Augmented reality navigation with intraoperative 3D imaging vs fluoroscopy-assisted free-hand surgery for spine fixation surgery: a matched-control study comparing accuracy

Abstract

This study aimed to compare screw placement accuracy and clinical aspects between Augmented Reality Surgical Navigation (ARSN) and free-hand (FH) technique. Twenty patients underwent spine surgery with screw placement using ARSN and were matched retrospectively to a cohort of 20 FH technique cases for comparison. All ARSN and FH cases were performed by the same surgeon. Matching was based on clinical diagnosis and similar proportions of screws placed in the thoracic and lumbosacral vertebrae in both groups. Accuracy of screw placement was assessed on postoperative scans according to the Gertzbein scale and grades 0 and 1 were considered accurate. Procedure time, blood loss and length of hospital stay, were collected as secondary endpoints. A total of 262 and 288 screws were assessed in the ARSN and FH groups, respectively. The share of clinically accurate screws was significantly higher in the ARSN vs FH group (93.9% vs 89.6%, p < 0.05). The proportion of screws placed without a cortical breach was twice as high in the ARSN group compared to the FH group (63.4% vs 30.6%, p < 0.0001). No statistical difference was observed for the secondary endpoints between both groups. This matched-control study demonstrated that ARSN provided higher screw placement accuracy compared to free-hand.Compared to conventional free-hand (FH) surgical technique, computer-assisted navigation using intraoperative 3D imaging has been shown to improve screw placement accuracy and reduce complications due to screw misplacements 1 . Moreover, improved accuracy has also been shown in more challenging conditions, such as scoliosis surgery, where it may be of even greater importance 2 . Consequently, navigation also reduces the frequency of postoperative revision surgery compared to FH surgery 3 .Although several studies have compared intraoperative image guidance to free-hand (FH) technique, the evidence in favor of navigation is still limited. In a recent systematic review, Chan et al., found only four studies comparing computed tomography (CT) guidance with free-hand methods head-to-head, including one small (10 patients in each group, 169 screws in total) randomized study 4 . Overall, the reviewers found only moderate level evidence showing that CT guidance has lower breach rates than FH, while screw-related complication rates were conflicting at 0% in CT navigation compared with 0%-1.7% in FH groups 5 . In a more recent retrospective study comparing O-arm navigation to FH, Wang et al. demonstrated higher pedicle screw accuracy and lower total

Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

“…This in turn resulted in a favorable simulated Gertzbein grading (100% accuracy), well in line with the vast majority of recent studies that typically report 98 -100% accuracy 34,[37][38][39][40][41] . Notably, the results of this study indicate a superior clinical, as well as technical accuracy, for the ARSN system with robotic guidance compared to previous results when the same ARSN system is used without robotic assistance (Table 2) [15][16][17][18][19] .…”

“…Previous studies have reported the development of a surgical navigation system based on augmented and virtual reality navigation in a hybrid operating room (OR) setup [15][16][17][18][19] . A clinical accuracy of 89% without, and 100% with instrument tracking, in MIS surgery has previously been demonstrated with the augmented reality surgical navigation system (ARSN) 17,18 .…”

Virtual Dissection: Emerging as the Gold Standard of Analyzing Living Heart Anatomy

“…For this purpose, both endocast and virtual dissection images are used. Virtual reality supports the interactive sharing of the three-dimensional images during the simulated operation and also can guide the invasive procedures and operations, especially in such fields of orthopedics and neurosurgery [ 47 , 48 ]. As the heart is a highly moving structure, the application of virtual reality into the clinical cardiovascular fields can be challenging.…”

Superimposed anatomical structures in Augmented Reality

“…Currently, many scientific papers on the use of augmented reality in various fields of medicine have been published: neurosurgery, cardiology, urology, plastic surgery, including dentistry and maxillofacial surgery (Ayoub & Pulijala, 2019;Elmi-Terander et al, 2020;Kim, Kim, & Kim, 2017;Kwon, Park, & Han, 2018). However, most of them are descriptions https://doi.org/10.17993/3ctecno.2020.specialissue6.21-31 of individual clinical cases or their series, which certainly does not have a very high class of evidence (Bosc et al, 2019).…”