How 4 surgeons see AR developing in spine


Augmented reality made a seismic breakthrough in spine surgery this year after Augmedics' Xvision system launched in the U.S. in December 2019.

The technology has impressed surgeons with its enhanced visualization of anatomy, improved surgeon control and eliminating radiation exposure. Many leading institutions have become early adopters of the technology, including Johns Hopkins in Baltimore and Midwest Orthopaedics at Rush in Chicago.

Here's how four surgeons are viewing the technology:

Antonio Prats, MD. Mercy Hospital (Miami): 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 an 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. 

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. 

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. 

Raymond Gardocki, MD. Vanderbilt University Medical Center (Nashville, Tenn.): I've had an opportunity to look at it and thought it was excellent. I can definitely see an application for it with endoscopic surgery. One of the big hurdles for surgeons starting with endoscopic surgery is being able to properly place the needle, especially in the foramen for transforaminal approaches. Surgeons are just not used to driving a needle, so being able to visualize where the needle is and see the foramen would be of tremendous value. Plus, with the Vanderbilt fellowship program, if we're going to allow fellows to perform endoscopic procedures, being able to see where the tip of the instruments and the scope are, instead of having to guess or use an X-ray, would be huge.

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