权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Image based registration and intraoperative updating for guiding spine surgery

基于图像的配准和术中更新用于指导脊柱手术

基本信息

批准号：
9976510
负责人：
Sohail K Mirza
金额：
$ 36.2万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-30 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9976510
关键词：
Adopted Adoption Anatomy Animal Experiments Animals Blood Clinical Clinical Trials Complex Complication Data Dose Effectiveness Europe Excision Exposure to Failure Goals Gold Hand Hospitals Human Image Image-Guided Surgery Implant Ionizing radiation Liquid substance Location Manuals Medicare Methods Microscope Motion Movement Navigation System North America Operative Surgical Procedures Patient Outcomes Assessments Patient-Focused Outcomes Patients Performance Positioning Attribute Postoperative Period Procedures Radiation Randomized Repeat Surgery Respiration Roentgen Rays Series Skin Spinal Spine surgery Spondylolisthesis Supination Surface Surgeon System Target Populations Techniques Technology Time Training Translating Update Variant Vertebral column Work X-Ray Computed Tomography arm base bone clinical implementation cone-beam computed tomography cost experimental study geometric structure image guided improved improved outcome innovation lumbar vertebra bone structure novel portability sample fixation spine bone structure standard of care

项目摘要

PROJECT SUMMARY Image-guidance has not been widely adopted in open lumbar fusion procedures because of cumbersome patient registration techniques. Accumulated mobility between vertebrae prohibits use of skin-affixed fiducials (requiring the surgeon to identify, expose, and localize anatomical landmarks within the surgical field), and registration at the start of surgery does not compensate for intervertebral motion between preoperative supine CT scans and intraoperative prone patient position. An automated registration procedure could accelerate adoption and improve outcomes, in addition to reducing costs, complexity, and x-ray dose associated with spine surgical guidance methods in current clinical use. Our target population is patients with symptomatic lumbar degenerative spondylolisthesis, where open decompression and fusion surgery, performed more than 300,000 times annually, improves patient-reported outcomes compared to non-surgical treatment. Image- guidance allows more accurate placement of pedicle screws, which could reduce revision rates and minimize patient harm, thereby allowing hospitals and surgeons to avoid reimbursement penalties from Medicare and other payers. We have developed an automated image-based intraoperative stereovision (iSV) to preoperative CT (pCT) registration that compensates for intervertebral motion, and have successfully applied the technique in two live animals, achieving excellent target registration errors (TREs less than 2.1 mm). We now propose to improve technical aspects of the approach in experimental studies and assess feasibility of this novel registration technology for clinical implementation. Specifically, we will (i) develop a portable iSV scanner as a radiation-free alternative to intraoperative CT (iCT) or O-arm, (ii) validate, evaluate and optimize the tehcnique in a systematic series of live animal surgeries, and (iii) translate the technology into a series of human cases of open lumbar fusion for degenerative spondylolisthesis. Comparisons of the new iSV approach to standard-of- care image-guidance with a commercial system (e.g., Medtronic StealthStation) and to high-fidelity navigation achieved with iCT will be performed to establish the relative performance improvements that can be obtained.

项目概要由于麻烦，图像引导尚未在开放腰椎融合手术中广泛采用患者登记技术。椎骨之间累积的活动度禁止使用贴在皮肤上的基准点（要求外科医生识别、暴露和定位手术区域内的解剖标志），以及手术开始时的配准不能补偿术前仰卧位之间的椎间运动 CT 扫描和术中患者俯卧位。自动注册程序可以加速除了降低成本、复杂性和与相关的 X 射线剂量外，采用并改善结果目前临床使用的脊柱手术引导方法。我们的目标人群是有症状的患者腰椎退行性脊柱滑脱症，开放式减压融合手术的效果超过每年 300,000 次，与非手术治疗相比，改善了患者报告的结果。图像- 引导可以更准确地放置椎弓根螺钉，这可以降低翻修率并最大限度地减少患者受到伤害，从而使医院和外科医生能够避免医疗保险和医疗保险的报销处罚其他付款人。我们开发了一种基于图像的自动化术中立体视觉 (iSV) 补偿椎间运动的 CT (pCT) 配准，并已成功应用该技术在两只活体动物中，实现了出色的目标配准误差（TRE 小于 2.1 毫米）。我们现在建议改进实验研究方法的技术方面并评估该小说的可行性临床实施的注册技术。具体来说，我们将 (i) 开发一款便携式 iSV 扫描仪作为术中 CT (iCT) 或 O 形臂的无辐射替代方案，(ii) 验证、评估和优化技术在一系列系统的活体动物手术中，以及（iii）将该技术转化为一系列人类病例开放性腰椎融合术治疗退行性脊柱滑脱。新 iSV 方法与标准的比较使用商业系统（例如 Medtronic StealthStation）和高保真导航进行护理图像引导将执行通过 iCT 实现的目标，以确定可以获得的相对性能改进。