method for endoscopic three-dimensional shape measurement with cone beam projection. In this method, changes in the shape of the optical sectioning profiles are quantified and fitted while scanning a calibration board in the depth direction, using a cubic function. In accuracy tests using a flat plate and a ring reference gauge, the proposed method obtains an accuracy of 0.02 mm in the depth dimension and 0.09 mm in the radial dimension. These results represent 88% and 55% improvements compared to previous analysis. For medical applications, an ear examination simulator was employed, and our measurement results were compared to ground truth data obtained by microfocus X-ray computed tomography. The surface deviation of our method relative to the ground truth data was ±0.36m m during manual operation. A comparison of the measurement results before and after calibration revealed an improvement in the peak agreement with the ground truth data, with the deviation shifting from 0.2 mm to -0.05m m. Our strategy achieves a digital transformation of 3D endoscopy, which would benefit a number of medical fields.
Collapse
|
3
|
Avrumova F, Goldman SN, Altorfer F, Paschal GK, Lebl DR. Anterior cervical osteotomy of diffuse idiopathic skeletal hyperostosis lesions with computer-assisted navigation surgery: A case report. Clin Case Rep 2024; 12:e8427. [PMID: 38197064 PMCID: PMC10774538 DOI: 10.1002/ccr3.8427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/24/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024] Open
Abstract
Key Clinical Message Diffuse idiopathic skeletal hyperostosis (DISH) involves spine ligament ossification. Computer-assisted navigation (CAN) effectively aids complex surgeries, such as anterior cervical osteotomy, to alleviate progressive DISH-related dysphagia. Abstract We describe a 68-year-old man with sudden onset dysphagia to both solids and liquids. Radiographic Imaging revealed DISH lesions from C2 down to the thoracic spine. The patient was successfully treated with CAN anterior osteotomy and resection of DISH lesions from C3-C6 and had complete symptom relief within 2 weeks post-operatively.
Collapse
Affiliation(s)
- Fedan Avrumova
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Samuel N. Goldman
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Franziska Altorfer
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Gregory K. Paschal
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Darren R. Lebl
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| |
Collapse
|
4
|
Diltz ZR, Sheffer BJ. Intraoperative Navigation and Robotics in Pediatric Spinal Deformity. Orthop Clin North Am 2023; 54:201-207. [PMID: 36894292 DOI: 10.1016/j.ocl.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Current technologies for image guidance navigation and robotic assistance with spinal surgery are improving rapidly with several systems commercially available. Newer machine vision technology has several potential advantages. Limited studies have shown similar outcomes to traditional navigation platforms with decreased intraoperative radiation and time required for registration. However, there are no active robotic arms that can be coupled with machine vision navigation. Further research is necessary to justify the cost, potential increased operative time, and workflow issues but the use of navigation and robotics will only continue to expand given the growing body of evidence supporting their use.
Collapse
Affiliation(s)
- Zachary R Diltz
- Department of Orthopedic Surgery, LeBonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA; Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA
| | - Benjamin J Sheffer
- Department of Orthopedic Surgery, LeBonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA; Department of Orthopedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, 1211 Union Avenue, Memphis, TN 38104, USA; Campbell Clinic Orthopedics, 1400 South Germantown Road, Germantown, TN 38138, USA.
| |
Collapse
|
5
|
The Current State of Visualization Techniques in Endoscopic Skull Base Surgery. Brain Sci 2022; 12:brainsci12101337. [PMID: 36291271 PMCID: PMC9599272 DOI: 10.3390/brainsci12101337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Skull base surgery has undergone significant progress following key technological developments. From early candle-lit devices to the modern endoscope, refinements in visualization techniques have made endoscopic skull base surgery (ESBS) a standard practice for treating a variety of conditions. The endoscope has also been integrated with other technologies to enhance visualization, including fluorescence agents, intraoperative neuronavigation with augmented reality, and the exoscope. Endoscopic approaches have allowed neurosurgeons to reevaluate skull base neuroanatomy from new perspectives. These advances now serve as the foundation for future developments in ESBS. In this narrative review, we discuss the history and development of ESBS, current visualization techniques, and future innovations.
Collapse
|
6
|
Zagzoog N, Rastgarjazi S, Ramjist J, Lui J, Hopfgartner A, Jivraj J, Yeretsian T, Zadeh G, Lin V, Yang VXD. Pilot Study of Optical Topographic Imaging Based Neuronavigation for Mastoidectomy. World Neurosurg 2022; 166:e790-e798. [PMID: 35953033 DOI: 10.1016/j.wneu.2022.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mastoidectomy involves drilling the temporal bone while avoiding the facial nerve, semicircular canals, sigmoid sinus, and tegmen. Optical topographic imaging (OTI) is a novel registration technique that allows rapid registration with minimal navigational error. To date, no studies have examined the use of OTI in skull-base procedures. METHODS In this cadaveric study, 8 mastoidectomies were performed in 2 groups-4 free-hand (FH) and 4 OTI-assisted mastoidectomies. Registration accuracy for OTI navigation was quantified with root mean square (RMS) and target registration error (TRE). Procedural time, percent of mastoid resected, and the proximity of the mastoidectomy cavity to critical structures were determined. RESULTS The average RMS and TRE associated with OTI-based registration were 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. The volume removed, expressed as a percentage of the total mastoid volume, was 37.5% (±10.2%) versus 31.2% (±2.3%), P = 0.31, for FH and OTI-assisted mastoidectomy. There were no statistically significant differences between FH and OTI-assisted mastoidectomies with respect to proximity to critical structures or procedural time. CONCLUSIONS This work is the first examining the application of OTI neuronavigation in lateral skull-base procedures. This pilot study revealed the RMS and TRE for OTI-based navigation in the lateral skull base are 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. This pilot study demonstrates that an OTI-based system is sufficiently accurate and may address barriers to widespread adoption of navigation for lateral skull-base procedures.
Collapse
Affiliation(s)
- Nirmeen Zagzoog
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, Toronto, Ontario, Canada; Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada.
| | - Siavash Rastgarjazi
- Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Joel Ramjist
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Justin Lui
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Otolaryngology, Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Adam Hopfgartner
- Orthopedic Biomechanics Laboratory, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jamil Jivraj
- Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Tiffany Yeretsian
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vincent Lin
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victor X D Yang
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Xu DR, Luan LR, Ma XX, Cong ZC, Zhou CL. Comparison of electromagnetic and optical navigation assisted Endo-TLIF in the treatment of lumbar spondylolisthesis. BMC Musculoskelet Disord 2022; 23:522. [PMID: 35650587 PMCID: PMC9158260 DOI: 10.1186/s12891-022-05443-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (Endo-TLIF) with percutaneous pedicle screw fixation is a promising, minimally invasive method for the treatment of lumbar spondylolisthesis. However, repeated radiation exposure from X-rays and the steep learning curve remain to be improved.
Collapse
Affiliation(s)
- De-Rong Xu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Liang-Rui Luan
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Xue-Xiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Zhi-Chao Cong
- Hi-Tech Zone Li Min Hospital of Weihai Central Hospital Medical Group, Weihai, Shandong Province, People's Republic of China, 264209.
| | - Chuan-Li Zhou
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China.
| |
Collapse
|
8
|
Rossi VJ, Wells-Quinn TA, Malham GM. Negotiating for new technologies: guidelines for the procurement of assistive technologies in spinal surgery: a narrative review. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:254-265. [PMID: 35875618 PMCID: PMC9263739 DOI: 10.21037/jss-21-107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE This is a narrative review with the objective to discuss available assistive technologies for spinal surgery. Characteristics, costs, and compatibility of the different systems are summarized and recommendations made regarding acquiring these technologies. The availability of assistive technologies in spine surgery continues to evolve rapidly. The literature is lacking a collective summary of the available technologies and guidelines for acquisition. This is a narrative review which (I) presents an up-to-date summary of the currently available assistive technologies in spinal surgery; (II) makes comment on the utility of imaging, navigation, and robotics; (III) makes recommendations for the utility of the platform based on hospital size and (IV) discuss factors involved in negotiating for the purchase of these new technologies. METHODS We assemble the most up-to-date collection of description, characteristics and pricing of assistive technologies in spinal surgery. We compare and contrast these technologies and make recommendations regarding acquisition. KEY CONTENT AND FINDINGS These technologies require a learning-curve for the surgeon and the operating room staff to understand how to use them efficiently. Surgeons need to be involved in the process of purchase decisions. Surgeons occupy a unique position in the health care infrastructure as their approach to care has significant ramifications on both the quality and cost of care. Surgeons should maintain conviction that their training and practice has allowed the use of these technologies to provide safer and more effective care for patients. CONCLUSIONS Assistive technologies and prostheses for spinal fusion are evolving rapidly. This article serves as an encompassing reference to the current technologies. These technologies will play a significant role in the delivery of spinal health care in the future. All stakeholders stand to benefit from the increased value these technologies bring to patient care.
Collapse
Affiliation(s)
- Vincent J. Rossi
- Epworth Hospital, Melbourne, Australia
- Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
- Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | | | - Gregory M. Malham
- Epworth Hospital, Melbourne, Australia
- Swinburne University of Technology, Melbourne, Australia
| |
Collapse
|
9
|
Stewart G. Visible Light Navigation in Spine Surgery: My Experience With My First 150 Cases. Int J Spine Surg 2022; 16:S28-S36. [PMID: 36456113 PMCID: PMC9808787 DOI: 10.14444/8274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Technological innovations have revolutionized spine surgery. There are a variety of image-guidance systems and navigation options including robotics and augmented reality. These devices provide the opportunity for increased safety and efficiency in surgery. There are advantages and disadvantages to each approach to spinal instrumentation. In this article, the author reviews his experience with visible light navigation using a 7-dimensional (7D) machine vision system and reviews the use, strengths, and weaknesses of this method of spinal navigation.This study is a retrospective cohort investigation of 150 consecutive patients who underwent spinal instrumentation placement utilizing visible light navigation. The objective was to determine the utility of the navigation system and its strengths and weaknesses as well as to assess patient safety when screw placement is performed with visible light navigation in place of C-arm localization. Visible light navigation was found to be effective and efficient, enhancing screw placement and decreasing surgical time. There were no complications in this series of patients and no instances of symptomatic screw malposition.
Collapse
Affiliation(s)
- Geoffrey Stewart
- The Spine and Scoliosis Cente, Orlando, FL, USA,University of Central Florida College of Medicine, Orlando, FL, USA, Geoffrey Stewart, The Spine and Scoliosis Cente, 1131 S Orange Ave, Orlando, FL 32806, USA;
| |
Collapse
|
10
|
Malham GM, Munday NR. Comparison of novel machine vision spinal image guidance system with existing 3D fluoroscopy-based navigation system: a randomized prospective study. Spine J 2022; 22:561-569. [PMID: 34666179 DOI: 10.1016/j.spinee.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The use of spinal image guidance systems (IGS) has increased patient safety, accuracy, operative efficiency, and reduced revision rates in pedicle screw placement procedures. Traditional intraoperative 3D fluoroscopy or CT imaging produces potentially harmful ionizing radiation and increases operative time to register the patient. An IGS, FLASH Navigation, uses machine vision through high resolution stereoscopic cameras and structured visible light to build a 3D topographical map of the patient's bony surface anatomy enabling navigation use without ionizing radiation. PURPOSE We aimed to compare FLASH navigation system to a widely used 3D fluoroscopic navigation (3D) platform by comparing radiation exposure and pedicle screw accuracy. DESIGN A randomized prospective comparative cohort study of consecutive patients undergoing open posterior lumbar instrumented fusion. PATIENT SAMPLE Adults diagnosed with spinal pathology requiring surgical treatment and planning for open posterior lumbar fusion with pedicle screws implanted into 1-4 vertebral levels. OUTCOME MEASURES Outcome measures included mean intraoperative fluoroscopy time and dose, mean CT dose length product (DLP) for preoperative and day 2 CT, pedicle screw accuracy by CT, estimated blood loss and revision surgery rate. METHODS Consecutive patients were randomized 1:1 to FLASH or 3D and underwent posterior lumbar instrumented fusion. Radiation doses were recorded from pre- and postoperative CT and intraoperative 3D fluoroscopy. 2 independent blinded radiologists reviewed pedicle screw accuracy on CT. RESULTS A total of 429 (n=210 FLASH, n=219 3D) pedicle screws were placed in 90 patients (n=45 FLASH, n=45 3D) over the 18-month study period. Mean age and indication for surgery were similar between both groups, with a non-significantly higher ratio of males in the 3D group. Mean intraoperative fluoroscopy time and doses were significantly reduced in FLASH compared to 3D (4.51±3.71s vs 79.6±23.0s, p<.001 and 80.9±68.1cGycm2 vs 3704.1±3442.4 cGycm2, p<.001, respectively). This represented a relative reduction of 94.3% in the total intraoperative radiation time and a 97.8% reduction in the total intraoperative radiation dose. Mean preoperative CT DLP and mean day 2 postoperative CT DLP were significantly reduced in FLASH compared to 3D (662.0±440.4mGy-cm vs 1008.9±616.3 mGy-cm, p<.001 and 577.9±294.3 mGy-cm vs 980.7±441.6 mGy-cm, p<.001, respectively). This represented relative reductions of 34.4% and 41.0% in the preoperative CT dose and postoperative total DLP, respectively. The FLASH group required an average of 1.2 registrations in each case with an average of 2447 (±961.3) data points registered with a mean registration time of 106s (±52.1). A rapid re-registration mechanism was utilized in 22% (n=10/45) of cases and took 22.7s (±11.3). Re-registration was used in 7% (n=3/45) in the 3D group. Pedicle screw accuracy was high in FLASH (98.1%) and 3D (97.3%) groups with no pedicle breach >2mm in either group (p<.001). EBL was not statistically different between the groups (p=.38). No neurovascular injuries occurred, and no patients required return to theatre for screw repositioning. CONCLUSIONS FLASH and 3D IGS demonstrate high accuracy for pedicle screw placement. FLASH showed significant reduction in intraoperative radiation time and dose with lower but non-significant blood loss. FLASH showed significant reduction in preoperative and postoperative radiation, but this may be associated to the lower number of males/females preponderance in this group. FLASH provides similar accuracy to contemporary IGS without requiring 3D-fluoroscopy or radiolucent operating tables. Reducing registration time and specialized equipment may reduce costs.
Collapse
Affiliation(s)
- Gregory M Malham
- Epworth Hospital, Richmond, Melbourne, Australia; Swinburne University of Technology, Melbourne, Australia.
| | | |
Collapse
|
11
|
Abdelrahman A, Bangash OK, Bala A. Percutaneous Posterior Lumbar Interbody Fusion using Optical Topographic Navigation: Operative Technique. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
12
|
Zagzoog N, Rastgarjazi S, Ramjist J, Lui J, Hopfgartner A, Jivraj J, Zadeh G, Lin V, Yang VX. Real-time synchronized recording of force and position data during a mastoidectomy – Toward robotic mastoidectomy development. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
13
|
Fisher C, Harty J, Yee A, Li CL, Komolibus K, Grygoryev K, Lu H, Burke R, Wilson BC, Andersson-Engels S. Perspective on the integration of optical sensing into orthopedic surgical devices. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:010601. [PMID: 34984863 PMCID: PMC8727454 DOI: 10.1117/1.jbo.27.1.010601] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Orthopedic surgery currently comprises over 1.5 million cases annually in the United States alone and is growing rapidly with aging populations. Emerging optical sensing techniques promise fewer side effects with new, more effective approaches aimed at improving patient outcomes following orthopedic surgery. AIM The aim of this perspective paper is to outline potential applications where fiberoptic-based approaches can complement ongoing development of minimally invasive surgical procedures for use in orthopedic applications. APPROACH Several procedures involving orthopedic and spinal surgery, along with the clinical challenge associated with each, are considered. The current and potential applications of optical sensing within these procedures are discussed and future opportunities, challenges, and competing technologies are presented for each surgical application. RESULTS Strong research efforts involving sensor miniaturization and integration of optics into existing surgical devices, including K-wires and cranial perforators, provided the impetus for this perspective analysis. These advances have made it possible to envision a next-generation set of devices that can be rigorously evaluated in controlled clinical trials to become routine tools for orthopedic surgery. CONCLUSIONS Integration of optical devices into surgical drills and burrs to discern bone/tissue interfaces could be used to reduce complication rates across a spectrum of orthopedic surgery procedures or to aid less-experienced surgeons in complex techniques, such as laminoplasty or osteotomy. These developments present both opportunities and challenges for the biomedical optics community.
Collapse
Affiliation(s)
- Carl Fisher
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - James Harty
- Cork University Hospital and South Infirmary Victoria University Hospital, Department of Orthopaedic Surgery, Cork, Ireland
| | - Albert Yee
- University of Toronto, Sunnybrook Research Institute, Department of Surgery, Holland Bone and Joint Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences; Orthopaedic Biomechanics Laboratory, Physical Sciences Platform, Toronto, Canada
| | - Celina L. Li
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Katarzyna Komolibus
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Konstantin Grygoryev
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Huihui Lu
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Ray Burke
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Brian C. Wilson
- University of Toronto, Princess Margaret Cancer Centre/University Health Network, Department of Medical Biophysics, Toronto, Canada
| | - Stefan Andersson-Engels
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
- University College Cork, Department of Physics, Cork, Ireland
| |
Collapse
|
14
|
Zagzoog N, Zadeh G, Lin V, Yang VXD. Perspective review on applications of optics in skull base surgery. Clin Neurol Neurosurg 2021; 212:107085. [PMID: 34894572 DOI: 10.1016/j.clineuro.2021.107085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022]
Abstract
The use of optic technology in skull base surgeries has the potential to revolutionize the field of medicine, particularly neurosurgery and neurology. Here, we briefly present the past, present, and future of skull-base surgery, with an emphasis on the applications of optical topography techniques. We discuss optical topography techniques such as functional near-infrared spectroscopy, optical diffusion tomography, and optical topographical imaging. Optical topography techniques are particularly advantageous when combined with other imaging methods. For instance, optical topography can be combined with techniques such as functional magnetic resonance imaging (fMRI) to combine the temporal resolution of optical topography with the spatial resolution of fMRI. Multimodal approaches will be critical to advance brain-related research as well as medicine. Structured light imaging techniques are also writing the future of 3-dimensional imaging. In short, optical topography can allow for non-invasive, high-resolution imaging that will provide real-time visualizations of the brain that are ideal for neurosurgery. From the limitations of traditional skull base surgeries to the newest developments in optical neuroimaging, here we will discuss the potential applications of optics in skull base procedures.
Collapse
Affiliation(s)
- Nirmeen Zagzoog
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vincent Lin
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Victor X D Yang
- Sunnybrook Health Sciences Centre, Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Ryerson University, Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Sommer F, Goldberg JL, McGrath L, Kirnaz S, Medary B, Härtl R. Image Guidance in Spinal Surgery: A Critical Appraisal and Future Directions. Int J Spine Surg 2021; 15:S74-S86. [PMID: 34675032 DOI: 10.14444/8142] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Image-guided spinal surgery (IGSS) underwent rapid development over the past decades. The goal of IGSS is to increase patient safety and improve workflow. We present an overview of the history of IGSS, illustrate its current state, and highlight future developments. Currently, IGSS requires an image set, a tracking system, and a calibration method. IMAGING Two-dimensional images have many disadvantages as a source for navigation. Currently, the most common navigation technique is three-dimensional (3D) navigation based on cross-sectional imaging techniques such as cone-beam computed tomography (CT) or fan-beam CT. TRACKING Electromagnetic tracking uses an electromagnetic field to localize instruments. Optical tracking using infrared cameras has currently become one of the most common tracking methods in IGSS. CALIBRATION The three most common techniques currently used are the point-matching registration technique, the surface-matching registration technique, and the automated registration technique. FUTURE Augmented reality (AR) describes a computer-generated image that can be superimposed onto the real-world environment. Marking pathologies and anatomical landmarks are a few examples of many possible future applications. Additionally, AR offers a wide range of possibilities in surgical training. The latest development in IGSS is robotic-assisted surgery (RAS). The presently available data on RAS are very encouraging, but further improvements of these procedures is expected. CONCLUSION IGSS significantly evolved since its inception and is becoming a routinely used technology. In the future, IGSS will combine the advantages of "active/freehand 3D navigation" with AR and RAS and will one day find its way into all aspects of spinal surgery, not only in instrumented procedures.
Collapse
Affiliation(s)
- Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Lynn McGrath
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| |
Collapse
|
16
|
Dorilio J, Utah N, Dowe C, Avrumova F, Alicea D, Brecevich A, Callanan T, Sama A, Lebl DR, Abjornson C, Cammisa FP. Comparing the Efficacy of Radiation Free Machine-Vision Image-Guided Surgery With Traditional 2-Dimensional Fluoroscopy: A Randomized, Single-Center Study. HSS J 2021; 17:274-280. [PMID: 34539267 PMCID: PMC8436349 DOI: 10.1177/15563316211029837] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Three-dimensional (3D) computer-assisted navigation (CAN) has emerged as a potential alternative to 2-dimensional (2D) fluoroscopy in the surgical placement of spinal instrumentation. Recently, 3D-CAN systems have improved significantly in their ability to provide real-time anatomical referencing while shortening the registration and set-up time. A novel system in navigation, Machine-Vision Image-Guided Surgery (MvIGS; 7D Surgical, Toronto, Canada) was cleared by the US Food and Drug Administration, but its potential benefits in reducing intra-operative radiation exposure to patients and enhancing surgical accuracy of pedicle screw placement are not fully known. Purpose: We sought to conduct a prospective, randomized, clinical study comparing the 3D-MvIGS spinal navigation system and 2D-fluoroscopy for pedicle screw insertion up to 3 levels (T10-S1) and for various measures of surgical efficacy. Methods: Sixty-two eligible patients were randomized to receive spine surgery using either the 3D-MvIGS group or the conventional 2D-fluoroscopy for pedicle screw fixation for the treatment of spinal stenosis and degenerative spondylolisthesis. Intra-operative parameters and procedure-related unintended protocol violations were recorded. Results: Operative time and estimated blood loss were not significantly different between groups. Radiation time and exposure to patients were significantly reduced in the 3D-MvIGS group. There was no difference between groups in pedicle screw placement accuracy (2D-fluoroscopy group, 96.6%; 3D-MvIGS group, 94.2%). There were no major complications or cases that required revision surgery. Conclusion: The 3D-MvIGS navigation system performed comparably with 2D-fluoroscopy in terms of pedicle screw placement accuracy and operative time. The 3D-MvIGS showed a significant reduction in radiation exposure to patients. In more complex cases or larger cohorts, the true value of greater anatomical visualization can be elucidated.
Collapse
Affiliation(s)
| | - Nicole Utah
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | | | | | - Andrew Sama
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | |
Collapse
|
17
|
Sklar M, Fatemi P, Wadhwa H, Leung C, Zygourakis C. First case report using optical topographic-guided navigation in revision spinal fusion for calcified thoracic disk. J Clin Neurosci 2021; 91:80-83. [PMID: 34373063 DOI: 10.1016/j.jocn.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/15/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
Computer assisted navigation systems are frequently used in spine surgery to improve the accuracy of pedicle screw placement. The 7D Surgical System utilizes optical topographic imaging (OTI) with a camera positioned directly above the surgical field to perform rapid registration from a pre-operative CT scan onto anatomical landmarks with zero intra-operative radiation exposure. This current technology requires an open approach with well-exposed bony anatomy, raising concerns about using the 7D Surgical System in revision surgery, where typical anatomical landmarks may be altered, missing, or obscured by prior hardware. To overcome this, the 7D Surgical System is capable of registering off prior hardware. Here, we present the first published report of 7D Surgical System's registration off prior hardware in a revision spinal fusion. The registration was accurate, and the workflow was easy and efficient with one registration required for 3 levels of instrumentation and discectomy/corpectomy. This demonstrates that the 7D Surgical System can be used in revision cases with altered, missing, or obscured anatomy.
Collapse
Affiliation(s)
- Matthew Sklar
- Department of Neurological Surgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA 94304, United States
| | - Parastou Fatemi
- Department of Neurological Surgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA 94304, United States
| | - Harsh Wadhwa
- Department of Neurological Surgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA 94304, United States
| | - Christopher Leung
- Department of Neurological Surgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA 94304, United States
| | - Corinna Zygourakis
- Department of Neurological Surgery, Stanford University, 300 Pasteur Drive, Palo Alto, CA 94304, United States.
| |
Collapse
|
18
|
Chen L, Zhang X, He Y, Wang W, Zhang F, Sun L. A method of 3D-3D multi-stage non-rigid registration of the spine based on binocular structured light. Int J Med Robot 2021; 17:e2283. [PMID: 34002453 DOI: 10.1002/rcs.2283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intraoperative deformation and radiation are common problems in spinal surgery. A three-dimensional multi-stage dynamic iterative non-rigid registration method of the spine based on binocular structured light is proposed in this paper to overcome these problems. METHOD The problem of intraoperative radiation in traditional X-ray and CT is overcome by using binocular structured light. A three-dimensional spinal mask based on binary code is designed to reduce the influence of non-interested regions on the operation. Principal component analysis (PCA) algorithm is used to complete the rough registration between the preoperative CT model of the spine and the reconstructed surface of the intraoperative structured light. A new framework of multi-stage dynamic iterative non-rigid registration of the spine is proposed. The Iterative Closest Point (ICP) algorithm based on bidirectional selection is proposed to complete the single-stage registration of the spine. Then the multi-stage dynamic iterative registration of the spine is completed to solve the problem of large registration error caused by the deformation of the spine. RESULTS The method proposed in this paper is compared with traditional registration methods, and its application is verified experimentally. The results show that the registration accuracy and time of the proposed method are 0 . 51 ± 0 . 31 mm and 5 . 21 ± 0 . 23 s, respectively. The accuracy of the method is 81.5% and 78.2% higher than that of the contour method and the method of marker points, respectively. CONCLUSIONS The method can effectively avoid intraoperative radiation, reduce the registration error caused by the deformation of the spine, and has a high practicability.
Collapse
Affiliation(s)
- Long Chen
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Xin Zhang
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Yuhao He
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Wencong Wang
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Fengfeng Zhang
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China.,Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University, Suzhou, China
| | - Lining Sun
- School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China.,Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University, Suzhou, China
| |
Collapse
|
19
|
Abstract
The advancements in computing and digital localizer technologies has led to the evolving clinical application of image-guided technology for the surgical management of spinal disorders. Image-guided spinal navigation addresses the limitations of fluoroscopy and improves the accurate placement of fixation screws. Several navigation platforms are currently available, each having its own unique advantages and disadvantages. The most recent spinal navigation system developed utilizes machine vision structured light imaging which creates a precise and detailed three-dimensional image of the exposed surface anatomy and co-registers it to a pre-operatively or intra-operatively acquired image. This system improves upon the intraoperative workflow and efficiency of the navigation process. With the continued advancements in machine vision, there is a potential for clinical applications that extend beyond surgical navigation. These applications include reducing the potential for wrong level spine surgery and providing for real-time tracking of spinal deformity correction. As the adoption and clinical experience with navigation continues to expand and evolve, the technology that enables navigation also continues to evolve.
Collapse
Affiliation(s)
- Iain H Kalfas
- Cleveland Clinic, Department of Neurosurgery, Cleveland, OH, United States
| |
Collapse
|
20
|
Mao JZ, Agyei JO, Khan A, Hess RM, Jowdy PK, Mullin JP, Pollina J. Technologic Evolution of Navigation and Robotics in Spine Surgery: A Historical Perspective. World Neurosurg 2020; 145:159-167. [PMID: 32916361 DOI: 10.1016/j.wneu.2020.08.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022]
Abstract
Spine surgery is continuously evolving. The synergy between medical imaging and advances in computation has allowed for stereotactic neuronavigation and its integration with robotic technology to assist in spine surgery. The discovery of x-rays in 1895, the development of image intensifiers in 1940, and then advancements in computational science and integration have allowed for the development of computed tomography. In combination with the advancements of stereotaxy in the late 1980s, and manipulation of volumetric and special data for 3-dimensional reconstruction in 1998, computed tomography has revolutionized neuronavigational systems. Integrating all these technologies, robotics in spine surgery was introduced in 2004. Since then, it has become a safe modality that can reproducibly place accurate pedicle screws. Robotics may have the added benefits of improving the surgical workflow and optimizing surgeon ergonomics. Growing at a rapid rate, the second-generation spinal robotics have overcome preliminary limitations and errors. However, comparatively, robotics in spine surgery remains in its infancy. By leveraging technologic advancements in medical imaging, computation, and stereotactic navigation, robotics in spine surgery will continue to mature and expand in utility.
Collapse
Affiliation(s)
- Jennifer Z Mao
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Justice O Agyei
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
| |
Collapse
|
21
|
Gueziri HE, Santaguida C, Collins DL. The state-of-the-art in ultrasound-guided spine interventions. Med Image Anal 2020; 65:101769. [PMID: 32668375 DOI: 10.1016/j.media.2020.101769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023]
Abstract
During the last two decades, intra-operative ultrasound (iUS) imaging has been employed for various surgical procedures of the spine, including spinal fusion and needle injections. Accurate and efficient registration of pre-operative computed tomography or magnetic resonance images with iUS images are key elements in the success of iUS-based spine navigation. While widely investigated in research, iUS-based spine navigation has not yet been established in the clinic. This is due to several factors including the lack of a standard methodology for the assessment of accuracy, robustness, reliability, and usability of the registration method. To address these issues, we present a systematic review of the state-of-the-art techniques for iUS-guided registration in spinal image-guided surgery (IGS). The review follows a new taxonomy based on the four steps involved in the surgical workflow that include pre-processing, registration initialization, estimation of the required patient to image transformation, and a visualization process. We provide a detailed analysis of the measurements in terms of accuracy, robustness, reliability, and usability that need to be met during the evaluation of a spinal IGS framework. Although this review is focused on spinal navigation, we expect similar evaluation criteria to be relevant for other IGS applications.
Collapse
Affiliation(s)
- Houssem-Eddine Gueziri
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, Montreal (QC), Canada; McGill University, Montreal (QC), Canada.
| | - Carlo Santaguida
- Department of Neurology and Neurosurgery, McGill University Health Center, Montreal (QC), Canada
| | - D Louis Collins
- McConnell Brain Imaging Center, Montreal Neurological Institute and Hospital, Montreal (QC), Canada; McGill University, Montreal (QC), Canada
| |
Collapse
|
22
|
Nguyen NQ, Priola SM, Ramjist JM, Guha D, Dobashi Y, Lee K, Lu M, Androutsos D, Yang V. Machine vision augmented reality for pedicle screw insertion during spine surgery. J Clin Neurosci 2020; 72:350-356. [PMID: 31937502 DOI: 10.1016/j.jocn.2019.12.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/31/2019] [Indexed: 11/18/2022]
Abstract
Implementing pedicle safe zones with augmented reality has the potential to improve operating room workflow during pedicle screw insertion. These safe zones will allow for image guidance when tracked instruments are unavailable. Using the correct screw trajectory as a reference angle for a successful screw insertion, we will determine the angles which lead to medial, lateral, superior and inferior breaches. These breaches serve as the boundaries of the safe zones. Measuring safe zones from the view of the surgical site and comparing to the radiological view will further understand the visual relationship between the radiological scans and the surgical site. Safe zones were measured on a spine phantom and were then replicated on patients. It was found that the largest causes for variance was between each of the camera views and the radiological views. The differences between the left and right cameras were insignificant. Overall, the camera angles appeared to be larger than the radiological angles. The magnification effect found in the surgical site result in an increased level of angle sensitivity for pedicle screw insertion techniques. By designing a virtual road map on top of the surgical site directly using tracked tools, the magnification effect is already taken into consideration during surgery. Future initiatives include the use of an augmented reality headset.
Collapse
Affiliation(s)
- Nhu Q Nguyen
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Stefano M Priola
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joel M Ramjist
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Daipayan Guha
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Yuta Dobashi
- Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kenneth Lee
- 7D Surgical Incorporated, Toronto, ON, Canada
| | - Michael Lu
- 7D Surgical Incorporated, Toronto, ON, Canada
| | - Dimitrios Androutsos
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON, Canada
| | - Victor Yang
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; 7D Surgical Incorporated, Toronto, ON, Canada.
| |
Collapse
|
23
|
Nguyen NQ, Cardinell J, Ramjist JM, Lai P, Dobashi Y, Guha D, Androutsos D, Yang VXD. An augmented reality system characterization of placement accuracy in neurosurgery. J Clin Neurosci 2019; 72:392-396. [PMID: 31892493 DOI: 10.1016/j.jocn.2019.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022]
Abstract
Computer assisted navigation (CAN) is a technology which has been available for commercial use in operating rooms for quite some time now. CAN relies on the information presented in patient imaging (usually CT or MRI images) and the surgical site. The method for registration between these two sets of data is crucial for safe image guided navigation during surgery. Although the existing technologies are extremely accurate, they still pose problems in the operating. Motivation for this study is to explore the possibility of using augmented reality (AR) to improve ease of use for surgical navigation and provide a system which complements the existing operating room workflow. As with all commercially available surgical navigation systems, registration accuracy is of utmost important to maintain patient safety. In this paper, we propose a novel method to quantify registration accuracy for augmented reality (AR) devices in neurosurgery.
Collapse
Affiliation(s)
- Nhu Q Nguyen
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Jillian Cardinell
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Joel M Ramjist
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Philips Lai
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Yuta Dobashi
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON M5S, Canada
| | - Daipayan Guha
- Division of Neurosurgery, University of Toronto, ON M5S, Canada
| | - Dimitrios Androutsos
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Victor X D Yang
- Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON M5S, Canada; Division of Neurosurgery, University of Toronto, ON M5S, Canada.
| |
Collapse
|
24
|
Guha D, Jakubovic R, Leung MK, Ginsberg HJ, Fehlings MG, Mainprize TG, Yee A, Yang VXD. Quantification of computational geometric congruence in surface-based registration for spinal intra-operative three-dimensional navigation. PLoS One 2019; 14:e0207137. [PMID: 31450234 PMCID: PMC6710030 DOI: 10.1371/journal.pone.0207137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND CONTEXT Computer-assisted navigation (CAN) may guide spinal instrumentation, and requires alignment of patient anatomy to imaging. Iterative closest-point (ICP) algorithms register anatomical and imaging surface datasets, which may fail in the presence of geometric symmetry (congruence), leading to failed registration or inaccurate navigation. Here we computationally quantify geometric congruence in posterior spinal exposures, and identify predictors of potential navigation inaccuracy. METHODS Midline posterior exposures were performed from C1-S1 in four human cadavers. An optically-based CAN generated surface maps of the posterior elements at each level. Maps were reconstructed to include bilateral hemilamina, or unilateral hemilamina with/without the base of the spinous process. Maps were fitted to symmetrical geometries (cylindrical/spherical/planar) using computational modelling, and the degree of model fit quantified based on the ratio of model inliers to total points. Geometric congruence was subsequently assessed clinically in 11 patients undergoing midline exposures in the cervical/thoracic/lumbar spine for posterior instrumented fusion. RESULTS In cadaveric testing, increased cylindrical/spherical/planar symmetry was seen in the high-cervical and subaxial cervical spine relative to the thoracolumbar spine (p<0.001). Extension of unilateral exposures to include the ipsilateral base of the spinous process decreased symmetry independent of spinal level (p<0.001). In clinical testing, increased cylindrical/spherical/planar symmetry was seen in the subaxial cervical relative to the thoracolumbar spine (p<0.001), and in the thoracic relative to the lumbar spine (p<0.001). Symmetry in unilateral exposures was decreased by 20% with inclusion of the ipsilateral base of the spinous process. CONCLUSIONS Geometric congruence is most evident at C1 and the subaxial cervical spine, warranting greater vigilance in navigation accuracy verification. At all levels, inclusion of the base of the spinous process in unilateral registration decreases the likelihood of geometric symmetry and navigation error. This work is important to allow the extension of line-of-sight based registration techniques to minimally-invasive unilateral approaches.
Collapse
Affiliation(s)
- Daipayan Guha
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Raphael Jakubovic
- Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Biomedical Physics, Ryerson University, Toronto, Ontario, Canada
| | - Michael K. Leung
- Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Howard J. Ginsberg
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Todd G. Mainprize
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Albert Yee
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victor X. D. Yang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Biomedical Physics, Ryerson University, Toronto, Ontario, Canada
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Optical Topographic Imaging for Spinal Intraoperative 3-Dimensional Navigation in the Cervical Spine: Initial Preclinical and Clinical Feasibility. Clin Spine Surg 2019; 32:303-308. [PMID: 30839418 DOI: 10.1097/bsd.0000000000000795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OF BACKGROUND DATA Computer-assisted 3-dimensional navigation may guide spinal instrumentation. Optical topographic imaging (OTI) is a novel navigation technique offering comparable accuracy and significantly faster registration workflow relative to current navigation systems. It has previously been validated in open posterior thoracolumbar exposures. OBJECTIVE To validate the utility and accuracy of OTI in the cervical spine. STUDY DESIGN This is a prospective preclinical cadaveric and clinical cohort study. METHODS Standard midline open posterior cervical exposures were performed, with segmental OTI registration at each vertebral level. In cadaveric testing, OTI navigation guidance was used to track a drill guide for cannulating screw tracts in the lateral mass at C1, pars at C2, lateral mass at C3-6, and pedicle at C7. In clinical testing, translaminar screws at C2 were also analyzed in addition. Planned navigation trajectories were compared with screw positions on postoperative computed tomographic imaging, and quantitative navigation accuracies, in the form of absolute translational and angular deviations, were computed. RESULTS In cadaveric testing (mean±SD) axial and sagittal translational navigation errors were (1.66±1.18 mm) and (2.08±2.21 mm), whereas axial and sagittal angular errors were (4.11±3.79 degrees) and (6.96±5.40 degrees), respectively.In clinical validation (mean±SD) axial and sagittal translational errors were (1.92±1.37 mm) and (1.27±0.97 mm), whereas axial and sagittal angular errors were (3.68±2.59 degrees) and (3.47±2.93 degrees), respectively. These results are comparable to those achieved with OTI in open thoracolumbar approaches, as well as using current spinal neuronavigation systems in similar applications. There was no radiographic facet, canal or foraminal violations, nor any neurovascular complications. CONCLUSIONS OTI is a novel navigation technique allowing efficient initial and repeat registration. Accuracy even in the more mobile cervical spine is comparable to current spinal neuronavigation systems.
Collapse
|
26
|
Guha D, Jakubovic R, Alotaibi NM, Klostranec JM, Saini S, Deorajh R, Gupta S, Fehlings MG, Mainprize TG, Yee A, Yang VX. Optical Topographic Imaging for Spinal Intraoperative Three-Dimensional Navigation in Mini-Open Approaches: A Prospective Cohort Study of Initial Preclinical and Clinical Feasibility. World Neurosurg 2019; 125:e863-e872. [DOI: 10.1016/j.wneu.2019.01.201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
|
27
|
Malham GM, Wells-Quinn T. What should my hospital buy next?-Guidelines for the acquisition and application of imaging, navigation, and robotics for spine surgery. JOURNAL OF SPINE SURGERY 2019; 5:155-165. [PMID: 31032450 DOI: 10.21037/jss.2019.02.04] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The range of assistive technology options available for spinal fusion surgery has significantly increased. However, surgeons and hospital administrators may lack sufficient information to compare options and make purchasing decisions. We summarize currently available navigation, robotics, and imaging technologies for spinal surgery, highlighting key characteristics, utility, differences, price, and compatibility with other technologies and spinal implants. Guidelines for optimal use and combinations are provided based on surgical approach, operative site, patient anatomy, optimal image quality, and workflow efficiency. Key recommendations include the following. (I) Open-platform navigation and robotics systems that provide surgeons with access to all software and hardware features regardless of implant choice are preferred. (II) Imaging systems that have maximum compatibility with navigation and robotics platforms are optimal. (III) Navigation systems that offer a universal registration mechanism should be standard. (IV) 3D fluoroscopy provides the greatest benefit when speed, operative efficiency, and mobility are required. (V) Intraoperative CT is more useful for imaging long constructs, high BMI, or cervicothoracic anatomy. (VI) Radiation safety awareness that new 3D-fluoroscopy units can deliver radiation comparable to that of CT is needed. (VII) New robotic arm platforms require more clinical and health economic data to justify increased costs.
Collapse
|