Great Expectations with Augmented Reality in Spine Surgery: Hope or Hype?A commentary on the article ‘Operator independent reliability of direct augmented reality navigated pedicle screw placement and rod bending’ by Farshad et al.

摘要

In NASSJ, Farshad et al. have reported the results of their cadaveric study wherein they investigated the accuracy and the operator-independent reliability of ‘direct’ augmented reality navigated pedicle screw placement and rod bending [[1]Farshad M Spirig JM Suter D Hoch A Burkhard MD Liebmann F et al.Operator independent reliability of direct augmented reality navigated pedicle screw placement and rod bending.North American Spine Society Journal (NASSJ). 2021; 8100084Abstract Full Text Full Text PDF Scopus (2) Google Scholar] Over the past few decades, pedicle screws have become the undisputed choice for spinal instrumentation. The consequences of inaccurate pedicle screw placement can be disastrous – ranging from decreased pull-out strength owing to compromised purchase in the bone to iatrogenic injury to critical neurovascular structures. Conventional, free-hand technique of pedicle screw insertion relies on anatomical landmarks and experience of the surgeon – the element of skill that this involves had led to variable rates of pedicle screw accuracy across medical literature, with rates of pedicle screw perforation ranging from 10%-40% [[2]Jing L Wang Z Sun Z Zhang H Wang J Wang G. Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique.Chinese Neurosurgical Journal. 2019; 5: 137-143Crossref Scopus (4) Google Scholar,[3]Sun J Wu D Wang Q Wei Y Yuan F. Pedicle Screw Insertion: Is O-Arm–Based Navigation Superior to the Conventional Freehand Technique? A Systematic Review and Meta-Analysis.World Neurosurgery. 2020; 144: e87-e99https://doi.org/10.1016/j.wneu.2020.07.205Crossref PubMed Scopus (13) Google Scholar].In a bid to make pedicle screw placement more reproducible and less error-prone while seeking an improvement in safety profile of spinal instrumentation and quality metrics related to spine care, contemporary spine surgery has seen the advent of several technological advancements such as image-guided navigation, deployment of surgical robots and use of patient-specific templates [3Sun J Wu D Wang Q Wei Y Yuan F. Pedicle Screw Insertion: Is O-Arm–Based Navigation Superior to the Conventional Freehand Technique? A Systematic Review and Meta-Analysis.World Neurosurgery. 2020; 144: e87-e99https://doi.org/10.1016/j.wneu.2020.07.205Crossref PubMed Scopus (13) Google Scholar, 4Garg B Mehta N. Current status of 3D printing in spine surgery.Journal of Clinical Orthopaedics and Trauma. 2018; 9: 218-225Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar, 5Garg B Mehta N Malhotra R. Robotic spine surgery: ushering in a new era.Journal of Clinical Orthopaedics and Trauma. 2020; 11: 753-760Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. Quite appropriately, there has recently been a surge of Level-1 studies directed towards finding out whether these innovations and emerging technologies have increased the accuracy of pedicle screw placement in comparison to the freehand technique. While the reported accuracy rates have shown an improvement, demonstrable benefits in context to other important outcome measures such as cost-effectiveness, radiation exposure, operative duration and patient-reported functional outcomes have not been conclusively established [6Han X Tian W Liu Y Liu B He D Sun Y et al.Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial.Journal of Neurosurgery: Spine. 2019; 30: 615-622Crossref Scopus (90) Google Scholar, 7Hyun S-J Kim K-J Jahng T-A Kim H-J. Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions: a randomized controlled trial.Spine. 2017; 42: 353-358Crossref PubMed Scopus (148) Google Scholar, 8Ringel F Stüer C Reinke A Preuss A Behr M Auer F et al.Accuracy of robot-assisted placement of lumbar and sacral pedicle screws: a prospective randomize