Minimally Invasive Spine Surgery Complications with Implant Placement and Fixation

Hohl, Justin B.; Holt, David C; Brodke, Darrel S.

doi:10.1007/978-1-4614-5674-2_37

Minimally Invasive Spine Surgery 2014

DOI: 10.1007/978-1-4614-5674-2_37

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Minimally Invasive Spine Surgery Complications with Implant Placement and Fixation

Justin B. Hohl¹,

David C Holt²,

Darrel S. Brodke³

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2020

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“…5,6,15 However, a significant learning curve is also involved in attaining proficiency with MIS procedures and instrumentations, and complication rates are higher during this learning period. 10,16,19 Percutaneous lumbar pedicle screw placement is a routine operation in MIS procedures, and the accuracy of screw placement is highly dependent on the guidance by intraoperative fluoroscopy. AR technology could provide an overlay of not only the intraoperative fluoroscopic images, but also the patient's 3D anatomical structures, which could improve the surgeon's experience and provide an easier way to overcome the learning curve with MIS procedures.…”

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confidence: 99%

Percutaneous placement of lumbar pedicle screws via intraoperative CT image–based augmented reality–guided technology

Liu¹,

Wu²,

Tang³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe authors aimed to assess, in a bone-agar experimental setting, the feasibility and accuracy of percutaneous lumbar pedicle screw placements using an intraoperative CT image–based augmented reality (AR)–guided method compared to placements using a radiograph-guided method. They also compared two AR hologram alignment methods.METHODSTwelve lumbar spine sawbones were completely embedded in hardened opaque agar, and a cubic marker was fixed on each phantom. After intraoperative CT, a 3D model of each phantom was generated, and a specialized application was deployed into an AR headset (Microsoft HoloLens). One hundred twenty pedicle screws, simulated by Kirschner wires (K-wires), were placed by two experienced surgeons, who each placed a total of 60 screws: 20 placed with a radiograph-guided technique, 20 with an AR technique in which the hologram was manually aligned, and 20 with an AR technique in which the hologram was automatically aligned. For each K-wire, the insertion path was expanded to a 6.5-mm diameter to simulate a lumbar pedicle screw. CT imaging of each phantom was performed after all K-wire placements, and the operative time required for each K-wire placement was recorded. An independent radiologist rated all images of K-wire placements. Outcomes were classified as grade I (no pedicle perforation), grade II (screw perforation of the cortex by up to 2 mm), or grade III (screw perforation of the cortex by > 2 mm). In a clinical situation, placements scored as grade I or II would be acceptable and safe for patients.RESULTSAmong all screw placements, 75 (94%) of 80 AR-guided placements and 40 (100%) of 40 radiograph-guided placements were acceptable (i.e., grade I or II; p = 0.106). Radiograph-guided placements had more grade I outcomes than the AR-guided method (p < 0.0001). The accuracy of the two AR alignment methods (p = 0.526) was not statistically significantly different, and neither was it different between the AR and radiograph groups (p < 0.0001). AR-guided placements required less time than the radiograph-guided placements (mean ± standard deviation, 131.76 ± 24.57 vs 181.43 ± 15.82 seconds, p < 0.0001). Placements performed using the automatic-alignment method required less time than those using the manual-alignment method (124.20 ± 23.80 vs 139.33 ± 23.21 seconds, p = 0.0081).CONCLUSIONSIn bone-agar experimental settings, AR-guided percutaneous lumbar pedicle screw placements were acceptable and more efficient than radiograph-guided placements. In a comparison of the two AR-guided placements, the automatic-alignment method was as accurate as the manual method but more efficient. Because of some limitations, the AR-guided system cannot be recommended in a clinical setting until there is significant improvement of this technology.

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confidence: 99%

Percutaneous placement of lumbar pedicle screws via intraoperative CT image–based augmented reality–guided technology

Liu¹,

Wu²,

Tang³

et al. 2020

Journal of Neurosurgery: Spine

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Minimally Invasive Spine Surgery Complications with Implant Placement and Fixation

Cited by 1 publication

References 46 publications

Percutaneous placement of lumbar pedicle screws via intraoperative CT image–based augmented reality–guided technology

Percutaneous placement of lumbar pedicle screws via intraoperative CT image–based augmented reality–guided technology

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