Last reviewed: November 2026. This guide is for general information and is not medical advice. Talk to a qualified clinician about any treatment decision.
Surgeons use augmented reality (AR) to see scan data and planned instrument paths over the patient during an operation, and virtual reality (VR) to study a patient’s anatomy in 3D beforehand. Spine surgery is where the research is most developed, and even there it mostly measures accuracy, not how patients do afterwards.
Key takeaways
- Spine screws: pooled studies report that 93% to 97% of screws placed with AR navigation were judged accurate.
- Compared with other methods: one 2025 review found better screw accuracy with AR, but no significant difference in operating time or hospital stay.
- Regulation: the FDA’s public list of AR and VR medical devices had 104 entries at its December 2025 update, many of them surgical or imaging systems.
- Open questions: learning curve, cost, and whether better accuracy leads to better outcomes for patients.
In this guide
How AR and VR are used in surgery
- Navigation during the operation (AR). With conventional computer navigation, the surgeon looks away from the patient to a separate screen. AR systems place the same guidance, such as the planned path of a screw, in the surgeon’s view of the operating field, through a headset or a camera-based display.
- Planning before the operation (VR and 3D viewing). CT and MRI scans are turned into a 3D model the surgical team can rotate, enlarge and discuss before the first incision.
- Training. Simulators let trainees rehearse procedures away from patients. That is covered in our guide to virtual reality in medical training.
Spine surgery: the best-studied use
Spinal fusion often involves placing screws through a narrow bridge of bone close to nerves and blood vessels, so small errors matter. That makes it a natural test case for AR guidance, and several reviews have pooled the results.
- A 2023 meta-analysis combined 8 studies covering 163 patients and 1,259 screws and calculated an overall accuracy of 97.2%.
- A 2024 systematic review in the European Spine Journal found 93.1% of 2,232 AR-guided screws were clinically accurate. Results in individual studies ranged from 26.3% to 100%, a reminder that systems and settings differ widely.
- A 2025 systematic review of 31 papers compared AR navigation with other techniques. About 93% of AR-guided screws met its accuracy standard against about 86% without AR. Operating time and length of hospital stay were not significantly different.
- An earlier review of 28 studies reported workflow advantages and accuracy at least as good as free-hand or conventional navigation, while describing the research as being at an early stage.
The picture is consistent: AR navigation can place spinal screws accurately. What the reviews keep asking for is larger prospective studies that compare it directly with established methods and report cost, operating time and radiation exposure.
Planning an operation in 3D
Software that shows scans as immersive 3D models is an established product category. A 2025 review of VR in radiology lists FDA-cleared examples, including a system cleared in 2022 for immersive 3D viewing of medical images in preoperative planning.
Clearance of this kind confirms that a product works as a viewing tool. It is not, by itself, evidence that operations planned in VR turn out better. Our guide to augmented reality in medical imaging covers this area in more detail.
What regulators have cleared
The FDA publishes a list of medical devices that use AR or VR. According to an analysis by the consultancy Exponent, the list held 104 entries after its December 2025 update, up from 39 in December 2022. Most were cleared through the 510(k) route, which is based on similarity to an existing device, and nearly 90% were reviewed by the agency’s neurology or radiology panels. The FDA notes that the list is not comprehensive.
Limits of the evidence
- Accuracy is not the same as outcome. Most studies measure where a screw ended up, not pain, function or the need for repeat surgery years later.
- Few head-to-head comparisons. Much of the data comes from case series without a comparison group.
- Learning curve. The 2024 review notes that clinical adoption is still early and that the learning curve for surgeons is not yet known.
- Beyond the spine. AR is being tried in orthopedic, brain and other surgery, but pooled evidence there is thinner than for spinal screws.
Questions to ask
- Is the navigation system cleared for this type of operation?
- How many procedures has the surgical team done with it?
- What is the plan if the system cannot be used on the day?
For the wider picture, see our guide to augmented reality in healthcare.
Common questions
How accurate is AR-guided spine surgery?
Pooled studies report that 93% to 97% of screws placed with AR navigation were judged accurate.
Is AR-guided surgery better than conventional surgery?
One 2025 review found better screw accuracy with AR navigation, but no significant difference in operating time or hospital stay. Whether patients do better in the long term is not yet known.
Are AR surgical systems cleared by the FDA?
Some are. The FDA’s public list of AR and VR medical devices had 104 entries at its December 2025 update, many of them surgical or imaging systems.
Sources
- Assessing the Accuracy of Spinal Instrumentation Using Augmented Reality: A Systematic Review of the Literature and Meta-Analysis. Journal of Clinical Medicine, 2023.
- Youssef S, et al. Accuracy of augmented reality-assisted pedicle screw placement: a systematic review. European Spine Journal, 2024.
- Taylor C, et al. The Clinical Impact of Augmented Reality Surgical Navigation on Pedicle Screw Placement and its Effect on Perioperative Outcomes. Spine Surgery and Related Research, 2025.
- Burström G, et al. Augmented reality navigation in spine surgery: a systematic review. 2021.
- Review of virtual reality in radiology, including FDA-cleared devices. 2025.
- Exponent. FDA expands AR/VR medical device list, February 2026.
- U.S. Food and Drug Administration. Augmented Reality and Virtual Reality in Medical Devices.
