Tamburini Lisa M, Viola Anthony, Patel Rohan R, Korabelnikov Tomer, Nayak Raghunandan, King Justin S, Mallozzi Scott, Moss Isaac L, Singh Hardeep
Department of Orthopaedic Surgery, University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States.
N Am Spine Soc J. 2025 May 29;23:100618. doi: 10.1016/j.xnsj.2025.100618. eCollection 2025 Sep.
BACKGROUND: Augmented reality (AR) has gained popularity in spine surgery. Head mounted AR devices superimpose a 3D reconstructed model on patient anatomy which has been shown to assist with accurate placement of lumbar spine pedicle screws. We aimed to evaluate the accuracy and precision of AR in cervical spine pedicle screw placement. METHODS: Seven fresh-frozen cadaveric C2-T1 specimens were used. Computed tomography (CT) scans were obtained and uploaded to the AR navigation system. Fiducial markers were utilized to ensure accurate registration. Bilateral C2-C7 pedicle screws were placed. Images containing planned trajectory with tap and navigated screw placement were captured. A post-navigation CT scan was obtained. Time from initial CT scan to navigation and total navigation time were recorded. Radiation dose information was obtained. Linear and angular differences between planned trajectory and navigated screw position as well as navigated screw position and actual screw position were measured on axial and sagittal images. Screw position was graded using the Gertzbein-Robbins classification. RESULTS: 82 pedicle screws were placed. The mean angular and linear deviation between the tap trajectory and navigated screw position were 2.63 ± 2.65° and 3.08 ± 2.32° and 1.11 ± 1.04 mm and 1.24 ± 0.84 mm in the axial and sagittal planes. The mean angular and linear deviation between navigated screw and actual screw were 3.68 ± 4.15° and 2.44 ± 2.17° and 1.51 ± 1.53 mm and 1.02 mm ± 0.88 in the axial and sagittal planes. 95% of screws were given a grade of A or B. Average time from CT scan to navigation was 139.4 seconds and average navigation time was 33 minutes and 46 seconds. Average radiation exposure time was 12.76 ± 1.57 seconds and the average dose-length product (DLP) was 551.15 ± 74.04 mGy-cm. CONCLUSIONS: AR can assist in accurate placement of pedicle screws in the cervical spine. Deviation from navigated screw position to actual screw position was within clinically acceptable range throughout the cervical spine.
背景：增强现实（AR）在脊柱手术中越来越受欢迎。头戴式AR设备将三维重建模型叠加在患者解剖结构上，已证明其有助于腰椎椎弓根螺钉的精确置入。我们旨在评估AR在颈椎椎弓根螺钉置入中的准确性和精确性。 方法：使用7个新鲜冷冻的尸体C2-T1标本。获取计算机断层扫描（CT）图像并上传至AR导航系统。使用基准标记确保精确配准。置入双侧C2-C7椎弓根螺钉。采集包含带有定位针的计划轨迹和导航螺钉置入的图像。术后进行CT扫描。记录从初始CT扫描到导航的时间以及总导航时间。获取辐射剂量信息。在轴向和矢状位图像上测量计划轨迹与导航螺钉位置之间以及导航螺钉位置与实际螺钉位置之间的线性和角度差异。使用Gertzbein-Robbins分类法对螺钉位置进行分级。 结果：共置入82枚椎弓根螺钉。定位针轨迹与导航螺钉位置在轴向平面上的平均角度和线性偏差分别为2.63±2.65°和3.08±2.32°，在矢状平面上分别为1.11±1.04mm和1.24±0.84mm。导航螺钉与实际螺钉在轴向平面上的平均角度和线性偏差分别为3.68±4.15°和2.44±2.17°，在矢状平面上分别为1.51±1.53mm和1.02±0.88mm。95%的螺钉评级为A或B。从CT扫描到导航的平均时间为139.4秒，平均导航时间为33分46秒。平均辐射暴露时间为12.76±1.57秒，平均剂量长度乘积（DLP）为551.15±74.04mGy-cm。 结论：AR可协助颈椎椎弓根螺钉的精确置入。在整个颈椎范围内，从导航螺钉位置到实际螺钉位置的偏差在临床可接受范围内。
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