The DOI matches its Crossref record; 41 of the 41 references it cites were found in a registry or an index.
Accuracy of augmented reality-assisted pedicle screw placement: a systematic review
Open accessAbstract
OBJECTIVE: Conventional freehand methods of pedicle screw placement are associated with significant complications due to close proximity to neural and vascular structures. Recent advances in augmented reality surgical navigation (ARSN) have led to its adoption into spine surgery. However, little is known regarding its overall accuracy. The purpose of this study is to delineate the overall accuracy of ARSN pedicle screw placement across various models. METHODS: A systematic review was conducted of Medline/PubMed, Cochrane and Embase Library databases according to the PRISMA guidelines. Relevant data extracted included reports of pedicle screw placement accuracy and breaches, as defined by the Gertzbein-Robbins classification, in addition to deviation from pre-planned trajectory and entry point. Accuracy was defined as the summation of grade 0 and grade 1 events per the Gertzbein-Robbins classification. RESULTS: Twenty studies reported clinically accurate placed screws. The range of clinically accurate placed screws was 26.3-100%, with 2095 screws (93.1%) being deemed clinically accurate. Furthermore, 5.4% (112/2088) of screws were reported as grade two breaches, 1.6% (33/2088) grade 3 breaches, 3.1% (29/926) medial breaches and 2.3% (21/926) lateral breaches. Mean linear deviation ranged from 1.3 to 5.99 mm, while mean angular/trajectory deviation ranged 1.6°-5.88°. CONCLUSION: The results of this study highlight the overall accuracy of ARSN pedicle screw placement. However, further robust prospective studies are needed to accurately compare to conventional methods of pedicle screw placement.
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“While AR technology has been developed for various applications in healthcare and education, its use in a blended-reality approach is considered effective for administering CBT, particularly for SAD [28,29,30,31,32].”
From Advancing Undergraduate Student Mental Healthcare of Social Anxiety Disorder: Evaluating the Acceptance of AR-Assisted Cognitive Behavioral Therapy Through TAM-Based Constructs. (2026) · cites this paper as [28]
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Cites
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Objective structured assessment of technical skill (OSATS) for surgical residents
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“However, it is often considered a low-cost alternative requiring minimum infrastructure compared to certain intraoperative navigation systems and can be employed as a supplement to existing equipment for procedures other than pedicle screw placement, such as operating microscopes [37].”
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“Accuracy was defined as the summation of grade 0 and grade 1 events per the Gertzbein–Robbins classification [7].”
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InfluentialRecent Development of Augmented Reality in Surgery: A Review
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“Of note, one study was omitted from further analysis in terms of collectively evaluating overall accuracy and respective breaches as the ARSN patient cohort was included in an additional study [18, 26].”
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InfluentialAugmented reality for the surgeon: Systematic review
Yoon, J. W., Chen, R. E., Kim, E. J., Akinduro, O. O., Kerezoudis, P., Han, P. K., Si, P., Freeman, W. D., Diaz, R. J., Komotar, R. J., et al. (2018) · International Journal of Medical Robotics and Computer Assisted Surgery · doi:10.1002/rcs.1914 · Cited by 185
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Cited by
Revolutionizing spine surgery with emerging AI–FEA integration
Franceschini, C., Ahmadi, M., Zhang, X., Wu, K. L., Lin, M., Weston, R., Rodio, A., Tang, Y., Engeberg, E. D., Pires, G., et al. (2025) · Journal of Robotic Surgery · doi:10.1007/s11701-025-02772-w · Cited by 29
Xiao, S.-X., Wu, W., Yu, T., Chen, I., & Yeh, K. (2024) · Medicina · doi:10.3390/medicina60091485 · Cited by 18
“Youssef et al. [2] conducted a systematic review on the accuracy of AR-assisted pedicle screw placement.”
BackgroundInfluentialShcherbakova, Y. M., Lafranca, P. P. G., Foppen, W., van der Velden, T. A., Nievelstein, R. A. J., Castelein, R. M., Ito, K., Seevinck, P. R., & Schlösser, T. P. C. (2024) · European Journal of Radiology · doi:10.1016/j.ejrad.2024.111542 · Cited by 16
“Moreover, the accepted standard error that represents a true change in spinal curvature is considered to be 5 ◦ , and the average angulation error of spinal navigation systems is approximately 2 – 6 ◦ [34,35].”
Wearable Devices in Scoliosis Treatment: A Scoping Review of Innovations and Challenges
Veisari, S. F., Bidari, S., Barati, K., Atlasi, R., & Komeili, A. (2025) · Bioengineering · doi:10.3390/bioengineering12070696 · Cited by 11
MacLeod, J., Compton, T. M., Bakaes, Y., Chopra, A., Akwuole, F. N., Christenson, C., & Hsu, W. K. (2025) · Current Reviews in Musculoskeletal Medicine · doi:10.1007/s12178-025-09972-9 · Cited by 10
“…demonstrated accurate screw placement in cadaveric and clinical studies through real-time visualization, suggesting its potential as a viable training modality for surgeons in the early stages of their careers, those transitioning to new systems and as an adjunct for experienced surgeons [ 18–23 ].”
Ohashi, M., Satō, M., Tashi, H., Minato, K., Makino, T., & Kawashima, H. (2024) · Cureus · doi:10.7759/cureus.59240 · Cited by 6
“However, AR-assisted systems usually require intraoperative CT or 3D fluoroscopy [14,17,18], which is one of the barriers to the widespread adoption of AR technology for PS placement.”
BackgroundInfluentialEl-Hajj, V. G., Charalampidis, A., Fell, D., Edström, E., Terander, A. E., & Gerdhem, P. (2025) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-025-08817-3 · Cited by 5
“Other prospective studies and recent meta-analyses of the literature have demonstrated similar results regarding the use of augmented-reality guidance [37, 38].”
Framework for Adoption of Enabling Technologies for Improved Outcomes in Spine Surgery
Muthu, S., Ramasubramanian, S., Jeyaraman, M., Härtl, R., Tavakoli, J., Cho, S. K.-W., Scaramuzzo, L., Singh, H., Louie, P. K., Demetriades, A. K., et al. (2025) · Global Spine Journal · doi:10.1177/21925682251323277 · Cited by 5
“4 AR technology, for example, has been instrumental in improving the accuracy of pedicle screw placement, 5,6 while VR has created immersive training environments, enabling surgeons to re fi ne their skills in a risk-free setting.”
Advanced Imaging and Augmented Reality in Neurosurgery: Bridging Innovation and Precision
Mashiach, E., Soldozy, S., Sacknovitz, A., Jain, A., Donaldson, H., Zeller, S., Shukla, G. G., Rawanduzy, C. A., Vasconcellos, F. D. N., Gandhi, C. D., et al. (2025) · IntechOpen eBooks · doi:10.5772/intechopen.1008969 · Cited by 5
Adaptive Hand Visibility for Accurate 3D User Interactions in Virtual Environments
Türkmen, R., Voisard, L., Kersten‐Oertel, M., & Batmaz, A. U. (2025) · Proceedings - International Symposium on Mixed and Augmented Reality, ISMAR · doi:10.1109/ismar67309.2025.00015 · Cited by 4
“As PSP requires a high degree of precision, it is widely used in in both clinical and simulation-based settings [10, 45, 11, 49].”
InfluentialChoueiri, J. E., Pellicanò, F., Cosmo, L. D., Caimi, E., Laurelli, F., Salman, H., Gionso, M., El-Hajj, V. G., Terander, A. E., & Cannizzaro, D. (2025) · World Neurosurgery · doi:10.1016/j.wneu.2025.124204 · Cited by 4
Coden, G. S., Kuznetsov, M., Schoeller, L., Patti, J. C., Grant, A. R., Miller, J. P., & Talmo, C. T. (2025) · Journal of Orthopaedics · doi:10.1016/j.jor.2025.01.031 · Cited by 3
Reddy, S. C., Shafi, M., Park, A., Hughes, L. P., Khalifeh, J. M., Azad, T. D., & Witham, T. F. (2025) · Acta Neurochirurgica · doi:10.1007/s00701-025-06729-8 · Cited by 4
Ma, T., Pan, S., Guan, J., Tang, Q., & Wang, G. (2026) · Journal of Robotic Surgery · doi:10.1007/s11701-025-03131-5 · Cited by 2
Hatzl, J., Henning, D., Böckler, D., Hartmann, N., Meisenbacher, K., & Uhl, C. (2024) · Journal of Imaging · doi:10.3390/jimaging10040076 · Cited by 2
Digital Twin Technology for Precision Medicine
Tripathi, S., & Chumnanvej, S. (2025) · IGI Global eBooks · doi:10.4018/979-8-3373-0659-9.ch006 · Cited by 2
Tamburini, L. M., Viola, A., Patel, R. R., Korabelnikov, T., Nayak, R., King, J. S., Mallozzi, S. S., Moss, I. L., & Singh, H. (2025) · North American Spine Society Journal (NASSJ) · doi:10.1016/j.xnsj.2025.100618 · Cited by 2
“Youssef et al re-ported a mean linear deviation from 1.3 to 5.99 mm and a mean angular deviation of 1.6° to 5.88° [ 23 ].”
InfluentialBiomechanical stability and pedicle screw loosening
Cui, C., & Yang, H. (2026) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2026.113174 · Cited by 1
Role of Smartphones and Digital Technology in Spine Surgery: A Comprehensive Narrative Review
Sharma, A., Kadam, S., Marathe, N. A., Rangala, A., Rampure, A., & Das, S. L. (2026) · Indian Spine Journal · doi:10.4103/isj.isj_83_25 · Cited by 1
Kumar, P., Siddarthan, I. J., Keim, C. K., Cho, D., Rubin, J. E., White, R. S., & Jotwani, R. (2026) · Journal of Personalized Medicine · doi:10.3390/jpm16040202 · Cited by 1
“…reality surgical navigation achieved superior screw placement accuracy compared to freehand, fluoroscopic, and intraoperative image-guided techniques, with statistically significant improvements across all comparators, and additionally results in significantly less intraoperative blood loss [8].”
Zhou, Z., Zhou, Y., Ouyang, B., Man, S. S., & Chan, A. H. S. (2026) · Healthcare · doi:10.3390/healthcare14131978
“While AR technology has been developed for various applications in healthcare and education, its use in a blended-reality approach is considered effective for administering CBT, particularly for SAD [28–32].”
Kommentar zu Roboterassistierte Wirbelsäulenchirurgie: Ergebnisse und Komplikationen
Tschöke, S. K. (2024) · Die Wirbelsäule · doi:10.1055/a-2236-4846
Liu, T., Zou, H., & Zou, H. (2025) · Indian Journal of Orthopaedics · doi:10.1007/s43465-025-01585-1 · Cited by 1
“This synergy facilitates accurate surgical Our findings identify “augmented reality” (AR) and “object detection” as emerging themes, consistent with the rapid advancement of AI-powered intraoperative guidance systems in spine surgery [9, 28].”
Chytas, D., Vasiliadis, A. V., Choucroun, E., Chindore, T. N., Ouhenach, T., Sadiq, D. E., & Malahias, M. (2025) · Cureus · doi:10.7759/cureus.94768
Letter to editor: Augmented reality-guided pedicle screw fixation
Daungsupawong, H., & Wiwanitkit, V. (2025) · Asian Spine Journal · doi:10.31616/asj.2025.0533.r1
“As a result, interpretations should emphasize the “clinical safety margin” rather than relying merely on average accuracy numbers [2,3].”
He, Q., Ding, J., Li, Y., Li, Y., Shidujaman, M., & Zhang, Y. (2026) · Lecture notes in computer science · doi:10.1007/978-3-032-12657-3_23
Kimchi, G., Johnston, D., Kolcun, J. P. G., Serbousek, J. A., & Fessler, R. G. (2026) · North American Spine Society Journal (NASSJ) · doi:10.1016/j.xnsj.2026.100861
Complications With Navigation-Assistance in Thoraco-Lumbar Spine Surgery
Fujii, T., Lipson, P., Nguyen, K. T., Vadalà, G., Scaramuzzo, L., Hsieh, P. C., Krause, K. L., Yoon, S. T., Louie, P. K., & Degenerative, A. S. K. F. (2026) · Global Spine Journal · doi:10.1177/21925682261431286
“56 Other innovations, such as improved monitors for visualization, smaller registration trackers, live tracking technologies, and the use of AR headsets with navigation in real time and directly overlaid on the patient are also attracting current attention.”
Delafontaine, A., Cartiaux, O., Francq, B. G., & Cordemans, V. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15062328
“Clinical and cadaveric studies report pedicle screw placement accuracy in the range of approximately 90–95% for AR-assisted methods, with some systems achieving comparable results to advanced navigation or robotic assistance [16].”
Younus, I., de Oliveira, R. G., Lipson, P., Bansal, A., & Louie, P. K. (2026) · European Spine Journal · doi:10.1007/s00586-026-09972-4
Investigating Adaptive Hand Visibilities for Accurate 3D User Interactions in Augmented Reality
Türkmen, R., Hatira, N., Teather, R. J., Kersten‐Oertel, M., Stuerzlinger, W., & Batmaz, A. U. (2026) · IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) · doi:10.1109/vrw70859.2026.00067
“PSP has been widely studied in both AR [29, 28, 14] and VR environments [27, 21], and can be systematically decomposed into movement phases such as reaching, grasping, transporting, and inserting [24, 23].”
Nygård, M., Karlsson, M., Wänman, J., & Åkerstedt, J. (2026) · Computer Methods in Biomechanics and Biomedical Engineering Imaging & Visualization · doi:10.1080/21681163.2026.2675253
Immersive spatial computing in neurosurgery
Bolton, W. S., Kamaly-Asl, I. D., & Mathew, R. (2026) · British Journal of Neurosurgery · doi:10.1080/02688697.2026.2670643
“28 These systems are often evaluated alongside established navigation and robotic platforms, with early evidence suggesting comparable accuracy and potential workflow advantages, particularly in reducing reliance on fluoroscopy.”
Gao, R., Niu, K., Cheng, L., Wei, Z., Wang, X., Wei, T., Huang, B., Xu, F., & Xiong, C. (2026) · Frontiers in Surgery · doi:10.3389/fsurg.2026.1801856
“Using postoperative axial CT and the Gertzbein – Robbins grading system, we found clinically acceptable screw placement (Grades 0 – 1) of 99.2% in the 2D group and 98.1% in the 3D group, with no significant difference, consistent with prior reports (33, 34).”
InfluentialCampana, F., Ancetti, S., Cini, C., Spath, P., Pini, A., Gallitto, E., Gasbarrini, A., & Gargiulo, M. (2026) · EJVES Vascular Forum · doi:10.1016/j.ejvsvf.2026.07.007
“…such as computer assisted navigation, robotic guidance, and intra-operative three dimensional imaging have improved pedicle screw placement accuracy, 3,14 most studies focus on intrapedicular precision and orthopaedic outcomes rather than the vascular consequences of anterior cortical breach.”
Günther, C., Winkler, D., Jung, S., Hoffmann, M., Scheidt, K., Kropla, F., Güresir, E., & Grunert, R. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1764807
“Specifically, AR has been successfully applied to the planning of craniotomies (10, 42), the visualization of tumor margins and neurovascular structures (11, 12), and the accurate placement of pedicle screws (13, 41, 43, 44).”
Metadata
- Authors
- Youssef, S., McDonnell, J. M., Wilson, K. V., Turley, L., Cunniffe, G., Morris, S., Darwish, S., & Butler, J. S.
- Affiliations
- University College Dublin (IE)
- Trinity College Dublin (IE)
- Tallaght University Hospital (IE)
- Mater Misericordiae University Hospital (IE)
- Corresponding author
- Wilson, Kielan V.
- ORCID
- Venue
- European Spine Journal
- Published
- 2024-01-04
- Volume
- 33
- Issue
- 3
- Pages
- 974-984
- ISSN
- 0940-6719 (ISSN-L)
- 1432-0932
- OpenAlex
- W4390576596
- Cited by
- 36
- References
- 41
- Citations by year
- 2026: 16 · 2025: 15 · 2024: 5
- FWCI
- 3.99
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- creativecommons.org/licenses/by/4.0 (tdm)
- creativecommons.org/licenses/by/4.0 (vor)
- Locations
- European Spine Journal (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- University College Dublin
- Topics
- Health Sciences › Medicine › Surgery › Spinal Fractures and Fixation Techniques
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Augmented Reality Applications
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone fractures and treatments
- Keywords
- augmented reality surgical navigation, pedicle screw placement, placement accuracy, Gertzbein-Robbins classification, trajectory deviation, spinal surgery
- MeSH terms
- Augmented Reality, Humans, Prospective Studies, Spinal Fusion, Surgery, Computer-Assisted, Pedicle Screws
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