Virtual Reality for Perioperative Assessment during Lateral Lumbar Interbody Fusion and Spinal Revision Surgery

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Presenting Author (Person doing the Podium Present(s)

GE

Galal Elsayed

United States

View E-Poster

Co-Author(s)

RL

Raj S. Lavadi, M.B.B.S.

Washington University School of Medicine in St. Louis, United States
SP

Sangami Pugazenthi

United States
VJ

Vinay Jaikumar

United States
RM

Rida Mitha

United States
DH

Daniel Hafez, M.D., Ph.D.

Washington University School of Medicine, United States
JO

John Ogunlade, D.O.

Washington University School of Medicine, United States
NA

Nitin Agarwal, M.D.

University of Pittsburgh Medical Center, United States

Submitter(s)

RL

Raj S. Lavadi, M.B.B.S.

Washington University School of Medicine in St. Louis, United States

Disclosure(s):

Galal Elsayed: No financial relationships to disclose

Introduction: Virtual reality (VR) offers stereopsis to reconstructed, interactive, four-dimensional models of radiological imaging. Stereopsis provides depth perception due to binocular vision of the reconstructed radiological image.

Aims/

Objectives: To present a case whereby VR offered preoperative assessment of thoracic myelopathy secondary to cord compression, and back pain with lumbar pseudoarthrosis as its suspected etiology.

Methods: The patient's imaging was exported into a spatial computing and virtual reality environment. The VR reconstruction confirms a lack of bony bridging between L2-3 and L4-5 with suspected pseudoarthrosis on the reconstructed CT scan. The configuration of the psoas muscle and lumbosacral plexus are evaluated in virtual reality. Trajectory to the L5-S1 disc while in lateral decubitus is measured from the center of the iliac crest to the L5-S1 interspace. Graft sizing is performed in virtual reality.

Results: Postoperative upright scoliosis films demonstrated increases in lumbar lordosis from 40° to 51° and in sacral slope from 22° to 27°. Decreased metrics were noted in pelvic tilt from 27° to 23°, pelvic obliquity from 3° to 1.7°, and thoracic kyphosis from 21° to 20°. The patient's sagittal vertical axis and pelvic incidence did not change and were 7.4 cm and 54°, respectively. At two months postoperative follow up, the patient no longer reports back pain and continues to regain strength in his lower extremities.

Conclusion: VR offers increased familiarity with the patient’s specific anatomy and enhances the perioperative assessment. VR has a strong potential to help accelerate the pace of innovation in surgical techniques/approaches while offering patients and surgeon a personalized surgical experience. Validity studies are necessary to help understand the potential of VR in surgical planning and postoperative evaluation.