Assessment of vertebral body motion during spine surgery.
METHODS
In vitro and in vivo assessment of the accuracy of devices proposed for tracking spine motion during surgery; in vivo assessment of vertebral motion during spine surgery.


OBJECTIVE
1) To quantify the accuracy of newly designed vertebral body trackers; 2) to demonstrate the feasibility of tracking vertebral motion in a cadaveric model; and 3) to quantify the vertebral motion that occurs during spinal surgery.


BACKGROUND
Computer techniques are beginning to be applied to spine surgery. Validation of accuracy of methods of spinal tracking has not been reported. No information exists on the amount of vertebral motion that occurs during surgery. Because the new techniques require accurate positional information for the vertebral body, it is important to understand and evaluate methods of tracking vertebrae.


METHODS
An optical tracking system (Northern Digital, Waterloo, Ontario, Canada) was used to track custom-designed trackers. The reliability and accuracy of the trackers were evaluated in vitro. The proposed tracking methodology for human testing was performed using a cadaveric model, and after successful completion, human testing was done in the operating room to evaluate the motion of two vertebral bodies during exposure for instrumentation of the lumbar spine. This technique was used to evaluate the custom designed trackers effectiveness for tracking vertebral bodies for pedicle screw insertion.


RESULTS
The trackers developed were accurate and capable of tracking the motion of the spine. Measured motion of L3 and L4 during breathing was 1.3 mm, peak to peak. Maximal intraoperative motion of the vertebral bodies was 12.3 mm during maneuvers simulating dissection of soft tissue and targeting of spinal pedicles.


CONCLUSIONS
Significant motion occurs in lumbar vertebral bodies during surgery. Breathing motion alone is up to 1.3 mm, and surgeon-induced motion up to 10 times greater. Vertebral body trackers for use with an optical position sensor were capable of measuring this motion.
Glossop
N
N
Department of Surgery, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Hu
R
R
D000328:Adult; D001858:Bone Nails; D001863:Bone Screws; D002102:Cadaver; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000502:physiology / Q000601:surgery*; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D009068:Movement; D055095:Optics and Photonics / Q000295:instrumentation*; D012119:Respiration; D013813:Therapy, Computer-Assisted