Magliano Alfonso, Naddeo Francesco, Naddeo Alessandro
Department of Industrial Engineering, University of Salerno, Fisciano, SA, Italy.
Heliyon. 2024 Feb 16;10(4):e26334. doi: 10.1016/j.heliyon.2024.e26334. eCollection 2024 Feb 29.
Many diseases of the spine require surgical treatments that are currently performed based on the experience of the surgeon. The basis of this study is to deliver an automatic and patient-specific algorithm able to come to the aid of the surgeons in pedicle arthrodesis operations, by finding the optimal direction of the screw insertion, the maximum screw diameter and the maximum screw length.
The paper introduce an algorithm based on the reconstructed geometry of a vertebra by 3D-scan that is able to identify the best introduction direction for screw and to select, from commercial and/or personalised databases, the best screws in order to maximize the occupation of the bone while not intersecting each other and not going through the walls of the pedicle and the bounds of the vertebral body. In fact, for pedicle arthrodesis surgery, the incorrect positioning of the screws may cause operating failures, an increase in the overall duration of surgery and, therefore, more harmful, real-time X-ray checks. In case of not availability on market, the algorithm also suggests parameters for designing and manufacturing an 'ad hoc' solution. The algorithm has been tested on 6 vertebras extracted by a medical database. Furthermore, the algorithm is based on a procedure through which the surgeon can freely choose the entering point of the screw (based on his/her own experience and will). A real patient vertebra has been processed with almost 400 different entering point, always giving a feedback on the possibility to use the entering point (in case of unavailability of a good trajectory) and on the individuation of the right trajectory and the choose of the better screws.
In very recent bibliography, several papers deal with procedure to screw' trajectory planning in arthrodesis surgery by using Computer Aided surgery systems, and some of them used also modern methodologies (KBE, AI, Deep learning, etc.) methods for planning the surgery as better as possible. Nevertheless, no methodologies or algorithm have been still realized to plan the trajectory and choose the perfect fitting screws on the basis of the patient-specific vertebra. This paper represents a wind of novelty in this field and allow surgeons to use the proposed algorithm for planning their surgeries. Finally, it allows also the easy creation of a customized surgical template, characterized by two cylindrical guides that follow a correct trajectory previously calculated by means of that automatic algorithm generated on the basis of a vertebra CAD model for a specific patient. The surgeon will be able to set the template (drilling guides) on the patient's vertebra and safely apply the screws.
许多脊柱疾病需要手术治疗，目前这些手术是基于外科医生的经验进行的。本研究的目的是提供一种自动且针对患者的算法，通过确定螺钉植入的最佳方向、最大螺钉直径和最大螺钉长度，来协助外科医生进行椎弓根融合手术。
本文介绍了一种基于三维扫描重建的椎体几何形状的算法，该算法能够确定螺钉的最佳植入方向，并从商业和/或个性化数据库中选择最佳螺钉，以在不相互交叉且不穿透椎弓根壁和椎体边界的情况下最大限度地填充骨质。事实上，对于椎弓根融合手术，螺钉定位不正确可能导致手术失败、手术总时长增加，进而导致更有害的实时X射线检查。如果市场上没有合适的产品，该算法还会给出设计和制造“特制”解决方案的参数。该算法已在从医学数据库中提取的6个椎体上进行了测试。此外，该算法基于一种程序，外科医生可以根据自己的经验和意愿自由选择螺钉的进入点。对一个真实患者的椎体使用了近400个不同的进入点进行处理，始终会给出关于使用该进入点的可能性（如果没有良好的轨迹）以及正确轨迹的确定和更好螺钉选择的反馈。
在最近的文献中，有几篇论文讨论了通过使用计算机辅助手术系统进行融合手术中螺钉轨迹规划的程序，其中一些还使用了现代方法（如知识工程、人工智能、深度学习等）来尽可能优化手术规划。然而，尚未有方法或算法能够根据患者特定的椎体来规划轨迹并选择完美适配的螺钉。本文在该领域具有创新性，使外科医生能够使用所提出的算法来规划他们的手术。最后，它还允许轻松创建定制的手术模板，其特点是有两个圆柱形导向器，沿着基于特定患者的椎体CAD模型生成的自动算法预先计算出的正确轨迹。外科医生将能够在患者的椎体上设置模板（钻孔导向器）并安全地植入螺钉。
