In global first, Shaare Zedek spine surgeon combines augmented reality with robotics

25-year-old patient with severely broken back after falling from a height was on his feet and walking without assistance less than a day after the procedure

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Dr. Cezar Mizrahi uses augmented reality robotic technology in complex minimally invasive spine surgery for the first time in the world in August 2023. (Courtesy of Shaare Zedek Medical Center)
Dr. Cezar Mizrahi uses augmented reality robotic technology in complex minimally invasive spine surgery for the first time in the world in August 2023. (Courtesy of Shaare Zedek Medical Center)

A world-first surgery took place earlier this month at Shaare Zedek Medical Center in Jerusalem involving the use of augmented reality (AR) robotic technology in a minimally invasive procedure to repair a complex spine fracture.

AR had been used in minimally invasive spine surgery before, but according to Medtronic, the company that makes the AR technology, this had never before been combined with robotic technology.

When a 25-year-old patient was brought to the hospital’s emergency department with a severe fracture in the lower thoracic region of the spine after a fall from a height, Dr. Cezar Mizrahi decided that the case called for AR to help him achieve the best instrumentation positioning and the best chances for patient healing.

Mizrahi, a surgeon from the spine surgery unit and the department of neurosurgery, told The Times of Israel that he is a proponent of robot-assisted minimally invasive surgery.

“I don’t remember the last case I did that was an open surgery, old school procedure. I believe in minimally invasive surgery and I would say that in more than 90 percent of my cases, I use the most advanced robot that we have for instrumentation,” he said.

Dr. Cezar Mizrahi (Courtesy of Shaare Zedek Medical Center)

However, this was the first time that Mizrahi added AR into the mix. While at a conference in Madrid several weeks earlier he had the chance to try out the system made by Medtronic, a multinational healthcare technology company with an Israeli office in Herzliya. He asked the Medtronic representatives if he could have access to the AR technology — still in pilot use — if need be.

“They said yes, so when this patient arrived and I realized that the AR technology would increase my chances for accuracy and precision in my positioning, I got in touch with them… I really thought that it would give me an advantage with this very complex fracture,” Mizrahi said.

With time ticking and the chances for paralysis and neurological deficits for the patient increasing, Mizrahi reached out to his Medtronic contacts in Israel, who sent him the AR system immediately.

The robotic arm achieves a three-dimensional recognition of the patient based on previously done scans. According to Mizrahi, the robot achieves “perfect registration,” which gives the surgeon the ideal trajectory for their instruments.

The AR technology further minimizes the risks of placing a screw on the spinal cord or nerve roots by allowing the surgeon to see the navigation system within the robot. It is as though they are inside the robot and view what it is seeing.

“I see the coronal, sagittal and axial views,” Mizrahi said.

In addition, the AR headset worn on the surgeon’s head allows them to see all scans and pre-surgery planning that were uploaded before the surgery.

Shaare Zedek Medical Center in Jerusalem, Israel on October 15, 2008. (Yossi Zamir / Flash 90)

“You just move your eyes around this visual field — left, right, up and down — and you have everything. It’s like a PlayStation,” Mizrahi explained.

The surgery to stabilize the fracture took a few hours and by the next day, the patient was on his feet, walking independently and making coffee on his own, according to Mizrahi.

Five days later, once the patient’s pain was under better control, he was discharged.

“The procedure went successfully and we’re so thankful for Dr. Mizrahi’s treatment. Before the surgery, we were very worried and didn’t know what would be but it was performed quickly and successfully and I’ve recovered faster than expected. I can walk now… From the bottom of my heart I’m just so grateful,” the unnamed patient said.

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