Cadaveric Studies Utilizing Augmented Reality in Pedicle Screw Placement: A Systematic Review  (Preprint)

Abstract

BACKGROUND Spinal procedures often employ real-time imaging techniques to ensure accurate implant placement. Augmented Reality (AR) is a burgeoning technology with a wide range of applications. In surgery, AR is a novel system that allows for superimposed visual information directly onto the body. The efficacy of AR in pedicle screw placement has been examined in cadaveric studies. OBJECTIVE Our objective is to review current literature that assesses the accuracy, utility, and limitations of AR in cadaveric spinal procedures. METHODS This systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search terms consisted of “augmented reality pedicle screw cadaver”. Studies that utilized AR in pedicle screw placement using a human cadaveric study design were included. The technical accuracy of pedicle screw placement using AR as compared to the current standards was examined. RESULTS 11 results were returned from the initial search, 7 of these fitting inclusion criteria. An additional landmark article was added for review. Three of the articles were excluded as they failed to meet inclusion criteria. When compared to current image-guided techniques (n=3), AR’s accuracy yielded mixed results. When compared to freehand techniques (n=2) and preplanned trajectories (n=3), there was greater accuracy in the AR screw placements compared to freehand placements while AR screw placements were deemed clinically accurate when deviation from preoperative paths was assessed. CONCLUSIONS The technical accuracy of pedicle screw placement using AR is significantly more accurate compared to placement using freehand technique but not significantly different compared to the screws guided with current image-guided modalities. Potential benefits of AR include the reduced need for radiation. Technical limitations exist in registration concerns and imperfect headset ergonomics. More research should further assess clinical accuracy and to address limitations noted.