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Type Journal Article
Scope Discipline-based scholarship
Title Pedicle screw navigation using surface digitization on the Microsoft HoloLens
Organization Unit
Authors
  • Florentin Liebmann
  • Simon Roner
  • Marco von Atzigen
  • Davide Scaramuzza
  • Reto Sutter
  • Jess Snedeker
  • Mazda Farshad
  • Philipp Fürnstahl
Item Subtype Original Work
Refereed Yes
Status Published in final form
Language
  • English
Journal Title International Journal of Computer Assisted Radiology and Surgery
Publisher Springer
Geographical Reach international
ISSN 1861-6410
Volume 14
Number 7
Page Range 1157 - 1165
Date 2019
Abstract Text 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∘±1.73∘ 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.
Free access at DOI
Digital Object Identifier 10.1007/s11548-019-01973-7
Other Identification Number merlin-id:20292
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