A Robot Armtype Navigation System for Pedicle Screw Placement: A Feasibility Study

Jin Sup Yeom; Whoan Jeang Kim; Won Sik Choy; Jong Won Kang; Yeong Ho Kim; Nam Kug Kim; Jae Bum Lee; Hyung Min Kim; Seok Lee; Dong Hyun Seo

doi:10.4184/jkss.2002.9.4.270

Journal List > J Korean Soc Spine Surg > v.9(4) > 1036029

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Yeom, Kim, Choy, Kang, Kim, Kim, Lee, Kim, Lee, and Seo: A Robot Armtype Navigation System for Pedicle Screw Placement: A Feasibility Study

Original Article

Journal of Korean Spine Surg 2002;9(4):270-279.

Published online: 12 February 2002

DOI: https://doi.org/10.4184/jkss.2002.9.4.270

A Robot Armtype Navigation System for Pedicle Screw Placement: A Feasibility Study

Jin Sup Yeom, M.D., Whoan Jeang Kim, M.D., Won Sik Choy, M.D., Jong Won Kang, M.D., Yeong Ho Kim, Ph.D.^∗, Nam Kug Kim, M.S.^∗∗, Jae Bum Lee^∗∗, Hyung Min Kim, M.S.^∗∗, Seok Lee, M.S.^∗∗, Dong Hyun Seo, B.S.

Department of Orthopaedic Surgery, Eulji University, Daejeon, Korea

^∗ Department of Industrial Engineering, College of Engineering, Seoul National University, Seoul, Korea

^∗∗Cybermed Inc., Seoul, Korea

Address reprint requests to Yeong Ho Kim, Ph.D. Department of Industrial Engineering, Seoul National University #San 56-1, Shillim-dong, Kwanak-gu, Seoul 151-742, Korea Tel : 82-2-880-8335, Fax : 82-2-889-8560, E-mail : yeongho@snu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Conclusions

We have developed a robot armtype Three-dimensional digitizer- based navigation system for pedicle screw insertion, and found that its accuracy is equal or slightly better than that of optical tracker- based navigators.

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Keywords: Pedicle screw, Robot arm, Three-dimensional digitizer, Navigation system

REFERENCES

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Fig. 1.

A robot-arm type three-dimensional digitizer is shown. The stylus portion is arrowed.

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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.

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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.

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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).

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Fig. 5.

A phantom made with a plastic lumbosacral bone model is shown. It was used for the accuracy test.

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Table 1.

Registration error and target localization error of the navigation system.

Registration method	Error (mm)
Registration method	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

^∗ Four points were used for each registration process.∗Fourteen points were used for each registration process.

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