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Purpose <p>Spinal navigation systems have improved the accuracy and safety of lumbar spinal surgeries. However, traditional manual planning of pedicle screw trajectories remains time-consuming and heavily dependent on surgeon experience. This study presents an automatic pedicle screw trajectory planning system based on preoperative computed tomography images.</p> Methods <p>A 3D U-Net is employed to segment the lumbar vertebrae, with a specific focus on isolating a Clinically Constrained Region that encompasses all feasible screw entry areas while explicitly excluding the articular processes. This segmented region provides essential input for subsequent screw trajectory computation, from which a comprehensive screw trajectory database is constructed. Four bone-mineral-density related strategies were introduced and retrieved from the trajectory database. Among them, two trajectories incorporate the clinically constrained region as an additional anatomical filter.</p> Results <p>Expert evaluation by experienced spine surgeons indicates that the trajectory extracted through this anatomical filtering closely replicates conventional planning and provides the greatest clinical value.</p> Conclusion <p>By integrating anatomical structure and biomechanical factors, the proposed system offers effective support for spinal navigation in lumbar procedures.</p>

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Automatic Planning of Lumbar Pedicle Screw Trajectory via a Clinically Constrained Region

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Yun-Chia Tsai,
  • Chun-Hsu Yao,
  • Feng-Sheng Tsai

摘要

Purpose

Spinal navigation systems have improved the accuracy and safety of lumbar spinal surgeries. However, traditional manual planning of pedicle screw trajectories remains time-consuming and heavily dependent on surgeon experience. This study presents an automatic pedicle screw trajectory planning system based on preoperative computed tomography images.

Methods

A 3D U-Net is employed to segment the lumbar vertebrae, with a specific focus on isolating a Clinically Constrained Region that encompasses all feasible screw entry areas while explicitly excluding the articular processes. This segmented region provides essential input for subsequent screw trajectory computation, from which a comprehensive screw trajectory database is constructed. Four bone-mineral-density related strategies were introduced and retrieved from the trajectory database. Among them, two trajectories incorporate the clinically constrained region as an additional anatomical filter.

Results

Expert evaluation by experienced spine surgeons indicates that the trajectory extracted through this anatomical filtering closely replicates conventional planning and provides the greatest clinical value.

Conclusion

By integrating anatomical structure and biomechanical factors, the proposed system offers effective support for spinal navigation in lumbar procedures.