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Updated: Dec 21, 2025

Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model
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Augmented reality-based navigation increases precision of pedicle screw insertion.

Cyrill Dennler1, Laurenz Jaberg2, José Spirig2

  • 1Spine Division, University Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland. cyrill.dennler@gmail.com.

Journal of Orthopaedic Surgery and Research
|May 16, 2020
PubMed
Summary

Augmented reality (AR) navigation improved pedicle screw insertion precision, especially for novice surgeons, by decreasing errors and enhancing accuracy in a lab setting. This technology shows potential to reduce the impact of surgeon experience in spinal surgery.

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Area of Science:

  • Spinal Surgery
  • Medical Technology
  • Surgical Navigation

Background:

  • Precise pedicle screw insertion is crucial in spinal surgery to prevent neurovascular injury.
  • The traditional free-hand technique relies on anatomical landmarks.
  • Augmented reality (AR) devices offer potential for enhanced guidance in instrument placement.

Purpose of the Study:

  • To evaluate the feasibility and precision of AR technology for pedicle screw insertion.
  • To compare AR-guided technique with the standard free-hand (FH) method.
  • To assess the impact of AR on surgeon experience levels.

Main Methods:

  • Two expert and two novice surgeons performed pedicle screw pilot hole drilling on 80 lumbar sawbone models.
  • 160 pedicles were randomized between the free-hand (FH) and augmented reality (AR) techniques.
  • AR involved superimposing a 3D vertebral model onto the surgical field via a headset.

Main Results:

  • Novice surgeons showed improved precision with AR, with a higher minimal distance to the pedicle wall (MAPW) and fewer primary drill pedicle perforations (PDPP).
  • Novices demonstrated significantly fewer secondary screw pedicle perforations (SSPP) with AR across various screw sizes.
  • AR improved the optimal medio-lateral convergent angle (oMLCA) and cranio-caudal inclination angle (CCIA) precision for novice surgeons.

Conclusions:

  • AR navigation enhances pedicle screw drilling precision in a laboratory setting.
  • The AR system mitigates the influence of surgeon experience on insertion accuracy.
  • Further validation studies are needed to explore the clinical benefits of AR-based spinal surgery navigation.