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. 2023 Jul;18(7):1151-1157.
doi: 10.1007/s11548-023-02940-z. Epub 2023 May 9.

Fast and versatile platform for pedicle screw insertion planning

Rafael Benito  1 , Álvaro Bertelsen  2   3 , Verónica de Ramos  2 , Amaia Iribar-Zabala  2 , Niccoló Innocenti  4 , Nicoló Castelli  4 , Karen Lopez-Linares  2   3 , Davide Scorza  5
Affiliations

Fast and versatile platform for pedicle screw insertion planning

Rafael Benito et al. Int J Comput Assist Radiol Surg. 2023 Jul.

Abstract

Purpose: Computer-assisted surgical planning methods help to reduce the risks and costs in transpedicular fixation surgeries. However, most methods do not consider the speed and versatility of the planning as factors that improve its overall performance. In this work, we propose a method able to generate surgical plans in minimal time, within the required safety margins and accounting for the surgeon's personal preferences.

Methods: The proposed planning module takes as input a CT image of the patient, initial-guess insertion trajectories provided by the surgeon and a reduced set of parameters, delivering optimal screw sizes and trajectories in a very reduced time frame.

Results: The planning results were validated with quantitative metrics and feedback from surgeons. The whole planning pipeline can be executed at an estimated time of less than 1 min per vertebra. The surgeons remarked that the proposed trajectories remained in the safe area of the vertebra, and a Gertzbein-Robbins ranking of A or B was obtained for 95 % of them.

Conclusions: The planning algorithm is safe and fast enough to perform in both pre-operative and intra-operative scenarios. Future steps will include the improvement of the preprocessing efficiency, as well as consideration of the spine's biomechanics and intervertebral rod constraints to improve the performance of the optimisation algorithm.

Keywords: Automated planning; Computer-assisted surgery; Pedicle screw; Transpedicular fixation.

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