Computer-assisted fluoroscopic navigation of percutaneous spinal interventions.

Abstract

Percutaneous spine procedures may occasionally be difficult and subject to complications. Navigation using a dynamic reference base (DRB) may ease the procedure. Yet, besides other shortcomings, its fixation demands additional incisions and thereby defies the percutaneous character of the procedure. A new concept of atraumatic referencing was invented including a special epiDRB. The accuracy of navigated needle placement in soft tissue and bone was experimentally scrutinised. Axial and pin-point deviations from the planned trajectory were investigated with a CT-based 3D computer system. Clinical evaluation in a series of ten patients was also done. The new epiDRB proved convenient and reliable. Its fixation to the skin with adhesive foil provided a stable reference for navigation that improves the workflow of percutaneous interventions, reduces radiation exposure and helps avoid complications. Percutaneous spine interventions can be safely and accurately navigated using epiDRB with minimal trauma or radiation exposure and without additional skin incisions.