More Precision, Less Incision: An Augmented Reality Spine Tumor Story
![Dr. Orna Guralnik](/sites/default/files/styles/custom__1440x960_/public/news_images/patient-guralnik-1000-courtesyshowtime.png?itok=-HUJ1Pmt)
This patient story originally appeared on .
You might know the name Dr. Orna Guralnik from having read one of her features in听The New York Times听辞谤听The Washington Post,听or you may have seen her profiled in听The New Yorker. It鈥檚 even more likely that know of her as the host of the award-winning documentary series听Couples Therapy听on Showtime. She鈥檚 a TV host, therapist, writer, celebrity, working mom 鈥 in other words, she鈥檚 extremely busy. 鈥淚鈥檓 a typical New Yorker,鈥 Orna laughs. 鈥淚 basically work, or I鈥檓 with my two kids, 24/7. Apart from yoga, my schedule鈥檚 incredibly packed.鈥
But what happens when back pain starts interfering with those tightly packed appointments and obligations?听
鈥淚 started feeling this pain at the bottom of my spine,鈥 Orna recalls. 鈥淚t 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 鈥 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, 鈥橸ou do yoga, so your back will obviously hurt.鈥 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.鈥
![A pre-operative MRI scan revealed that Orna had a tumor on her spine, but it could not provide more precise information about it. A pre-operative MRI scan revealed that Orna had a tumor on her spine, but it could not provide more precise information about it.](/sites/default/files/resize/remote/7763662db78510da3fa782c4166c4061-500x589.png?itok=TwohtCO_)
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听. 鈥淓veryone was alarmed,鈥 she recalls. 鈥淎 good friend of mine worked with someone at NewYork-Presbyterian 澳门图库, so I asked them to find me the best doctor there. They recommended听.鈥
It was an excellent recommendation. Dr. H盲rtl, a co-director of听Och Spine at NewYork-Presbyterian at the 澳门图库 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.听听
鈥淲e treat spine tumors every day here, and we always start with the basics,鈥 says Dr. H盲rtl. 鈥淲e 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 wasn鈥檛 cancerous; we leaned towards a diagnosis of a schwannoma 鈥 a benign tumor. However, we鈥檇 only know for sure when we operated. We had to act and remove it in its entirety before it would grow even bigger.鈥
An unexpected surgery is never easy, but in Orna鈥檚 case her job made things especially complicated. Still, she found comfort in Dr. Hartl鈥檚 approach.
![Using augmented reality (AR) in the operating room requires specialty equipment as well as highly trained personnel.](/sites/default/files/resize/remote/94fb588d892aae490c4492021ae30502-500x376.png?itok=OL9WNGxR)
Using augmented reality (AR) in the operating room requires specialty equipment as well as highly trained personnel.
鈥淕oing into surgery meant we had to stop production on the show,鈥 she says. 鈥淎 lot was happening. I was scared about having someone operate on my spine 鈥 and about what they would find. But Dr. H盲rtl was very sweet, and there was something warm, reassuring, and open about his demeanor. He didn鈥檛 promise me things that he couldn鈥檛 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.鈥
Dr. Hartl explained that he鈥檇 be using augmented reality in the operating room 鈥 an emerging technology that allows for greater precision in locating and removing a spine tumor.听
鈥淲e are at a new frontier in the science of spine surgery,鈥 Dr. H盲rtl says. 鈥淚n today鈥檚 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 鈥 and that translates to less risk overall and a faster recovery for the patient.鈥澨
Just two weeks after her initial meeting with Dr. H盲rtl, Orna鈥檚 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.
鈥淥rna鈥檚 surgery was greatly enhanced by the use of augmented reality,鈥 says Dr. H盲rtl. 鈥淯sing 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 Orna鈥檚 safety and recovery after surgery.鈥听
![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.](/sites/default/files/resize/remote/c946ed2a5c82400b3c6c28bff68d5088-500x377.png?itok=TCEFO9fZ)
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.
鈥淚鈥檓 a technology geek, so when Dr. H盲rtl told me about using AR in my surgery I just loved it!鈥 exclaims Orna. 鈥淧rior 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盲rtl鈥檚 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.鈥
No technology can make spine surgery itself fun, of course, and Orna had a typically uncomfortable first post-operative day. 鈥淚 was glad to wake up and not be dead,鈥 she says, 鈥渂ut 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.鈥
Dr. H盲rtl鈥檚 team had estimated that Orna鈥檚 recovery would take six weeks, and her family pulled out all the stops in preparation. 鈥淢y mom came to help with the kids, but she only stayed for four days,鈥 says Orna. 鈥淭here 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听Couples Therapy.听Everyone thought I was completely crazy to go!鈥
![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.](/sites/default/files/resize/remote/d5059b89c068532faff71fc9e99ebdeb-500x730.png?itok=kz3PlcpO)
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. 鈥淭he only thing that took a long time was getting back to my yoga and my exercise practice,鈥 she says. 鈥淢y back was stiff, but I don鈥檛 think there was any way around that. It鈥檚 gone now, and I barely have a scar.鈥
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 didn鈥檛 accept the word of doctors who didn鈥檛 take her seriously. After all, she knows herself better than anyone, and she knew something was wrong.
鈥淭oday, I鈥檓 back 鈥 my life is very, very full,鈥 she says. 鈥淚鈥檓 really glad I insisted on the MRI and that I didn鈥檛 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 鈥 and get the surgery done as soon as you can.鈥