Computer-assisted fluoroscopic targeting system for pedicle screw insertion

被引:98
作者
Choi, WW
Green, BA
Levi, ADO
机构
[1] Univ Miami, Jackson Mem Hosp, Dept Neurosurg, Miami, FL 33136 USA
[2] Univ Miami, Jackson Mem Hosp, Miami Project Cure Paralysis, Miami, FL 33136 USA
关键词
computer-assisted surgery; fluoroscope; frameless stereotaxy; robotic surgery; spine surgery;
D O I
10.1097/00006123-200010000-00017
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: Biplanar fluoroscopic imaging linked to a computer-driven mechanical end-effector is under development as a targeting system for spinal surgery. This technology has the potential to enhance standard intraoperative fluoroscopic information for localization of the pedicle entry point and trajectory, and it may be an effective alternative to the computed tomography-based image-guided system (ICS) in pedicle screw placement. A preclinical study to assess the accuracy and time efficiency of this system versus a conventional IGS was conducted. METHODS: Pedicle screw placement was performed in six cadavers from T1 to S1 levels using the ViewPoint IGS (Picker International, Inc., Cleveland, OH) on one side versus the Fluorotactic guidance system (Z-Kat, Inc., Miami, FL) on the other side. Of 216 possible pedicles, 208 were instrumented; 8 pedicle diameters were too small or were not adequately imaged. Postinsertion, each pedicle was assessed for the presence and location of cortical perforation using computed tomographic scanning and direct visualization. RESULTS: The number of successful screw placements was 89 (87.3%) of 102 for ICS and 87 (82.1%) of 106 for the Fluorotactic guidance system, respectively. The mean time to register and operate on one level using the Fluorotactic guidance system was 14:34 minutes (minutes:seconds), compared with 6:50 minutes using the IGS. The average fluoroscope time was 4.6 seconds per pedicle. CONCLUSION: Our data indicate that this first-generation fluoroscopy-based targeting system can significantly assist the surgeon in pedicle screw placement. The overall accuracy is comparable to an IGS, especially in the region of T9-L5. A second-generation system with a faster end-effector and user-friendly interface should significantly reduce the operating and fluoroscope time.
引用
收藏
页码:872 / 878
页数:7
相关论文
共 19 条
[1]   COMPUTER-ASSISTED PEDICLE SCREW FIXATION - A FEASIBILITY STUDY [J].
AMIOT, LP ;
LABELLE, H ;
DEGUISE, JA ;
SATI, M ;
BRODEUR, P ;
RIVARD, CH .
SPINE, 1995, 20 (10) :1208-1212
[2]   INTRAOPERATIVE LOCALIZATION USING AN ARMLESS, FRAMELESS STEREOTAXIC WAND - TECHNICAL NOTE [J].
BARNETT, GH ;
KORMOS, DW ;
STEINER, CP ;
WEISENBERGER, J .
JOURNAL OF NEUROSURGERY, 1993, 78 (03) :510-514
[3]   A COMPARISON OF FLUOROSCOPY AND COMPUTED TOMOGRAPHY-DERIVED VOLUMETRIC MULTIPLE EXPOSURE TRANSMISSION HOLOGRAPHY FOR THE GUIDANCE OF LUMBAR PEDICLE SCREW INSERTION [J].
BENZEL, EC ;
RUPP, FW ;
MCCORMACK, BM ;
BALDWIN, NG ;
ANSON, JA ;
ADAMS, MS .
NEUROSURGERY, 1995, 37 (04) :711-716
[4]  
Foley KT, 1996, NEUROSURG CLIN N AM, V7, P171
[5]   Computer-aided pedicle screw placement using frameless stereotaxis [J].
Glossop, ND ;
Hu, RW ;
Randle, JA .
SPINE, 1996, 21 (17) :2026-2034
[6]  
GLOSSOP ND, 1996, COMP ASS ORTH SURG M
[7]  
GUTHRIE BL, 1992, CLIN NEUR, V38, P112
[8]   APPLICATION OF FRAMELESS STEREOTAXY TO PEDICLE SCREW FIXATION OF THE SPINE [J].
KALFAS, IH ;
KORMOS, DW ;
MURPHY, MA ;
MCKENZIE, RL ;
BARNETT, GH ;
BELL, GR ;
STEINER, CP ;
TRIMBLE, MB ;
WEISENBERGER, JP .
JOURNAL OF NEUROSURGERY, 1995, 83 (04) :641-647
[9]  
Lavallee S, 1995, J Image Guid Surg, V1, P65, DOI 10.1002/(SICI)1522-712X(1995)1:1<65::AID-IGS10>3.3.CO
[10]  
2-E