Abstract：
OBJECTIVE: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a highly reproducible procedure for the fusion of spinal segments. We recently introduced the concept of \"total navigation\" to improve workflow and eliminate fluoroscopy. Imageguided surgery incorporating augmented reality (AR) may further facilitate workflow. In this study, we developed and evaluated a protocol to integrate AR into the workflow of MISTLIF.
METHODS: A case series of 10 patients was the basis for the evaluation of a protocol to facilitate tubular MIS-TLIF by the application of AR. Surgical TLIF landmarks were marked on a preoperative computed tomography (CT)-scan using dedicated software. This marked CT scan was fused intraoperatively with the low-dose navigation CT scan using elastic image fusion, and the markers were transferred to the intraoperative scan. Our experience with this workflow and the surgical outcomes were collected.
RESULTS: Our AR protocol was safely implemented in all cases. The TLIF landmarks could be preoperatively planned and transferred to the intraoperative imaging. Of the 10 cases, 1 case had additionally a synovial cyst resection and in 2 cases an additional bony decompression was performed due to central stenosis. The average procedure time was 160.6 ± 31.9 minutes. The AR implementation added 1.72 ± 0.37 minutes to the overall procedure time. No complications occurred.
CONCLUSIONS: Our findings support the idea that total navigation with AR may further facilitate the workflow, especially in cases with more complex anatomy and for teaching and training purposes. More work is needed to simplify the software and make AR integration more user-friendly.
METHODS: A case series of 10 patients was the basis for the evaluation of a protocol to facilitate tubular MIS-TLIF by the application of AR. Surgical TLIF landmarks were marked on a preoperative computed tomography (CT)-scan using dedicated software. This marked CT scan was fused intraoperatively with the low-dose navigation CT scan using elastic image fusion, and the markers were transferred to the intraoperative scan. Our experience with this workflow and the surgical outcomes were collected.
RESULTS: Our AR protocol was safely implemented in all cases. The TLIF landmarks could be preoperatively planned and transferred to the intraoperative imaging. Of the 10 cases, 1 case had additionally a synovial cyst resection and in 2 cases an additional bony decompression was performed due to central stenosis. The average procedure time was 160.6 ± 31.9 minutes. The AR implementation added 1.72 ± 0.37 minutes to the overall procedure time. No complications occurred.
CONCLUSIONS: Our findings support the idea that total navigation with AR may further facilitate the workflow, especially in cases with more complex anatomy and for teaching and training purposes. More work is needed to simplify the software and make AR integration more user-friendly.
摘要：
目的：微创经椎间孔腰椎椎间融合术（MIS-TLIF）是一种高度可重复的脊柱节段融合术。我们最近引入了“总导航”的概念，以改善工作流程并消除透视检查。结合增强现实(AR)的图像引导式手术可以进一步促进工作流程。在这项研究中,我们开发并评估了将AR集成到MISTLIF工作流程中的方案.
方法：10例患者的病例系列是评估通过应用AR促进肾小管MIS-TLIF的方案的基础。使用专用软件在术前计算机断层扫描（CT）扫描上标记手术TLIF标志。该标记的CT扫描在术中与使用弹性图像融合的低剂量导航CT扫描融合，标记物转移到术中扫描.收集我们在此工作流程和手术结果方面的经验。
结果：我们的AR方案在所有病例中均安全实施。TLIF标志可以在术前计划并转移到术中成像。在这10个案例中,1例另外进行了滑膜囊肿切除术，2例因中央狭窄而进行了骨减压。平均手术时间为160.6±31.9分钟。AR的实施使整个手术时间增加了1.72±0.37分钟。无并发症发生。
结论：我们的研究结果支持使用AR进行总导航可能会进一步促进工作流程的想法，特别是在解剖结构更复杂的情况下，为了教学和培训的目的。需要做更多的工作来简化软件并使AR集成更加用户友好。
方法：10例患者的病例系列是评估通过应用AR促进肾小管MIS-TLIF的方案的基础。使用专用软件在术前计算机断层扫描（CT）扫描上标记手术TLIF标志。该标记的CT扫描在术中与使用弹性图像融合的低剂量导航CT扫描融合，标记物转移到术中扫描.收集我们在此工作流程和手术结果方面的经验。
结果：我们的AR方案在所有病例中均安全实施。TLIF标志可以在术前计划并转移到术中成像。在这10个案例中,1例另外进行了滑膜囊肿切除术，2例因中央狭窄而进行了骨减压。平均手术时间为160.6±31.9分钟。AR的实施使整个手术时间增加了1.72±0.37分钟。无并发症发生。
结论：我们的研究结果支持使用AR进行总导航可能会进一步促进工作流程的想法，特别是在解剖结构更复杂的情况下，为了教学和培训的目的。需要做更多的工作来简化软件并使AR集成更加用户友好。
