Augmented Reality-assisted Epidural Needle Insertion: User Experience and Performance

Abstract

The epidural injection is a medical intervention to inject therapeutics directly in the vicinity of the spinal cord and the nerves branching from it. Epidural needle insertion is a blind procedure that relies merely on the physician’s tactile feedback. Nevertheless, tactile feedback can be polluted with needle-tissue friction and may vary from patient to patient. In order to achieve sub-millimetre accuracy, preempt neurological damage, and reduce the radiation exposure time for patients and physicians, new technologies have been used. Most recently, augmented reality (AR)-based methods have shown promising results in reducing the need for intraoperative X-ray imaging, especially in spine surgery. AR navigation is based on displaying images directly on a wearable device or screen visualizing surgical instruments and patients’ anatomy. Combined with robotic precision, AR shows an excellent prospect for increasing accuracy for spinal injection similar to that of spine surgery [1]. Studies have shown that the AR navigation systems, when compared to the free- hand methods, resulted in increased precision of pedicle screw placement without intraoperative fluoroscopy [1], [2] and decreased radiation [3]. Inspired by the recent de- velopments in spine surgery, in this study we have studied the user experience who used our robot-assisted needle insertion system for epidural space localization and needle insertion. In addition, the accuracy and repeatability of augmented reality-assisted epidural needle insertion were compared to that of non-assisted robotic needle insertion. For user experience assessment, NASA Task Load Index (TLX) [4] was used and analyzed.