116 OpEyes-Augmented Reality Surgical Navigation and Advanced Minimally Invasive Pedicle Screw Navigation

Abstract

INTRODUCTION: The spine surgery market is moving away from open dissection to minimally invasive spine surgery (MISS). Precise operative navigation is imperative for MISS to achieve its potential. Guidance systems have been available for years, but adoption is limited by laborious set-up, costs and intraoperative imaging requirements. Herein is described the use of OpEyes-Augmented Reality (Novarad, American Fork, UT) for navigation and guidance of MISS for highly accurate insertion of pedicle screws. METHODS: A Microsoft HoloLens 2 (Microsoft, Redmond, WA) was used as the hardware platform for OpEyes-AR software. AprilTags, printed with CT visible ink, were either adhered to the skin, anchored to the iliac crests, or a vertebra. Following CT, the radiologist identified virtual pathways for ideal placement of pedicle screws for each vertebra.The annotated studies were wirelessly uploaded to the software/visor combination by viewing an encrypted QR code assigned by the pre-op system. The studies were registered to the AprilTags captured during CT. The virtual pathways were called by voice command for each vertebra and were used to establish skin entry point, trajectory, and depth with target bullseyes. Fluoroscopy was not required for navigation. Excella MIS hardware was used for placement of the screws into the pedicles of a donor torso (Innovasis, Salt Lake City, UT). RESULTS: Pedicle screws were instrumented through levels L5-T9 for a total of 15 screws. There were no breaches. Many of the thoracic pedicles were narrow with little or no tolerance. Guidance and navigation were performed solely with OpEyes-AR. CONCLUSION: OpEyes-AR is a tether-less, holographic visor and software combination offering the potential for precise navigation of MISS percutaneous insertion of pedicle screws with a nominal OR footprint and elimination of OR imaging.