The impact of augmented reality on radiation exposure during spine surgery: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not specified

• Effect Size: Not quantified - described as 'statistically significant reductions' and 'substantially lower staff doses'

• Primary Outcome: Reduced fluoroscopy use and radiation exposure with AR-assisted spine surgery

• Nnt Or Sensitivity: High surgical accuracy maintained across AR platforms

• Confidence Interval: Not reported

Clinical Application

Limited by technology availability, learning curves, and cost considerations Relevant to Australian neurosurgical centres with AR capabilities; aligns with radiation safety principles under ACMA and TGA guidelines for medical devices Spine surgery patients and operating room staff in centres with AR technology capability

Abstract

BACKGROUND: Augmented reality (AR) has rapidly emerged as an important navigational technology in spine surgery, with growing interest in its potential to reduce dependence on fluoroscopy and mitigate radiation exposure for both patients and operating room staff. METHODS: This systematic review examined current evidence on radiation-related outcomes of AR-assisted spine procedures. A PRISMA-guided search of PubMed, Embase, and Scopus identified twelve eligible studies, including randomized trials, prospective and retrospective clinical cohorts, and cadaveric or synthetic-model investigations. RESULTS: Across the included studies, AR was consistently associated with reduced fluoroscopy use, with several studies demonstrating statistically significant reductions in exposure time compared with conventional fluoroscopy. Two clinical studies directly measured occupational radiation and reported substantially lower staff doses when AR-based navigation and optimized shielding strategies were employed. Patient radiation exposure was similarly decreased in most studies, particularly when AR was integrated with low-dose cone-beam CT protocols. Operative time findings were mixed, reflecting early learning curves and variability in AR systems, but accuracy remained high across platforms. CONCLUSION: Current evidence suggests that AR may reduce intraoperative radiation exposure without compromising workflow or surgical precision, available studies are limited by small sample sizes, heterogenous methodologies, and a paucity of direct staff-dosimetry data. Larger, high-quality multicenter studies are needed to clarify the magnitude of AR's radiation-sparing benefits and to define its role in modern spine surgery.

References

1. 1.El Choueiri, J., De Rossi, L., Pellicanò, F., Di Cosmo, L., Rota, A., Pellegrini, L., El-Hajj, V. G., Elmi-Terander, A., Creatura, D., De Robertis, M., Baram, A., Brembilla, C., Panciani, P. P., & Capo, G. (2026). The impact of augmented reality on radiation exposure during spine surgery: a systematic review. Neurosurgical Review. https://doi.org/10.1097/MD.0000000000011560