Augmented Reality Device for Preoperative Marking of Spine Surgery Can Improve the Accuracy of Level Identification

Abstract

Introduction Wrong-site spine surgery is an incident that could result in possible severe complications. In this present spinal surgery, the accurate spinal level is confirmed via preoperative or intraoperative radiographic marking. However, the location of radiographic marking has been determined from the manual palpation on the landmarks of the body surface. As a result, severe spine deformity can make it hard to identify the spinal level by manual palpation, thus leading to misidentification of the spinal level. Recently, the use of mixed reality in spine surgery is gradually increasing. In this study, we will demonstrate a head-mounted display (HMD) device that can project a hologram (3D image) of the patient's bone onto the actual patient's body to improve the accuracy of level identification for spine surgery. Technical Note 3D CT images are created preoperatively, and the bone's STL data (3D data) are generated with the workstation. The created STL data are downloaded to the augmented reality software Holoeyes, installed on the HMD. Through this device, surgeons can view the hologram (3D image) of a patient's bone overlaying on an actual patient's body. We temporally estimated the spinous process level only by manual palpation without an HMD. Then, we estimated the spinous process level again after matching this hologram to a real bone with an HMD. The accuracy of the level identification with an HMD and without an HMD was examined by radiographic marking in order to evaluate the misidentification rate of the level. Without an HMD, the misidentification rate of the level was at 26.5%, while with it, the rate was reduced to 14.3%. Conclusions On preoperative marking, an HMD-projecting bone image onto a patient's body could allow us to estimate the spinal level more accurately. Identification of the spinal level using mixed reality is effective in preventing wrong-site spine surgery.

Mixed reality for spine surgery: a step into the future with a human cadaveric accuracy study

“…For example, Aoyama et al reported that misidentification when overlaying datasets with anatomical markers was reduced by their use of the HoloLens (from 26.5% to 14.3%). 35 Gibby et al 36 showed that 97% of the screws placed with the aid of the HoloLens had good to perfect placement in the phantom. In addition, the registration showed an approximately circular deviation with a maximum radius of 2.5 mm.…”

Successful laparoscopic retroperitoneal tumor resection using mixed reality and guiding marker techniques

“…1b–d). The generated STL data were then imported into the augmented reality software “Holoeyes” (Holoeyes Inc., Tokyo, Japan) and deployed on a HMD called HoloLens2 (Microsoft Corporation, Redmond, WA, USA) 7,8 . Preoperatively, the surgical team used HoloLens2 to identify the retroperitoneal tumor.…”

“…The generated STL data were then imported into the augmented reality software “Holoeyes” (Holoeyes Inc., Tokyo, Japan) and deployed on a HMD called HoloLens2 (Microsoft Corporation, Redmond, WA, USA). 7 , 8 Preoperatively, the surgical team used HoloLens2 to identify the retroperitoneal tumor. Following anesthesia induction, a guiding marker (Guiding‐Marker SYSTEM, Hakko Co. Ltd., Nagano, Japan) (21G × 150 mm) was precisely placed 1 cm caudal to the tumor within the adipose tissue (flank pad) under ultrasonographic guidance (Fig.…”

Letter to the Editor Concerning "Augmented Reality Device for Preoperative Marking of Spine Surgery Can Improve the Accuracy of Level Identification," by Aoyama et al.

“…We were interested in the article of Aoyama et al 1 , who concluded that identification of the spinal level using augmented reality (AR) is effective in preventing wrong-site spine surgery. Although we entirely support the use of this novel technology for level confirmation, we have some concerns regarding the outcomes of AR-assisted marking and the validation of its usefulness.…”