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shorter screws to avoid pedicle rupture or protrusion outside the vertebral body. To
address these limitations, we intend to conduct a double cohort study that enables
the translation of the plan into the OR for appropriate comparison of both virtual
and traditional plans followed all the way to post-procedure outcome. This study
will provide a larger sample size for analysis and enable us to investigate any
differences between experienced and novice surgeons as far as implant selection
and planning.
For the sake of a consistent comparison of homologous implants in both the
retrospective plan and procedure with respect to different parameters (implant size,
displaced bone volume, mean voxel intensity of displaced bone volume and lastly
the fastening strength), we used the paired Student t-statistic to compare the paired
results. However, we also computed the correlation between the retrospective plan
and post-operative outcome for each of the
five parameters mentioned above.
A moderate correlation was found between the retrospective plan and post-proce-
dure outcome for the implant diameter, implant length and displaced bone volume
(0.63, 0.59 and 0.52, respectively), and a higher correlation was revealed between
the plan and procedure with respect to the Fastening Strength and Mean Voxel
Intensity of the displaced bone volume (0.82 and 0.79, respectively). These cor-
relations con
rm the more conservative plans performed by the fellow (selection of
slightly thinner and shorter implants) compared to the implants used during the
actual procedures by the staff surgeon. Nevertheless, the trajectory of the implants
and their positioning within the vertebral body was consistent between the retro-
spective plans conducted by the fellow and the procedures performed by the
surgeon.
Clinical Limitations and Impact: We recognize ongoing efforts in computer-
assisted spine surgery to assist the surgeon with implant positioning during the
procedure, and we believe that such endeavours, although valuable in the intra-
operative setting, make limited effort to improve procedure planning and eventually
enabling the planning process be conducted out of the OR. The platform described
here is intended to complement the intra-operative endeavours and enable planning
to be performed once a CT scan is available, outside of the OR, to reduce anaes-
thesia time, and overall procedure time and costs. Hence it is not counter-intuitive
to conclude that by performing the planning prior to the procedure, the time under
anesthesia, overall OR time and all associated costs could be reduced. Moreover,
given the planning platform utilizes typical standard of care pre-operative image
datasets, it can be seamlessly integrated with both manual implantation procedures,
as well as computer-assisted navigation, providing the added bonus of precisely
translating the planned trajectories from the pre-operative planning stage to the
intra-operative stage by means of plan-to-patient registration and tracking of the
surgical instruments and implants.
