Augmented reality (AR) is an emerging technology that has great potential for guiding the safe and accurate placement of spinal hardware, including percutaneous pedicle screws. The goal of this study was to assess the accuracy of 63 percutaneous pedicle screws placed at a single institution using an AR head-mounted display (ARHMD) system.

Retrospective analyses were performed for 9 patients who underwent thoracic and/or lumbar percutaneous pedicle screw placement guided by ARHMD technology. Clinical accuracy was assessed via the Gertzbein-Robbins scale by the authors and by an independent musculoskeletal radiologist. Thoracic pedicle subanalysis was also performed to assess screw accuracy based on pedicle morphology.

Nine patients received thoracic or lumbar AR-guided percutaneous pedicle screws. The mean age at the time of surgery was 71.9 ± 11.5 years and the mean number of screws per patient was 7. Indications for surgery were spinal tumors (n = 4, 44.4%), degenerative disease (n = 3, 33.3%), spinal deformity (n = 1, 11.1%), and a combination of deformity and infection (n = 1, 11.1%). Presenting symptoms were most commonly low-back pain (n = 7, 77.8%) and lower-extremity weakness (n = 5, 55.6%), followed by radicular lower-extremity pain, loss of lower-extremity sensation, or incontinence/urinary retention (n = 3 each, 33.3%). In all, 63 screws were placed (32 thoracic, 31 lumbar). The accuracy for these screws was 100% overall; all screws were Gertzbein-Robbins grade A or B (96.8% grade A, 3.2% grade B). This accuracy was achieved in the thoracic spine regardless of pedicle cancellous bone morphology.

AR-guided surgery demonstrated a 100% accuracy rate for the insertion of 63 percutaneous pedicle screws in 9 patients (100% rate of Gertzbein-Robbins grade A or B screw placement). Using an ARHMS system for the placement of percutaneous pedicle screws showed promise, but further validation using a larger cohort of patients across multiple surgeons and institutions will help to determine the true accuracy enabled by this technology.

增强现实 (AR) 是一项新兴技术，在指导脊柱硬件（包括经皮椎弓根螺钉）的安全和准确放置方面具有巨大潜力。本研究的目的是使用 AR 头戴式显示器 (ARHMD) 系统评估在单个机构放置的 63 颗经皮椎弓根螺钉的准确性。

对 9 例在 ARHMD 技术引导下接受胸椎和/或腰椎经皮椎弓根螺钉置入术的患者进行了回顾性分析。作者和独立的肌肉骨骼放射科医生通过 Gertzbein-Robbins 量表评估了临床准确性。还进行了胸椎椎弓根亚组分析，以根据椎弓根形态评估螺钉的准确性。

9 名患者接受了胸椎或腰椎 AR 引导的经皮椎弓根螺钉。手术时的平均年龄为 71.9 ± 11.5 岁，每位患者的平均螺钉数为 7。手术指征为脊柱肿瘤（n = 4, 44.4%）、退行性疾病（n = 3, 33.3%）、脊柱畸形（n = 1, 11.1%），以及畸形和感染的组合（n = 1, 11.1%）。最常见的症状是腰痛 (n = 7, 77.8%) 和下肢无力 (n = 5, 55.6%)，其次是根性下肢疼痛、下肢感觉丧失或失禁/小便保留（每个 n = 3，33.3%）。总共放置了 63 颗螺钉（胸椎 32 颗，腰椎 31 颗）。这些螺钉的总体准确度为 100%；所有螺钉均为 Gertzbein-Robbins A 级或 B 级螺钉（96.8% A 级，3.2% B 级）。

AR 引导手术在 9 名患者中插入 63 颗经皮椎弓根螺钉的准确率是 100%（Gertzbein-Robbins A 级或 B 级螺钉置入率为 100%）。使用 ARHMS 系统放置经皮椎弓根螺钉显示出前景，但使用跨多个外科医生和机构的更大患者队列进行进一步验证将有助于确定该技术实现的真正准确性。