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Khan M, Ahuja K, Tsirikos AI. AI and machine learning in paediatric spine deformity surgery. Bone Jt Open 2025; 6:569-581. [PMID: 40407025 PMCID: PMC12100669 DOI: 10.1302/2633-1462.65.bjo-2024-0089.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2025] Open
Abstract
Paediatric spine deformity surgery is a high-stakes procedure. It demands the surgeon to have exceptional anatomical knowledge and precise visuospatial awareness. There is increasing demand for precision medicine, which rapid advancements in computational technologies have made possible with the recent explosion of AI and machine learning (ML). We present the surgical and ethical applications of AI and ML in diagnosis, prognosis, image processing, and outcomes in the field of paediatric spine deformity.
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Affiliation(s)
- Mohsin Khan
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Kaustubh Ahuja
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Athanasios I Tsirikos
- Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK
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Lebovic J, Galetta MS, Sardar ZM, Goytan M, Daniels AH, Miyanji F, Smith JS, Burton DC, Protopsaltis TS. Enabling technology in adult spinal deformity. Spine Deform 2025:10.1007/s43390-025-01086-z. [PMID: 40234366 DOI: 10.1007/s43390-025-01086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Accepted: 03/21/2025] [Indexed: 04/17/2025]
Abstract
This review analyzes enabling technology in Adult Spinal Deformity (ASD), with a focus on optimizing safety and teaching. The prevalence of ASD is rising, and recent technological advancements can empower surgeons to improve outcomes for ASD patients but also each comes with specific challenges. The paper highlights opportunities and potential obstacles in effective technology integration and assesses key enabling technologies, including surgical planning software, machine leaning, three-dimensional printing, augmented and virtual reality, patient-specific instrumentation as well as navigation and robotics.
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Affiliation(s)
- Jordan Lebovic
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Matthew S Galetta
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, USA
| | - Michael Goytan
- Winnipeg Spine Program, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Alan H Daniels
- Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI, USA
| | - Firoz Miyanji
- Department of Orthopaedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, Medical Center, University of Kansas, Kansas City, KS, USA
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Chang CN, Li CR, Liao SS, Shen CC, Chen KY, Lee CH, Yang MY. Augmented Reality in Scoliosis Correction Surgery: Efficiency and Accuracy in Pedicle Screw Instrumentation. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:576. [PMID: 40282867 PMCID: PMC12028456 DOI: 10.3390/medicina61040576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 03/05/2025] [Accepted: 03/19/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: Recent advancements in spinal navigation methodologies, particularly augmented reality (AR) techniques, have significantly enhanced the precision of spinal instrumentation procedures. This study aimed to evaluate the efficacy of AR-assisted navigation in spinal instrumentation surgery for thoracolumbar scoliosis. Materials and Methods: This retrospective observational study included 10 patients with thoracolumbar scoliosis who met specific inclusion criteria and were recruited at a single medical center. Two neurosurgeons and one neuroradiologist used the Gertzbein-Robbins scale (GRS) for radiological evaluation. Preoperative and postoperative Cobb angles were measured to assess the correction of scoliosis. Overall, 257 screws were placed using the AR-assisted navigation system during thoracic and lumbar spinal deformity surgeries. Results: Among the 257 screws, 197 were placed in the thoracic spine and 60 in the lumbar spine, achieving an overall instrumentation accuracy of 98%. The preoperative Cobb angle of 69.5 ± 22.2° significantly improved to 10.1 ± 4.1° postoperatively. Regarding first-attempt screw placement accuracy, 97.4% of the screws in the thoracic spine (graded as GRS A or B) and 100% in the lumbar spine were placed with precision. Five grade C thoracic screws were identified, one of which required re-instrumentation. Conclusions: The AR navigation technique substantially improved the precision of spinal deformity surgery, with a high screw placement accuracy rate and significant scoliosis correction. The benefits of reduced attention diversion and an intuitive surgical experience suggest that AR technology could significantly improve spinal surgery practices and training programs, indicating potential for broader applicability in the future.
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Affiliation(s)
| | | | | | | | | | | | - Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard, Sec. 4, Taichung City 40705, Taiwan; (C.-N.C.); (C.-R.L.); (S.-S.L.); (C.-C.S.); (K.-Y.C.); (C.-H.L.)
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Wilson BR, Wang TY, O'Toole J. Augmented Reality in Spine Surgery. Neurosurgery 2025; 96:S103-S110. [PMID: 39950790 DOI: 10.1227/neu.0000000000003343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 09/19/2024] [Indexed: 05/09/2025] Open
Abstract
Augmented reality (AR) is a technology that allows digital information to be superimposed onto a user's view of the real world, thereby enhancing the user's experience of a given real-world scenario. As recent advances in AR technology have made it more available for a variety of applications, hospitals and doctors have begun to test its utility in the operating room. AR technology allows surgeons to supplement their view of the operative field with useful patient-specific information for which they might otherwise need to turn their attention away from the task at hand. For spine surgeons in particular, AR has begun to emerge as a promising option to assist with surgical performance. The field of spine surgery is uniquely positioned to benefit from AR, given the extent to which many spine surgeons already rely on intraoperative navigation techniques for certain surgical tasks, including pedicle screw and interbody device placement. In this review, we outline the origins and history of AR in spine surgery and cover the current state of the literature regarding the applications, benefits, and drawbacks of its use within the field. Lastly, we speculate as to the future of AR in spine surgery and propose which gaps in knowledge must be addressed before the technology enjoys a degree of adoption on par with currently available intraoperative navigation techniques.
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Affiliation(s)
- Bayard R Wilson
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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Schmidt FA, Hussain I, Boadi B, Sommer FJ, Thomé C, Härtl R. The Use of Augmented Reality as an Educational Tool in Minimally Invasive Transforaminal Lumbar Interbody Fusion. Oper Neurosurg (Hagerstown) 2025; 28:183-192. [PMID: 39185869 DOI: 10.1227/ons.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/03/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES One of the major challenges in training neurosurgical and orthopedic residents the technique for minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the lack of visualization of surgical landmarks (pedicle, pars, lamina). This is due to the limited access to the bony spine through a tubular retractor, in addition to a smaller working corridor or patient-specific factors such as bony overgrowth, disk space collapse, and listhesis. These factors increase the possibility for surgical error and prolonged surgery time. With augmented reality (AR), relevant surgical anatomy can be projected directly into the user's field of view through the microscope. The purpose of this study was to assess the utility, accuracy, efficiency, and precision of AR-guided MIS-TLIF and to determine its impact in spine surgery training. METHODS At 2 centers, 12 neurosurgical residents performed a one-level MIS-TLIF on a high-fidelity lumbar spine simulation model with and without AR projection into the microscope. For the MIS-TLIF procedures with AR, surgical landmarks were highlighted in different colors on preoperative image data . These landmarks were visualized in the spinal navigation application on the navigation monitor and in the microscope to confirm the relevant anatomy. Postprocedural surveys (National Aeronautics and Space Administration Task Load Index) were given to the residents. RESULTS Twelve residents were included in this trial. AR-guided procedures had a consistent impact on resident anatomical orientation and workload experience. Procedures performed without AR had a significantly higher mental demand ( P = .003 ) than with AR. Residents reported to a significantly higher rate that it was harder work for them to accomplish their level of performance without AR ( P = .019 ). CONCLUSION AR can bring a meaningful value in MIS teaching and training to confirm relevant anatomy in situations where the surgeon will have less direct visual access. AR used in surgical simulation can also speed the learning curve.
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Affiliation(s)
- Franziska A Schmidt
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck , Austria
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York , New York , USA
| | - Blake Boadi
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York , New York , USA
| | - Fabian J Sommer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York , New York , USA
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck , Austria
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York , New York , USA
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Ma Y, Wu J, Dong Y, Tang H, Ma X. Augmented Reality Navigation System Enhances the Accuracy of Spinal Surgery Pedicle Screw Placement: A Randomized, Multicenter, Parallel-Controlled Clinical Trial. Orthop Surg 2025; 17:631-643. [PMID: 39815419 PMCID: PMC11787979 DOI: 10.1111/os.14295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 10/27/2024] [Accepted: 10/29/2024] [Indexed: 01/18/2025] Open
Abstract
OBJECTIVE The pedicle screw insertion technique has evolved significantly, and despite the challenges of precise placement, advancements like AR-based surgical navigation systems now offer enhanced accuracy and safety in spinal surgery by integrating real-time, high-resolution imaging with virtual models to aid surgeons. This study aims to evaluate the differences in accuracy between novel AR-guided pedicle screw insertion and conventional surgery techniques. METHODS A randomized controlled trial was conducted from March 2019 to December 2023 to compare the efficacy of AR-guided pedicle screw fixation with conventional freehand surgery using CT guidance. The study included 150 patients, aged 18-75, with 75 patients in each group. The total number of pedicle screws planned for the clinical trial placement was 351 and 348 in the experimental and control groups. The safety and efficacy of the procedures were evaluated by assessing screw placement accuracy and complication rates. RESULTS In the full analysis set (FAS) analysis, the difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 6.3% [3.0%-9.8%], with a p value of 0.0003 for the superiority test. In the FAS sensitivity analysis, the success rate was 98.0% (344 out of 351) in the experimental group and 91.7% (319 out of 348) in the control group, with a difference and 95% confidence interval of 6.3% [2.9% and 9.8%, respectively]. In the per-protocol set (PPS) analysis, the difference in the excellent and good rates of screw placement between the experimental and control groups, and the 95% confidence interval was 6.4% [3.3%-9.5%], with a p value of 0.0001 for the superiority test. In the actual treatment set (ATS) analysis, the excellent and good rates of screw placement were 99.1% in the experimental group and 91.7% in the control group. The difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 7.3% [4.1%-10.6%], with a p value of < 0.0001 for the superiority test. CONCLUSIONS The AR surgical navigation system can improve the accuracy of pedicle screw implantation and provide precise guidance for surgeons during pedicle screw insertion.
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Affiliation(s)
- Yichao Ma
- Shanghai University of Traditional Chinese MedicineShanghaiChina
- Department of Orthopedics, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiangpeng Wu
- Department of Orthopedics, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yanlong Dong
- Linyan Medical Technology Company LimitedShanghaiChina
| | - Hongmei Tang
- Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Xiaojun Ma
- Department of Orthopedics, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Aye WMM, Kiraly L, Kumar SS, Kasivishvanaath A, Gao Y, Kofidis T. Mixed Reality (Holography)-Guided Minimally Invasive Cardiac Surgery-A Novel Comparative Feasibility Study. J Cardiovasc Dev Dis 2025; 12:49. [PMID: 39997483 PMCID: PMC11856421 DOI: 10.3390/jcdd12020049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 01/18/2025] [Accepted: 01/20/2025] [Indexed: 02/26/2025] Open
Abstract
The operative field and exposure in minimally invasive cardiac surgery (MICS) are limited. Meticulous preoperative planning and intraoperative visualization are crucial. We present our initial experience with HoloLens® 2 as an intraoperative guide during MICS procedures: aortic valve replacement (AVR) via right anterior small thoracotomy, coronary artery bypass graft surgery (CABG) via left anterior small thoracotomy (LAST), and pulmonary valve replacement (PVR) via LAST. Three-dimensional (3D) segmentations were performed using the patient's computer tomography (CT) data subsequently rendered into a 3D hologram on the HoloLens® 2. The holographic image was then superimposed on the patient lying on the operating table, using the xiphoid and the clavicle as landmarks, and was used as a real-time anatomical image guide for the surgery. The incision site marking made using HoloLens® 2 differed by one intercostal space from the marking made using a conventional surgeon's mental reconstructed image from the patient's preoperative imaging and was found to be a more appropriate site of entry into the chest for the structure of interest. The transparent visor of the HoloLens® 2 provided unobstructed views of the operating field. A mixed reality (MR) device could contribute to preoperative surgical planning and intraoperative real-time image guidance, which facilitates the understanding of anatomical relationships. MR has the potential to improve surgical precision, decrease risk, and enhance patient safety.
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Affiliation(s)
- Winn Maung Maung Aye
- Department of Cardiac, Thoracic and Vascular Surgery, Division of Congenital Cardiac Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore; (L.K.); (S.S.K.); (T.K.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Department of Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore;
| | - Laszlo Kiraly
- Department of Cardiac, Thoracic and Vascular Surgery, Division of Congenital Cardiac Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore; (L.K.); (S.S.K.); (T.K.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Department of Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore;
- Department of Public Health, Semmelweis University, 1085 Budapest, Hungary
| | - Senthil S. Kumar
- Department of Cardiac, Thoracic and Vascular Surgery, Division of Congenital Cardiac Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore; (L.K.); (S.S.K.); (T.K.)
| | | | - Yujia Gao
- Department of Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore;
| | - Theodoros Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, Division of Congenital Cardiac Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore; (L.K.); (S.S.K.); (T.K.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Department of Surgery, National University Hospital, National University Health System, Singapore 119228, Singapore;
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Kong H, Wang S, Zhang C, Chen Z, Wu Z, Wang J. A Novel Pedicle Screw Placement Surgery Based on Integration of Surgical Guides and Augmented Reality. J Neurol Surg A Cent Eur Neurosurg 2025. [PMID: 37890512 DOI: 10.1055/a-2200-3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Augmented reality is a new technology that, when applied to spinal surgery, offers the potential for efficient, safe, and accurate placement of pedicle screws. This study investigated whether augmented reality combined with a guide board improved the safety and accuracy of pedicle screw placement compared to traditional freehand screw placement. METHODS Four trainers were divided into augmented reality navigation and freehand groups. Each group consisted of a novice and an experienced spine surgeon. A total of 80 pedicle screws were implanted. First, the AR group reconstructed the three-dimensional (3D) model and planned the screw insertion route according to the computed tomography (CT) data of L2 lumbar vertebrae. Next, the Microsoft HoloLens 2 was used to identify the vertebral model, and the planned virtual path was superimposed on the real cone model. Then, the screw was placed according to the projected trajectory. Finally, Micron Tracker was used to measure the deviation of screws from the preoperatively planned trajectory, and pedicle screws were evaluated using the Gertzbein-Robbins scale. RESULTS In the augmented reality group, the linear deviation of the experienced doctors and novices was 1.59 ± 0.39 and 1.73 ± 0.52 mm, respectively, and the deviation angle was 2.72 ± 0.61 and 2.87 ± 0.63 degrees, respectively. In the freehand group, the linear deviation of the experienced doctors and novices was 2.88 ± 0.58 and 5.25 ± 0.62 mm, respectively, and the deviation angle was 4.41 ± 1.18 and 7.15 ± 1.45 degrees, respectively. The screw placement accuracy rate was 97.5% in the augmented reality navigation group and 77.5% in the freehand group. CONCLUSIONS Augmented reality navigation improves the accuracy and safety of pedicle screw implantation compared with the traditional freehand method and can assist inexperienced doctors in successfully completing the surgery.
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Affiliation(s)
- Huiyang Kong
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Shuyi Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Can Zhang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Zhanglei Wu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Jiayu Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Rohmer K, Becker M, Georgiades M, March C, Melekh B, Sperka P, Spinczyk D, Wolińska-Sołtys A, Pech M. Acceptance and feasibility of an augmented reality-based navigation system with optical tracking for percutaneous procedures in interventional radiology - a simulation-based phantom study. ROFO-FORTSCHR RONTG 2024. [PMID: 39366404 DOI: 10.1055/a-2416-1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2024]
Abstract
Augmented reality (AR) projects additional information into the user's field of view during interventions. The aim was to evaluate the acceptance and clinical feasibility of an AR system and to compare users with different levels of experience. A system was examined that projects a CT-generated 3D model of a phantom into the field of view using a HoloLens 2, whereby the tracked needle is displayed and navigated live. A projected ultrasound image is used for live control of the needle positioning. This should minimize radiation exposure and improve orientation.The acceptance and usability of the AR navigation system was evaluated by 10 physicians and medical students with different levels of experience by performing punctures with the system in a phantom. The required time was then compared and a questionnaire was completed to assess clinical acceptance and feasibility. For statistical analysis, frequencies for qualitative characteristics, location and dispersion measures for quantitative characteristics and Spearman rank correlations for correlations were calculated.9 out of 10 subjects hit all 5 target regions in the first attempt, taking an average of 29:39 minutes for all punctures. There was a significant correlation between previous experience in interventional radiology, years in the profession, and the time required. Overall, the time varied from an average of 43:00 min. for medical students to 15:00 min. for chief physicians. All test subjects showed high acceptance of the system and rated especially the potential clinical feasibility, the simplification of the puncture, and the image quality positively. However, the majority require further training for sufficient safety in use.The system offers distinct advantages for navigation and orientation, facilitates percutaneous interventions during training and enables professionally experienced physicians to achieve short intervention times. In addition, the system improves ergonomics during the procedure by making important information always directly available in the field of view and has the potential to reduce the radiation exposure of staff in particular by combining AR and sonography and thus shortening CT-fluoroscopy times. · AR navigation offers advantages for orientation during percutaneous radiological interventions.. · The subjects would like to use the AR system in everyday clinical practice on patients.. · AR improves ergonomics by making important information directly available in the field of view.. · The combination of AR and sonography can significantly reduce radiation exposure for staff.. · Rohmer K, Becker M, Georgiades M et al. Acceptance and feasibility of an augmented reality-based navigation system with optical tracking for percutaneous procedures in interventional radiology - a simulation-based phantom study. Fortschr Röntgenstr 2024; DOI 10.1055/a-2416-1080.
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Affiliation(s)
- Karl Rohmer
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Mathias Becker
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Marilena Georgiades
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine March
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Bohdan Melekh
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Piotr Sperka
- Holo4Med Spółka S. A., Holo4Med Spółka S. A., Białystok, Poland
| | - Dominik Spinczyk
- Faculty of Biomedical Engineering/Department of Medical Informatics and Artificial Intelligence, Silesian University of Technology, Gliwice, Poland
- Holo4Med Spółka S. A., Holo4Med Spółka S. A., Białystok, Poland
| | | | - Maciej Pech
- University Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
- Research Campus STIMULATE, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Park SM, Kim HJ, Yeom JS. Is minimally invasive surgery a game changer in spinal surgery? Asian Spine J 2024; 18:743-752. [PMID: 39434232 PMCID: PMC11538812 DOI: 10.31616/asj.2024.0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 08/16/2024] [Accepted: 09/22/2024] [Indexed: 10/23/2024] Open
Abstract
Minimally invasive spine surgery (MISS) has revolutionized the treatment of spinal disorders over the past few decades. This review provides an in-depth analysis of MISS techniques, technologies, outcomes, and future directions. The evolution of MISS techniques-including tubular retractor systems, percutaneous pedicle screw fixation, minimally invasive transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and endoscopic spine surgery-has expanded the scope of treatable spinal pathologies while minimizing tissue trauma. Technological advancements such as intraoperative navigation, robotics, and augmented reality applications have enhanced precision and capabilities. Clinical evidence supports the efficacy and safety of MISS techniques for various spinal pathologies, demonstrating comparable or superior outcomes to traditional open approaches with reduced tissue trauma, blood loss, and hospital stays. Cost-effectiveness analyses also favor MISS over open techniques. Future directions in MISS include expanding indications, integrating artificial intelligence and machine learning, advancing tissue engineering and biologics, and refining robotic and augmented reality applications. As MISS continues to evolve, it is poised to play an increasingly important role in the treatment of spinal disorders, offering improved patient outcomes with reduced morbidity. However, ongoing rigorous evaluation of new techniques and technologies is crucial to balance potential benefits with associated risks and costs.
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Affiliation(s)
- Sang-Min Park
- Spine Center, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho-Joong Kim
- Spine Center, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin S Yeom
- Spine Center, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Egger J, Gsaxner C, Luijten G, Chen J, Chen X, Bian J, Kleesiek J, Puladi B. Is the Apple Vision Pro the Ultimate Display? A First Perspective and Survey on Entering the Wonderland of Precision Medicine. JMIR Serious Games 2024; 12:e52785. [PMID: 39292499 PMCID: PMC11447423 DOI: 10.2196/52785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/26/2024] [Accepted: 07/02/2024] [Indexed: 09/19/2024] Open
Abstract
At the Worldwide Developers Conference in June 2023, Apple introduced the Vision Pro. The Apple Vision Pro (AVP) is a mixed reality headset; more specifically, it is a virtual reality device with an additional video see-through capability. The video see-through capability turns the AVP into an augmented reality (AR) device. The AR feature is enabled by streaming the real world via cameras on the (virtual reality) screens in front of the user's eyes. This is, of course, not unique and is similar to other devices, such as the Varjo XR-3 (Varjo Technologies Oy). Nevertheless, the AVP has some interesting features, such as an inside-out screen that can show the headset wearer's eyes to "outsiders," and a button on the top, called the "digital crown," that allows a seamless blend of digital content with the user's physical space by turning it. In addition, it is untethered, except for the cable to the battery, which makes the headset more agile, compared to the Varjo XR-3. This could actually come closer to "The Ultimate Display," which Ivan Sutherland had already sketched in 1965. After a great response from the media and social networks to the release, we were able to test and review the new AVP ourselves in March 2024. Including an expert survey with 13 of our colleagues after testing the AVP in our institute, this Viewpoint explores whether the AVP can overcome clinical challenges that AR especially still faces in the medical domain; we also go beyond this and discuss whether the AVP could support clinicians in essential tasks to allow them to spend more time with their patients.
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Affiliation(s)
- Jan Egger
- Institute for Artificial Intelligence in Medicine, Essen University Hospital (AöR), Essen, Germany
- Center for Virtual and Extended Reality in Medicine (ZvRM), Essen University Hospital (AöR), Essen, Germany
- Cancer Research Center Cologne Essen (CCCE), University Medicine Essen (AöR), Essen, Germany
| | - Christina Gsaxner
- Institute for Artificial Intelligence in Medicine, Essen University Hospital (AöR), Essen, Germany
- Department of Oral and Maxillofacial Surgery & Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany
- Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - Gijs Luijten
- Institute for Artificial Intelligence in Medicine, Essen University Hospital (AöR), Essen, Germany
- Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - Jianxu Chen
- Leibniz-Institut für Analytische Wissenschaften (ISAS), Dortmund, Germany
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotic, Shanghai Jiao Tong University, Shanghai, China
| | - Jiang Bian
- Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jens Kleesiek
- Institute for Artificial Intelligence in Medicine, Essen University Hospital (AöR), Essen, Germany
- Cancer Research Center Cologne Essen (CCCE), University Medicine Essen (AöR), Essen, Germany
- German Cancer Consortium (DKTK), Partner Site Essen, Essen, Germany
- Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery & Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany
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12
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González-González F, Aguilar-Chávez F, Martínez-Loya C, Marín-Castañeda LA, Arellanes-Chavez CA, Lee Á. Top 100 Most Cited Articles on Intraoperative Image-Guided Navigation in Spine Surgery. Cureus 2024; 16:e67950. [PMID: 39328685 PMCID: PMC11426548 DOI: 10.7759/cureus.67950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Navigation technologies have become essential in spine surgery over the last decade, offering precise procedures and minimizing risks. To the best of our knowledge, this is the first bibliometric analysis on this topic, providing insights and trends on topics, authors, and journals. The study identifies and analyzes the 100 most cited articles related to navigation in spine surgery. A systematic search was performed in Scopus and Google Scholar to identify all articles related to navigation in spine surgery (38,057 articles). The 100 most cited were analyzed for citations, titles, abstracts, authors, affiliations, keywords, country and institute of origin, year of publication, and level of evidence. The search was conducted in October 2023. The 100 most cited articles were published between 1995 and 2019, with 2010 to 2019 being the most prolific decade (46%). The most cited article had 733 citations, and the paper with the most citations per year averaged 59.27 citations/year. The Spine Journal had the most articles (34%). The United States contributed the most articles (39%). Most publications were clinical research and reviews (94%), with an overall evidence grade of IV-V (63%). A positive trend was noted in the last decade for incorporating augmented reality. This bibliometric analysis offers valuable insights and trends in spine surgery navigation literature. The findings indicate that technological advancements have led to more articles with higher levels of evidence. These pivotal articles shape evidence-based medicine, future surgeons, and industry improvements in navigated spine surgery.
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Affiliation(s)
| | - Felipe Aguilar-Chávez
- Cisne Spine Academy, Star Medica Hospital, Autonomous University of Chihuahua, Chihuahua, MEX
| | - Carolina Martínez-Loya
- Research, Faculty of Medicine and Biomedical Sciences, Autonomous University of Chihuahua, Chihuahua, MEX
| | | | | | - Ángel Lee
- Research, Dr. Manuel Gea González General Hospital, Mexico City, MEX
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13
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Youssef S, McDonnell JM, Wilson KV, Turley L, Cunniffe G, Morris S, Darwish S, Butler JS. Accuracy of augmented reality-assisted pedicle screw placement: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:974-984. [PMID: 38177834 DOI: 10.1007/s00586-023-08094-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Conventional freehand methods of pedicle screw placement are associated with significant complications due to close proximity to neural and vascular structures. Recent advances in augmented reality surgical navigation (ARSN) have led to its adoption into spine surgery. However, little is known regarding its overall accuracy. The purpose of this study is to delineate the overall accuracy of ARSN pedicle screw placement across various models. METHODS A systematic review was conducted of Medline/PubMed, Cochrane and Embase Library databases according to the PRISMA guidelines. Relevant data extracted included reports of pedicle screw placement accuracy and breaches, as defined by the Gertzbein-Robbins classification, in addition to deviation from pre-planned trajectory and entry point. Accuracy was defined as the summation of grade 0 and grade 1 events per the Gertzbein-Robbins classification. RESULTS Twenty studies reported clinically accurate placed screws. The range of clinically accurate placed screws was 26.3-100%, with 2095 screws (93.1%) being deemed clinically accurate. Furthermore, 5.4% (112/2088) of screws were reported as grade two breaches, 1.6% (33/2088) grade 3 breaches, 3.1% (29/926) medial breaches and 2.3% (21/926) lateral breaches. Mean linear deviation ranged from 1.3 to 5.99 mm, while mean angular/trajectory deviation ranged 1.6°-5.88°. CONCLUSION The results of this study highlight the overall accuracy of ARSN pedicle screw placement. However, further robust prospective studies are needed to accurately compare to conventional methods of pedicle screw placement.
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Affiliation(s)
- Salma Youssef
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Kielan V Wilson
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Luke Turley
- Department of Orthopaedics, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Seamus Morris
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Joseph S Butler
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
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14
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Bui T, Ruiz-Cardozo MA, Dave HS, Barot K, Kann MR, Joseph K, Lopez-Alviar S, Trevino G, Brehm S, Yahanda AT, Molina CA. Virtual, Augmented, and Mixed Reality Applications for Surgical Rehearsal, Operative Execution, and Patient Education in Spine Surgery: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:332. [PMID: 38399619 PMCID: PMC10890632 DOI: 10.3390/medicina60020332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR's main application has been for teaching and preparatory roles, while AR has been mostly used as a surgical adjunct. The objective of this study is to discuss the various applications and prospects for VR, AR, and MR specifically as they relate to spine surgery. Materials and Methods: A systematic review was conducted to examine the current applications of VR, AR, and MR with a focus on spine surgery. A literature search of two electronic databases (PubMed and Scopus) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study quality was assessed using the MERSQI score for educational research studies, QUACS for cadaveric studies, and the JBI critical appraisal tools for clinical studies. Results: A total of 228 articles were identified in the primary literature review. Following title/abstract screening and full-text review, 46 articles were included in the review. These articles comprised nine studies performed in artificial models, nine cadaveric studies, four clinical case studies, nineteen clinical case series, one clinical case-control study, and four clinical parallel control studies. Teaching applications utilizing holographic overlays are the most intensively studied aspect of AR/VR; the most simulated surgical procedure is pedicle screw placement. Conclusions: VR provides a reproducible and robust medium for surgical training through surgical simulations and for patient education through various platforms. Existing AR/MR platforms enhance the accuracy and precision of spine surgeries and show promise as a surgical adjunct.
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Affiliation(s)
- Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Miguel A. Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Harsh S. Dave
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Ryan Kann
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sofia Lopez-Alviar
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander T. Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Camilo A Molina
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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15
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Adida S, Legarreta AD, Hudson JS, McCarthy D, Andrews E, Shanahan R, Taori S, Lavadi RS, Buell TJ, Hamilton DK, Agarwal N, Gerszten PC. Machine Learning in Spine Surgery: A Narrative Review. Neurosurgery 2024; 94:53-64. [PMID: 37930259 DOI: 10.1227/neu.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023] Open
Abstract
Artificial intelligence and machine learning (ML) can offer revolutionary advances in their application to the field of spine surgery. Within the past 5 years, novel applications of ML have assisted in surgical decision-making, intraoperative imaging and navigation, and optimization of clinical outcomes. ML has the capacity to address many different clinical needs and improve diagnostic and surgical techniques. This review will discuss current applications of ML in the context of spine surgery by breaking down its implementation preoperatively, intraoperatively, and postoperatively. Ethical considerations to ML and challenges in ML implementation must be addressed to maximally benefit patients, spine surgeons, and the healthcare system. Areas for future research in augmented reality and mixed reality, along with limitations in generalizability and bias, will also be highlighted.
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Affiliation(s)
- Samuel Adida
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Andrew D Legarreta
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Joseph S Hudson
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - David McCarthy
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Edward Andrews
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Regan Shanahan
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Suchet Taori
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Raj Swaroop Lavadi
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Thomas J Buell
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Peter C Gerszten
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
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16
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Castille J, Remy S, Vermue H, Victor J. The use of virtual reality to assess the bony landmarks at the knee joint - The role of imaging modality and the assessor's experience. Knee 2024; 46:41-51. [PMID: 38061164 DOI: 10.1016/j.knee.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND At present, extended reality technologies such as virtual reality (VR) have gained popularity in orthopedic surgery. The first aim of this study was to assess the precision of VR and other imaging modalities - computed tomography (CT), magnetic resonance imaging (MRI) - to localize bony landmarks near the knee joint. Secondly, the impact of the educational level of the assessor - medical master students, orthopedic residents, and orthopedic surgeons - on the precision with which landmarks near the knee joint could be localized was analyzed. METHODS We included a total of 77 participants: 62 medical master students, 10 orthopedic residents, and 5 orthopedic surgeons to analyze three cadaver legs. Every participant localized a series of sixteen bony landmarks on six different imaging modalities (CT, MRI, 3D-CT, 3D-MRI, VR-CT, VR-MRI). RESULTS Concerning the imaging modality, the inter- and intra-observer variability were lowest for 3D and VR, higher for MRI (respectively 7.6 mm and 6.9 mm), and highest for CT (respectively 9 mm and 8.7 m).Concerning the educational level of the assessor, inter- and intra-observer variability in VR were lowest for surgeons, (respectively 3.2 mm and 3.6 mm), higher for residents (respectively 5.9 mm and 6.5 mm) and medical students (respectively 5.9 mm and 5.8 mm). CONCLUSIONS VR can be considered a reliable imaging technique. Localization of landmarks tends to be more precise in VR and on 3D than on conventional CT and MRI images. Furthermore, orthopedic surgeons localize landmarks more precisely than orthopedic residents and medical students in VR.
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Affiliation(s)
- Jocelyn Castille
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Stijn Remy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Hannes Vermue
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Jan Victor
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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17
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Xie X, Zhu M, He B, Xu J. Image-guided navigation system for minimally invasive total hip arthroplasty (MITHA) using an improved position-sensing marker. Int J Comput Assist Radiol Surg 2023; 18:2155-2166. [PMID: 36892722 DOI: 10.1007/s11548-023-02861-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Minimally invasive total hip arthroplasty (MITHA) is a treatment for hip arthritis, and it causes less tissue trauma, blood loss, and recovery time. However, the limited incision makes it difficult for surgeons to perceive the instruments' location and orientation. Computer-assisted navigation systems can help improve the medical outcome of MITHA. Directly applying existing navigation systems for MITHA, however, suffers from problems of bulky fiducial marker, severe feature-loss, multiple instruments tracking confusion, and radiation exposure. To tackle these problems, we propose an image-guided navigation system for MITHA using a novel position-sensing marker. METHODS A position-sensing marker is proposed to serve as the fiducial marker with high-density and multi-fold ID tags. It results in less feature span and enables the use of ID for each feature, overcoming the problem of bulky fiducial markers and multiple instruments tracking confusion. And the marker can be recognized even when a large part of locating features is obscured. As for the elimination of intraoperative radiation exposure, we propose a point-based method to achieve patient-image registration based on anatomical landmarks. RESULTS Quantitative experiments are conducted to evaluate the feasibility of our system. The accuracy of instrument positioning is achieved at 0.33 ± 0.18 mm, and that of patient-image registration is achieved at 0.79 ± 0.15 mm. And qualitative experiments are also performed, verifying that our system can be used in compact surgical spatial volume and can address severe feature-loss and tracking confusion problems. In addition, our system does not require any intraoperative medical scans. CONCLUSION Experimental results indicate that our proposed system can assist surgeons without larger space occupations, radiation exposure, and extra incision, showing its potential application value in MITHA.
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Affiliation(s)
- Xianzhong Xie
- School of Mechanical Engineering, Fuzhou University, Fuzhou, 350108, Fujian, China
| | - Mingzhu Zhu
- School of Mechanical Engineering, Fuzhou University, Fuzhou, 350108, Fujian, China.
| | - Bingwei He
- School of Mechanical Engineering, Fuzhou University, Fuzhou, 350108, Fujian, China
| | - Jie Xu
- Department of Orthopedic Surgery, Fujian Provincial Hospital, Fuzhou, 350013, Fujian, China
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18
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Huang X, Liu X, Zhu B, Hou X, Hai B, Li S, Yu D, Zheng W, Li R, Pan J, Yao Y, Dai Z, Zeng H. Evaluation of Augmented Reality Surgical Navigation in Percutaneous Endoscopic Lumbar Discectomy: Clinical Study. Bioengineering (Basel) 2023; 10:1297. [PMID: 38002421 PMCID: PMC10669401 DOI: 10.3390/bioengineering10111297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The puncture procedure in percutaneous endoscopic lumbar discectomy (PELD) is non-visual, and the learning curve for PELD is steep. METHODS An augmented reality surgical navigation (ARSN) system was designed and utilized in PELD. The system possesses three core functionalities: augmented reality (AR) radiograph overlay, AR puncture needle real-time tracking, and AR navigation. We conducted a prospective randomized controlled trial to evaluate its feasibility and effectiveness. A total of 20 patients with lumbar disc herniation treated with PELD were analyzed. Of these, 10 patients were treated with the guidance of ARSN (ARSN group). The remaining 10 patients were treated using C-arm fluoroscopy guidance (control group). RESULTS The AR radiographs and AR puncture needle were successfully superimposed on the intraoperative videos. The anteroposterior and lateral AR tracking distance errors were 1.55 ± 0.17 mm and 1.78 ± 0.21 mm. The ARSN group exhibited a significant reduction in both the number of puncture attempts (2.0 ± 0.4 vs. 6.9 ± 0.5, p = 0.000) and the number of fluoroscopies (10.6 ± 0.9 vs. 18.5 ± 1.6, p = 0.000) compared with the control group. Complications were not observed in either group. CONCLUSIONS The results indicate that the clinical application of the ARSN system in PELD is effective and feasible.
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Affiliation(s)
- Xin Huang
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (X.H.)
| | - Xiaoguang Liu
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (X.H.)
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Beijing 100052, China
| | - Xiangyu Hou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Bao Hai
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Shuiqing Li
- Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China; (X.H.)
| | - Dongfang Yu
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
| | - Wenhao Zheng
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
| | - Ranyang Li
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100191, China
| | - Youjie Yao
- Smart Learning Institute, Beijing Normal University, Beijing 100875, China
| | - Zailin Dai
- Smart Learning Institute, Beijing Normal University, Beijing 100875, China
| | - Haijun Zeng
- Smart Learning Institute, Beijing Normal University, Beijing 100875, China
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Qi Z, Bopp MHA, Nimsky C, Chen X, Xu X, Wang Q, Gan Z, Zhang S, Wang J, Jin H, Zhang J. A Novel Registration Method for a Mixed Reality Navigation System Based on a Laser Crosshair Simulator: A Technical Note. Bioengineering (Basel) 2023; 10:1290. [PMID: 38002414 PMCID: PMC10669875 DOI: 10.3390/bioengineering10111290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Mixed Reality Navigation (MRN) is pivotal in augmented reality-assisted intelligent neurosurgical interventions. However, existing MRN registration methods face challenges in concurrently achieving low user dependency, high accuracy, and clinical applicability. This study proposes and evaluates a novel registration method based on a laser crosshair simulator, evaluating its feasibility and accuracy. A novel registration method employing a laser crosshair simulator was introduced, designed to replicate the scanner frame's position on the patient. The system autonomously calculates the transformation, mapping coordinates from the tracking space to the reference image space. A mathematical model and workflow for registration were designed, and a Universal Windows Platform (UWP) application was developed on HoloLens-2. Finally, a head phantom was used to measure the system's target registration error (TRE). The proposed method was successfully implemented, obviating the need for user interactions with virtual objects during the registration process. Regarding accuracy, the average deviation was 3.7 ± 1.7 mm. This method shows encouraging results in efficiency and intuitiveness and marks a valuable advancement in low-cost, easy-to-use MRN systems. The potential for enhancing accuracy and adaptability in intervention procedures positions this approach as promising for improving surgical outcomes.
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Affiliation(s)
- Ziyu Qi
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany;
| | - Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany;
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany;
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Xiaolei Chen
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
| | - Xinghua Xu
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
| | - Qun Wang
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
| | - Zhichao Gan
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Shiyu Zhang
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Jingyue Wang
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Haitao Jin
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Medical School of Chinese PLA, Beijing 100853, China
- NCO School, Army Medical University, Shijiazhuang 050081, China
| | - Jiashu Zhang
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
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20
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Gharios M, El-Hajj VG, Frisk H, Ohlsson M, Omar A, Edström E, Elmi-Terander A. The use of hybrid operating rooms in neurosurgery, advantages, disadvantages, and future perspectives: a systematic review. Acta Neurochir (Wien) 2023; 165:2343-2358. [PMID: 37584860 PMCID: PMC10477240 DOI: 10.1007/s00701-023-05756-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Hybrid operating rooms (hybrid-ORs) combine the functionalities of a conventional surgical theater with the advanced imaging technologies of a radiological suite. Hybrid-ORs are usually equipped with CBCT devices providing both 2D and 3D imaging capability that can be used for both interventional radiology and image guided surgical applications. Across all fields of surgery, the use of hybrid-ORs is gaining in traction, and neurosurgery is no exception. We hence aimed to comprehensively review the use of hybrid-ORs, the associated advantages, and disadvantages specific to the field of neurosurgery. MATERIALS AND METHODS Electronic databases were searched for all studies on hybrid-ORs from inception to May 2022. Findings of matching studies were pooled to strengthen the current body of evidence. RESULTS Seventy-four studies were included in this review. Hybrid-ORs were mainly used in endovascular surgery (n = 41) and spine surgery (n = 33). Navigation systems were the most common additional technology employed along with the CBCT systems in the hybrid-ORs. Reported advantages of hybrid-ORs included immediate assessment of outcomes, reduced surgical revision rate, and the ability to perform combined open and endovascular procedures, among others. Concerns about increased radiation exposure and procedural time were some of the limitations mentioned. CONCLUSION In the field of neurosurgery, the use of hybrid-ORs for different applications is increasing. Hybrid-ORs provide preprocedure, intraprocedure, and end-of-procedure imaging capabilities, thereby increasing surgical precision, and reducing the need for postoperative imaging and correction surgeries. Despite these advantages, radiation exposure to patient and staff is an important concern.
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Affiliation(s)
- Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurosurgery, Karolinska University Hospital, Eugeniavägen 6, 4Th Floor, Solna, 17164, Stockholm, Sweden.
| | - Henrik Frisk
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Ohlsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Artur Omar
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Bhatt FR, Orosz LD, Tewari A, Boyd D, Roy R, Good CR, Schuler TC, Haines CM, Jazini E. Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws. Global Spine J 2023; 13:2047-2052. [PMID: 35000409 PMCID: PMC10556900 DOI: 10.1177/21925682211069321] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES In spine surgery, accurate screw guidance is critical to achieving satisfactory fixation. Augmented reality (AR) is a novel technology to assist in screw placement and has shown promising results in early studies. This study aims to provide our early experience evaluating safety and efficacy with an Food and Drug Administration-approved head-mounted (head-mounted device augmented reality (HMD-AR)) device. METHODS Consecutive adult patients undergoing AR-assisted thoracolumbar fusion between October 2020 and August 2021 with 2 -week follow-up were included. Preoperative, intraoperative, and postoperative data were collected to include demographics, complications, revision surgeries, and AR performance. Intraoperative 3D imaging was used to assess screw accuracy using the Gertzbein-Robbins (G-R) grading scale. RESULTS Thirty-two patients (40.6% male) were included with a total of 222 screws executed using HMD-AR. Intraoperatively, 4 (1.8%) were deemed misplaced and revised using AR or freehand. The remaining 218 (98.2%) screws were placed accurately. There were no intraoperative adverse events or complications, and AR was not abandoned in any case. Of the 208 AR-placed screws with 3D imaging confirmation, 97.1% were considered clinically accurate (91.8% Grade A, 5.3% Grade B). There were no early postoperative surgical complications or revision surgeries during the 2 -week follow-up. CONCLUSIONS This early experience study reports an overall G-R accuracy of 97.1% across 218 AR-guided screws with no intra or early postoperative complications. This shows that HMD-AR-assisted spine surgery is a safe and accurate tool for pedicle, cortical, and pelvic fixation. Larger studies are needed to continue to support this compelling evolution in spine surgery.
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Affiliation(s)
| | | | - Anant Tewari
- National Spine Health Foundation, Reston, VA, USA
| | - David Boyd
- Reston Radiology Consultants, Reston, VA, USA
| | - Rita Roy
- National Spine Health Foundation, Reston, VA, USA
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Seetohul J, Shafiee M, Sirlantzis K. Augmented Reality (AR) for Surgical Robotic and Autonomous Systems: State of the Art, Challenges, and Solutions. SENSORS (BASEL, SWITZERLAND) 2023; 23:6202. [PMID: 37448050 DOI: 10.3390/s23136202] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023]
Abstract
Despite the substantial progress achieved in the development and integration of augmented reality (AR) in surgical robotic and autonomous systems (RAS), the center of focus in most devices remains on improving end-effector dexterity and precision, as well as improved access to minimally invasive surgeries. This paper aims to provide a systematic review of different types of state-of-the-art surgical robotic platforms while identifying areas for technological improvement. We associate specific control features, such as haptic feedback, sensory stimuli, and human-robot collaboration, with AR technology to perform complex surgical interventions for increased user perception of the augmented world. Current researchers in the field have, for long, faced innumerable issues with low accuracy in tool placement around complex trajectories, pose estimation, and difficulty in depth perception during two-dimensional medical imaging. A number of robots described in this review, such as Novarad and SpineAssist, are analyzed in terms of their hardware features, computer vision systems (such as deep learning algorithms), and the clinical relevance of the literature. We attempt to outline the shortcomings in current optimization algorithms for surgical robots (such as YOLO and LTSM) whilst providing mitigating solutions to internal tool-to-organ collision detection and image reconstruction. The accuracy of results in robot end-effector collisions and reduced occlusion remain promising within the scope of our research, validating the propositions made for the surgical clearance of ever-expanding AR technology in the future.
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Affiliation(s)
- Jenna Seetohul
- Mechanical Engineering Group, School of Engineering, University of Kent, Canterbury CT2 7NT, UK
| | - Mahmood Shafiee
- Mechanical Engineering Group, School of Engineering, University of Kent, Canterbury CT2 7NT, UK
- School of Mechanical Engineering Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Konstantinos Sirlantzis
- School of Engineering, Technology and Design, Canterbury Christ Church University, Canterbury CT1 1QU, UK
- Intelligent Interactions Group, School of Engineering, University of Kent, Canterbury CT2 7NT, UK
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23
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Onuma H, Sakai K, Arai Y, Torigoe I, Tomori M, Sakaki K, Hirai T, Egawa S, Kobayashi Y, Okawa A, Yoshii T. Augmented Reality Support for Anterior Decompression and Fusion Using Floating Method for Cervical Ossification of the Posterior Longitudinal Ligament. J Clin Med 2023; 12:jcm12082898. [PMID: 37109235 PMCID: PMC10143834 DOI: 10.3390/jcm12082898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Anterior decompression and fusion (ADF) using the floating method for cervical ossification of the posterior longitudinal ligament (OPLL) is an ideal surgical technique, but it has a specific risk of insufficient decompression caused by the impingement of residual ossification. Augmented reality (AR) support is a novel technology that enables the superimposition of images onto the view of a surgical field. AR technology was applied to ADF for cervical OPLL to facilitate intraoperative anatomical orientation and OPLL identification. In total, 14 patients with cervical OPLL underwent ADF with microscopic AR support. The outline of the OPLL and the bilateral vertebral arteries was marked after intraoperative CT, and the reconstructed 3D image data were transferred and linked to the microscope. The AR microscopic view enabled us to visualize the ossification outline, which could not be seen directly in the surgical field, and allowed sufficient decompression of the ossification. Neurological disturbances were improved in all patients. No cases of serious complications, such as major intraoperative bleeding or reoperation due to the postoperative impingement of the floating OPLL, were registered. To our knowledge, this is the first report of the introduction of microscopic AR into ADF using the floating method for cervical OPLL with favorable clinical results.
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Affiliation(s)
- Hiroaki Onuma
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Kenichiro Sakai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Yoshiyasu Arai
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Ichiro Torigoe
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Masaki Tomori
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Kyohei Sakaki
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Yutaka Kobayashi
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi-shi 332-8558, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo 113-8519, Japan
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Ruggiero F, Cercenelli L, Emiliani N, Badiali G, Bevini M, Zucchelli M, Marcelli E, Tarsitano A. Preclinical Application of Augmented Reality in Pediatric Craniofacial Surgery: An Accuracy Study. J Clin Med 2023; 12:jcm12072693. [PMID: 37048777 PMCID: PMC10095377 DOI: 10.3390/jcm12072693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Augmented reality (AR) allows the overlapping and integration of virtual information with the real environment. The camera of the AR device reads the object and integrates the virtual data. It has been widely applied to medical and surgical sciences in recent years and has the potential to enhance intraoperative navigation. Materials and methods: In this study, the authors aim to assess the accuracy of AR guidance when using the commercial HoloLens 2 head-mounted display (HMD) in pediatric craniofacial surgery. The Authors selected fronto-orbital remodeling (FOR) as the procedure to test (specifically, frontal osteotomy and nasal osteotomy were considered). Six people (three surgeons and three engineers) were recruited to perform the osteotomies on a 3D printed stereolithographic model under the guidance of AR. By means of calibrated CAD/CAM cutting guides with different grooves, the authors measured the accuracy of the osteotomies that were performed. We tested accuracy levels of ±1.5 mm, ±1 mm, and ±0.5 mm. Results: With the HoloLens 2, the majority of the individuals involved were able to successfully trace the trajectories of the frontal and nasal osteotomies with an accuracy level of ±1.5 mm. Additionally, 80% were able to achieve an accuracy level of ±1 mm when performing a nasal osteotomy, and 52% were able to achieve an accuracy level of ±1 mm when performing a frontal osteotomy, while 61% were able to achieve an accuracy level of ±0.5 mm when performing a nasal osteotomy, and 33% were able to achieve an accuracy level of ±0.5 mm when performing a frontal osteotomy. Conclusions: despite this being an in vitro study, the authors reported encouraging results for the prospective use of AR on actual patients.
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Affiliation(s)
- Federica Ruggiero
- Department of Biomedical and Neuromotor Science, University of Bologna, 40138 Bologna, Italy
- Maxillo-Facial Surgery Unit, AUSL Bologna, 40124 Bologna, Italy
| | - Laura Cercenelli
- Laboratory of Bioengineering—eDIMES Lab, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Nicolas Emiliani
- Laboratory of Bioengineering—eDIMES Lab, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Giovanni Badiali
- Department of Biomedical and Neuromotor Science, University of Bologna, 40138 Bologna, Italy
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Mirko Bevini
- Department of Biomedical and Neuromotor Science, University of Bologna, 40138 Bologna, Italy
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40138 Bologna, Italy
| | - Emanuela Marcelli
- Laboratory of Bioengineering—eDIMES Lab, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Achille Tarsitano
- Department of Biomedical and Neuromotor Science, University of Bologna, 40138 Bologna, Italy
- Oral and Maxillo-Facial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Yamout T, Orosz LD, Good CR, Jazini E, Allen B, Gum JL. Technological Advances in Spine Surgery: Navigation, Robotics, and Augmented Reality. Orthop Clin North Am 2023; 54:237-246. [PMID: 36894295 DOI: 10.1016/j.ocl.2022.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Accurate screw placement is critical to avoid vascular or neurologic complications during spine surgery and to maximize fixation for fusion and deformity correction. Computer-assisted navigation, robotic-guided spine surgery, and augmented reality surgical navigation are currently available technologies that have been developed to improve screw placement accuracy. The advent of multiple generations of new technologies within the past 3 decades has presented surgeons with a diverse array of choices when it comes to pedicle screw placement. Considerations for patient safety and optimal outcomes must be paramount when selecting a technology.
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Affiliation(s)
- Tarek Yamout
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Lindsay D Orosz
- National Spine Health Foundation, 11800 Sunrise Valley Drive, Suite 330, Reston, VA 20191, USA
| | - Christopher R Good
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Ehsan Jazini
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Brandon Allen
- National Spine Health Foundation, 11800 Sunrise Valley Drive, Suite 330, Reston, VA 20191, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, 210 East Gray Street Suite 900, Louisville, KY 40202, USA.
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26
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Clinical applications of augmented reality in orthopaedic surgery: a comprehensive narrative review. INTERNATIONAL ORTHOPAEDICS 2023; 47:375-391. [PMID: 35852653 DOI: 10.1007/s00264-022-05507-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE The development of augmented reality (AR) technology allows orthopaedic surgeons to incorporate and visualize surgical data, assisting the execution of both routine and complex surgical operations. Uniquely, AR technology allows a surgeon to view the surgical field and superimpose peri-operative imaging, anatomical landmarks, navigation guidance, and more, all in one view without the need for conjugate gaze between multiple screens. The aim of this literature review was to introduce the fundamental requirements for an augmented reality system and to assess the current applications, outcomes, and potential limitations to this technology. METHODS A literature search was performed using MEDLINE and Embase databases, by two independent reviewers, who then collaboratively synthesized and collated the results of the literature search into a narrative review focused on the applications of augmented reality in major orthopaedic sub-specialties. RESULTS Current technology requires that pre-operative patient data be acquired, and AR-compatible models constructed. Intra-operatively, to produce manipulatable virtual images into the user's view in real time, four major components are required including a camera, computer image processing technology, tracking tools, and an output screen. The user is provided with a heads-up display, which is a transparent display, enabling the user to look at both their natural view and the computer-generated images. Currently, high-quality evidence for clinical implementation of AR technology in the orthopaedic surgery operating room is lacking; however, growing in vitro literature highlights a multitude of potential applications, including increasing operative accuracy, improved biomechanical angular and alignment parameters, and potentially reduced operative time. CONCLUSION While the application of AR systems in surgery is currently in its infancy, we anticipate rapid and widespread implementation of this technology in various orthopaedic sub-specialties.
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27
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Jiang J, Zhang J, Sun J, Wu D, Xu S. User's image perception improved strategy and application of augmented reality systems in smart medical care: A review. Int J Med Robot 2023; 19:e2497. [PMID: 36629798 DOI: 10.1002/rcs.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/26/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Augmented reality (AR) is a new human-computer interaction technology that combines virtual reality, computer vision, and computer networks. With the rapid advancement of the medical field towards intelligence and data visualisation, AR systems are becoming increasingly popular in the medical field because they can provide doctors with clear enough medical images and accurate image navigation in practical applications. However, it has been discovered that different display types of AR systems have different effects on doctors' perception of the image after virtual-real fusion during the actual medical application. If doctors cannot correctly perceive the image, they may be unable to correctly match the virtual information with the real world, which will have a significant impact on their ability to recognise complex structures. METHODS This paper uses Citespace, a literature analysis tool, to visualise and analyse the research hotspots when AR systems are used in the medical field. RESULTS A visual analysis of the 1163 articles retrieved from the Web of Science Core Collection database reveals that display technology and visualisation technology are the key research directions of AR systems at the moment. CONCLUSION This paper categorises AR systems based on their display principles, reviews current image perception optimisation schemes for various types of systems, and analyses and compares different display types of AR systems based on their practical applications in the field of smart medical care so that doctors can select the appropriate display types based on different application scenarios. Finally, the future development direction of AR display technology is anticipated in order for AR technology to be more effectively applied in the field of smart medical care. The advancement of display technology for AR systems is critical for their use in the medical field, and the advantages and disadvantages of various display types should be considered in different application scenarios to select the best AR system.
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Affiliation(s)
- Jingang Jiang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China.,Robotics & Its Engineering Research Center, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Jiawei Zhang
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Jianpeng Sun
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Dianhao Wu
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China
| | - Shuainan Xu
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, Heilongjiang, China
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28
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Shaikh TA, Dar TR, Sofi S. A data-centric artificial intelligent and extended reality technology in smart healthcare systems. SOCIAL NETWORK ANALYSIS AND MINING 2022; 12:122. [PMID: 36065420 PMCID: PMC9434088 DOI: 10.1007/s13278-022-00888-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
Extended reality (XR) solutions are quietly maturing, and their novel use cases are already being investigated, particularly in the healthcare industry. By 2022, the extended reality market is anticipated to be worth $209 billion. Certain diseases, such as Alzheimer's, Schizophrenia, Stroke rehabilitation stimulating specific areas of the patient's brain, healing brain injuries, surgeon training, realistic 3D visualization, touch-free interfaces, and teaching social skills to children with autism, have shown promising results with XR-assisted treatments. Similar effects have been used in video game therapies like Akili Interactive's EndeavorRx, which has previously been approved by the Food and Drug Administration (FDA) as a treatment regimen for children with attention deficit hyperactivity disorder (ADHD). However, while these improvements have received positive feedback, the field of XR-assisted patient treatment is in its infancy. The growth of XR in the healthcare sphere has the potential to transform the delivery of medical services. Imagine an elderly patient in a remote setting having a consultation with a world-renowned expert without ever having to leave their house. Rather than operating on cadavers in a medical facility, a surgical resident does surgery in a virtual setting at home. On the first try, a nurse uses a vein finder to implant an IV. Through cognitive treatment in a virtual world, a war veteran recovers from post-traumatic stress disorder (PTSD). The paper discusses the potential impact of XR in transforming the healthcare industry, as well as its use cases, challenges, XR tools and techniques for intelligent health care, recent developments of XR in intelligent healthcare services, and the potential benefits and future aspects of XR techniques in the medical domain.
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29
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Hagan MJ, Remacle T, Leary OP, Feler J, Shaaya E, Ali R, Zheng B, Bajaj A, Traupe E, Kraus M, Zhou Y, Fridley JS, Lewandrowski KU, Telfeian AE. Navigation Techniques in Endoscopic Spine Surgery. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8419739. [PMID: 36072476 PMCID: PMC9444441 DOI: 10.1155/2022/8419739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022]
Abstract
Endoscopic spine surgery (ESS) advances the principles of minimally invasive surgery, including minor collateral tissue damage, reduced blood loss, and faster recovery times. ESS allows for direct access to the spine through small incisions and direct visualization of spinal pathology via an endoscope. While this technique has many applications, there is a steep learning curve when adopting ESS into a surgeon's practice. Two types of navigation, optical and electromagnetic, may allow for widespread utilization of ESS by engendering improved orientation to surgical anatomy and reduced complication rates. The present review discusses these two available navigation technologies and their application in endoscopic procedures by providing case examples. Furthermore, we report on the future directions of navigation within the discipline of ESS.
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Affiliation(s)
- Matthew J. Hagan
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Thibault Remacle
- Department of Neurosurgery, CHR Citadelle, Bd du 12eme de Ligne, 1, 4000 Liege, Belgium
| | - Owen P. Leary
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, USA
| | - Joshua Feler
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, USA
| | - Elias Shaaya
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, USA
| | - Rohaid Ali
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, USA
| | - Bryan Zheng
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Ankush Bajaj
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Erik Traupe
- Helios Weißeritztal Clinics, Bürgerstraße 7, 01705 Freital, Germany
| | - Michael Kraus
- ORTHix Zentrum für Orthopädie, Stadtberger Str. 21, 86157 Augsburg, Germany
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jared S. Fridley
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
- Department of Neurosurgery, Warren Alpert School of Medicine of Brown University, 593 Eddy Street, APC 6, Providence, RI 02903, USA
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, The Surgical Institute of Tucson, 4787 E Camp Lowell Dr, Tucson, AZ 85712, USA
| | - Albert E. Telfeian
- Warren Alpert School of Medicine of Brown University, 222 Richmond Street, Providence, RI 02903, USA
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30
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Boaro A, Moscolo F, Feletti A, Polizzi G, Nunes S, Siddi F, Broekman M, Sala F. Visualization, navigation, augmentation. The ever-changing perspective of the neurosurgeon. BRAIN & SPINE 2022; 2:100926. [PMID: 36248169 PMCID: PMC9560703 DOI: 10.1016/j.bas.2022.100926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/23/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022]
Abstract
Introduction The evolution of neurosurgery coincides with the evolution of visualization and navigation. Augmented reality technologies, with their ability to bring digital information into the real environment, have the potential to provide a new, revolutionary perspective to the neurosurgeon. Research question To provide an overview on the historical and technical aspects of visualization and navigation in neurosurgery, and to provide a systematic review on augmented reality (AR) applications in neurosurgery. Material and methods We provided an overview on the main historical milestones and technical features of visualization and navigation tools in neurosurgery. We systematically searched PubMed and Scopus databases for AR applications in neurosurgery and specifically discussed their relationship with current visualization and navigation systems, as well as main limitations. Results The evolution of visualization in neurosurgery is embodied by four magnification systems: surgical loupes, endoscope, surgical microscope and more recently the exoscope, each presenting independent features in terms of magnification capabilities, eye-hand coordination and the possibility to implement additional functions. In regard to navigation, two independent systems have been developed: the frame-based and the frame-less systems. The most frequent application setting for AR is brain surgery (71.6%), specifically neuro-oncology (36.2%) and microscope-based (29.2%), even though in the majority of cases AR applications presented their own visualization supports (66%). Discussion and conclusions The evolution of visualization and navigation in neurosurgery allowed for the development of more precise instruments; the development and clinical validation of AR applications, have the potential to be the next breakthrough, making surgeries safer, as well as improving surgical experience and reducing costs.
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Affiliation(s)
- A. Boaro
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - F. Moscolo
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - A. Feletti
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - G.M.V. Polizzi
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - S. Nunes
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - F. Siddi
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, the Netherlands
| | - M.L.D. Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - F. Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
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31
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Accuracy Assessment of Percutaneous Pedicle Screw Placement Using Cone Beam Computed Tomography with Metal Artifact Reduction. SENSORS 2022; 22:s22124615. [PMID: 35746396 PMCID: PMC9228786 DOI: 10.3390/s22124615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022]
Abstract
Metal artifact reduction (MAR) algorithms are used with cone beam computed tomography (CBCT) during augmented reality surgical navigation for minimally invasive pedicle screw instrumentation. The aim of this study was to assess intra- and inter-observer reliability of pedicle screw placement and to compare the perception of baseline image quality (NoMAR) with optimized image quality (MAR). CBCT images of 24 patients operated on for degenerative spondylolisthesis using minimally invasive lumbar fusion were analyzed retrospectively. Images were treated using NoMAR and MAR by an engineer, thus creating 48 randomized files, which were then independently analyzed by 3 spine surgeons and 3 radiologists. The Gertzbein and Robins classification was used for screw accuracy rating, and an image quality scale rated the clarity of pedicle screw and bony landmark depiction. Intra-class correlation coefficients (ICC) were calculated. NoMAR and MAR led to similarly good intra-observer (ICC > 0.6) and excellent inter-observer (ICC > 0.8) assessment reliability of pedicle screw placement accuracy. The image quality scale showed more variability in individual image perception between spine surgeons and radiologists (ICC range 0.51−0.91). This study indicates that intraoperative screw positioning can be reliably assessed on CBCT for augmented reality surgical navigation when using optimized image quality. Subjective image quality was rated slightly superior for MAR compared to NoMAR.
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Augmented Reality-Assisted Percutaneous Pedicle Screw Instrumentation: A Cadaveric Feasibility and Accuracy Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Percutaneous pedicle screw instrumentation is the keystone of minimally invasive spine surgery. Percutaneous screw placement demands experience and relies greatly on intra-operative image guidance. This study aims to validate the feasibility and accuracy of augmented-reality (AR)-assisted percutaneous pedicle screw instrumentation. One cadaveric torso was prepared for this study. After a pre-operative computed tomography (CT) scan, the images were transferred to an AR station to generate a 3D hologram. The 3D hologram and navigation images were projected to a pair of goggles with a display screen. With registration, the 3D spine hologram was overlayed onto the cadaver. Bilateral instrumentation from T6 to L5 was performed by two surgeons using AR assistance. A post-operative CT scan was obtained. The Gertzbein–Robbins scale (grade 0–3) was used for accuracy assessment. A total of 24 screws were placed. The overall screw accuracy was 87.5%. There were three major medial breaches that occurred on Rt T6/7/8, which were the most distant screws from the iliac reference. The cause of the three major medial breaches appeared to be related to their distance from the iliac reference. AR-assisted percutaneous pedicle screw instrumentation could improve anatomical visualization, facilitate surgical workflow, and provide an intuitive way of performing surgery.
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Augmented Reality: Mapping Methods and Tools for Enhancing the Human Role in Healthcare HMI. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Augmented Reality (AR) represents an innovative technology to improve data visualization and strengthen the human perception. Among Human–Machine Interaction (HMI), medicine can benefit most from the adoption of these digital technologies. In this perspective, the literature on orthopedic surgery techniques based on AR was evaluated, focusing on identifying the limitations and challenges of AR-based healthcare applications, to support the research and the development of further studies. Methods: Studies published from January 2018 to December 2021 were analyzed after a comprehensive search on PubMed, Google Scholar, Scopus, IEEE Xplore, Science Direct, and Wiley Online Library databases. In order to improve the review reporting, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used. Results: Authors selected sixty-two articles meeting the inclusion criteria, which were categorized according to the purpose of the study (intraoperative, training, rehabilitation) and according to the surgical procedure used. Conclusions: AR has the potential to improve orthopedic training and practice by providing an increasingly human-centered clinical approach. Further research can be addressed by this review to cover problems related to hardware limitations, lack of accurate registration and tracking systems, and absence of security protocols.
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Liu Y, Lee MG, Kim JS. Spine Surgery Assisted by Augmented Reality: Where Have We Been? Yonsei Med J 2022; 63:305-316. [PMID: 35352881 PMCID: PMC8965436 DOI: 10.3349/ymj.2022.63.4.305] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022] Open
Abstract
This present systematic review examines spine surgery literature supporting augmented reality (AR) technology and summarizes its current status in spinal surgery technology. Database search strategies were retrieved from PubMed, Web of Science, Cochrane Library, Embase, from the earliest records to April 1, 2021. Our review briefly examines the history of AR, and enumerates different device application workflows in a variety of spinal surgeries. We also sort out the pros and cons of current mainstream AR devices and the latest updates. A total of 45 articles are included in our review. The most prevalent surgical applications included are the augmented reality surgical navigation system and head-mounted display. The most popular application of AR is pedicle screw instrumentation in spine surgery, and the primary responsible surgical levels are thoracic and lumbar. AR guidance systems show high potential value in practical clinical applications for the spine. The overall number of cases in AR-related studies is still rare compared to traditional surgical-assisted techniques. These lack long-term clinical efficacy and robust surgical-related statistical data. Changing healthcare laws as well as the increasing prevalence of spinal surgery are generating critical data that determines the value of AR technology.
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Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gi Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Karandikar P, Massaad E, Hadzipasic M, Kiapour A, Joshi RS, Shankar GM, Shin JH. Machine Learning Applications of Surgical Imaging for the Diagnosis and Treatment of Spine Disorders: Current State of the Art. Neurosurgery 2022; 90:372-382. [PMID: 35107085 DOI: 10.1227/neu.0000000000001853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/10/2021] [Indexed: 01/18/2023] Open
Abstract
Recent developments in machine learning (ML) methods demonstrate unparalleled potential for application in the spine. The ability for ML to provide diagnostic faculty, produce novel insights from existing capabilities, and augment or accelerate elements of surgical planning and decision making at levels equivalent or superior to humans will tremendously benefit spine surgeons and patients alike. In this review, we aim to provide a clinically relevant outline of ML-based technology in the contexts of spinal deformity, degeneration, and trauma, as well as an overview of commercial-level and precommercial-level surgical assist systems and decisional support tools. Furthermore, we briefly discuss potential applications of generative networks before highlighting some of the limitations of ML applications. We conclude that ML in spine imaging represents a significant addition to the neurosurgeon's armamentarium-it has the capacity to directly address and manifest clinical needs and improve diagnostic and procedural quality and safety-but is yet subject to challenges that must be addressed before widespread implementation.
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Affiliation(s)
- Paramesh Karandikar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- T.H. Chan School of Medicine, University of Massachusetts, Worcester, Massachusetts, USA
| | - Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhamed Hadzipasic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Kiapour
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rushikesh S Joshi
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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What Is the Superior Screw Fixation Technique for Posterior Decompression and Fusion in the Management of Cervical Spondylotic Myelopathy: Pedicle Screw or Lateral Mass Screw? Clin Spine Surg 2022; 35:91-94. [PMID: 33264127 DOI: 10.1097/bsd.0000000000001118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
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Spenkelink IM, Heidkamp J, Fütterer JJ, Rovers MM. Image-guided procedures in the hybrid operating room: A systematic scoping review. PLoS One 2022; 17:e0266341. [PMID: 35363811 PMCID: PMC8975112 DOI: 10.1371/journal.pone.0266341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The shift from open to minimally invasive procedures with growing complexity has increased the demand for advanced intraoperative medical technologies. The hybrid operating room (OR) combines the functionality of a standard OR with fixed advanced imaging systems to facilitate minimally invasive image-guided procedures. OBJECTIVE This systematic scoping review provides an overview of the use of the hybrid OR over the years, and reports on the encountered advantages and challenges. METHODS We conducted a systematic search in PubMed, Embase, Web of Science, and Cochrane library databases for studies that described procedures being performed with the aid of 3D imaging in the hybrid OR. RESULTS The search identified 123 studies that described 44 distinct procedures, divided over nine clinical disciplines. The number of studies increased from two in 2010 to 15 in the first five months of 2020. Ninety-nine (80%) of the studies described how 3D imaging was performed in the hybrid OR; 95 (96%) used cone-beam CT; four (4%) used multi-detector CT. Advantages and challenges of the hybrid OR were described in 94 (76%) and 34 (35%) studies, respectively. The most frequently reported advantage of using a hybrid OR is the achievement of more accurate treatment results, whereas elongation of the procedure time is the most important challenge, followed by an increase in radiation dose. CONCLUSION In conclusion, the growing number of clinical disciplines that uses the hybrid OR shows its wide functionality. To optimize its use, future comparative studies should be conducted to investigate which procedures really benefit from being performed in the hybrid OR.
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Affiliation(s)
- Ilse M. Spenkelink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Heidkamp
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J. Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M. Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Intraoperative Navigation in Plastic Surgery with Augmented Reality: A Preclinical Validation Study. Plast Reconstr Surg 2022; 149:573e-580e. [PMID: 35196700 DOI: 10.1097/prs.0000000000008875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Augmented reality allows users to visualize and interact with digital images including three-dimensional holograms in the real world. This technology may have value intraoperatively by improving surgical decision-making and precision but relies on the ability to accurately align a hologram to a patient. This study aims to quantify the accuracy with which a hologram of soft tissue can be aligned to a patient and used to guide intervention. METHODS A mannequin's face was marked in a standardized fashion with 14 incision patterns in red and nine reference points in blue. A three-dimensional photograph was then taken, converted into a hologram, and uploaded to HoloLens (Verto Studio LLC, San Diego, Calif.), a wearable augmented reality device. The red markings were then erased, leaving only the blue points. The hologram was then viewed through the HoloLens in augmented reality and aligned onto the mannequin. The user then traced the overlaid red markings present on the hologram. Three-dimensional photographs of the newly marked mannequin were then taken and compared with the baseline three-dimensional photographs of the mannequin for accuracy of the red markings. This process was repeated for 15 trials (n = 15). RESULTS The accuracy of the augmented reality-guided intervention, when considering all trials, was 1.35 ± 0.24 mm. Markings that were positioned laterally on the face were significantly more difficult to reproduce than those centered around the facial midline. CONCLUSIONS Holographic markings can be accurately translated onto a mannequin with an average error of less than 1.4 mm. These data support the notion that augmented reality navigation may be practical and reliable for clinical integration in plastic surgery.
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Feasibility and Accuracy of Thoracolumbar Pedicle Screw Placement Using an Augmented Reality Head Mounted Device. SENSORS 2022; 22:s22020522. [PMID: 35062483 PMCID: PMC8779462 DOI: 10.3390/s22020522] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023]
Abstract
Background: To investigate the accuracy of augmented reality (AR) navigation using the Magic Leap head mounted device (HMD), pedicle screws were minimally invasively placed in four spine phantoms. Methods: AR navigation provided by a combination of a conventional navigation system integrated with the Magic Leap head mounted device (AR-HMD) was used. Forty-eight screws were planned and inserted into Th11-L4 of the phantoms using the AR-HMD and navigated instruments. Postprocedural CT scans were used to grade the technical (deviation from the plan) and clinical (Gertzbein grade) accuracy of the screws. The time for each screw placement was recorded. Results: The mean deviation between navigation plan and screw position was 1.9 ± 0.7 mm (1.9 [0.3–4.1] mm) at the entry point and 1.4 ± 0.8 mm (1.2 [0.1–3.9] mm) at the screw tip. The angular deviation was 3.0 ± 1.4° (2.7 [0.4–6.2]°) and the mean time for screw placement was 130 ± 55 s (108 [58–437] s). The clinical accuracy was 94% according to the Gertzbein grading scale. Conclusion: The combination of an AR-HMD with a conventional navigation system for accurate minimally invasive screw placement is feasible and can exploit the benefits of AR in the perspective of the surgeon with the reliability of a conventional navigation system.
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Augmented Reality (AR) in Orthopedics: Current Applications and Future Directions. Curr Rev Musculoskelet Med 2021; 14:397-405. [PMID: 34751894 DOI: 10.1007/s12178-021-09728-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Imaging technologies (X-ray, CT, MRI, and ultrasound) have revolutionized orthopedic surgery, allowing for the more efficient diagnosis, monitoring, and treatment of musculoskeletal aliments. The current review investigates recent literature surrounding the impact of augmented reality (AR) imaging technologies on orthopedic surgery. In particular, it investigates the impact that AR technologies may have on provider cognitive burden, operative times, occupational radiation exposure, and surgical precision and outcomes. RECENT FINDINGS Many AR technologies have been shown to lower provider cognitive burden and reduce operative time and radiation exposure while improving surgical precision in pre-clinical cadaveric and sawbones models. So far, only a few platforms focusing on pedicle screw placement have been approved by the FDA. These technologies have been implemented clinically with mixed results when compared to traditional free-hand approaches. It remains to be seen if current AR technologies can deliver upon their multitude of promises, and the ability to do so seems contingent upon continued technological progress. Additionally, the impact of these platforms will likely be highly conditional on clinical indication and provider type. It remains unclear if AR will be broadly accepted and utilized or if it will be reserved for niche indications where it adds significant value. One thing is clear, orthopedics' high utilization of pre- and intra-operative imaging, combined with the relative ease of tracking rigid structures like bone as compared to soft tissues, has made it the clear beachhead market for AR technologies in medicine.
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Takahashi T, Watanabe S, Ito T. Current and future of anterior cruciate ligament reconstruction techniques. World J Meta-Anal 2021; 9:411-437. [DOI: 10.13105/wjma.v9.i5.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/09/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
In recent years, anterior cruciate ligament (ACL) reconstruction has generally yielded favorable outcomes. However, ACL reconstruction has not provided satisfactory results in terms of the rate of returning to sports and prevention of osteoarthritis (OA) progression. In this paper, we outline current techniques for ACL reconstruction such as graft materials, double-bundle or single-bundle reconstruction, femoral tunnel drilling, all-inside technique, graft fixation, preservation of remnant, anterolateral ligament reconstruction, ACL repair, revision surgery, treatment for ACL injury with OA and problems, and discuss expected future trends. To enable many more orthopedic surgeons to achieve excellent ACL reconstruction outcomes with less invasive surgery, further studies aimed at improving surgical techniques are warranted. Further development of biological augmentation and robotic surgery technologies for ACL reconstruction is also required.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Ehime University, Matsuyama 790-8577, Ehime, Japan
| | - Seiji Watanabe
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Toshio Ito
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Saijo 793-0030, Ehime, Japan
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Augmented and virtual reality in spine surgery, current applications and future potentials. Spine J 2021; 21:1617-1625. [PMID: 33774210 DOI: 10.1016/j.spinee.2021.03.018] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The field of artificial intelligence (AI) is rapidly advancing, especially with recent improvements in deep learning (DL) techniques. Augmented (AR) and virtual reality (VR) are finding their place in healthcare, and spine surgery is no exception. The unique capabilities and advantages of AR and VR devices include their low cost, flexible integration with other technologies, user-friendly features and their application in navigation systems, which makes them beneficial across different aspects of spine surgery. Despite the use of AR for pedicle screw placement, targeted cervical foraminotomy, bone biopsy, osteotomy planning, and percutaneous intervention, the current applications of AR and VR in spine surgery remain limited. PURPOSE The primary goal of this study was to provide the spine surgeons and clinical researchers with the general information about the current applications, future potentials, and accessibility of AR and VR systems in spine surgery. STUDY DESIGN/SETTING We reviewed titles of more than 250 journal papers from google scholar and PubMed with search words: augmented reality, virtual reality, spine surgery, and orthopaedic, out of which 89 related papers were selected for abstract review. Finally, full text of 67 papers were analyzed and reviewed. METHODS The papers were divided into four groups: technological papers, applications in surgery, applications in spine education and training, and general application in orthopaedic. A team of two reviewers performed paper reviews and a thorough web search to ensure the most updated state of the art in each of four group is captured in the review. RESULTS In this review we discuss the current state of the art in AR and VR hardware, their preoperative applications and surgical applications in spine surgery. Finally, we discuss the future potentials of AR and VR and their integration with AI, robotic surgery, gaming, and wearables. CONCLUSIONS AR and VR are promising technologies that will soon become part of standard of care in spine surgery.
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Cong T, Sivaganesan A, Mikhail CM, Vaishnav AS, Dowdell J, Barbera J, Kumagai H, Markowitz J, Sheha E, Qureshi SA. Facet Violation With Percutaneous Pedicle Screw Placement: Impact of 3D Navigation and Facet Orientation. HSS J 2021; 17:281-288. [PMID: 34539268 PMCID: PMC8436351 DOI: 10.1177/15563316211026324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The gold standard for percutaneous pedicle screw placement is 2-dimensional (2D) fluoroscopy. Data are sparse on the accuracy of 3-dimensional (3D) navigation percutaneous screw placement in minimally invasive spine procedures. Objective: We sought to compare a single surgeon's percutaneous pedicle screw placement accuracy using 2D fluoroscopy versus 3D navigation, as well as to investigate the effect of facet orientation on facet violation when using 2D fluoroscopy. Methods: We conducted a retrospective radiographic study of consecutive cohort of patients who underwent percutaneous lumbar instrumentation using either 2D fluoroscopy or 3D navigation. All procedures were performed by a single surgeon at 2 academic institutions between 2011 and 2018. Radiographic measurement of screw accuracy was assessed using a postoperative computed tomographic scan. The primary outcome was facet violation, and secondary outcomes were endplate/tip breaches, the Gertzbein-Robbins classification for cortical breaches, and the Simplified Screw Accuracy grade. Statistical comparisons were made between screws placed using 2D fluoroscopy versus 3D navigation. Axial facet angles were also measured to correlate with facet violation rates. Results: In the 138 patients included, 376 screws were placed with fluoroscopy and 193 with navigation. Superior (unfused) level facet violation was higher with 2D fluoroscopy than with 3D navigation (9% vs 0.5%), which comprises the main cause for poor screw placement. Axial facet angles exceeding 45° at L4 and 60° at L5 were correlated with facet violations. Conclusion: This retrospective study found that 3D navigation is associated with lower facet violation rates in percutaneous lumbar pedicle screw placement when compared with 2D fluoroscopy. These findings suggest that 3D navigation may be of particular value when facet joints are coronally oriented.
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Affiliation(s)
- Ting Cong
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Joseph Barbera
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Evan Sheha
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Wessels L, Komm B, Bohner G, Vajkoczy P, Hecht N. Spinal alignment shift between supine and prone CT imaging occurs frequently and regardless of the anatomic region, risk factors, or pathology. Neurosurg Rev 2021; 45:855-863. [PMID: 34379226 PMCID: PMC8827393 DOI: 10.1007/s10143-021-01618-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/25/2021] [Indexed: 11/05/2022]
Abstract
Computer-assisted spine surgery based on preoperative CT imaging may be hampered by sagittal alignment shifts due to an intraoperative switch from supine to prone. In the present study, we systematically analyzed the occurrence and pattern of sagittal spinal alignment shift between corresponding preoperative (supine) and intraoperative (prone) CT imaging in patients that underwent navigated posterior instrumentation between 2014 and 2017. Sagittal alignment across the levels of instrumentation was determined according to the C2 fracture gap (C2-F) and C2 translation (C2-T) in odontoid type 2 fractures, next to the modified Cobb angle (CA), plumbline (PL), and translation (T) in subaxial pathologies. One-hundred and twenty-one patients (C1/C2: n = 17; C3-S1: n = 104) with degenerative (39/121; 32%), oncologic (35/121; 29%), traumatic (34/121; 28%), or infectious (13/121; 11%) pathologies were identified. In the subaxial spine, significant shift occurred in 104/104 (100%) cases (CA: *p = .044; T: *p = .021) compared to only 10/17 (59%) cases that exhibited shift at the C1/C2 level (C2-F: **p = .002; C2-T: *p < .016). The degree of shift was not affected by the anatomic region or pathology but significantly greater in cases with an instrumentation length > 5 segments (“∆PL > 5 segments”: 4.5 ± 1.8 mm; “∆PL ≤ 5 segments”: 2 ± 0.6 mm; *p = .013) or in revision surgery with pre-existing instrumentation (“∆PL presence”: 5 ± 2.6 mm; “∆PL absence”: 2.4 ± 0.7 mm; **p = .007). Interestingly, typical morphological instability risk factors did not influence the degree of shift. In conclusion, intraoperative spinal alignment shift due to a change in patient position should be considered as a cause for inaccuracy during computer-assisted spine surgery and when correcting spinal alignment according to parameters that were planned in other patient positions.
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Affiliation(s)
- Lars Wessels
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bettina Komm
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Georg Bohner
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Nils Hecht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Augmented reality-navigated pedicle screw placement: a cadaveric pilot study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3731-3737. [PMID: 34350487 DOI: 10.1007/s00586-021-06950-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/04/2020] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Augmented reality (AR) is an emerging technology with great potential for surgical navigation through its ability to provide 3D holographic projection of otherwise hidden anatomical information. This pilot cadaver study investigated the feasibility and accuracy of one of the first holographic navigation techniques for lumbar pedicle screw placement. METHODS Lumbar computer tomography scans (CT) of two cadaver specimens and their reconstructed 3D models were used for pedicle screw trajectory planning. Planned trajectories and 3D models were subsequently uploaded to an AR head-mounted device. Randomly, k-wires were placed either into the left or the right pedicle of a vertebra (L1-5) with or without AR-navigation (by holographic projection of the planned trajectory). CT-scans were subsequently performed to assess accuracy of both techniques. RESULTS A total of 18 k-wires could be placed (8 navigated, 10 free hand) by two experienced spine surgeons. In two vertebrae, the AR-navigation was aborted because the registration of the preoperative plan with the intraoperative anatomy was imprecise due to a technical failure. The average differences of the screw entry points between planning and execution were 4.74 ± 2.37 mm in the freehand technique and 5.99 ± 3.60 mm in the AR-navigated technique (p = 0.39). The average deviation from the planned trajectories was 11.21° ± 7.64° in the freehand technique and 5.88° ± 3.69° in the AR-navigated technique (p = 0.09). CONCLUSION This pilot study demonstrates improved angular precision in one of the first AR-navigated pedicle screw placement studies worldwide. Technical shortcomings need to be eliminated before potential clinical applications.
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Ivan ME, Eichberg DG, Di L, Shah AH, Luther EM, Lu VM, Komotar RJ, Urakov TM. Augmented reality head-mounted display-based incision planning in cranial neurosurgery: a prospective pilot study. Neurosurg Focus 2021; 51:E3. [PMID: 34333466 DOI: 10.3171/2021.5.focus20735] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Monitor and wand-based neuronavigation stations (MWBNSs) for frameless intraoperative neuronavigation are routinely used in cranial neurosurgery. However, they are temporally and spatially cumbersome; the OR must be arranged around the MWBNS, at least one hand must be used to manipulate the MWBNS wand (interrupting a bimanual surgical technique), and the surgical workflow is interrupted as the surgeon stops to "check the navigation" on a remote monitor. Thus, there is need for continuous, real-time, hands-free, neuronavigation solutions. Augmented reality (AR) is poised to streamline these issues. The authors present the first reported prospective pilot study investigating the feasibility of using the OpenSight application with an AR head-mounted display to map out the borders of tumors in patients undergoing elective craniotomy for tumor resection, and to compare the degree of correspondence with MWBNS tracing. METHODS Eleven consecutive patients undergoing elective craniotomy for brain tumor resection were prospectively identified and underwent circumferential tumor border tracing at the time of incision planning by a surgeon wearing HoloLens AR glasses running the commercially available OpenSight application registered to the patient and preoperative MRI. Then, the same patient underwent circumferential tumor border tracing using the StealthStation S8 MWBNS. Postoperatively, both tumor border tracings were compared by two blinded board-certified neurosurgeons and rated as having an excellent, adequate, or poor correspondence degree based on a subjective sense of the overlap. Objective overlap area measurements were also determined. RESULTS Eleven patients undergoing craniotomy were included in the study. Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence. Both raters agreed on the rating in all cases. AR tracing was possible in all cases. CONCLUSIONS In this small pilot study, the authors found that AR was implementable in the workflow of a neurosurgery OR, and was a feasible method of preoperative tumor border identification for incision planning. Future studies are needed to identify strategies to improve and optimize AR accuracy.
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Affiliation(s)
- Michael E Ivan
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and.,2Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Daniel G Eichberg
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Long Di
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Ashish H Shah
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Evan M Luther
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Victor M Lu
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and
| | - Ricardo J Komotar
- 1Department of Neurological Surgery, University of Miami Miller School of Medicine; and.,2Sylvester Comprehensive Cancer Center, Miami, Florida
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A Novel Precise Optical Navigation System for Craniomaxillofacial Surgery Registered With an Occlusal Splint. J Craniofac Surg 2021; 33:344-349. [PMID: 34260445 PMCID: PMC8694255 DOI: 10.1097/scs.0000000000007833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND An augmented reality tool allows visual tracking of real anatomical structures and superimposing virtual images, so it can be used for navigation of important structures during surgery. OBJECTIVES The authors have developed a new occlusal splint-based optical navigation system for craniomaxillofacial surgery. In this study, the authors aim to measure the accuracy of the system and further analyze the main factors influencing precision. METHODS Ten beagle dogs were selected and a three-dimensional model was established through computed tomography scanning, dental model making, and laser scanning, and then registration was performed according to the tooth marking points. The bilateral mandibular osteotomy was performed on Beagle dogs under navigation system based on the occlusal splint. The left side was taken to compare the deviation between the preoperative plan and the surgical results, and the accuracy of distance and angle and the stability of the system were analyzed. RESULTS The average position deviation between the preoperative design and intraoperative navigation was: 0.01 ± 0.73 mm on the lateral height of the mandibular ramus, 0.26 ± 0.57 mm on the inner height of the mandibular ramus, and 0.20 ± 0.51 mm on the osteotomy length. The average angle deviation is 0.94° ± 1.38° on the angle between the mandibular osteotomy plane and ramus plane and 0.66° ± 0.97° on the angle of the retained mandibular angle. And most of the data showed good consistency. CONCLUSIONS In summary, the accuracy of the system can meet clinical requirements and can be used as a useful tool to improve the accuracy of craniomaxillofacial surgery.
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Godzik J, Farber SH, Urakov T, Steinberger J, Knipscher LJ, Ehredt RB, Tumialán LM, Uribe JS. "Disruptive Technology" in Spine Surgery and Education: Virtual and Augmented Reality. Oper Neurosurg (Hagerstown) 2021; 21:S85-S93. [PMID: 34128065 DOI: 10.1093/ons/opab114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/04/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Technological advancements are the drivers of modern-day spine care. With the growing pressure to deliver faster and better care, surgical-assist technology is needed to harness computing power and enable the surgeon to improve outcomes. Virtual reality (VR) and augmented reality (AR) represent the pinnacle of emerging technology, not only to deliver higher quality education through simulated care, but also to provide valuable intraoperative information to assist in more efficient and more precise surgeries. OBJECTIVE To describe how the disruptive technologies of VR and AR interface in spine surgery and education. METHODS We review the relevance of VR and AR technologies in spine care, and describe the feasibility and limitations of the technologies. RESULTS We discuss potential future applications, and provide a case study demonstrating the feasibility of a VR program for neurosurgical spine education. CONCLUSION Initial experiences with VR and AR technologies demonstrate their applicability and ease of implementation. However, further prospective studies through multi-institutional and industry-academic partnerships are necessary to solidify the future of VR and AR in spine surgery education and clinical practice.
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Affiliation(s)
- Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Timur Urakov
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Jeremy Steinberger
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Liza J Knipscher
- Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ryan B Ehredt
- Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Luis M Tumialán
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Abstract
BACKGROUND/INTRODUCTION Pedicle screws have long been part of the continued advancements in spine surgery. Despite the many techniques that have been devised for their safe placement, malposition of screws continues to occur. Studies have evaluated the possible safe limits of screw malposition, and have given some insight on anatomic variation in spinal deformity. Review of the literature reveals several cases of deleterious long-term sequelae of malpositioned screws. DISCUSSION With the current experience, proposed recommendations are provided to detect and avoid the potential long-term sequelae. Though the literature has helped to define possible concerning screws, there are no good studies predicting long-term risk. CONCLUSION Improvements in technology and techniques, advancements in intraoperative confirmation and postoperative surveillance, studies that assist risk stratification, and expert consensus evaluations will help guide surgeons in their decision for addressing misplaced screws.
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Burström G, Persson O, Edström E, Elmi-Terander A. Augmented reality navigation in spine surgery: a systematic review. Acta Neurochir (Wien) 2021; 163:843-852. [PMID: 33506289 PMCID: PMC7886712 DOI: 10.1007/s00701-021-04708-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
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.
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