Pedicle screw placement in the cervical vertebrae using augmented reality-head mounted displays: a cadaveric...

Area of Science:

• Spine Surgery
• Surgical Navigation
• Augmented Reality Applications

Background:

• Accurate cervical pedicle screw placement is critical for spinal stability and patient safety.
• Augmented reality (AR) has shown utility in thoracolumbar spine surgery, but its application in the cervical spine is less understood.
• Evaluating the feasibility of AR for cervical pedicle screw insertion is essential for advancing minimally invasive spinal techniques.

Purpose of the Study:

• To evaluate the precision and safety of augmented reality-assisted pedicle screw placement in the cervical spine.
• To compare AR navigation accuracy with established methods in cadaveric models.

Main Methods:

• An experimental study involving the instrumentation of 5 cadaveric cervical spines (C3-C7) by 5 surgeons.
• Pedicle screw placement was guided by an AR navigation system.
• Postprocedural CT scans were analyzed for clinical accuracy (Gertzbein-Robbins scale) and technical precision (tip and trajectory deviations).

Main Results:

• A total of 41 pedicle screws were placed with 100% achieving Gertzbein-Robbins grades A or B.
• Mean deviations between virtual and actual screw positions were less than 3 mm (tip) and 30° (trajectory) in axial and sagittal planes (p<.05).
• No screws violated the cortex by more than 2 mm, and no neurovascular structures were displaced.

Conclusions:

• AR-assisted cervical pedicle screw placement achieved clinical accuracy comparable to existing image-guided navigation techniques.
• The study demonstrates the technical precision and safety of AR for subaxial cervical pedicle screw insertion.
• Results support further clinical trials for AR-guided cervical spine surgery.