Intraoperative use of AR technology in surgical operating rooms during spinal fusion procedures
Key Highlights
AR-assisted pedicle screw placement improves accuracy by real-time tracking of screw position and angle with preserved haptic feedback
This study evaluated 59 consecutive patients undergoing AR-assisted spinal fusion with prospective follow-up using ODI and SF-36 patient-reported outcomes
Long-term outcomes including surgical revision rates, physical and mental functioning, and postoperative complications were assessed to determine clinical impact of AR assistance
Guideline-Based Recommendations
Diagnosis
Use preoperative imaging and clinical assessment to identify candidates for thoracolumbar spinal fusion with pedicle screw instrumentation
Exclude cervical spine and revision cases when evaluating AR-assisted pedicle screw placement outcomes due to anatomical complexity and confounding factors
Management
Employ AR head-mounted displays (e.g., Augmedics XVision) intraoperatively to overlay CT images on surgical field for enhanced pedicle screw placement accuracy
Maintain standard surgical protocols for thoracolumbar fusion including monitoring for complications such as durotomy, infection, and instrumentation issues
Monitoring & Follow-up
Collect perioperative data including blood loss, surgery length, and intraoperative complications
Monitor postoperative outcomes including junctional kyphosis, neurological deficits, pseudarthrosis, and need for revision surgery
Use validated patient-reported outcome measures (Oswestry Disability Index and SF-36) to assess physical and mental functioning pre- and postoperatively
Risks
Potential recall bias in retrospective patient-reported preoperative functional assessments
Possible complications include wound infection, hematoma, CSF leak, pulmonary embolism, deep vein thrombosis, and instrumentation misplacement
Exclusion of cervical and revision cases due to increased anatomical complexity and confounding variables
AR assistance is feasible and safe during early adoption, with potential to improve surgical accuracy and patient-reported physical and mental outcomes compared to traditional navigation methods
Clinical Best Practices
Standardize surgical technique, equipment, and workflow during AR-assisted pedicle screw placement to ensure consistency
Utilize intraoperative AR visualization to reduce line-of-sight interruptions and attention shifts associated with external monitors
Incorporate prospective patient-reported outcome measures to evaluate long-term functional benefits of AR-assisted spinal fusion
Exclude complex cases such as cervical spine fusions and revisions when assessing AR technology efficacy to reduce confounding factors
