Augmented reality-navigated pedicle screw placement: a cadaveric pilot study

2021 ◽  
Author(s):  
José Miguel Spirig ◽  
Simon Roner ◽  
Florentin Liebmann ◽  
Philipp Fürnstahl ◽  
Mazda Farshad
Keyword(s):  
Pilot Study ◽  
Augmented Reality ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement

scholarly journals Learning Retention of Thoracic Pedicle Screw Placement Using a High-Resolution Augmented Reality Simulator With Haptic Feedback

2011 ◽  
Vol 69 (suppl_1) ◽  
pp. ons14-ons19 ◽  
Author(s):  
Cristian J Luciano ◽  
P Pat Banerjee ◽  
Brad Bellotte ◽  
G Michael Oh ◽  
Michael Lemole ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
Haptic Feedback ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Data Set ◽  
Learning Retention ◽  
Performance Accuracy ◽  
Thoracic Pedicle Screw ◽  
Thoracic Pedicle Screws

Abstract BACKGROUND: We evaluated the use of a part-task simulator with 3D and haptic feedback as a training tool for a common neurosurgical procedure - placement of thoracic pedicle screws. OBJECTIVE: To evaluate the learning retention of thoracic pedicle screw placement on a high-performance augmented reality and haptic technology workstation. METHODS: Fifty-one fellows and residents performed thoracic pedicle screw placement on the simulator. The virtual screws were drilled into a virtual patient's thoracic spine derived from a computed tomography data set of a real patient. RESULTS: With a 12.5% failure rate, a 2-proportion z test yielded P = .08. For performance accuracy, an aggregate Euclidean distance deviation from entry landmark on the pedicle and a similar deviation from the target landmark in the vertebral body yielded P = .04 from a 2-sample t test in which the rejected null hypothesis assumes no improvement in performance accuracy from the practice to the test sessions, and the alternative hypothesis assumes an improvement. CONCLUSION: The performance accuracy on the simulator was comparable to the accuracy reported in literature on recent retrospective evaluation of such placements. The failure rates indicated a minor drop from practice to test sessions, and also indicated a trend (P = .08) toward learning retention resulting in improvement from practice to test sessions. The performance accuracy showed a 15% mean score improvement and more than a 50% reduction in standard deviation from practice to test. It showed evidence (P = .04) of performance accuracy improvement from practice to test session.

scholarly journals A Novel Augmented-Reality-Based Surgical Navigation System for Spine Surgery in a Hybrid Operating Room: Design, Workflow, and Clinical Applications

2019 ◽  
Vol 18 (5) ◽  
pp. 496-502 ◽  
Author(s):  
Erik Edström ◽  
Gustav Burström ◽  
Rami Nachabe ◽  
Paul Gerdhem ◽  
Adrian Elmi Terander
Keyword(s):  
Augmented Reality ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Operating Room ◽  
Wound Closure ◽  
Surgical Navigation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Hybrid Operating Room ◽  
Pedicle Screw Placement

Abstract BACKGROUND Treatment of several spine disorders requires placement of pedicle screws. Detailed 3-dimensional (3D) anatomic information facilitates this process and improves accuracy. OBJECTIVE To present a workflow for a novel augmented-reality-based surgical navigation (ARSN) system installed in a hybrid operating room for anatomy visualization and instrument guidance during pedicle screw placement. METHODS The workflow includes surgical exposure, imaging, automatic creation of a 3D model, and pedicle screw path planning for instrument guidance during surgery as well as the actual screw placement, spinal fixation, and wound closure and intraoperative verification of the treatment results. Special focus was given to process integration and minimization of overhead time. Efforts were made to manage staff radiation exposure avoiding the need for lead aprons. Time was kept throughout the procedure and subdivided to reflect key steps. The navigation workflow was validated in a trial with 20 cases requiring pedicle screw placement (13/20 scoliosis). RESULTS Navigated interventions were performed with a median total time of 379 min per procedure (range 232-548 min for 4-24 implanted pedicle screws). The total procedure time was subdivided into surgical exposure (28%), cone beam computed tomography imaging and 3D segmentation (2%), software planning (6%), navigated surgery for screw placement (17%) and non-navigated instrumentation, wound closure, etc (47%). CONCLUSION Intraoperative imaging and preparation for surgical navigation totaled 8% of the surgical time. Consequently, ARSN can routinely be used to perform highly accurate surgery potentially decreasing the risk for complications and revision surgery while minimizing radiation exposure to the staff.

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

Spine ◽  
2018 ◽  
Vol 43 (14) ◽  
pp. 1018-1023 ◽  
Author(s):  
Adrian Elmi-Terander ◽  
Rami Nachabe ◽  
Halldor Skulason ◽  
Kyrre Pedersen ◽  
Michael Söderman ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement

scholarly journals Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging

Spine ◽  
2019 ◽  
Vol 44 (7) ◽  
pp. 517-525 ◽  
Author(s):  
Adrian Elmi-Terander ◽  
Gustav Burström ◽  
Rami Nachabe ◽  
Halldor Skulason ◽  
Kyrre Pedersen ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
3D Imaging ◽  
Surgical Navigation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative 3D Imaging

scholarly journals First in-human report of the clinical accuracy of thoracolumbar percutaneous pedicle screw placement using augmented reality guidance

2021 ◽  
Vol 51 (2) ◽  
pp. E10
Author(s):  
Alexander T. Yahanda ◽  
Emelia Moore ◽  
Wilson Z. Ray ◽  
Brenton Pennicooke ◽  
Jack W. Jennings ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Lower Extremity ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Spinal Tumors ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw ◽  
Clinical Accuracy ◽  
The Mean

OBJECTIVE Augmented reality (AR) is an emerging technology that has great potential for guiding the safe and accurate placement of spinal hardware, including percutaneous pedicle screws. The goal of this study was to assess the accuracy of 63 percutaneous pedicle screws placed at a single institution using an AR head-mounted display (ARHMD) system. METHODS Retrospective analyses were performed for 9 patients who underwent thoracic and/or lumbar percutaneous pedicle screw placement guided by ARHMD technology. Clinical accuracy was assessed via the Gertzbein-Robbins scale by the authors and by an independent musculoskeletal radiologist. Thoracic pedicle subanalysis was also performed to assess screw accuracy based on pedicle morphology. RESULTS Nine patients received thoracic or lumbar AR-guided percutaneous pedicle screws. The mean age at the time of surgery was 71.9 ± 11.5 years and the mean number of screws per patient was 7. Indications for surgery were spinal tumors (n = 4, 44.4%), degenerative disease (n = 3, 33.3%), spinal deformity (n = 1, 11.1%), and a combination of deformity and infection (n = 1, 11.1%). Presenting symptoms were most commonly low-back pain (n = 7, 77.8%) and lower-extremity weakness (n = 5, 55.6%), followed by radicular lower-extremity pain, loss of lower-extremity sensation, or incontinence/urinary retention (n = 3 each, 33.3%). In all, 63 screws were placed (32 thoracic, 31 lumbar). The accuracy for these screws was 100% overall; all screws were Gertzbein-Robbins grade A or B (96.8% grade A, 3.2% grade B). This accuracy was achieved in the thoracic spine regardless of pedicle cancellous bone morphology. CONCLUSIONS AR-guided surgery demonstrated a 100% accuracy rate for the insertion of 63 percutaneous pedicle screws in 9 patients (100% rate of Gertzbein-Robbins grade A or B screw placement). Using an ARHMS system for the placement of percutaneous pedicle screws showed promise, but further validation using a larger cohort of patients across multiple surgeons and institutions will help to determine the true accuracy enabled by this technology.

Clinical accuracy and initial experience with augmented reality–assisted pedicle screw placement: the first 205 screws

2021 ◽  
pp. 1-7
Author(s):  
Ann Liu ◽  
Yike Jin ◽  
Ethan Cottrill ◽  
Majid Khan ◽  
Erick Westbroek ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Lower Extremity Weakness ◽  
Head Mounted Display ◽  
Clinical Accuracy

OBJECTIVE Augmented reality (AR) is a novel technology which, when applied to spine surgery, offers the potential for efficient, safe, and accurate placement of spinal instrumentation. The authors report the accuracy of the first 205 pedicle screws consecutively placed at their institution by using AR assistance with a unique head-mounted display (HMD) navigation system. METHODS A retrospective review was performed of the first 28 consecutive patients who underwent AR-assisted pedicle screw placement in the thoracic, lumbar, and/or sacral spine at the authors’ institution. Clinical accuracy for each pedicle screw was graded using the Gertzbein-Robbins scale by an independent neuroradiologist working in a blinded fashion. RESULTS Twenty-eight consecutive patients underwent thoracic, lumbar, or sacral pedicle screw placement with AR assistance. The median age at the time of surgery was 62.5 (IQR 13.8) years and the median body mass index was 31 (IQR 8.6) kg/m2. Indications for surgery included degenerative disease (n = 12, 43%); deformity correction (n = 12, 43%); tumor (n = 3, 11%); and trauma (n = 1, 4%). The majority of patients (n = 26, 93%) presented with low-back pain, 19 (68%) patients presented with radicular leg pain, and 10 (36%) patients had documented lower extremity weakness. A total of 205 screws were consecutively placed, with 112 (55%) placed in the lumbar spine, 67 (33%) in the thoracic spine, and 26 (13%) at S1. Screw placement accuracy was 98.5% for thoracic screws, 97.8% for lumbar/S1 screws, and 98.0% overall. CONCLUSIONS AR depicted through a unique HMD is a novel and clinically accurate technology for the navigated insertion of pedicle screws. The authors describe the first 205 AR-assisted thoracic, lumbar, and sacral pedicle screws consecutively placed at their institution with an accuracy of 98.0% as determined by a Gertzbein-Robbins grade of A or B.

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