초록접수[미리보기]
| 21KF-049 |
Virtual Simulation for Interventional Procedure of Severely Deformed Lumbar Spine : A Case Report
Department of Anesthesiology and Pain Medicine, Korea
University Anam Hospital, Seoul, Republic of Korea
Introduction
It is often very difficult to perform interventional procedures in patients with severely deformed anatomical structures. Since various procedures of the spine are performed under the guidance of x-ray using C-arm which only present 2D images, it requires a lot of training to figure out an actual 3D anatomical structure while performing procedures. In addition, due to the mismatch between the position of needle and the clinician\'s visual direction, it becomes more difficult to place the tool in the correct position under C-arm guidance. If we can predict how the patient\'s actual anatomical structure and surgical tools will appear as a 2D x-ray image before the procedure, it will be of great help in performing difficult procedures.
In this case report, we presented a case of successful transforaminal epidural injection through pre-procedural virtual simulation for a patient who was expected to undergo difficult procedure due to severe spinal deformity.
Case
An 84-year-old female patient visited our hospital for chronic low back pain radiating to the left lateral sides of lower extremity and the dorsum of foot. L5 nerve root stimulation was suspected according to her MRI. However, due to facet joint hypertrophy and degenerative changes, we failed a transforaminal epidural injection at L5/S1 though several attempts (Figure 1). In that, we decided to build virtual simulation for successful procedure.
From her CT data, we built virtual simulation of the spine using several programs. We set the most appropriate position to place the needle by freely showing or hiding the lumbar spine, pelvis, and sacrum. After that, we simulated x-ray images according to the manipulation of the virtual c-arm at which the needle was visualized as a point. We saved the image of the simulation and carefully tried to understand the 3D positional relationships between patient\'s anatomy and the needle (Figure 2A).
When she visited our hospital, the c-arm was adjusted to obtain a similar picture of the L5 vertebra in the simulation. From that position, the 25-gauge needle was successfully advanced to the L5/S1 intervertebral epidural space by single attempt (Figure 2B).
Conclusion
We created a virtual simulation system for x-ray guided spine intervention procedure and it was successfully applicated on a patient with severe lumbar intervertebral foraminal stenosis.
It is often very difficult to perform interventional procedures in patients with severely deformed anatomical structures. Since various procedures of the spine are performed under the guidance of x-ray using C-arm which only present 2D images, it requires a lot of training to figure out an actual 3D anatomical structure while performing procedures. In addition, due to the mismatch between the position of needle and the clinician\'s visual direction, it becomes more difficult to place the tool in the correct position under C-arm guidance. If we can predict how the patient\'s actual anatomical structure and surgical tools will appear as a 2D x-ray image before the procedure, it will be of great help in performing difficult procedures.
In this case report, we presented a case of successful transforaminal epidural injection through pre-procedural virtual simulation for a patient who was expected to undergo difficult procedure due to severe spinal deformity.
Case
An 84-year-old female patient visited our hospital for chronic low back pain radiating to the left lateral sides of lower extremity and the dorsum of foot. L5 nerve root stimulation was suspected according to her MRI. However, due to facet joint hypertrophy and degenerative changes, we failed a transforaminal epidural injection at L5/S1 though several attempts (Figure 1). In that, we decided to build virtual simulation for successful procedure.
From her CT data, we built virtual simulation of the spine using several programs. We set the most appropriate position to place the needle by freely showing or hiding the lumbar spine, pelvis, and sacrum. After that, we simulated x-ray images according to the manipulation of the virtual c-arm at which the needle was visualized as a point. We saved the image of the simulation and carefully tried to understand the 3D positional relationships between patient\'s anatomy and the needle (Figure 2A).
When she visited our hospital, the c-arm was adjusted to obtain a similar picture of the L5 vertebra in the simulation. From that position, the 25-gauge needle was successfully advanced to the L5/S1 intervertebral epidural space by single attempt (Figure 2B).
Conclusion
We created a virtual simulation system for x-ray guided spine intervention procedure and it was successfully applicated on a patient with severe lumbar intervertebral foraminal stenosis.
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