Top

International Orthopaedics

Published in:

01-09-2016 | Original Paper

Precision insertion of percutaneous sacroiliac screws using a novel augmented reality-based navigation system: a pilot study

Authors: Huixiang Wang, Fang Wang, Anthony Peng Yew Leong, Lu Xu, Xiaojun Chen, Qiugen Wang

Published in: International Orthopaedics | Issue 9/2016

Abstract

Purpose

Augmented reality (AR) enables superimposition of virtual images onto the real world. The aim of this study is to present a novel AR-based navigation system for sacroiliac screw insertion and to evaluate its feasibility and accuracy in cadaveric experiments.

Methods

Six cadavers with intact pelvises were employed in our study. They were CT scanned and the pelvis and vessels were segmented into 3D models. The ideal trajectory of the sacroiliac screw was planned and represented visually as a cylinder. For the intervention, the head mounted display created a real-time AR environment by superimposing the virtual 3D models onto the surgeon’s field of view. The screws were drilled into the pelvis as guided by the trajectory represented by the cylinder. Following the intervention, a repeat CT scan was performed to evaluate the accuracy of the system, by assessing the screw positions and the deviations between the planned trajectories and inserted screws.

Results

Post-operative CT images showed that all 12 screws were correctly placed with no perforation. The mean deviation between the planned trajectories and the inserted screws was 2.7 ± 1.2 mm at the bony entry point, 3.7 ± 1.1 mm at the screw tip, and the mean angular deviation between the two trajectories was 2.9° ± 1.1°. The mean deviation at the nerve root tunnels region on the sagittal plane was 3.6 ± 1.0 mm.

Conclusions

This study suggests an intuitive approach for guiding screw placement by way of AR-based navigation. This approach was feasible and accurate. It may serve as a valuable tool for assisting percutaneous sacroiliac screw insertion in live surgery.

Shuler TE, Boone DC, Gruen GS, Peitzman AB (1995) Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Trauma 38:453–458CrossRefPubMed

Routt ML Jr, Kregor PJ, Simonian PT, Mayo KA (1995) Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma 9:207–214CrossRefPubMed

Yu X, Tang M, Zhou Z, Peng X, Wu T, Sun Y (2013) Minimally invasive treatment for pubic ramus fractures combined with a sacroiliac joint complex injury. Int Orthop 37:1547–1554. doi:10.1007/s00264-013-1954-x CrossRefPubMedPubMedCentral

Peng KT, Li YY, Hsu WH, Wu MH, Yang JT, Hsu CH, Huang TJ (2013) Intraoperative computed tomography with integrated navigation in percutaneous iliosacral screwing. Injury 44:203–208. doi:10.1016/j.injury.2012.09.017 CrossRefPubMed

Hinsche AF, Giannoudis PV, Smith RM (2002) Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws. Clin Orthop Relat Res 135–144

Templeman D, Schmidt A, Freese J, Weisman I (1996) Proximity of iliosacral screws to neurovascular structures after internal fixation. Clin Orthop Relat Res 194–198

Xu P, Wang H, Liu ZY, Mu WD, Xu SH, Wang LB, Chen C, Cavanaugh JM (2013) An evaluation of three-dimensional image-guided technologies in percutaneous pelvic and acetabular lag screw placement. J Surg Res 185:338–346. doi:10.1016/j.jss.2013.05.074 CrossRefPubMed

Grossterlinden L, Rueger J, Catala-Lehnen P, Rupprecht M, Lehmann W, Rucker A, Briem D (2011) Factors influencing the accuracy of iliosacral screw placement in trauma patients. Int Orthop 35:1391–1396. doi:10.1007/s00264-010-1092-7 CrossRefPubMed

Gras F, Marintschev I, Klos K, Muckley T, Hofmann GO, Kahler DM (2012) Screw placement for acetabular fractures: which navigation modality (2-dimensional vs. 3-dimensional) should be used? An experimental study. J Orthop Trauma 26:466–473. doi:10.1097/Bot.0b013e318234d443 CrossRefPubMed

10.

Wahnert D, Raschke MJ, Fuchs T (2013) Cement augmentation of the navigated iliosacral screw in the treatment of insufficiency fractures of the sacrum. A new method using modified implants. Int Orthop 37:1147–1150. doi:10.1007/s00264-013-1875-8 CrossRefPubMedPubMedCentral

11.

Arand M, Kinzl L, Gebhard F (2004) Computer-guidance in percutaneous screw stabilization of the iliosacral joint. Clin Orthop Relat Res 201–207. doi:10.1097/01.blo.0000128644.46013.08

12.

Takao M, Nishii T, Sakai T, Yoshikawa H, Sugano N (2014) Iliosacral screw insertion using CT-3D-fluoroscopy matching navigation. Inj Int J Care Inj 45:988–994. doi:10.1016/j.injury.2014.01.015 CrossRef

13.

Vigh B, Muller S, Ristow O, Deppe H, Holdstock S, den Hollander J, Navab N, Steiner T, Hohlweg-Majert B (2014) The use of a head-mounted display in oral implantology: a feasibility study. Int J Comput Assist Radiol Surg 9:71–78. doi:10.1007/s11548-013-0912-9 CrossRefPubMed

14.

Besharati Tabrizi L, Mahvash M (2015) Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique. J Neurosurg 1–6. doi:10.3171/2014.9.JNS141001

15.

Kang X, Azizian M, Wilson E, Wu K, Martin AD, Kane TD, Peters CA, Cleary K, Shekhar R (2014) Stereoscopic augmented reality for laparoscopic surgery. Surg Endosc 28:2227–2235. doi:10.1007/s00464-014-3433-x CrossRefPubMed

16.

Qu M, Hou Y, Xu Y, Shen C, Zhu M, Xie L, Wang H, Zhang Y, Chai G (2015) Precise positioning of an intraoral distractor using augmented reality in patients with hemifacial microsomia. J Cranio-Maxillofac Surg: Off Publ Eur Assoc Cranio-Maxillofac Surg 43:106–112. doi:10.1016/j.jcms.2014.10.019 CrossRef

17.

Suenaga H, Hoang Tran H, Liao H, Masamune K, Dohi T, Hoshi K, Mori Y, Takato T (2013) Real-time in situ three-dimensional integral videography and surgical navigation using augmented reality: a pilot study. Int J Oral Sci 5:98–102. doi:10.1038/ijos.2013.26 CrossRefPubMedPubMedCentral

18.

Abe Y, Sato S, Kato K, Hyakumachi T, Yanagibashi Y, Ito M, Abumi K (2013) A novel 3D guidance system using augmented reality for percutaneous vertebroplasty: technical note. J Neurosurg Spine 19:492–501. doi:10.3171/2013.7.spine12917 CrossRefPubMed

19.

Chen X, Xu L, Wang Y, Wang H, Wang F, Zeng X, Wang Q, Egger J (2015) Development of a surgical navigation system based on augmented reality using an optical see-through head-mounted display. J Biomed Inform 55:124–131. doi:10.1016/j.jbi.2015.04.003 CrossRefPubMed

20.

Smith HE, Yuan PS, Sasso R, Papadopolous S, Vaccaro AR (2006) An evaluation of image-guided technologies in the placement of percutaneous iliosacral screws. Spine 31:234–238CrossRefPubMed

21.

Wong JM, Bewsher S, Yew J, Bucknill A, de Steiger R (2015) Fluoroscopically assisted computer navigation enables accurate percutaneous screw placement for pelvic and acetabular fracture fixation. Injury 46:1064–1068. doi:10.1016/j.injury.2015.01.038 CrossRefPubMed

22.

Zwingmann J, Konrad G, Kotter E, Sudkamp NP, Oberst M (2009) Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res 467:1833–1838. doi:10.1007/s11999-008-0632-6 CrossRefPubMed

23.

Routt ML Jr, Simonian PT, Mills WJ (1997) Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma 11:584–589CrossRefPubMed

24.

Rolland JP, Fuchs H (2000) Optical versus video see-through mead-mounted displays in medical visualization. Presence Teleop Virt 9:287–309. doi:10.1162/105474600566808 CrossRef

25.

Shuhaiber JH (2004) Augmented reality in surgery. Arch Surg 139:170–174. doi:10.1001/archsurg.139.2.170 CrossRefPubMed

Title: Precision insertion of percutaneous sacroiliac screws using a novel augmented reality-based navigation system: a pilot study
Authors: Huixiang Wang
Fang Wang
Anthony Peng Yew Leong
Lu Xu
Xiaojun Chen
Qiugen Wang
Publication date: 01-09-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-3028-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Precision insertion of percutaneous sacroiliac screws using a novel augmented reality-based navigation system: a pilot study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2016

Hamstring tendon autograft versus fresh-frozen tibialis posterior allograft in primary arthroscopic anterior cruciate ligament reconstruction: a retrospective cohort study with three to six years follow-up

Long-term results with the Atlas IIIp elastic cementless acetabular component in total hip replacement

National trends and in hospital outcomes for total hip arthroplasty in avascular necrosis in the United States

Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience

Silicone ring tourniquet or pneumatic cuff tourniquet for total knee arthroplasty

Three-dimensional in vivo difference between native acetabular version and acetabular component version influences iliopsoas impingement after total hip arthroplasty