title: A CT-free, intra-operative planning and navigation system for minimally invasive anterior spinal surgery - an accuracy study.
abstract: OBJECTIVE
  A comprehensive study was performed to evaluate the accuracy of a newly developed CT-free, intra-operative planning and navigation system for anterior spine surgery.
  
  
  METHODS
  Instruments and an image intensifier were tracked using the SurgiGATE navigation system. A laboratory study was performed on 27 plastic vertebrae. Fiducial markers were implanted in the vertebrae for accuracy evaluation purposes, and a dynamic reference base was placed on the vertebrae to establish a patient coordinate system (P-COS). Two fluoroscopic images were used for intra-operative planning. The graft bed plan was recorded in P-COS, followed by surgical formation of the graft bed, which was visualized. To evaluate the accuracy, the vertebrae were scanned with CT, and the markers were used to calculate an accurate paired-point registered transformation between the CT coordinate system and P-COS.
  
  
  RESULTS
  Using the new SPO module, accurate planning and navigation of a resection of the vertebral body is possible using two fluoroscopic images. The overall mean error between the planned resection volume and the actual resection was 0.98 mm. In addition, the module can serve as an educational tool for training spine surgeons.
  
  
  CONCLUSIONS
  The new fluoroscopy-based system can be used safely for accurate performance of anterior resection during spondylodesis. New methods for safe and accurate registration during anterior spine surgery need to be developed.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Johann Wolfgang Goethe University Medical School, Germany. bernd.maier@trauma.uni-frankfurt.de
authors.forename: B
authors.initials: B
authors.lastname: Maier
authors.forename: G
authors.initials: G
authors.lastname: Zheng
authors.forename: C
authors.initials: C
authors.lastname: Ploss
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.forename: K
authors.initials: K
authors.lastname: Welle
authors.forename: L-P
authors.initials: LP
authors.lastname: Nolte
authors.forename: I
authors.initials: I
authors.lastname: Marzi
mesh_terms: D004867:Equipment Design; D005240:Feasibility Studies; D005471:Fluoroscopy; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed