The global spinal fusion market is expected to exceed $1.2 billion by 2027, growing at a 5.4 percent compound annual growth rate, according to a Future Market Insights report.
Here, four spine surgeons discuss where they see spinal fusions headed.
Christopher Wolf, MD. Orthopedic Spine Surgeon at Cedars-Sinai Kerlan-Jobe Institute (Los Angeles): Advances in bone grafting in the past led us from using autologous grafts to grafts from cadavers. Over time, these advances with the use of proteins such as BMP are enhancing fusion potential. This will continue to improve and make surgery safer and more effective for patients.
Implants are continually advancing with a number of companies competing. It likely will move to some extent towards more custom implants for patients that can be 3D printed to exact size/shape for implantation based on preoperative imaging. Also, improvements with the application of stem cells are advancing, but not as rapidly as most would hope. At present, stem cells can help augment a fusion. It is hoped that in the future the disc itself can be 'regenerated/restored' with this technology. But that potential in humans remains to be seen.
Michael Goldsmith, MD. The Centers for Advanced Orthopaedics (Bethesda, Minn.): Hopefully revision surgery for pseudarthrosis will be less prevalent in the coming years. As our implants and techniques become better and our adjuncts to bone grafts become more powerful through advancement in biologics, I would expect to see fusion rates rise. Revision surgery is extremely costly and has higher complication rates than index fusions, so the goal is to avoid reoperation to benefit both the patient and health system.
One concern I have, which is a bleak prediction, is that innovation may decrease as well. In an effort to save money, many hospitals, in particular the larger health systems, are moving to one or two vendor systems which drives out smaller companies and may have the downstream effect of diminishing innovation. Oftentimes smaller companies have the ability to be more innovative either because they were created around a new technology or in order to differentiate themselves. We need to continue to encourage true innovation at the ground level by supporting all technology, not just from the big companies.
Roger Hartl, MD. Weill Cornell Medicine (New York City): The combination of MIS, biologics for disc repair, regeneration and replacement, better surgical planning (navigation/robotics) and a better understanding of the pathophysiology will result in a reduced need for fusion surgery. This will take some time but will surely happen. As surgeons, we can decide to be at the forefront of research and innovation or have insurance carriers and governmental decision-makers take the lead.
Daniel Birk, MD. Stony Brook (N.Y.) Medicine: New kinodynamic models of spine biomechanics will combine with advances in material science, robotics, additive manufacturing, computer vision and nanotechnology. Novel diagnostic modalities will accompany groundbreaking insights into spine pathophysiology. Today, I am unable to offer my patients spinal restoration. However, in 10 years, I predict that fusion surgery, and the associated complications, will become mostly obsolete and will give way to dynamic and adaptable spine technologies that restore and maintain spine physiology without rigid fixation or titanium implants.
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