Regenerative medicine, patient-specific implants and artificial intelligence continue to gather momentum in the spine field, but robotics and augmented reality are the technologies surgeons expect to become more prominent in the next five years.
Spine robots may catch up with the abilities of their joint replacement counterparts and the Iron Man-like headsets associated with AR systems will find themselves in more operating rooms across the country.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Editor's note: The following responses were lightly edited for style and clarity.
Question: What spine technology do you expect to take off in the next 5 years?
Daniel Yanni, MD. Hoag (Newport Beach, Calif.): The emerging spine tech that's going to take off in the next five years is augmented reality. While we are continuing to improve on biologics, hardware and robotics, nothing is as groundbreaking as the advancements being made in AR. This technology expands the amenities of a multimillion-dollar operating theater to a whole new reality, utilizing a portable headset that can be used anywhere, in any operating room. It is analogous to bringing the Iron Man helmet to your local surgeon.
AR technology allows surgeons to enhance what they see during a procedure with real-time 3D guidance and feedback based on a hologram-like reconstruction of the body. With access to multiple displays inside a single set of AR goggles, surgeons can customize their surgical suite. The AR overlays include a wide variety of information, from 3D reconstructions, source imaging (CT, MRI, angiography) and any other data source tailored to the surgeon's preference and comfort.
AR results in more efficient and less invasive surgeries, streamlined surgical planning, less exposure to X-ray radiation and optimal surgical precision. Surgeons at all levels can benefit from this technology. Even preliminary studies are showing significant improvement in trainee accuracy.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Five years on, we will likely see spinal robotics in the same place as the joint arthroplasty devices. We will be able to do better, faster, and safer spinal decompression and instrumentation. Electromagnetic guidance will be coupled with static imaging such as intraop CT scan, providing real-time updates during surgery. We will likely see more wide adoption of spinal endoscopy and MIS fusions and their corresponding tech to grow. In all likelihood, there will be consolidation in the endoscopy and arthroplasty space and see more "big box" companies add these to their offerings.
William Taylor, MD. University of California San Diego: We strongly believe that artificial intelligence is an opportunity to change the way we think about operative planning and decision making. This includes not just intraoperative hardware and assistance during surgery but preoperative planning, patient-specific implants and data-directed care based on specific patient outcomes.
Michael Goldsmith, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): I believe a number of exciting technologies will grow significantly in the next five years, with robotics at the top of the list. Although spinal robotics has now been available for over a decade, it is still in its infancy. As the technology continues to mature, I believe a larger number of surgeons will adopt this technology as the platform expands from targeting pedicle screws to actual placement of hardware and possibly decompression of the spine. I expect we will see further integration of robotics with AR to help both in the planning and execution of surgery to improve results, lessen complications and create efficiencies. In addition, I believe the role of big data will continue to expand in practice patterns for spine surgeons as well as in how payers make decisions related to spine surgery.
John Burleson, MD. Hughston Clinic Orthopaedics (Nashville, Tenn.): I think we will continue to see further adoption of robotic spine surgery and navigated spine surgery, especially at the training levels. Most residency programs still do not have enough navigation in robotics to train residents and fellows with this technology, but I believe this will continue to improve. In private practice, I think we will see more adoption of AR, which I think will also trickle down to academics eventually.
Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): Endoscopic spine surgery is currently gaining momentum in the U.S., but it is still way behind Europe and Asia regarding this technology. Misperception, lack of training, steep learning curve, reimbursement and costs are identified factors [limiting adoption] in the U.S. There are level 1 published studies from all over the world that show the safety and efficacy of this technology. I personally integrated endoscopic technology in my practice in the last three years and we are proud to offer our patients full endoscopic spine service. The other area that will continue to evolve in my opinion is robotics, navigation and AI.
Noam Stadlan, MD. NorthShore Neurological Institute and NorthShore Spine Center (Evanston and Skokie, Ill.): I think that the use of robots will increase, not necessarily because they have proven efficient and beneficial, but due to public demand. Perhaps the most beneficial new technology will be augmented reality, although it is too early to predict the impact and applications.
Neel P. Shah, MD. DISC Sports and Spine Center (Newport Beach, Calif.): Motion preservation seems to be becoming more mainstream over the last five years, and I see this being the trend moving forward over the next five years. I believe that cervical and lumbar disc arthroplasty will become a tool that more spine surgeons use to help treat spinal pathologies.
Mohammed Faraz Khan, MD. New Jersey Brain & Spine (Oradell): I think AR will really take off. With Web 3.0 and the Metaverse buzz in full gear, I anticipate that spine techniques courses and meetings will likely shift toward a convenient format of AR where we will soon be attending the spine event in a virtual land just by putting on a VR headset in our living room.