Surgeons are accustomed, in various degrees, to identifying a plan of action for their surgeries. However, there has never been a way to three-dimensionally represent the plan in the OR, until now. Becker’s Spine Review spoke with Christopher Kleck, M.D., an orthopedic spine surgeon and co-director of the spine fellowship program at the University of Colorado Hospital in Aurora to discuss this new link between preoperative planning and intraoperative confirmation. Dr. Kleck went on to describe his experience using UNiD adaptive spine intelligence technology by Medtronic.
Question: How did you originally perceive the usefulness of preoperative planning in your practice?
Dr. Christopher Kleck (CK): I have always been a big believer in preoperative planning and systematically used it in my practice, though I was aware of its shortcomings, in particular, the inability to directly implement the plan in surgery. This is how spine surgery uniquely became known as an art. I took pride in my ability as an artist, to select and manipulate implants and change my strategy on-the-fly, as many surgeons do. Although being medically trained, surgeons are also very scientific in their methodologies. I knew there was room to bridge this planning gap and improve my practice.
Q: What was your reaction to introducing patient-specific implants, like the UNiD rod, to spine surgery?
CK: For this type of technology to be effective in spine surgery, it needs to be holistic. Offering a patient-specific implant, even with a surgical planning component, was not sufficient for my practice. In my opinion, to be truly powerful, there must be a scientific methodology driving the entire process. For instance, a manufacturer could produce a custom rod, but it may not be the ideal rod for the patient or the surgical strategy. Further, designing a patient-specific implant preoperatively does not necessarily provide insight into the efficacy of that implant postoperatively versus a standard one.
Q: What was the tipping point when you began to believe in preoperative planning, predictive modeling, and “trusting” the UNiDTM rods?
CK: We had an early case example where we planned a fairly large thoracic spine correction in a young patient. An initial comparison between the 3-D printed model of the patient’s spine compared to the patient-specific rods had me questioning whether I could achieve the correction I originally planned. I kept the rods on hand as I began moving through the case. Near the end of the case, I positioned the rods against the patient’s spine and was surprised to see how close I was to achieving my original plan. After a few adjustments to the patient, I was able to implant the patient-specific rod.
Q: Do you think there is a benefit in applying preoperative planning and predictive analytics to degenerative cases?
CK: After experiencing success in my complex cases, I started implementing UNiD adaptive spine intelligence into my degenerative cases, including minimally invasive applications. When I think of deformity, it is all about achieving the desired alignment. It turns out the same is true of degenerative surgery. I know adjacent level disease is significantly increased when certain alignment parameters are not met, even in short- construct cases. So, as spinal surgeons, we are either dealing directly with deformity or, if we choose to ignore it, we are at risk of creating deformity. The UNiD rods I am implanting today in my degenerative cases have a significantly higher lordosis than I was previously applying with traditional rods. In my mind, the ultimate goal for the industry should be to end revision surgery.
Q: I understand the predictive analytics component includes data from pre and postoperative analysis. Have you found these procedural analyses to be directly helpful and how?
CK: Prior to my first 50 or 60 cases, I really was not looking closely enough at a patient’s thoracic kyphosis when I was planning. However, by reviewing the thorough postoperative analysis provided by the UNiD Hub software interface system, I saw some junctional failures in my cases that I thought were probably due to the patient being hypokyphotic in the thoracic spine. This prompted me to make an immediate strategic change when forming my next preoperative surgical plans for patients, whom I began to see were really hypokyphotic, based on the preoperative analytics at our fingertips. I believe the analytical services are key elements in helping surgeons improve their planning strategy.
More than just outcomes — Predictive analytics provide support through the surgical continuum
The rise of value-based care is placing additional economic pressure on surgeons to deliver the highest standard of treatment for less cost. Medtronic is focusing its efforts on integrating predictive analytics into a system that actively drives preoperative planning, intraoperative confirmation, and postoperative analysis. Becker’s Spine Review had the opportunity to interview Chief Scientific Officer Thomas Mosnier to better understand how his team of biomedical engineers and data scientists work to apply patient-specific medicine in spine care, and how UNiD adaptive spine intelligence has the potential to improve the standard of care.
Q: How do predictive analytics work?
Thomas Mosnier (TM): Through this new data-heavy service workflow, we developed our own proprietary software platform to capture the iterative feedback loop of clinical data to improve future surgical plans and build our predictive models. Knowledge of scientific publications can help to define surgical strategy, such as the curvature of the spinal rods, but huge amounts of data must be considered to reach surgical objectives. Predictive analytics can amalgamate and channel this data set with great efficiency through specially constructed machine learning algorithms to craft a data-driven strategy for each surgery.
Q: Why haven’t information technology solutions been done before within the spinal industry?
TM: Traditionally, a device manufacturer’s workflow centers on delivering solutions exclusively for the operating room. We saw a need for innovation beyond this one area of the surgical continuum. We also recognized our unique position to do so, which is what led us to pioneer the integration of intelligent information technology with our next-generation manufacturing capabilities.
Q: What do you see are the benefits of introducing a more holistic service?
TM: Our primary ambition has been to improve clinical outcomes and efficiencies in spine surgery by generating surgical plans and patient-specific implants. As an example, a recent study examining rod fracture rates found when patients were treated with UNiD rods, fracture rates dropped to 2.2 percent, compared to the industry average of 9 percent. Surgeons also have access to global data and advanced analytics to determine more specifically what works and what should be changed.
Q: Were there any challenges with building a predictive model for spinal surgery?
TM: Building a predictive model is all about the data. It is not as simple as just gathering information and putting it into a database; biomedical engineers must be accurate regarding the measurements and descriptions of the patient X-rays, imaging, clinical notes, etc. With new data science experts and an experienced biomedical engineering team in place, building the predictive models for spinal surgery was an exciting task.
Q: What do surgeons have to look forward to as you continue to innovate patient-specific spine care?
TM: As surgeons continue to express positive feedback and future desires of this technology, we have plenty of ideas where we are going next with the technology. Like reaching adequate sagittal alignment; prevention of proximal junctional kyphosis failure is also an important topic for spine surgeons. Based on UNiD ASI user feedback, we believe this is a critical area of spinal surgery where we can improve outcomes and efficiencies with our machine learning technology.
Q: How can one learn more about what predictive analytics can bring to their practice?
TM: Our team of trained UNiD lab biomedical engineers are available for contact 24/7 through the UNiD hub software interface system and able to provide personalized demonstrations with case samples and discussions around surgical strategy. We encourage everyone interested in learning more to schedule a demonstration by visiting www. medtronic.com/unid.
Key Takeaways
1. Aligning the patient-specific rod, industrially pre-bent with precision to preserve strength, with the preoperative surgical plan has shown a reduced incidence of rod fracture in ASD procedures.
2. Predictive analytics amalgamates and channels data with great efficiency through specially constructed and proprietary machine learning algorithms to craft a strategy for each surgery that is adapted to the patient and surgeon’s tendencies.
3. Digital planning simulations, which utilize predictive modeling for compensatory mechanisms, are incorporated into the UNiD lab biomedical engineer service.
This content is sponsored by Medtronic and contains the opinions of, and personal surgical techniques practiced by Dr Kleck. The opinions and techniques presented herein are for information purposes only and the decision of which techniques to use in a particular surgical application should be made by the surgeon based on the individual facts and circumstances of the patient and previous surgical experience.
Dr. Kleck is a paid consult for Medtronic.