Image based registration and intraoperative updating for guiding spine surgery

项目摘要 由于操作繁琐，图像引导在开放式腰椎融合术中尚未被广泛采用。 患者登记技术。椎骨之间的累积活动性禁止使用皮肤固定基准点 （要求外科医生识别、暴露和定位术野内的解剖标志），以及 手术开始时的配准不能补偿术前仰卧位和仰卧位之间的椎间运动 CT扫描和术中患者俯卧位。自动化登记程序可以加快 采用和改善结果，除了降低成本，复杂性和X射线剂量相关 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 腰椎退行性滑脱，其中开放减压和融合手术， 每年30万次，与非手术治疗相比，改善了患者报告的结局。图片- 引导可以更准确地放置椎弓根螺钉，这可以降低翻修率， 病人的伤害，从而使医院和外科医生，以避免报销罚款从医疗保险， 其他付款人。我们已经开发了一种自动化的基于图像的术中立体视觉（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，实现了极好的目标配准误差（TREs小于2.1 mm）。我们现建议 在实验研究中改进该方法的技术方面，并评估这种新方法的可行性 临床实施的注册技术。具体而言，我们将（i）开发便携式iSV扫描仪， 术中CT（iCT）或O型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， 开放腰椎融合术治疗退行性脊椎滑脱。新的iSV方法与标准方法的比较 使用商业系统的护理图像引导（例如，Medtronic StealthStation）和高保真导航 将执行iCT实现的性能评估，以确定可以获得的相对性能改进。

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.