Robotic advancement, augmented reality & more: 4 spine surgeons on the next big innovation in the field


Four spine surgeons discuss the next big breakthrough in spine surgery.

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 week's question:  What strategies has your practice taken to prepare for price transparency? How do you see it impacting the spine field?

Please send responses to Alan Condon at by 5 p.m. CDT Wednesday, May 13.

Note: The following responses were lightly edited for style and clarity.

Question: What is the next big innovation for minimally invasive spine surgery?

Srdjan Mirkovic, MD. Northshore Orthopaedic & Spine Institute (Chicago): I see two big minimally invasive spine surgery innovations in spine care. First, robots have advanced in spine surgery. Robotic and free-hand spine surgical procedures are proving to insert screws with great precision and accuracy for surgeons. Secondly, we are managing pain much better through more aggressive, nonoperative steroid injection protocols.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): MIS spine surgery is an excellent option for most patients. It has been shown to be safer, with less postoperative pain and quicker recovery times than traditional open techniques. We now have multiple studies with long term data to prove this. The next innovation would be to make MIS spine surgery more common through better technologies and surgeon education. Intraoperative computer navigation and robotic technology allow for precise preoperative planning, accurate hardware placement and lower radiation exposure. This technology will make it much easier for spine surgeons to adapt minimally invasive techniques and eventually make it the standard of care.  

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The use of electromagnetic-guided navigation are very exciting developments. I think endoscopic decompression and expandable cages offer excellent techniques to keep incisions small and drive positive outcomes. The next big innovation will be the development of a spinal robot that actually helps us do the surgery part of the operation. While the placement of pedicle screws with robots is making surgery safer, it is not the game changer we are waiting for. When we can marry intraoperative visualization with augmented reality and a robot, then you're talking revolution.

Issada Thongtrangan, MD. Microspine (Phoenix): Full endoscopic and MIS spine surgery will continue to evolve. There are several level I studies from Asia and Europe showing the positive outcomes for spinal stenosis and disc herniation. There are few centers in Asia, especially in Korea, China and Japan, that started to do interbody fusions using an endoscope. The obstacle in the U.S. is going to be adoption of the technology, training on how to do the surgery and the cost of technology.

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