Four spine surgeons discuss the future of spinal instrumentation and what excites them most.
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Question: What are some of the most exciting trends in spine instrumentation?
Mark M. Mikhael, MD. Spine Surgeon at NorthShore University HealthSystem's Orthopaedic Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): The most exciting trend in spine instrumentation comes with cervical disc replacement. It's proving to have better long-term clinical outcomes for patients with symptomatic degenerative disease versus the 'gold standard' anterior cervical discectomy and fusion. Current literature shows CDR resulting in superior quality of life outcomes, compared to fusion, based on patient-reported outcome measures.
Additionally, long-term studies now demonstrate improved preservation of neck range of motion and a decreased revision/re-operation rate while pain resolution is comparable. Cervical disc arthroplasty also has shown evidence of being cost-effective, which is important as there's more pressure to show value in treatment options. As a result, inserting a two-level artificial cervical disc in the spine might soon prove to be the best option for most patients in need of a damaged disc fix.
Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): The continuing evolution of minimally invasive technologies is the most intriguing. With the improvement of navigation, many forms of spine surgery we currently do may be replaced with outpatient procedures with minimal recovery and improved function.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: The most exciting trend I have seen is insurers now approving hybrid constructs. There is a growing body of literature that using both arthroplasty and fusion in selected cases is beneficial in longitudinal studies. We will have the ability to offer more than the standard cookie-cutter operations and really customize surgery for a patient's actual pathology, rather than what insurers and their guidelines state we can and cannot do.
S. Samuel Bederman, MD, PhD. Spine Surgeon at St. Joseph Hospital (Orange, Calif.): There has never been a more exciting time to be a spinal surgeon. Spinal surgical technology has advanced by leaps and bounds in the last decade. We have a better understanding of our surgical goals, in particular as it relates to curvatures of the spine, such as scoliosis (side-to-side curvature) and kyphosis (round back or stooped posture) and better tools to achieve them.
We can approach the spine through different approaches from the front, side or back either in a minimally invasive or more effective manner. Surgical implants have evolved in both materials to better achieve healing as well as design to improve our ability to restore proper alignment. Finally, other technologies such as computer navigation, robotics and patient-specific 3D printed models allow us to treat the spine surgically in highly complex situations in a safer and more efficient manner.