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Pedicle screw navigation using surface digitization on the Microsoft HoloLens

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Florentin Liebmann, Simon Roner, Marco von Atzigen & Philipp Fürnstahl

  2. Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland

    Florentin Liebmann, Marco von Atzigen & Jess Snedeker

  3. Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland

    Simon Roner, Jess Snedeker & Mazda Farshad

  4. Department of Informatics, University of Zurich, Zurich, Switzerland

    Davide Scaramuzza

  5. Department of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland

    Davide Scaramuzza

  6. Radiology Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland

    Reto Sutter

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  1. Florentin Liebmann
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Correspondence to Florentin Liebmann.

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Liebmann, F., Roner, S., von Atzigen, M. et al. Pedicle screw navigation using surface digitization on the Microsoft HoloLens. Int J CARS 14, 1157–1165 (2019). https://doi.org/10.1007/s11548-019-01973-7

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  • DOI: https://doi.org/10.1007/s11548-019-01973-7

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