March 2025

NEUROSCIENCES

CASE REPORT: ADVANCED SPINE SURGERY USING AUGMENTED REALITY FOR SCOLIOSIS AND FLAT BACK DEFORMITY

Featuring: Najib El Tecle, MD

Patient Profile
A 65-year-old woman from South Bend, Indiana, with a longstanding diagnosis of scoliosis that significantly worsened over the years.
  • The patient was diagnosed with scoliosis in her early teens.
  • Notable deterioration began in 2013, leading to surgery involving the L3, L4 and L5 discs.
  • Following her initial surgery, she experienced severe pain after 18 months.
  • She underwent five more spinal surgeries between 2013 and 2020, yielding no relief from her persistent pain and functional limitations.
​
In April 2024, after getting a second opinion, she underwent a two-day spinal surgery at Northwestern Medicine in Chicago using augmented reality (AR) technology, with remarkable immediate results — post-operatively, she stood upright and pain-free.

Diagnosis
The Northwestern Medicine team diagnosed the patient with a flat back deformity, a common outcome of multiple spinal fusion surgeries.

Clinical Presentation
Notable spinal misalignment characterized by a forward head position in relation to the pelvis. This anterior head posture imposed significant strain on the lower back muscles as they worked to stabilize the body and prevent the patient from tipping forward.
As a result, the patient experienced increasing levels of back pain due to the ongoing muscle strain and compensatory mechanisms.
​Unique Challenges of the Case
  • The structural changes of the spine from multiple fusions. When a patient has multiple fusions, the spine solidifies.
  • The extensive osteotomies to restore proper spinal alignment, using techniques such as the chevron cut.

Treatment Approach
  • Conservative management first: Our standard strategy for managing degenerative spine conditions involves exploring all conservative treatment options before we consider surgery, unless urgent conditions arise that require immediate intervention. We offer options such as:
    • Consultation with physical medicine and rehabilitation specialists
    • Physical therapy
    • Injections
  • Patient comfort: We place significant weight on patient feedback during the decision-making process. In this case, the patient attempted all available conservative treatments without obtaining relief.
  • Surgical evaluation: If surgery is appropriate, we follow a comprehensive high-risk spine protocol, established at Northwestern Medicine for over a decade and continually refined for effectiveness. Key parts include:
    • Coordination by the pre-operative clinic and our advanced practice provider team
    • A thorough pre-op checklist for each patient, ensuring we address potential complications
    • More consultations with specialists if red flags arise during the assessment

Surgical Procedure
The patient received complex spine surgery using AR goggles. This approach integrates 3D images from a CT scan with real-time visuals. The AR goggles gave us better visualization of the patient's spine.

Surgical Approach
  • Anterior surgery: The first phase of the procedure involved an anterior approach, performed in collaboration with Heron Rodriguez, MD, a vascular surgeon. Access to the spine required us to manipulate the bowel, during which we inserted wedges to elevate and adjust the spinal angle.
  • Posterior surgery: Two days later, we conducted the second phase, focusing on posterior stabilization and further correction of spinal alignment. We aimed to achieve optimal spinal angles while minimizing the risk of future surgical interventions.

How AR Affected the Outcomes
The use of AR goggles may hold promise for better surgical outcomes in the future. While we’re still evaluating the specific impact on this patient’s recovery, the technology did not lead to any adverse effects compared to traditional methods.
 
Post-operative Recovery
  • The patient was discharged from the hospital within a week and transitioned to rehabilitation before returning home.
  • She progressed from being able to walk just one block to walking 5 miles a day.

Future Considerations
  • Despite the positive recovery in this case, there’s still a possibility that this patient will need more spinal surgeries due to the degenerative nature of spine conditions.
  • Fusing one or two levels of the spine can increase stress on adjacent segments, potentially accelerating degeneration.
  • Patients may face a 1% to 3% annual risk of requiring further surgical intervention, necessitating ongoing monitoring for any new symptoms or deterioration.
 
QUICK READ: The Future of Spine Surgery and Augmented Reality
Najib El Tecle, MD, Assistant Professor of Neurological Surgery at Northwestern Medicine

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