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Toward Virtual Modeling and Templating
for Enhanced Spine Surgery Planning
Cristian A. Linte, Kurt E. Augustine, Jon J. Camp, Richard A. Robb
and David R. Holmes III
Abstract Traditional 2D images provide limited use for accurate planning of spine
interventions, due to their inability to display the complex 3D spine anatomy and
close proximity of nerve bundles and vascular structures that must be avoided
during the procedure. We have developed a platform for spine surgery planning that
employs standard of care 3D pre-operative images and enables oblique reformatting
and 3D rendering of individual or multiple vertebrae, interactive templating, and
placement of virtual pedicle implants into the patient-speci
c CT data. Here we
propose a combined surrogate metric
to provide esti-
mates of the optimal implant selection and trajectory based on implant dimension
and bone mineral density of the displaced bone substrate. We conducted a retro-
spective clinical study based on pre- and post-operative data from four patients who
underwent procedures involving pedicle screw implantation. We assessed the ret-
rospective plans against the post-operative imaging data according to implant
dimension, mean voxel intensity of implant trajectory, and Fastening Strength and
showed consistency between the proposed plans and the post-operative procedure
outcome. Our preliminary studies have demonstrated the feasibility of the platform
in assisting the surgeon with the selection of appropriate size implant and trajectory
that optimizes Fastening Strength, given the intrinsic vertebral geometry and bone
mineral density. Herein we describe the platform infrastructure and capabilities,
present preliminary studies conducted to assess impact on typical instrumentation
procedures, and share our initial clinical experience in employing the proposed tool
for the planning of several complicated spinal correction procedures for which the
traditional planning approaches proved insuf
the Fastening Strength
cient. Lastly, we also disseminate on
several clinical cases and their post-operative assessment for which the proposed
platform was employed by the surgical team.
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