Implementation of augmented reality support in spine surgery

Carl, Barbara; Bopp, Miriam; Saß, Benjamin; Voellger, Benjamin; Nimsky, Christopher

doi:10.1007/s00586-019-05969-4

Cited by 90 publications

(83 citation statements)

References 26 publications

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“…68 The employment of AR has also found a possible application in microscope-based MISS. In fact, by using the heads-up displays of the operating microscope, a 3D representation of vertebrae and implants from preoperative imaging was superimposed to the microscope video and implemented with navigation in 2 recent studies on spinal tumors 69 and degenerative spine disease. 70 This approach greatly facilitated surgery due to intuitive understanding of the 3D anatomy and additionally yielded to a 70% reduction of effective dose radiation.…”

Section: Augmented Reality In Spine Surgerymentioning

confidence: 99%

“…70 This approach greatly facilitated surgery due to intuitive understanding of the 3D anatomy and additionally yielded to a 70% reduction of effective dose radiation. 69 In addition, Umebayashi et al 71 recently reported the use of AR in microscopic transvertebral anterior cervical foraminotomy and posterior cervical laminoforaminotomy: 2 minimally invasive although complex techniques requesting accurate planning and great surgical skills. During navigated surgery, O-arm imaging was used to build a 3D model of the patient's vertebrae and the keyhole tunnel was marked and subsequently transferred to the microscope and merged with the live view, thus greatly facilitating the procedure.…”

Section: Augmented Reality In Spine Surgerymentioning

confidence: 99%

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

et al. 2020

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Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.

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Section: Augmented Reality In Spine Surgerymentioning

confidence: 99%

Section: Augmented Reality In Spine Surgerymentioning

confidence: 99%

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

et al. 2020

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“…If the doctor wore the head-mounted display for a long time, it would cause discomfort to the doctor and affect the operation. Carl et al [60] applied the method of AR operation microscopy to spine surgery.…”

Section: Display Device In Surgical Navigation Based On Armentioning

confidence: 99%

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

et al. 2020

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Background: The traditional navigation interface was intended only for two-dimensional observation by doctors; thus, this interface does not display the total spatial information for the lesion area. Surgical navigation systems have become essential tools that enable for doctors to accurately and safely perform complex operations. The image navigation interface is separated from the operating area, and the doctor needs to switch the field of vision between the screen and the patient's lesion area. In this paper, augmented reality (AR) technology was applied to spinal surgery to provide more intuitive information to surgeons. The accuracy of virtual and real registration was improved via research on AR technology. During the operation, the doctor could observe the AR image and the true shape of the internal spine through the skin. Methods: To improve the accuracy of virtual and real registration, a virtual and real registration technique based on an improved identification method and robotassisted method was proposed. The experimental method was optimized by using the improved identification method. X-ray images were used to verify the effectiveness of the puncture performed by the robot. Results: The final experimental results show that the average accuracy of the virtual and real registration based on the general identification method was 9.73 ± 0.46 mm (range 8.90-10.23 mm). The average accuracy of the virtual and real registration based on the improved identification method was 3.54 ± 0.13 mm (range 3.36-3.73 mm). Compared with the virtual and real registration based on the general identification method, the accuracy was improved by approximately 65%. The highest accuracy of the virtual and real registration based on the robot-assisted method was 2.39 mm. The accuracy was improved by approximately 28.5% based on the improved identification method. Conclusion: The experimental results show that the two optimized methods are highly very effective. The proposed AR navigation system has high accuracy and stability. This system may have value in future spinal surgeries.

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“…Therefore, we implemented a combination of intraoperative computed tomography (iCT)–based automatic patient registration and nonlinear image registration to minimize overall registration errors when applying AR for spine surgery. 17…”

Section: Introductionmentioning

confidence: 99%

Spine Surgery Supported by Augmented Reality

Carl

Bopp

Saß

et al. 2020

Global Spine Journal

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Study Design: A prospective, case-based, observational study. Objectives: To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery. Methods: In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation. Results: AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0.28 mm) resulted in a reliable AR representation with a close matching of visualized objects and reality, distinctly supporting anatomical orientation in the surgical field. Flexible AR visualization applying either the microscope HUD or video superimposition, including the ability to selectively activate objects of interest, as well as different display modes allowed a smooth integration in the surgical workflow, without disturbing the actual procedure. On average, 7.1 ± 4.6 objects were displayed visualizing target and risk structures reliably. Conclusions: Microscope-based AR can be applied successfully to various kinds of spinal procedures. AR improves anatomical orientation in the surgical field supporting the surgeon, as well as it offers a potential tool for education.

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Implementation of augmented reality support in spine surgery

Cited by 90 publications

References 26 publications

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

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

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

Spine Surgery Supported by Augmented Reality

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