• Daisuke Sakai, Jordy Schol, Asami Kawachi, Kosuke Sako, Akihiko Hiyama, Hiroyuki Katoh, Masato Sato, and Masahiko Watanabe.
• Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan. Electronic address: daisakai@is.icc.u-tokai.ac.jp.
• World Neurosurg. 2023 Oct 1; 178: e96e103e96-e103.

ObjectiveAugmented reality (AR) is becoming more common and slowly being integrated into the surgical field. With the continuous progression of navigation and visualization techniques, AR has great potential to improve surgical quality and safety. Nevertheless, the effects of AR on surgical outcomes and surgeons' well-being remains poorly studied. The present prospective controlled study aims to assess the effect of surgery assisted with AR smart glasses on adolescent idiopathic scoliosis (AIS) deformity correction outcomes and surgeon fatigue.MethodsAIS patients scheduled for surgical deformity correction were prospectively recruited and assigned to standard or AR-supported surgery, using lightweight AR smart glasses. The demographic and clinical features were recorded. The pre- and postoperative spinal features, operative time, and blood loss were recorded and compared. Finally, the participating surgeons were asked to complete a questionnaire (e.g., visual analog scale for fatigue) to compare the effects of AR on their well-being.ResultsOur results have shown enhanced spinal deformity corrections with Cobb angle (-35.7° vs. -46.9°), thoracic kyphosis (8.1° vs. 11.6°), and vertebral rotation (-9.3° vs. -13.8°) changes favoring AR-supported surgery. Moreover, AR resulted in significantly lower violation rates per patient (7.5% vs. 6.6%; P = 0.023). Finally, the visual analog scale for fatigue scores consistently showed a significant reduction in fatigue (5.7 ± 1.7 vs. 3.3 ± 1.2; P < 0.001) and other fatigue classifiers for the surgeons after AR-supported surgery.ConclusionsOur controlled study has highlighted the enhanced spinal correction rates in AR-supported surgery and also improved surgeons' well-being and fatigue. These results endorse the adaptation of AR techniques to support AIS surgical correction.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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