Accuracy requirements for image-guided spinal pedicle screw placement

Y. Raja Rampersaud, David A. Simon, Kevin Foley

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Study Design: Accuracy requirement analysis for image-guided pedicle screw placement. Objectives: To derive theoretical accuracy requirements for image-guided spinal pedicle screw placement. Summary of Background Data: Underlying causes of inaccuracy in image-guided surgical systems and methods for quantifying this inaccuracy have been studied. However, accuracy requirements for specific spinal surgical procedures have not been delineated. In particular, the accuracy requirements for image-guided spinal pedicle screw placement have not been previously reported. Methods: A geometric model was developed relating spinal pedicle anatomy to accuracy requirements for image-guided surgery. This model was used to derive error tolerances for pedicle screw placement when using clinically relevant screw diameters in the cervical (3.5 mm), thoracic (5.0 mm), and thoracolumbar spine (6.5 mm). The error tolerances were represented as the permissible rotational and translational deviations from the ideal screw trajectory that would avoid pedicle wall perforation. The relevant dimensions of the pedicle model were extracted from existing morphometric data. Results: As anticipated, accuracy requirements were greatest at spinal levels where the relevant screw diameter approximated the dimensions of the pedicle. These requirements were highest for T5, followed in descending order by T4, T7, T6, T3, T12, L1, T8, T11, C4, L2, C3, T10, C5, T2, T9, C6, L3, C2, T1, C7, L4, and L5. Maximum permissible translational/rotational error tolerances ranged from 0.0 mm/O.O° at T5 to 3.8 mm/12.7° at L5. Conclusions: These results, obtained by mathematical analysis, demonstrate that extremely high accuracy is necessary to place pedicle screws at certain levels of the spine without perforating the pedicle wall. These accuracy requirements exceed the accuracy of current image-guided surgical systems, based on clinical utility errors reported in the literature. In actual use, however, these systems have been shown to improve the accuracy of pedicle screw placement. This dichotomy indicates that other factors, such as the surgeon's visual and tactile feedback, may be operative.

Original languageEnglish (US)
Pages (from-to)352-359
Number of pages8
JournalSpine
Volume26
Issue number4
DOIs
StatePublished - Feb 15 2001

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Spine
Computer-Assisted Surgery
Sensory Feedback
Touch
Pedicle Screws
Anatomy
Thorax
Surgeons

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Accuracy requirements for image-guided spinal pedicle screw placement. / Rampersaud, Y. Raja; Simon, David A.; Foley, Kevin.

In: Spine, Vol. 26, No. 4, 15.02.2001, p. 352-359.

Research output: Contribution to journalArticle

Rampersaud, Y. Raja ; Simon, David A. ; Foley, Kevin. / Accuracy requirements for image-guided spinal pedicle screw placement. In: Spine. 2001 ; Vol. 26, No. 4. pp. 352-359.
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abstract = "Study Design: Accuracy requirement analysis for image-guided pedicle screw placement. Objectives: To derive theoretical accuracy requirements for image-guided spinal pedicle screw placement. Summary of Background Data: Underlying causes of inaccuracy in image-guided surgical systems and methods for quantifying this inaccuracy have been studied. However, accuracy requirements for specific spinal surgical procedures have not been delineated. In particular, the accuracy requirements for image-guided spinal pedicle screw placement have not been previously reported. Methods: A geometric model was developed relating spinal pedicle anatomy to accuracy requirements for image-guided surgery. This model was used to derive error tolerances for pedicle screw placement when using clinically relevant screw diameters in the cervical (3.5 mm), thoracic (5.0 mm), and thoracolumbar spine (6.5 mm). The error tolerances were represented as the permissible rotational and translational deviations from the ideal screw trajectory that would avoid pedicle wall perforation. The relevant dimensions of the pedicle model were extracted from existing morphometric data. Results: As anticipated, accuracy requirements were greatest at spinal levels where the relevant screw diameter approximated the dimensions of the pedicle. These requirements were highest for T5, followed in descending order by T4, T7, T6, T3, T12, L1, T8, T11, C4, L2, C3, T10, C5, T2, T9, C6, L3, C2, T1, C7, L4, and L5. Maximum permissible translational/rotational error tolerances ranged from 0.0 mm/O.O° at T5 to 3.8 mm/12.7° at L5. Conclusions: These results, obtained by mathematical analysis, demonstrate that extremely high accuracy is necessary to place pedicle screws at certain levels of the spine without perforating the pedicle wall. These accuracy requirements exceed the accuracy of current image-guided surgical systems, based on clinical utility errors reported in the literature. In actual use, however, these systems have been shown to improve the accuracy of pedicle screw placement. This dichotomy indicates that other factors, such as the surgeon's visual and tactile feedback, may be operative.",
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