Augmented reality-assisted pedicle screw insertion: A cadaveric proof-of-concept study

Camilo A. Molina, Nicholas Theodore, A. Karim Ahmed, Erick M. Westbroek, Yigal Mirovsky, Ran Harel, Emanuele Orru, Majid Khan, Timothy Witham, Daniel M. Sciubba

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Augmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator's retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods. METHODS: Five cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures. RESULTS: The overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification. CONCLUSIONS: AR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

Original languageEnglish (US)
Pages (from-to)139-146
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Robotics
Torso
Retina
Pedicle Screws
Technology
Safety

Keywords

  • Augmented reality
  • Augmented reality-assisted surgery
  • Cadaveric trial
  • Computer-navigated surgery
  • Neuronavigation
  • Robotic spine surgery
  • Surgical technique

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Augmented reality-assisted pedicle screw insertion : A cadaveric proof-of-concept study. / Molina, Camilo A.; Theodore, Nicholas; Karim Ahmed, A.; Westbroek, Erick M.; Mirovsky, Yigal; Harel, Ran; Orru, Emanuele; Khan, Majid; Witham, Timothy; Sciubba, Daniel M.

In: Journal of Neurosurgery: Spine, Vol. 31, No. 1, 01.01.2019, p. 139-146.

Research output: Contribution to journalArticle

Molina, Camilo A. ; Theodore, Nicholas ; Karim Ahmed, A. ; Westbroek, Erick M. ; Mirovsky, Yigal ; Harel, Ran ; Orru, Emanuele ; Khan, Majid ; Witham, Timothy ; Sciubba, Daniel M. / Augmented reality-assisted pedicle screw insertion : A cadaveric proof-of-concept study. In: Journal of Neurosurgery: Spine. 2019 ; Vol. 31, No. 1. pp. 139-146.
@article{7a190229612c44a1b1ea92bf853ff29e,
title = "Augmented reality-assisted pedicle screw insertion: A cadaveric proof-of-concept study",
abstract = "OBJECTIVE: Augmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator's retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods. METHODS: Five cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures. RESULTS: The overall screw placement accuracy achieved with the AR system was 96.7{\%} based on the HGS and 94.6{\%} based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification. CONCLUSIONS: AR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.",
keywords = "Augmented reality, Augmented reality-assisted surgery, Cadaveric trial, Computer-navigated surgery, Neuronavigation, Robotic spine surgery, Surgical technique",
author = "Molina, {Camilo A.} and Nicholas Theodore and {Karim Ahmed}, A. and Westbroek, {Erick M.} and Yigal Mirovsky and Ran Harel and Emanuele Orru and Majid Khan and Timothy Witham and Sciubba, {Daniel M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.3171/2018.12.SPINE181142",
language = "English (US)",
volume = "31",
pages = "139--146",
journal = "Journal of Neurosurgery: Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "1",

}

TY - JOUR

T1 - Augmented reality-assisted pedicle screw insertion

T2 - A cadaveric proof-of-concept study

AU - Molina, Camilo A.

AU - Theodore, Nicholas

AU - Karim Ahmed, A.

AU - Westbroek, Erick M.

AU - Mirovsky, Yigal

AU - Harel, Ran

AU - Orru, Emanuele

AU - Khan, Majid

AU - Witham, Timothy

AU - Sciubba, Daniel M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVE: Augmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator's retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods. METHODS: Five cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures. RESULTS: The overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification. CONCLUSIONS: AR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

AB - OBJECTIVE: Augmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator's retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods. METHODS: Five cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures. RESULTS: The overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification. CONCLUSIONS: AR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

KW - Augmented reality

KW - Augmented reality-assisted surgery

KW - Cadaveric trial

KW - Computer-navigated surgery

KW - Neuronavigation

KW - Robotic spine surgery

KW - Surgical technique

UR - http://www.scopus.com/inward/record.url?scp=85068435834&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068435834&partnerID=8YFLogxK

U2 - 10.3171/2018.12.SPINE181142

DO - 10.3171/2018.12.SPINE181142

M3 - Article

C2 - 30925479

AN - SCOPUS:85068435834

VL - 31

SP - 139

EP - 146

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

SN - 1547-5654

IS - 1

ER -