First experience with laser guided percutaneous pedicle screw placement in the lumbar spine

Since many years surgeons are trying to optimize pedicle screw placement in spine surgeries to reduce severe complications. Intraoperative image guidance could improve the accuracy in pedicle screw placement (Tain 2011). However no significant reduction of complications could be seen (Verma 2010). With the implementation of robotic 3D flat-panel detectors in hybrid operating rooms a new form of navigation is now accessible. A 3D scan (Dyna-CT) of the target area is acquired. After image reconstruction a startand endpoint can be planned. Afterwards the C-arm is able to automatically move into different position always visualizing the planned route. With the help of an integrated laser crosshair the endpoint and the angulation of the planned line can be seen. This enables the surgeon to align his tools and puncture with a needle or implant a wire. Until now this planning tool has only been used for needle procedures (Ritter 2013, Freundt 2013). The aim of our study was to find out, if Syngo iGuide® (Siemens Medical Solutions, Erlangen, Germany) is feasible for pedicle screw placement in an ex-vivo model.