4 spine surgeons on technology innovation


Four spine surgeons weigh in on the devices and technologies they would like to see enter the spine care arena in the new future.

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. We invite all spine surgeon and specialist responses.


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Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Feb. 28, at 5 p.m. CST.


Question: What innovations would you like to see in terms of spine-focused devices & technologies?


Mark M. Mikhael, MD, Spine Surgeon at NorthShore Orthopaedic Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): I would like to see better computer-assisted navigation or robotic image guidance that utilizes real-time intraoperative imaging without an increase in radiation load. Radiation exposure in current CT-based or fluoroscopy-based systems is still problematic, while current robotic image guidance relies on preoperative imaging that does not represent actual intraoperative anatomy after deformity correction, fracture reduction or any change in spinal alignment.


In addition to accurate placement of instrumentation, a real-time 3-D based intraoperative imaging system can also assist with decompression surgeries, especially those aberrant/variable anatomy or complex deformities. It also would be beneficial to develop a system to rate quality and accuracy with the different surgical technologies to better understand outcomes.


Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I would like to see a lumbar arthroplasty device that can be placed through a lateral interbody technique. I have heard rumors this is coming, and I am very excited about the possibilities. For spinal stimulation, I am looking forward to more MRI-compatible paddle leads and improvement on surgical technology.


Other exciting innovations are in customizable implants, but I do see that as an inherently expensive and perhaps fad-type situation. Perhaps there will be a niche market for custom implants for deformity or oncological spine cases, but I see more of the same, with standard sizes and surgeons doing their "carpentry" to make it fit well. The Mako robot in the joint replacement sphere is able to tell the surgeon when to stop shaving bone so that the implants will fit correctly, and I foresee that type of technology coming to spine.


Michael J. Musacchio, Jr., MD. Spine surgeon at NorthShore University HealthSystem's Neurological Institute (Chicago): I would like to see innovations come in the form of refining some existing devices and technologies. Fine-tuning needs to be done with surgical planning software to make it more user-friendly, especially for non-deformity surgeons.


For example, 3-D navigation can be more intuitive for minimal tissue destruction to the supporting structures of the spine. Most surgeons approach surgery based on their instruction, unique skill set and experience — seeing it as more of an art than a science. But if technology better addresses the pathology of the spine, 3-D navigation would enable less-experienced physicians to do surgery optimally every time. This technology would essentially reproduce the standardization of spine surgeries. There would be greater control and efficiencies in this type of innovation. Already, there is a medical device company leading the way in this area for minimally invasive spine fusion procedures. It will be exciting to see how other companies follow suit.


Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): Having surgeon-directed innovation is key to the advancement of spine technology. I would like to see the development of new minimally invasive techniques, with improved patient outcomes long term and reduction in complication rates.



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