Accuracy of Stereovision-Updated Versus Preoperative CT-Based Image Guidance in Multilevel Lumbar Pedicle Screw Placement: A Cadaveric Swine Study.
Accuracy of Stereovision-Updated Versus Preoperative CT-Based Image Guidance in Multilevel Lumbar Pedicle Screw Placement: A Cadaveric Swine Study.
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DOI：
10.2106/jbjs.oa.21.00129
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Paulsen KD
中科院分区：
文献类型：
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作者：
Fan X;Mirza SK;Li C;Evans LT;Ji S;Paulsen KD
术前成像和手术过程之间椎体位置的变化降低了图像引导脊柱手术的准确性，需要重复成像和手术野配准，这个过程需要时间并且使患者暴露于额外的辐射。我们开发了一种手持式、基于摄像头的可变形配准系统（术中立体视觉，iSV），可自动配准手术视野并在手术过程中补偿脊柱运动，而无需进一步暴露于辐射。我们使用最先进的商业脊柱导航（StealthStation；Medtronic）和补偿术中椎体运动的 iSV 配准，测量了 6 具整猪尸体中图像引导腰椎椎弓根螺钉放置过程中运动引起的误差。我们通过使用术前腰椎计算机断层扫描（pCT）来诱导脊柱运动，在仰卧位进行腰椎前凸加重，并对动物进行俯卧位手术。 PCT 的 StealthStation 配准使用植入每个椎骨的金属基准标记进行，并获取 iSV 数据以在 pCT 和手术区域之间执行可变形配准。使用 iSV 和 StealthStation 注册，将 68 个椎弓根螺钉按椎骨水平的随机顺序放置在 6 具整猪尸体中，仅依靠图像引导，而不调用外科医生的判断。通过术后 CT 评估每个椎弓根螺钉的位置，并通过解剖学解剖确认。根据植入的基准点评估配准误差。与 StealthStation 相比，iSV 登记的椎弓根螺钉穿孔频率和严重程度较低（iSV 和 StealthStation 0 级内侧穿孔分别为 97% 和 68%）。仅 StealthStation 发生严重穿孔（iSV 为 18%，而 iSV 为 0%）。 iSV 注册所需的总时间（计算效率）约为 10 至 15 分钟，与 StealthStation 注册（约 10 分钟）相当。相对于 StealthStation，iSV 的平均目标配准误差更小（2.81 ± 0.91 与 8.37 ± 1.76 毫米）。当手术期间脊柱的排列发生变化时，与基于术前 CT 的最先进的商业导航相比，iSV 配准的椎弓根螺钉放置更加准确。 iSV 系统可补偿椎间运动，从而无需重复进行椎骨配准，同时在开放性脊柱手术期间提供高效、准确、无辐射的导航。
Change in vertebral position between preoperative imaging and the surgical procedure reduces the accuracy of image-guided spinal surgery, requiring repeated imaging and surgical field registration, a process that takes time and exposes patients to additional radiation. We developed a handheld, camera-based, deformable registration system (intraoperative stereovision, iSV) to register the surgical field automatically and compensate for spinal motion during surgery without further radiation exposure. We measured motion-induced errors in image-guided lumbar pedicle screw placement in 6 whole-pig cadavers using state-of-the-art commercial spine navigation (StealthStation; Medtronic) and iSV registration that compensates for intraoperative vertebral motion. We induced spinal motion by using preoperative computed tomography (pCT) of the lumbar spine performed in the supine position with accentuated lordosis and performing surgery with the animal in the prone position. StealthStation registration of pCT occurred using metallic fiducial markers implanted in each vertebra, and iSV data were acquired to perform a deformable registration between pCT and the surgical field. Sixty-eight pedicle screws were placed in 6 whole-pig cadavers using iSV and StealthStation registrations in random order of vertebral level, relying only on image guidance without invoking the surgeon’s judgment. The position of each pedicle screw was assessed with post-procedure CT and confirmed via anatomical dissection. Registration errors were assessed on the basis of implanted fiducials. The frequency and severity of pedicle screw perforation were lower for iSV registration compared with StealthStation (97% versus 68% with Grade 0 medial perforation for iSV and StealthStation, respectively). Severe perforation occurred only with StealthStation (18% versus 0% for iSV). The overall time required for iSV registration (computational efficiency) was ∼10 to 15 minutes and was comparable with StealthStation registration (∼10 min). The mean target registration error was smaller for iSV relative to StealthStation (2.81 ± 0.91 versus 8.37 ± 1.76 mm). Pedicle screw placement was more accurate with iSV registration compared with state-of-the-art commercial navigation based on preoperative CT when alignment of the spine changed during surgery. The iSV system compensated for intervertebral motion, which obviated the need for repeated vertebral registration while providing efficient, accurate, radiation-free navigation during open spinal surgery.