Johns Hopkins surgeons used augmented reality to perform spinal surgery

When surgeons at the Johns Hopkins Hospital performed surgery to stabilize a patient’s spine last month, they did so wearing a headset that looked like a fighter pilot’s headgear, with a foot pedal they could turn on and off hands free. The headset overlaid 3D images directly into their view of the patient’s anatomy as they placed screws to stabilize the patient’s spine.

“This is like a GPS for the spine,” said Dr. Timothy Witham, director of the Johns Hopkins Neurosurgery Spinal Fusion Laboratory, who was one of three surgeons performing the procedure.

The June 8 procedure marked the first use of an augmented reality system that is designed specifically to guide surgeons. Developed by Chicago-based Augmedics, the system, known as xvision Spine System, brings the technology that puts a computer-generated image into a person’s sight line into surgery.

For the procedure known as spinal decompression and fusion operation, surgeons placed screws and rods to stabilize the spine of a woman with low back and leg pain due to arthritis. It takes precision, as surgeons want to place the screws as firmly as possible, while also doing so in a way that will avoid any harm of the nearby spinal cord and nerves, or organs. Typically, this has been accomplished using surgeons’ own eyes and X-rays. It’s also an area where computer assistance or robotics has come into play.

But in the case of computer assistance, there remained the need to look at another screen. With augmented reality, the system determines both the position of the tools and displays the trajectory of the procedure to guide the surgeon.

A Historic moment for Surgery!
Neurosurgeons Daniel Sciubba, MD, MBA, Timothy Witham MD and Camilo A. Molina M.D. have performed the WORLD'S FIRST Augmented Reality Surgery at Johns Hopkins Hospital with Augmedics's xvision system…https://t.co/2LIylU7Tgb https://t.co/VEPD65NFWd

— Augmedics (@augmedics) June 11, 2020

For the surgeons, the system is designed to be lightweight. They are used to wearing a headset, and it includes clear eyepieces that projects the images right to their retinas, even as they can still see the physical world in front of them. The patient’s CT scan with 3D navigation data is projected right into their field of view via the headset. That way, the surgeons don’t have to look away from the patient, and it brings a view of the patient’s anatomy in higher focus. It also goes deeper into detail, with a view through the tissues just next to or deeper beyond what they see.

“In essence, it allows almost an ‘x-ray vision’ when we look at the patient,” said Dr. Daniel Sciubba, a professor of neurosurgery who was one of the surgeons performing the procedure. “This makes the surgery so much safer and faster as now we can ‘see’ things beyond what is normally visualized by the average surgeon.”

It was a milestone moment for Augmedics, which said xvision is the first AR guidance system to be used in surgery. The company was founded in 2014 and has a team of 50 people spilt between the U.S. and Israel. Two team members were onsite for the surgery to answer questions, but reported that the system performed “flawlessly.”

“Today marks a new era in spine surgery,” Augmedics founder Nissan Elimelech said in a statement. “This first case is just the beginning of a revolutionary change to the way surgery is performed by providing surgeons with more control, giving them the information they need, directly within their working field of sight, to instill technological confidence in the surgical workflow, and to help surgeons perform as safely and effectively as possible.”

The system was also used during a second procedure that week, and both patients are doing well, said Dr. Sciubba.

The development of the technology involved close collaboration with the Hopkins team, which included Drs. Sciubba, Witham and Camilo Molina, a JHU neurosurgery resident. They worked with the Augmedics team over years as they conducted studies of the technology and published the results in peer-reviewed journals, and Dr. Sciubba was also on the team that presented the prototype to the U.S. Food and Drug Administration, which granted regulatory approval for use.

Augmented reality gained wide popularity through the Pokemon GO craze, but use cases have sprung up in less public formats, now including AR in the OR. The company is also exploring use in procedures beyond spinal surgery. It’s also the latest sign of Hopkins playing a role in developing new forms of technology for healthcare.

“Usually there is a tradeoff between increased accuracy, precision and safety versus efficiency or time. So, as we get safer, usually the procedure takes longer,” said Dr. Sciubba. “However, with this innovative technology, there is no tradeoff. This technology with shift the innovation frontier and set the new standard.”