The aim of this study was to assess the potential of surgical guides as a complementary tool to augmented reality (AR) in enhancing the safety and precision of pedicle screw placement in spinal surgery. Four trainers were divided into the AR navigation group using surgical guides and the free-hand group. Each group consisted of a novice and an experienced spine surgeon. A total of 80 pedicle screws were implanted. First, the AR group reconstructed the 3D model and planned the screw insertion route according to the computed tomography data of L2 lumbar vertebrae. Then, the Microsoft HoloLensTM 2 was used to identify the vertebral model, and the planned virtual path was superimposed on the real cone model. Next, the screw was placed according to the projected trajectory. Finally, Micron Tracker was used to measure the deviation of screws from the preoperatively planned trajectory, and pedicle screws were evaluated using the Gertzbein-Robbins scale. In the AR group, the
linear deviations of the experienced doctor and the novice were (1.59±0.39) mm and (1.73±0.52) mm respectively, and the angle deviations were 2.72◦ ± 0.61◦ and 2.87◦ ± 0.63◦ respectively. In the free-hand group, the linear deviations of the experienced doctor and the novice were (2.88 ± 0.58) mm and (5.25 ± 0.62) mm respectively, and the angle deviations were 4.41◦ ± 1.18◦ and 7.15◦ ± 1.45◦ respectively. Both kinds of deviations between the two groups were significantly different (P < 0.05). The screw accuracy rate was 95% in the AR navigation group and 77.5% in the free-hand group. The results of this study indicate that the integration of surgical guides and AR is an innovative technique that can substantially enhance the safety and precision of spinal surgery and assist inexperienced doctors in completing the surgery.
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