Spine surgery is an innovative medical specialty that has seen significant technological strides in the past decade.
Here are 10 technologies that spine surgeons are championing as the next big thing.
1. Single-position spine surgery.
Recent studies in The Spine Journal and The Journal of Neurosurgery: Spine demonstrated the advantages of single-position approaches to spine surgery compared to the traditional open method. Most notably, single-position techniques have been deemed safe and reproducible procedures that can reduce OR time as staff do not need to reposition the patient during surgery.
Themistocles Protopsaltis, MD, chief of spine surgery and co-director of the Spine Center at NYU Langone in New York City, is one surgeon whose practice has benefitted from single-position spine surgery. "We can achieve better height restoration, especially for slipped disks where the vertebrae shift out of position," he said. "It gives us more powerful anatomical control to restore disks to their normal alignment — which is more likely to heal and eliminate problems patients can experience later due to segment degeneration."
During the pandemic, the use of telemedicine was kicked into overdrive, with physicians in many specialties getting a closer look at how the technology can streamline and facilitate the traditional office visit. It is expected to 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," Alex Vaccaro, MD, PhD, of Philadelphia-based Rothman Orthopaedics, told Becker's. "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."
3. Augmented reality.
Interest in augmented reality has grown significantly over the past decade, stemming from a desire to limit complications associated with instrumented spine surgery and improving procedural efficiency.
Initial AR technologies focus on placing pedicle screws accurately and efficiently, which represents the "low-hanging fruit," according to Frank Phillips, MD, of Chicago-based Midwest Orthopaedics at Rush. The next step for AR spine surgery will be to assist placing interbody cages and facilitate precision neural compression.
"Given the significant capital expenses associated with spinal robotics making them largely cost-prohibitive in ASCs, the far more manageable cost of the AR system makes it ideal for ASC fusion procedures," Dr. Phillips said. "It could play an increasing role in surgical planning and providing virtual guidance intraoperatively as to how our surgical execution — for example, deformity correction — is matching preoperative goals."
4. Virtual reality.
Virtual reality technology has arrived in spine, but the widespread adoption is still waiting to break into the mainstream. One key benefit, particularly during the COVID-19 era, is the use of virtual reality for surgical training — a recent study showed virtual reality to be safer in training younger surgeons and less costly.
"As a training tool, both for new graduates as well as surgeons that want to improve their skills, these technologies can be very useful," according to Alok Sharan, MD, of NJ Spine and Wellness in East Brunswick, N.J. "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."
5. 3D printing.
Residents and fellows in spine programs are increasingly using 3D-printed anatomical models for patient education and surgical planning, and have demonstrated particular use for complex procedures. Device companies are also developing more 3D-printed implants with unique structures and surfaces to optimize fusion.
"In the next three years, I see 3D printing growing significantly to fill the need of patient-specific implants," Samuel Joseph Jr., MD, of Joseph Spine Institute, told Becker's. "This will be carried into pedicle screws, cervical plating, as well as cage design. With better technology, including artificial intelligence and preop planning, we will be able to develop implants that reduce OR time, cost, as well as allow us to restore appropriate alignment with reduced complications."
6. Artificial intelligence.
Artificial intelligence and machine learning algorithms are expected to play a big part in how spine surgeons approach preoperative clinic visits and guide decisions based on predictive models.
"In spinal deformity, algorithms have been developed, capturing over 100 variables, which can quickly and accurately — in real time — inform the surgeon of the risk and benefit of a particular operation for a specific patient," according to David Kaye, MD, of Rothman Orthopaedics. "Similar algorithms have been created to suggest 'ideal' alignment parameters for a specific patient based on their unique profile, and tools such as patient specific rods have been developed to help the surgeon achieve these end goals. As outcomes from these surgeries are collected and added to the datasets, machine learning allows the algorithm to become even more accurate."
7. Motion-preservation technology.
In recent years, cervical disc replacement has taken off, with more long-term data continuing to impress the spine community. Lumbar artificial disc replacement has also been picking up steam.
"The newest generation disc implants have pliable cores that allow vertical compression and some lateral shear (twisting) movement, as we see with natural discs," said Todd Lanman, MD, of Beverly Hills, Calif.-based Lanman Spinal Neurosurgery. "The new generation implants give patients even greater stability while also providing natural multidirectional flex as it preserves range of motion."
8. Stem cells.
Stem cell-based therapies have shown promise for the treatment of degenerative spine conditions, and use in augmenting spinal fusion has already proven effective. But the overarching feeling by most surgeons is that more research must be conducted.
"As clinicians, we must be cautious in the way we communicate about it with our patients," according to Vladimir Sinkov, MD, of Las Vegas-based Sinkov Spine Center. "Our opinions and treatment decisions must be based on sound scientific judgement and available high-quality research, which is still very scant."
Robotics have made significant strides in spine over the past decade, but still lag behind robotics in other specialties, such as general surgery, urology and OB/GYN. Robots have impressed with their improved precision in the placement of pedicle screws and limiting radiation exposure in the OR, but their high cost and learning curve have somewhat curbed adoption. However, they are expected to continue to advance and expand beyond assisting surgeons with screws in the future.
"In order to gain wider adoption, robots need to be less expensive and cumbersome, and improve efficiencies and outcomes for all surgeons, including those with the greatest experience and outcomes," said Ali H. Mesiwala, MD, of DISC Sports & Spine Center in Newport Beach, Calif. "Similarly, when the cost of robotic surgery decreases to an amount that can be absorbed by private practice facilities and ASCs, and insurance/Medicare provide payment or incentives for its adoption, widespread adoption will follow."
10. Endoscopic spine surgery.
Endoscopic spine surgery is steadily picking up steam among surgeons, particularly in the outpatient setting, and has been demonstrated to lower complication risks, reduce blood loss and lead to quicker recovery times for patients.
"One of the cool things about endoscopic procedures is it's allowed me to do decompressions on many different patients who would have traditionally obtained a fusion," said Peter Derman, MD, of Texas Back Institute in Plano. "You can sometimes decompress transforaminally even to the center of the canal without destabilizing the segment in any way. As our disc replacement devices improve, and our ability to decompress without destabilizing improves, we're going to see more and more of a trend away from fusion as a treatment paradigm."