Schmidt Franziska A, Hussain Ibrahim, Boadi Blake, Sommer Fabian J, Thomé Claudius, Härtl Roger
Department of Neurosurgery, Medical University Innsbruck, Innsbruck , Austria.
Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital-OCH Spine, New York , New York , USA.
Oper Neurosurg. 2025 Feb 1;28(2):183-192. doi: 10.1227/ons.0000000000001317. Epub 2024 Aug 26.
One of the major challenges in training neurosurgical and orthopedic residents the technique for minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is the lack of visualization of surgical landmarks (pedicle, pars, lamina). This is due to the limited access to the bony spine through a tubular retractor, in addition to a smaller working corridor or patient-specific factors such as bony overgrowth, disk space collapse, and listhesis. These factors increase the possibility for surgical error and prolonged surgery time. With augmented reality (AR), relevant surgical anatomy can be projected directly into the user's field of view through the microscope. The purpose of this study was to assess the utility, accuracy, efficiency, and precision of AR-guided MIS-TLIF and to determine its impact in spine surgery training.
At 2 centers, 12 neurosurgical residents performed a one-level MIS-TLIF on a high-fidelity lumbar spine simulation model with and without AR projection into the microscope. For the MIS-TLIF procedures with AR, surgical landmarks were highlighted in different colors on preoperative image data . These landmarks were visualized in the spinal navigation application on the navigation monitor and in the microscope to confirm the relevant anatomy. Postprocedural surveys (National Aeronautics and Space Administration Task Load Index) were given to the residents.
Twelve residents were included in this trial. AR-guided procedures had a consistent impact on resident anatomical orientation and workload experience. Procedures performed without AR had a significantly higher mental demand ( P = .003 ) than with AR. Residents reported to a significantly higher rate that it was harder work for them to accomplish their level of performance without AR ( P = .019 ).
AR can bring a meaningful value in MIS teaching and training to confirm relevant anatomy in situations where the surgeon will have less direct visual access. AR used in surgical simulation can also speed the learning curve.
在培训神经外科和骨科住院医师进行微创经椎间孔腰椎椎间融合术（MIS-TLIF）技术时，主要挑战之一是缺乏对手术标志（椎弓根、椎弓峡部、椎板）的可视化。这是由于通过管状牵开器进入骨性脊柱的通道有限，此外工作通道较小，或存在患者特异性因素，如骨质增生、椎间盘间隙塌陷和椎体滑脱。这些因素增加了手术失误的可能性和手术时间延长的风险。借助增强现实（AR）技术，相关手术解剖结构可通过显微镜直接投射到用户的视野中。本研究的目的是评估AR引导下的MIS-TLIF的实用性、准确性、效率和精确性，并确定其在脊柱手术培训中的影响。
在2个中心，12名神经外科住院医师在一个高保真腰椎脊柱模拟模型上进行单节段MIS-TLIF手术，手术过程中显微镜有无AR投影。对于有AR的MIS-TLIF手术，术前图像数据上的手术标志用不同颜色突出显示。这些标志在导航监视器上的脊柱导航应用程序和显微镜中可视化，以确认相关解剖结构。术后对住院医师进行问卷调查（美国国家航空航天局任务负荷指数）。
12名住院医师纳入本试验。AR引导的手术对住院医师的解剖定位和工作量体验有持续影响。无AR的手术比有AR的手术有更高的精神需求（P = 0.003）。住院医师报告称，在没有AR的情况下，他们要达到同等手术水平的工作难度明显更高（P = 0.019）。
AR在MIS教学和培训中可带来有意义的价值，在外科医生直接视觉通路较少的情况下确认相关解剖结构。手术模拟中使用AR还可加快学习曲线。
