Michael Goldsmith, MD, spine surgeon at Bethesda, Md.-based The Centers for Advanced Orthopaedics and chief of orthopedics at Washington, D.C.-based Sibley Memorial Hospital, discusses spine technology and where he sees it heading in the future.
Question: What emerging technology or technique do you think will have the biggest impact on the spine field five years from now?
Dr. Michael Goldsmith: Robotics and biologics will have the biggest impact on the field of spine surgery five years from now. We have advanced image guidance technology that is extremely useful in both simple and complex spinal procedures and provides a high level of accuracy and safety. In addition, our field has exciting robotic technology from companies such as Globus and Mazor, but this is still in its infancy. The technology is rapidly advancing to extend its indications across the field of spine surgery and improve its speed and accuracy. In addition, biologics will [have] a major impact on how the field of spine surgery looks in five years, both from an improved fusion perspective and a motion preservation perspective through regeneration and maintenance of normal anatomy.
Q: What do you think will fade or disappear from the spine field over the next few years?
MG: Hopefully revision surgery for pseudarthrosis will be less prevalent in the coming years. As our implants and techniques become better and our adjuncts to bone grafts become more powerful through advancement in biologics, I would expect to see fusion rates rise. Revision surgery is extremely costly and has higher complication rates than index fusions, so the goal is to avoid reoperation to benefit both the patient and health system.
One concern I have, which is a bleak prediction, is that innovation may decrease as well. In an effort to save money, many hospitals, in particular the larger health systems, are moving to one or two vendor systems which drives out smaller companies and may have the downstream effect of diminishing innovation. Oftentimes smaller companies have the ability to be more innovative either because they were created around a new technology or in order to differentiate themselves. We need to continue to encourage true innovation at the ground level by supporting all technology, not just from the big companies.
Q: Where do you see the biggest room for innovation in spine? What do you need to provide better care that doesn't currently exist?
MG: The biggest room for innovation is in lumbar motion preservation. Cervical disc arthroplasty has demonstrated amazing results when using the appropriate selection guidelines. Eight-to 10-year data shows fantastic results and a lower reoperation rate compared to fusion. We have never really seen those types of results in motion preservation techniques in the lumbar spine.
I believe one of the major obstacles to care in the field of spine surgery is administrative; insurance companies setting up major road blocks to care through denials of imaging and treatment, most of the time being evaluated by people with no background in the care of spine patients. This becomes frustrating for both the patient and surgeon and denies people access to necessary care.
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