Frank Phillips, MD, Professor and Director of the Division of Spine Surgery and the Section of Minimally Invasive Spine Surgery at Rush University Medical Center talks about new augmented reality surgical guidance technology for minimally invasive spine surgery.
Tell me about this gaming technology and how are you using this for spine surgery?
Dr. Phillips: In my opinion, augmented reality takes minimally invasive spine surgery to the next level. To date, we have used it primarily in lumbar fusion surgery. It enables us to place screws through tiny poke incisions with 3D visualization of the spine through the skin. Essentially the skin’s intact but we are seeing the spine laid out in front of us, which allows for very precise and efficient placement of spinal instrumentation and screws as part of the fusion surgery.
What are the main benefits of using this technology?
Dr. Phillips: I think the benefits for the patients are less tissue trauma because we can precisely make incisions with one pass to screw into the appropriate anatomy. It also leads to efficiency. It is much faster in my hands than the traditional techniques of placing screws which obviously means less anesthetic time. So, I think it translates into a more efficient surgery with the potential for a quicker recovery for patients.
How much less time in surgery do you spend?
Dr. Phillips: There has been considerable time saving with this technology. I can place screws in five vertebrae in under a half hour using augmented reality techniques, that would often take double the amount of time and probably not be as precise as the augmented reality technique enables.
Are there some patients this would be a better option for compared to others?
Dr. Phillips: Any time you are placing screws in the spine, augmented reality technology is applicable. It is really going to become an integral part of every fusion with screws that I do. I think it is more accurate, efficient, and it translates to greater safety for the patient.
How complicated is it?
Dr. Phillips: The ability to see the spine in three dimensions with the skin intact allows you with one pass to perfectly position the starting point of the screw. Then with the heads-up C.T. imaging it provides in addition to the 3D anatomy, you can direct the screw down a perfect path the first time.
How does it change a patient’s quality of life when they only have that one attempt to be accurate?
Dr. Phillips: Anytime you place screws, particularly with minimally invasive techniques, you are going through the muscles around the back of the spine, which are critical to the patient’s function both short term and long term. The more we can do to minimize trauma to the muscles in their back the better patients do in terms of immediate recovery after surgery and long term. So, the augmented reality feature allows us to make the incision in the perfect spot and place the screw as close to perfect as we can get with one pass, to minimize the damage to the muscle envelope around the back of the spine. That translates into quicker recovery post-op and in the long term into less muscle damage to the back of the spine.
How long have you been using this?
Dr. Phillips: The technology is new. We first did it about six weeks ago and I have incorporated it into most if not all my cases.
Do you know how many surgeries you have used this technology in?
Dr. Phillips: I have used it in the last six weeks maybe 10 times. I think other centers are starting to use it as well.
Do you have any numbers on how quickly the recovery time is?
Dr. Phillips: It is obviously new technology, so it is going to take larger patient numbers to measure the outcomes accurately. We are certainly doing that and continue to do that by doing formal studies in terms of time saved, the length of hospital stays and all the outcome parameters that matter to patients. Hopefully, we will get that data over the next six months or so.
How long do people stay in the hospital right after a spine surgery without this technology?
Dr. Phillips: Obviously, it depends on what procedures we do. For me, I am a minimally invasive outpatient type of surgeon. So, a lot of my fusion patients leave within a day or so, sometimes they are even outpatients. This technology will really facilitate more complex surgeries being done with less invasive techniques. I think this will enable us to discharge them within a day or so if we can minimize the posterior back muscle assault.
Is there anything more that you feel people should know?
Dr. Phillips: This technology combines all the benefits of traditional navigation, which involves intra-op CAT scan images, but does it in a heads-up retina display so there is no distraction. You are not looking at a monitor away from the surgical field. The CAT scan images are directly in front of you overlaid on the patients anatomy as you look at the surgical field through the headset. In addition, we now have the game changing piece of this technology. Coupled with the C.T. imaging you have a three-dimensional image of the spine through the skin. It allows us to combine all the technology we already have in a more efficient way and then adds in the 3D imaging, which is new and, in my mind, absolutely game changing.
Are there any limitations that you can see so far?
Dr. Phillips: There are no real limitations to the technology. Obviously with any new technology, there are learning curves in the software. As we learn things, the software continues to get upgraded to make the imaging even more clear, and perfect. I have not had limitations in terms of situations where I cannot use it. I do think over the next year or so, there’ll be iterations that make everything about it better – lighter headsets, more efficient visualization of the spine -small tweaks to make it even better than it is now.
Did you have to take a course to learn it?
Dr. Phillips: A couple of years ago when I met the company that designed the system, we did several trial surgeries on plastic saw bone spine models. We then did cases on cadaver spines in the lab, which was used as part of the FDA study. So, I had a lot of experience using cadaver spines and placing the screws that way. Only after I had been through all of that did I use it on patients in surgery.
Have you used it in all your surgeries so far?
Dr. Phillips: Right now, the prime indication is for placing screws from the back of the lumbar thoracic spine. So, I have used mostly it in those cases.
Interview conducted by Ivanhoe Broadcast News.
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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