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Expanding access to spine surgery simulation through smartphone-based augmented reality. Download PDF Abstract This study presents the development and validation of a low-cost, portable augmented reality (AR) simulator for screw placement training in the spine.

Designed to operate on existing smart devices, the system uses image-based tracking to overlay virtual anatomical structures, landmarks, ideal screw placements and trajectories, and surgical tool animations onto 3D-printed vertebrae, eliminating the need for external tracking hardware or head-mounted displays. Vertebral models (C1 and C2, C5, T10, L5, and sacrum) were generated from segmentations of CT scans, and 3D printed with bases to place image targets.

Virtual tools and animations of screw placement procedural steps were integrated into an interactive AR application developed in Unity. Technical validation included assessing the accuracy of 3D prints using Hausdorff distance analysis and image-tracking experiments evaluating linear displacement, angular rotation, and overlay accuracy on an iPhone and iPad.

Relative displacement errors were 1.78% (iPhone) and 2.09% (iPad), with mean rotation errors under 1° for both devices. Overlay accuracy averaged about 1 mm (iPhone: 0.99 mm ± 0.24 mm, iPad: 1.41 mm ± 0.20 mm).

System accuracy met suggested benchmarks for surgical AR simulation systems, supporting its feasibility as an accessible training tool for spine surgery education.

Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with qualified healthcare professionals for medical decisions and treatment options.