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Surgeons Use Augmented Reality for Minimally Invasive Spine Surgery

Published December 4, 2020
| Written By SpineNation Editorial Staff  
With the creation of the mobile game Pokémon Go and the release of smart glasses like Google Glass, augmented reality became a household word. But this technology, which superimposes images and text over a person’s view of the world, is helping surgeons perform minimally invasive spine surgery safer, quicker, and more efficiently.

“The really game changing aspect of this [technology] is the ability to actually see the spine through the skin,” says Dr. Frank Phillips, professor and director of the Division of Spine Surgery and the Section of Minimally Invasive Spine Surgery at Rush Medical Center. “You are essentially seeing the 3D anatomy of the spine with the skin intact. And the image looks like the spine, not a computer-recreated image of it.”

Philips recently became the first surgeon to use the Augmedics xvision Spine System surgical guidance system during surgery, according to Midwest Orthopaedics at Rush. In June, he used the system to carry out a minimally-invasive lumbar fusion with spinal implants on a patient who had spinal instability that was causing severe back pain and limited mobility. Phillips reports that the patient is now doing well.

With this system, a headset worn by the surgeon superimposes images of the patient’s spine and surrounding tissue over what the surgeon is looking at in the real world, giving them an augmented reality version of X-ray vision. The images come from CT imaging of the patient that occurs throughout the surgery.

Phillips says the system is intuitive and easy to use in the operating room. “It’s not like you're immersed in this virtual reality world where you feel like you're out of touch with reality,” he says. “If you adjust your eyes a few degrees, you're seeing what you normally see in an operating room. So it’s not disorienting as you might expect from virtual reality.”

The xvision system has received approval from the U.S. Food and Drug Administration. Given its ease of use, it could change how surgeons carry out spine surgery by giving them clearer visualization of a patient’s bones and tissues, as well as better control of surgical implements. The hope is that this will result in safer procedures and faster recovery times.


Phillips says that while the system can be used for open surgeries, it is especially helpful for minimally-invasive procedures. “With minimally-invasive surgery, you’re looking at the skin and a five-millimeter incision, and putting a screw in,” he says. “So you’re not seeing the spine at all. You’re relying entirely on X-ray images.”

According to Chicago-based Augmedics, the system uses an augmented reality headset with a transparent display that allows surgeons to see both what is in front of them in the real world and 3D images of the patient’s anatomy. The headset projects the images onto the surgeon’s retina in real-time. This allows them to see CT scan images without having to look away from a patient and at a remote screen during a procedure.

Prior to approval by the FDA, Phillips tested the xvision system during a cadaver dissection carried out at Rush Medical Center. A study related to this, published last March in the Journal of Neurosurgery, compared the placement of pedicle screws in the spine using the augmented reality system to conventional methods.

Researchers found that the accuracy of the screw placement using the xvision system was 96.7 percent. This was similar to what was achieved with robotics-assisted computer-navigated insertion and superior to inserting the screws manually by hand. In addition, the user experience of the augmented reality system was found to be “excellent.”

“The speed [when using the system] is a huge advantage,” says Phillips. “It’s so precise and you can see the anatomy so clearly during a minimally-invasive procedure.”
Updated: November 20, 2020

Information provided within this article is for educational purposes and is not a substitute for medical advice. Those seeking specific medical advice should consult his or her doctor or surgeon. If you need to consult with a specialist, you may be able find a health care provider in our Specialist Finder. SpineNation does not endorse treatments, procedures, products or physicians.

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