Current innovation in virtual and augmented reality in spine surgery

Abstract

In spinal surgery, outcomes are directly related both to patient and procedure selection, as well as the accuracy and precision of instrumentation placed. Poorly placed instrumentation can lead to spinal cord, nerve root or vascular injury. Traditionally, spine surgery was performed by open methods and placement of instrumentation under direct visualization. However, minimally invasive surgery (MIS) has seen substantial advances in spine, with an ever-increasing range of indications and procedures. For these reasons, novel methods to visualize anatomy and precisely guide surgery, such as intraoperative navigation, are extremely useful in this field. In this review, we present the recent advances and innovations utilizing simulation methods in spine surgery. The application of these techniques is still relatively new, however quickly being integrated in and outside the operating room. These include virtual reality (VR) (where the entire simulation is virtual), mixed reality (MR) (a combination of virtual and physical components), and augmented reality (AR) (the superimposition of a virtual component onto physical reality). VR and MR have primarily found applications in a teaching and preparatory role, while AR is mainly applied in hands-on surgical settings. The present review attempts to provide an overview of the latest advances and applications of these methods in the neurosurgical spine setting.

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

“…21 Other studies have suggested that AR may provide favorable accuracy compared with fluoroscopy-guided screw placement. [22][23][24][25] Many of these studies utilized the Gertzbein-Robbins scale to assess accuracy of pedicle screws, which allows for direct comparison between our results and this literature. However, using the classification system created by Watanabe et al 13 is less common.…”

Evaluation of the effect of standard neuronavigation and augmented reality on the integrity of the perifocal structures during a neurosurgical approach

“…The novel development of mixed reality, or the combination of virtual and physical components, opens new perspectives in surgical planning for cranial and spine surgery. 23,24…”

Augmented Reality, Virtual Reality and Artificial Intelligence in Orthopedic Surgery: A Systematic Review

“…Studies were published between 2013 [21] and 2021 [28]. VR was used for training procedures and preoperative planning [2,3,5,21,22,27,32,33,36]. AR was utilized for preoperative planning and intraoperative purposes [2,3,11,[23][24][25][26][28][29][30][31]34,35,[37][38][39].…”

“…VR was used for training procedures and preoperative planning [2,3,5,21,22,27,32,33,36]. AR was utilized for preoperative planning and intraoperative purposes [2,3,11,[23][24][25][26][28][29][30][31]34,35,[37][38][39]. AI was found reported only in two studies and was adopted to improve the preoperative diagnosis accuracy [27,33].…”

“…With VR, the surgeon can interact with a virtual environment that is completely generated by a computer. In this setting, the surgeon can prepare preoperative planning or perform a surgical simulation [2][3][4]. However, the entire simulation is virtual and does not allow the surgeon to interact with the patient.…”