Feasibility of mixed reality–based intraoperative three-dimensional image-guided navigation for atlanto-axial pedicle screw placement

Abstract

This study aimed to evaluate the safety and accuracy of mixed reality–based intraoperative three-dimensional navigated pedicle screws in three-dimensional printed model of fractured upper cervical spine. A total of 27 cervical model from patients of upper cervical spine fractures formed the study group. All the C1 and C2 pedicle screws were inserted under mixed reality–based intraoperative three-dimensional image-guided navigation system. The accuracy and safety of the pedicle screw placement were evaluated on the basis of postoperative computerized tomography scans. A total of 108 pedicle screws were properly inserted into the cervical three-dimensional models under mixed reality–based navigation, including 54 C1 pedicle screws and 54 C2 pedicle screws. Analysis of the dimensional parameters of each pedicle at C1/C2 level showed no statistically significant differences in the ideal and the actual entry points, inclined angles, and tailed angles. No screw was misplaced outside the pedicle of the three-dimensional printed model, and no ionizing X-ray radiation was used during screw placement under navigation. It is easy and safe to place C1/C2 pedicle screws under MR surgical navigation. Mixed reality–based navigation is feasible within upper cervical spinal fractures with improved safety and accuracy of C1/C2 pedicle screw insertion.

Keywords

Mixed reality navigation atlanto-axial pedicle screw three-dimensional print

Get full access to this article

View all access options for this article.

References

Lindsey

Miclau

Posterior lateral mass plate fixation of the cervical spine. J South Orthop Assoc 2000; 9(1): 36–42, discussion 42.

Jeanneret

Magerl

Primary posterior fusion C1/C2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 1992; 5(4): 464–475.

Abumi

Itoh

Taneichi

, et al. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord 1994; 7(1): 19–28.

Kotani

McNulty

Abumi

, et al. The role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine: a biomechanical study. Spine (Phila Pa 1976) 1998; 23(14): 1559–1565.

Esses

Sachs

Dreyzin

Complications associated with the technique of pedicle screw fixation: a selected survey of ABS members. Spine (Phila Pa 1976) 1993; 18(15): 2231–2238, discussion 2238–2239.

Yoshihara

Passias

Errico

. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review. J Neurosurg Spine 19(5): 614–623.

Wang

MY.

Cervical crossing laminar screws: early clinical results and complications. Neurosurgery 2007; 61(5 Suppl. 2): 311–315, discussion 315–316.

Karaikovic

Yingsakmongkol

Griffiths

, et al. Possible complications of anterior perforation of the vertebral body using cervical pedicle screws. J Spinal Disord Tech 2002; 15(1): 75–78.

Vaccaro

Klein

Flanders

, et al. Long-term evaluation of vertebral artery injuries following cervical spine trauma using magnetic resonance angiography. Spine (Phila Pa 1976) 1998; 823(7): 789–794, discussion 795.

10.

Fiore

Haid

Rodts

, et al. Atlantal lateral mass screws for posterior spinal reconstruction: technical note and case series. Neurosurg Focus 2002; 12(1): E5.

11.

Wright

NM.

Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 2004; 17(2): 158–162.

12.

Sauer

Queisner

Tang

, et al. Mixed reality in visceral surgery: development of a suitable workflow and evaluation of intraoperative use-cases. Ann Surg 2017; 266(5): 706–712.

13.

Hodges

Eck

Newton

Analysis of CT-based navigation system for pedicle screw placement. Orthopedics 2012; 35(8): e1221–e1224.

14.

Zhou

Yang

Jiang

, et al. Design and validation of a surgical navigation system for brachytherapy based on mixed reality. Med Phys 2019; 46: 3709–3718.

15.

Jayender

Xavier

King

, et al. A novel mixed reality navigation system for laparoscopy surgery. Med Image Comput Comput Assist Interv 2018; 11073: 72–80.

16.

Davrieux

Gimenez

Gonzalez

, et al. Mixed reality navigation system for ultrasound-guided percutaneous punctures: a pre-clinical evaluation. Surg Endosc. Epub ahead of print 25 March 2019. DOI: 10.1007/s00464-019-06755-5.

17.

Zhou

, et al. Application of mixed reality real-time navigation combined with 3D visualization in complicated hepatectomy. Zhonghua Yi Xue Za Zhi 2019; 99(4): 279–283.

18.

Marwan

Kombar

Al-Saeed

, et al. The feasibility of two screws anterior fixation for type II odontoid fracture among Arabs. Spine (Phila Pa 1976) 2016; 41(11): E643–E646.

19.

Yin

Wang

, et al. Applied anatomy of transoral atlantoaxial reduction plate internal fixation. Spine (Phila Pa 1976) 2006; 31(2): 128–132.

20.

Resnick

Lapsiwala

Trost

GR.

Anatomic suitability of the C1-C2 complex for pedicle screw fixation. Spine (Phila Pa 1976) 2002; 27(14): 1494–1498.

21.

Melcher

Puttlitz

Kleinstueck

, et al. Biomechanical testing of posterior atlantoaxial fixation techniques. Spine (Phila Pa 1976) 2002; 27(22): 2435–2440.

22.

Lee

Chen

Lee

ST.

Clinical experience with rigid occipitocervical fusion in the management of traumatic upper cervical spinal instability. J Clin Neurosci 2006; 13(2): 193–198.

23.

Richter

Cakir

Schmidt

Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine (Phila Pa 1976) 2005; 30(20): 2280–2287.

24.

Ludwig

Kramer

Balderston

, et al. Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine (Phila Pa 1976) 2000; 25(13): 1655–1667.

25.

Liu

, et al. Deviation analysis for C1/C2 pedicle screw placement using a three-dimensional printed drilling guide. Proc IMechE, Part H: J Engineering in Medicine 2017; 231(6): 547–554.

26.

Kovanda

Ansari

Qaiser

, et al. Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience. J Neurosurg Pediatr 2015; 16: 590–598.

27.

Amiot

Lang

Putzier

, et al. Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine (Phila Pa 1976) 2000; 25(5): 606–614.

28.

Kotani

Abumi

Ito

, et al. Improved accuracy of computer-assisted cervical pedicle screw insertion. J Neurosurg 2003; 99(Suppl. 3): 257–263.

29.

Kotani

Abumi

Ito

, et al. Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine (Phila Pa 1976) 2007; 32(14): 1543–1550.

30.

Rajasekaran

Kanna

Shetty

TA.

Intra-operative computer navigation guided cervical pedicle screw insertion in thirty-three complex cervical spine deformities. J Craniovertebr Junction Spine 2010; 1(1): 38–43.

31.

Richter

Amiot

Neller

, et al. Computer-assisted surgery in posterior instrumentation of the cervical spine: an in-vitro feasibility study. Eur Spine J 2000; 9(Suppl. 1): S65–S70.

32.

Ludwig

Kowalski

Edwards

, et al. Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine (Phila Pa 1976) 2000; 25(20): 2675–2681.

33.

Volonte

Pugin

Bucher

, et al. Augmented reality and image overlay navigation with OsiriX in laparoscopic and robotic surgery: not only a matter of fashion. J Hepatobiliary Pancreat Sci 2011; 18(4): 506–509.

34.

Radtke

Sotiropoulos

Molmenti

, et al. Computer-assisted surgery planning for complex liver resections: when is it helpful? A single-center experience over an 8-year period. Ann Surg 2010; 252(5): 876–883.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.04 MB