Spine Surgery Assisted by Augmented Reality: Where Have We Been?

Abstract

This present systematic review examines spine surgery literature supporting augmented reality (AR) technology and summarizes its current status in spinal surgery technology. Database search strategies were retrieved from PubMed, Web of Science, Cochrane Library, Embase, from the earliest records to April 1, 2021. Our review briefly examines the history of AR, and enumerates different device application workflows in a variety of spinal surgeries. We also sort out the pros and cons of current mainstream AR devices and the latest updates. A total of 45 articles are included in our review. The most prevalent surgical applications included are the augmented reality surgical navigation system and head-mounted display. The most popular application of AR is pedicle screw instrumentation in spine surgery, and the primary responsible surgical levels are thoracic and lumbar. AR guidance systems show high potential value in practical clinical applications for the spine. The overall number of cases in AR-related studies is still rare compared to traditional surgical-assisted techniques. These lack long-term clinical efficacy and robust surgical-related statistical data. Changing healthcare laws as well as the increasing prevalence of spinal surgery are generating critical data that determines the value of AR technology.

Augmented Reality-Assisted Navigation System for Transforaminal Epidural Injection

“…Therefore, it may be possible to reduce radiation exposure to both patients and physicians. However, although studies have reported on AR-assisted navigation systems in spine surgery, 1,[3][4][5] we could not find previous research on its application in procedures using small-diameter needles such as transforaminal epidural injection.…”

Advances in surgical treatment for atlantoaxial instability focusing on rheumatoid arthritis: Analysis of a series of 67 patients

“…Most recently, microscope-based AR navigation became feasible in spinal surgery. [34][35][36] AR navigation uses computer software to render virtual objects in the real-world environment, using the Kinevo 900 microscope (Carl Zeiss Meditec AG) HUD to assist with the instrumentation of C1-C2 surgery. This microscope-based AR system is an optical see-through AR, in which the overlaid information is projected into the optical view by a half-silvered mirror of the microscope lens.…”

“…Most recently, microscope‐based AR navigation became feasible in spinal surgery 34–36 . AR navigation uses computer software to render virtual objects in the real‐world environment, using the Kinevo 900 microscope (Carl Zeiss Meditec AG) HUD to assist with the instrumentation of C1–C2 surgery.…”

Innovation in Neurosurgery: Lessons Learned, Obstacles, and Potential Funding Sources

“…Over the last decade, pedicle screw insertion in spine surgery has seen a great deal of advancement; beginning with manual-visual insertion (i.e., relying on preoperative radiographic imaging) to intra-operative computer-assisted navigation models, to more recent intraoperative roboticassisted surgical applications [3][4][5][6]. Even more recent is the advent of augmented reality and machine learning applications for the use of pedicle screw insertion, including the use of 3D printed technologies [6][7][8]. Since their inception, these technology-driven advanced approaches have been increasingly adopted amongst neurosurgical and orthopedic fields [9].…”