Purpose This study was designed to evaluate the feasibility, inter-observer agreement and accuracy of Syngo iGuide intraoperative navigation planning system for percutaneous spine interventions.

Methods and materials This cadaveric study was performed according to our institution guidelines for cadaver work. Two fresh frozen cadaver (one for thoracic and one for lumbar levels) were used to test the utility of a recently launched, commercially available flat panel application from Siemens Medical Systems that provides intraoperative virtual guidance to a user predefined needle path and target. Using this system, a total of 18 needle passes (eight thoracic and 10 lumbar levels) were performed by two experienced interventional neuroradiologists (nine passes per operator, alternate side and levels) using a unilateral transpedicular approach from T5 to T12 vertebral bodies and a bipedicular approach from L1 to L5 vertebral bodies. Entry and target points were first selected on a C arm dynaCT image to determine a safe path for the needle. The needle path, target point and three-dimensional images were registered to live fluoroscopy during the procedure and were used to guide needle placement in real time. After satisfactory placement of the needle, strictly using the guiding system, post C arm dynaCT images were obtained for measurements.

Results Needle placement data from eight thoracic and 10 lumbar vertebral levels (T5–T12; L1–L5) were available for review. Needles were safely placed at all levels with no breach of the central canal, lateral or medial wall of pedicle or that of the anterior cortex. The average distance from the center of the predefined target to needle tip was 2.94 mm (3.07 for thoracic, 2.83 mm for lumbar) with a range from 1.4 mm to 4.8 mm. The average distance from the center of the target to the nearest part of the needle trajectory was 0.93 mm (0.97 mm for thoracic, 0.88 mm for lumbar) with a range from 0.00 mm to 2.4 mm. There was no significant difference between the two operators.

Conclusion Use of the Syngo iGuide Needle Guidance intraoperative navigation system is feasible for spinal interventions. The needle can be placed to the target with less than 3 mm error in cadaver study. This software allows reliable and accurate needle placement by providing real time intraoperative navigation. Further testing in live subjects is needed to establish patient safety. Preliminary work on live patients is underway at our institution and appears promising.