Related Experiment Video
Updated: Jul 10, 2026
Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model
Published on: May 24, 2024
Mixed-reality, heads-up navigation for percutaneous pedicle screw placement: a prospective accuracy and workflow
Ruili Zhuo1, Hongrui Liu2, Wei Liang2
1Department of Spine Surgery, Puyang Oilfield General Hospital, No. 124 Daqing Road, Puyang, Henan Province, 457000, China. 13653930023@126.com.
Background:
Mixed-reality (MR) head-mounted navigation projects a three-dimensional hologram of the patient's spine directly into the surgeon's field of view, potentially enhancing the precision and speed of percutaneous pedicle screw fixation. High-quality prospective data comparing MR with conventional fluoroscopy are scarce, prompting the present randomized study.
Results:
Sixty-one adults (274 screws) were allocated to MR (30 patients, 136 screws) or fluoroscopy (31 patients, 138 screws). MR navigation yielded a greater proportion of accurately placed screws (96.3% vs. 89.9%; absolute difference 6.4%; p = 0.04) and shortened mean operative time by 28 min (83 ± 11 min vs. 111 ± 14 min; p < 0.001). Entry-point, angular and depth deviations were all significantly smaller with MR, while intra-operative fluoroscopic images fell by 42%. Early complications occurred in 3.3% of MR cases and 16.1% of controls, and holographic pre-operative counselling improved patient understanding and satisfaction (p < 0.001).
Conclusions:
MR head-mounted navigation is feasible, safe and more precise than fluoroscopic guidance, delivering faster procedures, fewer fluoroscopic shots and a short learning curve. These advantages support MR as a cost-effective next-generation guidance modality for minimally invasive spine surgery.
