Pedicle screw placement in the cervical vertebrae using augmented reality-head mounted displays: a cadaveric proof-of-concept study

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY Spine Journal Pub Date : 2024-12-01 DOI:10.1016/j.spinee.2024.08.012

Miguel A. Ruiz-Cardozo MD, MPH , Karma Barot BA, MA , Samuel Brehm BS , Tim Bui BS , Karan Joseph BS , Michael Ryan Kann BE , Gabriel Trevino PhD , Michael Olufawo MBA , Som Singh MD , Alexander T. Yahanda MD , Alexander Perdomo-Pantoja MD , Julio J. Jauregui MD , Magalie Cadieux MD, MMSc , Brian J. Ipsen MD , Ripul Panchal DO , Kornelis Poelstra MD, PhD , Michael Y. Wang MD , Timothy F. Witham MD , Camilo A. Molina MD

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Abstract

Background

The accurate and safe positioning of cervical pedicle screws is crucial. While augmented reality (AR) use in spine surgery has previously demonstrated clinical utility in the thoracolumbar spine, its technical feasibility in the cervical spine remains less explored.

Purpose

The objective of this study was to assess the precision and safety of AR-assisted pedicle screw placement in the cervical spine.

Study Design

In this experimental study, 5 cadaveric cervical spine models were instrumented from C3 to C7 by 5 different spine surgeons. The navigation accuracy and clinical screw accuracy were evaluated.

Methods

Postprocedural CT scans were evaluated for clinical accuracy by 2 independent neuroradiologists using the Gertzbein-Robbins scale. Technical precision was assessed by calculating the angular trajectory (°) and linear screw tip (mm) deviations in the axial and sagittal planes from the virtual pedicle screw position as recorded by the AR-guided platform during the procedure compared to the actual pedicle screw position derived from postprocedural imaging.

Results

A total of forty-one pedicle screws were placed in 5 cervical cadavers, with each of the 5 surgeons navigating at least 7 screws. Gertzbein-Robbins grade of A or B was achieved in 100% of cases. The mean values for tip and trajectory errors in the axial and sagittal planes between the virtual versus actual position of the screws was less than 3 mm and 30°, respectively (p<.05). None of the cervical screws violated the cortex by more than 2 mm or displaced neurovascular structures.

Conclusions

AR-assisted cervical pedicle screw placement in cadavers demonstrated clinical accuracy comparable to existing literature values for image-guided navigation methods for the cervical spine.

Clinical Significance

This study provides technical and clinical accuracy data that supports clinical trialing of AR-assisted subaxial cervical pedicle screw placement.

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使用增强现实头戴式显示器在颈椎中植入椎弓根螺钉：一项尸体概念验证研究。

背景：颈椎椎弓根螺钉的准确安全定位至关重要。虽然增强现实技术（AR）在脊柱手术中的应用已在胸腰椎手术中显示出临床实用性，但其在颈椎手术中的技术可行性仍未得到充分探索。目的：本研究旨在评估 AR 辅助颈椎椎弓根螺钉置入的精确性和安全性：在这项实验研究中，五名不同的脊柱外科医生对五具尸体颈椎模型从C3到C7进行了器械置入。评估了导航的准确性和临床螺钉的准确性：由两名独立的神经放射学专家使用 Gertzbein-Robbins 量表对手术后 CT 扫描的临床准确性进行评估。技术精确度的评估方法是计算 AR 引导平台在手术过程中记录的虚拟椎弓根螺钉位置与术后成像得出的实际椎弓根螺钉位置在轴向和矢状面上的角度轨迹（°）和螺钉尖端线性偏差（毫米）：结果：在五具颈椎尸体上共放置了41枚椎弓根螺钉，五位外科医生每人至少引导了7枚螺钉。Gertzbein-Robbins分级100%达到A级或B级。螺钉虚拟位置与实际位置在轴向和矢状面上的尖端和轨迹误差的平均值分别小于3毫米和30°（p结论：AR辅助颈椎椎弓根螺钉置入术在尸体上的临床准确性与现有文献中颈椎图像导航方法的准确性相当：本研究提供了技术和临床准确性数据，支持临床试用 AR 辅助轴下颈椎椎弓根螺钉置入术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.