3-D MRI/CT fusion imaging of the lumbar spine

Yamanaka, Yuki; Kamogawa, Junji; Katagi, Ryosuke; Kodama, Kazuaki; Misaki, Hiroshi; Kamada, Kohei; Okuda, Shunsuke; Morino, Tadao; Ogata, Tadanori; Yamamoto, Haruyasu

doi:10.1007/s00256-009-0788-5

Cited by 25 publications

(19 citation statements)

References 2 publications

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“…First, our jig design was based on CT imaging, which is not always obtained in patients with a primary bone sarcoma and is associated with local radiation exposure [31]. Because MRI shows intramedullary tumor extent more accurately than CT [26], MRI findings should be incorporated into the jig design, perhaps via use of available MRI and CT fusion software [1,33]. Second, our jig was proximally rather than distally based.…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Khan

Lipman

Pearle

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Manual techniques of reproducing a preoperative plan for primary bone tumor resection using rudimentary devices and imprecise localization techniques can result in compromised margins or unnecessary removal of unaffected tissue. We examined whether a novel technique using computer-generated custom jigs more accurately reproduces a preoperative resection plan than a standard manual technique. Description of TechniqueUsing CT images and advanced imaging, reverse engineering, and computer-assisted design software, custom jigs were designed to precisely conform to a specific location on the surface of partially skeletonized cadaveric femurs. The jigs were used to perform a hemimetaphyseal resection. Methods We performed CT scans on six matched pairs of cadaveric femurs. Based on a primary bone sarcoma model, a joint-sparing, hemimetaphyseal wide resection was precisely outlined on each femur. For each pair, the resection was performed using the standard manual technique on one specimen and the custom jig-assisted technique on the other. Superimposition of preoperative and postresection images enabled quantitative analysis of resection accuracy. Results The mean maximum deviation from the preoperative plan was 9.0 mm for the manual group and 2.0 mm for the custom-jig group. The percentages of times the maximum deviation was greater than 3 mm and greater than 4 mm was 100% and 72% for the manual group and 5.6% and 0.0% for the custom-jig group, respectively. Conclusions Our findings suggest that custom-jig technology substantially improves the accuracy of primary bone tumor resection, enabling a surgeon to reproduce a given preoperative plan reliably and consistently.

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Section: Discussionmentioning

confidence: 99%

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Khan

Lipman

Pearle

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Because there have been few reports on the use of 3D CT/MR fusion images of the spinal region, [19][20][21][37][38][39] indications for using this information have yet to be established. Although errors may occur because of body positioning and other factors when different modalities are combined, the 3D CT/MR fusion images created in the present study were successfully centered on the affected intervertebral spaces.…”

Section: Resultsmentioning

confidence: 99%

Clinical Outcomes Based on Preoperative Kambin's Triangular Working Zone Measurements on 3D CT/MR Fusion Imaging to Determine Optimal Approaches to Transforaminal Endoscopic Lumbar Diskectomy

Hirayama¹,

Hashimoto²,

Sakamoto³

2020

J Neurol Surg A Cent Eur Neurosurg

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Background Transforaminal endoscopic lumbar diskectomy (TELD) is a widely used minimally invasive surgical procedure to treat herniated disks. Postoperative dysesthesia (POD) is a significant complication that affects patient satisfaction. Several anatomical and magnetic resonance (MR) imaging studies of the intervertebral foramina showed that TELD should be avoided in patients with small Kambin's triangular working zones. Recently, some reports indicated the usefulness of three-dimensional (3D) computed tomography/magnetic resonance (CT/MR) fusion images. To date, no articles have been published in the English literature regarding the use of 3D CT/MR fusion images before TELD to evaluate Kambin's triangular working zone. Our objective was to examine clinical outcomes when preoperative Kambin's triangular working zone measurements from 3D CT/MR fusion images were used to determine the approach to TELD. Patients and Methods We included 31 patients who underwent TELD. We rotated the 3D CT/MR fusion images from the posteroanterior view on the approach side to the angle at which Kambin's triangular working zone appeared the largest. This was used to determine the intraoperative insertion angle for the working cannula. When the perpendicular line extending from the exiting nerve at the intervertebral disk level to the upper margin of the superior articular process (exiting nerve-superior articular process distance [ESD]) was less than or equal to 7 mm, an approach that combined foraminoplasty with an outside-in technique (F + outside-in) was used. We compared ESD and clinical outcomes, such as POD, between the approaches. Results Surgical plans were based on ESD values from 22 patients. ESD was 7 mm in 21 patients, all of whom underwent F + outside-in. The inside-out approach was used in eight of nine patients who did not have ESD measurements. Of these, five patients had retrospective ESD measurements of 7 mm. The mean ESD was 6.3 ± 1.0 mm when inside-out was used and 4.4 ± 1.6 mm when F + outside-in was used, a significant difference. Significant improvements were observed in the visual analog scale scores for low back pain, lower limb pain, and lower limb paresthesia. There were no incidences of POD or intraoperative complications. Conclusion Based on preoperative Kambin's triangular working zone measurements from 3D CT/MR fusion images, F + outside-in should be selected when the working zone is smaller than the cannula diameter. This method successfully avoided POD in our study. Preoperative Kambin's triangular working zone measurements from 3D CT/MR fusion imaging can enhance patient safety during TELD.

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“…Despite the advantage of 3D CT/MR fusion images, few reports have described their application in spinal surgery, [23][24][25][26][27] and therefore it is not an established procedure for spinal surgery at this time. Although the possibility of errors as a result of 3D transformation cannot be ruled out, these errors can be minimized by calibration by performing positional adjustment centered on the intervertebral region of interest, as per our methods in this study.…”

Section: L3-l4mentioning

confidence: 99%

Percutaneous Endoscopic Diskectomy using an Interlaminar Approach Based on 3D CT/MR Fusion Imaging

Hirayama¹,

Hashimoto²

2018

J Neurol Surg A Cent Eur Neurosurg

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Background With effective preoperative planning, percutaneous endoscopic diskectomy (PED) via an interlaminar approach (PED-IL) can reduce the need for partial laminectomy. Our aim was to assess the clinical outcomes of PED-IL, planned using three-dimensional fusion of computed tomography and magnetic resonance (3D CT/MR) images. Material and Methods Our retrospective analysis was based on data from 102 patients (66 were men) treated by PED-IL. Preoperative planning was based on the positional relationship between the nerve root and the lumbar disk herniation, visualized on 3D CT/MR fusion images through a simulated IL window. Two approaches were planned: type I, via a partial window opening of the ligamentum flavum, and type II, via a partial IL window opening and partial laminectomy. Decisions were then made to approach the herniation from the shoulder (subtype s) or axillary (subtype a) portion of the nerve, or we used a combination of both approaches (subtype a + s). Operative time and the pre- to postsurgical change in pain and pain-related disability scores (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire scores) were evaluated. The number of cases in which the preoperative planned surgery was modified intraoperatively and the incidence of complications were also evaluated. Results A type I approach was planned in 30 cases (29.4%) and type II in 72 cases (70.6%). Intraoperative change from type I to type II was required in two cases. The mean operative time was longer for type II than type I procedures. Pain and pain-related disability scores improved in all patients, and only one case of dural sleeve damage was identified. Conclusions Preoperative planning using a simulated IL window to visualize the 3D regional anatomy is effective in predicting the feasibility of a PED-IL.

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3-D MRI/CT fusion imaging of the lumbar spine

Cited by 25 publications

References 2 publications

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Clinical Outcomes Based on Preoperative Kambin's Triangular Working Zone Measurements on 3D CT/MR Fusion Imaging to Determine Optimal Approaches to Transforaminal Endoscopic Lumbar Diskectomy

Percutaneous Endoscopic Diskectomy using an Interlaminar Approach Based on 3D CT/MR Fusion Imaging

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