Projects / Programmes
Computer-assisted spine surgery planning based on quantitative image analysis
| Code |
Science |
Field |
Subfield |
| 2.06.07 |
Engineering sciences and technologies |
Systems and cybernetics |
Biomedical technics |
| Code |
Science |
Field |
| T111 |
Technological sciences |
Imaging, image processing |
| Code |
Science |
Field |
| 2.06 |
Engineering and Technology |
Medical engineering
|
image analysis, image processing, surgery planning, preoperative planning, computer-assisted surgery
Researchers (24)
Organisations (2)
Abstract
Present-day sedentary lifestyle and problems with overweight and aging are reflected in an increased number of spine and spine-related diseases. Surgical interventions are the preferred treatment for patients with acute disorders or traumatic spine injuries, and are inevitable when other approaches, e.g. painkillers, physiotherapy or bracing, are not effective. Vertebral fixation is a surgical procedure for treating conditions such as scoliosis, kyphosis, spondylolisthesis and other degenerative conditions that cause instability of the spine. As spinal instability may cause damage to the spinal cord and nerve roots, the aim of vertebral fixation is to reduce vertebral mobility and, as a result, avoid such damage. The vertebral fixation procedure is based on anchoring two (or more) vertebrae to each other by metal fixation devices such as rods, plates and/or screws. One of the most widely used fixation techniques is pedicle screw placement, which consists of inserting screws through vertebral pedicles from the posterior side so that they reach the interior of the vertebral body, and then attaching a stabilizing rod to the exterior part of the screws on each side of the vertebra. As there is a limited visibility of anatomical structures during surgery, it is important to gain a mental conceptualization and reconstruction of the three-dimensional (3D) anatomy of spinal structures that are hidden from direct view. For a safe pedicle screw placement, the spine surgeon has to perform proper surgery planning by taking into account pedicle morphology (shape and structure), and choosing the appropriate size (diameter and length) and insertion trajectory (entry point and inclination) of each pedicle screw, which has proved valuable for reducing the risk of screw misplacement. As a result, preoperative surgery planning has become essential for pedicle screw placement, during which the surgeon on the basis of 3D spine images accurately studies the anatomy of the treated patient. Preoperative imaging is therefore necessary for reliable surgery planning, and computed tomography (CT) proved to be the imaging modality of choice for assessing the bone structures forming the spine and vertebrae. Modern computer software allows the surgeon to manually plan the size and insertion trajectory of each pedicle screw by navigating through 3D images and manipulating with 3D models of the spine, vertebrae and screws in 3D space. However, human capability of surgery planning by proper interpretation of medical images is limited due to our nonsystematic search patterns and natural biological variability of human anatomy, while the presence of noise may conceal actual geometrical relationships between anatomical structures. As a result, surgery planning is a relatively time-consuming task, and its reliability and accuracy depend on the subjective interpretation of the surgeon.
Our research objective is to achieve a quantitative, objective and reproducible evaluation of vertebral morphology from 3D spine images, especially of the morphology of pedicles and vertebral bodies for the purpose of preoperative planning of vertebral fixation by pedicle screw placement procedures. For this purpose, we will develop new computer-assisted techniques that will be based on automated processing and quantitative analysis of 3D spine images, and as such contribute to an improved planning of pedicle screw placement procedures as well as of other spine surgical procedures that require an accurate evaluation of vertebral morphology. The topic of this research project is therefore to develop and validate new techniques for automated computer-assisted quantitative analysis of 3D images for spine surgery planning.
Significance for science
We will develop novel automated techniques that will be based on computer-assisted processing, analysis and quantitative evaluation of 3D spine images, with emphasis on methods for statistical and parametrical modeling of vertebral bodies, pedicles and other vertebral anatomical structures, as well as on methods for image registration and segmentation. As such, the results of the proposed research project will fall into the category of medical technology, as they will represent application of knowledge and skills in the form of techniques that will be developed to solve a particular health problem, and can in general improve the quality of life and the general well-being of individuals and of the society. Although the ultimate success of a new medical technology is measured mostly by its impact on clinical practice, it can be also evaluated through its contributions to scientific knowledge. Based on the present research project proposal and past research activities of the research group members, and the reputation of the research team in the field of medical image processing and analysis, which are all reflected in numerous publications in high ranked peer-reviewed scientific journals, it is expected that the impact of the proposed research project to scientific knowledge will be high. In particular, relevant contributions to engineering and medical sciences will be one of the important results of the proposed research project. New findings related to spinal imaging, morphology of the spine and vertebrae, and pedicle screw placement as a technique for spine surgery are expected to result in advances in the understanding of spinal anatomy, and in understanding, diagnosis and treatment of spinal and spine-related diseases. On the other hand, new findings related to the design and development of automated techniques for computer-assisted analysis and quantitative evaluation of 3D spine images are expected to result in advances in the fields of biomedical engineering, medical imaging and biomechanics. These advances will be reflected in new publications, application of novel ideas and methods, and transfer and implementation of knowledge into national and foreign healthcare institutions and business communities. The impact in the fields of medicine, biomedical engineering and image analysis may also stimulate the development of adequate technology that can be transferred to clinical environment.
Significance for the country
The results of the proposed research projects are expected to directly impact the fields of medicine, biomedical engineering and biomechanics, providing direct benefits for the patients, medical doctors and healthcare in general, and therefore also for the society and economy. In particular, the following benefits are expected:
For patients, medical doctors and healthcare: Efficiently designed computer-assisted methods can aid in making preoperative planning less time-consuming and surgical procedures more reliable. The results will therefore have a positive impact for patients, as surgical procedures based on such preoperative plans will be more accurate and reliable, resulting in better surgery outcomes, less complications after surgery and faster recovery, and therefore shorter hospital stays and shorter recovery times after discharge, which will be reflected in a direct reduction of healthcare costs. The results will be beneficial also for surgeons and clinicians, as computer-assisted methods will provide them with additional information during preoperative surgery planning, resulting in more confident and accurate decisions and surgical procedures.
For the economy: The proposed techniques can be implemented as software, which may have commercial value, while the research outcomes may be attractive for developers and manufacturers of medical devices. The results will be therefore interesting for the medical imaging and medical device industry sectors. Companies that are active in these sectors, both national (e.g. XLab – Slovenia, Ekliptik – Slovenia) and foreign (e.g. Stryker – USA, DePuy Synthes – Switzerland, etc.), will potentially benefit from technology transfer in the form of copyrights and patents. The reduction of healthcare costs resulting from better surgery outcomes, faster patient recovery and shorter hospital stays, as well as shorter patient recovery times after discharge, and therefore faster return to work and everyday activities will also be beneficial for the economy.
For human resources development: Personal and organizational skills, knowledge and abilities of researchers will be improved. The highly relevant and interesting research topic, and the expertise of the research team will attract new talented researcher specialists with background in engineering and/or medicine.
For institutional capacity strengthening: Acquiring new and reconditioning, improving and renovating existing hardware and software, literature and access to scientific publications, as well as administrative and management systems.
For research collaboration: Working relationships with different individuals, organizations and institutions will be established and strengthened, leading to more effective future collaborations.
For funds and resources: The ability to generate new financial, technical or organizational support resources for future projects will increase for the research team, as well as for involved organizations.
Most important scientific results
Interim report,
final report
Most important socioeconomically and culturally relevant results
Interim report,
final report
