Pedicle screw navigation using surface digitization on the Microsoft HoloLens

Liebmann, Florentin; Roner, Simon; Atzigen, Marco von; Scaramuzza, Davide; Sutter, Reto; Snedeker, Jess G.; Farshad, Mazda; Fürnstahl, Philipp

doi:10.1007/s11548-019-01973-7

Cited by 131 publications

(127 citation statements)

References 37 publications

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“…The drill guide template using a 3D printing technique may be the best choice at present [18]. This may be the best choice because 3D printing technology and related imaging equipment can provide the spinal surgeon a three-dimensional model or imaging data of the patient's diseased spine [30,31]. There are different pedicle shapes, and 3D printing technology can produce many different drill guide templates that flexibly adjust the angle of the screw [7,20,32].…”

Section: Discussionmentioning

confidence: 99%

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

Xie

et al. 2020

J Orthop Surg Res

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Background: Many surgeons believe that the use of a 3D-printed drill guide template shortens operative time and reduces intraoperative blood loss compared with those of the free-hand technique. In this study, we investigated the effects of a drill guide template on the accuracy of pedicle screw placement (the screw placed completely in the pedicle), operative time, and intraoperative blood loss. Materials/Methods: We systematically searched the major databases, such as Medline via PubMed, EMBASE, Ovid, Cochrane Library, and Google Scholar, regarding the accuracy of pedicle screw placement, operative time, and intraoperative blood loss. The χ 2 test and I 2 statistic were used to examine heterogeneity. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the accuracy rate of pedicle screw placement, and weighted mean differences (WMDs) with 95% CIs were utilized to express operative time and intraoperative blood loss. Results: This meta-analysis included 13 studies (seven randomized controlled trials and six prospective cohort studies) involving 446 patients and 3375 screws. The risk of research bias was considered moderate. Operative time (WMD = − 20.75, 95% CI − 33.20~− 8.29, P = 0.001) and intraoperative blood loss (WMD = − 106.16, 95% CI − 185.35 − 26.97, P = 0.009) in the thoracolumbar vertebrae, evaluated by a subgroup analysis, were significantly different between groups. The 3D-printed drill guide template has advantages over the free-hand technique and improves the accuracy of pedicle screw placement (OR = 2.88; 95% CI, 2.39~3.47; P = 0.000). Conclusion: The 3D-printed drill guide template can improve the accuracy rate of pedicle screw placement, shorten operative time, and reduce intraoperative blood loss.

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Section: Discussionmentioning

confidence: 99%

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

Xie

et al. 2020

J Orthop Surg Res

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“…Advancements in information technology and hardware manufacturing transformed former bulky and cable-bound AR headsets into ergonomic devices fulfilling strict requirements of ergonomic design [16]. Recent studies demonstrated that AR may improve accuracy, safety, and efficacy of surgical procedures [17][18][19]. The aim of this study was to compare the classical free-hand technique of pedicle screw placement to a novel, ARsupported technique using a commercially available state-of-the-art AR headset (Microsoft Hololens®, Microsoft, Redmond, WA, USA) ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Augmented reality-based navigation increases precision of pedicle screw insertion

Dennler¹,

Jaberg²,

Spirig³

et al. 2020

J Orthop Surg Res

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Background: Precise insertion of pedicle screws is important to avoid injury to closely adjacent neurovascular structures. The standard method for the insertion of pedicle screws is based on anatomical landmarks (free-hand technique). Head-mounted augmented reality (AR) devices can be used to guide instrumentation and implant placement in spinal surgery. This study evaluates the feasibility and precision of AR technology to improve precision of pedicle screw insertion compared to the current standard technique. Methods: Two board-certified orthopedic surgeons specialized in spine surgery and two novice surgeons were each instructed to drill pilot holes for 40 pedicle screws in eighty lumbar vertebra sawbones models in an agarbased gel. One hundred and sixty pedicles were randomized into two groups: the standard free-hand technique (FH) and augmented reality technique (AR). A 3D model of the vertebral body was superimposed over the AR headset. Half of the pedicles were drilled using the FH method, and the other half using the AR method. Results: The average minimal distance of the drill axis to the pedicle wall (MAPW) was similar in both groups for expert surgeons (FH 4.8 ± 1.0 mm vs. AR 5.0 ± 1.4 mm, p = 0.389) but for novice surgeons (FH 3.4 mm ± 1.8 mm, AR 4.2 ± 1.8 mm, p = 0.044). Expert surgeons showed 0 primary drill pedicle perforations (PDPP) in both the FH and AR groups. Novices showed 3 (7.5%) PDPP in the FH group and one perforation (2.5%) in the AR group, respectively (p > 0.005). Experts showed no statistically significant difference in average secondary screw pedicle perforations (SSPP) between the AR and the FH set 6-, 7-, and 8-mm screws (p > 0.05). Novices showed significant differences of SSPP between most groups: 6-mm screws, 18 (45%) vs. 7 (17.5%), p = 0.006; 7-mm screws, 20 (50%) vs. 10 (25%), p = 0.013; and 8-mm screws, 22 (55%) vs. 15 (37.5%), p = 0.053, in the FH and AR group, respectively. In novices, the average optimal medio-lateral convergent angle (oMLCA) was 3.23°(STD 4.90) and 0.62°(STD 4.56) for the FH and AR set screws (p = 0.017), respectively. Novices drilled with a higher precision with respect to the cranio-caudal inclination angle (CCIA) category (p = 0.04) with AR. Conclusion: In this study, the additional anatomical information provided by the AR headset superimposed to realworld anatomy improved the precision of drilling pilot holes for pedicle screws in a laboratory setting and decreases the effect of surgeon's experience. Further technical development and validations studies are currently being performed to investigate potential clinical benefits of the herein described AR-based navigation approach.

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“…If you want to make registration more accurate, easier to operate, and more interactive, it is necessary to implement software that controls the movement and rotation of virtual models. This method is similar to the method adopted by Microsoft's HoloLens, in which the virtual model can be moved to the position of the real model in the space by means of a handheld identification, thus achieving the first registration [32,33]. The second registration is completed by voice control of the movement of front, back, left, right, up and down as well as the rotation of six degrees of freedom, so as to accurately fine-tune the position of the 3D model [34].…”

Section: Discussionmentioning

confidence: 99%

Research on Accuracy of Augmented Reality Surgical Navigation System Based on Multi-View Virtual and Real Registration Technology

et al. 2020

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The traditional navigation system used in spinal puncture is not able to monitor the surgical process in real time and the accuracy of navigation is unsatisfactory. In this study, an augmented reality surgical navigation system based on multi-view virtual and real registration is proposed to solve these problems. The theory of virtual and real registration in augmented reality technology is analyzed, and the methods of single-view and multi-view virtual and real registration are compared. The principle of coordinate transformation in the surgical navigation module is analyzed. The platform of augmented reality surgical navigation system based on multi-view virtual and real registration technology is designed. The experiments of the spinal model are used to verify the accuracy of virtual and real registration. The accuracy of the proposed navigation system is verified by the experiment of simulating puncture operation with robotic control of surgical tool. The experimental results show that the accuracy of single-view and multi-view virtual and real registration is 9.85 0.80  mm and 1.62 0.22  mm respectively. The accuracy of the augmented reality surgical navigation system added with multi-view virtual and real registration technology is 1.70 0.25  mm, which is 35% higher than that of the augmented reality surgical navigation system not previously used. The augmented reality surgical navigation system for spinal puncture based on multi-view virtual and real registration proposed in this study can meet the requirements of physician on the accuracy of surgery. It can also help physician to monitor the surgical process in real time and improve the success rate of surgery.

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Pedicle screw navigation using surface digitization on the Microsoft HoloLens

Cited by 131 publications

References 37 publications

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

Pedicle screw placement in spinal neurosurgery using a 3D-printed drill guide template: a systematic review and meta-analysis

Augmented reality-based navigation increases precision of pedicle screw insertion

Research on Accuracy of Augmented Reality Surgical Navigation System Based on Multi-View Virtual and Real Registration Technology

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