Egon Doppenberg, MD, is a neurosurgeon and physician advisor with Lumere.
In a recent interview with Becker's Spine Review, Dr. Doppenberg talked about the evolution of spine surgery and new advancements in minimally invasive surgery.
Question: How has minimally invasive spine surgery developed/advanced in the past five years?
Dr. Egon Doppenberg: The basic equipment needed to perform minimally invasive surgery has undergone technical refinements and surgeons now have better retractors and other tools to perform minimally invasive surgery. Additionally, oblique lumbar interbody fusion has emerged to provide more minimally invasive anterior access to the lumbar spine. Finally, robotics and navigation are starting to be used more and more.
Q: What challenges do you face currently that minimally invasive technologies could fix?
ED: Overall, spine surgery is transitioning to become as minimally invasive as possible. However, the minimally invasive term is often being misused. For example, robotics doesn’t reduce the amount of access required compared to traditional minimally invasive freehand techniques. For instance, it doesn’t matter if you use a robotic arm or a minimally invasive retractor. As such, patient selection becomes a very important consideration for these surgeries. Minimally invasive approaches are great when your practice is high in ‘virgin’ cases (i.e. no prior hardware). However, when your practice includes complex cases like revision patients with prior hardware or those with complex tumors, you will also need to use open approaches for full access. That’s why I believe there’s always a place for open traditional approaches even as we transition more and more to minimally invasive surgery.
Q: Are there any new minimally invasive techniques or technologies you expect to enter the field in the coming years?
ED: Posterior cervical spine, deformity cases and possibly trauma may have additional upcoming minimally invasive surgery applications. However, again, it’s important to consider appropriate patient selection for these potential minimally invasive surgery applications.
Q: Was it difficult to transition from traditional surgery to minimally invasive surgery?
ED: If you have done traditional open procedures, transitioning to minimally invasive surgery is much easier because you’ve already seen the anatomy wide open in front of you and you know the anatomy so well. On the other hand, if most of your experience has been with minimally invasive and you must transition to open procedures due to the type of patient and issue it would be much harder.