Long-term Outcomes Following Augmented-reality Assisted Pedicle Screw Placement

Introduction: Augmented reality (AR) has emerged as a novel form of navigation in spine surgery, superimposing preoperative imaging onto the surgical field through AR headsets. Despite achieving high accuracy for instrumentation placement, little is known about long-term outcomes of patients who underwent AR-guided spine surgery.

Methods: At our institution, the first 59 patients who underwent AR-assisted pedicle screw placement were reviewed. Demographic data, preoperative clinical characteristics, intraoperative and postoperative outcomes were collected. Additionally, scores for patient-reported outcome measures [Oswestry Disability Index (ODI) and 36-Item Short Form Survey (SF-36)], prior to and following surgery, were collected retrospectively for patients in our cohort. SF-36 responses were used to derive mental component and physical component scores (MCS and PCS, respectively). Univariate statistics were used to characterize findings, and paired Wilcoxon tests were used to compare patient-reported outcomes preoperatively and postoperatively.

Results: 59 patients were included in this study (34% male, median age of 61 years, and median follow-up time of 25 months). The most common presenting symptoms were back pain (N=57, 96.6%) and radiculopathy (N=41, 81.4%), whereas degeneration (N=22, 37.3%) and deformity (N=26, 44.1%) were the most common surgical indications. 9 patients (15.3%) underwent reoperation (3 due to adjacent segment disease, 4 due to pseudoarthrosis, and 2 due to other reasons) at a median time of 21 months. Preoperatively, the median ODI was 46%—which corresponds to severe disability—and median MCS and PCS were 40.20 and 27.01 (out of 100), respectively. Mental component and physical component scores (derived from SF-36) were significantly improved following surgery (P=0.03 and 0.01, respectively). Additionally, ODI scores, numerical ratings of back pain, and numerical ratings of leg pain were lower following surgery (P=0.001, P< 0.001, and P=0.001, respectively).

Conclusion : The excellent short-term outcomes following AR-guided spine surgery persist at long-term follow up. AR guidance is an effective and durable adjunct for spinal navigation.