Accuracy of augmented reality surgical navigation for minimally invasive pedicle screw insertion in the thoracic and lumbar spine with a new tracking device

Peh, Simon; Chatterjea, Anindita; Pfarr, Julian; Schäfer, Jost Philipp; Weuster, Matthias; Klüter, Tim; Seekamp, Andreas; Lippross, Sebastian

doi:10.1016/j.spinee.2019.12.009

“…Although there is a low morbidity of complications, a misplaced screw can result in neurovascular damage, dural tearing, or visceral involvement. Therefore, robot-assisted techniques are designed to help spinal surgeons with more precision and convenience of pedicle screw placement [14][15][16]. Gao et al performed a metaanalysis including six studies involving 158 patients (688 pedicle screws) in a robot-assisted group and 148 patients (672 pedicle screws) in a freehand group, and showed that the robot-assisted technique was associated with equivalent accuracy rate of pedicle screw implantation, fewer proximal facet joint violations, and less intraoperative radiation exposure, but longer surgical duration than that with the freehand technique [12].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have reported early experiences with robot-assisted pedicle screw placement and the outcomes are promising [12][13][14]. Increasingly, researchers have already focused on the combination of MIS and robotic navigation to improve the e ciency and accuracy of spinal surgeries [15,16]. However, application of robotic technology in percutaneous endoscopic spinal surgery has not been reported up to now.…”

Section: Introductionmentioning

confidence: 99%

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Fan

¹

,

Yuan

²

,

Du

³

et al. 2020

Preprint

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Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of Computed tomography and Magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical target through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

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“…Although there is a low morbidity of complications, a misplaced screw can result in neurovascular damage, dural tearing, or visceral involvement [18]. Therefore, robot-assisted techniques are designed to help spinal surgeons with more precision and convenience of pedicle screw placement [14][15][16]. Gao et al performed a metaanalysis including six studies involving 158 patients (688 pedicle screws) in a robot-assisted group and 148 patients (672 pedicle screws) in a freehand group, and showed that the robot-assisted technique was associated with equivalent accuracy rate of pedicle screw implantation, fewer proximal facet joint violations, and less intraoperative radiation exposure, but longer surgical duration than that with the freehand technique [12].…”

Section: Discussionmentioning

confidence: 99%

“…In the past decades, the use of robotics in surgeries has been successfully employed across many surgical subspecialties, and is considered to set the trend for future surgical development. [15,16]. However, application of robotic technology in percutaneous endoscopic spinal surgery has not been reported up to now.…”

Section: Introductionmentioning

confidence: 99%

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Fan

¹

,

Yuan

²

,

Du

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of Computed tomography and Magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical target through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

show abstract

“…Multiple studies have reported early experiences with robot-assisted pedicle screw placement and the outcomes are promising [ 12 – 14 ]. Increasingly, researchers have already focused on the combination of MIS and robotic navigation to improve the efficiency and accuracy of spinal surgeries [ 15 , 16 ]. However, application of robotic technology in percutaneous endoscopic spinal surgery has not been reported up to now.…”

Section: Introductionmentioning

confidence: 99%

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Fan

¹

,

Yuan

²

,

Du

³

et al. 2020

View full text Add to dashboard Cite

Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of computed tomography and magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical levels through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

show abstract

Accuracy of augmented reality surgical navigation for minimally invasive pedicle screw insertion in the thoracic and lumbar spine with a new tracking device

Cited by 57 publications

References 27 publications

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

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