Augmented Reality-Assisted Navigation System for Transforaminal Epidural Injection

Abstract

Purpose Multiple studies have attempted to demonstrate the benefits of augmented reality (AR)-assisted navigation systems in surgery. Lumbosacral transforaminal epidural injection is an effective treatment commonly used in patients with radiculopathy due to spinal degenerative pathologies. However, few studies have applied AR-assisted navigation systems to this procedure. The study aimed to investigate the safety and effectiveness of an AR-assisted navigation system for transforaminal epidural injection. Patients and Methods Through a real-time tracking system and a wireless network to the head-mounted display, computed tomography images of the spine and the path of a spinal needle to the target were visualized on a torso phantom with respiration movements installed. From L1/L2 to L5/S1, needle insertions were performed using an AR-assisted system on the left side of the phantom, and the conventional method was performed on the right side. Results The procedure duration was approximately three times shorter, and the number of radiographs required was reduced in the experimental group compared to the control group. The distance from the needle tips to the target areas in the plan showed no significant difference between the two groups. (AR group 1.7 ± 2.3mm, control group 3.2 ± 2.8mm, P value 0.067). Conclusion An AR-assisted navigation system may be used to reduce the time required for spinal interventions and ensure the safety of patients and physicians in view of radiation exposure. Further studies are essential to apply AR-assisted navigation systems to spine interventions.

Clinical Application of an Augmented Reality Navigation System for Transforaminal Epidural Injection: A Randomized Controlled Trial

“…In response, we developed an augmented reality navigation system that can be easily applied in the outpatient setting. The feasibility of this system was successfully verified in our previous studies using simulation phantoms [18,19]. However, to the best of our knowledge, no reports have been published on the clinical application of such an augmented-reality-guided system in an outpatient setting.…”

“…We used an AR-assisted navigation system developed by our team. The feasibility of this system was ascertained through the utilization of simulation phantoms in our previous studies [18,19]. This system comprises several key components: planning and navigation software based on virtual reality, an advanced system for tracking both the patient and surgical tools [20], and an AR-assisted navigation module that seamlessly integrates with a head-mounted display (HMD, HoloLens 2, Microsoft, Redmond, WA, USA).…”

Mobile Devices or Head-Mounted Displays: A Comparative Review and Analysis of Augmented Reality in Healthcare

“…To create a multimodal interaction system that allows users to control service robots and devices via touch, eye movements, gestures, voice commands, and AR controls, using a robotic arm equipped with a tablet PC 3D reconstruction role in surgical assistance, such as navigation and guidance during surgeries, as well as in intraoperative planning [4], [40], [42], [44], [46], [48]- [60]. A common thread throughout the studies was the superposition of patient data into the surgeon's view to eliminate the need for the surgeon to look up from the patient during the operation to view the data on a traditional screen.…”

“…There are also numerous benefits to adopting either mobile-or HMD-based AR in healthcare. One of the benefits is its capability to offer 3D visualization [4], [35]- [37], [39], [44]- [46], [49], [51]- [53], [55]- [57], [59], [61]- [63], [67], [68], [70]. The ability to visualize an organ or tissue in 3D provides intuitive information to surgeons.…”

“…The ability to visualize an organ or tissue in 3D provides intuitive information to surgeons. This, in turn, facilitates the rapid location of the target [39], enhances a surgeon's confidence in decision-making [52], [57], reduces procedure time [53], [54], and improves surgery efficiency, precision, and quality [39], [46], [48], [49], [51]. In a study that compared using AR and standard liquid crystal display in diagnostic right heart catheterizations and coronary angiography, researchers observed that the use of AR's 3D visualization capability decreased fluoroscopy time and radiation exposure [50].…”