What 5 spine surgeons are thinking about augmented reality


Interest in augmented reality has grown significantly in spine in the last decade, stemming from a desire to limit complications linked to instrumented spine surgery and improving procedural efficiency.

Surgeons at Baltimore-based Johns Hopkins University recently performed the first two spinal surgeries using Augmedics' xvision Spine System, reportedly the first AR technology for spine surgery.

Five spine surgeons share their thoughts on the future of AR in spine:

Christopher Good, MD. Virginia Spine Institute (Reston): I foresee the modern OR using AR not only to enhance navigation and instrumentation, but to also provide surgeons endoscopic or magnified views of the patient's anatomy, and to superimpose clinical and radiographic data all on a simple to use heads-up display. I see this as a huge breakthrough with the potential to streamline and partner several technologies in the OR. We have already seen this technology incorporated into many areas outside of medicine. I believe there will be a strong patient interest and demand for AR as we continue to push to make our surgeries safer and less invasive.

Mark Mikhael, MD. NorthShore Orthopaedic Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): It's too early to know the true impact of AR and virtual reality in spine, but I do see it as another tool to help surgeons with navigation. For AR, instead of relying on the preop scans and imaging as well as the bulky equipment — the monitors and mobile systems — we have a high-tech headset with glasses. I see two advantages with the setup. 

First, we have the ability to look directly at the patient while performing surgery, seeing the anatomy through the glasses, instead of looking up at the monitor; and second, we don't have a lot of equipment in the surgical suite with us. Overall, it seems to cut cost and clutter in the OR. But we still don't know the accuracy of the technology and its reproducibility — how well it will work in the hands of all surgeons with varying degrees of experience. VR is a similar approach. Navigation systems are here to stay, but I expect it will be another five years before AR and VR are fully adopted. We will likely stay with traditional navigation until then. 

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The next big innovation will be the development of a spinal robot that actually helps us do the surgery part of the operation. While the placement of pedicle screws with robots is making surgery safer, it is not the game- changer we are waiting for. When we can marry intraoperative visualization with augmented reality and a robot, then you're talking revolution.

Raymond Hah, MD. Keck School of Medicine of USC (Los Angeles): I am very excited to see the way that robotics will be applied beyond the limited scope of assisting planned pedicle screw placement, including potential motion restriction for "no-fly zones," automation of surgical decompression and use of artificial intelligence and machine learning for anatomy recognition and guidance of surgical execution. An interesting overlap will be as AR becomes available in a commercially applicable fashion and the ways that this may assist surgeons intraoperatively. This could also prove to be an extremely valuable tool for presurgical planning as well as patient education.

Frank Phillips, MD. Rush University Medical Center (Chicago): I am particularly excited by the use of AR in spine surgery. Recently the FDA has approved a unique system that comprises a headset with integrated tracking cameras and direct retinal near-eye display that provides for virtual 3D visualization of the spinal anatomy as well as standard 2D CT navigation images. At Rush we performed the cadaveric testing of this system that resulted in FDA approval, and I was highly impressed with the advantages this system provides.

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