TY - JOUR
T1 - Technology improvements for image-guided and minimally invasive spine procedures
AU - Cleary, Kevin
AU - Clifford, Mark
AU - Stoianovici, Dan
AU - Freedman, Matthew
AU - Mun, Seong K.
AU - Watson, Vance
N1 - Funding Information:
Manuscript received January 25, 2001. Manuscript accepted July 27, 2001. This work was supported in part by the U.S. Army under Grants DAMD17-96-2-6004 and DAMD17-99-1-9022. The content of this manuscript does not necessarily reflect the position or policy of the U.S. Government. A company (ImageGuide, Inc.) has been established to develop the robot described as part of this article. Dr. Cleary is on the Scientific Advisory Board and is a consultant to the company. Under a licensing agreement between ImageGuide and the Johns Hopkins University, Dr. Stoianovici is entitled to a share of royalty received by the University on sales of products described in this article. Dr. Stoianovici and the University own ImageGuide stock, which is subject to certain restrictions under University policy. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict of interest policies.
PY - 2002/12
Y1 - 2002/12
N2 - This paper reports on technology developments aimed at improving the state of the art for image-guided minimally invasive spine procedures. Back pain is a major health problem with serious economic consequences. Minimally invasive procedures to treat back pain are rapidly growing in popularity due to improvements in technique and the substantially reduced trauma to the patient versus open spinal surgery. Image guidance is an enabling technology for minimally invasive procedures, but technical problems remain that may limit the wider applicability of these techniques. The paper begins with a discussion of low back pain and the potential shortcomings of open back surgery. The advantages of minimally invasive procedures are enumerated, followed by a list of technical problems that must be overcome to enable the more widespread dissemination of these techniques. The technical problems include improved intraoperative imaging, fusion of images from multiple modalities, the visualization of oblique paths, percutaneous spine tracking, mechanical instrument guidance, and software architectures for technology integration. Technical developments to address some of these problems are discussed next. The discussion includes intraoperative computerized tomography (CT) imaging, magnetic resonance imaging (MRI)/CT image registration, three-dimensional (3-D) visualization, optical localization, and robotics for percutaneous instrument placement. Finally, the paper concludes by presenting several representative clinical applications: biopsy, vertebroplasty, nerve and facet blocks, and shunt placement. The program presented here is a first step to developing the physician-assist systems of the future, which will incorporate visualization, tracking, and robotics to enable the precision placement and manipulation of instruments with minimal trauma to the patient.
AB - This paper reports on technology developments aimed at improving the state of the art for image-guided minimally invasive spine procedures. Back pain is a major health problem with serious economic consequences. Minimally invasive procedures to treat back pain are rapidly growing in popularity due to improvements in technique and the substantially reduced trauma to the patient versus open spinal surgery. Image guidance is an enabling technology for minimally invasive procedures, but technical problems remain that may limit the wider applicability of these techniques. The paper begins with a discussion of low back pain and the potential shortcomings of open back surgery. The advantages of minimally invasive procedures are enumerated, followed by a list of technical problems that must be overcome to enable the more widespread dissemination of these techniques. The technical problems include improved intraoperative imaging, fusion of images from multiple modalities, the visualization of oblique paths, percutaneous spine tracking, mechanical instrument guidance, and software architectures for technology integration. Technical developments to address some of these problems are discussed next. The discussion includes intraoperative computerized tomography (CT) imaging, magnetic resonance imaging (MRI)/CT image registration, three-dimensional (3-D) visualization, optical localization, and robotics for percutaneous instrument placement. Finally, the paper concludes by presenting several representative clinical applications: biopsy, vertebroplasty, nerve and facet blocks, and shunt placement. The program presented here is a first step to developing the physician-assist systems of the future, which will incorporate visualization, tracking, and robotics to enable the precision placement and manipulation of instruments with minimal trauma to the patient.
KW - Interoperative imaging
KW - Magnetic resonance imaging (MRI)/computerized tomography (CT) registration
KW - Medical robotics
KW - Minimally invasive procedures
KW - Spine
KW - Three-dimensional (3-D) visualization
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U2 - 10.1109/TITB.2002.806089
DO - 10.1109/TITB.2002.806089
M3 - Article
C2 - 15224839
AN - SCOPUS:0036959130
SN - 1089-7771
VL - 6
SP - 249
EP - 261
JO - IEEE Transactions on Information Technology in Biomedicine
JF - IEEE Transactions on Information Technology in Biomedicine
IS - 4
ER -