Abstract
BACKGROUND: Spinal fusion is a common form of orthopedic surgery, the most common of which involves pedicle screw placement (PSP). Despite well-documented benefits, pedicle screws are associated with several intraoperative complications. This area of surgery has subsequently been recipient to many surgical developments. Currently, augmented reality surgical navigation (ARSN) is at the forefront of surgical interest. This systematic review evaluates whether, when compared to freehand, fluoroscopic, and intraoperative image-guided navigation, ARSN results in superior screw accuracy and operative outcomes for patients undergoing PSP surgery. METHODS: Data collection was performed on PubMed, Ovid MEDLINE, the Cochrane Library, Embase, and the Web of Science between January 7, 2023, and January 8, 2024. PRISMA guidelines were followed and the level of evidence was graded per the Centre for Evidence-Based Medicine's recommendations. Risk of bias was assessed per the ROBINS-I tool and the Cochrane guide for assessing study quality. A modified version of the Newcastle-Ottawa Scale was used to determine the certainty of the body of evidence. RESULTS: A total of 521 papers were obtained from all bibliographical databases, 31 of which were included in the final review. ARSN resulted in a significantly greater number of screws placed as Gertzbein and Robbins grade 1 or 2 (93.33% vs 85.86%, p<0.000), significantly reduced intraoperative blood loss (470.32 vs 802.44 ml, p=0.050), comparative operative duration (281.6 vs 255.5 min, p=0.819), comparative time to place a screw (2.71 vs 3.1 min, p=0.703), and a nonsignificant reduction in hospital stay (5.4 vs 7.5 days, p=0.097). Maximum follow-up was more than 14 days. CONCLUSIONS: ARSN results in a significantly greater number of screws placed at Gertzbein-Robertson grade 1 or 2 than non-ARSN surgery. Therefore, ARSN can be considered as a safe and efficacious technical innovation within PSP surgery.