Augmented Reality Navigation in Pedicle Screw Placement for Thoracolumbar Trauma

Abstract

Background: Pedicle screw fixation is the mainstay of surgical stabilization for unstable thoracolumbar fractures, but freehand
and fluoroscopy-guided techniques carry measurable malposition and radiation risk. Objective: To synthesise the published evidence on augmented reality (AR)-based navigation for pedicle screw placement, with emphasis on thoracolumbar trauma, comparing it with freehand, fluoroscopy, 3D/O-arm navigation, and robotic guidance. Methods: Narrative review of comparative cohorts, randomised trials, systematic reviews, and meta-analyses indexed through 2026. Findings: Pooled AR clinical accuracy (Gertzbein-Robbins grade A/B) ranges from 93% to over 99%, exceeding freehand rates of 89-96% in matched comparisons, and approaching or matching robotic accuracy. AR reduces fluoroscopy use and, in dedicated trauma cohorts, achieves accuracy and complication rates comparable with robotic navigation, with a learning curve of roughly 20-30 cases. Conclusions: AR navigation is an accurate, radiation-sparing adjunct for thoracolumbar trauma instrumentation, though head-to-head trauma-specific trials remain few.