Navigation and Image Injection for Control of Bone Removal and Osteotomy Planes in Spine Surgery

Kosterhon, Michael; Gutenberg, Angelika; Kantelhardt, Sven R.; Archavlis, Eleftherios; Giese, Alf

doi:10.1093/ons/opw017

Cited by 52 publications

(34 citation statements)

References 18 publications

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“…Microscope-based AR can be successfully applied in spinal surgery. 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.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Spine Surgery Supported by Augmented Reality

Carl

Bopp

Saß

et al. 2020

Global Spine Journal

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“…A similar system was also employed in a case of congenital vertebral deformity to accurately define resection volumes and osteotomy planes, in order to acquire a higher degree of precision and surgical safety. 72 Another device used in spine surgery is MicroOptical (Micro-Optical Corp., Westwood, MA, USA): a head-up display used for visualizing intraoperative fluoroscopy during open reduction and internal fracture fixations and spinal pedicle screw placement in a study of 50 cases. The study demonstrated a reduction of surgical time since the surgeon had not to turn away from the patient to view the imaging monitor.…”

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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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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“…Wu et al (45) evaluated the usefulness of AR technology in spine surgery and demonstrated the feasibility and accuracy of the AR system, while the surgeons who participated in the study noted reduced operative time and radiation dose. Kosterhon et al (47) reported the use of AR in a patient with congenital hemivertebra of the thoracolumbar spine, and the system was found useful for the surgeon during the resection of a complex-shaped bone wedge, offering more accuracy and patient safety. Finally, Abe et al (46) dealt with the value of AR technology in percutaneous vertebroplasty.…”

Section: Clinical Studies About the Use Of Augmented Reality In Orthomentioning

confidence: 99%

Augmented Reality in Orthopedics: Current State and Future Directions

2019

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Augmented reality (AR) comprises special hardware and software, which is used in order to offer computer-processed imaging data to the surgeon in real time, so that real-life objects are combined with computer-generated images. AR technology has recently gained increasing interest in the surgical practice. Preclinical research has provided substantial evidence that AR might be a useful tool for intra-operative guidance and decision-making. AR has been applied to a wide spectrum of orthopedic procedures, such as tumor resection, fracture fixation, arthroscopy, and component's alignment in total joint arthroplasty. The present study aimed to summarize the current state of the application of AR in orthopedics, in preclinical and clinical level, providing future directions and perspectives concerning potential further benefits from this technology.

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Navigation and Image Injection for Control of Bone Removal and Osteotomy Planes in Spine Surgery

Abstract: The intraoperative visualization of resection planes in a microscope's head-up display was found to assist the surgeon during the resection of a complex-shaped bone wedge and may help to further increase accuracy and patient safety.

Cited by 52 publications

References 18 publications

Spine Surgery Supported by Augmented Reality

Spine Surgery Supported by Augmented Reality

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

Augmented Reality in Orthopedics: Current State and Future Directions

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