Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Microscope-based augmented reality navigated pedicle screw insertion for thoracolumbar spine diseases (#211)

Fumitake FT Tezuka 1 , Saori SS Soeda 1 , Yutaka YK Kinoshita 1 , Kosuke KS Sugiura 1 , Masatoshi MM Morimoto 1 , Kazuta KY Yamashita 1 , Koichi KS Sairyo 1
  1. Tokushima Univesity, Tokushima, TOKUSHIMA, Japan

655543bc5ff13-ISSLS2023_image.jpgPurpose:

In recent years, there have been significant advancements in the application of augmented reality (AR) technology in the spine surgery. Microscope-based AR is a new navigation system makes us able to perform surgery with preplanned objects displayed in the actual surgical field through head-up display. We report the first case series of microscope-based AR navigated pedicle screw (PS) insertion for open and percutaneous procedures.

 

Materials and Methods:

We performed a retrospective study of the first 9 patients who underwent microscope-based AR navigated PS insertion in the thoracic and lumbar spine. First step: We created virtual images of the spinous process, lamina, pedicle, and vertebral body from CT images using the workstation (Brainlab, Elements). Second step: We placed a navigation antenna on spinous process and performed surface registration using navigation platform (Brainlab, Curve). Third step: The virtual images were displayed in the surgical field through head-up display of microscope (Zeiss, Kinevo 900). Fourth step: PS was inserted while displaying the location of pedicle without C-arm navigation. Left-side screws were inserted by one attending spine surgeon and right-side screws were inserted by young spine surgeons. The accuracy of PS insertion was assessed by Gertzbein-Robbins classification (Grade A-E), and Grade A and B were judged to be accurate.

 

Results:

A total of 48 screws were placed. The overall screw insertion accuracy was 97.9% (Grade A: 23 screws in left /21 screws in right, Grade B: 1 screw /2 screws, Grade C: 0 screw /1 screw). The only 1 screw was judged to be Grade C; however, there was no clinical complication. There was no difference in accuracy between right and left (P=0.348).

 

Conclusion:

This is the first report of AR microscope navigated PS insertion. Although this study is limted preliminary cases, microscope-based AR navigated PS insertion is safe and accurate, and can reduce intraoperative irradiation for surgeons and patients. And also, it is helpful for young spine surgeons as novel educational tool.