Enhancing endoscopic spine surgery with intraoperative augmented reality: A case report

Augmented reality (AR) has been recently implemented in spine surgery with current applications to visualize computer navigation while performing spinal instrumentation. Endoscopic spine surgery relies on high-definition video to perform the procedures. The combination of AR and endoscopic spine surgery can now be utilized to simultaneously display the endoscopic video and important clinical information to the surgeon during the procedure.

The patient is an 84-year-old male with low back pain and bilateral lower extremity pain and tingling that radiated to the posterior lower legs with the left side worse than the right. He had difficulty with walking long distances. He completed physical therapy with some improvement of his symptoms and gabapentin provided some relief. Physical examination was normal with no neurological deficits. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated severe L4-5 stenosis. The patient elected to proceed with a biportal endoscopic L4-5 unilateral laminotomy and bilateral decompression (ULBD). The surgery was performed using Apple Vision Pro headset with the endoscopic video displayed within the headset simultaneously with the electronic medical record (EMR) and MRI images. The surgeon visualized the endoscopic video in a larger window as compared to the operating room monitor without perceptible lag or interruption. The procedure was completed without difficulty or complication. The patient was discharged on the same day and experienced significant clinical improvement over three months.

AR technology was successfully utilized for the first time to complete an endoscopic ULBD for the treatment of lumbar stenosis. The technology can provide useful clinical information such as the EMR and MRI images simultaneously with the endoscopic video. The large display can be positioned in front of the surgeon to optimize neck position and ergonomics. Novice learners and patients interested in endoscopic spine surgery can remotely experience the surgery since the surgery can be recorded from the surgeon's perspective for educational purposes. Current AR headsets are relatively large and bulky, however, which may cause discomfort from the headset's weight if used for long periods of time.

AR technology can be effectively utilized in endoscopic spine surgery with several benefits to the surgeon. The technology can be used as an educational aid for surgeons learning the technique. As headsets become smaller, lighter, and more powerful, AR may become an important surgical tool, especially in endoscopic spine surgery.