More Precision, Less Incision: An Augmented Reality Spine Tumor Story
This patient story originally appeared on .
You might know the name Dr. Orna Guralnik from having read one of her features in泭The New York Times泭棗娶泭The Washington Post,泭or you may have seen her profiled in泭The New Yorker. Its even more likely that know of her as the host of the award-winning documentary series泭Couples Therapy泭on Showtime. Shes a TV host, therapist, writer, celebrity, working mom in other words, shes extremely busy. Im a typical New Yorker, Orna laughs. I basically work, or Im with my two kids, 24/7. Apart from yoga, my schedules incredibly packed.
But what happens when back pain starts interfering with those tightly packed appointments and obligations?泭
I started feeling this pain at the bottom of my spine, Orna recalls. It would hurt at night and it would wake me up. I was tired from the pain, but I worked through it. The main thing it affected was my yoga practice it really constricted what I was doing and I worried that I was damaging myself. I saw physical therapists and did some exercises that did absolutely nothing. Doctors I visited thought I was just complaining. It felt dismissive, like, You do yoga, so your back will obviously hurt. But something just felt strange. Finally, I went to a rheumatologist and asked him if he could get me an MRI since everyone was denying me one.
A pre-operative MRI scan revealed that Orna had a tumor on her spine, but it could not provide more precise information about it.
Her persistence paid off when the MRI revealed that Orna had a泭. Everyone was alarmed, she recalls. A good friend of mine worked with someone at NewYork-Presbyterian 厙ぴ勛圖, so I asked them to find me the best doctor there. They recommended泭.
It was an excellent recommendation. Dr. H瓣rtl, a co-director of泭Och Spine at NewYork-Presbyterian at the 厙ぴ勛圖 Center for Comprehensive Spine Care, is one of the most respected spine surgeons in the world. He is well known as an expert clinician, and also as one of the most technologically advanced spine surgeons anywhere.泭泭
We treat spine tumors every day here, and we always start with the basics, says Dr. H瓣rtl. We identify its primary location, see if there are other lesions, and then try to determine whether it is benign or malignant. Looking at her scans, we strongly felt that the tumor wasnt cancerous; we leaned towards a diagnosis of a schwannoma a benign tumor. However, wed only know for sure when we operated. We had to act and remove it in its entirety before it would grow even bigger.
An unexpected surgery is never easy, but in Ornas case her job made things especially complicated. Still, she found comfort in Dr. Hartls approach.
Using augmented reality (AR) in the operating room requires specialty equipment as well as highly trained personnel.
Going into surgery meant we had to stop production on the show, she says. A lot was happening. I was scared about having someone operate on my spine and about what they would find. But Dr. H瓣rtl was very sweet, and there was something warm, reassuring, and open about his demeanor. He didnt promise me things that he couldnt promise. He explained what the plan was and took the cue from me that I really wanted to understand the details of what was going on. It was really important to me that he was willing to go into the details of the procedure and the technology they would use.
Dr. Hartl explained that hed be using augmented reality in the operating room an emerging technology that allows for greater precision in locating and removing a spine tumor.泭
We are at a new frontier in the science of spine surgery, Dr. H瓣rtl says. In todays operating room, we pair our surgical skills with new technology to perform more advanced, minimally invasive techniques. Augmented reality, or AR, helps us fine-tune our accuracy. On a macro level, that allows us to extend minimally invasive surgery towards more and more types of surgeries. And on a micro level, the increased precision AR affords us in the operating room means smaller incisions and that translates to less risk overall and a faster recovery for the patient.泭
Just two weeks after her initial meeting with Dr. H瓣rtl, Ornas husband and son dropped her off at NewYork-Presbyterian/Weill Cornell Medical Center. Her daughter and mother stayed with her until she went into the operating room.
Ornas surgery was greatly enhanced by the use of augmented reality, says Dr. H瓣rtl. Using the pre-surgical scans as a guide, we were able to navigate to the vicinity of the tumor. Once we confirmed the mass was indeed a schwannoma, we were able to remove it completely with the assistance of AR, reducing the amount of disruption in the muscles in her back to get there. Overall, this approach optimized Ornas safety and recovery after surgery.泭
Augmented reality allows a neurosurgeon to visualize the margins of a tumor even when they are not visible to the eye. In this case the white area at center is the visible tumor; the AR outline shows how much larger the tumor is.
Im a technology geek, so when Dr. H瓣rtl told me about using AR in my surgery I just loved it! exclaims Orna. Prior to the surgery I was worried about the possibility of an errant cut damaging my spinal cord. But knowing about the technology in Dr. H瓣rtls capable hands helped ease my concerns. What was more impressive was seeing them perform my surgery later via a recording. It felt like sci-fi; it was fun.
No technology can make spine surgery itself fun, of course, and Orna had a typically uncomfortable first post-operative day. I was glad to wake up and not be dead, she says, but it was 24 hours of nausea hell and some pain. It was uncomfortable, but it cleared up, and after a couple of nights I was cleared to go home.
Dr. H瓣rtls team had estimated that Ornas recovery would take six weeks, and her family pulled out all the stops in preparation. My mom came to help with the kids, but she only stayed for four days, says Orna. There was a lot of preparation for an intense recovery, but it was a lot less than I thought. After a few days of feeling lousy from the anesthesia, the swelling, and the pain, it was a pretty fast healing curve. After two weeks, I felt fine enough to fly out to Los Angeles, where Showtime was having a big Christmas celebration for泭Couples Therapy.泭Everyone thought I was completely crazy to go!
Just two weeks after surgery, Orna was on a plane to Los Angeles for a Showtime party celebrating Couples Therapy. Today she feels great and is glad she spoke up for herself. Photo: Sean McGinty, courtesy Showtime
Orna returned to her regular routine, and show tapings resumed. The only thing that took a long time was getting back to my yoga and my exercise practice, she says. My back was stiff, but I dont think there was any way around that. Its gone now, and I barely have a scar.
With the experience behind her, Orna says she feels great and is glad to put it all in the past. She is especially glad she didnt accept the word of doctors who didnt take her seriously. After all, she knows herself better than anyone, and she knew something was wrong.
Today, Im back my life is very, very full, she says. Im really glad I insisted on the MRI and that I didnt listen to my previous doctors. I felt mad that they were dismissive. But I would tell anyone who was in the same position as I was to get the best doctor you can and get the surgery done as soon as you can.