Augmented reality surgical navigation with ultrasound-assisted registration for pedicle screw placement: a pilot study

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.

Download Full-text

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

Spine ◽

10.1097/brs.0000000000002876 ◽

2019 ◽

Vol 44 (7) ◽

pp. 517-525 ◽

Cited By ~ 46

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

Download Full-text

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

European Spine Journal ◽

10.1007/s00586-021-06950-w ◽

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

Download Full-text

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

Operative Neurosurgery ◽

10.1227/neu.0b013e31821954ed ◽

2011 ◽

Vol 69 (suppl_1) ◽

pp. ons14-ons19 ◽

Cited By ~ 24

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.

Download Full-text

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

Spine ◽

10.1097/brs.0000000000002502 ◽

2018 ◽

Vol 43 (14) ◽

pp. 1018-1023 ◽

Cited By ~ 37

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

Download Full-text

Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

Scientific Reports ◽

10.1038/s41598-020-64462-x ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 4

Author(s):

Gustav Burström ◽

Marcin Balicki ◽

Alexandru Patriciu ◽

Sean Kyne ◽

Aleksandra Popovic ◽

...

Keyword(s):

Pedicle Screw ◽

Operating Room ◽

Spine Surgery ◽

Surgical Navigation ◽

Guidance System ◽

Screw Placement ◽

Robot Arm ◽

Hybrid Operating Room ◽

Pedicle Screw Placement ◽

Technical Accuracy

AbstractThe combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory. The goal of this study was to examine the feasibility, accuracy and efficacy of a new robot-guided system for semi-automated, minimally invasive, pedicle screw placement. A custom robotic arm was integrated into a hybrid operating room (OR) equipped with an augmented reality surgical navigation system (ARSN). The robot was mounted on the OR-table and used to assist in placing Jamshidi needles in 113 pedicles in four cadavers. The ARSN system was used for planning screw paths and directing the robot. The robot arm autonomously aligned with the planned screw trajectory, and the surgeon inserted the Jamshidi needle into the pedicle. Accuracy measurements were performed on verification cone beam computed tomographies with the planned paths superimposed. To provide a clinical grading according to the Gertzbein scale, pedicle screw diameters were simulated on the placed Jamshidi needles. A technical accuracy at bone entry point of 0.48 ± 0.44 mm and 0.68 ± 0.58 mm was achieved in the axial and sagittal views, respectively. The corresponding angular errors were 0.94 ± 0.83° and 0.87 ± 0.82°. The accuracy was statistically superior (p < 0.001) to ARSN without robotic assistance. Simulated pedicle screw grading resulted in a clinical accuracy of 100%. This study demonstrates that the use of a semi-automated surgical robot for pedicle screw placement provides an accuracy well above what is clinically acceptable.

Download Full-text

The use of computer-assisted surgery as an educational tool for the training of orthopedic surgery residents in pedicle screw placement: a pilot study and survey among orthopedic residents

Canadian Journal of Surgery ◽

10.1503/cjs.012115 ◽

2016 ◽

Vol 59 (6) ◽

pp. 391-398 ◽

Cited By ~ 2

Author(s):

Ahmed Aoude ◽

Hamzah Alhamzah ◽

Maryse Fortin ◽

Peter Jarzem ◽

Jean Ouellet ◽

...

Keyword(s):

Pilot Study ◽

Pedicle Screw ◽

Orthopedic Surgery ◽

Computer Assisted Surgery ◽

Screw Placement ◽

Computer Assisted ◽

Educational Tool ◽

Pedicle Screw Placement

Download Full-text

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

Neurosurgical FOCUS ◽

10.3171/2021.5.focus21217 ◽

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.

Download Full-text