Augmented Reality Visualization–guided Microscopic Spine Surgery: Transvertebral Anterior Cervical Foraminotomy and Posterior Foraminotomy

Abstract

Objective:We describe intraoperative augmented reality (AR) imaging to obtain a microscopic view in spine keyhole surgery.Background:Minimally invasive keyhole surgery has been developed even for spine surgery, including transvertebral anterior cervical foraminotomy and posterior cervical laminoforaminotomy. These methods are complex and require a skillful technique. Therefore, inexperienced surgeons hesitate to perform keyhole surgeries. The technology used in surgery is rapidly advancing, including intraoperative imaging devices that have enabled AR imaging and facilitated complicated surgeries in many fields. However, data are not currently available on the use of AR imaging in spine surgery. The purpose of this article was to introduce the utility of AR for spine surgery.Methods:We performed O-arm intraoperative imaging to create an augmented imaging model in navigation systems. Navigation data were linked to a microscope to merge the live view and AR. Augmented reality imaging shows the model plan in the real-world surgical field. We used this novel method in patients who underwent both keyhole surgeries.Results:We successfully performed both surgeries using the AR visualization guide.Conclusions:The AR navigation system facilitates complicated keyhole surgeries in patients who undergo spine surgery.Study Design:Technical report

Comprehensive review of surgical microscopes: technology development and medical applications

“…Moreover, contemporary surgical microscopes are enriched with various intraoperative imaging modules such as fluorescence imaging 27 – 35 and optical coherence tomography (OCT), 36 – 42 and they are open for adaptation of other imaging modalities including hyperspectral imaging (HSI), photoacoustic microscopy (PAM), 43 – 48 and laser speckle contrast imaging (LSCI). Augmented reality (AR) 49 – 54 has been actively evaluated on the surgical microscope and has offered huge convenience for surgery as an intraoperative diagnostic tool. Furthermore, high-definition (HD) display, 22 , 55 , 56 image injection techniques, 50 , 57 , 58 and three-dimensional (3D) display facilitate better visualization of both the surgical field and the multimodality images.…”

“…Augmented reality (AR) 49 – 54 has been actively evaluated on the surgical microscope and has offered huge convenience for surgery as an intraoperative diagnostic tool. Furthermore, high-definition (HD) display, 22 , 55 , 56 image injection techniques, 50 , 57 , 58 and three-dimensional (3D) display facilitate better visualization of both the surgical field and the multimodality images.…”

“…With numerous advantages such as clear and bright visualization, easy documentation and adaptation, stability, maneuverability, and improved ergonomics, surgical microscopes have been applied in various types of surgeries, including neuro and spine surgery, 8 , 10 , 50 , 59 – 61 ENT surgery, 5 , 20 , 51 , 62 – 64 dentistry, 11 , 13 , 65 – 77 ophthalmology, 15 , 36 – 38 , 40 – 42 , 78 – 80 and plastic and reconstructive surgery. 14 , 81 – 86 For example, they have been used for brain tumor resection, 27 aneurysm surgery, 87 nasal surgery, 88 head and neck cancer resection, 89 corneal keratoplasty, 37 vitreoretinal macular hole repair, 90 root therapy, 91 root coverage procedure, 92 craniosynostosis surgery, 93 and hepatic artery reconstruction.…”

Spine Surgery Supported by Augmented Reality

“…We had implemented microscope-based AR using commercially available system components 17,18 after the feasibility of microscope-based AR had been shown in a visualization of osteotomy planes 19 and in cervical foraminotomy. 20 In our observational study on 42 patients, AR supported various kinds of spine procedures and facilitated anatomical orientation in the surgical field in all cases. Target and risk structures could be reliably visualized.…”

Augmented reality in neurosurgical navigation: A survey

“…Umebayashi et al 59 AR CT P/I Described intraoperative AR imaging to obtain a microscopic view in spine keyhole surgery.…”