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

Abstract

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.

Navigation Techniques in Endoscopic Spine Surgery

“…In a subsequent human trial performed by the same authors with the placement of 253 pedicle screws, a 94.1% accuracy rate was achieved using AR for screw placement, comparable to accuracy rates reported when using other navigation systems in the literature [ 60 ]. One group has reported using AR-based techniques combined with ICT-Nav-guided lateral MIS approaches to the lumbar spine for cases with mixed indications, including disc herniations and spinal column tumors [ 64 ].…”

CORR Insights®: Reoperation Rates of Microendoscopic Discectomy Compared With Conventional Open Lumbar Discectomy: A Large-database Study

“…However, fluoroscopy delivers a two-dimensional image in one plane of orientation, and placement of guidewires during microendoscopic discectomy can be challenging because several punctures might be needed to position the guidewires adequately [1]. Three-dimensional navigation and robotic assistance can considerably improve accuracy during positioning [5, 9]. Additional benefits include less surgical time, decreased radiation exposure, less soft tissue damage, and fewer complications [9-11].…”

“…theyse@kleintierklinik.uni-leipzig.de guidewires adequately [1]. Threedimensional navigation and robotic assistance can considerably improve accuracy during positioning [5,9]. Additional benefits include less surgical time, decreased radiation exposure, less soft tissue damage, and fewer complications [9][10][11].…”

“…These systems also allow us to check the result of decompression intraoperatively, beyond the direct field of view in an endoscope or microscope. Retrospective studies have suggested that navigation-assisted spinal surgery can improve a patient's treatment and outcome [6,9]. However, the main disadvantages of using imaging navigation and robot assistance are the additional costs, training, and learning curve.…”

Editorial: Neurosurgery and Neuroanatomy

“…The article published by Pojskić et al [10] is a prospective study focusing on the use of intraoperative computer tomography-guided augmented reality, which provides a better understanding of 3D anatomy to avoid severe complications, for lateral interbody fusion cases with various indications, including oncological and infectious spinal diseases.…”