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Youssef S, McDonnell JM, Wilson KV, Turley L, Cunniffe G, Morris S, Darwish S, Butler JS. Accuracy of augmented reality-assisted pedicle screw placement: a systematic review. 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 2024; 33:974-984. [PMID: 38177834 DOI: 10.1007/s00586-023-08094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Conventional freehand methods of pedicle screw placement are associated with significant complications due to close proximity to neural and vascular structures. Recent advances in augmented reality surgical navigation (ARSN) have led to its adoption into spine surgery. However, little is known regarding its overall accuracy. The purpose of this study is to delineate the overall accuracy of ARSN pedicle screw placement across various models. METHODS A systematic review was conducted of Medline/PubMed, Cochrane and Embase Library databases according to the PRISMA guidelines. Relevant data extracted included reports of pedicle screw placement accuracy and breaches, as defined by the Gertzbein-Robbins classification, in addition to deviation from pre-planned trajectory and entry point. Accuracy was defined as the summation of grade 0 and grade 1 events per the Gertzbein-Robbins classification. RESULTS Twenty studies reported clinically accurate placed screws. The range of clinically accurate placed screws was 26.3-100%, with 2095 screws (93.1%) being deemed clinically accurate. Furthermore, 5.4% (112/2088) of screws were reported as grade two breaches, 1.6% (33/2088) grade 3 breaches, 3.1% (29/926) medial breaches and 2.3% (21/926) lateral breaches. Mean linear deviation ranged from 1.3 to 5.99 mm, while mean angular/trajectory deviation ranged 1.6°-5.88°. CONCLUSION The results of this study highlight the overall accuracy of ARSN pedicle screw placement. However, further robust prospective studies are needed to accurately compare to conventional methods of pedicle screw placement.
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Affiliation(s)
- Salma Youssef
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Kielan V Wilson
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Luke Turley
- Department of Orthopaedics, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Seamus Morris
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Joseph S Butler
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
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Bui T, Ruiz-Cardozo MA, Dave HS, Barot K, Kann MR, Joseph K, Lopez-Alviar S, Trevino G, Brehm S, Yahanda AT, Molina CA. Virtual, Augmented, and Mixed Reality Applications for Surgical Rehearsal, Operative Execution, and Patient Education in Spine Surgery: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:332. [PMID: 38399619 PMCID: PMC10890632 DOI: 10.3390/medicina60020332] [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: 01/17/2024] [Revised: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR's main application has been for teaching and preparatory roles, while AR has been mostly used as a surgical adjunct. The objective of this study is to discuss the various applications and prospects for VR, AR, and MR specifically as they relate to spine surgery. Materials and Methods: A systematic review was conducted to examine the current applications of VR, AR, and MR with a focus on spine surgery. A literature search of two electronic databases (PubMed and Scopus) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study quality was assessed using the MERSQI score for educational research studies, QUACS for cadaveric studies, and the JBI critical appraisal tools for clinical studies. Results: A total of 228 articles were identified in the primary literature review. Following title/abstract screening and full-text review, 46 articles were included in the review. These articles comprised nine studies performed in artificial models, nine cadaveric studies, four clinical case studies, nineteen clinical case series, one clinical case-control study, and four clinical parallel control studies. Teaching applications utilizing holographic overlays are the most intensively studied aspect of AR/VR; the most simulated surgical procedure is pedicle screw placement. Conclusions: VR provides a reproducible and robust medium for surgical training through surgical simulations and for patient education through various platforms. Existing AR/MR platforms enhance the accuracy and precision of spine surgeries and show promise as a surgical adjunct.
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Affiliation(s)
- Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Miguel A. Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Harsh S. Dave
- 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
| | - 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 15261, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sofia Lopez-Alviar
- 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
| | - Samuel Brehm
- 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
| | - Camilo A Molina
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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