Park Don Young, Park Sofie Mei, Hashmi Sohaib, Lee Yu-Po, Bhatia Nitin, Oh Michael
University of California Irvine, Department of Orthopaedic Surgery, 101 The City Drive South, Pavillion III, Building 29A, Orange, CA 92868, United States of America.
University of California Irvine, Department of Orthopaedic Surgery, 101 The City Drive South, Pavillion III, Building 29A, Orange, CA 92868, United States of America.
Int J Surg Case Rep. 2025 Jun;131:111342. doi: 10.1016/j.ijscr.2025.111342. Epub 2025 Apr 23.
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.
近年来，增强现实（AR）已应用于脊柱手术，目前的应用是在进行脊柱内固定时可视化计算机导航。内镜脊柱手术依靠高清视频来进行手术操作。现在，AR与内镜脊柱手术相结合，可在手术过程中同时向外科医生显示内镜视频和重要的临床信息。
患者为一名84岁男性，有下背部疼痛以及双侧下肢疼痛和刺痛，疼痛放射至小腿后侧，左侧比右侧更严重。他行走长距离困难。他完成了物理治疗，症状有所改善，加巴喷丁也提供了一些缓解。体格检查正常，无神经功能缺损。腰椎磁共振成像（MRI）显示L4 - 5严重狭窄。患者选择进行双孔道内镜下L4 - 5单侧椎板切开术和双侧减压术（ULBD）。手术使用苹果Vision Pro头戴设备进行，内镜视频与电子病历（EMR）和MRI图像同时显示在头戴设备内。与手术室监视器相比，外科医生在更大的窗口中可视化内镜视频，没有明显的延迟或中断。手术顺利完成，无困难或并发症。患者于同日出院，在三个月内临床症状有显著改善。
AR技术首次成功用于完成内镜下ULBD治疗腰椎管狭窄。该技术可同时提供如EMR和MRI图像等有用的临床信息与内镜视频。大显示屏可放置在外科医生面前，以优化颈部位置和人体工程学。由于手术可从外科医生的视角进行录制用于教学目的，新手学习者和对内镜脊柱手术感兴趣的患者可以远程体验手术。然而，目前的AR头戴设备相对较大且笨重，如果长时间使用，可能会因头戴设备的重量而导致不适。
AR技术可有效应用于内镜脊柱手术，对外科医生有诸多益处。该技术可作为外科医生学习该技术的教学辅助工具。随着头戴设备变得更小、更轻且功能更强大，AR可能会成为一种重要的手术工具，尤其是在内镜脊柱手术中。
