Pedicle Screw Placement With Augmented Reality Versus Robotic-Assisted Surgery

STUDY DESIGN: This was a single-center prospective clinical and radiographic analysis of pedicle screw instrumentation with robotic-assisted navigation (RAN) and augmented reality (AR). OBJECTIVE: This study aimed to compare the accuracy of lumbosacral pedicle screw placement with RAN versus AR. SUMMARY OF BACKGROUND DATA: RAN and AR have demonstrated superior accuracy in lumbar pedicle screw placement compared with conventional free-hand techniques. RAN and AR techniques both tout-specific advantages over their counterparts, but to date, no study has directly compared the two technologies regarding pedicle screw accuracy. PATIENTS AND METHODS: Patients who underwent RAN or head-mounted AR navigated lumbosacral (L1-S1) pedicle screw placement for degenerative conditions were included. Screw accuracy was assessed by two independent reviewers on intraoperative 3D fluoroscopic scans using the Gertzbein and Robbins scale. A generalized linear mixed model was applied to evaluate the relationship between the screw placement technique and accuracy. RESULTS: Two hundred and twelve patients undergoing lumbosacral instrumentation with a total of 1211 pedicle screws placed using RAN (n=108; screws=827) or AR (n=104; screws=384). Overall, grade A was achieved in 92.6% of screws. No significant difference was found between RAN and AR screw placement regarding the incidence of accurate (grade A and B screws; RAN n=824; 99.6% and AR n=379, 98.7%) versus inaccurate screws (grade C and D screws; RAN n=3, 0.4% and AR n=5, 1.3%). When comparing "optimal" grade A screws (RAN n= 787, 95.2%, AR n=345, 89.8%) versus all other screws (B, C, and D), significantly higher accuracy was achieved using RAN ( P =0.001). CONCLUSION: RAN and AR both achieved high accuracy in lumbosacral pedicle screw placement, proving reliable for this procedure. However, RAN resulted in significantly more grade A screw placements than AR.