Augmented reality-assisted pedicle screw insertion: a cadaveric proof-of-concept study

Area of Science:

• Spinal surgery
• Medical technology
• Augmented reality applications

Background:

• Conventional pedicle screw insertion methods can be limited by technical feasibility, accuracy, and safety.
• Augmented reality (AR) offers potential improvements by overlaying visual data directly onto the surgical field, reducing the need to shift attention.
• AR technology aims to enhance precision and efficiency in surgical procedures.

Purpose of the Study:

• To evaluate the comparative accuracy of augmented reality-assisted pedicle screw insertion.
• To compare AR-assisted insertion accuracy against established freehand, manual computer-navigated, and robotics-assisted techniques.

Main Methods:

• A study involving 120 pedicle screws inserted bilaterally from T6 to L5 in five cadaveric torsos.
• Postprocedural CT scans were analyzed for screw placement accuracy using the Gertzbein scale (GS) and Heary-Gertzbein scale (HGS).
• Non-inferiority analysis compared AR-assisted accuracy to literature data for other insertion methods; user experience was assessed via questionnaire.

Main Results:

• Overall AR-assisted pedicle screw accuracy was 96.7% (HGS) and 94.6% (GS).
• AR accuracy was non-inferior to manual computer-navigated insertion and superior to freehand insertion.
• AR demonstrated non-inferiority to robotics-assisted insertion (GS) and superiority (HGS), with excellent reported usability.

Conclusions:

• Augmented reality-assisted pedicle screw insertion is a technically feasible and accurate surgical method.
• AR technology shows significant promise for improving pedicle screw placement accuracy and potentially surgical outcomes.
• The system offers excellent usability, suggesting a positive surgeon experience.