Perspective review on applications of optics in spinal surgery

Abstract

Optical technologies may be applied to multiple facets of spinal surgery from diagnostics to intraoperative image guidance to therapeutics. In diagnostics, the current standard remains cross-sectional static imaging. Optical surface scanning tools may have an important role; however, significant work is required to clearly correlate surface metrics to radiographic and clinically relevant spinal anatomy and alignment. In the realm of intraoperative image guidance, optical tracking is widely developed as the current standard of instrument tracking, however remains compromised by line-of-sight issues and more globally cumbersome registration workflows. Surface scanning registration tools are being refined to address concerns over workflow and learning curves, and allow real-time update of tissue deformation; however, the line-of-sight issues plaguing instrument tracking remain to be addressed. In therapeutics, optical applications exist in both visualization, in the form of endoscopes, and ablation, in the form of lasers. Further work is required to extend the feasibility of laser ablation to multiple tissues, including disc, bone, and tumor, in a safe and time-efficient manner. Finally, we postulate some of the short- and long-term opportunities for future growth of optical techniques in the context of spinal surgery. Particular emphasis is placed on intraoperative image guidance, the area of the authors' primary expertise.

Comparing the Efficacy of Radiation Free Machine-Vision Image-Guided Surgery With Traditional 2-Dimensional Fluoroscopy: A Randomized, Single-Center Study

“…In traditional fluoroscopy, radiographic imaging is required to account for changes in screw placement per level. Optical topographic imaging allows for the tracking of vertebral levels in real time by repeated registration, computing global placement changes without continuous fluoroscopic imaging [5]. The experimental device can quickly re-register through active calibration [6].…”

“…Studies have shown a reduction in breach rates from 12% to 40% to under 10% with 3D-CAN. Specifically, 3D-CAN has demonstrated screw placement accuracy of 96.7% in the lumbosacral spine, 93.2% in the thoracic, and 90.3% in the cervical [5,10,13].…”

Grant Funding Needs Parallel the Start-Up Venture: An Analogy for Translational Research Success

“…This journal recently initiated a needs-based series of articles, called perspective reviews, 6 which should be one useful guidepost for the community of biomedical optics. 7 Translational research in biomedical optics, the largest fraction of technology in medicine, has driven the majority of innovations in biomedical technology research and industry R&D. 8 The community needs to ensure that active motivated researchers are well positioned to advance their work in the coming years, keeping plans for grants focused around innovative technologies and applications, having an eye towards making the best team that they can create, talking to their potential customer(s), creating a culture of innovation throughout their network, targeting the right funding opportunities, and ensuring that they balance needs with solutions. Biomedical optics has so many successful innovative technologies, and it is critical that translational research groups get the financial backing needed to move through to entrepreneurship and development.…”