1067 Accuracy of an Augmented Reality Spine Surgery Guidance System With Stereoscopic Targeting Head Mounted Display Compared to Standard Computer Navigation, Robotic Systems, and Existing AR Systems

Abstract

INTRODUCTION: Augmented Reality (AR) offers the benefit of improved hand-eye coordination by accurately superimposing 3D stereoscopic displays for surgical instruments onto anatomic landmarks. METHODS: 120 pedicle screws were implanted using an AR system (OnPoint AR, OnPoint Surgical, Bedford, MA) (thoracic 50, lumbosacral 70; pre-op CT 40, O-arm 80). Heary grading was applied by an independent radiologist assessing the degree of pedicle breaches. 3D measurements of positional error (PE) and angular error (AE) were performed by comparing post-operative CT scans of implanted screws with planned trajectories. Statistical analyses compared PE and AE for OnPoint AR with the available values for other systems using an unequal variance t-test method. RESULTS: 113 screws placed demonstrated Heary grade 1 accuracy. 6 screws had a larger diameter than the pedicle and were planned with in-out-in technique with Heary grade 2 accuracy. One screw demonstrated a lateral breach (grade 2) caused by a loose connection to the screwdriver. PE and AE (mean ± 1SD) for OnPoint AR were the following: for intra-operative spin 1.1mm±0.5mm and 1.3°±0.5°; for pre-operative CT 1.9mm±1.2mm and 2.2°±1.3°. Percent increment in PE and AE for Medtronic Stealth Station, Brainlab navigation, Stryker nav3i, Medtronic Mazor X robot, Globus Excelsius robot, Augmedics Xvision, and Novarad VisAR compared to OnPoint AR ranged between 40–80%, with differences being highly significant for all comparisons. CONCLUSIONS: PE and AE for placing pedicle screws are statistically significantly smaller for the novel AR system compared to existing navigation, robotic, and AR systems. A positional error of 1.1mm and angular error of 1.3° makes this technology particularly suited for small pedicles, challenging anatomy, and MIS techniques.