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Case Reports
. 2018 Apr 13;2(4):e008.
doi: 10.5435/JAAOSGlobal-D-17-00008. eCollection 2018 Apr.

Augmented Reality Visualization-guided Microscopic Spine Surgery: Transvertebral Anterior Cervical Foraminotomy and Posterior Foraminotomy

Daisuke Umebayashi  1 , Yu Yamamoto  1 , Yasuhiro Nakajima  1 , Nobuhisa Fukaya  1 , Masahito Hara  1
Affiliations
Case Reports

Augmented Reality Visualization-guided Microscopic Spine Surgery: Transvertebral Anterior Cervical Foraminotomy and Posterior Foraminotomy

Daisuke Umebayashi et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Objective: We describe intraoperative augmented reality (AR) imaging to obtain a microscopic view in spine keyhole surgery.

Background: Minimally invasive keyhole surgery has been developed even for spine surgery, including transvertebral anterior cervical foraminotomy and posterior cervical laminoforaminotomy. These methods are complex and require a skillful technique. Therefore, inexperienced surgeons hesitate to perform keyhole surgeries. The technology used in surgery is rapidly advancing, including intraoperative imaging devices that have enabled AR imaging and facilitated complicated surgeries in many fields. However, data are not currently available on the use of AR imaging in spine surgery. The purpose of this article was to introduce the utility of AR for spine surgery.

Methods: We performed O-arm intraoperative imaging to create an augmented imaging model in navigation systems. Navigation data were linked to a microscope to merge the live view and AR. Augmented reality imaging shows the model plan in the real-world surgical field. We used this novel method in patients who underwent both keyhole surgeries.

Results: We successfully performed both surgeries using the AR visualization guide.

Conclusions: The AR navigation system facilitates complicated keyhole surgeries in patients who undergo spine surgery.

Study design: Technical report.

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Conflict of interest statement

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Umebayashi, Dr. Yamamoto, Dr. Nakajima, Dr. Fukaya, and Dr. Hara. Dr. Umebayashi designed research. Dr. Umebayashi, Dr. Yamamoto, Dr. Nakajima, Dr. Fukaya, and Dr. Hara performed research. Dr. Umebayashi analyzed the data and wrote the article. The device(s)/drug(s) is approved by the FDA or by the corresponding national agency for this indication.

Figures

Figure 1
Figure 1
The authors made a start window on the ventral surface of the vertebra (A) and an end window behind the vertebra (B) by using the push cursor of the software. The remaining dots were carefully erased, and the authors confirmed the start (C) and the end (D) windows of the tunnel on coronal views. After clicking the interpolated selection cursor, a tunnel model was created (E and F).
Figure 2
Figure 2
Transvertebral anterior cervical foraminotomy. A, Photographs showing navigation display views. B through F, Photographs showing microscopic views. G, Final view of the keyhole tunnel. The yellow outline in panels B through F is the outline of the tunnel model.
Figure 3
Figure 3
Postoperative sagittal (A) and axial (B) CT demonstrating that the bone defect of the vertebra is very small. C, Postoperative reconstructed three-dimensional CT image. A small tunnel window is seen on the right side of the C7 vertebra.
Figure 4
Figure 4
Posterior cervical laminoforaminotomy. A, Photographs showing navigation display views. B through E, Photographs showing microscopic views. The yellow circle is the outline of the tunnel model.
Figure 5
Figure 5
Postoperative sagittal (A) and axial (B) CT images demonstrating that the bone defect of the lamina is very small. A small tunnel window is connected to the left foramen at C5-6.
See this image and copyright information in PMC

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