Pedicle screw navigation using tracked ultrasound

Computerized navigation improves the accuracy of minimally invasive pedicle screw placement during spine surgery. Such navigation, however, exposes both the patient and the staff to radiation during the surgery. To avoid intraoperative exposure to radiation tracked ultrasound snapshots—US image frames coupled with corresponding spatial positions—could be used to map preoperatively defined screw plans into the intraoperative coordinate frame. The feasibility of such an approach, however, has not yet been investigated. Are there vertebral landmarks that can be identified using tracked ultrasound snapshots? Can tracked ultrasound snapshots allow preoperative pedicle screw plans to be accurately mapped—compared to CT-derived pedicle screw plans—into the intraoperative coordinate frame in a simulated setting?Methods Ultrasound visibility of registration landmarks was checked on volunteers and phantoms. An ultrasound machine with integrated electromagnetic tracking was used for tracked ultrasound acquisition. Registration was performed using the 3D Slicer open-source software. Two artificial lumbar spine phantoms were used to evaluate registration accuracy of pedicle screw plans using tracked ultrasound snapshots. Registration accuracy was determined by comparing the ultrasound-derived plans to the CT-derived plans. The four articular processes proved to be identifiable using tracked ultrasound snapshots. Pedicle screw plans were registered to the intraoperative coordinate system using landmarks. The registrations were sufficiently accurate in that none of the registered screw plans intersected the pedicle walls. Registered screw plan positions had an error less than 1.28 ± 1.37 mm (average ± SD) in each direction and an angle difference less than 1.92 ± 1.95 around each axis, relative to the CT-derived positions. Conclusions Registration landmarks could be located using tracked ultrasound snapshots and permitted accurate mapping of pedicle screw plans to the intraoperative coordinate frame in a simulated setting.

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Ungi T, Moult E, Schwab JH, Fichtinger G. Tracked ultrasound snapshots in percutaneous pedicle screw placement navigation: a feasibility study. Clin Orthop Relat Res. 2013 Dec;471(12):4047-55.