Augmented reality navigation for spinal pedicle screw instrumentation using intraoperative 3D imaging

Area of Science:

• Medical Technology
• Surgical Navigation
• Augmented Reality

Background:

• Augmented reality (AR) with head-mounted devices (HMDs) enables displaying surgical plans as holograms in a surgeon's view.
• The application of 3D intraoperative fluoroscopy for HMD-based holographic navigation in spine surgery remains unexplored.

Purpose of the Study:

• To evaluate the surgical accuracy of pedicle screw navigation using an HMD-based holographic system with 3D intraoperative fluoroscopy.

Main Methods:

• A cadaver study compared HMD-based AR navigation accuracy against a state-of-the-art pose-tracking system.
• Three lumbar cadaver spines were used, with registration via 3D fluoroscopy and fiducial markers.
• Twenty K-wires were navigated using AR, and ten using the pose-tracking system, with accuracy measured by post-experimental CT scans.

Main Results:

• No significant difference in accuracy was found between AR-navigated and pose-tracking system-guided pedicle screw placement.
• Mean translational errors for entry points were 3.4±1.6 mm (AR) vs. 3.2±2.0 mm (pose-tracking), with p=.85.
• Mean angular errors for trajectories were 4.3°±2.3° (AR) vs. 3.5°±1.4° (pose-tracking), with p=.30.

Conclusions:

• Holographic navigation utilizing HMDs demonstrates accuracy comparable to high-end pose-tracking systems in spine surgery.
• This technology presents a potential new method for surgical navigation with reduced infrastructural requirements.
• Further clinical studies are necessary to confirm these findings.