Augmented Reality in Spine Surgery: A Narrative Review

2021 ◽  
pp. 155633162110285
Author(s):  
Andrew Hersh ◽  
Smruti Mahapatra ◽  
Carly Weber-Levine ◽  
Tolulope Awosika ◽  
John N. Theodore ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Spine Surgery ◽  
Surgical Navigation ◽  
Orthopedic Procedures ◽  
Line Of Sight ◽  
Navigation Systems ◽  
Operative Field ◽  
Novel Technologies ◽  
Head Mounted Displays ◽  
The U.S

Augmented reality (AR) navigation refers to novel technologies that superimpose images, such as radiographs and navigation pathways, onto a view of the operative field. The development of AR navigation has focused on improving the safety and efficacy of neurosurgical and orthopedic procedures. In this review, the authors focus on 3 types of AR technology used in spine surgery: AR surgical navigation, microscope-mediated heads-up display, and AR head-mounted displays. Microscope AR and head-mounted displays offer the advantage of reducing attention shift and line-of-sight interruptions inherent in traditional navigation systems. With the U.S. Food and Drug Administration’s recent clearance of the XVision AR system (Augmedics, Arlington Heights, IL), the adoption and refinement of AR technology by spine surgeons will only accelerate.

Augmented Reality Surgical Navigation in Spine Surgery to Minimize Staff Radiation Exposure

Spine ◽  
2020 ◽  
Vol 45 (1) ◽  
pp. E45-E53 ◽  
Author(s):  
Erik Edström ◽  
Gustav Burström ◽  
Artur Omar ◽  
Rami Nachabe ◽  
Michael Söderman ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Radiation Exposure ◽  
Spine Surgery ◽  
Surgical Navigation

Augmented Reality for Retrosigmoid Craniotomy Planning

2021 ◽  
Author(s):  
Caio A. Neves ◽  
Christoph Leuze ◽  
Alejandro M. Gomez ◽  
Nassir Navab ◽  
Nikolas Blevins ◽  
...  
Keyword(s):  
Medical Imaging ◽  
Augmented Reality ◽  
Surgical Navigation ◽  
Internal Auditory Canal ◽  
Navigation Systems ◽  
Imaging Data ◽  
Dural Sinuses ◽  
Bone Removal ◽  
Surgical Navigation Systems ◽  
Medical Imaging Data

AbstractWhile medical imaging data have traditionally been viewed on two-dimensional (2D) displays, augmented reality (AR) allows physicians to project the medical imaging data on patient's bodies to locate important anatomy. We present a surgical AR application to plan the retrosigmoid craniotomy, a standard approach to access the posterior fossa and the internal auditory canal. As a simple and accurate alternative to surface landmarks and conventional surgical navigation systems, our AR application augments the surgeon's vision to guide the optimal location of cortical bone removal. In this work, two surgeons performed a retrosigmoid approach 14 times on eight cadaver heads. In each case, the surgeon manually aligned a computed tomography (CT)-derived virtual rendering of the sigmoid sinus on the real cadaveric heads using a see-through AR display, allowing the surgeon to plan and perform the craniotomy accordingly. Postprocedure CT scans were acquired to assess the accuracy of the retrosigmoid craniotomies with respect to their intended location relative to the dural sinuses. The two surgeons had a mean margin of davg = 0.6 ± 4.7 mm and davg = 3.7 ± 2.3 mm between the osteotomy border and the dural sinuses over all their cases, respectively, and only positive margins for 12 of the 14 cases. The intended surgical approach to the internal auditory canal was successfully achieved in all cases using the proposed method, and the relatively small and consistent margins suggest that our system has the potential to be a valuable tool to facilitate planning a variety of similar skull-base procedures.

scholarly journals Augmented Reality as a Tool to Guide PSI Placement in Pelvic Tumor Resections

Sensors ◽  
2021 ◽  
Vol 21 (23) ◽  
pp. 7824
Author(s):  
Mónica García-Sevilla ◽  
Rafael Moreta-Martinez ◽  
David García-Mato ◽  
Alicia Pose-Diez-de-la-Lastra ◽  
Rubén Pérez-Mañanes ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Surgical Navigation ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Target Surface ◽  
Patient Specific ◽  
Resection Margins ◽  
Navigation Systems ◽  
Pelvic Tumor ◽  
Similar Accuracy

Patient-specific instruments (PSIs) have become a valuable tool for osteotomy guidance in complex surgical scenarios such as pelvic tumor resection. They provide similar accuracy to surgical navigation systems but are generally more convenient and faster. However, their correct placement can become challenging in some anatomical regions, and it cannot be verified objectively during the intervention. Incorrect installations can result in high deviations from the planned osteotomy, increasing the risk of positive resection margins. In this work, we propose to use augmented reality (AR) to guide and verify PSIs placement. We designed an experiment to assess the accuracy provided by the system using a smartphone and the HoloLens 2 and compared the results with the conventional freehand method. The results showed significant differences, where AR guidance prevented high osteotomy deviations, reducing maximal deviation of 54.03 mm for freehand placements to less than 5 mm with AR guidance. The experiment was performed in two versions of a plastic three-dimensional (3D) printed phantom, one including a silicone layer to simulate tissue, providing more realism. We also studied how differences in shape and location of PSIs affect their accuracy, concluding that those with smaller sizes and a homogeneous target surface are more prone to errors. Our study presents promising results that prove AR’s potential to overcome the present limitations of PSIs conveniently and effectively.

scholarly journals Augmented reality navigation in spine surgery: a systematic review

2021 ◽  
Vol 163 (3) ◽  
pp. 843-852
Author(s):  
Gustav Burström ◽  
Oscar Persson ◽  
Erik Edström ◽  
Adrian Elmi-Terander
Keyword(s):  
Systematic Review ◽  
Augmented Reality ◽  
Spine Surgery ◽  
Surgical Navigation ◽  
Negative Impact ◽  
Cost Benefit ◽  
Final Analysis ◽  
Current Evidence ◽  
Current Evidence Base ◽  
Spinal Navigation

Abstract Background Conventional spinal navigation solutions have been criticized for having a negative impact on time in the operating room and workflow. AR navigation could potentially alleviate some of these concerns while retaining the benefits of navigated spine surgery. The objective of this study is to summarize the current evidence for using augmented reality (AR) navigation in spine surgery. Methods We performed a systematic review to explore the current evidence for using AR navigation in spine surgery. PubMed and Web of Science were searched from database inception to November 27, 2020, for data on the AR navigation solutions; the reported efficacy of the systems; and their impact on workflow, radiation, and cost-benefit relationships. Results In this systematic review, 28 studies were included in the final analysis. The main findings were superior workflow and non-inferior accuracy when comparing AR to free-hand (FH) or conventional surgical navigation techniques. A limited number of studies indicated decreased use of radiation. There were no studies reporting mortality, morbidity, or cost-benefit relationships. Conclusions AR provides a meaningful addition to FH surgery and traditional navigation methods for spine surgery. However, the current evidence base is limited and prospective studies on clinical outcomes and cost-benefit relationships are needed.

Frameless Patient Tracking With Adhesive Optical Skin Markers for Augmented Reality Surgical Navigation in Spine Surgery

Spine ◽  
2020 ◽  
Vol 45 (22) ◽  
pp. 1598-1604 ◽  
Author(s):  
Gustav Burström ◽  
Rami Nachabe ◽  
Robert Homan ◽  
Jurgen Hoppenbrouwers ◽  
Ronald Holthuizen ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Spine Surgery ◽  
Surgical Navigation ◽  
Patient Tracking

scholarly journals Surgical Navigation Systems Based On AR/VR Technologies

2021 ◽  
Author(s):  
Vladimir Ivanov ◽  
Anton Krivtsov ◽  
Sergey Strelkov ◽  
Dmitry Gulyaev ◽  
Denis Godanyuk ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Soft Tissues ◽  
Surgical Navigation ◽  
Navigation Systems ◽  
Actual Patient ◽  
Peter The Great ◽  
Ct Data ◽  
Visualization Systems ◽  
Surgical Navigation Systems ◽  
Surgical Operations

Abstract This study considers modern surgical navigation systems based on augmented reality technologies. Augmented reality glasses are used to construct holograms of the patient's organs from MRI and CT data, subsequently transmitted to the glasses. Thus, in addition to seeing the actual patient, the surgeon gains visualization inside the patient's body (bones, soft tissues, blood vessels, etc.). The solutions developed at Peter the Great St. Petersburg Polytechnic University allow reducing the invasiveness of the procedure and preserving healthy tissues. This also improves the navigation process, making it easier to estimate the location and size of the tumor to be removed.We describe the application of developed systems to different types of surgical operations (removal of a malignant brain tumor, removal of a cyst of the cervical spine). We consider the specifics of novel navigation systems designed for anesthesia, for endoscopic operations. Furthermore, we discuss the construction of novel visualization systems for ultrasound machines. Our findings indicate that the technologies proposed show potential for telemedicine.

scholarly journals Combining Augmented Reality and 3D Printing to Improve Surgical Workflows in Orthopedic Oncology: Smartphone Application and Clinical Evaluation

Sensors ◽  
2021 ◽  
Vol 21 (4) ◽  
pp. 1370
Author(s):  
Rafael Moreta-Martinez ◽  
Alicia Pose-Díez-de-la-Lastra ◽  
José Antonio Calvo-Haro ◽  
Lydia Mediavilla-Santos ◽  
Rubén Pérez-Mañanes ◽  
...  
Keyword(s):  
Augmented Reality ◽  
3D Printing ◽  
Surgical Navigation ◽  
Three Dimensional ◽  
Smartphone Application ◽  
Navigation Systems ◽  
Surgical Workflow ◽  
Orthopedic Oncology ◽  
Innovative Solution ◽  
3D Printed

During the last decade, orthopedic oncology has experienced the benefits of computerized medical imaging to reduce human dependency, improving accuracy and clinical outcomes. However, traditional surgical navigation systems do not always adapt properly to this kind of interventions. Augmented reality (AR) and three-dimensional (3D) printing are technologies lately introduced in the surgical environment with promising results. Here we present an innovative solution combining 3D printing and AR in orthopedic oncological surgery. A new surgical workflow is proposed, including 3D printed models and a novel AR-based smartphone application (app). This app can display the patient’s anatomy and the tumor’s location. A 3D-printed reference marker, designed to fit in a unique position of the affected bone tissue, enables automatic registration. The system has been evaluated in terms of visualization accuracy and usability during the whole surgical workflow. Experiments on six realistic phantoms provided a visualization error below 3 mm. The AR system was tested in two clinical cases during surgical planning, patient communication, and surgical intervention. These results and the positive feedback obtained from surgeons and patients suggest that the combination of AR and 3D printing can improve efficacy, accuracy, and patients’ experience.

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

Augmented Reality in Spine Surgery

2021 ◽  
Vol 151 ◽  
pp. 290
Author(s):  
Alexander J. Schupper ◽  
Jeremy Steinberger ◽  
Yakov Gologorsky
Keyword(s):  
Augmented Reality ◽  
Spine Surgery

scholarly journals First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

2021 ◽  
Author(s):  
Valentina Pennacchietti ◽  
Katharina Stoelzel ◽  
Anna Tietze ◽  
Erwin Lankes ◽  
Andreas Schaumann ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Morphological Variability ◽  
Case Series ◽  
Relevant Information ◽  
Navigation Systems ◽  
Postoperative Mri ◽  
The Mean ◽  
Clinical Conditions

Abstract Introduction Endoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. In children, endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. This paper aims to analyze our first experience on augmented reality navigation in endoscopic skull base surgery in a pediatric case series. Patients and methods A retrospective review identified seventeen endoscopic-assisted endonasal or transoral procedures performed in an interdisciplinary setting in a period between October 2011 and May 2020. In all the cases, the surgical target was a lesion in the sellar or parasellar region. Clinical conditions, MRI appearance, intraoperative conditions, postoperative MRI, possible complications, and outcomes were analyzed. Results The mean age of our patients was 14.5 ± 2.4 years. The diagnosis varied, but craniopharyngiomas (31.2%) were mostly represented. AR navigation was experienced to be very helpful for effectively targeting the lesion and defining the intraoperative extension of the pathology. In 65% of the oncologic cases, a radical removal was proven in postoperative MRI. The mean follow-up was 89 ± 79 months. There were no deaths in our series. No long-term complications were registered; two cerebrospinal fluid (CSF) fistulas and a secondary abscess required further surgery. Conclusion The implementation of augmented reality to endoscopic-assisted neuronavigated procedures within the skull base was feasible and did provide relevant information directly in the endoscopic field of view and was experienced to be useful in the pediatric cases, where anatomical variability and rarity of the pathologies make surgery more challenging.

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