The application of navigation system based on augmented reality head-mounted devices in spine surgery

Background: Augmented reality (AR) technology can simultaneously superimpose virtual images on real objects, which is different from conventional image-guided solutions. After wearing AR head-mounted devices (ARHMDs), doctors can have the ability to see through the spine without shifting their eyes to an external navigation screen. Objective: This review aims to summarize the current application of ARHMDs in spine surgery, and analyze the research problems and future potentials. Methods: We performed a review of the application of ARHMDs in spinal surgery. Pubmed and google schoolar were searched from database inception to November 1, 2021, for studies on the application of ARHMDs in spine surgery. Summarize studies with definite technical routes, workflows, and effective assessment. Results: 16 studies were included in this review, with surgical applications focusing on vertebroplasty, pedicle screw placement, rod bending. According to the different image registration and tracking methods, the researches involved contour registration, body surface marker registration and spinous process marker registration. Most of the results showed that ARHMDs could be competent for these clinical navigation tasks, and were non-inferior when comparing to free-hand (FH). Some studies even met the standard of CANS, but require the assistance of intraoperative CBCT or CT. Conclusions: At present, ARHMDs can assist clinical tasks through image registration and tracking. However, due to the insufficient ARHMD hardware performance and the need of professional engineers in software development, it is not enough to complete high-precision navigation surgery alone. With the rapid development in science and technology. The ARHMD technology is still a promising method that will play an important role in navigated spine surgery.