{
  "abstract": "Objective: Posterior C1–C2 instrumentation is technically demanding because of the complex osseous and vascular anatomy of the atlantoaxial region. This retrospective single-center case series aimed to describe the technical feasibility and observed screw-placement outcomes of a combined microscope-integrated augmented reality (AR)-assisted navigation workflow in patients with atlantoaxial instability. Methods: Two neurosurgeons and one radiologist assessed screw placement accuracy on computed tomography (CT) images using the Gertzbein–Robbins classification, applying the Bredow modification for the cervical spine. Cortical breaches were classified as Grade 1, <1 mm; Grade 2, 1 to <2 mm; Grade 3, 2 to <3 mm; Grade 4, 3 to <4 mm; and Grade 5, ≥4 mm, or as transverse foramen obstruction exceeding half the screw diameter. Grades 1 and 2 were considered acceptable for screw insertion. Results: A total of 40 screws were successfully placed in 10 patients, comprising 20 C1 lateral mass screws and 20 C2 pedicle screws, achieving an overall acceptable placement rate of 97.5% (39/40; 95% CI, 86.8–99.9%). All 20 C1 lateral mass screws were accurately positioned, while the acceptable placement rate for C2 pedicle screws was 95.0%. One C2 pedicle screw in a 1.7 mm pedicle was graded as Grade 3. No clinically apparent vascular or neurological injuries were observed. Conclusions: The combined microscope-integrated AR-assisted navigation workflow was feasible in this small case series, with a high observed acceptable screw-placement rate and no observed neurovascular complications. The independent contribution of AR and its effects on outcomes relative to other guidance techniques require evaluation in larger comparative studies.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407219, Taiwan",
    "Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan",
    "Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan",
    "Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan",
    "College of Health, National Taichung University of Science and Technology, Taichung 404336, Taiwan",
    "Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407219, Taiwan",
    "Institute of Biomedical Sciences, National Chung Hsing University, Taichung 402202, Taiwan",
    "Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Houlong, Miaoli County 356006, Taiwan"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Chi-Ruei Li",
      "orcid": "0000-0001-7998-6607"
    },
    {
      "affs": [
        2
      ],
      "name": "Song-Ru Jhan"
    },
    {
      "affs": [
        0,
        3,
        4
      ],
      "name": "Hsi-Kai Tsou",
      "orcid": "0000-0001-9374-9923"
    },
    {
      "affs": [
        0
      ],
      "name": "Yu-Jui Chang"
    },
    {
      "affs": [
        0
      ],
      "name": "Mao-Shih Lin",
      "orcid": "0000-0002-9960-5354"
    },
    {
      "affs": [
        5,
        6,
        7
      ],
      "name": "Chung-Yuh Tzeng",
      "orcid": "0000-0002-6415-8670"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Ting-Hsien Kao",
      "orcid": "0000-0001-8440-5096"
    },
    {
      "affs": [
        0
      ],
      "name": "Chiu-Chun Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Jheng-Yan Chen"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Chih-Wei Huang",
      "orcid": "0000-0002-2547-0581"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6y900k0cn1ph4.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15207812",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705249/?tool=EBI",
  "id": "6y900k0cn1ph4",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/7812",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Spinal Fractures and Fixation Techniques"
    ]
  ],
  "openalex": "W7221336789",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705249/pdf/?tool=EBI",
  "pmcid": "PMC13705249",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/6y900k0cn1ph4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15207812",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/7812"
    },
    {
      "first_seen": "2026-10-30T12:21:31Z",
      "native_id": "PMC:PMC13705249",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13705249"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Spinal Fractures and Fixation Techniques",
      "subfield": "surgery"
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  ],
  "title": "Microscope-Integrated Augmented Reality-Assisted Navigation for C1–C2 Instrumentation: A Retrospective Single-Center Case Series",
  "title_text": "Microscope-Integrated Augmented Reality-Assisted Navigation for C1–C2 Instrumentation: A Retrospective Single-Center Case Series",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:31Z",
  "url": "https://research.draconitic.com/paper/6y900k0cn1ph4",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}