Eight spine surgeons discuss the technology at the forefront of the field today and on the horizon.
Kee Kim, MD. Chief of Spinal Neurosurgery at UC Davis School of Medicine (Sacramento, Calif.) and Co-director of the UC Davis Spine Center: There is a dizzying array of innovation in our field so it's very hard to pinpoint just one technology. For example, there is a new polymer that may be a suitable bone graft substitute and a novel alloy implant with advantages over what we use currently. Also, the role of robotics in spine surgery will be more versatile. Right now, it is utilized primarily for accurate screw placement, but it should be adapted to help with surgical access, tumor resection and decompression including osteotomy.
Mick Perez-Cruet, MD. Michigan Head & Spine Institute (Southfield, Mich.): Stem cell for intervertebral disc regeneration. This is a very exciting area of clinical research and investigation and has the potential to benefit most of our patients, provided the appropriate cost-effective technologies are developed.
Jason Huang, MD. Baylor Scott & White Medical Center (Temple, Texas): I am personally most interested in new and emerging technology to analyze big data in the field of spine – such as massive quantities of data from electronic medical records of spine patients within our aging and more diverse populations and the advanced analytics that could give it meaning. Such technology holds the prospect of becoming an engine for the medical knowledge generation that is necessary to address the significant unmet information needs of our patients, spine surgeons and other providers, hospital administrators, as well as health policy legislators.
In our growing field of spine, such big data analytical method would improve classification of spine diseases, reveal ways to evaluate the influence of particular spine technology or surgeons on practice patterns, or predict a spine patient’s clinical outcomes.
Thomas Loftus, MD. Austin (Texas) Neurosurgical Institute: I feel private practice physicians like myself will be burdened even more by increasing government regulation, drug prescription monitoring requirements, and increased costs associated with staffing to address these regulations. We try to tackle these head-on as they arise so that we don't have to spend even more time trying to 'catch up' as the regulations become more complicated and restrictive to patient care. Over the next three years we are expecting this to increase unless much-needed deregulation is enacted by our government.
Khoi Than, MD. Duke Spine Center (Durham, N.C.): The most interesting emerging technology available right now is robotic spine surgery. The capabilities of robotic technology in spine aren't extremely beneficial right now, in that the robots simply provide data for screw placement. But, I think as robotics evolves it will be able to do more complicated procedures, such as challenging osteotomies and corrections, and that's when robotic technology will be really useful as an adjunct to surgery.
All technology has to begin simple and progress to accommodate more difficult procedures. I know different companies have this in mind and are working toward it.
Ashutosh Pradhan, MD. Ascension St. Vincent's Riverside (Jacksonville, Fla.): Lumbar arthroplasty and robotics. Lumbar arthroplasty is not necessarily a new idea, but we have had limited improvement on current offerings. I think we still need to evolve in maintaining motion in the spine rather stopping motion. There are only two FDA approved lumbar arthroplasty devices: Centinel Spine's prodisc-L and Aescalup's Active-L. I hope there will be more products to come to market.
Robotics have a lot of possibilities, but we are not there yet. Improving outcomes and decreasing revisions would go a long way in spine. The robots are currently limited in capabilities and do not have live feedback. I think the growth of use will force improvement and indications.
Kevin Foley, MD. Semmes Murphey Clinic (Memphis, Tenn.): I am interested in technologies that have the potential to improve upon various aspects of contemporary spine surgery, especially those that can add value by improving the quality of spine surgery at a competitive cost. For example, I am involved in the development of progenitor cells derived from human disc tissue to treat degenerative disc disease and postpone or avoid fusion, ultrasonic imaging combined with artificial intelligence-enhanced algorithms to detect critical neural structures and prevent damage to these structures, a bioresorbable, osteoconductive, wet-field mineral-organic bone adhesive to repair and enhance bony structures and improve spinal fixation in poor quality bone, an improved means of generating intraoperative three-dimensional images, and a cost-effective spinal robotic system.
Jaime Nieto, MD. Chief of the Section of Neurological Surgery and Spine Surgery at NewYork-Presbyterian/Queens: Endoscopic spine surgery will become the skill that patients will ask their spine surgeons about. Patients are becoming more interested in their care and with the internet resources they will be able to find what they want. Minimally invasive surgery continues to evolve and the endoscopic techniques will promote evolution.