Spine surgery innovation accelerated in the years leading up to the pandemic, before slowing as elective procedures halted. Now, companies are launching new products, implants and systems again, with the promise of better outcomes.
Are they moving too quickly?
"Given the increasing rapidity of expanding technology and techniques, one major issue we need to address in spine surgery is the rapid adoption of novel techniques and technology just based on novelty, without adequate properly designed and honest research and training to support the optimal usage of these technologies," said Peter Passias, MD, an orthopedic and spine surgeon at NYU Langone Health in New York City.
He sees a particular spike in rapid technology advancement in less invasive procedures, which some may consider less regulated because they are lower risk.
In other areas, spine procedures may have become overly complex.
"The most dangerous trend in spine surgery today is the utilization of increasingly complicated and resource-intensive solutions as implant companies seek to differentiate themselves in the marketplace," said Maahir Haque, MD, a surgeon at Spine Group Orlando in Celebration, Fla. "There is less investment in the elegant and simple solution."
He points to the proliferation of positioning solutions for procedures like lateral and prone lateral interbody fusions as inefficient investments.
"The bolstering systems are a branding exercise and unnecessary for those procedures — they are designed and marketed for the purpose of differentiation rather than for patient benefit," said Dr. Haque.
Enrest Braxton, MD, a neurosurgeon at Vail (Colo.) Summit Orthopaedics and Neurosurgery, sees overutilization of procedures, including spinal fusion, as a dangerous trend if patients won't benefit from the procedures. Overutilization leads to unnecessary risks, complications and additional costs.
"This trend can be exacerbated by the concept of moral hazard, where the availability of insurance coverage or financial incentives may influence surgeons to recommend or perform surgeries that may not be medically necessary," said Dr. Braxton. "To address this trend, there is a growing emphasis on evidence-based medicine, shared decision-making and professional guidelines among spine surgeons to ensure that surgical interventions are used judiciously and appropriately."
But not all advancements are more marketing than results. There is still room for real innovation and needle-moving technologies.
"As many novel technologies represent major advances in our field, the lack of success of a minority of these should not take credit away or deter true advancements in the field," said Dr. Passias.