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Updated: Oct 14, 2025
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Multi-Modality guidance based surgical navigation for percutaneous endoscopic transforaminal discectomy.
Junjun Pan1, Dongfang Yu2, Ranyang Li1
1State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China; PENG CHENG Laboratory, Shenzhen 518000, China.
This study introduces an augmented reality surgical navigation system for percutaneous endoscopic transforaminal discectomy (PETD) that reduces radiation exposure. The system accurately guides puncture needles, improving safety and potentially lowering costs in surgical procedures.
Area of Science:
- Medical Imaging
- Surgical Navigation
- Augmented Reality
Background:
- Fluoroscopic guidance is crucial for percutaneous endoscopic transforaminal discectomy (PETD) but increases radiation risk due to 2D limitations.
- Accurate spatial assessment of patient anatomy and needle trajectory requires extensive fluoroscopic imaging, posing risks to patients and surgeons.
Purpose of the Study:
- To develop an augmented reality (AR) surgical navigation system for PETD.
- To reduce radiation exposure during PETD procedures by minimizing fluoroscopy use.
- To enhance the accuracy of puncture needle placement in PETD.
Main Methods:
- An AR surgical navigation system integrating fluoroscopy, optical tracking, and depth camera data.
- A novel lightweight, non-invasive fiducial marker system for accurate fluoroscopic image registration using deep learning.
- A self-adaptive calibration method for optical tracking devices and depth cameras.
Main Results:
- The system achieved real-time tracking and superimposition of a virtual puncture needle on fluoroscopy images.
- In vivo animal experiments demonstrated average positioning accuracy of 1.98mm and orientation accuracy of 1.19°.
- Clinical validation showed a 42.7% reduction in fluoroscopy imaging frequency, significantly lowering radiation risk.
Conclusions:
- The developed AR navigation system shows high potential for clinical utility in PETD.
- The system offers accurate guidance with reduced fluoroscopy, enhancing patient and surgeon safety.
- Unlike expensive systems, this AR navigation solution utilizes common operating room equipment, making it accessible even for smaller hospitals.
