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Co-Developing AR Software for Spinal Surgeries

When some surgeons want to do more for their patients, they reach for the latest tools. When Hoag’s neurosurgeons want to do more for their patients, they invent those tools if they don’t already exist.

Hoag’s Pickup Family Neurosciences Institute neurosurgeons Robert Louis, M.D., Chief of Neurosurgery and the Empower360 Endowed Chair in Skull Base and Minimally Invasive Neurosurgery, and Daniel Yanni, M.D., F.A.A.N.S., vice chair of the division of neurosurgery, are working with medical visualization platform leader Surgical Theater to develop augmented reality (AR) software that will shape the future of spine surgery.

“This software expands the amenities of a multimillion-dollar operating theater to a whole new reality, utilizing a portable headset that can be used anywhere,” Dr. Yanni said. “It is analogous to bringing the Iron Man helmet to your local surgeon.” 

SpineAR, co-developed with industry partners at Hoag’s Pickup Family Neurosciences Institute, uses 3D virtual reconstruction and image guidance to create an AR view that incorporates previously acquired 3D CT and MRI spine-scan data in the surgical field, and enhances what the surgeon sees during a procedure. This helps provide the surgeon with real-time 3D guidance and feedback based on a hologram-like reconstruction of the body. Utilizing visualization of multiple displays inside a single set of AR goggles allows millimeter precision of pre-planned surgical guidance and accuracy of instrument placement and surgical motion.

“Look to the left and you see a view of the CT scan. Look to the right and you see a 360-degree reconstruction model. Look down and you see the actual surgical field superimposed on the underlying scan,” Dr. Yanni said.

This enhanced view will result in more efficient surgeries, streamlined surgical planning, less exposure to X-rays and optimal surgical precision. It also enables training of existing and future spine surgeons while deploying Hoag’s technological capabilities to hospitals anywhere.

“Integrating augmented reality into the operating room has the potential to improve patient outcomes at hospitals around the world,” said Burak Ozgur, M.D., chief of service for the Neurosurgery Spine Program at  Pickup Family Neurosciences Institute.

Pickup Family Neurosciences Institute’s comprehensive Spine Program is a recognized leader in accurately diagnosing neck and back pain, while providing the most advanced non-surgical and minimally invasive treatment options available. Hoag’s board-certified, fellowship-trained neurosurgical spine experts provide personalized patient-centered care that enables them to achieve some of the highest clinical outcomes in the nation.

“Much of the discussion of surgical innovation centers around the next hardware iteration. Few people think, ‘How do we change surgical execution?’” Dr. Yanni said. “It takes a hospital as forward-thinking as Hoag to work to change the way surgery is conducted.”

Hoag’s neurosurgeons have recently published the results of a scientific study of the technology on 3D-printed models of the spine. This study showed an accuracy of >99% for pedicle screw placement as compared to 94% using standard approaches. After rigorous testing, followed by independent radiologist evaluation of the accuracy of the tool, an application has been submitted to the FDA for 510K clearance and is now pending final approval. Once this critical milestone has been reached, the system will be available to guide live surgical cases.

“In an academic setting, the speed of evolution would be much slower,” said Dr. Louis. “We are leaps and bounds ahead in terms of both the development and deployment of advanced technologies. We are thrilled to bring this technology to our community and beyond.”