Apple Vision Pro has spine surgery potential, but it's not ready yet, 2 physicians say

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Apple Vision Pro, an augmented reality headset from Apple, was unveiled in June. While the system is marketed for everyday use, like an iPhone, some physicians are thinking about its applications in medicine.

For spine surgeons, navigation systems and headsets are prominent in the industry. These devices enable increased precision and more efficient workflows.

Two spine surgeons discussed Apple Vision Pro in spine surgery, and whether it will make its operating room debut anytime soon.

Note: Responses were lightly edited for clarity.

Question: What potential does Apple Vision Pro have for spine surgery applications?

Maahir Haque, MD. Spine Group Orlando (Celebration, Fla.): Augmented reality devices, if integrated and implemented in the operating room, have the potential to bring significant procedural efficiencies to the spine surgical suite. Surgeons and assistants could for instance have access to preoperative studies during surgery without having to step away from the patient. Augmented reality may allow superimposition of imaging studies and navigation data on the patient anatomy. They could take photos and videos during the case, in a more seamless way than is currently possible, which is very helpful for educational and medicolegal purposes.

That said, there are drawbacks to additional technology. This technology will add cost. The weight of the goggles may lead to fatigue over time. There are concerns with maintaining sterility when doing and doffing the goggles. For surgeons who aren't trained with AR, it may prove challenging to adapt. Lastly, devices in the OR often utilize proprietary communication protocols so an AR solution will be limited by its ability to interact with those devices.

Kris Okumu, MD. Coastal Health Partners (Watsonville, Calif.): In 2013, I used a pair of Epson Moverio BT-100 AR glasses to perform the first "AR guided" spine surgery on a patient in Mountain View, Calif. But essentially, all I was doing was streaming the video output from a Stealth Station and using the semi-transparent display so that I did not have to look away from the operative site as I inserted pedicle screws into vertebrae through small incisions. It worked great, and I have since performed hundreds of AR-guided spine and orthopedic surgeries using just about every form factor, each with its own pros and cons. The problem is that none of them are specifically designed for use in the operating room, so there were limitations. The only device specifically designed for the operating room, as far as I know, is one that is being used for navigated spine surgery, and it works fine for that purpose. If we get to the point where there is a form factor that surgeons will find easy to use, comfortable enough to wear for extended periods of time, and serves a practical purpose (and for surgeons this means making surgery more efficient and safer for patients), then AR glasses may become a useful tool that all surgeons who perform image-guided procedures will want to use. At that point, if the device also has significant processing power, you then have surgeons wearing a powerful computer in the operating room, performing procedures, and the possibilities are endless.  

I have not yet tried Apple Vision Pro, but it does seem quite a powerful device with loads of sensors that can do all sorts of things. And I think that attempts will be made to use it in spine surgery, orthopedic surgery, etc. The problem remains that it too was not designed for the operating room, nor to be worn by surgeons for extended periods of time. Not so long ago, there were attempts to modify an existing, quite powerful AR platform to enhance battlefield capabilities for soldiers. From what I understand, the project was shelved because users complained of eye strain, headaches, nausea, bulkiness of the device, etc. As you can imagine, you don't want those problems when a soldier is on the battlefield. And you wouldn't want them in the operating room when a spine surgeon is millimeters away from delicate structures with sharp instruments … So while I think Vision Pro may have some applications in the operating room, unless there is a Vision Pro Surgical or something of that sort, specifically designed for the operating room, we are still waiting for an optimal solution. And I don't think we are too far away from that point in time.

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