Multi-Modality guidance based surgical navigation for percutaneous endoscopic transforaminal discectomy

Junjun Pan; Dongfang Yu; Ranyang Li; Xin Huang; Xinliang Wang; Wenhao Zheng; Bin Zhu; Xiaoguang Liu

doi:10.1016/j.cmpb.2021.106460

Multi-Modality guidance based surgical navigation for percutaneous endoscopic transforaminal discectomy

Comput Methods Programs Biomed. 2021 Nov:212:106460. doi: 10.1016/j.cmpb.2021.106460. Epub 2021 Oct 24.

Authors

Junjun Pan¹, Dongfang Yu², Ranyang Li³, Xin Huang⁴, Xinliang Wang², Wenhao Zheng², Bin Zhu⁴, Xiaoguang Liu⁴

Affiliations

¹ State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China; PENG CHENG Laboratory, Shenzhen 518000, China. Electronic address: pan_junjun@buaa.edu.cn.
² State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China.
³ State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China; PENG CHENG Laboratory, Shenzhen 518000, China. Electronic address: liranyang666@buaa.edu.cn.
⁴ The Pain Medicine Center, Peking University Third Hospital, Beijing, China.

PMID: 34736173
DOI: 10.1016/j.cmpb.2021.106460

Abstract

Objective: Fluoroscopic guidance is a critical step for the puncture procedure in percutaneous endoscopic transforaminal discectomy (PETD). However, two-dimensional observations of the three-dimensional anatomic structure suffer from the effects of projective simplification. To accurately assess the spatial relations between the patient vertebra tissues and puncture needle, a considerable number of fluoroscopic images from different orientations need to be acquired by the surgeons. This process significantly increases the radiation risk for both the patient and surgeons.

Methods: In this paper, we propose an augmented reality (AR) surgical navigation system for PETD based on multi-modality information, which contains fluoroscopy, optical tracking, and depth camera. To register the fluoroscopic image with the intraoperative video, we design a lightweight non-invasive fiducial with markers and detect the markers based on the deep learning method. It can display the intraoperative video fused with the registered fluoroscopic images. We also present a self-adaptive calibration and transformation method between a 6-DOF optical tracking device and a depth camera, which are in different coordinate systems.

Results: With the substantially reduced frequency of fluoroscopy imaging, the system can accurately track and superimpose the virtual puncture needle on fluoroscopy images in real-time. From operating theatre in vivo animal experiments, the results illustrate that the system average positioning accuracy can reach 1.98mm and the orientation accuracy can reach 1.19^∘. From the clinical validation results, the system significantly lower the frequency of fluoroscopy imaging (42.7%) and reduce the radiation risk for both the patient and surgeons.

Conclusion: Coupled with the user study, both the quantitative and qualitative results indicate that our navigation system has the potential to be highly useful in clinical practice. Compared with the existing navigation systems, which are usually equipped with a variety of large and high-cost medical equipments, such as O-arm, cone-beam CT, and robots, our navigation system does not need special equipment and can be implemented with common equipment in the operating room, such as C-arm, desktop, etc., even in small hospitals.

Keywords: Marker detection; Multi-modality; PETD; Registration; Surgical navigation.

MeSH terms

Animals
Diskectomy
Fluoroscopy
Humans
Imaging, Three-Dimensional*
Surgery, Computer-Assisted*
Tomography, X-Ray Computed