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Article

Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

1
Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany
2
Marburg Center for Mind, Brain and Behavior (MCMBB), 35043 Marburg, Germany
3
Department of Visceral, Thoracic and Vascular Surgery, University of Marburg, 35043 Marburg, Germany
4
Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: Kaan Yagmurlu
Brain Sci. 2021, 11(5), 646; https://doi.org/10.3390/brainsci11050646
Received: 20 April 2021 / Revised: 10 May 2021 / Accepted: 12 May 2021 / Published: 15 May 2021
(This article belongs to the Special Issue Neurosurgery and Neuroanatomy)
Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery. View Full-Text
Keywords: augmented reality; computer-assisted surgery; effective radiation dose; image-guided surgery; intraoperative imaging; spine navigation; lateral approach to the spine augmented reality; computer-assisted surgery; effective radiation dose; image-guided surgery; intraoperative imaging; spine navigation; lateral approach to the spine
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MDPI and ACS Style

Pojskić, M.; Bopp, M.; Saß, B.; Kirschbaum, A.; Nimsky, C.; Carl, B. Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine. Brain Sci. 2021, 11, 646. https://doi.org/10.3390/brainsci11050646

AMA Style

Pojskić M, Bopp M, Saß B, Kirschbaum A, Nimsky C, Carl B. Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine. Brain Sciences. 2021; 11(5):646. https://doi.org/10.3390/brainsci11050646

Chicago/Turabian Style

Pojskić, Mirza, Miriam Bopp, Benjamin Saß, Andreas Kirschbaum, Christopher Nimsky, and Barbara Carl. 2021. "Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine" Brain Sciences 11, no. 5: 646. https://doi.org/10.3390/brainsci11050646

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