Augmented reality–mediated stereotactic navigation for execution of en bloc lumbar spondylectomy osteotomies

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  • 1 Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri; and
  • 2 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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En bloc spinal tumor resections are technically demanding procedures with high morbidity because of the conventionally large exposure area and aggressive resection goals. Stereotactic surgical navigation presents an opportunity to perform the smallest possible resection plan while still achieving an en bloc resection. Augmented reality (AR)–mediated spine surgery (ARMSS) via a mounted display with an integrated tracking camera is a novel FDA-approved technology for intraoperative “heads up” neuronavigation, with the proposed advantages of increased precision, workflow efficiency, and cost-effectiveness. As surgical experience and capability with this technology grow, the potential for more technically demanding surgical applications arises. Here, the authors describe the use of ARMSS for guidance in a unique osteotomy execution to achieve an en bloc wide marginal resection of an L1 chordoma through a posterior-only approach while avoiding a tumor capsule breach. A technique is described to simultaneously visualize the navigational guidance provided by the contralateral surgeon’s tracked pointer and the progress of the BoneScalpel aligned in parallel with the tracked instrument, providing maximum precision and safety. The procedure was completed by reconstruction performed with a quad-rod and cabled fibular strut allograft construct, and the patient did well postoperatively. Finally, the authors review the technical aspects of the approach, as well as the applications and limitations of this new technology.

ABBREVIATIONS AR = augmented reality; ARMSS = AR-mediated spine surgery; FOV = field of view; HMD = head-mounted display; ITC = integrated tracking camera; LOS = line of sight; RTC = remote tracking camera.

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Contributor Notes

Correspondence Camilo A. Molina: Washington University School of Medicine, St. Louis, MO. cmolina@wustl.edu.

INCLUDE WHEN CITING Published online March 5, 2021; DOI: 10.3171/2020.9.SPINE201219.

Disclosures Dr. Molina reports being a consultant for Augmedics and DePuy Synthes. Dr. Witham reports direct stock ownership in Augmedics and Additive Orthopedics, membership on the medical advisory board of Augmedics, and receiving support of a non–study-related clinical research effort that he oversees in a grant from Eli Lilly and Co. and from the Gordon and Marilyn Macklin Foundation. Dr. Sciubba reports being a consultant for Medtronic, K2M, Misonix, DePuy Synthes, Stryker, NuVasive, and Baxter and having direct stock ownership in Augmedics. Dr. Molina reports being a consultant for Augmedics and DePuy Synthes. Dr. Witham reports direct stock ownership in Augmedics and Additive Orthopedics, membership on the medical advisory board of Augmedics, and receiving support of a non–study-related clinical research effort that he oversees in a grant from Eli Lilly and Co. and from the Gordon and Marilyn Macklin Foundation. Dr. Sciubba reports being a consultant for Medtronic, K2M, Misonix, DePuy Synthes, Stryker, NuVasive, and Baxter and having direct stock ownership in Augmedics.

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