Timing of Paired Points and Surface Matching Registration in Three-Dimensional (3D) Image-guided Spinal Surgery

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Abstract
Image-guidance can increase the safety and accuracy of spinal instrumentation placement. However, many spine surgeons are reluctant to incorporate spinal image-guidance into their surgical practice due to the perception that it is time-consuming and tedious, especially the task of vertebral registration. The authors evaluated the time required for paired points and surface matching registration when using the BrainLAB (BrainLAB, Westchester, IL) image-guided spine application for spinal surgery cases. The time required to register vertebral segments using paired points and surface matching techniques was assessed in 13 consecutive patients undergoing spinal fusions by the senior author. Overall, 23 vertebral segments were registered spanning from T1 to S1. Note was made of the vertebral segments that required reregistration due to poor accuracy. The average time required to register a single vertebral segment using the paired points and surface matching technique was 117 seconds (1 min 57 s). Average accuracy obtained was 0.9 mm. Inaccurate registration occurred in 3/23 (13%) of the segments requiring a second attempt at registration. In 3/23 (13%) of segments, adequate navigation accuracy was maintained on an adjacent vertebral segment thereby allowing for instrumentation to be placed in that adjacent segment without having to register that segment. Though associated with a learning curve, image-guidance can be used effectively and efficiently in spinal surgery. Average time required for registration of a vertebral segment using the BrainLAB spine application in this study was less than 2 minutes. The average accuracy obtained was 0.9 mm.