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International Journal of Computer Assisted Radiology and Surgery
Published in: International Journal of Computer Assisted Radiology and Surgery 3/2019

01-03-2019 | Original Article

Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography

Authors: Jacob T. Gibby, Samuel A. Swenson, Steve Cvetko, Raj Rao, Ramin Javan

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 3/2019

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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.
Literature
1.
Thakkar SC, Thakkar RS, Sirisreetreerux N, Carrino JA, Shafiq B, Hasenboehler EA (2017) 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology. Int J Comput Assist Radiol Surg 12(1):69–76CrossRefPubMed
2.
Wolf MK, Rostetter C, Stadlinger B, Locher M, Damerau G (2015) Preoperative 3D imaging in maxillary sinus: brief review of the literature and case report. Quintessence Int 46(7):627–631PubMed
3.
Adamczak SE, Bova FJ, Hoh DJ (2017) Intraoperative 3D computed tomography: spine surgery. Neurosurg Clin N Am 28(4):585–594CrossRefPubMed
4.
Javan R, Zeman MN (2017) A prototype educational model for hepatobiliary interventions: unveiling the role of graphic designers in medical 3D printing. J Digit Imaging 23(9):1183–1189
5.
6.
Ballard DH, Trace AP, Ali S, Hodgdon T, Zygmont ME, DeBenedectis CM, Smith SE, Richardson ML, Patel MJ, Decker SJ, Lenchik L (2018) Clinical applications of 3D printing: primer for radiologists. Acad Radiol 25(1):52–65CrossRefPubMed
7.
Bourgeois A, Faulkner A, Bradley YC, Pasciak AS, Barlow PB, Gash JR, Reid WS (2015) Improved accuracy of minimally invasive transpedicular screw placement in the lumbar spine with 3-dimensional stereotactic image guidance: a comparative meta-analysis. Clin Spine Surg 28(9):324–329
8.
Simpfendörfer T, Baumhauer M, Müller M, Gutt CN, Meinzer HP, Rassweiler JJ, Guven S, Teber D (2011) Augmented reality visualization during laparoscopic radical prostatectomy. J Endourol 25(12):1841–1845CrossRefPubMed
9.
Faiella E, Frauenfelder G, Santucci D, Luppi G, Schena E, Beomonte ZB, Grasso RF (2017) Percutaneous low-dose CT-guided lung biopsy with an augmented reality navigation system: validation of the technique on 496 suspected lesions. Clin Imaging 49:101–105CrossRefPubMed
10.
Grasso RF, Faiella E, Luppi G, Schena E, Giurazza F, Del Vescovo R, D’Agostino F, Cazzato RL, Beomonte ZB (2013) Percutaneous lung biopsy: comparison between an augmented reality CT navigation system and standard CT-guided technique. Int J Comput Assist Radiol Surg 8(5):837–848CrossRefPubMed
11.
Lee SC, Fuerst B, Tateno K, Johnson A, Fotouhi J, Osgood G, Tombari F, Navab N (2017) Multi-modal imaging, model-based tracking, and mixed reality visualisation for orthopaedic surgery. Healthc Technol Lett 4(5):168–173CrossRefPubMedPubMedCentral
12.
13.
Pfandler M, Lazarovici M, Stefan P, Wucherer P, Weigl M (2017) Virtual reality-based simulators for spine surgery: a systematic review. Spine J 17(9):1352–1363CrossRefPubMed
14.
Léger E, Drouin S, Collins DL, Popa T, Kersten-Oertel M (2017) Quantifying attention shifts in augmented reality image-guided neurosurgery. Healthc Technol Lett 4(5):188–192CrossRefPubMedPubMedCentral
15.
Kosterhon M, Gutenberg A, Kantelhardtt SR, Archavlis E, Giese A (2017) Navigation and image injection for control of bone removal and osteotomy planes in spine surgery. Oper Neurosurg 13(2):297–304CrossRef
16.
Singla R, Edgcumbe P, Pratt P, Nguan C, Rohling R (2017) Intra-operative ultrasound-based augmented reality guidance for laparoscopic surgery. Healthc Technol Lett 4(5):204–209CrossRefPubMedPubMedCentral
17.
Sauer IM, Queisner M, Tang P, Moosburner S, Hoepfner O, Horner R, Lohmann R, Pratschke J (2017) Mixed reality in visceral surgery: development of a suitable workflow and evaluation of intraoperative use-cases. Ann Surg 266(5):706–712CrossRefPubMed
18.
Galvis V, Berrospi RD, Arias JD, Tello A, Bernal JC (2017) Heads up Descemet membrane endothelial keratoplasty performed using a 3D visualization system. J Surg Case Rep 11(1):1–4
19.
Chu Y, Yang J, Ma S, Ai D, Li W, Song H, Li L, Chen D, Chen L, Wang Y (2017) Registration and fusion quantification of augmented reality based nasal endoscopic surgery. Med Image Anal 42:241–256CrossRefPubMed
20.
Scolozzi P, Bijlenga P (2017) Removal of recurrent intraorbital tumour using a system of augmented reality. Br J Oral Maxillofac Surg 55(9):962–964CrossRefPubMed
21.
Aydin A, Raison N, Khan MS, Dasgupta P, Ahmed K (2016) Simulation-based training and assessment in urological surgery. Nat Rev Urol 13(9):503–519CrossRefPubMed
22.
23.
24.
Gasco J, Patel A, Ortega-Barnett J, Branch D, Desai S, Kuo YF, Luciano C, Rizzi S, Kania P, Matuyauskas M, Banerjee P, Roitberg BZ (2014) Virtual reality spine surgery simulation: an empirical study of its usefulness. Neurol Res 36(11):968–973CrossRefPubMed
25.
Johnston MJ, Paige JT, Aggarwal R, Stefanidis D, Tsuda S, Khajuria A, Arora S, Association for Surgical Education Simulation Committee (2016) An overview of research priorities in surgical simulation: what the literature shows has been achieved during the 21st century and what remains. Am J Surg 211(1):214–225CrossRefPubMed
26.
Dawe SR, Pena GN, Windsor JA, Broeders JA, Cregan PC, Hewett PJ, Maddern GJ (2014) Systematic review of skills transfer after surgical simulation-based training. Br J Surg 101(9):1063–1076CrossRefPubMed
27.
28.
Barsom EZ, Graafland M, Schijven MP (2016) Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc 30(10):4174–4183CrossRefPubMedPubMedCentral
29.
Kwon OH, Muelder C, Lee K, Ma KL (2017) A study of layout, rendering, and interaction methods for immersive graph visualization. IEEE Trans Vis Comput Graphics 22(7):1802–1815CrossRef
30.
Qian L, Barthel A, Johnson A, Osgood G, Kazanzides P, Navab N, Fuerst B (2017) Comparison of optical see-through head-mounted displays for surgical interventions with object-anchored 2D-display. Int J Comput Assist Radiol Surg 12(6):901–910CrossRefPubMedPubMedCentral
31.
32.
Kuhlemann I, Kleemann M, Jauer P, Schweikard A, Ernst F (2017) Towards X-ray free endovascular interventions—using HoloLens for on-line holographic visualisation. Healthc Technol Lett 4(5):184–187CrossRefPubMedPubMedCentral
33.
Bederman SS, Le VH, Pahlavan S (2016) An approach to lumbar revision spine surgery in adults. J Am Acad Orthop Surg 24(7):433–442CrossRefPubMed
34.
35.
Chan A, Parent E, Narvacan K, San C, Lou E (2017) Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates. Spine J 17(9):1215–1229CrossRefPubMed
36.
Chaudhari A, Lakhani K, Deulkar K (2015) Transforming the world using holograms. Int. J Comput Appl Eng Sci 130(1):30–32
37.
38.
Matsukawa K, Yato Y (2017) Lumbar pedicle screw fixation with cortical bone trajectory: a review from anatomical and biomechanical standpoints. Spine Surg Relat Res 1(4):164–173CrossRefPubMedPubMedCentral
39.
Gabbita A, Usman MM, Kishan A, Varadaraju DN, Patil SG, Hosmath AV (2016) Pedicle screw placement in the thoracic and lumbar spine by the c-arm guided navigation and the free hand method: a technical and outcome analysis. J Spine Surg 3(3):90–95CrossRef
40.
Bernard TN, Seibert CE (1992) Pedicle diameter determined by computed tomography. Its relevance to pedicle screw fixation in the lumbar spine. Spine J 17(6):160–163CrossRef
41.
42.
Theologis AA, Burch S, Pekmezci M (2016) Placement of iliosacral screws using 3D image-guided (O-Arm) technology and Stealth Navigation: comparison with traditional fluoroscopy. Bone Joint J 98-B(5):696–702CrossRefPubMed
43.
Spitz SM, Sandhu FA, Voyadzis JM (2015) Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time. J Neurosurg Spine 22(4):422–431CrossRefPubMed
44.
Wray S, Mimran R, Vadapalli S, Shetve SS, McGilvray KC, Puttlitz CM (2015) Pedicle screw placement in the lumbar spine: effect of trajectory and screw design on acute biomechanical purchase. J Neurosurg Spine 22(5):503–510CrossRefPubMed
45.
Chung KJ, Sug SW, Desai S, Song HR (2008) Ideal entry point for the thoracic pedicle screw during the free hand technique. Int Orthop 32(5):657–662CrossRefPubMed
46.
Zindrick MR, Wiltse LL, Doornik A, Widell EH, Knight GW, Patwardhan AG, Thomas JC, Rothman SL, Fields BT (1987) Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine 12(2):160–166CrossRefPubMed
47.
Labadie RF, Davis BM, Fitzpatrick JM (2005) Image-guided surgery: what is the accuracy? Curr Opin Otolaryngol Head Neck Surg 13(1):27–31CrossRefPubMed
48.
Afshari E, Rostami M, Farahmand F (2017) Review on different experimental techniques developed for recording force-deformation behaviour of soft tissues; with a view to surgery simulation applications. J Med Eng Technol 41(4):257–274CrossRefPubMed
49.
Tonutti M, Gras G, Yang GZ (2017) A machine learning approach for real-time modelling of tissue deformation in image-guided neurosurgery. Artif Intell Med 80:39–47CrossRefPubMed
50.
51.
Hervey-Jumper SL, Berger MS (2016) Maximizing safe resection of low- and high-grade glioma. J Neurooncol 130(2):269–282CrossRefPubMed
52.
Jensen ME, McGraw JK, Cardella JF, Hirsch JA (2009) Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology. J Vasc Interv Radiol 20(7):326–331CrossRef
53.
Alaraj A, Charbel FT, Birk D, Tobin M, Luciano C, Banerjee PP, Rizzi S, Sorenson J, Foley K, Slavin K, Roitberg B (2013) Role of cranial and spinal virtual and augmented reality simulation using immersive touch modules in neurosurgical training. Neurosurgery 72(1):115–123CrossRefPubMedPubMedCentral
Metadata
Title
Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography
Authors
Jacob T. Gibby
Samuel A. Swenson
Steve Cvetko
Raj Rao
Ramin Javan
Publication date
01-03-2019
Publisher
Springer International Publishing
Published in
International Journal of Computer Assisted Radiology and Surgery / Issue 3/2019
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI
https://doi.org/10.1007/s11548-018-1814-7

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