The future of spinal fusion: 5 spine surgeon predictions for 2019 & beyond

Written by Alan Condon | August 14, 2019 | Print  |

Five spine and neurosurgeons share their insight on the evolution of spinal fusion.

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. We invite all spine surgeon and specialist responses.

Next week's question: Where do you see the biggest need for advancement in spine patient care?

Please send responses to Alan Condon at acondon@beckershealthcare.com by Wednesday, August 21, 5 p.m. CST.

Note: The following responses were edited for length and clarity.

Question How do you see spinal fusions evolving in the future?

Joshua Schwind, MD. Hoag Orthopedic Institute (Irvine, Calif.): Historically, arthritis of the hip and knee were treated with fusions. As orthopedic surgeons' understanding of joint kinematics and motion preservation improved, the rate of fusion decreased. Today, most orthopedic surgeons in practice will have never treated a patient with fusion of the hip or knee. I predict a similar trend for the spine. 

Fusion and its attendant loss of motion has deleterious effects on the remainder of the spinal column; however, it is the best and most predictable solution for a variety of disease processes. In the future, as we advance our understanding of materials, metallurgy, robotics and nanotechnology, rates of fusion will fall. I also believe that outcomes for fusion will improve as we create better implants and utilize less disruptive techniques.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I see a wider field of motion preservation and a move away from fusions. Some of my colleagues are working very hard to show value in doing the 'big cases.' There are surgeons working on using artificial intelligence and deep analysis to find out who benefits from fusions, outcome predictors and so forth — but for the rank and file, I see fewer fusions being done. 

Here is why: 1)  fewer carriers are willing to accept even good indications to pay for fusions, 2) outcomes measures, I think will bear out that fusions are not necessarily the best treatment for many patients; 3) the public perception of fusion remains dubious — many of my patients consider fusion a dirty word.

William Taylor, MD. University of California San Diego Health System: From a technical point of you there will be an increase in the options available both for implants outside of pedicle screws, changes in both cage and bone graft options which will increase the decision making process for individual surgeons.

There will invariably be pushback from stakeholders as cost increases without improvements in length of stay and outcomes. Our literature needs to continually evolve past simple technical aspects to provide meaningful data to guide our use of these new technologies

Issada Thongtrangan, MD. Microspine (Phoenix): Spinal fusion has been on the rise in the past decades and will continue to grow. The 'better' technologies and techniques are still evolving through better surface technology, 3D printing, biologics and expandable technology etc. My prediction is that the future of fusion surgery (when indicated) will be done through the least invasive approach utilizing endoscopic, robotic and artificial intelligence.

I predict that in the next 10 to 15 years we will be performing less fusion surgery due to the evolution of endoscopic-assisted surgery, artificial disc replacement, and even stem cells or biologics for degenerative disc disease.

Andrew Cordover, MD. Andrews Sports Medicine & Orthopaedic Center (Birmingham, Ala.): I foresee continual advances being made in biologics, spinal navigation and regenerative medicine. I will be very interested to see what the long-term outcomes will be regarding motion preservation and disc arthroplasty. As a counterbalance, we need to remain pragmatic about our outcomes as there is a financial incentive (within the device industry) to advance technology.

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