Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical study

Abstract Background Intraoperative navigation has significantly facilitated spinal surgery and enhanced surgical accuracy. Nevertheless, it is often encumbered by the need for expensive equipment, a complex workflow, and frequently exhibits inefficiencies. Leveraging permanent calibration technology...

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Main Authors: Wen Xia, Zhengyang Wu, Rui Zuo, Jiang Wu, Jing Ling, Linfeng Mo, Zegang Shi, Yue Zhou, Changqing Li, Wenjie Zheng, Chao Zhang
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Musculoskeletal Disorders
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Online Access:https://doi.org/10.1186/s12891-025-08769-8
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author Wen Xia
Zhengyang Wu
Rui Zuo
Jiang Wu
Jing Ling
Linfeng Mo
Zegang Shi
Yue Zhou
Changqing Li
Wenjie Zheng
Chao Zhang
author_facet Wen Xia
Zhengyang Wu
Rui Zuo
Jiang Wu
Jing Ling
Linfeng Mo
Zegang Shi
Yue Zhou
Changqing Li
Wenjie Zheng
Chao Zhang
author_sort Wen Xia
collection DOAJ
description Abstract Background Intraoperative navigation has significantly facilitated spinal surgery and enhanced surgical accuracy. Nevertheless, it is often encumbered by the need for expensive equipment, a complex workflow, and frequently exhibits inefficiencies. Leveraging permanent calibration technology, we have developed a novel two-dimensional fluoroscopic image navigation system with the aim of streamlining and expediting the navigation process. In this study, we comprehensively evaluated its feasibility and accuracy. Methods The accuracy of the 2D-navigation system was rigorously assessed using a standardized high-precision mold. To validate the feasibility and accuracy of the novel navigation system for spinal surgery, the bare-bones of the pig lumbar spine are employed for evaluation. Subsequently, 2D navigation-assisted pedicle penetrations were meticulously carried out on the spine (L1-L5) of live animals. The navigation accuracy was quantified by comparing the visualized position of the surgical tool in the actual fluoroscopic image with the virtual position pre-planned by the navigation system. Results During the experimental process, an excellent correlation between the virtual fluoroscopic images and actual fluoroscopic images was prominently observed. The navigation positioning accuracy, as evaluated by the standardized high-precision mold, was determined to be 0.54±0.16mm (AP view) and 0.57±0.14mm (lateral view). Specifically, in the bare-bones of the pig lumbar spine, the average distance errors between the virtual and actual fluoroscopic images under anteroposterior and lateral views were 0.99±0.48mm and 0.87±0.60mm, respectively. Meanwhile, the average angle errors were 0.41±0.29 $$^{\circ }$$ ∘ and 0.37±0.11 $$^{\circ }$$ ∘ , respectively. In the surgical procedure on normal adult pigs (L1-L5), the average distance errors were 1.14±0.58mm(95% CI [0.50-0.59]) and 1.54±0.79mm(95% CI [0.11-0.12]), respectively. The corresponding average angle errors were 0.61±0.49 $$^{\circ }$$ ∘ (95% CI [0.33-0.35]) and 0.40±0.31 $$^{\circ }$$ ∘ (95% CI [0.33-0.47]), respectively. Throughout a single navigation registration and the entire surgical procedure, the navigation accuracy across the L1 to L5 segments remained consistently high, with no statistically significant differences detected among the segments (p>0.05). Conclusion The two-dimensional fluoroscopic image navigation system based on permanent calibration technology is characterized by a rapid and convenient workflow. It demonstrates high-level navigation accuracy, thereby meeting the stringent requirements for spinal navigation in live surgical procedures.
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spelling doaj-art-9769c0e1e58d405c8fb57a37ea0a811d2025-08-20T01:52:23ZengBMCBMC Musculoskeletal Disorders1471-24742025-05-0126111210.1186/s12891-025-08769-8Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical studyWen Xia0Zhengyang Wu1Rui Zuo2Jiang Wu3Jing Ling4Linfeng Mo5Zegang Shi6Yue Zhou7Changqing Li8Wenjie Zheng9Chao Zhang10Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University)Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University)Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University)R & D Center, Chongqing Boshikang Technology Co., Ltd.R & D Center, Chongqing Boshikang Technology Co., Ltd.R & D Center, Chongqing Boshikang Technology Co., Ltd.Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University)Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University)Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University)Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University)Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University)Abstract Background Intraoperative navigation has significantly facilitated spinal surgery and enhanced surgical accuracy. Nevertheless, it is often encumbered by the need for expensive equipment, a complex workflow, and frequently exhibits inefficiencies. Leveraging permanent calibration technology, we have developed a novel two-dimensional fluoroscopic image navigation system with the aim of streamlining and expediting the navigation process. In this study, we comprehensively evaluated its feasibility and accuracy. Methods The accuracy of the 2D-navigation system was rigorously assessed using a standardized high-precision mold. To validate the feasibility and accuracy of the novel navigation system for spinal surgery, the bare-bones of the pig lumbar spine are employed for evaluation. Subsequently, 2D navigation-assisted pedicle penetrations were meticulously carried out on the spine (L1-L5) of live animals. The navigation accuracy was quantified by comparing the visualized position of the surgical tool in the actual fluoroscopic image with the virtual position pre-planned by the navigation system. Results During the experimental process, an excellent correlation between the virtual fluoroscopic images and actual fluoroscopic images was prominently observed. The navigation positioning accuracy, as evaluated by the standardized high-precision mold, was determined to be 0.54±0.16mm (AP view) and 0.57±0.14mm (lateral view). Specifically, in the bare-bones of the pig lumbar spine, the average distance errors between the virtual and actual fluoroscopic images under anteroposterior and lateral views were 0.99±0.48mm and 0.87±0.60mm, respectively. Meanwhile, the average angle errors were 0.41±0.29 $$^{\circ }$$ ∘ and 0.37±0.11 $$^{\circ }$$ ∘ , respectively. In the surgical procedure on normal adult pigs (L1-L5), the average distance errors were 1.14±0.58mm(95% CI [0.50-0.59]) and 1.54±0.79mm(95% CI [0.11-0.12]), respectively. The corresponding average angle errors were 0.61±0.49 $$^{\circ }$$ ∘ (95% CI [0.33-0.35]) and 0.40±0.31 $$^{\circ }$$ ∘ (95% CI [0.33-0.47]), respectively. Throughout a single navigation registration and the entire surgical procedure, the navigation accuracy across the L1 to L5 segments remained consistently high, with no statistically significant differences detected among the segments (p>0.05). Conclusion The two-dimensional fluoroscopic image navigation system based on permanent calibration technology is characterized by a rapid and convenient workflow. It demonstrates high-level navigation accuracy, thereby meeting the stringent requirements for spinal navigation in live surgical procedures.https://doi.org/10.1186/s12891-025-08769-8Spine surgeryIntraoperative navigationPermanent calibrationTwo-dimensional fluoroscopic image
spellingShingle Wen Xia
Zhengyang Wu
Rui Zuo
Jiang Wu
Jing Ling
Linfeng Mo
Zegang Shi
Yue Zhou
Changqing Li
Wenjie Zheng
Chao Zhang
Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical study
BMC Musculoskeletal Disorders
Spine surgery
Intraoperative navigation
Permanent calibration
Two-dimensional fluoroscopic image
title Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical study
title_full Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical study
title_fullStr Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical study
title_full_unstemmed Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical study
title_short Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical study
title_sort feasibility and accuracy evaluation of novel 2d instant navigation system on spinal surgery a preclinical study
topic Spine surgery
Intraoperative navigation
Permanent calibration
Two-dimensional fluoroscopic image
url https://doi.org/10.1186/s12891-025-08769-8
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