Augmented Reality-Assisted Percutaneous Pedicle Screw Instrumentation: A Cadaveric Feasibility and Accuracy Study

Chih Chang Chang, Chao Hung Kuo, Hsuan Kan Chang, Tsung Hsi Tu*, Li Yu Fay, Jau Ching Wu, Henrich Cheng, Wen Cheng Huang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Percutaneous pedicle screw instrumentation is the keystone of minimally invasive spine surgery. Percutaneous screw placement demands experience and relies greatly on intra-operative image guidance. This study aims to validate the feasibility and accuracy of augmented-reality (AR)-assisted percutaneous pedicle screw instrumentation. One cadaveric torso was prepared for this study. After a pre-operative computed tomography (CT) scan, the images were transferred to an AR station to generate a 3D hologram. The 3D hologram and navigation images were projected to a pair of goggles with a display screen. With registration, the 3D spine hologram was overlayed onto the cadaver. Bilateral instrumentation from T6 to L5 was performed by two surgeons using AR assistance. A post-operative CT scan was obtained. The Gertzbein–Robbins scale (grade 0–3) was used for accuracy assessment. A total of 24 screws were placed. The overall screw accuracy was 87.5%. There were three major medial breaches that occurred on Rt T6/7/8, which were the most distant screws from the iliac reference. The cause of the three major medial breaches appeared to be related to their distance from the iliac reference. AR-assisted percutaneous pedicle screw instrumentation could improve anatomical visualization, facilitate surgical workflow, and provide an intuitive way of performing surgery.

Original languageEnglish
Article number5261
JournalApplied Sciences (Switzerland)
Issue number10
StatePublished - 1 May 2022


  • 3D hologram
  • augmented reality (AR)
  • minimally invasive spine surgery (MISS)


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