Highly innovative technology revolutionizes spinal operations

Augmented reality in the operating theater

Professor Mazda Farshad’s eyes light up when he talks about the first three patients he operated on as part of a clinical trial in the UMZH SURGENT project. Farshad is a spinal specialist and Medical Director of Balgrist University Hospital and a professor in the Faculty of Medicine at the University of Zurich. «All three patients are doing well,» he says, sitting in his office at the hospital and starting up his laptop to demonstrate the new technology in the operating theater using a computer animation. Farshad himself carries out around 300 to 400 spinal operations each year. In total, 1,200 of these operations are performed annually at Balgrist University Hospital.

Before surgery, the three patients he mentioned suffered from spinal degeneration, chronic pain, and sensory disturbances in their legs. Their quality of life had deteriorated and they were sometimes unable to sleep because of the pain. The physicians had already exhausted all the conventional treatments such as painkillers, cortisone injections, physiotherapy, and back training. The final option was an operation. Farshad and his team inserted screws and rods into specific parts of the patients’ spines to brace them and in the process they used a brand-new technology.

Driven by the thirst for knowledge and the stories of suffering

The detailed evaluation of the three interventions has not yet been completed and the SURGENT project is only in its early stages. However, Farshad, who is leading the trial, has great hopes for it: «This is potentially an important evolutionary step in the planning and implementation of surgical interventions,» he says. Professor Mazda Farshad is driven by his thirst for knowledge and by the stories of suffering that he hears from the patients in his clinic. For some people with back pain, he is the first port of call, but others have already been operated on more than a dozen times without providing a lasting cure.

Augmented reality supplements the human senses

The technological world innovation that Farshad is helping to develop in a research network consisting of Balgrist University Hospital, the University of Zurich, University Hospital Zurich and ETH Zurich is based on augmented reality. SURGENT stands for Surgeon Enhancing Technologies. The augmented reality supplements the surgeons’ own senses, giving them abilities that enhance their existing expertise and experience. As Farshad explains: «The goal is to be able to plan and implement the operations on a more individual basis with greater precision and therefore more successfully, which will benefit the patients. We want to improve their quality of life on a long-term basis.»

From planning to implementation

The SURGENT project, a flagship project of «Hochschulmedizin Zurich», is divided into two parts. The first relates to planning surgical interventions on the spine. In the future, patients’ individual characteristics will be given greater emphasis in the planning process. During the preparatory phase, MRI and CT scans and X-rays will be used as before, but the surgeons will also take into consideration other factors which are different for every individual. Wearable sensors will measure the patients’ movement patterns and this data will be included in the operation planning. The angle at which the surgeon inserts screws into the bone will be determined by the patient’s individual anatomy. A range of basic principles have already been identified for this part of the project and an application for a clinical trial will be submitted soon.

The second part of the SURGENT project focuses on the implementation of spinal operations. The clinical trial for this part is already underway. During the operation, the surgeon wears a special augmented reality headset that shows additional visual information. Images that have been individually generated for the patient in question are overlaid on the real-life view of the wound, the tissue, the nerves, or the bones. These images show the surgeons the direction for inserting the screws, for example. Another possible enhancement is the use of audible information that will help the surgeon to carry out the individual steps in the operation in a highly precise and targeted way.

Combining technology and surgery

The team led by Mirko Meboldt, Professor of Product Development at ETH Zurich, plays an important role in the research network. His group works on the human-machine interface. «The collaboration is both exciting and challenging,» says Meboldt. Also involved in the development is Philipp Fürnstahl, head of the ROCS team at Balgrist University Hospital. ROCS stands for Research in Orthopedic Computer Science. Fürnstahl is also Professor of Orthopedic Research specializing in the application of computer technologies at the University of Zurich. He explains: «We are combining technology and surgery and we need everyone to be involved. The surgeons contribute their clinical knowledge and the technical experts put into practice the methods that will help the surgeons.»

Collaboration within the UMZH network ensures efficiency

Mazda Farshad emphasizes the fact that the efficiency of the collaboration within the Academic Medicine Zurich (UMZH) network is internationally unique. He does not want to commit to a date when he thinks the SURGENT project might be completed and the technology will become part of standard surgical practice. He simply says: «It could be sooner than we think!»

Are you suffering from back or neck pain
or would you like a second opinion?
Clinic at Balgrist University Hospital

SURGENT:
The name of the project. It stands for SURGeon ENhancing Technologies. A technology that enhances the abilities of the surgeon.

Augmented Reality:
This technology helps the surgeon by supplementing their senses and their perception of reality. Orthopedics is an ideal discipline for the use of augmented reality. This is because the patient’s bones hardly move during the operation, which makes a comparison with previous CT scans much easier.

Orthopedics:
The science of identifying and treating congenital or acquired defects in the human musculoskeletal system.

CT (computed tomography): 
An X-ray technique that provides detailed cross-sectional images of organs such as the brain. The bones and joints can also be clearly represented, which allows diseases and injuries to be easily identified. This diagnostic imaging process is carried out by radiologists.

MRI (magnetic resonance imaging):
This method creates cross-sectional images of the human body. Unlike other methods, it uses magnetic fields instead of X-rays. These have no known harmful side effects.

Text and audio: Rebekka Haefeli
Pictures: Tagesanzeiger, Sabina Bobst
University of Zurich: Mazda Farshad, Philipp Fürnstahl
Balgrist University Hospital: Mazda Farshad, Philipp Fürnstahl
ETH Zurich: Mirko Meboldt, Marc Pollefeys
Hochschulmedizin Zürich: Corina Schütt