Explore the vast range of titles available.

Intraoperative navigation is critical during spine surgery to ensure accurate instrumentation placement. From the early era of fluoroscopy to the current advancement in robotics, spinal navigation has continued to evolve. By understanding the variations in system protocols and their respective usage in the operating room, the surgeon can use and maximize the potential of various image guidance options more effectively. At the same time, maintaining navigation accuracy throughout the procedure is of the utmost importance, which can be confirmed intraoperatively by using an internal fiducial marker, as demonstrated herein. This technology can reduce the need for revision surgeries, minimize postoperative complications, and enhance the overall efficiency of operating rooms.

Objective Adult thoracolumbar kyphosis secondary to osteoporotic vertebral fractures (OVF) impairs the quality of life. Traditional 3CO provides correction but carries a high risk of complications, especially in the elderly. Minimally invasive anterior approaches may be safer. This study aims to compare the radiographic and clinical outcomes of septuagenarians with thoracolumbar kyphosis treated with single‐position navigated lateral column realignment with anterior longitudinal ligament release (LCR‐A) plus posterior column osteotomy (PCO) and posterior spinal fusion (PSF), or percutaneous pedicle screws (PPS) versus three‐column osteotomy (3CO). Materials and Methods This retrospective study included 21 patients with LCR‐A and 54 with 3CO prospectively treated between March 2020 and April 2024. Radiographic parameters, the Oswestry Disability Index (ODI), SRS‐22 scores, complications, and perioperative data were analyzed over a 2‐year follow‐up period. Results Although LCR‐A patients were older, they had significantly reduced blood loss, shorter operative times, and fewer fused levels than 3CO patients. LCR‐A achieved comparable deformity correction, with fewer complications, lower postoperative ODI, and better SRS‐22 scores. The LCR‐A group maintained radiographic correction, with fewer new neurological deficits and lower rates of infection, ileus, and delirium. Conclusions Single‐position navigated LCR‐A is a safer and less invasive alternative to 3CO in elderly patients with thoracolumbar kyphosis, offering effective deformity correction, fewer complications, improved functional outcomes, and enhanced recovery. Level of Evidence IV. Navigation‐assisted LCR‐A plus PCO/PSF offers effective correction of adult thoracolumbar kyphosis secondary to OVF. Compared with 3CO, LCR‐A demonstrated lower blood loss, shorter operative time, and fewer complications. Thus, LCR‐A may serve as a safer and less invasive alternative for elderly patients.

Abstract BACKGROUND Augmented reality mediated spine surgery is a novel technology for spine navigation. Benchmark cadaveric data have demonstrated high accuracy and precision leading to recent regulatory approval. Absence of respiratory motion in cadaveric studies may positively bias precision and accuracy results and analogous investigations are prudent in live clinical scenarios. OBJECTIVE To report a technical note, accuracy, precision analysis of the first in-human deployment of this technology. METHODS A 78-yr-old female underwent an L4-S1 decompression, pedicle screw, and rod fixation for degenerative spine disease. Six pedicle screws were inserted via AR-HMD (xvision; Augmedics, Chicago, Illinois) navigation. Intraoperative computed tomography was used for navigation registration as well as implant accuracy and precision assessment. Clinical accuracy was graded per the Gertzbein-Robbins (GS) scale by an independent neuroradiologist. Technical precision was analyzed by comparing 3-dimensional (3D) (x, y, z) virtual implant vs real implant position coordinates and reported as linear (mm) and angular (°) deviation. Present data were compared to benchmark cadaveric data. RESULTS Clinical accuracy (per the GS grading scale) was 100%. Technical precision analysis yielded a mean linear deviation of 2.07 mm (95% CI: 1.62-2.52 mm) and angular deviation of 2.41° (95% CI: 1.57-3.25°). In comparison to prior cadaveric data (99.1%, 2.03 ± 0.99 mm, 1.41 ± 0.61°; GS accuracy 3D linear and angular deviation, respectively), the present results were not significantly different (P > .05). CONCLUSION The first in human deployment of the single Food and Drug Administration approved AR-HMD stereotactic spine navigation platform demonstrated clinical accuracy and technical precision of inserted hardware comparable to previously acquired cadaveric studies.

Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR’s main application has been for teaching and preparatory roles, while AR has been mostly used as a surgical adjunct. The objective of this study is to discuss the various applications and prospects for VR, AR, and MR specifically as they relate to spine surgery. Materials and Methods: A systematic review was conducted to examine the current applications of VR, AR, and MR with a focus on spine surgery. A literature search of two electronic databases (PubMed and Scopus) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study quality was assessed using the MERSQI score for educational research studies, QUACS for cadaveric studies, and the JBI critical appraisal tools for clinical studies. Results: A total of 228 articles were identified in the primary literature review. Following title/abstract screening and full-text review, 46 articles were included in the review. These articles comprised nine studies performed in artificial models, nine cadaveric studies, four clinical case studies, nineteen clinical case series, one clinical case–control study, and four clinical parallel control studies. Teaching applications utilizing holographic overlays are the most intensively studied aspect of AR/VR; the most simulated surgical procedure is pedicle screw placement. Conclusions: VR provides a reproducible and robust medium for surgical training through surgical simulations and for patient education through various platforms. Existing AR/MR platforms enhance the accuracy and precision of spine surgeries and show promise as a surgical adjunct.

Study DesignNon-inferiority randomized controlled study.ObjectivesPedicle screws are the standard for thoracic and lumbar spine fixation. Various guidance techniques exist for optimal screw placement, among which three-dimensional (3D) navigation is regarded as one of the most accurate. The marker screw (MS) technique has been proposed as a method for defining entry points and trajectories. This study compares the accuracy of pedicle screw placement using the MS technique vs that of 3D-navigation.MethodsThe study was conducted in a tertiary center, where patients undergoing thoracic and lumbar spine pedicle instrumentation were assessed. Patients with deformities, tumors, and infections were excluded. Informed consent was obtained. Candidates were assigned to a guidance method by randomly withdrawing a sealed envelope. A computed tomography scan was obtained postoperatively, and the accuracy of pedicle screw placement was assessed and compared between the two groups. The Gertzbein and Robbins system was used to assess pedicle breach.ResultsForty-six patients (23 MS and 23 navigation) received a total of 266 pedicle screws (146 MS and 120 navigation). Baseline demographics and surgical parameters were comparable between groups. Overall accuracy was 94.5% in the MS group vs 99.1% in the navigation group ( .04). However, MS accuracy was not inferior to navigation and within the non-inferiority margin. No neurologic or vascular complications were attributed to screw misplacement.ConclusionsThe MS technique achieved high placement accuracy with no breach-related complications. Given its safety profile, lower cost, and broader availability, the MS guidance technique represents a viable alternative.

Transpedicular screw fixation has been accepted worldwide since Harrington et al. first placed pedicle screws through the isthmus. In vivo and in vitro studies indicated that pedicle screw insertion accuracy could be significantly improved with image-assisted systems compared with conventional approaches. The O-arm is a new generation intraoperative imaging system designed without compromise to address the needs of a modern OR like no other system currently available. The aim of our study was to check the accuracy of O-arm based and S7-navigated pedicle screw implants in comparison to free-hand technique described by Roy-Camille at the lumbar and sacral spine using CT scans. The material of this study was divided into two groups, free-hand group (group I) (30 patients; 152 screws) and O-arm group (37 patients; 187 screws). The patients were operated upon from January to September 2009. Screw implantation was performed during PLIF or TLIF mainly for spondylolisthesis, osteochondritis and post-laminectomy syndrome. The accuracy rate in our work was 94.1% in the free-hand group compared to 99% in the O-arm navigated group. Thus it was concluded that free-hand technique will only be safe and accurate when it is in the hands of an experienced surgeon and the accuracy of screw placement with O-arm can reach 100%.

Introduction Although pedicle screw fixation is a well-established technique for the lumbar spine, screw placement in the thoracic spine is more challenging because of the smaller pedicle size and more complex 3D anatomy. The intraoperative use of image guidance devices may allow surgeons a safer, more accurate method for placing thoracic pedicle screws while limiting radiation exposure. This generic 3D imaging technique is a new generation intraoperative CT imaging system designed without compromise to address the needs of a modern OR. Aim The aim of our study was to check the accuracy of this generic 3D navigated pedicle screw implants in comparison to free hand technique described by Roy-Camille at the thoracic spine using CT scans. Material and methods The material of this study was divided into two groups: free hand group (group I) (18 patients; 108 screws) and 3D group (27 patients; 100 screws). The patients were operated upon from January 2009 to March 2010. Screw implantation was performed during internal fixation for fractures, tumors, and spondylodiscitis of the thoracic spine as well as for degenerative lumbar scoliosis. Results The accuracy rate in our work was 89.8 % in the free hand group compared to 98 % in the generic 3D navigated group. Conclusion In conclusion, 3D navigation-assisted pedicle screw placement is superior to free hand technique in the thoracic spine.

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.

Study Design: Literature review and transversal study. Objective: Advances in new technologies give the surgeons confidence to manage complex spine conditions with a lower morbidity rate. This has changed the expectations of patients and medical payers and foreshadows the shift now underway: the use of minimally invasive techniques. The ethical considerations of learning directly on patients require a change in the education and training programs. Methods: The education paradigm has changed, and surgical training on minimally invasive surgery of the spine (MISS) techniques should follow a “curriculum.” The assessment of skill proficiency while learning the MISS techniques must be measurable to objectively show the performance gained over time and the changes that should be performed during training. Different strategies include “ex vivo” and “in vivo” training. Results: We have worked on a curriculum in which the participants can perceive the growth in their knowledge through the different educational opportunities. There are 3 levels: basic, advanced, and masters. Conclusions: We developed an educational curriculum for MISS rationale and techniques, that showed to be effective and interesting in our region.