Feasibility of Spinal Facet Joint Injections With Augmented Reality Headset: A Cadaveric Study

BACKGROUND AND OBJECTIVES: Augmented reality (AR) head-mounted displays (HMDs) offer 3-dimensional (3D) visualization to enhance procedural accuracy and reduce fluoroscopy use in spinal interventions. This study aimed to evaluate the feasibility and accuracy of an AR-HMD navigation system for facet joint injections in comparison with the conventional C-arm-guided approach. METHODS: In this prospective controlled study, 5 cadavers underwent computed tomography to generate 3D spine models. An AR application developed in Unity with Vuforia Engine was deployed on the HoloLens 2 headset for navigation. A neurosurgeon performed 216 facet joint needle placements (108 AR-assisted, 108 C-arm-guided). Postprocedural computed tomography validated placement accuracy. An independent blinded radiologist evaluated all placements. RESULTS: Of 216 total needle placements, 74 (34.3%) were rated excellent, 109 (50.5%) acceptable, and 33 (15.3%) failed. No significant difference in overall success rates was found between AR-guided and C-arm-guided approaches, χ 2 (2, 216) = 2.96, P = .23. However, lumbar region placements showed significantly higher success in the AR group compared with the control group, χ 2 (2, 120) = 7.09, P = .03. CONCLUSION: AR-guided facet joint needle placement demonstrates accuracy and safety comparable to conventional C-arm-guided techniques. The AR-HMD system enhances 3D anatomic visualization and may reduce radiation exposure for healthcare personnel. These findings support further exploration of AR technology in spinal interventions.