In a preclinical study, neurosurgeons using augmented reality were able to more precisely place screws in cadavers’ spines.

Royal Philips is working on an augmented reality surgical navigation technology designed to help surgeons perform image-guided open and minimally-invasive spine surgery.
Augmented reality has implications for thoracic spine fusion surgery in adults, pediatric spine surgery, and for cranial and trauma surgeries, according to a company statement. Located in the mid- to upper back, the thoracic spine is made up of smaller vertebrae than the lower, lumbar spine, making thoracic fusion surgery more challenging and dangerous to surrounding tissue and nerves.

A preclinical study of the new technology involving the placement of pedicle screws in the thoracic spines of cadavers demonstrated an 85% accuracy rate, versus 64% accuracy for freehand placement. Philips, Karolinska University Hospital (Stockholm, Sweden) and the Cincinnati Children’s Hospital Medical Center collaborated on the study, published in the journal Spine.

Augmented-Reality-in-Healthcare IDR Medical Philips Augmented RealitySuch improved accuracy implies lower complication rates, according to Ronald Tabaksblat, business leader of image-guided therapy systems at the Amsterdam-based company.

Philips would need regulatory clearance to add its latest technology to its existing low-dose X-ray systems for clinical trials scheduled at Karolinska, Cincinnati Children’s and about eight other sites globally, Tabaksblat said in an interview. If fully approved by FDA and the EU, Philips could deploy it to thousands of hospitals around the world, he noted.

The technology uses high-resolution optical cameras mounted on a flat panel X-ray detector to image the surface of the patient. By combining the external camera view and the internal 3D view of the patient acquired by the X-ray system, the technology constructs a 3D augmented-reality view of the external and internal anatomy. This real-time, 3D view of the patient’s spine, is designed to improve procedure planning, surgical tool navigation, and implant accuracy, and to reduce procedure time.

The technology could prove especially helpful in cranial surgery because the pressure released by opening the cranium allows the brain to change shape. That movement can make pre-surgical images from MRI and CT scans less valuable to neurosurgeons, and make real-time imaging more valuable, according to Tabaksblat.

“There are significant challenges in that area, and we feel our technology can really make a difference there as well,” he said. “We are starting with spine. We have a lot of experience in designing image guidance systems. You need to tailor them to the specific procedure.”

Tabaksblat declined to discuss a timeline for a system to assist in brain surgery but said fine-tuning the system for trauma surgeries would follow.

“We will really have to narrow it down to specific scenarios, but our customers are indicating that trauma is very interesting to look at,” he said.