Augmented Reality-Assisted Navigation System for Transforaminal Epidural Injection

Abstract

Eun Kyung Jun,1,* Sunghwan Lim,2,* Joonho Seo,3 Kae Hong Lee,1 Jae Hee Lee,1 Deukhee Lee,2 Jae Chul Koh1 1Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Seoul, Korea; 2Center for Healthcare Robotics, Artificial Intelligence and Robotics Institute, Korea Institute of Science and Technology, Seoul, Korea; 3Department of Medical Assistant Robot, Korea Institute of Machinery and Materials, Daegu, Korea*These authors contributed equally to this workCorrespondence: Deukhee Lee, Center for Bionics, Korea Institute of Science and Technology, Hwarangno 14-gil 5, Seongbuk-gu, Seoul, 136-791, Republic of Korea, Tel [phone], Fax [phone], Email [email protected] Jae Chul Koh, Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, 73, Goryeodae-ro, Seongbukgu, Seoul, 02841, Korea, Tel [phone], Fax [phone], Email [email protected]: Multiple studies have attempted to demonstrate the benefits of augmented reality (AR)-assisted navigation systems in surgery. Lumbosacral transforaminal epidural injection is an effective treatment commonly used in patients with radiculopathy due to spinal degenerative pathologies. However, few studies have applied AR-assisted navigation systems to this procedure. The study aimed to investigate the safety and effectiveness of an AR-assisted navigation system for transforaminal epidural injection.Patients and Methods: Through a real-time tracking system and a wireless network to the head-mounted display, computed tomography images of the spine and the path of a spinal needle to the target were visualized on a torso phantom with respiration movements installed. From L1/L2 to L5/S1, needle insertions were performed using an AR-assisted system on the left side of the phantom, and the conventional method was performed on the right side.Results: The procedure duration was approximately three times shorter, and the number of radiographs required was reduced in the experimental group compared to the control group. The distance from the needle tips to the target areas in the plan showed no significant difference between the two groups. (AR group 1.7 ± 2.3mm, control group 3.2 ± 2.8mm, P value 0.067).Conclusion: An AR-assisted navigation system may be used to reduce the time required for spinal interventions and ensure the safety of patients and physicians in view of radiation exposure. Further studies are essential to apply AR-assisted navigation systems to spine interventions.Keywords: interventional procedure, epidural injection, augmented reality, navigation system, radiation exposure

Keywords

• interventional procedure
• epidural injection
• augmented reality
• navigation system
• radiation exposure