gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Three-dimensional visualization and planning of full endoscopic postero-lateral transforaminal approach in lumbo-sacral discectomy

Meeting Abstract

  • M. Leimert - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • D. Podlesek - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • T. Meyer - Institut für Biomedizinische Technik, Universitätsklinikum Carl Gustav Carus, Dresden
  • G. Schackert - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • R. von Kummer - Abteilung Neuroradiologie, Universitätsklinikum Carl Gustav Carus, Dresden
  • S. Sobottka - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden
  • M. Kirsch - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.10-08

DOI: 10.3205/09dgnc069, URN: urn:nbn:de:0183-09dgnc0693

Published: May 20, 2009

© 2009 Leimert et al.
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Outline

Text

Objective: The endoscopic transforaminal approach in lumbar-sacral discectomy is frequently difficult to plan preoperatively, since three-dimensional imaging is not used routinely. The purpose of this study was to utilize sophisticated software algorithms to visualize and plan the endoscopic transforaminal approach in order to detect those patients eligible for an endoscopic approach. Secondly, the use of co-registered 3D-data sets of different imaging modalities including spiral CT and MRI volume data as enhanced visual information in our spinal educational program was evaluated.

Methods: 15 patients were included in the ongoing study within this year that harbored lumbo-sacral disc-herniation requiring operation. At least two different imaging modalities were used, mainly spiral CT and MRI. Image data sets were coregistered and visualized using a commercial and self developed software system. In addition, autostereoscopic 3D displays and a 3D mouse were used for advanced segmentation and visualization purposes. The positioning and the final localisation for the instrument hardware were simulated within the 3D environment.

Results: Comparison of three-dimensional reconstruction of different placements of optical systems and instruments showed the complex relationship of osseous, cartilaginous and neural structures. In addition, spinal endoscopic hardware was scanned separately and put into an imaging database. A procedure was developed which allows the import, preprocessing, segmentation, registration and visualization employing a network of various image-processing modules. Despite the large amount of data, the processing and visualization of high resolution data was successfully performed on standard personal computers. This allowed simulating hardware placement avoiding vascular and neural compression. In the case of 10 patients we decided to start the operation with the more careful postero-lateral approach, despite the critical pelvic bone in lumbosacral herniated discs and succeeded in 8 patients.

Conclusions: The 3D visualization of spinal full endoscopic procedures facilitated and improved understanding of the complex anatomy as well as operation simulation and planning. For inexperienced surgeons, we offered the additional value to evaluate the surgical approach for didactic purposes both pre- and postoperatively. In addition, fused and segmented data were successfully integrated data into a commercial spinal navigation system.