ABSTRACT
BACKGROUND: The puncture procedure in percutaneous endoscopic lumbar discectomy (PELD) is non-visual, and the learning curve for PELD is steep. METHODS: An augmented reality surgical navigation (ARSN) system was designed and utilized in PELD. The system possesses three core functionalities: augmented reality (AR) radiograph overlay, AR puncture needle real-time tracking, and AR navigation. We conducted a prospective randomized controlled trial to evaluate its feasibility and effectiveness. A total of 20 patients with lumbar disc herniation treated with PELD were analyzed. Of these, 10 patients were treated with the guidance of ARSN (ARSN group). The remaining 10 patients were treated using C-arm fluoroscopy guidance (control group). RESULTS: The AR radiographs and AR puncture needle were successfully superimposed on the intraoperative videos. The anteroposterior and lateral AR tracking distance errors were 1.55 ± 0.17 mm and 1.78 ± 0.21 mm. The ARSN group exhibited a significant reduction in both the number of puncture attempts (2.0 ± 0.4 vs. 6.9 ± 0.5, p = 0.000) and the number of fluoroscopies (10.6 ± 0.9 vs. 18.5 ± 1.6, p = 0.000) compared with the control group. Complications were not observed in either group. CONCLUSIONS: The results indicate that the clinical application of the ARSN system in PELD is effective and feasible.
ABSTRACT
BACKGROUND: In minimally invasive spine surgery (MISS), where the surgeon cannot directly see the patient's internal anatomical structure, the implementation of augmented reality (AR) technology may solve this problem. METHODS: We combined AR, artificial intelligence, and optical tracking to enhance the augmented reality minimally invasive spine surgery (AR-MISS) system. The system has three functions: AR radiograph superimposition, AR real-time puncture needle tracking, and AR intraoperative navigation. The three functions of the system were evaluated through beagle animal experiments. RESULTS: The AR radiographs were successfully superimposed on the real intraoperative videos. The anteroposterior (AP) and lateral errors of superimposed AR radiographs were 0.74 ± 0.21 mm and 1.13 ± 0.40 mm, respectively. The puncture needles could be tracked by the AR-MISS system in real time. The AP and lateral errors of the real-time AR needle tracking were 1.26 ± 0.20 mm and 1.22 ± 0.25 mm, respectively. With the help of AR radiographs and AR puncture needles, the puncture procedure could be guided visually by the system in real-time. The anteroposterior and lateral errors of AR-guided puncture were 2.47 ± 0.86 mm and 2.85 ± 1.17 mm, respectively. CONCLUSIONS: The results indicate that the AR-MISS system is accurate and applicable.
