Evaluation of a navigated and power controlled milling system “navigated control spine” for spinal surgery

Abstract

The aim of this work was the evaluation of a navigated and power controlled milling system for spine surgery (navigated control spine). The navigation is based on a set of intraoperatively taken fluoroscopic images from different angles. A manually planned workspace limits the power of the mill and assures a higher automatisation degree than any other established navigation system for spine surgery. Both a technical study in workspace planning from fluoroscopic images and a milling study on a spine phantom were performed with participants with different level of knowledge of spinal surgery. In the region of interest the workspace planning could be performed with a maximum excess of 1.40 mm for surgeons. In the study performing the milling of a standardised workspace the remnant bone after milling had a mean difference from the planned workspace margin of 1.96-2.12 mm in the region of most interest. Accurate handling of the mill still required a certain level of medical knowledge and experience. In both studies the time needed for application of the system proved acceptable for clinical purposes. This concept of navigated and power controlled spinal surgery has proven feasible in an experimental study. This navigation system seems therefore promising for clinical application.