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Updated: May 17, 2025

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S2 Alar-Iliac Screw Insertion Safety With Augmented Reality-Assisted Surgical Navigation.

Maximillian Y Lee1, Hania Shahzad, Varun K Singh

  • 1From The Ohio State University College of Medicine, Columbus, OH (Mr. Lee); Department of Orthopaedic Surgery, UC Davis Health, Sacramento, CA (Dr. Shahzad and Dr. Khan); Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Dr. Singh); Department of Neurological Surgery, UC Davis Health, Sacramento, CA (Dr. Price); Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Dr. Phillips).

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|April 4, 2025
PubMed
Summary
This summary is machine-generated.

Augmented reality (AR) navigation is safe and accurate for S2 alar-iliac (S2AI) screw placement in spine surgery. This technology offers advantages over robotic navigation, with no complications observed in the S2AI corridor.

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Area of Science:

  • Spine Surgery
  • Surgical Navigation Technologies
  • Augmented Reality Applications

Background:

  • Augmented reality (AR) is underutilized in spine surgery despite a favorable safety profile and workflow benefits.
  • Previous studies highlight AR's advantages over robotic navigation for pedicle screw placement.
  • The S2 alar-iliac (S2AI) corridor presents unique anatomical challenges for screw placement, with limited published research on AR navigation.

Purpose of the Study:

  • To evaluate the safety and accuracy of AR navigation for S2AI screw placement.
  • To compare AR navigation with existing navigation techniques in a high-risk surgical area.

Main Methods:

  • Retrospective chart review of patients undergoing spine surgery with S2AI screw placement.
  • Analysis of data from November 2022 to September 2024 across two academic medical centers.
  • Radiographic and CT scan analysis to assess screw safety and accuracy.

Main Results:

  • Seventy screws were analyzed, all fully penetrating the sacroiliac joint.
  • One screw showed medial pelvic breach; no screws breached the greater sciatic notch.
  • No complications were reported in the S2AI corridor during the study period.

Conclusions:

  • AR navigation is noninferior to robotic navigation for S2AI screw placement.
  • AR offers potential advantages in radiation exposure, workflow efficiency, and training compared to robotic systems.
  • Future research should focus on patient-reported outcomes, cost-effectiveness, and the learning curve for AR in spine surgery.