Robotic ultrasound-guided facet joint insertion

  • Javier EstebanEmail author
  • Walter Simson
  • Sebastian Requena Witzig
  • Anna Rienmüller
  • Salvatore Virga
  • Benjamin Frisch
  • Oliver Zettinig
  • Drazen Sakara
  • Yu-Mi Ryang
  • Nassir Navab
  • Christoph Hennersperger
Original Article



Facet joint insertion is a common treatment of chronic pain in the back and spine. This procedure is often performed under fluoroscopic guidance, where the staff’s repetitive radiation exposure remains an unsolved problem. Robotic ultrasound (rUS) has the potential to reduce or even eliminate the use of radiation by using ultrasound with a robotic-guided needle insertion. This work presents first clinical data of rUS-based needle insertions extending previous work of our group.


Our system implements an automatic US acquisition protocol combined with a calibrated needle targeting system. This approach assists the physician by positioning the needle holder on a trajectory selected in a 3D US volume of the spine.


By the time of submission, nine facets were treated with our approach as first data from an ongoing clinical study. The insertion success rate was shown to be comparable to current clinical practice. Furthermore, US imaging offers additional anatomical context for needle trajectory planning.


This work shows first clinical data for robotic ultrasound-assisted facet joint insertion as a promising solution that can easily be incorporated into the clinical workflow. Presented results show the clinical value of such a system.


Robotic ultrasound Neurosurgery Needle guidance Facet joint infiltration Surgical planning 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Supplementary material 1 (mp4 160435 KB)


  1. 1.
    Abayazid M, Moreira P, Shahriari N, Patil S, Alterovitz R, Misra S (2015) Ultrasound-guided three-dimensional needle steering in biological tissue with curved surfaces. Med Eng Phys 37(1):145–150CrossRefPubMedGoogle Scholar
  2. 2.
    Abayazid M, Vrooijink GJ, Patil S, Alterovitz R, Misra S (2014) Experimental evaluation of ultrasound-guided 3D needle steering in biological tissue. Int J Comput Assist Radiol Surg 9(6):931–939CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Adebar TK, Fletcher AE, Okamura AM (2014) 3-D ultrasound-guided robotic needle steering in biological tissue. IEEE Trans Biomed Eng 61(12):2899–2910CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Ding J, Stoianovici D, Petrisor D, Mozer P, Avila R, Ibanez L, Turner W, Yankelvitz D, Wilson E, Banovac F, Cleary K (2008) Medical needle steering for lung biopsy: Experimental results in tissue phantoms using a robotic needle driver. In: 8th IEEE international conference on bioinformatics and bioengineering, pp 1–5Google Scholar
  5. 5.
    Gopinathan A, Peh WC (2011) Image-guided facet joint injection. Biomed Imaging Interv J 7(2):e4Google Scholar
  6. 6.
    Gorniak G, Conrad W (2015) Lower lumbar facet joint complex anatomy. Austin J Anat 2(1):1–8Google Scholar
  7. 7.
    Hennersperger C, Fuerst B, Virga S, Zettinig O, Frisch B, Neff T, Navab N (2017) Towards MRI-based autonomous robotic us acquisitions: a first feasibility study. IEEE Trans Med Imaging 36(2):538–548CrossRefPubMedGoogle Scholar
  8. 8.
    Hoon Han S, Park K, Rai Cho K, Park Y (2017) Ultrasound versus fluoroscopy-guided medial branch block for the treatment of lower lumbar facet joint pain: a retrospective comparative study. Medicine 96(16):e6655CrossRefGoogle Scholar
  9. 9.
    Khallaghi S, Mousavi P, Gong RH, Gill S, Boisvert J, Fichtinger G, Pichora D, Borschneck D, Abolmaesumi P (2010) Registration of a statistical shape model of the lumbar spine to 3D ultrasound images. Med Image Comput Comput Assist Interv MICCAI 2010:68–75Google Scholar
  10. 10.
    Lasso A, Heffter T, Rankin A, Pinter C, Ungi T, Fichtinger G (2014) PLUS: open-source toolkit for ultrasound-guided intervention systems. IEEE Trans Biomed Eng 61(10):2527–2537CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mohammed Motawea A, Ramadan El Kholy M, Mohamed Ebied O, El Fattah Abd, Mousa W, Shawky Abdullah M (2015) Imaging-guided facet joint injection technique for lower back pain management. Am J Health Res 3(2):52–56CrossRefGoogle Scholar
  12. 12.
    Moult E, Ungi T, Welch M, Lu J, McGraw RC, Fichtinger G (2013) Ultrasound-guided facet joint injection training using perk tutor. Int J Comput Assist Radiol Surg 8(5):831–836CrossRefPubMedGoogle Scholar
  13. 13.
    Rasoulian A, Seitel A, Osborn J, Sojoudi S, Nouranian S, Lessoway VA, Rohling RN, Abolmaesumi P (2015) Ultrasound-guided spinal injections: a feasibility study of a guidance system. Int J Comput Assist Radiol Surg 10(9):1417–1425CrossRefPubMedGoogle Scholar
  14. 14.
    Soni NJ, Franco-Sadud R, Schnobrich D, Dancel R, Tierney DM, Salame G, Restrepo MI, McHardy P (2016) Ultrasound guidance for lumbar puncture. Neurol Clin Pract 6(4):358–368CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Ungi T, Abolmaesumi P, Jalal R, Welch M, Ayukawa I, Nagpal S, Lasso A, Jaeger M, Borschneck DP, Fichtinger G, Mousavi P (2012) Spinal needle navigation by tracked ultrasound snapshots. IEEE Trans Biomed Eng 59(10):2766–2772CrossRefPubMedGoogle Scholar
  16. 16.
    Yaniv Z (2015) Which pivot calibration? Image-Guided Proced Robot Interv Model 9415:941527Google Scholar
  17. 17.
    Yoon SH, O’Brien SL, Tran M (2013) Ultrasound guided spine injections: advancement over fluoroscopic guidance? Curr Phys Med Rehabil Rep 1(2):104–113CrossRefGoogle Scholar
  18. 18.
    Zettinig O, Frisch B, Virga S, Esposito M, Rienmüller A, Meyer B, Hennersperger C, Ryang YM, Navab N (2017) 3D ultrasound registration-based visual servoing for neurosurgical navigation. Int J Comput Assist Radiol Surg 12(9):1607–1619CrossRefPubMedGoogle Scholar
  19. 19.
    Zettinig O, Fuerst B, Kojcev R, Esposito M, Salehi M, Wein W, Rackerseder J, Sinibaldi E, Frisch B, Navab N (2016) Toward real-time 3d ultrasound registration-based visual servoing for interventional navigation. In: IEEE international conference on robotics and automation (ICRA), pp 945–950Google Scholar

Copyright information

© CARS 2018

Authors and Affiliations

  • Javier Esteban
    • 1
    Email author
  • Walter Simson
    • 1
  • Sebastian Requena Witzig
    • 1
  • Anna Rienmüller
    • 4
  • Salvatore Virga
    • 1
  • Benjamin Frisch
    • 3
  • Oliver Zettinig
    • 2
  • Drazen Sakara
    • 4
  • Yu-Mi Ryang
    • 4
  • Nassir Navab
    • 1
    • 5
  • Christoph Hennersperger
    • 1
  1. 1.Technical University of MunichGarching bei MünchenGermany
  2. 2.Imfusion GmbHMunichGermany
  3. 3.Medidee Services SAEpalingesSwitzerland
  4. 4.Klinikum rechts der IsarMunichGermany
  5. 5.Johns Hopkins UniversityBaltimoreUSA

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