6 surgeons on the next big breakthrough in spine: Advanced imaging, new robotic applications & more

Alan Condon -   Print  |

Six spine surgeons discuss emerging technologies and what advancements will provide the most value in the field.

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: Will the COVID-19 pandemic accelerate the shift of orthopedic procedures from hospitals to outpatient settings? How do you see this trend developing?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, July 22.

Note: The following responses were lightly edited for style and clarity.

Question: What innovation do you see making the next big breakthrough in spine?

John Liu, MD. USC Spine Center (Los Angeles): Minimally invasive surgery has come a long way since I started practice in 1999. However, there currently are still very few cervical MIS options for decompression and fusions that are reliable and consistent. I would like to see the use of robotics or advanced imaging and navigational systems to help us tackle these cases to provide more options and quality of life for patients.   

Noam Stadlan, MD. NorthShore Neurological Institute (Evanston, Ill.): We have excellent technology for fixation and for encouraging fusion. Currently, most surgeries are done for pain, but we lack advanced technology to help us identify sources of pain. I think advanced MRI imaging and other technologies may help with that. The widening use of hospital and outcome databases hopefully will fuel an increased emphasis on quality and outcome prediction.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Seeing the exciting developments in robotics and endoscopy remain two of my most anticipated developments. Current techniques in endoscopy look promising, although I am not totally sold on endoscopic transforaminal lumbar interbody fusions. I think decompressions and discectomies will all be done endoscopically in 10 years. I would love to see a Mako-like surgical robot that helps us with more than just the screw placement. Other than that, electromagnetic navigation is very exciting and is a game changer in terms of mutual radiation exposure for the surgeon and patient.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): There will be continued drive toward minimally invasive procedures, especially for the lumbar spine. There are a lot of new technologies coming out to increase precision of the surgical procedure and implant placement through navigation, robotic technologies and augmented reality. Less invasive procedures with the same or better outcome than traditional open techniques are already being done routinely, but not widely adopted. We now have more scientific evidence showing the benefits of MIS procedures in spine. We also have better technologies to shorten the learning curve, minimize complications and lower radiation exposure to the patient and surgeon. All of this will help with wider adoption of MIS surgery in spine. Since MIS surgery results in less pain and quicker recovery, it will drive more spine procedures out of hospitals and into the ASC setting.

Richard Kube, MD. Prairie Spine (Peoria, Ill.): One technology I am excited to see is the augmented reality platform for navigation technology introduced by Augmedics. As an almost fully MIS spine surgeon, radiation exposure is a distinct concern over time. While I personally have not had any real issues with implant position, certainly navigation technology can be beneficial in a variety of situations. Having also had a multilevel cervical fusion of my own, having the navigation screens in locations other than in front of me has slowed my implementation of navigation. With the Augmedics headsets, you remain focused upon the patient. That greatly improves ergonometric concerns and maintains focus directly on the surgical field and everything a surgical assist or scrub tech may be doing as well. It is a system agnostic to type of implant, so it does not force me to change what I am using to access the navigation platform.

Ara Deukmedjian, MD. Deuk Spine Institute (Melbourne, Fla.): The most significant innovation in spine care in the last decade is our ability to cure chronic back or neck pain. In the past, curing CBNP wasn't possible as we did not possess a complete understanding of the exact causation of pain in the back or neck in every patient. With advanced diagnostic testing, physicians can now pinpoint the source of each patient's pain in their back or neck and within hours of their initial office visit. Although each patient does have a unique combination of pain sources, almost like a fingerprint, the actual pain generators — joints, disc, ligaments and muscles — are now well understood. There are specific treatment strategies that completely cure pain at its source and without pills, ongoing injections or extended courses of therapy. One of these advanced therapies is an endoscope and medical laser used to repair painful bulging, herniated or degenerated discs in the neck or back.

More articles on spine:
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2 hospitals with new spine surgery programs

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