OBJECTIVE Augmented reality (AR) has the potential to improve the accuracy and efficiency of instrumentation placement in spinal fusion surgery, increasing patient safety and outcomes, optimizing ergonomics in the surgical suite, and ultimately lowering procedural costs. The authors sought to describe the use of a commercial prototype Spine AR platform (SpineAR) that provides a commercial AR head-mounted display (ARHMD) user interface for navigation-guided spine surgery incorporating real-time navigation images from intraoperative imaging with a 3D-reconstructed model in the surgeon's field of view, and to assess screw placement accuracy via this method. METHODS Pedicle screw placement accuracy was assessed and compared with literature-reported data of the freehand (FH) technique. Accuracy with SpineAR was also compared between participants of varying spine surgical experience. Eleven operators without prior experience with AR-assisted pedicle screw placement took part in the study: 5 attending neurosurgeons and 6 trainees (1 neurosurgical fellow, 1 senior orthopedic resident, 3 neurosurgical residents, and 1 medical student). Commercially available 3D-printed lumbar spine models were utilized as surrogates of human anatomy. Among the operators, a total of 192 screws were instrumented bilaterally from L2–5 using SpineAR in 24 lumbar spine models. All but one trainee also inserted 8 screws using the FH method. In addition to accuracy scoring using the Gertzbein-Robbins grading scale, axial trajectory was assessed, and user feedback on experience with SpineAR was collected. RESULTS Based on the Gertzbein-Robbins grading scale, the overall screw placement accuracy using SpineAR among all users was 98.4% (192 screws). Accuracy for attendings and trainees was 99.1% (112 screws) and 97.5% (80 screws), respectively. Accuracy rates were higher compared with literature-reported lumbar screw placement accuracy using FH for attendings (99.1% vs 94.32%; p = 0.0212) and all users (98.4% vs 94.32%; p = 0.0099). The percentage of total inserted screws with a minimum of 5° medial angulation was 100%. No differences were observed between attendings and trainees or between the two methods. User feedback on SpineAR was generally positive. CONCLUSIONS Screw placement was feasible and accurate using SpineAR, an ARHMD platform with real-time navigation guidance that provided a favorable surgeon-user experience.

BACKGROUND Cadaveric studies on surgical anatomy and approaches are hampered by the limited number of specimens. Virtual reality (VR) technology can overcome this limitation, allowing for more in-depth statistical analysis of the data. OBJECTIVE To determine the benefit of a supraorbital ridge osteotomy in a supraorbital craniotomy targeting (1) the anterior communicating artery complex (ACOM), and (2) a lesion 25 mm above tuberculum sellae, using a large dataset generated by VR. METHODS Computed tomography scans of 30 subjects without cranial osseous pathology were identified for use with VR technology. After correlating VR and DICOM datasets, supraorbital craniotomies were simulated without and with removal of supraorbital ridge, bilaterally (n = 60). Area of freedom (AOF) from the outer table to the targets and the vertical center angle (VCA) to targets were calculated, before and after the orbitotomy. RESULTS For the ACOM, AOF averaged 496 mm2 (range: 322-805) and increased 8.9% to an average of 547 mm2 with the removal of the supraorbital ridge (P < .001). VCA increased from 18.5 to 20.3 degrees. For the suprasellar target, AOF averaged 507 mm2 (range 324-772) and increased 42.5% to 722 mm2 after orbitotomy (P < .001). VCA increased from 22.1 to 30.8 degrees. CONCLUSION VR technology is an emerging tool to study neurosurgical approaches. Here, we demonstrate with VR that the removal of the supraorbital ridge in a supraorbital craniotomy affords greater access to superiorly located lesions of the anterior fossa floor; however, deeper and lower lesions require a more aggressive orbital roof osteotomy to widen the exposure.

No abstract

In recent years, the advancement of eXtended Reality (XR) technologies including Virtual and Augmented reality (VR and AR respectively) has created new human-computer interfaces that come increasingly closer to replicating natural human movements, interactions, and experiences. In medicine, there is a need for tools that accelerate learning and enhance the realism of training as medical procedures and responsibilities become increasingly complex and time constraints are placed on trainee work. XR and other novel simulation technologies are now being adapted for medical education and are enabling further interactivity, immersion, and safety in medical training. In this review, we investigate efforts to adopt XR into medical education curriculums and simulation labs to help trainees enhance their understanding of anatomy, practice empathetic communication, rehearse clinical procedures, and refine surgical skills. Furthermore, we discuss the current state of the field of XR technology and highlight the advantages of using virtual immersive teaching tools considering the COVID-19 pandemic. Finally, we lay out a vision for the next generation of medical simulation labs using XR devices summarizing the best practices from our and others’ experiences.

No abstract