By Tarek Yamout, MD, Virginia Spine Institute and Ehsan Jazini, MD, Virginia Spine Institute
Augmented Reality (AR) is a novel form of navigation technology that spine surgeons are increasingly using during spinal fusion procedures. For context, many instrumentation approaches are used in spine surgery, including: freehand technique, fluoroscopic guidance, computer-assisted navigation (CAN), and robotic-assisted navigation (RAN). AR works by projecting computer-generated images of patient anatomy and surgical tracking information onto the surgeon’s retina, essentially combining a virtual object with the “real world”. In the United States, the first head-mounted AR (HMD-AR) device was FDA approved in 2019.
WHAT ARE THE ADVANTAGES OF USING AN AUGMENTED REALITY-ASSISTED DEVICE FOR SPINAL FUSION?
Safety and Accuracy
The goal of any spine surgery, and accompanying advances in technology, is to ensure patient safety and optimal treatment outcomes. Although AR is a relatively new technology in the realm of spine surgery, there have been several reported advantages with its use. One advantage is accuracy. Pedicle screws placed with the assistance of HMD-AR devices have been demonstrated to be clinically accurate. Accuracy is graded by whether a screw deviates from its planned trajectory. The majority of screws that have been clinically assessed using AR have achieved the highest accuracy rating (grade A). Additionally, AR has been shown to be a safe procedure. Studies have demonstrated that the rates of intraoperative and postoperative complications are very low. This means the risk of needing a revision surgery to address any complication is also reduced.
Radiation exposure is a major concern for both patients and surgeons during spine surgery. An advantage with AR is the limited need for live x-ray during surgery, which differs from other more traditional surgical techniques. It is important to note that a patient will still be subject to the radiation of a 3D scan, which is unavoidable in utilizing this technology, however the degree to which one would be exposed is significantly reduced with AR.
There have been incredible advances in spine navigation technology over the past three decades, and AR presents itself as a viable modality for pedicle screw guidance. It is important for spine patients to have a general awareness of the current technology to have an informed discussion on the advantages and disadvantages with their surgeon.
To read more articles like this one on evidence supports augmented reality-assisted spinal fusion, you can go to our Spine Health Journal page.
- Bhatt, F. R., Orosz, L. D., Tewari, A., Boyd, D., Roy, R., Good, C. R., Schuler, T. C., Haines, C. M., & Jazini, E. (2022). Augmented Reality-Assisted Spine Surgery: An Early Experience Demonstrating Safety and Accuracy with 218 Screws. Global Spine Journal, 0(0), 1–6. https://doi. org/10.1177/21925682211069321
- Yuk, F. J., Maragkos, G. A., Sato, K., & Steinberger, J. (2021). Current innovation in virtual and augmented reality in spine surgery. Annals of Translational Medicine, 9(1), 94–94. https://doi.org/10.21037/atm-20-1132
- Molina CA, Phillips FM, Colman MW, et al. A cadaveric precision and accuracy analysis of augmented reality-mediated percutaneous pedicle implant insertion [published online ahead of print, 2020 Oct 30]. J Neurosurg Spine. 2020;1-9. doi:10.3171/2020.6.SPINE20370
- Molina CA, Sciubba DM, Greenberg JK, Khan M, Witham T. Clinical Accuracy, Technical Precision, and Workflow of the First in Human Use of an Augmented-Reality Head-Mounted Display Stereotactic Navigation System for Spine Surgery [published correction appears in Oper Neurosurg (Hagerstown). 2021 Mar 15;20(4):433]. Oper Neurosurg (Hagerstown). 2021;20(3):300-309. doi:10.1093/ons/opaa398