PT  - JOURNAL ARTICLE
AU  - Dennler, Cyrill
AU  - Safa, Nico Akhavan
AU  - Bauer, David Ephraim
AU  - Wanivenhaus, Florian
AU  - Liebmann, Florentin
AU  - Götschi, Tobias
AU  - Farshad, Mazda
TI  - Augmented Reality Navigated Sacral-Alar-Iliac Screw Insertion
AID  - 10.14444/8021
DP  - 2021 Feb 01
TA  - International Journal of Spine Surgery
PG  - 161--168
VI  - 15
IP  - 1
4099  - https://www.ijssurgery.com/content/15/1/161.short
4100  - https://www.ijssurgery.com/content/15/1/161.full
SO  - Int J Spine Surg2021 Feb 01; 15
AB  - Background: Sacral-alar-iliac (SAI) screws are increasingly used for lumbo-pelvic fixation procedures. Insertion of SAI screws is technically challenging, and surgeons often rely on costly and time-consuming navigation systems. We investigated the accuracy and precision of an augmented reality (AR)–based and commercially available head-mounted device requiring minimal infrastructure.Methods: A pelvic sawbone model served to drill pilot holes of 80 SAI screw trajectories by 2 surgeons, randomly either freehand (FH) without any kind of navigation or with AR navigation. The number of primary pilot hole perforations, simulated screw perforation, minimal axis/outer cortical wall distance, true sagittal cranio-caudal inclination angle (tSCCIA), true axial medio-lateral angle, and maximal screw length (MSL) were measured and compared to predefined optimal values.Results: In total, 1/40 (2.5%) of AR-navigated screw hole trajectories showed a perforation before passing the inferior gluteal line compared to 24/40 (60%) of FH screw hole trajectories (P < .05). The differences between FH- and AR-guided holes compared to optimal values were significant for tSCCIA with −10.8° ± 11.77° and MSL −65.29 ± 15 mm vs 55.04 ± 6.76 mm (P = .001).Conclusions: In this study, the additional anatomical information provided by the AR headset and the superimposed operative plan improved the precision of drilling pilot holes for SAI screws in a laboratory setting compared to the conventional FH technique. Further technical development and validation studies are currently being performed to investigate potential clinical benefits of the AR-based navigation approach described here.Level of Evidence: 4.