Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging

Elmi-Terander, Adrian; Burström, Gustav; Nachabé, Rami; Skúlason, Halldór; Pedersen, Kyrre; Fagerlund, Michael; Ståhl, Fredrik; Charalampidis, Anastasios; Söderman, Michael; Holmin, Staffan; Babić, Draženko; Jenniskens, Inge; Edström, Erik; Gerdhem, Paul

doi:10.1097/brs.0000000000002876

Cited by 162 publications

(142 citation statements)

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“…In this way, sub-surface structures can be visualized and a pointer tool is not needed [20][21][22]. AR navigation systems have been successfully applied in several surgical fields, including microsurgery and spine surgery [23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking

et al. 2020

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ObjectiveSurgical navigation is a well-established tool in endoscopic skull base surgery. However, navigational and endoscopic views are usually displayed on separate monitors, forcing the surgeon to focus on one or the other. Aiming to provide real-time integration of endoscopic and diagnostic imaging information, we present a new navigation technique based on augmented reality with fusion of intraoperative cone beam computed tomography (CBCT) on the endoscopic view. The aim of this study was to evaluate the accuracy of the method. Material and methodsAn augmented reality surgical navigation system (ARSN) with 3D CBCT capability was used. The navigation system incorporates an optical tracking system (OTS) with four video cameras embedded in the flat detector of the motorized C-arm. Intra-operative CBCT images were fused with the view of the surgical field obtained by the endoscope's camera. Accuracy of CBCT image co-registration was tested using a custom-made grid with incorporated 3D spheres.

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Section: Introductionmentioning

confidence: 99%

“…Alternatively, navigation systems based on intraoperative cone beam computed tomography (CBCT) have proved to reach sub-millimeter accuracy in skull-base surgery [29]. In addition, intraoperative CBCT allows for acquisition of updated images during surgery [26,[30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking

et al. 2020

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“…Navigation has been demonstrated to have the largest impact on accuracy in complex deformity surgeries, especially in the neuromuscular type of scoliosis 14 , and in the thoracic spine where the pedicles can be very small 15 . Narrow thoracic pedicles, altered by scoliosis, can provide a formidable challenge in spinal instrumentation 8,9,16 . Studies showing smaller differences in accuracy are mainly studies without matching per diagnosis, or proportion of screws placed in the thoracic and lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

“…The ARSN system described in this article is currently a research prototype not available for commercial use. The surgeries in the ARSN group, were performed in a hybrid operating room (Allura Flexmove, Philips, Best, The Netherlands) with a ceiling-mounted robotic C-arm with integrated video cameras within the x-ray detector frame for AR navigation 8 . After exposure of the spine, adhesive skin markers were placed for patient tracking and a 3D cone beam CT (CBCT) was performed to image the region that required spinal instrumentation.…”

Section: Methodsmentioning

confidence: 99%

“…A video-based system, providing augmented reality surgical navigation (ARSN) with intraoperative 3-dimensional (3D) imaging is a novel form of computer-assisted navigation 7 . It has been shown to be accurate, safe and effective for pedicle screw placement 8 . However, ARSN has not yet been directly compared to the conventional FH technique in a clinical setting.…”

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confidence: 99%

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

Elmi-Terander

Burström

Nachabé

et al. 2020

Sci Rep

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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

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Design and control of an image‐guided robot for spine surgery in a hybrid OR

Balicki

Kyne

Toporek

et al. 2020

Robotics Computer Surgery

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BackgroundMinimally invasive spine (MIS) fusion surgery requires image guidance and expert manual dexterity for a successful, efficient, and accurate pedicle screw placement. Operating room (OR)‐integrated robotic solution can provide precise assistance to potentially minimize complication rates and facilitate difficult MIS procedures.MethodsA 5‐degrees of freedom robot was designed specifically for a hybrid OR with integrated surgical navigation for guiding pedicle screw pilot holes. The system automatically aligns an instrument following the surgical plan using only instrument tracking feedback. Contrary to commercially available robotic systems, no tracking markers on the robotic arm are required. The system was evaluated in a cadaver study.ResultsThe mean targeting error (N = 34) was 1.27±0.57 mm and 1.62±0.85°, with 100% of insertions graded as clinically acceptable.ConclusionsA fully integrated robotic guidance system, including intra‐op imaging, planning, and physical guidance with optimized robot design and control, can improve workflow and provide pedicle screw guidance with less than 2 mm targeting error.

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Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging

Cited by 162 publications

References 40 publications

Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking

Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking

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

Design and control of an image‐guided robot for spine surgery in a hybrid OR

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