scholarly journals Present and Future Spinal Robotic and Enabling Technologies

2021 ◽  
Vol 21 (Supplement_1) ◽  
pp. S48-S56
Author(s):  
Siri Sahib S Khalsa ◽  
Praveen V Mummaneni ◽  
Dean Chou ◽  
Paul Park
Keyword(s):  
Intraoperative Imaging ◽  
Three Dimensional ◽  
Robotic Systems ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Planning Software ◽  
Enabling Technologies ◽  
Advanced Planning ◽  
Spinal Navigation

Abstract Enabling technologies include surgical planning software, computer-assisted navigation, intraoperative three-dimensional (3D) imaging, and robotic systems. Presently, these technologies are in various stages of refinement. Spinal robots in particular are currently limited to the positioning of an alignment guide for pedicle screw placement. Current generation spinal robots, therefore, play a more limited role in spinal surgery. In contrast to spinal robots, intraoperative imaging technology has been developed further, to a stage that allows accurate 3D spinal image acquisition that can be readily utilized for spinal navigation. The integration of these various technologies has the potential to maximize the safety, consistency, reliability, and efficacy of surgical procedures. To that end, the trend for manufacturers is to incorporate various enabling technologies into the spinal robotic systems. In the near-term, it is expected that integration of more advanced planning software and navigation will result in wider applicability and value. In the long-term, there are a variety of enabling technologies such as augmented reality that may be a component of spinal robots. This article reviews the features of currently available spinal robots and discusses the likely future advancements of robotic platforms in the near- and long-term.

scholarly journals Application of a new percutaneous multi-function pedicle locator in minimally invasive spine surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaojian Liu ◽  
Hairun Liu ◽  
Yushan Wang
Keyword(s):  
Minimally Invasive ◽  
Spine Surgery ◽  
Three Dimensional ◽  
Operation Time ◽  
Minimally Invasive Spine Surgery ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Number Of Patients ◽  
Potential Benefits ◽  
Minimally Invasive Spine

AbstractIn this study, a new percutaneous multi-function pedicle locator was designed for personalized three-dimensional positioning of a pedicle in minimally invasive spine surgery (MISS) without computer-assisted navigation technology. The proposed locator was used in a number of patients during MISS, and its advantages were analyzed. Based on the position of a pedicle determined by computed tomography (CT) and fluoroscopic images of a patient, 6 lines and 2 distances were used to determine the puncture point of a pedicle screw on skin, while 2 angles were used to indicate the direction of insertion of a pedicle guide needle from the patient's body surface. The results of the proposed locator were compared with those of the conventional freehand technique in MISS. The potential benefits of using the locator included enhanced surgical accuracy, reduced operation time, alleviation of the harmful intra-operative radiation exposure, lower costs, and shortened learning curve for young orthopedists.

scholarly journals Trackerless 3D Ultrasound Stitching for Computer-Assisted Orthopaedic Surgery and Pelvic Fractures

10.29007/3wlw ◽  
2018 ◽  
Author(s):  
Prashant Pandey ◽  
Rafeef Abugharbieh ◽  
Antony J. Hodgson
Keyword(s):  
Pelvic Fracture ◽  
Orthopaedic Surgery ◽  
Intraoperative Imaging ◽  
Three Dimensional ◽  
3D Ultrasound ◽  
Field Of View ◽  
Surrounding Tissue ◽  
Computer Assisted ◽  
Surgical Guidance ◽  
Computer Assisted Orthopaedic Surgery

In pelvic fracture surgeries, percutaneous screws must be placed accurately for effective fixation and to prevent damage to surrounding tissue structures. Fluoroscopy is currently used to image the pelvis to provide guidance, but this produces harmful ionising radiation and does not allow three-dimensional (3D) visualisation. Ultrasound offers three-dimensional, non-ionising, real-time, and inexpensive imaging. It has thus emerged as an alternative to fluoroscopy for intraoperative imaging in computer-assisted orthopaedic surgery (CAOS). However, ultrasound-based surgical guidance is challenging because ultrasound produces inherently noisy images with limited field-of-view. While several techniques have been proposed to improve bone clarity in ultrasound scans, there is limited work on enhancing ultrasound’s field-of-view for CAOS. In particular, improving the field-of-view for surgical guidance for pelvic fracture surgeries would be needed to achieve accurate and reliable registration to preoperative data, and accurate screw placement in the pelvis.We propose and evaluate the feasibility of a trackerless method for stitching volumetric ultrasound to achieve an extended field-of-view. Stitching is performed using corresponding features in the overlap between three ultrasound volumes, extracted using an implementation of the 3D scale-invariant feature transform. The volumes are processed using confidence-map weighted phase symmetry detection. Alignment between the volumes is calculated using coherent point drift rigid registration.We succeeded in extending the field-of-view of 3D ultrasound by creating a 39×43×115mm volume from three initial overlapping volumes, with reasonable overall accuracy. We show a mean post-registration surface error of 0.54mm, compared to 0.33mm achieved by previous tracking-based stitching. Our method achieved a mean distance error of 5.1%, compared to 2% in a similar tracked and 3D SIFT-based technique. Our stitching method does not use tracking, thus contributing towards simpler surgical navigation.

scholarly journals Utilization of Spinal Intra-operative Three-dimensional Navigation by Canadian Surgeons and Trainees: A Population-based Time Trend Study

2019 ◽  
Vol 46 (1) ◽  
pp. 87-95 ◽  
Author(s):  
Daipayan Guha ◽  
Ali Moghaddamjou ◽  
Zaneen H. Jiwani ◽  
Naif M. Alotaibi ◽  
Michael G. Fehlings ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Population Based ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Capital Costs ◽  
Orthopedic Surgeons ◽  
Surgical Trainees ◽  
Single Payer ◽  
The Impact

AbstractBackgroundComputer-assisted navigation (CAN) improves the accuracy of spinal instrumentation in vertebral fractures and degenerative spine disease; however, it is not widely adopted because of lack of training, high capital costs, workflow hindrances, and accuracy concerns. We characterize shifts in the use of spinal CAN over time and across disciplines in a single-payer health system, and assess the impact of intra-operative CAN on trainee proficiency across Canada.MethodsA prospectively maintained Ontario database of patients undergoing spinal instrumentation from 2005 to 2014 was reviewed retrospectively. Data were collected on treated pathology, spine region, surgical approach, institution type, and surgeon specialty. Trainee proficiency with CAN was assessed using an electronic questionnaire distributed across 15 Canadian orthopedic surgical and neurosurgical programs.ResultsIn our provincial cohort, 16.8% of instrumented fusions were CAN-guided. Navigation was used more frequently in academic institutions (15.9% vs. 12.3%, p<0.001) and by neurosurgeons than orthopedic surgeons (21.0% vs. 12.4%, p<0.001). Of residents and fellows 34.1% were fully comfortable using spinal CAN, greater for neurosurgical than orthopedic surgical trainees (48.1% vs. 11.8%, p=0.008). The use of CAN increased self-reported proficiency in thoracic instrumentation for all trainees by 11.0% (p=0.036), and in atlantoaxial instrumentation for orthopedic trainees by 18.0% (p=0.014).ConclusionsSpinal CAN is used most frequently by neurosurgeons and in academic centers. Most spine surgical trainees are not fully comfortable with the use of CAN, but report an increase in technical comfort with CAN guidance particularly for thoracic instrumentation. Increased education in spinal CAN for trainees, particularly at the fellowship stage and, specifically, for orthopedic surgery, may improve adoption.

scholarly journals Efficacy of a simple intraoperative stem-anteversion measuring device in total hip arthroplasty

2020 ◽  
Author(s):  
Kentaro Iwakiri ◽  
Yoichi Ohta ◽  
Yohei Ohyama ◽  
Yukihide Minoda ◽  
Akio Kobayashi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Measuring Device ◽  
Correction Angle ◽  
Assisted Navigation ◽  
Total Hip ◽  
Flexion Extension

Abstract Background Background: Stem anteversion is important in reducing postoperative complications in total hip arthroplasty (THA). THA utilizing the combined-anteversion theory requires stem anteversion angle (SAA) measurement intraoperatively; however, intraoperative SAA estimation is difficult for surgeons without computer-assisted navigation system. We evaluated the accuracy of the SAA measured intraoperatively using a newly developed device by comparing the three-dimensional measurements using postoperative computed tomography (CT).Materials & Methods In 127 hips in 127 patients who underwent unilateral THA at our hospital, we used our newly developed device that can be easily attached to rasping broach handles for measuring the SAA intraoperatively, which required the addition of the correction angle obtained in the preoperative epicondylar view. Postoperative SAA and its discrepancies from the measured intraoperative SAA with or without adding the correction angle were compared between the groups to evaluate the usefulness of the device.Results The intraoperative SAA measured by the device was 17.93 ± 7.53°. The true SAA measured on postoperative CT was 26.40 ± 9.73°. The discrepancy between the intraoperative SAA and true SAA was 8.94 ± 5.44° (without the correction angle), and 4.93 ± 3.85° (with the correction angle). Accuracy with a discrepancy of <5 degrees was achieved in 77 (60.6%) and <10 degrees was achieved in 113 (89.0%). The accuracy was unaffected by the stem placement angle (varus/valgus, or flexion/extension), or ipsilateral knee osteoarthritis.Conclusion The SAA measuring device, easily attachable to various rasping handles, is useful to measure the intraoperative SAA in a simple, economical, and noninvasive manner during THA.Level of Evidence Therapeutic Level IV.

Three-dimensional computer-assisted study model analysis of long-term oral-appliance wear. Part 1: Methodology

2008 ◽  
Vol 134 (3) ◽  
pp. 393-407 ◽  
Author(s):  
Hui Chen ◽  
Alan A. Lowe ◽  
Fernanda Riberiro de Almeida ◽  
Mary Wong ◽  
John A. Fleetham ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Oral Appliance ◽  
Model Analysis ◽  
Computer Assisted

scholarly journals Application of computer-assisted navigation in mandibular angle osteotomy

2019 ◽  
Vol 47 (7) ◽  
pp. 3160-3170 ◽  
Author(s):  
Liqin Lin ◽  
Bokai Fan ◽  
Zheyuan Yu ◽  
Liang Xu ◽  
Jie Yuan ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Approach ◽  
Mandibular Angle ◽  
Traditional Group ◽  
Assisted Navigation ◽  
Surgical Safety ◽  
Traditional Technique ◽  
Computed Tomography Images ◽  
Navigation Group

Objective To compare the effectiveness, accuracy, and surgical safety of a navigation technique with those of a traditional technique for intraoperative mandibular angle osteotomy. Methods Forty-three postsurgical patients with mandibular angle hypertrophy who were admitted to our Department from June 2014 to June 2017 were retrospectively reviewed. Of these patients, 23 underwent mandibular angle osteotomy using computer-assisted navigation (navigation group), and 20 underwent osteotomy using a traditional technique (traditional group). Postoperative computed tomography images were analyzed by three-dimensional software. Each patient’s facial proportion indices were measured using Mimics 19.0 software, and statistical comparisons and analyses were performed preoperatively and postoperatively. Results The postoperative facial contour morphology and facial proportion were improved in both groups; the navigation group showed greater improvement. The difference between the predicted and postoperative values was smaller in the navigation group than traditional group. The postoperative shape of the mandibular angle sample was similar to the preoperative predicted shape in the navigation group. No complications occurred in the navigation group, but paresthesia occurred in 17% of patients in the traditional group. Conclusions Mandibular angle osteotomy aided with computer-assisted navigation is more effective, accurate, and safe than the traditional technique and represents a promising clinical approach.

scholarly journals The outcome of skeletofacial reconstruction with mandibular rotation for management of asymmetric skeletal class III deformity: A three-dimensional computer-assisted investigation

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Ting-Yu Wu ◽  
Rafael Denadai ◽  
Hsiu-Hsia Lin ◽  
Cheng-Ting Ho ◽  
Lun-Jou Lo
Keyword(s):  
Three Dimensional ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Computer Assisted ◽  
Rigid Fixation ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Skeletal Class ◽  
Jaw Surgery

Abstract The mandibular proximal ramus segments should be moved and rotated during orthognathic surgery-based skeletofacial reconstruction for the correction of challenging patients with facial asymmetry and malocclusion, but quantitative data regarding this rotation were not sufficient to date. This 3D computer-assisted study measured the proximal ramus segment rotation after 3D simulation-guided two-jaw surgery in patients with facial asymmetric deformity and class III malocclusion (n = 31). Using 3D mandible models and a reliable proximal ramus segment-related plane, angular changes in pitch, roll and yaw directions were measured before and one month after surgery. Significant rotational changes (p < 0.01) were observed in the left and right sides and overall proximal ramus segments after surgery, with absolute differences of 4.1 ± 3.0 (range −7.8 to 6.9), 2.8 ± 2.3 (−8.8 to 5.0), and 2.7 ± 2.4 (−6.6 to 9.9) degrees in pitch, roll, and yaw rotations, respectively. Numbness and mouth opening limiting occurred within the first 6 months after surgery but the patients had an unremarkable long-term postoperative course, with no revisionary surgery required. This study contributes to the multidisciplinary-related literature by revealing that proximal ramus segment rotation and rigid fixation with no postoperative intermaxillary immobilization was practicable in skeletofacial surgery for the successful treatment of asymmetric deformity and class III malocclusion.

scholarly journals GP.01 Quantification of computational geometric congruence in surface-based registration for spinal intra-operative three-dimensional navigation

2017 ◽  
Vol 44 (S2) ◽  
pp. S7-S7
Author(s):  
D Guha ◽  
R Jakubovic ◽  
VX Yang
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Thoracolumbar Spine ◽  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Computational Modelling ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Subaxial Cervical Spine ◽  
Geometric Symmetry

Background: Computer-assisted navigation (CAN) may guide spinal instrumentation, and requires alignment of patient anatomy to imaging. Iterative-Closest-Point algorithms register anatomical and imaging datasets, which may fail in the presence of significant geometric congruence leading to inaccurate navigation. We computationally quantify geometric congruence in posterior spinal exposures, and identify predictors of potential navigation inaccuracy. Methods: Midline posterior exposures were performed from C1-S1 in four human cadavers. An optically-based CAN generated surface maps of the posterior elements at each level. Maps were reconstructed to include bilateral hemilamina, or unilateral hemilamina with/without the base of the spinous process. Maps were fitted to symmetrical geometries (cylindrical/spherical/planar) using computational modelling, and the degree of model fit quantified. Results: Increased cylindrical/spherical/planar symmetry was seen in the subaxial cervical spine relative to the high-cervical and thoracolumbar spine (p<0.001). Inclusion of the base of the spinous process decreased symmetry independent of spinal level (p<0.001). Registration with bilateral vs. unilateral hemilamina did not significantly reduce geometric symmetry. Conclusions: Geometric congruence is most evident at C1 and the subaxial cervical spine, warranting greater vigilance in navigation accuracy verification. At all levels, inclusion of the base of the spinous process in unilateral registration decreases the likelihood of geometric symmetry and navigation error.

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