1Pickup Family Neurosciences Institute, Hoag Memorial Hospital Presbyterian Newport Beach; and.
2Disc Comfort, Inc., Newport Beach, California.
Neurosurg Focus. 2021 Aug;51(2):E11. doi: 10.3171/2021.5.FOCUS21209.
Augmented reality (AR) has the potential to improve the accuracy and efficiency of instrumentation placement in spinal fusion surgery, increasing patient safety and outcomes, optimizing ergonomics in the surgical suite, and ultimately lowering procedural costs. The authors sought to describe the use of a commercial prototype Spine AR platform (SpineAR) that provides a commercial AR head-mounted display (ARHMD) user interface for navigation-guided spine surgery incorporating real-time navigation images from intraoperative imaging with a 3D-reconstructed model in the surgeon's field of view, and to assess screw placement accuracy via this method.
Pedicle screw placement accuracy was assessed and compared with literature-reported data of the freehand (FH) technique. Accuracy with SpineAR was also compared between participants of varying spine surgical experience. Eleven operators without prior experience with AR-assisted pedicle screw placement took part in the study: 5 attending neurosurgeons and 6 trainees (1 neurosurgical fellow, 1 senior orthopedic resident, 3 neurosurgical residents, and 1 medical student). Commercially available 3D-printed lumbar spine models were utilized as surrogates of human anatomy. Among the operators, a total of 192 screws were instrumented bilaterally from L2-5 using SpineAR in 24 lumbar spine models. All but one trainee also inserted 8 screws using the FH method. In addition to accuracy scoring using the Gertzbein-Robbins grading scale, axial trajectory was assessed, and user feedback on experience with SpineAR was collected.
Based on the Gertzbein-Robbins grading scale, the overall screw placement accuracy using SpineAR among all users was 98.4% (192 screws). Accuracy for attendings and trainees was 99.1% (112 screws) and 97.5% (80 screws), respectively. Accuracy rates were higher compared with literature-reported lumbar screw placement accuracy using FH for attendings (99.1% vs 94.32%; p = 0.0212) and all users (98.4% vs 94.32%; p = 0.0099). The percentage of total inserted screws with a minimum of 5° medial angulation was 100%. No differences were observed between attendings and trainees or between the two methods. User feedback on SpineAR was generally positive.
Screw placement was feasible and accurate using SpineAR, an ARHMD platform with real-time navigation guidance that provided a favorable surgeon-user experience.
增强现实（AR）技术具有提高脊柱融合手术器械放置准确性和效率的潜力，从而提高患者安全性和手术结果，优化手术室内的人体工程学，并最终降低手术成本。作者旨在描述一种商业原型 Spine AR 平台（SpineAR）的使用，该平台为导航引导下的脊柱手术提供了一个商业 AR 头戴式显示器（ARHMD）用户界面，将术中成像的实时导航图像与外科医生视野中的 3D 重建模型结合起来，并通过该方法评估螺钉放置的准确性。
评估并比较了徒手（FH）技术的文献报道数据与 SpineAR 的椎弓根螺钉放置准确性。还比较了 SpineAR 在不同脊柱手术经验的参与者之间的准确性。11 名没有使用 AR 辅助椎弓根螺钉放置经验的操作人员参与了这项研究：5 名神经外科主治医生和 6 名学员（1 名神经外科研究员、1 名高级骨科住院医师、3 名神经外科住院医师和 1 名医学生）。商业上可获得的 3D 打印腰椎模型被用作人体解剖结构的替代品。在操作人员中，总共使用 SpineAR 在 24 个腰椎模型中从 L2-5 双侧植入 192 个螺钉。除了一名学员外，所有学员还使用 FH 方法插入了 8 颗螺钉。除了使用 Gertzbein-Robbins 分级量表进行准确性评分外，还评估了轴向轨迹，并收集了操作人员对使用 SpineAR 的体验的反馈。
根据 Gertzbein-Robbins 分级量表，所有用户使用 SpineAR 的总体螺钉放置准确性为 98.4%（192 颗螺钉）。主治医生和学员的准确性分别为 99.1%（112 颗螺钉）和 97.5%（80 颗螺钉）。与文献报道的主治医生使用 FH 时的腰椎螺钉放置准确性（99.1%比 94.32%；p=0.0212）和所有用户（98.4%比 94.32%；p=0.0099）相比，准确性更高。具有至少 5°内侧成角的总植入螺钉百分比为 100%。在主治医生和学员之间或两种方法之间没有观察到差异。操作人员对 SpineAR 的反馈总体上是积极的。
使用 SpineAR 进行螺钉放置是可行且准确的，SpineAR 是一种具有实时导航指导功能的 ARHMD 平台，为外科医生提供了良好的用户体验。
