Abstract
Background: To investigate the accuracy of augmented reality (AR) navigation using the Magic Leap head mounted device (HMD), pedicle screws were minimally invasively placed in four spine phantoms. Methods: AR navigation provided by a combination of a conventional navigation system integrated with the Magic Leap head mounted device (AR-HMD) was used. Forty-eight screws were planned and inserted into Th11-L4 of the phantoms using the AR-HMD and navigated instruments. Postprocedural CT scans were used to grade the technical (deviation from the plan) and clinical (Gertzbein grade) accuracy of the screws. The time for each screw placement was recorded. Results: The mean deviation between navigation plan and screw position was 1.9 ± 0.7 mm (1.9 [0.3–4.1] mm) at the entry point and 1.4 ± 0.8 mm (1.2 [0.1–3.9] mm) at the screw tip. The angular deviation was 3.0 ± 1.4° (2.7 [0.4–6.2]°) and the mean time for screw placement was 130 ± 55 s (108 [58–437] s). The clinical accuracy was 94% according to the Gertzbein grading scale. Conclusion: The combination of an AR-HMD with a conventional navigation system for accurate minimally invasive screw placement is feasible and can exploit the benefits of AR in the perspective of the surgeon with the reliability of a conventional navigation system.
Highlights
Publisher’s Note: MDPI stays neutralAn increasing number of pedicle screws are placed using minimally invasive techniques [1]
We investigate the technical and clinical accuracy of minimally invasive thoracolumbar pedicle screw placement with augmented reality (AR) navigation using the Magic Leap head mounted device in combination with a conventional surgical navigation system
Monitor-based-AR has gradually been improved with increasing clinical acaccuracy from in the preclinical study to 94%
Summary
An increasing number of pedicle screws are placed using minimally invasive techniques [1]. This has the benefit of fewer surgical site infections, less blood loss and shortened hospital stay [2,3,4,5]. While the reported accuracies of freehand pedicle screw placement in the thoracic and lumbar spine are highly variable, the benefits of improved accuracy, especially in minimally invasive surgery, are evident [6,7]. The traditional image guidance method for pedicle screw placement has been intraoperative fluoroscopy, providing two-dimensional information. To investigate the accuracy of augmented reality (AR) navigation using the Magic Leap head mounted device (HMD), pedicle screws were minimally invasively placed in four spine phantoms. Conclusion: The combination of an AR-HMD with a conventional navigation system for accurate minimally invasive screw placement is feasible and can exploit the benefits of AR in the perspective of the surgeon with the reliability of a conventional navigation system
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