AR provides unparalleled views inside the human body that help surgeons make better plans for difficult procedures
Key Takeaways:
- AR overcomes the navigational and visual challenges of precision surgery
- AR is being used in pedicle screw replacement with an accuracy rate of 94.1%, eliminating many of the risks, including neurological damage, via precise instrument placement
- AR allows for minimally invasive procedures that once required large open incisions
- For cervical foraminotomy, which still requires a large incision, AR proves its value in the planning stages
- Other surgical applications include neurology and cardiology, as well as maxillofacial surgery.
Computer-assisted surgery has been in use for some time, but conventional navigation of these systems means that surgeons must look into a navigation screen away from the surgical field to verify positions and landmarks via a 3D virtual presentation.
This far-from-ideal situation is now being superseded with augmented reality (AR) navigation solutions where the real environment, as well as virtual information, is presented on the same field of view. This technology is especially useful in spinal procedures, which are complex and delicate, and usually require a large incision for the surgeon to physically see the spine.
Using AR, surgeons can more easily avoid neurological and vascular systems close to the spine with a minimally invasive procedure that induces less trauma. This provides greater accuracy, has the potential to reduce radiation doses, and can improve workflow and provide cost benefits. Let’s explore the use of AR in spinal surgery and beyond.
Applications of AR in spinal surgery
An image-guided, minimally invasive approach allows the surgeon to make a small incision, which means the patient has less postoperative pain, a shorter stay in the hospital, less blood loss and soft tissue damage, and reduced chance of infection. AR can also be used to plan surgery as well as to explain to patients the risks and benefits.
Here are some current applications for AR in spinal surgery today:
Pedicle screw placement
Pedicle screw fixation is used to stabilize the thoracic and lumbar spine, but there are a number of associated complications, including pedicle breach, which can cause neurological injury, durotomy, vascular injury, and suboptimal fixation.
One large study of pedicle screws reported a breach rate of 5.1%. Because AR allows surgeons to keep their field of vision on the patient, it was able to increase accuracy and efficiency when inserting thoracic pedicle screws, which are difficult to place because they are smaller than the lumbar spine. Another study found that using AR provided a thoracic pedicle screw accuracy rate of 94.1%.
Cervical foraminotomy
Cervical foraminotomy, performed to relieve pressure on compressed nerves in the neck, carries the usual surgical risks of infection and blood loss as well as the possibility of nerve damage, spinal cord damage, and stroke. In these surgical cases, open surgery is required, but AR proves its value in the planning stages.
Using AR, surgeons can make a pre-operative, accurate evaluation of the bone removal area and the nerve root position to allow removal of bone with less contact with the blood vessels, which reduces bleeding. Additionally, the images can show the lateral edge of the foraminotomy. Decompression planning that includes details on how to handle the dural tube and nerve roots means fewer unnecessary bone resections and avoids nerve damage.
Osteotomy
Osteotomy is a general catch-term for any sort of spinal deformity. These surgeries are traditionally difficult to perform because of high complication rates and the fact that the spine deviates from normal anatomy. Precise surgical execution is imperative for proper reconstruction.
AR provides surgeons with a way to visualize resection planes and provides guidance through a heads-up display implemented into a surgical microscope. A recent clinical case report on a surgery for scoliosis reported no complications, no neurological deficiencies, and a pain reduction of up to 75%.
Arthroplasty
Arthroplasty deals with the surgical reconstruction and total replacement of degenerated joints through the use of prosthetics made from various materials. A successful outcome, functional recovery, and longevity relies on exact implantation of these prosthetics with respect to the patient’s anatomy. The detailed visualization provided by AR enables surgical precision.
The use of AR in surgery can improve patient outcomes, enhance the experience for patients and staff, and potentially reduce the cost of care, and not just for spinal surgery. Let’s look at some additional applications for this amazing technology.
Other surgical applications for AR
Neurosurgeons have embraced computer-aided surgery since it was invented as a way to resect the smallest volume of brain tissue possible. With AR, a 3D, interactive anatomic map is visualized that provides precise navigation.
Current applications include neuro-oncology, neurovascular surgery, and spinal surgery as a subspecialty. AR is also invaluable as a tool for training neurosurgery residents and surgeons.
AR is used in maxillofacial surgery, extending to orthognathic surgery, tumor surgery, temporomandibular joint motion analysis, foreign body removal, osteotomy, minimally invasive biopsy, prosthetic surgery, and dental implantation. Surgery becomes less invasive due to the amount of information on deep-tissue structures provided by AR.
In the field of otolaryngology, the majority of advances afforded by AR come from minimally invasive surgery of the head and neck. AR is especially useful in diagnosis, sinus biopsies, skull base surgery, orbital decompression, carcinoma excision, and removal of foreign bodies.
AR is used in thoracic surgery via a thoracoscopic approach, while in cardiac surgery, AR enables totally endoscopic mitral valve repair as well as aortic valve replacement.
When it comes to surgery, precision is everything. With AR and its revolutionary visualization of the human body, precision is virtually guaranteed.
Intravision XR for unparalleled visual detail
For intraoperative surgical guidance, pre-surgery planning, and post-surgical analysis, you need fully-formed 3D models. Intravision XR, a cloud-based 3D modeling software, visualizes these models from any DICOM dataset, such as CT and MRI scans. They contain complete anatomical detail and can be viewed using AR, VR, or the standard screen on a phone, tablet, or computer.
For more information about how we can equip you for not only today’s technology but the future of medicine, please contact us today
