Attending Neurosurgeon Swift Institute Reno, Nevada, United States
Introduction: Minimally invasive lumbar revision can be technically challenging. Removal of previous pedicle screws and rods via a tubular retractor is tedious and time consuming. Additionally, the surgeon and staff are exposed to high levels of radiation to accurately place tubular retractors to gain access to old instrumentation. Xvision (Augmedics) is a recently FDA-approved augmented reality (AR) technology for spine surgery. The technology is traditionally utilized to place pedicle screws. However, the utilization of augmented reality in spine surgery is rapidly expanding. Xvision can be used as an adjunct for revision spine surgery.
Methods: An intra-operative CT was performed and the data loaded into xvision console for processing. The surgeon and assistant were fitted with xvision head-mounted display (HMD). Utilizing xvision AR, previous instrumentation was identified and trajectories for removal access were planned. Incisions were made and then a Jamshidi was placed directly onto the set screw. A guidewire was placed through the Jamshidi and then the Jamshidi was removed with guidewire still on set screw. Tubular dilators were placed over guidewire before placing 16 mm tubular retractor. The primary surgeon removed the HMD to work under microscope while assistant continued the HMD for navigation. Soft tissue dissection and removal of instrumentation was performed under the microscope with xvision console used for navigation as needed. This process was repeated for additional instrumentation. Xvision was then used to place new instrumentation as indicated.
Results: Xvision technology has been successfully utilized in four lumbar revision spine surgeries. In each case, there was zero radiation exposure to surgeon or staff. Additionally, AR-guided placement of tubular retractor allows for precise retractor placement enabling the retractor to fit over the pedicle screw tulip. This allows for excellent visualization when removing previous instrumentation. Finally, the precision allotted by xvision significantly reduces operative time and minimizes tissue damage.
Conclusion : This is the first report of applying AR for minimally invasive revision lumbar spine surgery. AR enables optimal placement of tubular retractors to efficiently remove previous instrumentation. This ultimately leads to reduced operative time, minimal tissue damage, and zero radiation exposure to surgeon and staff.
