gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

3D-Flatpanel C-Arm: A new benchmark for intraoperative 3D imaging and navigation in spine surgery?

Meeting Abstract

  • Ulrich Hubbe - Abt. Allg. Neurochirurgie, Universitätsklinikum Freiburg, Germany
  • Jan-Helge Klingler - Abt. Allg. Neurochirurgie, Universitätsklinikum Freiburg, Germany
  • Ronen Sircar - Abt. Allg. Neurochirurgie, Universitätsklinikum Freiburg, Germany
  • Christian Scheiwe - Abt. Allg. Neurochirurgie, Universitätsklinikum Freiburg, Germany
  • Martin Deininger - Abt. Allg. Neurochirurgie, Universitätsklinikum Freiburg, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1653

doi: 10.3205/10dgnc126, urn:nbn:de:0183-10dgnc1262

Published: September 16, 2010

© 2010 Hubbe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Since introduction of intraoperative 3D imaging, navigated spine surgery could considerably be simplified and optimized. Through this, an automated referencing became available, that is exceptionally accurate and furthermore allows spinal navigation also for minimally invasive spine surgery. The new 3D C arm with flatpanel detector offers the advantages of the flatpanel technology for intraoperative 3D imaging. By this it eliminates the system immanent image distortion of conventional image intensifiers. In this study we investigated, whether this leads to marked improvement in practice.

Methods: 60 patients, for whom spinal navigation was considered reasonable were operated. Navigation was performed based on intraoperative 3D scans either acquired by a conventional 3D C arm (Siemens Iso-C-3D) or by the new flatpanel 3D C arm (Ziehm Vision FD Vario 3D) using the Stryker Navigation System (SpineMap 3D). Handling, image quality and intraoperative accuracy were evaluated.

Results: In all cases, a 3D dataset suitable for navigation could be acquired. The handling of the flatpanel C arm proved to be more handy. Though being remarkably smaller it offers a nearly 20 cm increased distance between the x-ray tube and the detector compared to the conventional C arm. This appeared to be especially helpful in obese patients. Furthermore the operating of the system turned out to be clearly more intuitive due to the touchpanel, which only displays those functions, that are available during the particular step of the process. The intraoperative accuracy was comparable concerning the center of the scan volume. In the edges of the scan volume image distortions were observable using the conventional C arm. The image quality was judged clearly superior concerning 2D images and tended to be better in 3D images using the flatpanel C arm.

Conclusions: The application of a 3D flatpanel C arm simplifies the handling and enhances the image quality of intraoperative imaging with C arms in spinal surgery. It increases the accuracy of the dataset in the border area for navigational use.