Abstract
Spinal fusion combined with vertebral fixation through pedicle screw placement is the preferred surgical treatment for several spinal deformities. The accuracy of pedicle screw placement is directly related to the surgical outcome, however, manual planning of screw size and trajectory is time-consuming, while automated approaches do not take into account the screw fastening strength. We propose a novel automated method for optimal planning of pedicle screw size and trajectory that takes into account both geometric (i.e. morphometry) and anatomical (i.e. bone mineral density) properties of vertebrae to maximize the screw fastening strength. The size and trajectory of 61 pedicle screws, determined by the automated method in computed tomography images of nine patients, were in high agreement with preoperative manual plans defined by a spine surgeon (mean difference of 0.6 mm in diameter, 4.0 mm in length, 1.7 mm in pedicle crossing, and (6.1\(^{\circ }\))in screw insertion angles), and an increased fastening strength was observed for 50 cases (\(82\,\%\)).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Manbachi, A., Cobbold, R., Ginsberg, H.: Guided pedicle screw insertion: techniques and training. Spine J. 14(1), 165–179 (2014)
Linte, C., Augustine, K., Camp, J., Robb, R., Holmes III, D.: Toward virtual modeling and templating for enhanced spine surgery planning. In: Li, S., Yao, J. (eds.) Spinal Imaging and Image Analysis. LNCVB, vol. 18, pp. 441–467. Springer, Heidelberg (2015)
Lee, J., Kim, S., Kim, Y., Chung, W.: Optimal surgical planning guidance for lumbar spinal fusion considering operational safety and vertebra-screw interface strength. Int. J. Med. Robot. 8(3), 261–272 (2012)
van Dijk, J., van den Ende, R., Stramigioli, S., Köchling, M., Höss, N.: Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery. Spine 40(17), E986–E991 (2015)
Lehman Jr., R., Polly Jr., D., Kuklo, T., Cunningham, B., Kirk, K., Belmont Jr., P.: Straight-forward versus anatomic trajectory technique of thoracic pedicle screw fixation: a biomechanical analysis. Spine 28(18), 2058–2065 (2003)
Tian, N., Huang, Q., Zhou, P., Zhou, Y., Wu, R., Lou, Y., Xu, H.: Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur. Spine J. 20(6), 846–859 (2011)
Helm, P., Teichman, R., Hartmann, S., Simon, D.: Spinal navigation and imaging: history, trends and future. IEEE Trans. Med. Imaging 34(8), 1738–1746 (2015)
Lee, J., Kim, S., Kim, Y., Chung, W.: Automated segmentation of the lumbar pedicle in CT images for spinal fusion surgery. IEEE Trans. Biomed. Eng. 58(7), 2051–2063 (2011)
Štern, D., Likar, B., Pernuš, F., Vrtovec, T.: Parametric modelling and segmentation of vertebral bodies in 3D CT and MR spine images. Phys. Med. Biol. 56(23), 7505–7522 (2011)
Štern, D., Njagulj, V., Likar, B., Pernuš, F., Vrtovec, T.: Quantitative vertebral morphometry based on parametric modeling of vertebral bodies in 3D. Osteoporos. Int. 24(4), 1357–1368 (2013)
Homolka, P., Beer, A., Birkfellner, W., Nowotny, R., Gahleitner, A., Tschabitscher, M., Bergmann, H.: Bone mineral density measurement with dental quantitative CT prior to dental implant placement in cadaver mandibles: pilot study. Radiology 224(1), 247–252 (2002)
Tominc, U., Vesel, M., Al Mawed, S., Dobravec, M., Jug, M., Herman, S., Kreuh, D.: Personalized guiding templates for pedicle screw placement. In: Proceedings of 37th International Convention on Information and Communication Technology, Electronics and Microelectronics - MIPRO 2014, pp. 249–251. IEEE (2014)
Press, W., Teukolsky, S., Vetterling, W., Flannery, B.: Numerical Recipes: The Art of Scientific Computing, 3rd edn. Cambridge University Press, Cambridge (2007)
Acknowledgements
This work was supported by the Slovenian Research Agency under grants P2-0232, J2-5473, J7-6781 and J2-7118. The authors thank Ekliptik d.o.o., Slovenia, for providing images and manual preoperative pedicle screw placement plans.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this paper
Cite this paper
Knez, D., Likar, B., Pernuš, F., Vrtovec, T. (2016). Automated Pedicle Screw Size and Trajectory Planning by Maximization of Fastening Strength. In: Vrtovec, T., et al. Computational Methods and Clinical Applications for Spine Imaging. CSI 2015. Lecture Notes in Computer Science(), vol 9402. Springer, Cham. https://doi.org/10.1007/978-3-319-41827-8_1
Download citation
DOI: https://doi.org/10.1007/978-3-319-41827-8_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-41826-1
Online ISBN: 978-3-319-41827-8
eBook Packages: Computer ScienceComputer Science (R0)