Augmented Reality, Robotics, and User-operated Navigation for Pedicle Screw Placement Provide Comparable Postoperative Outcomes

Introduction: Robotic techniques (RT) and augmented reality head-mounted-display (AR-HMD) are emerging technologies implemented to avoid screw malposition during pedicle screw placement. The impact of these technologies on surgical outcomes has not been fully described, and this study was performed to compare the perioperative outcomes and utility of spine instrumentation using AR-HMD, RT, or freehand techniques at a single institution.

Methods: Retrospective analyses were performed for 212 patients who underwent pedicle screw placement utilizing manual navigation (N=117), AR-HMD (N=43), or RT (N=52) techniques. Differences in operative time (ORT), blood loss (BL), length of stay (LOS), and change in post-operative 3-month Oswestry Disability Index(ODI) and Neck Disability Index (NDI) scores were determined. Statistical analysis was completed in SPSS and groups were compared using a one-way ANOVA.

Results: There was no significant difference in Charlson comorbidity scores between groups. Patients that underwent AR-HMD had an average ORT of 434.05 minutes (CI 383.19–484.90), BL of 702.24ml (CI 299.16–1111.32), LOS of 14.95 days (CI 9.24–20.66), and 3-month decrease in ODI/NDI of 7.42 (N=24, CI 2.15–12.68). Patients that underwent RT had an average ORT of 404.50 minutes (CI 348.07–460.93), BL of 606.22ml(CI 417.22–795.22), LOS of 6.33 days(CI 4.43–8.22), and 3-month decrease in ODI/NDI of 10.91 (N=32, CI 7.38–14.43). Patients that underwent freehand surgery had an average ORT of 366.38 minutes (CI 328.32–404.43), BL of 482.50ml(CI 369.72–595.28), LOS of 9.41 days(CI 7.79–11.02), and 3-month decrease in ODI/NDI of 9.77 (N=48, CI 6.53–13.01). A statistical difference was only found for LOS between ARMSS and RT (p < 0.001) and ARMSS and freehand (p=0.015).

Conclusion : This study suggests a similarity in perioperative outcomes between AR-HMD, RT, and freehand spine surgery. Controlled study designs, a larger patient cohort, and additional outcome measures are needed to fully determine the efficacy of each surgical approach.