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Pedicle screw navigation using surface digitization on the Microsoft HoloLens

  • Florentin LiebmannEmail author
  • Simon Roner
  • Marco von Atzigen
  • Davide Scaramuzza
  • Reto Sutter
  • Jess Snedeker
  • Mazda Farshad
  • Philipp Fürnstahl
Original Article
  • 20 Downloads

Abstract

Purpose

In spinal fusion surgery, imprecise placement of pedicle screws can result in poor surgical outcome or may seriously harm a patient. Patient-specific instruments and optical systems have been proposed for improving precision through surgical navigation compared to freehand insertion. However, existing solutions are expensive and cannot provide in situ visualizations. Recent technological advancement enabled the production of more powerful and precise optical see-through head-mounted displays for the mass market. The purpose of this laboratory study was to evaluate whether such a device is sufficiently precise for the navigation of lumbar pedicle screw placement.

Methods

A novel navigation method, tailored to run on the Microsoft HoloLens, was developed. It comprises capturing of the intraoperatively reachable surface of vertebrae to achieve registration and tool tracking with real-time visualizations without the need of intraoperative imaging. For both surface sampling and navigation, 3D printable parts, equipped with fiducial markers, were employed. Accuracy was evaluated within a self-built setup based on two phantoms of the lumbar spine. Computed tomography (CT) scans of the phantoms were acquired to carry out preoperative planning of screw trajectories in 3D. A surgeon placed the guiding wire for the pedicle screw bilaterally on ten vertebrae guided by the navigation method. Postoperative CT scans were acquired to compare trajectory orientation (3D angle) and screw insertion points (3D distance) with respect to the planning.

Results

The mean errors between planned and executed screw insertion were \(3.38^{\circ }\pm {1.73}^{\circ }\) for the screw trajectory orientation and 2.77±1.46 mm for the insertion points. The mean time required for surface digitization was 125±27 s.

Conclusions

First promising results under laboratory conditions indicate that precise lumbar pedicle screw insertion can be achieved by combining HoloLens with our proposed navigation method. As a next step, cadaver experiments need to be performed to confirm the precision on real patient anatomy.

Keywords

Surgical navigation Augmented reality Surface digitization HoloLens Spine Pedicle screw 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animals rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Patient data

This articles does not contain patient data.

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Copyright information

© CARS 2019

Authors and Affiliations

  1. 1.Computer Assisted Research and Development Group, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
  2. 2.Laboratory for Orthopaedic BiomechanicsETH ZurichZurichSwitzerland
  3. 3.Orthopaedic Department, Balgrist University HospitalUniversity of ZurichZurichSwitzerland
  4. 4.Department of InformaticsUniversity of ZurichZurichSwitzerland
  5. 5.Department of NeuroinformaticsUniversity of Zurich and ETH ZurichZurichSwitzerland
  6. 6.Radiology Department, Balgrist University HospitalUniversity of ZurichZurichSwitzerland

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