Once thought to be a futuristic technology for video games, augmented reality (AR) is now transforming surgery. Recently, Timothy O’Connor, M.D., director of minimally invasive and robotic spine surgery at Marcus Neuroscience Institute, part of Baptist Health, became the first neurosurgeon in Florida to perform next-generation augmented reality (AR) spinal surgery using the latest version of a novel, advanced, high-resolution technology.

The surgery took place at Baptist Health Bethesda Hospital West and the patient suffered from severe neural compression with spinal instability.

“This is the future of spine surgery,” Dr. O’Connor said. “We can see the patient’s anatomy in high definition, and their imaging is superimposed directly in my field of vision to allow real-time guidance when wearing the AR headset during surgery.”

The technology allows surgeons to plan the operative approach while looking at the patient’s anatomy and offers superior visualization and guidance trajectory. “When you’re doing a complex spine surgery, it’s extremely important to place screws accurately because the spinal cord, nerves and vessels are in close proximity,” Dr. O’Connor said. “It allows us to perform surgeries in a safer and more accurate environment.”

The first patient was a 73-year-old female who had severe neural compression with instability of the spine causing considerable pain. She was unable to walk for more than a few moments at a time. Dr. O’Connor relieved the pressure on the nerves and stabilized the spine with pedicle screws using the next-generation augmented reality. “The patient did well and went home within a few days with significant improvement in symptoms,” he said.

Dr. O’Connor was part of a team of physicians from Marcus Neuroscience Institute, Weill Cornell Medical College, Tulane University, Boston University Medical Center and Kaiser Permanente to initially demonstrate the new technology in cadaveric studies. The results of the preclinical studies that he presented at the Congress of Neurological Surgeons (CNS) in 2023 proved the accuracy of the system and revealed that it exceeded major existing navigation and robotic systems by two to five times in peer-reviewed studies. This led to its FDA clearance for use in open and minimally invasive spine surgeries.

The oral presentation at the Congress of Neurological Surgeons by Dr. O’Connor, Accuracy of an Augmented Reality Spine Surgery Guidance System With Stereoscopic Targeting Head Mounted Display Compared to Standard Computer Navigation, Robotic Systems, and Existing AR Systems, detailed that this technology “offers the benefit of improved hand-eye coordination by accurately superimposing 3D stereoscopic displays for surgical instruments onto anatomic landmarks.”

In addition, the presentation stated: “Positional Error and Angular Error for placing pedicle screws are statistically significantly smaller for the novel AR system compared to existing navigation, robotic, and AR systems. A positional error of 1.1mm and angular error of 1.3° makes this technology particularly suited for small pedicles, challenging anatomy, and MIS techniques.”

Dr. O’Connor completed a complex spine fellowship at the University of Buffalo. While there, he received the AO Discovery and Innovation Young Investigator grant by the AO Spine Foundation for his biomechanical research. “I’ve always had an interest in new, enabling technologies and then bringing that capability to our patients in the operating room,” he said. “This system has improved our ability to integrate information in real time and improve patient outcomes.”

While Dr. O’Connor uses both robotic and augmented reality technologies to perform minimally invasive spine surgery, unlike robotic spine surgery he is able to use tactile feedback while viewing the patient’s spine with augmented reality. Instead of looking at a screen, he can see the navigation while looking at the patient’s spine without the need to look away from the patient to a screen or monitor.

“This novel, high-resolution AR technology is a groundbreaking achievement in advancing patient care,” Dr. O’Connor said. “By using this technology, we’re able to improve minimally invasive surgery, reduce recovery times and significantly enhance outcomes for our patients. This is only the beginning of how we can use next-generation augmented reality to advance spine surgery, and a testament to our commitment to lead the way improving the lives of our patients.”