Design Engineering

Digital platform utilizes augmented reality for spinal surgery

Devin Jones   

Automation General Medical Data Analytics machine learning

ARAI combines 3D visualization and machine learning to improve outcomes, reduce surgical time and surgical complications.


Augmented reality image overlay utilizing AR connected goggles.

Earlier this month, HoloSurgical Inc announced the first human surgical procedure utilizing an augmented reality and artificial intelligence (ARAI) based surgical navigation system.

As a digital platform, ARAI combines 3D visualization, data analytics, and machine learning to improve outcomes, reduce surgical time, and decrease surgical complications. The surgical guidance system provides real-time, patient-specific, 3D anatomical visualization for pre-surgical planning, real-time intraoperative guidance, and post-surgical data analytics.

The first ARAI surgery was a lumbar decompression and fusion procedure performed on a 61-year-old male suffering from severe back and leg pain as a result of a grade 2 spondylolisthesis, a degenerative spinal condition resulting in spinal stenosis. The surgery was performed in a minimally invasive fashion and the ARAI system was incorporated into the surgeon’s regular work-flow.

“The ARAI provided me with 3D visualization of the spinal anatomy, including the lumbar nerves, while suggesting implant trajectories and guiding me in real time, before I even made the incision,” said lead surgeon Rafał Pankowski MD, PhD, Director of the AO Spine Center and head of spine surgery, Department of Orthopedic Surgery at the Medical University of Gdansk, Poland. “This system allows for a significantly less invasive procedure while increasing surgeon confidence and decreasing chances for human error.”


Representation of colour-coded anatomy.

ARAI is comprised of the surgeon’s workstation, an AR headset, optical 6 DOF movement tracking hardware and the technician’s computer workstation. The surgeon’s station works with an image generator and connected 14-inch screen that provides the AR overlay, allowing them to “see” colour-coded organs via the AR goggles. The 3D synchronization between the AR screen and goggles works by way of a 120Hz radio frequency.

Furthermore, ARAI’s A.I segments, analyzes and identifies patient anatomy by colour coding key anatomical landmarks in real time. The A.I lets surgeons pre-plan surgical procedures, including implant size and position – avoiding inadvertent injury to critical structures such as nerves and vessels.

During the procedure, the ARAI system identified relevant anatomical structures and colour-coded them, presented a treatment plan, and guided the surgeon to place the implant using augmented reality-based 3D visualization.

“The smart visualization is a fundamental pillar of ‘digital surgery’ of the future. The use of our digital surgery platform has the potential to simplify and automate a wide variety of surgical procedures while decreasing soft tissue morbidity thus improving patient outcomes,” said HoloSurgical’s CEO Dr. Kris Siemionow, MD, PhD. “We are extremely pleased with this successful first in man case – it is another big step toward making surgery simpler, faster, and less invasive.”

HoloSurgical was founded in 2015 by It was founded by virtual and augmented reality professor Cristian Luciano, PhD, and spine surgeon Dr. Kris Siemionow, MD, PhD. Professor and AI pioneer Paul Lewicki, PhD, joined the company in 2016. 


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