Intra-operative 3D navigation and TRE reduction in image guided spine surgery

Registration of preoperative images to intra-operative patient space is a crucial step in image guided surgery for tracking surgical tools relative to patient’s anatomy. In image guided spine surgery, due to the difference in patient’s positioning in preoperative imaging, compared with intra-operative situation, there is a difference in spine curvature in these two positioning which means that a single rigid registration is not sufficient for registering the whole spine and it is necessary for each vertebra to be registered separately as a rigid body and with it’s appropriate transformation parameters. The registration was carried out using ICP algorithm. For evaluating the registration, TRE was calculated in the pedicle of the vertebra which is the target in pedicle screw insertion. In order to optimize the TRE this study was focused on the factors affecting TRE including different configuration of landmarks used in registration and the registration algorithm. Optimal configurations for the landmarks used in the registration were proposed and FLE for the point pairs were included in the registration algorithm to increase the registration accuracy. The results indicate a total improvement of 45% in the registration accuracy by optimizing the landmarks’ configuration and the registration algorithm.