Brainlab Navigation System with BoneMRI for Radiation-Free Spine Navigation

Research was conducted on scoliotic cadavers, and findings were presented at the NOF conference 2024

Utrecht, July 8, 2024 – Findings on radiation-free spinal navigation in cadavers were presented by researcher Peter Lafranca from UMC Utrecht at the Nordic Orthopedic Federation (NOF) conference 2024. During the study, the full spines of five cadavers were included to perform surface matching for navigated placement of K-wires using Brainlab Spine Navigation and BoneMRI. This is another demonstration that BoneMRI can be used as a preoperative imaging modality for surgical planning and then utilized in the navigation software to execute the surgery, eliminating the need for X-ray based techniques in these steps.

The two main objectives of the research were:

  1. To confirm the safety and accuracy of radiation-free spinal navigation using an ultrashort, scoliosis-specific BoneMRI protocol compared to CT
  2. To confirm the safety of cervical pedicle screw navigation based on AI-generated, MRI-based synthetic-CT (BoneMRI) versus CT

Surgeons Tom Schlosser, Sander Muijs, Yorck Rommelspacher and Sebastian Walter performed the CT-based and BoneMRI-based navigation to compare both modalities. These virtual screw placements were verified based on a postoperative CT.

Pedicle screw planned on BoneMRI using Brainlab Spine Navigation

Results using the recently published ultra-short scoliosis specific MRI protocol showed that:


  • Surface matching was possible on all vertebral levels and sides
  • For the lumbar and thoracic spine on both modalities no major breaches were found exceeding the pedicle cortex >2mm
  • For the lumbar and thoracic spine,72% of the CT-guided screws were classified with Gertzbein-Robbins A, 28% as B. For BoneMRI, 87% were grade A and 13% grade B.
  • For the cervical spine, 93% of the CT-navigated screws were within the pedicle or <2mm exceeding the pedicle cortex, compared to 100% of the BoneMRI-navigated screws.

MRI-based, AI-generated synthetic-CT spinal navigation is feasible and noninferior to conventional CT for insertion of thoracic and lumbar pedicle screws. The use of radiation-free spinal navigation in pediatric spinal deformity surgery should be explored.

Peter Lafranca

Abstract: The Safety and Accuracy of Radiation-Free Spinal Navigation using an Ultrashort, Scoliosis-Specific BoneMRI-Protocol compared to CT

Additionally, “Radiation-free, MRI-based synthetic CT is non inferior to conventional CT for surface matching and navigated cervical pedicle screw placement.” Lafranca concluded in the abstract Safety of Cervical Pedicle Screw Navigation based on AI-generated, MRIbased Synthetic-CT versus CT.

The study demonstrates that BoneMRI combined with the Brainlab Spine Navigation is a viable, radiation-free alternative to conventional preoperative CT for surgical planning and navigation for spine screw placements. These findings confirm the potential of a completely radiation-free surgical workflow, which is of particular importance for the pediatric population with spine deformities.