Article • Increase confidence in the operating theatre

Adapting to image guided surgery

In more than 21% of complex anatomical osteosynthesis procedures, an intraoperative improvement of the implant position or a revision of reduction has to be performed (Recum von, J. et al., Unfallchirurg 2012, 115:196-201, Die intraoperative 3D-C-Bogen-Anwendung. State of the art).

 Image-guided surgery is gaining relevance as a method to increase confidence in these complex procedures. The goal is to enable clinicians to deliver  high-quality care and manage less-invasive approaches to shorten  hospital stays, which potentially improve patient outcomes. By utilising  preferred, navigation-ready instruments from different implant  companies, automatic registration of images for navigation and  intraoperative 3-D control scans allow quick progress checks and  documentation at all times. This, in turn, ensures efficient clinical  workflows, contributing to increased accuracy and reduced X-ray exposure  (Richter et. al., Cervical pedicle screws: conventional versus  computer-assisted placement of cannulated screws. Spine (PhilaPa 1976).  2005 Oct 15;30(20):2280-7. And, Gebhard et al., Does computer  assisted spine surgery reduce intraoperative radiation doses? Spine  (PhilaPa1976). 2006 Aug 1;31(17). 

 For these demanding procedures in areas such as  the cervical and upper thoracic spine, as well as for pelvic or  minimally invasive surgeries, Ziehm Imaging partnered with leading  surgical navigation providers to develop an interface that combines  navigation systems and intraoperative 3-D imaging with the Ziehm Vision  RFD 3D mobile C-arm.


The Ziehm NaviPort navigation interface connects  the C-arm seamlessly with the navigation system. A high-resolution 3-D  dataset can be transferred automatically; real-time visualisation of the  surgical instrument position can then be performed on the acquired  dataset. This allows more accuracy during orthopaedics, trauma, and  spinal procedures compared to conventional surgical techniques.

With the combination of advanced intraoperative  3-D imaging and navigated surgery, these complex procedures for accurate  screw and implant positioning can be handled with greater confidence  thanks to visual guidance requiring less fluoroscopic control. With  image-guided surgery and intraoperative control scans, post-operative CT  scans become obsolete. ‘Moreover, the ability to perform intraoperative  control scans enables us to significantly reduce the need for  postoperative CT scans,’ says Professor Christoph Josten, Orthopaedics,  Trauma, and Reconstructive Surgeon at Leipzig University Hospital.


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