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Original research
Combining C-arm CT with a new remote operated positioning and guidance system for guidance of minimally invasive spine interventions
  1. Christoph Czerny1,
  2. Katrin Eichler2,
  3. Yann Croissant2,
  4. Boris Schulz2,
  5. Gernot Kronreif3,
  6. Renate Schmidt4,
  7. Martin von Roden5,
  8. Christof Schomerus6,
  9. Thomas J Vogl2,
  10. Ingo Marzi1,
  11. Stephan Zangos2
  1. 1Department of Trauma Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany
  2. 2Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
  3. 3Austrian Centre for Medical Innovation and Technology—ACMIT, Wiener Neustadt, Austria
  4. 4iSYS Medizintechnik GmbH, Kitzbuehel, Austria
  5. 5Siemens AG, Healthcare Sector, Forchheim, Germany
  6. 6Fachbereich Medizin der Goethe-Universität, Dr Senckenbergische Anatomie, Frankfurt am Main, Germany
  1. Correspondence to Dr S Zangos, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe-University, Theodor-Stern-Kai 7, Frankfurt am Main D-60590, Germany; s.zangos{at}em.uni-frankfurt.de

Abstract

Objective To report our experience using C-arm cone beam CT (C-arm CBCT) combined with the new remote operated positioning and guidance system, iSYS1, for needle guidance during spinal interventions.

Methods A C-arm CBCT with a flat panel angiography system was acquired (Artis Zeego; Siemens Healthcare Sector, Forchheim, Germany). Reconstruction of CT-like images and planning of the needle path were performed using a common workstation. The needle holder of iSYS1 acted as a guide during insertion of Kirschner (K) wires. 20 percutaneous K wires were placed in the pedicles at T2–T3, T7–T12, and L1–L2 in a cadaver specimen. Postprocedure C-arm CBCT scans were obtained to confirm the accuracy of the K wire placement.

Results All K wire placements were successfully performed. Mean planning time with Syngo iGuide was 4:16 min, mean positioning time of iSYS1 was 3:35 min, and mean placement time of the K wires was 2:22 min. Mean total intervention time was 10:13 min per pedicle. A mean deviation of 0.35 mm between the planned path and the placed K wire with a mean path length of 6.73 cm was documented.

Conclusions Our results demonstrate the potential of combining C-arm CBCT with iSYS1 for safe and accurate percutaneous placement of pedicle K wires in spinal interventions.

  • Intervention
  • Spine
  • guidewire
  • Navigation
  • CT

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