The next game changer in spine: 4 surgeon insights


From telemedicine to augmented reality and the advancement of single-position procedures, the technology that will have the most significant effect on the future of the field is discussed by four spine surgeons.

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: As consumerism continues to rise, so too will competition among practices. How does your practice plan to stand out in the post-pandemic market?

Please send responses to Alan Condon at by 5 p.m. CDT Wednesday, June 16.

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

Question: What technology do you see as the next true game changer in spine surgery?

Alexander Vaccaro, MD, PhD. (Rothman Orthopaedic Institute (Philadelphia): Telemedicine is an inevitable game changer in spine surgery. As the field advances, the traditional doctor's visit is due for a much needed update. With the pandemic, the implementation of telemedicine was kicked into overdrive, and its utilization will continue to reshape clinical practice. This will ultimately allow patients to receive the best care possible at their convenience, despite common boundaries such as busy work schedules, living in rural areas or having functional limitations. Patients can now receive second opinions from world-class thought leaders at a fraction of the price, and a surgeon's office hours can now be mobile, exploiting downtime at medical meetings and between surgical cases if necessary.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: I think it remains to be elucidated what is and is not a game changer in spine. We have seen so many pretenders to the throne. In truth, this is a marathon, not a race. As a whole, spine surgery is getting safer. When technology is used in conjunction with good judgment and not the ringing up of [relative value units] or maintaining a surgeon's lifestyle, we all get better at what we do. Shrewd selection of cases, application of the plethora of helpful technology, surgical experience and good outcome data applied in a thoughtful manner will lead to the continued progress and safe evolution of spine surgery.  

Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): I think the next big game changer in spine surgery will be the common use of virtual surgery tools, such as augmented reality glasses. These glasses, along with the technologies that will allow other surgeons to proctor a surgeon in another state or country, will help improve the quality and efficiency of surgeons. As there is a greater emphasis on quality and outcomes, surgeons will have to ensure that they are able to produce reproducible results. This will require virtual coaching by other surgeons who can help a surgeon attain higher quality and efficiency in the OR.

Currently, to learn a new technique, a surgeon has to travel to a weekend course. This becomes burdensome in terms of time off from your practice and personal obligations. With AR glasses, surgeons will be able to learn new techniques and also improve their current surgical techniques.

Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): Endoscopic spine surgery, including fusion, will be a game changer as it is gaining more acceptance in the U.S. The challenges are training, steep learning curve, cost of the equipment and reimbursement. Motion preservation, especially cervical disc replacement, will continue to gain more acceptance, as the data is undeniable. Single-position surgery, such as prone-transpsoas, will be a game changer as well.

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