Introduction: The increasing complexity of spinal surgeries demands precise navigation to optimize patient outcomes and minimize complications. Accurate angular navigation trajectories are critical for procedures involving diverse spinal access points and anatomical landmarks. The Augmedics XVision-Spine (XVS) system, which provides real-time 3D navigation using intraoperative and 2D-3D registration methods, aims to enhance surgical accuracy. This study evaluates the accuracy of angular navigation trajectories using the XVS system in cadaveric models, focusing on its utility and precision for spine procedures.
Methods: 67 navigation trajectories in 4 cadavers (full spine) were performed by 4 different surgeons, with 31 trajectories using Intra-Op registration method and 36 trajectories using 2D-3D registration method in sacro-lumbar and lower thoracic level. Jamshidi tools were used to simulate angular navigation through various spinal levels. Absolute stereotactic navigation accuracy was assessed by comparing the tool's final trajectory position on postoperative CT scans to its virtual trajectory as presented by the XVS system. Descriptive statistics were used to calculate the mean, STD, and 99% confidence intervals of system's accuracy. Angular deviations were quantified in axial and sagittal planes, with a success criterion of a 99% upper bound of tool position deviations ≤ 3.0°.
Results: The tested cadavers were all males with an average age of 72.5 years, BMI of 22.2kg/m², and no history of spine surgery. The 99% upper bounds for angular errors were 1.65° (axial) and 1.54° (sagittal) for the Intra-Op method, and 1.78° (axial) and 1.75° (sagittal) for the 2D-3D registration method, all meeting the predefined success criterion. Mean trajectory errors in both planes were consistently below the pre-defined threshold of 3.0°.
Conclusion : The study validated the accuracy of the XVS system in guiding angular navigation trajectories, with comparable accuracy demonstrated for both Intra-Op and 2D-3D registration methods. These results highlight the system's potential to enhance precision in complex spine procedures that require access to disc space, canal, and other anatomical landmarks; thus, supporting its role in improving surgical outcomes through accurate 3D trajectory guidance and minimizing procedural risks.
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