Long-term outcomes following augmented reality-assisted pedicle screw placement in spinal fusion patients

Purpose: Augmented reality (AR) technology integrates intraoperative imaging into the surgical field through AR headsets, enabling real-time, heads-up surgical navigation. While previous work has demonstrated that AR navigation achieves excellent radiographic accuracy for instrumentation placement, no studies have reported long-term patient-reported outcomes (PROs) following AR-guided spine surgery. Methods: In this retrospective study with prospective follow-up, patient electronic medical records were reviewed for demographic, clinical, and outcome data. Pre- and postoperative PROs were collected, including Oswestry Disability Index (ODI) and 36-Item Short Form Survey (SF-36). Mental (MCS) and physical (PCS) component scores were derived from SF-36 responses. Univariate statistics and paired Wilcoxon tests were used to analyze patient characteristics and PROs. Multivariate linear regression was used to assess predictors of postoperative improvement in outcomes of interest. Results: We identified 59 patients who underwent AR-guided spine surgery with ≥ 10 months follow-up (34% male, median age: 61 years, median follow-up: 25 months). Nine patients (15.3%) underwent reoperation at a median of 19 months—three for adjacent segment disease, four for pseudarthrosis, and two for other indications. Preoperatively, median ODI was 44 (severe disability), and MCS and PCS were 41.3 and 27.0. Postoperatively, ODI was 24 (moderate disability), and MCS and PCS were 54.1 and 37.7—representing significant improvements that exceed the minimal clinically important differences reported in the literature (approximately 10 points for ODI and 4 points for PCS and MCS; p < 0.001, p = 0.03, and p = 0.001, respectively). Conclusion: This study represents one of the first efforts to evaluate the clinical impact of augmented reality–assisted spinal surgery beyond intraoperative usage. While AR technology has been shown to enhance pedicle screw placement accuracy, our findings extend this knowledge by demonstrating sustained long-term improvements in physical functioning, mental health, and disability among patients undergoing AR-guided pedicle screw placement that are reasonably similar to those reported following other means of pedicle screw placement.