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      Augmented reality navigation in spine surgery: a systematic review

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          Abstract

          Background

          Conventional spinal navigation solutions have been criticized for having a negative impact on time in the operating room and workflow. AR navigation could potentially alleviate some of these concerns while retaining the benefits of navigated spine surgery. The objective of this study is to summarize the current evidence for using augmented reality (AR) navigation in spine surgery.

          Methods

          We performed a systematic review to explore the current evidence for using AR navigation in spine surgery. PubMed and Web of Science were searched from database inception to November 27, 2020, for data on the AR navigation solutions; the reported efficacy of the systems; and their impact on workflow, radiation, and cost-benefit relationships.

          Results

          In this systematic review, 28 studies were included in the final analysis. The main findings were superior workflow and non-inferior accuracy when comparing AR to free-hand (FH) or conventional surgical navigation techniques. A limited number of studies indicated decreased use of radiation. There were no studies reporting mortality, morbidity, or cost-benefit relationships.

          Conclusions

          AR provides a meaningful addition to FH surgery and traditional navigation methods for spine surgery. However, the current evidence base is limited and prospective studies on clinical outcomes and cost-benefit relationships are needed.

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          Most cited references36

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          The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

          Alessandro Liberati, Douglas G. Altman, Jennifer Tetzlaff … (2009)
          Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement-a reporting guideline published in 1999-there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (www.prisma-statement.org) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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            Recent advances in augmented reality

            R Azuma, Y. Baillot, R. Behringer … (2001)
            Article 0 comments Cited 358 times – based on 0 reviews     Review now
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              Augmented reality in neurosurgery: a systematic review.

              Antonio Meola, Fabrizio Cutolo, Marina Carbone … (2017)
              Neuronavigation has become an essential neurosurgical tool in pursuing minimal invasiveness and maximal safety, even though it has several technical limitations. Augmented reality (AR) neuronavigation is a significant advance, providing a real-time updated 3D virtual model of anatomical details, overlaid on the real surgical field. Currently, only a few AR systems have been tested in a clinical setting. The aim is to review such devices. We performed a PubMed search of reports restricted to human studies of in vivo applications of AR in any neurosurgical procedure using the search terms "Augmented reality" and "Neurosurgery." Eligibility assessment was performed independently by two reviewers in an unblinded standardized manner. The systems were qualitatively evaluated on the basis of the following: neurosurgical subspecialty of application, pathology of treated lesions and lesion locations, real data source, virtual data source, tracking modality, registration technique, visualization processing, display type, and perception location. Eighteen studies were included during the period 1996 to September 30, 2015. The AR systems were grouped by the real data source: microscope (8), hand- or head-held cameras (4), direct patient view (2), endoscope (1), and X-ray fluoroscopy (1) head-mounted display (1). A total of 195 lesions were treated: 75 (38.46 %) were neoplastic, 77 (39.48 %) neurovascular, and 1 (0.51 %) hydrocephalus, and 42 (21.53 %) were undetermined. Current literature confirms that AR is a reliable and versatile tool when performing minimally invasive approaches in a wide range of neurosurgical diseases, although prospective randomized studies are not yet available and technical improvements are needed.
              Article 0 comments Cited 74 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Gustav Burström:
                ORCID: http://orcid.org/0000-0001-6606-1867
                gustav.burstrom@ki.se
                Journal
                Journal ID (nlm-ta): Acta Neurochir (Wien)
                Journal ID (iso-abbrev): Acta Neurochir (Wien)
                Title: Acta Neurochirurgica
                Publisher: Springer Vienna (Vienna )
                ISSN (Print): 0001-6268
                ISSN (Electronic): 0942-0940
                Publication date (Electronic): 28 January 2021
                Publication date PMC-release: 28 January 2021
                Publication date (Print): 2021
                Volume: 163
                Issue: 3
                Pages: 843-852
                Affiliations
                [1 ]GRID grid.4714.6, ISNI 0000 0004 1937 0626, Department of Clinical Neuroscience, , Karolinska Institutet, ; Stockholm, Sweden
                [2 ]GRID grid.24381.3c, ISNI 0000 0000 9241 5705, Department of Neurosurgery, , Karolinska University Hospital, ; 171 76 Stockholm, Sweden
                Author information
                http://orcid.org/0000-0001-6606-1867
                Article
                Publisher ID: 4708
                DOI: 10.1007/s00701-021-04708-3
                PMC ID: 7886712
                PubMed ID: 33506289
                SO-VID: 9bb3ae04-3d50-452c-98c3-8f0e20bd9504
                Copyright © © The Author(s) 2021
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 29 October 2020
                Date accepted : 6 January 2021
                Funding
                Funded by: Karolinska Institute
                Open Access :

                Open Access funding provided by Karolinska Institute

                Categories
                Subject: Review Article - Spine - Other
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Austria, part of Springer Nature 2021

                ScienceOpen disciplines: Surgery
                Keywords: accuracy,augmented reality,pedicle screw,systematic review,surgical navigation,virtual path tracking
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: accuracy, augmented reality, pedicle screw, systematic review, surgical navigation, virtual path tracking

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