Abstract

PurposeWe present a feasibility study for the visuo-haptic simulation of pedicle screw tract palpation in virtual reality, using an approach that requires no manual processing or segmentation of the volumetric medical data set.MethodsIn a first experiment, we quantified the forces and torques present during the palpation of a pedicle screw tract in a real boar vertebra. We equipped a ball-tipped pedicle probe with a 6-axis force/torque sensor and a motion capture marker cluster. We simultaneously recorded the pose of the probe relative to the vertebra and measured the generated forces and torques during palpation. This allowed us replaying the recorded palpation movements in our simulator and to fine-tune the haptic rendering to approximate the measured forces and torques. In a second experiment, we asked two neurosurgeons to palpate a virtual version of the same vertebra in our simulator, while we logged the forces and torques sent to the haptic device.ResultsIn the experiments with the real vertebra, the maximum measured force along the longitudinal axis of the probe was 7.78 N and the maximum measured bending torque was 0.13 Nm. In an offline simulation of the motion of the pedicle probe recorded during the palpation of a real pedicle screw tract, our approach generated forces and torques that were similar in magnitude and progression to the measured ones. When surgeons tested our simulator, the distributions of the computed forces and torques were similar to the measured ones; however, higher forces and torques occurred more frequently.ConclusionsWe demonstrated the suitability of direct visual and haptic volume rendering to simulate a specific surgical procedure. Our approach of fine-tuning the simulation by measuring the forces and torques that are prevalent while palpating a real vertebra produced promising results.

Highlights

  • Pedicle screws are commonly used in spinal fusion surgeries to treat congenital spine deformities as well as traumatic or degenerative spine conditions

  • We presented a method for direct visual and haptic volume rendering of medical data sets in virtual reality (VR) [6]

  • The motion of the force/torque sensor attached to the pedicle probe relative to the pedicle screw tract in the vertebra and the corresponding forces/torques are shown in Fig. 2 for an exemplary trial

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Summary

Introduction

Pedicle screws are commonly used in spinal fusion surgeries to treat congenital spine deformities as well as traumatic or degenerative spine conditions. Before placing a pedicle screw, the posterior elements of the spine are exposed. The cortical bone of the vertebra is breached with a burr and the pedicle screw tract created with an awl or a drill. The bony walls of the pedicle are palpated for their integrity, i.e., the screw tract is checked for anterior, medial, lateral, superior, or inferior breaches with a ball-tipped probe or similar device. The screw is inserted and its placement is verified via imaging [11].

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