An orthopedic surgeon at Hospital for Special Surgery (HSS) has performed the first augmented reality-guided spine surgery in New York State. Frank Cammisa, MD, chief emeritus of HSS Spine, performed a successful spinal decompression and fusion on a 28-year-old male patient with the first augmented reality (AR) system cleared by the FDA for navigation in spine surgery.

Augmented reality refers to digital information that is superimposed on a user’s view of the physical environment, providing images that can’t be seen with the naked eye. AR navigation in spine surgery superimposes 3D images of a patient’s anatomy onto the surgeon’s view of the operative field. Critical elements include a preoperative CT scan of the patient’s spine, which is used to plan and perform the surgery, and an augmented reality headset worn during the procedure.

The system Dr. Cammisa uses consists of a near-eye-display headset and the elements of a traditional navigation system. During surgery, it accurately determines the position of surgical instruments in real time and superimposes them on the patient’s CT data. It has been likened to giving surgeons “x-ray vision,” enabling them to see structures underneath the skin.

Visualizing the patient’s anatomy

“The technology allows us to visualize the patient’s 3D spinal anatomy during surgery to accurately guide instruments and place surgical implants, such as pedicle screws, while looking directly at the patient rather than at a separate computer screen,” Dr. Cammisa explained. “Improved control and visualization of the patient’s anatomy and critical structures can lead to a more precise, efficient surgery and can enhance safety.” 

He notes that the technology allows for a highly personalized surgery that can be used for most spinal procedures requiring the use of implants. People with degenerative disc disease, spinal stenosis and spinal deformities may be candidates.

Dr. Cammisa notes that as more surgeries are performed with the augmented reality system, patient follow-up and data collection will enable HSS researchers to compare AR to other technologies used in spine surgery to evaluate outcomes.