Chirurgie computérisée de la fixation des vis pédiculaires. Techniques et pratique clinique

Imaging, sensing and computing technologies that are being introduced to aid in the planning and execution of surgical procedures on spine are providing orthopaedic surgeons with a powerful new set of tools for improving clinical accuracy, reliability and patient outcomes while reducing costs and operating times. Current computer assisted spine surgery systems typically include four steps. 1. A measurement process for collecting patient specific medical data: pre-operative images (CT, x-rays, MRI), intra-operative images (fluoroscopy, ultrasound images), intra-operative positions of tools or bones obtained using 3D localizers. 2. A registration process for aligning all images and data to the patient coordinate system using anatomical landmarks, bone surfaces digitized directly or with ultrasounds, x-rays. 3. A decision making process for generating a surgical plan on multi-modality information: interactive placement of tools or bones on images, monitoring of criteria (angles, positions, impingement….). 4. An action process for accurately achieving the goals specified in the plan: passive systems that display the position of tools or bones on images and data; semi-active systems that position drill or cutting guides; active robots. In the future, it is expected that computer assisted spine surgery systems will enable surgeons to measure the performances of surgical techniques accurately and consistently, which is a first step for optimization of surgery.