Fluoroscopy-based navigation system in spine surgery.
The variability in width, height, and spatial orientation of a spinal pedicle makes pedicle screw insertion a delicate operation. The aim of the current paper is to describe a computer-assisted surgical navigation system based on fluoroscopic X-ray image calibration and three-dimensional optical localizers in order to reduce radiation exposure while increasing accuracy and reliability of the surgical procedure for pedicle screw insertion. Instrumentation using transpedicular screw fixation was performed: in a first group, a conventional surgical procedure was carried out with 26 patients (138 screws); in a second group, a navigated surgical procedure (virtual fluoroscopy) was performed with 26 patients (140 screws). Evaluation of screw placement in every case was done by using plain X-rays and post-operative computer tomography scan. A 5 per cent cortex penetration (7 of 140 pedicle screws) occurred for the computer-assisted group. A 13 per cent penetration (18 of 138 pedicle screws) occurred for the non computer-assisted group. The radiation running time for each vertebra level (two screws) reached 3.5 s on average in the computer-assisted group and 11.5 s on average in the non computer-assisted group. The operative time for two screws on the same vertebra level reaches 10 min on average in the non computer-assisted group and 11.9 min on average in the computer-assisted group. The fluoroscopy-based (two-dimensional) navigation system for pedicle screw insertion is a safe and reliable procedure for surgery in the lower thoracic and lumbar spine.
Merloz
P
P
University Department of Orthopaedic and Trauma Surgery, CHU A. Michallon, BP 217, Grenoble Cedex 09, 38043, France. PMerloz@chu-grenoble.fr
Troccaz
J
J
Vouaillat
H
H
Vasile
C
C
Tonetti
J
J
Eid
A
A
Plaweski
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D003196:Computer Graphics; D003198:Computer Simulation; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012371:Robotics / Q000379:methods; D012984:Software; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013131:Spine / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface