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Background <p>Mixed-reality (MR) head-mounted navigation projects a three-dimensional hologram of the patient’s spine directly into the surgeon’s field of view, potentially enhancing the precision and speed of percutaneous pedicle screw fixation. High-quality prospective data comparing MR with conventional fluoroscopy are scarce, prompting the present randomized study.</p> Results <p>Sixty-one adults (274 screws) were allocated to MR (30 patients, 136 screws) or fluoroscopy (31 patients, 138 screws). MR navigation yielded a greater proportion of accurately placed screws (96.3% vs. 89.9%; absolute difference 6.4%; <i>p</i> = 0.04) and shortened mean operative time by 28&#xa0;min (83 ± 11&#xa0;min vs. 111 ± 14&#xa0;min; <i>p</i> &lt; 0.001). Entry-point, angular and depth deviations were all significantly smaller with MR, while intra-operative fluoroscopic images fell by 42%. Early complications occurred in 3.3% of MR cases and 16.1% of controls, and holographic pre-operative counselling improved patient understanding and satisfaction (<i>p</i> &lt; 0.001).</p> Conclusions <p>MR head-mounted navigation is feasible, safe and more precise than fluoroscopic guidance, delivering faster procedures, fewer fluoroscopic shots and a short learning curve. These advantages support MR as a cost-effective next-generation guidance modality for minimally invasive spine surgery.</p>

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Mixed-reality, heads-up navigation for percutaneous pedicle screw placement: a prospective accuracy and workflow study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Ruili Zhuo,
  • Hongrui Liu,
  • Wei Liang,
  • Chen Xu,
  • Shaodong Sun,
  • Guoyu Li

摘要

Background

Mixed-reality (MR) head-mounted navigation projects a three-dimensional hologram of the patient’s spine directly into the surgeon’s field of view, potentially enhancing the precision and speed of percutaneous pedicle screw fixation. High-quality prospective data comparing MR with conventional fluoroscopy are scarce, prompting the present randomized study.

Results

Sixty-one adults (274 screws) were allocated to MR (30 patients, 136 screws) or fluoroscopy (31 patients, 138 screws). MR navigation yielded a greater proportion of accurately placed screws (96.3% vs. 89.9%; absolute difference 6.4%; p = 0.04) and shortened mean operative time by 28 min (83 ± 11 min vs. 111 ± 14 min; p < 0.001). Entry-point, angular and depth deviations were all significantly smaller with MR, while intra-operative fluoroscopic images fell by 42%. Early complications occurred in 3.3% of MR cases and 16.1% of controls, and holographic pre-operative counselling improved patient understanding and satisfaction (p < 0.001).

Conclusions

MR head-mounted navigation is feasible, safe and more precise than fluoroscopic guidance, delivering faster procedures, fewer fluoroscopic shots and a short learning curve. These advantages support MR as a cost-effective next-generation guidance modality for minimally invasive spine surgery.