Dr. Antonio Prats: How augmented reality is changing spine surgery

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Mercy Hospital in Miami is one of three HCA East Florida hospitals now offering augmented reality spine surgery.

Antonio Prats, MD, leader of the AR spine program at Mercy, spoke to Becker's about how the Augmedics Xvision Spine system is revolutionizing spine surgery at his hospital.

Note: Responses are lightly edited for style and clarity.

Question: How does augmented reality improve how spine surgeons operate?

Dr. Antonio Prats: With the headset on, I can look through the patient's body and do the surgery as I would if it was an open procedure and everything is in front of me. That's the beauty of it. If you're in the OR, you're seeing on a monitor exactly what I'm seeing through my headset. An example of this is when I'm placing pedicle screws. The OR staff can see exactly what I'm seeing — it's another pair of eyes for surgeons to utilize. 

Q: What about this technology particularly excites you?

AP: It just makes things so much easier for the surgeon. That's the bottom line. For example, if you're working with fluoroscopy, you have to move the machine in and out, you're wearing a lead vest covering your thyroid gland. The machine has to come in and out and a lot of times you contaminate the machine. It's X-ray that's going through the patient and surgical staff. With this technology, you remove all that. I'm not putting on lead at all. I just put on my headset and get to work. In a nutshell, it just makes things a lot easier and it's more accurate. Any time you have more accuracy — and in spine surgery where millimeters count — it's better for the patient and the surgeon. 

Q: What spine cases will the Augmedics device benefit most?

AP: The answer is anything. It's great for straightforward MIS cases like spondylolisthesis. For more complex cases, anything that you use navigation with, like thoracolumbar fractures and when you have to use pedicle screws, that's where I envision this technology working beautifully. MIS procedures, where you would normally use the O-arm, are the ideal cases for the Augmedics system. 

Q: What is the learning curve like with the Augmedics system? How difficult is it to get to grips with?

AP: I think everything has a learning curve, but I've noticed that the learning curve with this new technology is minimal. If you have experience putting in pedicle screws with fluoroscopy or the O-arm, it should be a piece of cake for any surgeon to pick this up and use it very easily. In a nutshell, this technology takes something that everybody is familiar with and makes it better, and makes it so that the surgeon is using his or her hands in a way that everybody is accustomed to. Essentially, you're looking down at the patient through your headset, and you're seeing things that you'd normally have to see by looking at a monitor off to the side of the patient. It makes your technique much more comfortable, and, in my opinion, it's going to be a lot more accurate.

Anything that makes your life easier in surgery, potentially shortens your surgery, or removes the risk of radiation to the surgeons and surgical staff, is better for the patient. These are all positive things, so for me this technology is a no brainer. 

Q: Is it an expensive system to acquire? 

AP: The O-arm is the initial expense, which most hospitals have, but the headsets are not expensive to acquire. The O-arm is used to take a CT scan once we place fiducial markers or points. The staff steps out of the room and the CT scan takes place. When you come back in, everything is ready for you. The other beauty of this device is there's no radiation exposure to the patients or surgical staff, because you're doing everything through this neuronavigation. 

Q: Does HCA plan to roll this program out to more hospitals in the near future? 

AP: I believe so. I think this is going to be a technique that's going to be required throughout spine surgery. The three HCA hospitals in Miami-Dade have acquired this technology and it's already being used in spine cases.

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