NYC Gazette

A recent study conducted at the Hospital for Special Surgery (HSS) has compared robotic-assisted navigation (RAN) with augmented reality (AR) in spine surgery. The research, published online in the journal Spine, highlights that both methods offer high accuracy and safety for pedicle screw placement.

Spinal surgeries often require pedicle screws to stabilize the spine, making precise positioning crucial. "Compared to conventional free-hand techniques, both robotic-assisted navigation and the use of augmented reality have demonstrated superior accuracy," stated Dr. Darren R. Lebl, a spine surgeon and director of research at HSS, who led the study. He noted that this is the first study to directly compare RAN with AR regarding screw placement precision.

Over the past decade, various systems using robotic-assisted navigation and augmented reality have been developed for spine surgery. "In addition to enhanced accuracy, the potential advantages of both technologies include reduced radiation exposure and provide for improved safety in spine surgery," said Dr. Lebl. He added that many major medical centers across the country are adopting these technologies.

RAN involves using a robotic arm guided by 3D images and GPS-like navigation technology to assist surgeons in performing minimally invasive procedures planned with advanced software. In contrast, AR-assisted surgery uses an augmented reality headset to overlay 3D images onto a surgeon's visual field during operations.

The HSS study involved 212 adult patients undergoing lumbar or sacral spine surgeries for degenerative conditions between June 2020 and October 2023. A total of 1,211 pedicle screws were placed—827 using robotics on 108 patients and 384 using AR on 104 patients—by experienced surgeons.

Post-surgery assessments were conducted using CT scans or 3D fluoroscopy following the Gertzbein-Robbins classification system. Grades A and B were deemed acceptable by researchers; Grade A indicates perfect placement within the pedicle while Grade B allows for slight deviation.

Independent evaluations revealed no significant difference between RAN and AR regarding screw placement accuracy: 99.6% of RAN screws received Grades A or B compared to 98.7% for AR screws, with overall top Grade A ratings achieved by 92.6% of all screws.

"Our results confirmed excellent accuracy for both techniques," remarked Dr. Lebl about their findings' implications on safe lumbosacral pedicle screw positioning through robotics or AR assistance; however he noted higher precision seen among those treated via robotics may suggest its superiority over alternatives like augmented realities when it comes down strictly towards achieving optimal outcomes related specifically around precise surgical interventions involving spinal implants themselves."

Dr.Lebl envisions advancements stemming from this research shaping future approaches toward more automated execution processes within field-specific practices aimed ultimately reducing invasiveness alongside enhancing overall procedural efficacy throughout broader contexts associated primarily concerning patient care standards alike: "Our team at HSS is working tirelessly advancing such methodologies further still today ensuring safer less intrusive means delivering effective treatment options remain forefront considerations always moving forward collectively together."