Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images
Introduction: Sacroiliac joint fusion (SIJF) is a minimally invasive treatment for sacroiliac (SI) dysfunction. It involves placing implants through the SI joint under fluoroscopic guidance, requiring precise implant positioning to avoid nerve injury. Preoperative virtual surgical planning (VSP) aid...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529424001619 |
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| author | Steven Lankheet Nick Kampkuiper Jorm Nellensteijn Edsko Hekman Gabriëlle Tuijthof Femke Schröder Maaike Koenrades |
| author_facet | Steven Lankheet Nick Kampkuiper Jorm Nellensteijn Edsko Hekman Gabriëlle Tuijthof Femke Schröder Maaike Koenrades |
| author_sort | Steven Lankheet |
| collection | DOAJ |
| description | Introduction: Sacroiliac joint fusion (SIJF) is a minimally invasive treatment for sacroiliac (SI) dysfunction. It involves placing implants through the SI joint under fluoroscopic guidance, requiring precise implant positioning to avoid nerve injury. Preoperative virtual surgical planning (VSP) aids in optimal positioning, but replicating it accurately in the operating room is challenging. Research question: This study aims to assess the feasibility of superimposing VSP onto intraoperative fluoroscopic images to aid in optimal implant placement. Material and methods: A method for intraoperative guidance using 3D/2D registration was developed and tested during SIJF as an available and potentially efficient alternative for costly and more invasive navigation systems. Preoperatively, a VSP is performed and simulated fluoroscopic images are generated from a preoperative CT scan. During surgery, the simulated image that visually best matches the intraoperative fluoroscopic image is selected. Subsequently, the VSP is superimposed onto the intraoperative fluoroscopic image using a developed script-based workflow. The surgeon then places the implants accordingly. Postoperative implant placement accuracy was evaluated. Results: Five interventions were performed on five patients, resulting in a total of 15 placed implants. Minor complications without clinical consequences occurred in one case, primarily attributable to the patient's anatomy and pathological manifestations. Mean deviations at implant apex and 3D angle were 4.7 ± 1.6 mm and 3.5 ± 1.3°, respectively. Discussion and conclusions: The developed intraoperative workflow was feasible and resulted in implants placed with low deviations from the VSP. Further research is needed to automate and validate this method in a larger cohort. |
| format | Article |
| id | doaj-art-92828d36a04c4aa195e86bbeb0dced00 |
| institution | OA Journals |
| issn | 2772-5294 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-92828d36a04c4aa195e86bbeb0dced002025-08-20T02:35:50ZengElsevierBrain and Spine2772-52942024-01-01410290510.1016/j.bas.2024.102905Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic imagesSteven Lankheet0Nick Kampkuiper1Jorm Nellensteijn2Edsko Hekman3Gabriëlle Tuijthof4Femke Schröder5Maaike Koenrades6Medical 3D Lab, Medical Spectrum Twente, Enschede, the Netherlands; Department of Orthopedic Surgery, Medical Spectrum Twente, Enschede, the Netherlands; Department of Biomechanical Engineering, Faculty of Engineering Technology, Technical Medical Center, University of Twente, Enschede, the NetherlandsMedical 3D Lab, Medical Spectrum Twente, Enschede, the Netherlands; Department of Orthopedic Surgery, Medical Spectrum Twente, Enschede, the Netherlands; Department of Biomechanical Engineering, Faculty of Engineering Technology, Technical Medical Center, University of Twente, Enschede, the Netherlands; Corresponding author. Drienerlolaan 5, Enschede, 7522NB, the Netherlands.Department of Orthopedic Surgery, Medical Spectrum Twente, Enschede, the NetherlandsDepartment of Biomechanical Engineering, Faculty of Engineering Technology, Technical Medical Center, University of Twente, Enschede, the NetherlandsDepartment of Biomechanical Engineering, Faculty of Engineering Technology, Technical Medical Center, University of Twente, Enschede, the NetherlandsMedical 3D Lab, Medical Spectrum Twente, Enschede, the Netherlands; Department of Orthopedic Surgery, Medical Spectrum Twente, Enschede, the Netherlands; Department of Biomechanical Engineering, Faculty of Engineering Technology, Technical Medical Center, University of Twente, Enschede, the NetherlandsMedical 3D Lab, Medical Spectrum Twente, Enschede, the Netherlands; Multi-Modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Center, University of Twente, Enschede, the NetherlandsIntroduction: Sacroiliac joint fusion (SIJF) is a minimally invasive treatment for sacroiliac (SI) dysfunction. It involves placing implants through the SI joint under fluoroscopic guidance, requiring precise implant positioning to avoid nerve injury. Preoperative virtual surgical planning (VSP) aids in optimal positioning, but replicating it accurately in the operating room is challenging. Research question: This study aims to assess the feasibility of superimposing VSP onto intraoperative fluoroscopic images to aid in optimal implant placement. Material and methods: A method for intraoperative guidance using 3D/2D registration was developed and tested during SIJF as an available and potentially efficient alternative for costly and more invasive navigation systems. Preoperatively, a VSP is performed and simulated fluoroscopic images are generated from a preoperative CT scan. During surgery, the simulated image that visually best matches the intraoperative fluoroscopic image is selected. Subsequently, the VSP is superimposed onto the intraoperative fluoroscopic image using a developed script-based workflow. The surgeon then places the implants accordingly. Postoperative implant placement accuracy was evaluated. Results: Five interventions were performed on five patients, resulting in a total of 15 placed implants. Minor complications without clinical consequences occurred in one case, primarily attributable to the patient's anatomy and pathological manifestations. Mean deviations at implant apex and 3D angle were 4.7 ± 1.6 mm and 3.5 ± 1.3°, respectively. Discussion and conclusions: The developed intraoperative workflow was feasible and resulted in implants placed with low deviations from the VSP. Further research is needed to automate and validate this method in a larger cohort.http://www.sciencedirect.com/science/article/pii/S2772529424001619Simulated fluoroscopic imagesVirtual surgical planningComputer-assisted surgeryMinimally invasive sacroiliac joint fusion |
| spellingShingle | Steven Lankheet Nick Kampkuiper Jorm Nellensteijn Edsko Hekman Gabriëlle Tuijthof Femke Schröder Maaike Koenrades Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images Brain and Spine Simulated fluoroscopic images Virtual surgical planning Computer-assisted surgery Minimally invasive sacroiliac joint fusion |
| title | Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images |
| title_full | Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images |
| title_fullStr | Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images |
| title_full_unstemmed | Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images |
| title_short | Sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images |
| title_sort | sacroiliac joint fusion guided by intraoperatively superimposed virtual surgical planning using simulated fluoroscopic images |
| topic | Simulated fluoroscopic images Virtual surgical planning Computer-assisted surgery Minimally invasive sacroiliac joint fusion |
| url | http://www.sciencedirect.com/science/article/pii/S2772529424001619 |
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