Surgeons at Baltimore-based Johns Hopkins University performed the first two spinal surgeries using augmented reality technology from Augmedics on June 8 and 10 and are excited about the technology's future.
The xvision Spine System includes a headset for real-time spinal anatomy projection, allowing for 3D visualization of the spinal anatomy during surgery. It is designed to appear as if the surgeon has X-ray vision into the patient's anatomy to accurately navigate instruments and implants while looking directly at the patient instead of a screen.
Timothy Witham, MD, director of the Johns Hopkins neurosurgery spinal fusion laboratory, performed the first procedures along with Daniel Sciubba, MD, director of spinal tumor and spine deformity surgery in the department of neurosurgery at Johns Hopkins, and Johns Hopkins neurological surgery resident Camilo Molina, MD. The procedure was a posterior lumbar decompression, spondylolisthesis correction and fusion.
Dr. Sciubba and his team at Johns Hopkins performed the second procedure on June 10, which was a complete spinal tumor resection. He considers the technology invaluable for treating malignant spinal tumors with an en-bloc resection.
"For the surgeon, Augmedics provides increased visualization of the entire spine and tumor anatomy, allowing complete tumor resection to be accomplished safely," he said. "The technology also allows a more efficient surgery and saves time in the operating room. Finally, augmented reality also limits the use of radiation to the patient, to the surgeon, and to the operating room staff. In short, it allows for the most effective treatment for the removal of spine tumors I have experienced in the last 20 years of doing such surgeries."
En-bloc resections for spinal tumors are challenging procedures and risky for patients because they are performed adjacent to the spinal cord and great vessels; this technology allows surgeons to perform a more precise procedure because they can see the detailed elements of the spine, tumor and adjacent anatomical structures simultaneously.
"Surgeons are limited by what they can see in the operating room. To overcome this limitation, we use different tools to 'help us see,'" said Dr. Sciubba. "Such tools include fluoroscopy, navigation and now, robotics. However, the reason that there is no single premier technology for spine surgeons is because each of these tools has a major limitation. Fluoroscopy involves radiation to the patient and surgical staff; navigation draws the surgeon's attention away from the surgical field and can be distracting and inaccurate; robotics removes the surgical instruments from the surgeons' hands, risking error within the robotic platform. Augmented reality combines the best of all three of these tools."
With augmented reality, surgeons don't need to shoot multiple X-rays like they do with fluoroscopy to visualize the instruments' lcoation, and the anatomical information is transmitted directly onto the retina of surgeons while operating to avoid the attention shift and distractions that could occur with other monitor-based navigation systems.
"Surgeons are able to operate in their most comfortable positions, without an intervening bulky robot, while still being able to use all the advanced information in real time," said Dr. Sciubba. "In my opinion, all spinal procedures will be able to harness this technology: open surgery, minimally invasive, degenerative, trauma, tumor and deformity. Likewise, both novice and master surgeons alike will be able to improve their surgical techniques, allowing improved outcomes for all of our patients."
The first procedure Dr. Sciubba performed with the augmented reality technology was successful to remove the entire L1 vertebral body and place spinal hardware including pedicle screws, rods, titanium cages and structural bone graft. The patient is now neurologically intact, tumor free and going through the rehabilitation process.
The Johns Hopkins team has also authored two articles based on the augmented reality technology in spine. One article, titled "Augmented reality-assisted pedicle screw insertion: a cadaveric proof-of-concept study" is published in the Journal of Neurosurgery: Spine. The second article, titled "A Cadaveric Precision and Accuracy Analysis of Augmented Reality Meditated Percutaneous Pedicle Implant Insertion" is pending publication in JNS: Spine. Dr. Molina is the lead author on both studies.