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and midthoracic level spina bi
da, while the other three all presented severe pro-
gressive scoliosis. In each case, spinal instrumentation was required for fusion.
Aided by the 3-D templating software, precise size and location of pedicle screws
for safe implantation were identi
ed, and full-sized models were generated from the
templated image data (Fig.
16
). The models were used in the operating room as a
reference in all four cases, helping the surgeon to easily transfer the precise plan
directly to the procedure. Clinical and radiographic outcomes were considered
excellent in each of the four cases and each surgery was performed without
complication.
6 Discussion
This work demonstrates that accurate 3D pre-surgical planning for complex pedicle
screw placement in spinal deformity correction interventions can be achieved using
pre-acquired high resolution volumetric images and user-interactive guidance.
Moreover, the virtual pre-surgical plan can be used to rapidly prototype a 3D
physical anatomical model of the patient
'
guration.
Surgeons reported that the planning software and 3D models provided signi
s spine in its corrected con
cant
information which increased the surgeon
'
s ability to plan several concurrent sur-
gical approaches, and, therefore, consider several viable options in the procedure
room.
Due to the broad variety of implants used in this procedure (including hooks and
rods), future work will include the incorporation of different types of instrumen-
tation. Moreover, we envision to further improve the capabilities of the currently
developed platform to enable a better integration of the planning module with the
intra-operative guidance. To date, the SSP application is solely used to plan the
procedure and the resulting data is available for visualization, either virtually or
physically, in the operating room. However, we believe that the current work
ow
can be further enhanced by providing the surgeon with a direct spatial relationship
that enables the translation and implementation of the pre-operative plan into sur-
gical guidance. One approach is to perform a virtual model-to-patient registration
using a surgical instrument localization system, and to make use of the tracked
instruments to better guide the instrumentation, ensuring that the insertion point and
trajectory of the pedicle screw follow the procedure plan.
Several other techniques have been explored by different groups in parallel with
the development of the Spine Surgery Planning platform. As mentioned in the
introduction, the initial iteration of our spine surgery planning platform was
developed simultaneously with the iPlan platform developed simultaneously by
BrainLab [
11
] and features similar capabilities, including selection of virtual
implants, trajectory planning, as well image segmentation, registration and overlay
of multiple datasets into the templating work
fl
ow.
Bichlmeier et al. [
1
] disseminated on a new method for navigated spine surgery
using a stereoscopic video see-through head-mounted display (HMD) and an
fl
