J. Brian Gill, MD, MBA, is a fellowship trained and board-certified orthopedic spine surgeon at Nebraska Spine Hospital in Omaha.
Dr. Gill's interests include minimally invasive cervical and lumbar spine surgeries, deformity and degenerative conditions, spinal tumors, spinal fusion, spinal cord decompression and disc herniation among others.
Dr. Gill completed an adult surgery fellowship at Duke University in Durham, N.C., and completed his residency and graduated medical school at Texas Tech University Health Sciences Center in Lubbock.
Question: How do you see spinal fusions evolving in the future?
Dr. Brian Gill: We have been doing spinal fusions for decades and will continue to do so for decades to come. I do think that surgeons are becoming smarter in types of fusions being performed such as minimally invasive, lateral approaches and limited levels. The advancement of technologies to better assess global alignment is resulting in better patient outcomes with not only deformity surgeries but for degenerative surgeries as well. I do think that ACDFs will largely be replaced with cervical disc replacements. The indications for cervical surgery are much clearer and largely agreed upon compared to lumbar disc replacement. Patient outcomes will largely direct type of procedure being performed. The data for lumbar disc replacement is there but it is not superior to lumbar fusions at this time. This may change as the technology advances but it will take time.
Q: Where do you see the biggest opportunities for implant surface technology to make a difference in procedure outcomes?
BG: Implant surface technology that promotes bone adherence to the implant continues to advance creating a quicker and more reliable bone implant interface to achieve a fusion or fixation of a prosthesis. Implant surface technology has been well studied in the joint arthroplasty literature to find the most reliable metal or matrix for the bone to adhere. Personally, I have been using much less bone graft substitutes with the use implants that have surfaces that promote bone adherence. Thus far, I have been satisfied. I realize that is anecdotal evidence but that is all we have at this time since there is limited data on these technologies in terms of fusion success and overall outcomes.
Q: How do you think 3D printing will fit in spine moving forward?
BG: 3D printing is another innovation as it relates to implants. These types of implants allow for a wider array of implants depending on the procedure. Larger lordosis cages can be manufactured to correct sagittal imbalances for example. 3D printed materials may allow bone ongrowth as well as ingrowth achieving a higher fusion rate or even a more rapid fusion.
Q: What modern technology has dramatically improved efficiency in the OR?
BG: There are lots of factors that contribute to efficiency in the OR. These include a high volume hospital/ASC where procedures are performed regularly, dedicated team of OR nurses, techs and anesthesiologists, and then technology. Technology is a broad term that includes many separate but interconnected items. This interconnection of technologies is what drives efficiencies.
For example, in lumbar fusion surgeries, I use technologies to help navigate pedicle screw placement safely while seamlessly monitoring EMGs to make sure appropriate placement of the screws. This is all done under a limited open or minimally invasive procedure reducing surgical exposure time. The placement of the screws and subsequent interbody cages is facilitated with devices that makes ease of placement safer, better and reliable in an attempt to achieve the best patient outcome.
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