'Half of what we do today will be history': How spine surgery will look in 10 years


In the next decade, spine surgeons will move further toward a multidisciplinary approach to care, with robotics becoming the standard of care for instrumentation placement, fewer fusions being performed and more total disc replacements.

Here's what spine surgery in 2030 will look like, according to eight spine surgeons:

Question: How will surgeons in 2030 look back at how spine care is performed today?

Srdjan Mirkovic, MD. Northshore Orthopaedic & Spine Institute (Chicago, Skokie, Ill.): I believe surgeons practicing at the start of the next decade will appreciate an enhanced multidisciplinary approach to treating spine pain. Between now and then, I see spine surgeons and pain specialists working in closer cooperation, referring more often and increasing interactions through case discussions, perhaps through a multidisciplinary conference. Also, I anticipate more evidence-based, minimally invasive procedures that prove effective as technology evolves in the coming years. Lastly, I expect surgery will continue to evolve towards less invasive options.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Given the amount of research and development currently devoted to improving spine surgery techniques and instrumentation, there are a lot of exciting developments that I look forward to in the field of spine surgery in the future. By 2030 I anticipate spine surgery to be a lot less invasive than current techniques. There will likely be more regenerative options available to treat spine disease in earlier stages, before invasive fusion interventions are needed for degenerative spine disease. Most decompression procedures will likely be done endoscopically. Both endoscopic decompressions and all fusion surgeries will be done in a minimally invasive fashion with use of navigation and augmented reality. 

Robotic assisted surgery will be the standard of care for instrumentation placement, nerve decompression and disc space preparation. This will allow for more precise, predictable and safe surgery. I sincerely hope that more research will be devoted to determining the most effective and cost-conscious bone-grafting materials for fusion surgeries. There will likely be improvement in implant quality and outcomes as well as expanded indications for motion preservation procedures, too.

Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): My prediction is that in 2030, the majority of spine surgeries will be performed using minimally invasive techniques in outpatient settings. Endoscopy, navigation, virtual reality and artificial intelligence will be the standard of care. There will be more advanced and acceptable solutions in biologics and stem cells for degenerative disc treatments. Half of what we do today will be history if not obsolete.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: We will solve many problems, such as facet replacement, three or more disc arthroplasty indications and a way to reliably select the right surgery for the right patients, in indifference to unrelated concerns such as [relative value unit] goalposts, departmental demands or medical school debt. Augmented reality with heads-up displays, real-time dynamic navigation with little to no radiation and near-bloodless surgery will be very prevalent. In short, things will be cooler, safer and better.  

There are patients I see at times, who had a microdiscectomy or decompression 10-15 years ago, and the incisions look enormous. I am sure my prejudice and hubris would be different if I were that surgeon 10-15 years prior and be very proud of using a "small" incision. Ten years hence, I hope our successors will look on us kindly and with an understanding heart.

Todd Lanman, MD. Lanman Spinal Neurosurgery and ADR Advanced Disc Replacement Spinal Restoration Center (Beverly Hills, Calif.): In the next nine years, I think that spine surgeons will look back at the number of fusions that were performed and how debilitating and often restrictive this type of surgery was for a patient's health. 

As artificial disc replacements and motion preservation surgery continue to develop, these will become the mainstays of treatment in the future. Fusions will become very limited in their usage, mostly reserved for severely arthritic degenerative or scoliotic spines, but not for the general cases of patients that need spine care. Most of these patients can be treated using artificial disc replacements. As we are finding out now, the indications for artificial disc replacements are being expanded greatly. 

For example, patients that are believed to have arthritic joints once required a fusion, but this is indeed not true, particularly in the cervical spine where most patients who have somewhat arthritic facet joints in the can undergo artificial disc replacements with certain discs that help unload or offload the facet joints, lessen facet pain and keep mobility and function.

Jeremy Smith, MD. Hoag Orthopedic Institute (Irvine, Calif.): I believe we will look back and think that our surgeries were too invasive, and over performed. Over the next ten years, spine surgery will become less invasive, more motion preserving and more reliant on image guided technology. It will be performed more regularly in the ASC on an outpatient basis and recovery will be more expeditious. Artificial intelligence will help build evidence based treatment algorithms tailored to the individual patient. These pathways will make the surgical outcome more predictable and help drive down revision rates. 

Ali H. Mesiwala, MD. DISC Sports & Spine Center (Newport Beach, Calif.): The years 2020 and 2021 will likely be viewed as a turning point when spine surgery became more acceptable and available in the outpatient setting. For the decade or two prior to this, limited centers existed which specialized in spine surgery, and many surgeons and medical device companies did not feel comfortable performing these operations in the outpatient setting.

With the COVID-19 pandemic, hospitals were overrun with patients who truly needed inpatient care, and elective cases were pushed to the side or delayed indefinitely. For surgeons working in the outpatient setting with established outpatient spine practices, the pandemic proved to be an opportunity to showcase what could be done. As more facilities and surgeons recognized the safety, efficiency and convenience of outpatient surgery, it became more accepted and, in fact, requested by patients.

In 2030, most elective spine surgeries will be performed in the outpatient setting, and only those complex cases or medically risky patients will be taken to traditional hospitals and medical centers.

Rojeh Melikian, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Similar to how we might look back on 2010's surgical landscape today, I imagine we will wonder how we did some surgeries without the newer technologies that came out in 2025 or 2030.

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