Augmented Reality Navigated Sacral-Alar-Iliac Screw Insertion

Abstract

Background: Sacral-alar-iliac (SAI) screws are increasingly used for lumbo-pelvic fixation procedures. Insertion of SAI screws is technically challenging, and surgeons often rely on costly and time-consuming navigation systems. We investigated the accuracy and precision of an augmented reality (AR)-based and commercially available head-mounted device requiring minimal infrastructure.Methods: A pelvic sawbone model served to drill pilot holes of 80 SAI screw trajectories by 2 surgeons, randomly either freehand (FH) without any kind of navigation or with AR navigation. The number of primary pilot hole perforations, simulated screw perforation, minimal axis/outer cortical wall distance, true sagittal cranio-caudal inclination angle (tSCCIA), true axial medio-lateral angle, and maximal screw length (MSL) were measured and compared to predefined optimal values.Results: In total, 1/40 (2.5%) of AR-navigated screw hole trajectories showed a perforation before passing the inferior gluteal line compared to 24/40 (60%) of FH screw hole trajectories (P , .05). The differences between FH-and AR-guided holes compared to optimal values were significant for tSCCIA with À10.88 6 11.778 and MSL À65.29 6 15 mm vs 55.04 6 6.76 mm (P ¼ .001).Conclusions: In this study, the additional anatomical information provided by the AR headset and the superimposed operative plan improved the precision of drilling pilot holes for SAI screws in a laboratory setting compared to the conventional FH technique. Further technical development and validation studies are currently being performed to investigate potential clinical benefits of the AR-based navigation approach described here.Level of Evidence: 4.

XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis

“…There have been numerous reports on proof of concept and surgical simulation with cadaveric, phantom, and animal models using XR technology: pedicle screw insertion (cervical [91], thoracic [92,93], thoracolumbar [94,95], lumbar [31,63,64,93,[96][97][98][99][100][101]), cervical lateral mass screw insertion [32], vertebral body puncture [102][103][104], vertebroplasty (kyphoplasty) [105][106][107][108][109], percutaneous sacroiliac screw insertion [110][111][112], percutaneous lumbar discectomy [105,[113][114][115], and facet joint injection [116][117][118]. However, few studies have evaluated the application of XR technology in clinical practice for pedicle screw placement [90,119], targeted cervical foraminotomy [120], osteotomy planning [121] and percutaneous intervention [122][123][124], or extradural and intradural tumor resection [125,126].…”

In-Human Report of S2 Alar-Iliac Screw Placement Using Augmented Reality Assistance

“…AR allows for real-time trajectory planning to avoid cortical breach and visualize crossing of the sacroiliac joint. Dennler et al 11 have demonstrated significantly decreased perforations with AR-assisted S2AI placement in a sawbone model compared with freehand placement which indicate that AR may enhance patient safety. Furthermore, in cases which necessitate multiple points of pelvic fixation and/or a combination of S2AI and traditional iliac fixation (such as after spondylectomy or extensive three-column osteotomy), entry point selection and screw trajectory planning allow for optimal construct formation and prevention of screw trajectory collision.…”

Learning how to perform ultrasound-guided interventions with and without augmented reality visualization: a randomized study

“…Use of AR technology is increasing in several fields, including medicine. Early adaptations include image-guided infiltrations [6-10, 16, 26], surgery [5,[11][12][13][14][15], and other procedures benefitting from imaging guidance. Our aim was to determine whether AR US would be of value in training individuals who had not previously been taught how to perform US-guided biopsies and had not performed any such procedures.…”

“…Within the last few years, virtual reality and augmented reality (AR) have been increasingly used in the fields of entertainment and gaming. More recently, they have also been implemented in the field of medicine, particularly for training [1][2][3][4] but also clinically, such as in the fields of surgery and medical imaging [5][6][7][8][9][10][11][12][13][14][15]. Various head-mounted displays (HMDs), such as Google Glass and Microsoft HoloLens, are commercially available.…”