A study conducted at the Hospital for Special Surgery (HSS) compared robotic-assisted navigation (RAN) and augmented reality (AR) technologies in spine surgery, focusing on the precision and safety of pedicle screw placement. Published in the journal Spine, the research concludes that both approaches provide high accuracy and safety, with minimal differences in outcomes.
Pedicle screws are crucial in spinal surgeries for stabilizing the spine, requiring precise placement for successful outcomes. Dr. Darren R. Lebl, spine surgeon and director of research at HSS, noted that both RAN and AR demonstrate superior accuracy compared to traditional free-hand techniques. This study represents the first direct comparison between the two technologies for screw placement precision.
The study analyzed data from 212 adult patients who underwent spine surgery between June 2020 and October 2023. Of the 1,211 pedicle screws placed, 827 were implanted using RAN and 384 using AR-assisted techniques. Procedures targeted the lumbar and sacral regions, addressing degenerative spinal conditions. Postoperative assessments were performed using the Gertzbein-Robbins classification system, with Grades A and B considered acceptable placements. Grade A indicates screws placed entirely within the pedicle, while Grade B allows for up to 2 mm of deviation.
Results showed that 99.6% of screws placed with RAN were rated as Grade A or B, compared to 98.7% for AR-assisted screws. Additionally, 92.6% of all screws achieved the highest Grade A rating. While both technologies demonstrated high accuracy, the RAN group exhibited a slightly higher proportion of Grade A screws, indicating a potential edge in precision.
RAN employs a robotic arm and GPS-like navigation technology to guide surgeon-operated instruments, enabling minimally invasive procedures planned with advanced imaging software. In contrast, AR technology overlays 3D anatomical images onto the surgeon’s visual field through a headset, allowing real-time guidance during surgery.
Dr. Lebl emphasized the broader implications of these technologies, including reduced radiation exposure and enhanced safety. “Our team is advancing spine surgery to be safer, less invasive, and more precise, with innovations such as real-time confirmation of implant accuracy in the operating room,” he said. He also highlighted the potential for increased automation in surgical execution in the future.
Photo credit: Hospital for Special Surgery
