{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:31:48Z","timestamp":1792636308559,"version":"4.5.0"},"reference-count":65,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The aim of this study is to present our experience in the surgical treatment of calcified thoracic herniated disc disease via a transthoracic approach in the lateral position with the use of intraoperative computed tomography (iCT) and augmented reality (AR). Materials and Methods: All patients who underwent surgery for calcified thoracic herniated disc via a transthoracic transpleural approach at our Department using iCT and microscope-based AR were included in the study. Results: Six consecutive patients (five female, median age 53.2 \u00b1 6.4 years) with calcified herniated thoracic discs (two patients Th 10\u201311 level, two patients Th 7\u20138, one patient Th 9\u201310, one patient Th 11\u201312) were included in this case series. Indication for surgery included evidence of a calcified thoracic disc on magnet resonance imaging (MRI) and CT with spinal canal stenosis of &gt;50% of diameter, intractable pain, and neurological deficits, as well as MRI-signs of myelopathy. Five patients had paraparesis and ataxia, and one patient had no deficit. All surgeries were performed in the lateral position via a transthoracic transpleural approach (Five from left side). CT for automatic registration was performed following the placement of the reference array, with a high registration accuracy. Microscope-based AR was used, with segmented structures of interest such as vertebral bodies, disc space, herniated disc, and dural sac. Mean operative time was 277.5 \u00b1 156 min. The use of AR improved orientation in the operative field for identification, and tailored the resection of the herniated disc and the identification of the course of dural sac. A control-iCT scan confirmed the complete resection in five patients and incomplete resection of the herniated disc in one patient. In one patient, complications occurred, such as postoperative hematoma, and wound healing deficit occurred. Mean follow-up was 22.9 \u00b1 16.5 months. Five patients improved following surgery, and one patient who had no deficits remained unchanged. Conclusions: Optimal surgical therapy in patients with calcified thoracic disc disease with compression of dural sac and myelopathy was resectioned via a transthoracic transpleural approach. The use of iCT-based registration and microscope-based AR significantly improved orientation in the operative field and facilitated safe resection of these lesions.<\/jats:p>","DOI":"10.3390\/medicina60060887","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T05:19:49Z","timestamp":1716873589000},"page":"887","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Surgical Treatment of Calcified Thoracic Herniated Disc Disease via the Transthoracic Approach with the Use of Intraoperative Computed Tomography (iCT) and Microscope-Based Augmented Reality (AR)"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6123-5589","authenticated-orcid":false,"given":"Mirza","family":"Pojski\u0107","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 35039 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1574-7572","authenticated-orcid":false,"given":"Miriam H. A.","family":"Bopp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 35039 Marburg, Germany"},{"name":"Marburg Center for Mind, Brain and Behavior (MCMBB), 35032 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8216-9410","authenticated-orcid":false,"given":"Christopher","family":"Nimsky","sequence":"additional","affiliation":[{"name":"Marburg Center for Mind, Brain and Behavior (MCMBB), 35032 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2855-3443","authenticated-orcid":false,"given":"Benjamin","family":"Sa\u00df","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Marburg, 35039 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.wneu.2022.06.097","article-title":"Minimally Invasive Dorsal Approach in the Surgery of Giant Thoracic Disk Herniation: Technical Note and Clinical Case Report","volume":"165","author":"Feigl","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3171\/spi.2005.3.3.0191","article-title":"Surgical management of giant herniated thoracic discs: Analysis of 20 cases","volume":"3","author":"Hott","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2387","DOI":"10.1007\/s00586-023-07784-4","article-title":"Clinical and radiographic features of adult calcified thoracic disc herniation: A retrospective analysis of 31 cases","volume":"32","author":"Yuan","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1093\/ons\/opy348","article-title":"Thoracic Discectomy Through a Unilateral Transpedicular or Costotransversectomy Approach With Intraoperative Ultrasound Guidance","volume":"17","author":"Wessell","year":"2019","journal-title":"Oper. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"520","DOI":"10.3171\/2010.12.SPINE10273","article-title":"Thoracic disc herniation and acute myelopathy: Clinical presentation, neuroimaging findings, surgical considerations, and outcome","volume":"14","author":"Cornips","year":"2011","journal-title":"J. Neurosurg. Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s00586-013-3054-4","article-title":"Circumspinal decompression and fusion through a posterior midline incision to treat central calcified thoracolumbar disc herniation: A minimal 2-year follow-up study with reconstruction CT","volume":"23","author":"Liu","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Pojski\u0107, M., Bopp, M., Sa\u00df, B., Kirschbaum, A., Nimsky, C., and Carl, B. (2021). Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine. Brain Sci., 11.","DOI":"10.3390\/brainsci11050646"},{"key":"ref_8","unstructured":"Christopher Nimsky, B.S. (2023). Surgical Treatment of Calcified Thoracic Herniated Disc Disease via Transthoracic Approach with Use of Intraoperative Computed Tomography (ICT) and Microscope-Based Augmented Reality (AR), National Library of Medicine. Available online: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S2772529423007889."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1007\/s00701-019-04005-0","article-title":"Augmented reality in intradural spinal tumor surgery","volume":"161","author":"Carl","year":"2019","journal-title":"Acta Neurochir."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"41S","DOI":"10.1177\/2192568219868217","article-title":"Spine Surgery Supported by Augmented Reality","volume":"10","author":"Carl","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/00007632-199204000-00013","article-title":"Multiple calcified thoracic disc herniations. A case report","volume":"17","author":"Severi","year":"1992","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S76","DOI":"10.1007\/s00586-014-3210-5","article-title":"Calcified giant thoracic disc herniations: Considerations and treatment strategies","volume":"23","author":"Quraishi","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"E781","DOI":"10.1097\/01.brs.0000238717.51102.79","article-title":"How many ligations of bilateral segmental arteries cause ischemic spinal cord dysfunction? An experimental study using a dog model","volume":"31","author":"Fujimaki","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e921","DOI":"10.1016\/j.wneu.2018.08.191","article-title":"Transfacet and Transpedicular Posterior Approaches to Thoracic Disc Herniations: Consecutive Case Series of 24 Patients","volume":"120","author":"Sivakumaran","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1177\/2192568220933275","article-title":"Posterior Minimally Invasive Transpedicular Approach for Giant Calcified Thoracic Disc Herniation","volume":"11","author":"Shedid","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"107062","DOI":"10.1016\/j.clineuro.2021.107062","article-title":"Posterior-only approach for the treatment of symptomatic central thoracic disc herniation regardless of calcification: A consecutive case series of 30 cases over five years","volume":"212","author":"Patel","year":"2022","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/978-3-031-36084-8_57","article-title":"Costotransversectomy in the Surgical Treatment of Mediolateral Thoracic Disk Herniations: Long-Term Results and Recent Minimally Invasive Technical Adjuncts","volume":"135","author":"Spallone","year":"2023","journal-title":"Acta Neurochir. Suppl."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s00586-002-0468-9","article-title":"Results of hemivertebrectomy and fusion for symptomatic thoracic disc herniation","volume":"12","author":"Debnath","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S212","DOI":"10.1007\/s00586-012-2263-6","article-title":"Anterior thoracic foraminotomy through mini-thoracotomy for the treatment of giant thoracic disc herniations","volume":"21","author":"Russo","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E1079","DOI":"10.1097\/BRS.0b013e3182574657","article-title":"Mini-open retropleural transthoracic approach for the treatment of giant thoracic disc herniation","volume":"37","author":"Moran","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1093\/ons\/opaa228","article-title":"Management of Thoracic Disc Herniation Using the Mini-Open Retropleural Approach: Technique Illustration and Clinical Outcomes of 33 Patients From a Single Academic Center","volume":"19","author":"Noureldine","year":"2020","journal-title":"Oper. Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1097\/00007632-200204150-00018","article-title":"Video-assisted thoracoscopic surgery for thoracic disc disease: Classification and outcome study of 100 consecutive cases with a 2-year minimum follow-up period","volume":"27","author":"Anand","year":"2002","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1097\/BRS.0000000000000332","article-title":"Crippling upper back pain after whiplash and other motor vehicle collisions caused by thoracic disc herniations: Report of 10 cases","volume":"39","author":"Cornips","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00586-011-2103-0","article-title":"Thoracoscopic treatment for single level symptomatic thoracic disc herniation: A prospective followed cohort study in a group of 167 consecutive cases","volume":"21","author":"Quint","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e984","DOI":"10.1016\/j.wneu.2021.11.128","article-title":"T3-T4 Disc Herniations: Clinical Presentation, Imaging, and Transaxillary Approach","volume":"158","author":"Cornips","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"V3","DOI":"10.3171\/2022.3.FOCVID221","article-title":"Antero-lateral transthoracic endoscopic approach for a calcified thoracic disc herniation","volume":"7","author":"Mesa","year":"2022","journal-title":"Neurosurg. Focus. Video"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.wneu.2012.05.031","article-title":"Minimally invasive thoracic microendoscopic diskectomy: Surgical technique and case series","volume":"80","author":"Smith","year":"2013","journal-title":"World Neurosurg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1227\/ons.0000000000000461","article-title":"Lateral Retropleural Thoracic Diskectomy for a Calcified Herniated Disk: 2-Dimensional Operative Video","volume":"24","author":"Gibbs","year":"2023","journal-title":"Oper. Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"494","DOI":"10.14444\/8071","article-title":"Five-Year Outcomes After Transforaminal Endoscopic Foraminotomy and Discectomy for Soft and Calcified Thoracic Disc Herniations","volume":"15","author":"Houra","year":"2021","journal-title":"Int. J. Spine Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E44","DOI":"10.1093\/ons\/opab048","article-title":"Posterior Transdural Approach for a Calcified Thoracic Intradural Disc Herniation Using a 3-Dimensional Exoscope: 2-Dimensional Operative Video","volume":"21","author":"Kim","year":"2021","journal-title":"Oper. Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1093\/ons\/opy225","article-title":"A Novel Surgical Technique for Management of Giant Central Calcified Thoracic Disk Herniations: A Dual Corridor Method Involving Tubular Transthoracic\/Retropleural Approach Followed by a Posterior Transdural Diskectomy","volume":"16","author":"Lowe","year":"2019","journal-title":"Oper. Neurosurg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"568","DOI":"10.3171\/2014.6.SPINE13682","article-title":"Thoracic discectomy by posterior pedicle-sparing, transfacet approach with real-time intraoperative ultrasonography: Clinical article","volume":"21","author":"Nishimura","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"221","DOI":"10.3171\/2009.9.SPINE09476","article-title":"Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion","volume":"12","author":"Bransford","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2685","DOI":"10.1007\/s00586-023-07807-0","article-title":"Full-endoscopic anterior excision of thoracic disc herniations, including giant and calcified discs with spinal cord compression: Surgical technique and outcomes","volume":"32","author":"Komp","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"V18","DOI":"10.3171\/2021.10.FOCVID2112","article-title":"Outpatient endoscopic resection of large calcified thoracic disc herniation with caudal displacement","volume":"6","author":"Konakondla","year":"2022","journal-title":"Neurosurg. Focus. Video"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1007\/s00586-017-5406-y","article-title":"Minimally invasive transpedicular approach for the treatment of central calcified thoracic disc disease: A technical note","volume":"27","author":"Nakhla","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1080\/02688697.2018.1557593","article-title":"Percutaneous endoscopic decompression for calcified thoracic disc herniation using a novel T rigid bendable burr","volume":"37","author":"Zhang","year":"2023","journal-title":"Br. J. Neurosurg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3171\/2017.5.SPINE161285","article-title":"Circumferential dural resection technique and reconstruction for the removal of giant calcified transdural herniated thoracic discs","volume":"28","author":"Walker","year":"2018","journal-title":"J. Neurosurg. Spine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1016\/j.spinee.2013.09.053","article-title":"Anterior or posterior approach of thoracic disc herniation? A comparative cohort of mini-transthoracic versus transpedicular discectomies","volume":"14","author":"Arts","year":"2014","journal-title":"Spine J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1302\/0301-620X.64B3.7096401","article-title":"Surgical treatment of thoracic disc herniation using the anterior approach","volume":"64","author":"Otani","year":"1982","journal-title":"J. Bone Joint. Surg. Br."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1007\/s00586-010-1294-0","article-title":"The transdural approach for thoracic disc herniations: A technical note","volume":"19","author":"Moon","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1080\/02688697.2020.1779660","article-title":"Trans-thoracic versus retropleural approach for symptomatic thoracic disc herniations: Comparative analysis of 94 consecutive cases","volume":"35","author":"Soda","year":"2021","journal-title":"Br. J. Neurosurg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1227\/00006123-199511000-00009","article-title":"Retropleural approach to the thoracic and thoracolumbar spine","volume":"37","author":"McCormick","year":"1995","journal-title":"Neurosurgery"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1055\/s-0031-1284400","article-title":"Minimally invasive retropleural approach for central thoracic disc herniation","volume":"54","author":"Kasliwal","year":"2011","journal-title":"Minim Invasive Neurosurg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s10143-013-0461-2","article-title":"Surgical treatment of thoracic disc disease via minimally invasive lateral transthoracic trans\/retropleural approach: Analysis of 33 patients","volume":"36","author":"Nacar","year":"2013","journal-title":"Neurosurg. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3171\/2017.12.SPINE171096","article-title":"Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach","volume":"29","author":"Ruetten","year":"2018","journal-title":"J. Neurosurg. Spine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1007\/s00586-014-3369-9","article-title":"Transthoracic lateral retropleural minimally invasive microdiscectomy for T9-T10 disc herniation","volume":"23","author":"Berjano","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s00701-022-05470-w","article-title":"A minimally invasive tubular retractor-assisted retropleural approach for thoracic disc herniations\u2013case series and technical note","volume":"165","author":"Hubertus","year":"2023","journal-title":"Acta Neurochir."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"V2","DOI":"10.3171\/2022.3.FOCVID2217","article-title":"Mini-open lateral retropleural thoracic discectomy approach","volume":"7","author":"Uribe","year":"2022","journal-title":"Neurosurg. Focus Video"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e220","DOI":"10.1227\/ons.0000000000000315","article-title":"Minimally Invasive Retropleural Thoracic Diskectomy: Step-by-Step Operative Planning, Execution, and Results","volume":"23","author":"Farber","year":"2022","journal-title":"Oper. Neurosurg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/2192568221989964","article-title":"Comparison of Anterior Approach and Posterior Circumspinal Decompression in the Treatment of Giant Thoracic Discs","volume":"13","author":"Yuan","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"800","DOI":"10.3171\/2021.8.SPINE21819","article-title":"Ultrasonic spine surgery for every thoracic disc herniation: A 43-patient case series and technical note demonstrating safety and efficacy using a partial transpedicular thoracic discectomy with ultrasonic aspiration and ultrasound guidance","volume":"36","author":"Saway","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_53","first-page":"19","article-title":"Giant calcified thoracic herniated disc: Considerations aiming a proper surgical strategy","volume":"53","author":"Barbanera","year":"2009","journal-title":"J. Neurosurg. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.1007\/s00586-016-4380-0","article-title":"Giant central thoracic disc herniations: Surgical outcome in 17 consecutive patients treated by mini-thoracotomy","volume":"25","author":"Roelz","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/s10143-018-01064-2","article-title":"Clinical outcomes of symptomatic thoracic disk herniations treated surgically through minimally invasive lateral transthoracic approach","volume":"42","author":"Oltulu","year":"2019","journal-title":"Neurosurg. Rev."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"E11","DOI":"10.3171\/2019.8.FOCUS19621","article-title":"Reliable navigation registration in cranial and spine surgery based on intraoperative computed tomography","volume":"47","author":"Carl","year":"2019","journal-title":"Neurosurg. Focus."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/ans.16943","article-title":"Intraoperative computed tomography-guided transthoracic approach to giant calcified thoracic disc protrusion: Technical note","volume":"92","author":"Vyas","year":"2022","journal-title":"ANZ J. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Alcachupas, A., Srikandarajah, N., Carleton-Bland, N., and Clark, S. (2021). Anterolateral thoracic approach for thoracic discectomy using pedicle marking and 3D intraoperative imaging system. Br. J. Neurosurg., 1\u20133.","DOI":"10.1080\/02688697.2021.2006142"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3340\/jkns.2014.55.6.383","article-title":"Ultrasound-guided posterolateral approach for midline calcified thoracic disc herniation","volume":"55","author":"Tan","year":"2014","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1007\/s00586-019-05969-4","article-title":"Implementation of augmented reality support in spine surgery","volume":"28","author":"Carl","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e767","DOI":"10.1016\/j.wneu.2019.06.020","article-title":"Mixed Reality-Based Preoperative Planning for Training of Percutaneous Transforaminal Endoscopic Discectomy: A Feasibility Study","volume":"129","author":"Yu","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Huang, X., Liu, X., Zhu, B., Hou, X., Hai, B., Li, S., Yu, D., Zheng, W., Li, R., and Pan, J. (2023). Evaluation of Augmented Reality Surgical Navigation in Percutaneous Endoscopic Lumbar Discectomy: Clinical Study. Bioengineering, 10.","DOI":"10.3390\/bioengineering10111297"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2755","DOI":"10.1007\/s00586-023-07622-7","article-title":"Minimally invasive endoscopy in spine surgery: Where are we now?","volume":"32","author":"Jitpakdee","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e541","DOI":"10.1016\/j.wneu.2019.04.192","article-title":"Microscope-Based Augmented Reality in Degenerative Spine Surgery: Initial Experience","volume":"128","author":"Carl","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"22S","DOI":"10.1177\/2192568220907896","article-title":"Evolving Navigation, Robotics, and Augmented Reality in Minimally Invasive Spine Surgery","volume":"10","author":"Hussain","year":"2020","journal-title":"Glob. 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