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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: 3] [Impact Index Per Article: 1.5] [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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Chan AK, Eastlack RK, Fessler RG, Than KD, Chou D, Fu KM, Park P, Wang MY, Kanter AS, Okonkwo DO, Nunley PD, Anand N, Uribe JS, Mundis GM, Bess S, Shaffrey CI, Le VP, Mummaneni PV. Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity. J Neurosurg Spine 2021; 36:595-608. [PMID: 34740175 DOI: 10.3171/2021.7.spine21138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have demonstrated the short-term radiographic and clinical benefits of circumferential minimally invasive surgery (cMIS) and hybrid (i.e., minimally invasive anterior or lateral interbody fusion with an open posterior approach) techniques to correct adult spinal deformity (ASD). However, it is not known if these benefits are maintained over longer periods of time. This study evaluated the 2- and 3-year outcomes of cMIS and hybrid correction of ASD. METHODS A multicenter database was retrospectively reviewed for patients undergoing cMIS or hybrid surgery for ASD. Patients were ≥ 18 years of age and had one of the following: maximum coronal Cobb angle (CC) ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic incidence-lumbar lordosis mismatch (PI-LL) ≥ 10°, or pelvic tilt (PT) > 20°. Radiographic parameters were evaluated at the latest follow-up. Clinical outcomes were compared at 2- and 3-year time points and adjusted for age, preoperative CC, levels operated, levels with interbody fusion, presence of L5-S1 anterior lumbar interbody fusion, and upper and lower instrumented vertebral level. RESULTS Overall, 197 (108 cMIS, 89 hybrid) patients were included with 187 (99 cMIS, 88 hybrid) and 111 (60 cMIS, 51 hybrid) patients evaluated at 2 and 3 years, respectively. The mean (± SD) follow-up duration for cMIS (39.0 ± 13.3 months, range 22-74 months) and hybrid correction (39.9 ± 16.8 months, range 22-94 months) were similar for both cohorts. Hybrid procedures corrected the CC greater than the cMIS technique (adjusted p = 0.022). There were no significant differences in postoperative SVA, PI-LL, PT, and sacral slope (SS). At 2 years, cMIS had lower Oswestry Disability Index (ODI) scores (adjusted p < 0.001), greater ODI change as a percentage of baseline (adjusted p = 0.006), less visual analog scale (VAS) back pain (adjusted p = 0.006), and greater VAS back pain change as a percentage of baseline (adjusted p = 0.001) compared to hybrid techniques. These differences were no longer significant at 3 years. At 3 years, but not 2 years, VAS leg pain was lower for cMIS compared to hybrid techniques (adjusted p = 0.032). Those undergoing cMIS had fewer overall complications compared to hybrid techniques (adjusted p = 0.006), but a higher odds of pseudarthrosis (adjusted p = 0.039). CONCLUSIONS In this review of a multicenter database for patients undergoing cMIS and hybrid surgery for ASD, hybrid procedures were associated with a greater CC improvement compared to cMIS techniques. cMIS was associated with superior ODI and back pain at 2 years, but this difference was no longer evident at 3 years. However, cMIS was associated with superior leg pain at 3 years. There were fewer complications following cMIS, with the exception of pseudarthrosis.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Richard G Fessler
- 3Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Khoi D Than
- 4Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Kai-Ming Fu
- 5Department of Neurosurgery, Weill Cornell Medical Center, New York, New York
| | - Paul Park
- 6Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Y Wang
- 7Department of Neurosurgery, University of Miami, Florida
| | - Adam S Kanter
- 8Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David O Okonkwo
- 8Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Neel Anand
- 10Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Juan S Uribe
- 11Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | | | - Shay Bess
- 12Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | | | - Vivian P Le
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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