Abstract
Background Augmented reality is a new technology that, when applied to spinal surgery, offers
the potential for efficient, safe, and accurate placement of pedicle screws. This
study investigated whether augmented reality combined with a guide board improved
the safety and accuracy of pedicle screw placement compared to traditional freehand
screw placement.
Methods Four trainers were divided into augmented reality navigation and freehand groups.
Each group consisted of a novice and an experienced spine surgeon. A total of 80 pedicle
screws were implanted. First, the AR group reconstructed the three-dimensional (3D)
model and planned the screw insertion route according to the computed tomography (CT)
data of L2 lumbar vertebrae. Next, the Microsoft HoloLens 2 was used to identify the
vertebral model, and the planned virtual path was superimposed on the real cone model.
Then, the screw was placed according to the projected trajectory. Finally, Micron
Tracker was used to measure the deviation of screws from the preoperatively planned
trajectory, and pedicle screws were evaluated using the Gertzbein–Robbins scale.
Results In the augmented reality group, the linear deviation of the experienced doctors and
novices was 1.59 ± 0.39 and 1.73 ± 0.52 mm, respectively, and the deviation angle
was 2.72 ± 0.61 and 2.87 ± 0.63 degrees, respectively. In the freehand group, the
linear deviation of the experienced doctors and novices was 2.88 ± 0.58 and 5.25 ± 0.62 mm,
respectively, and the deviation angle was 4.41 ± 1.18 and 7.15 ± 1.45 degrees, respectively.
The screw placement accuracy rate was 97.5% in the augmented reality navigation group
and 77.5% in the freehand group.
Conclusions Augmented reality navigation improves the accuracy and safety of pedicle screw implantation
compared with the traditional freehand method and can assist inexperienced doctors
in successfully completing the surgery.
Keywords
augmented reality - pedicle screw placement - three dimensions - surgery navigation
- surgical guide
