Neurosurgery Resident UC Davis Medical Center Sacramento, CA, US
Disclosure(s):
Jose A. Castillo, MD, Jr.: No financial relationships to disclose
Introduction: Augmented reality (AR) utilizes optical images that are projected into the user’s field of view to create a digital overlay. Lumbar lateral interbody fusion (XLIF) cases can be challenging secondary to positioning of the patient. Extensive fluoroscopy is necessary to find a safe corridor into the disc space while avoiding the lumbar plexus. Here we demonstrate the addition of AR to the life cycle of XLIF surgery.
Methods: The patient was positioned in the either left lateral decubitus position for extreme lateral or prone for prone transpsoas approach. An intra-operative CT was performed, and the data loaded into Xvision console for processing. The surgeon was fitted with the Xvision head-mounted display. After standard fashion exposure, 3D AR visualization navigated a guidewire with an attached navigation array into the target disc space without the use of fluoroscopy. The area around the guidewire was stimulated and once deemed safe, retractors were placed and the XLIF continued in standard fashion.
Results: A total of five patients underwent AR driven XLIF for a total of eight levels. Two were revision surgeries for adjacent segment disease while three cases were virgin spines. Levels spanned L2-5 (L2/3: 2, L3/4: 5, L4/5: 1). With each level, AR successfully navigated a guidewire safely into an idea the disc space without the need for fluoroscopy. Additionally, AR was used to plan the discectomy and final position of interbody. No patients experienced major surgical complications or lumbar plexopathies. There was a significant reduction (p < 0.01) in fluoroscopy time compared with traditional XLIF approach. All instrumentation were accurately positioned as verified by post-operative Xrays. For patients undergoing single position surgery (n=3, percutaneous MIS pedicle screws were placed using AR the same time without the need for an additional OR spin.
Conclusion : AR can successfully be utilized for XLIF. The integration of the technology allows for not only placement of pedicle screws, but also precise and safe navigation into the lateral disc space. This reduces the traditional reliance on fluoroscopy when accessing the lateral disc space. Additionally, AR negates the need for radiation use for access to the disc space and placement of pedicle screws.