Computed Tomography-Based Preoperative Simulation System for Pedicle Screw Fixation in Spinal Surgery.
Mesh Smoothing
Pedicle-Screw Fixation
Spinal Surgery
Surgical Planning
Journal
Journal of Korean medical science
ISSN: 1598-6357
Titre abrégé: J Korean Med Sci
Pays: Korea (South)
ID NLM: 8703518
Informations de publication
Date de publication:
11 May 2020
11 May 2020
Historique:
received:
01
12
2019
accepted:
01
03
2020
entrez:
9
5
2020
pubmed:
10
5
2020
medline:
21
1
2021
Statut:
epublish
Résumé
A preoperative planning system facilitates improving surgical outcomes that depend on the experience of the surgeons, thanks to real-time interaction between the system and surgeons. It visualizes intermediate surgical planning results to help surgeons discuss the planning. The purpose of this study was to demonstrate the use of a newly-developed preoperative planning system for surgeons less experienced in pedicle-screw fixation in spinal surgery, especially on patients with anatomical variations. The marching cubes algorithm, a typical surface extraction technique, was applied to computed tomography (CT) images of vertebrae to enable three-dimensional (3D) reconstruction of a spinal mesh. Real-time processing of such data is difficult, as the surface mesh extracted from high-resolution CT data is rough, and the size of the mesh is large. To mitigate these factors, Laplacian smoothing was applied, followed by application of a quadric error metric-based mesh simplification to reduce the mesh size for the level-of-detail (LOD) image. Taubin smoothing was applied to smooth out the rough surface. On a multiplanar reconstruction (MPR) cross-sectional image or a 3D model view, the insertion position and orientation of the pedicle screw were manipulated using a mouse. The results after insertion were then visualized in each image. The system was used for pre-planning pedicle-screw fixation in spinal surgery. Using any pointing device such as a mouse, surgeons can manipulate the position and angle of the screws. The pedicle screws were easy to manipulate intuitively on the MPR images, and the accuracy of screw fixation was confirmed on a trajectory view and 3D images. After surgery, CT scans were performed again, and the CT images were checked to ensure that the screws were inserted properly. The preoperative planning system allows surgeons and students who are not familiar with pedicle-screw fixation to safely undertake surgery following preoperative planning. It also provides opportunities for screw-fixation training and simulation.
Sections du résumé
BACKGROUND
BACKGROUND
A preoperative planning system facilitates improving surgical outcomes that depend on the experience of the surgeons, thanks to real-time interaction between the system and surgeons. It visualizes intermediate surgical planning results to help surgeons discuss the planning. The purpose of this study was to demonstrate the use of a newly-developed preoperative planning system for surgeons less experienced in pedicle-screw fixation in spinal surgery, especially on patients with anatomical variations.
METHODS
METHODS
The marching cubes algorithm, a typical surface extraction technique, was applied to computed tomography (CT) images of vertebrae to enable three-dimensional (3D) reconstruction of a spinal mesh. Real-time processing of such data is difficult, as the surface mesh extracted from high-resolution CT data is rough, and the size of the mesh is large. To mitigate these factors, Laplacian smoothing was applied, followed by application of a quadric error metric-based mesh simplification to reduce the mesh size for the level-of-detail (LOD) image. Taubin smoothing was applied to smooth out the rough surface. On a multiplanar reconstruction (MPR) cross-sectional image or a 3D model view, the insertion position and orientation of the pedicle screw were manipulated using a mouse. The results after insertion were then visualized in each image.
RESULTS
RESULTS
The system was used for pre-planning pedicle-screw fixation in spinal surgery. Using any pointing device such as a mouse, surgeons can manipulate the position and angle of the screws. The pedicle screws were easy to manipulate intuitively on the MPR images, and the accuracy of screw fixation was confirmed on a trajectory view and 3D images. After surgery, CT scans were performed again, and the CT images were checked to ensure that the screws were inserted properly.
CONCLUSION
CONCLUSIONS
The preoperative planning system allows surgeons and students who are not familiar with pedicle-screw fixation to safely undertake surgery following preoperative planning. It also provides opportunities for screw-fixation training and simulation.
Identifiants
pubmed: 32383365
pii: 35.e125
doi: 10.3346/jkms.2020.35.e125
pmc: PMC7211513
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e125Subventions
Organisme : Institute for Information and communications Technology Promotion
ID : 2017-0-01815
Pays : Korea
Informations de copyright
© 2020 The Korean Academy of Medical Sciences.
Déclaration de conflit d'intérêts
The authors have no potential conflicts of interest to disclose.
Références
Comput Med Imaging Graph. 2003 Sep-Oct;27(5):411-35
pubmed: 12821034
Comput Aided Des. 2012 May 1;44(5):400-412
pubmed: 22328787
J Spinal Disord Tech. 2009 Oct;22(7):502-6
pubmed: 20075813
Int J Numer Method Biomed Eng. 2012 Jan;28(1):133-57
pubmed: 25830210
Med Eng Phys. 2014 Dec;36(12):1626-35
pubmed: 25271191
Neurol India. 2018 Nov-Dec;66(6):1766-1770
pubmed: 30504578
Comput Methods Appl Mech Eng. 2010 Jan 1;199(5-8):405-415
pubmed: 20161555
Spine (Phila Pa 1976). 1990 Jan;15(1):11-4
pubmed: 2326693
J Biomed Opt. 2013 Aug;18(8):86007
pubmed: 23942632
Spine (Phila Pa 1976). 1993 Nov;18(15):2231-8; discussion 2238-9
pubmed: 8278838
Phys Med Biol. 2014 Sep 21;59(18):5287-303
pubmed: 25144615
World Neurosurg. 2018 Oct;118:e550-e556
pubmed: 30257308
IEEE Trans Biomed Eng. 2017 Sep;64(9):2110-2121
pubmed: 27893375
IEEE Trans Vis Comput Graph. 2011 May;17(5):669-81
pubmed: 20498507
Neurosurgery. 2002 Jan;50(1):222-3; discussion 223-4
pubmed: 11844256
Musculoskelet Surg. 2016 Dec;100(3):165-169
pubmed: 27866324
J Spinal Disord Tech. 2015 Feb;28(1):E25-9
pubmed: 25075987