Becker's Spine Review

36 DEVICES & IMPLANTS How 4 surgeons see AR developing in spine By Alan Condon A ugmented reality made a seismic breakthrough in spine surgery this year aer Augmedics' Xvision system launched in the U.S. in December 2019. e technology has impressed surgeons with its enhanced visualiza- tion of anatomy, improved surgeon control and eliminating radiation exposure. Many leading institutions have become early adopters of the technology, including Johns Hopkins in Baltimore and Midwest Orthopaedics at Rush in Chicago. Here's how four surgeons are viewing the technology: Antonio Prats, MD. Mercy Hospital (Miami): It just makes things so much easier for the surgeon. at's the bottom line. For example, if you're working with fluoroscopy, you have to move the machine in and out, you're wearing a lead vest covering your thyroid gland. e machine has to come in and out and a lot of times you contaminate the machine. It's an X-ray that's going through the patient and sur- gical staff. With this technology, you remove all that. I'm not putting on lead at all. I just put on my headset and get to work. In a nutshell, it just makes things a lot easier and it's more accurate. Any time you have more accuracy — and in spine surgery where millimeters count — it's better for the patient and the surgeon. It's great for straightforward MIS cases like spondylolisthesis. For more complex cases, anything that you use navigation with, like tho- racolumbar fractures and when you have to use pedicle screws, that's where I envision this technology working beautifully. MIS proce- dures, where you would normally use the O-arm, are the ideal cases for the Augmedics system. Christopher Good, MD. Virginia Spine Institute (Reston): I fore- see the modern OR using AR not only to enhance navigation and instrumentation, but to also provide surgeons endoscopic or magni- fied views of the patient's anatomy, and to superimpose clinical and radiographic data all on a simple-to-use, heads-up display. I see this as a huge breakthrough with the potential to streamline and partner several technologies in the OR. We have already seen this technology incorporated into many areas outside of medicine. I believe there will be a strong patient interest and demand for AR as we continue to push to make our surgeries safer and less invasive. Mark Mikhael, MD. NorthShore Orthopaedic Institute and Illi- nois Bone & Joint Institute (Chicago & Glenview, Ill.): It's too early to know the true impact of AR and virtual reality in spine, but I do see it as another tool to help surgeons with navigation. For AR, in- stead of relying on the preop scans and imaging as well as the bulky equipment — the monitors and mobile systems — we have a high- tech headset with glasses. I see two advantages with the setup. First, we have the ability to look directly at the patient while perform- ing surgery, seeing the anatomy through the glasses, instead of look- ing up at the monitor; and second, we don't have a lot of equipment in the surgical suite with us. Overall, it seems to cut cost and clutter in the OR. But we still don't know the accuracy of the technology and its reproducibility — how well it will work in the hands of all sur- geons with varying degrees of experience. VR is a similar approach. Navigation systems are here to stay, but I expect it will be another five years before AR and VR are fully adopted. We will likely stay with traditional navigation until then. Raymond Gardocki, MD. Vanderbilt University Medical Center (Nashville, Tenn.): I've had an opportunity to look at it and thought it was excellent. I can definitely see an application for it with endo- scopic surgery. One of the big hurdles for surgeons starting with en- doscopic surgery is being able to properly place the needle, especially in the foramen for transforaminal approaches. Surgeons are just not used to driving a needle, so being able to visualize where the needle is and see the foramen would be of tremendous value. Plus, with the Vanderbilt fellowship program, if we're going to allow fellows to per- form endoscopic procedures, being able to see where the tip of the instruments and the scope are, instead of having to guess or use an X-ray, would be huge. n Stryker introduces next-gen surgical helmet By Alan Condon S tryker launched the next generation of its T7 helmet, a personal protection system designed for surgeons, according to a Jan. 4 news release. Three details: 1. T7 features ethylene-vinyl acetate foam to provide a light- er and cooler headset. 2. The upgraded system has an extended battery life, a dual adjustment knob to control height and width and a noise reduction of 40 percent compared to the prior model. 3. Stryker also launched a line of surgical hoods and gowns called T7plus, which is designed to keep surgeons cool and protects against infectious diseases. n ChoiceSpine device surpasses 3K implantations By Alan Condon T iger Shark, a 3D-printed titanium interbody designed by ChoiceSpine, has been implanted in more than 3,000 patients, according to a Dec. 31 news release. Three things to know: 1. Tiger Shark implants are radiolucent, allowing for porosity and a rough surface area that facilitates bone growth to optimize fusion. 2. The implants feature large graft windows and a large bone ingrowth surface area designed to assist surgeons restoring sagittal balance. 3. The Tiger Shark portfolio includes a cervical, lumbar and lateral interbody. n

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