title: Real-time tracking of vertebral body movement with implantable reference microsensors.
abstract: OBJECTIVE
  In the spine, navigation techniques serve mainly to control and accurately target insertion of implants. The main source of error is that the spine is not a rigid organ, but rather a chain of semiflexible movement segments. Any intraoperative manipulation of the patient alters the geometry and volumetry as compared to the 3D volume model created from the image data. Thus, the objective of the study was to implement the theoretical principle of microsensor referencing in a model experiment and to clarify which anatomical structures are suitable for intermittent implantation of positional sensors, as illustrated with cervical vertebral bodies.
  
  
  METHODS
  Laboratory tests were conducted using 70 models of human cervical vertebral bodies. The first experiment investigated whether arbitrary movements of vertebral bodies can be tracked with the positional information from the implanted microsensors. The accuracy of this movement monitoring was determined quantitatively on the basis of positional error measurement. In the second experiment, different ventral and dorsal surgical operations were simulated on five models of the cervical spine. Quantifiable measurement values such as the spatial extension of the intervertebral space and the relative positions of the planes of the upper plates were determined.
  
  
  RESULTS
  With respect to the differing anatomy of the individual vertebral bodies of the cervical spine, the sensors could be placed securely with a 5x2 mm drill. The registration error (RE) was determined as a root mean square error. The mean value was 0.9425 mm (range: 0.57-1.2 mm; median: 0.9400 mm; SD: 0.1903 mm). The precision of the movement monitoring of the vertebral body was investigated along its three main axes. The error tolerance between post-interventional 3D reconstruction and direct measurement on the model did not exceed 1.3 mm in the distance measurements or 2.5 degrees in the angular measurements. The tomograms on the system monitor could be updated in close to real time on the basis of the positional information from the reference sensor.
  
  
  CONCLUSIONS
  Motion sensors implanted into the vertebral bodies communicated any change in position to the navigation system in close to real time, thus enabling the preoperative image data set to be updated. The experiments described could ultimately show that continuous real-time visualization of individual vertebral body movements along the movement axes (flexion-extension, tilting and rotation) is possible with high accuracy using implantable microsensors. A future application of such microsensors might be the integration of robot systems into spinal microsurgery.
authors.affiliation: Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. sven.mularski@charite.de
authors.forename: Sven
authors.initials: S
authors.lastname: Mularski
authors.forename: Thomas
authors.initials: T
authors.lastname: Picht
authors.forename: Björn
authors.initials: B
authors.lastname: Kuehn
authors.forename: Theodoros
authors.initials: T
authors.lastname: Kombos
authors.forename: Mario
authors.initials: M
authors.lastname: Brock
authors.forename: Olaf
authors.initials: O
authors.lastname: Suess
mesh_terms: D002574:Cervical Vertebrae / Q000503:physiopathology*; D055590:Electromagnetic Phenomena; D006801:Humans; D021621:Imaging, Three-Dimensional; D020007:Implants, Experimental / Q000009:adverse effects*; D008953:Models, Anatomic; D009068:Movement; D038361:Neuronavigation / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D025321:Surgery, Computer-Assisted; D013996:Time and Motion Studies