Technical Advances in Minimally Invasive Spine Surgery: Navigation, Robotics, Endoscopy, Augmented and Virtual Reality

✍ Scribed by Jin-Sung Kim (editor), Roger Härtl (editor), Michael Y. Wang (editor), Adrian Elmi-Terander (editor)

• Publisher: Springer
• Year: 2022
• Tongue: English
• Leaves: 484
• Edition: 1st ed. 2022
• Category: Library

✦ Synopsis

This book is a comprehensive guide to the application of recently introduced and emerging technologies in minimally invasive spine surgery (MISS). These technologies, including 2D and 3D navigation, endoscopy, virtual and augmented reality, robotics, and 3D printing, are helping to overcome previous limitations of MISS, such as the steep learning curve and the need for a great deal of experience in order to achieve optimal outcomes. Compared with traditional techniques, their use is designed to reduce local operative tissue damage, alleviate systemic surgical stress, and enable earlier return to function. The book provides detailed and extensively illustrated accounts of the role of the new technologies and techniques in a wide range of indications. In essence, all spine conditions, whether degenerative, traumatic, or oncologic, will in the near future be amenable to MISS using these approaches. The book will be a source of insight and practical assistance for all surgeons who perform MISS, regardless of their level of experience.

✦ Table of Contents

Foreword
Foreword
Preface
Contents
List of Contributors
Part I: Navigation Guided Spinal Fusion
1: History of Navigation Guided Spine Surgery
1.1 Introduction
1.2 Single and Biplanar Fluoroscopy (Non-navigated)
1.3 Navigated Two-Dimensional Fluoroscopy
1.4 Fan Beam and Cone Beam Computed Tomography-Based Three-Dimensional Navigation
1.5 Robotics
1.6 Augmented Reality and Virtual Reality
1.7 Conclusion
References
2: Navigation Guided Single-Stage Lateral Surgery
2.1 Introduction
2.2 Published Reports of Single-Stage Lateral Surgery
2.3 Single Position Lateral Surgery with Navigation
2.4 General Technique
2.5 Positioning and Lateral Interbody Cage Placement
2.6 Navigated Pedicle Screw Placement
2.7 Illustrative Cases
2.7.1 Case 1
2.7.2 Case 2
2.7.3 Case 3
2.7.4 Case 4
References
3: The Six Pillars of Minimally Invasive Spine Surgery
3.1 The Unmet Potential of Minimally Invasive Spinal Surgery
3.2 The “6 T’s of MISS”
3.3 Target
3.3.1 Tools and Technology
3.3.2 Surgical Technique
3.3.3 Teaching/Training
3.3.4 Curriculum Development
3.3.5 Testing: Research and Outcomes
3.3.6 Talent
3.4 Conclusion
References
4: MI-TLIF with 3D Navigation
4.1 Introduction
4.2 Components in Spine Navigation Systems [5]
4.2.1 Image Acquisition and Processing Unit
4.2.2 Referencing System
4.2.2.1 Dynamic Reference Array
4.2.2.2 Light-Emitting Diodes
4.2.2.3 Tracking System
4.2.3 Registration Process
4.3 Evolution
4.4 Generations of Navigation System [5]
4.4.1 First-Generation Spine Navigation
4.4.2 Second-Generation Spine Navigation
4.4.2.1 3D C-Arm Navigation System
4.4.2.2 Cone Beam CT
4.4.2.3 Third-Generation Spine Navigation Systems
4.4.3 Senior Author’s MIS Navigation Surgical Technique
4.5 Indications
4.5.1 Operating Room Setup
4.5.2 Anaesthesia
4.5.3 Positioning
4.5.4 3D Navigation Registration
4.5.5 Decompression
4.5.6 Disc Space Preparation
4.5.7 Percutaneous Pedicle Screw and Rod Fixation
4.5.8 Post Operative Care
4.5.9 Advantages of MIS
4.6 Advantages of Navigation-Assisted Surgery
4.6.1 Accuracy
4.6.2 Radiation Safety
4.6.3 Surgical Site Infection
4.6.4 Facet Joint Preservation
4.6.5 In Obese/Osteoporotic Patients
4.7 Concerns with Spine Navigation
4.7.1 Operative Time
4.7.2 Wobbling and Motion Related Artefacts
4.7.3 Distance from Reference Array
4.7.4 Cost-Effectiveness
4.7.5 Learning Curve
4.8 Senior Authors Experience
4.8.1 Results
4.9 Conclusions
References
5: Navigation Guided Oblique Lumbar Interbody Fusion
5.1 Indications
5.2 Advantages of OLIF Over Other Interbody Fusion Techniques [8]
5.2.1 OLIF Vs. TLIF
5.2.2 OLIF Vs. Direct/Lateral Lumbar Interbody Fusion (DLIF/LLIF)
5.3 Relevant Surgical Anatomy
5.4 Advantages of Navigation in OLIF
5.5 Technique of OLIF
5.6 Complications of OLIF and Tips to Avoid them
5.7 Disadvantages of OLIF
5.8 Limitations of OLIF
5.9 Conclusion
References
6: Navigation-Guided Spinal Fusion: MIS Fusion and Reconstruction in Complex Spine Disease and Deformity
6.1 Introduction
6.2 CT (O-Arm)-Based Navigation Surgery
6.3 Mixed Reality-Based Navigation
6.4 Augmented Reality-Based Navigation
References
7: Single-Stage Lateral Lumbar Interbody Fusion Based on O-arm Navigation
7.1 Introduction
7.2 Settings and Surgical Techniques
7.3 Advantages of Single-Position Anterior and Posterior Lumbar Interbody Fusion
7.4 Learning Curve
7.5 Future Possibilities of Single-Position Surgery
References
8: The Role of 3D Navigation for MIS Cervical Spine Surgery
8.1 The 3D Navigation for MIS Cervical Spine Surgery
8.1.1 Evolution of Posterior Cervical Fixation
8.1.2 Development of Navigation System for Cervical Spine Surgery
8.1.3 Development of Navigation Tools
8.2 Cervical Pedicle Screw Placement with Navigation
8.2.1 CPS Placement with Intraoperative 3D-CT Based Navigation System (O-Arm)
8.2.2 The Problems of the Navigated CPS Placement
8.2.3 Navigated Surgical Drill for CPS Placement
8.2.3.1 CPS Placement with the Use of a Navigated Drill with Use of O-arm
8.2.3.2 Clinical Results
8.2.3.3 Case Presentation
8.3 Minimally Invasive Cervical Pedicle Screw Fixation (MICEPS) via a Posterolateral Approach
8.3.1 Minimally Invasive Cervical Pedicle Screw Fixation (MICEPS)
8.3.1.1 Instruments and Materials
8.3.1.2 Surgical Technique
8.3.1.3 Instructions for the Procedure
8.3.1.4 Complications
8.3.1.5 Clinical Results
8.3.2 Advantages of MICEPS
8.4 Minimally Invasive C1–C2 Posterior Fixation Via a Posterolateral Approach.
8.4.1 Minimally Invasive C1–C2 Posterior Fixation
8.4.1.1 Surgical Technique
8.4.1.2 Instructions for the Procedure
8.4.1.3 Complications
8.4.1.4 Clinical Results
8.4.2 The Intraoperative 3D Navigation for Minimally Invasive C1–C2 Posterior Fixation
References
9: Minimally Invasive Lateral Transpsoas Approach with Intraoperative CT Navigation
9.1 Introduction
9.1.1 Background
9.1.2 3D Navigation with an Intraoperative CT
9.1.3 Main Indications and Contraindications
9.1.4 Preoperative Assessment and Planning
9.2 Description of the Procedure
9.2.1 Surgical Technique
9.2.1.1 Patient Positioning
9.2.1.2 Room and Navigation Setup
9.2.1.3 Planning Skin Incision and Performing Initial Dissection
9.2.1.4 Deep Dissection and Crossing of the Psoas Muscle
9.2.1.5 Discectomy and Implant Insertion
9.2.2 Use of Intraoperative CT Navigation
9.2.3 IONM Tools
9.2.4 Postoperative Management
9.3 Outcomes
9.4 Complications
9.5 General Considerations
9.6 Conclusion
9.7 Summary
References
Part II: Navigation Guided MIS Decompressive Spinal Surgery
10: Navigation Guided MIS Tubular Decompression in Cervical Spine
10.1 Introduction
10.2 Anatomical Considerations
10.3 Indications
10.4 Surgical Technique
10.4.1 Patient Positioning, Anaesthesia, and Operating Room Set-Up
10.4.2 Surgical Procedure
10.4.3 Post-operative Care
10.4.4 Complications
10.5 Conclusion
References
11: Navigation-Guided Tubular Decompression in the Lumbar Spine
11.1 Introduction
11.2 Indications and Contraindications
11.3 Operating Room Setup and Localization
11.4 Surgical Technique
11.5 Case Example 1: Revision Case
11.6 Case Example 2: Upper Lumbar Level
11.7 Case Example 3: Complex Anatomy
11.8 Conclusion
References
12: EM-Based Navigation-Guided Transforaminal Endoscopic Lumbar Discectomy
12.1 Introduction
12.2 Components of the Electromagnetic Navigation System
12.3 Indications and Contraindications
12.3.1 Indications
12.3.2 Contraindications
12.4 Surgical Procedure
12.5 Case Study
12.6 Discussion
12.7 Conclusions
References
13: Navigation-Guided Endoscopic Lumbar Laminotomy
13.1 Introduction
13.2 Indications
13.3 Operative Procedures
13.3.1 Equipment and Instruments
13.4 Operative Setting
13.5 Surgical Technique
13.6 Case Illustration
13.7 Discussion
13.8 Conclusion
References
14: O-arm Navigation-Guided Lumbar Foraminotomy
14.1 Introduction
14.1.1 Anatomy
14.1.2 Options of Full-Endoscopic Lumbar Foraminotomy
14.1.3 Indications
14.2 Surgical Technique
14.2.1 Operating Room Setup
14.2.1.1 O-arm Navigation-Guided Transforaminal Endoscopic Lumbar Foraminotomy
14.2.1.2 Case Illustration
14.2.1.3 O-arm Navigation-Guided Interlaminar Contralateral Endoscopic Lumbar Foraminotomy
14.2.1.4 Case Illustration
14.3 Pitfalls and Complication Avoidance
14.4 Conclusion
References
15: EM-based Navigation-Guided Percutaneous Endoscopic Lumbar Foraminoplasty
15.1 Introduction
15.1.1 Development of Foraminoplasty
15.1.2 Anatomical Basis of Lumbar Foraminoplasty
15.1.3 The Key Steps of TESSYS Technique
15.1.4 Application of Navigation System in Spinal Surgery
15.2 Working Principle of EM-Based Navigation
15.3 Indications and Contraindications
15.3.1 Indications
15.3.2 Contraindications
15.4 Surgical Tools
15.5 Surgical Procedure
15.6 Case Study
15.7 Discussion
15.8 Conclusion
References
16: O-Arm Navigation-Guided Endoscopic Cervical Laminoforaminotomy
16.1 Introduction
16.2 Goal of the Surgery
16.3 Patient Selection and Indications [7–10]
16.4 Contraindications [7–10]
16.5 Setup
16.5.1 Information for the Patient
16.5.2 Preparation for Surgery
16.5.3 Instruments
16.6 Surgical Technique
16.6.1 Data Acquisition and Registration
16.6.2 Access
16.6.3 Decompression (Laminoforaminotomy)
16.7 Pearls and Pitfalls
16.7.1 Neural Structure Injury
16.7.2 Intraoperative Bleeding Control
16.7.3 Maintaining Navigation Accuracy
16.8 Conclusion
References
17: Feasibility of Endoscopic Transforaminal Lumbar Interbody Fusion
17.1 Introduction
17.2 Anatomical Description of Kambin’s Triangle
17.3 The Working Zone and Safe Zone
17.4 Technical Considerations and Limitations
17.5 Conclusion
References
18: O-Arm Navigation-Guided Biportal Endoscopic Transforaminal Lumbar Interbody Fusion
18.1 Introduction
18.2 Basic Concepts
18.3 Advantages of Navigation-Guided UBE-TLIF
18.4 Surgical Anatomy
18.5 Indications and Contraindications
18.6 Operative Technique
18.7 Discussion
18.8 Conclusions
References
19: O-Arm Navigation-Guided Endoscopic Oblique Lumbar Interbody Fusion
19.1 Introduction
19.2 Indications
19.3 Contraindications
19.4 Operative Procedure
19.4.1 Preoperative Planning
19.4.2 Equipment and Instruments
19.4.3 Operative Flow
19.4.4 Endoscope and Its Role in OLIF
19.5 Advantages
19.6 Disadvantages
19.7 Discussion
19.8 Conclusion
19.9 Case Illustration
References
20: Virtu4D Navigation-Guided Endoscopic Transforaminal Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation
20.1 Historical Perspective
20.2 Terminology
20.3 Patient Selection
20.3.1 General Indications
20.3.2 Indications for Endo-TLIF
20.4 Pros and Cons of Endo-LIF
20.4.1 Pros
20.4.2 Cons
20.5 Preoperative Planning
20.5.1 Examinations
20.5.2 Preparation
20.5.3 Anesthesia
20.5.4 Positioning
20.5.5 Technical Equipment
20.6 Surgical Procedures
20.6.1 Surface Localization of the Surgical Area and Incision Planning
20.6.2 Electromagnetic Navigation Registration
20.6.3 Anatomical Identification and Exposure
20.6.4 Endoscopic Decompression
20.6.5 Intervertebral Disc Space Treatment
20.6.6 Intervertebral Bone Grafting and Cage Implantation
20.6.7 Percutaneous Pedicle Screws Implantation
20.6.8 Cleaning the Operating Field
20.7 Postoperative Care
20.8 Complications
References
21: Three-dimensional Endoscopic Spine Surgery Using the Biportal Endoscopic Approach
21.1 Introduction
21.2 Surgical Instruments and Equipment
21.3 Surgical Procedure
21.4 Clinical Application
21.5 Discussion
21.6 Conclusion
References
22: Navigation in Spinal Tumor Surgery
22.1 Introduction
22.2 Applications of Navigation in Spinal Tumor Surgery
22.2.1 Localization with Intraoperative CT Scanography
22.2.2 Tracking During the Surgical Procedures
22.3 Case Illustration
22.4 Conclusion
References
23: The Usefulness of Navigation in Thoracic Endoscopic Discectomy and Decompression
23.1 Introduction
23.2 Anatomical Considerations
23.3 Indications and Contraindications of Full-Endoscopic Thoracic Decompression
23.4 Options of Full-Endoscopic Thoracic Decompression
23.5 Surgical Technique
23.5.1 Operating Room Setup
23.5.2 Navigation Setup
23.5.3 Case Illustration: Full-Endoscopic Interlaminar Thoracic Decompression
23.5.4 Determine Entry Point and Docking the Endoscope
23.5.5 Full-Endoscopic Discectomy and Decompression
23.6 Pitfalls and Avoidance of Complications
23.7 Conclusion
References
Part III: Robot-Assisted MISS
24: Currently Available Robot Systems in Spinal Surgery
24.1 Introduction
24.1.1 Brief History of Robotic Surgery
24.2 Currently Available Technologies
24.2.1 Medtronic/Mazor Robotics: Mazor Spine Assist, Renaissance, X
24.2.2 Zimmer Biomet/Medtech: ROSA® Spine
24.2.3 Globus Medical: ExcelsiusGPS
24.2.4 Brainlab: Cirq
24.2.5 Other Technologies
24.3 Where We Are
24.4 Where We Are Going
24.5 Conclusion
References
25: Evidence of Navigation-Guided/Robot-Assisted Spinal Surgery
25.1 Introduction
25.2 Computer-Assistant Navigation
25.3 Telesurgical Robot System
25.3.1 da Vinci
25.4 Robotic-Assisted Navigation Systems
25.4.1 Mazor: SpineAssist
25.4.2 Mazor: Renaissance
25.4.3 Mazor: Mazor X
25.4.4 ROSA
25.4.5 ExcelsiusGPS
25.4.6 CUVIS-Spine
25.5 Advantages of Robotics and Navigation Systems
25.6 Accuracy of Pedicle Screw Placement
25.7 Radiation Exposure
25.8 Expansion of the Field of Use of Robotic Systems in Spine Surgery
25.9 Augmented Reality in Spine Surgery
25.10 Conclusion
References
26: Workflows for Robotic Surgery in the Lumbar Spine: MIS TLIF
26.1 Case History
26.2 Surgical Decision-Making
26.3 Surgical Workflow
26.4 Procedure Description
References
27: Recent Advancements in Robot-Assisted Spinal Surgery in China and Future Perspective
27.1 Introduction
27.2 Clinical Outcomes and Accuracy
27.3 TiRobot®
27.4 Mazor Renaissance®
27.5 Cost-Effectiveness Analysis
27.6 Future Perspective
27.7 Conclusion
References
28: The Role of Robot-Assisted MIS Spinal Deformity Surgery
28.1 Case History
28.2 Key Challenges
28.3 Surgeon’s Rationale
28.4 Procedural Steps
28.5 Pearls and Tips to Optimize Surgical Planning
28.6 Key Points
References
29: Endoscopic Robotic Spinal Surgery: Current Status and Future
29.1 Introduction
29.2 Localization and Access
29.3 Robotic Endoscopic Technique
29.4 Future Outlook
29.5 Conclusions
References
30: Robot-Assisted Posterior Endoscopic Cervical Decompression
30.1 Introduction
30.2 The Composition of the TiRobot
30.3 The Key Principle of the TiRobot
30.4 Indications and Contraindications
30.4.1 Indications
30.4.2 Contraindications
30.5 Surgical Procedure
30.6 Case Study
30.7 Discussion
30.8 Conclusion
References
31: Robot-Assisted Percutaneous Endoscopic Lumbar Interbody Fusion
31.1 Introduction
31.2 The Key Working Principle of Orthopedic Robot
31.3 The Composition of the Robot
31.3.1 Robotic Arm System
31.3.2 Optical Tracking System
31.3.3 Surgical Planning and Navigation System
31.4 Indications and Contraindications
31.4.1 Indications
31.4.2 Contraindications
31.5 Surgical Procedure
31.6 Case Study
31.7 Discussion
31.8 Conclusion
References
32: Future Perspective of Robot-Assisted Minimally Invasive Spine Surgery
32.1 Introduction
32.2 Current Products in the Corporate Pipeline
32.2.1 NuVasive: Pulse
32.2.2 Medtronic: Mazor X Stealth
32.2.3 Globus: Excelsius GPS
32.2.4 Zimmer Biomet: Rosa ONE
32.2.5 Discussion
32.3 New Advances in Robotics
32.3.1 Remote Surgery
32.3.2 Haptic and Auditory Feedback
32.3.3 Expanding Procedures for Robotics in MISS
32.3.4 Machine Learning (ML) for MISS
32.3.4.1 What Is Machine Learning?
32.3.4.2 Radiation- and Fluoroscopy-Free Navigation
32.3.4.3 Collision Avoidance and Path Planning
32.3.4.4 Outcome predictions
32.4 Necessity Dictates Innovation: What the Field of MISS Needs
32.4.1 Reduction of Cost
32.4.2 Increased Portability
32.4.3 Better Generalization
32.5 Conclusion
References
Part IV: Augmented and Virtual Reality in Spine Surgery
33: Current Status of Augmented Reality in the Spine
33.1 Introduction
33.2 Historical Background
33.3 Terminology
33.4 Why Do We Need AR Navigation in Spine Surgery?
33.5 How to Design a Surgical Navigation System: The Necessary Components
33.6 Current Applications of VR, AR, MIXR Navigation
33.7 Currently Available AR Navigation Systems
References
34: Optimizing Visualization in Endoscopic Spine Surgery
34.1 A Global View of Spinal Endoscopy
34.2 A Brief History of Light and Endoscopy
34.3 The Scientific Foundations of the Modern Spinal Endoscope
34.3.1 Transmission of Light
34.3.2 Image Visualization and Processing
34.4 Methods of Enhanced Visualization
34.5 Methods of Direct Tissue Manipulation
34.5.1 Topical Chromoendoscopy
34.5.2 Endoscopic Tattooing
34.6 Methods of Light Transformation
34.6.1 Optical Chromendoscopy
34.6.2 LASER as a Light Source
34.7 A Culmination of Methods: Tissue Manipulation with Light Transformation
34.7.1 5-ALA
34.7.2 Indocyanine Green
34.7.3 Fluorescein
34.7.4 Laser Scanning Confocal Endomicroscopy
34.8 Methods of Image Processing
34.8.1 Three-Dimensional Endoscopy
34.9 Looking Forward: The Future of Endoscopic Spinal Surgery
References
35: MIS-TLIF with 3D Navigation and Augmented Reality Enhanced
35.1 Introduction
35.1.1 Preoperative Planning
35.1.2 Procedure Steps
35.2 Summary
References
36: Application of Extended Reality to MIS Lumbar Fusion
36.1 Single Position Lateral Surgery with 3D Navigation Enhanced by XR
36.2 Extended Reality (XR)
36.3 Single Position Lumbar Interbody Fusion in VR Technology
36.4 Utility of Augmented Reality (AR) in Spinal Surgery
36.5 Intraoperative MR Assistance for PPS in the Lateral Position
36.6 Remote Conferencing Using XR Technology (Teleconferencing)
36.7 Future Prospects and Challenges of Reality Technology
References
37: Technical Feasibility of Augmented Reality in Spinal Tumor Surgery
37.1 Introduction
37.2 Spinal Tumor Surgery
37.3 Intradural Tumors
37.4 Extradural Tumors
References
38: Future Perspective of Augmented Reality in Minimally Invasive Spine Surgery
38.1 Introduction
38.2 Segmentation
38.3 Hybrid OR and AR
38.4 Tracking Technologies
38.5 Intraoperative Imaging to Realign Co-registration
38.6 Robotics and AR
38.7 Machine Learning Technology
38.8 Tissue Recognition for MISS and AR Navigation
References
Part V: Augmented and Virtual Reality in Spine Surgery Training
39: History and Application of Virtual Reality in Spinal Surgery
39.1 Historical Overview of Surgical Simulation
39.2 Historical Overview of Virtual Reality in Surgery
39.3 First Publications on Spinal Surgery and VR
References
40: The Impact of Virtual Reality on Surgical Training
References
41: Mixed and Augmented Reality Simulation for Minimally Invasive Spine Surgery Education
41.1 Introduction
41.2 VR and AR Simulation
41.3 AR in Spine Surgery Simulation
41.4 AR in Simulation-Based Assessment
41.5 Discussion
41.5.1 The Goal of the Simulation
41.5.2 The Case for AR
41.5.3 Current Status of AR Spine Simulation
41.5.4 Skills Transfer
41.5.5 Economics
41.6 Conclusion
References
42: Immersive Virtual Reality of Endoscopic and Open Spine Surgery Training
42.1 Introduction
42.2 Immersive Virtual Reality
42.2.1 Haptics and Spine Surgery Training with Immersive Virtual Reality
42.3 Endoscopic Spine Surgery Training and Immersive Virtual Reality
42.3.1 Skill Acquisition
42.3.2 Medical Student
42.3.3 Resident
42.3.4 Surgeons
42.3.5 Summary
42.4 Open Spine Surgery Training and Immersive Virtual Reality
42.4.1 Medical Student
42.4.2 Resident
42.4.3 Surgeon
42.5 Future Directions
42.5.1 Evidence of Training Effectiveness
42.5.2 Skill Retention
42.5.3 Improved Haptic Interfaces, Commercial Availability, and Cost Analyses
42.5.4 Integrative Immersive VR, AR, and MR and Longitudinal Patient Study
References
43: Future Applications of Virtual Reality in Spinal Surgery