XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis

Abstract

In recent years, with the rapid advancement and consumerization of virtual reality, augmented reality, mixed reality, and extended reality (XR) technology, the use of XR technology in spine medicine has also become increasingly popular. The rising use of XR technology in spine medicine has also been accelerated by the recent wave of digital transformation (i.e., case-specific three-dimensional medical images and holograms, wearable sensors, video cameras, fifth generation, artificial intelligence, and head-mounted displays), and further accelerated by the COVID-19 pandemic and the increase in minimally invasive spine surgery. The COVID-19 pandemic has a negative impact on society, but positive impacts can also be expected, including the continued spread and adoption of telemedicine services (i.e., tele-education, tele-surgery, tele-rehabilitation) that promote digital transformation. The purpose of this narrative review is to describe the accelerators of XR (VR, AR, MR) technology in spine medicine and then to provide a comprehensive review of the use of XR technology in spine medicine, including surgery, consultation, education, and rehabilitation, as well as to identify its limitations and future perspectives (status quo and quo vadis).

Looking through the Lens: The Reality of Telesurgical Support with Interactive Technology Using Microsoft’s HoloLens 2

“…This is perhaps a limitation of the current application; however, applications are being released that include holographic recognition of surgical instruments and holographic screens for other intraoperative digital technologies. Other technologies, such as video conferencing systems, have been shown to be valuable in remote surgical education across the globe, including broadcasting of surgical procedures [ 9 , 10 ]. This often requires the use of extensive operating theatre upgrades for catching different camera angles, additional microphones, and even a surgeon narrator.…”

“…Madani et al [ 9 ] noted limitations of such systems for open procedures given the limited mobility of the cameras, though they did suggest the ability to use head-mounted cameras may resolve these concerns. Morimoto et al [ 10 ] describe the use of “action cameras” to record surgery from the surgeon's perspective, but note that an ideal camera is not currently available. Though these recordings may perform well in educational settings, they do not allow real-time interaction from the surgeon's viewpoint intraoperatively.…”

“…Further, the security measures for these “action cameras” appear limited in comparison to certified methods reported by Microsoft [ 6 , 11 , 12 ]. Head-mounted displays, such as the HoloLens 2, may provide more realistic and immersive education opportunities for surgical trainees [ 10 ]. The MR headset used in this case report combines the multiple products used in a modern video conferencing capable operating theatre into a smart headset with sensors, cameras, and microphone built in, and there is no need for a surgeon narrator.…”

Augmented reality–assisted craniofacial reconstruction in skull base lesions — an innovative technique for single-step resection and cranioplasty in neurosurgery

“…In this context, AR holds high capability for future concepts. In spinal neurosurgery, AR-assisted procedures have been applied especially for screw placement in combination with navigation or robot assistance within the last decade [ 12 , 23 , 35 ]. Phantom studies and cadaver simulations have also demonstrated promising applications of AR in cranial neurosurgery with techniques for cranial biopsy or accurate catheter placement.…”

Application Effect of Motion Capture Technology in Basketball Resistance Training and Shooting Hit Rate in Immersive Virtual Reality Environment

“…Under VR technology, the real environment where the user is located can be any place with little interference. When the user wears the virtual device, all the environment perceived by the user is a virtual effect, which plays an important role in the user's body detection and observation [11]. Figure 1 shows the basic situation of VR technology.…”