Dr. Safdar Khan's vision for AR in spine surgery, how new tech can stand out

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Safdar Khan, MD, is one of the first spine surgeons to use Augmedics' Xvision augmented reality system, and he completed the company's 3,000th case in January. 

Dr. Khan, chief of orthopedic spine surgery at the Ohio State University Wexner Medical Center in Columbus, spoke with Becker's about his experiences with AR and the importance of data in medtech.

Note: This conversation was lightly edited for length and clarity.

Question: Tell me about the first AR spine surgery you did and your 50th case. How has your technique evolved in your time using Xvision?

Dr. Safdar Khan: The first case was onboarding a very innovative platform of visualizing the lumbar spine and creating a digital environment in a very precise way to put hardware in the order of screws in the spine and achieving the surgical goals in a minimally invasive fashion. So I was very excited about that. The learning curve wasn't as steep as I thought it would be. How so? The first year for the first case went very smoothly. We chose to do a single level fusion operation, and it went very, very well. 

Fast forward to the 50th case, and the technology is familiar to me, to my surgical fellow, to my team and to the nurses who assisted and supported us. It cuts down on time. It's highly efficient, and because of the widespread media coverage that these patients now are asking if I'll do their surgery using augmented reality.

Q: How has it been teaching your surgical staff and fellows with this technology?

SK: I think there is such a preponderance of new technology in spine surgery that there could be sometimes, at least from the trainees and certainly from the hospital administrative side, some new technology fatigue. However, Xvision was such a differentiator in terms of ensuring accuracy, ensuring ease of use, ensuring the ability for ergonomic relief for the surgeon and opened a portal of teaching and training in real time that was not supported previously. I think after a couple of cases, everybody quickly recognized that using augmented reality was highly beneficial for everybody in the room.

Q: Can you talk more about this new adoption fatigue in spine surgery? It sounds like surgical staff and surgeons are exhausted by keeping up with new spine technologies.

SK: I think it's a little bit of that, but it's a little bit of every company that is now trading off their commodity implants. In other words, the screws and rods that don't differentiate companies, now they're looking for additives to these technologies. As a result, they're becoming less of implant companies and more like technology companies. Almost every company has a technology platform, whether it's an augmented reality system or a rod-bending system or a pre-operative planning system. There's so much technology now that sometimes it's difficult for surgeons and most importantly, hospital administrators and purchasing teams to decide where to spend.

Q: Is there anything you think medtech companies should be doing to avoid this among surgeons?

SK: I think the most important thing is there has to be a real focus on measuring data. If they can collect data that shows that their technology actually improves efficiency, accuracy and safety, then publish it. We all can use that as a benchmark to adopt new technology.

Q: What do you think will be the next major development to come for augmented reality spine surgery? What will this technology be like in five to 10 years?

SK: I think the headsets will become a lot sleeker. The pixelation and depth of perception of the actual image is going to be a lot clearer, and we're going to be able to visualize the cervical spine and the lumbar spine with a lot more accuracy. I would like to see a lot of visual technology which can backfill blood vessels and nerve roots. Depending on firewall restrictions and digital compliance, it'd be great to do live teaching modules with trainees and at other sites by logging in remotely into the headset as we expand the digital footprint of augmented reality for spine surgery.

Q: What other spine technologies have your interest today?

SK: My other interests start from the basic science laboratory, where we're working with my colleague Devina Purmessur, PhD, on cellular reprogramming where we're using a non-viral gene therapy approach to reprogram the function of intervertebral disc cells. That's a fascinating avenue where we're able to manipulate diseased disc cells to behave almost like healthy disc cells. In addition, I think the future holds great promise when it comes to big data and collecting data from multiple institutions to make a clinical decision-making algorithm. In that vein, I'm intrigued with the use of big data assimilation platforms or concepts such as Federated Learning.

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