J Korean Soc Spine Surg.  2019 Mar;26(1):26-32. 10.4184/jkss.2019.26.1.26.

Spine Surgery Using Augmented Reality

• Park SM
• Kim HJ
• Yeom JS
• Shin YG

• KMID: 2442345
• DOI: http://doi.org/10.4184/jkss.2019.26.1.26

Abstract

STUDY DESIGN: Review article.
OBJECTIVES
To present the latest knowledge on spine surgery using augmented reality (AR). SUMMARY OF LITERATURE REVIEW: AR is a new technology that simulates interactions with real-world surroundings using computer graphics, and it is a field that has recently been highlighted as part of the fourth industrial revolution.
MATERIALS AND METHODS
Review of related literature and introduction of latest research.
RESULTS
Spine surgery using AR is currently in its early stages. If industry, academia, and research institutes cooperate and develop, spine surgery using AR is highly likely to develop to the next level.
CONCLUSIONS
Spine surgeons should strive to develop relevant technology.

Keyword

Augmented reality; Spine surgery; 4th industrial revolution

MeSH Terms

Academies and Institutes
Computer Graphics
Spine*
Surgeons

Figure

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  Fig. 1. Microsoft Hololens (top) and ODG R-7 (bottom).

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  Fig. 2. Three-dimensional reconstructed model of the spine, simulated by pedicle screw simulator software.

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  Fig. 3. Three-dimensional reconstructed model of the spine, which can be seen using a head-mounted device.

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  Fig. 4. (A) Augmented reality marker and marker-attached screwdriver. (B) RGB camera.

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  Fig. 5. Schematic illustration of computed tomography (CT)-fluoroscopy registration. After creating a virtual C-arm image from CT, it is compared with the actual anteroposterior and lateral C-arm images to perform registration.

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  Fig. 6. (A) Schematic illustration of augmented reality (AR)-based spine surgery. After attaching the AR marker (DRB) to the patient's vertebrae, and completing the computed tomography (CT)-fluoroscopy or paired-point matching, the motion of the vertebrae can be tracked by only tracking the position of the DRB with the RGB camera. After the matching process, the 3-dimensional (3D) reconstructed vertebrae from CT images and surgical instruments can be overlaid on the actual patient's vertebrae. (B) Demonstration of the 3D reconstructed model on a notebook display. (C) Example of an augmented spine 3D reconstruction model during spine surgery. (D) The experimental setup consisted of vertebrae, a RGB cam-era, the C-arm, and the AR marker.

Reference

1. Shuhaiber JH. Augmented reality in surgery. Arch Surg. 2004 Feb; 139(2):170–4. DOI: 10.1001/archsurg. 139.2.170.

2. Graham M, Zook M, Boulton A. Augmented reality in urban places: contested content and the duplicity of code. Transactions of the Institute of British Geographers. 2013 Jul; 38(3):464–79. DOI: 10.1111/j.1475-5661.2012.00539. x.

3. Yoon JW, Chen RE, Kim EJ, et al. Augmented reality for the surgeon: Systematic review. Int J Med Robot. 2018 Aug; 14(4):E1914. DOI: 10.1002/rcs.1914.

4. Ma L, Fan Z, Ning G, et al. 3D Visualization and Augmented Reality for Orthopedics. Adv Exp Med Biol. 2018; 1093:193–205. 10.1007/978-981-13-1396-7_16.

5. Fida B, Cutolo F, di Franco G, et al. Augmented reality in open surgery. Updates Surg. 2018 Sep; 70(3):389–400. DOI: 10.1007/s13304-018-0567-8.

6. Weiss CR, Marker DR, Fischer GS, et al. Augmented reality visualization using Image-Overlay for MR-guided inter-ventions: system description, feasibility, and initial evaluation in a spine phantom. AJR Am J Roentgenol. 2011 Mar; 196(3):W305–7. DOI: 10.2214/AJR.10.5038.

7. Terander AE, Burstrom G, Nachabe R, et al. Pedicle Screw Placement Using Augmented Reality Surgical Navigation with Intraoperative 3D Imaging: A First In-Human Prospective Cohort Study. Spine (Phila Pa 1976). 2019 Apr; 44(7):517–25. DOI: 10.1097/BRS. 0000000000002876.

8. Elmi-Terander A, Nachabe R, Skulason H, et al. Feasibility and Accuracy of Thoracolumbar Minimally Invasive Pedicle Screw Placement With Augmented Reality Navigation Technology. Spine (Phila Pa 1976). 2018 Jul; 43(14):1018–23. DOI: 10.1097/BRS.0000000000002502.

9. Elmi-Terander A, Skulason H, Soderman M, et al. Surgi-cal Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging: A Spine Cadaveric Feasibility and Accuracy Study. Spine (Phila Pa 1976). 2016 Nov; 41(21):E1303–11. DOI: 10.1097/BRS.0000000000001830.

10. Umebayashi D, Yamamoto Y, Nakajima Y, et al. Aug-mented Reality Visualization-guided Microscopic Spine Surgery: Transvertebral Anterior Cervical Foraminotomy and Posterior Foraminotomy. J Am Acad Orthop Surg Glob Res Rev. 2018 Apr; 2(4):e008. DOI: 10.5435/JAAOSGlobal-D-17-00008.

11. Cho HS, Park YK, Gupta S, et al. Augmented reality in bone tumour resection: An experimental study. Bone Joint Res. 2017 Mar; 6(3):137–43. DOI: 10.1302/2046-3758.63.BJR-2016-0289.R1.

12. Hodges SD, Eck JC, Newton D. Analysis of CT-based navigation system for pedicle screw placement. Orthopedics. 2012 Aug; 35(8):e1221–4. DOI: 10.3928/01477447-20120725-23.

13. Papadopoulos EC, Girardi FP, Sama A, et al. Accuracy of single-time, multilevel registration in image-guided spinal surgery. Spine J. 2005 May-Jun; 5(3):263–7. discussion 68. DOI: 10.1016/j.spinee.2004.10.048.