Augmented Reality-Based Surgical Navigation of Pelvic Screw Placement. Feasibility, Technique, and Limitations

Abstract

Background Minimally invasive surgical treatment of pelvic trauma requires a significant level of surgical training and technical expertise. Novel imaging and navigation technologies have always driven surgical technique, and with head-mounted displays being commercially available nowadays, the assessment of such Augmented Reality (AR) devices in a specific surgical setting is appropriate. Methods In this experimental Level 2 study, an AR-based surgical navigation system was assessed in a specific clinical scenario with standard pelvic and acetabular screw pathways. The system has the following components: an optical-see-through Head Mounted Display (HMD, HoloLens 2), a specifically designed modular AR software (HoloMA), and surgical tool tracking using pose estimation with synthetic square markers (ArUco). Results The success rate for entry point navigation was 93.8%, the overall translational deviation of drill pathways was 3.99 ± 1.77mm, and the overall rotational deviation of drill pathways was 4.3 ± 1.8°. There was no relevant theoretic screw perforation, as shown by 88.7% Grade 0–1 and 100% Grade 0–2 rating in our pelvic screw perforation score. Regarding screw length, 103 ± 8% of the planned pathway length could be realized successfully. Conclusions The system proved feasible for the task of percutaneous screw placement in the pelvis and, thus, could easily be adapted to a specific clinical scenario. The system showed comparable performance with other computer-aided solutions while providing specific advantages such as true 3D vision without intraoperative radiation.