Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws

Abstract

Study Design Prospective cohort study. Objectives In spine surgery, accurate screw guidance is critical to achieving satisfactory fixation. Augmented reality (AR) is a novel technology to assist in screw placement and has shown promising results in early studies. This study aims to provide our early experience evaluating safety and efficacy with an Food and Drug Administration-approved head-mounted (head-mounted device augmented reality (HMD-AR)) device. Methods Consecutive adult patients undergoing AR-assisted thoracolumbar fusion between October 2020 and August 2021 with 2 -week follow-up were included. Preoperative, intraoperative, and postoperative data were collected to include demographics, complications, revision surgeries, and AR performance. Intraoperative 3D imaging was used to assess screw accuracy using the Gertzbein-Robbins (G-R) grading scale. Results Thirty-two patients (40.6% male) were included with a total of 222 screws executed using HMD-AR. Intraoperatively, 4 (1.8%) were deemed misplaced and revised using AR or freehand. The remaining 218 (98.2%) screws were placed accurately. There were no intraoperative adverse events or complications, and AR was not abandoned in any case. Of the 208 AR-placed screws with 3D imaging confirmation, 97.1% were considered clinically accurate (91.8% Grade A, 5.3% Grade B). There were no early postoperative surgical complications or revision surgeries during the 2 -week follow-up. Conclusions This early experience study reports an overall G-R accuracy of 97.1% across 218 AR-guided screws with no intra or early postoperative complications. This shows that HMD-AR-assisted spine surgery is a safe and accurate tool for pedicle, cortical, and pelvic fixation. Larger studies are needed to continue to support this compelling evolution in spine surgery.

The application of extended reality technology-assisted intraoperative navigation in orthopedic surgery

“…At the two-week follow-up, there were three complications among the 32 patients: one case of deep vein thrombosis (DVT) (3.1%) and two cases of pneumonia (6.3%). None of the patients required revision surgery during the two-week follow-up ( 31 ).…”

Machine Learning in Spine Surgery: A Narrative Review

“…ML algorithms for intraoperative imaging guidance and surgical navigation have already been implemented in spine surgery. 12,[31][32][33][34] In 2018, the 7D Surgical System became the first ML navigation system consisting of a small computer workstation with an attached, movable arm. The navigation is initiated by loading preoperatively acquired CT images into the program, which then uses ML to reconstruct the image data into a 3D topography of the spinal anatomy.…”

Minimalinvasive Wirbelsäulenchirurgie und aufkommende neue Techniken: Navigation, Robotik und Augmented Reality

“…Vor allem die Möglichkeit, die in der minimalinvasiven Wirbelsäulenchirurgie nicht chirurgisch offengelegte Anatomie in den Situs projizieren zu können, wird in vorangegangenen Studien im Vergleich zu vorhandenen Techniken als Vorteil beschrieben [59,60,68,69,70,71,72,73] (▶ Abb. 11c, d).…”