Our research highlights the potential of Diffuse Reflectance Spectroscopy (DRS) in detecting cortical breaches during pedicle screw placement. We propose a sideways-looking fiber-optic probe, integrating diffuse light emission with both forward and sideways light collection. Experiments on an optical tissue phantom validate the probe’s potential to distinguish bone tissues and provide real-time guidance for spine surgery. Our findings prove that DRS with diffuse emission can detect perpendicular breaches, and demonstrate how the integration of a 45^◦ slanted fiber coated with gold enables parallel breach detection, advancing spine surgery by allowing for accurate pedicle screw placement.

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As people’s life expectancy increases, more individuals will develop degenerative diseases over their lifetime. Surgeries like spinal fusion can help manage these diseases to improve mobility and alleviate pain in the aging population. During spinal fusion, two or more adjacent vertebrae are connected to stabilize part of the spine. Since it takes several months for the bones to grow together, connecting rods and pedicle screws provide support in the meantime. Inserting these screws into the vertebrae is a delicate procedure that, if not done correctly, could harm nearby nerves and blood vessels. To find the correct screw trajectory, surgeons rely on tactile feedback and their experience, as they cannot see inside the body. To support surgeons and enhance safety, the procedure can be guided by technology. Although surgical navigation systems exist, their high cost is a barrier to widespread use. A simple and affordable alternative is tissue sensing technology, which provides insights into the structure and composition of the tissue being examined. This information helps detect the border of the vertebra during spinal fusion to prevent breaches into surrounding tissue. Even where surgical navigation is available, tissue sensing offers an extra layer of safety, for instance, if the spine has moved during surgery....@en

Background: In brain tumor surgery, maximal tumor resection is typically desired. This is complicated by infiltrative tumor cells which cannot be visually distinguished from healthy brain tissue. Optical methods are an emerging field that can potentially revolutionize brain tumor surgery through intraoperative differentiation between healthy and tumor tissues. Methods: This study aimed to systematically explore and summarize the existing literature on the use of Raman Spectroscopy (RS), Hyperspectral Imaging (HSI), Optical Coherence Tomography (OCT), and Diffuse Reflectance Spectroscopy (DRS) for brain tumor detection. MEDLINE, Embase, and Web of Science were searched for studies evaluating the accuracy of these systems for brain tumor detection. Outcome measures included accuracy, sensitivity, and specificity. Results: In total, 44 studies were included, covering a range of tumor types and technologies. Accuracy metrics in the studies ranged between 54 and 100% for RS, 69 and 99% for HSI, 82 and 99% for OCT, and 42 and 100% for DRS. Conclusions: This review provides insightful evidence on the use of optical methods in distinguishing tumor from healthy brain tissue.

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Diffuse Reflectance Spectroscopy (DRS) can provide tissue feedback for pedicle screw placement in spine surgery, yet the integration of fiber optics into the tip of the pedicle probe, a device used to pierce through bone, is challenging, since the optical probing depth and signal-to-noise ratio (SNR) are affected negatively compared to those of a blunt DRS probe. Through Monte Carlo simulations and optical phantom experiments, we show how differences in the shape of the instrument tip influence the acquired spectrum. Our findings demonstrate that a single bevel with an angle of 30∘ offers a solution to anticipate cortical breaches during pedicle screw placement. Compared to a blunt probe, the optical probing depth and SNR of a cone tip are reduced by 50%. The single bevel tip excels with 75% of the optical probing depth and a SNR remaining at approximately ⅔, facilitating the construction of a surgical instrument with integrated DRS.@en

Accuracy in spinal fusion varies greatly depending on the experience of the physician. Real-time tissue feedback with diffuse reflectance spectroscopy has been shown to provide cortical breach detection using a conventional probe with two parallel fibers. In this study, Monte Carlo simulations and optical phantom experiments were conducted to investigate how angulation of the emitting fiber affects the probed volume to allow for the detection of acute breaches. Difference in intensity magnitude between cancellous and cortical spectra increased with the fiber angle, suggesting that outward angulated fibers are beneficial in acute breach scenarios. Proximity to the cortical bone could be detected best with fibers angulated at θf = 45° for impending breaches between θp = 0° and θp = 45°. An orthopedic surgical device comprising a third fiber perpendicular to the device axis could thus cover the full impending breach range from θp = 0° to θp = 90°.

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Introduction: Steering light is relevant to many medical applications that require tissue illumination, sensing, or modification. To control the propagation direction of light beams, a great variety of innovative fiber-optic medical devices have been designed. Areas covered: This review provides a comprehensive overview of the patent literature on light beam control in fiber-optic medical devices. The Web of Science Derwent Innovation Index database was scanned, and 81 patents on fiber-optic devices published in the last 20 years (2001–2021) were retrieved and categorized based on the working principle to steer light (refraction/reflection, scattering, diffraction) and the design strategy that was employed (within fiber, at fiber end, outside fiber). Expert opinion: Patents describing medical devices were found for all categories, except for generating diffraction at the fiber end surface. The insight in the different designs reveals that there are still several opportunities to design innovative devices that can collect light at an angle off-axis, reduce the angular distribution of light, or split light into multiple beams.

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Background: The increased popularity of minimally invasive spinal surgery calls for a revision of guidance techniques to prevent injuries of nearby neural and vascular structures. Lipid content has previously been proposed as a distinguishing criterion for different bone tissues to provide guidance along the interface of cancellous and cortical bone. This study aims to investigate how fat is distributed throughout the spinal column to confirm or refute the suitability of lipid content for guidance purposes. Results: Proton density fat fraction (PDFF) was assessed over all vertebral levels for six human cadavers between 53 and 92 years of age, based on fat and water MR images. According to their distance to the vertebra contour, the data points were grouped in five regions of interest (ROIs): cortical bone (−1 mm to 0 mm), pre-cortical zone (PCZ) 1–3 (0–1 mm; 1–2 mm; 2–3 mm), and cancellous bone (≥ 3 mm). For PCZ1 vs. PCZ2, a significant difference in mean PDFF of between −7.59 pp and −4.39 pp on average was found. For cortical bone vs. PCZ1, a significant difference in mean PDFF of between −27.09 pp and −18.96 pp on average was found. Conclusion: A relationship between distance from the cortical bone boundary and lipid content could be established, paving the way for guidance techniques based on fat fraction detection for spinal surgery.

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