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Neurospine > Volume 21(2); 2024 > Article
Liawrungrueang: Commentary on “The Utility and Feasibility of Smart Glasses in Spine Surgery: Minimizing Radiation Exposure During Percutaneous Pedicle Screw Insertion”
Scientific knowledge used to medicine to aid in diagnosis, prevention, treatment, and innovation is referred to as medical technology. It does this by creating tools, machines, and pharmaceuticals using engineering and biotechnology methods [1,2]. The manufacturing of equipment and techniques utilized in the medical field such as augmented reality (AR)-assisted real-time visualization of spine surgery, neuromonitoring systems, robotics-assisted surgery, robotic-assisted pedicle screw placement, and intraoperative navigation systems is specifically referred to when discussing spinal medical technology [1,3-5].
Augmented and mixed-reality technologies are included in smart glasses (SG) for spine surgery, giving surgeons access to real-time imaging, guidance, and patient information [6,7]. With the use of these glasses, the surgeon may plan and navigate surgery more efficiently by the image on the wearable displays are closer than those on a fluoroscopic monitor, allowing for a clearer view and reducing radiation exposure during percutaneous pedicle screw (PPS) insertion [7,8]. This study [9] examines the potential and usefulness of SG in spine surgery. Adoption of SG offers a possible way to reduce related health concerns, since radiation exposure to spine surgeons during fluoroscopy-guided treatments increases. The MOVERIO SG manufactured by Epson Co., Ltd. (Tokyo, Japan) are a series of wearable AR devices designed for various applications. The latest MOVERIO smart glass delivers an engaging AR experience through quality QHD (quad high definition) or 3-dimensional (3D) images. Its binocular and lightweight see-through display also keeps you aware of your surroundings while you are viewing your content. The objective of the research, which employed operators with varying degrees of experience, was to assess how much SG reduced radiation exposure and increased procedural accuracy. Operators alternated between SG and traditional approaches to direct the insertion of PPS into lumbar model bones under fluoroscopic supervision, using the MOVERIO SG model BT-30E and the COREVISION 3D fluoroscopy system. The SG and non-SG groups’ insertion times did not differ significantly, according to the data. However, especially for less experienced operators, the use of SG considerably decreased the duration and amount of radiation exposure. Additionally, deviation studies showed that SG did not impair the precision of screw insertion.
The introduction of SG addressed critical concerns regarding radiation exposure in spine surgery, in line with the principles of minimizing time near radiation sources, maximizing distance, and using shielding devices. By projecting real-time fluoroscopic images into wearable displays, SG enabled surgeons to maintain focus on the operative field, minimizing the need for head movement and reducing fatigue compared to traditional methods. Furthermore, SG facilitated clearer image visualization, potentially enhancing procedural accuracy. While acknowledging limitations such as the use of model bones and a small sample size, the study underscores the potential of SG integration in spinal surgeries to enhance safety and optimize outcomes. Future research could explore SG integration with radiation protection goggles and validate findings in larger clinical settings.
In future direction, SG is poised to transform spine surgery with their potential applications. The application of AR guidance augments the surgeon’s field of view with digital information, hence improving surgical precision. Experts can offer real-time instruction throughout difficult operations through remote help. They also facilitate training and education through immersive experiences and live streaming. Integration with surgical navigation systems ensures accurate feedback on instrument positioning. Patient-specific planning optimizes surgical approaches, while enhanced communication features streamline teamwork in the operating room. As technology advances, SG promise to revolutionize spine surgery, improving outcomes and patient care. My summary of the advancements in current surgical smart glass in the field of spine surgery shows great potential and is continuously developing (Table 1).
This commentary on this study highlights the promising impact of SG in reducing radiation exposure and enhancing procedural efficiency in spine surgeries. It presents a viable and cost-effective solution to bolster surgical safety, thereby reducing health risks for patients and healthcare professionals alike. However, it’s essential for spine surgeons to possess the necessary knowledge and skills to conduct surgeries autonomously, without solely depending on robotics or computer assistance. Emergency situations demand swift and informed decisionmaking, calling for the expertise and proficiency of physicians. It’s crucial to acknowledge that complications may arise unexpectedly.


Conflict of Interest

The author has nothing to disclose.

Table 1.
Summary of the advancements in current surgical smart glass in the field of spine surgery shows great potential and is continuously developing
Product Company Description of surgical glass Advantages
HoloLens [10] Microsoft A headset offering mixed-reality experiences and precise guidance for surgical procedures operated hands-free Enables a nuanced division between the real and digital realms through an immersive mixed-reality encounter. Utilizing holographic overlays enhances accuracy and reduces errors in surgery. Enables users to engage with holograms and complete tasks using hands-free technology, eliminating the need for physical input.
M-Series Smart Glasses [11] Vuzix Lightweight and ergonomic smart glasses packed with various features for augmented reality experiences These devices are characterized by a comfortable and lightweight design, perfect for long-term use. High-quality display and optics, they offer clear visuals and an enhanced user interface.
MOVERIO Smart Glasses [12] Epson Smart glasses equipped with augmented reality capabilities, featuring a binocular display for immersive experiences Enhances realism and offers depth awareness through its binocular display, creating an immersive experience. provides flexible applications with interactive 3-dimensional models that are beneficial for training, teaching, and amusement.
Atheer AiR Glasses [13] Atheer Gesture-controlled smart glasses with augmented reality interface, offering real-time guidance for surgical procedures The user experience and efficiency are improved with intuitive gesture controls that make interaction smooth and easy to use. With the help of real-time augmented reality guidance, surgeons may perform surgeries more accurately and with better patient outcomes.
X2 Smart Glasses [14] ThirdEye Gen Lightweight smart glasses with a wide field of view, providing an extensive augmented reality experience A large field of view improves immersion and makes it easier for people to interact with digital information. Well-known for their comfortable and lightweight designs, they can be used for extended periods of time in a variety of settings.
HMT Smart Glasses [15] RealWear Ruggedized smart glasses designed for hands-free operation in industrial environments, featuring a voice-operated interface Industrial-grade durability guarantees reliability in tough work environments such as manufacturing, construction, and field services. Hands-free usage is made possible by voice-activated interfaces, enhancing both efficiency and user experience.
Xvision [16] Augmedics Surgical navigation system utilizing augmented reality for precise real-time guidance during procedures By offering accurate real-time guidance, it improves surgical accuracy and lowers the possibility of complications. Additionally, it increases safety by reducing errors and enhancing results by giving surgeons vital information and visualizations during surgeries.
Caduceus S [17] SURGLASSES Inc. Augmented reality display shows real-time info to surgeons, hands-free for focus and enables remote collaboration. Customizable interface for personal support, sterile, ergonomic design for surgical settings. Training modules enhance skills through immersive simulations Enhanced visuals and hands-free operation promote accurate decision-making and focus. Real-time collaboration offers instant support, while personalized interfaces and clean design meet hygiene standards. Immersive training aids in skill development.


1. Liawrungrueang W, Cho ST, Sarasombath P, et al. Current trends in artificial intelligence-assisted spine surgery: a systematic review. Asian Spine J 2024;18:146-57.
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2. Lee JS, Son DW, Lee SH, et al. Robotic-assisted spine surgery: role in training the next generation of spine surgeons. Neurospine 2024;21:116-27.
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3. Lee YS, Cho DC, Kim KT. Navigation-guided/robot-assisted spinal surgery: a review article. Neurospine 2024;21:8-17.
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4. Khalifeh K, Brown NJ, Pennington Z, et al. Spinal robotics in adult spinal deformity surgery: a systematic review. Neurospine 2024;21:20-9.
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5. Kitahama Y, Shizuka H, Nakano Y, et al. Advancements and challenges in robot-assisted bone processing in neurosurgical procedures. Neurospine 2024;21:97-103.
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6. Liu Y, Lee MG, Kim JS. Spine surgery assisted by augmented reality: where have we been? Yonsei Med J 2022;63:305-16.
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7. Sommer F, Waterkeyn F, Hussain I, et al. Feasibility of smart glasses in supporting spinal surgical procedures in low- and middle-income countries: experiences from East Africa. Neurosurg Focus 2022;52:E4.
8. Sakai D, Schol J, Kawachi A, et al. Adolescent idiopathic scoliotic deformity correction surgery assisted by smart glasses can enhance correction outcomes and accuracy and also improve surgeon fatigue. World Neurosurg 2023;178:e96-103.
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9. Hiranaka Y, Takeoka Y, Yurube T, et al. The utility and feasibility of smart glasses in spine surgery: minimizing radiation exposure during percutaneous pedicle screw insertion. Neurospine 2024;21:432-9.
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10. Microsoft HoloLens 2 [Internet]. Redmond (WA): Microsoft Corp.; 2024 [cited 2024 Jun 6]. Available from: https://www.microsoft.com/en-us/hololens.

11. Vuzix Smart Glasses [Internet]. West Henrietta (NY): Vuzix Corp.; 2024 [cited 2024 Jun 6]. Available from: https://www.vuzix.com/pages/smart-glasses.

12. Augmented Reality and Mixed Reality [Internet]. Tokyo (Japan): Epson Ltd.; 2024 [cited 2024 Jun 6]. Available from: https://epson.com/moverio-augmented-reality?utm_source=marketing&utm_medium=van&utm_campaign=us-moverio.

13. Atheer Air Glasses | Wearable device [Internet]. Vancouver (Canada) Vandrico Inc.; 2024 [cited 2024 Jun 6]. Available from: https://vandrico.com/wearables/device/atheer-airglasses.

14. ThirdEye Gen [Internet]. Princeton (NJ): ThirdEye; 2024 [cited 2024 Jun 6]. Available from: https://www.thirdeyegen.com.

15. RealWear | Hands free industrial smart glasses [Internet]. Vancouver (WA): RealWear; 2024 [cited 2024 Jun 6]. Available from: https://www.realwear.com/.

16. xvision Spine System | Augmedics | United States [Internet]. Arlington Heights (IL): Augmedics; 2024 [cited 2024 Jun 6]. Available from: https://augmedics.com/.

17. AR Augmented Reality Computer Surgical Navigation System (Caduceus S) [Internet]. Las Vegas (NV): SURGLASSES LLC; 2024 [cited 2024 Jun 6]. Available from: https://surglasses.com/en/surgery/caduceus-s-ar/.

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