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Kann MR, Ruiz-Cardozo MA, Brehm S, Bui T, Joseph K, Barot K, Trevino G, Carey-Ewend A, Singh SP, De La Paz M, Hanafy A, Olufawo M, Patel RP, Yahanda AT, Perdomo-Pantoja A, Jauregui JJ, Cadieux M, Pennicooke B, Molina CA. Utilization of Augmented Reality Head-Mounted Display for the Surgical Management of Thoracolumbar Spinal Trauma. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:281. [PMID: 38399568 PMCID: PMC10890598 DOI: 10.3390/medicina60020281] [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: 12/29/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Augmented reality head-mounted display (AR-HMD) is a novel technology that provides surgeons with a real-time CT-guided 3-dimensional recapitulation of a patient's spinal anatomy. In this case series, we explore the use of AR-HMD alongside more traditional robotic assistance in surgical spine trauma cases to determine their effect on operative costs and perioperative outcomes. Materials and Methods: We retrospectively reviewed trauma patients who underwent pedicle screw placement surgery guided by AR-HMD or robotic-assisted platforms at an academic tertiary care center between 1 January 2021 and 31 December 2022. Outcome distributions were compared using the Mann-Whitney U test. Results: The AR cohort (n = 9) had a mean age of 66 years, BMI of 29.4 kg/m2, Charlson Comorbidity Index (CCI) of 4.1, and Surgical Invasiveness Index (SII) of 8.8. In total, 77 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 378 mL, 0.78 units transfused, 398 min spent in the operating room, and a 20-day LOS. The robotic cohort (n = 13) had a mean age of 56 years, BMI of 27.1 kg/m2, CCI of 3.8, and SII of 14.2. In total, 128 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 432 mL, 0.46 units transfused units used, 331 min spent in the operating room, and a 10.4-day LOS. No significant difference was found between the two cohorts in any outcome metrics. Conclusions: Although the need to address urgent spinal conditions poses a significant challenge to the implementation of innovative technologies in spine surgery, this study represents an initial effort to show that AR-HMD can yield comparable outcomes to traditional robotic surgical techniques. Moreover, it highlights the potential for AR-HMD to be readily integrated into Level 1 trauma centers without requiring extensive modifications or adjustments.
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Affiliation(s)
- Michael Ryan Kann
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Miguel A. Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Abigail Carey-Ewend
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Som P. Singh
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew De La Paz
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ahmed Hanafy
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rujvee P. Patel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander T. Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander Perdomo-Pantoja
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Julio J. Jauregui
- Department of Orthopedic Surgery, University of Maryland Medical System, Baltimore, MD 21201, USA
| | - Magalie Cadieux
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Brenton Pennicooke
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Camilo A. Molina
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Wu N, Liu L, Chen G, Wang S, Yang Y, Wu Z, Zhang TJ. The effect of pedicle screw instrumentation at a young age on upper thoracic vertebra and canal development. Spine J 2023; 23:1358-1364. [PMID: 37209967 DOI: 10.1016/j.spinee.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/29/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND CONTEXT Pedicle screws are widely used in spinal surgeries. Pedicle screw fixation has shown better clinical effects than other techniques by providing steady fixation from the posterior arch to the vertebral body. However, there are several concerns about the impact of pedicle screw instrumentation insertion on vertebral development in young children, including early closure of the neurocentral cartilage (NCC). The effect of pedicle screw insertion in an early age on further growth of the upper thoracic spine is still unclear. PURPOSE This study aimed to evaluate the impact of pedicle screw insertion on further growth of the upper thoracic vertebra and spinal canal. STUDY DESIGN A retrospective case study. PATIENT SAMPLE Twenty-eight patients. OUTCOME MEASUREMENTS X-ray and CT parameters including length, height and area of the vertebrae and spinal canal were manually measured. METHODS Twenty-eight patients who underwent pedicle screw fixation (T1-T6) before the age of 5 years from March 2005 to August 2019 at Peking Union Medical College Hospital were recruited, and records were retrospectively reviewed. Vertebral body and spinal canal parameters were measured at instrumented and adjacent noninstrumented levels and compared using statistical methods. RESULTS Ninety-seven segments met the inclusion criteria (average age at instrumentation 44.57 months, range from 23-60 months). Thirty-nine segments had no screws, and 58 had at least one screw. There was no significant difference between the preoperative and final follow-up values of the measurement of vertebral body parameters. No significant difference was observed between the growth rates in levels with or without screws in pedicle length, vertebral body diameter, or spinal canal parameters. CONCLUSION Pedicle screw instrumentation in the upper thoracic spine does not cause a negative effect on the development of the vertebral body and spinal canal in children younger than 5 years old.
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Affiliation(s)
- Nan Wu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Lian Liu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China; Department of Emergency Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Guilin Chen
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College, Beijing, 100730, China
| | - Shengru Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yang Yang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhihong Wu
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China; Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Terry Jianguo Zhang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China; Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China; Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Katz AD, Song J, Hasan S, Galina JM, Virk S, Silber JS, Essig D, Sarwahi V. Navigated versus conventional pediatric spinal deformity surgery: Navigation independently predicts reoperation and infectious complications. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:165-174. [PMID: 37448507 PMCID: PMC10336894 DOI: 10.4103/jcvjs.jcvjs_28_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/09/2023] [Indexed: 07/15/2023] Open
Abstract
Context Literature on treating pediatric spinal deformity with navigation is limited, particularly using large nationally represented cohorts. Further, the comparison of single-institution data to national-level database outcomes is also lacking. Aim (1) To compare navigated versus conventional posterior pediatric deformity surgery based on 30-day outcomes and perioperative factors using the National Surgical Quality Improvement Program (NSQIP) database and (2) to compare the outcomes of the NSQIP navigated group to those of fluoroscopy-only and navigated cases from a single-institution. Settings and Design Retrospective cohort study. Subjects and Methods Pediatric patients who underwent posterior deformity surgery with and without navigation were included. Primary outcomes were 30-day readmission, reoperation, morbidity, and complications. The second part of this study included AIS patients < 18 years old at a single institution between 2015 and 2019. Operative time, length of stay, transfusion rate, and complication rate were compared between single-institution and NSQIP groups. Statistical Analysis Used Univariate analyses with independent t-test and Chi-square or Fisher's exact test was used. Multivariate analyses through the application of binary logistic regression models. Results Part I of the study included 16,950 patients, with navigation utilized in 356 patients (2.1%). In multivariate analysis, navigation predicted reoperation, deep wound infection, and sepsis. After controlling for operative year, navigation no longer predicted reoperation. In Part II of the study, 288 single institution AIS patients were matched to 326 navigation patients from the NSQIP database. Operative time and transfusion rate were significantly higher for the NSQIP group. Conclusions On a national scale, navigation predicted increased odds of reoperation and infectious-related events and yielded greater median relative value units (RVUs) per case but had longer operating room (OR) time and fewer RVUs-per-minute. After controlling for operative year, RVUs-per-minute and reoperation rates were similar between groups. The NSQIP navigated surgery group was associated with significantly higher operative time and transfusion rates compared to the single-institution groups.
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Affiliation(s)
- Austen D. Katz
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Junho Song
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Sayyida Hasan
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Jesse M. Galina
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Sohrab Virk
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Jeff Scott Silber
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - David Essig
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Vishal Sarwahi
- Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, USA
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Cirrincione P, Widmann RF, Heyer JH. Advances in robotics and pediatric spine surgery. Curr Opin Pediatr 2023; 35:102-109. [PMID: 36354112 DOI: 10.1097/mop.0000000000001199] [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] [Indexed: 11/12/2022]
Abstract
PURPOSE OF REVIEW Robotic-assisted surgical navigation for placement of pedicle screws is one of the most recent technological advancements in spine surgery. Excellent accuracy and reliability results have been documented in the adult population, but adoption of robotic surgical navigation is uncommon in pediatric spinal deformity surgery. Pediatric spinal anatomy and the specific pediatric pathologies present unique challenges to adoption of robotic assisted spinal deformity workflows. The purpose of this article is to review the safety, accuracy and learning curve data for pediatric robotic-assisted surgical navigation as well as to identify "best use" cases and technical tips. RECENT FINDINGS Robotic navigation has been demonstrated as a safe, accurate and reliable method to place pedicle screws in pediatric patients with a moderate learning curve. There are no prospective studies comparing robotically assisted pedicle screw placement with other techniques for screw placement, however several recent studies in the pediatric literature have demonstrated high accuracy and safety as well as high reliability. In addition to placement of pediatric pedicle screws in the thoracic and lumbar spine, successful and safe placement of screws in the pelvis and sacrum have also been reported with reported advantages over other techniques in the setting of high-grade spondylolisthesis as well as pelvic fixation utilizing S2-alar iliac (S2AI) screws. SUMMARY Early studies have demonstrated that robotically assisted surgical navigation for pedicle screws and pelvic fixation for S2AI screws is safe, accurate, and reliable in the pediatric population with a moderate learning curve.
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Affiliation(s)
- Peter Cirrincione
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Butler AJ, Colman MW, Lynch J, Phillips FM. Augmented reality in minimally invasive spine surgery: early efficiency and complications of percutaneous pedicle screw instrumentation. Spine J 2023; 23:27-33. [PMID: 36182070 DOI: 10.1016/j.spinee.2022.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Augmented reality (AR) employs an optical projection directly onto the user's retina, allowing complex image overlay on the natural visual field. In general, pedicle screw accuracy rates have improved with increasingly use of technology, with navigation-based instrumentation described as accurate in 89%-100% of cases. Emerging AR technology in spine surgery builds upon current spinal navigation to provide 3-dimensional imaging of the spine and powerfully reduce the impact of inherent ergonomic and efficiency difficulties. PURPOSE This publication describes the first known series of in vivo pedicle screws placed percutaneously using AR technology for MIS applications. STUDY DESIGN / SETTING After IRB approval, 3 senior surgeons at 2 institutions contributed cases from June, 2020 - March, 2022. 164 total MIS cases in which AR used for placement of percutaneous pedicle screw instrumentation with spinal navigation were identified prospectively. PATIENT SAMPLE 155 (94.5%) were performed for degenerative pathology, 6 (3.6%) for tumor and 3 (1.8%) for spinal deformity. These cases amounted to a total of 606 pedicle screws; 590 (97.3%) were placed in the lumbar spine, with 16 (2.7%) thoracic screws placed. OUTCOME MEASURES Patient demographics and surgical metrics including total posterior construct time (defined as time elapsed from preincision instrument registration to final screw placement), clinical complications and instrumentation revision rates were recorded in a secure and de-identified database. METHODS The AR system used features a wireless headset with transparent near-eye display which projects intra-operative 3D imaging directly onto the surgeon's retina. After patient positioning, 1 percuntaneous and 1 superficial reference marker are placed. Intra-operative CT data is processed to the headset and integrates into the surgeon's visual field creating a "see-through" 3D effect in addition to 2D standard navigation images. MIS pedicle screw placement is then carried out percutaneously through single line of sight using navigated instruments. RESULTS Time elapsed from registration and percutaneous approach to final screw placement averaged 3 minutes and 54 seconds per screw. Analysis of the learning curve revealed similar surgical times in the early cases compared to the cases performed with more experience with the system. No instrumentation was revised for clinical or radiographic complication at final available follow-up ranging from 6-24 months. A total of 3 screws (0.49%) were replaced intra-operatively. No clinical effects via radiculopathy or neurologic deficit postoperatively were noted. CONCLUSIONS This is the first report of the use of AR for placement of spinal pedicle screws using minimally invasive techniques. This series of 164 cases confirmed efficiency and safety of screw placement with the inherent advantages of AR technologies over legacy enabling technologies.
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Affiliation(s)
- Alexander J Butler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Matthew W Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Frank M Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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