Percutaneous kyphoplasty assisted with/without mixed reality technology in treatment of OVCF with IVC: a prospective study

Abstract

Background The purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). Method Forty cases of OVCF with IVC undergoing PKP were randomized into a MR technology-assisted group (group A) and a traditional C-arm fluoroscopy group (group B). Both groups were performed PKP and evaluated by VAS scores, ODI scores, radiological evidence of vertebral body height, and kyphotic angle (KA) at pre-operation and post-operation. The volume of injected cement, fluoroscopy times, and operation time were recorded. And cases of non-PMMA-endplates-contact(NPEC) in radiological evidence was also recorded postoperatively. The clinical outcomes and complications were evaluated afterwards. All patients received 10 to 14 months follow-up, with an average of 12 months. Result This MR-assisted group (group A) acquired more about the amount of the polymethyl methacrylate (PMMA) injection and postoperative vertebral height and less about postoperative KA, fluoroscopy times, and operation time compared with the control group (group B) ( P < 0.05). The VAS scores and ODI scores in both groups have improved, but more significantly in group A ( P < 0.05). Also, more cases achieve both-endplates-touching of cement in group A ( P < 0.05). And there are less of the loss of vertebral height, KA, and occurrence of re-collapse of the vertebra in group A during the follow-up ( P < 0.05). Conclusion PKP assisted with MR technology can accurately orientate the position of IVC area, which can be augmented by the balloon leading to more satisfied vertebral height improvement, cement diffusion, and pain relief. Trial registration ClinicalTrials.gov Identifier: NCT03959059 . Registered 25 September 2016.

Augmented reality navigation in spine surgery: a systematic review

“…Multiple intraoperative views are depicted, with the AR overlay superimposed as viewed by the surgeon. The figure is an unmodified reproduction of the work of Wei et al, published in the Journal of Orthopaedic Surgery and Research [ 46 ]. It is reproduced under the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/ )

Fig.

…”

“…Eight studies used intraoperative computed tomography (CT) with simultaneous patient position registration [ 10 – 13 , 32 , 35 , 36 , 40 ]. The remaining studies used preoperative CT in some fashion, either coupled to manual alignment with hand gestures, fluoroscopy, or custom-made pointers to register bone surfaces in the OR [ 1 , 23 , 30 , 33 , 37 , 42 , 45 , 46 ].…”

“…Nine studies used a dynamic reference frame usually attached to a spinous process or firmly attached to the patients’ skin [ 1 , 10 – 13 , 35 – 37 , 40 ]. Seven studies relied on surface tracking combined with manual adjustments, where the camera system identified patients’ surface anatomy or exposed spinal anatomy [ 14 , 23 , 30 , 31 , 42 , 45 , 46 ]. One study relied on direct surface matching and tracking without the need for manual adjustments [ 44 ].…”

“…They found no significant difference between the groups. In a similar setup, Wei et al performed a randomized controlled trial on percutaneous kyphoplasty comparing HMD-AR to FH with fluoroscopy [ 46 ]. No accuracies were reported, but clinical outcomes differed significantly.…”

The Use of Augmented and Mixed Reality Technology to Improve Surgical Outcomes: a Systematic Review Protocol

“…AR has been shown to help signi cantly reduce the radiation dosage to patients during percutaneous vertebroplasty(5). A reduction in operating time, as well as reduced pain at one-year follow-up, was seen with the use of MR in percutaneous kyphoplasty(6). Very recently, the use of MR during cardiac ablation procedures signi cantly improved the accuracy of intraprocedural navigation (7).It is hoped that some surgeons will see their work transformed by AR and MR; this will require the continuing development of a strong evidence base.…”