Facet joint replacement, stem cells & AR: 9 surgeons discuss new technologies


From advancement in stem cells to artificial facet joint replacements, here are the biggest technologies that nine spine surgeons are excited about:

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.

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, Oct. 14.

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

Question: What technology, not currently available, are you most looking forward to in spine?

Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): What we've been working on lately are artificial facet joint replacements. Remember, artificial disc replacements replace an unhealthy disc, but at times we have unhealthy facet joints. Currently, we do not have an FDA-approved clear facet joint replacement device that is small and easy to insert. We are undergoing studies and evaluations of devices that are a bit bulky and cumbersome to implant that do show some promise. 

As the technology develops, I believe this will become a great method of treating patients' spinal conditions. An example of a surgery that may be perfect would be someone with very arthritic facets and a degenerative disc where one can certainly do the artificial disc replacement. Then you can turn the patient over and replace the arthritic facets. Basically, it's replacing all three of the mobile points at each level of the spine, which would be a big move forward in the treatment of spinal disorders.

John Burleson, MD. Hughston Clinic Orthopaedics (Nashville, Tenn.): I remember in the early 2000s, when desktop printers were terrible and always jamming, drying up and failing. I told my friends that I didn't want the "next big thing" to be a new processor or new kind of printer or anything like that. Rather, I wanted the next big thing to be that our current things actually worked. In that same vein, I love the technology we have for spine now with robotics, navigation and some patient-specific options. I am hoping that the next big thing in spine is that they all work together. Combining these technologies with computers that can help us make decisions will make our cases more predictable and improve our patient's outcomes.

Hugh Bassewitz, MD. Desert Orthopaedic Center (Las Vegas): I am looking forward to the continued trend toward robotic and navigation technologies being deployed in spine surgery. These technologies are helping lower risk, increase the rate of successful outcomes and assist in moving more spinal surgery to the outpatient setting, which more and more patients are desiring. I am also looking forward to the use of augmented reality. Spine surgeons are beginning to use AR headsets to assist with navigation and intraoperative placement of instrumentation. The ability to see the intraoperative navigation images through a heads-up display, which eliminates the need to move one's head to see a monitor while using navigation, is very appealing.

Khalid Kurtom, MD. University of Maryland Shore Medical Center at Easton: Robotics in spine surgery are rapidly advancing, with increasing utility in most spinal fusion operations. Currently, most robots assist in safe placement of hardware with the use of navigation. In the future, robots will have the capability to assist with the decompression portion of the operation. Improvement in optics and utilization of fine robotic instruments will allow the surgeon to perform the entire operation from a console using the robot. These advancements are being developed and are on the horizon in the near future. Despite the steep learning curve and training required initially, this technology will improve accuracy and safety in our spine surgeries and the overall outcome for our patients. 

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I would like to see fully integrated navigation systems with augmented reality that do not depend on line of sight for accuracy. This will help perform surgery more precisely and with the least possible amount of soft tissue disruption, ultimately improving outcomes and decreasing the risk of complications.  

Issada Thongtrangan, MD. Microspine (Phoenix): I would like to see advances in biologics that can treat degenerative disc disease and/or facet arthritis. This includes advancement in stem cells and any other injectables that we can use to rejuvenate the disc or halt the process of arthrosis. My prediction is that it will take years as the process has to be meticulous with reliable data in humans. 

Jeffrey Gross, MD. Spine (Newport Beach, Calif.): As a spine surgeon, my patients and I seek additional nonfusion intradiscal enhancement methods, including both non-biological (injectable viscoelastic materials) and biologic approaches to fill the gap in treatment for discogenic lower back pain while preventing the need for complete discectomy/stabilization. 

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: The ability of robots to guide us real-time during complex and multilevel decompression surgeries. Until that time, robots are essentially an extension of intraoperative navigation. There will be a time when robots will be there to give us real-time feedback as we operate and guide us to faster and safer surgeries. The time of an Iron Man-like heads-up display with a Jarvis-like assistant helping us do our jobs will be a reality in the not too distant future.

Jeffrey Wang, MD. USC Spine Center (Los Angeles): Virtual and augmented reality are the future. I hope to see it develop to the point where it can be used to replace hands-on cadaver courses. The ultimate goal would be to be able to teach a novel surgical technique through virtual reality to someone on the other side of the world. This, combined with robotics and navigation, make the future so exciting. I envision collaborative spine surgeries being done between two centers for a live surgery, where input, advice and even some surgical assistance could be provided remotely. 

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