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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Citations
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · cited 1×
“Y) performed a literature search per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [6].”
Objective structured assessment of technical skill (OSATS) for surgical residents
Martin, J. A., Regehr, G., Reznick, R., Macrae, H., Murnaghan, J., Hutchison, C., & Brown, M. (1997) · British Journal of Surgery · doi:10.1002/bjs.1800840237 · Cited by 2,527 · cited 1×
“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].”
Accuracy of Pedicular Screw Placement In Vivo
GERTZBEIN, S. D., & ROBBINS, S. E. (1990) · Spine · doi:10.1097/00007632-199001000-00004 · Cited by 1,381 · cited 1×
“Accuracy was defined as the summation of grade 0 and grade 1 events per the Gertzbein–Robbins classification [7].”
Objective assessment of technical skills in surgery
Moorthy, K., Munz, Y., Sarker, S. K., & Darzi, A. (2003) · BMJ · doi:10.1136/bmj.327.7422.1032 · Cited by 651 · cited 1×
“Other limitations include micromovement of fiducial markers which can affect accuracy, inadequate brightness or inattention blindness from natural light and battery life of AR head-packs [38, 39].”
Amiot, L.-P., Lang, K., Putzier, M., Zippel, H., & Labelle, H. (2000) · Spine · doi:10.1097/00007632-200003010-00012 · Cited by 450 · cited 1×
“…accuracy between freehand and computer-aided placement using augmented reality, Amiot et al. found that in screws placed between T5 and S1, freehand placement had an error rate of 15.3% from 544 cases, whereas there was a 5.4% error rate from 294 cases when computer-assistance was used [42].”
InfluentialRecent Development of Augmented Reality in Surgery: A Review
Vávra, P., Roman, J., Zonča, P., Ihnát, P., Němec, M., Kumar, J., Habib, N., & El-Gendi, A. (2017) · Journal of Healthcare Engineering · doi:10.1155/2017/4574172 · Cited by 394 · cited 3×
“A recent systematic review by Vavra et al. [1] reports an accuracy range of 1–5 mm for augmented reality systems, highlighting its safety and efficacy across a variety of surgical procedures.”
Tian, N.-F., Huang, Q.-S., Zhou, P., Zhou, Y., Wu, R.-K., Lou, Y., & Xu, H.-Z. (2011) · European Spine Journal · doi:10.1007/s00586-010-1577-5 · Cited by 345 · cited 3×
“…to the novel application for AR-assisted pedicle screw placement in the cervical region, and mitigate concerns due to the close proximity of vertebral arteries to cervical pedicles, with similar accuracy rates to novel intraoperative navigation systems employed for similar purposes [35, 36].”
Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging
Terander, A. E., Burström, G. L., Nachabe, R. A., Skúlason, H., Pedersen, K., Fagerlund, M., Ståhl, F. L., Charalampidis, A., Söderman, M., Holmin, S., et al. (2018) · Spine · doi:10.1097/brs.0000000000002876 · Cited by 228 · cited 1×
“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].”
Gibby, J. T., SWENSON, S. A., Cvetko, S., Rao, R., & Javan, R. (2018) · International Journal of Computer Assisted Radiology and Surgery · doi:10.1007/s11548-018-1814-7 · Cited by 196 · cited 1×
“2.07 mm 2.41° Farshad et al. [11] 4.0 mm 6.8° Frisk et al. [12] 1.9 mm 3.0° Dennler et al. [16] NR 0.14° Gibby et al. [17] Mediolateral: 1.30 In terms of orthopaedics, the first VR orthopaedic application was a knee arthroscopy simulator introduced in the 1990s.”
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
Research works printed but not linked: 4
- Liu A, Jin Y, Cottrill E, Khan M, Westbroek E, Ehresman J, Pennington Z, Lo SL, Sciubba DM, Molina CA, Witham TF (2021) Clinical accuracy and initial experience with augmented reality-assisted pedicle screw placement: the first 205 screws. J Neurosurg Spine 8:1–7
- Bhatt FR, Orosz LD, Tewari A, Boyd D, Roy R, Good CR, Schuler TC, Haines CM, Jazini E (2022) Augmented reality-assisted spine surgery: an early experience demonstrating safety and accuracy with 218 screws. Global Spine J 10:21925682211069320
- Gu Y, Yao Q, Xu Y, Zhang H, Wei P, Wang L (2020) A clinical application study of mixed reality technology assisted lumbar pedicle screws implantation. Med Sci Monit 10(26):e924982
- Carl B, Bopp M, Sab B, Pojskic M, Voellger B, Nimsky C (2020) Spine surgery supported by augmented reality. Spine 10(2S):41S-55S
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 ].”
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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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
