Robotics, endoscopy and more: Spine innovations expected to soar by 2025


As new spine innovations continue to grow, six surgeons told Becker's what they think will gain the fastest adoption in the coming years.

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. Becker's invites all spine surgeon and specialist responses.

Next week's question: What is something new you're implementing at your spine practice this year?

Please send responses to Carly Behm at by 5 p.m. CDT Wednesday, May 3.

Editor's note: Responses were lightly edited for clarity and length.

Question: Which spine innovations/surgical techniques will see the fastest adoption in the next two to three years?

Harel Deutsch, MD. Midwest Orthopaedics at Rush (Chicago): I believe that AI will be rapidly adopted in the next few years for healthcare management.

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (Livonia, Mich.): The implementation of robotic assistance will likely be the fastest adoption in the next two to three years. Endoscopic spine surgery is not as likely to be adopted by most spine surgeons unless already incorporated into their training compared to more conventional techniques. I believe augmented reality systems are still further out from being utilized regularly but are likely to be more popularized in about five to 10 years.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The fastest adoption I see coming in the next couple of years will be spinal endoscopy. We are seeing a rapid uptick in the adaptation of the techniques. I myself have done a handful and I think for decompression surgery, it is extremely impactful. Fusion outcomes being done via this technique I think remains to be really studied in detail. I am a bit leery of it as the basic tenets of fusion require good bone preparation, a large surface area and solid fixation. That being said, if it is found to be not inferior to the standards of lateral, anterior and transforaminal fusions, I see no reason for it to be more popular.

Yu-Po Lee, MD. UCI Health (Orange, Calif.): The use of image navigation and robotic-assisted surgery will most likely be one of the technologies seeing the greatest adoption over the next two to three years. Image navigation and robot technology can improve efficiency, shorten surgical time, decrease morbidity, and reduce radiation to the surgeon and surgical team. Image navigation and robotic surgery can potentially improve accuracy in the placement of pedicle screws in the thoracic spine, scoliosis surgeries, cervicothoracic junction, upper cervical spine and revision surgery. The placement of screws can be more complex in these cases because the anatomy can be distorted or because the anatomy prevents the surgeons from obtaining good fluoroscopic images. In these cases, image navigation and robotic surgery can be very beneficial because the surgeon cannot rely on the anatomy or fluoroscopy to guide them. There are also studies which show that the use of image navigation and robotic surgery can shorten operative time and can decrease morbidity from errant placement of the pedicle screws.

In addition to the potential improved accuracy of pedicle screw placement, image navigation and robotic surgery has the potential benefit of decreasing radiation to the operative staff. In a study by Rampersaud et al., the authors noted that the use of fluoroscopy in spine surgery has the potential to expose the surgeons up to 10 to 12 times more radiation than other orthopedic surgeons who do not do spine surgery. So the risk of radiation can be a source of concern to surgeons and staff. The use of image navigation and robotic surgery can help decrease overall radiation to operative personnel. So I anticipate that there will be increased use of image navigation and robotics in spine surgery because of potential benefits to patients and surgeons.   

Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): Endoscopic spine surgery and motion preservation will continue to grow and be adopted as more and more level 1 data showed excellent outcomes if not superior to traditional surgery. There will be more motion preservations, including total facet joint arthroplasty, which will be available as early as next quarter. The obstacle is the rejection of covering these technologies by commercial insurances, including the majority of Medicare Advantage plans.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): From this perspective and barring the ever pressing issue of reimbursement, image guidance and robotics will most likely continue to grow and become more mainstream in the foreseeable future. Even a number of late partygoers are introducing guidance systems and hitching these systems to compatible or competitor systems to compete more robustly in the market. Nanotechnologies and biologics will also continue their place in the market, but once again research dollars are limited and cost per unit case remains top priority. Telemedicine is another formidable and universally accepted methodology for patient management.

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