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. 2020 Jan 20;10:707. doi: 10.1038/s41598-020-57693-5

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© The Author(s) 2020

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Surgical workflow comparison between augmented reality surgical navigation (ARSN) and free-hand (FH) techniques for spine fixation. Anatomical identification and exposure is similar for both groups (steps 1 and 2). ARSN require an intraoperative cone beam CT (CBCT) is remotely acquired behind a lead shield for screw planning and sizing to ensure an optimized placement (step 3 of ARSN). Subsequently, instruments are navigated (a drill in the example of step 4) and a CBCT for screw placement verification is performed (step 5 ARSN). In the FH group, instruments are manually used relying on visual and tactile feedbacks (step 3 FH). X-rays are performed for screw verification (step 4 FH).