| Computer-assisted navigation in bone tumor surgery: seamless workflow model and evolution of technique. | |
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MedLine Citation:
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PMID: 20635175 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Computer-assisted navigation was recently introduced to aid the resection of musculoskeletal tumors. However, it has not always been possible to directly navigate the osteotomy with real-time manipulation of available surgical tools. Registration techniques vary, although most existing systems use some form of surface matching. QUESTIONS/PURPOSES: We developed and evaluated a workflow model of computer-assisted bone tumor surgery and evaluated (1) the applicability of currently available software to different bones; (2) the accuracy of the navigated excision; and (3) the accuracy of a new registration technique of fluoro-CT matching. METHODS: Our workflow involved detailed preoperative planning with CT-MRI image fusion, three-dimensional mapping of the tumor, and planning of the resection plane. Using the workflow model, we reviewed 15 navigation procedures in 12 patients, including four with joint-saving resections and three with custom implant reconstructions. Intraoperatively, registration was performed with either paired points and surface matching (Group 1, n = 10) or a new technique of fluoro-CT image matching (Group 2, n = 5). All osteotomies were performed under direct computer navigation. Postoperatively, each case was evaluated for histologic margin and gross measurement of the achieved surgical margin. RESULTS: The margins were free from tumor in all resected specimens. In the Group 1 procedures, the correlation between preoperative planned margins and actual achieved margins was 0.631, whereas in Group 2 procedures (fluoro-CT matching), the correlation was 0.985. CONCLUSIONS: Our findings suggest computer-assisted navigation is accurate and useful for bone tumor surgery. The new registration technique using fluoro-CT matching may allow more accurate resection of margins. |
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Authors:
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Timothy Y C So; Ying-Lee Lam; Ka-Lok Mak |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: Clinical orthopaedics and related research Volume: 468 ISSN: 1528-1132 ISO Abbreviation: Clin. Orthop. Relat. Res. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-09-30 Completed Date: 2010-10-21 Revised Date: 2011-11-01 |
Medline Journal Info:
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Nlm Unique ID: 0075674 Medline TA: Clin Orthop Relat Res Country: United States |
Other Details:
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Languages: eng Pagination: 2985-91 Citation Subset: AIM; IM |
Affiliation:
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Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong, 30 Gascoigne Road, Kowloon, Hong Kong, SAR, China. soyc@ha.org.hk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Bone Neoplasms / mortality, radiography, secondary, surgery* Child China Female Fluoroscopy Humans Image Interpretation, Computer-Assisted Magnetic Resonance Imaging Male Middle Aged Osteotomy / instrumentation, methods* Predictive Value of Tests Prosthesis Implantation / instrumentation, methods* Surgery, Computer-Assisted* / instrumentation Time Factors Tomography, X-Ray Computed* / instrumentation Treatment Outcome Workflow* Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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