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Geng Z, Wang J, Liu J, Miao J. Bibliometric Analysis of the Development, Current Status, and Trends in Adult Degenerative Scoliosis Research: A Systematic Review from 1998 to 2023. J Pain Res 2024; 17:153-169. [PMID: 38204581 PMCID: PMC10778169 DOI: 10.2147/jpr.s437575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Adult degenerative scoliosis (ADS) research lacks bibliometric analysis, despite numerous studies. This study aimed to systematically analyze the development, current status, hot topics, frontier areas, and trends in ADS research. Patients and Methods A systematic literature review was conducted in the Web of Science Core Collection database from January 1998 to June 2023. Information regarding the country, institution, author, journal, and keywords was collected for each article. Bibliometric analysis was performed using VOSviewer and Citespace software. Results The final analysis covered 1695 publications, demonstrating a steady increase in ADS research. The United States was the most prolific and influential country with 684 publications, followed by China and Japan. The University of California System was the most productive institution with 113 publications. Shaffrey, CI (47 publications) and Lenke, LG (41 publications) were top authors. The analysis revealed seven main research clusters: "intervertebral disc", "adult spinal deformity", "lumbar fusion", "minimally invasive surgery", "navigation", "postoperative complications", and "mental retardation". Keywords with strong bursts of activity included degeneration, prevalence, imbalance, classification, lumbar spinal stenosis, and kyphosis. Conclusion In conclusion, in recent years, ADS research has undergone rapid development. This study analyzed its hot topics, advancements, and research directions, making it the latest bibliometric analysis in this field. The findings aim to provide a new perspective and guidance for clinical practitioners and researchers.
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Affiliation(s)
- Ziming Geng
- Department of Spine Surgery, Tianjin Hospital, Tianjin, People’s Republic of China
| | - Jian Wang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, People’s Republic of China
| | - Jianchao Liu
- Department of Spine Surgery, Tianjin Hospital, Tianjin, People’s Republic of China
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital, Tianjin, People’s Republic of China
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Azad TD, Warman A, Tracz JA, Hughes LP, Judy BF, Witham TF. Augmented reality in spine surgery - past, present, and future. Spine J 2024; 24:1-13. [PMID: 37660893 DOI: 10.1016/j.spinee.2023.08.015] [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: 04/13/2023] [Revised: 07/27/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT Augmented reality (AR) is increasingly recognized as a valuable tool in spine surgery. Here we provides an overview of the key developments and technological milestones that have laid the foundation for AR applications in this field. We also assess the quality of existing studies on AR systems in spine surgery and explore potential future applications. PURPOSE The purpose of this narrative review is to examine the role of AR in spine surgery. It aims to highlight the evolution of AR technology in this context, evaluate the existing body of research, and outline potential future directions for integrating AR into spine surgery. STUDY DESIGN Narrative review. METHODS We conducted a thorough literature search to identify studies and developments related to AR in spine surgery. Relevant articles, reports, and technological advancements were analyzed to establish the historical context and current state of AR in this field. RESULTS The review identifies significant milestones in the development of AR technology for spine surgery. It discusses the growing body of research and highlights the strengths and weaknesses of existing investigations. Additionally, it presents insights into the potential for AR to enhance spine surgical education and speculates on future applications. CONCLUSIONS Augmented reality has emerged as a promising adjunct in spine surgery, with notable advancements and research efforts. The integration of AR into the spine surgery operating room holds promise, as does its potential to revolutionize surgical education. Future applications of AR in spine surgery may include real-time navigation, enhanced visualization, and improved patient outcomes. Continued development and evaluation of AR technology are essential for its successful implementation in this specialized surgical field.
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Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Anmol Warman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Jovanna A Tracz
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Liam P Hughes
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA.
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Moglia A, Marsilio L, Rossi M, Pinelli M, Lettieri E, Mainardi L, Manzotti A, Cerveri P. Mixed Reality and Artificial Intelligence: A Holistic Approach to Multimodal Visualization and Extended Interaction in Knee Osteotomy. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 12:279-290. [PMID: 38410183 PMCID: PMC10896423 DOI: 10.1109/jtehm.2023.3335608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Recent advancements in augmented reality led to planning and navigation systems for orthopedic surgery. However little is known about mixed reality (MR) in orthopedics. Furthermore, artificial intelligence (AI) has the potential to boost the capabilities of MR by enabling automation and personalization. The purpose of this work is to assess Holoknee prototype, based on AI and MR for multimodal data visualization and surgical planning in knee osteotomy, developed to run on the HoloLens 2 headset. METHODS Two preclinical test sessions were performed with 11 participants (eight surgeons, two residents, and one medical student) executing three times six tasks, corresponding to a number of holographic data interactions and preoperative planning steps. At the end of each session, participants answered a questionnaire on user perception and usability. RESULTS During the second trial, the participants were faster in all tasks than in the first one, while in the third one, the time of execution decreased only for two tasks ("Patient selection" and "Scrolling through radiograph") with respect to the second attempt, but without statistically significant difference (respectively [Formula: see text] = 0.14 and [Formula: see text] = 0.13, [Formula: see text]). All subjects strongly agreed that MR can be used effectively for surgical training, whereas 10 (90.9%) strongly agreed that it can be used effectively for preoperative planning. Six (54.5%) agreed and two of them (18.2%) strongly agreed that it can be used effectively for intraoperative guidance. DISCUSSION/CONCLUSION In this work, we presented Holoknee, the first holistic application of AI and MR for surgical planning for knee osteotomy. It reported promising results on its potential translation to surgical training, preoperative planning, and surgical guidance. Clinical and Translational Impact Statement - Holoknee can be helpful to support surgeons in the preoperative planning of knee osteotomy. It has the potential to impact positively the training of the future generation of residents and aid surgeons in the intraoperative stage.
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Affiliation(s)
- Andrea Moglia
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
| | - Luca Marsilio
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
| | - Matteo Rossi
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
- Istituto Auxologico Italiano IRCCS20149MilanItaly
| | - Maria Pinelli
- Department of Management, Economics and Industrial EngineeringPolitecnico di Milano20133MilanItaly
| | - Emanuele Lettieri
- Department of Management, Economics and Industrial EngineeringPolitecnico di Milano20133MilanItaly
| | - Luca Mainardi
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
| | | | - Pietro Cerveri
- Department of ElectronicsInformation and BioengineeringPolitecnico di Milano20133MilanItaly
- Istituto Auxologico Italiano IRCCS20149MilanItaly
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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: 1.0] [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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Patel RV, Yearley AG, Isaac H, Chalif EJ, Chalif JI, Zaidi HA. Advances and Evolving Challenges in Spinal Deformity Surgery. J Clin Med 2023; 12:6386. [PMID: 37835030 PMCID: PMC10573859 DOI: 10.3390/jcm12196386] [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: 08/29/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Surgical intervention is a critical tool to address adult spinal deformity (ASD). Given the evolution of spinal surgical techniques, we sought to characterize developments in ASD correction and barriers impacting clinical outcomes. METHODS We conducted a literature review utilizing PubMed, Embase, Web of Science, and Google Scholar to examine advances in ASD surgical correction and ongoing challenges from patient and clinician perspectives. ASD procedures were examined across pre-, intra-, and post-operative phases. RESULTS Several factors influence the effectiveness of ASD correction. Standardized radiographic parameters and three-dimensional modeling have been used to guide operative planning. Complex minimally invasive procedures, targeted corrections, and staged procedures can tailor surgical approaches while minimizing operative time. Further, improvements in osteotomy technique, intraoperative navigation, and enhanced hardware have increased patient safety. However, challenges remain. Variability in patient selection and deformity undercorrection have resulted in heterogenous clinical responses. Surgical complications, including blood loss, infection, hardware failure, proximal junction kyphosis/failure, and pseudarthroses, pose barriers. Although minimally invasive approaches are being utilized more often, clinical validation is needed. CONCLUSIONS The growing prevalence of ASD requires surgical solutions that can lead to sustained symptom resolution. Leveraging computational and imaging advances will be necessary as we seek to provide comprehensive treatment plans for patients.
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Affiliation(s)
- Ruchit V. Patel
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (R.V.P.); (A.G.Y.); (E.J.C.); (J.I.C.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Alexander G. Yearley
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (R.V.P.); (A.G.Y.); (E.J.C.); (J.I.C.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Hannah Isaac
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (R.V.P.); (A.G.Y.); (E.J.C.); (J.I.C.)
| | - Eric J. Chalif
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (R.V.P.); (A.G.Y.); (E.J.C.); (J.I.C.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Joshua I. Chalif
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (R.V.P.); (A.G.Y.); (E.J.C.); (J.I.C.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Hasan A. Zaidi
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA; (R.V.P.); (A.G.Y.); (E.J.C.); (J.I.C.)
- Harvard Medical School, Boston, MA 02115, USA
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6
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Hey G, Guyot M, Carter A, Lucke-Wold B. Augmented Reality in Neurosurgery: A New Paradigm for Training. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1721. [PMID: 37893439 PMCID: PMC10608758 DOI: 10.3390/medicina59101721] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023]
Abstract
Augmented reality (AR) involves the overlay of computer-generated images onto the user's real-world visual field to modify or enhance the user's visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been shown to improve surgical planning, refine neuronavigation, and reduce operation time. In addition, AR has the potential to serve as a valuable training tool for neurosurgeons in a way that minimizes patient risk while facilitating comprehensive training opportunities. The increased use of AR in neurosurgery over the past decade has led to innovative research endeavors aiming to develop novel, more efficient AR systems while also improving and refining present ones. In this review, we provide a concise overview of AR, detail current and emerging uses of AR in neurosurgery and neurosurgical training, discuss the limitations of AR, and provide future research directions. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 386 articles were initially identified. Two independent reviewers (GH and AC) assessed article eligibility for inclusion, and 31 articles are included in this review. The literature search included original (retrospective and prospective) articles and case reports published in English between 2013 and 2023. AR assistance has shown promise within neuro-oncology, spinal neurosurgery, neurovascular surgery, skull-base surgery, and pediatric neurosurgery. Intraoperative use of AR was found to primarily assist with surgical planning and neuronavigation. Similarly, AR assistance for neurosurgical training focused primarily on surgical planning and neuronavigation. However, studies included in this review utilize small sample sizes and remain largely in the preliminary phase. Thus, future research must be conducted to further refine AR systems before widespread intraoperative and educational use.
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Affiliation(s)
- Grace Hey
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Michael Guyot
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ashley Carter
- Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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7
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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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Shahzad H, Bhatti NS, Phillips FM, Khan SN. Applications of Augmented Reality in Orthopaedic Spine Surgery. J Am Acad Orthop Surg 2023; 31:e601-e609. [PMID: 37105182 DOI: 10.5435/jaaos-d-23-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
The application of augmented reality (AR) in surgical settings has primarily been as a navigation tool in the operating room because of its ease of use and minimal effect on surgical procedures. The surgeon can directly face the surgical field while viewing 3D anatomy virtually, thus reducing the need to look at an external display, such as a navigation system. Applications of AR are being explored in spine surgery. The basic principles of AR include data preparation, registration, tracking, and visualization. Current literature provides sufficient preclinical and clinical data evidence for the use of AR technology in spine surgery. AR systems are efficient assistive devices, providing greater accuracy for insertion points, more comfort for surgeons, and reduced operating time. AR technology also has beneficial applications in surgical training, education, and telementorship for spine surgery. However, costs associated with specially designed imaging equipment and physicians' comfort in using this technology continue to remain barriers to its adoption. As this technology evolves to a more widespread use, future applications will be directed by the cost-effectiveness of AR-assisted surgeries.
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Affiliation(s)
- Hania Shahzad
- From the Department of Orthopedics, The Ohio State University, Wexner Medical Center, Columbus, OH (Shahzad, Bhatti, and Khan) and Department of Orthopedics, Rush University Medical Center, Chicago, IL (Phillips)
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Pierzchajlo N, Stevenson TC, Huynh H, Nguyen J, Boatright S, Arya P, Chakravarti S, Mehrki Y, Brown NJ, Gendreau J, Lee SJ, Chen SG. Augmented Reality in Minimally Invasive Spinal Surgery: A Narrative Review of Available Technology. World Neurosurg 2023; 176:35-42. [PMID: 37059357 DOI: 10.1016/j.wneu.2023.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Spine surgery has undergone significant changes in approach and technique. With the adoption of intraoperative navigation, minimally invasive spinal surgery (MISS) has arguably become the gold standard. Augmented reality (AR) has now emerged as a front-runner in anatomical visualization and narrower operative corridors. In effect, AR is poised to revolutionize surgical training and operative outcomes. Our study examines the current literature on AR-assisted MISS, synthesizes findings, and creates a narrative highlighting the history and future of AR in spine surgery. MATERIAL AND METHODS Relevant literature was gathered using the PubMed (Medline) database from 1975 to 2023. Pedicle screw placement models were the primary intervention in AR. These were compared to the outcomes of traditional MISS RESULTS: We found that AR devices on the market show promising clinical outcomes in preoperative training and intraoperative use. Three prominent systems were as follows: XVision, HoloLens, and ImmersiveTouch. In the studies, surgeons, residents, and medical students had opportunities to operate AR systems, showcasing their educational potential across each phase of learning. Specifically, one facet described training with cadaver models to gauge accuracy in pedicle screw placement. AR-MISS exceeded free-hand methods without unique complications or contraindications. CONCLUSIONS While still in its infancy, AR has already proven beneficial for educational training and intraoperative MISS applications. We believe that with continued research and advancement of this technology, AR is poised to become a dominant player within the fundamentals of surgical education and MISS operative technique.
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Affiliation(s)
| | | | - Huey Huynh
- Mercer University, School of Medicine, Savannah, GA, USA
| | - Jimmy Nguyen
- Mercer University, School of Medicine, Savannah, GA, USA
| | | | - Priya Arya
- Mercer University, School of Medicine, Savannah, GA, USA
| | | | - Yusuf Mehrki
- Department of Neurosurgery, University of Florida, Jacksonville, FL, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California Irvine, Orange, CA, USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Seung Jin Lee
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Selby G Chen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
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Xin X, Liu X, Zhu Y, Li J, Yue C, Hao D. 3D-Printed Guide Plate System-Assisted Thoracolumbar Kyphosis Osteotomy: A Technical Case Series. World Neurosurg 2023; 173:28-33. [PMID: 36780984 DOI: 10.1016/j.wneu.2023.02.039] [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] [Received: 01/16/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVE This paper reports a new three-dimensional (3D)-printed osteotomy guidance system to assist thoracolumbar kyphosis osteotomy and describe the guide plate design, surgical procedure, and short-term clinical results. METHODS The computer-aided design software reconstructs the 3D model of the spinal deformity region using the computed tomography data of the patient and plans the correction angle according to the deformity. The guide plate design described in previous experimental studies was used and optimized before clinical application. The lamina positioning, lamina osteotomy, and vertebral osteotomy guides were designed, and three 3D guides with different functions were used to assist osteotomy. RESULTS Seven patients successfully underwent osteotomy under the guidance of a 3D guide plate. Kyphosis was corrected to different degrees without serious complications. At the last follow-up, the back pain and nerve function of 7 patients were improved to varying degrees and the internal fixation without displacement and fracture. CONCLUSIONS The preliminary clinical application of the new 3D osteotomy guidance system shows that it provides an effective connection between the guide plates and a clinically operative visual field. The use of a 3D guide plate system for positioning and guidance is helpful to complete preoperative planning of anterior and middle column vertebral body osteotomy. However, the efficacy of this method should be compared to that of the free-hand technique with long-term follow-up.
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Affiliation(s)
- Xin Xin
- Ankang Center Hospital, Department of Orthopaedics, Ankang, Shaanxi Province, P.R. China.
| | - Xinxin Liu
- Hong Hui Hospital of Xi'an Jiaotong University, Department of Magnetic Resonance Imaging, Xi'an, Shaanxi Province, P.R. China
| | - Yanan Zhu
- Ankang Center Hospital, Department of Imaging, Ankang, Shaanxi Province, P.R. China
| | - Jiawei Li
- Ankang Center Hospital, Department of Orthopaedics, Ankang, Shaanxi Province, P.R. China
| | - Chen Yue
- Ankang Center Hospital, Department of Orthopaedics, Ankang, Shaanxi Province, P.R. China
| | - Dingjun Hao
- Hong Hui Hospital of Xi'an Jiaotong University, Department of Spine Surgery, Xi'an, Shaanxi Province, P.R. China
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Mofatteh M, Mashayekhi MS, Arfaie S, Chen Y, Mirza AB, Fares J, Bandyopadhyay S, Henich E, Liao X, Bernstein M. Augmented and virtual reality usage in awake craniotomy: a systematic review. Neurosurg Rev 2022; 46:19. [PMID: 36529827 PMCID: PMC9760592 DOI: 10.1007/s10143-022-01929-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/21/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Augmented and virtual reality (AR, VR) are becoming promising tools in neurosurgery. AR and VR can reduce challenges associated with conventional approaches via the simulation and mimicry of specific environments of choice for surgeons. Awake craniotomy (AC) enables the resection of lesions from eloquent brain areas while monitoring higher cortical and subcortical functions. Evidence suggests that both surgeons and patients benefit from the various applications of AR and VR in AC. This paper investigates the application of AR and VR in AC and assesses its prospective utility in neurosurgery. A systematic review of the literature was performed using PubMed, Scopus, and Web of Science databases in accordance with the PRISMA guidelines. Our search results yielded 220 articles. A total of six articles consisting of 118 patients have been included in this review. VR was used in four papers, and the other two used AR. Tumour was the most common pathology in 108 patients, followed by vascular lesions in eight patients. VR was used for intraoperative mapping of language, vision, and social cognition, while AR was incorporated in preoperative training of white matter dissection and intraoperative visualisation and navigation. Overall, patients and surgeons were satisfied with the applications of AR and VR in their cases. AR and VR can be safely incorporated during AC to supplement, augment, or even replace conventional approaches in neurosurgery. Future investigations are required to assess the feasibility of AR and VR in various phases of AC.
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Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | | | - Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | | | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Northwestern Medicine Malnati Brain Tumor Institute, Feinberg School of Medicine, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Edy Henich
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Xuxing Liao
- Department of Neurosurgery, Foshan Sanshui District People's Hospital, Foshan, China
| | - Mark Bernstein
- Division of Neurosurgery, Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada
- Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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12
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The intraoperative use of augmented and mixed reality technology to improve surgical outcomes: A systematic review. Int J Med Robot 2022; 18:e2450. [DOI: 10.1002/rcs.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/23/2022] [Accepted: 07/27/2022] [Indexed: 11/07/2022]
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13
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Augmented Reality in Orthopedic Surgery and Its Application in Total Joint Arthroplasty: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105278] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The development of augmented reality (AR) and its application in total joint arthroplasty aims at improving the accuracy and precision in implant components’ positioning, hopefully leading to increased outcomes and survivorship. However, this field is far from being thoroughly explored. We therefore performed a systematic review of the literature in order to examine the application, the results, and the different AR systems available in TJA. A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles on the application of augmented reality in total joint arthroplasty using various combinations of keywords since the inception of the database to 31 March 2022. Accuracy was intended as the mean error from the targeted positioning angle and compared as mean values and standard deviations. In all, 14 articles met the inclusion criteria. Among them, four studies reported on the application of AR in total knee arthroplasty, six studies on total hip arthroplasty, three studies reported on reverse shoulder arthroplasty, and one study on total elbow arthroplasty. Nine of the included studies were preclinical (sawbones or cadaveric), while five of them reported results of AR’s clinical application. The main common feature was the high accuracy and precision when implant positioning was compared with preoperative targeted angles with errors ≤2 mm and/or ≤2°. Despite the promising results in terms of increased accuracy and precision, this technology is far from being widely adopted in daily clinical practice. However, the recent exponential growth in machine learning techniques and technologies may eventually lead to the resolution of the ongoing limitations including depth perception and their high complexity, favorably encouraging the widespread usage of AR systems.
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14
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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: 4.5] [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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XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis. J Clin Med 2022; 11:jcm11020470. [PMID: 35054164 PMCID: PMC8779726 DOI: 10.3390/jcm11020470] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
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).
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16
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Visualization, navigation, augmentation. The ever-changing perspective of the neurosurgeon. BRAIN AND 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] [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]
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17
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Augmented reality visualization in brain lesions: a prospective randomized controlled evaluation of its potential and current limitations in navigated microneurosurgery. Acta Neurochir (Wien) 2022; 164:3-14. [PMID: 34904183 PMCID: PMC8761141 DOI: 10.1007/s00701-021-05045-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022]
Abstract
Background Augmented reality (AR) has the potential to support complex neurosurgical interventions by including visual information seamlessly. This study examines intraoperative visualization parameters and clinical impact of AR in brain tumor surgery. Methods Fifty-five intracranial lesions, operated either with AR-navigated microscope (n = 39) or conventional neuronavigation (n = 16) after randomization, have been included prospectively. Surgical resection time, duration/type/mode of AR, displayed objects (n, type), pointer-based navigation checks (n), usability of control, quality indicators, and overall surgical usefulness of AR have been assessed. Results AR display has been used in 44.4% of resection time. Predominant AR type was navigation view (75.7%), followed by target volumes (20.1%). Predominant AR mode was picture-in-picture (PiP) (72.5%), followed by 23.3% overlay display. In 43.6% of cases, vision of important anatomical structures has been partially or entirely blocked by AR information. A total of 7.7% of cases used MRI navigation only, 30.8% used one, 23.1% used two, and 38.5% used three or more object segmentations in AR navigation. A total of 66.7% of surgeons found AR visualization helpful in the individual surgical case. AR depth information and accuracy have been rated acceptable (median 3.0 vs. median 5.0 in conventional neuronavigation). The mean utilization of the navigation pointer was 2.6 × /resection hour (AR) vs. 9.7 × /resection hour (neuronavigation); navigation effort was significantly reduced in AR (P < 0.001). Conclusions The main benefit of HUD-based AR visualization in brain tumor surgery is the integrated continuous display allowing for pointer-less navigation. Navigation view (PiP) provides the highest usability while blocking the operative field less frequently. Visualization quality will benefit from improvements in registration accuracy and depth impression. German clinical trials registration number. DRKS00016955. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-05045-1.
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18
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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: 65] [Impact Index Per Article: 21.7] [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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Hersh A, Mahapatra S, Weber-Levine C, Awosika T, Theodore JN, Zakaria HM, Liu A, Witham TF, Theodore N. Augmented Reality in Spine Surgery: A Narrative Review. HSS J 2021; 17:351-358. [PMID: 34539277 PMCID: PMC8436352 DOI: 10.1177/15563316211028595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Augmented reality (AR) navigation refers to novel technologies that superimpose images, such as radiographs and navigation pathways, onto a view of the operative field. The development of AR navigation has focused on improving the safety and efficacy of neurosurgical and orthopedic procedures. In this review, the authors focus on 3 types of AR technology used in spine surgery: AR surgical navigation, microscope-mediated heads-up display, and AR head-mounted displays. Microscope AR and head-mounted displays offer the advantage of reducing attention shift and line-of-sight interruptions inherent in traditional navigation systems. With the U.S. Food and Drug Administration's recent clearance of the XVision AR system (Augmedics, Arlington Heights, IL), the adoption and refinement of AR technology by spine surgeons will only accelerate.
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Affiliation(s)
- Andrew Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Smruti Mahapatra
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carly Weber-Levine
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tolulope Awosika
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hesham M Zakaria
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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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: 16] [Impact Index Per Article: 5.3] [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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21
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Massaad E, Shankar GM, Shin JH. Novel Applications of Spinal Navigation in Deformity and Oncology Surgery-Beyond Screw Placement. Oper Neurosurg (Hagerstown) 2021; 21:S23-S38. [PMID: 34128068 DOI: 10.1093/ons/opaa322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
Computer-assisted navigation has made a major impact on spine surgery, providing surgeons with technological tools to safely place instrumentation anywhere in the spinal column. With advances in intraoperative image acquisition, registration, and processing, many surgeons are now using navigation in their practices. The incorporation of navigation into the workflow of surgeons continues to expand with the evolution of minimally invasive techniques and robotic surgery. While numerous investigators have demonstrated the benefit of navigation for improving the accuracy of instrumentation, few have reported applying this technology to other aspects of spine surgery. Surgeries to correct spinal deformities and resect spinal tumors are technically demanding, incorporating a wide range of techniques not only for instrumentation placement but also for osteotomy planning and executing the goals of surgery. Although these subspecialties vary in their objectives, they share similar challenges with potentially high complications, invasiveness, and consequences of failed execution. Herein, we highlight the utility of using spinal navigation for applications beyond screw placement: specifically, for planning and executing osteotomies and guiding the extent of tumor resection. A narrative review of the work that has been done is supplemented with illustrative cases demonstrating these applications.
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Affiliation(s)
- Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 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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22
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Casari FA, Navab N, Hruby LA, Kriechling P, Nakamura R, Tori R, de Lourdes Dos Santos Nunes F, Queiroz MC, Fürnstahl P, Farshad M. Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art. Curr Rev Musculoskelet Med 2021; 14:192-203. [PMID: 33544367 PMCID: PMC7990993 DOI: 10.1007/s12178-021-09699-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Augmented reality (AR) is becoming increasingly popular in modern-day medicine. Computer-driven tools are progressively integrated into clinical and surgical procedures. The purpose of this review was to provide a comprehensive overview of the current technology and its challenges based on recent literature mainly focusing on clinical, cadaver, and innovative sawbone studies in the field of orthopedic surgery. The most relevant literature was selected according to clinical and innovational relevance and is summarized. RECENT FINDINGS Augmented reality applications in orthopedic surgery are increasingly reported. In this review, we summarize basic principles of AR including data preparation, visualization, and registration/tracking and present recently published clinical applications in the area of spine, osteotomies, arthroplasty, trauma, and orthopedic oncology. Higher accuracy in surgical execution, reduction of radiation exposure, and decreased surgery time are major findings presented in the literature. In light of the tremendous progress of technological developments in modern-day medicine and emerging numbers of research groups working on the implementation of AR in routine clinical procedures, we expect the AR technology soon to be implemented as standard devices in orthopedic surgery.
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Affiliation(s)
- Fabio A Casari
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
- ROCS, Research in Orthopedic Computer Science, Balgrist Campus, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Nassir Navab
- Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany
- Computer Aided Medical Procedures (CAMP), Johns Hopkins University, Baltimore, MD, USA
| | - Laura A Hruby
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Kriechling
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ricardo Nakamura
- Computer Engineering and Digital Systems Department, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Romero Tori
- Computer Engineering and Digital Systems Department, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Marcelo C Queiroz
- Orthopedics and Traumatology Department, Faculty of Medical Sciences of Santa Casa de Sao Paulo, Sao Paulo, SP, Brazil
| | - Philipp Fürnstahl
- ROCS, Research in Orthopedic Computer Science, Balgrist Campus, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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McKnight RR, Pean CA, Buck JS, Hwang JS, Hsu JR, Pierrie SN. Virtual Reality and Augmented Reality-Translating Surgical Training into Surgical Technique. Curr Rev Musculoskelet Med 2020; 13:663-674. [PMID: 32779019 PMCID: PMC7661680 DOI: 10.1007/s12178-020-09667-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW As immersive learning outside of the operating room is increasingly recognized as a valuable method of surgical training, virtual reality (VR) and augmented reality (AR) are increasingly utilized in orthopedic surgical training. This article reviews the evolving nature of these training tools and provides examples of their use and efficacy. The practical and ethical implications of incorporating this technology and its impact on both orthopedic surgeons and their patients are also discussed. RECENT FINDINGS Head-mounted displays (HMDs) represent a possible adjunct to surgical accuracy and education. While the hardware is advanced, there is still much work to be done in developing software that allows for seamless, reliable, useful integration into clinical practice and training. Surgical training is changing: AR and VR will become mainstays of future training efforts. More evidence is needed to determine which training technology translates to improved clinical performance. Volatility within the HMD industry will likely delay advances in surgical training.
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Affiliation(s)
- R Randall McKnight
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA.
| | - Christian A Pean
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - J Stewart Buck
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - John S Hwang
- Department of Orthopedic Surgery, Mount Carmel, Columbus, OH, USA
- Department of Orthopedic Surgery, Orthopedic ONE, Columbus, OH, USA
| | - Joseph R Hsu
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1001 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Sarah N Pierrie
- Department of Orthopaedics and Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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Detchou DK, Dimentberg R, Vaughan KA, Kolster R, Braslow BM, Malhotra NR. Navigated Ultrasonic Osteotomy to Aid in En Bloc Chordoma Resection via Spondylectomy. World Neurosurg 2020; 143:319-324. [PMID: 32791231 DOI: 10.1016/j.wneu.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chordomas are rare, locally malignant tumors derived from remnants of the notochord that can manifest anywhere in the spine or base of the skull. Surgical treatment for chordomas of the lumbar spine often fails to achieve successful en bloc resection, which is critical to minimizing recurrence risk. CASE DESCRIPTION In this case report, the authors describe total en bloc resection of a lumbar vertebral body chordoma via the first documented approach of navigated ultrasonic osteotomy for spondylectomy. The patient is a 43-year-old man with end-stage renal disease, requiring dialysis, secondary to diabetes mellitus. The lesion in question was incidentally discovered in the L5 vertebral body during full body scanning for evaluation for a renal transplant. The lesion was diagnosed as a chordoma via percutaneous coaxial needle biopsy. Allogeneic renal transplant was canceled pending treatment of this newly discovered lesion. A combined, staged approach of L3-pelvis posterior instrumented fusion, L5 laminectomy and spondylectomy, and anterior L5 cage reconstruction with L4-S1 fusion was planned. Intraoperative computed tomography scan was performed and stereotactic osteotomies were planned. Ultrasonic osteotome (SONOPET Ultrasonic Aspirator) was registered as a navigation tool and employed, after verification, to complete the posterior stereotactic osteotomies, with postoperative computed tomography, magnetic resonance imaging, and pathology demonstrating successful en bloc resection. The navigated osteotome provided a critical combination of surgical precision and efficiency intraoperatively. CONCLUSIONS This approach offers a promising technological adjunct for the treatment of complex spine tumors requiring precise resection and reconstruction.
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Affiliation(s)
- Donald K Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Dimentberg
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kerry A Vaughan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Kolster
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin M Braslow
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Translational Spine Research Lab, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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25
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Enhancing Reality: A Systematic Review of Augmented Reality in Neuronavigation and Education. World Neurosurg 2020; 139:186-195. [DOI: 10.1016/j.wneu.2020.04.043] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
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26
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McDonnell JM, Ahern DP, Ó Doinn T, Gibbons D, Rodrigues KN, Birch N, Butler JS. Surgeon proficiency in robot-assisted spine surgery. Bone Joint J 2020; 102-B:568-572. [DOI: 10.1302/0301-620x.102b5.bjj-2019-1392.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient outcomes, can be assisted by the deployment of advanced technologies including navigation, intraoperative CT imaging, and surgical robots. The latest generation of robotic surgical systems allows the simultaneous application of a range of digital features that provide the surgeon with an improved view of the surgical field, often through a narrow portal. There is emerging evidence that procedure-related complications and intraoperative blood loss can be reduced if the new technologies are used by appropriately trained surgeons. Acceptance of the role of surgical robots has increased in recent years among a number of surgical specialities including general surgery, neurosurgery, and orthopaedic surgeons performing major joint arthroplasty. However, ethical challenges have emerged with the rollout of these innovations, such as ensuring surgeon competence in the use of surgical robotics and avoiding financial conflicts of interest. Therefore, it is essential that trainees aspiring to become spinal surgeons as well as established spinal specialists should develop the necessary skills to use robotic technology safely and effectively and understand the ethical framework within which the technology is introduced. Traditional and more recently developed platforms exist to aid skill acquisition and surgical training which are described. The aim of this narrative review is to describe the role of surgical robotics in spinal surgery, describe measures of proficiency, and present the range of training platforms that institutions can use to ensure they employ confident spine surgeons adequately prepared for the era of robotic spinal surgery. Cite this article: Bone Joint J 2020;102-B(5):568–572.
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Affiliation(s)
| | - Daniel P. Ahern
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tiarnan Ó Doinn
- National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Denys Gibbons
- School of Medicine, Trinity College Dublin, Dublin, Ireland, National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Nick Birch
- The Chris Moody Rehabilitation and Sports Injury Centre, Northampton, UK
| | - Joseph S. Butler
- National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Abstract
STUDY DESIGN A prospective, case-based, observational study. OBJECTIVES To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery. METHODS In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation. RESULTS AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0.28 mm) resulted in a reliable AR representation with a close matching of visualized objects and reality, distinctly supporting anatomical orientation in the surgical field. Flexible AR visualization applying either the microscope HUD or video superimposition, including the ability to selectively activate objects of interest, as well as different display modes allowed a smooth integration in the surgical workflow, without disturbing the actual procedure. On average, 7.1 ± 4.6 objects were displayed visualizing target and risk structures reliably. CONCLUSIONS Microscope-based AR can be applied successfully to various kinds of spinal procedures. AR improves anatomical orientation in the surgical field supporting the surgeon, as well as it offers a potential tool for education.
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Affiliation(s)
- Barbara Carl
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Miriam Bopp
- Department of Neurosurgery, University Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Benjamin Saß
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Mirza Pojskic
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | | | - Christopher Nimsky
- Department of Neurosurgery, University Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
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Vadalà G, De Salvatore S, Ambrosio L, Russo F, Papalia R, Denaro V. Robotic Spine Surgery and Augmented Reality Systems: A State of the Art. Neurospine 2020; 17:88-100. [PMID: 32252158 PMCID: PMC7136092 DOI: 10.14245/ns.2040060.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022] Open
Abstract
Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.
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Affiliation(s)
- Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Pérez-Pachón L, Poyade M, Lowe T, Gröning F. Image Overlay Surgery Based on Augmented Reality: A Systematic Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1260:175-195. [PMID: 33211313 DOI: 10.1007/978-3-030-47483-6_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Augmented Reality (AR) applied to surgical guidance is gaining relevance in clinical practice. AR-based image overlay surgery (i.e. the accurate overlay of patient-specific virtual images onto the body surface) helps surgeons to transfer image data produced during the planning of the surgery (e.g. the correct resection margins of tissue flaps) to the operating room, thus increasing accuracy and reducing surgery times. We systematically reviewed 76 studies published between 2004 and August 2018 to explore which existing tracking and registration methods and technologies allow healthcare professionals and researchers to develop and implement these systems in-house. Most studies used non-invasive markers to automatically track a patient's position, as well as customised algorithms, tracking libraries or software development kits (SDKs) to compute the registration between patient-specific 3D models and the patient's body surface. Few studies combined the use of holographic headsets, SDKs and user-friendly game engines, and described portable and wearable systems that combine tracking, registration, hands-free navigation and direct visibility of the surgical site. Most accuracy tests included a low number of subjects and/or measurements and did not normally explore how these systems affect surgery times and success rates. We highlight the need for more procedure-specific experiments with a sufficient number of subjects and measurements and including data about surgical outcomes and patients' recovery. Validation of systems combining the use of holographic headsets, SDKs and game engines is especially interesting as this approach facilitates an easy development of mobile AR applications and thus the implementation of AR-based image overlay surgery in clinical practice.
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Affiliation(s)
- Laura Pérez-Pachón
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
| | - Matthieu Poyade
- School of Simulation and Visualisation, Glasgow School of Art, Glasgow, UK
| | - Terry Lowe
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Head and Neck Oncology Unit, Aberdeen Royal Infirmary (NHS Grampian), Aberdeen, UK
| | - Flora Gröning
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Carl B, Bopp M, Saß B, Pojskic M, Nimsky C. Augmented reality in intradural spinal tumor surgery. Acta Neurochir (Wien) 2019; 161:2181-2193. [PMID: 31300886 DOI: 10.1007/s00701-019-04005-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Microscope-based augmented reality (AR) is commonly used in cranial surgery; however, until recently, this technique was not implemented for spinal surgery. We prospectively investigated, how AR can be applied for intradural spinal tumor surgery. METHODS For ten patients with intradural spinal tumors (ependymoma, glioma, hemangioblastoma, meningioma, and metastasis), AR was provided by head-up displays (HUDs) of operating microscopes. User-independent automatic AR registration was established by low-dose intraoperative computed tomography. The objects visualized by AR were segmented in preoperative imaging data; non-linear image registration was applied to consider spine flexibility. RESULTS In all cases, AR supported surgery by visualizing the tumor outline and other relevant surrounding structures. The overall AR registration error was 0.72 ± 0.24 mm (mean ± standard deviation), a close matching of visible tumor outline and AR visualization was observed for all cases. Registration scanning resulted in a low effective dose of 0.22 ± 0.16 mSv for cervical and 1.68 ± 0.61 mSv for thoracic lesions. The mean HUD AR usage in relation to microscope time was 51.6 ± 36.7%. The HUD was switched off and turned on again in a range of 2 to 17 times (5.7 ± 4.4 times). Independent of the status of the HUD, the AR visualization was displayed on monitors throughout surgery. CONCLUSIONS Microscope-based AR can be reliably applied to intradural spinal tumor surgery. Automatic AR registration ensures high precision and provides an intuitive visualization of the extent of the tumor and surrounding structures. Given this setting, all advanced multi-modality options of cranial AR can also be applied to spinal surgery.
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Yoo JS, Patel DS, Hrynewycz NM, Brundage TS, Singh K. The utility of virtual reality and augmented reality in spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S171. [PMID: 31624737 DOI: 10.21037/atm.2019.06.38] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As the number of advances in surgical techniques increases, it becomes increasingly important to assess and research the technology regarding spine surgery techniques in order to increase surgical accuracy, decrease overall length of surgery, and minimize overall radiation exposure. Currently, augmented reality and virtual reality have shown promising results in regard to their applicability beyond their current functions. At present, VR has been generally applied to a teaching and preparatory role, while AR has been utilized in surgical settings. As such, the following review attempts to provide an overview of both virtual reality and augmented reality, followed by a discussion of their current applications and future direction.
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Affiliation(s)
- Joon S Yoo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Dillon S Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nadia M Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Thomas S Brundage
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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32
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Carl B, Bopp M, Saß B, Nimsky C. Microscope-Based Augmented Reality in Degenerative Spine Surgery: Initial Experience. World Neurosurg 2019; 128:e541-e551. [DOI: 10.1016/j.wneu.2019.04.192] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
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Chytas D, Malahias MA, Nikolaou VS. Augmented Reality in Orthopedics: Current State and Future Directions. Front Surg 2019; 6:38. [PMID: 31316995 PMCID: PMC6610425 DOI: 10.3389/fsurg.2019.00038] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/12/2019] [Indexed: 12/29/2022] Open
Abstract
Augmented reality (AR) comprises special hardware and software, which is used in order to offer computer-processed imaging data to the surgeon in real time, so that real-life objects are combined with computer-generated images. AR technology has recently gained increasing interest in the surgical practice. Preclinical research has provided substantial evidence that AR might be a useful tool for intra-operative guidance and decision-making. AR has been applied to a wide spectrum of orthopedic procedures, such as tumor resection, fracture fixation, arthroscopy, and component's alignment in total joint arthroplasty. The present study aimed to summarize the current state of the application of AR in orthopedics, in preclinical and clinical level, providing future directions and perspectives concerning potential further benefits from this technology.
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Affiliation(s)
- Dimitrios Chytas
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Kaliya-Perumal AK, Soh T, Tan M, Nolan CP, Yu CS, Oh JYL. Spinal Navigation during Orthopedic Residency Training: A Double-Edged Sword? Clin Orthop Surg 2019; 11:170-175. [PMID: 31156768 PMCID: PMC6526122 DOI: 10.4055/cios.2019.11.2.170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/15/2019] [Accepted: 01/24/2019] [Indexed: 01/07/2023] Open
Abstract
Background Orthopedic residents in our institute have the opportunity to participate in navigation-assisted spine surgery during their residency training. This paves the way for a new dimension of learning spine surgery, which the previous generation was not exposed to. To study this in detail, we conducted a cross-sectional descriptive survey among our residents to analyse their perception, understanding, and competency regarding pedicle screw application using spinal navigation. Methods We selected orthopedic residents (n = 20) who had completed 3 years of training that included at least one rotation (4–6 months) in our spine division. They were asked to respond to a four-part questionnaire that included general and Likert scale-based questions. The first two parts dealt with various parameters regarding spinal navigation and free-hand technique for applying pedicle screws. The third part dealt with residents' opinion regarding the advantages and disadvantages of spinal navigation. The final part was an objective analysis of residents' ability to identify the pedicle screw entry points in selected segments. Results We found that our residents were better trained to apply pedicle screws using spinal navigation. The mean Likert scale score for perception regarding their competency to apply pedicle screws using spinal navigation was 3.65 ± 0.81, compared to only 2.8 ± 0.77 when using the free-hand technique. All residents agreed that spinal navigation is an excellent teaching tool with higher accuracy and greater utility in anatomically critical cases. However, 35% of the residents were not able to identify the entry points correctly in the given segments. Conclusions All selected residents were perceived to be competent to apply pedicle screws using spinal navigation. However, some of them were not able to identify the entry points correctly, probably due to overreliance on spinal navigation. Therefore, we encourage residents to concentrate on surface anatomy and tactile feedback rather than completely relying on the navigation display monitor during every screw placement. In addition, incorporating cadaveric and saw bone workshops as a part of teaching program can enhance better understanding of surgical anatomy.
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Affiliation(s)
- Arun-Kumar Kaliya-Perumal
- Division of Spine, Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore.,Department of Orthopedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Tamil Nadu, India
| | - Tamara Soh
- Division of Spine, Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Mark Tan
- Division of Spine, Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Chun Sing Yu
- Division of Spine, Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore
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35
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Carl B, Bopp M, Saß B, Voellger B, Nimsky C. Implementation of augmented reality support in spine surgery. 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 2019; 28:1697-1711. [DOI: 10.1007/s00586-019-05969-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/02/2018] [Accepted: 04/02/2019] [Indexed: 01/07/2023]
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37
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Gibby JT, Swenson SA, Cvetko S, Rao R, Javan R. Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography. Int J Comput Assist Radiol Surg 2018; 14:525-535. [PMID: 29934792 DOI: 10.1007/s11548-018-1814-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/13/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Augmented reality has potential to enhance surgical navigation and visualization. We determined whether head-mounted display augmented reality (HMD-AR) with superimposed computed tomography (CT) data could allow the wearer to percutaneously guide pedicle screw placement in an opaque lumbar model with no real-time fluoroscopic guidance. METHODS CT imaging was obtained of a phantom composed of L1-L3 Sawbones vertebrae in opaque silicone. Preprocedural planning was performed by creating virtual trajectories of appropriate angle and depth for ideal approach into the pedicle, and these data were integrated into the Microsoft HoloLens using the Novarad OpenSight application allowing the user to view the virtual trajectory guides and CT images superimposed on the phantom in two and three dimensions. Spinal needles were inserted following the virtual trajectories to the point of contact with bone. Repeat CT revealed actual needle trajectory, allowing comparison with the ideal preprocedural paths. RESULTS Registration of AR to phantom showed a roughly circular deviation with maximum average radius of 2.5 mm. Users took an average of 200 s to place a needle. Extrapolation of needle trajectory into the pedicle showed that of 36 needles placed, 35 (97%) would have remained within the pedicles. Needles placed approximated a mean distance of 4.69 mm in the mediolateral direction and 4.48 mm in the craniocaudal direction from pedicle bone edge. CONCLUSION To our knowledge, this is the first peer-reviewed report and evaluation of HMD-AR with superimposed 3D guidance utilizing CT for spinal pedicle guide placement for the purpose of cannulation without the use of fluoroscopy.
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Affiliation(s)
- Jacob T Gibby
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA
| | - Samuel A Swenson
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA
| | - Steve Cvetko
- Novarad Corporation, 752 East 1180 South, Suite 200, American Fork, UT, 84003, USA
| | - Raj Rao
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA.,Department of Orthopedic Surgery, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA
| | - Ramin Javan
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA. .,Department of Neuroradiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
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