Augmented Reality in Minimally Invasive Spine Surgery

Augmented reality (AR) projects images or data to alter the surgeon’s view of the real world. AR technology in spine surgery is currently in the innovator/early adopter stage of development. This new technology may have application to minimally invasive spinal surgery (MIS), as, by definition, the MIS surgeon has more limited visualization of spinal anatomy. Current AR devices can be classified as head-mounted displays, microscope-based heads-up displays, and augmented reality surgical navigation. The majority of AR in MIS studies to date have focused on pedicle screw placement and comparisons with fluoroscopy or navigated techniques. These have all demonstrated comparable to superior accuracy of pedicle screw placement with AR. More recent studies have expanded into the use of AR for interbody fusion and tumor resections with favorable results. Studies have indicated the unique educational value of AR in resident training for MIS. Limitations of current AR systems include ergonomics, registration inaccuracy, and cost. At such an early stage of adoption, it can be expected that rapid innovation will not only improve existing technology but also expand AR indications within the field of MIS.