The spine technology 12 early-career surgeons are most excited about

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Twelve spine surgeons who launched their practice over the past 10 years discuss the technology advancements and techniques they are most excited about for the future.

Kris Radcliff, MD. Rothman Institute (Philadelphia): I believe that improving the sophistication of our clinical outcome measures is the most important technology available to spine surgeons at this time. Legacy measures, such as Oswestry Disability Index and Roland-Morris Disability Questionnaire, are going to be replaced by validated, computer-adaptive instruments such as Promis Pain or Physical Function. Also, I believe that we will see an increase in non-patient reported outcome measures (such as steps recorded) from wearable technologies and smartphones.

Andrew Schoenfeld, MD. Brigham and Women's Hospital (Boston): I find minimally invasive surgical interventions to be one of the more exciting technological advancements and an area with the best opportunity for expansion. I think the potential for minimally invasive procedures to reduce postoperative morbidity and improve recovery from surgery is one of the most attractive features of these interventions, and this also has the capacity to reduce systemic healthcare costs as well as individual expenses. How minimally invasive interventions can be leveraged to the benefit of the healthcare system as a whole remains to be seen, but clearly this represents an important area of exploration in the future.

Samuel Joseph Jr., MD. Spine Surgeon (Tampa, Fla.): Continued growth in the area of minimally invasive and outpatient surgery along with stem cell and regenerative science being applied to spine patients, as well as new developments in the area of implants and biologics. The best opportunity for growth lies in surgery centers and putting control back into the physician's hands.

Brett Braly, MD. Community Hospital (Oklahoma City): We have been fortunate to get involved with lateral lumbar fusions early in practice. To achieve the benefits of an ALIF (large graft footprint, increased fusion rates, better sagittal correction) through a 3 to 4 cm incision is revolutionary. New advances in lateral L5-S1 ALIF have made a tremendous impact for our patients' early mobilization and recovery. This is also allowing for single position surgery, minimizing OR costs and anesthesia time all without sacrificing outcome.

Elizabeth Yu, MD. The Ohio State University Wexner Medical Center (Columbus): I am most excited [about] the increasing use of minimally invasive spine products in the field of spine surgery. The benefits of MIS procedures to the patient include not only decreased pain, but less tissue disruption and shorter hospital stay.

Tobias Mattei, MD. SLUCare Physician Group (St. Louis): The possibility of incorporating intraoperative imaging guidance to intraoperative CT scan and spinal robotics represents a major development toward improving surgical accuracy and precision, which are crucial technical aspects especially when considering complex spine surgeries for correction of spinal deformity. Additionally the development of a new generation of spinal implants, such as expandable cages and cages with improved bone-implant interface to enhance fusion, has opened a new avenue which is expected to enable better correction of severe spinal deformities through minimally invasive approaches.

Despite the exponential growth observed in the past few years, the technological landscape in spine surgery is still quite incipient and the next decades will definitely witness even greater innovations, such as the possible incorporation of micro-electro-mechanical sensoring devices to current spinal implants in order to provide live feedback regarding the biomechanical status of that specific spinal segment.

Nima Salari, MD. Desert Institute for Spine Care (Phoenix): There is tremendous buzz around improved navigation technology and the emergence of robotics in spine surgery. We will see the technology further the adoption of minimally invasive techniques as it increases safety, accuracy, and reproducibility all while reducing radiation exposure to the patient and surgical team.

My concern, however, remains the capital expenditures required to implement such technology. The push to move care delivery to outpatient surgical centers and optimize cost savings is in direct contrast to this type of advancement.

Patient-matched 3D-printed drill guides carry the same promise of increased safety, accuracy, and reliability, but at a fraction of the cost. Medacta International first hit the scene with this technology for open screw placement in large deformity cases. Its latest line of drill guides take advantage of the cortical screw trajectory via a minimally invasive midline approach. The radiation exposure is minimized by obtaining a low-dose CT scan of the lumbar spine to create the patient-matched drill guides. Intraoperative fluoroscopy use is minimized, limited to final confirmation of implant position. This technology can easily be implemented in the outpatient surgical setting.

Emmanuel Menga, MD. University of Rochester (N.Y.) Medical Center: Over the past decade, great strides have been made towards spinal navigation surgery and disc arthroplasty. There is promising evidence to support using navigation to perform both minimal invasive surgeries and complex spinal deformity surgeries. There is opportunity for further research and for expanding the indications and use of these new technologies in our practices.

Jared Ament, MD. Sierra Neuroscience Institute (Los Angeles): Robotics, radiation-free navigation and motion-preserving technologies are the future of spine surgery. My particular interests are in how to make these novel, expensive technologies cost-effective and sustainable.

Emeka Nwodim, MD. Centers for Advanced Orthopedics, Bay Area Orthopaedics & Sports Medicine (Glen Burnie, Md.): I'm most excited about the technological advancements in spine navigation. Being able to decompress and instrument the spine with 3-D computer technology. This not only improves surgical accuracy but also improves time spent in the operating room and minimizes numerous complications and surgical risks. I look forward to further advancements and the incorporation of live 3-D imaging and even virtual or augmented reality into the operating room.

Tom Chapman, MD. OrthoCarolina Spine Center (Charlotte, N.C.): I am most excited about the current understandings that we have of spine alignment and how it can affect clinical outcomes for patients. As our understanding of the drivers of outcomes improves, we will be able to better determine the areas where technological advancements can help achieve these radiographic views. Combining this new knowledge with the basic and infallible tenets of spine surgery is where we can continue to further advance and develop technologies that will offer our patients better outcomes. As we decrease the negative impacts of our procedures while maximizing our positive impacts, we can deliver more meaningful and impactful care.

I see the most opportunity for growth to be focused around fusionless surgery. Decreasing spine motion through fusions to correct underlying spine conditions is a sacrifice that our patients make to have their current ailments alleviated. And while we can continue to perform fusions that offer better outcomes with less disruptive impacts on our patients, targeting non-fusion technologies is an area that has not been adequately explored.

Sheyan Armaghani, MD. Florida Orthopaedic Institute (Tama): I'm interested in the future of robotics and improvements in navigation. Currently, the technology is just a way to accurately place pedicle screws in the end. Personally, I think there are good ways to use it and other ways where it's more efficient to place them freehand. In the future, I'd be interested to see something more than screw placement. The ability to aid in decompression or cage placement, for example, would be a step forward. The integration of augmented reality technology to improve safety would also be interesting to see.

Learn more about the latest trends in spine technology at the Becker's 17th Annual Future of Spine + The Spine, Orthopedic & Pain Management-Driven ASC Conference, June 13-15, 2019. Click here for more information. To learn more about exhibiting and sponsorship opportunities, contact Maura Jodoin at mjodoin@beckershealthcare.com.

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