Implementation of augmented reality support in spine surgery

Abstract

Purpose

To implement a straightforward workflow that allows to establish augmented reality (AR) support in spine surgery.

Methods

Intraoperative computed tomography (iCT) applying a 32-slice movable scanner was used for navigation registration in a series of 10 patients who underwent surgery for extra- or intradural spinal lesions. Preoperative multimodal image data were integrated by nonlinear registration with the iCT images. Automatic segmentation was used to delineate the 3-dimensional (3-D) outline of the vertebra, and in addition, the tumor extent, as well as implants, was segmented and visualized.

Results

Automatic patient registration without user interaction resulted in high navigation accuracy with a mean registration error of only about 1 mm. Moreover, the workflow for establishing AR was straightforward and could be easily integrated in the normal surgical procedure. Low-dose iCT protocols resulted in a radiation exposure of 0.35–0.98 mSv for cervical, 2.16–6.92 mSv for thoracic, and 3.55–4.20 mSv for lumbar surgeries, which is a reduction in the effective radiation dose by 70%. The segmented structures were intuitively visualized in the surgical field using the heads-up display of the operating microscope. In parallel, the microscope video was superimposed with the segmented 3-D structures, which were visualized in a semitransparent manner along with various display modes of the image data.

Conclusions

A microscope-based AR environment was successfully implemented for spinal surgery. The application of iCT for registration imaging ensures high navigational accuracy. AR greatly supports the surgeon in understanding the 3-D anatomy thereby facilitating surgery.

Graphical abstract

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Acknowledgements

We would like to thank J.-W. Bartsch for thoroughly proofreading the manuscript.

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Correspondence to Barbara Carl.

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B Carl, M. Bopp, B. Saß and B. Voellger declare that they have no conflict of interest. Ch. Nimsky received speaker fees from Brainlab.

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Carl, B., Bopp, M., Saß, B. et al. Implementation of augmented reality support in spine surgery. Eur Spine J 28, 1697–1711 (2019). https://doi.org/10.1007/s00586-019-05969-4

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Keywords

  • Augmented reality
  • Intraoperative computed tomography
  • Low-dose computed tomography
  • Navigation registration
  • Spine tumor surgery