Feasibility and Accuracy of Thoracolumbar Minimally Invasive Pedicle Screw Placement With Augmented Reality Navigation Technology

Abstract

Study Design.Cadaveric laboratory study.Objective.To assess the feasibility and accuracy of minimally invasive thoracolumbar pedicle screw placement using augmented reality (AR) surgical navigation.Summary of Background Data.Minimally invasive spine (MIS) surgery has increasingly become the method of choice for a wide variety of spine pathologies. Navigation technology based on AR has been shown to be feasible, accurate, and safe in open procedures. AR technology may also be used for MIS surgery.Methods.The AR surgical navigation was installed in a hybrid operating room (OR). The hybrid OR includes a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D imaging capabilities, integrated optical cameras for AR navigation, and patient motion tracking using optical markers on the skin. Navigation and screw placement was without any x-ray guidance. Two neurosurgeons placed 66 Jamshidi needles (two cadavers) and 18 cannulated pedicle screws (one cadaver) in the thoracolumbar spine. Technical accuracy was evaluated by measuring the distance between the tip of the actual needle position and the corresponding planned path as well as the angles between the needle and the desired path. Time needed for navigation along the virtual planned path was measured. An independent reviewer assessed the postoperative scans for the pedicle screws’ clinical accuracy.Results.Navigation time per insertion was 90 ± 53 seconds with an accuracy of 2.2 ± 1.3 mm. Accuracy was not dependent on operator. There was no correlation between navigation time and accuracy. The mean error angle between the Jamshidi needles and planned paths was 0.9° ± 0.8°. No screw was misplaced outside the pedicle. Two screws breached 2 to 4 mm yielding an overall accuracy of 89% (16/18).Conclusion.MIS screw placement directed by AR with intraoperative 3D imaging in a hybrid OR is accurate and efficient, without any fluoroscopy or x-ray imaging during the procedure.Level of Evidence: N/A

Percutaneous kyphoplasty assisted with/without mixed reality technology in treatment of OVCF with IVC: a prospective study

“…Combined with MR, it can assist virtual positioning, give doctors the correct positioning point and direction when punctured, make the procedure more accurate and safer, is easy to operate, and obviously reduce the number of fluoroscopy and operation time. Elmi-terander et al [46] confirmed that combined with intraoperative 3D image, navigation technology is expected to replace intraoperative X-ray or fluoroscopy in the process of thoracolumbar pedicle puncture and has high accuracy and safety.…”

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

“…Subsequently, the surgical field recorded by 4 cameras with different angulations was shown on a high-definition monitor with the superimposition of 2D and 3D images of the vertebral segments together with the drilling trajectory. 52 The studies showed that ARSN resulted in a higher accuracy of thoracic pedicle screw placement compared to the FH technique without the need for intraoperative fluoroscopy or prior surgeon training. 51 Moreover, the system proved to be efficacious even when adopting a minimally invasive approach with the percutaneous placement of Jamshidi needles to determine screw entry point and orientation.…”

Virtual, augmented, and mixed reality applications in orthopedic surgery

“…Recent improvements in hardware that can function within traditional operative workflow and fit into the sterile environment, AR can also support intraoperative navigation for a wide set of orthopedic procedures, including fracture fixation and bone tumor resection . In a study by Wang et al, the investigators utilized a three‐dimensional reconstruction of patient CT data displayed on the HoloLens head‐mounted device for placement of a sacroiliac screw.…”

“…Left: Video see-through displays provide the user with a video feed of the surrounding real world combined with computer-generated graphics. Right: Augmented reality optical see-through devices project computer-generated graphics on a transparent lens, allowing the user to directly visualize the surrounding real-world surfaces with augmented overlayRecent improvements in hardware that can function within traditional operative workflow and fit into the sterile environment, AR can also support intraoperative navigation for a wide set of orthopedic procedures, including fracture fixation and bone tumor resection [46][47][48]. In a study by Wang et al, the investigators utilized a three-dimensional reconstruction of patient CT data displayed on the HoloLens headmounted device for placement of a sacroiliac screw.…”