Augmented and virtual reality in spine surgery, current applications and future potentials

A Systematic Study to Compare the Precise Implantation of Hololens 2 Assisted with Acetabular Prosthesis for Total Hip Replacement

This study aims to evaluate the accuracy of the precise implantation of Hololens 2 assisted with acetabular prosthesis for total hip replacement. A total of 80 orthopaedic doctors from our hospital are enrolled in this systematic study and these doctors are divided into following four groups based on the experience of doctors treatment for orthopaedic patients and the Hololens 2 assisted:Rich experienced group with Hololens 2, rich experienced group without Hololens 2, inexperienced group with Hololens 2, inexperienced group without Hololens 2. The abduction angle, the anteversion angle, the offset degree in the abduction angle, the offset degree in the anteversion angle in four groups are presented and these result are used to evaluate the accuracy of precise implantation of Hololens 2 assisted with acetabular prosthesis for total hip replacement. Finally, all date in this study is collected and analyzed. The total of 80 physicians are included in this study. The results show that the outcomes between rich experienced group with Hololens 2 and rich experienced group without Hololens 2 are significant difference, and the outcomes between inexperienced group with Hololens 2 and inexperienced group without Hololens 2 are significant difference. The result between any other two groups is no significant difference. Hololens 2 assisted with acetabular prosthesis for total hip replacement can improve the accuracy.

Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

A number of minimally invasive spine surgeries (MISSs) have been developed to address the drawbacks of open spine surgery. Their advantages include small skin incisions, reduction in tissue damage, quick recovery, and short hospital stay. However, the clinical outcomes are comparable to open surgery. There was a cap on the number of indications that could be set for all spinal illnesses. The indications for MISSs have been expanding owing to mechanical and technological advances in medical equipment. Thus, this review presents the various MISSs developed to date, surgical indications, surgical techniques, and their advantages and disadvantages.

Augmented Reality Neuronavigation for En Bloc Resection of Spinal Column Lesions

BACKGROUND

Primary tumors involving the spine are relatively rare but represent surgically challenging procedures with high patient morbidity. En bloc resection of these tumors necessitates large exposures, wide tumor margins, and poses risks to functionally relevant anatomical structures. Augmented reality neuronavigation (ARNV) represents a paradigm shift in neuronavigation, allowing on-demand visualization of 3D navigation data in real-time directly in line with the operative field.

METHODS

Here, we describe the first application of ARNV to perform distal sacrococcygectomies for the en bloc removal of sacral and retrorectal lesions involving the coccyx in 2 patients, as well as a thoracic 9-11 laminectomy with costotransversectomy for en bloc removal of a schwannoma in a third patient.

RESULTS

In our experience, ARNV allowed our teams to minimize the length of the incision, reduce the extent of bony resection, and enhanced visualization of critical adjacent anatomy. All tumors were resected en bloc, and the patients recovered well postoperatively, with no known complications. Pathologic analysis confirmed the en bloc removal of these lesions with negative margins.

CONCLUSIONS

We conclude that ARNV is an effective strategy for the precise, en bloc removal of spinal lesions including both sacrococcygeal tumors involving the retrorectal space and thoracic schwannomas.

Development of metaverse for intelligent healthcare

The metaverse integrates physical and virtual realities, enabling humans and their avatars to interact in an environment supported by technologies such as high-speed internet, virtual reality, augmented reality, mixed and extended reality, blockchain, digital twins and artificial intelligence (AI), all enriched by effectively unlimited data. The metaverse recently emerged as social media and entertainment platforms, but extension to healthcare could have a profound impact on clinical practice and human health. As a group of academic, industrial, clinical and regulatory researchers, we identify unique opportunities for metaverse approaches in the healthcare domain. A metaverse of 'medical technology and AI' (MeTAI) can facilitate the development, prototyping, evaluation, regulation, translation and refinement of AI-based medical practice, especially medical imaging-guided diagnosis and therapy. Here, we present metaverse use cases, including virtual comparative scanning, raw data sharing, augmented regulatory science and metaversed medical intervention. We discuss relevant issues on the ecosystem of the MeTAI metaverse including privacy, security and disparity. We also identify specific action items for coordinated efforts to build the MeTAI metaverse for improved healthcare quality, accessibility, cost-effectiveness and patient satisfaction.

Evolution and Revolution of Imaging Technologies in Neurosurgery

We understand only a small fraction of the events happening in our brains; therefore, despite all the progress made thus far, a whole array of questions remains. Nonetheless, neurosurgeons invented new tools to circumvent the challenges that had plagued their predecessors. With the manufacturing boom of the 20th century, technological innovations blossomed enabling the neuroscientific community to study and operate upon the living brain in finer detail and with greater precision while avoiding harm to the nervous system. The purpose of this chronological review is to 1) raise awareness among future neurosurgeons about the latest advances in the field, 2) become familiar with innovations such as augmented reality (AR) that should be included in education given their ready applicability in surgical training, and 3) be comfortable with customizing these technologies to real-life cases like in the case of mixed reality.

Practical Use of Augmented Reality Modeling to Guide Revision Spine Surgery: An Illustrative Case of Hardware Failure and Overriding Spondyloptosis

BACKGROUND AND IMPORTANCE

Augmented reality (AR) is a novel technology with broadening applications to neurosurgery. In deformity spine surgery, it has been primarily directed to the more precise placement of pedicle screws. However, AR may also be used to generate high fidelity three-dimensional (3D) spine models for cases of advanced deformity with existing instrumentation. We present a case in which an AR-generated 3D model was used to facilitate and expedite the removal of embedded instrumentation and guide the reduction of an overriding spondyloptotic deformity.

CLINICAL PRESENTATION

A young adult with a remote history of a motor vehicle accident treated with long-segment posterior spinal stabilization presented with increasing back pain and difficulty sitting upright in a wheelchair. Imaging revealed pseudoarthrosis with multiple rod fractures resulting in an overriding spondyloptosis of T6 on T9. An AR-generated 3D model was useful in the intraoperative localization of rod breaks and other extensively embedded instrumentation. Real-time model thresholding expedited the safe explanation of the defunct system and correction of the spondyloptosis deformity.

CONCLUSION

An AR-generated 3D model proved instrumental in a revision case of hardware failure and high-grade spinal deformity.

A Scoping Review of Deep Learning in Cancer Nursing Combined with Augmented Reality: the Era of Intelligent Nursing is Coming

Artificial intelligence has been developing greatly in the field of medicine. As a new research hotspot of artificial intelligence, deep learning (DL) has been widely applied in the fields of cancer risk assessment, symptom recognition, and cancer detection. Therefore, nursing care issues in terms of consuming time and energy, lower accuracy, and lower efficiency can be solved with applying DL in caring cancer patients. In addition, augmented reality (AR) has great navigation potential through combining computer-generated virtual elements with the real world. Thus, DL ​+ ​AR may facilitate patients with cancer to possess a brand-new model of nursing care that is more intelligent, mobile, and adapted to the information age, compared to traditional nursing. With the advent of the era of intelligent nursing, future nursing models can not only learn from the DL ​+ ​AR model to meet the needs of patients with cancer but also reduce nursing workload, save healthcare resources, and improve work efficiency, the quality of nursing care, as well as the quality of life for cancer patients.

Home Hospital for Orthopaedic Surgery: Opportunities and Challenges of a New Delivery Model

ABSTRACT

Home Hospital (HH) is a clinical service involving the delivery of acute inpatient care in the home setting. Acute care services provided via HH include continuous telemonitoring, intravenous fluids and medications, nursing care, point-of-care imaging and laboratory tests, and in-person and virtual clinician visits. Despite offering an inpatient level of care, HH has lower fixed costs and less overhead than conventional hospital settings and offers rapid scalability. Originally implemented for acute medical conditions, HH has proven to be a safe and value-based care-delivery model for a variety of medical conditions, ranging from heart failure to chronic obstructive pulmonary disease exacerbations. For surgical conditions, HH represents an opportunity to reduce adverse hospital-acquired conditions, improve patient and caregiver satisfaction, and decrease cost. The patient profile of orthopaedic surgery inpatients matches that of patients who are most likely to benefit from HH-namely, those who are prone to functional decline, delirium, and nosocomial infections. A focus on surgeon leadership, quality and safety, and digital health with collection of patient-reported outcome measures (PROMs) will ensure that the potential of HH is realized as implementation and widespread rollout proceed.

Technology Behavior Model—Beyond Your Sight with Extended Reality in Surgery

Extended Reality Smart Glasses is a new pattern that uses extended reality technology to present a visual environment that combines the physical and virtual worlds. However, the surgical technique using Smart Glasses implementation is still unknown, to the infancy in clinical surgery, derived to the limits of existing technology. This study researched the acceptability and possibility of XRSG for medical experts. It combines human seen behavioral control with information technology research to construct a new “Extended Reality Technology Behavior Model” using method Technology Acceptance Model and Theory of Planned Behavior. To improve the accuracy of the study, statistical analysis, exploratory analysis, and cross-sectional research triangulation were used to collect data in five hospitals in Malaysia using a convenience sampling method and a questionnaire on behavioral influences. From the collected data, PLS-SEM analysis was used to reflect the relationship between variables. The strong positive results suggest that using XRSG by medical experts helps to improve the composition, interactivity, standardization, and clarity of medical images, resulting in increased efficiency and reduced procedure time and felt the usefulness and ease of use of XRSG through their behavior, providing a basis for technology acceptance in surgery.

XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis

In recent years, with the rapid advancement and consumerization of virtual reality, augmented reality, mixed reality, and extended reality (XR) technology, the use of XR technology in spine medicine has also become increasingly popular. The rising use of XR technology in spine medicine has also been accelerated by the recent wave of digital transformation (i.e., case-specific three-dimensional medical images and holograms, wearable sensors, video cameras, fifth generation, artificial intelligence, and head-mounted displays), and further accelerated by the COVID-19 pandemic and the increase in minimally invasive spine surgery. The COVID-19 pandemic has a negative impact on society, but positive impacts can also be expected, including the continued spread and adoption of telemedicine services (i.e., tele-education, tele-surgery, tele-rehabilitation) that promote digital transformation. The purpose of this narrative review is to describe the accelerators of XR (VR, AR, MR) technology in spine medicine and then to provide a comprehensive review of the use of XR technology in spine medicine, including surgery, consultation, education, and rehabilitation, as well as to identify its limitations and future perspectives (status quo and quo vadis).

Augmented reality in medical education: students' experiences and learning outcomes

Augmented reality (AR) is a relatively new technology that allows for digitally generated three-dimensional representations to be integrated with real environmental stimuli. AR can make use of smart phones, tablets, or other devices to achieve a highly stimulating learning environment and hands-on immersive experience. The use of AR in industry is becoming widespread with applications being developed for use not just for entertainment and gaming but also healthcare, retail and marketing, education, military, travel and tourism, automotive industry, manufacturing, architecture, and engineering. Due to the distinct learning advantages that AR offers, such as remote learning and interactive simulations, AR-based teaching programs are also increasingly being adopted within medical schools across the world. These advantages are further highlighted by the current COVID-19 pandemic, which has caused an even greater shift towards online learning. In this review, we investigate the use of AR in medical training/education and its effect on students' experiences and learning outcomes. This includes the main goals of AR-based learning, such as to simplify the delivery and enhance the comprehension of complex information. We also describe how AR can enhance the experiences of medical students, by improving knowledge and understanding, practical skills and social skills. These concepts are discussed within the context of specific AR medical training programs, such as HoloHuman, OculAR SIM, and HoloPatient. Finally, we discuss the challenges of AR in learning and teaching and propose future directions for the use of this technology in medical education.

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.