Advancing Neurosurgical Training through Mixed Reality Modules: a MR prototype for precise Freehand Lumbar Pedicle Screw Placement.

Introduction: To demonstrate the potential of MR technology in spinal neurosurgery training, we present a novel MR pedicle screw placement prototype designed for neurosurgical resident training through an integrative VR-MR application.

Methods: Patient imaging CT scan was selected, anonymized, and used to create a precise 3D anatomical model of an adult degenerative lumbar scoliosis case (ADLS). The model served as a 3D-printed anatomical model integrated with hardware trackers and conductive materials. Real time feedback integrated with the MR application and infrared hardware trackers provide precise tracking of the surgical tools including: lenke probe, vertebral anatomical model, and the polyaxial pedicle screwdriver. A scoring system was designed to localize the bridge of the conductive material, providing breach assessment, and angle visualization for pedicle accuracy. Finally realistic CT imaging simulations are obtained according to trajectory. The application was designed with interactive game engines and patient-specific models to enhance pedicle screw placement and neurosurgical training simulation.

Results: The MR prototype significantly advances medical education by offering real-time feedback, compressive procedural assessment, and immersive visualization, making it a promising alternative to traditional spine training methods. The integration of conductive materials and microcontrollers enhances its realism and utility for neurosurgical training. The integration of scoring systems while performing pedicle screw placement could provide multiple technical rehearsals. The prototype was able to provide screw placement scoring, angle visualization, breach assessment, and realistic CT imaging simulations. Real time feedback integrated with the MR application was successfully achieved.

Conclusion : This mixed-reality prototype holds immense potential for various spinal pathologies and surgeries, offering an economically valuable, low risk alternative, and potential to improve traditional training.