Daniel Birk, MD, director of the Neurosurgery Spine Center at Stony Brook (N.Y.) Medicine, discusses the biggest challenges and opportunities in spine device development today.
Question: What emerging technology or technique do you think will have the biggest impact on the spine field five years from now?
Dr. Daniel Birk: Today, the cutting-edge spine surgeon utilizes an array of synergistic technologies to achieve minimally invasive decompression or fusion, including tubular retractors, endoscopes, image-guided navigation, robotics and biologically enhanced arthrodesis. Instrumented fusion is reaching a zenith of sophistication and the next five years are going to see MIS, robotic and biologic technologies become pervasive.
Combined with an understanding of sacro-pelvic parameters and sagittal balance, the art of pedicle screw-based instrumented fusion is close to being perfected. Due to economic inertia and regulatory challenges, the fundamental techniques and technologies of spine surgery will not be significantly different five years from now. Instead, I foresee the continued refinement and proliferation of the current paradigm in the short term.
Q: Where do you see the biggest room for innovation in spine?
DB: This state of affairs is analogous to the end of World War II when piston-powered aircrafts were reaching peak development just at the same moment the jet engine made its debut and rapidly made piston aircraft obsolete. Similarly, titanium implants and arthrodesis technology will achieve their maximum potential in the next five years just as disruptive innovations and treatment strategies are emerging through new basic science discoveries, proof-of-concept prototypes and clinical trials.
New kinodynamic models of spine biomechanics will combine with advances in material science, robotics, additive manufacturing, computer vision and nanotechnology. Novel diagnostic modalities will accompany groundbreaking insights into spine pathophysiology. Today, I am unable to offer my patients spinal restoration. However, in 10 years, I predict that fusion surgery, and the associated complications, will become mostly obsolete and will give way to dynamic and adaptable spine technologies that restore and maintain spine physiology without rigid fixation or titanium implants.
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