Ronald Lehman, MD, director of degenerative, minimally invasive and robotic surgery at NewYork-Presbyterian Och Spine Hospital in New York City discusses the big trends and opportunities in the spine arena.
Question: What emerging technology or technique do you think will have the biggest impact on the spine field five years from now?
Dr. Ronald Lehman: The biggest impact on the field of spine surgery over the next two to five years will be the increased utilization of robotic assistance, navigation guidance and surgical synergy. This is an exciting time for the field of spine surgery, as many of our industry partners are actively pursing the use of 'assist technologies' to help make spine surgery: 1) safer, 2) more efficient, 3) more accurate, and 4) more reproducible for all spine surgeons.
Additionally, robotic assistance and navigation are currently being combined into one system, thereby allowing the surgeon and their team to have the best of both worlds. Also, planning software and enabling technologies are actively assisting surgeons to carefully plan their cases preoperatively. Some of these planning tools are incorporated into the robotics platform, thereby allowing true 'surgical synergy' to allow the surgeon and team to begin with planning, culminating with accurate execution in the operating room.
This allows us to perform more minimally invasive spine surgery with more accuracy, and with better techniques, so that we can execute a fusion, decompression of interbody fusion in much the same fashion as standard, traditional open techniques; but with smaller incisions. Another exciting concept is that as these technologies evolve, there will be an increased ability for these systems that utilize segmentation and alignment registration to begin to perform additional aspects of the surgery in addition to pedicle screw placement. This will really allow our field to evolve, similar to other surgical specialties that have been using this technology for over a decade.
Furthermore, there is a growing understanding of using predictive modeling, risk stratification and artificial intelligence to predict which patients will have good outcomes after surgical intervention. By understanding and mitigating risk factors, we can better optimize and predict patient-reported outcome measures, therefore allowing us to have better dialogue and understanding to tell patients what the 'real' risks are for various surgeries.
Q: What do you think will fade or disappear from the spine field over the next few years?
RL: It is always difficult to predict if anything will fade or disappear, but there continues to be better adoption of more minimally invasive techniques, less muscle and tissue dissection and faster return to work and activities. Now that we are truly beginning to understand that we have to restore lordosis in the lumbar spine, even with one-and two-level surgeries, we hope that we can prevent the need for performing three column osteotomies (pedicle subtraction osteotomies).
Q: Where do you see the biggest room for innovation in spine? What do you need to provide better care that doesn't currently exist?
RL: The biggest room for innovation will be in coordinating preoperative planning, reproducibly executing the plan intraoperatively and understanding in 'real-time' if we achieved our surgical goals. This will allow us to make everything more objective, so that we are relatively certain before leaving the operating theatre that we achieved all of our goals for each individual patient. As previously stated, the next several years will be an exciting time for innovation in our field as our understanding of patient-specific risk factors, assessing and executing surgical goals and being able to standardize this approach across the world continues to improve the care for our patients.
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