Accuracy and effectiveness of thoracolumbar pedicle screw placement with a mixed reality head mounted device: first clinical experience and results

Mixed reality (MR) has the potential to enhance the accuracy and effectiveness of spine surgery, particularly in the placement of pedicle screws. This technology can lead to improved outcomes, optimized ergonomics, and reduced operative time and costs. This study evaluates the efficacy and accuracy of MR in thoracolumbar pedicle screw placement using neuronavigation and a head-mounted device. We conducted a prospective review of the initial series of thoracolumbar pedicle screw placements utilizing neuronavigation (Brainlab) and MR with a head-mounted device (MagicLeap2). Data from 22 patients were analyzed, involving a total of 144 pedicle screws placed. The Gertzbein-Robbins classification (GRC) was used to assess screw position: Grade A (screw within the pedicle), Grade B (breach <2mm), Grade C (breach 2-4mm), Grade D (breach 4-6mm), and Grade E (breach >6mm). Grades A and B were considered accurate placements. Out of 144 thoracolumbar pedicle screws, 139 were accurately positioned according to GRC grades A and B, resulting in a clinical accuracy rate of 96.5%. The mean deviation at the bone entry point compared to preoperative plans was 2.35 ± 1.1 mm, with a mean angular deviation of 3.1 ± 1.4°. Surgeons reported no issues with the head-mounted device, including dizziness or headaches, and noted no limitations in visualization of the surgical field. This study demonstrates the successful application of MR combined with neuronavigation for precise pedicle screw placement, eliminating the need for fluoroscopy and enhancing surgical efficiency. • first clinical evaluation of an AR head-mounted device combined with a conventional navigation system • clinical accuracy rate was 96.5% for pedicle screw placement, with 139 out of 144 screws • AR-HMD provides visual guidance for identifying entry points, determining skin incisions • use of the HMD allowed surgeons to maintain focus on the surgical field