Epiduroscopy (EDS) is an emerging branch of less invasive treatment of chronic back pain and lumber herniated intervertebral disc disease. However, the EDS leads to X-ray radiation exposure and contrast agent-induced nephrotoxicity, since it is usually performed under the guidance of fluoroscopy. In this regard, We propose a new surgical navigation system for the EDS, which uses an electromagnetic tracking system (EMTS) and an optical tracking system (OTS) in a complementary way to compensate for inherent tacking inaccuracy of the EMTS and finally improve the navigation accuracy. The proposed system aims at replacing the conventional fluoroscopy to reduce the radiation doses and providing 3D visual information to help sur-geons more easily understand the surgical situation. For further improvement in the navigation accuracy of the proposed system, correction for magnetic field distortion based on the polynomial fitting technique are also studied. The phantom experiments were performed to quantitatively evaluate the accuracy of the pro-posed system and qualitative assessment was also performed with clinical application of the system over 14 patients. ⓒ 2014 DGIST
Table Of Contents
Ⅰ. Introduction -- 1.1 Brief Anatomy of the Spine and vertebrae 1 -- 1.2 Conventional procedure: its limitations and related research 3 -- 1.3 Goal of the Thesis 7 -- 1.4 Thesis Outline 8 -- Ⅱ. Surgical Navigation System for Epidurosopic Procedure -- 2.1 Basics 9 -- 2.1.1 Surgical Navigation 9 -- 2.1.2 Tracking Modality 10 -- 2.1.3 Imaging Modality 14 -- 2.2 EMTS-based Navigation System 17 -- 2.3 Hybrid Navigation System 25 -- 2.3.1 Tracker Calibration between Tracking Systems 26 -- 2.3.2 Patient-to-Image Registration 29 -- 2.4 Compensation of Error from Electromagnetic Field Distortion 31 -- 2.4.1 Definition of Error 32 -- 2.4.2 Data Acquisition 33 -- 2.4.3 Error Modeling 34 -- 2.4.4 Real-time Measurement Compensation 37 -- 2.5 Development of Navigation Software 38 -- 2.5.1 Functionality 38 -- 2.5.2 Implementation Procedure 42 -- Ⅲ. Experiments -- 3.1 Experiment 1: Evaluation and Compensation of Error Field 43 -- 3.2 Experiment 2: Evaluation of Registration Accuracy 45 -- Ⅳ. Experimental Results -- 4.1 Evaluation and Compensation of Error Field 47 -- 4.2 Evaluation of Registration Accuracy 50 -- Ⅴ. Clinical Application -- 5.1 Epiduroscopic Laser Neural Decompression (ELND) 51 -- 5.2 Navigation-Guided ELND 52 -- 5.2.1 Preoperative Preparations 52 -- 5.2.2 Intraoperative Set-up for ELND Navigation 58 -- 5.2.3 Catheter Insertion under Guidance of Navigation 62 -- 5.2.4 Discussion on Clinical Application 63 -- Ⅵ. Discussions 65 -- Ⅶ. Conclusions 66