Disc replacement innovation will likely be more customized and integrate biologics, Ehsan Jazini, MD, said.
Dr. Jazini, who was the first in the U.S. to combine Centinel Spine’s prodisc C-Nova and C-Vivo disc replacement implants in one case, spoke with Becker’s about the milestone and what’s next for motion preservation surgery.
Note: Responses were lightly edited for clarity.
Question: What are the biggest challenges and learning curves with new procedures like this custom C-Vivo and C-Nova surgery?
Dr. Ehsan Jazini: The biggest challenge for spine surgeons in disc replacement surgery is choosing the most suitable disc and then counseling patients on this recommendation. As we adopt newer procedures such as custom disc replacements, it’s crucial to ensure that the surgical indication aligns with the patient’s recovery goals. Another challenge involves mastering the customization of implants at each damaged level to maximize functionality and longevity. With custom devices like C-Vivo and C-Nova, the surgeon must fully understand the patient’s anatomy and biomechanics to select and position the implant optimally. Additionally, segmental motion analysis is becoming increasingly important, as it helps us understand how each spinal level contributes to overall function and guides truly individualized surgical planning.
Q: How else do you foresee disc replacement being combined with other implants and techniques in the next five years?
EJ: We’re already seeing disc replacement surgery being combined with biologic treatments, and I believe that trend will accelerate. Many cases of discogenic pain can be treated without surgery using holistic or regenerative approaches. As the evidence behind biologics continues to grow, I expect we’ll see more synergy, combining biologics with disc replacement to improve outcomes, enhance healing, and potentially delay or eliminate the need for spinal fusion in select patients.
Q: As motion-preserving technologies continue to advance, what will the role of spinal fusion look like in the specialty in 2035?
EJ: Fusion will still have a role, especially in cases where instability, deformity, or severe degeneration limit the viability of motion preservation. But I believe the number of fusions, particularly in the cervical spine, will continue to decline.
In my practice, cervical fusions once made up 65% to 75% of procedures a decade ago; now they account for just 5% to 10%. This shift has been driven by advances in implant design, customization, and enabling technologies like robotics and navigation. By 2035, I believe fusion will be more of a secondary option, used selectively when motion-preserving techniques aren’t feasible or appropriate.
Q: How often do you encounter payer-related roadblocks in your motion-preserving spine work? What’s your approach to these?
EJ: Insurance challenges have become part of the standard process for motion-preserving spine surgery. Payers often lag behind the clinical data and surgical innovation.
My approach starts with a patient-first mindset: if surgery is indicated, I prioritize motion preservation with the most customized implant available. Then I advocate for my patients, providing insurance companies with the clinical rationale and supporting documentation to help ensure my patients receive the care they deserve. It’s time-consuming but necessary.
Q: What will the next generation of total disc replacement implants look like?
EJ: The next generation of disc replacements (both lumbar and cervical) will be ultra-customized to each patient’s unique anatomy. Using high-resolution imaging and 3D modeling, we’ll be able to create implants that achieve one-to-one conformity, improving integration and reducing wear. Material science is also advancing rapidly. We’ll likely see implants made with more durable, biocompatible materials that enhance longevity and function. These improvements will allow us to expand indications and push the boundaries with motion preservation.
