A new approach to computer-aided spine surgery: fluoroscopy-based surgical navigation
Open accessAbstract
A new computer-based navigation system for spinal surgery has been designed. This was achieved by combining intraoperative fluoroscopy-based imaging using conventional C-arm technology with free-hand surgical navigation principles. Modules were developed to automate digital X-ray image registration. This is in contrast to existing computed tomography- (CT) based spinal navigation systems, which require a vertebra-based registration procedure. Cross-referencing of the image intensifier with the surgical object allows the real-time image-interactive navigation of surgical tools based on one single registered X-ray image, with no further image updates. Furthermore, the system allows the acquisition and real-time use of multiple registered images, which provides an advanced multi-directional control (pseudo 3D) during surgical action. Stereotactic instruments and graphical user interfaces for image-interactive transpedicular screw insertion have been developed. A detailed validation of the system was performed in the laboratory setting and throughout an early clinical trial including eight patients in two spine centers. Based on the resulting data, the new technique promises improved accuracy and safety in open and percutaneous spinal surgery.
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Intraoperative imaging techniques such as C-arm fluoroscopy or X-ray are important for localizing the greater trochanter, tracking and navigating the drilling and injection device to the femoral head, and positioning the trephine and scraping spoon while removing dead bone.
“Intraoperative imaging techniques such as C-arm fluoroscopy or X-ray have become important for the localization of the greater trochanter, tracking and navigation of the drilling and injection device to the femoral head, and positioning of the trephine and scraping spoon while removing the dead bones (Nolte et al. 2000; Geisert et al. 2017; Tian et al. 2021).”
From Towards 2D/3D Registration of the Preoperative MRI to Intraoperative Fluoroscopic Images for Visualisation of Bone Defects (2023) · cites this paper as Nolte et al. 2000
The Introduction and Surgical procedure sections describe C-arm fluoroscopy for navigating instruments during spinal pedicle-screw placement. They do not address the greater trochanter, femoral head, drilling or injection devices, or instruments for removing dead bone. Page numbers were not provided for these passages. (LLM, conf=0.88)
Experimental — accuracy not yet measuredImage-based navigation techniques do not require specialized equipment but rely on traditional intra-operative imaging.
“Image-based navigation techniques do not require specialized equipment but rely on traditional intra-operative imaging that enabled the minimally invasive technique in the first place.”
From The Impact of Machine Learning on 2D/3D Registration for Image-Guided Interventions: A Systematic Review and Perspective (2021) · cites this paper as Nolte et al., 2000
The Discussion says the system uses widely available C-arm fluoroscopy for intraoperative imaging. But the System components section describes an optoelectronic navigator, tracked instruments, and custom software, so the claim that it requires no specialized equipment is not supported. Page numbers are not provided in our copy. (LLM, conf=0.90)
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References 30 · Cited by 159
Research works printed but not linked: 9
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- Authors
- Nolte, L. P., Slomczykowski, M. A., Berlemann, U., Strauss, M. J., Hofstetter, R., Schlenzka, D., Laine, T., & Lund, T.
- Affiliations
- University of Bern (CH)
- University Medical Center Hamburg-Eppendorf (DE)
- Tekonivelsairaala Orton (FI)
- Venue
- European Spine Journal
- Published
- 2000-02-25
- Volume
- 9
- Issue
- S1
- Pages
- S078-S088
- ISSN
- 0940-6719 (ISSN-L)
- PMC
- PMC3611449
- OpenAlex
- W2064673484
- Cited by
- 159
- References
- 30
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 2 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 2 · 2015: 3 · 2014: 5 · 2013: 5 · 2012: 8
- FWCI
- 11.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Spine Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kommission für Technologie und Innovation
- Topics
- Health Sciences › Medicine › Surgery › Spinal Fractures and Fixation Techniques
- Physical Sciences › Engineering › Biomedical Engineering › Medical Imaging and Analysis
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Medical Image Segmentation Techniques
- Keywords
- surgical navigation, intraoperative fluoroscopy, C-arm imaging, image registration, image intensifier, open spine surgery
- MeSH terms
- Bone Screws, Equipment Design, Female, Fluoroscopy, Humans, Male, Orthopedic Equipment, Spine, Therapy, Computer-Assisted, In Vitro Techniques
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