Augmented Reality Navigated Sacral-Alar-Iliac Screw Insertion
Journal Paper/Review - Feb 18, 2021
Dennler Cyrill, Safa Nico Akhavan, Bauer David Ephraim, Wanivenhaus Florian, Liebmann Florentin, Götschi Tobias, Farshad Mazda
Sacral-alar-iliac (SAI) screws are increasingly used for lumbo-pelvic fixation procedures. Insertion of SAI screws is technically challenging, and surgeons often rely on costly and time-consuming navigation systems. We investigated the accuracy and precision of an augmented reality (AR)-based and commercially available head-mounted device requiring minimal infrastructure.
A pelvic sawbone model served to drill pilot holes of 80 SAI screw trajectories by 2 surgeons, randomly either freehand (FH) without any kind of navigation or with AR navigation. The number of primary pilot hole perforations, simulated screw perforation, minimal axis/outer cortical wall distance, true sagittal cranio-caudal inclination angle (tSCCIA), true axial medio-lateral angle, and maximal screw length (MSL) were measured and compared to predefined optimal values.
In total, 1/40 (2.5%) of AR-navigated screw hole trajectories showed a perforation before passing the inferior gluteal line compared to 24/40 (60%) of FH screw hole trajectories ( < .05). The differences between FH- and AR-guided holes compared to optimal values were significant for tSCCIA with -10.8° ± 11.77° and MSL -65.29 ± 15 mm vs 55.04 ± 6.76 mm ( = .001).
In this study, the additional anatomical information provided by the AR headset and the superimposed operative plan improved the precision of drilling pilot holes for SAI screws in a laboratory setting compared to the conventional FH technique. Further technical development and validation studies are currently being performed to investigate potential clinical benefits of the AR-based navigation approach described here.
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