Augmented reality (AR) has the potential to improve the accuracy and efficiency of instrumentation placement in spinal fusion surgery, increasing patient safety and outcomes, optimizing ergonomics in the surgical suite, and ultimately lowering procedural costs. The authors sought to describe the use of a commercial prototype Spine AR platform (SpineAR) that provides a commercial AR head-mounted display (ARHMD) user interface for navigation-guided spine surgery incorporating real-time navigation images from intraoperative imaging with a 3D-reconstructed model in the surgeon's field of view, and to assess screw placement accuracy via this method.

Pedicle screw placement accuracy was assessed and compared with literature-reported data of the freehand (FH) technique. Accuracy with SpineAR was also compared between participants of varying spine surgical experience. Eleven operators without prior experience with AR-assisted pedicle screw placement took part in the study: 5 attending neurosurgeons and 6 trainees (1 neurosurgical fellow, 1 senior orthopedic resident, 3 neurosurgical residents, and 1 medical student). Commercially available 3D-printed lumbar spine models were utilized as surrogates of human anatomy. Among the operators, a total of 192 screws were instrumented bilaterally from L2–5 using SpineAR in 24 lumbar spine models. All but one trainee also inserted 8 screws using the FH method. In addition to accuracy scoring using the Gertzbein-Robbins grading scale, axial trajectory was assessed, and user feedback on experience with SpineAR was collected.

Based on the Gertzbein-Robbins grading scale, the overall screw placement accuracy using SpineAR among all users was 98.4% (192 screws). Accuracy for attendings and trainees was 99.1% (112 screws) and 97.5% (80 screws), respectively. Accuracy rates were higher compared with literature-reported lumbar screw placement accuracy using FH for attendings (99.1% vs 94.32%; p = 0.0212) and all users (98.4% vs 94.32%; p = 0.0099). The percentage of total inserted screws with a minimum of 5° medial angulation was 100%. No differences were observed between attendings and trainees or between the two methods. User feedback on SpineAR was generally positive.

Screw placement was feasible and accurate using SpineAR, an ARHMD platform with real-time navigation guidance that provided a favorable surgeon-user experience.

增强现实 (AR) 有可能提高脊柱融合手术中器械放置的准确性和效率，提高患者的安全性和结果，优化手术室的人体工程学，并最终降低手术成本。作者试图描述商业原型脊柱 AR 平台 (SpineAR) 的使用，该平台为导航引导的脊柱手术提供商业 AR 头戴式显示器 (ARHMD) 用户界面，将术中成像的实时导航图像与 3D-在外科医生的视野中重建模型，并通过这种方法评估螺钉放置的准确性。

评估了椎弓根螺钉放置的准确性，并与徒手 (FH) 技术的文献报告数据进行了比较。还在不同脊柱手术经验的参与者之间比较了 SpineAR 的准确性。11 名没有 AR 辅助椎弓根螺钉置入经验的操作员参与了这项研究：5 名主治神经外科医生和 6 名实习生（1 名神经外科研究员、1 名高级骨科住院医师、3 名神经外科住院医师和 1 名医学生）。市售的 3D 打印腰椎模型被用作人体解剖学的替代品。在操作者中，在 24 个腰椎模型中使用 SpineAR 从 L2-5 双侧安装了总共 192 个螺钉。除一名受训者外，所有受训者还使用 FH 方法插入了 8 颗螺钉。除了使用 Gertzbein-Robbins 评分量表进行准确度评分之外，

根据 Gertzbein-Robbins 分级量表，所有用户使用 SpineAR 的总体螺钉放置精度为 98.4%（192 个螺钉）。参加者和受训者的准确率分别为 99.1%（112 颗螺钉）和 97.5%（80 颗螺钉）。与文献报道的使用 FH 的腰椎螺钉放置精度相比，对于主治医生（99.1% 对 94.32%；p = 0.0212）和所有用户（98.4% 对 94.32%；p = 0.0099），准确率更高。具有最小内侧角度 5° 的总插入螺钉的百分比为 100%。在参加者和受训者之间或两种方法之间没有观察到差异。用户对 SpineAR 的反馈总体上是积极的。

使用 SpineAR 是一种具有实时导航指导的 ARHMD 平台，可提供良好的外科医生用户体验，螺钉放置是可行且准确的。