In-Human Report of S2 Alar-Iliac Screw Placement Using Augmented Reality Assistance. Issue 1 (4th January 2023)

• Record Type: Journal Article
• Authors: Judy, Brendan F.; Liu, Ann; Jin, Yike; Ronkon, Charles; Khan, Majid; Cottrill, Ethan; Ehresman, Jeff; Pennington, Zach; Bydon, Ali; Lo, Sheng-Fu L.; Sciubba, Daniel M.; Molina, Camilo A.; Witham, Timothy F.
• Is Part Of: Operative neurosurgery. Volume 24:Issue 1(2023)
• Page Start: 68
• Page End: 73
• Publication Date: 2023-01-04
• Subjects: Augmented reality -- Sacral alar-iliac screws -- Surgical technique; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1227/ons.0000000000000439
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract : BACKGROUND: S2 alar-iliac (S2AI) screws provide spinopelvic fixation with the advantages of minimized dissection, easier rod contouring, and decreased symptomatic screw-head prominence. However, placement of S2AI screws may be challenging because of the anatomy of the lumbosacral junction. Augmented reality is a nascent technology that may enhance placement of S2AI screws. OBJECTIVE: To report the first in-human placement of augmented reality (AR)–assisted S2 alar-iliac screws and evaluate the accuracy of screw placement. METHODS: A retrospective review was performed of patients who underwent AR-assisted S2AI screw placement. All surgeries were performed by 2 neurosurgeons using an AR head-mounted display (Xvision, Augmedics). Screw accuracy was analyzed in a blinded fashion by an independent neuroradiologist using the cortical breach grading scale. RESULTS: Twelve patients underwent AR-assisted S2AI screw placement for a total of 23 screws. Indications for surgery included deformity, degenerative disease, and tumor. Twenty-two screws (95.6%) were accurate—defined as grade 0 or grade 1. Twenty-one screws (91.3%) were classified as grade 0, 1 screw (4.3%) was grade 1, and 1 screw (4.3%) was grade 3. All breaches were asymptomatic. CONCLUSION: AR-assisted S2AI screw placement had an overall accuracy rate of 95.6% (grade 0 and grade 1 screws) in a cohort of 12 patients and 23 screws. This compares favorably with freehand and robotic placement. 1, 2 AR enables spine surgeons to both better visualize anatomy and accurately place spinal instrumentation. Future studies are warranted to research the learning curve and cost analysis of AR-assisted spine surgery.