Augmented reality navigation in spine surgery: a systematic review

Burström, Gustav; Persson, Oscar; Edström, Erik; Elmi-Terander, Adrian

doi:10.1007/s00701-021-04708-3

Cited by 78 publications

(67 citation statements)

References 47 publications

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“…AR systems have demonstrated a high accuracy compared to free-hand and conventional navigation in spine surgery in several clinical studies [ 38 ]. Good 3D depth perception, resulting in smooth hand–eye coordination, was provided using advanced AR visualization in combination with additional views on screens near the surgical field [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

et al. 2021

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Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

et al. 2021

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“…One of the applications of AR with the highest potential is spinal surgery. 3,4 AR has been shown previously, both in cadaver studies and in real patients, to be of clinical utility for guiding the placement of spinal hardware. [4][5][6][7][8] These studies have suggested that pedicle screw placement and tumor resection guided by AR have the potential to be highly accurate and precise.…”

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confidence: 92%

“…AR thus may be a meaningful surgical adjunct to conventional freehand pedicle screw placement or other spinal procedures and may enable comparable accuracy to robotic pedicle screw placement. 3 It may also reduce fluoroscopy-or CT-associated radiation exposure to patients and surgeons.As the applications for AR guidance in spinal surgery increase, more data are required to quantify the utility of this technology. Until this point, little has been written regarding the use of AR guidance for the placement of percutaneous thoracic or lumbar pedicle screws, particularly regarding AR head-mounted display (ARHMD) stereotac-ABBREVIATIONS AR = augmented reality; ARHMD = AR head-mounted display.…”

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confidence: 99%

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First in-human report of the clinical accuracy of thoracolumbar percutaneous pedicle screw placement using augmented reality guidance

Yahanda¹,

Moore

Ray³

et al. 2021

Neurosurgical Focus

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OBJECTIVE Augmented reality (AR) is an emerging technology that has great potential for guiding the safe and accurate placement of spinal hardware, including percutaneous pedicle screws. The goal of this study was to assess the accuracy of 63 percutaneous pedicle screws placed at a single institution using an AR head-mounted display (ARHMD) system. METHODS Retrospective analyses were performed for 9 patients who underwent thoracic and/or lumbar percutaneous pedicle screw placement guided by ARHMD technology. Clinical accuracy was assessed via the Gertzbein-Robbins scale by the authors and by an independent musculoskeletal radiologist. Thoracic pedicle subanalysis was also performed to assess screw accuracy based on pedicle morphology. RESULTS Nine patients received thoracic or lumbar AR-guided percutaneous pedicle screws. The mean age at the time of surgery was 71.9 ± 11.5 years and the mean number of screws per patient was 7. Indications for surgery were spinal tumors (n = 4, 44.4%), degenerative disease (n = 3, 33.3%), spinal deformity (n = 1, 11.1%), and a combination of deformity and infection (n = 1, 11.1%). Presenting symptoms were most commonly low-back pain (n = 7, 77.8%) and lower-extremity weakness (n = 5, 55.6%), followed by radicular lower-extremity pain, loss of lower-extremity sensation, or incontinence/urinary retention (n = 3 each, 33.3%). In all, 63 screws were placed (32 thoracic, 31 lumbar). The accuracy for these screws was 100% overall; all screws were Gertzbein-Robbins grade A or B (96.8% grade A, 3.2% grade B). This accuracy was achieved in the thoracic spine regardless of pedicle cancellous bone morphology. CONCLUSIONS AR-guided surgery demonstrated a 100% accuracy rate for the insertion of 63 percutaneous pedicle screws in 9 patients (100% rate of Gertzbein-Robbins grade A or B screw placement). Using an ARHMS system for the placement of percutaneous pedicle screws showed promise, but further validation using a larger cohort of patients across multiple surgeons and institutions will help to determine the true accuracy enabled by this technology.

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“…As personal computers and augmented reality (AR) equipment performance improve, it is becoming easier to handle 3D images at home. In the medical field as well, various AR devices have been used recently [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

The Utility of Augmented Reality in Spinal Decompression Surgery Using CT/MRI Fusion Image

Aoyama¹,

Anazawa²,

Hotta³

et al. 2021

Cureus

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In spine surgery, instrumentation surgery using augmented reality (AR) and navigation systems have become widespread, while decompression surgery using those applications is not so common. However, we sometimes encounter intraoperative problems such as excessive blood loss or bony resection in decompression surgery. Therefore, a practical navigation system is needed for safer spinal decompression surgery. Furthermore, the cost of AR and navigation systems has been expensive. In this study, we report the utility of applying the AR system of the head-mounted display (HMD) at a lower cost to identify the osteotomy area of laminectomy for spinal decompression surgery. 3D CT/MRI fusion images are created preoperatively to generate 3D data consisting of the nerve elements, a dural tube and nerve roots, and the bony elements of the spine. Then, we made the 3D data of the bone after decompression by 3D editing free software. Uploading the created 3D data of both 3D CT/MRI fusion and preoperative planned laminectomy images to the AR software in the HMD, we could confirm the proper decompression area with the 3D images projected through the HMD. This system was useful for cervical and lumbar decompression for confirming the proper decompression area preoperatively. We could perform decompression surgery just designed with this system. This system is a preoperative planning system that allows 3D HMD visualization to keep track of surgical orientation. It does not allow preoperative verification so far. However, this system has various possible applications and is considered a promising system for the future.

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Augmented reality navigation in spine surgery: a systematic review

Cited by 78 publications

References 47 publications

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

First in-human report of the clinical accuracy of thoracolumbar percutaneous pedicle screw placement using augmented reality guidance

The Utility of Augmented Reality in Spinal Decompression Surgery Using CT/MRI Fusion Image

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