Four spine surgeons discuss the technologies they see as the future and what they think are just fads that will eventually disappear.
Dwight Tyndall, MD. Spine Care Specialists (Munster, Ind.): Robotics and biologics hold great promise long term but will take significant development to become an every day standard of care. If you apply these technologies correctly you can achieve better and more consistent clinical outcomes. With robotics, you can standardize procedures therefore making them more consistent and hence patient care more consistent and predictable. There is a larger upfront cost, but over time and with enough cases the technology should pay for itself.
Robots can help the surgeons by taking the variability out of the procedure, which then will make the surgeon more efficient. There are a lot of surgeons putting in pedicle screws with the robot now, and it is surprising how quickly and consistently that part of the procedure can now become.
In some ways, I think of a robotic system like an MRI, in that MRI facilitated greatly improved patient care with better and more precise imaging.
I think fluoroscopic-guided percutaneous TLIFs is a fad in that we will evolve away from it with better techniques and technology.
Andre Jakoi, MD. North Kansas City (Mo.) Hospital: I think the concept of sagittal balance is not just a fad but will be the gold standard when discussing fusion and good long-term outcomes, which may decrease adjacent segment disease and morbidities that follow fusion after the recovery period ends.
Conversely, I think a new fad of robotic surgery is not quite there in terms of what it can provide for surgeons. It's early, and I think ultimately the technology will meet the demands and requests of what surgeons need from it, whether that is assistance with osteotomies or decompression,or implementing a surgical plan for deformity cases. Currently I think not as many surgeons are excited about the robot merely planning screw holes when technique, experience and fluoroscopy/navigation are all gold standards.
Harel Deutsch, MD. Rush University Medical Center (Chicago): Some of the current trends in the market involve materials. The surface of the implants and the affinity of the implant to bone based on microscopic surface features is a new trend. 3-D printed devices are another technology that is evolving. Some devices can now be made for significantly less cost and therefore there are more innovative product design possibilities.
Finally, value-added services, such as navigation and robotics, are used as a hook to get surgeons to use specific devices. The orthopedic devices are built in to integrate with a system such as a robotic system. Some areas in orthopedic devices that I see as fads or at least as possibly declining in popularity are lateral interbody fusions and sacroiliac bone fusions.
Alpesh Patel, MD. Chicago Spine MD: I think the biggest trends will come from new technologies and devices that address procedural problems: improving safety and predictability of our surgical procedures. This may come in the form of novel implant materials and/or designs that improve fusion rates, new retractors and neural monitoring that decrease collateral damage and new imaging modalities in the operating room that provide real-time 3D anatomy with more precision and more reliability. The fad that we continue to see, however, is the development of non-differentiating devices. This unfortunately creates a larger drag on pricing across the industry that is starting to be tapped into by large health systems.