Image based registration and intraoperative updating for guiding spine surgery

基于图像的配准和术中更新用于指导脊柱手术

• 批准号: 9976510
• 负责人: Sohail K Mirza
• 金额: $ 36.2万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9976510
• 关键词: Adopted; Adoption; Anatomy; Animal Experiments; Animals; Blood; Clinical; Clinical Trials; Complex; Complication; Data; Dose; Effectiveness; Europe; Excision; Exposure to; Failure; Goals; Gold; Hand; Hospitals; Human; Image; Image-Guided Surgery; Implant; Ionizing radiation; Liquid substance; Location; Manuals; Medicare; Methods; Microscope; Motion; Movement; Navigation System; North America; Operative Surgical Procedures; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Performance; Positioning Attribute; Postoperative Period; Procedures; Radiation; Randomized; Repeat Surgery; Respiration; Roentgen Rays; Series; Skin; Spinal; Spine surgery; Spondylolisthesis; Supination; Surface; Surgeon; System; Target Populations; Techniques; Technology; Time; Training; Translating; Update; Variant; Vertebral column; Work; X-Ray Computed Tomography; arm; base; bone; clinical implementation; cone-beam computed tomography; cost; experimental study; geometric structure; image guided; improved; improved outcome; innovation; lumbar vertebra bone structure; novel; portability; sample fixation; spine bone structure; standard of care

PROJECT SUMMARY Image-guidance has not been widely adopted in open lumbar fusion procedures because of cumbersome patient registration techniques. Accumulated mobility between vertebrae prohibits use of skin-affixed fiducials (requiring the surgeon to identify, expose, and localize anatomical landmarks within the surgical field), and registration at the start of surgery does not compensate for intervertebral motion between preoperative supine CT scans and intraoperative prone patient position. An automated registration procedure could accelerate adoption and improve outcomes, in addition to reducing costs, complexity, and x-ray dose associated with spine surgical guidance methods in current clinical use. Our target population is patients with symptomatic lumbar degenerative spondylolisthesis, where open decompression and fusion surgery, performed more than 300,000 times annually, improves patient-reported outcomes compared to non-surgical treatment. Image- guidance allows more accurate placement of pedicle screws, which could reduce revision rates and minimize patient harm, thereby allowing hospitals and surgeons to avoid reimbursement penalties from Medicare and other payers. We have developed an automated image-based intraoperative stereovision (iSV) to preoperative CT (pCT) registration that compensates for intervertebral motion, and have successfully applied the technique in two live animals, achieving excellent target registration errors (TREs less than 2.1 mm). We now propose to improve technical aspects of the approach in experimental studies and assess feasibility of this novel registration technology for clinical implementation. Specifically, we will (i) develop a portable iSV scanner as a radiation-free alternative to intraoperative CT (iCT) or O-arm, (ii) validate, evaluate and optimize the tehcnique in a systematic series of live animal surgeries, and (iii) translate the technology into a series of human cases of open lumbar fusion for degenerative spondylolisthesis. Comparisons of the new iSV approach to standard-of- care image-guidance with a commercial system (e.g., Medtronic StealthStation) and to high-fidelity navigation achieved with iCT will be performed to establish the relative performance improvements that can be obtained.

项目概要 由于麻烦，图像引导尚未在开放腰椎融合手术中广泛采用 患者登记技术。椎骨之间累积的活动度禁止使用贴在皮肤上的基准点 （要求外科医生识别、暴露和定位手术区域内的解剖标志），以及 手术开始时的配准不能补偿术前仰卧位之间的椎间运动 CT 扫描和术中患者俯卧位。自动注册程序可以加速 除了降低成本、复杂性和与相关的 X 射线剂量外，采用并改善结果 目前临床使用的脊柱手术引导方法。我们的目标人群是有症状的患者 腰椎退行性脊柱滑脱症，开放式减压融合手术的效果超过 每年 300,000 次，与非手术治疗相比，改善了患者报告的结果。图像- 引导可以更准确地放置椎弓根螺钉，这可以降低翻修率并最大限度地减少 患者受到伤害，从而使医院和外科医生能够避免医疗保险和医疗保险的报销处罚 其他付款人。我们开发了一种基于图像的自动化术中立体视觉 (iSV) 补偿椎间运动的 CT (pCT) 配准，并已成功应用该技术 在两只活体动物中，实现了出色的目标配准误差（TRE 小于 2.1 毫米）。我们现在建议 改进实验研究方法的技术方面并评估该小说的可行性 临床实施的注册技术。具体来说，我们将 (i) 开发一款便携式 iSV 扫描仪作为 术中 CT (iCT) 或 O 形臂的无辐射替代方案，(ii) 验证、评估和优化技术 在一系列系统的活体动物手术中，以及（iii）将该技术转化为一系列人类病例 开放性腰椎融合术治疗退行性脊柱滑脱。新 iSV 方法与标准的比较 使用商业系统（例如 Medtronic StealthStation）和高保真导航进行护理图像引导 将执行通过 iCT 实现的目标，以确定可以获得的相对性能改进。

项目成果

Hand-Held Stereovision System for Image Updating in Open Spine Surgery.

用于开放脊柱手术中图像更新的手持式立体视觉系统。

• 发表时间: 2020
• 作者: Fan, Xiaoyao;Durtschi, Maxwell S;Li, Chen;Evans, Linton T;Ji, Songbai;Mirza, Sohail K;Paulsen, Keith D
• 通讯作者: Paulsen, Keith D

A level-wise spine registration framework to account for large pose changes.

一个水平脊柱注册框架来考虑大的姿势变化。

• 发表时间: 2021-06
• 作者: Cai, Yunliang;Wu, Shaoju;Fan, Xiaoyao;Olson, Jonathan;Evans, Linton;Lollis, Scott;Mirza, Sohail K;Paulsen, Keith D;Ji, Songbai
• 通讯作者: Ji, Songbai

Accuracy of Stereovision-Updated Versus Preoperative CT-Based Image Guidance in Multilevel Lumbar Pedicle Screw Placement: A Cadaveric Swine Study.

多级腰椎椎弓根螺钉置入中立体视觉更新与术前基于 CT 的图像引导的准确性：尸体猪研究。

• 发表时间: 2022
• 作者: Fan, Xiaoyao;Mirza, Sohail K;Li, Chen;Evans, Linton T;Ji, Songbai;Paulsen, Keith D
• 通讯作者: Paulsen, Keith D