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MRI-guided Navigation Surgery with Temporary Implantable Bone Markers in Limb Salvage for Sarcoma

  • Surgical Technique
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Technical errors during navigation-assisted bone tumor resection may occur by: (1) incorrect registration of images and corresponding anatomic points of bone sent to the navigation system; and (2) incorrect fusion of two or more images that have been transported to the navigation system.

Questions/purposes

We investigated new methods of navigation surgery to minimize technical errors during the registration and image fusion processes and specifically asked whether a navigated cannula probe would reduce unnecessary soft tissue dissection, and allow percutaneous registration and implantation of a reference base tracker in the margin of bone to be resected.

Methods

We performed direct MRI-guided navigation surgery without image fusion on a patient with osteosarcoma using absorbable pins as temporary implanted bone markers that prevent artifacts on MR images.

Results

Direct MRI-guided navigation surgery was possible using bone markers. A navigated cannula probe allowed percutaneous registration and a navigated blade-shaped probe provided a real-time check on the narrow osteotomy gap. The surgical procedure was facilitated by implantation of a reference base tracker on the margin of bone to be resected.

Conclusions

Our modified technique of MRI-guided navigation surgery for patients with a malignant bone tumor may reduce processing errors by increased accuracy and be helpful for joint preserving surgery.

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Acknowledgments

We thank Dr Yoon Whan Roh and physician assistant Byuk Kim for help with preparation and assistance of this surgery.

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Authors and Affiliations

  1. Orthopaedic Oncology Clinic, National Cancer Center, 111 jungbalsanro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea

    June Hyuk Kim MD & Hyun Guy Kang MD, PhD

  2. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea

    Han-Soo Kim MD, PhD

Authors
  1. June Hyuk Kim MD
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  2. Hyun Guy Kang MD, PhD
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  3. Han-Soo Kim MD, PhD
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Corresponding author

Correspondence to Hyun Guy Kang MD, PhD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Orthopaedic Oncology Clinic, National Cancer Center, Gyeonggi-do, Korea.

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Kim, J.H., Kang, H.G. & Kim, HS. MRI-guided Navigation Surgery with Temporary Implantable Bone Markers in Limb Salvage for Sarcoma. Clin Orthop Relat Res 468, 2211–2217 (2010). https://doi.org/10.1007/s11999-009-1209-8

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  • DOI: https://doi.org/10.1007/s11999-009-1209-8

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