The key technological trends in spine for 2019


Twelve spine surgeons, neurosurgeons and pain specialists discuss the trends they expect to see in the spine technology arena this year.

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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Question: What is the most major technological trend you expect to see this year?

Bryce Johnson, MD. Medical Director of Saddleback Medical Center for Spine Health (Laguna Hills, Calif.): Over the course of the next year, I expect to see an increase in utilization and refinement of computer-navigated and robotic technologies for spinal surgery. Both of these techniques help to increase the accuracy of implant placement. Computer navigation takes advantage of real-time simulation of implant location, while robotic surgery allows implementation of either intraoperative or preoperative plans. Additionally, both techniques reduce radiation exposure to surgeons, especially during minimally invasive procedures.

Sheri Dewan, MD. Spine Surgeon at Northwestern Medicine Central DuPage Hospital (Winfield, Ill.): As our society becomes more technologically driven, spinal surgery will also follow suit. The addition of robotic surgery as a tool in the armamentarium of the practicing spine surgeon will not only allow for pre-planning, accuracy and reproducibility; but will also aid in costs, quality and outcome. As the estimated number of patients afflicted with low back pain reaches the estimate of over 70 million, this need will only increase over the next year and over the next decade.

Josh Murphy, MD. Orthopedic Surgeon at Children's Healthcare of Atlanta: In my opinion, the most major technological trend of 2019 will be further advancement of robotics and navigation for pedicle screw placement in spine deformity patients. I believe it has the opportunity to continue improving safety of instrumentation placement in challenging spine surgeries.

Osama Kashlan, MD. Assistant Professor of Neurosurgery and Spine Surgeon at Michigan Medicine (Ann Arbor): The most major technological trend I expect to see this year is continued innovation in both robotic and endoscopic spine surgery. In the more distant future, I would not be surprised to see both of those technologies converge in a way that would change the way we approach spine surgery forever.

James Petros, MD. Founder and Medical Director of Allied Pain & Spine Institute (San Jose, Calif.): Robot-guided spine surgery is a hugely significant development, and it will be the major technological trend to watch out for in 2019. Its cutting edge, safer approach means that surgeons can undertake less invasive operations that cause less trauma and encourage faster healing. Robot-guided spine surgery is also undertaken with reduced amounts of radiation, which is good for patients, surgeons and other healthcare providers. Reduced complication rates are also possible with this technology, not to mention the ability to pre-plan procedures that result in reproducible outcomes. Keep your eyes trained on robot-guided spine surgery this year, it's going to be very promising and very exciting!

Issada Thongtrangan, MD. Orthopedic Spine and Neurosurgeon at Minimally Invasive Spine (Phoenix): This year I expect to see more [advancements in] surface technology for better fusion, navigation/robotic-assisted technology for precise hardware placements and real-time planning software to achieve sagittal balance. I also expect to see an early phase of AI technology.

Dennis Devito, MD. Medical Director of the Spine Program at Children's Healthcare of Atlanta: Children's is the leading center for pediatric robotic spine surgery in the world. We've done more than 1,000 robotic-assisted spinal surgeries for children. We work continuously with partners that are advancing surgical technology to prepare for what innovations are on the horizon, and I expect that robotic-assisted navigation and surgery will continue to be the wave of the future.

Michael Oberlander, MD. Founder and CMO of Trainer Rx (Walnut Creek, Calif.): As demand for clinical information and solutions to improve efficiencies increase, healthcare IT promises to transform an antiquated paper-based healthcare system into a digitized one. In this era of digitalization, integrating patient-reported outcome measures into clinical practice will become common place. This improves our ability to critically evaluate various treatment regimens in an unbiased fashion and ultimately improve outcomes and quality of care. Interestingly, despite considerable progress being made in the electronic measurement and collection of patient-reported outcome measures, little or no attention has been paid to designing user-friendly, visual dashboard displays. But more companies now are addressing this gap.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: There continues to be a rising need for accuracy and safety. To this, we will see increasing number of quality intraoperative guidance, low-emission fluoroscopy, electromagnetic guidance and robotic surgery. We will likely see a Mako-style spine robot in the months and years to come. The use of augmented reality in hardware placement I think will radically alter our ability to place hardware and make things faster and more accurate.

Christopher Wolf, MD. Orthopedic Spine Surgeon at Cedars-Sinai Kerlan-Jobe Institute (Los Angeles): Placement of instrumentation with standard 2D radiographs is being replaced with very accurate CT-guided computer imaging. This is making screw placement much safer for patients than in the past. Additionally, advances in bone grafting in the past led us from using autologous grafts to grafts from cadavers. Over time, these advances with the use of proteins such as BMP are enhancing fusion potential. This will continue to improve and make surgery safer and more effective for patients.

Implants are continually advancing with a number of companies competing. It likely will move to some extent towards more custom implants for patients that can be 3D printed to exact size/shape for implantation based on preoperative imaging. Also, improvements with the application of stem cells are advancing, but not as rapidly as most would hope. At present, stem cells can help augment a fusion. It is hoped that in the future the disc itself can be 'regenerated/restored' with this technology. But that potential in humans remains to be seen.

Marc D. Moisi, MD. Neurosurgeon at DMC's Detroit Receiving Hospital: The two major trends in spine are the use of robotics for the navigation of screws for spine fusions with correction of deformity and spinal cord stimulation for spinal cord injury. In terms of deformity and placement of screws, there are several robots that have been developed and many that are in the process of being developed that will assist in maximizing screw placement and efficiency in the operation room, by preplanning trajectories and correction preoperatively, as well as creating optimized results for the correction of the deformity. The more streamlined and accurate these robots become, the better the outcomes, the shorter the operative and OR times and the quicker the patients will be able to be on the road to recovery. These robots are not there to replace the surgeon and his expertise but rather to aid him in efficiency and optimized outcomes.

Spinal cord injury is a devastating condition that, when permanent, leaves very little therapeutic options for recovery. As we continue to expand our understanding of the intricacies of spinal cord anatomy, we will be able to apply new technologies in the realm of spinal cord injury recovery. There has been some recent positive traction in spinal cord stimulation with recent studies. As we gain a deeper understanding, we can hopefully move forward rapidly with treatment protocols to help treat this injured population and give them real hope.

Christian Zimmerman, MD. Spinal Neurosurgeon at Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The most major technological trend will be the ramping [up] of artificial intelligence as it applies to routine healthcare issues to minimize inefficiencies. In an effort to maximize both administrative and operational efficiency, the use in templated medical workflow may be better served with data input and review with AI. Labor costs and streamlining this end of costly healthcare may be assisted with AI implementation.


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