1
|
Chan A, Parent E, Mahood J, Lou E. 3D ultrasound navigation system for screw insertion in posterior spine surgery: a phantom study. Int J Comput Assist Radiol Surg 2021; 17:271-281. [PMID: 34725774 DOI: 10.1007/s11548-021-02516-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Posterior spinal fusion surgery is required to correct severe idiopathic scoliosis. The surgery involves insertion of screws which requires high accuracy to prevent neurologic damage to the spinal cord. Although conventional CT navigation can reduce this risk, 3D-ultrasound-based navigation could achieve this without added ionizing radiation and usage of expensive and bulky equipment. This study aimed to evaluate the accuracy of a 3D ultrasound navigation system for posterior spine surgery. METHODS A custom 3D ultrasound (3DUS) with model-to-surface registration algorithm was developed and integrated into a 3D navigation environment. A CT scan of an adolescent spine (T3-T11) was segmented and 3D printed for experiments. A probe with reflective markers was placed in vertebral pedicles 684 times in varying levels, positions in the capture space and orientation of vertebra, and the entrypoint and trajectory accuracies were measured. RESULTS Among 684 probe placements in vertebral levels T3 to T11 in the phantom spine, 95.5% were within 1 mm and 5° of accuracy, with an average accuracy of 0.4 ± 0.4 mm and 2.1 ± 0.9°, requiring 8.8 s to process. Accuracies were statistically significantly affected by vertebral orientation and position in the capture volume, though this was still within the targeted accuracies of 1 mm and 5°. CONCLUSION This preliminary ultrasound-based navigation system is accurate and fast enough for guiding placement of pedicle screws into the spine in posterior fusion surgery. The current results are limited to phantom spines, and future study in animal or human cadavers is needed to investigate soft tissue effects on registration accuracy.
Collapse
Affiliation(s)
- Andrew Chan
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada
| | - Eric Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G2G4, Canada
| | - Jim Mahood
- Department of Surgery, University of Alberta, 2D, Walter C Mackenzie Health Sciences Center - 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Edmond Lou
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada.
- Department of Surgery, University of Alberta, 2D, Walter C Mackenzie Health Sciences Center - 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada.
- Department of Electrical Engineering, University of Alberta, Donadeo ICE 11-263, 9211-116 Street, Edmonton, AB, T6G 1H9, Canada.
| |
Collapse
|
2
|
Qu H, Zhao Y. Advances in tissue state recognition in spinal surgery: a review. Front Med 2021; 15:575-584. [PMID: 33990898 DOI: 10.1007/s11684-020-0816-3] [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: 12/09/2019] [Accepted: 07/27/2020] [Indexed: 12/27/2022]
Abstract
Spinal disease is an important cause of cervical discomfort, low back pain, radiating pain in the limbs, and neurogenic intermittent claudication, and its incidence is increasing annually. From the etiological viewpoint, these symptoms are directly caused by the compression of the spinal cord, nerve roots, and blood vessels and are most effectively treated with surgery. Spinal surgeries are primarily performed using two different techniques: spinal canal decompression and internal fixation. In the past, tactile sensation was the primary method used by surgeons to understand the state of the tissue within the operating area. However, this method has several disadvantages because of its subjectivity. Therefore, it has become the focus of spinal surgery research so as to strengthen the objectivity of tissue state recognition, improve the accuracy of safe area location, and avoid surgical injury to tissues. Aside from traditional imaging methods, surgical sensing techniques based on force, bioelectrical impedance, and other methods have been gradually developed and tested in the clinical setting. This article reviews the progress of different tissue state recognition methods in spinal surgery and summarizes their advantages and disadvantages.
Collapse
Affiliation(s)
- Hao Qu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yu Zhao
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
3
|
Chan A, Coutts B, Parent E, Lou E. Development and Evaluation of CT-to-3D Ultrasound Image Registration Algorithm in Vertebral Phantoms for Spine Surgery. Ann Biomed Eng 2020; 49:310-321. [PMID: 32533392 DOI: 10.1007/s10439-020-02546-5] [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: 03/08/2020] [Accepted: 06/04/2020] [Indexed: 12/18/2022]
Abstract
Posterior spinal fusion surgery requires careful insertion of screws into the spine to avoid neurologic injury. While current systems use CT-scans, three-dimensional ultrasound (3DUS) could provide guidance by reconstructing the vertebral surface, and then registering a pre-operative vertebral model to that surface for localization. The aim of this study was to evaluate the accuracy and processing time of a custom CT-3DUS registration algorithm. A phantom human vertebra was 3D-printed and scanned with a motion capture-based 3D ultrasound (3DUS) system. Image registration was performed that included a pre-alignment phase using vertebral symmetry information, and then comparing Gaussian pyramid intensity-based registration with iterative-closest-point registration for final transformations. Image registration was performed 192 times while surgical registration between CT and real-world position was performed 84 times. The accuracy of image registration (CT-to-3DUS) was 0.3 ± 0.2 mm and 0.9 ± 0.8° completed in 13.3 ± 2.9 s. The surgical navigation accuracy (CT model to real-world position) of the system was 1.2 ± 0.5 mm and 2.2 ± 2.0° completed in 16.2 ± 3.0 s. Both meet accuracy thresholds of < 2 mm and < 5° required for the surgery. A feasibility study on porcine spine qualitatively showed appropriate overlapping anatomy in CT-3DUS registrations. The usage of 3D ultrasound for navigation has demonstrated accuracy to provide radiation-free image guidance for spine surgery.
Collapse
Affiliation(s)
- Andrew Chan
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada
| | - Brendan Coutts
- Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-203, 9211-116 Street, Edmonton, AB, T6G 1H9, Canada
| | - Eric Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G2G4, Canada
| | - Edmond Lou
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada. .,Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-203, 9211-116 Street, Edmonton, AB, T6G 1H9, Canada.
| |
Collapse
|
4
|
Chan A, Parent E, Lou E. Reconstruction and positional accuracy of 3D ultrasound on vertebral phantoms for adolescent idiopathic scoliosis spinal surgery. Int J Comput Assist Radiol Surg 2018; 14:427-439. [PMID: 30519871 DOI: 10.1007/s11548-018-1894-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Determine the positional, rotational and reconstruction accuracy of a 3D ultrasound system to be used for image registration in navigation surgery. METHODS A custom 3D ultrasound for spinal surgery image registration was developed using Optitrack Prime 13-W motion capture cameras and a SonixTablet Ultrasound System. Temporal and spatial calibration was completed to account for time latencies between the two systems and to ensure accurate motion tracking of the ultrasound transducer. A mock operating room capture volume with a pegboard grid was set up to allow phantoms to be placed at a variety of predetermined positions to validate accuracy measurements. Five custom-designed ultrasound phantoms were 3D printed to allow for a range of linear and angular dimensions to be measured when placed on the pegboard. RESULTS Temporal and spatial calibration was completed with measurement repeatabilities of 0.2 mm and 0.5° after calibration. The mean positional accuracy was within 0.4 mm, with all values within 0.5 mm within the critical surgical regions and 96% of values within 1 mm within the full capture volume. All orientation values were within 1.5°. Reconstruction accuracy was within 0.6 mm and 0.9° for geometrically shaped phantoms and 0.5 and 1.9° for vertebrae-mimicking phantoms. CONCLUSIONS The accuracy of the developed 3D ultrasound system meets the 1 mm and 5° requirements of spinal surgery from this study. Further repeatability studies and evaluation on vertebrae are needed to validate the system for surgical use.
Collapse
Affiliation(s)
- Andrew Chan
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada
| | - Eric Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G2G4, Canada
| | - Edmond Lou
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada. .,Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-371, 9211-116 Street, Edmonton, AB, T6G 1H9, Canada.
| |
Collapse
|
5
|
Radcliff K, Smith H, Kalantar B, Isaacs R, Woods B, Vaccaro AR, Brannon J. Feasibility of Endoscopic Inspection of Pedicle Wall Integrity in a Live Surgery Model. Int J Spine Surg 2018; 12:241-249. [PMID: 30276081 DOI: 10.14444/5030] [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: 11/20/2022] Open
Abstract
Background Perforations of the pedicle wall during cannulation can occur with experienced surgeons. Direct endoscopic visualization has not been used to inspect pedicles previously due to bone bleeding obscuring the camera visualization. The hypothesis of this study was that endoscopic visualization of pedicle wall integrity was technically feasible and would enable identification of clinically significant pedicle breaches. Methods A live porcine model was used. Eight lumbar pedicles were cannulated. Clinically significant breaches were created. An endoscope was introduced and was used to inspect the pedicles. Results All lumbar pedicles were endoscopically visible at a systolic pressure of 100 mm Hg. Clinically relevant anatomic structures and iatrogenic pathology, such as medial, lateral, and anterior breaches, were identified. There were no untoward events resulting from endoscopic inspection of the pedicle endosteal canal. Conclusions Endoscopic inspection of lumbar pedicles was safe and effective. The findings on endoscopic inspection corresponded with the ball-tip probe palpation techniques. Additional techniques, such as selection between 2 tracts, was possible with the endoscopic technique.
Collapse
Affiliation(s)
- Kristen Radcliff
- Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Egg Harbor, New Jersey
| | - Harvey Smith
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bobby Kalantar
- Department of Orthopedic Surgery, Georgetown University, Washington, DC
| | - Robert Isaacs
- Department of Neurological Surgery, Duke University, Durham, North Carolina
| | - Barrett Woods
- Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Egg Harbor, New Jersey
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Thomas Jefferson University, Rothman Institute, Egg Harbor, New Jersey
| | - James Brannon
- Orthopedic Sciences, Inc, Seal Beach, California, Joint Preservation Institute of Kansas, Overland Park, Kansas
| |
Collapse
|
6
|
Zhai X, Cui J, Shao J, Wang Q, Chen X, Wei X, Zhou X, Chen Z, Bai Y, Li M. Global research trends in spinal ultrasound: a systematic bibliometric analysis. BMJ Open 2017; 7:e015317. [PMID: 29061600 PMCID: PMC5665321 DOI: 10.1136/bmjopen-2016-015317] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In recent years, there has been increased interest in the use of ultrasound technology in the evaluation of spinal and paraspinal regions. OBJECTIVE This study aimed to investigate trends in spinal ultrasound research from 1994 to 2015 and compare the contributions of such research from different countries and authors. STUDY DESIGN Bibliometric analysis. SETTING Publications related to spinal ultrasound from 1994 to 2015 were retrieved from the Web of Science database. METHODS Excel 2013, GraphPad Prism 5, and VOSviewer were used to summarise bibliometric features, including the number of publications, citation frequency, H-index, and country contributions and hotspots (keywords of popular scientific fields). RESULTS A total of 3859 papers were included. The global inflection point (the point in time when the publication growth rate moved from positive to negative) came in 2010. The United States contributed the largest percentage of articles (1041; 26.9%), with the most citations (19 848) and the highest H-index (61). The journals Osteoporosis International and Spine had the highest publication number. The University of Toronto and the University of California, San Francisco were the most contributive institutions. Studies could be divided into three clusters: surgery, osteoporosis, and others. The keywords 'adolescent idiopathic scoliosis' and 'anaesthesia' were the latest hotspots, appearing around 2012. CONCLUSION Spinal ultrasound literature has grown continuously over the last 22 years, with the rate slowing down after 2010. The United States was the largest contributor in this field. Recent studies on topics related to 'adolescent idiopathic scoliosis' and 'anaesthesia' were relatively new and should be closely followed in spinal ultrasound research.
Collapse
Affiliation(s)
- Xiao Zhai
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jin Cui
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
- Graduate Management Unit, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jie Shao
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qijin Wang
- Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiao Chen
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xianzhao Wei
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiaoyi Zhou
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ziqiang Chen
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yushu Bai
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ming Li
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|