The Utility of Augmented Reality in Spinal Decompression Surgery Using CT/MRI Fusion Image.

Ryoma Aoyama,Ukei Anazawa,Itsuo Watanabe,Yuichiro Takahashi,Shogo Matsumoto,Hiraku Hotta

doi:10.7759/cureus.18187

Ryoma Aoyama, Ukei Anazawa + Show 4 more

Open Access

https://doi.org/10.7759/cureus.18187

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Journal: Cureus	Publication Date: Sep 22, 2021
Citations: 5	License type: cc-by

Affiliation: Tokyo Dental College Ichikawa General Hospital

Abstract

In spine surgery, instrumentation surgery using augmented reality (AR) and navigation systems have become widespread, while decompression surgery using those applications is not so common. However, we sometimes encounter intraoperative problems such as excessive blood loss or bony resection in decompression surgery. Therefore, a practical navigation system is needed for safer spinal decompression surgery. Furthermore, the cost of AR and navigation systems has been expensive. In this study, we report the utility of applying the AR system of the head-mounted display (HMD) at a lower cost to identify the osteotomy area of laminectomy for spinal decompression surgery.3D CT/MRI fusion images are created preoperatively to generate 3D data consisting of the nerve elements, a dural tube and nerve roots, and the bony elements of the spine. Then, we made the 3D data of the bone after decompression by 3D editing free software. Uploading the created 3D data of both 3D CT/MRI fusion and preoperative planned laminectomy images to the AR software in the HMD, we could confirm the proper decompression area with the 3D images projected through the HMD. This system was useful for cervical and lumbar decompression for confirming the proper decompression area preoperatively.We could perform decompression surgery just designed with this system. This system is a preoperative planning system that allows 3D HMD visualization to keep track of surgical orientation. It does not allow preoperative verification so far. However, this system has various possible applications and is considered a promising system for the future.

Highlights

As personal computers and augmented reality (AR) equipment performance improve, it is becoming easier to handle 3D images at home
Plain radiograph, CT, MRI, etc. are evaluated on a 2D display, even if they are reconstructed into 3D images
A 3D image must be assessed on the monitor that can only display in 2D, so the data is likely reconstructed in 3D in the brain of the evaluators

Summary

Introduction

As personal computers and augmented reality (AR) equipment performance improve, it is becoming easier to handle 3D images at home. D. Preoperative MRI T2-weighted transverse section of C5/6 showed compression of the left C6 nerve root and spinal canal stenosis. E. Postoperative MRI T2-weighted transverse image showed that the left C6 root and spinal canal were decompressed by laminectomy and foraminotomy. B. Preoperative MRI T2-weighted transverse image showed a shift of the dural tube to the left due to the herniation (arrow) that prolapsed to the right at L5/S. c. Postoperative MRI T2-weighted transverse section showed the disappearance of the herniation, widening of the dural tube, and the decompressed right S1 nerve root. In the right image (B), the bone transparency is increased to make it easier to identify the nerve, which makes it easier to confirm the positional relationship between the nerve compression sites (defect indicated by the arrow) and the surrounding bone and confirm whether the decompression site is appropriate in this model. The position of the missing right S1 nerve root could be inferred from the position of the left S1 nerve root (Figure 8)

Discussion

Conclusions

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