Spinal technologies that will rise to prominence in 2021: 5 surgeons weigh in


From the expansion of robotic spine surgery to disc replacement and augmented reality, five surgeons discuss the technologies and procedures they expect to play a bigger role in 2021.

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 key areas will your practice focus on this year?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CST Wednesday, Jan. 6.

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

Question: What spinal technologies do you see becoming more prominent in 2021?

Jeremy Smith, MD. Hoag Orthopedic Institute (Irvine, Calif.): Innovation in spine surgery continues to revolutionize the field. Techniques used in the future will make our current ones look archaic. The most fascinating and applicable technology that will be welcomed in 2021 will center around minimally invasive techniques. With COVID-19 limiting hospital beds and resources, the drive toward outpatient surgery will accelerate. Techniques involving single-position surgery (lateral or prone) will continue to improve and allow 360-degree fusions with minimal blood loss and perioperative morbidity. Endoscopic spine surgery continues to grow, and as surgeons continue to refine their skills, indications will become broader. Industry competition has allowed for multiple navigation and robotic technologies that continue to maximize accuracy and minimize invasiveness.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Minimally invasive surgery and technologies that enable MIS procedures will continue gaining popularity. There is more scientific evidence on benefits of MIS surgery and patients demand it. These technologies also make it easier to do more advanced spine surgery, such as lumbar fusions, at an ASC. That will drive better outcomes, cost savings and avoid the need to take elective spine surgery patients to the already overwhelmed acute care hospitals. Robotic-assisted spine surgery will continue gaining popularity as newer capabilities (beyond placing pedicles screws) become more available and accessible.

Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): I think arthroplasty is going to continue to grow, with newer technology discs that are evolving and will be used more often. Discs with not just mobile cores, but potentially compressible cores that mimic normal physiologic motions of discs, will be more in use next year. Furthermore, expanded indications in arthroplasty will continue to broaden. This means not only placing artificial discs in people with significant degenerative discs or even facet joint disease in the cervical spine, but also patients who have severe motion restriction from prior multilevel fusions who will now be able to have those reversed. 

We are doing reversals of such fusions in order to restore motion in certain patients. We call this restorative motion surgery, used for patients who have had multilevel spinal fusions. So far, it has been very successful with no significant complications. We are continuing to study this and we'll be publishing more on it in the near future.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Expandable and augmented reality technologies will become more prominent in the coming year. Implantation through an endoscopic-type approach will be more feasible and allow for patients to have much less invasive surgery. Some of my colleagues are now doing awake fusion surgery, which I think is fascinating. Unfortunately, it requires a lot of buy-in from anesthesia. Adoption in some places, like my own, will likely be slow. Lastly, I see technologies involving virtual learning and teaching become more prevalent. As the COVID-19 pandemic hopefully starts to recede, the way people learn is going to be forever changed. The companies that can do that effectively will be front and center in 2021 and beyond.  

John Burleson, MD. Hughston Clinic Orthopaedics (Nashville, Tenn.): I believe robotics will continue to increase next year. We will also start to see the first wave of adoption of augmented reality in the clinic and the operating room.

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