ParticipantsJacob Gibby, BS, Washington, DC (Presenter) Nothing to Disclose
Samuel Swenson, Arlington, VA (Abstract Co-Author) Nothing to Disclose
Steve T. Cvetko, PhD, American Fork, UT (Abstract Co-Author) Vice President, Novarad Corporation
Ramin Javan, MD, Washington, DC (Abstract Co-Author) Nothing to Disclose
Wendell A. Gibby, MD, Provo, UT (Abstract Co-Author) CEO, Novarad Corporation
jakegibby@hotmail.com
CONCLUSIONWe demonstrated feasibility of using HMD-AR in facet and sacroiliac joint injections, and percutaneous discectomy. To the authors' knowledge, this is the first reported use of HMD-AR guidance in live surgery.
BackgroundHead Mounted Display Augmented Reality (HMD-AR) is a recent technological advancement that can be used to superimpose CT or MRI images on a patient in real space to visualize inner anatomical structures in three dimensions, as well as axial, sagittal, and coronal views. We used HMD-AR to perform three common image-guided spine procedures, facet and sacroiliac (SI) joint injections as well as percutaneous discectomy, with no real time fluoroscopic guidance on a 3D printed lumbar model. Finally, we successfully demonstrated the utility of HMD-AR by performing these procedures on live patients using HMD-AR guidance.
EvaluationCT images were performed of a 3D printed lumbar phantom made of radiodense gypsum-based material encased in silicone. Suggested trajectories for instrumentation were embedded in the images, which were uploaded to the Microsoft Hololens using Novarad Open Sight system. Images were superimposed on the phantom, and localization of the facet joint, sacroiliac joint, and nucleus pulposus was performed by placing 18-gauge cannulated needles along holographic trajectories. Repeat CT images confirmed accurate placement of the needles. Registration accuracy was determined by measuring deviation of model to hologram and was found to be roughly spherical with radius of 2.5 mm (STD 0.44 mm). Finally, a certified neuro-radiologist used the same method to localize the facet joint, sacroiliac joint and nucleus pulposus during three separate live procedures, all of which were confirmed with fluoroscopy.
DiscussionHMD-AR can be used to project holographic guidance trajectories within vital anatomic structures, allowing accurate interventional and surgical instrumentation, potentially decreasing operating and fluoroscopy time and reducing error for select procedures. HMD-AR can also utilize existing images, potentially reducing radiation exposure by minimizing need of fluoroscopy use intraoperatively.