Feasibility study of artificial intelligence algorithm based on deep learning in C1 pedicle screw automatic planning_West China Medical Journal

Authors：

LIU Xin ¹ , DENG Jiayan ² , SHEN Danwei ² , LIN Xu ³ , HU Haigang ³ ,  WU Chao ^2,3

1. Health Management Center, Zigong First People’s Hospital, Zigong, Sichuan 643000, P. R. China;
2. Digital medical Center, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;
3. Orthopaedics Center, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

WU Chao, Email: flightiness@163.com

Keywords：

Artificial intelligence; deep learning; spatial key point; C1; pedicle screw

DOI：

10.7507/1002-0179.202408139

Video：

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Objective To investigating the safety and accuracy of artificial intelligence (AI) assisted automatic planning of pedicle screws parallel to sagittal plane for C1. Methods The subjects who completed cervical CT scan in Zigong Fourth People’s Hospital btween January 2020 and December 2023 were selected. The subjects who completed cervical CT scan were randomly divided into two groups using a random number table method. Among them, 80% were used as the training model (training group), and 20% were used as the validation model (validation group). The original cervical CT data of the training group were imported into ITK-SNAP software to mark the feature points. Four feature points were selected. In order to obtain the weighted function model of the four feature points, training group were trained with the spatial key point location algorithm. pedicle trajectory based on the four key points obtained. Finally, the algorithm was compiled to form a visual interface, and imported into the verification group of annular vertebral CT data to calculate the pedicle screw trajectory. Results A total of 500 patients were included. Among them, there were 400 cases in the training group and 100 cases in the validation group. The average positioning error of spatial key points is (0.47±0.16) mm. The average distance between the planned pedicle screw center line and the internal edge of the pedicle was (2.86±0.12) mm. Pedicle screw placement parallel to the sagittal plane and 3D display can be safely performed for the C1 pedicle that is large enough to accommodate a 3.5 mm diameter screw without cortical breakthrough. Conclusions For pedicle screw planning parallel to the sagittal plane in C1, training based on the spatial positioning algorithm of anterior and posterior tubercles and bilateral tangential points can obtain a safe and accurate pedicle screw trajectory. It provides theoretical basis for orthopedic robot automatic screw placement. For vertebral bodies with narrow or deformed pedicles, further expansion of the training data is needed to expand the adaptive range and improve the accuracy of the algorithm.

Citation： LIU Xin, DENG Jiayan, SHEN Danwei, LIN Xu, HU Haigang, WU Chao. Feasibility study of artificial intelligence algorithm based on deep learning in C1 pedicle screw automatic planning. West China Medical Journal, 2024, 39(10): 1531-1536. doi: 10.7507/1002-0179.202408139 Copy

1.	Ma XY, Yin QS, Wu ZH, et al. C1 pedicle screws versus C1 lateral mass screws: comparisons of pullout strengths and biomechanical stabilities. Spine (Phila Pa 1976), 2009, 34(4): 371-377.
2.	Ma XY, Yin QS, Wu ZH, et al. Anatomic considerations for the pedicle screw placement in the first cervical vertebra. Spine (Phila Pa 1976), 2005, 30(13): 1519-1523.
3.	Ma J, Tang J, Wang D, et al. Comparison of perpendicular to the coronal plane versus medial inclination for atlas pedicle screw insertion: an anatomic and radiological study in human cadavers. International Orthopaedics, 2016, 40(1): 141-147.
4.	Dawes B, Perchyonok Y, Gonzalvo A. Radiological evaluation of C1 pedicle screw anatomic feasibility. J Clin Neurosci, 2018, 51: 18-21.
5.	Kim HB, Lee MK, Lee YS, et al. An Assessment of the medial angle of inserted subaxial cervical pedicle screw during surgery: practical use of preoperative ct scanning and intraoperative X-rays. Neurol Med Chir (Tokyo), 2017, 57(4): 159-165.
6.	Tan M, Wang H, Wang Y, et al. Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine (Phila Pa 1976), 2003, 28(9): 888-895.
7.	Wu C, Deng J, Wang Q, et al. Feasibility of atlas pedicle screw fixation perpendicular to the coronal plane-a 3D anatomic analysis. Global Spine J, 2022, 12(7): 1369-1374.
8.	Wu C, Deng J, Zeng B, et al. Three-dimensional anatomic analysis and navigation templates for C1 pedicle screw placement perpendicular to the coronal plane: a retrospective study. Neurol Res, 2021, 43(12): 961-969.
9.	Ma C, Zou D, Qi H, et al. A novel surgical planning system using an AI model to optimize planning of pedicle screw trajectories with highest bone mineral density and strongest pull-out force. Neurosurg Focus, 2022, 52(4): E10.
10.	Jia S, Weng Y, Wang K, et al. Performance evaluation of an AI-based preoperative planning software application for automatic selection of pedicle screws based on computed tomography images. Front Surg, 2023, 10: 1247527.
11.	陈其昕, 沈金明, 李方财, 等. 寰椎侧块置钉安全区域的建立及其应用. 中华创伤杂志, 2006, 22(6): 404-407.
12.	陈其昕. 寰椎后弓变异患者寰椎椎弓根螺钉的置钉策略. 中国脊柱脊髓杂志, 2013, 23(5): 426-430.
13.	杨利斌. 寰椎椎弓根螺钉进钉通道的选择. 郑州大学学报 (医学版), 2014, 49(2): 287-290.
14.	Yang M, Jung JW, Kim J, et al. Current and future of spinal robot surgery. Kor J Spine, 2010, 7(2): 61-65.
15.	Lang JE, Mannava S, Floyd AJ, et al. Robotic systems in orthopaedic surgery. J Bone Joint Surg Br, 2011, 93(10): 1296-1299.
16.	Davies B. A review of robotics in surgery. Proc Inst Mech Eng H, 2000, 214(1): 129-140.
17.	Khan F , Pearle A , Lightcap C , et al. Haptic robot-assisted surgery improves accuracy of wide resection of bone tumors: a pilot study. Clin Orthop Relat Res, 2013, 471(3): 851-859.
18.	Zhu Z, Liu E, Su Z, et al. Three-dimensional lumbosacral reconstruction by an artificial intelligence-based automated MR image segmentation for selecting the approach of percutaneous endoscopic lumbar discectomy. Pain Physician, 2024, 27(2): E245-E254.

1. Ma XY, Yin QS, Wu ZH, et al. C1 pedicle screws versus C1 lateral mass screws: comparisons of pullout strengths and biomechanical stabilities. Spine (Phila Pa 1976), 2009, 34(4): 371-377.
2. Ma XY, Yin QS, Wu ZH, et al. Anatomic considerations for the pedicle screw placement in the first cervical vertebra. Spine (Phila Pa 1976), 2005, 30(13): 1519-1523.
3. Ma J, Tang J, Wang D, et al. Comparison of perpendicular to the coronal plane versus medial inclination for atlas pedicle screw insertion: an anatomic and radiological study in human cadavers. International Orthopaedics, 2016, 40(1): 141-147.
4. Dawes B, Perchyonok Y, Gonzalvo A. Radiological evaluation of C1 pedicle screw anatomic feasibility. J Clin Neurosci, 2018, 51: 18-21.
5. Kim HB, Lee MK, Lee YS, et al. An Assessment of the medial angle of inserted subaxial cervical pedicle screw during surgery: practical use of preoperative ct scanning and intraoperative X-rays. Neurol Med Chir (Tokyo), 2017, 57(4): 159-165.
6. Tan M, Wang H, Wang Y, et al. Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine (Phila Pa 1976), 2003, 28(9): 888-895.
7. Wu C, Deng J, Wang Q, et al. Feasibility of atlas pedicle screw fixation perpendicular to the coronal plane-a 3D anatomic analysis. Global Spine J, 2022, 12(7): 1369-1374.
8. Wu C, Deng J, Zeng B, et al. Three-dimensional anatomic analysis and navigation templates for C1 pedicle screw placement perpendicular to the coronal plane: a retrospective study. Neurol Res, 2021, 43(12): 961-969.
9. Ma C, Zou D, Qi H, et al. A novel surgical planning system using an AI model to optimize planning of pedicle screw trajectories with highest bone mineral density and strongest pull-out force. Neurosurg Focus, 2022, 52(4): E10.
10. Jia S, Weng Y, Wang K, et al. Performance evaluation of an AI-based preoperative planning software application for automatic selection of pedicle screws based on computed tomography images. Front Surg, 2023, 10: 1247527.
11. 陈其昕, 沈金明, 李方财, 等. 寰椎侧块置钉安全区域的建立及其应用. 中华创伤杂志, 2006, 22(6): 404-407.
12. 陈其昕. 寰椎后弓变异患者寰椎椎弓根螺钉的置钉策略. 中国脊柱脊髓杂志, 2013, 23(5): 426-430.
13. 杨利斌. 寰椎椎弓根螺钉进钉通道的选择. 郑州大学学报 (医学版), 2014, 49(2): 287-290.
14. Yang M, Jung JW, Kim J, et al. Current and future of spinal robot surgery. Kor J Spine, 2010, 7(2): 61-65.
15. Lang JE, Mannava S, Floyd AJ, et al. Robotic systems in orthopaedic surgery. J Bone Joint Surg Br, 2011, 93(10): 1296-1299.
16. Davies B. A review of robotics in surgery. Proc Inst Mech Eng H, 2000, 214(1): 129-140.
17. Khan F , Pearle A , Lightcap C , et al. Haptic robot-assisted surgery improves accuracy of wide resection of bone tumors: a pilot study. Clin Orthop Relat Res, 2013, 471(3): 851-859.
18. Zhu Z, Liu E, Su Z, et al. Three-dimensional lumbosacral reconstruction by an artificial intelligence-based automated MR image segmentation for selecting the approach of percutaneous endoscopic lumbar discectomy. Pain Physician, 2024, 27(2): E245-E254.

West China Medical Journal

Feasibility study of artificial intelligence algorithm based on deep learning in C1 pedicle screw automatic planning

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