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American Association of Neurological Surgeons, Neurosurgical Focus, 4(52), p. E10, 2022

DOI: 10.3171/2022.1.focus21721



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A novel surgical planning system using an AI model to optimize planning of pedicle screw trajectories with highest bone mineral density and strongest pull-out force

Journal article published in 2022 by Chi Ma, Da Zou, Huan Qi, Chentian Li, Cheng Zhang, Kedi Yang, Feng Zhu, Weishi Li, William W. Lu
Distributing this paper is prohibited by the publisher
Distributing this paper is prohibited by the publisher

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OBJECTIVE The purpose of this study was to evaluate the ability of a novel artificial intelligence (AI) model in identifying optimized transpedicular screw trajectories with higher bone mineral density (BMD) as well as higher pull-out force (POF) in osteoporotic patients. METHODS An innovative pedicle screw trajectory planning system called Bone’s Trajectory was developed using a 3D graphic search and an AI-based finite element analysis model. The preoperative CT scans of 21 elderly osteoporotic patients were analyzed retrospectively. The AI model automatically calculated the number of alternative transpedicular trajectories, the trajectory BMD, and the estimated POF of L3–5. The highest BMD and highest POF of optimized trajectories were recorded and compared with AO standard trajectories. RESULTS The average patient age and average BMD of the vertebral bodies were 69.6 ± 7.8 years and 55.9 ± 17.1 mg/ml, respectively. On both sides of L3–5, the optimized trajectories showed significantly higher BMD and POF than the AO standard trajectories (p < 0.05). On average, the POF of optimized trajectory screws showed at least a 2.0-fold increase compared with AO trajectory screws. CONCLUSIONS The novel AI model performs well in enabling the selection of optimized transpedicular trajectories with higher BMD and POF than the AO standard trajectories.