Evaluating a Cutting-edge Augmented Reality-supported Navigation System for Spinal Instrumentation

Introduction: Dorsal instrumentation using pedicle screws is a standard treatment for multiple spinal pathologies such as trauma, infection, or degenerative indications. Intraoperative three-dimensional (3D) imaging and navigated pedicle screw placement is used at multiple centers. For the present study we evaluated a new navigation system enabling augmented reality (AR)-supported pedicle screw placement while integrating navigation cameras into the reference array and drill guide. The aim of the present study was to evaluate its clinical application regarding safety, efficacy, and accuracy.

Methods: A total of 20 patients were operated on between 06/2021 and 01/2022 using the new technique for intraoperative navigation. Intraoperative data with focus on accuracy and patient safety including patient outcome were analyzed. The accuracy of pedicle screw placement was evaluated by intraoperative CT imaging.

Results: A median of 8 (4-18) pedicle screws were placed in each case. Percutaneous instrumentation was performed in 14 patients (70%). The duration of pedicle screw placement (duration scan - scan) was 56 +/- 26 (30-107) minutes. Intraoperative screw revision was necessary in 2 of 180 pedicle screws (1.1%). Intraoperatively, no major complications occurred – one case of delay due to software issues and one case of difficult screw placement were reported.

Conclusion : The use of the present AR-supported system for navigated pedicle screw placement for dorsal instrumentation in clinical routine could be confirmed by the present study’s results. It provides a reliable and safe tool for 3D imaging-based pedicle screw placement, only requires a minimal intraoperative setup, and provides new opportunities by integrating AR.