Motion preservation may be a promising technology in spine surgery, but it faces one key hurdle, Frank Vironis, MD, PhD, said.
Dr. Vironis, Chief of Neurosurgery at Marcus Neuroscience Institute, part of Baptist Health South Florida in Boca Raton, discussed his perspective during an upcoming episode of “Becker’s Spine and Orthopedic Podcast.”
Note: This is an edited excerpt.
Question: What spine technologies excite you the most?
Dr. Frank Vironis: What I’ve been very excited about is the motion-preservation technology that has become part of my practice on a daily basis. As you know, in spine surgery, we have essentially two types of procedures. We can decompress something or we can reconstruct the spine. Reconstructing the spine typically has been the domain of fusions where you glue together pieces of the spine. This works in the short term, but in the long term a lot of times people develop problems above or below their fusions because of the stresses that developed adjacent to a fused segment of the spine. Motion preservation, such as disc replacement as well as facet replacement, has been a thing that really can restore the motion segment and prevent this domino effect that we see with fusions. [It can] stop that particular cascade of more segments that need to be fused that lead to lack of mobility.
Q: Spinal fusion has been a “gold standard” in spine surgery for ages. How are you balancing the push for motion preservation with fusion?
FV: The issue is more or less with the indications. Many times our biggest problem with motion preservation is getting insurance approval. A lot of insurance companies consider it experimental despite the fact that there is decades of research, and pretty much everything that we use is FDA approved. When something is FDA approved, I don’t know how people can claim that it is experimental.
I think especially for young people, you would like to do as many motion preservation operations instead of fusions. You don’t want to have 30-year-olds with fusions, because then inevitably they’re going to have more issues down the road. If somebody is very old and their spine is very rigid, motion preservation may not be the best option there. But we’re still learning about how we effectively can utilize these types of technologies.
