Baltimore-based Johns Hopkins Medicine surgeons used the Augmedics Xvision Spine System surgical guidance system to perform a pair of spine surgeries in early June, making Johns Hopkins the first institution in the U.S. to perform augmented reality spine surgeries.
Here, Daniel Sciubba, MD, and Timothy Witham, MD, elaborate on the procedures and explore the potential AR technology has in the spine field.
Note: Responses were edited for style and content.
Question: What did you think of the AR technology? How difficult was it to use?
Dr. Daniel Sciubba: The technology was easier to use than I had expected. The headset set-up, registration and retinal imaging display were all very efficient and intuitive. As a very impatient surgeon, I am terrible when technology has a challenging learning curve. I felt the first case went great, and by the second case, we were moving more than twice as fast. I would anticipate that other surgeons see this rapid learning curve for themselves as well.
Dr. Timothy Witham: The AR technology really has a chance to change spine surgery. We have used it for placing instrumentation, but it will likely be applicable to many other aspects of spinal surgery — performing the decompression, resecting tumors, performing osteotomies to correct deformities and probably more. At first the technology requires some getting used to, but the learning curve is very rapid.
Q: Does the technology necessitate additional time before or during the procedure?
DS: There is no extra work needed before the procedure. With regard to additional time during the procedure, if surgeons are completely "free hand" [and don't] use X-rays or fluoroscopy to place pedicle screws, but just use open, topographical landmarks, then the setup adds the time of running an O-arm or Iso-C spin. However, for anyone that uses fluoroscopy, navigation and/or a robot, this setup during the procedure will definitely be faster.
TW: This technology, at the present time, does require obtaining a CT scan during the surgery for registration of anatomical data to generate the augmented reality computer overlay or roadmap for the surgeon. However, this is easily made up for by the efficiency and improved speed at which the instrumentation can be placed.
Q: How does this have the potential to change spine surgery?
DS: Surgeons can operate in their most comfortable positions, while obtaining navigation type information directly projected onto their retinas while looking at the patient. Such technology avoids the radiation of fluoroscopy, the attention diversion of looking at a monitor-based navigation system, and the extra setup of a robot. It may provide the best of all worlds without the extra time, effort or investment in these costly devices.
TW: Again, this technology, while great for instrumentation placement now, will likely be expanded to allow for accuracy and precision in other portions of the procedure (osteotomies, resection of tumors, decompression).
Q: What sort of benefits does AR-assisted surgery have over traditional surgery?
DS: AR-assisted surgery provides the possibility of faster and safer surgery for the patient, cheaper capital investment for the hospital or surgery center, and improved ergonomics for the operating surgeon.
TW: Right now, I think, it gives you real-time confidence to know that your instrumentation is being placed accurately and precisely. Unlike traditional navigation systems, the heads-up display that directly projects images on your retina allows you to attend directly to the patient and not have to look away at a remote computer monitor.