Augmented reality, endoscopic surgery & robotics — what 7 spine surgeons are adapting in 2020


Seven spine and neurosurgeons discuss what strategies they will introduce in their practices next 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.

Next Question: What breakthrough or event in spine had the biggest impact on your practice in 2019?

Please send responses to Alan Condon at by Wednesday, Jan. 1, 5 p.m. CST.

Note: The following responses were edited for length and clarity.

Question: What strategies or programs do you plan to introduce next year?

Mark Mikhael, MD. NorthShore Orthopaedic Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): As NorthShore Orthopaedic & Spine Institute launches its spine center, our team of spine specialists are working to improve in three main areas. First, we plan to refine our enhanced recovery after surgery program for spine. We want to decrease the amount of opioid medications we are prescribing while encouraging early mobilization and shorter length of stay. Second, we want to implement a perioperative physical therapy education program for patients to get them in and out of bed quicker following surgery. This will help in overall better patient education. 

Third, we want to develop tools that will give patients ownership of their outcomes. We want to hear how patients are doing two weeks, three months, six months and one year after surgery. Right now, only 30 percent of patients are following through to the end. We expect compliance on patient-reported outcomes to improve as we offer frequent patient questionnaires in various ways such as through in-office tablets, email and paper forms mailed to their homes. 

Christopher Good, MD. Virginia Spine Institute (Reston): Advances in technology have greatly impacted spine surgery over the last decade. 3D navigation, robotic guidance and computerized surgical planning have become commonplace in the modern spine OR. The use of such advanced technology is supported by multicenter data showing that this technology can lead to improved accuracy and better patient outcomes by decreasing complications. Looking to 2020, we will continue to advance this vast experience and build on current research to improve safety during spine surgery. 

I'm excited to introduce augmented reality into my OR. Augmented reality offers potential benefits beyond standard navigation because it allows me to simultaneously visualize my patient and the data from my navigation system while operating. I will be able to more easily merge technology into a spine surgery and improve workflow, making surgery more efficient. Augmented reality promises future benefits to spine surgeons as we will be able to use these headsets to visualize many different types of critical information while performing surgery. 

I foresee the modern OR using augmented reality not only to enhance navigation and instrumentation, but to also provide surgeons endoscopic or magnified views of the patient's anatomy, and to superimpose clinical and radiographic data all on a simple to use heads-up display. I see this as a huge breakthrough with the potential to streamline and partner several technologies in the OR.

We have already seen this technology incorporated into many areas outside of medicine. I believe there will be a strong patient interest and demand for augmented reality as we continue to push to make our surgeries safer and less invasive.

Issada Thongtrangan, MD. Microspine (Phoenix): I am planning to offer more minimally invasive outpatient procedures utilizing endoscopic techniques. My patients are doing very well from this surgery comparing to a MIS tubular-based approach. Recently, there are multiple quality outcomes data showing excellent results of endoscopic surgery. I am also planning to launch flat fee-based consultations to uninsured or high deductible patients.

Brian R. Gantwerker, MD. Craniospinal Center of Los Angeles: We plan on beginning an endoscopic spine and a robotics program. I am also getting trained on one of the industry-leading companies to learn their single position approach to surgery. It is intriguing to be able to operate without changing a table, and the time, value and safety increase to my patients and our local hospital. I am also going to continue and redouble my advocacy efforts with both the North American Spine Society and Neurosurgery. I decided a long time ago that I can't complain without trying to affect change.  

William Taylor, MD. University of California San Diego Health System: Routine use of preoperative planning databases for individual patient guided outcomes and complication risks. Until artificial intelligence is available in the future, that will continue to aid in our preoperative planning and surgical decision making.

James Chappuis, MD. Spine Center Atlanta: We plan to expand our virtual practice as well as increase the amount of endoscopic spine surgeries performed. We are also offering alternative complimentary treatment options for neck and back pain to include stem cell therapy, and we will most likely expand that as well.

Vladimir Sinkov, MD. New Hampshire Orthopaedic Center (Nashua): There will be new advances in robotic-assisted spine surgery in 2020. I plan to use the robotic and navigation technology for interbody spacer placement and disc preparation which will achieve better outcomes, more efficient surgical procedures and faster recovery after lumbar fusion surgeries. I also plan to become more involved with social media to communicate with my patients.

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