Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine
<b>Background.</b> Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-05-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/11/5/646 |
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| author | Mirza Pojskić Miriam Bopp Benjamin Saß Andreas Kirschbaum Christopher Nimsky Barbara Carl |
| author_facet | Mirza Pojskić Miriam Bopp Benjamin Saß Andreas Kirschbaum Christopher Nimsky Barbara Carl |
| author_sort | Mirza Pojskić |
| collection | DOAJ |
| description | <b>Background.</b> Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. <b>Methods.</b> We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). <b>Results.</b> Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. <b>Conclusions.</b> Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery. |
| first_indexed | 2024-03-10T11:22:36Z |
| format | Article |
| id | doaj.art-176cf3f53eb940ff8314cfc6a2b190d0 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-10T11:22:36Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-176cf3f53eb940ff8314cfc6a2b190d02023-11-21T19:55:32ZengMDPI AGBrain Sciences2076-34252021-05-0111564610.3390/brainsci11050646Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the SpineMirza Pojskić0Miriam Bopp1Benjamin Saß2Andreas Kirschbaum3Christopher Nimsky4Barbara Carl5Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, GermanyDepartment of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, GermanyDepartment of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, GermanyDepartment of Visceral, Thoracic and Vascular Surgery, University of Marburg, 35043 Marburg, GermanyDepartment of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, GermanyDepartment of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany<b>Background.</b> Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. <b>Methods.</b> We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). <b>Results.</b> Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. <b>Conclusions.</b> Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.https://www.mdpi.com/2076-3425/11/5/646augmented realitycomputer-assisted surgeryeffective radiation doseimage-guided surgeryintraoperative imagingspine navigation |
| spellingShingle | Mirza Pojskić Miriam Bopp Benjamin Saß Andreas Kirschbaum Christopher Nimsky Barbara Carl Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine Brain Sciences augmented reality computer-assisted surgery effective radiation dose image-guided surgery intraoperative imaging spine navigation |
| title | Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine |
| title_full | Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine |
| title_fullStr | Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine |
| title_full_unstemmed | Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine |
| title_short | Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine |
| title_sort | intraoperative computed tomography based navigation with augmented reality for lateral approaches to the spine |
| topic | augmented reality computer-assisted surgery effective radiation dose image-guided surgery intraoperative imaging spine navigation |
| url | https://www.mdpi.com/2076-3425/11/5/646 |
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