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Xiao SX, Wu WT, Yu TC, Chen IH, Yeh KT. Augmenting Reality in Spinal Surgery: A Narrative Review of Augmented Reality Applications in Pedicle Screw Instrumentation. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1485. [PMID: 39336526 PMCID: PMC11434084 DOI: 10.3390/medicina60091485] [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: 07/28/2024] [Revised: 09/07/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: The advent of augmented reality (AR) in spinal surgery represents a key technological evolution, enhancing precision and safety in procedures such as pedicle screw instrumentation. This review assesses the current applications, benefits, and challenges of AR technology in spinal surgery, focusing on its effects on surgical accuracy and patient outcomes. Materials and Methods: A comprehensive review of the literature published between January 2023 and December 2024 was conducted, focusing on AR and navigational technologies in spinal surgery. Key outcomes such as accuracy, efficiency, and complications were emphasized. Results: Thirteen studies were included, highlighting substantial improvements in surgical accuracy, efficiency, and safety with AR and navigational systems. AR technology was found to significantly reduce the learning curve for spinal surgeons, improve procedural efficiency, and potentially reduce surgical complications. The challenges identified include high system costs, the complexity of training requirements, the integration with existing workflows, and limited clinical evidence. Conclusions: AR technology holds promise for advancements in spinal surgery, particularly in improving the accuracy and safety of pedicle screw instrumentation. Despite existing challenges such as cost, training needs, and regulatory hurdles, AR has the potential to transform spinal surgical practices. Ongoing research, technological refinements, and the development of implementation strategies are essential to fully leverage AR's capabilities in enhancing patient care.
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Affiliation(s)
- Sheng-Xian Xiao
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (S.-X.X.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (S.-X.X.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan
| | - Tzai-Chiu Yu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (S.-X.X.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (S.-X.X.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (S.-X.X.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 97004, Taiwan
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
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Judy BF, Menta A, Pak HL, Azad TD, Witham TF. Augmented Reality and Virtual Reality in Spine Surgery: A Comprehensive Review. Neurosurg Clin N Am 2024; 35:207-216. [PMID: 38423736 DOI: 10.1016/j.nec.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Augmented reality (AR) and virtual reality (VR) are powerful technologies with proven utility and tremendous potential. Spine surgery, in particular, may benefit from these developing technologies for resident training, preoperative education for patients, surgical planning and execution, and patient rehabilitation. In this review, the history, current applications, challenges, and future of AR/VR in spine surgery are examined.
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Affiliation(s)
- Brendan F Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, 6007 Zayed Tower, Baltimore, MD 21287, USA.
| | - Arjun Menta
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, 6007 Zayed Tower, Baltimore, MD 21287, USA
| | - Ho Lim Pak
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, 6007 Zayed Tower, Baltimore, MD 21287, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, 6007 Zayed Tower, Baltimore, MD 21287, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 1800 Orleans Street, 6007 Zayed Tower, Baltimore, MD 21287, USA.
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Bian D, Lin Z, Lu H, Zhong Q, Wang K, Tang X, Zang J. The application of extended reality technology-assisted intraoperative navigation in orthopedic surgery. Front Surg 2024; 11:1336703. [PMID: 38375409 PMCID: PMC10875025 DOI: 10.3389/fsurg.2024.1336703] [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] [Received: 11/11/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
Extended reality (XR) technology refers to any situation where real-world objects are enhanced with computer technology, including virtual reality, augmented reality, and mixed reality. Augmented reality and mixed reality technologies have been widely applied in orthopedic clinical practice, including in teaching, preoperative planning, intraoperative navigation, and surgical outcome evaluation. The primary goal of this narrative review is to summarize the effectiveness and superiority of XR-technology-assisted intraoperative navigation in the fields of trauma, joint, spine, and bone tumor surgery, as well as to discuss the current shortcomings in intraoperative navigation applications. We reviewed titles of more than 200 studies obtained from PubMed with the following search terms: extended reality, mixed reality, augmented reality, virtual reality, intraoperative navigation, and orthopedic surgery; of those 200 studies, 69 related papers were selected for abstract review. Finally, the full text of 55 studies was analyzed and reviewed. They were classified into four groups-trauma, joint, spine, and bone tumor surgery-according to their content. Most of studies that we reviewed showed that XR-technology-assisted intraoperative navigation can effectively improve the accuracy of implant placement, such as that of screws and prostheses, reduce postoperative complications caused by inaccurate implantation, facilitate the achievement of tumor-free surgical margins, shorten the surgical duration, reduce radiation exposure for patients and surgeons, minimize further damage caused by the need for visual exposure during surgery, and provide richer and more efficient intraoperative communication, thereby facilitating academic exchange, medical assistance, and the implementation of remote healthcare.
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Affiliation(s)
- Dongxiao Bian
- Department of Musculoskeletal Tumor, Peking University People’s Hospital, Beijing, China
| | - Zhipeng Lin
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Hao Lu
- Traumatic Orthopedic Department, Peking University People’s Hospital, Beijing, China
| | - Qunjie Zhong
- Arthritis Clinic and Research Center, Peking University People’s Hospital, Beijing, China
| | - Kaifeng Wang
- Spinal Surgery Department, Peking University People’s Hospital, Beijing, China
| | - Xiaodong Tang
- Department of Musculoskeletal Tumor, Peking University People’s Hospital, Beijing, China
| | - Jie Zang
- Department of Musculoskeletal Tumor, Peking University People’s Hospital, Beijing, China
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Pahwa B, Azad TD, Liu J, Ran K, Liu CJ, Tracz J, Sattari SA, Khalifeh JM, Judy BF, Bydon A, Witham TF. Assessing the Accuracy of Spinal Instrumentation Using Augmented Reality (AR): A Systematic Review of the Literature and Meta-Analysis. J Clin Med 2023; 12:6741. [PMID: 37959207 PMCID: PMC10649145 DOI: 10.3390/jcm12216741] [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: 08/15/2023] [Revised: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Technological advancements, particularly in the realm of augmented reality (AR), may facilitate more accurate and precise pedicle screw placement. AR integrates virtual data into the operator's real-world view, allowing for the visualization of patient-specific anatomy and navigated trajectories. We aimed to conduct a meta-analysis of the accuracy of pedicle screw placement using AR-based systems. A systematic review of the literature and meta-analysis was performed using the PubMed/MEDLINE database, including studies reporting the accuracy of pedicle screw placement using AR. In total, 8 studies with 163 patients and 1259 screws were included in the analysis. XVision (XVS) was the most commonly used AR system (595 screws) followed by the Allura AR surgical navigation system (ARSN) (462 screws). The overall accuracy was calculated as 97.2% (95% CI 96.2-98.1% p < 0.001). Subgroup analysis revealed that there was no statistically significant difference in the accuracy rates achieved by XVS and Allura ARSN (p = 0.092). AR enables reliable, accurate placement of spinal instrumentation. Future research efforts should focus on comparative studies, cost effectiveness, operative time, and radiation exposure.
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Affiliation(s)
- Bhavya Pahwa
- University College of Medical Sciences, GTB Hospital, New Delhi 110095, India;
| | - Tej D. Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jiaqi Liu
- School of Medicine, Georgetown University, Washington, DC 20007, USA
| | - Kathleen Ran
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Connor J. Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jovanna Tracz
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Jawad M. Khalifeh
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Brendan F. Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
| | - Timothy F. Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.D.A.); (C.J.L.); (J.T.); (S.A.S.); (J.M.K.); (B.F.J.); (A.B.)
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Luca A, Giorgino R. Augmented and virtual reality in spine surgery. J Orthop 2023; 43:30-35. [PMID: 37555206 PMCID: PMC10405158 DOI: 10.1016/j.jor.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
Augmented Reality (AR) and Virtual Reality (VR) have developed unprecedentedly in recent years, providing interesting opportunities for medical applications. Their integration into clinical assessment, surgical workflow, and training has shown tremendous potential to improve daily life activity in spine surgery. The paper explores the utilization of VR and AR in spine surgery, with their applications, benefits, challenges, and forthcoming prospects.
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Affiliation(s)
- Andrea Luca
- Spine Unit III, IRCSS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Riccardo Giorgino
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20141, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy
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Móga K, Hölgyesi Á, Zrubka Z, Péntek M, Haidegger T. Augmented or Mixed Reality Enhanced Head-Mounted Display Navigation for In Vivo Spine Surgery: A Systematic Review of Clinical Outcomes. J Clin Med 2023; 12:jcm12113788. [PMID: 37297990 DOI: 10.3390/jcm12113788] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND This research paper provides a systematic literature review (SLR) on the current status of augmented-reality head-mounted devices (AR-HMDs) that guide and navigate spine surgeries and pedicle screw placement. METHODS Embase, Scopus, PubMed, Cochrane Library and IEEE Xplore databases were screened for the systematic literature search to collect and statistically analyze live patient clinical, procedural and user experience data. Multi-level Poisson and binominal models were used for analysis. RESULTS In vivo patient data, only the clinically widely used Gertzbein-Robbins Scale, were published as an outcome in the recent heterogeneous literature. The statistical analysis supports the hypothesis that using AR-HMDs has the same clinical outcomes as using more expensive robot-assisted surgical (RAS) systems. CONCLUSIONS AR-HMD-guided pedicle screw insertion is reaching its technology readiness, providing similar benefits to RAS. Further meta-analysis is expected in the future from higher case-numbered and standardized randomized clinical trials.
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Affiliation(s)
- Kristóf Móga
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Antal Bejczy Center for Intelligent Robotics (BARK), Óbuda University, 1034 Budapest, Hungary
| | - Áron Hölgyesi
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Health Economics Research Center (HECON), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center (HECON), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center (HECON), University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary
| | - Tamás Haidegger
- Austrian Center for Medical Innovation and Technology (ACMIT), 2700 Wiener Neustadt, Austria
- University Research and Innovation Center (EKIK), Óbuda University, 1034 Budapest, Hungary
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Avrumova F, Lebl DR. Augmented reality for minimally invasive spinal surgery. Front Surg 2023; 9:1086988. [PMID: 36776471 PMCID: PMC9914175 DOI: 10.3389/fsurg.2022.1086988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023] Open
Abstract
Background Augmented reality (AR) is an emerging technology that can overlay computer graphics onto the real world and enhance visual feedback from information systems. Within the past several decades, innovations related to AR have been integrated into our daily lives; however, its application in medicine, specifically in minimally invasive spine surgery (MISS), may be most important to understand. AR navigation provides auditory and haptic feedback, which can further enhance surgeons' capabilities and improve safety. Purpose The purpose of this article is to address previous and current applications of AR, AR in MISS, limitations of today's technology, and future areas of innovation. Methods A literature review related to applications of AR technology in previous and current generations was conducted. Results AR systems have been implemented for treatments related to spinal surgeries in recent years, and AR may be an alternative to current approaches such as traditional navigation, robotically assisted navigation, fluoroscopic guidance, and free hand. As AR is capable of projecting patient anatomy directly on the surgical field, it can eliminate concern for surgeon attention shift from the surgical field to navigated remote screens, line-of-sight interruption, and cumulative radiation exposure as the demand for MISS increases. Conclusion AR is a novel technology that can improve spinal surgery, and limitations will likely have a great impact on future technology.
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Affiliation(s)
| | - Darren R. Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, United States
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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: 4.0] [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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