Dr. Safdar Khan, MD, professor of orthopedic surgery and chief of the Division of Spine Surgery in the Department of Orthopedic Surgery at The Ohio State Wexner Medical Center, talks about a new way to perform spine surgery using augmented reality.
Interview conducted by Ivanhoe Broadcast News in April 2022.
Can you describe what the system of augmented reality is and how it helps with spine surgery?
DR KHAN: Augmented reality is an exciting new innovation in spinal surgery. Typically, spinal surgery has been fraught with some degree of inaccuracy or complications. Augmented reality is such an exciting paradigm that promises a lot more accuracy for patient care with complex spinal pathologies.
You’re wearing a special pair of goggles during surgery. Can you kind of walk me through the procedure and how it works?
DR KHAN: Typically, in spine surgery, we use a combination of navigation tools to put our instrumentation in the spine to reconstruct complex pathologies. In augmented reality, we’re combining a headset that loads a 3D real-time image through the headset and marries it together with the patient’s own anatomy in a very personalized way. No longer does the surgeon need to move his or her head back and forth to try to capture the navigation that’s typical with such a procedure. But it’s all loaded into the headset. The trainees can also have a headset that allows them to see what I’m seeing. In fact, we can see the patient’s spine even before we are making an incision. So, our incisions are smaller. Our operative approaches are more technical. There’s a lot less operative time, and the accuracy is incredible.
You mentioned that in traditional surgery, you continue to look down and look up. Can explain that is, that you have to keep taking your eyes off the patient?
DR KHAN: So, in open spine surgery, or even minimally invasive spine surgery, the accuracy of our procedure depends on certain specific navigation tools, whether it’s real time X-rays or other forms of navigation. There’s a screen opposite to where we’re working on the patient. And in order to place the instrumentation, the surgeon has to look down in real time and then look up and then look down. And that can change the accuracy profile, the safety profile. With augmented reality headsets, my entire focus is on the patient right in front of me. And I can plan out a better surgery because I can see the patient’s anatomy even before making an incision, which is truly groundbreaking.
What are some of the things you’d be doing during spine surgery that require that focus?
DR KHAN: I would say everything. In fact, when we have our patient on the table making an appropriate incision, approaching the tissue in a way that is gentle for the patient so that they heal better, approaching the actual bony anatomy in the spine with anatomic corridors that are specific and patient centric, placing screws in, allowing us to decompress or relieve the pressure on the nerves in the spinal cord. All these are made so much more accurate, and I believe patient centric when we use augmented reality technology.
Is this a minimally invasive procedure?
DR KHAN: We can use augmented reality for minimally invasive purposes.
When you are doing a minimally invasive procedure, can you describe the tools? Is there a camera in the tool? How are you getting the vision?
DR KHAN: If I’m doing a minimally invasive spine operation, the way the workflow for augmented reality would work is the patient is under anesthesia. We take an intraoperative CT scan. That intraoperative CT scan is loaded onto the headset, and then, I can see the patient’s anatomy even before making an incision. Consequently, I can take my incision into a very tiny, small, minimally invasive type approach rather than making an incision and then finding out where I am, I can actually build a road map before I’m going into the spine. Consequently, the incisions are smaller. The operative approach is more targeted. Patients recover quicker. In my opinion, patients also do better.
What’s the benefit to the patient allowing doctors to have this higher level of precision?
DR KHAN: Its high level of precision allows our patients to heal quicker. Our incision lengths are shorter. Our operative times are reduced. Our accuracy is increased. I would say that patients would probably be discharged from the hospital quicker, and we’re still doing research whether it could decrease some of the medications post operatively that they need as they need to recover from larger incisions or more invasive surgery.
What’s the percentage of surgeries that need a redo because of the incorrect placement of hardware or screws?
DR KHAN: The literature is varied, but it can reach up to 10 to 15%. And it’s not always just the inability to place screws in the appropriate position. Revision spine surgery can even range from an incorrect diagnosis or incorrect operative approach, a smaller approach when a large approach is needed or vice versa, where a large approach could have been avoided with more precision and accuracy like we use in augmented reality.
With augmented reality, is there a percentage, a higher or lower percentage of revisions?
DR KHAN: We’re still looking at that. It’s so innovative and it’s so new that we only have one or two companies that are FDA approved right now. I’m proud that in Ohio State, we were the first institution in the entire state to use augmented reality for spinal surgery. So, we’re doing the research. We’re very eager to push the envelope and see how we can improve patient care with augmented reality.
Are there some patients for whom this wouldn’t work? Or can you use this pretty much on every patient?
DR KHAN: At this point, we’re using augmented reality primarily for patients with low back and lumbar or thoracolumbar pathology. Currently, cervical or neck pathology isn’t available, but I anticipate that in the next couple of months, we will have patients with cervical or neck pathology augmented reality interventions available.
Why is it not available? Is it a matter of the images?
DR KHAN: It’s a little bit of just a technical part of the algorithm of loading the scans onto the augmented reality headset. But I believe that it should be coming very soon.
Can you tell me a little bit about the patient, Jennifer?
DR KHAN: Jennifer is a patient that I’ve known for a couple of years, now. I was privileged to help her with some of her neck symptoms. And I understand that she had a lot of lower back pain with leg pain and buttock pain, shooting, electrical zingers, as we say, down her legs. The approach we decided to use was an augmented reality approach where we were able to scan her spine when she was asleep in the operating room with an intraoperative CT scan. Wearing those headsets, myself and my assistant were able to visualize her spine, see her pathology, without even making an incision. That tailored our incision to what we specifically had planned to do. We then were able to put screws with incredible accuracy, and then we were able to decompress or relieve the pressure on her spinal nerve sac. This all took probably a quarter to two thirds less time than it would have taken typically. And I believe she’s doing very well.
Had you performed other surgeries on her with a traditional procedure?
DR KHAN: Yes, in her neck. I had helped her with neck and arm pain before, too.
How long have you had the system there?
DR KHAN: We did a trial and Jennifer was part of the trial for 10, 12 patients. We should have it freely available because we’re going through contracting and stuff probably by the summer in like two months or so.
Did COVID slow that at all?
DR KHAN: Yeah.
Is there anything else that you would want to make sure that viewers know?
DR KHAN: Just that we are really at the cutting edge here at Ohio State. I think our division of spine surgery and orthopedics is at the forefront of innovation, new technologies. We’re working relentlessly to bring innovation to Central Ohio. And this is one great innovation that I’m proud of.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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