R. Todd Allen, MD, PhD, Professor of Orthopedic Surgery at UC San Diego Health, and the interim chief of spine and director of the Spine Fellowship, talks about how to use augmented reality for spinal surgeries.
How many spine surgeries do you do a day?
ALLEN: It depends. Somewhere between one or none and four to six sometimes.
I mean, it’s such a common problem for people.
ALLEN: Yeah. Back and leg pain can be disabling. In fact, we have several studies that show that the effectiveness of some spine surgeries can be on par with hip replacement, knee replacement and other things that we think are very highly functional surgeries.
Surgery has changed lately, and now it’s more like a video game.
ALLEN: It has a little bit, but I think that it’s not in everybody’s hands yet, to be honest.
Tell me about augmented reality and spine surgery.
ALLEN: We have the opportunity, here at UC San Diego, to employ some of the latest technologies. With augmented reality, or three-dimensional navigated surgery, I have the ability to intraoperatively place a screw in the spine. I have the ability to get the most advanced navigation, three-dimensional picture of the spine prior to placing screws. For example, in the spine to stabilize the spine for either back pain, leg pain or other issues. What that does is if I scan them intraoperatively, I get this three-dimensional view of the spine. It’s all real time. So, for example, I get an instrument and I would take that instrument and I would place a screw in the spine.
How does it change the game for you?
ALLEN: In many ways, and to be frank, there are several ways to train fellows. We train residents and fellows here all the time. And what the fellows and residents normally see is a surgeon, for example, taking a burr and burring something in and placing a screw in the spine. But all they see is a picture looking down at the spine. And then they look and they see someone’s hand moving to create a pathway for a screw. I think it’s very rare to have a technology where you have improved safety and efficiency. And I think truly the most advanced way to train fellows for future spine surgeons. It really is a remarkable way to do it because I could do it in real time. They see exactly what I feel. They see exactly what I see. On the flip side of that, say that they’re going down in – and the best analogy for this is to have the most advanced GPS navigation system in front of you. With most systems in spine surgery that we call navigated or robotic, often you’re looking at a separate screen. In doing so, you’re looking away from the patient. The navigation systems all currently have you look at a screen, you look at the image, and your kind of doing this away from the patient. This system allows you to look down at the patient. All that muscle memory that you have to take a probe and cannulate it very carefully into this corridor, into this pathway in the spine. I can see all the normal tactile muscle memory and feedback that I feel, I can get that in live real time. I can watch somebody do that. I can increase their cadence or their speed. I can slow their cadence down to make it safer. It really is the future way we should train surgeons and future surgeons in the spine. The remarkable thing to me is that it’s like if you superimposed the most advanced navigation system in your car. We always look away in the car. In this situation, we’re so used to looking at the road, so if you superimpose the system of the road in three dimensions for the depth, the speed, understanding there’s a curve ahead, I think it’s just incredible to watch. If you superimpose that for people, you could adjust for a curve ahead, whether it’s a hill, it’s a mountain. You can account for all of that with this three-dimensional system.
For patients and for doctors, does it mean less time spent in surgery? Less risk?
ALLEN: I do think it’s less risk. I do believe that it improves efficiency. I think the safety and the quickness efficiency in the operating room are the two biggest advantages of augmented reality here. I put on this wireless headset, and it lets me look at the spine and see it in three dimensions. The safety and efficiency typically means less blood loss for patients. It typically means a shorter length of stay, hopefully. Really the potential for a quicker recovery and more mobility and an earlier return to kind of their life and function.
I talked to another doctor on Monday about brain surgery, and he’s using this, as well. Is this augmented reality, just the future of surgery?
ALLEN: I think in many ways, because of the technology and because of how it adapts to a patient on the table, I think that it is maybe the future. I do believe for training. I do believe that there are so many things that are better with this system and augmented reality than the current navigation systems. All of the repetitive motions that we do as surgeons are all live basically feeding back to us. When someone else is doing something across from you and you’re doing it, you get all of those feedback mechanisms that let you know that you’re safe and you’re being efficient, and you can place screws quite quickly and safely with this system. That’s really remarkable for patients.
Was it kind of weird to get used to it?
ALLEN: You know, I’ve thought about this. I’ve thought about it because orthopedic surgeons were so used to navigating. We’re so used to arthroscopy of the shoulder, and we want to grab a scope and we triangulate. We say, OK, this camera’s here, this is here, etc. We want to look and see in the shoulder or the knee where that meniscus or where that problem is. We’re so used to doing that. This actually is just kind of a step, a next level step, because you see it all as you’re doing it. It’s not that you’re triangulating on a camera. You’re seeing everything in three dimensions. It’s fun. It’s safe. It’s really efficient. I do think it’s the next level and the next generation of what we need to do for patients to keep them safe.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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