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Augmented reality-navigated pedicle screw placement: a cadaveric pilot study

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Abstract

Purpose

Augmented reality (AR) is an emerging technology with great potential for surgical navigation through its ability to provide 3D holographic projection of otherwise hidden anatomical information. This pilot cadaver study investigated the feasibility and accuracy of one of the first holographic navigation techniques for lumbar pedicle screw placement.

Methods

Lumbar computer tomography scans (CT) of two cadaver specimens and their reconstructed 3D models were used for pedicle screw trajectory planning. Planned trajectories and 3D models were subsequently uploaded to an AR head-mounted device. Randomly, k-wires were placed either into the left or the right pedicle of a vertebra (L1-5) with or without AR-navigation (by holographic projection of the planned trajectory). CT-scans were subsequently performed to assess accuracy of both techniques.

Results

A total of 18 k-wires could be placed (8 navigated, 10 free hand) by two experienced spine surgeons. In two vertebrae, the AR-navigation was aborted because the registration of the preoperative plan with the intraoperative anatomy was imprecise due to a technical failure. The average differences of the screw entry points between planning and execution were 4.74 ± 2.37 mm in the freehand technique and 5.99 ± 3.60 mm in the AR-navigated technique (p = 0.39). The average deviation from the planned trajectories was 11.21° ± 7.64° in the freehand technique and 5.88° ± 3.69° in the AR-navigated technique (p = 0.09).

Conclusion

This pilot study demonstrates improved angular precision in one of the first AR-navigated pedicle screw placement studies worldwide. Technical shortcomings need to be eliminated before potential clinical applications.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No financial funding sources were acquired for this study.

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Authors and Affiliations

  1. Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    José Miguel Spirig, Simon Roner & Mazda Farshad

  2. Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Florentin Liebmann & Philipp Fürnstahl

Authors
  1. José Miguel Spirig
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  2. Simon Roner
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  3. Florentin Liebmann
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  4. Philipp Fürnstahl
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  5. Mazda Farshad
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Corresponding author

Correspondence to José Miguel Spirig.

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Conflict of interest

MF declares to be member of the board and shareholder of Incremed AG, a Balgrist University Startup with the aim to innovate AR solution in medicine.

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Spirig, J.M., Roner, S., Liebmann, F. et al. Augmented reality-navigated pedicle screw placement: a cadaveric pilot study. Eur Spine J 30, 3731–3737 (2021). https://doi.org/10.1007/s00586-021-06950-w

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  • DOI: https://doi.org/10.1007/s00586-021-06950-w

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