The world’s first artificial intelligence (AI)-driven, augmented reality (AR) guidance system for spine surgery is set to transform patient outcomes.

HOLO Portal, the world’s first surgical guidance system to incorporate AI and AR, from Surgalign Holdings, Inc. (Deerfield, IL, USA) represents the initial clinical application of the company HOLO AI digital health platform. The system’s AI processes intraoperative images to autonomously segment and label the anatomy and plan patient-specific pedicle screw trajectories that are approved by the surgeon. The HOLO Portal system uses AR to overlay the segmented AI reconstruction over the patient’s actual anatomy, providing real-time 3D visualization throughout the surgical procedure. This AR display helps surgeons visualize trajectories and guide surgical instruments.

The patented HOLO Portal software includes several convolutional neural networks to segment and group patient anatomy based on intraoperative 3D imaging. This results in a patient-specific 3D model that is automatically labeled with anatomic structures for use during surgery: Pedicle, vertebral body, spinal canal, articular processes, transverse process, lamina, spinous process, ribs, pelvis. HOLO Portal software immediately suggests screw ​trajectories and measures pedicle sizes from the patient-specific 3D model. The system then suggests the appropriate screw size based on a surgeon-defined pedicle fill ratio. The resulting surgical plan is designed to maximize construct stability and eliminate time spent ​manually planning trajectories and measuring screw sizes.

HOLO Portal software displays the surgical plan intraoperatively through the interactive AR display and provides a 3D guidance overlay on the patient’s anatomy. 3D trajectory and targeting are superimposed on surgical instruments in real time within the surgical field. This innovative design may reduce the surgeon’s cognitive load by providing intuitive guidance that allows the surgeon to keep focus on the surgical field – no bulky headset required. HOLO Portal is designed for improved surgical planning, enhanced anatomy visualization, and more efficient workflow to reduce time spent in the O.R. In January 2022, the company received U.S. Food & Drug Administration (FDA) 510(k) clearance for use of the HOLO Portal surgical guidance system within lumbar spine procedures. 

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