Current Trends in Augmented Reality in Endoscopic Spine Surgery: A Systematic Review With Real-World Clinical Insights

Abstract

This study aimed to evaluate current trends, clinical applications, and limitations of augmented reality (AR) in endoscopic spine surgery (ESS). A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar were searched for studies published between January 1, 2019, and April 1, 2026. Studies investigating AR, mixed reality, virtual reality, and related immersive technologies in ESS were included. Experimental, preclinical, and clinical studies were considered because of the emerging nature of the field and the limited availability of comparative clinical evidence, whereas case reports and nonrelevant studies were excluded. Eligible studies were categorized as experimental, preclinical, or clinical. Outcomes included operative efficiency, radiation exposure, visualization, ergonomics, cognitive workload, and patient-reported outcomes. Risk of bias was assessed using the ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) tool. Six studies were included, comprising 1 experimental training study, 2 preclinical studies, and 3 clinical studies, all involving lumbar procedures. AR-assisted systems consistently improved procedural efficiency, including reductions in puncture attempts, operative time, and radiation exposure. Visualization and workflow were enhanced through improved magnification, an expanded field of view, and integrated imaging. Clinical studies demonstrated reduced surgeon workload and improved ergonomic posture. However, patient-reported outcomes, including pain and disability scores, improved similarly in both AR-assisted and conventional groups, with no significant between-group differences. No study demonstrated validated improvements in surgical accuracy. The overall risk of bias ranged from moderate to serious. Current preliminary evidence suggests that AR-assisted ESS is feasible and may improve visualization, workflow efficiency, radiation exposure, and surgeon ergonomics. However, evidence supporting improvements in surgical accuracy and patient-reported outcomes remains limited. Further high-quality prospective studies are needed to better define the clinical role of immersive technologies in ESS.