Doctors in Jerusalem perform revolutionary AR robotic spine surgery

Doctors in Jerusalem perform revolutionary AR robotic spine surgery

A 25-year-old man is being treated in the emergency department of Jerusalem’s Shaare Zedek Medical Center (SZMC) after being seriously injured in a fall at work. The trauma team diagnosed an unstable spinal fracture that put the man at risk for paralysis and other severe neurological damage.

After examining the patient, Dr. Cezar Mizrahi, a neurosurgeon in the hospital’s spine surgery department, thinks patients can benefit from new technological advancements: robotic-guided imaging of fractured spines and the aid of augmented reality.

The patient became the first person in the world to undergo a procedure using augmented reality (AR) to repair an unstable spinal fracture. The surgery involved AR-assisted spinal surgery robots, which allowed the team to place surgical screws in a very precise way along the spine.

AR is an interactive experience that enhances the real world with computer-generated perceptual information. Using software, applications, and hardware such as special glasses, AR overlays digital content onto real-life environments and objects. This enriches the user experience and transforms the surrounding environment into an interactive learning environment that is revolutionizing the way companies manufacture, improve and distribute their products. This allows industrial users to “become one” with the systems and machines they use and to optimize and augment human ingenuity, observation and creativity.

AR works by superimposing digital information onto real-world objects to create 3D experiences that allow users to interact with both the physical and digital worlds, but AR cannot and does not exist alone. It is part of the Industry 4.0 ecosystem (the number 4 stands for Fourth Industrial Revolution) that is cloud-connected and integrates everything from big data to automated robots.

Doctors practice freezing cryotherapy to treat a malignant tumor in the pelvis using Novarad’s augmented reality system. (credit: Levin’s Center for Surgical Innovation and 3D Printing Unit at Tel Aviv Sourasky Medical Center)

How can augmented reality be used for surgery?

AR-enabled devices with cameras such as smart glasses, tablets or smartphones parse the video feed to identify physical objects or the environment around the user, such as machinery or warehouse layouts. 3D digital replicas of objects in the cloud connect real and virtual environments and collect information from physical and digital objects. AR devices then download information about the object from the cloud and place digital information over the object using markers or trackers such as GPS, accelerometers, orientation and barometric sensors, and more. It creates a 3D interface that is part real and part digital.

“Combining AR and robotics in this minimally invasive technique has never been done in surgery anywhere in the world,” Mizrahi said after the successful operation. “We are very excited that this new combination of innovations is providing direct benefits for these patients and an overall improvement in healthcare for the people of Jerusalem and beyond.

The experience of carrying out an operation equipped with an AR headset was like being a combat pilot,” he recalled. “All important patient information, including CT images, was displayed right in front of me. I could look in one direction and see my planned arrangement of surgical screws before the procedure, then look down and see the surgical field zoomed in. That experience has helped me carry out the procedure exactly as I planned it, and only make the adjustments I may feel necessary as the operation progresses.”

Nevo Margalit, head of SZMC’s neurosurgery unit, added, “We view the opportunity to take advantage of all technological advances for the benefit of our patients as the most important. We are committed to being at the forefront of introducing new and future technologies for the advancement of medicine in Israel and around the world.”

Yair Barzilai, director of the spine surgery unit, commented that “our unit acts as a technology pioneer resulting from close partnership with the digital healthcare industry. We are very happy to see the amazing results after the surgery performed by Dr. Mizrahi, where he was able to treat unstable fractures which without successful intervention can cause the patient to suffer severe nerve damage.”

The patient said he felt fine and was able to walk without any assistance immediately after the surgery and is expected to be discharged from the hospital in the coming days. He thanked the hospital staff, and said, “We are very grateful for Dr. Mizrahi. Before the surgery, we were very worried and didn’t know what to expect, but the operation was done quickly and successfully, and I recovered much quicker than expected. Mizrahi regularly comes to check on me and from the bottom of my heart, I am very grateful.”

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