The Los Angeles-based navigation company integrates its RJB angle measurement technology with NuEyes’ wearable platforms
Spine navigation has a placement problem. The technology works — the accuracy data is not seriously contested — but the monitors that display it sit at the edge of the room, not in the surgeon’s line of sight. Attending to them means looking away from the field, which is exactly what guidance systems are supposed to prevent.
Ruthless Spine has announced an integration with NuEyes Technologies that addresses this directly. The company’s RJB intraoperative angle measurement system will now feed data into two NuEyes wearable platforms: the Pro 4 smart glasses, which are available now, and NuLoupes, the company’s stereoscopic surgical loupe system expected to launch commercially later this year. In both cases, the angular trajectory information appears as an overlay in the surgeon’s field of view — no secondary screen, no dedicated navigation staff, no capital line item.
The Ruthless Spine Platform
The RJB is a single-use, Bluetooth-connected instrument cleared by the FDA under De Novo for lumbosacral pedicle screw placement. Setup runs about 30 seconds; it pairs with a standard tablet; there is no infrastructure requirement. The NavJam Jamshidi, its companion for the screw entry step, added 510(k) clearance in September 2025, extending trajectory feedback to the moment of needle placement.
The company’s positioning has never been about competing with robotic navigation on precision claims. It is about reaching the cases that robotic navigation never touches — hospitals without the capital budget, ORs without the specialist staff, geographies where a multimillion-dollar system is not a realistic option. Ruthless has reported active use in Turkey, Ukraine, and parts of Africa alongside its U.S. rollout.
What the Wearable Layer Changes
With the Pro 4, the integration works through pass-through augmented reality: the surgeon sees the operative field with RJB data overlaid. With NuLoupes the pairing goes further. NuLoupes offers continuous stereoscopic 3D magnification from 1x to 13x, with near-zero latency and depth perception the company’s engineers describe as exceeding unaided human vision. It received FDA Class I 510(k) exemption in December 2023. The Ruthless Spine application is shaping up to be one of the first third-party integrations on the platform before its commercial launch — an early test of the open software ecosystem NuEyes has been building toward.
That ecosystem has a name: NuVision App Store. The idea is a developer layer sitting on top of the NuEyes hardware, allowing specialty applications to run without requiring hospitals to choose between platforms. Whether it scales depends on how many developers find the hardware worth building for — but Ruthless Spine’s integration at least demonstrates the concept is functional.
Dr. William D. Hunter, FAANS, who is involved with the integration, put it this way: “Navigation has transformed spine surgery. The next evolution is making critical information intuitive and seamless. By placing that information directly in the surgeon’s field of view, wearable technology has the potential to redefine surgical efficiency and confidence.”
The honest version of that argument is narrower but still interesting. Ruthless Spine is not replacing navigation — it is making a specific type of lightweight, low-cost guidance less disruptive to use. If the wearable layer removes the habit of glancing away from the field, that is a real improvement even if it does not change the underlying accuracy equation.
NuLoupes has not yet launched commercially, and the Pro 4 was originally designed for low vision and enterprise applications. How either platform performs across a full day of spine cases — battery life, display fatigue, fogging, hygiene protocols — remains to be seen in practice. These are not trivial questions for a device meant to stay on a surgeon’s face for four hours.
But the direction makes sense. Getting critical information out of the corner of the room and into the surgeon’s direct view does not require a robot. Sometimes it just requires better hardware in the right place.