Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Novarad Corporation, Provo, Utah, USA.
World Neurosurg. 2024 Feb;182:e284-e291. doi: 10.1016/j.wneu.2023.11.100. Epub 2023 Nov 24.
Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels.
A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared.
The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P = 0.017) and attending neurosurgeon (P = 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P = 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P = 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P = 0.69).
AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.
增强现实（AR）是一种新兴技术，可能会加速技能的掌握并提高胸腰椎椎弓根螺钉放置的准确性。我们旨在量化 AR 相对于徒手（FH）椎弓根螺钉准确性的相对辅助作用，跨越不同的手术经验水平。
一位脊柱研究员培训并获得董事会认证的神经外科医生、四年级神经外科住院医师和二年级医学生在 3 具尸体上分别放置了 32 个 FH 和 32 个 AR 辅助胸腰椎椎弓根螺钉。使用无绳、语音激活的 AR 系统与耳机配对。使用 χ 分析和 Gertzbein-Robbins 量表评估准确性。收集并比较角度误差、距离误差和每个椎弓根螺钉的时间。
主治神经外科医生在 FH 和 AR 组中均有 91.6%（11/12）临床可接受（Gertzbein-Robbins 量表 A 或 B）的插入；住院医师神经外科医生在两种情况下均有 100%（9/9）的 FH 和 AR；医学生的 FH 准确率为 72.3%（8/11），AR 准确率为 81.8%（9/11）。医学生的 FH 理想（Gertzbein-Robbins 量表 A）准确性明显低于住院医师神经外科医生（P=0.017）和主治神经外科医生（P=0.005），但使用 AR 时没有差异。主治神经外科医生（中位数 46 秒对 94.5 秒，P=0.0047）和神经外科住院医师（中位数 144 秒对 140 秒，P=0.05）的 FH 螺钉放置速度都更快。AR 和 FH 的总临床可接受准确率分别为 90.6%（29/32）和 87.5%（28/32）（P=0.69）。
AR 螺钉放置使经验不足的医学生在 1 次培训课程中准确性提高了一倍。随着后续迭代，这项有前途的技术可能成为手术培训的重要工具。
