Augmented Reality Is Used in Minimally Invasive Spine Surgery
Jacob Bourne posted on June 22, 2020 |
The AR system could revolutionize surgical practice.
Augmented reality surgical headset. (Image courtesy of Augmedics.)
Augmented reality surgical headset. (Image courtesy of Augmedics.)

An xvision surgical guidance system created by Augmedics equips surgeons with the ability to see a patient’s spine in three dimensions, similar to X-ray vision. Dr. Frank Phillips, professor and director of the Division of Spine Surgery and the Section of Minimally Invasive Spine Surgery at Rush Medical Center recently became the first practitioner ever to use the technology during surgery, according to Midwest Orthopaedics. The procedure took place on June 15 on a patient who suffered from spinal instability requiring a lumbar fusion and spinal implants. Augmedics plans to explore the use of xvision for other surgical procedures in addition to spine surgery.

“Having 3-dimensional (3D) spinal anatomic and 2-dimensional (2D) CT scan images directly projected onto the surgeon’s retina and superimposed over the surgical field takes spinal surgery to another level,” said Phillips. “Being able to place minimally invasive spinal instrumentation extremely accurately and efficiently, reducing surgical time and complication risk, is critical to improving outcomes for spinal surgery. Traditional surgical navigation platforms have been shown to improve accuracy of implant placement; however, using augmented reality allows for the advantages of traditional (non-3D) navigation plus the ability to visualize the patient’s spinal anatomy in 3D through the skin.”

According to Phillips, the patient is doing well post-surgery. The xvision system has received FDA approval and could represent a revolution in surgical practice by giving surgeons better control of surgical implements and clearer visualization of anatomy and tissue being operated on. This in turn could result in simpler and safer procedures, as well as faster recovery times for patients.

The xvision system uses an augmented reality (AR) headset that consists of a transparent near-eye display. According to Augmedics, the headset accurately determines the position of surgical tools in real time and also shows a virtual trajectory that is then superimposed on patient CT data. During a minimally invasive procedure, the 3D data is projected onto the surgeon’s retina by the headset, which allows them to see both the patient and the navigation data at the same time—bypassing the need to look away from the patient and at a remote screen as is often the case in conventional robotic-assisted surgeries.

Features of the headset include a custom fit for each user, a high-speed processor for seamless visual tracking, a wireless system for freedom of movement, a transparent AR display, a headlamp and a built-in surgical tool tracking system. According to Augmedics, “the intuitive design aligns the hands and eyes of the surgeon, eliminating the need to avert their eyes to an ancillary screen. The technology provides ‘tip of the spear’ visualization, breaking down the wall between traditional navigation and the patient.” The company also stated that the xvision system is a fraction of the cost of traditional surgical navigation and robotics.

“When we set out to create a better navigation system, we knew it had to be intuitively designed to work within the surgical workflow and align the hands and eyes of the surgeon, eliminating the need to avert his or her eyes to an ancillary screen. Our innovative visualization technology breaks down the wall between traditional navigation and the patient,” said Nissan Elimelech, founder and CEO of Augmedics. “Moreover, the xvision Spine System’s 3D anatomy visualization allows surgeons to accurately guide instruments and implants intraoperatively, in real time, while looking directly at the patient, as if they had X-ray vision.”

Prior to the June 15 surgery, the xvision system had been used during a cadaver dissection by Phillips at Rush Medical Center. A proof-of-concept study published in the Journal of Neurosurgery assessed the comparative accuracy of AR-assisted pedicle screw insertion to conventional pedicle screw insertion methods and found that the overall screw placement accuracy of the AR system was 96.7 percent. The outcome rivaled the accuracy for robotic-assisted computer-navigated screw insertion. User experience of the AR system was also deemed to be “excellent.”

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