From robotic-assisted surgery to augmented reality and potential virtual health innovations, 10 spine surgeons discuss the technologies that they see making the next big breakthrough in the field.
Frank Phillips, MD. Rush University Medical Center (Chicago): I am particularly excited by augmented reality in spine surgery. Recently, the FDA approved a unique system that comprises a headset with integrated tracking cameras and direct retinal near-eye-display that provides for virtual 3D visualization of the spinal anatomy as well as standard 2D CT navigation images. At Rush, we performed the cadaveric testing of this system that resulted in FDA approval and I was highly impressed with the advantages this system provides.
Peter Derman, MD. Texas Back Institute (Plano): I hope we will look back 10 years from now and think that the surgery we were doing in 2020 was archaic. In the future, I think that far fewer fusions will be performed as disc replacement and other motion preserving technologies continue to improve. I am also excited about endoscopic spine surgery, which is becoming an increasingly large part of my practice. It is a true paradigm shift in the field, which allows surgeons to access and address spinal pathology without the morbidity associated with traditional techniques. In many cases, it allows me to perform an ultra-minimally invasive decompression when a fusion might otherwise have been necessary. Patients are comfortably home within hours of surgery and often only take Tylenol for postoperative pain control in the days after the procedure.
Richard Chua, MD. Northwest NeuroSpecialists (Tucson, Ariz.): With continued improvements in minimally invasive techniques, implant design/engineering, preoperative patient education, postoperative rehab and extended recovery after surgery pain management strategies, I see a continual evolution of spine surgeries into the outpatient world. I am now selecting certain patients for outpatient lumbar fusion in the hospital using an extended recovery phase for up to four hours, after their initial recovery room phase. With adequate pain control, early ambulation with physical therapy as well as appropriate patient education and home support, I am hoping to perform up to 25 percent of my single level lumbar fusions on an outpatient basis by the end of the year.
John Liu, MD. USC Spine Center (Los Angeles): The continued changes and dynamics of spine care and surgery in general is what's exciting about spine care. What we are doing today is very different compared to when I first started, primarily based on our increased knowledge and technical advancements. The next five years will continue to bring exciting developments in regenerative medicine that will help alter how we take care of spinal cord injury and degenerative spine disease.
Stephen Hochschuler, MD. Texas Back Institute (Plano): It's my belief that we will see many changes in spinal care delivery. Just as there has been a convergence of cardiovascular surgery and interventional cardiology, I believe spine will see an acceleration of the convergence of spine interventionalists with spine surgeons. The spine world has already accepted that interventionalists (physical medicine and rehabilitation physicians, anesthesiologist/dolorologists and interventional radiologists) utilize dorsal column stimulators. In addition, interdiscal injections, minimally invasive rhizotomies, facet and epidural injections are all accepted by the spine world.
Roger Hartl, MD. Weill Cornell Medicine (New York City): The next big trend will be a more targeted approach for minimally invasive spinal surgery. We need to obtain a better understanding of which patients benefit the most from minimally invasive surgery. Endoscopic surgery will play a very important part especially in conjunction with more complex pathologies. The integration of biologics for disc regeneration, disc repair and maybe even total disc replacement is evolving. Eventually, I envision a combination of better diagnostic and therapeutic understanding of spinal pathologies, and integration of minimally invasive surgery and biologics.
Dalip Pelinkovic, MD. Suburban Orthopaedics (Chicago): Simplified, sophisticated surgical instruments and approaches in contrast to technology/industry driven expensive spine care. I think that peel packed sterile implants off the shelf may be a great asset for ASCs. It simplifies logistics, sterilization, reduces trays and OR setup time. Hand in hand with simplified, sophisticated surgical instruments and approaches, it may eliminate the need of industry driven expensive spine care, which necessitates in hospital care.
Noam Stadlan, MD. NorthShore Neurological Institute (Evanston, Ill.): The trend that excites me is one that sounds extremely boring: data and outcomes. However, in order to better serve our patients, we need better and more detailed data collection on common conditions and outcomes, so we can more expertly tailor our treatments to fit the patient and their particular problem. Better data, utilized properly, will lead to better outcomes.
Issada Thongtrangan, MD. Microspine (Phoenix): The COVID-19 pandemic significantly changed our communication with the patients. Virtual health and social media platforms will be a new normal from now on. The challenges for me are the physical examination. I cannot do a thorough exam with these platforms. I anticipate that there will be innovations that will overcome this.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I am excited by new technologies that will lead to better outcomes, faster recovery and lower complication rates. These technologies that enable minimally invasive spine surgery, robotic-assisted surgery, computer navigation and augmented reality bring added costs. However, the cost savings associated with minimally invasive spine surgery results in faster recovery and return to work and function, shorter hospitalization or even avoiding admission altogether, lower complication rates or need for revision surgery will more than compensate for such extra expenses. Once the technologies are widely implemented, costs will inevitably decrease while we continue to provide the best and most innovative care to patients.