ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Automated multi-trajectory planning for C1-C2 screw fixation using CT-derived 3D models.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate an automated computed tomography (CT)-derived three-dimensional (3D) model-based planning pipeline for C1-C2 screw fixation that generates multiple anatomically grounded trajectories per side, and to test the hypothesis that redundancy-by-design provides at least one Grade 0-1 candidate per evaluable side.
methodsThis retrospective, single-center study with supportive external dataset testing on VerSe 2019 used CT-derived 3D surface models, PointNet++ (aligned) point cloud segmentation, and geometric landmarking to generate four candidate screw axes for C1 and three for C2 per side. Internal and external candidates were graded independently by two spine-surgeon raters using the Gertzbein-Robbins scale. Conservative consensus was defined as Grade 0-1 only when both raters graded a candidate as Grade 0 or 1. The primary endpoint was side-level coverage of at least one Grade 0-1 candidate; secondary endpoints included candidate-level Grade 0-1 rate, segmentation performance mean intersection-over-union (mIoU), landmark localization error, and inter-rater agreement.
resultsOn the internal test set, segmentation achieved a mean region-wise mIoU of 88.8%, with landmark localization errors of approximately 1 mm. By conservative consensus, 93.6% of internal candidates were Grade 0-1 (96.1% and 93.8% by individual raters). On the external VerSe 2019 dataset, the conservative-consensus Grade 0-1 rate was 88.5% overall, including 82.1% for C1 and 97.0% for C2. Every evaluable internal and external side had at least one Grade 0-1 candidate. Inter-rater agreement was substantial in both datasets.
conclusionsThe CT-derived 3D point-cloud and geometric planning pipeline generated multiple C1-C2 screw trajectory candidates and the redundancy-by-design strategy provides retrospective preclinical feasibility evidence for a reproducible preoperative decision-support framework. Further multicentre, vascular-risk-aware, cadaveric/intraoperative, and prospective validation is required before clinical deployment.
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