Ziehm NaviPort interface and BrainLAB Fluoro 3D surgical navigation software improves surgical procedures

Ziehm Imaging and BrainLAB have extended their cooperation to assist surgeons in the intra-operative guidance of pedicle screw and hardware placement during surgical trauma and spinal instrumentation procedures.

Ziehm's "NaviPort" interface now allows high-resolution 3D images from the Ziehm Vision2 FD Vario 3D mobile C-arm to be used for surgical navigation driven by BrainLAB technology. Ziehm's Vision2 FD Vario 3D provides distortion-free, fully-digital flat-panel technology which reproduces images in more than 16,000 shades of gray. This technology can assist surgeons by providing an improved overview of the finest anatomical structures in three dimensions, for example, when inserting screws and implants. Professor Josten and the Clinic and Outpatients' Department for Trauma, Reconstructive and Plastic Surgery at Leipzig University Clinic were the first in Germany to use this new technology. More installations are now underway in the United States. The Vision2 FD Vario 3D, in combination with BrainLAB technology, will be shown at CNS (October 26-28 in New Orleans) and NASS (November 11-13 in San Francisco).

New study shows: 3D images can facilitate more precise pedicle screw placement

3D imaging is a crucial aid to surgeons operating on the spinal column. Studies prove that pedicle screws are positioned erroneously in 40 percent of all operations that do not employ X-ray monitoring. A study by the Department for Trauma and Reconstructive Surgery at Rostock University Clinic shows that, "using image intensifiers for 3-D imaging makes it possible...to correctly assess screw position and offers the advantage of immediate correction of the screws in case of malpositioning." The study further states, "In the future, with good 3-D scan imaging quality, a postoperative CT scan to assess screw position will not be necessary."

High-resolution images for optimum orientation in the OR

Three-dimensional X-ray images from the Ziehm Vision2 FD Vario 3D offer surgeons an intra-operative 3D view of the patient's anatomy in the current surgical position and are therefore particularly suitable for complicated procedures in which millimeter-level precision is essential. The C-arm's fully-digital flat-panel technology provides distortion-free images in more than 16,000 shades of gray-four times more than C-arms with conventional image intensifiers. This can enable doctors to make more precise diagnoses.

At the Clinic and Outpatients' Department for Trauma, Reconstructive and Plastic Surgery at Leipzig University Clinic, Professor Christoph Josten has gained clinical experience with Ziehm Vision2 FD Vario 3D. "3D imaging during operations provides us with a precise overview, allowing us to position pedicle screws more accurately", explains Professor Josten. "This applies particularly for the problematic cervical spine and the thoracic spine that are hard to spot with conventional X-rays. The 3D function especially helps us to avoid injuring any sensitive structures such as the spinal cord. Therefore, it increases the safety of the surgery and can replace radiological follow-up scans. As a result, our patients are only exposed to low doses of X-rays and do not have to accept high radiation in post-operative control scans. Our clinic benefits from more efficient procedures and from the possibility of minimally invasive surgeries that help reduce the need for pain treatment, rehab phases and eventually the stationary stays."

X-ray based navigation with BrainLAB technology

Surgical navigation can also work more precisely in combination with optimized 3D X-ray images. Ziehm Imaging Inc.'s exclusive Vision2 FD Vario 3D imaging can be used with surgical navigation from BrainLAB, providing intra-operative 3D datasets with advantages such as distortion-free images, high resolution, and expanded dynamic range.

The new Ziehm NaviPort interface and the latest Fluoro 3D navigation software from BrainLAB allow 3D datasets taken during the operation to be used immediately for further interventions with the navigation system, without additional steps required for registration. This unique link between the two technologies saves valuable time in the operating room. BrainLAB Fluoro 3D surgical navigation software automatically and uniquely matches the C-arm dataset taken during surgery with the anatomical structures of the patient within seconds. With the aid of BrainLAB Fluoro 3D software, the surgeon can follow the patient's anatomy and the movements of the surgical instruments on the monitor in real-time during the operation. This provides surgeons with an improved overview of a minimally invasive procedure where they can, for example, plan for and position screws even more precisely than before.

Flexibility during surgery

In addition, the flat-panel detector is also unsusceptible to magnetic fields and can be used in any operational environment, even in the vicinity of an MR scanner. The narrow profile of the flat-panel detector allows for more free space between the generator and detector. This makes it easier for technologists to position the C-arm comfortably around the patient and surgical table. Optimal fluoroscopic views are thus possible from more angles-a crucial advantage, in particular, for operations on the spinal column.

"Ziehm Imaging has almost 40 years of experience in developing high-tech C-arms", explains Martin Herzmann, Director of Global Marketing at Ziehm Imaging. "We cooperate closely with more than 100 clinics in which we have installed our systems in order to continue development of X-ray based imaging with flat-panel technology. As a technology leader, we are expanding the range of clinical applications of our systems for the benefit of patients and for the benefit of the customers of BrainLAB and Ziehm Imaging."