Use of augmented reality for image-guided spine procedures



Because of its ability to superimpose imaging data on a patient, while anchoring the user’s view to the immediate surroundings, augmented reality (AR) has the potential to dramatically improve the accuracy and reduce the time required for preoperative planning and performance of minimally invasive spine surgeries and procedures. Described and reported herein is the direct clinical application of AR navigation on a series of common percutaneous image-guided spine procedures.

Materials and methods

AR, including a “virtual needle” (VN) asset, was used to guide and navigate a total of 18 procedures performed on 10 patients. Comparative control data were generated using a phantom model (n = 32). These data are used to determine the accuracy of AR for federal drug administration submissions. Optical codes were implemented to allow automatic and real-time registration. A manual process was used when the use of optical codes was not available. Target error, distance to the target and target size were measured for both phantom and clinical groups. Mean errors between the two groups were compared.


Target error between the control and clinical data sets showed no significant difference. Moreover, the distance to the target site and the target size had no effect on target acquisition.


This data set suggests that AR navigation, utilizing a VN, is an emerging, accurate, valuable additive method for surgical and procedural planning for percutaneous image-guided spinal procedures and has potential to be applied to a broad range of clinical and surgical applications.

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We thank Novarad for use of their technology to perform this research and Brady Roundy for statistical analyses.


Funding of Novarad PACS software, Novarad OpenSight, and a research version of the HoloLens was provided by Novarad. No other funding was received for this publication.

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Correspondence to Ryan Parr.

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Wendell Gibby, Steve Cvetko and Ryan Parr are employees of Novarad.

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“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Blue Rock Medical Institutional Review Board) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards”.

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Gibby, J., Cvetko, S., Javan, R. et al. Use of augmented reality for image-guided spine procedures. Eur Spine J (2020).

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  • Augmented reality
  • Virtual needle
  • Minimally invasive surgery
  • Spine procedures