Departments of1Neurosurgery and.
2Wayne State University School of Medicine, Detroit, Michigan.
Neurosurg Focus. 2021 Aug;51(2):E10. doi: 10.3171/2021.5.FOCUS21217.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
目的：增强现实（AR）是一种新兴技术，在引导脊柱硬件（包括经皮椎弓根螺钉）的安全、准确放置方面具有巨大潜力。本研究的目的是评估单家机构使用 AR 头戴式显示器（ARHMD）系统放置的 63 枚经皮椎弓根螺钉的准确性。
方法：对 9 例接受 ARHMD 技术引导的胸腰椎经皮椎弓根螺钉置入术的患者进行回顾性分析。作者和一位独立的肌肉骨骼放射科医生使用 Gertzbein-Robbins 量表评估临床准确性。还进行了胸椎亚分析，以根据椎弓根形态评估螺钉准确性。
结果：9 例患者接受了胸腰椎 AR 引导的经皮椎弓根螺钉置入术。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 枚。手术适应证为脊柱肿瘤（n=4，44.4%）、退行性疾病（n=3，33.3%）、脊柱畸形（n=1，11.1%）和畸形合并感染（n=1，11.1%）。主要症状为腰痛（n=7，77.8%）和下肢无力（n=5，55.6%），其次为下肢神经根痛、下肢感觉丧失或尿失禁/尿潴留（n=3，各 33.3%）。共置入 63 枚螺钉（32 枚胸椎，31 枚腰椎）。所有螺钉的准确性均为 100%；所有螺钉均为 Gertzbein-Robbins 分级 A 或 B（96.8%为 A 级，3.2%为 B 级）。在胸椎中，无论椎弓根松质骨形态如何，均能达到这一准确性。
结论：在 9 例患者中，AR 引导手术对 63 枚经皮椎弓根螺钉的置入显示出 100%的准确性（Gertzbein-Robbins 分级 A 或 B 螺钉放置率为 100%）。使用 ARHMS 系统进行经皮椎弓根螺钉放置具有很大的潜力，但需要更多的患者在多个外科医生和机构中进行验证，以确定该技术带来的真正准确性。
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