Neurosurgeon Disc Comfort, Inc. Newport Beach, California, United States
Introduction: The purpose of the study was to evaluate pedicle screw placement accuracy on a spine deformity model using a Spine Augmented Reality platform (SpineAR) that utilizes a commercial AR head-mounted display (ARHMD) showing preoperative or intraoperative imaging displayed in 3D in the operative field for navigation-guided spine surgery.
Methods: Pedicle screw placement accuracy was assessed using the Gertzbein-Robbins grading scale and compared with literature-reported data from similar studies. Five neurosurgery residents of varying spine surgical experience (PGY-2 through PGY-7) placed a total of 80 pedicle screws bilaterally from L2 to L5 on commercially available 3-plane thoracolumbar scoliosis deformity models using both SpineAR (Surgical Theater, Los Angeles, CA) and the freehand technique. Each participant was surveyed regarding their prior experience with pedicle screw placement as well as their experience with SpineAR.
Results: Prior to this study, all participants had received formal training on pedicle screw placement and at least three participants had placed pedicle screws on a deformity correction case using each of the following techniques: freehand (3/5; 60%), fluoroscopy guidance (3/5; 60%), manual navigation guidance (5/5; 100%); and robotics-assisted navigation guidance (4/5; 80%). Using SpineAR, 90% of screws were placed within the pedicle with a Gertzbein-Robbins Grade 0 score. This accuracy was statistically significantly greater than the freehand accuracy (67.5% vs 90%; p=0.027).
Conclusion : The ARHMD-based spine surgery platform was easy to use and effective in guiding precise pedicle instrumentation in a deformity model. The increased accuracy and precision by trainees demonstrates the utility both in surgeon education and intraoperative value.
How to Improve Patient Care: The facilitation of more precise pedicle instrumentation by the ARHMD-based navigation guidance platform has the potential to improve surgical safety, performance, ergonomics, and ultimately patient outcomes. Additionally, given the diversity of trainee experience levels and the difference shown between freehand and AR guidance demonstrate value in surgeon education.
