Augmented reality navigation for spinal pedicle screw instrumentation using intraoperative 3D imaging

Abstract

BACKGROUND CONTEXT Due to recent developments in augmented reality with headmounted devices, holograms of a surgical plan can be displayed directly in the surgeon's field of view. To the best of our knowledge, three dimensional (3D) intraoperative fluoroscopy has not been explored for the use with holographic navigation by head-mounted devices in spine surgery. PURPOSE To evaluate the surgical accuracy of holographic pedicle screw navigation by head-mounted device using 3D intraoperative fluoroscopy. STUDY DESIGN In this experimental cadaver study, the accuracy of surgical navigation using a head-mounted device was compared with navigation with a state-of-the-art posetracking system. METHODS Three lumbar cadaver spines were embedded in nontransparent agar gel, leaving only commonly visible anatomy in sight. Intraoperative registration of preoperative planning was achieved by 3D fluoroscopy and fiducial markers attached to lumbar vertebrae. Trackable custom-made drill sleeve guides enabled real-time navigation. In total, 20 K-wires were navigated into lumbar pedicles using AR-navigation, 10 K-wires by the state-of-the-art pose-tracking system. 3D models obtained from postexperimental CT scans were used to measure surgical accuracy. MF is the founder and shareholder of Incremed AG, a Balgrist University Hospital start-up focusing on the development of innovative techniques for surgical executions. The other authors declare no conflict of interest concerning the contents of this study. No external funding was received for this study. RESULTS No significant difference in accuracy was measured between AR-navigated drillings and the gold standard with pose-tracking system with mean translational errors between entry points (3D vector distance; p=.85) of 3.4±1.6 mm compared with 3.2±2.0 mm, and mean angular errors between trajectories (3D angle; p=.30) of 4.3°±2.3°compared with 3.5°±1.4°. CONCLUSIONS In conclusion, holographic navigation by use of a head-mounted device achieve accuracy comparable to the gold standard of high-end pose-tracking systems. CLINICAL SIGNIFICANCE These promising results could result in a new way of surgical navigation with minimal infrastructural requirements but now have to be confirmed in clinical studies.

Optimization of virtual and real registration technology based on augmented reality in a surgical navigation system

“…Simultaneously tracking two or more markers as the HMD moves through space can sometimes cause the hologram to wobble and may even require a reboot. Compared with our study, the accuracy and stability proposed by this study are slightly lower than those of our system [40]. In response to the analysis of the future development of AR navigation systems, Urakov et al discussed the potential and limitations of AR in the current state in 2019 [41].…”

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

“…Visualization of the spine hologram through the HoloLens resulted in > 90% correct screw placement with faster insertion times [62][63][64] and no significant difference in accuracy between ARnavigated screw placement and conventional navigation. 65 Comparable outcomes were reported in a cadaveric study conducted by Urakov et al 66 comparing the accuracy of screw placement with either AR or traditional fluoroscopic guidance. While no major breaches occurred under radiological assistance, the use of HoloLens was accompanied by 3 major medial breaches and 3 major inferior breaches out of 19 screws, suggesting that the system is promising but still needs considerable improvements.…”

Research on Accuracy of Augmented Reality Surgical Navigation System Based on Multi-View Virtual and Real Registration Technology

“…Although it is more accurate than the robot-assisted navigation system proposed in our study, there is a large amount of radiation in obtaining perspective images with C-arm, which causes great harm to human. In the same year, Fabio et al used head-mounted augmented reality 3D fluoroscopy to assess the accuracy of holographic pedicle screw navigation [54]. The headmounted navigation device is compared with the most advanced position tracking system, and the final navigation accuracy is 3.4±1.6mm.…”