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Abstract
Study Design
The study involved the development and accuracy testing of an intra-operative navigation system
Objectives
This study was undertaken to develop a navigation system using a robot armtype Three-dimensional digitizer. A nd, to apply the developed system to pedicle screw insertion, and to evaluate its accuracy.
Summary of Literature Review
To the best of our knowledge, no navigation system has been developed using a robot arm-type Three-dimensional digitizer.
Materials and Methods
We have developed a navigator using a Three-dimensional digitizer (Microscribe 3- D G2, Immersion, USA) supported by a personal computer. Four types of patient- to- image registration techniques were implemented. During navigation, the central axis of the robot arm's stylus and arm extension can be displayed over multiplanar and Three-dimensional images, which are reconstructed from axial CT scan images. Registration errors and target localization errors of the navigation system were evaluated using a phantom made from a plastic lumbosacral bone model. The accuracy of pedicle screw insertion was also evaluated by placing 18 pedicle screws in such bone models.
Results
The registration error was 0.78± .27 mm at fiducial registration and 0.76± .24 mm at hybrid registration, and the target localization error was 1.34± .32 mm at fiducial registration and 1.28± .29 mm at hybrid registration. Of the 18 screws placed in the plastic bone models, one (6%) screw breached the pedicle wall.
REFERENCES
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Fig. 2.
The user interface of hybrid registration is shown. Fig. 4. A. Paired point registration is carried out first, which approximately matches 4~6 points on real bones with those on three-dimensional images. Fig. 4. B. Then, surface registration is carried out by additionally inputting 10~12 arbitrary points.
Fig. 3.
Planning software is shown. Optimal entry points and trajectories of screws can be determined pre-operatively using multi-planar and three-dimensional images reconstructed from axial CT scan images.
Fig. 4.
The user interface of navigation software is shown. Fig. 4. A. The central axis of the robot arm’s stylus along with the planned trajectory is displayed on multi-planar and three-dimensional images. Fig. 4. B. They can also be displayed on two-dimensional images reconstructed along the axis of the stylus (the two upper left windows).
Fig. 5.
A phantom made with a plastic lumbosacral bone model is shown. It was used for the accuracy test.
Table 1.
Registration error and target localization error of the navigation system.
| Registration method | Error (mm) | |
|---|---|---|
| Registration error | Target localization error | |
| Fiducial registration∗ | 0.78± 0.27 | 1.34± 0.32 |
| Hybrid registration∗∗ | 0.76± 0.24 | 1.28± 0.29 |
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